Chris Morgan

Care for Development intervention in rural China: a prospective follow-up study.

Objective: The aim of this study was to test the efficacy and appropriateness of the World Health Organizations Care for Development (CFD) counseling materials, which form part of the Integrated Management of Childhood Illness (IMCI) strategy. The CFD materials are based on the Mothers Card, which contained age-specific messages on how caregivers can better play and communicate with a child. Method: We enrolled 100 families with a child of younger than 2 years of age from seven randomly selected villages in an impoverished rural county in Anhui Province, China. Two counseling sessions, using the CFD Mothers Card, were provided to 50 families randomly selected from among the study participants. All children were assessed with Gesell Developmental Schedules before counseling and after 6 months. A questionnaire on family situation and knowledge, attitudes, and practices regarding child development was also administered at the start and conclusion of the study. Results: At baseline assessment, both control and intervention groups were equal, with average developmental scores less than the national norms. Children in families who received counseling had significantly higher development quotient scores in cognitive, social, and linguistic domains. Questionnaire data on child rearing suggested that responsive and rich interactions and consistent caregivers correlated with higher scores. The CFD Mothers Card was found to be feasible and helpful in those families who received counseling. Conclusion: There is urgent need for further work on promotion of child development in rural China. The World Health Organizations CFD approach and Mothers Card is feasible and effective and should be expanded in use, especially within the national IMCI program.

Low back pain in rural Tibet

In a baseline assessment of 30 rural villages surrounding Shigatse City, Tibet, many people, especially women, identified low back pain as a serious health problem. Consequently, we aimed to establish the prevalence of such pain and to develop appropriate interventions. We did a cross-sectional study of the prevalence of low back pain and related functional disability using two-stage random cluster sampling. We included 499 adults aged at least 15 years from 19 villages. The point prevalence of low back pain was 34.1% (95% CI 27.9-40.3% [170 people]); the 12-month prevalence was 41.9% (35.5-48.3% [209 people]). 100 (20%) villagers had substantial functional disability associated with low back pain. Low back pain is likely to be an important and under recognised problem in rural societies like Tibet.

How does progress towards the MDG 4 affect inequalities between different subpopulations? Evidence from Nepal

Background Few previous studies have examined non-wealth-based inequalities in child mortality within developing countries. This study estimates changes in under-5-year-olds and neonatal mortality in Nepal across a range of subnational levels, which allows us to assess the degree of equity in Nepals progress towards Millennium Development Goal 4. Methods Direct estimates of under-5-year-olds and neonatal death rates were generated for 1990–2005 using three Demographic and Health Surveys and two Living Standards Surveys by the following levels: national, rural/urban location, ecological region, development region, ethnicity and wealth. Absolute and relative inequalities were measured by rate differences and rate ratios, respectively. Additionally, wealth-related inequality was calculated using slope and relative indexes of inequality and concentration indices. Results Estimates suggest that while most rates of under-5-year-olds and neonatal mortality have declined across the different equity markers, leading to a downward trend in absolute inequalities, relative inequalities appear to have remained stable over time. The decline in absolute inequalities is strongest for under-5-year-olds’ mortality, with no statistically significant trend in either relative or absolute inequalities found for neonatal mortality. A possible increase in inequalities, at least in relative terms, was found across development regions, where death rates remain high in the mid-western region. Conclusions By 2015, our estimates suggest that more than 65% of deaths of under-5-year-olds will occur in the neonatal period, with stable trends in neonatal mortality inequalities. These findings along with the fact that health outcomes for neonates are more highly dependent on health systems, suggest further equitable reductions in under-5-year-olds mortality will require broad health-system strengthening, with a focus on the improvement of healthcare services provided for mothers and newborns. Other inequities suggest continued special attention for vulnerable subpopulations is warranted, particularly to overcome social exclusion and financial barriers to care in urban areas.

Neuroendocrine proliferations of the stomach: A pragmatic approach for the perplexed pathologist

The classifications of neuroendocrine proliferations that lead from enterochromaffin-like cell hyperplasia to neuroendocrine tumors in the stomach are complicated and relatively inaccessible to nonspecialists. Consequently, these lesions tend to remain widely underdiagnosed until they progress to easily recognizable neuroendocrine tumors. This review provides simple, yet rigorous guidelines on how to recognize, classify, and diagnose the neuroendocrine proliferations found in the stomach, emphasizing the most common background in which they arise, atrophic gastritis. After a succinct outline of the types and distribution of the neuroendocrine cells in the normal gastric mucosa we discuss the most common situations in which the pathologist needs to think about gastric neuroendocrine cells. In general practice gastric biopsy specimens are often numerically and topographically inadequate for the evaluation of atrophic gastritis; therefore, we have included an algorithm to address specifically the steps that should be taken when confronted with suboptimal sampling. Finally, we illustrate the suggested diagnostic process with 4 cases that are fairly representative of the type of situations encountered in everyday practice. The pathologist who follows our simple steps will be better aware of this neglected area of gastric pathology and will learn to suspect, recognize, and accurately diagnose the most common abnormalities of the neuroendocrine system in the stomach.

Helicobacter pylori Gastritis in HIV‐Infected Patients: A Review

The risk factors for acquiring Helicobacter pylori and Human Immunodeficiency Virus (HIV) infections are different: H. pylori is transmitted by gastro‐ or fecal‐oral routes and is associated with low socioeconomic conditions, while HIV is transmitted through sexual intercourse, infected body fluids, and transplacentally. If the host responses to these infections were independent, the prevalence of H. pylori should be similar in HIV‐infected and non‐infected patients. Yet, several studies have detected a lower prevalence of H. pylori in patients with HIV infection, whereas other studies found either no differences or greater rates of H. pylori infection in HIV‐positive subjects.

The effects, safety and acceptability of compact, pre-filled, autodisable injection devices when delivered by lay health workers.

To systematically assess (i) the effects and safety and (ii) the acceptability of using lay health workers (LHWs) to deliver vaccines and medicines to mothers and children through compact pre‐filled autodisable devices (CPADs).

Measles in Papua New Guinea: An age-specific serological survey

We aimed to determine the proportion of the population in Madang (Papua New Guinea) immune to measles infection by age groups, with respect to immunization status and study location, using dried blood sampling technology. We performed a prospective cross-sectional sero-survey. Population immunity against measles was sub-optimal (77%) and reported measles vaccine coverage in children <10 years of age was low (41%). The urban population was more susceptible to measles infection, compared with the rural population (66% vs 79% immune, aOR=0.6, p=0.05). Sero-conversion and long term protection rates appeared to be higher when at least one dose of vaccine was provided at or after 12 months of age (84% vs 59%, aOR=4.3, p=0.004). Such a dose is, however, not currently prescribed by the national immunization schedule.

Causes of puerperal and neonatal sepsis in resource‐constrained settings and advocacy for an integrated community‐based postnatal approach

Puerperal sepsis and neonatal sepsis are important causes of mortality and morbidity in low‐income countries.

Cost-effectiveness of the controlled temperature chain for the hepatitis B virus birth dose vaccine in various global settings: a modelling study

BACKGROUND The controlled temperature chain (CTC) strategy allows vaccines to be kept outside the cold chain for a short period of time. In remote rural areas, the CTC strategy for the hepatitis B virus (HBV) birth dose vaccination could improve its geographical coverage and timeliness of delivery, but with additional outreach costs. We assessed the cost-effectiveness of the CTC strategy for the HBV birth dose across six world regions and 72 countries according to their HBV prevalence, delivery costs, and birth dose coverage and timing. METHODS By use of a mathematical model of perinatal HBV transmission and disease progression, we calculated per 1000 births the total HBV-related disability-adjusted life-years (DALYs) and costs, including vaccine delivery costs and costs associated with HBV-related disease, with and without the CTC strategy. FINDINGS A CTC strategy produced health benefits in all regions and was cost-saving in the regions of east Asia and Pacific, Latin America and Caribbean, sub-Saharan Africa, and north Africa and Middle East. The CTC strategy cost US

Feasibility and acceptability of clean birth kits containing misoprostol for self-administration to prevent postpartum hemorrhage in rural Papua New Guinea

0·15 (IQR -7·11 to 4·75) per DALY averted in the central and eastern Europe and central Asia region and