A Conflict Model for Strategists and Managers

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67210/2/10.1177_000276427201500604.pd

The impact of provider-initiated (opt-out) HIV testing and counseling of patients with sexually transmitted infection in Cape Town, South Africa: a controlled trial

<p>Abstract</p> <p>Background</p> <p>The effectiveness of provider-initiated HIV testing and counseling (PITC) for patients with sexually transmitted infection (STI) in resource-constrained settings are of particular concern for high HIV prevalence countries like South Africa. This study evaluated whether the PITC approach increased HIV testing amongst patients with a new episode of sexually transmitted infection, as compared to standard voluntary counseling and testing (VCT) at the primary care level in South Africa, a high prevalence and low resource setting.</p> <p>Methods</p> <p>The design was a pragmatic cluster-controlled trial with seven intervention and 14 control clinics in Cape Town. Nurses in intervention clinics integrated PITC into standard HIV care with few additional resources, whilst lay counselors continued with the VCT approach in control clinics. Routine data were collected for a six-month period following the intervention in 2007, on new STI patients who were offered and who accepted HIV testing. The main outcome measure was the proportion of new STI patients tested for HIV, with secondary outcomes being the proportions who were offered and who declined the HIV test.</p> <p>Results</p> <p>A significantly higher proportion of new STI patients in the intervention group tested for HIV as compared to the control group with (56.4% intervention versus 42.6% control, p = 0.037). This increase was achieved despite a significantly higher proportion intervention group declining testing when offered (26.7% intervention versus 13.5% control, p = 0.0086). Patients were more likely to be offered HIV testing in intervention clinics, where providers offered the HIV test to 76.8% of new STI patients versus 50.9% in the control group (p = 0.0029). There was significantly less variation in the main outcomes across the intervention clinics, suggesting that the intervention also facilitated more consistent performance.</p> <p>Conclusions</p> <p>PITC was successful in three ways: it increased the proportion of new STI patients tested for HIV; it increased the proportion of new STI patients offered HIV testing; and it delivered more consistent performance across clinics. Recommendations are made for increasing the impact and feasibility of PITC in high HIV prevalence and resource-constrained settings. These include more flexible use of clinical and lay staff, and combining PITC with VCT and other community-based approaches to HIV testing.</p> <p>Trial registration</p> <p>Controlled trial ISRCTN93692532</p

Weaning food provision in refugee situations

Meeting: Improving Young Child Feeding in Eastern and Southern Africa : Household Level Food Technology, 12-16 Oct. 1987, Nairobi, KEIn IDL-129

Prestation d'aliments de sevrage dans le cas des réfugiés

Réunion: Pour améliorer l'alimentation des jeunes en Afrique orientale et australe : une technologie à la portée des ménages, 12-16 oct. 1987, Nairobi, KEDans IDL-405

Prevention and control of measles in emergency situations

All children from 6 months to 5 years of age should be vaccinated against measles as soon as they arrive at a camp. If there are not enough doses of vaccine, preference should be given to children in feeding centers. The occurrence of measles in a camp is not a contraindication to conducting a vaccination campaign. It should be coordinated by a suitable lead agency, and cooperation with the local expanded program of immunization should be encouraged so as to take advantage of available cold chain equipment, training protocols, and management manuals. In cases of severe malnutrition, vitamin A should be given routinely along with the vaccine in order to reduce mortality and morbidity in children with measles. -from English summar

Measles prevention and control in emergency settings

Outbreaks of measles continue to be a common occurrence among refugee and famine-affected children in emergency relief camps. Extremely high measles-associated mortality rates have been reported from refugee camps - where undernutrition is common - in several countries over the past 10 years. Mortality from measles is, however, preventable, and immunization against the disease is a high priority in emergency relief programmes, second only in importance to the provision of adequate food rations. All children aged 6 months to 5 years should be immunized with measles vaccine as soon as they enter an organized camp or settlement. Should supplies of measles vaccine be inadequate, children in feeding centres, or those otherwise identified as undernourished, are the top priority for immunization. The occurrence of measles in a camp is not a contraindication to conducting an immunization campaign. Strong coordination by a designated lead agency is needed if such campaigns are to be successful; however, cooperation with the local expanded programme on immunization is essential to ensure that existing cold chain equipment, training protocols, and management manuals are used. If additional equipment is necessary, a complete immunization kit developed by the Office of the United Nations High Commissioner for Refugees, the World Health Organization, and Oxfam can be procured from Oxfam headquarters in the United Kingdom. Vitamin A supplements should be given routinely at the time of measles immunization in situations where malnutrition is severe. Mortality and morbidity in children with clinical measles can be reduced by administering doses of vitamin A

Measles prevention and control in emergency settings.

Outbreaks of measles continue to be a common occurrence among refugee and famine-affected children in emergency relief camps. Extremely high measles-associated mortality rates have been reported from refugee camps--where undernutrition is common--in several countries over the past 10 years. Mortality from measles is, however, preventable, and immunization against the disease is a high priority in emergency relief programmes, second only in importance to the provision of adequate food rations. All children aged 6 months to 5 years should be immunized with measles vaccine as soon as they enter an organized camp or settlement. Should supplies of measles vaccine be inadequate, children in feeding centres, or those otherwise identified as undernourished, are the top priority for immunization. The occurrence of measles in a camp is not a contraindication to conducting an immunization campaign. Strong coordination by a designated lead agency is needed if such campaigns are to be successful; however, cooperation with the local expanded programme on immunization is essential to ensure that existing cold chain equipment, training protocols, and management manuals are used. If additional equipment is necessary, a complete immunization kit developed by the Office of the United Nations High Commissioner for Refugees, the World Health Organization, and Oxfam can be procured from Oxfam headquarters in the United Kingdom. Vitamin A supplements should be given routinely at the time of measles immunization in situations where malnutrition is severe. Mortality and morbidity in children with clinical measles can be reduced by administering high doses of vitamin A