DHS Working Papers No. 102
The new WHO recommendations for the treatment of isoniazid-resistant, rifampicin-susceptible TB are based upon a review of evidence from patients treated with such regimens by a Guideline Development Group in conformity with WHO requirements for evidence-based policies.
A Guide For Multicentre Trials in High-Burden Countries
DHS Analytical Studies No. 51
Child Health, Family Planning, Geographic Information, HIV, Malaria, Maternal Health
The purpose of this Operational Guideline is to support state health authorities, programme managers and health care professionals with recommendations on appropriate management of children with SAM in the health facilities. Facility based management includes setting up and managing within the healt...h facility premises, a functional space where these children are cared for. This Facility Based Unit is referred to as Nutritional Rehabilitation Centre or NRC in the document. While the scale and design may vary in a given situation, it is intended that the document provide the basis for a consistent set of principles that can be used by all states for facility based management of children with SAM. The Operational Guideline focuses on the Facility/Hospital based approach for the management of SAM children under 5 years of age based on the WHO and revised IAP protocols.
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Vol. 7, No. 1 (2018) | ISSN 2166-7403 (online) DOI 10.5195/cajgh.2018.295 | http://cajgh.pitt.edu
This report investigates the impact of potential misclassification of samples on HIV prevalence estimates for 23 surveys conducted from 2010-2014. In addition to visual inspection of laboratory results, we examined how accounting for potential misclassification of HIV status through Bayesian latent ...class models affected the prevalence estimates. Two types of Bayesian models were specified: a model that only uses the individual dichotomous test results and a continuous model that uses the quantitative information of the EIA (i.e., the signal-to-cutoff values). Overall, we found that adjusted prevalence estimates matched the surveys’ original results, with overlapping uncertainty intervals. This suggested that misclassification of HIV status should not affect the prevalence estimates in most surveys. However, our analyses suggested that two surveys may be problematic. The prevalence could have been overestimated in the Uganda AIDS Indicator Survey 2011 and the Zambia Demographic and Health Survey 2013-14, although the magnitude of overestimation remains difficult to ascertain. Interpreting results from the Uganda survey is difficult because of the lack of internal quality control and potential violation of the multivariate normality assumption of the continuous Bayesian latent class model. In conclusion, despite the limitations of our latent class models, our analyses suggest that prevalence estimates from most of the surveys reviewed are not affected by sample misclassification.
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DHS Working Papers No. 69
This paper uses data from the three Indian National Family Health Surveys (1992-93, 1998-99, 2005-06) to examine how the relationship between household wealth and child mortality evolved during a time of significant economic change in India. The main predictor is a new... measure of household wealth that captures changes in wealth over time. Outcomes include neonatal mortality, postneonatal mortality, child mortality, and under-five mortality. Multivariate analysis is conducted at the national, urban, rural, and regional levels.
Results indicate that the overall relationship between household wealth and mortality weakened over time, as evidenced by the coefficients for under-five mortality at the national level.
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Despite recent global declines, under-five mortality remains high in many of the poorest countries. Barriers to timely
quality care, including user fees, distance to facilities and the availability of trained health workers and medical supplies,
hinder progress in further reducing morbidity and m...ortality
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Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries (LMIC). The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in LMIC. Barriers at the... patient, health-care provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including: (1) effective measures for tobacco control; (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of health care through task-sharing (non-physician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above, will lead to substantial reductions in CVD and related mortality.
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The frequency of infectious disease epidemics is increasing, and the role of the health sector in the management of epidemics is crucial in terms of response. In the context of infectious disease epidemics, the use of climate-informed early warning systems (EWS) has the potential to increase the eff...ectiveness of disease control by intervening before or at the beginning of the epidemic curve, instead of during the downward slope.
Currently, the initiation of interventions is heavily reliant on routine disease surveillance systems – data that often arrive too late for preventative response. However, forecasting of disease outbreaks using surveillance and weather information shows promising potential – there also remains further scope to examine seasonal climate forecasts. By combining these elements in new EWS based on computational models, it will be possible to improve both the timeliness and impact of disease control. The World Health Organization (WHO) is strengthening existing surveillance systems for infectious diseases to enable the development of more robust and timely EWS, which has resulted in the rapid development and innovation of EWS for disease outbreaks.
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