Rapid assessment of tuberculosis in a large prison system--Botswana, 2002

Prisons are settings in which tuberculosis (TB) transmission occurs, and TB rates in prisons are often five to 10 times higher than national rates. Data on the prevalence of TB in prisons in Africa are limited; however, studies from Malawi, Ivory Coast, and Tanzania that used active screening found TB rates > or = 10 times higher than national rates. During 1989-2001, TB rates in Botswana increased threefold, from 199 cases per 100,000 population to 620 (Botswana National TB Program, unpublished data, 2002). This increase has been associated with the human immunodeficiency virus (HIV) epidemic. In Botswana, prisoners are not screened routinely for TB. To determine the prevalence of TB and drug-resistant TB in the Botswana prison system and to improve future screening for TB among prisoners and guards, CDC, in collaboration with the Botswana Ministry of Health and the Division of Prisons and Rehabilitation, screened prisoners and guards at four prisons during April-May 2002. This report summarizes the results of the survey, which indicate a high point prevalence of TB among prisoners in Botswana of 3,797 cases per 100,000 population and support the need for improved screening.     

Rapid assessment of immunization practices in Agra district

A cross sectional study was conducted utilizing rapid assessment procedures, covering 516 children of 12-23 months in 80 clusters of both urban and rural areas of district Agra. The results revealed that 41.5% had immunization cards; only 37.2% children were fully immunized and 37.6% children were unimmunized. 43.6% had received measles vaccine. The most common reason for non immunization was obstacles (46%), followed by lack of motivation (22.6%), lack of information (19.4%). 13.8% had received vitamin-A oil along with measles vaccine while only 5.3% had received vitamin A upto three years.     

Rapid ethnographic assessment of breastfeeding practices in periurban Mexico City.

Before carrying out a breastfeeding promotion programme in a periurban area of Mexico City, we conducted a rapid ethnographic study to determine the factors associated with absence of exclusive breastfeeding. The responses to pilot interviews were used to develop a standardized questionnaire regarding reasons for infant feeding choice, sources of advice, and barriers to breastfeeding. We interviewed a random sample of 150 mothers with a child < 5 years of age; 136 (91%) of them had initiated breastfeeding; but only 2% exclusively breastfed up to 4 months. The mothers consistently stated that the child's nutrition, health, growth, and hygiene were the main reasons for the type of feeding selected; cost, comfort, and the husband's opinion were less important. Physicians were ranked as the most important source of advice. Reduction or cessation of breastfeeding occurred on the doctor's advice (68%); or when the mothers encountered local folk illnesses such as "coraje" (52%) or "susto" (54%), which are associated with anger or fright; or had "not enough milk" (62%) or "bad milk" (56%); or because of illness of the mother (56%) or child (43%). During childhood illnesses and conditions, breastfeeding was reduced and the use of supplementary foods was increased. This study emphasizes the importance of cultural values in infant feeding choices, defines specific barriers to breastfeeding, and provides a basis for interventions to promote exclusive breastfeeding in the study population.     

中国北方农村地区某县安全注射现况调查

目的：估计中国农村地区居民接受注射的频次和不安全注射的比例，分析产生不安全注射的主要因素，调查卫生服务人员和居民对安全注射的认知。方法：采用面向面问卷调查和现场观察相结合的方法对居民注射频次、注射器材的使用和管理、居民和卫生服务人员对安全注射的认知等内容进行调查。结果：1004名居民中，过去3个月至少接受1次注射的有145人（14．4％）、457次（0．46次／人），按年估计，每人每年接受注射的频次为1．84次。≤12岁和＞12岁两个年龄组接受预防和治疗注射的比例差异有显著性。一次性注射器使用率为94．4％。普通居民和卫生服务人员对安全注射的认知依然有限。结论：农村地区人均每年接受注射1．84次的结果是比较适度的，一次性注射器的使用率也很高。但如何正确合理地使用注射、提高卫生服务人员的自我保护意识和对安全注射的认知水平，如何加强对群众的健康教育，都值得卫生决策部门深入思考。     

Evaluation of immunization knowledge, practices, and service-delivery in the private sector in Cambodia

A study of private-sector immunization services was undertaken to assess scope of practice and quality of care and to identify opportunities for the development of models of collaboration between the public and the private health sector. A questionnaire survey was conducted with health providers at 127 private facilities; clinical practices were directly observed; and a policy forum was held for government representatives, private healthcare providers, and international partners. In terms of prevalence of private-sector provision of immunization services, 93% of the private inpatient clinics surveyed provided immunization services. The private sector demonstrated a lack of quality of care and management in terms of health workers' knowledge of immunization schedules, waste and vaccine management practices, and exchange of health information with the public sector. Policy and operational guidelines are required for private-sector immunization practices that address critical subject areas, such as setting of standards, capacity-building, public-sector monitoring, and exchange of health information between the public and the private sector. Such public/private collaborations will keep pace with the trends towards the development of private-sector provision of health services in developing countries.     

Cross-sectional studies of tuberculosis prevalence in Cambodia between 2002 and 2011

Objective

To measure trends in the pulmonary tuberculosis burden between 2002 and 2011 and to assess the impact of the DOTS (directly observed treatment, short-course) strategy in Cambodia.

Methods

Cambodia’s first population-based nationwide tuberculosis survey, based on multistage cluster sampling, was conducted in 2002. The second tuberculosis survey, encompassing 62 clusters, followed in 2011. Participants aged 15 years or older were screened for active pulmonary tuberculosis with chest radiography and/or for tuberculosis symptoms. For diagnostic confirmation, sputum smear and culture were conducted on those whose screening results were positive.

Findings

Of the 40 423 eligible subjects, 37 417 (92.6%) participated in the survey; 103 smear-positive cases and 211 smear-negative, culture-positive cases were identified. The weighted prevalences of smear-positive tuberculosis and bacteriologically-positive tuberculosis were 271 (95% confidence interval, CI: 212–348) and 831 (95% CI: 707–977) per 100 000 population, respectively. Tuberculosis prevalence was higher in men than women and increased with age. A 38% decline in smear-positive tuberculosis (P = 0.0085) was observed with respect to the 2002 survey, after participants were matched by demographic and geographical characteristics. The prevalence of symptomatic, smear-positive tuberculosis decreased by 56% (P = 0.001), whereas the prevalence of asymptomatic, smear-positive tuberculosis decreased by only 7% (P = 0.7249).

Conclusion

The tuberculosis burden in Cambodia has declined significantly, most probably because of the decentralization of DOTS to health centres. To further reduce the tuberculosis burden in Cambodia, tuberculosis control should be strengthened and should focus on identifying cases without symptoms and in the middle-aged and elderly population.     

Preventive-care practices among adults with diabetes--Puerto Rico, 2000-2002

Preventive-care practices among persons with diabetes can prevent or delay complications such as eye disease, kidney disease, or nerve damage that is a precursor to disabling foot disease. However, the level of diabetes-related preventive care is inadequate in the United States, and little has been reported about preventive care in Puerto Rico, where an estimated 10% of adults have diagnosed diabetes. CDC analyzed data from 2000, 2001, and 2002 Behavioral Risk Factor Surveillance System (BRFSS) surveys to assess the percentage of adults with diabetes in Puerto Rico who engaged in five selected preventive-care practices. This report summarizes the results of that analysis, which indicated that, with the exception of hemoglobin A1c testing, the percentages of adults engaging in preventive-care practices were lower than the target percentages set by U.S. national health objectives for 2010.     

A sustainability assessment of a health equity fund initiative in Cambodia

All but one of the health equity funds (HEFs) currently operating in Cambodia, introduced to address the adverse effects of low user fee exemption rates, rely heavily on external funding and have high administrative overheads. This article reports on a study of one type of HEF, based in Kirivong Operational Health District (KOD) and operated through local pagoda structures, which demonstrates minimal reliance on external funding and low administrative overheads. We utilize an adapted sustainability assessment framework to assess the ability of pagoda structures to enable financial access for the poorest to public sector health services. We further analyse the strengths and limitations of the pagoda-managed equity fund initiative, with a view to assessing not only its sustainability but its potential for replication in other settings.Our study shows that, against key sustainability indicators (health service utilization and health outcomes; management capacity and financial viability; community mobilization and government support), the pagoda-managed equity fund initiative scores well. However, it is evident that some external financial support is needed to allow the HEFs to function effectively. We conclude with recommendations for replicating the initiative, which include working innovatively with indigenous grassroots organizations to enhance community HEF ownership and to keep administrative overheads low.     

2002 AHA environmental assessment

This year's AHA Environmental Assessment analyzes the trends and issues that are likely to affect the health care delivery system. Compiled from more than 30 sources, the Environmental Assessment looks at the present to plan for the future.     

Weight-control practices among U.S. adults, 2001-2002

BACKGROUND: Approximately $50 billion a year is spent by Americans on weight-loss products and services. Despite the high cost, few national studies have described specific weight-loss and weight-maintenance practices among U.S. adults. This analysis describes the use of specific practices by U.S. adults who tried to lose weight or tried only not to gain weight during the previous 12 months. METHODS: Data were analyzed from the 2001-2002 National Health and Nutrition Examination Survey (NHANES) conducted on a nationally representative sample of the U.S. population. This study focused on adults aged 20 years or older who were both interviewed and examined (n =5027). RESULTS: Fifty-one percent of U.S. adults tried to control their weight in the previous 12 months, including those who tried to lose weight (34% of men, 48% of women) and those who tried only not to gain weight (11% vs 10%, respectively). Among 2051 adults who tried to control their weight, the top four practices were the same: ate less food (65% among those who tried to lose weight, 52% among those who tried only not to gain weight); exercised (61% vs 46%, respectively); ate less fat (46% vs 42%); and switched to foods with lower calories (37% vs 36%). Less than one fourth combined caloric restriction with the higher levels of physical activity (300 or more minutes per week) recommended in the 2005 dietary guidelines by the U.S. Department of Health and Human Services and U.S. Department of Agriculture. CONCLUSIONS: Although weight control is a common concern, most people who try do not use recommended combinations of caloric restriction and adequate levels of physical activity.     

Rehabilitation for children with cerebral palsy in rural Cambodia: parental perceptions of family-centred practices

Background Rehabilitation service providers in Cambodia are increasingly adopting family‐centred practices when working with children with cerebral palsy and their families. This study examined the perceptions of parents living in rural Cambodia regarding family‐centred rehabilitation practices. Methods This qualitative study used in‐depth semi‐structured individual and small group interviews with a convenience sample of 24 parents of children with cerebral palsy from three rural provinces. Participants were drawn from Cambodia Trust's client database and had been involved in a rehabilitation planning process which incorporated family‐centred practices. Results Twenty‐four parents and carers of children with cerebral palsy aged 3–12 years were interviewed. Almost all parents valued family‐centred practices in rehabilitation, with many of the needs and preferences of parents living in rural Cambodia similar to those of parents in Western contexts. Conclusions Family‐centred approaches to paediatric rehabilitation were found to be valued in and appropriate for a rural Cambodian context. Social and cultural mechanisms to be considered when adapting a Western, family‐centred model of rehabilitation planning to the rural Cambodian context include the hierarchical nature of Cambodian culture, the emphasis on group relational patterns rather than individual needs and the context of chronic poverty.     

Rapid assessment and response studies of injection drug use: knowledge gain, capacity building, and intervention development in a multisite study

OBJECTIVES: We evaluated the World Health Organization's rapid assessment and response (RAR) method of assessing injection drug use and its associated health problems, focusing on knowledge gain, capacity building, and whether RAR leads to the development of interventions reducing the health effects of injection drug use. METHODS: Data were derived from RAR studies conducted in Beijing, China; Bogotá, Colombia; Greater Rosario, Argentina; Hanoi, Vietnam; Kharkiv, Ukraine; Minsk, Belarus; Nairobi, Kenya; Penang, Malaysia; St. Petersburg, Russia; and Tehran, Iran. RESULTS: Substantial gains in knowledge and response capacity were reported at all of the study sites. Before RAR initiation, prevention and intervention programs had been absent or inadequate at most of the sites. The RARs resulted in many new or modified interventions; 7 sites reported 24 health-related interventions that were subsequently developed and influenced by the RARs. CONCLUSIONS: RARs, which require relatively little external funding, appear to be effective in linking assessment to development of appropriate interventions. The present results add to the evidence that rapid assessment is an important public health tool.     

Baseline assessment for addressing acute malnutrition by public-health staff in Cambodia

The objective of this study was to formulate appropriate responses by the public-health sector to reduce acute malnutrition among children in Cambodia. A cross-sectional survey to identify wasting together with a simple wealth-ranking exercise was conducted. Thereafter, separate focus-group discussions were also conducted with mothers of malnourished and non-malnourished children, who belonged to the poorest strata, to identify coping mechanisms and to assess feeding and hygiene practices. There was no statistical correlation between wasting and socioseconomic status (df=3, p=0.06). Reported feeding practices were poor, including not giving of colostrum, too early introduction of weaning, low feeding frequency, and late introduction of nutritious foods. Healthcare-seeking behaviour appeared inadequate, and hand-washing with soap was not practised. Acute malnutrition was mainly related to these factors rather than to food insecurity. An education campaign in tandem with peer-counselling would be the most appropriate option.     

Melioidosis, Phnom Penh, Cambodia

We describe 58 adult patients with melioidosis in Cambodia (2007–2010). Diabetes was the main risk factor (59%); 67% of infections occurred during the rainy season. Bloodstream infection was present in 67% of patients, which represents 12% of all bloodstream infections. The case-fatality rate was 52% and associated with inappropriate empiric treatment.     

Rapid assessment of cholera-related deaths, Artibonite Department, Haiti, 2010

We evaluated a high (6%) cholera case-fatality rate in Haiti. Of 39 community decedents, only 23% consumed oral rehydration salts at home, and 59% did not seek care, whereas 54% of 48 health facility decedents died after overnight admission. Early in the cholera epidemic, care was inadequate or nonexistent.     

Burkholderia pseudomallei antibodies in children, Cambodia

Antibodies to Burkholderia pseudomallei were detected in 16% of children in Siem Reap, Cambodia. This organism was isolated from 30% of rice paddies in the surrounding vicinity. Despite the lack of reported indigenous cases, melioidosis is likely to occur in Cambodia.     

Rapid point-of-care testing for HIV-1 during labor and delivery--Chicago,Illinois, 2002

On November 7, 2002, the Food and Drug Administration (FDA) approved the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Inc., Bethlehem, Pennsylvania). Rapid human immunodeficiency virus (HIV) testing during labor and delivery allows pregnant women who were not tested previously during pregnancy to be tested and, if HIV-infected, to begin antiretroviral therapy immediately to prevent perinatal transmission. To evaluate whether point-of-care rapid HIV testing during labor and delivery expedites the diagnosis of HIV infection in pregnant women, CDC assessed turnaround testing times at three hospitals in Chicago, Illinois, in which obstetric staff performed rapid tests on whole blood specimens at point of care, and at a fourth hospital in which testing was performed in the hospital laboratory. This report summarizes the results of that analysis, which indicate that point-of-care rapid testing provided HIV test results faster than laboratory testing, resulting in prompt administration of intrapartum and neonatal antiretroviral prophylaxis. Hospitals should assess the costs and benefits of implementing point-of-care HIV testing within their institutions.