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PubMed2002

Sexually transmitted diseases in the older population in Singapore.

BACKGROUND: Sexually transmitted diseases (STDs) in persons older than 50 years are rarely studied because STDs are more common in young people. AIM: To study the distribution and types of STDs in older persons, defined in our study as individuals aged 50 years or older. METHOD: Retrospective analysis of surveillance data for diseases notified under the Infectious Disease Act, which include syphilis, gonorrhoea, non-gonococcal urethritis (NGU), vaginal discharge and chancroid. Human immunodeficiency virus (HIV) infections were not included. Data from notifications of diseases, such as genital herpes and genital warts, which are not compulsory, were also analysed. Period of study was from January 1996 to December 2000. RESULTS: During the study period, STD notifications for persons aged 50 years and older accounted for 7.6% of all notifications. Among these older persons, males were predominantly affected. The most common disease notified in older persons was gonorrhoea (600 cases), followed by non-infectious syphilis (578 cases) and NGU (339 cases). There were 76 cases of infectious syphilis. The age-specific disease rates for this group of older patients were as follows (number of cases per 100,000 patients per year): gonorrhoea-17.61, non-infectious syphilis-16.96, infectious syphilis-2.23, NGU-20.66, genital warts-6.92 and genital herpes-7.33. CONCLUSION: Although STDs occur mainly in the young, it affects a small but significant proportion of persons aged 50 years and older. A better understanding of the epidemiology of STDs in these population is important for reducing STD morbidity and improving STD care.

Adult↗
PubMedDate not supplied

[Quality of disease management of sexually transmitted diseases: investigation of care in six countries in West Africa].

OBJECTIVES: the objectives of this study were, in healthcare facilities in six countries in West Africa, to: (1) estimate the proportion of patients consulting for sexually transmitted diseases (STDs) for whom an adequate case history was taken and who received an appropriate physical examination and effective treatement (prevention indicator PI6); (2) to determine the percentage of patients who were given advice on condom use and notification of sexual partners for STD treatment (prevention indicator PI7); (3) to determine the level of knowledge of healthcare workers concerning STD case management; and (4) to compare reported and observed behaviour regarding STD case management by healthcare workers. MATERIAL AND METHOD: this descriptive study was carried out in 240 health care facilities in six countries: Benin, Burkina Faso, Côte d'Ivoire, Guinea, Mali, and Senegal, using the WHO protocol for PI6 and PI7 indicators to evaluate the quality of management of urethral discharge and genital ulcers, as well as an extension of this protocol to evaluate STD syndromes specific to women, namely vaginal discharge and pelvic inflammatory disease. Healthcare workers were observed during STD consultations, and thereafter interviewed. Up to five observations per healthcare worker were carried out over a period of three days spent at each health care facility. Criteria for an adequate case history were inclusion of questions on the nature, time of initiation and duration of symptoms, and for physical examination, visualisation and examination of genital organs for discharge and lesions. Treatments prescribed were judged as effective when in conformity with national algorithms for syndromic STD management. The PI6 indicator was estimated as the proportion of cases where an adequate case history was taken, an appropriate physical examination carried out and effective treatment prescribed. The PI7 score corresponded to the percentage of patients who received advice on condom use and partner notification for treatment. In order to control for intra-healthcare-worker correlation, the SUUDAN software was used for the computation of 95% confidence intervals of the proportions, obtained from univariate analysis in EPI-INFO, and for the comparison of the PI6 and PI7 scores by country, sex, marital status and symptoms of the patient, as well as by level of qualification of the healthcare workers, using the khi2 test. RESULTS: overall, 613 observations and 504 interviews of 263 healthcare workers were carried out. The majority of STD patients were female (57.1%) and unmarried (53.0%). Healthcare workers were most frequently doctors (33.6%) and the most common complaint was vaginal discharge (42.2%). Intercountry variation was observed for all these variables. An adequate case history was taken in 84.6% of cases and an adequate physical examination carried out in 60.8% of cases. Healthcare workers gave a diagnosis in conformity with national syndromic STD management algorithms in 35.3% of cases, while effective treatment was given to 14.1% of patients. Patients were encouraged to use condoms in 19.5% of cases and to advise their partners to seek treatment in 50.8% of cases; this advice was given more frequently to men than to women. PI6 and PI7 scores were respectively 9.9% (95% CI: 6.9%; 12.9%) and 15.4% (95% CI: 11.4%; 19.2%). Healthcare workers' knowledge of effective STD treatment regimes was low. Practices reported during interviews with regard to STD patients were comparable to observed behaviour with regard to case history-taking and physical examination, but not for diagnosis and treatment nor for condom promotion or partner notification advice. CONCLUSION: the results of this study demonstrate the low quality of STD management in the six countries evaluated, which may be explained by the lack of availability of examination material, the inadequate knowledge of healthcare workers, as well as the infrequent promotion of STD prevention methods, particularly in women.

Adult↗
PubMed2003

Tuberculosis transmission patterns in a high-incidence area: a spatial analysis.

SETTING: In the Cape Town suburbs of Ravensmead and Uitsig, tuberculosis has reached epidemic levels, with notifications of 1340/100,000 in 1996. These suburbs are characterised by overcrowding, high unemployment and poverty. It is traditionally believed that tuberculosis transmission takes place mainly in households after close contact with an infectious person. Studies have recently linked tuberculosis transmission to locations outside the household, and have associated these places with a particular high-risk lifestyle. Anthropological studies in some suburbs of Cape Town, in which a very high number of local drinking places (shebeens) were identified (17 per km2), have suggested that social drinking is part of such a lifestyle. OBJECTIVE: To investigate various risk factors and places of transmission of tuberculosis using a geographical information system (GIS). RESULTS AND CONCLUSION: The 1128 bacteriologically-proven cases of tuberculosis studied over the period 1993-1998 were investigated using spatial epidemiological techniques of exploratory disease mapping. Point pattern analysis and spatial statistics indicated clustering of cases in the areas of high incidence. Significant associations of tuberculosis notifications were found with unemployment, overcrowding and number of shebeens per enumerator sub-district. High tuberculosis notifications with unemployment and its associated poverty emerged as the strongest association.

Adult↗
PubMed2000

Gastrointestinal infections presenting in general practice in Scotland.

OBJECTIVES: To determine the incidence of gastrointestinal infections (GII) presenting to general practitioners (GPs) in Scotland, To record the demographic and clinical characteristics of persons presenting with GII, To determine the proportion and characteristics of GII investigated in the laboratory, To report on the microbiological aetiology of the GII. DESIGN: Descriptive epidemiological study. SETTING: Twenty three general practices in Scotland serving a total practice population of 152,471. SUBJECTS: Patients consulting their GPs for a 'gastrointestinal infection' which met the study case definition. RESULTS: These are presented for the 3872 patient consultations for GII between April 1996 and December 31st 1997 which met the survey case definition. The crude annual rate of new consultations recorded was 1.7 per 100 person years. The crude monthly consultation rate for new cases ranged between 11 and 18 per 10,000 patients. GPs notified 9% of the cases as 'food poisoning'. A request for microbiological testing of samples at the local laboratory for clinical reasons was documented for 34% of cases with diarrhoea. The study laboratory received faecal samples by post from 66% of these cases. About one in five of the samples tested revealed evidence of infection with a common gastrointestinal pathogen. The pathogens most frequently reported were Campylobacter sp and Salmonella sp. CONCLUSION: The incidence of consultations for GII in Scotland is similar to that recorded in a recent survey in England. The very low notification rate by GPs means that statutory notification by telephone or post is a poor basis for early warning of outbreaks. It is recommended that a pilot study of electronic notification using the NHS net is set up.

Adolescent↗
PubMedDate not supplied

Problems to control TB in eastern Europe and consequences in low incidence countries.

The regular decline in tuberculosis (TB) notification rates observed in the majority of industrialised countries over the past decades has levelled off or reversed in recent years in both the USA and in Europe, where relevant differences between Central/Eastern and Western countries have become more and more apparent. In the countries of the Central and Eastern European sub-region, notification rates have ceased to decline or markedly increased since the 1990s, particularly in the Baltic States, in Romania, Russian Federation and other countries belonging to the previous USSR. The evaluation of age-specific notification rates shows that the majority of the countries in the Central and Eastern European sub-region still have a pattern of middle-income countries, where TB is affecting significantly the younger cohorts, and the infection in the community is still rampant. The aim of the present paper is to discuss the main determinants of the deteriorated TB control in Eastern Europe, the main consequences of this situation for Western European Countries, and the possible solutions. The major constraints described are: socio-economic crisis, health system weaknesses, HIV pandemic, multidrug-resistant TB (MDRTB) and failure to control TB in prisons and in other risk groups. The main consequences of the sub-optimal TB control achieved in Eastern Europe, are the exportation of TB trough immigration and, as part of this phenomenon, the exportation of drug resistance and MDRTB. Proper TB control is possible in the sub-region, as testified by the successful results achieved in the Czech republic, Slovakia and Slovenia. A global reform of health systems is necessary, particularly in the previous USSR countries, based on cost-effective interventions. MDRTB should be managed promptly as an international emergency, based on a cooperative approach of donor and assisted countries. As opportunities for improved funding of TB control in the region exist, there is the potential to reverse to TB pandemic before the explosion of the HIV epidemic expected in Eastern Europe.

Emigration and Immigration↗
PubMed1956

Poliomyelitis in 1954.

As in an earlier study, the authors have endeavoured to review the world incidence of poliomyelitis on the basis of the available statistical information (official notifications of cases and deaths) and to compare these data with data received from various sources regarding the prevailing viruses.It is certainly not yet possible to establish side by side the cartography of actual poliomyelitis cases and that of the prevalence and distribution of the polioviruses. However, it may not be too early to make a start in this direction.In Africa there was a rise of about 40% in the number of poliomyelitis notifications. Part of this increase is probably due to improved reporting. Characteristic epidemics were observed in the west (Senegal, Cameroons under French administration), as well as in the east (Sudan, Kenya, Tanganyika, Northern and Southern Rhodesia, Union of South Africa).In America the most outstanding outbreaks were observed in Alaska, in Wyoming, Nebraska, Iowa, Florida, and California, and all round the Caribbean Sea (Costa Rica, Guatemala, Haiti, Jamaica, Puerto Rico, Trinidad).In the Asiatic countries the number of notifications was generally of the same order as in 1953.The incidence also declined in Europe, in spite of the fact that Greece was affected by the most serious epidemic recorded in its history. Other outbreaks were recorded in Finland, Switzerland, and Austria, where the incidence had also been high in the previous year. An increase was also noted in Scotland.Finally, in Oceania, poliomyelitis took on epidemic proportions in Australia (in the territory of the Federal Capital and in the States of Victoria and Western Australia) and in the Hawaiian Islands.

Africa↗
PubMed2003

Quality analysis of medical device vigilance reports.

The quality of the notifications issued within the European Medical Device Vigilance system were retrospectively reviewed and the adequacy of the recommended guidelines evaluated. The study material comprised all 589 vigilance notifications the Finnish competent authority received from manufacturers and other national competent authorities during 1997, 1999, and 2001. The number of vigilance reports, particularly the reports issued by national competent authorities, has increased from 82 in 1997 up 166 in 2001 while the proportion of reports with demonstrated bearing on health risk has decreased from about 40% down to 20% during the last five years. The number of manufacturers' reports has also increased from 28 in 1997 up to 98 in 2001 while the information given in the reports have become somewhat more incoherent. The time needed to close a device-related incident has increased, too. It is obvious that the present vigilance guidelines provide adequate guidance for both the manufacturers and competent authorities to manage vigilance cases efficiently and appropriately. It is crucial that all pertinent parties should adopt the recommended procedures and act accordingly. The vigilance system underpinned with high quality notifications only assures the continuous enhancement of patient safety, the bottom line.

Equipment Safety↗
PubMed2003

A proposed clinical decision support system (CDSS) output message.

When a clinical decision support system (CDSS) or other ancillary system detects an abnormal or problematic condition, healthcare providers must be notified in a timely manner so that appropriate corrective action can be taken. Delivery of clinical alerts to the appropriate providers is the role of a notification system.1,2 The content generating system must therefore communicate to the notification system the content to be delivered and any additional directives regarding the resulting notifications. This work is sanctioned by the Health Level Seven, Inc., Clinical Decision Support Technical Committee (CDS TC) and is based on previous proposals to the CDS TC.3 The proposed message model is presented as an XML schema.4

Decision Support Systems, Clinical↗
PubMed1992

[Contact tracing routines for genital chlamydia infections used by Norwegian physicians. A questionnaire study].

Notification of partner(s) is recommended as a measure to control the epidemic of genital chlamydial infection. We surveyed a random sample of Norwegian general practitioners and privately practising gynaecologists. Only one in five general practitioners initiated notification of partner(s) after diagnosing a patient with genital chlamydial infection. A proposed new Communicable Diseases Act will make it mandatory to notify the partner in the event of such infections. 49% of general practitioners are in favour of the proposal, 21% oppose it while 30% remain uncertain. After implementation of similar legislation, Sweden has experienced a decline in the incidence of genital chlamydial infection. We believe increased notification of partner would help to control the Norwegian epidemic.

Chlamydia Infections↗
PubMed2004

Effect of altitude on the frequency of pulmonary tuberculosis.

SETTING: Pulmonary tuberculosis (PTB) incidence greatly varies around the world, a phenomenon usually attributed to socio-economic factors or health service availability. A recent study, however, indicated that PTB was inversely related to altitude. OBJECTIVE: To evaluate factors associated with PTB notification rates in Mexico. METHODS: Annual notification rates (1998-2002) of PTB in each of the 32 Mexican states were analysed, and likely factors were assessed through correlation and multiple regression analyses. RESULTS: Most variables lacked association with PTB rates, including percentage of population aged > or = 65 years, population density, percentage of population with < or = 2 minimum salaries, percentage of population with social security, level of education, diabetes incidence, percentage of immigration, percentage of rural population and a global marginalisation index. Only altitude above sea level correlated with tuberculosis incidence (r = -0.74, P < 0.0001). Likewise, in the multiple regression analysis only altitude reached a statistically significant association. CONCLUSION: Our results showed that altitude had a strong inverse relationship to PTB notification rates in Mexico, which might be related to the well known changes in alveolar oxygen pressure at different altitudes. Interestingly, several factors traditionally considered as predisposing conditions for the development of PTB did not correlate with the disease.

Adolescent↗
PubMed2005

[Tuberculosis in Poland in 2003].

In 2003 year decrease of tuberculosis notification rates in Poland has continued. In this year 10 125 tuberculosis cases (TB) were notified in Poland--incidence rate--26.5 per 100 000 population, with the large differences in notification rates between voivodeships (from 16.9 to 39.8/100 000). Between 1994-2003 notification rates decreased by 3.9% yearly overall. 87.8% of the TB cases notified were new cases. Pulmonary cases represented 90.9% of TB cases. Male to female sex ratio--2.1. Age specific rates were much lower in children--1.5/100 000 (100 cases)--1% of all TB cases and highest in person over 65 years--57.6/100 000 (27.9% all TB cases). Sixty percent of all pulmonary cases were confirmed by culture and 38% were sputum smear positive. Among all the pulmonary TB cases treated there were 292 cases with resistance to at least one drug. They represented 3.4% of bacteriologically positive pulmonary cases treated and from many years remains relatively low. There 892 death due tuberculosis reported in 2002 y.i.e. 2.3/100 000. Mortality among males--3.7 and 1.1/100 000 among females. Since many years the TB mortality is of the order 0.2% of total mortality and almost 40% mortality from infectious diseases. In 2003 year--93.5% new born babies were vaccinated BCG; 82% of all TB pulmonary cases were detect by symptoms and 4% by contact examination. Success rates (cured or completed) of treatment were reported in 83.3%; failed 1.0%; deaths during treatment were reported in 6.2% (2.4% from TB) treatment default in 7.8% treated cases.

Adolescent↗
PubMed2006

Progress toward tuberculosis control and determinants of treatment outcomes--Kazakhstan, 2000-2002.

INTRODUCTION: In Kazakhstan, during 1995-2002, the annual notification rate per 100,000 population for new cases of tuberculosis (TB) increased from 67.1 to 165.1. Beginning in 1998, public health authorities have used the national case management strategy (DOTS) promulgated by the World Health Organization (WHO) to control TB. Intended goals of DOTS include achieving a cure rate of >85% for persons with newly detected pulmonary TB sputum-smear-positive (PTB+) cases and having PTB+ represent >65% of all PTB cases among adults. Surveillance data collected during 2000-2002 were analyzed to evaluate progress toward achieving these goals and identify factors associated with specific treatment outcomes. METHODS: Surveillance data included the following nonidentifiable information on persons with newly reported cases of PTB: dates of disease onset and treatment initiation; methods of diagnosis; treatment outcomes; HIV status; and selected demographic, socioeconomic, and behavioral characteristics. Cure rates and proportions of PTB+ cases were calculated on the basis of the TB case definition and treatment outcome classification format outlined in DOTS guidelines issued by WHO. Denominator data to calculate rates were obtained from the National Census Office of Kazakhstan. Logistic regression was employed to investigate factors associated with treatment outcomes using Epi Info version 3.2. RESULTS: During 2000-2002, a total of 65,011 new cases of PTB were detected in Kazakhstan. The average annual countrywide notification rate per 100,000 population was 146.0; provincial notification rates varied (range: 65.1-274.0). The countrywide cure rate for newly detected PTB+ was 72.2%; provincial rates varied (range: 65%-81%). Of 59,905 cases of PTB among adults during 2000-2002, a total of 26,804 (44.7%) were PTB+. Unfavorable treatment outcome of new PTB+ cases was associated with alcohol abuse, homelessness, and previous incarceration. CONCLUSION: The cure rate for new PTB+ cases and the proportion of cases of PTB+ among all adults with PTB were below targeted goals. This might, in part, be explained by the 1998 adoption of DOTS. Improving program indicators requires evaluation of detection efforts, laboratory diagnostic capabilities, and adherence to treatment regimens, especially in provinces in which rates are high and among persons at high risk for unfavorable treatment outcomes.

Adolescent↗
PubMed2006

Tuberculosis epidemiology in six provinces of Vietnam after the introduction of the DOTS strategy.

SETTING: Six provinces in Vietnam where the DOTS strategy was introduced in 1989. OBJECTIVE: To assess the impact of improved tuberculosis (TB) control on TB epidemiology in Vietnam. METHODS: Data from the surveillance system in the period 1990-2003 were analysed to assess trends of notification rates and the mean ages of notified cases. Data from repeated tuberculin surveys in the period 1986-2002 were estimated to assess the prevalence of TB infection, the annual risk of infection and its trend using various cut-off points in those with and without bacille Calmette-Guérin (BCG) scar. RESULTS: Age-standardised notification rates in the period 1996-2003 declined significantly, by 2.6% to 5.9% per year, in five provinces. However, in four provinces notification rates in the age group 15-24 years increased significantly, by 4.5% to 13.6% per year, during this period. The mean age of newly diagnosed patients with smear-positive TB increased up to 1995 but decreased thereafter. The annual risk of TB infection showed a significant annual decrease (4.9% per year) in one province in surveys performed between 1986 and 1997, and in two provinces (6.6% and 4.7%) in surveys conducted between 1993 and 2002. CONCLUSION: These data suggest limited impact to date of the DOTS strategy in Vietnam.

Adolescent↗
PubMedDate not supplied

HIV-infected men's practices in notifying past sexual partners of infection risk.

The researchers studied the self-reported practices of men infected with the human immunodeficiency virus (HIV) in Los Angeles concerning notifying past sexual partners of their risk of infection. The sample of 111 men consisted of 87 Hispanics, 14 whites, 9 blacks, and 1 Asian. Ninety-three percent identified themselves as homosexual or bisexual, and 13 percent reported having injected a nonprescription drug. Seventy-five percent had tested HIV seropositive within the previous 8 months. Subjects were asked about notifying sexual partners with whom they had contact in the 12-months before the subject tested HIV seropositive. Of the 111 subjects, 39 (35 percent) reported that they had attempted to inform 1 or more past partners. Of those who attempted, 30 subjects (76.9 percent) reported notifying at least 1 partner. Overall, the 111 subjects reported a total of 926 individual sexual partners during the 12 months; 51 partners (5.5 percent) were informed of their risk by the subjects. A multivariate logistic regression analysis indicated that those with the most past sexual partners were least likely to attempt to notify any partner. The same inverse relationship was obtained for actual notification and may stem in part from the greater frequency of nonidentifiable partners among those reporting many encounters. The extent and quality of posttest counseling regarding partner notification was not assessed. However, rates of attempted notification were nonsignificantly higher among those who received private professional counseling, who belonged to a support group, or who received social support from family or friends. The data suggest that without concerted and culturally appropriate counseling, many HIV infected persons do not attempt to notify past sexual partners of their risk.

Adolescent↗
PubMed1991

[Whooping cough in Denmark among children under 1 year of age during 1980-1986].

On the basis of individual notifications, reports of cases verified by culture and letters of discharge or case reports of infants under one year with whooping cough during the period 1980-1986, the distribution of the disease is described together with vaccine efficacy and the presumed sources of infection for infants in this age group. The incidence of whooping cough in infants under one year is estimated to be approximately three cases per 1,000 per annum as compared with 150 per 1,000 at the beginning of this century and 60 per 1,000 in the nineteen fifties before routine vaccination was introduced in 1961. The first vaccination is calculated to provide a vaccine efficacy of 39%, after the second vaccination the vaccine efficacy rises to 86% and after the third vaccination the vaccine efficacy is about 98% during the remainder of the first year of life. Even although the times of vaccination were advanced in 1970, this has not reduced the frequency of whooping cough in infants as the vaccination programme has simultaneously been weakened because children are now vaccinated only three times with a weaker vaccine and the immunity is of briefer duration. The commonest sources of infection for infants are siblings. A lower infective risk is desirable and this could be obtained by vaccinating infants an extra time. Alterations in the system of notification in 1980 have resulted in increased under-notification of whooping cough in children under one year while, simultaneously, the notified cases have been described better.

Age Factors↗
PubMed1990

[Informed consent of the family in the chemotherapy for lung cancer].

In Japan where the question of cancer notification has yet to be resolved, it is difficult to obtain an informed consent from the patient himself in clinical studies of the chemotherapies for cancer. In fact, the chemotherapy is administered while not enough explanation is given to the family let alone the patient. Such is the present situation. For the purpose of finding out the best possible method at present, we carried out a method whereby an informed consent of the family is substituted for a consent of the patient in phase II study of inoperable non-small cell carcinoma of the lung. As a result, the consent was obtained from 21 (91.3%) out of 23 families. This method should be taken into consideration as a feasible one under the present circumstances. It was in only one family (4.3%) that a consent on the notification of diagnosis from the family to the patient was obtained. In order for the informed consent to be established, efforts to form a social consensus on cancer notification are needed.

Adult↗
PubMed1990

[Yellow fever in Western Africa, 1973-1987. Observed facts--studies realized, campaign, prevention and forecast].

This global analysis of the situation is based on a review of notifications, observations and studies concerning yellow fever in 16 of 17 countries of the West African subregion (Algeria is not affected for the years 1973-1987). In view of this analysis and the epidemiological picture, the author proposes a plan of concerted action to confine yellow fever to its monkey-to-monkey cycle in the wild. Official notifications vary greatly from one country to the next. Any of five major causes could explain this: ecological and ethological conditions that favour circulation of the virus in the wild and man-to-man transmission to different extents; the immune status of the populations; the difficulty of diagnosing especially isolated cases; lack of means for investigation; and negligence. The quantity and gravity of human cases are systematically underestimated, sometimes to a great extent. Lack of resources and difficulty of diagnosis, but also in many instances the attitude of the population, can account for this. Modern means of investigation, faster intervention by specialists, and better knowledge of how the virus is transmitted, have shown recently an increasing gap between notifications and the actual situation. Research and monitoring programmes are particularly important. The programmes under way in Senegal and Côte d'Ivoire have already resulted in considerable improvement in the action against epidemics. Because of these programmes, our knowledge of the very complex pattern of viral circulation is improving, thereby helping us develop systems for prevention and enabling us to forecast epidemics. Priority areas for study and research are: (i) Basic programmes for detailed study of all the topotypes of the virus, and identification of the viral amplification cycles that recur over several years. Such studies are under way in Senegal and Côte d'Ivoire. They would be particularly useful in Ghana and in Nigeria, where the taxonomy and bioecology of A. africanus s.l. should also be studied. (ii) Surveys of sylvatic vectors should show, for the endemic zones of each country, the type of contact between sylvatic vectors and man in both rural and wild biotopes. (iii) A complete map of the Stegomyia foci with an assessment of their potential epidemic risk (an analysis of the productivity of the sites depending on their type). (iv) Assessment of the immune status of the populations of the various ecosystems of each country, taking account of past or present vaccination strategies. There are several prevention strategies to choose from. The author advocates preparation of a scientifically based, subregional plan for optimum cost effectiveness.(ABSTRACT TRUNCATED AT 400 WORDS)

Africa, Western↗
PubMed1988

The activities of the Hungarian Centre for Congenital Anomaly Control.

The Hungarian Centre for Congenital Anomaly Control manages a number of surveillance programmes based on the Hungarian Congenital Malformation Registry. Notification of congenital anomalies, which is compulsory, originates exclusively from physicians working in various health institutions and is based on their diagnosis of malformed patients--newborns and infants. In recent years, the total birth prevalence of registered congenital anomalies has exceeded 47 per 1,000 total births. The notified data are critically evaluated and centrally coded according to the unit of notification, the affected individual. Diagnostic accuracy, completeness of notifications and the effect of confounding variables are continuously checked. The purpose of the Case-Control Surveillance System is to obtain etiological information concerning drug consumption, maternal diseases and occupational hazards during pregnancy. The surveillance of mutations through indicator conditions (sentinel anomalies. Down's syndrome and pairs of components of unidentified multiple congenital anomalies) is an attempt to measure the rate and trend of new germinal mutations. The nationwide follow-up of multimalformed infants helps to increase the proportion of identified congenital anomaly entities, to identify new ones, and to detect clusters caused by new environmental teratogenic or mutagenic factors.

Abnormalities, Multiple↗