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Asthma is the most common chronic illness of childhood. The prevalence is rising and the mortality and morbidity from asthma are unacceptably high in South Africa. This article emphasizes the importance to make a correct diagnosis based, most importantly, on the clinical history and supported by inv
...
estigations. Further, the appropriate drug and device must be chosen to achieve good asthma control. It explains that patients must be followed up regularly and their asthma control must be assessed so that the treatment can then be adjusted according to the level of control. Additionally, Asthma education and adherence are important components of management of the condition.
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HIV/AIDS Knowledge Among Women Across Seven Post-Soviet Countries
H. Zainiddinov; N. Habibov
Central Asian Journal of Global Health; University of Pittsburgh
(2018)
C2
Vol. 7, No. 1 (2018) | ISSN 2166-7403 (online) DOI 10.5195/cajgh.2018.295 | http://cajgh.pitt.edu
European Scientific Journal, November edition vol. 8, No.26 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
Accessed: 29.09.2019
The Open Infectious Diseases Journal, 2013, 7, (Suppl 1: M6) 54-59
Vol. 7, No. 1 (2018) | ISSN 2166-7403 (online) DOI 10.5195/cajgh.2018.295 | http://cajgh.pitt.edu
Zule et al. Harm Reduction Journal (2018) 15:44 https://doi.org/10.1186/s12954-018-0249-3
Clinical and epidemiological characteristics associated with unfavorable tuberculosis treatment outcomes in TB-HIV co-infected patients in Brazil: a hierarchical polytomous analysis
T. N. do Pradoa; J.t V. Rajand; A. E. Miranda; et al.
The Brazilian Journal of infectious diseases; Elsevier Editora Ltda.
(2016)
C2
braz j infect dis 2 0 1 7;2 1(2):162–170
http://dx.doi.org/10.1016/j.bjid.2016.11.006
1413-8670/© 2016 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
The Open AIDS Journal, 2012, 6, 245-258
Guidelines for the vaccination of HIV-infected adolescents and adults in South Africa
S. K. Dlamini; S. A. Madhi; R. Muloiwa; et al.
Southern African Journal of HIV Medicine; AOSIS
(2018)
CC
Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
http://www.sajhivmed.org.za
Published: 23 May 2018
What will it take to end AIDS in the Americas?
C. F. Etienne
PAHO (Pan American Health Organization; World Health Organization); Iris (Institutional Repository); Rev Panam Salud Publica; Pan American Journal of Public Health
(2016)
C2
Editorial
Rev Panam Salud Publica 40(6), 2016
Les Urgences Obstétricales à L’HÔpital Universitaire de Parakou au Bénin : Aspects Cliniques, Thérapeutiques et Évolutifs
Blaise Adelin Tchaou, Nouessewa Fanny Maryline Hounkponou Kabibou Salifou, Eugène Zoumenou, Martin Chobli
European Scientific Journal
(2015)
C2
European Scientific Journal March 2015 edition vol.11, No.9 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
Objective: To describe the clinical, therapeutic and outcome aspects of emergency obstetric care at the University Hospital of Parakou in
...
Benin
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African Evaluation Journal
ISSN: (Online) 2306-5133, (Print) 2310-4988
Background: For some years, non-governmental organisations (NGOs) and civil society have
become increasingly involved in the fight against the HIV/AIDS pandemic in Africa. B
...
ut even
though their role is well appreciated, their actions are perceived as ineffective because of a lack
of monitoring and evaluation capacity.
Objective: This paper aims to describe local HIV/AIDS NGOs’ involvement in evaluation and
the characteristics of this involvement.
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BMJ is offering a range of free online resources to support researchers, doctors, nurses, and other healthcare professionals to understand and respond to the global health emergency caused by the novel coronavirus (2019-nCoV).
The free online resources are aimed at healthcare professionals locate
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d in China and across the world, to help keep them updated with the latest developments and guidance
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Le défi des pays en voie de développement est la disponibilité de méthodes de diagnostic rapide et précis pour le management de la tuberculose. Des techniques moléculaires offrent cet avantage et nous avons utilisé le test GeneXpert MTB/RIF dans le diagnostic de la tuberculose extra-pulmonair
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e pour évaluer sa performance par rapport aux méthodes conventionnelles.
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Les maladies chroniques non transmissibles (MCNT) constituent un problème de santé publique. La transition épidémiologique coexiste avec les maladies infectieuses. En Afrique subsaharienne, leur ampleur est peu connue et l'OMS recommande aux pays à faible et moyen revenu de réaliser des enquê
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tes STEPS portant sur les comportements, des mesures physiques et biochimiques. L'absence de données au niveau national justifie cette étude auprès d'un groupe spécifique. L'objectif de l'étude était de déterminer la prévalence des MCNT et de leurs facteurs de risque chez les militaires Sénégalais.
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Introduction: Premier niveau de référence de la pyramide sanitaire du Bénin, les hôpitaux de zone sanitaire s’acquittent de leurs missions dans un contexte difficile. L’objectif de la présente étude a été d’évaluer la performance de l’hôpital de la zone sanitaire de Comè en 2013.
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Pan African Medical Journal. 2014; 18:63 doi:10.11604/pamj.2014.18.63.3465
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Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma medication improves asthma control and quality of life. The aim of this
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journal is to provide an evidence-based approach for chronic asthma management in young children and adolescents and provide guidance on the use of new asthma drugs in children.
For that, the South African Childhood Asthma Working Group (SACAWG) convened in January 2017. The asthma treatment task group reviewed the available scientific literature and international asthma treatment guidelines. The evidence was then graded according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system and recommendations were made based on scientific evidence and local context. Asthma management recommendations were made for children ˂6 years of age and older children and adolescents, as well as for stepping up and stepping down of therapy. This review does not include biologics or novel asthma drugs, which are covered in another CME article in this edition of SAMJ.
The final conclusions are that it is important to ensure good response, treatment and adherence, type of medication, device and checking of technique are all critical. Stepping up of therapy should be done only after ensuring good adherence and technique. Once therapeutic response is achieved, medication administration has to be stepped down to improve ease of use and avoid unnecessary side-effects.
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L’utilisation des services de santé de base est l’un des facteurs clefs favorisant une meilleure santé des populations. Conceptuellement, si la qualité des services est l’une des explications du niveau d’utilisation, cette étude a essayé de montrer aussi l’importance d’un ensemble d
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’autres facteurs qui devraient être pris en compte pour améliorer la fréquentation des services de santé. Les résultats de cette étude indiquent que pour le dernier épisode de maladie, plus de 92% des malades ont recouru à différentes structures des soins modernes et 7,4% ont fait recours à la médecine traditionnelle. Pour la santé maternelle, l’utilisation des méthodes contraceptives est de 29.5% et 73% d’accouchements ont été assistés par un personnel qualifié. Parmi les 96% des femmes qui ont consulté les services de CPN pendant la grossesse, seulement 24% ont complété les quatre visites standards de CPN.
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Cancellation of elective surgical procedures in the university teaching hospital center Yalgado Ouedraogo in Burkina Faso: incidence, reasons and proposals for improvement
Lankoande M., P. Bonkoungou, S. Traore et al.
Southern African Journal of Anaesthesia and Analgesia
(2016)
C2
Cancellation of scheduled surgery leads to operating theatre under-occupancy and is recognised as a major cause of emotional trauma to patients and their families. This study aimed to assess the incidence of elective surgery cancellation in order to make proposals for healthcare improvement.
Coronavirus (Covid-19) - A collection of articles and other resources on the Coronavirus (Covid-19) outbreak, including clinical reports, management guidelines, and commentary.
The New England Journal of Medicine; Massachusetts Medical Society
The New England Journal of Medicine; Massachusetts Medical Society
(2020)
C2
Accessed: 25.03.2020
Pan African Medical Journal. 2016; 25:213 doi:10.11604/pamj.2016.25.213.88
BMJ has created a free resource on SARS-CoV-2 and covid-19 to inform diagnosis and treatment, and to promote the wellbeing and safety of staff and patients during this extremely stressful and challenging period.
BMJ’s dedicated covid-19 hub not only draws on the latest peer reviewed research, n
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ews and opinion from The BMJ and BMJ’s 70 + specialist journals. It also provides online CPD from BMJ Learning and guidance on the evidence-based management of covid-19 from BMJ Best Practice.
The content is updated daily so that healthcare professionals on the frontline of care can readily keep abreast of the latest developments in thinking and practice
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Hygiene des mains NEJM
WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals & Faculty of Medicine, Geneva, Switzerland
he New England Journal of Medicine
(2013)
C_WHO
Les infections associées aux soins sont les complications les plus fréquentes qui affectent les patients hospitalisés. L'hygiène des mains est la plus efficace des mesures préventives de ces infections. Cependant, l'observance à ce geste simple parmi les professionnels médico-soignants reste
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faible, souvent inférieure à 40 %. L'hygiène des mains est essentielle à la pratique des soins de tous les professionnels médico-soignants
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Hand Hygiene VIDEOS
WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals & Faculty of Medicine, Geneva, Switzerland
he New England Journal of Medicine
(2013)
CC
A list of some of the many free documents and websites that can add to the information in the papers published in this issue of SSMJ. Many are regularly updated. Let us know of other resources relevant to those working in and with South Sudan.
Volume 2019, Article ID 4157574, 7 pages
https://doi.org/10.1155/2019/4157574
Video of how to obtain a good SARS CoV II sample
New England Journal of Medicne NJM 2020 382, 22
You can download the video here https://medbox.org/document/how-to-obtain-a-nasopharyngeal-swab-specimen-video#GO
COVID-19 Vaccine Resource Center
recommended
A collection of resources on Covid-19 vaccines, including frequently asked questions, continuing medical education, published research, and commentary.
The authors state that researchers, governments and global agencies should proceed with particular care in the evaluation of candidate SARS-CoV-2 vaccines in LMICs, with effective communication to build trust and avoid generation of vaccine hesitancy. Vaccine efficacy is often highly variable betwee
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n high-resource and low-resource settings
Archives of Disease in Childhood, vol.106 Issue 2
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For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complicated by clinical guidance that is out of date, inconsistent and informed by evidence from high-income countries that ignores LMIC resource constraints and
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burden of disease. The Knowledge Translation Unit (KTU) of the University of Cape Town Lung Institute has developed, implemented and evaluated a health systems intervention in South Africa, and localised it to Botswana, Nigeria, Ethiopia and Brazil, that simplifies and standardises the care delivered by primary health workers while strengthening the system in which they work. At the core of this intervention, called Practical Approach to Care Kit (PACK), is a clinical decision support tool, the PACK guide. This paper describes the development of the guide over an 18-year period and explains the design features that have addressed what the patient, the clinician and the health system need from clinical guidance, and have made it, in the words of a South African primary care nurse, ‘A tool for every day for every patient’. It describes the lessons learnt during the development process that the KTU now applies to further development, maintenance and in-country localisation of the guide: develop clinical decision support in context first, involve local stakeholders in all stages, leverage others’ evidence databases to remain up to date and ensure content development, updating and localisation articulate with implementation.
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RESULTS: Between 76 and 97% of the PHCS offered RMCAH services before the lockdown. Except in antenatal, delivery and adolescent care, there was a decline of between 2 and 6% in all the services during the lockdown and up to 10% decline after the lockdown with variation across and within States. Dur
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ing the lockdown. Full-service delivery was reported by 75.2% whereas 24.8% delivered partial services. There was a significant reduction in clients' utilization of the services during the lockdown, and the difference between States before the pandemic, during, and after the lockdown. Reported difficulties during the lockdown included stock-out of drugs (25.7%), stock-out of contraceptives (25.1%), harassment by the law enforcement agents (76.9%), and transportation difficulties (55.8%). Only 2% of the PHCs reported the availability of gowns, 18% had gloves, 90.1% had hand sanitizers, and a temperature checker was available in 94.1%. Slightly above 10% identified clients with symptoms of COVID-19.
CONCLUSIONS: The large proportion of PHCs who provided RMCAH services despite the lockdown demonstrates resilience. Considering the several difficulties reported, and the limited provision of primary protective equipment more effort by the government and non-governmental agencies is recommended to strengthen delivery of sexual and reproductive health in primary health centres in Nigeria during the pandemic.
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CHWs demonstrated social commitment and purpose in the short term observed. The evaluation of the training of CHWs revealed that most demonstrated the necessary skills for referrals to prevent complications, caring for newborns and their mothers at home immediately after discharge from health care c
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enters. CHW upskilling training on maternal-newborn services should be prioritized in the most affected areas.
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BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3086
Using infectious diseases sensitive to climate as indicators of climate change helps stimulate and inform public health responses
The Lancet olume 395, ISSUE 10232, P1259-1267, April 18, 2020. Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifa
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mpicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions.
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Phillips and colleagues have shown that rifampicin combined with clarithromycin is non-inferior to RS8, and is safer. This much anticipated trial provides us with a high degree of confidence that an 8-week course of oral rifampicin and clarithromycin should now be the cornerstone of the treatment of
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Buruli ulcer everywhere. However, this finding does not mean that
Buruli ulcer is cured at 8 weeks.
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The Lancet Global Health Volume 7, ISSUE 7, e912-e922, July 01, 2019
Clinical and Laboratory Diagnosis of Buruli Ulcer Disease: A Systematic Review
Sakyi; S.A.; Aboagye, S. Y.; Otchere, I. D. ; et al
The Canadian Journal of Infectious Diseases & Medical Microbiology
(2016)
C1
Volume 2016 | Article ID 5310718 | https://doi.org/10.1155/2016/5310718. Buruli ulcer (BU) is a necrotizing cutaneous infection caused by Mycobacterium ulcerans. Early diagnosis is crucial to prevent morbid effects and misuse of drugs. We review developments in laboratory diagnosis of BU, discuss li
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mitations of available diagnostic methods, and give a perspective on the potential of using aptamers as point-of-care.
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Global Epidemiology of Buruli Ulcer, 2010–2017, and Analysis of 2014 WHO Programmatic Targets
Omansen, T.F.; A. Erbowor-Becksen, R. Yotsu, et al.
Emerging Infectious Diseases (EID) Journal
(2019)
C_CDC
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 25, No. 12, December 2019 2183
Buruli ulcer is a neglected tropical disease caused by Myocobacterium ulcerans; it manifests as a skin lesion, nodule, or ulcer that can be extensive and disabling. To assess the global burden and the progress
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on disease control, we analyzed epidemiologic data reported by countries to the World Health Organization during 2010–2017.
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Over 6 million people worldwide are infected with Trypanosoma cruzi, the protozoan that causes Chagas disease
(CD). T. cruzi is transmitted by triatomine insects, congenitally, through uncontrolled blood donations and organ transplants,
and via consumption of food or drink contaminated by triatomi
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nes.
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Dengue is the fastest spreading, mosquito-borne viral infectious disease worldwide, with remarkable morbidity and mortality. In the past decades, profound contributions have been made towards understanding its epidemiology, including disease burden and distributions, risk factors, and control and pr
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evention practices. Dengue continues to disseminate to new areas, including high latitude regions, and a new serotype (dengue virus serotype 5) has been identified. Vaccine research has made new progress, in which the licensed yellow fever and dengue virus quadrivalent chimeric vaccine is now under further safety assessment. In disease surveillance, because of its operational simplicity, rapidity, capability, and utility as an indicator of disease severity, dengue virus NS1 antigen detection has great promotion and application value among primary health care institutions. Vector control progress has driven new breakthroughs in biotechnology, including Wolbachia-infected Aedes and genetically modified Aedes. Both Aedes variants have been used to block transmission of the dengue virus through population replacement and suppression. In the future, vector control should still be pursued as a key measure to prevent transmission, along with anti-viral drug and vaccine research.
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Yaws, an infectious disease caused by Treponema pallidum subspecies pertenue, is endemic in many parts of the world. A community-wide treatment program in Papua New Guinea, in which a single dose of azithromycin was administered, showed substantial disease control. Watch the new Quick Take animation
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. Click through to read the study.
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Antimicrobial resistance (AMR) as a serious public health threat was globally acknowledged by WHO in 2015, through the launch of the Global Action Plan (GAP). With a limited number of new antibiotics in the developmental pipeline, many countries are in the process of establishing strategies for anti
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microbial stewardship (AMS). Within each country, different healthcare challenges have
contributed to AMR. This has also shaped individual AMS strategies and policies. In South Africa (SA), there is a high burden of infectious diseases, mainly of bacterial origin. In addition, SA also has the highest number of people living with
human immunodeficiency virus (HIV) globally. According to the 2019 statistics, there are approximately 7.97 million people living with HIV in SA. Together with this, SA has the fourth largest tuberculosis population globally.
Other important challenges include poverty, malnutrition, a high burden of non-communicable diseases, and a dire shortage of trained healthcare professionals (e.g. clinicians, pharmacists, and nurses).
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Development and Introduction of the Filariasis Test Strip: A New Diagnostic Test for the Global Program to Eliminate Lymphatic Filariasis
Pantelias, A.; King, J.D.; Lammie, P.; Weil, G.J.
The American Journal of Tropical Medicine and Hygiene
(2022)
CC
Lymphatic filariasis (LF) is a parasitic disease that is a major cause of chronic disability in the developing world. According to the 2021–2030 road map for neglected tropical diseases (NTDs) published by the World Health Organization (WHO), the global goal for LF is elimination as a public healt
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h problem by 2030 through repeated rounds of mass drug administration (MDA). Critical components of any elimination program are monitoring and surveillance. Appropriate assessment tools and methods are needed for each stage of an elimination program; mapping to identify which areas require intervention, monitoring to assess the impact of interventions, and post-intervention surveillance to validate elimination or detect recrudescence.
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Website last accessed on 10.04.2023
The Chagas disease is frequently referred to as the effects that the parasite Trypanosoma cruzi (T. cruzi) has on people’s health. However, from our perspective, Chagas is much more than that: it is a complex socioenvironmental health problem in which elemen
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ts of different nature converge and interact. The biomedical and epidemiological aspects, which are most frequently addressed, are only a piece of the puzzle that needs to be complete in order to understand Chagas in all its complexity. Social, environmental, economic, political, cultural, and educational elements turn out to be essential in comprehending the magnitude of the problem without prejudice or stigmatizations.
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Since 2002 the distribution of external funding to reproductive, maternal, newborn, and child health (RMNCH) has become more equitable and better targeted at the poorest countries and those experiencing the highest mortality. The aid envelope is not large enough or well enough concentrated to close
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gaps in domestic government fund ing between the poorest and middle income countries. Donors and governments of low and middle income countries should increase their investments for RMNCH . Donors should further concentrate their funds on the poorest countries and those with the highest maternal, newborn, and child mortality. Investment is also needed to close serious data and methodological gaps for assessing equity of financing between and within countries
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Tracking official development assistance for reproductive health in conflict-affected countries: 2002—2011
Patel P.; Dahab M.; Tanabe M. et al.
BJOG An International Journal of Obstetics and Gynaecology
(2016)
CC
To provide information on trends on official development assistance (ODA) disbursement patterns for
reproductive health activities in 18 conflict-affected countries
Heart failure with a reduced ejection fraction (HFrEF) is a condition frequently encountered by healthcare professionals and, in order to achieve the best outcomes for patients, needs to be managed optimally. This guideline document is based on the European Society of Cardiology Guidelines for the t
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reatment of acute and chronic heart failure published in 2016, and summarises what is considered the best current management of patients with the condition. It provides information on the definition, diagnosis and epidemiology of HFrEF in the African context. The best evidence-based treatments for HFrEF are discussed, including established therapies (beta-blockers, ACE-i/ARBs, mineralocorticoid receptor antagonists (MRAs), diuretics) that form the cornerstone of heart failure management as well as therapies that have only recently entered clinical use (angiotensin receptor-neprilysin inhibitor (ARNI), sodium/glucose cotransporter-2 (SGLT2) inhibitors). Guidance is offered in terms of more invasive therapies (revascularisation, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) by implantation of a biventricular pacemaker with (CRT-D) or without (CRT-P) an ICD, left ventricular assist device (LVAD) use and heart transplantation) in order to ensure efficient use of these expensive treatment modalities in a resourcelimited environment. Furthermore, additional therapies (digoxin, hydralazine and nitrates, ivabradine, iron supplementation) are discussed and advice is provided on general preventive strategies (vaccinations). Sections to discuss conditions that are particularly prevalent in sub-Saharan Africa (HIV-associated cardiomyopathy (CMO), peripartum CMO, rheumatic heart disease, atrial fibrillation) have been added to further improve clinical care for these commonly encountered disease processes.
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Cardiovascular diseases are the world’s leading cause of disability and death. Such diseases were responsible in 2019 for an estimated 18.6 million deaths globally and 957,000 deaths in the United States.
The South African (SA) guidelines for cardiac patients for non-cardiac surgery were developed to address the need for cardiac risk assessment and risk stratification for elective non-cardiac surgical patients in SA, and more broadly in Africa.
The guidelines were developed by updating the Canadian
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Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment
and Management for Patients Who Undergo Non-cardiac Surgery, with a search of literature from African countries and recent publications. The updated proposed guidelines were then evaluated in a Delphi consensus process by SA anaesthesia and vascular surgical experts.
The recommendations in these guidelines are:
1. We suggest that elective non-cardiac surgical patients who are 45 years and older with either a history of coronary artery disease, congestive cardiac failure, stroke or transient ischaemic attack, or vascular surgical patients 18 years or older with peripheral vascular disease require further preoperative risk stratification as their predicted 30-day major adverse cardiac event (MACE) risk exceeds 5%
(conditional recommendation: moderate-quality evidence).
2. We do not recommend routine non-invasive testing for cardiovascular risk stratification prior to elective non-cardiac surgery in adults (strong recommendation: low-to-moderate-quality evidence).
3. We recommend that elective non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease should have preoperative natriuretic peptide (NP) screening (strong recommendation: high-quality evidence).
4. We recommend daily postoperative troponin measurements for 48 - 72 hours for non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease, i.e. (i) a baseline risk >5% for MACE 30 days after elective surgery (if no preoperative NP screening), or (ii) an elevated B-type natriuretic peptide (BNP)/N-terminal-prohormone B-type natriuretic peptide (NT-proBNP) measurement before elective surgery (defined as BNP >99 pg/mL or a NT-proBNP >300 pg/mL) (conditional recommendation: moderate-quality evidence).
Additional recommendations are given for the management of myocardial injury after non-cardiac surgery (MINS) and medications for comorbidities.
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The cardiovascular disease continuum begins with risk factors such as diabetes mellitus (DM), progresses to vasculopathy and myocardial dysfunction, and finally ends with cardiovascular death. Diabetes is associated with a 2- to 4-fold increased risk for heart failure (HF). Moreover, HF patients wit
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h DM have a worse prognosis than those without DM. Diabetes can cause myocardial ischemia via micro- and macrovasculopathy and can directly exert deleterious effects on the myocardium. Hyperglycemia, hyperinsulinemia, and insulin resistance can cause alterations in vascular homeostasis. Then, reduced nitric oxide and increased reactive oxygen species levels favor inflammation leading to atherothrombotic progression and myocardial dysfunction. The classification, diagnosis, and treatment of HF for a patient with and without DM remain the same. Until now, drugs targeting neurohumoral and metabolic pathways improved mortality and morbidity in HF with reduced ejection fraction (HFrEF). Therefore, all HFrEF patients should receive guideline-directed medical therapy. By contrast, drugs modulating neurohumoral activity did not improve survival in HF with preserved ejection fraction (HFpEF) patients. Trials investigating whether sodium-glucose cotransporter-2 inhibitors are effective in HFpEF are on-going. This review will summarize the epidemiology, pathophysiology, and treatment of HF in diabetes.
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Patients with diabetes are at increased risk of developing cardiovascular disease (CVD) with its manifestations of coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), and stroke, as well as aortic and peripheral artery diseases. In addition, diabetes is a major risk factor f
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or developing chronic kidney disease (CKD), which in itself is associated with developing CVD. The combination of diabetes with these cardio-renal comorbidities enhances the risk not only for cardiovascular (CV) events but also for CV and all-cause mortality. The current European Society of Cardiology (ESC) Guidelines on the management of cardiovascular disease in patients with diabetes are designed to guide prevention and management of the manifestations of CVD in patients with diabetes based on data published until end of January 2023. Over the last decade, the results of various large cardiovascular outcome trials (CVOTs) in patients with diabetes at high CV risk with novel glucose- lowering agents, such as sodium–glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), but also novel non-steroidal mineralocorticoid receptor antagonists (MRAs), such as finerenone have substantially expanded available therapeutic op-
tions, leading to numerous evidence-based recommendations for the management of this patient population.
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The article "Capacity-Building in Community-Based Drug Treatment Services" by Michael J. Cole focuses on the global challenges in providing adequate community-based drug treatment services. It highlights the gaps in availability, quality, and accessibility of evidence-based care. The article discuss
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es the principles and strategies for capacity-building at three levels: individual, organizational, and service sector. It emphasizes using an empowerment model, engaging community stakeholders, and creating sustainable practices. The paper also addresses the need for systematic planning, assessment, and collaboration to strengthen drug treatment systems globally.
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The article "Time to Align: Development Cooperation for the Prevention and Control of Non-Communicable Diseases" argues for greater international cooperation and investment in addressing non-communicable diseases (NCDs), especially in low- and middle-income countries. Traditionally, global health fu
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nding has focused on infectious diseases, but the growing burden of NCDs—such as cardiovascular diseases, cancer, and diabetes—necessitates new approaches to development assistance.
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A 20-year follow-up study on chronic respiratory effects of exposure to cotton dust
Wang, X-R.; Zhang, H-X.; Sun, B-X.; et al.
European Respiratory Journal, part of the European Respiratory Society (ERS)
(2005)
CC2
The article "A 20-year follow-up study on chronic respiratory effects of exposure to cotton dust" evaluates the long-term impact of cotton dust exposure on respiratory health. It followed a cohort of Chinese cotton and silk workers from 1981 to 2001, comparing lung function and symptoms. Results sho
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wed that cotton workers experienced greater declines in lung function and persistent respiratory symptoms compared to silk workers. The study found that exposure to airborne endotoxins in cotton dust was strongly linked to chronic respiratory impairment. It highlighted that stopping exposure helped improve lung function, particularly in non-smoking men, while smokers continued to show negative effects.
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The article "Asthma treatment in children: A guide to screening for and management of hypothalamic-pituitary-adrenal axis suppression" discusses the risks associated with the use of corticosteroids in pediatric asthma treatment. It highlights that prolonged corticosteroid use can suppress the hypoth
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alamic-pituitary-adrenal (HPA) axis, potentially leading to adrenal insufficiency, especially during stress. The article reviews diagnostic and screening approaches, recommending specific tests and management strategies based on current evidence. It emphasizes the need for monitoring children on corticosteroids to mitigate the risk of serious complications and suggests modifications in treatment to prevent HPA axis suppression.
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The article investigates the diagnostic capabilities and prevalence of chronic obstructive pulmonary disease (COPD) in primary care settings in northern Brazil. It highlights that COPD is often underdiagnosed and undertreated in resource-limited regions. The study involved 34 general practitioners a
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nd used spirometry to evaluate their diagnostic accuracy compared to clinical assessments. Findings revealed significant discrepancies between GP diagnoses and spirometry results, with many false positives and negatives. The study underscores the need for better training and the use of spirometry to improve COPD diagnosis and case-finding in primary care, emphasizing the importance of targeted strategies to enhance healthcare outcomes in developing countries.
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The article outlines the prioritized research agenda for the prevention and control of chronic respiratory diseases (CRDs) as part of the World Health Organization's (WHO) action plan on noncommunicable diseases (NCDs) from 2008 to 2013. It highlights the significant global impact of CRDs, including
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asthma, chronic obstructive pulmonary disease (COPD), and other related conditions, particularly in low- and middle-income countries (LMICs). The document stresses the need for effective prevention strategies and better surveillance, as well as enhanced healthcare infrastructure and resources in LMICs. It calls for research into CRD risk factors, effective interventions, and integrated care approaches that align with broader NCD prevention programs. The article emphasizes the importance of public health initiatives and cross-sector collaborations to reduce the disease burden and improve patient outcomes.
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The article from the European Respiratory Journal discusses the natural history of chronic obstructive pulmonary disease (COPD), emphasizing its increasing global impact on morbidity and mortality. It highlights that while cigarette smoking is a pri
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mary risk factor, other influences such as environmental exposures and genetics also play significant roles. The article notes that lung function, measured by FEV1 (forced expiratory volume in one second), is a critical indicator of both diagnosis and prognosis. It further explores the impact of exacerbations, comorbidities, and systemic inflammation on disease progression and outcomes. The need for comprehensive patient management, which considers various comorbid conditions and inflammatory factors, is emphasized to improve clinical outcomes and reduce healthcare costs.
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The article discusses the significant impact of chronic obstructive pulmonary disease (COPD) as a global health issue, with cigarette smoking as the main risk factor. However, in developing countries, the causes of COPD are often multifactorial, involving environmental tobacco smoke, biomass fuel sm
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oke, dust, fumes, childhood illnesses, and tuberculosis (TB). Up to half of COPD patients in these regions are non-smokers. The article emphasizes that while smoking is crucial, other risk factors contribute significantly to COPD, particularly in low- and middle-income countries. It highlights the need for targeted research and public health strategies to address these diverse contributors to COPD, especially in Africa.
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BACKGROUND. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The burden of asthma in children is increasing in low- and middle-income countries and remains under-recognised and poorly managed.
OBJE
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CTIVES. To quantify the burden of asthma in the South African (SA) population and identify the risk factors associated with disease severity in the local context.
METHODS. The SA Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The epidemiology task group reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system.
CONCLUSIONS. Asthma in children remains a common condition, which has shown an increasing prevalence in urban and rural populations of SA. Of concern is that almost half of children in urban communities experience severe asthma symptoms, and many asthmatics lack a formal diagnosis and thus access to treatment. Exposure to tobacco smoke and living in highly polluted areas increase the severity of wheezing in young children.
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The epidemiology of wheeze in children, when assessed by questionnaires, is dependent on parents' understanding of the term “wheeze”.
In a questionnaire survey of a random population sample of 4,236 children aged 6–10 yrs, parents' definition of wheeze was assessed. Predictors of a correct
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definition were determined and the potential impact of incorrect answers on prevalence estimates from the survey was assessed.
Current wheeze was reported by 13.2% of children. Overall, 83.5% of parents correctly identified “whistling or squeaking” as the definition of wheeze; the proportion was higher for parents reporting wheezy children (90.4%). Frequent attacks of reported wheeze (adjusted odds ratio (OR) 3.0), maternal history of asthma (OR 1.5) and maternal education (OR 1.5) were significantly associated with a correct answer, while the converse was found for South Asian ethnicity (OR 0.6), first language not English (OR 0.6) and living in a deprived neighbourhood (OR 0.6).
In summary, the present study showed that misunderstanding could lead to an important bias in assessing the prevalence of wheeze, resulting in an underestimation in children from South Asian and deprived family backgrounds. Prevalence estimates for the most severe categories of wheeze might be less affected by this bias and questionnaire surveys on wheeze should incorporate measures of parents' understanding of the term wheeze.
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he aetiology of asthma and allergic disease remains poorly understood, despite considerable research. The International Study of Asthma and Allergies in Childhood (ISAAC), was founded to maximize the value of epidemiological research into asthma and allergic disease, by establishing a standardized m
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ethodology and facilitating international collaboration. Its specific aims are: 1) to describe the prevalence and severity of asthma, rhinitis and eczema in children living in different centres, and to make comparisons within and between countries; 2) to obtain baseline measures for assessment of future trends in the prevalence and severity of these diseases; and 3) to provide a framework for further aetiological research into genetic, lifestyle, environmental, and medical care factors affecting these diseases. The ISAAC design comprises three phases. Phase 1 uses core questionnaires designed to assess the prevalence and severity of asthma and allergic disease in defined populations. Phase 2 will investigate possible aetiological factors, particularly those suggested by the findings of Phase 1. Phase 3 will be a repetition of Phase 1 to assess trends in prevalence.
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The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist i
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n various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma.
22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus.
This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised.
Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence.
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Respiratory Effects of Exposure to Diesel Traffic in Persons with Asthma
McCreanor, J.; Cullinan, P.; Nieuwenhuijsen, M.J.; et al.
The New England Journal of Medecine
(2007)
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Air pollution from road traffic is a serious health hazard, and people with preexisting respiratory disease may be at increased risk. We investigated the effects of short-term exposure to diesel traffic in people with asthma in an urban, roadside environment.
The National Asthma Education Programme (NAEP) is a registered non-profit organisation whose mission is to provide asthma education to healthcare professionals, patients and the lay public. It was founded in 1994 by Dr Mike Greenblatt and Profs Dave Luyt and Robin Green. This year NAEP celebrates it
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s 25th anniversary and remains driven by the need to improve the daily lives of numerous asthmatics in South Africa (SA) and Africa.
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Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children. A task force supported by the European Respiratory Society has developed these evidence
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-based clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework.
Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.
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Although asthma is very common, affecting 5–10% of the population, the diagnosis of asthma in adults remains a challenge in the real world, which results in both over- and under-diagnosis. A taskforce was set up by the European Respiratory Society to systematically review the literature on the dia
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gnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendations for clinical practice.
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Movilidad poblacional y VIH/sida en Centroamérica y México
R. Leyva-Flores; B. Aracena-Genao; E. Serván-Mori
PAHO (Pan American Health Organization; World Health Organization); Rev Panam Salud Publica; Pan American Journal of Public Health
(2014)
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Investigación original / Original research
Rev Panam Salud Publica 36(3), 2014
Diabetes is not new to South-East Asia, since this condition was first described by Indian and Egyptian physicians three and a half thousand years ago. Diabetes is a serious, chronic disease characterized by chronic elevation of blood glucose and disturbance of carbohydrate, fat and protein metaboli
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sm that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Raised blood glucose, a common effect of uncontrolled diabetes, may, over time, lead to serious damage to the heart, blood vessels, eyes, kidneys and nerves. Diabetes is therefore not only a disease in itself but also an intermediate stage for many other serious conditions.
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Disability, CBR & Inclusive Development, [S.l.], v. 24, n. 3, p. 112-122, nov. 2013. ISSN 2211-5242
Children with disabilities encounter more violence in their lives than their peers without disability. Organisations involved in Community Based Rehabilitation (CBR) come across many cases of violen
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ce against the children they work with. Many organisations have no policy on child protection since it is not within the scope of their expertise. Others work with child protection policies that are hard to apply in the realities they deal with. Through research done in Ethiopia, with a recent update, the author attempts to show that there is a need for policies in CBR, that follow a community approach rather than an individual approach to child protection.
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Parental Stress in Raising a Child with Disabilities in India
Vidya Bhushan Gupta, Priyanka Mehrotra, Naveen Mehrotra
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2012)
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“Our children have the right to an education too”: Strategies Employed by Orange Farm Caregivers of Children with Disabilities in Pursuit of the Right to a Basic Education
Elphick, J., De SasKropiwnicki, Z. &Elphick, R.
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2015)
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This paper aims to understand the agency that caregivers who participated in a CBR empowerment component programme exercised, in order to promote the rights of their children with disabilities to a basic education.
This paper aimed to demonstrate how participatory action research (PAR) within a Community-based Rehabilitation (CBR) project facilitated community participation to advocate for the rights of people with visual impairment. An advocacy campaign, led by the local people with and without disabilities,
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was launched for the construction of an accessible foot over- bridge (FOB) at Vangani railway station in Maharashtra, India.
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CBR Workers’ Training Needs for People with Communication Disability
Yeap, C.E., Ibrahim, H., Van Dort, S., et al.
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2016)
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This study, although not generalizable, builds up the literature on worker training needs in developing countries, and would be of benefit for speech-language pathologists and worker trainers. This paper aimed to investigate the training needs of Malaysian workers in relation to people with communic
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ation disability. The primary aim was to investigate common self-perceived training needs in relation to communication disability and to find how important these needs are to workers. A secondary aim was to explore the relationship between selected worker variables and training needs.
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Cross-sectional Survey to Assess Prevalence of Disability and Access to Services in Albay Province, The Philippines
Hodge, M., Bolinas, A., Jaucian, E., et al.
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2017)
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In this article a cluster randomized cross-sectional survey, conducted in Albay Province in the Philippines in April 2016, was used to assess the prevalence of disability and access to support services. This was done with the purpose of generating representative data for local programme development
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. A cross-sectional survey was carried out with the WG/UNICEF methodology to examine the prevalence of disabilities, and the accessibility and coverage of relevant services. The aim is for this information to be used for public policy formulation at all levels, as well as to improve communication and advocacy on disabilities.
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Prevalence of Physical Disability among Urban Community-dwelling Adults in Sri Lanka
Weerasinghe, I.F., Foneska, P., Dharmaratne, S.D., & Jayatilake, J.A.M.S.
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2015)
Assessment of physical disability at the community level is essential for rehabilitation and supply of services. This study aimed to assess the prevalence of physical disability among adults in an urban community in Sri Lanka.
This paper explores the effect of inherent social inequalities on disability rights movements and their political activities in India and Nepal. The situation for persons with disabilities is similar in both countries. Many social and cultural phenomena coincide, and laws and policies are currently
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being formulated in line with the human rights agenda. In order to understand the current situation and the envisioned future for persons with disabilities, it is important to probe how, and under what circumstances, the disability issue is framed.
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This study explored family adjustment and access to rehabilitative services for children with Down syndrome, between 0-5 years of age, in the ecoculture of Petchaburi Province, Thailand.
Assistive Technologies in a Workplace Environment: Barriers for the Employment of Persons with Disabilities
Maria Jakovljevic & Sheryl Buckley
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2011)
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Users’ Satisfaction with Prosthetic and Orthotic Assistive Devices in the Lao People’s Democratic Republic: a Cross-sectional Study
Jo Durham, Vanphanom Sychareun, Phonevilay Santisouk & Kongmany Chaleunvong
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2016)
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User satisfaction with assistive devices is a predictor of use and an important outcome measure. This study evaluated client satisfaction with prosthetic and orthotic assistive devices and services in three provinces in the Lao People’s Democratic Republic. Clients were quite satisfied with the as
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sistive device and services provided, yet many reported barriers to optimal device use and difficulties in accessing follow-up services. There is a need to examine how prosthetic and orthotic devices can be improved further for better comfort and ambulation on uneven ground in low-resource contexts and to address access barriers.
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Conclusion: To ensure that people with disabilities can successfully access the necessary health services, the barriers on the demand side (the individuals requiring healthcare) as well as the barriers that are part of the healthcare system, should be attended to.
Indicators are a representation of reality. They are just numbers on a piece of paper or on a computer screen, but they stand for something far greater – the success of your project. Indicators are usually defined in the context of project planning and show something about or give an indication of
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progress towards realising the project goal, without being complete or comprehensive. Of course, there could be other representations of this reality, such as stories (Dart and Davies, 2003) or drawings (Feuerstein, 1986) or photographs (Tijm et al, 2011). However, indicators are a widely accepted way of representing what is being achieved in a programme or project.
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Community-Based Rehabilitation Services in Low and Middle-Income Countries in the Asia-Pacific Region: Successes and Challenges in the Implementation of the CBR Matrix
Adela Cayetano, R.D.; and J. Elkins
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2016)
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Conclusion: CBR has improved the quality of life, access to medical services, functional independence, autonomy, community inclusion, and empowerment of people with disabilities in LMICs in the Asia-Pacific region. However, challenges in the implementation of CBR remain. These include lack of awaren
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ess and understanding of CBR, and physical, environmental, socio-economical and personal barriers.
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This study aimed to estimate the cost-effectiveness of a community-based rehabilitation (CBR) programme known as Inspire2Care (I2C), implemented in Nepal by Karuna Foundation Nepal. In the absence of any gold standard methodology to measure cost-effectiveness, the authors developed a new methodology
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to estimate the programme’s achievements and cost-effectiveness.
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Disability Data Collection in Community-based Rehabilitation
Sunil Deepak, Franesca Ortali, Geraldine Mason Halls, Tulgamaa Damdinsuren, Enhbuyant Lhagvajav, Steven Msowoya, Malek Qutteina, Jayanth Kumar
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2016)
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Today there are Community-based Rehabilitation (CBR) programmes in a large number of countries. In many countries, the CBR approach is a part of the national rehabilitation services. However, there is a lack of reliable data about persons with disabilities who benefit from CBR and the kind of benefi
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ts they receive. This article reviews the disability data collection systems and presents some case studies to understand the influence of operational factors on data collection in the CBR programmes. The review shows that most CBR programmes use a variable number of broad functional categories to collect information about persons with disabilities, combined occasionally with more specific diagnostic categories. This categorisation is influenced by local contexts and operational factors, including the limitations of human and material resources available for its implementation, making it difficult to have comparable CBR data. Therefore, any strategies to strengthen the data collection in CBR programmes must take these operational factors into account.
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Sustainability Criteria for CBR Programmes – Two Case studies of Provincial Programmes in Vietnam
Mijnarends DM, Pham D, Swaans K, et al.
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2011)
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This paper aims to explore the conditions needed for sustainable community based rehabilitation (CBR) programmes for persons with disabilities in Vietnam, and to identify the conditions and opportunities missing at present for the implementation of such programmes.
There are social and environmental barriers faced by persons with disabilities which have been reported in literature. In discussing these barriers, attention is yet to be given to the support from families to members with disabilities. This study aimed to examine family support and its impact on th
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e lives of persons with disabilities in Ghana.
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Towards a Core Set of Clinical Skills for Health-Related Community Based Rehabilitation in Low and Middle Income Countries
Jessica O'Dowd, Malcolm MacLachlan, Chapel Khasnabis, Priscille Geiser
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2015)
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This research aims to identify a core set of clinical skills for working in
a Community Based Rehabilitation (CBR) setting, and to discuss whether they are appropriate for task shifting to a new or an alternative cadre of rehabilitation workers.
The Community Action Research on Disability (CARD) programme in Uganda embraced and modified the EDR approach, recognising the need for including people with disability in the research process from concept to outcome, and nurturing participation and collaboration between all the stakeholders in achi
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eving action-based research. T
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Access to Services and Barriers faced by People with Disabilities: A Quantitative Survey
Nathan Grills, Lawrence Singh, Hira Pant, Jubin Varghese, GVS Murthy, Monsurul Hoq, Manjula Marella
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2017)
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In low- and middle-income middle-income countries, reliable and disaggregated disability data on prevalence, participation and barriers are often unavailable. This study aimed to estimate disability prevalence, determine associated socio-demographic factors and compare access in the community betwee
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n people with and without disability in Dehradun district of Uttarakhand, India, using the Rapid Assessment of Disability survey.
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Knowledge of Primary School Teachers in Identifying Children with Learning Disabilities
Shari Moothedath, Mysore Narasimha Vranda
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2015)
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This study explores the knowledge of primary school teachers in
identifying children with learning disabilities.
Health-Related Quality of Life of Nigerian Children with Cerebral Palsy
Bosede Abidemi Tella, Caleb Ademola Gbiri, Oluwaseyi Abigail Osho, A E Ogunrinu
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2011)
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This article aims to assess the impact of cerebral palsy on health-related quality of life (HRQoL) of Nigerian children.
Understanding the Lives of Caregivers of Children with Cerebral Palsy in Rural Bangladesh: Use of Mixed Methods
Maria A Zuurmond, Ilias Mahmud, Sarah Polack, Jenny Evans
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2015)
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This study aims to explore the impact on the lives of caregivers of
children with cerebral palsy.
This study attempts a comprehensive qualitative and quantitative analysis of un-annotated bibliographic listing of books and citations compiled on specific learning disability published by researchers in India.
Attitudes of Parents towards Behavioural Management of Children with Intellectual Disability
Amina Mushtaq, Attiya Inam, Muhammad Abiodullah
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2015)
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The study was designed to understand the attitudes of parents of children with intellectual disabilities, with regard to the management of problematic behaviour of their children, and to identify whether the mothers or the fathers had more positive attitudes.
