Extracts from Journals / For your Resource Centre - November 2009
Change in drug treatment reduces HIV infection in newborn babies
HIV-positive pregnant women who take a combination of three ARV drugs from the last trimester of pregnancy until six months into breastfeeding (rather than a short course of drugs that ends at delivery) are over 40% are less likely to infected their babies.
The WHO-led ‘Kesho Bora’ study involved 1,140 women from Burkina Faso, Kenya and South Africa and showed that a significant reduction can be achieved in many pregnant women with a lowered immune cell count.
HIV-positive mothers face a tough choice between breastfeeding their babies and risking the transmission of the virus through their milk, or giving them formula which deprives infants of the natural immunity passed on through breast milk and helps protect against diarrhoea, malnutrition and other potentially deadly diseases.
The Kesho Bora results increase the range of treatment options available to HIV+ mothers and gives them a greater chance of safely breastfeeding their babies. There is no increased risk to the health of the mother or the infant associated with this triple-ARV regimen, consisting of zidovudine, lamivudine and lopinavir/ritonavir.
Extract of findings presented at the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, Cape Town, South Africa. See http://www.ias2009.org and http://www.un.org/apps/news/story.asp?NewsID=31545&Cr=UNAIDS&Cr1=22 July 2009.
Facility versus home-based care of HIV patients
In rural sub-Saharan Africa, access to treatment is commonly denied to patients who live far from health centres. A cluster-randomised trial of facility versus home-based care in Uganda found no difference in mortality and virological suppression. Median annual costs for patients accessing care were five-times less via the home-based approach. Extract from Highlights of the International AIDS Society Conference in The Lancet Infectious Diseases, vol 9, issue 9, Page 528, September 2009
Doctor versus nurse provision of ART
An important barrier to accessing care is the chronic shortage of doctors to provide antiretroviral therapy. To overcome this, nurse-based models of care have been proposed. Two studies—a randomised trial from South Africa and a concordance study from the Democratic Republic of the Congo—found no difference in the performance of doctors and nurses in the provision of ART care, providing reassuring evidence of effectiveness. Extract from Highlights of the International AIDS Society Conference in The Lancet Infectious Diseases, vol 9, issue 9, Page 528, September 2009
Mixed progress in reducing world under-5 mortality
The aim of the 4th Millennium Development Goal is to reduce under-5 mortality by two thirds between 1990 and 2015. A new UNICEF report shows that, although fewer children died between 2000-2008 than between 1990-2000, the rate of decline is presently too slow in many countries to reach this Goal. However the effect of interventions such as vaccination programmes and insecticide-treated bednets, may improve the rates.
The key findings are:
- The estimated global mortality for children under-5 in 2008 is 65 per 1,000 live births, versus 90 in 1990
- Around 8.8 million children under 5 died during 2008, compared with 12.5 million in 1990
- Africa (51%) and Asia (42%) represented 93% of all deaths globally.
Extracted from UNICEF Press Release September 2009.
Update on zinc supplementation
Zinc deficiency is responsible for ~4% of worldwide morbidity and mortality of young children. A new technical document from the International Zinc Nutrition Consultative Group (IZiNCG) provides information on intervention strategies for controlling zinc deficiency and reviews their efficacy and effectiveness. These analyses confirm that:
- Preventive supplementation reduces the incidence of diarrhoea by ~27% in young children over 12 months and the incidence of acute lower respiratory tract infections by ~15%; it may reduce the incidence of malaria. An earlier meta-analysis showed that zinc supplementation during pregnancy reduced the rate of preterm births by 14% but there were no consistent effects on complications of labour or delivery, or on birth weights.
- Therapeutic supplementation as an adjunct treatment reduced the duration of acute diarrhoea by 0.5 days and of persistent diarrhoea by 0.7 days (see WHO guidelines on treatment of diarrhoea below). There is insufficient evidence to know whether zinc enhances the treatment of respiratory infections; studies have found no impact on the outcome of malaria treatment.
To see the full document (Technical Document no. 2. Systematic reviews of zinc intervention strategies) and a one-page summary of advocacy points seewww.IZiNCG.org or http://www.foodandnutritionbulletin.org/downloads/FNB_v30n1_Supplement_izinc.pdf
WHO/UNICEF recommendations on zinc supplementation in the management of diarrhoea
Children with acute diarrhoea need zinc supplements for 10-14 days at the following doses:
- Children aged <6 months give 10 mg zinc/day.
- Children aged 6 months - 5 years give 20 mg zinc/day.
For details on how to treat diarrhoea and specifications of zinc products see WHO/UNICEF. Implementing the new recommendations on the clinical management of diarrhoea: guidelines for policy makers and programme managers. Geneva: WHO, 2006 at
Heart disease and H1N1
Cardiac patients are among the at-risk groups that should receive the H1N1 flu drug oseltamivir (Tamiflu) as soon as they are suspected of having swine flu, according to WHO's Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses. The guidelines are available at www.who.int/csr/disease/swineflu/notes/h1n1_use_antivirals_20090820/en
Sepsis in low-income countries
Sepsis is a disorder characterised by systemic inflammation secondary to infection. Despite recent progress in the understanding and treatment of sepsis, no recommendations exist that give effective approaches to sepsis care in resource-limited low-income countries. Due to the prevalence of HIV and other conditions, sepsis is probably substantially contributes to mortality in these countries. Health personnel should be educated in the recognition of sepsis and the importance of early and appropriate antibiotic use. Simple and low-cost standardised laboratory testing should be emphasised to allow accurate diagnosis, prognosis, and monitoring of treatment response.
From: Surviving sepsis in low-income and middle-income countries: new directions for care and research Becker JU et al Lancet Infectious Diseases, vol 9 issue 9, 577 - 582, September 2009.
For Your Resource Centre
Child Health and Nutrition:
Field Exchange – searchable archive on a free CD or in hard copy
Field Exchange is a free well-illustrated useful publication available in hard copy. It is published 3 times a year by the Emergency Nutrition Network (ENN) and distributed to those working in the fields of emergency nutrition and food security. To join the mailing list contact ENN using the address below.
ENN has produced an online search database, accompanying CD and print catalogue of the archive of Field Exchange (issues 1-35) This allows you to find all the articles related to a particular topic or country – for example, Southern Sudan. The e-version and online search is available athttp://fex.ennonline.net or follow the Field Exchange link from the home page http://www.ennonline.net
The CDs and the print catalogue are available free from: ENN, 32, Leopold Street, Oxford, OX4 1TW, UK [email protected]. Bulk CD orders are welcome – contact ENN re mailing costs.
Examples of articles in Field Exchange related to Southern Sudan:
- Addressing chronic malnutrition in South Sudan (issue 31, page 6)
- Home treatment for severe malnutrition in South Sudan (issue 28, page 18)
Community Nutrition: A Handbook for Health and Development Workers 2009
This new book has been written for health and other development professionals who work at community and district levels, as well as for teachers and students of nutrition. It is written in an easy to read style and is well illustrated.
The book covers nutrients and foods, feeding the family and the causes, diagnosis and control of malnutrition through the life cycle. It deals with undernutrition and micronutrient deficiencies and pays particular attention to the emerging challenge of chronic conditions (such as diabetes, obesity, hypertension and cardiovascular diseases) and to the links between nutrition and HIV. It gives guidelines on programme implementation and on changing behaviour through better communication, and has appendices on energy and nutrients needs, sources of nutrients, food composition tables and anthropometric measurements as well as a list of additional sources of information.
The book is edited by Ann Burgess, Marlou Bijlsma and Carina Ismael with contributions from other nutritionists working both in and outside Africa. It is available from Teaching-aids At Low Cost (TALC) www.talcuk.org price UK£5.50 plus delivery, and the African Medical and Research Foundation (AMREF bookshop, PO Box 30125-00100, Nairobi, Kenya, [email protected]).
WHO Fact Sheets on Child Health
These new Fact Sheets provide basic but useful information for members of the news media and other audiences, and could be useful in preparing health education for the public. They are:
- Diarrhoea www.who.int/mediacentre/factsheets/fs330
- Pneumonia www.who.int/mediacentre/factsheets/fs331
- Early child development www.who.int/mediacentre/factsheets/fs332
- Reducing newborn mortality www.who.int/mediacentre/factsheets/fs333 – see page 12
Fact sheet on using the 2006 WHO Child Growth Standards in nutrition programmes for children aged 6-59 months
This fact sheet gives a framework and guidance for changing from the 1977 National Centre for Health Statistics/WHO growth reference to the 2006 WHO Child Growth Standards. It should be useful if you are involved with nutrition surveys and with programmes for the management of acute malnutrition.
The Fact Sheet attempts to answer the common questions that may arise during the change-over process. More information is on the WHO website or the links at the end of the fact sheet. http://www.unscn.org/files/Task_Forces/Assessment_Monitoring_and_Evaluation/WHO_GS_English.pdf From IASC Global Nutrition Cluster, and Standing Committee on Nutrition (SCN) Task Force on Assessment, Monitoring, and Evaluation
Nutrition in Emergencies: Harmonized Training Materials Package and Toolkit
The Global Nutrition Cluster, in partnership with NutritionWorks has developed:
- The Harmonized Training Materials Package. The materials cover a broad range of subject areas concerned with nutrition in emergencies. Based on priority capacity gaps in nutrition in emergencies, 21 areas were identified for inclusion in the training package. Each module comprises four sections: i) briefing paper for senior decision makers; ii) technical notes for practitioners; iii) trainers' guide and iv) reference material/sources.
- A Toolkit – this is an easy-to-use field guide that outlines the key basic interventions for nutritional support to individuals and groups during an emergency situation. It provides the what, why, when, and how for different nutrition interventions, including basic monitoring benchmarks and expected standards. The Toolkit offers guidance and support for nutritionists and humanitarian workers to ensure that basic guidelines are followed and the basic nutritional needs of populations in emergencies are met.
Materials can be downloaded from
The Clinical Practice Guideline Development Handbook for Stroke Care
This 26-page handbook provides a basic guide for healthcare professionals who wish to develop or adapt clinical guidelines for stroke care across any point in the continuum of care. It is particularly intended for those who manage stroke patients in developing countries or where healthcare resources are scarce. It aims to promote the use of evidence-informed care through locally developed or adapted guidelines without compromising the quality of the resource.The handbook was developed by the World Stroke Organization in 2009 and is available at http://www.world-stroke.org/guidelines.asp
Surgery in Africa Monthly Reviews:
- August 2009 Review, "Lower Gastrointestinal Hemorrhage – a Review for African Surgeons " by Brian Ostrow
- September 2009 Review, "Intracranial Infections" by David W. Cadotte; Malika Sharma and Mark Bernstein
These reviews, archives of reviews since 2005 and a resource library, are available free at www.ptolemy.ca/members
The Iodine Deficiency Disorders Newsletter
August 2009 issue has an article on the importance of iodine in women's health, and can be downloaded fromhttp://www.iccidd.org.