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  • Second political regime does very little

    2019-06-28

    Second, political regime does very little to explain differences between countries. Rwanda, Congo (Brazzaville), and Tanzania have very similar child mortality rates (between 40 and 60 deaths per 1000 livebirths in 2014) to South Africa, Botswana, and Namibia despite the former countries being considered autocratic and the latter democratic.
    In his Correspondence, Samuel Watson refers to two sets of African countries to support his argument that one cannot necessarily interpret the synthetic control method (SCM) results of our study as causal effects.
    Increased funding in the past decade has improved healthcare coverage of the population and access to vaccines and drugs across sub-Saharan Africa. However, there is still a need to collect valid and sufficient baseline data, data on the safety of drugs and vaccines used during pregnancy, and for innovative approaches to pharmacovigilance in pregnancy to inform policy makers and to improve treatment guidelines. Interest in establishing sustainable pharmacovigilance systems in Africa is gaining momentum thanks to plans for large-scale implementation of artemisinin-based combination therapies across Africa. However, less than 1% of individual case safety reports in WHO\'s database (VigiBase®) are from Africa. Drugs such as tetracycline, metronidazole, albendazole, mebendazole, and efavirenz are not recommended during the first trimester because of potential gsk-3 toxicity. Nonetheless, these drugs are still used by women of childbearing age, and even pregnant women, by self-medication or irrational prescriptions. A different strategy, such as continuous longitudinal follow-up, is needed to collect reliable data on pregnant women. The health and demographic surveillance system (HDSS) platform of the INDEPTH Network is one such strategy that longitudinally documents millions of person-years and vital statistics relating to individuals in specific communities. The HDSS can be used for pharmacovigilance for the general population, but specifically for pregnant women and other susceptible groups. For example, a study in Tanzania used an HDSS platform to monitor the safety of drugs during pregnancy. More recently, INDEPTH introduced CHESS, a new generation of population surveillance operations that integrates across population and health facility data systems and links demographic, epidemiological, mortality, morbidity, clinical, laboratory, household, environmental, health systems, and other contextual data, with a unique electronic individual identification system throughout. CHESS will make pharmacovigilance more effective.
    Early diagnosis of tuberculosis and rapid treatment initiation are crucial for tuberculosis care and for interrupting transmission and require delivery of tuberculosis care services where most patients seek initial care. In most countries, National Tuberculosis Programs (NTPs) are expected to have basic tuberculosis diagnosis by use of smear microscopy available at the primary care level, via a network of microscopy centres. However, there is little published information on where latent tuberculosis and multi-drug resistant tuberculosis (MDR-TB) diagnostic and treatment services are exactly available in the highest tuberculosis burden countries. We addressed this gap by surveying 14 countries that have been identified by WHO as having the highest burden of tuberculosis cases, MDR-TB, and co-infection of HIV and tuberculosis. These countries are Angola, China, DR Congo, Ethiopia, India, Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Papua New Guinea, South Africa, Thailand, and Zimbabwe.
    From Dec 5, 2015 to Oct 13, 2016, 4306 suspected cases of yellow fever were reported in Angola, with 369 deaths and an alarming case fatality ratio of 8·8%. Three countries: the Democratic Republic of the Congo, Kenya, and China, have reported imported cases from Angola. This is the first time yellow fever has been reported in Asia. Of the ten laboratory-confirmed yellow fever cases reported in China, six people reside in Fujian Province, an area where dengue transmission has occurred, raising concerns of autochthonous transmission. In response to global concerns about the spread of yellow fever and the first cases reported in Asia, we analysed the border health procedures pertaining to yellow fever vaccination and epidemiological surveillance, regulation, and control in Sri Lanka as a case study for other non-endemic countries, particularly those in Asia with an abundance of the vector .