ABSTRACT
Despite the enormous benefits of vaccination, global immunisation coverage progress has stalled and remains suboptimal in many countries. In this commentary, we review the recently published update of the World Health Organization and United Nations Children's Fund Estimates of National Immunization Coverage. We highlight trends in which, despite substantial gains made in improving immunisation coverage at the global level, there remain numerous challenges with reaching and sustaining optimal coverage. We contextualise the trends by exploring plausible supply- and demand-side root causes. Based on these, we stress the need for targeted, context-appropriate strategies for reaching and maintaining optimal immunisation coverage.
Subject(s)
Immunization Programs , Vaccination Coverage , Child , Global Health , Humans , United Nations , Vaccination , World Health OrganizationABSTRACT
OBJECTIVE: This study is designed to further characterize Limited Joint Mobility (LJM) of the hand using quantitative goniometric measurements among Black Africans with Type 2 diabetes mellitus and non-diabetes. METHODS: Seventy-six patients with Type 2 diabetes and 63 normal controls matched for age and gender were purposively selected. Visual clinical examination and quantitative goniometric assessment of patients with DM and non-DM controls were done. The LJM was graded using the criteria of Silverstein et al. Glycaemic control and proteinuria were also assessed. RESULTS: Prevalence of LJM among Type 2 DM patients was 26.3% compared with 4.8% in normal controls. Subjects with LJM within the control group were significantly older than those with LJM within the DM group (p < 0.05). Prayer sign was 11.8% in DM patients compared with 4.8% of control. The flattening sign demonstrated by the inability to flatten their hands on a flat surface was more in patients with DM (10.5%) compared with 4.8% in the control group. Stage II LJM with 18.4% prevalence was the commonest followed by Stage III (7.9%) among patients with DM. Poor glycaemic control was found in 85%, using fasting plasma glucose and 70%, using 2-hour postprandial blood glucose (2 hpp). CONCLUSION: We conclude that Black Africans with Type 2 DM only have moderately severe cases of LJM.
OBJETIVO: Este estudio fue diseñado para caracterizar más a fondo la limitación de la movilidad articular (LMA) de la mano, usando mediciones goniométricas entre africanos. MÉTODOS: Setenta y seis pacientes con diabetes mellitus tipo 2 y 63 controles normales pareados por edad y género fueron seleccionados para este propósito. Se realizó un examen clínico visual y una evaluación goniométrica cuantitativa de los pacientes con DM y controles no DM. La LMA fue graduada usando los criterios de Silverstein et al. También se evaluaron el control glicérico y la proteinuria. RESULTADOS: La prevalencia de LMA entre pacientes con DM tipo 2 fue de 26.3% comparada con 4.8% en los controles normales. Los sujetos con LMA en el grupo de control fueron significativamente mayores en edad que aquellos con LMA en el grupo con DM (p < 0.05). La signo de las manos en oración fue 11.8% en los pacientes con DM comparado con el 4.8% del control. El signo de aplanamiento demostrado por la incapacidad de los pacientes de poner sus manos totalmente planas sobre una superficie, fue mayor en aquellos con DM (10.5%) en comparación con el 4.8% del grupo control. La LMA de la segunda etapa con una prevalencia de 18.4%, fue la más común seguida por la de etapa III (7.9%) entre pacientes con DM. Un control glicémico pobre fue hallado en 85%, usando glucosa plasmática en ayunas. CONCLUSIÓN: Concluimos que los africanos negros con DM tipo 2 presentan sólo casos moderadamente severos de LMA.
Subject(s)
Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Black People , /complications , /ethnology , Joint Diseases/ethnology , Range of Motion, Articular , Blood Glucose/metabolism , Case-Control Studies , /blood , Nigeria , Prospective StudiesABSTRACT
OBJECTIVE: This study is designed to further characterize Limited Joint Mobility (LJM) of the hand using quantitative goniometric measurements among Black Africans with Type 2 diabetes mellitus and non-diabetes. METHODS: Seventy-six patients with Type 2 diabetes and 63 normal controls matched for age and gender were purposively selected. Visual clinical examination and quantitative goniometric assessment of patients with DM and non-DM controls were done. The LJM was graded using the criteria of Silverstein et al. Glycaemic control and proteinuria were also assessed. RESULTS: Prevalence of LJM among Type 2 DM patients was 26.3% compared with 4.8% in normal controls. Subjects with LJM within the control group were significantly older than those with LJM within the DM group (p < 0.05). Prayer sign was 11.8% in DM patients compared with 4.8% of control. The flattening sign demonstrated by the inability to flatten their hands on a flat surface was more in patients with DM (10.5%) compared with 4.8% in the control group. Stage II LJM with 18.4% prevalence was the commonest followed by Stage III (7.9%) among patients with DM. Poor glycaemic control was found in 85%, using fasting plasma glucose and 70%, using 2-hour postprandial blood glucose (2 hpp). CONCLUSION: We conclude that Black Africans with Type 2 DM only have moderately severe cases of LJM.
