Abstract:
:Evaluation of disease outcome is central to the assessment of tuberculosis (TB) control programmes. In the study reported in this article we examined the factors influencing the measurement of outcome, survival rates during and after treatment, smear conversion rates, and relapse rates for patients diagnosed with TB in a rural area of Malawi between 1986 and mid-1994. Patients with less certain diagnoses of TB were more likely to die than those with confirmed TB, both among those who were seropositive and those who were seronegative to human immunodeficiency virus (HIV). The mortality rate among smear-positive patients with a separate culture-positive specimen was half that of patients with no such diagnostic confirmation. Patients not registered by the Ministry of Health had much higher mortality and default rates than did registered patients. Among smear-positive patients, HIV serostatus was the most important influence on mortality both during and after treatment (crude hazard ratios (95% confidence intervals) = 5.6 (3.0-10) and 7.7 (3.4-17), resp.), but HIV serostatus did not influence smear conversion rates. The initial degree of smear positivity influenced smear conversion rates, but not mortality rates. No significant predictors of relapse were identified. Unless considerable care is taken to include all TB patients, and to exclude nontuberculous patients, recorded TB outcome statistics are difficult to interpret and may be misleading. In populations with high rates of HIV infection, TB target cure rates of 85% are unrealistic. When new interventions are assessed it cannot be assumed that factors which influence the smear conversion rate will also influence the mortality rate. :Measurement of treatment outcome is central to tuberculosis control programs. A study conducted in Malawi's rural Karonga District in 1986-94 examined factors influencing the measurement of outcome: survival rates during and after treatment, smear conversion rates, and relapse rates for patients diagnosed with tuberculosis. Information was available on 1655 certain, probable, or possible tuberculosis patients. Overall, 22.5% of patients died before the end of treatment, 57.9% completed treatment and were discharged, 4.3% moved out of the district, and 15.3% defaulted or were lost to follow-up. 35% of HIV-positive patients, compared with 11% of HIV-negative patients, died before the end of treatment. Patients with uncertain tuberculosis diagnoses were more likely to die than those with certain diagnoses, regardless of their HIV serostatus. The mortality rate among smear-positive patients with a separate culture-positive specimen was half that of patients with no such diagnostic confirmation. Patients not registered by the Ministry of Health had substantially higher mortality and default rates than registered patients. HIV serostatus was the most important determinant of mortality both during and after treatment in smear-positive patients (crude hazards ratios, 5.6 and 7.7, respectively; 95% confidence intervals, 3.0-10 and 3.4-17, respectively), but HIV status did not influence smear conversion rates. The initial degree of smear positivity influenced smear conversion rates but not mortality rates. No significant predictors of relapse were identified. These findings indicate that tuberculosis outcome statistics may be misleading unless care is taken to include all tuberculosis patients and exclude nontubercular patients.
journal_name
Bull World Health Organjournal_title
Bulletin of the World Health Organizationauthors
Glynn JR,Warndorff DK,Fine PE,Munthali MM,Sichone W,Pönnighaus JMsubject
Has Abstractpub_date
1998-01-01 00:00:00pages
295-305issue
3eissn
0042-9686issn
1564-0604journal_volume
76pub_type
杂志文章abstract::The author sees the task of industrial psychiatry as one of preventing emotional maladjustment and the more serious mental disorders in the industrial population, and of treating early cases of emotional disorders. He classifies the preventive functions as: giving "emotional" first-aid, holding psychiatric consultatio...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1955-01-01 00:00:00
abstract::Measurements of spermatheca diameter and wing length were made on 8 East African mosquito populations comprising Anopheles merus and A. gambiae species A, species B, and the "Bwamba cytotype" (=species D). The results showed that, on average, the spermatheca in species A females is larger than in species B. In each of...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1972-01-01 00:00:00
abstract::Paula Radcliffe tells Gary Humphreys about her journey from athlete to clean air advocate and her hopes for a clean air initiative launched by the International Association of Athletics Federation. ...
journal_title:Bulletin of the World Health Organization
pub_type: 面试,新闻
doi:10.2471/BLT.19.030319
更新日期:2019-03-01 00:00:00
abstract::The alpha antitoxin contents of the International Reference Preparations of Clostridium welchii Types B and D Antitoxins were assayed against two type A test toxins-Cl. welchii (perfringens) test toxin P2, issued by the Statens Seruminstitut, Copenhagen, and Cl. welchii test toxin AGX 1373, issued by the Wellcome Rese...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1956-01-01 00:00:00
abstract::This article provides a framework for the design of future eradication programmes so that the greatest benefit accrues to health systems development from the implementation of such programmes. The framework focuses on weak and fragile health systems and assumes that eradication leads to the cessation of the interventi...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1998-01-01 00:00:00
abstract::The availability of affordable medicines is a major barrier to providing high-quality health care in many countries. Fatima Suleman talks to Fiona Fleck. ...
journal_title:Bulletin of the World Health Organization
pub_type: 传,历史文章,新闻
doi:10.2471/BLT.17.031217
更新日期:2017-12-01 00:00:00
abstract::In the course of a village-scale trial of fenthion, carried out in a village near Lagos, Nigeria, 40% fenthion water-dispersible powder was used at a 3.75% concentration. This was applied by Galeazzi "OM" sprayers with constant-pressure assemblies. The target concentration was 1.5 g/m(2). Filter-papers were placed on ...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1963-01-01 00:00:00
abstract:OBJECTIVE:To ascertain the reliability of applying the WHO Cardiovascular Risk Management Package by non-physician health-care workers (NPHWs) in typical primary health-care settings. METHODS:Based on an a priori 80% agreement level between the NPHWs and the "expert" physicians (gold standard), 649 paired (matched) ap...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:10.2471/blt.06.032177
更新日期:2007-06-01 00:00:00
abstract::Asthma is a very common chronic disease that occurs in all age groups and is the focus of various clinical and public health interventions. Both morbidity and mortality from asthma are significant. The number of disability-adjusted life years (DALYs) lost due to asthma worldwide is similar to that for diabetes, liver ...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:2005-07-01 00:00:00
abstract::Health impact assessment (HIA) is a multidisciplinary aid to decision-making that assesses the impact of policy on public health and on health inequalities. Its purpose is to assist decision-makers to maximize health gains and to reduce inequalities. The 1999 Gothenburg Consensus Paper (GCP) provides researchers with ...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:/S0042-96862005000100015
更新日期:2005-01-01 00:00:00
abstract::Few widespread diseases show such marked local differences in community patterns as does trachoma; these differences occur not only in over-all prevalence but also in the mean age at onset, the age distribution of the evolutive stages and the role of associated infections. These are among the factors which determine t...
journal_title:Bulletin of the World Health Organization
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1968-01-01 00:00:00
abstract:PROBLEM:Acute diarrhoeal diseases and acute respiratory infections (ARIs) are the most common causes of child mortality worldwide. Safe, effective and inexpensive solutions are available for prevention and control, but they do not reach needy communities. APPROACH:Interventions based on research were designed to train...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:10.2471/BLT.09.065649
更新日期:2010-03-01 00:00:00
abstract:OBJECTIVE:To determine how much influenza contributes to severe acute respiratory illness (SARI), a leading cause of death in children, among people of all ages in Bangladesh. METHODS:Physicians obtained nasal and throat swabs to test for influenza virus from patients who were hospitalized within 7 days of the onset o...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:10.2471/BLT.11.090209
更新日期:2012-01-01 00:00:00
abstract::The cross-reactivity of filarial heteroantigens, the non-availability of adult Wuchereria bancrofti for antigen extraction, and the lack of structural information on purified filarial heteroantigens make the serological diagnosis of W. bancrofti infection in man a difficult problem. The use of immune sera from cattle ...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1980-01-01 00:00:00
abstract::A possible method for genetic control of insect vector species involves the use of translocation heterozygotes. The potential of single and double heterozygotes already available in Aedes aegypti has been investigated with computer simulations of release strategies. Such simulations indicate a possible role for transl...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1971-01-01 00:00:00
abstract::LATEX/IgM, a rapid agglutination test for the semi-quantitative detection of IgM in cerebrospinal fluid of patients with African trypanosomiasis, is described in this article. The lyophilized reagent has been designed for field use and remains stable at 45 degrees C for one year. The test has been evaluated on cerebro...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1998-01-01 00:00:00
abstract::In 1961 the WHO Expert Committee on Biological Standardization asked the National Institute for Medical Research, London, to collect and study material to replace the first International Standard for Serum Gonadotrophin, stocks of which were running low. This paper describes the material that was contributed, its dist...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1966-01-01 00:00:00
abstract::Asian influenza appears to have reached India via Madras in May 1957. The main pandemic wave swept through the subcontinent within the next 12 weeks; cases occurring thereafter represent the permanent infiltration of the new virus into the population. Between 19 May 1957 and 8 February 1958 there were reported 4 451 7...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1959-01-01 00:00:00
abstract::There is a need to reassess the role of the trypanosomiases, both human and animal, in African ecology and economy. Withdrawal of control services from the Congo basin was followed by a resurgence of infection from ancient foci, many of them thought to have been extinguished. Successful elimination of Glossina in sava...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1969-01-01 00:00:00
abstract::In a case-control study we examined the association of Plasmodium falciparum circumsporozoite antibodies (anti-R32tet32) with subsequent P. falciparum infections. A study population of 140 children living in an endemic area was followed longitudinally for 25 weeks with weekly blood smears for malaria parasites and, on...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1988-01-01 00:00:00
abstract::Notifications of morbidity are frequently incomplete but they represent the only practicable way of carrying out large-scale surveillance. Studies of hepatitis in the Central District of Israel offered an opportunity of assessing the reliability of routine data. The regular canvassing of physicians resulted in a 2-3-f...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1972-01-01 00:00:00
abstract::This paper is an attempt to relate modifications observed in general and infant mortality rates with the dynamic changes in transmission induced by malaria control measures. The observations indicated relationships between the efficacy of control and a decrease in mortality. The daily parasitological inoculation rate ...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1976-01-01 00:00:00
abstract::Hospital- and community-based studies were conducted in central Sudan to investigate the association between pesticide exposure and perinatal mortality. The cases were 197 stillbirths in the hospital and 36 perinatal deaths in the community; the controls were 812 liveborn, normal-birth-weight infants in the hospital, ...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1993-01-01 00:00:00
abstract::Light-traps have been used successfully as mechanical sampling tools for insects of agricultural importance but medical entomologists have had only limited success because of the assumption that light-traps would attract vectors, even when sited in open fields well away from hosts. The investigations reported in this ...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1969-04-01 00:00:00
abstract::Village-wide use of permethrin-impregnated bed nets, compared with placebo-treated nets, has reduced clinical attacks of malaria by 63% in the Gambia. Costs were calculated for nets made by local tailors and for their treatment with insecticide in the villages, as well as for targeted chemoprophylaxis and back-up trea...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1989-01-01 00:00:00
abstract::Much has been learnt of the epidemiology of yaws during eradication campaigns in populations in which the prevalence of active yaws was high, but not all has been published. The recognition of the importance of latent cases in the maintenance of yaws has contributed to the effectiveness of these campaigns. Yaws eradic...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1960-01-01 00:00:00
abstract::Over the last decade, a massive increase in data collection and analysis has occurred in many fields. In the health sector, however, there has been relatively little progress in data analysis and application despite a rapid rise in data production. Given adequate governance, improvements in the quality, quantity, stor...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章,评审
doi:10.2471/BLT.14.139022
更新日期:2015-03-01 00:00:00
abstract::Presented is an assessment of the cost-effectiveness of cataract surgery using cost and services data from the Lumbini Zonal Eye Care Programme in Nepal. The analysis suggests that cataract surgery may be even more cost-effective than previously reported. Under a "best estimate" scenario, cataract surgery had a cost o...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1996-01-01 00:00:00
abstract::The findings in a highly selected group of patients, such as those attending clinics or sanatoria, cannot be used as the basis for assessing the true prevalence of strains of Mycobacterium tuberculosis with acquired or primary resistance or of sensitive strains in a community. The present report describes the prevalen...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1968-01-01 00:00:00
abstract::This paper describes the research conducted by a WHO collaborative study group for the development of a questionnaire method for the assessment of quality in child-care settings. The results of an inter-rater reliability study undertaken in Greece and Nigeria suggest that the Child Care Facility Schedule (CCFS), compo...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1991-01-01 00:00:00