Tuberculosis treatment in complex emergencies: are risks outweighing benefits? (25/157)

Tuberculosis (TB) is a major public health problem in complex emergencies. Humanitarian agencies usually postpone the decision to offer TB treatment and opportunities to treat TB patients are often missed. This paper looks at the problem of tuberculosis treatment in these emergencies and questions whether treatment guidelines could be more flexible than international recommendations. A mathematical model is used to calculate the risks and benefits of different treatment scenarios with increasing default rates. Model outcomes are compared to a situation without treatment. An economic analysis further discusses the findings in a trade-off between the extra costs of treating relapses and failures and the savings in future treatment costs. In complex emergencies, if a TB programme could offer 4-month treatment for 75% of its patients, it could still be considered beneficial in terms of public health. In addition, the proportion of patients following at least 4 months of treatment can be used as an indicator to help evaluate the public health harm and benefit of the TB programme.  (+info)

Famine-affected, refugee, and displaced populations: recommendations for public health issues. (26/157)

During the past three decades, the most common emergencies affecting the health of large populations in developing countries have involved famine and forced migrations. The public health consequences of mass population displacement have been extensively documented. On some occasions, these migrations have resulted in extremely high rates of mortality, morbidity, and malnutrition. The most severe consequences of population displacement have occurred during the acute emergency phase, when relief efforts are in the early stage. During this phase, deaths--in some cases--were 60 times the crude mortality rate (CMR) among non-refugee populations in the country of origin (1). Although the quality of international disaster response efforts has steadily improved, the human cost of forced migration remains high. Since the early 1960s, most emergencies involving refugees and displaced persons have taken place in less developed countries where local resources have been insufficient for providing prompt and adequate assistance. The international community's response to the health needs of these populations has been at times inappropriate, relying on teams of foreign medical personnel with little or no training. Hospitals, clinics, and feeding centers have been set up without assessment of preliminary needs, and essential prevention programs have been neglected. More recent relief programs, however, emphasize a primary health care (PHC) approach, focusing on preventive programs such as immunization and oral rehydration therapy (ORT), promoting involvement by the refugee community in the provision of health services, and stressing more effective coordination and information gathering. The PHC approach offers long-term advantages, not only for the directly affected population, but also for the country hosting the refugees. A PHC strategy is sustainable and strengthens the national health development program.  (+info)

Mortality among displaced former UNITA members and their families in Angola: a retrospective cluster survey. (27/157)

OBJECTIVE: To measure retrospectively mortality among a previously inaccessible population of former UNITA members and their families displaced within Angola, before and after their arrival in resettlement camps after ceasefire of 4 April 2002. DESIGN: Three stage cluster sampling for interviews. Recall period for mortality assessment was from 21 June 2001 to 15-31 August 2002. SETTING: Eleven resettlement camps over four provinces of Angola (Bie, Cuando Cubango, Huila, and Malange) housing 149 000 former UNITA members and their families. PARTICIPANTS: 900 consenting family heads of households, or most senior household members, corresponding to an intended sample size of 4500 individuals. MAIN OUTCOME MEASURES: Crude mortality and proportional mortality, overall and by period (monthly, and before and after arrival in camps). RESULTS: Final sample included 6599 people. The 390 deaths reported during the recall period corresponded to an average crude mortality of 1.5/10 000/day (95% confidence interval 1.3 to 1.8), and, among children under 5 years old, to 4.1/10 000/day (3.3 to 5.2). Monthly crude mortality rose gradually to a peak in March 2002 and remained above emergency thresholds thereafter. Malnutrition was the leading cause of death (34%), followed by fever or malaria (24%) and war or violence (18%). Most war victims and people who had disappeared were women and children. CONCLUSIONS: This population of displaced Angolans experienced global and child mortality greatly in excess of normal levels, both before and after the 2002 ceasefire. Malnutrition deaths reflect the extent of the food crisis affecting this population. Timely humanitarian assistance must be made available to all populations in such conflicts.  (+info)

International surgery: definition, principles and Canadian practice. (28/157)

This article is dedicated to the Canadian international surgeon, Norman Bethune (1890-1939). International surgery is defined as a humanitarian branch of medicine concerned with the treatment of bodily injuries or disorders by incision or manipulations, emphasizing cooperation and understanding among nations and involving education, research, development and advocacy. In this article I review the colonial past, the dark ages following the Declaration of Alma-Ata, the progress made and the present challenges in international surgery. I present a definition of international surgery that recognizes the current era of surgical humanitarianism, validates a global understanding of surgical issues and promotes cooperation among nations. Included are the principles of international surgery: education, research, infrastructure development and advocacy. International surgical projects are classified according to type (clinical, relief, developmental) and integration strategy (vertical or horizontal). Also reviewed are the Canadian practice of international surgery by nongovernmental, professional and academic organizations and the requirements of international and Canadian funding agencies, the development concepts basic to all projects, including results-based management and the cross-cutting themes of gender equity, environmental protection and human safety. I recommend formalizing international surgery into a discipline as a means of promoting surgical care in low-income countries. If international surgery is to be sustained in Canada, infrastructure and support from Canadian surgeons is particularly important. An understanding of the history, definition and classification of international surgery should promote surgical care in low-income countries.  (+info)

Rapid community health and needs assessments after Hurricanes Isabel and Charley--North Carolina, 2003-2004. (29/157)

On September 18, 2003, Hurricane Isabel, a Category 2 hurricane, made landfall on the Outer Banks of North Carolina (NC). The storm, moving to the northeast with winds exceeding 100 mph, caused extensive power outages and structural damage in northeastern NC and southern Virginia. In NC, approximately 762,000 residents lost power during the storm, and the shelter population peaked at an estimated 16,600 persons. Six storm-related fatalities were reported, and 26 eastern NC counties were included in a federal disaster area declaration. The North Carolina Division of Public Health (NCDPH) activated the Office of Public Health Preparedness and Response (PHPR) and seven Public Health Regional Surveillance Teams (PHRSTs) to conduct a rapid community health and needs assessment for the affected population. CDC deployed staff to provide technical support to NCDPH. The assessment determined that the majority of public health emergencies resulted from electric power outages, which affected access to food, water, and medical care. Data and recommendations were provided immediately to local and state emergency responders, who used the information to direct Hurricane Isabel recovery efforts and also to improve the assessment, which was next deployed in August 2004 with Hurricane Charley.  (+info)

Health problems in Iraq.(30/157)

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A field trial of a survey method for estimating the coverage of selective feeding programmes. (31/157)

OBJECTIVE: To test a survey method for estimating the coverage of selective feeding programmes in humanitarian emergencies. METHODS: The trial survey used a stratified design with strata that were defined using the centric systematic area sample method. Thirty 100 km2 quadrats were sampled. The communities located closest to the centre of each quadrat were sampled using a case-finding approach. FINDINGS: The method proved simple and rapid to implement and allowed overall and per-quadrat coverage to be estimated. Overall coverage was 20.0% (95% confidence intervals, 13.8-26.3%). Per-quadrat coverage ranged from zero (in nine quadrats) to 50% (in one quadrat). Coverage was highest in the quadrats closest to therapeutic feeding centres and in quadrats containing major roads leading to the towns in which therapeutic feeding centres were located. CONCLUSION: The method should be used, in preference to WHO Expanded Programme on Immunization (EPI)-derived survey methods, for estimating the coverage of selective feeding programmes. Its use should also be considered when evaluating the coverage of other selective entry programmes or when coverage is likely to be spatially inhomogeneous.  (+info)

Medical needs of tsunami disaster refugee camps. (32/157)

BACKGROUND AND OBJECTIVES: In response to the massive tsunami disaster in South Asia, two Korean medical relief teams provided emergency medical care in the southern coastal area of Sri Lanka. Their findings are reported here to provide a realistic picture of medical needs created by the tsunami disaster and to enable a better-prepared medical response to future disasters of this type. METHODS: All victims of the tsunami in the area of operation of the two medical relief teams were encouraged to receive medical care. Care provided to each victim was documented in individual medical records. All medical records were reviewed and classified by age, gender, and diagnosis. RESULTS: A total of 4,710 people were treated by the two Korean medical relief teams for 9 days of operation in southern Sri Lanka. Respiratory problems were common, but diarrhea was diagnosed in an average of only 4.3 patients per day. Minor skin trauma and wound infection in the extremities were frequent as long as 3 weeks after the disaster. The proportion of skin trauma in relation to total trauma decreased as days elapsed from the disaster. CONCLUSIONS: Because of the provision of adequate quantities of potable water, the likelihood of waterborne diarrhea was low. Acute respiratory problems and chronic problems were prevalent in tsunami refugee camps. Despite concerted international relief efforts, inadequate treatment of minor skin trauma and skin infections was evident.  (+info)