Joel G. Breman

Disease control priorities in developing countries

This first edition provides information on disease control interventions for the most common diseases and injuries in developing countries to help them define essential health service packages. Life expectancy in developing countries increased from forty to sixty-three years between 1950 and 1990 with a concommitant rise in the incidence of noncommunicable diseases of adults and the elderly. It is still necessary to deal with under nutrition and communicable childhood diseases. Also, new epidemic diseases like AIDS are emerging, and the health of the poor during economic crisis is a growing concern. These health developments intensify the need for better information on the effectiveness and cost of health interventions. The information is intended for health practitioners at every level. Individual chapters offer preventive and case management guidelines critical to improving the quality of care. The need for health sector reform is global. Both developed and developing countries, and centrally planned and market oriented health systems share basic dissatisfaction with the present organization and financing of health care delivery and a conviction that there are better ways to obtain results with the available resources. This book attempts to assist health sector reformers to review existing services and adapt them to provide the most cost effective interventions available.

Disease control priorities in developing countries, second edition

This is the second edition of the original 1993 publication on public health. The purpose of this book is to provide information about what works, specifically, the cost-effectiveness of health interventions in a variety of settings. Such information should influence the redesign of programs and the reallocation of resources, thereby helping to achieve the ultimate goal of reducing morbidity and mortality. As was the case with the first edition, this second edition of will serve an array of audiences. This second edition of Disease Control Priorities in Developing Countries (DCP2) seeks to update and improve guidance on the what-to-do questions in DCP1 and to address the institutional, organizational, financial, and research capacities essential for health systems to deliver the right interventions. DCP2 is the principal product of the Disease Control Priorities Project, an alliance of organizations designed to review, generate, and disseminate information on how to improve population health in developing countries. In addition to DCP2, the project produced numerous background papers, an extensive range of interactive consultations held around the world, and several additional major publications.

Advancement of global health: key messages from the Disease Control Priorities Project

The Disease Control Priorities Project (DCPP), a joint project of the Fogarty International Center of the US National Institutes of Health, the WHO, and The World Bank, was launched in 2001 to identify policy changes and intervention strategies for the health problems of low-income and middle-income countries. Nearly 500 experts worldwide compiled and reviewed the scientific research on a broad range of diseases and conditions, the results of which are published this week. A major product of DCPP, Disease Control Priorities in Developing Countries, 2nd edition (DCP2), focuses on the assessment of the cost-effectiveness of health-improving strategies (or interventions) for the conditions responsible for the greatest burden of disease. DCP2 also examines crosscutting issues crucial to the delivery of quality health services, including the organisation, financial support, and capacity of health systems. Here, we summarise the key messages of the project.In June 2004 six fighters from the Congolese Rally for Democracy-Goma gang-raped a woman in the presence of her husband and children while another soldier raped her three-year-old daughter according to Human Rights Watch. In June 2005 a 17-year-old boy was arrested by a Mai-Mai officer after he refused to draw water for the military stationed there and was severely tortured while he was held in detention in the camp. A local non-governmental organization (NGO) reported that the boy was released only after a large fine was paid. In November 2005 three soldiers from the United Congolese forces tied an 11-year-old girl with an electric cable and repeatedly raped her in a military camp according to the United Nations Organization Mission in the Democratic Republic of the Congo (MONUC). These cases are examples of the brutal violations against Congolese children as documented by the Watchlist on Children and Armed Conflict in its April 2006 report Struggling to Survive: Children in Armed Conflict in the Democratic Republic of the Congo. The country continues to endure the worlds deadliest humanitarian crisis and according to the International Rescue Committee more than 38000 people die every month as a direct and indirect consequence of the armed conflict in the Democratic Republic of the Congo (DRC). As many as 45 per cent of these deaths occurred among children who fell victim to intolerable human rights violations committed in an atmosphere of almost complete impunity. (excerpt)

Poor-quality antimalarial drugs in southeast Asia and sub-Saharan Africa

Poor-quality antimalarial drugs lead to drug resistance and inadequate treatment, which pose an urgent threat to vulnerable populations and jeopardise progress and investments in combating malaria. Emergence of artemisinin resistance or tolerance in Plasmodium falciparum on the Thailand-Cambodia border makes protection of the effectiveness of the drug supply imperative. We reviewed published and unpublished studies reporting chemical analyses and assessments of packaging of antimalarial drugs. Of 1437 samples of drugs in five classes from seven countries in southeast Asia, 497 (35%) failed chemical analysis, 423 (46%) of 919 failed packaging analysis, and 450 (36%) of 1260 were classified as falsified. In 21 surveys of drugs from six classes from 21 countries in sub-Saharan Africa, 796 (35%) of 2297 failed chemical analysis, 28 (36%) of 77 failed packaging analysis, and 79 (20%) of 389 were classified as falsified. Data were insufficient to identify the frequency of substandard (products resulting from poor manufacturing) antimalarial drugs, and packaging analysis data were scarce. Concurrent interventions and a multifaceted approach are needed to define and eliminate criminal production, distribution, and poor manufacturing of antimalarial drugs. Empowering of national medicine regulatory authorities to protect the global drug supply is more important than ever.

Combating Tropical Infectious Diseases: Report of the Disease Control Priorities in Developing Countries Project

Infectious diseases are responsible for >25% of the global disease toll. The new Disease Control Priorities in Developing Countries Project (DCPP) aims to decrease the burden of these diseases by producing science-based analyses from demographic, epidemiologic, disease intervention, and economic evidence for the purpose of defining disease priorities and implementing control measures. The DCPP recently reviewed selected tropical infectious diseases, examined successful control experiences, and defined unsettled patient treatment, prevention, and research issues. Disease elimination programs against American trypanosomiasis (Chagas disease), onchocerciasis, lymphatic filariasis, leprosy, trachoma, and measles are succeeding. Dengue, leishmaniasis, African trypanosomiasis, malaria, diarrheal diseases, helminthic infections, and tuberculosis have reemerged because of inadequate interventions and control strategies and the breakdown of health delivery systems. Application of technologies must be cost-effective and intensified research is essential if these and other scourges are to be controlled or eliminated in the 21st century.

The Confirmation and Maintenance of Smallpox Eradication

In December 1979, an independent scientific commission certified global eradication of smallpox. This conclusion was accepted at the 33d World Health Assembly of the World Health Organization (WHO) in May 1980. After WHOs intensified eradication program began in 1967, special certification procedures were used in 35 countries where the disease had been endemic and in 44 others at special risk. Six laboratories are known to retain variola virus; efforts have been made to ensure strict containment of these strains. There is no evidence that smallpox will recur as an endemic disease. Nevertheless, WHO will promote surveillance of smallpox-like disease and selected laboratory research on certain orthopoxviruses. These efforts will maintain confidence that smallpox has been eradicated and confirm that there are no animal reservoirs of variola virus. A more complete understanding of the orthopoxviruses, including monkeypox virus, should also be obtained.

Artemisinin-Resistant Malaria: Research Challenges, Opportunities, and Public Health Implications

Artemisinin-based combination therapies are the most effective drugs to treat Plasmodium falciparum malaria. Reduced sensitivity to artemisinin monotherapy, coupled with the emergence of parasite resistance to all partner drugs, threaten to place millions of patients at risk of inadequate treatment of malaria. Recognizing the significance and immediacy of this possibility, the Fogarty International Center and the National Institute of Allergy and Infectious Diseases of the U.S. National Institutes of Health convened a conference in November 2010 to bring together the diverse array of stakeholders responding to the growing threat of artemisinin resistance, including scientists from malarious countries in peril. This conference encouraged and enabled experts to share their recent unpublished data from studies that may improve our understanding of artemisinin resistance. Conference sessions addressed research priorities to forestall artemisinin resistance and fostered collaborations between field- and laboratory-based researchers and international programs, with the aim of translating new scientific evidence into public health solutions. Inspired by this conference, this review summarizes novel findings and perspectives on artemisinin resistance, approaches for translating research data into relevant public health information, and opportunities for interdisciplinary collaboration to combat artemisinin resistance.

Potential for large outbreaks of Ebola virus disease

Highlights • We revisited data from the first known Ebola outbreak in Zaire in 1976.• Using a mathematical model, we estimated transmission rates in different settings.• Analysis suggests the person-to-person R0 was 1.34 (95% CI: 0.92–2.11).• Epidemiological conditions in 1976 could have generated a larger outbreak.

Priorities in Health

This companion guide to Disease Control Priorities in Developing Countries, second edition, speeds the diffusion of life-saving knowledge by distilling the contents of the larger volume into an easily read format. Readers will get an overview of the messages and analysis in Disease Control Priorities in Developing Countries, second edition; be alerted to the scope of major diseases; learn strategies to improve policies and choices to implement cost-effective interventions; and locate chapters of immediate interest.

A Search for Ebola Virus in Animals in the Democratic Republic of the Congo and Cameroon: Ecologic, Virologic, and Serologic Surveys, 1979–1980

More than 30 years after the first outbreak of Marburg virus disease in Germany and Yugoslavia and 20 years after Ebola hemorrhagic fever first occurred in central Africa, the natural history of filoviruses remains unknown. In 1979 and 1980, animals in the Democratic Republic of the Congo and Cameroon were collected during the dry season near the site of the 1976 Ebola hemorrhagic fever epidemic. The study objectives were to identify local animals and search for evidence of Ebola virus in their tissues. A total of 1664 animals representing 117 species was collected, including >400 bats and 500 rodents. Vero and CV-1 cells and IFA and RIA were used for virus and antibody detection, respectively. No evidence of Ebola virus infection was found. This study was limited in time and animal collections and excluded insects and plants. Long-term, prospective, multidisciplinary comparative studies will yield more information than will repeat short forays on the ecology of filoviruses.