The epidemiology of diarrhoeal disease in children at Queen Elizabeth Central Hospital, Blantyre, Malawi, 1994-1997

Diarrhoeal disease (DD) is a leading cause of childhood morbidity and mortality in developing countries throughout the world. To begin to understand the burden of DD at Queen Elizabeth Central Hospital (QECH), its seasonality and age distribution, we reviewed inpatient and outpatient records for cases of gastroenteritis between 1994 and 1997. Annually, DO. accounted for an average of 7,300 attendances to the; Under 5's rehydration clinic, 1219 paediatric admissions (12% of all hospitalisations) and 183 deaths in hospitalised children (19% of total). A distinct seasonal pattern was identified with monthly peaks for DD occurring between October to January. Over 75% children (inpatients and outpatients) were below two years of age. During the study period, an increase in the number of outpatient attendances for DD was observed. In contrast, the number of children with a more severe outcome, hospitalisation or death, declined during the study period. This is likely to be explicable by the increasing and appropriate use of oral rehydration therapy. We conclude that DD is a substantial cause of morbidity and mortality in Malawian children. Further studies of the patterns of DD at QECH will be necessary to assess the impact ofDD control programmes

Epidemic infectious gastrointestinal illness aboard U.S. Navy ships deployed to the Middle East during peacetime operations – 2000–2001

BACKGROUND: Infectious gastrointestinal illness (IGI) outbreaks have been reported in U.S. Navy ships and could potentially have an adverse mission impact. Studies to date have been anecdotal. METHODS: We conducted a retrospective analysis of weekly reported disease and non-battle injury health data collected in 2000 – 2001 from 44 U.S. Navy ships while sailing in the 5(th )Fleet (Persian Gulf and nearby seas). RESULTS: During this period, 11 possible IGI outbreaks were identified. Overall, we found 3.3 outbreaks per 100 ship-weeks, a mean outbreak duration of 4.4 weeks, and a mean cumulative ship population attack rate of 3.6%. Morbidity, represented by days lost due to personnel being placed on sick-in-quarters status, was higher during outbreak weeks compared to non-outbreak weeks (p = 0.002). No clear seasonal distribution was identified. CONCLUSION: Explosive outbreaks due to viruses and bacteria with the potential of incapacitating large proportions of the crew raise serious concerns of mission impact and military readiness

Implementing new health interventions in developing countries: why do we lose a decade or more?

BACKGROUND: It is unclear how long it takes for health interventions to transition from research and development (R&D) to being used against diseases prevalent in resource-poor countries. We undertook an analysis of the time required to begin implementation of four vaccines and three malaria interventions. We evaluated five milestones for each intervention, and assessed if the milestones were associated with beginning implementation. METHODS: The authors screened WHO databases to determine the number of years between first regulatory approval of interventions, and countries beginning implementation. Descriptive analyses of temporal patterns and statistical analyses using logistic regression and Cox proportional hazard models were used to evaluate associations between five milestones and the beginning of implementation for each intervention. The milestones were: (A) presence of a coordinating group focused on the intervention; (B) availability of an intervention tailored to developing country health systems; (C) international financing commitment, and; (D) initial and (E) comprehensive WHO recommendations. Countries were categorized by World Bank income criteria. RESULTS: Five years after regulatory approval, no low-income countries (LICs) had begun implementing any of the vaccines, increasing to an average of only 4% of LICs after 10 years. Each malaria intervention was used by an average of 7% of LICs after five years and 37% after 10 years. Four of the interventions had similar implementation rates to HepB, while one was slower and one was faster than HepB. A financing commitment and initial WHO recommendation appeared to be temporally associated with the beginning of implementation. The initial recommendation from WHO was the only milestone associated in all statistical analyses with countries beginning implementation (relative rate = 1.97, P > 0.001). CONCLUSIONS: Although possible that four milestones were not associated with countries beginning implementation, we propose an alternative interpretation; that the milestones were not realized early enough in each intervention's development to shorten the time to beginning implementation. We discuss a framework built upon existing literature for consideration during the development of future interventions. Identifying critical milestones and their timing relative to R&D, promises to help new interventions realize their intended public health impact more rapidly

Evaluation of RIX4414, a live, attenuated rotavirus vaccine, in a randomized, double-blind, placebo-controlled phase 2 trial involving 2464 Singaporean infants

10.1086/431511Journal of Infectious Diseases192SUPPL.