Basing policy on evidence: low HIV, STIs, and risk behaviour in Dili, East Timor argue for more focused interventions.
BACKGROUND: East Timor is a newly independent, poor nation with many internally displaced people and foreign peace keeping forces. Similarities with Cambodia, which now has Asia's worst HIV epidemic, caused donors to earmark money for HIV prevention in East Timor, but no data were available to plan appropriate programmes. OBJECTIVES: To determine levels of infection with HIV and other sexually transmitted infections (STIs) and associated risk behaviours in Dili, East Timor, in order to guide resource allocation and appropriate prevention and care strategies. METHODS: In mid-2003, a cross sectional survey of female sex workers, men who have sex with men (MSM), taxi drivers, and soldiers was conducted. Participants provided biological specimens and all answered structured questionnaires. RESULTS: HIV prevalence was 3% among female sex workers (3/100), 0.9% among MSM (1/110), and zero in the other groups. All the HIV infected sex workers reported sex with foreign clients. Partner turnover reported by all groups was among the lowest in Asia, so was condom use. Access to basic HIV prevention services, including condoms and STI services, was extremely low in all groups. CONCLUSIONS: A few sex workers are infected with HIV in East Timor, but the virus is not circulating widely among their clients, and sexual networking is limited. The risk of a generalised HIV epidemic in East Timor is minimal. HIV can be contained by the provision of basic services to the small minority of the population at highest risk, preserving resources for other health and development needs. (+info)
Efficacy of sulfadoxine-pyrimethamine in the treatment of uncomplicated Plasmodium falciparum malaria in East Timor.
The efficacy of sulfadoxine-pyrimethamine (SP) in East Timor is unknown. We treated 38 individuals with uncomplicated Plasmodium falciparum malaria with SP and monitored the outcome for 28 days. Recrudescent parasitemia, confirmed by genotyping, were detected in three individuals resulting in a late treatment failure rate of 7.9% (95% confidence interval = 1.7-21.4%). The results suggest that SP is still efficacious in treating uncomplicated P. falciparum malaria in East Timor. However, the useful life of SP in East Timor may be limited because 80% of the parasites in our samples were found to already carry double mutations in P. falciparum dihydrofolate reductase (S108N/C59R). The data from this study also highlights that the presence of gametocytes may significantly influence the estimate of SP efficacy determined by genotyping. (+info)
Rehabilitating the health system after conflict in East Timor: a shift from NGO to government leadership.
Efforts to rehabilitate health systems after periods of prolonged conflict have often been characterized by poor coordination of external actors - multilateral agencies, donors and non-governmental organizations (NGOs). This paper describes the process and analyses the roles of the different stakeholders in the establishment of a government-led district health system in East Timor, between 1999 and 2002, after decades of chronic conflict and Indonesian occupation. Future East Timorese policy-makers and health professionals began to mobilize in May 1999, in preparation for independence. During the emergency phase, from September 1999, when violence erupted, to March 2000, NGOs played a major role in the provision of relief to the population, coordinated by United Nations agencies. An Interim Health Authority, led by local Timorese, was established in March and the major donors began to shift funding from NGOs to the newly established Ministry of Health. A rapid phasing-out of NGOs, accompanied by a sequence of steps to build the capacity of Timorese to manage the new district health system, was implemented. Early evidence shows that health service utilization continued to grow during and after implementation. (+info)
A case of fatal Plasmodium falciparum malaria complicated by acute dengue fever in East Timor.
A case is reported of a seven-year-old girl who had concurrent infections with Plasmodium falciparum malaria and dengue in a remote area of East Timor. The diagnosis of malaria was delayed because of two false-negative results with malaria rapid diagnosis test cards. Diagnosis was eventually made on microscopic examination of the patient's blood. Despite treatment, the patient subsequently died. This case serves as a reminder of the fallibility of rapid diagnostic tests, and the importance of examining the patient's blood microscopically if malaria is suspected. (+info)
An isolated case of leprosy presenting in a migrant worker in Northern Ireland.
Leprosy was first recorded in 600 bc in India. Europe saw its first cases in the fourteenth century. The worldwide incidence is falling, but the disease can still present in the most unexpected places: this is a report of the first case of leprosy presenting to an emergency department in Northern Ireland. It is important for physicians in both community and hospital medicine to have a high index of suspicion for leprosy in patients with chronic skin conditions who were born outside the UK or other developed countries. (+info)
Reconstructing tuberculosis services after major conflict: experiences and lessons learned in East Timor.
BACKGROUND: Tuberculosis (TB) is a major public health problem in developing countries. Following the disruption to health services in East Timor due to violent political conflict in 1999, the National Tuberculosis Control Program was established, with a local non-government organisation as the lead agency. Within a few months, the TB program was operational in all districts. METHODS AND FINDINGS: Using the East Timor TB program as a case study, we have examined the enabling factors for the implementation of this type of communicable disease control program in a post-conflict setting. Stakeholder analysis was undertaken, and semi-structured interviews were conducted in 2003 with 24 key local and international stakeholders. Coordination, cooperation, and collaboration were identified as major contributors to the success of the TB program. The existing local structure and experience of the local non-government organisation, the commitment among local personnel and international advisors to establishing an effective program, and the willingness of international advisers and local counterparts to be flexible in their approach were also important factors. This success was achieved despite major impediments, including mass population displacement, lack of infrastructure, and the competing interests of organisations working in the health sector. CONCLUSIONS: Five years after the conflict, the TB program continues to operate in all districts with high notification rates, although the lack of a feeling of ownership by government health workers remains a challenge. Lessons learned in East Timor may be applicable to other post-conflict settings where TB is highly prevalent, and may have relevance to other disease control programs. (+info)
Fataluku medicinal ethnobotany and the East Timorese military resistance.
BACKGROUND: An ethnobotanical study of medicinal and poisonous plants used by the East Timor resistance was undertaken in the Lautem District of East Timor to study medicinal plant use in the region. Interviews were conducted with a single key consultant from the resistance army who belonged to the Fataluku culture. This study is of importance as a historical document and because no previous medicinal ethnobotanical studies on this region exist. METHODS: A rapid ethnobotanical survey of medicinal and poisonous plants was conducted through the proposed Conis Santana National Park in the Lautem district of East Timor. Medicinal and poisonous plants were identified by a Consultant and data was collected by the authors using classical descriptive ethnobotanical techniques (i.e. no quantitative measures) through an unstructured open ended interview. RESULTS: During the survey 40 medicinal and poisonous plants were identified by the Consultant and collected by the authors. Defining characteristics of the Consultant's knowledge include a high frequency use of trees, heavily forested habitats, leaves, decoctions and drinks for a range of conditions relevant to a resistance army. CONCLUSION: Despite limitations of the study, important contributions of this study include preservation of a part of the cultural history of the resistance movement and traditional botanical knowledge of the Fataluku. Furthermore, initial findings may indicate that traditional botanical knowledge is unique amongst different East Timorese cultures in terms of plant selection. (+info)
Correction of refractive error and presbyopia in Timor-Leste.
AIM: To investigate the aspects of spectacle correction of vision-impairing refractive error and presbyopia in those aged >or=40 years in Timor-Leste. METHOD: A population-based cross-sectional survey with cluster random sampling was used to select 50 clusters of 30 people. Those who had uncorrected or undercorrected refractive error (presenting acuity worse than 6/18, but at least 6/18 with pinhole), uncorrected or undercorrected presbyopia (near vision worse than N8), and/or who were using or had used spectacles were identified. Dispensing history, willingness to wear and willingness to pay for spectacles were elicited. RESULTS: Of 1470 people enumerated, 1414 were examined (96.2%). The "met refractive error need" in the sample was 2.2%, and the "unmet refractive error need" was 11.7%. The "refractive error correction coverage" was 15.7%. The "met presbyopic need" was 11.5%, and the "unmet presbyopic need" was 32.3%. The "presbyopia correction coverage" was 26.2%. Lower correction coverage was associated with rural domicile, illiteracy and farming. Of the sample, 96.0% were willing to wear spectacles correcting impaired vision. Of these, 17.0% were willing to pay US$3 ( pound 1.52, euro 2.24) for spectacles, whereas 50.2% were unwilling to pay US$1 ( pound 0.51, euro 0.75). Women and rural dwellers were less likely to be willing to pay at least US$1 for spectacles. CONCLUSION: Refractive error and presbyopia correction coverage rates are low in Timor-Leste. There is a large need for spectacles, especially for elderly and illiterate people, farmers and rural dwellers: those least able to pay for them. An equitable cross-subsidisation spectacle system should be possible. (+info)