Household contact investigation of multidrug-resistant and extensively drug-resistant tuberculosis in a high HIV prevalence setting.

SETTING: Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are now a nationwide epidemic in South Africa. Epidemiological data suggest nosocomial transmission as the primary route of spread; however, transmission among household contacts has not yet been investigated. OBJECTIVE: To determine the incidence rates of MDR- and XDR-TB among household contacts of MDR- and XDR-TB index cases diagnosed between January 2005 and September 2008 in a high human immunodeficiency virus prevalence setting. DESIGN: Prospective, observational study evaluating adult household contacts for active TB by culture and drug susceptibility testing at index case diagnosis and again 1 year later. Outcomes were incidence and time to diagnosis of MDR- and XDR-TB. RESULTS: A total of 1766 contacts of 221 MDR-TB and 287 XDR-TB index cases were screened. Of 793 contacts of MDR-TB index cases, 14 (1.8%) were diagnosed with MDR-TB (incidence 1765/100 000); 19 (2.0%) of 973 XDR-TB contacts had XDR-TB (incidence 1952/100 000). Median time to diagnosis of household cases was 70 days (interquartile range 57-89). CONCLUSION: Incidence rates of MDR- and XDR-TB among household contacts were extremely high, with most secondary cases occurring shortly after the diagnosis of the index case. Active case finding of drug-resistant TB is a high-yield public health activity and must be a priority, as early diagnosis may stem further disease spread and improve survival.

Epidemiology and outcome of burns in Esteqlal Hospital of Kabul, Afghanistan.

INTRODUCTION: Burns are a major public health issue in Afghanistan, at least in terms of morbidity and long term disability. Little data exists to document the extent of the problem. This study reports the epidemiology and outcome of burns seen in Esteqlal Hospital of Kabul, a regional referral and teaching hospital run jointly by the Afghan Ministry of Public Health and the Italian Cooperation. It furthermore aims to investigate the underlying conditions which lead to this dramatically widespread event in order to develop effective burn prevention programmes. METHODS: A total of 532 patients admitted for burns between March 1, 2007 and June 30, 2008 in Esteqlal Hospital were studied retrospectively through the review of medical records. RESULTS: Male to female ratio was 0.7:1 and the median age at presentation was 19 years. The mean total body surface area (TBSA) burned was 36.5%. Overall mortality rate was 28% with a prevalence of death among females (68%). The most common cause of burn was flame (46.2%), followed by gas cylinder explosion (36.4%). Self-immolation was reported in 21 patients, 76% of whom resulted in death. CONCLUSION: A large number of burn injuries occur in domestic settings and are preventable. Strategies might include implementation of educational programs through mass communications and development of policies for the commerce of unadulterated petroleum products. Other goals such as disability prevention and mortality reduction might be achieved building burns centres and training healthcare professionals working at the peripheral level.

Design and implementation of a hospital information system for the Palestine Red Crescent Society in Lebanon.

A case-mix hospital information system was designed and implemented in Palestine Red Crescent Society hospitals in order to support the network of Palestinian hospitals in Lebanon and to improve the health of refugees in the country. The system is based on routine collection of essential administrative and clinical data for each episode of hospitalization, relying on internationally accepted diagnostic codes. It is a computerized, user-friendly information system that is a stepping-stone towards better hospital management and evaluation of quality of care. It is also a useful model for the development of hospital information systems in Lebanon and in the Near East.

Italian Development Cooperation: the commitment for the struggle against malaria in Africa.

The Italian Development Cooperation (DGCS) support the health reform process in Developing Countries, with the aim to provide populations in greatest need with access to decentralized health services. DGCS acts in close coordination with the donor community, United Nations' system and the World Bank, in agreement with sector-wide approach (SWAP) for health sector development. Since malaria control in endemic countries is a relevant component of the health system, DGCS is actively involved in the struggle against malaria in sub-Saharan Africa, supporting control activities and research capability strengthening. The following African countries are presently receiving bilateral support for antimalaria activities: Burkina Faso, Centre de Lutte contre le Paludisme in Ouagadougou; Ethiopia, community-based malaria control in Tigray; Eritrea, malaria control at national level in the framework of the Public Health and Rehabilitation Programme for Eritrea (PHARPE) initiative; Madagascar, malaria surveillance at national level; Tanzania, feasibility study for the support to the national malaria control programme. Support is provided by technical/financial assistance involving Italian academic and research institutions. On the multilateral channel, DGCS has provided regular contribution for WHO's work in malaria control and participates to the WHO Roll Back Malaria initiative. A new commitment to malaria is the trilateral joint scientific endeavour USA-Italy-Burkina Faso for the development and field testing of a candidate vaccine suitable for African populations.