Survey and surveillance development in settings with low human immunodeficiency virus prevalence.

In most countries, during the early phases of a human immunodeficiency virus epidemic, independently initiated surveys of perceived high-risk groups tend to precede the development of formal surveillance systems. Unfortunately, in low-prevalence settings, small sample sizes produce unreliable estimates of prevalence and trends, with an inevitable tendency towards positive results. In our study, we present sample size calculations and typical samples used in actual surveys, with Pakistan as our example. More useful data on risk behaviour and potential for spread can be derived from the study of commoner sexually transmitted diseases and associated risk behaviours, including assessments of knowledge, attitudes, beliefs and practices.

The obesity pandemic--implications for Pakistan.

BACKGROUND: Adverse health outcomes are associated with overweight and obesity. In February 2000, the WHO Regional Office for the Western Pacific, the International Association for the Study of Obesity and the International Obesity Task Force published provisional recommendations for adults for the Asia-Pacific region: overweight at Body Mass Index (BMI) > or = 23 and obesity at BMI > or = 25. METHODS: Data from the National Health Survey of Pakistan, 1990-94 were reanalyzed using BMI cut-offs recommended for Asians to reassess prevalence of overweight and obesity in the adult Pakistani population. RESULTS: Prevalence of obesity (BMI > or = 25) in 25-44 year olds in rural areas was 9% for men and 14% for women; in urban areas, prevalence was 22% and 37% for men and women, respectively. For 45-64 year olds, prevalence was 11% for men and 19% for women in rural areas, and 23% and 40% in urban areas for men and women, respectively. Obesity prevalence was directly associated with SES, regardless of residence. CONCLUSION: In South Asia, including Pakistan, social and environmental changes are occurring rapidly, with increasing urbanization, changing lifestyles, higher energy density of diets, and reduced physical activity. The coexistence of underweight in early life with obesity in adults may presage both a higher prevalence and incidence for noncommunicable diseases (NCDs) such as hypertension and diabetes. Use of BMI > or = 23 for overweight, and BMI > or = 25 for obesity, may provide a more accurate determination of the health of Pakistanis, especially in those with more than one risk factor for NCDs.

Survey and surveillance development in settings with low human immunodeficiency virus prevalence.

In most countries, during the early phases of a human immunodeficiency virus epidemic, independently initiated surveys of perceived high-risk groups tend to precede the development of formal surveillance systems. Unfortunately, in low-prevalence settings, small sample sizes produce unreliable estimates of prevalence and trends, with an inevitable tendency towards positive results. In our study, we present sample size calculations and typical samples used in actual surveys, with Pakistan as our example. More useful data on risk behaviour and potential for spread can be derived from the study of commoner sexually transmitted diseases and associated risk behaviours, including assessments of knowledge, attitudes, beliefs and practices.

Survey and surveillance development in settings with low human immunodeficiency virus prevalence

In most countries, during the early phases of a human immunodeficiency virus epidemic, independently initiated surveys of perceived high-risk groups tend to precede the development of formal surveillance systems. Unfortunately, in low-prevalence settings, small sample sizes produce unreliable estimates of prevalence and trends, with an inevitable tendency towards positive results. In our study, we present sample size calculations and typical samples used in actual surveys, with Pakistan as our example. More useful data on risk behaviour and potential for spread can be derived from the study of commoner sexually transmitted diseases and associated risk behaviours, including assessments of knowledge, attitudes, beliefs and practices

Capture-recapture: reconnaissance of a demographic technique in epidemiology.

The objective of this paper is to review capture-recapture (CR) methodology and its usefulness in epidemiology. Capture-recapture is an established and well-accepted sampling tool in wildlife studies, and it has been proposed as a cost-effective demographic technique for conducting censuses. However, the application of CR in the field of epidemiology requires consideration of relevant factors such as the nature of the condition under surveillance, its case definition, patient characteristics, reporting source and propensity for misdiagnosis and underdiagnosis. The use of CR in epidemiology has expanded over the last 10 years and no doubt will continue to be adopted. Although it has a role in public health surveillance, a more traditional approach to disease monitoring seems more advantageous in certain instances.

Homicide-related injuries in Saint Lucia - abstract

For World Health Day, April 7, 1993, the World Health Organization (WHO) released information on male homicides, quoting men in Saint Lucia with the highest rate worldwide, 22.8 per 100,000 (1988 data). The Government of Saint Lucia investigated its homicide rates and those of selected countries (Trinidad and Tobago, Puerto Rico, Venezuela and the USA) for 1987-1992, using the most recent available figures. On comparison of the calculated standardized rates for male homicides (direct method), Saint Lucia no longer ranked number one worldwide for male homicide rates. This analysis led to the passing of a resolution in September, 1993 at the XXXVII Meeting of the Directing Council of PAHO/WHO whereby, before information on specific aspects on countries is released to the press, its accuracy be checked and the consequences for the country concerned considered (AU)