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T E Mertens

Publications and source records attributed to T E Mertens.

At least 19 recordsLinked to original sources
PubMed1998

Provisional country estimates of prevalent adult human immunodeficiency virus infections as of end 1994: a description of the methods.

BACKGROUND: A country-by-country review of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) data was undertaken by the World Health Organization. This paper describes the methods used to make estimates of HIV prevalence. RESULTS: It is estimated that, globally, approximately 16.9 million adults were living with HIV infections at the end of 1994. The majority (66%) of the infections were in sub-Saharan Africa (over 11000000), followed by South and South East Asia (over 3000000). Estimated prevalence rates for HIV infection ranged from less than 1 per 100000 sexually active adult population to 18 per 100 (18%), with a median prevalence of 14 per 10000. In 50 countries the estimated HIV prevalence rate was less than 5 per 10000 sexually active adults. In 15 countries (all in sub-Saharan Africa) the prevalence rate was above 5%. The lowest estimated prevalence rates were seen in Central and East Asia and the highest in Central and Southern Africa. CONCLUSIONS: Estimates of prevalent HIV infections are intended to give an indication of the magnitude of the HIV pandemic but, due to the difficulties in accurately assessing the levels of HIV infections in national populations, should be considered provisional.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Observations of sexually transmitted disease consultations in India.

OBJECTIVES: To assess the quality of sexually transmitted disease (STD) case management provided in public and private health facilities in selected areas of Madras, Tamil Nadu, India, in order to make recommendations for improving the quality of care and promote the syndromic approach to STD treatment. METHODS: Structured observations of consultations for STDs in health care facilities. Scoring of the observations according to standards for history taking, examination, treatment and provision of basic health promotion advice allows evaluation of STD case management. RESULTS: With STD treatment adequacy scored against Indian national guidelines (which recommend aetiologic treatment), history taking, examination and treatment were satisfactory in 76 out of 108 (70%) of observed consultations. However, if STD treatment adequacy is scored with respect to the syndrome approach towards selected STD (male urethritis and non herpetic genital ulcer for both sexes), only 8 out of 81 (10%) of the patients were satisfactory managed. During 32 out of 108 (30%) of the consultations, advice on the use of condoms in order to prevent STD or HIV/AIDS was given. Instructions regarding how to use condoms were offered to seven (6%) patients and condoms were only provided to one patient (1%). Patients were urged to refer their partner(s) for treatment during 29 (27%) of consultations. A criterion of adequate use of the STD consultation for health promotion, requiring both promotion of condoms and encouragement to refer partner(s) for treatment, was met during 13 (12%) of consultations. CONCLUSIONS: Monitoring and improving the standards of care at facilities at which STDs are treated have become key roles of STD/HIV/AIDS programmes. The present report suggests that in Madras the activities of medical practitioners who treat STD patients are far from ideal at present. Improvements would involve simplifying existing treatment guidelines by promoting the syndromic approach to STD management, continuing education programmes for health care providers in the public and private sectors and repeat assessments and feedback of the quality of STD care.

Case Management↗
PubMed1997

Health seeking behaviour and the control of sexually transmitted disease.

What people do when they have symptoms or suspicion of a sexually transmitted disease (STD) has major implications for transmission and, consequently, for disease control. Delays in seeking and obtaining diagnosis and treatment can allow for continued transmission and the greater probability of adverse sequelae. An understanding of health seeking behaviour is therefore important if STD control programmes are to be effective. However, taboos and stigma related to sex and STD in most cultures mean that gaining a true picture is difficult and requires considerable cultural sensitivity. At the moment relatively little is known about who people turn to for advice, or about how symptoms are perceived, recognized or related to decisions to seek help. It is argued that such knowledge would assist programme planners in the development of more accessible and effective services, that studies of health seeking behaviour need to include a combination of qualitative and quantitative methods, and that studies should include data collection about people who do not present to health care facilities as well as those who do. A pilot protocol for studying STD-related health seeking behaviour in developing countries is briefly presented.

Clinical Protocols↗
PubMed1997

Evaluation of HIV/STD prevention, care and support: an update on WHO's approaches.

Over the past decade only a limited number of public health initiatives have been subjected to systematic monitoring and evaluation and, in many instances, there is growing pressure to estimate which approaches work best for a given level of inputs in order to allocate resources effectively. However, evaluation is very often seen as punitive, and a change in perception is needed to allow evaluation to be owned by all stakeholders in public programs. In the field of HIV/AIDS prevention and care, the first difficulty is that many national AIDS programs lack clearly stated objectives and involve a wide variety of players. These players each have their own guidelines for project/program design, monitoring, and evaluation. The second difficulty relates to the fact that evaluation involves "multiple methods, multiple audiences, multiple funding sources, multiple perspectives, multiple paradigms, multiple roles, and multiple solutions to multiple problems" (Quinn Patton, 1986). To some people, evaluation calls for complex experimental studies while to others it means pausing at the end of an activity to sort out what went well and what went less successfully. This paper examines briefly some of the problems and challenges facing the evaluation of HIV prevention and care and summarizes the approaches adopted by the World Health Organization (WHO) to assist AIDS programs around the world in evaluating their initiatives. The paper also provides an update on the progress of developments, training, and implementation of these approaches.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Epidemiology of HIV and AIDS in the Asia-Pacific region.

The incidence of new HIV infections in Asia and the Pacific will soon pass that in Africa and is projected to increase into the next century. The AIDS epidemic arising from these infections will have enormous consequences for the health and socioeconomic development of a region encompassing more than half the world's population.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Human immunodeficiency virus infection dynamics in east Africa deduced from surveillance data.

Knowledge of human immunodeficiency virus type 1 (HIV) incidence patterns in East African HIV epidemics like that in Uganda is fundamental for guiding interventions and forecasting the future course of the pandemic, yet they are difficult to determine from surveillance data. The authors deduce hypotheses of HIV incidence dynamics from birth cohort analyses of Ugandan acquired immunodeficiency syndrome (AIDS) incidence from 1987 to 1992 and from the age and sex distribution of sexually transmitted disease: an age dependency for HIV risk; a period effect of varying HIV incidence growth; and a replenishment of HIV-susceptible populations through demographic renewal. The hypotheses are tested by incorporating them into a model that generates patterns of HIV incidence, prevalence, and AIDS cases that are consistent with empiric data. When applied to Uganda, the modeled HIV incidence is characterized by a short temporal concentration of high incidence, followed by a decline, stabilization, and concentration in younger ages. The ensuing HIV dynamics result in a rapid build-up and subsequent stabilization of prevalence and mortality in years 10 and 13, respectively, after epidemic onset. When this model is used to forecast scenarios from 1980 to 2000, HIV prevalence declines in some populations, which is different from earlier scenarios. The techniques presented provide an empiric basis to better direct interventions, forecast epidemic impacts, and evaluate determinants of changing incidence and prevalence patterns.

Acquired Immunodeficiency Syndrome↗
PubMed1996

HIV and AIDS: where is the epidemic going?

Routine surveillance of HIV (human immunodeficiency virus) infection and AIDS has been established over the past decade in many countries around the world. HIV estimates derived from empirical data are essential to the assessment of the HIV situation in different parts of the world and trends are used in tracking the development of regional epidemics, thereby keeping intervention activities focused on realities. As of the end of 1995, and following an extensive country-by-country review of HIV/AIDS data, a cumulative total of 6 million AIDS cases were estimated to have occurred in adults and children worldwide and currently 20.1 million adults are estimated to be alive and infected with HIV or have AIDS. Of the total prevalent HIV infections, the majority remain concentrated in eastern, central and southern Africa, but the epidemic is evolving with spread of infection from urban to rural areas, as well as to West and South Africa, India and South-east Asia, and to a lesser extent--with proportional shifts to heterosexual infections--in North America, western Europe and Latin America. While the longer-term dimensions of the HIV epidemic at global level cannot be forecast with confidence, WHO currently projects a cumulative total of close to 40 million HIV infections in men, women and children by the year 2000. By that time, the male:female ratio of new infections will be close to 1:1. Recent trends indicate that HIV prevalence levels may be stabilizing or even decreasing among pregnant women in southern Zaire and parts of Uganda, among military recruits aged 21 in Thailand, and in some populations of northern Europe and the USA. While these changes may take place as part of the intrinsic dynamic of the epidemic, there is some evidence that declines in HIV prevalence are related to declines in HIV incidence which are, at least partly, due to prevention efforts. The challenge of surveillance and evaluation methods is now to identify the ingredients of success which may reveal a glimmer of hope.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Baseline for the evaluation of an AIDS programme using prevention indicators: a case study in Ethiopia.

Strategies for preventing transmission of human immunodeficiency virus (HIV) include ensuring that individuals have adequate knowledge of how HIV infection can be prevented and encouraging behaviours that decrease risk of HIV infection. In addition, there is evidence that early and appropriate management of other sexually transmitted disease is effective in reducing HIV transmission. Programmes and projects promoting prevention of HIV transmission should be evaluated periodically for their effectiveness. Between March and September 1995, ten prevention indicators developed by the WHO Global Programme on AIDS were used to establish a baseline measure for evaluating the effectiveness of the Ethiopian AIDS control programme. The indicators were measured using a structured population survey, through record review and key informants, structured observation and interview in health care facilities, and through a serosurvey among antenatal clinic attenders. The following results were found: promoting knowledge of preventive practices was successful; a relatively high proportion of young male adults had sexual risk behaviour; poor condom availability outside Addis Ababa, the capital; and very weak STD case management. The prevalence of syphilis and HIV were 8.8% and 13.6%, respectively, among pregnant women aged 15-49 years. These results should serve as a baseline for repeat surveys to assess the effectiveness of HIV prevention programmes in Ethiopia.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Home testing for HIV.

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Acquired Immunodeficiency Syndrome↗
PubMed1992

Excreta disposal behaviour and latrine ownership in relation to the risk of childhood diarrhoea in Sri Lanka.

A case-control study of environmental and behavioural risk factors for childhood diarrhoea was conducted in Kurunegala district, Sri Lanka. From five hospitals, 2458 children aged less than 5 years and suffering from diarrhoea were recruited as clinic cases, and a further 4140 reporting with complaints other than diarrhoea were recruited as clinic controls. Community-based cross-sectional surveys were also conducted in three of the five areas served by these hospitals, and from these a further 1659 children were recruited as community controls. Children from households where excreta were reported to be disposed of in a latrine were less likely to have diarrhoea than children whose families improperly disposed of excreta. The results obtained from comparisons of cases with clinic controls (adjusted odds ratio [OR] 1.42, 95% confidence interval [CI] : 1.01-1.98), and of cases with community controls (OR 1.35, 95% CI : 0.85-2.13) were in agreement, suggesting that no important selection bias operated on this association. If the observed proportion (91%) of improper excreta disposal among the population could be reduced to 50%, 12% of childhood diarrhoea episodes would be prevented. Although latrine ownership may be a necessary condition for safe excreta disposal behaviour, diarrhoeal morbidity may only be reduced in Sri Lanka if behavioural changes take place concomitant with the construction of sanitation facilities.

Case-Control Studies↗
PubMed1991

[Perinatal mortality in Burkina Faso: risk factors in an urban environment of Bobo-Dioulasso].

A total of 96 mothers of stillborn babies (cases) and 402 mothers of live-born babies (controls) were studied between the 1st November 1988 and the 31st July 1989 in an attempt to identify the risk factors for the high number of stillbirths in the Maternity wing of the Hôpital National Sourô SANON in Bobo-Dioulasso, Burkina Faso. From a stratified analysis, eight risk factors emerged as significant predictors of mortality: mother older than 35 years, high parity (five or more), previous history of stillbirth, lack of medical supervision of pregnancy, interval between last consultation and birth longer than 30 days, complications during delivery and birth weight less than 2,500 g. Polygamy was associated with a 51% reduction in the risk of stillbirth. The problem of selection bias which affects the validity of hospital based case-control studies is discussed. Techniques for reducing selection bias in hospital based case-control studies are proposed. Improvements in antenatal care in Bobo-Dioulasso are suggested.

Birth Intervals↗
PubMed1990

Epidemiological methods to study the interaction between HIV infection and other sexually transmitted diseases.

Numerous studies performed over the past 5 years have indicated an association between HIV infection and other sexually transmitted diseases (STDs), particularly those involving genital ulceration. Such an association may be causal, indicating that STDs increase susceptibility to, or infectivity of, HIV infection or may result, in whole or in part, from the mutual dependence of HIV and STDs on patterns of sexual activity, or from an effect of HIV infection on the clinical course of STDs. In this paper we discuss the issues arising in the design and analysis of studies conducted to investigate this association. A numerical illustration is used to demonstrate non-causal associations that may arise in observational studies due to confounding and misclassification. Published cross-sectional and longitudinal studies are reviewed, and recommendations made for future studies. Special emphasis is given to the use of randomized intervention trials to overcome many of the biases associated with observational studies, and to provide information on the efficacy of intensive STD treatment programmes in reducing the transmission of HIV.

Cross-Sectional Studies↗
PubMed1990

The anthropometric status of children in Kurunegala district in Sri Lanka: its relation to water supply, sanitation and hygiene practice.

Anthropometric data for 1295 children were collected during cross-sectional surveys conducted in Kurunegala District, Sri Lanka between March 1987 and March 1988. The relationship between anthropometric status and a range of water, sanitation and hygiene-related exposures was examined. After taking account of socioeconomic and other potential confounding factors, some evidence was found that boiling of water was associated with improved height-for-age. It seems unlikely that boiling of water alone could be responsible for the observed increase in height-for-age. Boiling of water may be acting as a "marker" for a range of hygiene and child-care behaviours. No convincing evidence of any other association was found. In particular, water source was not associated with anthropometric status. A concurrent study conducted in the same population found evidence of a substantial reduction in diarrhoea morbidity associated with the use of improved sources. These findings, taken together, lend support to the hypothesis that interventions for the control of diarrhoea may have no detectable impact on anthropometric status.

Anthropometry↗