Showing papers in "Tropical Medicine & International Health in 2012"

The sexual behaviour of adolescents in sub-Saharan Africa: patterns and trends from national surveys.

Abstract: OBJECTIVES: To describe the sexual and reproductive behaviour of adolescents in sub-Saharan Africa particularly 15- to 19-year-olds. METHODS: Using DHS/AIS data (2000-2010) nine indicators of adolescent behaviour and one of adult attitudes towards condom education for adolescents were described for 24 countries. Indicators were disaggregated by gender urban/rural residency and educational status and time trends were described. RESULTS: Up to 25% of 15- to 19-year-olds reported sex before age 15; this proportion shrank over time in many countries. In most countries >/=5% of females reported marriage before age 15 and >20% had commenced childbearing. Early sexual debut and childbearing were more common among the least educated and/or rural females. Reporting of multiple sexual partnerships was more common among males than among females but decreases over time were more common among males. Urban males and females and females with higher education were more likely to report multiple partnerships. Urban youth and those with higher education also reported more condom use. Adult support for condom education for 12- to 14-year-olds has increased over time to 60-65%. CONCLUSIONS: Many 15- to 19-year-olds are at risk of HIV/STIs and unplanned pregnancies because of multiple partnerships and insufficient condom and other contraceptive use. In many countries trends are moving in a favourable direction. To better inform prevention programmes in this important area we recommend routine collection of sexual and reproductive behaviour data for adolescents aged <15 years expanding the data collected for 15- to 19-year-olds to include detailed information on sexual behaviour within partnerships and disaggregating data according to sociodemographic variables. (c) 2012 Blackwell Publishing Ltd.

Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis

Abstract: objectives To assess the proportion of patients lost to programme (died, lost to follow-up, transferred out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub-Saharan Africa, and determine factors associated with loss to programme. methods Systematic review and meta-analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow-up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random-effects meta-analysis. results Twenty-nine studies from sub-Saharan Africa including 148 912 patients were analysed. Six studies covered the whole period from HIV diagnosis to ART start. Meta-analysis of these studies showed that of the 100 patients with a positive HIV test, 72 (95% CI 60‐84) had a CD4 cell count measured, 40 (95% CI 26‐55) were eligible for ART and 25 (95% CI 13‐37) started ART. There was substantial heterogeneity between studies (P < 0.0001). Median CD4 cell count at presentation ranged from 154 to 274 cells ⁄ll. Patients eligible for ART were less likely to become lost to programme (25% vs. 54%, P < 0.0001), but eligible patients were more likely to die (11% vs. 5%, P < 0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio-economic status and in recent time periods. conclusions Monitoring and care in the pre-ART time period need improvement, with greater emphasis on patients not yet eligible for ART.

Screening of patients with tuberculosis for diabetes mellitus in China

Abstract: objective There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and this study aimed to assess feasibility and results of screening patients with TB for DM within the routine healthcare setting of six health facilities. method Agreement on how to screen, monitor and record was reached in May 2011 at a stakeholders’ meeting, and training was carried out for staff in the six facilities in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012. results There were 8886 registered patients with TB. They were first asked whether they had DM. If the answer was no, they were screened with a random blood glucose (RBG) followed by fasting blood glucose (FBG) in those with RBG ‡ 6.1 mm (one facility) or with an initial FBG (five facilities). Those with FBG ‡ 7.0 mm were referred to DM clinics for diagnostic confirmation with a second FBG. Altogether, 1090 (12.4%) patients with DM were identified, of whom 863 (9.7%) had a known diagnosis of DM. Of 8023 patients who needed screening for DM, 7947 (99%) were screened. This resulted in a new diagnosis of DM in 227 patients (2.9% of screened patients), and of these, 226 were enrolled to DM care. In addition, 575 (7.8%) persons had impaired fasting glucose (FBG 6.1 to <7.0 mm). Prevalence of DM was significantly higher in patients in health facilities serving urban populations (14.0%) than rural populations (10.6%) and higher in hospital patients (13.5%) than those attending TB clinics (8.5%). conclusion This pilot project shows that it is feasible to screen patients with TB for DM in the routine setting, resulting in a high yield of patients with known and newly diagnosed disease. Free blood tests for glucose measurement and integration of TB and DM services may improve the diagnosis and management of dually affected patients.

Linking women who test HIV‐positive in pregnancy‐related services to long‐term HIV care and treatment services: a systematic review

Abstract: Objectives To quantify attrition between women testing HIV-positive in pregnancy-related services and accessing long-term HIV care and treatment services in low- or middle-income countries and to explore the reasons underlying client drop-out by synthesising current literature on this topic. Methods A systematic search in Medline, EMBASE, Global Health and the International Bibliography of the Social Sciences of literature published 2000–2010. Only studies meeting pre-defined quality criteria were included. Results Of 2543 articles retrieved, 20 met the inclusion criteria. Sixteen (80%) drew on data from sub-Saharan Africa. The pathway between testing HIV-positive in pregnancy-related services and accessing long-term HIV-related services is complex, and attrition was usually high. There was a failure to initiate highly active antiretroviral therapy (HAART) among 38–88% of known-eligible women. Providing ‘family-focused care’, and integrating CD4 testing and HAART provision into prevention of mother-to-child HIV transmission services appear promising for increasing women’s uptake of HIV-related services. Individual-level factors that need to be addressed include financial constraints and fear of stigma. Conclusions Too few women negotiate the many steps between testing HIV-positive in pregnancy-related services and accessing HIV-related services for themselves. Recent efforts to stem patient drop-out, such as the MTCT-Plus Initiative, hold promise. Addressing barriers and enabling factors both within health facilities and at the levels of the individual woman, her family and society will be essential to improve the uptake of services. Objectif: Quantifier le decouragement chez les femmes testees VIH positives dans les services lies a la grossesse et l’acces aux services de soins et de traitement de longue duree du VIH dans les pays a revenus faibles ou intermediaires, explorer les raisons qui sous-tendent le desistement des patients en synthetisant la litterature actuelle sur ce sujet. Methodes: Recherche systematique dans Medline, EMBASE, Global Health et l’International Bibliography of Social Sciences, sur la litterature publiee entre 2000 et 2010. Seules les etudes repondant aux criteres de qualite predefinis ont ete incluses. Resultats: Sur 2.543 articles trouves, 20 repondaient aux criteres d’inclusion. 16 (80%) articles etaient appuyes sur des donnees provenant d’Afrique subsaharienne. La voie entre le resultat VIH-positif dans les services lies a la grossesse et l’acces aux services de traitements de longue duree du VIH est complexe et le decouragement etait generalement eleve. La therapie antiretrovirale hautement active (HAART) n’a pas ete initiee chez 38 a 88% des femmes eligibles connues. La fourniture «des soins axes sur la famille», l’integration de la mesure des CD4 et l’administration de l’HAART dans les services de prevention de la transmission mere-enfant du VIH (PTME) semblent prometteuses pour accroitre l’utilisation des services VIH par les femmes. Les facteurs qui devraient etre adresses a l’echelle individuelle comprennent les contraintes financieres et la crainte de la stigmatisation. Conclusions: Trop peu de femmes negocient les nombreuses etapes entre le resultat VIH-positif dans les services lies a la grossesse et l’acces aux services VIH pour elles-memes. Les recents efforts visant a endiguer le decouragement des patientes, comme l’initiative PTME-Plus, sont prometteurs. Surmonter les obstacles et permettre des facteurs favorables a la fois au sein des etablissements de sante et a l’echelle individuelle de la femme, de sa famille et de la societe est essentiel pour ameliorer l’utilisation des services. Objetivo: Cuantificar el abandono entre mujeres que dieron positivo en una prueba de VIH en servicios prenatales y el acceso a los cuidados y el tratamiento para el VIH de larga duracion en paises con ingresos bajos y medios, y mediante la sintesis de la literatura actual sobre este tema explorar las razones por las cuales los clientes abandonan. Metodos: Busqueda sistematica en Medline, EMBASE, Global Health y la Bibliografia Internacional de Ciencias Sociales de la literatura publicada entre el 2000 y 2010. Solo se incluyeron estudios que cumplian criterios de calidad predefinidos. Resultados: De 2,543 articulos encontrados, 20 cumplian los criterios de inclusion. 16 (80%) eran datos sobre Africa subSahariana. El camino entre dar positivo para VIH en servicios prenatales y acceder a servicios de larga duracion para el VIH es complejo y el abandono es usualmente alto. Habia un fallo a la hora de iniciar el tratamiento antirretroviral de gran actividad (TARGA) en 38-88% de las mujeres que se sabia eran elegibles. La provision de ‘cuidados en el hogar’ e integracion de la prueba de CD4 asi como la entrega del TARGA dentro de los servicios de prevencion de la transmision vertical (PTV) parecen aumentar la aceptacion, por parte de las mujeres, de los servicios relacionados con el VIH. Los factores individuales que deben ser atendidos incluyen las restricciones financieras y el miedo a la estigmatizacion. Conclusiones: Muy pocas mujeres consiguen superar los multiples pasos que hay entre el dar positivo en una prueba realizada en un centro prenatal y el acceder a los servicios para VIH por si solas. Los esfuerzos recientes para erradicar el abandono de los pacientes, tales como la iniciativa MTCT-Plus, mantienen la esperanza. En la mejora de la aceptacion y toma de servicios para VIH sera esencial remover las barreras y promover los factores, tanto dentro de los centros sanitarios como a nivel individual de la mujer, de su familia y sociedad.

Universal voluntary HIV testing in antenatal care settings: a review of the contribution of provider-initiated testing & counselling.

Abstract: Objective To assess the contribution of provider-initiated testing and counselling (PITC) to achieving universal testing of pregnant women and, from available data on components of PITC, assess whether PITC adoption adheres to pre-test information, post-test counselling procedures and linkage to treatment. Methods Systematic review of published literature. Findings were collated and data extracted on HIV testing uptake before and after the adoption of a PITC model. Data on pre- and post-test counselling uptake and linkage to anti-retrovirals, where available, were also extracted. Results Ten eligible studies were identified. Pre-intervention testing uptake ranged from 5.5% to 78.7%. Following PITC introduction, testing uptake increased by a range of 9.9% to 65.6%, with testing uptake ≥85% in eight studies. Where reported, pre-test information was provided to between 91.5% and 100% and post-test counselling to between 82% and 99.8% of pregnant women. Linkage to ARVs for prevention of mother to child transmission (PMTCT) was reported in five studies and ranged from 53.7% to 77.2%. Where reported, PITC was considered acceptable by ANC attendees. Conclusion Our review provides evidence that the adoption of PITC within ANC can facilitate progress towards universal voluntary testing of pregnant women. This is necessary to increase the coverage of PMTCT services and facilitate access to treatment and prevention interventions. We found some evidence that PITC adoption does not undermine processes inherent to good conduct of testing, with high levels of pre-test information and post-test counselling, and two studies suggesting that PITC is acceptable to ANC attendees.

Determinants of low birthweight, small-for-gestational-age and preterm birth in Lombok, Indonesia: analyses of the birthweight cohort of the SUMMIT trial.

Abstract: OBJECTIVE: To examine the determinants of low birthweight (LBW) small-for-gestation (SGA) and preterm births in Lombok Indonesia an area of high infant mortality. METHODS: Data from The Supplementation with Multiple Micronutrient Intervention Trial (SUMMIT) a double-blind cluster-randomised controlled trial were analysed. The odds ratio of factors known to be associated with LBW SGA and preterm birth was assessed and adjusted for the cluster design of the trial using hierarchical logistic regression. Determinants included constitutional demographic and psychosocial factors toxic exposure maternal nutrition and obstetric history and maternal morbidity during and prior to pregnancy. Population attributable risks of modifiable determinants were calculated. RESULTS: A cohort of 14040 singleton births was available for analysis of LBW with 13498 observations for preterm births and 13461 for SGA births. Determinants of LBW and SGA were similar and included infants sex womans education season at birth mothers residence household wealth maternal mid-upper arm circumference (MUAC) height and a composite variable of birth order and pregnancy interval. Socioeconomic indicators were also related to preterm births and included mothers education residence and household wealth while nutritional-related factors including low MUAC and birth order and interval were associated with preterm birth but not maternal height. Nausea was protective of preterm birth while diarrhoea was associated with higher odds of preterm birth. Oedema during pregnancy was protective of SGA but associated with higher odds of preterm delivery. Around 33% 13% and 13% of the determinants of LBW SGA and preterm births were preventable. CONCLUSION: Womens education maternal nutrition and household wealth and family planning are key factors to improving birth outcomes. (c) 2012 Blackwell Publishing Ltd.

Screening patients with Diabetes Mellitus for Tuberculosis in China.

Abstract: objective There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and as DM increases the risk of TB and adversely affects TB treatment outcomes, there is a need for bidirectional screening of the two diseases. How this is best performed is not well determined. In this pilot project in China, we aimed to assess the feasibility and results of screening DM patients for TB within the routine healthcare setting of five DM clinics. method Agreement on how to screen, monitor and record was reached in May 2011 at a national stakeholders meeting, and training was carried out for staff in the five clinics in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012. DM patients were screened for TB at each clinic attendance using a symptom-based enquiry, and those positive to any symptom were referred for TB investigations. results In the three quarters, 72% of 3174 patients, 79% of 7196 patients and 68% of 4972 patients were recorded as having been screened for TB, resulting in 7 patients found who were already known to have TB, 92 with a positive TB symptom screen and 48 of these newly diagnosed with TB as a result of referral and investigation. All patients except one were started on anti-TB treatment. TB case notification rates in screened DM patients were several times higher than those of the general population, were highest for the five sites combined in the final quarter (774 ⁄100 000) and were highest in one of the five clinics in the final quarter (804 ⁄100 000) where there was intensive in-house training, special assignment of staff for screening and colocation of services. conclusion This pilot project shows that it is feasible to carry out screening of DM patients for TB resulting in high detection rates of TB. This has major public health and patient-related implications.

A review of training opportunities for ultrasonography in low and middle income countries.

Abstract: Objective To review the current training opportunities for ultrasound use for health workers practising in low- and middle-income countries (LMICs). Methods A PubMed search using terms ultrasound, sonography, echocardiography, developing country/countries, developing world, low resource settings, low income country/countries, training and education was conducted. Articles from 2000 to 2011 that included data on ultrasonography training were eligible for inclusion. Results This review shows that most ultrasound scans are performed by generalist and obstetric physicians and even non-medical personnel with little to no formal training in ultrasonography. The spectrum of ultrasonography training described spanned from no formal training to formal certification and residency programmes. All courses included some component of didactics and hands-on training. Follow-up of trainee skills ranged from none, to telemedicine case review, to formal re-evaluations and intensive refresher courses. Ultrasonographic training in LMICs often does not meet the WHO criteria such as the number of scans under supervision and length of training programme recommended by WHO. Nevertheless, some programmes manage to have excellent outcomes with regard to diagnostic accuracy and retention of knowledge by trained personnel. Conclusion Regulation and quality control of training in ultrasound skills for those working in LMICs can be improved. Research on effective training and follow-up should be encouraged. Objectifs: Examiner les opportunites actuelles de formation dans l’utilisation des ultrasons pour les agents de la sante exercant dans les pays a ressources faibles et intermediaires (PFR-PRI). Methodes: Une recherche a ete menee sur PubMed utilisant les termes suivants: ultrason, echographie, echocardiographie, pays en developpement, monde en developpement, pays a ressources faibles, pays a ressources elevees, formation, education. Les articles de 2000 a 2011 comportant des donnees sur la formation en echographie etaient eligibles pour inclusion. Resultats: Cette revue montre que la plupart des analyses par ultrasons sont effectuees par les medecins generalistes obstetricaux et meme par du personnel non medical, avec peu ou aucune formation officielle en echographie. Le spectre de la formation en echographie decrite allait de l’absence de formation officielle a la certification officielle et a des programmes de residence. Tous les cours comportaient des composantes theoriques et pratiques de la formation. Le suivi de la competence des stagiaires variait de nul a l’analyse des cas par telemedecine, a la reevaluation officielle et a des cours intensifs de recyclage. La formation en echographique dans les PFR-PRI ne repond pas souvent aux criteres de l’OMS tels que le nombre de balayages sous supervision et la duree recommandee du programme de formation. Neanmoins, certains programmes parviennent a obtenir d’excellents resultats pour ce qui est de la precision du diagnostic et du maintien des connaissances par un personnel forme. Conclusion: La reglementation et le controle de qualite de la formation dans les competences aux ultrasons pour ceux qui travaillent dans les PFR-PRI peuvent etre ameliores. La recherche sur la formation effective et le suivi devraient etre encouragee. Objetivos: Revisar las oportunidades actuales de entrenamiento en el uso de ultrasonido para sanitarios trabajando en paises de ingresos medios y bajos (PIMBs). Metodos: Busqueda en PubMed utilizando las palabras: ultrasonido, sonografia, ecocardiografia, pais / paises en vias de desarrollo, mundo en vias de desarrollo, emplazamiento con bajos recursos, entrenamiento, educacion. Los articulos encontrados pertenecientes a los anos 2000 a 2011 que tenian datos sobre entrenamiento en ultrasonografia eran elegible para inclusion. Resultados: Esta revision muestra que la mayoria de los escaneres de ultrasonido son realizados por medicos generalistas y obstetras, e incluso por personal no medico, con poco o ningun entrenamiento formal en ultrasonografia. El espectro de entrenamiento en ultrasonografia descrito iba desde el entrenamiento no formal a la certificacion formal y programas para residentes. Todos los cursos incluian algunos componentes de didactica y entrenamiento practico. El seguimiento de las habilidades del aprendiz iba de absolutamente ninguno a una revision de casos telematica, o a re-evaluaciones formales y cursillos intensivos de actualizacion. El entrenamiento en ultrasonografia en PIMBs a menudo no cumple con los criterios de la OMS, como en el numero de escaneres bajo supervision o en la duracion de los programas de entrenamiento. Sin embargo, algunos programas consiguen tener resultados excelentes en lo que respecta a la precision diagnostica y la retencion de conocimientos del personal entrenado. Conclusion: Puede mejorarse la regulacion y el control de calidad del entrenamiento en ultrasonido, de quienes trabajan en PIMBs. Deberia fomentarse la investigacion para un entrenamiento efectivo y su seguimiento.

Unvaccinated children in years of increasing coverage : how many and who are they? : Evidence from 96 low- and middle-income countries

Abstract: OBJECTIVE While childhood immunisation coverage levels have increased since the 70s, inequities in coverage between and within countries have been widely reported. Unvaccinated children remain undetected by routine monitoring systems and strikingly unreported. The objective of this study was to provide evidence on the magnitude of the problem and to describe predictors associated with non-vaccination. METHODS Two hundred and forty-one nationally representative household surveys in 96 countries were analysed. Proportions and changes in time of 'unvaccinated' (children having not received a single dose of vaccine), 'partially vaccinated' and 'fully vaccinated' children were estimated. Predictors of non-vaccination were explored. RESULTS The percentage of unvaccinated children was 9.9% across all surveys. 66 countries had more than one survey: 38 showed statistically significant reductions in the proportion of unvaccinated children between the first and last survey, 10 countries showed increases and the rest showed no significant changes. However, while 18 of the 38 countries also improved in terms of partially and fully vaccinated, in the other 20 the proportion of fully vaccinated decreased. The predictors more strongly associated with being unvaccinated were education of the caregiver, education of caregiver's partner, caregiver's tetanus toxoid (TT) status, wealth index and type of family member participation in decision-making when the child is ill. Multivariable logistic regression identified the TT status of the caregiver as the strongest predictors of unvaccinated children. Country-specific summaries were produced and sent to countries. CONCLUSION The number of unvaccinated children is not negligible and their proportion and the predictors of non-vaccination have to be drawn from specific surveys. Specific vaccine indicators cannot properly describe the performance of immunisation programmes in certain situations. National immunisation programmes and national and international immunisation stakeholders should also consider monitoring the proportion of unvaccinated children (i.e. those who have received no vaccines at all) and draw specific plans on the determinants of non-vaccination.

Costs, effects and cost-effectiveness of breast cancer control in Ghana.

Abstract: objective Breast cancer control in Ghana is characterised by low awareness, late-stage treatment and poor survival. In settings with severely constrained health resources, there is a need to spend money wisely. To achieve this and to guide policy makers in their selection of interventions, this study systematically compares costs and effects of breast cancer control interventions in Ghana. methods We used a mathematical model to estimate costs and health effects of breast cancer interventions in Ghana from the healthcare perspective. Analyses were based on the WHO-CHOICE method, with health effects expressed in disability-adjusted life years (DALYs), costs in 2009 US dollars (US$) and cost-effectiveness ratios (CERs) in US$ per DALY averted. Analyses were based on local demographic, epidemiological and economic data, to the extent these data were available. results Biennial screening by clinical breast examination (CBE) of women aged 40–69 years, in combination with treatment of all stages, seems the most cost-effective intervention (costing $1299 per DALY averted). The intervention is also economically attractive according to international standards on cost-effectiveness. Mass media awareness raising (MAR) is the second best option (costing $1364 per DALY averted). Mammography screening of women of aged 40–69 years (costing $12 908 per DALY averted) cannot be considered cost-effective. conclusions Both CBE screening and MAR seem economically attractive interventions. Given the uncertainty about the effectiveness of these interventions, only their phased introduction, carefully monitored and evaluated, is warranted. Moreover, their implementation is only meaningful if the capacity of basic cancer diagnostic, referral and treatment and possibly palliative services is simultaneously improved.

Factors influencing adherence to antiretroviral treatment in Asian developing countries: a systematic review.

Abstract: OBJECTIVE: To systematically review the literature of factors affecting adherence to Antiretroviral treatment (ART) in Asian developing countries. METHODS: Database searches in Medline/Ovid Cochrane library CINAHL Scopus and PsychINFO for studies published between 1996 and December 2010. The reference lists of included papers were also checked with citation searching on key papers. RESULTS: A total of 437 studies were identified and 18 articles met the inclusion criteria and were extracted and critically appraised representing in 12 quantitative four qualitative and two mixed-method studies. Twenty-two individual themes including financial difficulties side effects access stigma and discrimination simply forgetting and being too busy impeded adherence to ART and 11 themes including family support self-efficacy and desire to live longer facilitated adherence. CONCLUSION: Adherence to ART varies between individuals and over time. We need to redress impeding factors while promoting factors that reinforce adherence through financial support better accessible points for medicine refills consulting doctors for help with side effects social support and trusting relationships with care providers. (c) 2011 Blackwell Publishing Ltd.

Reliability and accuracy of anthropometry performed by community health workers among infants under 6 months in rural Kenya

Abstract: OBJECTIVE: To assess the inter-observer variability and accuracy of Mid Upper Arm Circumference (MUAC) and weight-for-length Z score (WFLz) among infants aged <6 months performed by community health workers (CHWs) in Kilifi District Kenya. METHODS: A cross-sectional repeatability study estimated inter-observer variation and accuracy of measurements initially undertaken by an expert anthropometrist nurses and public health technicians. Then after training 18 CHWs (three at each of six sites) repeatedly measured MUAC weight and length of infants aged <6 months. Intra-class correlations (ICCs) and the Pitmans statistic were calculated. RESULTS: Among CHWs ICCs pooled across the six sites (924 infants) were 0.96 (95% CI 0.95-0.96) for MUAC and 0.71 (95% CI 0.68-0.74) for WFLz. MUAC measures by CHWs differed little from their trainers: the mean difference in MUAC was 0.65 mm (95% CI 0.023-1.07) with no significant difference in variance (P = 0.075). CONCLUSION: Mid Upper Arm Circumference is more reliably measured by CHWs than WFLz among infants aged <6 months. Further work is needed to define cut-off values based on MUACs ability to predict mortality among younger infants. (c) 2012 Blackwell Publishing Ltd.

Seroprevalence and incidence of transfusion-transmitted infectious diseases among blood donors from regional blood transfusion centres in Burkina Faso, West Africa

Abstract: BACKGROUND AND OBJECTIVE: The high prevalence of numerous transfusion-transmitted infectious diseases such as HIV HBV HCV and syphilis in sub-Saharan Africa affects blood safety for transfusion recipients. The aim of this study was to evaluate the prevalence and incidence of transfusion-transmissible infectious diseases among blood donors in Burkina Faso. METHODS: A retrospective study of blood donors records from January to December 2009 was conducted. Prevalence and incidence of viral infections were calculated among repeat and first-time blood donors. RESULTS: Of the total of 31405 first-time volunteer blood donors in 2009 24.0% were infected with at least one pathogen and 1.8% had serological evidence of multiple infections. The seroprevalence of HIV HBV HCV and syphilis in first-time volunteer donors was 1.8% 13.4% 6.3% and 2.1% respectively. In 3981 repeat donors the incidence rate was 3270.2 5874.1 and 6784.6 per 100000 donations for anti-HIV-1 HBsAg and anti-HCV respectively. These numbers varied significantly according to populations where blood is collected and blood centres in Burkina Faso. CONCLUSION: The relatively high prevalence of viral markers in first-time volunteers and remarkably high incidence of infections in repeat donors raise concerns regarding the safety of these donors and suggest that implementation of NAT might significantly improve the situation. (c) 2011 Blackwell Publishing Ltd.

Review: analysis of parasite and other skewed counts

Abstract: Objective To review methods for the statistical analysis of parasite and other skewed count data. Methods Statistical methods for skewed count data are described and compared, with reference to a 10-year period of Tropical Medicine and International Health (TMIH). Two parasitological datasets are used for illustration. Results The review of TMIH found 90 articles, of which 89 used descriptive methods and 60 used inferential analysis. A lack of clarity is noted in identifying the measures of location, in particular the Williams and geometric means. The different measures are compared, emphasising the legitimacy of the arithmetic mean for the skewed data. In the published articles, the t test and related methods were often used on untransformed data, which is likely to be invalid. Several approaches to inferential analysis are described, emphasising (1) non-parametric methods, while noting that they are not simply comparisons of medians, and (2) generalised linear modelling, in particular with the negative binomial distribution. Additional methods, such as the bootstrap, with potential for greater use are described. Conclusions Clarity is recommended when describing transformations and measures of location. It is suggested that non-parametric methods and generalised linear models are likely to be sufficient for most analyses. Objectifs: Examiner les methodes d’analyse statistique des donnees du parasite et de celles d’autres mesures faussees. Methodes: Les methodes statistiques pour les donnees de mesures faussees sont decrites et comparees, pour celles utilisees sur une periode de dix ans dans le journal ‘Tropical Medicine and International Health’. Deux ensembles de donnees parasitologiques sont utilises a titre d’illustration. Resultats: 90 articles ont ete identifies; 89 avec une analyse descriptive et 60 avec une analyse inferentielle. Un manque de clarte a ete observe dans l’identification des mesures de localisation, en particulier dans la moyenne geometrique et dans celle de Williams. Les differentes mesures sont comparees, en insistant sur la legitimite de la moyenne arithmetique des donnees faussees. Dans les articles publies, le test t et les methodes associees ont ete souvent utilises sur des donnees non transformees, ce qui est susceptible de les rendre invalides. Plusieurs approches de l’analyse inferentielle sont decrites, mettant l’accent sur (1) des methodes non parametriques, tout en notant qu’elles ne sont pas simplement des comparaisons de medianes et (2) la modelisation lineaire generalisee, en particulier avec la loi de distribution binomiale negative. D’autres methodes sont decrites, telles que celle d’amorcage ‘bootstrap’, qui a un potentiel d’utilisation plus grand. Conclusions: La clarte est recommandee lors de la description des transformations et des mesures de localisation. Il est suggere que les methodes non parametriques et les modeles lineaires generalises sont probablement suffisants pour la plupart des analyses. Objetivo: Revisar los metodos para el analisis estadistico del conteo parasitario y otros conteos con sesgo. Metodos: Se describen y comparan los metodos estadisticos utilizados para el analisis de datos de conteos con sesgo, haciendo referencia a aquellos utilizados durante un periodo de diez anos en el Tropical Medicine and International Health. Se utilizaron dos grupos de datos parasitologicos como ejemplos ilustrativos. Resultados: Se identificaron 90 publicaciones, 89 con analisis descriptivo y 60 con analisis inferencial. Se observa una falta de claridad para identificar medidas de localizacion, en particular la media de geometrica y de Williams. Se compararon las diferentes medidas, haciendo enfasis en la legitimidad de la media aritmetica para datos sesgados. En los articulos publicados se utilizaron a menudo la prueba t y metodos relacionados en datos sin transformar, lo cual probablemente sea invalido. Se describen varios enfoques del analisis inferencial, enfatizando (1) metodos no-parametricos, teniendo en cuenta que no son solo comparaciones de las medias, (2) modelo lineal generalizado, en particular con distribucion binomial negativa. Se describen metodos adicionales, tales como el bootstrap, con potencial para un mayor uso. Conclusiones: Se recomienda claridad para describir transformaciones y medidas de localizacion. Se sugiere que los metodos no parametricos y los modelos lineales generalizados podrian ser suficientes para la mayoria de los analisis.

Low mortality risk but high loss to follow-up among patients in the Tanzanian national HIV care and treatment programme.

Abstract: OBJECTIVE To analyse survival and retention rates of the Tanzanian care and treatment programme. METHODS: Routine patient-level data were available from 101 of 909 clinics. Kaplan-Meier probabilities of mortality and attrition after ART initiation were calculated. Mortality risks were corrected for biases from loss to follow-up using Eggers nomogram. Smoothed hazard rates showed mortality and attrition peaks. Cox regression identified factors associated with death and attrition. Median CD4 counts were calculated at 6 month intervals. RESULTS: In 88875 adults 18% were lost to follow up 12 months after treatment initiation and 36% after 36 months. Cumulative mortality reached 10% by 12 months (15% after correcting for loss to follow-up) and 14% by 36 months. Mortality and attrition rates both peaked within the first six months and were higher among males those under 45 kg and those with CD4 counts below 50 cells/mul at ART initiation. In the first year on ART median CD4 count increased by 126 cells/mul with similar changes in both sexes. CONCLUSION: Earlier diagnoses through expanded HIV testing may reduce high mortality and attrition rates if combined with better patient tracing systems. Further research is needed to explore reasons for attrition. (c) 2012 Blackwell Publishing Ltd.

Epidemiological aspects of non‐human antibiotic usage and resistance: implications for the control of antibiotic resistance in Ghana

Abstract: Objectives To provide insights into the epidemiology of antibiotic usage in animal husbandry in Ghana and its effect on resistance. Methods Three hundred and ninety-five randomly sampled commercial livestock keepers who practised intensive or extensive farming were interviewed about their antibiotic usage practices using a structured questionnaire. Escherichia coli isolated from stool specimens of farmers and their animals were tested against eight antibiotics using the Kirby Bauer method. Results Ninety-eight percent (387) of the farmers used antibiotics on animals and the main purpose was to prevent infections in animals; 41% applied antibiotics monthly. The overall prevalence of multiple drug resistance among the E. coli isolates was 91.6%; rates in human and animal isolates were 70.6% and 97.7%, respectively. The prevalence of resistance in animal isolates to the various drugs ranged from 60.8% (amikacin) to 95.7% (ampicillin); the prevalence of resistance in human isolates to the drugs ranged from 2% (cefuroxime) to 94.1% (gentamicin). Animal E. coli isolates showed higher resistance than that of human isolates for five of eight drugs tested. Conclusion It is concluded that antibiotic usage in animal husbandry in Ghana is more driven by the interest of livestock keepers to prevent and treat animal infections than growth enhancement. Both animal and human E. coli showed high levels of antibiotic resistance, although resistance of animal isolates appeared to be higher than that of humans. There is the need for the development of an antibiotic-resistance management programme in Ghana that will focus simultaneously on human and animal use of antibiotics. Objectifs: Fournir un apercu de l’epidemiologie de l’utilisation des antibiotiques dans l’elevage des animaux au Ghana et son effet sur la resistance. Methodes: Un echantillon aleatoirement de 395 eleveurs commerciaux qui pratiquaient une agriculture intensive ou extensive ont ete interroges sur leurs pratiques d’utilisation des antibiotiques a l’aide d’un questionnaire structure. Des isolats d’E. coli obtenus a partir d’echantillons de selles des eleveurs et de leurs animaux ont ete testes contre 8 antibiotiques en utilisant la methode Kirby Bauer. Resultats: 98% (387) des agriculteurs utilisaient des antibiotiques pour prevenir les infections chez les animaux; 41% appliquaient des antibiotiques mensuellement. La prevalence globale de la resistance multiple aux medicaments parmi les isolats d’E. colietait de 91,6%, les taux parmi les isolats humains et animaux etaient de 70,6% et 97,7% respectivement. La prevalence de la resistance parmi les isolats animaux pour les differents medicaments variait de 60,8% (amikacine) a 95,7% (ampicilline). La prevalence de la resistance aux medicaments parmi les isolats humains variait de 2% (cefuroxime) a 94,1% (gentamicine). Les isolats animaux d’E. coli montraient une plus grande resistance que les isolats humains pour 5 des 8 medicaments testes. Conclusion: Il a ete conclu que l’utilisation des antibiotiques dans l’elevage au Ghana est plus guidee par l’interet des eleveurs a prevenir et traiter les infections des animaux que pour l’amelioration de la croissance. Les isolats animaux et humains d’E. coli ont tous revele des niveaux eleves de resistance aux antibiotiques, quoique la resistance des isolats animaux semblent etre plus elevee que celles des isolats humains. Il est necessaire de developper un programme de gestion de la resistance aux antibiotiques au Ghana, qui portera simultanement sur l’utilisation humaine et animale des antibiotiques. Objetivos: Aportar informacion sobre la epidemiologia del uso de antibioticos en la cria de animales en Ghana y sus efectos sobre la resistencia a los mismos. Metodos: Se entrevistaron 395 granjeros comerciales que practicaban ganaderia intensiva o extensiva, y mediante un cuestionario estructurado se les pregunto acerca de sus practicas en el uso de antibioticos. A las cepas de E. coli aisladas de las muestras de heces de los ganaderos y sus animales se les realizo una prueba de susceptibilidad frente a 8 antibioticos mediante el metodo de Kirby Bauer. Resultados: Un 98% (387) de los ganaderos daba antibioticos a sus animales para prevenir infecciones; y un 41% aplicaba los antibioticos mensualmente. La prevalencia general de resistencia multiple entre las cepas de E. coli era del 91.6%; las tasas en cepas aisladas de hombres y animales eran del 70.6% y 97.7% respectivamente. La prevalencia de resistencia en cepas aisladas de animales a los diferentes antibioticos testados estaban en un rango de 60.8% (amikacina) a 95.7% (ampicilina); la prevalencia de resistencias a los antibioticos en aislados provenientes de humanos estaban en un rango del 2% (cefuroxima) al 94.1% (gentamicina). Las cepas de E. coli aisladas de animales, mostraban una mayor resistencia que las aisladas de humanos, para 5 de los 8 antimicrobianos evaluados. Conclusion: En Ghana, el uso de antibioticos en ganaderia se debe principalmente al interes de los ganaderos de prevenir y tratar las infecciones de los animales, mas que en inducir una mejora en el crecimiento y el engorde. Las cepas aisladas de E. coli, tanto de humanos como de animales, mostraron altos niveles de resistencia a los antibioticos, aunque la resistencia de las cepas aisladas de animales parecia ser mayor que la de cepas aisladas de humanos. En Ghana es necesario desarrollar un programa para el manejo de las resistencias a los antibioticos, que se centre simultaneamente en el uso de antibioticos tanto en animales como en humanos.

Millennium Development Goals water target claim exaggerates achievement

Abstract: In March 2012, the United Nations made an important announcement: ‘The goal of reducing by half the number of people without access to safe drinking water has been achieved’ (United Nations 2012). While major news organizations heralded the achievement, this may be another premature claim of ‘mission accomplished’. This is because the way progress is measured on the Millennium Development Goals (MDG) water target does not fully address water quality, quantity and access – key components of the target that are fundamental to human health. Target 7c of the MDGs calls for ‘reducing by half the portion of people without sustainable access to safe drinking water’ (UN 2000). Unfortunately, there is no clear guidance on precisely what was intended by the language of the target or definitions of the key terms ‘sustainable’, ‘access’ or ‘safe’. However, the language used in the target has a history and that history provides insights into its intent. The 1977 Mar del Plata Declaration by the United Nations, which launched the Water and Sanitation Decade (1981–1990), asserted the universal right to ‘access to drinking water in quantities and of a quality equal to their basic needs’ (UN 1977). Agenda 21, the UN action plan for sustainable development that emerged from the United Nations Conference on Environment and Development, expressed its goal in terms of ‘safe water’ and set a minimum quantity of 20 l/person/day (WSSCC 2000). Finally, the Secretary General’s report to Millennium Summit urged the adoption of a target to reduce by half the portion of people who lack ‘sustainable access to adequate sources of affordable and safe water’ (Annan 2000). After adoption of the MDGs, the UN Millennium Project was commissioned to identify the best strategies for meeting the goals. In its report, the Millennium Project’s Task Force for Water and Sanitation defines ‘safe drinking water’ as ‘water that is safe to drink and available in sufficient quantities for hygienic purposes’ (UN Millennium Project 2005). The Task Force also explained that ‘access to drinking water requires the existence of infrastructure in good working order.’ It also noted that sustainable access implies ‘a type of service that is secure, reliable, and available for use on demand by users on a long-term basis.’ From this prior history, a few conclusions can be drawn about the intent of the MDG water target. First, with respect to quality, the intent is absolutely clear: drinking water must be ‘safe’. In opting for this criterion over ‘acceptable’, ‘acceptable quality’ or ‘quality equal to their basic needs’, the MDG target establishes an unequivocal mandate that water be free of pathogens. By focusing on ‘drinking water’ rather than water ‘sources’, the target also implies that the water be safe at the point of use, not just at the point of distribution. Second, like most of the previous statements, the MDG expressly includes the concept of ‘access’. The MDG Task Force on Water and Sanitation interprets this to include not only time spent procuring water – the traditional measure of access – but also in terms of (i) affordability, (ii) reliability and (iii) the environmental impact of the supply (UN Millennium Project 2005). However, access also implies quantity, as the inverse relationship between distance to water supplies and the amount of water used has been consistently shown for more than 40 years (White et al. 1972). Each of these priorities – quality, quantity and access – has been shown by research to be fundamental to optimising health and development. Systematic reviews of dozens of field studies have shown that interventions to improve water quality are effective in preventing diarrhoeal diseases – a leading killer of children (Esrey et al. 1991; Fewtrell et al. 2005; Clasen et al. 2006; Waddington et al. 2009). Field studies have consistently shown that in the absence of safe storage, even water that is safe at the point of distribution is subject to frequent and extensive contamination during collection, transport, storage and use in the home (Wright et al. 2004). Systematic reviews have Tropical Medicine and International Health doi:10.1111/j.1365-3156.2012.03052.x

Space-time clusters of dengue fever in Bangladesh.

Abstract: Objective To examine the space-time clustering of dengue fever (DF) transmission in Bangladesh using geographical information system and spatial scan statistics (SaTScan). Methods We obtained data on monthly suspected DF cases and deaths by district in Bangladesh for the period of 2000–2009 from Directorate General of Health Services. Population and district boundary data of each district were collected from national census managed by Bangladesh Bureau of Statistics. To identify the space-time clusters of DF transmission a discrete Poisson model was performed using SaTScan software. Results Space-time distribution of DF transmission was clustered during three periods 2000–2002, 2003–2005 and 2006–2009. Dhaka was the most likely cluster for DF in all three periods. Several other districts were significant secondary clusters. However, the geographical range of DF transmission appears to have declined in Bangladesh over the last decade. Conclusion There were significant space-time clusters of DF in Bangladesh over the last decade. Our results would prompt future studies to explore how social and ecological factors may affect DF transmission and would also be useful for improving DF control and prevention programs in Bangladesh. Objectif: Examiner le regroupement spatio-temporel de la transmission de la fievre dengue (FD) au Bangladesh en utilisant le systeme d’information geographique et les statistiques d’analyse spatiale (SaTScan). Methodes: Nous avons obtenu des donnees mensuelles sur les cas et les deces suspects de FD par district au Bangladesh pour la periode 2000–2009, de la Direction Generale des Services de Sante. Les donnees sur les delimitations de la population et du district de chaque district ont ete recueillies a partir du recensement national gere par le Bureau des Statistiques du Bangladesh. Afin de pouvoir identifier les regroupes spatio-temporels de la transmission de la FD un modele de Poisson discret a ete applique en utilisant le logiciel SaTScan. Resultats: La distribution spatio-temporelle de la transmission de la FD a ete regroupee lors de trois periodes: 2000–2002, 2003–2005 et 2006–2009. Dhaka a connu le regroupement le plus probable pour la FD au cours des trois periodes. Plusieurs autres districts ont connu d’importants regroupements secondaires. Cependant, l’etendue geographique de la transmission de la FD semble avoir diminue au Bangladesh au cours de la derniere decennie. Conclusion: Il y avait d’importants regroupements spatio-temporels de la FD au Bangladesh au cours de la derniere decennie. Nos resultats inciteraient les futures etudes a explorer comment les facteurs sociaux et ecologiques peuvent affecter la transmission de la FD et seraient egalement utiles pour ameliorer la lutte contre la FD et les programmes de prevention au Bangladesh. Objetivo: Examinar los conglomerados espacio-temporales de transmision de la fiebre del dengue (FD) en Bangladesh utilizando un sistema de informacion geografica y el programa SaTScan para el analisis estadistico de datos espaciales. Metodos: Se obtuvieron datos sobre los casos mensuales con sospecha de FD y las muertes por distrito de Bangladesh para el periodo del 2000–2009 de los Servicios Generales de Salud. Del censo nacional, manejado por la oficina de estadistica de Bangladesh, se recolectaron datos para cada distrito sobre la poblacion y los limites distritales. Para identificar los conglomerados espacio-temporales de transmision de FD se utilizo un modelo de Poisson con el programa SaTScan. Resultados: La distribucion espacio-temporal de la transmision de FD se agrupaba en tres periodos 2000–2002, 2003–2005 y 2006–2009. Dhaka era el conglomerado con mayor probabilidad para FD en los tres periodos. Sin embargo, el rango geografico de transmision de FD parece haber disminuido en Bangladesh durante la ultima decada. Conclusion: Durante la ultima decada ha habido conglomerados espacio-temporales significativos para la FD en Bangladesh. Nuestros resultados inducirian a estudios futuros para explorar como los factores sociales y ecologicos pueden afectar a la transmision de la FD y tambien serian utiles para mejorar el control de la FD y de los programas de prevencion en Bangladesh.

Defining retention and attrition in pre‐antiretroviral HIV care: proposals based on experience in Africa

Abstract: Objectif: Proposer des definitions standard pratiques pour le report des retentions dans les soins pre-ART. Methode: Definitions tablee sur trois stades: Stade 1, du test VIH-positif a l’evaluation initiale de l’eligibilite pour l’ART; Stade 2, de l’evaluation initiale a l’eligibilite pour l’ART et Stade 3, de l’eligibilitea l’initiation de l’ART. Pour chaque stade, les resultats negatifs comprennent le deces, les perdus de vue, ou le fait de ne pas etre retenu. Resultats: Retention dans le stade 1: la proportion de patients qui ont termine l’evaluation initiale de l’eligibilite pour l’ART dans les 3 mois du depistage du VIH, avec les reports des resultats de la cohorte a 3 et 12 mois apres le depistage du VIH. Les patients terminant le stade 1, eligibles pour l’ART, passent directement a l’etape 3. Retention dans le stade 2: la proportion de patients qui soit terminent toutes les possibles reevaluations pour l’eligibilitea l’ART dans les 6 mois du calendrier de visite standard du site, soit ont eu une evaluation endeans 1 an de la date du report et n’etaient pas admissibles pour l’ART a la derniere evaluation. La retention devrait etre rapportee a intervalles de 12 mois. Retention dans le stade 3: Initiation de l’ART (i.e. ART administre) dans les 3 mois de l’eligibilite pour l’ART, avec des reports a 3 mois apres l’eligibilite et avec des intervalles de 3 mois par la suite. Conclusion: Si la retention pre-ART doit etre amelioree, une terminologie coherente est necessaire pour la collecte des donnees, la mesure et le report des resultats, et la comparaison des resultats entre les programmes et les pays. Les definitions que nous proposons offrent une strategie pour ameliorer la coherence et la comparabilite des futurs rapports. Objetivo: Proponer definiciones practicas y estandarizadas para reportar la retencion en la atencion sanitaria previa al TAR (pre-TAR). Metodo: Las definiciones se plantean para tres etapas: Etapa 1, desde una prueba positiva para VIH hasta el inicio de la evaluacion para determinar si se es o no candidato para recibir el TAR; Etapa 2, evaluacion inicial para determinar si se es o no candidato para recibir el TAR; y Etapa 3, desde la eleccion como candidato para recibir TAR hasta el inicio del TAR. Para cada etapa, los resultados negativos incluian la muerte, perdida o no retencion dentro del tratamiento. Resultados: Retencion en la primera etapa: proporcion de pacientes que completaron la evaluacion inicial para determinar si era elegible para recibir el TAR dentro de los 3 meses posteriores a la realizacion de la prueba del VIH, con un informe de los resultados de la cohorte en los meses 3 y 12 despues de realizar la prueba de VIH. Los pacientes que completaban la Etapa 1 y eran candidatos para recibir el TAR se movian directamente a la Etapa 3. Etapa 2 Retencion: proporcion de pacientes que: o completaban todas las posibles re-evaluaciones para determinar si eran candidatos para recibir TAR dentro de los 6 meses posteriores a la visita estandar del centro; o completaban una evaluacion dentro del ano siguiente al diagnostico y no habian cumplido los requisitos para ser candidatos a recibir TAR en la ultima visita realizada. La retencion deberia ser reportada en intervalos de 12 meses. Etapa 3 Retencion: comenzar TAR (es decir, antirretrovirales entregados) dentro de los 3 meses siguientes a haberse determinado su candidatura para recibir el TAR, habiendose presentado dentro de los 3 meses siguientes a haber sido elegido para recibir el TAR y a partir de entonces, en intervalos de cada 3 meses. Conclusion: Para mejorar la retencion pre-TAR, es necesario contar con una terminologia consistente para la recoleccion de datos, para medir y reportar los resultados, y comparar los resultados obtenidos en diferentes programas y paises. Las definiciones que proponemos ofrecen una estrategia para mejorar la consistencia y la comparabilidad de informes futuros.

Cohort monitoring of persons with diabetes mellitus in a primary healthcare clinic for Palestine refugees in Jordan.

Abstract: objective To illustrate the method of cohort reporting of persons with diabetes mellitus (DM) in a primary healthcare clinic in Amman, Jordan, serving Palestine refugees with the aim of improving quality of DM care services. method A descriptive study using quarterly and cumulative case findings, as well as cumulative and 12-month analyses of cohort outcomes collected through E-Health in UNRWA Nuzha Primary Health Care Clinic. results There were 55 newly registered patients with DM in quarter 1, 2012, and a total of 2851 patients with DM ever registered on E-Health because this was established in 2009. By 31 March 2012, 70% of 2851 patients were alive in care, 18% had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow-up. Cumulative and 12-month cohort outcome analysis indicated deficiencies in several components of clinical care: measurement of blood pressure, annual assessments for foot care and blood tests for glucose, cholesterol and renal function. 10‐20% of patients with DM in the different cohorts had serious late complications such as blindness, stroke, cardiovascular disease and amputations. conclusion Cohort analysis provides data about incidence and prevalence of DM at the clinic level, clinical management performance and prevalence of serious morbidity. It needs to be more widely applied for the monitoring and management of non-communicable chronic diseases.

Space-time analysis of hospitalised dengue patients in rural Thailand reveals important temporal intervals in the pattern of dengue virus transmission.

Abstract: Objective To determine the temporal intervals at which spatial clustering of dengue hospitalisations occurs. Methods Space-time analysis of 262 people hospitalised and serologically confirmed with dengue virus infections in Kamphaeng Phet, Thailand was performed. The cases were observed between 1 January 2009 and 6 May 2011. Spatial coordinates of each patient’s home were captured using the Global Positioning System. A novel method based on the Knox test was used to determine the temporal intervals between cases at which spatial clustering occurred. These intervals are indicative of the length of time between successive illnesses in the chain of dengue virus transmission. Results The strongest spatial clustering occurred at the 15–17-day interval. There was also significant spatial clustering over short intervals (2–5 days). The highest excess risk was observed within 200 m of a previous hospitalised case and significantly elevated risk persisted within this distance for 32–34 days. Conclusions Fifteen to seventeen days are the most likely serial interval between successive dengue illnesses. This novel method relies only on passively detected, hospitalised case data with household locations and provides a useful tool for understanding region-specific and outbreak-specific dengue virus transmission dynamics. Objectif: Determiner les intervalles temporels au cours desquels survient le regroupement spatial des hospitalisations pour dengue. Methodes: L’’analyse spatio-temporelle de 262 personnes hospitalisees et confirmees par la serologie pour des infections au virus de la dengue a Kamphaeng Phet, en Thailande a ete realisee. Les cas ont ete observes entre le 1er janvier 2009 et le 6 mai 2011. Les coordonnees spatiales du domicile de chaque patient ont ete capturees a l’aide du Systeme de Positionnement Global. Une nouvelle methode basee sur le test de Knox a ete utilisee pour determiner les intervalles temporels entre les cas au cours desquels le regroupement spatial a eu lieu. Ces intervalles sont des indicateurs de la duree de temps entre les maladies successives dans la chaine de transmission de virus de la dengue. Resultats: Le plus important regroupement spatial a eu lieu dans l’intervalle de 15 a 17 jours. Il y avait egalement un regroupement spatial significatif sur des intervalles courts (2 a 5 jours). Le risque en exces le plus eleve a ete observea endeans 200 m d’un cas precedent hospitalise et un risque significativement eleve a persiste dans cette zone durant 32 a 34 jours. Conclusions: L’intervalle de series de 15 a 17 jours est le plus probable entre les maladies successives de la dengue. Cette nouvelle methode repose uniquement sur les donnees de cas hospitalises, detectes passivement avec les emplacements des menages et constitue un outil utile pour comprendre la dynamique de la transmission du virus de la dengue specifique a la region et specifique a l’epidemie. Objetivo: Determinar los intervalos temporales en los que ocurren conglomerados espaciales de hospitalizacion por dengue. Metodos: Se realizo un analisis espacio temporal a 262 personas hospitalizadas y con confirmacion serologica de infeccion por el virus del dengue en Kamphaeng Phet, Tailandia. Los casos se observaron entre el 1 de Enero del 2009 y el 6 de Mayo del 2011. Las coordenadas espaciales del hogar de cada paciente fueron capturadas utilizando un Sistema de Posicionamiento Global. Se utilizo un nuevo metodo, basado en la prueba de Knox, para determinar los intervalos temporales entre los casos en los que habia conglomerados espaciales. Estos intervalos son indicativos del lapso de tiempo entre enfermedades sucesivas en la cadena de transmision del virus del dengue. Resultados: El mayor conglomerado espacial ocurrio en un intervalo de 15 a 17 dias. Tambien habia un conglomerado espacial significativo en intervalos cortos (2–5 dias). El mayor exceso de riesgo se observo dentro de un radio de 200 m de un caso previamente hospitalizado y un riesgo significativamente elevado persistia, dentro de esta distancia, durante 32–34 dias. Conclusiones: Los 15–17 dias son el intervalo mas probable entre dos casos sucesivos de dengue. Este nuevo metodo depende solamente de la disponibilidad de datos de casos hospitalizados, detectados de forma pasiva y con hogares localizables, y brinda una herramienta util para entender la dinamica de transmision del virus del dengue, region-especifica y especifica de brotes.

Community participation and voice mechanisms under performance-based financing schemes in Burundi.

Abstract: objective Community participation is often described as a key for primary health care in lowincome countries. Recent performance-based financing (PBF) initiatives have renewed the interest in this strategy by questioning the accountability of those in charge at the health centre (HC) level. We analyse the place of two downward accountability mechanisms in a PBF scheme: health committees elected among the communities and community-based organizations (CBOs) contracted as verifiers of health facilities’ performance. method We evaluated 100 health committees and 79 CBOs using original data collected in six Burundi provinces (2009‐2010) and a framework based on the literature on community participation in health and New Institutional Economics. results Health committees appear to be rather ineffective, focusing on supporting the medical staff and not on representing the population. CBOs do convey information about the concerns of the population to the health authorities; yet, they represent only a few users and lack the ability to force changes. PBF does not automatically imply more ‘voice’ from the population, but introduces an interesting complement to health committees with CBOs. However, important efforts remain necessary to make both mechanisms work. More experiments and analysis are needed to develop truly efficient ‘downward’ mechanisms of accountability at the HC level.

Patterns of uptake of HIV testing in sub-Saharan Africa in the pre-treatment era.

Abstract: Objectives To compare nationally representative trends in self-reported uptake of HIV testing and receipt of results in selected countries prior to treatment scale-up. Methods Demographic and Health Survey (DHS) data from 13 countries in sub-Saharan Africa were used to describe the pattern of uptake of testing for HIV among sexually active participants. Univariate and multivariate logistic regression were used to analyse the associations between socio-demographic and behavioural characteristics and the uptake of testing. Results Knowledge of serostatus ranged from 2.2% among women in Guinea (2005) to 27.4% among women in Rwanda (2005). Despite varied levels of testing, univariate analysis showed the profile of testers to be remarkably similar across countries, with respect to socio-demographic characteristics such as area of residence and socio-economic status. HIV-positive participants were more likely to have tested and received their results than HIV-negative participants, with the exception of women in Senegal and men in Guinea. Adjusted analyses indicate that a secondary or higher level of education was a key determinant of testing, and awareness that treatment exists was independently positively associated with testing, once other characteristics were taken into account. Conclusion This work provides a baseline for monitoring trends in testing and exploring changes in the profile of those who get tested after the introduction and scale-up of treatment.

Access to, use of and satisfaction with health services among adults enrolled in Brazil's Family Health Strategy: evidence from the 2008 National Household Survey.

Abstract: Objective To assess the effects of participation in Brazil’s primary healthcare programme (the Family Health Strategy or FHS) on access, use and satisfaction with health services among adults. Methods Data are from the 2008 National Household Survey (PNAD) on 264 754 adults. This cross-sectional analysis compares FHS enrollees to both non-enrollees and those with private health plans. We calculated predicted probabilities of each outcome stratified by household wealth quintile, rural/urban location and sex using robust Poisson regression. We performed propensity score analysis to assess the differences in access among FHS enrollees and the rest of the population, once relevant socio-demographic characteristics and other determinants of access were balanced. Results Compared to families with neither FHS enrolment nor private health plans, adult FHS enrollees were generally more likely to have a usual source of care, to have visited a doctor or dentist in the past 12 months, to have access to needed medications and to be satisfied with the care they received. The FHS effect was largest among urban dwellers and the poorest. Conclusions The FHS appears to be associated with enhanced access to and utilization of health services in Brazil. However, it has not yet been able to match levels of access experienced by those with private health plans, perhaps because the population served by the FHS is among the poorest, most rural and least healthy in the country. Objectif: Evaluer les effets de la participation au programme bresilien de sante primaire (la strategie de sante familiale ou FHS) sur l’acces, l’utilisation et la satisfaction dans les services de sante chez les adultes. Methodes: Les donnees sont tirees de l’enquete nationale aupres des menages (PNAD) en 2008 sur 26.4754 adultes. Cette analyse transversale compare a la fois les inscrits au FHS aux non-inscrits et a ceux avec des plans de sante prives. Nous avons calcule les probabilites predites de chaque resultat stratifie par quintile de richesse des menages, zone rurale/urbaine et sexe, a l’aide de la regression de Poisson robuste. Nous avons effectue une analyse du score de propension afin d’evaluer les differences dans l’acces chez les personnes inscrites au FHS et dans le reste de la population, une fois que les caracteristiques sociodemographiques pertinentes et d’autres determinants de l’acces ont eteequilibres. Resultats: Comparativement aux familles non inscrites au FHS et sans plans de sante prives, les adultes inscrits au FHS etaient generalement plus susceptibles d’avoir une source habituelle de soins, d’avoir visite un medecin ou un dentiste au cours des 12 derniers mois, d’avoir acces aux medicaments necessaires et d’etre satisfaits des soins qu’ils ont recus. L’effet FHS etait plus important chez les citadins et les plus pauvres. Conclusions: Le FHS semble etre associea un meilleur acces et utilisation des services de sante au Bresil. Cependant, il n’a pas encore ete capable d’egaler les niveaux d’acces de ceux ayant des plans de sante prives, peut-etre parce que la population desservie par le FHS est parmi les plus pauvres, les plus rurales, et en moins bonne sante dans le pays. Objetivo: Evaluar los efectos de la participacion en el programa brasileno de cuidados sanitarios primarios (Estrategia de Salud Familiar o ESF) sobre el acceso, uso y satisfaccion con los servicios sanitarios para adultos. Metodos: Los datos se tomaron de la encuesta nacional de hogares del 2008 realizada a 264,754 adultos. Este analisis croseccional compara a los participantes de la ESF tanto con aquellos que no participaron como con aquellos con seguros privados de salud. Utilizando una regresion de Poisson hemos calculado las probabilidades de cada resultado, estratificado por el quintil de riqueza del hogar, localizacion rural/urbana y sexo. Realizamos un analisis con indices de propension para evaluar las diferencias en el acceso entre participantes del ESF y el resto de la poblacion, una vez que se habian balanceado las caracteristicas socio-demograficas relevantes asi como otros determinantes de acceso. Resultados: Comparados con las familias que no estaban incluidas en la ESF ni en planes privados de salud, los adultos que participaban en la ESF tenian generalmente una mayor fuente de cuidados, una mayor probabilidad de haber visitado un medico o un dentista en los ultimos 12 meses, un mayor acceso a las medicaciones necesarias, y una mayor probabilidad de estar satisfechos con los cuidados recibidos. El efecto del ESF era mayor entre los urbanitas que entre los mas pobres. Conclusiones: La ESF parece estar asociada con un mejor acceso a y utilizacion de los servicios sanitarios en Brasil. Sin embargo aun no ha logrado alcanzar los niveles de acceso experimentado por aquellos con planes de salud privados, tal vez porque la poblacion a la cual sirve el ESF esta entre la mas pobre, rural y menos sana del pais.

Cohort monitoring of persons with hypertension: an illustrated example from a primary healthcare clinic for Palestine refugees in Jordan.

Abstract: objective Recording and reporting systems borrowed from the DOTS framework for tuberculosis control can be used to record, monitor and report on chronic disease. In a primary healthcare clinic run by UNRWA in Amman, Jordan, serving Palestine refugees with hypertension, we set out to illustrate the method of cohort reporting for persons with hypertension by presenting on quarterly and cumulative case finding, cumulative and 12-month analysis of cohort outcomes and to assess how these data may inform and improve the quality of hypertension care services. method This was a descriptive study using routine programme data collected through E-Health. results There were 97 newly registered patients with hypertension in quarter 1, 2012, and a total of 4130 patients with hypertension ever registered since E-Health started in October 2009. By 31 March 2012, 3119 (76%) of 4130 patients were retained in care, 878 (21%) had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow-up. Cumulative and 12-month cohort outcome analysis indicated deficiencies in several components of clinical performance related to blood pressure measurements and fasting blood glucose tests to screen simultaneously for diabetes. Between 8% and 15% of patients with HT had serious complications such as cardiovascular disease and stroke. conclusion Cohort analysis is a valuable tool for the monitoring and management of noncommunicable chronic diseases such as HT.

Scaling up Xpert MTB/RIF technology: the costs of laboratory- vs. clinic-based roll-out in South Africa

Abstract: objective The World Health Organization recommends using Xpert MTB ⁄ RIF for diagnosis of pulmonary tuberculosis (PTB), but there is little evidence on the optimal placement of Xpert instruments in public health systems. We used recent South African data to compare the cost of placing Xpert at points of TB treatment (all primary clinics and hospitals) with the cost of placement at sub-district laboratories. methods We estimated Xpert’s cost ⁄ test in a primary clinic pilot and in the pilot phase of the national Xpert roll-out to smear microscopy laboratories; the expected future volumes for each of 223 laboratories or 3799 points of treatment; the number and cost of Xpert instruments required and the national cost of using Xpert for PTB diagnosis for each placement scenario in 2014. results In 2014, South Africa will test 2.6 million TB suspects. Laboratory placement requires 274 Xpert instruments, while point-of-treatment placement requires 4020 instruments. With an Xpert cartridge price of $14.00, the cost ⁄ test is $26.54 for laboratory placement and $38.91 for point-oftreatment placement. Low test volumes and a high number of sites are the major contributors to higher point-of-treatment costs. National placement of Xpert at laboratories would cost $71 million ⁄ year; point-of-treatment placement would cost $107 million ⁄ year, 51% more. conclusion Placing Xpert technology at points of treatment is substantially more expensive than placing the instruments in smear microscopy laboratories. The incremental benefits of pointof-treatment placement, in terms of better patient outcomes, will have to be equally substantial to justify the additional cost to the national health budget.

Schistosoma real-time PCR as diagnostic tool for international travellers and migrants.

Abstract: objective To evaluate the use of a genus-specific PCR that combines high sensitivity with the detection of different Schistosoma species for diagnosis in international travellers and migrants in comparison to standard microscopy. methods and results The genus-specific real-time PCR was developed to target the 28S ribosomal RNA gene of the major human Schistosoma species. It was validated for analytical specificity and reproducibility and demonstrated an analytical sensitivity of 0.2 eggs per gram of faeces. Its diagnostic performance was further evaluated on 152 faecal, 32 urine and 38 serum samples from patients presenting at the outpatient clinic of the Institute of Tropical Medicine in Antwerp (Belgium). We detected Schistosoma DNA in 76 faecal (50.0%) and five urine (15.6%) samples of which, respectively, nine and one were not detected by standard microscopy. Only two of the 38 serum samples of patients with confirmed schistosomiasis were positive with the presently developed PCR. Sequence analysis on positive faecal samples allowed identification of the Schistosoma species complex. conclusion The real-time PCR is highly sensitive and may offer added value in diagnosing imported schistosomiasis. The genus-specific PCR can detect all schistosome species that are infectious to humans and performs very well with faeces and urine, but not in serum.

Predictors of antibiotic use in African communities: evidence from medicines household surveys in five countries.

Abstract: Summary Objectives To investigate antibiotic use in five national household surveys conducted with the WHO methodology to identify key determinants of antibiotic use in the community. Methods Data from The Gambia, Ghana, Kenya, Nigeria and Uganda surveys were combined. We used logistic regression models that accounted for the clustered survey design to identify the determinants of care seeking outside the home and antibiotic use for 2914 cases of recent acute illness. Results Overall, 95% of individuals with acute illness took medicines, 90% sought care outside their homes and 36% took antibiotics. In multivariate analyses, illness severity was a strong predictor of seeking care outside the home. Among those who sought outside care, the strongest predictor of antibiotic use was the presence of upper respiratory symptoms (OR: 3.02, CI: 2.36–3.86, P < 0.001), followed by gastrointestinal symptoms or difficulty breathing, and antibiotics use was less likely if they had fever. The odds of receiving antibiotics were higher when visiting a public hospital or more than one healthcare facility. Conclusions The nature and severity of symptoms and patterns of care seeking had the greatest influence on decisions to take antibiotics. Antibiotics were widely available and inappropriately used in all settings. Policies to regulate antibiotics distribution as well as interventions to educate prescribers, dispensers and consumers are needed to improve antibiotic use. Objectifs: Investiguer l’utilisation des antibiotiques dans cinq enquetes nationales aupres des menages, menees avec la methode OMS pour identifier les principaux determinants de l’utilisation des antibiotiques dans la communaute. Methodes: Les donnees d’enquetes en Gambie, au Ghana, au Kenya, au Nigeria et en Ouganda ont ete combinees. Nous avons utilise des modeles de regression logistique qui ont tenu compte de la conception du sondage par grappes afin d’identifier les determinants du recours aux soins a l’exterieur du domicile et l’utilisation des antibiotiques pour 2914 cas de maladie aigue recente. Resultats: Au total, 95% des personnes atteintes de maladie aigue ont pris des medicaments, 90% ont fait recours a des soins a l’exterieur de leurs foyers et 36% ont pris des antibiotiques. Dans des analyses multivariees, la severite de la maladie etait un facteur predictif important du recours a des soins a l’exterieur du foyer. Parmi ceux qui ont recherche des soins a l’exterieur, le plus important facteur predictif de l’utilisation d’antibiotiques etait la presence de symptomes respiratoires superieurs (OR: 3,02, IC: 2,36 a 3,86; p < 0,001), suivi par les symptomes gastro-intestinaux ou la difficultea respirer. Les antibiotiques ont ete moins probablement utilises dans les cas de fievre. Les chances de recevoir des antibiotiques etaient plus elevees lors de la visite dans un hopital public ou dans plus d’un etablissement de sante. Conclusion: La nature et la severite des symptomes, ainsi que les modes de recours aux soins avaient le plus d’influence sur les decisions a prendre des antibiotiques. Les antibiotiques etaient largement disponibles et utilises de facon inappropriee dans tous les contextes. Des politiques visant a reglementer la distribution des antibiotiques ainsi que des interventions visant aeduquer les prescripteurs, les distributeurs et les utilisateurs, sont necessaires pour ameliorer l’usage des antibiotiques. Objetivos: Investigar el uso de antibioticos en cinco encuestas nacionales de hogares realizadas con el metodo de la OMS para identificar determinantes claves del uso de antibioticos en la comunidad. Metodos: Se combinaron datos de las encuestas de Gambia, Ghana, Kenia, Nigeria y Uganda. Utilizamos modelos de regresion logistica que justificaban el diseno por conglomerados del estudio para identificar los determinantes de busqueda de cuidados fuera del hogar y del uso de antibioticos para 2914 casos de enfermedad aguda reciente. Resultados: En general, un 95% de los individuos con enfermedad aguda tomo medicamentos, un 90% busco cuidados fuera de sus hogares, y un 36% tomo antibioticos. En analisis multivariables, la severidad de la enfermedad era un fuerte vaticinador de la busqueda de cuidados fuera del hogar. Entre aquellos que buscaron cuidados externos, el vaticinador mas fuerte del uso de antibioticos era la presencia de sintomas de compromiso del aparato respiratorio superior (OR: 3.02, IC: 2.36–3.86, p < 0.001), seguido por sintomas gastrointestinales o dificultad respiratoria, el uso de antibioticos era menos probable si tenian fiebre. La probabilidad de recibir antibioticos era mayor cuando se visitaba un hospital publico o mas de un centro sanitario. Conclusiones: La naturaleza y la severidad de los sintomas y patrones de busqueda de cuidados tenian la mayor influencia sobre la decision de tomar antibioticos. Los antibioticos estaban ampliamente disponibles y su uso era inapropiado en todos los emplazamientos. Con el fin de mejorar el uso de los antibioticos, se requieren politicas para regular la distribucion de antibioticos al igual que intervenciones para educar a quienes los prescriben, los dispensan y a los consumidores.

Health system barriers to implementation of collaborative TB and HIV activities including prevention of mother to child transmission in South Africa.

Abstract: In South Africa, the control of TB and HIV co-infection remains a major challenge despite the availability of international and national guidelines for integration of TB and HIV services. This study was undertaken in KwaZulu-Natal, one of the provinces most affected by both TB and HIV, to identify and understand managers' and community care workers' (CCWs) perceptions of health systems barriers related to the implementation of collaborative TB/HIV activities, including prevention of mother to child transmission of HIV (PMTCT). We conducted 29 in-depth interviews with health managers at provincial, district and facility level and with managers of NGOs involved in TB and HIV care, as well as six focus group discussions with CCWs. Thematic analysis of transcripts revealed a convergence of perspectives on the process and the level of the implementation of policy directives on collaborative TB and HIV activities across all categories of respondents (i.e. province-, district-, facility- and community- based organizations). The majority of participants felt that the implementation of the policy was insufficiently consultative and that leadership and political will were lacking. The predominant themes related to health systems barriers include challenges related to structure and organisational culture; management, planning and power issues; unequal financing; and human resource capacity and regulatory problems notably relating to scope of practice of nurses and CCWs. Accelerated implementation of collaborative TB/HIV activities including PMTCT will require political will and leadership to address these health systems barriers.

Prevalence of childhood and adolescent overweight and obesity in Benue State, Nigeria.

Abstract: Objective To evaluate demographic variation in the prevalence of overweight (OW) and obesity (OB) among 3240 children and adolescents (girls: n = 1714; boys: n = 1526) aged 9–16 years attending primary and secondary schools in Benue State of Nigeria. Methods Participants’ anthropometric characteristics (body weight, stature, body mass index: BMI and lean body mass: LBM) were determined using standard protocols. OW and OB were estimated using International Obesity task Force diagnostic criteria. Data were analysed with one-way anova and binary logistic regression method. Results Overall, 88.5%, 9.7% and 1.8% of the adolescents had normal BMI and were OW and obese, respectively. Prevalence of OW was higher among girls (20.3%) than boys (16.2%), whereas a relatively higher incidence of OB was noted among the boys (3.5%). Girls in urban areas had a significantly higher BMI (t524 = 3.61, P = 0.002) than their rural peers, but the rural girls were more significantly OW than their urban counterparts (BMI: t1186 = 2.506). Logistic regression models assessing the influence of age, gender and location on OW/OB in children (α2(3, N = 1014) = 6.185, P = 0.103) and adolescents (α2(3, N = 2226) = 1.435, P = 0.697) did not turn up significant results. In the gender-specific analysis, the younger boys’ model was also not significant (α2(2, N = 488) = 1.295, P = 0.523) in contrast to the girls’ (α2(2, N = 526) = 15.637, P = 0.0005), thus discriminating between OW and healthy weight among the children. Overall, the model explained 2.9–4.4% of the variance in weight status and correctly classified 76.8% of the cases. Age wise, the model yielded a significant odds ratio of 1.49, suggesting that the likelihood of being OW increases by a factor of 1.5 with a unit increase in age. Also, the likelihood of an urban girl becoming OW or obese was 0.57 times that of a rural girl. Conclusions In general, girls in urban areas had higher prevalence of OW and OB than girls in rural settings. Among the boys, similar but less marked trends were found, except that the rural boys tended to be more OW on average than their peers in urban areas. In view of its public health significance, it is important to periodically evaluate the prevalence of weight disorders in children and adolescents so that appropriate preventative strategies can be instituted. Objectif: Evaluer la variation demographique dans la prevalence du surpoids (SP) et de l’obesite (OB) parmi 3.240 enfants et adolescents (1.714 filles et 1.526 garcons) âges de 9 a 16 ans frequentant les ecoles primaires et secondaires dans l’Etat de Benue au Nigeria. Methodes: Les caracteristiques anthropometriques des participants (poids corporel, stature, indice de masse corporelle: IMC et masse corporelle maigre: MCM) ont ete determinees en utilisant des protocoles standard. SP et OB ont ete estimes a l’aide des criteres de diagnostic de l’International Obesity Task Force (IOTF). Les donnees ont ete analysees avec la methode ANOVA one-way et de regression logistique binaire. Resultats: Dans l’ensemble, 88,5% des adolescents avaient un IMC normal, 9,7% avaient un SP et 1,8%etaient obeses. La prevalence du SP etait plus elevee chez les filles (20,3%) que chez les garcons (16,2%), tandis qu’une incidence relativement plus elevee de l’OB a ete notee chez les garcons (3,5%). Les filles dans les zones urbaines avaient un IMC significativement plus eleve (IMC: t524 = 3,61, p = 0,002) que celles en milieu rural, mais les filles en milieu rural etaient nettement plus en surpoids que celles en milieu urbain (IMC: t1186 = 2,506). Les modeles de regression logistique evaluant l’influence de l’âge, du sexe et de la localisation sur l’obesite/surpoids chez les enfants (χ2(3, N = 1014) = 6,185; p = 0,103) et les adolescents (χ2(3, N = 2226) = 1,435; p = 0.697) n’ont pas revele des resultats significatifs. Dans l’analyse specifique au sexe, les resultats du modele des jeunes garcons n’etait pas non plus significatifs (χ2(2, N = 488) = 1,295; p = 0,523), contrairement a celui des filles (χ2(2, N = 526) = 15,637; p = 0,0005), discriminant ainsi entre surpoids et poids sain parmi les enfants. Globalement, le modele expliquait 2,9 a 4,4% de la variance dans le statut ponderal et a classe correctement 76,8% des cas. Pour ce qui est de l’âge, le modele a revele un rapport de cote (OR) significatif de 1,49 ce qui suggere que la probabilite d’etre en SP augmente d’un facteur 1,5 avec une augmentation d’une unite de l’âge. Aussi, la probabilite d’une jeune fille en milieu urbain d’etre en SP ou de devenir OB etait 0,57 fois plus elevee que celle d’une jeune fille en milieu rural. Conclusions: En general, les filles dans les zones urbaines avaient une prevalence plus elevee de SP et d’OB que les filles en milieu rural. Chez les garcons, des tendances similaires, mais moins marquees ont ete trouvees, sauf que les garcons en milieu rural avaient tendance aetre en moyenne plus en SP que ceux en milieu urbain. Compte tenu de son importance pour la sante publique, il est important d’evaluer periodiquement la prevalence des troubles de poids chez les enfants et les adolescents afin que des strategies de prevention appropriees puissent etre instituees. Objetivo: Evaluar las variaciones demograficas en la prevalencia del sobrepeso (SP) y la obesidad (OB) entre 3240 ninos y adolescentes (ninas: n=1714; ninos: n=1526) con edades comprendidas entre los 9-16 anos, escolarizados en escuelas primarias y secundarias del estado de Benue en Nigeria. Metodos: Utilizando protocolos estandar, se determinaron las caracteristicas antropometricas de los participantes (peso, estatura, indice de masa corporal: IMC y la masa corporal magra: MCM). El SP y la OB se calcularon utilizando el criterio diagnostico del grupo de trabajo sobre la obesidad (el International Obesity task Force - IOTF). Los datos se analizaron con una ANOVA de un sentido y el metodo de regresion logistica binaria. Resultados: En total un 88.5%, 9.7% y 1.8% de los adolescentes tenian respectivamente un IMC normal, SP y eran obesos. La prevalencia de SP era mayor entre las ninas (20.3%) que entre los ninos (16.2%), mientras que se observaba una incidencia relativamente mayor de OB entre los ninos (3.5%). Las ninas provenientes de areas urbanas tenian un IMC significativamente mayor (t524=3.61, p=0.002) que sus pares de areas rurales, pero las ninas rurales eran significativamente mas obesas que sus contrapartes (IMC: t1186=2.506). Los modelos de regresion logistica para evaluar la influencia de la edad, el genero y la localizacion sobre el sobrepeso/obesidad en ninos (χ2(3, N = 1014)=6.185, p=0.103) y adolescentes (χ2(3, N = 2226)=1.435, p=0.697) no aportaron resultados significativos. En el analisis genero-especifico el modelo para ninos mas jovenes tampoco era significativo (χ2(2, N = 488)=1.295, p=0.523), en contraste con el de las ninas (χ2(2, N = 526)=15.637, p=0.0005); discriminando entre el sobrepeso y un peso sano entre los ninos. En general el modelo explicaba 2.9-4.4% de la varianza en el estatus de peso y clasifico de forma correcta un 76.8% de los casos. En terminos de edad, el modelo arrojaba una razon de posibilidades significativa de 1.49, sugiriendo que la probabilidad de tener sobrepeso aumentaba en un factor de 1.5 con un aumento de 1 unidad de edad. Ademas, la probabilidad de que una nina viviendo en un area urbana tuviese sobrepeso o fuese obesa era 0.57 veces el de una nina viviendo en una zona rural. Conclusiones: En general, las ninas de areas urbanas tenian una mayor prevalencia de sobrepeso y obesidad que las ninas de zonas rurales. Entre los ninos se observaba una tendencia similar pero no tan marcada, excepto que los ninos rurales tendian a tener, en promedio, mas sobrepeso que sus pares de areas urbanas. Dada su relevancia a nivel de salud publica, es importante evaluar periodicamente la prevalencia de los desordenes de peso en ninos y adolescentes de forma que puedan instituirse las estrategias preventivas apropiadas.