WHO Standard Reference Research Articles

Evaluation of Rational Medicine Use based on WHO Core Drug Use Indicators in Public Hospitals in West Shoa Zone, Oromia, Ethiopia

Background: The irrational use of medicines is a worldwide problem increasing morbidity, mortality and costs through increasing adverse medicine reactions and hence patients are not achieving their desired outcomes. In Ethiopia, although there are studies that show the presence of irrational use of medicines in the country, there is limited objective evidence on evaluating medicine use from prescriber, patient and health facility perspectives. Therefore, the objective of this study was to evaluate rational medicine of the improved asphalt were contrasted together with each other as well as with the perspicuous asphalt. Conclusions Methods: Retrospective and prospective cross sectional study were employed to collect data from prescriptions dispensed through main pharmacies and Information for patients respectively. A structured questionnaire was employed to collect information from prescription papers and respondents after obtaining a verbal consent. Data was entered, cleaned, edited and analyzed using SPSS Version 23.0 statistical software package. Results: The average number of medicines prescribed per encounter was 1.74. The% of encounters in which an antibiotic and injection was prescribed was 48.9% and 12.6% respectively. The mean consultation time spent between the prescriber and patient was 5.12 minutes and the mean pharmacy dispensing time was 1.28 minutes. The availability of selected tracer medicines in the health facilities was 79.6%. Conclusion: The study identified that the pattern of prescribing was appreciable and nearly similar with WHO standard reference. However, the patient care factors needs to be improved.

Prevalence of overweight and obesity among children aged 5-15 years in a rural school in Coimbatore

Background: Childhood obesity is a fast emerging problem in developing countries such as India because of lifestyle changes and economic transition.[1] Childhood overweight and obesity are major risk factors for many chronic diseases such as diabetes, hypertension, cardiovascular diseases, and cancer.[1–4] Effective preventive measures will prevent the risk of developing chronic diseases in adult life. Objective: To study the prevalence of overweight and obesity among school children in a rural school in Coimbatore using the WHO standard reference for age 5–19 years. Materials and Methods: A cross-sectional study was conducted along with annual school health check up for the children studying in a rural matriculation school located in Neelambur village, Coimbatore district. A total of 890 school children in the age group 5–15 years enrolled in the study were examined for height and weight, and BMI was calculated. The WHO standard reference for age 5–19 years was used to define overweight (> 2SD) and obesity (> 3SD). Result: In our study, prevalence of overweight was 8.32% and prevalence of obesity was 4.72%. Among boys, prevalence of overweight and obesity was 8.43% and 6.43%, respectively. Among girls, prevalence of overweight and obesity was 8.20% and 2.96%, respectively. There is no statistical significant difference in the prevalence of overweight/obesity among boys and girls. Conclusion: A high proportion of Rural School children in our study are having weight more than their normal weight, indicating the need for public awareness and preventive measures on childhood obesity. Intervention in the form of health education should be initiated at all levels of society to stop the progression of the problem.

Determining EBV load: current best practice and future requirements

EBV, a gammaherpesvirus and the pathogenic agent for infectious mononucleosis, is also associated with a broad spectrum of lymphoid and epithelial malignancies in immunocompetent and immunosuppressed individuals. EBV-DNA-load measurement by PCR has been shown to be a potential tool for the diagnosis of these diseases, a prognostic factor of their outcome and a successful method to monitor immunosuppressed patients. Since the end of 2011, there is an international WHO standard reference for EBV quantification available; however, many questions still remain; for instance about the optimal amplified region of the EBV genome, or the best-used specimen for EBV detection. Additionally, the optimal specimen and amplified region may vary in different malignancies. In this article, the authors review the different methods to measure EBV load, focus on the best-used specimen for the different EBV-associated malignancies and discuss future requirements and opportunities for EBV-load measurement.

Nutritional Status of Highland and Lowland Children in Ecuador

We assessed the nutritional status of children in Ecuador using anthropometric measurements and body composition. To determine whether living in the highlands in Quito was a predisposing factor to poor nutrition in children. We compared the children in highlands at 2772 m above sea level with their costal (605 m above sea level) counterparts at Santo Domingo de Los Colorados. By using the WHO standard reference 2007, we distinguished malnourished children from healthy children using Z-score of -2 as a cut-off point. Mean Z-score indices for both height-for-age (HFA) and weight-for-age (WFA) were found to be significantly lower among urban children than for rural children (p < 0.001). Urban children were also four times more likely of becoming mildly stunted (OR = 3.95%, 95% confidence interval (CI): 1.818-8.448) and three times more likely of being mildly underweight (OR = 3.95%, 95% CI: 1.241-7.551). Living in highland urban areas of Ecuador is a predisposing factor for poor nutrition among children.

Nutritional status of children living in a community with high HIV prevalence in rural Uganda: a cross-sectional population-based survey

To assess the nutritional status of children in a rural community with high HIV prevalence in rural Uganda and to examine the impact of HIV infection at the individual and population level. Methods Cross-sectional population-based survey of children aged 0-12 in a cohort comprising the residents of 25 neighbouring villages in rural southwest Uganda. Anthropometric indicators of nutritional status (height for age, weight for age and weight for height) were assessed in relation to children's HIV serostatus, maternal HIV serostatus and maternal vital status. Children with a Z score of <-2 were defined as undernourished, with a Z score <-2 for weight for age defining underweight, for height for age defining stunting and for weight for height defining wasting. Of 5951 children surveyed, 91% underwent anthropometric measurement: 30% were underweight, 42% stunted and 10% wasted. HIV seroprevalence among children aged 2-12 was 0.7%. The prevalence of underweight was significantly higher in HIV-positive than in HIV-negative children (52%vs. 30%), as was the prevalence of stunting (68%vs. 42%), but there was no significant difference in the prevalence of wasting (4%vs. 9%). There were no significant differences in the prevalences of indicators of undernutrition in children classified by maternal HIV and vital status. Chronic childhood undernutrition is common in this rural community. HIV infection had a direct effect in worsening children's nutritional status, but no indirect effect in terms of maternal HIV infection or maternal death. The population-level impact of childhood HIV infection on nutritional status is limited on account of the low HIV prevalence in children. The response to undernutrition in children in Africa requires action on many fronts: not only delivering community-wide HIV and nutritional interventions but also addressing the many interacting factors that contributed to childhood undernutrition before the HIV era and still do so now.

First detection of measles genotype D7 from India

National Institute of Virology, India has instituted molecular surveillance of measles strains in the country. In phased manner, three major cities Pune, Chennai and Bangalore were covered. Throat swab and urine from suspected measles cases from Chennai and Pune and freshly frozen brain tissues, CSF from suspected SSPE case from Bangalore were subjected to RNA extraction and Measles N&H gene RT-PCR as per WHO standard protocols. PCR positive products were sequenced. Sequence alignment and phylogenetic analysis was carried out using WHO standard reference sequences. Virus isolation was attempted using B95a cell line. Measles genotype D7 was detected from two classical measles cases (Chennai and Pune) and in a fulminant SSPE case (Bangalore). This is the first detection of measles genotype D7 from India.

Resistance risk assessment of two insect development inhibitors, diflubenzuron and cyromazine, for control of the housefly Musca domestica L. Part II: Effect of selection pressure in laboratory and field populations

AbstractLaboratory selection with diflubenzuron (DFB) and cyromazine (CYR) was carried out with strains of houseflies collected on Danish farms. The adult flies were multiresistant to organophosphorus, carbamate and pyrethroid insecticides. Susceptibility to the larvicidal effect of DFB or CYR was monitored on Danish farms where fly control with DFB or CYR had been carried out for one to nine years. On these farms the fly population continued during the winter, but at a low level.Four strains were selected with DFB in seven out of 13–18 laboratory generations. The selections varied from 56% to 94% mortality. The strains showed 1–5 times increase of LC50 and LC95 to DFB. The larvicidal effect of DFB was monitored on five farms where treatment of fly breeding sources in manure (1 g DFB m−2) was carried out regularly for one to nine fly seasons. On none of the farms was any general increase of tolerance to DFB found. Resistance ratios (R/S) compared to the WHO Standard Reference Strain ranged from 0.8 to 2.0 at LC50 and from 1–0 to 2–9 at LC95.Two strains were selected with CYR in five or six out of 13 laboratory generations. The selections varied from 62 to 97% mortality. The strains showed no increase of LC50 or LC95. The larvicidal effect of CYR was monitored on three farms where housefly breeding places in the animal houses were treated with CYR (0.5 g m−2) for two fly seasons. No reduction of susceptibility to CYR was found and the R/S was 0.7 to 0.9.The effect of DFB or CYR selection pressure is compared with other investigations and discussed. Moderate to high resistance to DFB or CYR can develop in housefly populations if the selection pressure is strong, especially when used as feed‐through applications on poultry farms where all feed contains DFB or CYR. If the treatment of fly breeding sources is less complete, resistance problems may not develop.

A possible rôle for microsomal oxidases in metamorphosis and reproduction in the housefly

Housefly larvae and adults of the Isolan-B strain, insecticide resistant because of high microsomal oxidase activity, and the susceptible WHO Standard Reference (SR) strain, were reared on diets containing phenobarbital or piperonyl butoxide. Periodically throughout the treatments groups of insects were assayed for microsomal aldrin epoxidase activity. This activity was compared with such growth and development parameters as pupation, adult emergence, and reproduction in similar groups of insects. At diet levels of 0·01 to 0·50 per cent both chemicals caused large increases, as much as elevenfold in microsomal oxidase activity in third instar larvae and 15 to 100 per cent inhibition of pupation and emergence. In the adult diet at 1 per cent, both compounds caused at least 50 per cent decrease in egg production. Phenobarbital enhanced the enzyme system in both larval and adult stages of both strains but piperonyl butoxide, while enhancing enzyme activity in larvae of the Isolan-B strain, was an inhibitor in the adult stage. The results are interpreted as an indication of a direct connexion between microsomal oxidase activity and the action of hormones in the housefly, probably through regulation of hormone titre by these enzymes.