Background: Injecting drug use is the primary mode of HIV transmission and acquisition in Afghanistan. People who inject drugs (PWID) in the country have been characterized by high risk injecting behavior and a high burden of HCV infection. We aimed to estimate the burden of HIV, HCV, and other infectious diseases and to identify the correlates of HIV and HCV infection among PWID living in three major Afghan cities in 2009.Methods: Epidemiologic data was collected among PWID for the integrated biological and behavioral surveillance (IBBS) survey between May and August, 2009 in three Afghan cities. Data were collected using a structured questionnaire and biologic specimens to screen for HIV, HBV, HCV, syphilis, and HSV-2 using rapid testing kits. Multiple logistic regression models were constructed to identify correlates of infection.Results: Among 548 participants, pooled HIV prevalence was 7.1% (Mazar-i-Sharif: 1.0%, Kabul: 3.1%, Herat: 18.4%) and HCV prevalence was 40.3%. Almost all participants with HIV infection were co-infected with HCV (94.9%). Pooled prevalence estimates for other diseases included 7.1% for HBV, 5.5% for syphilis; and 9.3% for HSV-2. Living in Herat, ever in prison and time injecting were independently associated with HIV infection. Living in Kabul, Herat and time injecting were independently associated with HCV infection.Conclusions: There is a high and heterogeneous burden of HIV and HCV among PWID in Afghan cities. Provision of comprehensive harm reduction services to PWID in Afghanistan is warranted to reduce exposures associated with HIV and HCV infection, especially in the city of Herat. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON

On 7 August 1998 truck bombs destroyed the US Embassies in Kenya and Tanzania.(1) The response in both countries was characterised by an absence of incident command, limited pre-hospital care, a disorganised hospital response and a lack of transportation for those injured. In the next five years USD 50 million was provided by the United States Agency for International Development (USAID) to alleviate the resulting suffering, support reconstruction and strengthen disaster preparedness capacity in the two countries. These two programmes have enhanced awareness of disaster management issues, improved training capacity, built response structures and provided material resources. Their design and implementation provide lessons for future disasters in developing countries. The assistance programmes evolved very differently. In Kenya the programme largely excluded the public sector and the potential for government coordination, while the Tanzanian programme concentrated heavily on central government and regional hospital structures-largely omitting the non-governmental or civil society sector. Excluding key stakeholders raises concerns about programme sustainability and the ability to respond effectively to future emergencies.

The past 16 months have seen major disasters in Asia, Africa, and the Americas. Hundreds of thousands of people have died and millions have had their lives changed forever. Some attention has focused on a possible increase in the frequency of natural and man-made hazards that are responsible for these disasters. However, the right place for our attention is on the increasing vulnerabilities related to geography and livelihood. As new disasters occur in 2006, we cannot lose sight of what we should have learned from the disasters of 2004 and 2005. Serious thinking on these lessons can protect the lives of those who continue to live in circumstances particularly vulnerable to disaster. These are issues we cannot further delay addressing. How the world responded to the tragedy of the December 26 tsunami will continue to be examined in detail through expert panels, workshops, and reports. The same will be true for Hurricane Katrina and the Kashmir earthquake. Less attention will be paid to the planning and preparation that could have mitigated these disasters. Predictably, only some passing mention will be made about the lack of community disaster management capacity or the manifest failure to reduce the obvious vulnerabilities that resulted in widespread loss of life and property. At the heart of these disasters was the failure to develop effective national disaster management capacity--the capacity to plan and prepare for response, to coordinate assistance, to develop policies on reconstruction, and to confront the vulnerabilities of the population. Development of a national disaster response system stretches from policy formation in central government to community preparedness. It is a plodding and unexciting process that requires updated legislation and emergency operations plans at many levels and in many sectors. A variety of often disparate stakeholders must plan together, competing goals and highly variable capacities must be reconciled, training programs must be required, and capacities must be repeatedly tested. These initiatives need not be expensive to be effective, as demonstrated by cyclone response programs in Bangladesh and hurricane preparedness efforts in the Caribbean states. They require perseverance and unified focus by a capable team as well as consistent political support. External organizations also play an important role in helping make this happen. The popular image of disasters comes from pictures on television of the desperate homeowner, the harried relief worker, and the various logos of relief organizations. Little credit is given to the long and unflagging support provided by the International Federation of Red Cross and Red Crescent Societies, the consistent efforts of the Pan American Health Organization, or the work of the United Nations Development Programme (UNDP) in helping countries build their disaster management capacities in quiet and undramatic ways. There have been no headline-grabbing presidential initiatives for disaster preparedness, no Millennium Goals for disaster management. The UN International Decade for Natural Disaster Reduction quietly closed its doors in 2000 and its successor, the International Strategy for Disaster Reduction, is not making big waves. Promising major disaster relief initiatives or sending prominent public officials, such as former presidents and prime ministers, could give disaster preparedness a higher media profile. An all-out effort on the part of prosperous nations to strengthen disaster management capacity in less developed countries is the only way to create long-term stability and reduce human and economic losses worldwide. Responding to specific disasters by providing hand-to-mouth help is not the best way to help countries suffering from the effects of a natural disaster. Creating a standing fund to draw from to meet disaster needs immediately, sidestepping the present flash appeal process, could speed relief and make for more effective intervention. …

The proportion of child deaths that occurs in the neonatal period (38% in 2000) is increasing, and the Millennium Development Goal for child survival cannot be met without substantial reductions in neonatal mortality. Every year an estimated 4 million babies die in the first 4 weeks of life (the neonatal period). A similar number are stillborn, and 0.5 million mothers die from pregnancy-related causes. Three-quarters of neonatal deaths happen in the first week-the highest risk of death is on the first day of life. Almost all (99%) neonatal deaths arise in low-income and middle-income countries, yet most epidemiological and other research focuses on the 1% of deaths in rich countries. The highest numbers of neonatal deaths are in south-central Asian countries and the highest rates are generally in sub-Saharan Africa. The countries in these regions (with some exceptions) have made little progress in reducing such deaths in the past 10-15 years. Globally, the main direct causes of neonatal death are estimated to be preterm birth (28%), severe infections (26%), and asphyxia (23%). Neonatal tetanus accounts for a smaller proportion of deaths (7%), but is easily preventable. Low birthweight is an important indirect cause of death. Maternal complications in labour carry a high risk of neonatal death, and poverty is strongly associated with an increased risk. Preventing deaths in newborn babies has not been a focus of child survival or safe motherhood programmes. While we neglect these challenges, 450 newborn children die every hour, mainly from preventable causes, which is unconscionable in the 21st century.

An estimated 17.7 million persons, most of them in Africa, are infected with the parasite Onchocerca volvulus. Onchocerciasis has caused blindness in 270,000 and left another 500,000 with severe visual impairment. Onchocerciasis also can cause disfiguring skin changes, musculoskeletal complaints, weight loss, changes in immune function, epilepsy, and growth arrest. The development of ivermectin and its donation by the manufacturer has reduced transmission in many parts of Africa and Latin America. Progress in developing a drug that can destroy adult worms has been slow, however. The immediate need is to extend ivermectin mass distribution to as many endemic areas as possible on a continuing basis, with steps toward community ownership of such programs. This article presents a comprehensive review of the literature on the epidemiology, parasitology, vector, symptoms, diagnosis, and treatment and control of onchocerciasis. Future research aims include fuller understanding of the parasite and its relationship with the host, the nature of the systemic effects of O. volvulus infection, the natural history of skin disease, and a better appreciation of the social and economic consequences of this parasitic disease.

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This study was undertaken to determine the extent to which human immunodeficiency virus (HIV) infection has increased hospital admissions for tuberculosis (TB) in a rural population of southern Malawi. The notes and chest X-rays of TB patients admitted to Malamulo hospital in 1983 and 1984, before the recognition of acquired immune deficiency syndrome (AIDS) in Malawi, were compared with those of patients admitted in 1987 and 1988. We found a 160% increase in TB admissions between the 2 periods. Extrapulmonary TB, especially pleural TB, was much commoner in 1987-1988 and occurred in a younger age group. HIV seroreactivity was measured in a third group of 152 tuberculosis patients admitted during 1988-1989. HIV seropositivity was found in 52% of all tuberculosis admissions and in 75% of those with extrapulmonary disease. There was no difference in clinical response to TB therapy between the HIV seropositive patients and those who were seronegative. Extrapulmonary TB should be considered in all HIV seropositive patients, especially in areas where the prevalence of TB is high. Health personnel involved in TB programmes where HIV and TB infections are prevalent should plan for a large increase in the TB case load secondary to the HIV pandemic.

Journal Article Chloroquine-induced pruritus in Malawi: lack of association with onchocerciasis Get access Gilbert Burnham, Gilbert Burnham aMalamulo Hospital, P.O. Makwasa, Malawi Search for other works by this author on: Oxford Academic PubMed Google Scholar Anthony Harries, Anthony Harries bKamuzu Central Hospital, P.O. Box 149, Lilongwe, Malawi Search for other works by this author on: Oxford Academic PubMed Google Scholar Alan Macheso, Alan Macheso bKamuzu Central Hospital, P.O. Box 149, Lilongwe, Malawi Search for other works by this author on: Oxford Academic PubMed Google Scholar Jack Wirima, Jack Wirima bKamuzu Central Hospital, P.O. Box 149, Lilongwe, Malawi Search for other works by this author on: Oxford Academic PubMed Google Scholar Malcolm Molyneux Malcolm Molyneux ∗ cLiverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK ∗Address for correspondence: Dr Malcolm Molyneux, Department of Tropical Medicine, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 83, Issue 4, July-August 1989, Pages 527–528, https://doi.org/10.1016/0035-9203(89)90278-2 Published: 01 July 1989 Article history Received: 24 January 1989 Revision received: 24 February 1989 Accepted: 28 February 1989 Published: 01 July 1989