World Health Organization Publications Research Articles

Trachoma prevalence and risk factors in eight local government areas of Zamfara State

Introduction: Trachoma is the leading cause of infectious blindness worldwide and is targeted for elimination by the year 2020 by the World Health Organization (WHO). The aim of our study was to provide baseline data on trachoma for eight local government areas (LGAs) of Zamfara state, Nigeria to enable planning and control activities in affected communities. Materials and Methods: A population-based cross-sectional survey was conducted in the selected LGAs between October 2010 and July 2011 using a two-stage sampling with probability proportional to size. The WHO guidelines for trachoma control were used in planning the survey, while the risk factors assessment was based on a recommendation from another WHO publication. Results: Trachomatous inflammation - follicular prevalence in children 1-9 years was 0.04-18%; while trachomatous trichiasis (TT) prevalence in persons ≥ 15 years was 0-1.4% across the LGAs. Access to improved water sources was worst (>40%) in Bakura and Maradun LGAs. Latrine accessibility was the highest (64%) in Bakura and Bukkuyum LGAs. Awareness of trachoma as a disease was 7-92% across the LGAs, whereas knowledge of trachoma prevention is poor (1-8%). Chi-square analysis shows access to latrine, knowledge of trachoma as a disease, and its prevention was significantly protective for active disease (odds ratio [OR] <1, P < 0.05). A regression analysis, however, showed that only access to latrine and knowledge of trachoma prevention remained significantly protective (OR < 1, P < 0.05). Conclusion: The risk factors for trachoma are endemic in the study areas, and active control measures are needed. The burden of the disease is, however, clustered with most LGAs having a low burden of both the active and blinding disease.

Quality evaluation of commercially sold table water samples in Michael Okpara University of Agriculture, Umudike, Nigeria and surrounding environments

In Michael Okpara University of Agriculture, Umudike, Nigeria (MOUAU) and surrounding environments, table water of different brands is commercially hawked by vendors. To the best of our knowledge, there is no scientific documentation on the quality of these water samples. Hence this study which evaluated the quality of different brands of water samples commercially sold in MOUAU and surrounding environments. The physicochemical properties (pH, total dissolved solids (TDS), biochemical oxygen demand (BOD), total hardness, dissolved oxygen, Cl, NO3, ammonium nitrogen (NH3N), turbidity, total suspended solids (TSS), Ca, Mg, Na and K) of the water samples as indices of their quality were carried out using standard techniques. Results obtained from this study indicated that most of the chemical constituents of these table water samples commercially sold in Umudike environment conformed to the standards given by the Nigerian Industrial Standard (NIS), World Health Organization (WHO) and American Public Health Association (APHA), respectively, while values obtained for ammonium nitrogen in these water samples calls for serious checks on methods of their production and delivery to the end users.

A cross-sectional study of gender differentials in disability assessed on World Health Organization Disability Assessment Schedule 2.0 among rural elderly of Maharashtra

Background: Disability is important public health problem especially among elderly. Gender difference between disability statuses of elderly is quite obvious. Very little information about disability in a rural area hinders the proper formulation of policies. Objectives: This study determines role of selected socio-demographic factors in explaining gender differences in disability among rural elderly. Materials and Methods: A community-based cross-sectional study was carried out from January 12 to December 12. 227 (Two hundred and twenty seven)(aged 60 years and above) were selected from a rural village of Pune, Maharashtra. Data collected using newly published World Health Organization Disability Assessment Schedule 2.0. Chi-square test and odds ratio used for determining the association. Results: The result confirms higher prevalence of disability among females than that of males. Disability was found to be statistically significant with gender. Marital status and education were effect modifier of disability. Disability in mobility was most common. In almost all domain disability was more common among elderly women. Conclusion: Greater prevalence of disability among aging women compared with men requires more attention to be given toward them for proper planning of scarce health services.

Mercury exposure as a function of fish consumption in two Asian communities in coastal Virginia, USA.

Fish consumption and associated mercury exposure were explored for two Asian-dominated church communities in coastal Virginia and compared with that of two non-Asian church communities. Seafood-consumption rates for the Chinese (36.9g/person/day) and Vietnamese (52.7g/person/day) church communities were greater than the general United States fish-consumption rate (12.8g/person/day). Correspondingly, hair mercury concentrations for people from the Chinese (0.52µg/g) and the Vietnamese church (1.46µg/g) were greater than the overall level for United States women (0.20µg/g) but lower than the published World Health Organization exposure threshold (14µg/g). A conventional regression model indicated a positive relationship between seafood consumption rates and hair mercury concentrations suggesting the importance of mercury exposure through seafood consumption. The annual-average daily methylmercury intake rate for the studied communities calculated by Monte Carlo simulations followed the sequence: Vietnamese community>Chinese community>non-Asian communities. Regardless, their daily methylmercury intake rates were all lower than the United States Environmental Protection Agency reference dose of 0.1µg/kg body weight-day. In conclusion, fish-consumption patterns differed among communities, which resulted in different levels of mercury exposure. The greater seafood and mercury ingestion rates of studied Asian groups compared with non-Asian groups suggest the need for specific seafood consumption advice for ethnic communities in the United States. Otherwise the health benefits from fish consumption could be perceived as trivial compared with the ill-defined risk of mercury exposure.

Extraordinary Heterogeneity of Virological Outcomes in Patients Receiving Highly Antiretroviral Therapy and Monitored With the World Health Organization Public Health Approach in Sub-Saharan Africa and Southeast Asia

The limited access to virological monitoring in developing countries is a major weakness of the current antiretroviral treatment (ART) strategy in these settings. We conducted a large cross-sectional study in Burkina Faso, Cameroon, Cote d'Ivoire, Senegal, Togo, Thailand, and Vietnam to assess virological failure and drug resistance mutations (DRMs) after 12 or 24 months of ART. Between 2009 and 2011, we recruited adults attending ART centers 10-14 months (the M12 group) or 22-26 months (M24 group) after initiating ART. Demographic and clinical data were collected on site, and viral load was measured. Samples with a viral load of ≥ 1000 copies/mL, considered as the failure threshold, were genotyped for drug resistance assessment. Overall, 3935 patients were recruited (2060 at M12 and 1875 at M24). Median ages varied from 32 to 42 years. Median CD4(+) T-cell counts at ART initiation were low (99-172 cells/µL). The main ART regimens included stavudine/zidovudine plus lamivudine plus nevirapine/efavirenz. Overall, virological failure frequency was 11.1% for M12 patients and 12.4% for M24 patients, and 71.0% to 86.1% of these patients, respectively, had drug-resistant virus. Across sites, virological failure varied from 2.9% to 20.6% in M12 patients and from 3.7% to 26.0% in M24 patients. Predominant DRMs were associated with ART regimens, but virus in several patients accumulated DRMs to drugs not received, such as abacavir, didanosine, tenofovir, etravirine, and rilpivirine. Our findings show heterogeneous virological failure and illustrate that, in addition to routine access to viral load, good management of ART programs is even more critical to improve treatment outcomes in resource-limited countries.

Assessment of causality of individual adverse events following immunization (AEFI): A WHO tool for global use

Serious illnesses or even deaths may rarely occur after childhood vaccinations. Public health programs are faced with great challenges to establish if the events presenting after the administration of a vaccine are due to other conditions, and hence a coincidental presentation, rather than caused by the administered vaccines. Given its priority, the Global Advisory Committee for Vaccine Safety (GACVS) commissioned a group of experts to review the previously published World Health Organization (WHO) Adverse Event Following Immunization (AEFI) causality assessment methodology and aide-memoire, and to develop a standardized and user friendly tool to assist health care personnel in the processing and interpretation of data on individual events, and to assess the causality after AEFIs. We describe a tool developed for causality assessment of individual AEFIs that includes: (a) an eligibility component for the assessment that reviews the diagnosis associated with the event and identifies the administered vaccines; (b) a checklist that systematically guides users to gather available information to feed a decision algorithm; and (c) a decision support algorithm that assists the assessors to come to a classification of the individual AEFI. Final classification generated by the process includes four categories in which the event is either: (1) consistent; (2) inconsistent; or (3) indeterminate with respect of causal association; or (4) unclassifiable. Subcategories are identified to assist assessors in resulting public health decisions that can be used for action. This proposed tool should support the classification of AEFI cases in a standardized, transparent manner and to collect essential information during AEFI investigation. The algorithm should provide countries and health officials at the global level with an instrument to respond to vaccine safety alerts, and support the education, research and policy decisions on immunization safety.

A reply to Gomez and Hart's ‘goldrush’

When it comes to resilience building, we welcome constructive and cross-regional dialogues between scientists and practitioners. We were disappointed and indeed saddened by the tone of the response by Gomez and Hart (2013) to our invited and time-sensitive reflection (Crowley and Elliott 2012). As a scientist (Elliott) and practitioner (Crowley) pairing we wish to improve relations, understanding and practical applications across all sorts of boundaries. We hope that this response to our commentary will not undermine let alone deter the efforts of applied scientists engaging in interdisciplinary research with practitioners. We emphatically stand by our conclusion that, ‘Wealth, advanced earthquake science, strict building codes and community preparedness have saved thousands of lives in both Japan and New Zealand’ (p. 214). Straightforward comparisons of earthquakes of similar magnitude that have struck near cities are testament to this: the shallow magnitude 7 earthquake which occurred near Christchurch in September 2010 killed no one, however the same sized shallow event which occurred near Port-au-Prince, Haiti in January 2010 killed an estimated 50 000–300 000. Similar comparisons can be made between the massive earthquakes and tsunamis associated with the 2011 Tohoku-Oki event and the Indian Ocean tsunami in 2004, in which more than 10 times as many people were killed. The Fukushima accident resulted in no fatalities from the explosions and initial radiation release. A recently published World Health Organization (WHO 2013) report concludes that for the general population inside and outside of Japan, the predicted risks are low and no observable increase in cancer rates above the baseline rates are anticipated, except for those most nearest the plant in a region much smaller than the Fukushima prefecture. They note that the outcome could have been far worse, with the impact being much smaller than the primary consequences resulting from the earthquake and resulting tsunami. Gomez and Hart appear to interpret the data shown in their Figure 1 as a ‘goldrush’. An alternative interpretation is that science is built upon careful data collection, not rhetoric, so that it is not surprising to see an upsurge in publications when major new data sources arise. The scientific understanding that underpins applied Disaster Risk Reduction is founded on the forensic exploration of disaster events; without learning from past disasters there would be no progress in reducing vulnerability and building resilience. While welcoming the authors’ personal reflections on the current state of response in New Zealand and Japan, we would encourage them to think further about how those insights might contribute to applied research, in collaboration with relevant local authorities and communities. For us, in conclusion, our commentary made the case for the following:

075 The Use of GRADE Methods in the World Health Organization (Who) Public Health Guidelines (PHG): Distribution of Strength of Recommendations and Confidence in Estimates of Effect

BackgroundA perception exists that expert guideline panellists are sometimes reluctant to offer weak/conditional/contingent recommendations. GRADE guidance warns against strong recommendations when confidence in estimates of effect is low or very...

Clasificación inmunofenotípica de 3 casos de adenomas hepatocelulares. Diagnóstico diferencial con hiperplasia nodular focal

Interest in adenomas has been renewed by the discovery of the molecular changes in these tumors. The latest World Health Organization publication on gastrointestinal tract tumors (2010) includes four types of hepatic adenomas, which are well characterized immunohistochemically, genotypically and phenotypically. In these tumors, medical history and morphological behavior play an important role in determining the risk of malignancy, mainly in adenomas with a b-catenin mutation.The presence of steatosis, inflammation, vascular changes linked to response to L-FABP, serum amyloid A, and glutamyl synthetase help to classify these tumors into four groups: hepatocellular adenomas with the HNF1A mutation (H-HCA), those with the b-catenin mutation (b-HCA), inflammatory HCA (IHCA), and HCA without markers.The absence of glypican 3 expression, HSP 70 and perivenular mapping of glutamyl synthetase helps to distinguish these tumors from well differentiated hepatocellular carcinoma.We describe the clinical, morphological and immunophenotypic features of three patients diagnosed with hepatic adenomas in a 2-year period.

WHO publications available in the Peradeniya Medical Library: a bibliometric study

The collection of publications by World Health Organization (WHO) in the Medical Library contains documents published since 1950 to date which has been made available to the library free of charge by the WHO. The collection is very much under-used. A bibliometric study on the collection was carried out with the objective of making the readership and the library staff aware of what is available in the collection, which would indirectly improve the usage. The collection of WHO publications which is available in the Medical Library except periodicals was considered for the study. A head count on the total number of publications under study was obtained. The numbers of items in major subject divisions and in the most popular subject area within these divisions were counted separately. Contents of each publication in the collection were carefully read through in order to identify any specific topic or aspect of health on which the coverage was dominant. Items in monograph series were counted separately. Geographical coverage of contents of the publications was examined. A chronological evaluation of the collection was done by counting items published in each decade from 1950 to 2011. Data thus gathered was analyzed to obtain percentages of publications available in each category with respect to the total number. The results revealed that the collection contained information on various health related topics at national, regional and global levels. Collection needs to be improved by acquiring current publications. Journal of the University Librarians Association, Sri Lanka, Vol. 16, Issue 2, July 2012, Page 117-124 DOI: http://dx.doi.org/10.4038/jula.v16i2.5203

Adult T Lymphoblastic Leukemia (Pro-T ALL) with Reactive Monocytosis: A Case Report

Malignant lymphoid neoplasms of precursor T cell origin have been designated as T-lymphoblastic leukemia/lymphoma in the recently published world health organization classification for hematologic neoplasms [1]. T-acute lymphoblastic leukemia, T-ALL is a neoplasm of lymphoblasts committed to T-lineage, involving bone marrow and blood. T-ALL comprises of about 15 % of childhood and 25 % of adult ALL. Owing to its relative rarity, T-ALL arising in adults, has not been studied extensively. It typically presents with a high leukocyte count, often a large mediastinal mass of tissue with hepatosplenomegaly and lymphadenopathy. T-ALL can be stratified into different stages of intrathymic differentiation according to antigens expressed: Pro-T, Pre-T, Cortical-T and Medullary-T. Some studies have shown a correlation between the stages of T cell differentiation and survival. Compared to B-ALL, T-ALL patients have increased risk for induction failure, early relapse and isolated CNS relapse. We present a case of adult T-ALL with reactive monocytosis and rapidly fatal outcome, an association which has not yet been described in the literature but when present might cause diagnostic confusion with monocytic leukemias both morphologically as well as immunophenotypically and may possibly point towards a biologically more aggressive disease.

Multidrug-resistant tuberculosis in Eastern Europe: still on the increase?

The recently published World Health Organization (WHO) 2011 Global Report [1] provides important new information on the status of the tuberculosis (TB) epidemic and better estimates are now available on different indicators of TB control. These were possible thanks to new methodologies used to measure the disease, producing more precise figures on mortality, number of children orphaned by TB, budget needs and financial gaps. Overall, a clearer picture of TB in general, and multidrug-resistant (MDR)- and extensively drug-resistant (XDR)-TB in particular, is now available to guide the necessary national and international public health response [1–4]. A major response to this is that of the WHO Regional Office for Europe (Copenhagen, Denmark), which has recently prioritised MDR-TB prevention and control by developing a consolidated 5-yr action plan. The action plan and its resolution were endorsed at the 61st Regional Committee in Baku, Azerbaijan in September 2011. The plan envisages identifying and addressing the causes leading to emergence of drug-resistant TB in the region [5]. A complex interplay of factors, such as irrational drug policies, and social and clinical determinants ( e.g. HIV infection, imprisonment, migration and socioeconomic factors), are driving the emergence and the spread of MDR-TB and XDR-TB [6, 7]. Surveillance of drug resistance is a major tool to document the situation at the national level, and the trends in performance of TB care and control efforts, as long as three simple …

Relationship of testicular cancer incidence and cellular phone use.

e12008 Background: Because of the ubiquitous usage of cellphones, any health consequences, if found, would be of paramount importance. Many have questioned the relationship of cellphone radiofrequency waves and malignancies such as brain tumors. Because men usually store their phones in close proximately to the testicles, we analyzed the relationship between cell phone usage and testicular cancer. Methods: Testicular cancer data was obtained from SEER-9 United States Population Data Base of the National Cancer Institute. Cell phone subscription data was obtained from the World Health Organization publication. Initial data analysis was done from 1991 to 2008, with subsequent age specific and other analyses performed from 1999 to 2008. Trends over time were calculated as Annual Percentage Change of incidence rates (APC) by using log linear models. Results: Rates of United States mobile subscriptions increased exponentially since the late 1990’s reaching 88.87 percent of the population by 2008. There was no statistically significant change in incidence rates of all testicular tumors (APC 0.7; CI -0.2, 0.7), Seminoma (APC 0.2; CI 0.8, 1.1) and non-Seminoma (APC 1.4; CI -0.6, 3.4) from 1999 to 2008. In the age specific analysis, three groups showed an increase in incidence rates: all testicular cancer age 25-34 (APC 2; CI 0.6, 3.4), All testicular cancer age greater than 45 (APC 1.7; CI 0.1, 3.3) and Seminoma age 25-34 (APC 2.1; CI 0.6, 3.7). All these changes were only minor percentage increase when compared to mobile subscriptions. Conclusions: Based on incidence data, there is no convincing evidence of increased risk of testicular cancer from cell phone use. Given possible lag time incidence, continued monitoring is needed.

Desparasitação intestinal sistemática em idade pediátrica: Uma revisão baseada na evidência

Objectives: To determine whether systematic intestinal deworming with anthelmintic medications in pediatric populations affects height, weight, cognitive and academic performance, morbidity and mortality in children. Data Sources: MEDLINE database, electronic evidence-based medicine websites and World Health Organization publications. Review Methods: A search for articles using the MeSH terms albendazole, mebendazole, and pyrantel pamoate, published between January, 2000 and March, 2011 was conducted. Some related citations were also included. The Jadad Score was used to assess the quality of randomized clinical trials. The Strength of Recommendation Taxonomy (SORT) scale of the American Family Physician was used to assess the corresponding quality and strength of recommendations. Results: The search produced a total of 746 articles, of which 12 met the inclusion criteria. These included three systematic reviews, one meta-analysis, four clinical trials and four clinical practice guidelines. In children living in countries with a high prevalence of intestinal parasite infection, deworming proved to be beneficial in promoting height and weight gain. With reference to cognitive development and school performance, no evidence was found as to the benefits of deworming. Studies show inconsistent results in terms of morbidity. However, there seems to be an improvement in median hemoglobin levels, as well as a decrease in anemia and diarrhea. Conclusions:There is evidence for the benefits of systematic intestinal deworming with anthelmintics in children living in countries with a prevalence of intestinal parasite infection higher than 50% resulting from soil-transmitted helminths (SOR B). In countries with a low prevalence of infection, such as Portugal, individual treatment based on a diagnosis of infection is recommended (SOR C).

World Health Organization Discontinues Its Drinking-Water Guideline for Manganese

Background: The World Health Organization (WHO) released the fourth edition of Guidelines for Drinking-Water Quality in July 2011. In this edition, the 400-µg/L drinking-water guideline for manganese (Mn) was discontinued with the assertion that because “this health-based value is well above concentrations of manganese normally found in drinking water, it is not considered necessary to derive a formal guideline value.”Objective: In this commentary, we review the WHO guideline for Mn in drinking water—from its introduction in 1958 through its discontinuation in 2011.Methods: For the primary references, we used the WHO publications that documented the Mn guidelines. We used peer-reviewed journal articles, government reports, published conference proceedings, and theses to identify countries with drinking water or potential drinking-water supplies exceeding 400 µg/L Mn and peer-reviewed journal articles to summarize the health effects of Mn.Discussion: Drinking water or potential drinking-water supplies with Mn concentrations > 400 µg/L are found in a substantial number of countries worldwide. The drinking water of many tens of millions of people has Mn concentrations > 400 µg/L. Recent research on the health effects of Mn suggests that the earlier WHO guideline of 400 µg/L may have been too high to adequately protect public health.Conclusions: The toxic effects and geographic distribution of Mn in drinking-water supplies justify a reevaluation by the WHO of its decision to discontinue its drinking-water guideline for Mn.

Semen Analysis From A Point Of View Of Gynecologist And Recent Developments

SUMMARY Infertility is defined as the time of one year of unprotected intercourse without conception and affects approximately 15% of the couples. Data available over the years reveal that pathology is found among 55% of cases in women, 35% of cases in men and the remaining 10% of cases are defined as unexplained infertility. Male infertility is commonly due to deficiencies in the semen and semen quality is used as a surrogate measure of male fecundity. A semen analysis evaluates certain characteristics of a male's semen and the sperm contained in the semen. It should be the first laboratory investigation for men while evaluating a couple's infertility. Here, we tried to review the semen analysis as a very important laboratory investigation in evaluating the infertile couples with all points in the light of last published World Health Organization (WHO) criteria.

Commercial Serological Tests for the Diagnosis of Active Pulmonary and Extrapulmonary Tuberculosis: An Updated Systematic Review and Meta-Analysis

Serological (antibody detection) tests for tuberculosis (TB) are widely used in developing countries. As part of a World Health Organization policy process, we performed an updated systematic review to assess the diagnostic accuracy of commercial serological tests for pulmonary and extrapulmonary TB with a focus on the relevance of these tests in low- and middle-income countries. We used methods recommended by the Cochrane Collaboration and GRADE approach for rating quality of evidence. In a previous review, we searched multiple databases for papers published from 1 January 1990 to 30 May 2006, and in this update, we add additional papers published from that period until 29 June 2010. We prespecified subgroups to address heterogeneity and summarized test performance using bivariate random effects meta-analysis. For pulmonary TB, we included 67 studies (48% from low- and middle-income countries) with 5,147 participants. For all tests, estimates were variable for sensitivity (0% to 100%) and specificity (31% to 100%). For anda-TB IgG, the only test with enough studies for meta-analysis, pooled sensitivity was 76% (95% CI 63%-87%) in smear-positive (seven studies) and 59% (95% CI 10%-96%) in smear-negative (four studies) patients; pooled specificities were 92% (95% CI 74%-98%) and 91% (95% CI 79%-96%), respectively. Compared with ELISA (pooled sensitivity 60% [95% CI 6%-65%]; pooled specificity 98% [95% CI 96%-99%]), immunochromatographic tests yielded lower pooled sensitivity (53%, 95% CI 42%-64%) and comparable pooled specificity (98%, 95% CI 94%-99%). For extrapulmonary TB, we included 25 studies (40% from low- and middle-income countries) with 1,809 participants. For all tests, estimates were variable for sensitivity (0% to 100%) and specificity (59% to 100%). Overall, quality of evidence was graded very low for studies of pulmonary and extrapulmonary TB. Despite expansion of the literature since 2006, commercial serological tests continue to produce inconsistent and imprecise estimates of sensitivity and specificity. Quality of evidence remains very low. These data informed a recently published World Health Organization policy statement against serological tests. Please see later in the article for the Editors' Summary.

Serological Testing Versus Other Strategies for Diagnosis of Active Tuberculosis in India: A Cost-Effectiveness Analysis

Undiagnosed and misdiagnosed tuberculosis (TB) drives the epidemic in India. Serological (antibody detection) TB tests are not recommended by any agency, but widely used in many countries, including the Indian private sector. The cost and impact of using serology compared with other diagnostic techniques is unknown. Taking a patient cohort conservatively equal to the annual number of serological tests done in India (1.5 million adults suspected of having active TB), we used decision analysis to estimate costs and effectiveness of sputum smear microscopy (US$3.62 for two smears), microscopy plus automated liquid culture (mycobacterium growth indicator tube [MGIT], US$20/test), and serological testing (anda-tb ELISA, US$20/test). Data on test accuracy and costs were obtained from published literature. We adopted the perspective of the Indian TB control sector and an analysis frame of 1 year. Our primary outcome was the incremental cost per disability-adjusted life year (DALY) averted. We performed one-way sensitivity analysis on all model parameters, with multiway sensitivity analysis on variables to which the model was most sensitive. If used instead of sputum microscopy, serology generated an estimated 14,000 more TB diagnoses, but also 121,000 more false-positive diagnoses, 102,000 fewer DALYs averted, and 32,000 more secondary TB cases than microscopy, at approximately four times the incremental cost (US$47.5 million versus US$11.9 million). When added to high-quality sputum smears, MGIT culture was estimated to avert 130,000 incremental DALYs at an incremental cost of US$213 per DALY averted. Serology was dominated by (i.e., more costly and less effective than) MGIT culture and remained less economically favorable than sputum smear or TB culture in one-way and multiway sensitivity analyses. In India, sputum smear microscopy remains the most cost-effective diagnostic test available for active TB; efforts to increase access to quality-assured microscopy should take priority. In areas where high-quality microscopy exists and resources are sufficient, MGIT culture is more cost-effective than serology as an additional diagnostic test for TB. These data informed a recently published World Health Organization policy statement against serological tests.

The third ten years of the World Health Organization: 1968–1977

Important institutions deserve a historical record and at the same time have the obligation to provide their constituents with an account of their purpose and achievements. The World Health Organization (WHO) is such an institution and it has recently published a record of its third decade, reviewing its activities from 1968 to 1977. Based almost entirely on WHO publications, this is an invaluable summary of what happened within the Organization during those years. This book provides brief notes on the contemporary activities of all the departments, programmes, World Health Assembly decisions, Executive Board meetings, Expert Committee discussions and other matters concerning the Organization and world health. It helps the reader see rapidly what was happening then and saves him or her from consulting the mountain of Official Records, a search that could still be done easily as all the recorded facts are fully referenced. Being a “record of records”, as the author states, this book is a digest that provides researchers, staff and health ministries with a handy information tool about WHO, in particular about its third decade. But this facility also constitutes its relative weakness. In its care to summarize the records, there is no attempt for analysis nor a search for trends, interrelationships or interactions. This obviously was a deliberate decision, as it is stated that “the advantages of hindsight have been firmly resisted” and “no effort has been made to look forward in time to assess successes or failures”. This singular approach to history is a marked departure from the original idea of the 10-yearly volumes. In the first issue (1948–1958), the then Director-General noted that “… an effort has been made not only to review the history of these past ten years but also to place the events of that period against the background of previous achievements, and to indicate the broad lines along which future activities could develop”. The present volume’s limitation to a “record of records” does provide the bones and material for a history but does not write the history of this now historically mature sexagenarian Organization. The 14 chapters of the book touch upon the entire field of WHO’s work, some more extensively than others. The highlights of the decade are well recorded and the initial steps for smallpox eradication rightly receive special mention. Perhaps the best rendition is in the epilogue, which gives an excellent account of Alma-Ata: the international conference on primary health care that, paradoxically, falls outside the decade in question. It provides inspiration and sufficient analyses to make one yearn for more and to make it worth owning the book.

Casebook on ethical issues in international health research

This rich compilation of case studies in research ethics is designed for use by course instructors and workshop leaders. The use of case studies in workshops and formal courses is an especially valuable teaching tool, as students and workshop participants can grapple with ethical dilemmas and uncertainties in concrete situations. The editors have collected 64 case studies, based on episodes that have occurred in global health research throughout the world. Eight chapters comprise the cases under the following titles: Defining research; Issues in study design; Harm and benefit; Voluntary informed consent; Standard of care; Obligations to participants and communities; Privacy and confidentiality; and Professional ethics. Each chapter begins with an introduction that outlines the issues and provides some guidance for the topics addressed in the cases, and ends with a brief annotated list of suggested readings. Questions for discussion follow each case. In each chapter there is cross-referencing to cases in other chapters. Appropriately for a World Health Organization (WHO) publication, the case studies describe research that takes place in low- and middle-income countries. In several instances, the case begins with a caveat such as: “Although this case study is based on research that took place in the 1970s, the questions that it raises remain relevant today.” Readers may wonder why the editors chose cases from research that was conducted more than 30 years ago. Since the editors point out that the questions posed by each case remain relevant, it would have been better to choose more up-to-date examples. Case studies not only have to be credible as instructional materials, they also have to be timely. Knowledgeable physicians and researchers can become impatient with material they consider irrelevant to their current or future experience. Nevertheless, some cases have become classics in the field of research ethics and should, for that reason, be included in a collection such as this. An example is case 12, “Short-course AZT to prevent mother-to-child transmission of HIV”, which took place in the late 1990s. A degree of overlap in the content of different chapters is inevitable but can be confusing. An example is the inclusion of cases involving the ethics of placebo controls in chapter 2, Issues in study design, and the material covered in the introduction to chapter 5, Standard of care. In chapter 2, cases 8, 9, 10 and 12 all pose the central question of the ethics of a study design that includes a placebo control. Chapter 5 does not include any cases in which the ethical question revolves around placebo controls. However, most of the introduction to chapter 5 discusses the paragraph in the Declaration of Helsinki that deals with placebos. The fault in this confusion does not lie entirely with the editors of this casebook. Unfortunately, the phrase “standard of care” in the context of research is systematically ambiguous. Sometimes it refers to what the control group receives in a randomized, controlled trial (as in the placebo cases in chapter 2 and the Declaration of Helsinki discussion in the introduction to chapter 5). Sometimes the phrase refers to what participants in a prevention trial receive if they acquire the “target disease”, the one the research is designed to prevent (case 32, Testing a new HIV vaccine). Sometimes it is even used in a third sense to denote ancillary medical services that may be provided to research subjects (as in case 35). Chapter 6, Obligations to participants and communities, includes a discussion of ancillary care in the introduction, and several of the cases illustrate this third sense of “standard of care”. This confusion runs throughout the literature on research ethics and it would have been helpful to readers if the editors had clarified the ambiguity. Despite these minor shortcomings, this collection of cases is a valuable resource for workshop leaders and faculty teaching courses in global health research. WHO is to be commended for its choice of world-class experts to edit this publication.