AIDS epidemic update: December 2004

The total number of people living with the human immunodeficiency virus (HIV) rose in 2004 to reach its highest level ever: an estimated 39.4 million [35.9 million-44.3 million] people are living with the virus. The number of people living with HIV has been rising in every region, compared with two years ago, with the steepest increases occurring in East Asia, and in Eastern Europe and Central Asia. The number of people living with HIV in East Asia rose by almost 50 percent between 2002 and 2004, an increase that is attributable largely to China's swiftly growing epidemic. In Eastern Europe and Central Asia, there were 40 percent more people living with HIV in 2004 than in 2002. Sub-Saharan Africa remains by far the worst-affected region, with 25.4 million [23.4 million-28.4 million] people living with HIV at the end of 2004. Just under two-thirds (64 percent) of all people living with HIV are in sub-Saharan Africa, as are more than three quarters (76 percent) of all women living with HIV. HIV prevalence in the Caribbean is the second-highest in the world, exceeding 2 percent in five countries, and AIDS has become the leading cause of death among adults aged 15-44 years in this region (AU)

Immunization still saves lives

Under the immunization regulations, parents and guardians have equal responsibility to take their children for vaccination "within one year of child's birth or soon after". (AU)

Tobacco use by youth: a surveillance report from the Global Youth Survey project

The Global Youth Tobacco Survey (GYTS) project was developed by the World Health Organization and the US Centers for Disease Control and Prevention to track tobacco use among youth in countries across the world, using a common methodology and core questionnaire. The GYTS is school based and employs a two stage sample design to produce representative data on smoking among students aged 13-15 years. The first stage consists of a probabilistic selection of schools. All students in the selected classes are eligible for the survey. In 1999, the GYTS was conducted in 13 countries and is currently in progress in over 30 countries. This report describes data from 12 countries: Barbados, China, Costa Rica, Fiji, Jordan, Poland and the Russian Federation (Moscow), South Africa, Sri Lanka, Ukraine (Kiev), Venezuela and Zimbabwe. The findings show that tobacco use in the surveyed age group ranged from a high of 33 percent to a low of 10 percent. While the majority of current smokers wanted to stop smoking, very few were able to attend a cessation programme. In most countries the majority of young people reported seeing advertisements for cigarettes in media outlets, but anti-tobacco advertising was rare. The majority of young people being taught in school about the dangers of smoking. Environmental tobacco smoke exposure was very high in all countries. These results show that the GYTS surveillance system is enhancing the capacity of countries to design, implement, and evaluate tobacco prevention and control programmes. (AU)

Guidelines on Intinerant Surgeons in the Caribbean

An Itinerant Surgeon is a physician who volunteers to work in health care systems other than his or her own. The volunteer may provide services such as consultation, special tests and surgery but, in addition, may also transmit information or goods such as books, literature, equipment and instruments. SERVICES OF AN ITINERANT OR VISITING TEAM: For any itinerant team, an advance visit is desirable to define a programme of activities. The visiting team's efforts should focus on a sustainable change in the programme for prevention of blindness in the host country through advocacy for preventitive measures, quality eye care, human resources development, infrastructure building and development of administrative proceesses.The team should work within the existing system of eye care delivery at the governmental facilities or approved non-Governmental Development Organizations(NGDOs). Any visit of foreign team is an opportunity for interviews in the media to increase public awareness in eye care, and for advocacy by the team in the governmental structure. The local eye care professionals should identify posible technical and scientific topics in which they need training, if that aspect is recognised as an important product of the visit. The World Health Organization (WHO) has developed the following guidelines for donation of equipment in order to assist donors and recipients: the donation should benefit and fully respect the wishes and authority of the recipient; the quality should be based on an expressed need by the recipient; before a donation is made: - the need for specific items and their expiration date are evaluated; - there must be assurance that it will be used for the purpose for which it is donated; - the person or group who will be responsible for receipt and distribution must be identified; - the customs regulations and shipping costs must be determined. A visiting team may also provide very valuable knowledge in organisation and establishment of processes in the different aspects of a service such as organisation of an operating room, keeping an inventory of consumable supplies, organising an appointment and record system and basic statistics. JUSTIFICATION OF A VISITING OR ITINERANT TEAM: The itinerant service should provide solutions to specific problems or gaps in: availability of services (AU) [truncated at 2500 characters]

Relationships of fasting and postload glucose levels to sex and biased against detection of diabetes in women?

OBJECTIVE: To compare, in men and women, the prevalence of undiagnosed type 2 diabetes assessed using criteria from the American Diabetes Association (ADA) and the World Health Organization (WHO) and to investigate risk factors associated with fasting and 2-h postload plasma glucose. RESEARCH DESIGN AND METHOD: Data from two companion surveys of Europeans, South Asians, and Afro-Caribbean in west London were used. A total of 4,367 men and women aged 40-64 years who were not known to have diabetes underwent an oral glucose tolerance test after an overnight fast. The prevalence of undiagnosed diabetes was estimated using the ADA (fasting plasma glucose > or = 7.0 mmol/l) and WHO (2-h postload glucose > or = 11.1 mmol/l) criteria for epidemiologic studies. The association of body fat and usual alcohol intake with plasma glucose and diabetes prevalence was assessed. RESULTS: Compared with the WHO criterion, the ADA criterion gave a higher prevalence of diabetes in men (6.4 vs 4.7 percent) but a lower prevalence in women (3.3 vs. 4.2 percent). In Afro-Caribbeans, the sex difference in diabetes prevalence was reversed. Women had significantly lower fasting glucose than men despite higher 2-h glucose levels. Alcohol intake was positively associated with fasting glucose in men and women but not with 2-h glucose levels. CONCLUSIONS: The new ADA criterion, based on fasting glucose alone, does not take account of sex differences in metabolic response to fasting or possible artifactual effects on fasting glucose. With ADA criterion, alcohol intake was significant risk factor for diabetes in our study population; this was not the case with the WHO criterion.(AU)

The social worker: a member of the primary care team?

The primary health care team at present does not include social workers as routine members. If however, we, accept the World Health Organisation definition of health, which includes social well being, then it follows that the social worker should be considered as a member of the health team to attend to this aspect of health in the service delivery mix. This paper presents the experience of a social worker assigned to the August Town/Hermitage Type III health centre during the period March 1995 to February 1996 and her contribution to patient welfare. The expected roles of the social worker and his or her contribution to the health team are outlined.(AU)

The introduction of cyclofem into national family planning programmes: experience from studies in Indonesia, Jamaica, Mexico, Thailand and Tunisia. Task force on research on introduction and transfer of technologies for fertility regulation, special programme of research, development and research

Studies on the introduction of Cyclofem into family planning programmes have been undertaken in Indonesia, Jamaica, Mexico, Thailand and Tunisia. Cyclofem is a once-a-month injectable contraceptive containing 25mg medroxyprogesterone acetate and 5mg estradiol cypionate. A total of 7927 subjects were followed in close to routine service delivery conditions in primary and secondary family planning outlets. The studies confirmed the high efficacy of the method with 12-month pregnancy rates ranging from 0 to 0.7 percent. Major differences were seen in reasons and rates of discontinuation between countries, the overall 12-month life table discontinuation rates ranging from 33.5 percent in Indonesia to 71.8 percent in Tunisia. The reasons for discontinuation in each of the five countries described, differences between countries contrasted, and service delivery issues which should be addressed further, raised (AU)

A community-based rehabilitation programme for pre-school disabled children in Guyana

The limitation of the traditional institutionally-based model of rehabitlitation and the competing rationale for introducing a community-based model of services are examined. Problems with the World Health evaluation of CBR are discussed. The results of a CBR programme with 53 pre-school disabled children in rural areas of Guyana are presented. Quantitative and qualitative methods are combined to analyse the results. Portage and Griffiths pre/post test results showed improvement as a result of the training programme. Noticeable changes in the attitudes of the parents toward the child, the community and towards themselves are presented. The effective involvment of the community is analysed. (AU)

Haemoglobin levels in West Indian antenatals

Studies conducted in the English-speaking Caribbean have shown that anaemia is a public health problem in pregnancy. However, these studies have been questioned because the World Health Organization (WHO) haemoglobin criteria, which are based on studies of North American and European women, may not apply to Caribbean women. Antenatal clinic records were studied at the University of the West Indies (UHWI), Kingston, Jamaica. Over half of the antenatal women were between the ages of 21 and 27 years. Modal parity was 1 (41 percent) followed by a parity of 2 (31 percent). Median value for gestation was 13 weeks. The mean haemoglobin level was 12.4+1.5 gm/dl (median - 12.6). Twenty-one antenatal women (3.9 percent) had haemoglobin levels below 11 gm/dl and only 4 (0.6 percent) had haemoglobin levels below 10 gm/dl. The mean haemoglobin at the UHWI was 1.9 gm/dl higher than that of 159 patients from Antigua. However, the Antiguans were an average of 6 weeks further advanced in pregnancy. In Montserrat, the mean of 138 antenatal haemoglobin levels was 2.4 gm/dl lower than the UHWI mean; these patients were also about 6 weeks further advanced in pregnancy. This study suggests that, given the right environment, the antenatal women in Montserrat and Antigua, who are roughly the same ethnic origin as those from Jamaica, could achieve the same haemoglobin levels as those of pregnant women attending antenatal clinic at the UHWI, Kingston, Jamaica (AU)

A functional breakdown of the goal of "Health for all by the year 2000"

This paper presents an approach to the functional breakdown of the goal of Health for all by the Year 2000. Its aim is to facilitate the description in operational terms of sub-goals, priorities and specific interventions for individuals, families and communities in developing countries. Individuals with special needs include the child, the youth and the elderly. For the child, emphasis would be on child survival; for the youth, facilitating the transition from childhood to a physical, mentally and socially fit adult; and for the elderly, maintenance of physical and mental fitness and of social contacts. As far as families are concerned, emphasis would be on healthy reproductive practices, nutrition and diet, hygiene and sanitation, family life education, access to primary medical care and the satisfaction of special health care needs. The final aim is to ensure health, stable and economically viable families. As far as commuinities are concerned, emphasis, would be placed on several important areas - basic education and adult literacy; maximum employment, occupational health and safety; adequate and safe housing; adequate and safe water supplies; adequate and safe food supplies; sanitary disposal of wastes; population, social development and recreation; health and demographic data collection; public health education, information and legislation; disease surveillance, prevention and control; access to and financing of health care; promoting health development through educational, management and research activities. This approach would also facilitate the allocation of tasks between the health services sector, other socioeconomic sectors and the client communities. It lends itself to computerization, thus simplifying monitoring and evaluation. It can be the basis for exchange of information between countries and for promotion of international co-operation in health (AU)