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WHAT'S NEW THIS SUNDAY: FIRST QUARTER MILLION HITS; HIGH VOLUME MALE CIRCUMCISION, TANZANIA; SANITATION AND SOIL TRANSMITTED HELMINTHS

Saturday, 9th of June 2012

• WHAT’S NEW:  FIRST QUARTER MILLION HITS; HIGH VOLUME MALE CIRCUMCISION, TANZANIA; SANITATION AND SOIL TRANSMITTED HELMINTHS
  
  QUERY TO READERS
  
  To celebrate going over the quarter million mark, I am offering one bottle of French champagne (or other favorite libation ) to the reader who can name one child survival intervention not currently being implemented in most developing countries.
  
  I will not consider any of  the following:
  Vaccination
  LLINs/Residual spraying
  Vitamin A
  Nutritional monitoring
  Training and Fielding of Community Health Workers
  Onchocerciasis elimination/dracunculiasis eradication
  IMNCI
  Condoms/male circumcision/abstinence/PMTCT
  
  Your entries to rdavis@africamail.com
  
  Good luck, and may the best person win.
  BD
  
  
• FIRST QUARTER MILLION HITS

Since going public in December 2010 to 10 June 2012, this site has seen 250,000 hits. As so often happens, a minority of the items posted get the lion’s share of the reader’s hits. The 62 items listed below got over 1000 hits each, accounting for 83,000 of the total hits. Among these, four topics -- measles, with 15 articles, polio, with 14, malaria, with 7, and new and under-used vaccines, with 3 -- accounted for over half the total.

‘Reading maketh a full man; conference a ready man; and writing an exact man.’ – Sir Francis Bacon

Good reading.

BD

1.    CSU 4/2011: SELF LEARNING COURSES IN PUBLIC HEALTH	2227
2.      POLIO COMPARED TO MEASLES	2137
3.      SEASONALITY AND THE PERSISTENCE AND INVASION OF MEASLES	2096
4.      COCHRANE REVIEW: THE IMPACT OF USER FEES ON ACCESS TO HEALTH SERVICES IN LOW- AND MIDDLE-INCOME COUNTRIES -- A COCHRANE REVIEW	2083
5.      EQUALITY OF ACCESS FOR MEASLES VACCINATION/ AEROSOL VACCINATION AGAINST MEASLES	2055
6.      CSU 71/2010: NEW VACCINES FOR TUBERCULOSIS	2045
7.      GLOBAL MEASLES UPDATE	2039
8.      WHAT'S NEW THIS WEEKEND: CDC MALARIA POSITIONS, PREDICTORS OF CHILD SURVIVAL, SIMPLIFIED ARV DELIVERY MODELS, USE OF LAY PERSONNEL FOR ROUTINE IMMUNIZATION	1705
9.      CSU 25/2008: ANTIMALARIAL MONOTHERAPY IN THE MOST SEVERELY MALARIOUS PARTS OF AFRICA	1541
10.     CSU 28/2008: PNEUMONIA	1487
11.     TB VACCINE RESEARCH	1477
12.     CSU 52/2010: FOUR ON POLIO: BILL GATES, POLIO IN TAJIKISTAN	1451
13.     CSU 10/2009: ALLIANCE FOR MALARIA PREVENTION	1450
14.     CSU 20/2008: TWO ON MEASLES/BOOK REVIEW/READER FEEDBACK (2)	1435
15.     MEASLES REVIEW ARTICLE, MOSS & GRIFFIN	1425
16.     CSU 11/2008: GATES FOUNDATION ON MALARIA ERADICATION	1421
17.     CSU 18/2008: HIB VACCINATION IN UGANDA	1420
18.     CSU 3/2009: VACCINE DERIVED POLIOVIRUS	1419
19.     CSU 33/2008: BCG AND LEPROSY PROTECTION	1406
20.     CSU 36/2008: THE CASE FOR UNIVERSAL HEP B VACCINATION	1406
21.     CSU 27/2010: POLIO ERADICATION WITHIN FIVE YEARS	1405
22.     CSU 48/2008: PERSISTENCE OF HEP B PROTECTION IN VACCINEES AFTER 15 YEARS	1404
23.     CSU 24/2008: PREVENTING CHILD MALARIA BY PROTECTING ADULTS WITH BED NETS	1394
24.     49/2008: READER FEEDBACK/SEX RATIOS IN MUMBAI	1388
25.     CSU 37/2008: QUERY TO READERS/READER FEEDBACK/EPI TRAINING	1369
26.     COCHRANE REVIEW:: CASH INCENTIVES FOR CHILD HEALTH	1367
27.     CSU 31/2008: FUTURE GLOBAL POLICIES FOR MANAGING POLIOVIRUSES	1365
28.     CSU 38/2009: HORSTMANN ON POLIO/ NATHANSON ET AL ON US POLIO SURVEILLANCE, 1956 / THE CUTTER INCIDENT	1352
29.     CHILD SURVIVAL UPDATE 8/2009: THE FINAL PUSH TOWARDS POLIO ERADICATION	1348
30.     CSU 19/2008: LIMITS AND INTENSITY OF FALCIPARUM /READER FEEDBACK	1348
31.     MEASLES PRE-ELIMINATION GOAL, WHO/AFRO	1340
32.     CSU 51/2008: THREE ON MALARIA	1313
33.     SELF-INSTRUCTIONAL PUBLIC HEALTH TRAINING ONLINE/ RESEARCH CAPACITY IN AFRICA	1307
34.     CSU 2/2011: WHO WEBSITES/ UPDATED TOP HITS OF 2010: COCHRANE MAKES THE TOP 10	1300
35.     REVIEW ON AEROSOL MEASLES VACCINES/ FEASIBILITY OF GLOBAL MEASLES ERADICATION	1290
36.     MEASLES ELIMINATION IN AUSTRALIA AND 17 EUROPEAN COUNTRIES/ GENETIC DIVERSITY OF MEASLES VIRUS IN EUROPE	1285
37.     CSU 16/2008: INTERVENTIONS FOR MATERNAL & CHILD UNDERNUTRITION & SURVIVAL	1280
38.     WHAT'S NEW THIS SUNDAY: IS MALARIA VACCINE A MAGIC BULLET?; DISTRIBUTION OF HEALTH CARE BENEFITS IN KENYA; BOOK REVIEW, 'EPIDEMIOLOGICAL RESEARCH'	1264
39.     CSU 10/2008: THE GLOBAL IMPACT OF VACCINATION	1245
40.     CSU 33/2007: THREE ON ERADICATION	1245
41.     CSU 42/2008: PATERNAL SMOKING AND CHILD MORTALITY	1235
42.     CSU 40/2008: The Social Determinants of Health/Primary Health Care, Full Circle	1223
43.     FOUR IDEAS TOO CHEAP TO IMPLEMENT	1205
44.     CSU 42/2009: OBAMA ON POLIO/ HOPKINS ON DRACUNCULIASIS ERADICATION	1144
45.     CSU 169/2011: USE OF MASS MEDIA CAMPAIGNS TO CHANGE HEALTH BEHAVIOR	1091
46.     CSU 18/2011: THE ORIGIN OF THE HAITIAN CHOLERA OUTBREAK STRAIN	1066
47.     REDESIGNED VACCINATION CARDS TO REDUCE DROPOUT RATES	1061
48.     CSU 4/2008: BIRTH SPACING/ MORE ON MALE CIRCUMCISION	1047
49.     CSU 21/2008: CHILD SURVIVAL IN TANZANIA/QUERY TO READERS/READER FEEDBACK	1031
50.     BAD PRACTICES IN MEASLES VACCINATION	1030
51.     CSU 50/2009: HETEROSEXUAL RISK OF HIV-1 INFECTION PER SEXUAL ACT	1024
52.     CSU 17/2008: MATERNAL AND CHILD MORTALITY IN SOUTH AFRICA	1023
53.     CSU 12/2008: PROMOTING MALE CIRCUMCISION IN RWANDA	1019
54.     FEASIBILITY OF MEASLES ERADICATION	1012
55.     CSU 40/2009: WHEN IS A DISEASE ERADICABLE? /FIRST IN A SERIES	1011
56.     CSU 2/2009: PROGRESS TOWARDS MDGs IN BANGLADESH	1011
57.     MEASLES ERADICATION: 'NO' TO THE SKEPTICS	1009
58.     CSU 20/2009: 1) READER COMMENT / 2) MODELING THE IMPACT OF MALE CIRCUMCISION/ CALMETTE AND GUERIN	1006
59.     CSU 7/2008: LEPROSY, WHAT IS BEING ELIMINATED?	1006
60.     CSU 13/2009: MALE CIRCUMCISION/ DRIVERS OF INFANT AND CHILD MORTALITY / FERTILITY DECLINES AND SOCIAL SECURITY	1005
61.     CSU 7/2009: QUERY TO READERS, U5MR IN THE GAMBIA	1003
62.     CSU 46/2008: LANCET SERIES ON HIV PREVENTION	1001
TOTAL HITS	83597

 

• HIGH VOLUME MALE CIRCUMCISION, IRINGA REGION, TANZANIA

Voluntary Medical Male Circumcision: Matching Demand and Supply with Quality and Efficiency in a High-Volume Campaign in Iringa Region, Tanzania

Summary points and abstract below; full text, http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001131

Related article is at

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001127

Summary Points

The government of Tanzania has adopted voluntary medical male circumcision (VMMC) as an important component of its HIV prevention strategy and aims to reach 2.8 million uncircumcised men within the next three years.

In June and July 2010, a six-week VMMC campaign in Tanzania's Iringa Region performed 10,352 circumcisions.

Strategies adopted by the campaign to generate demand included the widespread dissemination of messages focused on the provision of free VMMC by specially trained health care providers and on the HIV prevention benefits of VMMC.

Clinical efficiency was improved through, for example, the use of multiple beds in an assembly line, and the efficient use of staff time through task shifting and task sharing.

The experiences of this campaign suggest that high-volume VMMC can be performed without compromising client safety, and provide a model for matching supply and demand for VMMC services elsewhere.

Abstract 

The government of Tanzania has adopted voluntary medical male circumcision (VMMC) as an important component of its national HIV prevention strategy and is scaling up VMMC in eight regions nationwide, with the goal of reaching 2.8 million uncircumcised men by 2015. In a 2010 campaign lasting six weeks, five health facilities in Tanzania's Iringa Region performed 10,352 VMMCs, which exceeded the campaign's target by 72%, with an adverse event (AE) rate of 1%. HIV testing was almost universal during the campaign. Through the adoption of approaches designed to improve clinical efficiency—including the use of the forceps-guided surgical method, the use of multiple beds in an assembly line by surgical teams, and task shifting and task sharing—the campaign matched the supply of VMMC services with demand. Community mobilization and bringing client preparation tasks (such as counseling, testing, and client scheduling) out of the facility and into the community helped to generate demand. This case study suggests that a campaign approach can be used to provide high-volume quality VMMC services without compromising client safety, and provides a model for matching supply and demand for VMMC services in other settings.

 

• SANITATION AND SOIL TRANSMITTED HELMINTHS: A SYSTEMATIC REVIEW

 

Editors’ summary is below; full text is at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001162

 

Editors' Summary 

Background

Worldwide, more than a billion people are infected with soil-transmitted helminths, parasitic worms that live in the human intestine (gut). Roundworm, whipworm, and hookworm infections mainly occur in tropical and subtropical regions and are most common in developing countries, where personal hygiene is poor, there is insufficient access to clean water, and sanitation (disposal of human feces and urine) is inadequate or absent. Because infected individuals excrete helminth eggs in their feces, in regions where people regularly defecate in the open, the soil becomes contaminated with eggs. People pick up roundworm or whipworm infections when they ingest these eggs after they have matured in the environment by eating raw, unwashed vegetables or by not washing their hands after handling contaminated soil (a common transmission route for children). In the case of hookworm, the immature, infective stages of the worms, which hatch in the soil, can penetrate human skin, and people usually become infected by walking barefoot on contaminated soil. Mild infections with soil-transmitted helminths rarely have symptoms, but severe infections can cause abdominal pain and diarrhea, weakness, and malnutrition that can impair physical and mental development. Many soil-transmitted helminth infections can be safely and effectively treated with anthelmintic drugs, but there is rapid reinfection after successful treatment.

Why Was This Study Done?

In 2001, the World Health Organization endorsed preventative chemotherapy as the global strategy to control soil-transmitted helminthiasis. The key component of this strategy is regular administration of anthelmintic drugs to at-risk groups—children, women of childbearing age, and adults in high-risk occupations such as nightsoil reuse and farming. Although this strategy reduces illness caused by soil-transmitted helminths, it does not prevent rapid reinfection. To interrupt transmission and to achieve local elimination of helminthiasis, integrated control approaches that include access to sanitation and other complementary interventions of a primary prevention nature are needed. In this systematic review and meta-analysis, the researchers investigate whether the availability and/or use of sanitation facilities (latrines or toilets) lowers the risk of soil-transmitted helminth infections. A systematic review uses predefined criteria to identify all the research on a given topic; a meta-analysis is a statistical method that combines the results of several studies.

What Did the Researchers Do and Find?

The researchers identified 36 publications that included data on sanitation availability and/or use and the number of people in the study population infected with one or more of three types of soil-transmitted helminths. Meta-analysis of the data from these publications indicates that, compared to people with no access to sanitation facilities, people with access to sanitation facilities were half as likely to be infected with soil-transmitted helminths. Specifically, the odds ratios (ORs; chances) of infection with soil-transmitted helminths among people with access to latrines compared to people without access to latrines were 0.46, 0.56, and 0.58 for roundworm, whipworm, and hookworm, respectively; for all three helminths combined, the OR was 0.49. Use of (as opposed to access to) sanitation facilities also protected against soil-transmitted helminth infection (ORs of 0.78, 0.54, and 0.63 for roundworm, whipworm, and hookworm infections, respectively). Finally, combining the data for both access and use, people who either had or used a latrine were half as likely to be infected with a soil-transmitted helminth as people who neither had or used a latrine (OR 0.51).

What Do These Findings Mean?

The studies included in this systematic review and meta-analysis have several shortcomings. For example, most were cross-sectional surveys—studies that examined the effect of the availability/use of sanitation on helminth infections in a population at a single time point. Given this study design, people who had latrines may have shared other characteristics that were actually responsible for the observed reductions in the risk of soil-transmitted helminth infections. Moreover, the data on latrine availability and use was derived from questionnaires and may, therefore, be inaccurate because people are often ashamed to admit that they defecate outside. Finally, the overall quality of the included studies was low. Nevertheless, these findings confirm that providing access to, and promoting use of, sanitation facilities is an effective control measure for soil-transmitted helminthiasis. Thus, there should be more emphasis on expanding access to adequate sanitation in control strategies for soil-transmitted helminths. This change in emphasis would reinforce the effects of preventative chemotherapy and ongoing health education on helminthiasis, in an economic, sustainability, and public health sense. Importantly, it would also improve the control of other neglected tropical diseases such as schistosomiasis and trachoma and would reduce the incidence of diarrhea, and thus child mortality, in developing countries.