The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
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Int. J. Tuberc. Lung Dis. · Jun 2001
ReviewClinical signs of hypoxaemia in children with acute lower respiratory infection: indicators of oxygen therapy.
Hypoxaemia is a common complication of acute lower respiratory tract infections in children. In most developing countries, where the majority of deaths from pneumonia occur, facilities for early detection of hypoxaemia are lacking and oxygen is in short supply. This review examines the usefulness of different clinical signs and symptoms in the prediction of hypoxaemia associated with acute respiratory infections in children. ⋯ These include very fast breathing (with a respiratory rate of more than 60 or 70 breaths per minute), cyanosis, grunting, nasal flaring, chest retractions, head nodding and auscultatory signs, as well as signs of general depression of the child, such as inability to feed or lethargy. The sensitivity and specificity of these signs, as described in the reviewed studies, is presented, and combination rules are discussed. Through appropriate combination of several physical signs, which can be used by peripheral health workers and be taught to mothers, it is possible to predict hypoxaemia in children with acute respiratory tract infections with reasonable accuracy.
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In 1998 the Government of Bangladesh changed its health and population sector strategy from a project-oriented approach (the Fourth Population and Health Project--FPHP) to sector-wide management (the Fifth Health and Population Sector Programme--HPSP). This article describes the development and achievements of the tuberculosis programme during the FPHP, and discusses the potential opportunities and challenges anticipated by the programme from the reformed health service delivery of the HPSP. 'Further strengthening of tuberculosis and leprosy control services' was one of the 66 projects of the FPHP. As part of the FPHP, the National Tuberculosis Programme policy was revised in 1992 and the project was implemented in phases. ⋯ Tuberculosis services will become more accessible as community clinics deliver essential health services for every 6000 population. Non-public health care providers, who contribute significantly to health services in the country, will be involved in service delivery. The main challenge is to maintain the quality of successful projects, such as tuberculosis control, during the transition period.
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Int. J. Tuberc. Lung Dis. · Jun 1999
ReviewWill DOTS do it? A reappraisal of tuberculosis control in countries with high rates of HIV infection.
In 1993 the WHO declared tuberculosis a global emergency, and subsequently introduced the DOTS strategy, a technical and management package based on earlier work of the IUATLD and international experience with directly observed therapy. Despite successful implementation of most of the elements of this strategy in several African countries and settings, tuberculosis case rates continue to escalate where the prevalence of HIV infection is high. We explore possible reasons for the failure to control tuberculosis even in the context of tuberculosis programmes that have been considered models for others to emulate. ⋯ Strategies for tuberculosis control programmes in countries of high and low HIV prevalence cannot be the same, but must take into account the epidemiology of HIV infection. HIV/AIDS in Africa poses severe challenges of purpose and identity to tuberculosis control programmes, which have not adapted to the altered realities of the HIV/AIDS era. DOTS alone is unlikely to control tuberculosis in sub-Saharan Africa; one major achievement of DOTS when implemented, however, has been its apparent ability to limit the development and spread of drug resistance.