Health Organization Collaborating Centre Research Articles

Seasonality and Annual Utilization Patterns of Antibacterials at Muhimbili National Hospital, Dar es Salaam, Tanzania: A 2015 Monthly Survey

IntroductionAntibacterial utilization studies can help identify areas of intervention of antimicrobial stewardship programs (ASP) to facilitate rational use and prevent the emergence of antimicrobial resistance (AMR). Assessment and comparison of antibacterial utilization depend on the Anatomical Therapeutic Chemical (ATC) classification system and Defined Daily Dose (DDD) recommended by the World Health Organization (WHO) collaborative center for international drug monitoring. This study aimed to determine the DDD of each prescribed antibacterial group and the proportions of wide-spectrum antibacterials used at Muhimbili National Hospital (MNH) in Tanzania to allow baseline data for hospital ASPs.MethodsA retrospective analytical study using data collected from 1st January 2015 to 31st December 2015 was undertaken at MNH. Data on antibacterials prescribed and dispensed were obtained from the MNH database. The ATC/DDD system was used to classify and quantify the antibacterial utilization patterns.ResultsA total of 10,643.1 DDDs were used in thirteen ward units at the Kibasila, Mwaisela and Sewahaji blocks of the MNH. Eighteen different antibacterials were prescribed and dispensed to 1496 patients. Capsules were the most dispensed dosage form. The drug ciprofloxacin was the leading antibacterial prescribed, with a DDD of about 3780 (35.5%) per year. This was followed by metronidazole and amoxicillin. The proportion of wide-spectrum antibacterials was as high as 66%. Utilization peaks were noted in April, July and September. There was a significant monthly increase in antibacterials utilization between January and December 2015 (p-value = 0.002, R-square = 0.64). The trends forecasted increased through June 2016.ConclusionsUtilization trends indicated a significant monthly increase in 2015 at MNH wards in Tanzania. The use of wide-spectrum antibacterials was widespread. This calls for continued antibacterial utilization surveillance and implementation of hospital-based ASP to mitigate the rapidly rising global threat of AMR.

Pan American Health Organization/World Health Organization Collaborating Centers in Nursing and Midwifery in Haiti.

ABSTRACTObjective.To describe partnerships that Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Centers in Nursing and Midwifery have in Haiti, and their contribution to promoting universal health coverage in that country.Methods.In 2017, semistructured interviews were conducted by telephone or email to update the status of activities and collaborations that were mentioned in a 2016 report (which covered efforts prior to early 2016) by the office of the Regional Advisor on Nursing and Allied Health Personnel at PAHO/WHO. Using that information, two of the authors categorized the Collaborating Center activities into focal areas.Results.Six of the nine Collaborating Centers mentioned in the 2016 PAHO/WHO report participated in the 2017 semistructured interviews. The five focal areas identified were: 1) direct care/primary health care, 2) research, 3) workforce development, 4) curriculum development, and 5) shared educational activities.Conclusions.Current PAHO/WHO Nursing and Midwifery Collaborating Center partnerships in Haiti support universal health access and coverage through direct provision of care with ongoing Haiti-based clinics; research in topics relevant to Haitian partners; assistance with continuing education for nurses; and shared educational activities. These efforts are enhanced through partnerships with Haitian organizations and the Ministry of Public Health and Population. Coordination among PAHO/WHO Collaborating Centers could augment individual schools’ efforts to assist health providers and institutions in Haiti to improve health outcomes and support universal health coverage.

Antihypertensive Drugs in Croatia: What Changes the Drug Usage Patterns?

Purpose: Possible factors that could influence changes in patterns of prescribing antihypertensives could be identified by monitoring national trends in hypertension treatment. The choice of pharmacologic treatment in people with hypertension has important therapeutic and financial implications, due to the fact that the financial costs associated with hypertension continue to increase. The aims of our study were to identify and analyze changes in the usage of antihypertensive drugs in Croatia from 2000 to 2016 and to identify the changes in prescribing patterns as well as mean prices per defined daily dose (DDD).Methods: Data on consumption in Croatia were obtained from the International Medical Statistics database. According to the World Health Organization's Collaborating Center for Drugs Statistics Methodology, per-annum volumes of drugs are presented in DDD per 1000 population per day (DDD/1000), while data on financial expenditure are presented in euros.Findings: The consumption of drugs for cardiovascular disease in Croatia during the period from 2000 to 2016 increased 150.81%, while financial expenditure in the same period increased 47.32%. The most frequently prescribed subgroup was agents acting on the renin-angiotensin system (RAS). Their share among antihypertensives increased from 39.13% (2000) to 53.39% (2016). The share of diuretics in the same period decreased from 20.16% in 2000 to 12.73% in 2016.Implications: The prescribing patterns of antihypertensive drugs in Croatia have changed, which could be a result of a combination of different factors, such as changes in laws, pharmaceutical marketing, and guidelines on hypertension therapy. The most prescribed subgroup in all of the investigated years was agents acting on the RAS, mainly because of the increased prescribing of combinations of RAS agents plus diuretics. The financial implications of legal changes and the introduction of new generic drugs led to decreased cost per DDD of antihypertensives during the investigated period, but the total expenditure on antihypertensives in Croatia increased due to increased consumption.

Editorial introductions

Current Opinion in Infectious Diseases was launched in 1988. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of infectious diseases is divided into 11 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Joseph M. VinetzJoseph M. VinetzDr Vinetz graduated from Yale University and received his medical degree from the University of California, San Diego (UCSD), USA. He completed a residency in internal medicine and a fellowship in infectious diseases at Johns Hopkins School of Medicine, USA, and he was a Howard Hughes Medical Institute Physician Postdoctoral Fellow at the National Institutes of Health, USA. Prior to joining the UCSD faculty in 2003, he was an infectious diseases specialist at the University of Texas Medical Branch, Galveston, USA, and of the World Health Organization's Collaborating Center for Tropical Diseases at Galveston, USA. His research focuses on tropical infectious diseases. His laboratory takes a comprehensive approach from laboratory bench to bedside, encompassing mechanistic molecular biology, biochemistry, immunology and cell biology approaches to the study of malaria transmission and leptospirosis, a disease transmitted from infected mammals (wild and domestic) to humans via infected urine. A key component of his research program is field work in the Peruvian Amazon city of Iquitos, where he maintains a state-of-the-art laboratory in collaboration with investigators from Peru and the United States. He is program director of a training program supported by the US National Institutes of Health, in partnership with the Universidad Peruana Cayetano Heredia, Lima, Peru, entitled ‘Endemic Infectious Diseases of the Peruvian Amazon’. His research is supported by grants from the United States Public Health Service and National Institutes of Health. Yukari C. ManabeYukari C. ManabeDr Manabe is currently the Associate Director of Global Health Research and Innovation within the Johns Hopkins Center for Global Health, USA, an Associate Professor of Medicine, International Health, and Molecular Microbiology and Immunology and a faculty member of both the Center for Tuberculosis Research and Center for Clinical Global Health Education at John Hopkins University, Baltimore, USA. From 2007 to 2012, she was the Head of Research at the Infectious Diseases Institute (IDI) in Kampala, Uganda, a research Center of Excellence in sub-Saharan Africa. She is also the Clinical Research Site Leader for the AIDS Clinical Trials Group at Johns Hopkins. Her own research focuses on the development and testing of point-of-care and rapid diagnostics, particularly for resource limited settings. She also engages in health systems strengthening and implementation science, particularly in the area of TB-HIV infection as well as translational research in HIV, TB and opportunistic infections. Dr Manabe is an author of more than 100 peer-reviewed publications. Dr Manabe obtained her undergraduate degree from Yale University, USA, and her MD from Columbia University College of Physicians and Surgeons, USA. She joined the Johns Hopkins School of Medicine faculty in 1999 after completing her residency in internal medicine and fellowship in infectious diseases at Johns Hopkins Hospital. Gagandeep KangGagandeep KangProfessor Kang is Head of the Wellcome Trust Research Laboratory at the Christian Medical College (CMC) in Vellore, India. Over the past two decades, she has built a research program that has conducted key studies to understand enteric infectious diseases in impoverished communities. She has published over 250 papers and is on several review committees for national and international research funding agencies. She is a member of the WHO's Global Advisory Committee on Vaccine Safety and the Immunization and Vaccine Implementation Research Advisory Committee and chairs the Immunization Technical Advisory Group for the WHO's South East Asian Region. She serves on the scientific advisory committee of several national and international organizations. A. Clinton WhiteA. Clinton WhiteDr White completed his undergraduate studies at Dartmouth College and medical studies at Indiana University School of Medicine, USA. He qualified in internal medicine at the University of Washington and in infectious diseases at Yale University. He completed six months as a visiting scientist in Venezuela before coming to Texas in 1989. He currently directs the Infectious Disease Division, in the Department of Internal Medicine at the University of Texas Medical Branch in Galveston, USA. Among his clinical and research interests are host-parasite interactions for Cryptosporidium and other interstinal protozoa, clinical studies in cysticercosis, host responses controlling strongyloidiasis, facioliasis, opportunistic infections in HIV, and immunoregulation in HIV-TB co-infection. He has published over 150 peer-reviewed publications in addition to numerous book chapters. He is a past president of the clinical group and a councilor of the American Society for Tropical Medicine and Hygiene.

Editorial introductions

Editorial introductions

Editorial introductions

Editorial introductions

Evolution of Salmonella nomenclature: a critical note

Salmonellae are widely distributed but nomenclaturally controversial pathogens of both humans and animals. Despite elaborate studies, much still remain to be discovered about these organisms. Although Salmonella nomenclature has proved to be rather complex, in 2005, Salmonella enterica finally gained official approval as the type species of the genus Salmonella. In addition, one other species has been approved and recognised in the genus Salmonella, namely, Salmonella bongori. New serovars (serotypes) are continually being discovered each year and reported in the journal Research in Microbiology. Salmonella serovars and their antigenic formulae are listed in the White-Kauffmann-Le Minor scheme and updated by the World Health Organization's Collaborating Centre for Reference and Research on Salmonella at the Pasteur Institute, Paris, France.

Editorial introductions

Current Opinion in Infectious Diseases was launched in 1988. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of infectious diseases is divided into 11 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. Section Editors Joseph M. VinetzJoseph M. VinetzDr Vinetz graduated from Yale University and received his medical degree from the University of California, San Diego (UCSD), USA. He completed a residency in internal medicine and a fellowship in infectious diseases at Johns Hopkins School of Medicine, and he was a Howard Hughes Medical Institute Physician Postdoctoral Fellow at the National Institutes of Health. Prior to joining the UCSD faculty in 2003, he was an infectious diseases specialist at the University of Texas Medical Branch, Galveston and of the World Health Organization's Collaborating Center for Tropical Diseases at Galveston. His research focuses on tropical infectious diseases. His laboratory takes a comprehensive approach from laboratory bench to bedside, encompassing mechanistic molecular biology, biochemistry, immunology and cell biology approaches to the study of malaria transmission and leptospirosis, a disease transmitted from infected mammals (wild and domestic) to humans via infected urine. A key component of his research program is field work in the Peruvian Amazon city of Iquitos, where he maintains a state-of-the-art laboratory in collaboration with investigators from Peru and the United States. He is program director of a training program supported by the US National Institutes of Health, in partnership with the Universidad Peruana Cayetano Heredia, Lima, Peru entitled ‘Endemic Infectious Diseases of the Peruvian Amazon’. His research is supported by grants from the United States Public Health Service, National Institutes of Health. Nicholas J. BeechingNicholas J. BeechingAfter undergraduate studies and clinical medical school in Oxford, UK, Nicholas Beeching qualified in 1977 and subsequently worked in training posts in Liverpool, Adelaide, Birmingham and Auckland. He was a consultant physician (with gastroenterology) in Khamis Mushayt, southern Saudi Arabia, for two years before taking up his current posts in Liverpool in 1987. He combines teaching and research activities as Senior Lecturer in Infectious Diseases at the Liverpool School of Tropical Medicine with clinical and administrative duties as Lead Consultant, Tropical and Infectious Disease Unit, Royal Liverpool University Hospital. Among his clinical and research interests are parasitic infections of the bowel, salmonella infections, HIV, hepatitis and ‘emerging’ and imported diseases and zoonoses. He also has a strong interest in postgraduate medical education and has served as Chair of the Specialist Advisory Committee in Infectious Diseases and Tropical Medicine and of the DTM&H examinations board of the Royal College of Physicians of London. He has published over 150 peer-reviewed papers, numerous book chapters and five books, and has recently stepped down after a three year term as President of the British Infection Society. A. Clinton WhiteA. Clinton WhiteDr White completed his undergraduate studies at Dartmouth College and medical studies at Indiana University School of Medicine, USA. He qualified in internal medicine at the University of Washington and in infectious diseases at Yale University. He completed six months as a visiting scientist in Venezuela before coming to Texas in 1989. He currently directs the Infectious Disease Division, in the Department of Internal Medicine at the University of Texas Medical Branch in Galveston, USA. Among his clinical and research interests are host-parasite interactions for Cryptosporidium and other interstinal protozoa, clinical studies in cysticercosis, host responses controlling strongyloidiasis, opportunistic infections in HIV, and immunoregulation in HIV-TB co-infection. He has published over 100 peer-reviewed publications in addition to numerous book chapters. He is a past president of the clinical group and a councilor of the American Society for Tropical Medicine and Hygiene and serves on the examination committee for the ASMTH certificate of knowledge in tropical medicine and travel health.

The International Circumpolar Surveillance Interlaboratory Quality Control Program for Streptococcus pneumoniae , 1999 to 2008

The International Circumpolar Surveillance (ICS) Program was initiated in 1999 to conduct population-based surveillance for invasive pneumococcal disease in select regions of the Arctic. An interlaboratory quality control (QC) program for pneumococcal serotyping and antibiotic susceptibility testing was incorporated into ICS by reference laboratories in northern Canada (Laboratoire de Santé Publique du Québec [LSPQ] in Sainte-Anne de Bellevue, Québec; National Centre for Streptococcus [NCS] in Edmonton, Alberta) and Alaska (Arctic Investigations Program [AIP]). The World Health Organization's Collaborating Centre for Reference and Research on Pneumococci at the Statens Serum Institute (SSI) in Copenhagen, Denmark, joined the QC program in 2004. The Iceland Reference Laboratory (IRL) in Reykjavik, Iceland, joined the QC program in 2006, but due to small sample sizes, data from IRL are not included in this report. From 1999 through 2008, 190 isolates were distributed among four laboratories (AIP, NCS, LSPQ, and SSI). The overall serotype concordance was 95.8%, and the overall serogroup concordance was 97.4%. The overall modal MIC concordance for testing by broth microdilution (BMD) and agar dilution was >96% for all the antibiotics except erythromycin (92.1%) and clindamycin (89.5%). MIC comparisons between the Etest and BMD resulted in lower concordance for erythromycin (73.9%), clindamycin (65.5%), and trimethoprim-sulfamethoxazole (80%); however, categorical concordance (susceptible, resistant) remained high at 98.6%, 89.1%, and 90.9%, respectively. Our data demonstrate a high degree of correlation of serotyping and antimicrobial susceptibility testing results between four participating laboratories.

Journal Digest

Journal Digest

Russia: The State-of-the-Art of Palliative Care

The Russian Federation is a country with a high cancer morbidity, which unfortunately has a tendency to increase annually. For example, St. Petersburg, the second largest city in Russia (population 5 million people) has the highest cancer morbidity in Russia, with more than 17,000 new patients per year. 1 In the Novosibirsk region, which covers a large territory of the Russian Federation, cancer morbidity is 333.5 per 100,000 citizens and has an annual increase of 5–6%. The majority of Russian patients with cancer are diagnosed with advanced disease. Palliative treatment for these patients is far from perfect. This can be explained by a number of factors. First, the lack of knowledge of the basic principles of palliation and a deficiency of skilled specialists pose obstacles to creating a structure for palliative care in Russia. Second, there are legislation limitations and problems of drug use regulation. Finally, evaluation of symptom severity and prevalence, its impact on quality of life, and adequacy of treatment, as well as studies of the barriers to effective palliative care and symptom management, are absolutely new in Russia. An extensive search of the current literature has found no citations describing the status of symptom control in cancer patients in Russia. Based on studies that have been done in countries with more health resources, we can expect symptom prevalence and severity to be greater among Russian cancer patients than in such countries as the United States and France. 2

Incidence/Prevalence of Sensorineural Hearing Impairment in Thailand and Southeast Asia: Incidencia/prevalencia de los trastornos auditivos sensorineurales en Tailandia y el Sudeste Asiatico

The Bangkok Otological Center (ISA-HI-IFOS/World Health Organization Collaborating Center) carried out a series of prevalence studies of hearing impairment throughout Thailand. This report includes background information for Thailand and its medical personnel and the results of five studies in different regions from 1988 to the present. This report emphasises sensorineural hearing loss (SNHL). Study 1 in three Thai provinces showed SNHL at 18.6 per cent. These results were considered abnormally high due to a number of extraneous reasons. Study 2 was conducted in 17 provinces in 5 regions and in Bangkok. Results showed that 8.3 per cent of those tested had a SNHL. Study 3, The Crown Prince Project, involved 21 Crown Prince Hospitals and showed an overall SNHL of 4.6 per cent. Study 4 was the Thai-Swedish project, where SNHL was reported at 22.7 per cent. Study 5 involved school children aged 6 to 15 in both rural Thailand and Bangkok. Results showed SNHL in Bangkok children at 3.5 per cent compared to 3.6 per cent in the rural children. After a careful review of the various studies, the overall results have been interpreted to suggest that the prevalence of SNHL in Thailand is between 3.5 and 5 per cent.SumarioEl Centro Otológico de Bangkok (Centro Colabora-tivo ISA/HI/IFOS/Organización Mundial de la Salud) llevó a cabo una serie de estudios de preva-lencia de sordera en todo Tailandia. Este reporte incluye información de antecedentes sobre Tailandia y su personal médico, y los resultados de cinco estudios en diferentes regiones, desde 1988 al presente. Este reporte concentra su énfasis en la sordera de tipo sensorineural (SNHL). El estudio 1, en ires provincias tailandesas, mostró un 18 por ciento de sordera (SNHL). Estos resultados fueron considerados anormalmente altos debido a un número de razones extranas. El estudio 2 fue conducido en 17 provincias de 5 regiones y en Bangkok. Los resultados mostraron que un 8.3% de los evaluados tenían hipoacusia sensorineural. El estudio 3: el Proyecto del Príncipe, involucró 21 hospitales Crown Prince y mostró resultados generales de 4.6 porciento. El estudio 4 fue el proyecto Sueco-Tailandés, donde la sordera sensorineural fue reportada en un 22.7 por ciento. El estudio 5 involucró escolares en edades de 6 a 15 años, tanto en áreas rurales de Tailandia como en Bangkok. Los resultados mostraron un 3.5 por ciento en los niños de Bangkok, comparado con un 3.6 por ciento en los niños de áreas rurales, en cuanto a hipoacusias sensorineurales. Luego de una revisión cuidadosa de los distintos estudios, los resultados globales se interpetan como sugestivos de que la prevalencia de hipoacusias sensorineurales en Tailandia, fluctúa entre el 3.5 y el 5 por ciento.

THE MOLECULAR ROOTS OF PAIN

There's an enormous need for us to know more about how to treat pain, said Kathleen M. Foley, a professor of neurology, neuroscience, and clinical pharmacology at Cornell University Medical School, New York City. Patients that I see with neuropathic pain, patients that I see with inflammatory pain—we don't have the best treatments. We have good treatments, but they are not enough. Foley, who is director of the World Health Organization's Collaborating Center for Cancer Pain Research & Education, addressed a symposium on new directions in pain research held late last month at the National Institutes of Health, Bethesda, Md. Organized by a consortium of institutes and offices at NIH, the symposium brought together clinicians and scientists to share their knowledge in the interest of advancing pain research. In all, 350 people attended. Neuropathic pain, which is characterized by a spontaneous, burning pain, is caused by injury to a nerve, but it ...

Lymphadenitis caused by Loa loa.

The World Health Organization's Collaborating Centre for the Histopathology of Filarial Diseases of Man contains specimens of lymph node from 13 patients infected by the filarial nematode Loa loa. Ten of these nodes have distinctive microscopic features characterized by distended sinuses that contain histiocytes and eosinophils and by atrophy of lymphoid follicles. Less striking features include fibrosis of capsule and trabeculae, dilated lymphatic vessels of capsule and medulla, and inflammatory cell infiltrates. We believe that these changes, although in themselves nonspecific, are characteristic of lymphadenitis caused by Loa loa. These 10 lymph nodes were removed from the inguinal region--one from each of 10 native Zairians . At the time of herniorrhaphy the nodes in eight patients were found to be enlarged and were removed for diagnosis. Seven of the 10 patients were infected with Dipetalonema perstans as well as Loa loa, and one of these seven had three filarial infections--L. loa, D. perstans and D. streptocerca . Lymph nodes from other patients infected by other filariae that were available for study at the AFIP did not have these histopathologic features.