Public health services and their relationship with rapid HIV test utilization and access for key populations in Morelos, Mexico / La organización de los servicios de salud y su relación con la utilización y acceso a las pruebas rápidas para la detección del VIH en las poblaciones clave en Morelos, México

Objective. In 2009, 4 749 rapid HIV tests were run in Morelos, Mexico, despite lacking evidence on their results. This article seeks to analyze how public health organization relates to utility of rapid HIV test among healthcare users. Materials and methods. Joint study: comparison of differences in applied test and positive results for each group with the Bonferroni statistical tool, observational study in 34 health subsystems, and 11 interviews with public healthcare users. Results. Each subsystem processes influenced the use and usefulness of screening; for instance, primary care centers test only pregnant women and exclude men who have sex with men (MSM). That group shows significant differences (p<0.007) in the HIV-positive test with respect to other groups. Conclusions. Despite the availability of rapid detection tests and epidemiological evidence, the way public health services are organized impedes an efficient diagnosis in the group with higher risk, namely MSM. The distribution of rapid HIV tests was guided by stigmatization.

Objetivo. En 2009, 4 749 pruebas rápidas de detección de VIH fueron aplicadas en Morelos, México, sin evidencias de resultados. Se hace necesario analizar la distribución de estas pruebas y las consecuencias que la organización de los servicios de salud tuvo para el diagnóstico del VIH en las poblaciones clave. Material y métodos. Estudio mixto: comparación de diferencias en pruebas aplicadas y casos diagnosticados en grupos mediante la técnica de Bonferroni, observaciones en 34 subsistemas de salud y 11 entrevistas a usuarios. Resultados. Los procesos de cada subsistema incidieron en la utilización y utilidad del tamizaje: se focalizó en mujeres embarazadas y se excluyó a grupos en mayor riesgo (p<0.007) en hombres que tienen sexo con otros hombres (HSH). Conclusiones. A pesar de la disponibilidad de las pruebas y de información epidemiológica, la organización de los servicios impidió una mayor captación de HSH. La estigmatización influyó en las formas de distribuirlas.

Antimicrobial prescription patterns for common acute infections in some rural & urban health facilities of India.

BACKGROUND & OBJECTIVES: Irrational use of antimicrobials is a key factor behind rapidly spreading antimicrobial resistance in microorganisms. This study was undertaken to determine the rate and pattern of antimicrobial prescribing in patients with uncomplicated acute respiratory infections, fever and diarrhoea attending a few rural and urban health settings. METHODS: The study was done in primary and secondary health care facilities of public/government and private settings at four sites in India. Patients with fever, cough, diarrhoea or ear, nose or throat infections of < 7 days were included. Pregnant women, lactating mothers, infants, seriously ill patients and patients with bloody diarrhoea or purulent nasal or ear discharge were excluded. RESULTS: Overall antimicrobial prescription rate was 69.4 per cent (95% CI 67.1, 71.7). Wide variation was observed (Thiruvananthapuram 47.6%, Lucknow 81.8%, Chennai 73.1% and Vellore 76.5%). Physicians practicing in rural and public/government settings prescribed antimicrobials more frequently than those in urban and private settings (83.8, 81.9, 68.3 and 68.2% respectively). Antimicrobials were more frequently prescribed for patients presenting with fever. Highest rate was noticed for children aged between 6 and 18 yr. Patients of the high-income group received antimicrobials more frequently (72.7%). In both public/ government and private settings, for patients who purchased medicines, the rate was higher (82.4 and 68.9% respectively), vs. those receiving free medicines (70.2 and 46.2% respectively). Two third of all antimicrobials prescribed were penicillins and co-trimoxazole, and > 40 per cent of prescriptions from private sector were quinolones and cephalosporins. INTERPRETATION & CONCLUSIONS: Our findings showed that prescription of antimicrobials for acute respiratory infections and diarrhoea was extremely common and warrants interventional strategies.

Fifty years of veterinary public health activities in the Eastern Mediterranean Region

This paper reviews the activities in veterinary public health in the Eastern Mediterranean Region over the past 50 years. It outlines the training and research carried out in the Region, with reference to the High Institute of Public Health in Alexandria and the Mediterranean Zoonoses Control Centre in Athens. It gives an overview of the activities carried out by the World Health Organization for the control of the different zoonoses prevalent in the Region and also looks at emerging and re-emerging zoonoses