Bulletin of the World Health Organization
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Bull. World Health Organ. · Jan 1999
ReviewSterilizable syringes: excessive risk or cost-effective option?
In recent years, many poorer countries have chosen to use disposable instead of sterilizable syringes. Unfortunately, the infrastructure and management systems that are vital if disposables are to be used safely do not exist. WHO estimates that up to 30% of injections administered are unsafe. ⋯ Health facility staff must be able to sterilize equipment, and the sterilizable syringe remains the least costly means of administering an injection. Data from countries that have acceptable systems for processing clinical waste indicate that safe and environmentally acceptable disposal, destruction and final containment cost nearly as much as the original cost of a disposable syringe. By careful supervision of staff behaviour and good management, some countries have demonstrated that they are able to administer safe injections with sterilizable syringes at a price they can afford.
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Bull. World Health Organ. · Jan 1999
Comparative StudyLong-term morbidity and mortality following hypoxaemic lower respiratory tract infection in Gambian children.
Acute lower respiratory infections (ALRI) are the main cause of death in young children worldwide. We report here the results of a study to determine the long-term survival of children admitted to hospital with severe pneumonia. The study was conducted on 190 Gambian children admitted to hospital in 1992-94 for ALRI who survived to discharge. ⋯ Children in Gambia who survive hospital admission with hypoxaemic pneumonia have a good prognosis. Survival depends more on nutritional status than on having been hypoxaemic. Investment in oxygen therapy appears justified, and efforts should be made to improve nutrition in malnourished children with pneumonia.
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Bull. World Health Organ. · Jan 1999
Reducing perinatal HIV transmission in developing countries through antenatal and delivery care, and breastfeeding: supporting infant survival by supporting women's survival.
In 1998, a joint UNAIDS/UNICEF/WHO working group announced an initiative to pilot test an intervention to reduce perinatal transmission of human immunodeficiency virus (HIV), based on new guidelines on HIV and infant feeding. This intervention for developing countries includes short-course perinatal zidovudine (AZT) treatment and advice to HIV-positive women not to breastfeed their infants, where this can be done safely. The present paper raises questions about the extent of the public health benefit of this intervention, even though it may be cost-effective, due to the limited capacity of antenatal and delivery services to implement it fully. ⋯ The intervention will prevent some infants from getting HIV even in the absence of many of these changes. However, a comprehensive approach to HIV prevention and care in developing countries that includes both women and infants would promote better health and survival of women, which would in turn contribute to greater infant health and survival. If combination antiretroviral therapy in the latter part of pregnancy and/or during the breastfeeding period can be shown to be safe for infants, preliminary evidence suggests that it might reduce perinatal HIV transmission as effectively as the current intervention and, in addition, might allow the practice of breastfeeding to be preserved.
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Recent global developments in the regulation of trade and intellectual property rights threaten to hinder the access of populations in developing countries to essential drugs. The authors argue for state intervention in the health and pharmaceutical markets in order to guarantee equitable access to these products.