Bulletin of the World Health Organization
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Bull. World Health Organ. · Jan 1997
Review Comparative Study Clinical TrialAlpha 1-antitrypsin deficiency: memorandum from a WHO meeting.
alpha 1-Antitrypsin (AAT) deficiency, also known as alpha 1-antiprotease inhibitor deficiency, is a disease caused by genetically determined AAT deficiency. It occurs as a result of inheritance of two protease inhibitor (PI) deficiency alleles from the AAT gene locus (designated PI) on chromosomal segment 14q32.1. The most common deficiency allele is PI*Z and a large majority of individuals with severe AAT deficiency are PI type ZZ. ⋯ AAT deficiency appears to be widely underdiagnosed and based on predicted gene frequencies even in the most intensely studied populations, only a small proportion of those predicted to have AAT deficiency have been diagnosed. Human AAT is available in limited quantity for augmentation therapy. This Memorandum summarizes the discussions and recommendations made by participants at a WHO meeting held in Geneva on 18-20 March 1996 to review existing knowledge about this highly prevalent genetic disorder, develop a strategy for enhancing awareness of it among health-care-givers and the general public, and explore new case-finding and disease-prevention strategies.
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Bull. World Health Organ. · Jan 1997
Evaluation of clinical signs to diagnose anaemia in Uganda and Bangladesh, in areas with and without malaria.
The object of this study was to assess the ability of pallor and other clinical signs, including those in the Integrated Management of Childhood Illness (IMCI) guidelines developed by WHO and UNICEF, to identify severe anaemia and some anaemia in developing country settings with and without malaria. A total of 1226 and 668 children aged 2 months to 5 years were prospectively sampled from patients presenting at, respectively, a district hospital in rural Uganda and a children's hospital in Dhaka, Bangladesh. The study physicians obtained a standardized history and carried out a physical examination that included pallor, signs of respiratory distress, and the remaining IMCI referral signs. ⋯ Our results show that simple clinical signs can correctly classify the anaemia status of most children. Grunting may serve as a useful adjunct to pallor in the diagnosis of severe anaemia. Conjunctival pallor should be added to the IMCI anaemia box, or the guidelines need to be adapted in regions where palmar pallor may not readily be detected.
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Bull. World Health Organ. · Jan 1997
Comparative StudyThe WHO Global Programme for Vaccines and Immunization Vaccine Trial Registry.
In 1995, the WHO Global Programme for Vaccines and Immunization established a Vaccine Trial Registry. As of September 1996, this registry included 50 WHO-supported vaccine trials, of which 25 (50%) were completed studies. ⋯ Among the 25 completed trials, outcomes measured were immune response (24 trials), adverse reactions (13 trials), morbidity (4 trials), and mortality (1 trial). WHO's contributions to these studies include direct funding, assistance with study design, site visits, data analysis, vaccine procurement, and vaccine potency testing.
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Bull. World Health Organ. · Jan 1997
ReviewClimate change, human health, and sustainable development.
Human-induced climate change threatens ecosystems and human health on a global scale. In order to withstand the worldwide threats to ecosystems, the concept of sustainable development was introduced during the 1980s. ⋯ Discussed is an integrated model containing the key indicators of sustainable development. The relevance of climate change, human health, and sustainable development for international climate change policy is also examined.
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Bull. World Health Organ. · Jan 1997
Multicenter Study Comparative StudyPerformance of health workers after training in integrated management of childhood illness in Gondar, Ethiopia.
The performance of six primary health workers was evaluated after following a 9-day training course on integrated management of childhood illness (IMCI). The participants were selected from three primary health centres in the Gondar District, Ethiopia, and the course was focused on assessment, classification, and treatment of sick children (aged 2 months to 5 years) and on counselling of their mothers. Immediately following this training, a 3-week study was conducted in the primary health centres to determine how well these workers performed in assessing, classifying and treating the children and in counselling the mothers. ⋯ The mother's counselling card, which summarized recommendations on feeding and home fluids, and advice on when to return, was widely used to aid communication. The time taken to perform the complete management of children did not change significantly (20 to 19 minutes) during the study. Lessons from our findings have been incorporated into an improved version of the IMCI charts.