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Bulletin of the World Health Organization [journal]
- Corrigendum. [PUBLISHED ERRATUM]
- Bull World Health Organ 2013 May 1; 91(5):388.
[This corrects the article on p. 167 in vol. 91, PMID: 23476089.].
- Health systems and services: the role of acute care. [Journal Article]
- Bull World Health Organ 2013 May 1; 91(5):386-8.
- Viral suppression after 12 months of antiretroviral therapy in low- and middle-income countries: a systematic review. [Journal Article]
- Bull World Health Organ 2013 May 1; 91(5):377-385E.
To establish estimates of viral suppression in low- and middle-income countries (LMICs) in patients who received antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection.Data on viral suppression after 12 months of ART in LMICs were collected from articles published in 2003 to 2011 and from abstracts of conferences held between 2009 and 2011. Pooled proportions for on-treatment and intention-to-treat populations were used as summary estimates. Random-effects models were used for heterogeneous groups of studies (I (2) > 75%).Overall, 49 studies covering 48 cohorts and 30 016 individuals met the inclusion criteria. With thresholds for suppression between 300 and 500 copies of viral ribonucleic acid (RNA) per ml of plasma, 84.3% (95% confidence interval, CI: 80.4-87.9) of the pooled on-treatment population and 70.5% (95% CI: 65.2-75.6) of the intention-to-treat population showed suppression. Use of different viral RNA thresholds changed the proportions showing suppression: to 84% and 76% of the on-treatment population with thresholds set above 300 and at or below 200 RNA copies per ml, respectively, and to 78%, 71% and 63% of the intention-to-treat population at thresholds set at 1000, 300 to 500, and 200 or fewer copies per ml, respectively.The pooled estimates of viral suppression recorded after 12 months of ART in LMICs provide benchmarks that other ART programmes can use to set realistic goals and perform predictive modelling. Evidence from this review suggests that the current international target - i.e. viral suppression in > 70% of the intention-to-treat population, with a threshold of 1000 copies per ml - should be revised upwards.
- Entry and exit screening of airline travellers during the A(H1N1) 2009 pandemic: a retrospective evaluation. [Journal Article]
- Bull World Health Organ 2013 May 1; 91(5):368-76.
To evaluate the screening measures that would have been required to assess all travellers at risk of transporting A(H1N1)pdm09 out of Mexico by air at the start of the 2009 pandemic.Data from flight itineraries for travellers who flew from Mexico were used to estimate the number of international airports where health screening measures would have been needed, and the number of travellers who would have had to be screened, to assess all air travellers who could have transported the H1N1 influenza virus out of Mexico during the initial stages of the 2009 A(H1N1) pandemic.Exit screening at 36 airports in Mexico, or entry screening of travellers arriving on direct flights from Mexico at 82 airports in 26 other countries, would have resulted in the assessment of all air travellers at risk of transporting A(H1N1)pdm09 out of Mexico at the start of the pandemic. Entry screening of 116 travellers arriving from Mexico by direct or connecting flights would have been necessary for every one traveller at risk of transporting A(H1N1)pdm09. Screening at just eight airports would have resulted in the assessment of 90% of all air travellers at risk of transporting A(H1N1)pdm09 out of Mexico in the early stages of the pandemic.During the earliest stages of the A(H1N1) pandemic, most public health benefits potentially attainable through the screening of air travellers could have been achieved by screening travellers at only eight airports.
- Recurrence of adverse perinatal outcomes in developing countries. [Journal Article]
- Bull World Health Organ 2013 May 1; 91(5):357-67.
To evaluate the risk of recurrence of adverse perinatal outcomes in second pregnancies in developing countries.Data from the 2004-2008 Global Survey on Maternal and Perinatal Health were used to determine the outcomes of singleton second pregnancies for 61 780 women in 23 developing countries. The mother-infant pairs had been followed up until discharge or for 7 days postpartum.At the end of their second pregnancies, women whose first pregnancy had ended in stillbirth (n = 1261) or been followed by neonatal death (n = 1052) were more likely than women who had not experienced either outcome to have given birth to a child with a birth weight of < 1500 g (odds ratio, OR: 2.52 and 2.78, respectively) or 1500-2499 g (OR: 1.22 and 1.60, respectively), or to an infant requiring admission to an intensive care unit (OR: 1.64 and 1.68, respectively). At the end of their second pregnancies, those whose first pregnancy had ended in a stillbirth were at increased risk of another stillbirth (OR: 2.35) and those whose first infant had died as a neonate were at increased risk of having the second infant die within the first 7 days of life (OR: 2.82). These trends were found to be largely unaffected by the continent in which the women lived.In the developing world, a woman whose first pregnancy ends in stillbirth or is followed by the death of the neonate is at increased risk of experiencing the same outcomes in her second pregnancy.
- Episiotomy rate in Vietnamese-born women in Australia: support for a change in obstetric practice in Viet Nam. [Journal Article]
- Bull World Health Organ 2013 May 1; 91(5):350-6.
To describe the use of episiotomy among Vietnamese-born women in Australia, including risk factors for, and pregnancy outcomes associated with, episiotomy.This population-based, retrospective cohort study included data on 598 305 singleton, term (i.e. ≥ 37 weeks' gestation) and vertex-presenting vaginal births between 2001 and 2010. Data were obtained from linked, validated, population-level birth and hospitalization data sets. Contingency tables and multivariate analysis were used to compare risk factors and pregnancy outcomes in women who did or did not have an episiotomy.The episiotomy rate in 12 208 Vietnamese-born women was 29.9%, compared with 15.1% in Australian-born women. Among Vietnamese-born women, those who had an episiotomy were significantly more likely than those who did not to be primiparous, give birth in a private hospital, have induced labour or undergo instrumental delivery. In these women, having an episiotomy was associated with postpartum haemorrhage (adjusted odds ratio, aOR: 1.26; 95% confidence interval, CI: 1.08-1.46) and postnatal hospitalization for more than 4 days (aOR: 1.14; 95% CI: 1.00-1.29). Among multiparous women only, episiotomy was positively associated with a third- or fourth-degree perineal tear (aOR: 2.00; 95% CI: 1.31-3.06); in contrast, among primiparous women the association was negative (aOR: 0.47; 95% CI: 0.37-0.60).Episiotomy was performed in far fewer Vietnamese-born women giving birth in Australia than in Viet Nam, where more than 85% undergo the procedure, and was not associated with adverse outcomes. A lower episiotomy rate should be achievable in Viet Nam.
- Determinants of reduced child stunting in Cambodia: analysis of pooled data from three Demographic and Health Surveys. [Journal Article]
- Bull World Health Organ 2013 May 1; 91(5):341-9.
To assess how changes in socioeconomic and public health determinants may have contributed to the reduction in stunting prevalence seen among Cambodian children from 2000 to 2010.A nationally representative sample of 10 366 children younger than 5 years was obtained from pooled data of cross-sectional surveys conducted in Cambodia in 2000, 2005, and 2010. The authors used a multivariate hierarchical logistic model to examine the association between the prevalence of childhood stunting over time and certain determinants. They estimated those changes in the prevalence of stunting in 2010 that could have been achieved through further improvements in public health indicators.Child stunting was associated with the child's sex and age, type of birth, maternal height, maternal body mass index, previous birth intervals, number of household members, household wealth index score, access to improved sanitation facilities, presence of diarrhoea, parents' education, maternal tobacco use and mother's birth during the Khmer Rouge famine. The reduction in stunting prevalence during the past decade was attributable to improvements in household wealth, sanitation, parental education, birth spacing and maternal tobacco use. The prevalence of stunting would have been further reduced by scaling up the coverage of improved sanitation facilities, extending birth intervals, and eradicating maternal tobacco use.Child stunting in Cambodia has decreased owing to socioeconomic development and public health improvements. Effective policy interventions for sanitation, birth spacing and maternal tobacco use, as well as equitable economic growth and education, are the keys to further improvement in child nutrition.
- Trends in smoking and lung cancer mortality in Japan, by birth cohort, 1949-2010. [Journal Article]
- Bull World Health Organ 2013 May 1; 91(5):332-40.
To determine smoking trends in Japan in comparison with lung cancer mortality.Age-specific smoking prevalence among cohorts born between 1897 and 1985 were determined for the period 1949-2010. The percentages of the cohorts born between 1893 and 1979 who initiated smoking early (e.g. before the age of 20 years) were determined. The results were compared against lung cancer mortality rates in people aged 40-84 years belonging to cohorts born between 1868 and 1968.In males, smoking prevalence was generally high, particularly among those born before the late 1950s, and early initiation was fairly uncommon. Early initiation was most common among recent birth cohorts of males, who showed relatively low prevalences of smoking. In females, the prevalence of smoking was generally low and early initiation was very uncommon, particularly among those born in the late 1930s and before the late 1940s, respectively. Recent cohorts of females showed relatively high prevalences of smoking and relatively high percentages of early initiation. In both sexes, lung cancer mortality was generally low but increased over the study period.Lung cancer mortality in Japanese males was relatively low given the high prevalence of smoking, perhaps because early initiation was fairly uncommon. Over the last four decades, however, early initiation of smoking has become more common in both sexes. The adverse effect this is likely to have on lung cancer mortality rates has probably not been observed because of the long time lag between smoking initiation and death from lung cancer.
- Breastfeeding rates in central and western China in 2010: implications for child and population health. [Journal Article]
- Bull World Health Organ 2013 May 1; 91(5):322-31.
To describe breastfeeding practices in rural China using globally recommended indicators and to compare them with practices in neighbouring countries and large emerging economies.A community-based, cross-sectional survey of 2354 children younger than 2 years in 26 poor, rural counties in 12 central and western provinces was conducted. Associations between indicators of infant and young child feeding and socioeconomic, demographic and health service variables were explored and rates were compared with the most recent data from China and other nations.Overall, 98.3% of infants had been breastfed. However, only 59.4% had initiated breastfeeding early (i.e. within 1 hour of birth); only 55.5% and 9.4% had continued breastfeeding for 1 and 2 years, respectively, and only 28.7% of infants younger than 6 months had been exclusively breastfed. Early initiation of breastfeeding was positively associated with at least five antenatal clinic visits (adjusted odds ratio, aOR: 3.48; P < 0.001) and negatively associated with delivery by Caesarean (aOR: 0.53; P < 0.001) or in a referral-level facility (aOR: 0.6; P = 0.014). Exclusive breastfeeding among children younger than 6 months was positively associated with delivery in a referral-level facility (aOR: 2.22; P < 0.05). Breastfeeding was not associated with maternal age or education, ethnicity or household wealth. Surveyed rates of exclusive and continued breastfeeding were mostly lower than in other nations.Despite efforts to promote breastfeeding in China, rates are very low. A commitment to improve infant and young child feeding is needed to reduce mortality and morbidity.
- Rocky road from the Semashko to a new health model. [Journal Article]
- Bull World Health Organ 2013 May 1; 91(5):320-1.
Health care is receiving much higher priority and more funds than ever before in the Russian Federation. Russian health economist Igor Sheiman talks to Fiona Fleck.