With the increase in global travel, no disease is beyond the reach of any population. Traveling patients should be advised to follow food and water precautions and encouraged to receive the recommended immunizations. Travel medicine plays a vital role not only in limiting the morbidity of travel-related illnesses but also in limiting the spread of diseases. This article addresses the common issues related to travel, reviews the care of the immunocompromised traveler, and updates the available vaccinations and prophylactic regimens available to limit sickness abroad. (+info)
Eradication: lessons from the past.
The declaration in 1980 that smallpox had been eradicated reawakened interest in disease eradication as a public health strategy. The smallpox programme's success derived, in part, from lessons learned from the preceding costly failure of the malaria eradication campaign. In turn, the smallpox programme offered important lessons with respect to other prospective disease control programmes, and these have been effectively applied in the two current global eradication initiatives, those against poliomyelitis and dracunculiasis. Taking this theme a step further, there are those who would now focus on the development of an inventory of diseases which might, one by one, be targeted either for eradication or elimination. This approach, while interesting, fails to recognize many of the important lessons learned and their broad implications for contemporary disease control programmes worldwide. (+info)
The principles of disease elimination and eradication.
The Dahlem Workshop discussed the hierarchy of possible public health interventions in dealing with infectious diseases, which were defined as control, elimination of disease, elimination of infections, eradication, and extinction. The indicators of eradicability were the availability of effective interventions and practical diagnostic tools and the essential need for humans in the life-cycle of the agent. Since health resources are limited, decisions have to be made as to whether their use for an elimination or eradication programme is preferable to their use elsewhere. The costs and benefits of global eradication programmes concern direct effects on morbidity and mortality and consequent effects on the health care system. The success of any disease eradication initiative depends strongly on the level of societal and political commitment, with a key role for the World Health Assembly. Eradication and ongoing programmes constitute potentially complementary approaches to public health. Elimination and eradication are the ultimate goals of public health, evolving naturally from disease control. The basic question is whether these goals are to be achieved in the present or some future generation. (+info)
Disease eradication and health systems development.
This article provides a framework for the design of future eradication programmes so that the greatest benefit accrues to health systems development from the implementation of such programmes. The framework focuses on weak and fragile health systems and assumes that eradication leads to the cessation of the intervention required to eradicate the disease. Five major components of health systems are identified and key elements which are of particular relevance to eradication initiatives are defined. The dearth of documentation which can provide "lessons learned" in this area is illustrated with a brief review of the literature. Opportunities and threats, which can be addressed during the design of eradication programmes, are described and a number of recommendations are outlined. It is emphasized that this framework pertains to eradication programmes but may be useful in attempts to coordinate vertical and horizontal disease control activities for maximum mutual benefits. (+info)
Health seeking behaviour and the control of sexually transmitted disease.
What people do when they have symptoms or suspicion of a sexually transmitted disease (STD) has major implications for transmission and, consequently, for disease control. Delays in seeking and obtaining diagnosis and treatment can allow for continued transmission and the greater probability of adverse sequelae. An understanding of health seeking behaviour is therefore important if STD control programmes are to be effective. However, taboos and stigma related to sex and STD in most cultures mean that gaining a true picture is difficult and requires considerable cultural sensitivity. At the moment relatively little is known about who people turn to for advice, or about how symptoms are perceived, recognized or related to decisions to seek help. It is argued that such knowledge would assist programme planners in the development of more accessible and effective services, that studies of health seeking behaviour need to include a combination of qualitative and quantitative methods, and that studies should include data collection about people who do not present to health care facilities as well as those who do. A pilot protocol for studying STD-related health seeking behaviour in developing countries is briefly presented. (+info)
Health policy development in wartime: establishing the Baito health system in Tigray, Ethiopia.
This paper documents health experiences and the public health activities of the Tigray People's Liberation Front (TPLF). The paper provides background data about Tigray and the emergence of its struggle for a democratic Ethiopia. The origins of the armed struggle are described, as well as the impact of the conflict on local health systems and health status. The health-related activities and public health strategies of the TPLF are described and critiqued in some detail, particular attention is focused on the development of the baito system, the emergent local government structures kindled by the TPLF as a means of promoting local democracy, accountability, and social and economic development. Important issues arise from this brief case-study, such as how emerging health systems operating in wartime can ensure that not only are basic curative services maintained, but preventive and public health services are developed. Documenting the experiences of Tigray helps identify constraints and possibilities for assisting health systems to adapt and cope with ongoing conflict, and raises possibilities that in their aftermath they leave something which can be built upon and further developed. It appears that promoting effective local government may be an important means of promoting primary health care. (+info)
The progress of the Polio Eradication Initiative: what prospects for eradicating measles?
Although various attempts have been made to eradicate infectious diseases, only smallpox has been eradicated to date. Polio is targeted for eradication in 2000 and already planning has begun for the eradication of measles. However, before we commit to a measles eradication effort, we must examine the lessons to be learned from polio eradication. Of particular importance is the debate over whether resources should be invested in 'horizontal' or 'vertical' programmes. The outcome of these debates will have a very deep and lasting impact on global health development in years to come. Collaboration between targeted programmes and the primary health care sector through polio and measles eradication efforts will help bring about the necessary balance between goal-oriented programmes, which are subject to quality control and can be evaluated by measurable outcomes, and broader efforts to build up sustainable health infrastructure. (+info)
Commentary: Emerging and other communicable diseases.
There is an increasing need for integrated, sustainable; and cost-effective approaches to the management of infectious diseases. For example, an emerging disease in one country may already be endemic in another country but nearing elimination in a third. A coordinated approach by WHO towards infectious diseases is therefore needed that will facilitate more effective support of on-going efforts for the prevention and control of endemic diseases, intensify efforts against those diseases targeted for eradication and elimination, and result in better preparedness and response to new and re-emerging diseases. In order to meet these challenges, WHO has created a new Programme on Communicable Diseases (CDS), which will replace the former Division of Emerging and other Communicable Diseases (EMC). The new Programme will better integrate surveillance, prevention, control, and research over the whole spectrum of communicable diseases. CDS will function as focal point for global data and information exchange on infectious diseases, and inter alia, will reinforce laboratory-based surveillance of bacterial, viral, and zoonotic diseases to ensure early detection of threats to international public health. Changes in susceptibility to infectious disease, increased opportunities for infection, and the ability of microbes to adapt rapidly will continue to challenge WHO to improve prevention and control of infectious diseases in the future by establishing strong partnerships with both the private and public sectors. (+info)