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Methods used to diagnose Trypanosoma cruzi infection differ in their ability to discriminate between sera from infected and uninfected individuals. We compared the results of an immunofluorescence (IF) test, a haemagglutination (HA) test, and an enzyme-linked immunosorbent assay (ELISA) for the diagnosis of T. cruzi infections in a large population-based survey in central Brazil using blood eluates from filter-paper and venous blood samples. The sensitivities of the tests on eluates, compared with results on serum samples, were low: ELISA (78.1%), IF (69.2%) and HA (64.6%). The level of agreement between the tests on eluates was very poor, with the best co-positivity for IF and ELISA. Both the positive and negative predictive values of the three tests on eluates were similar (around 96%) to those for sera. Higher co-positivity values were obtained for the three tests on sera. The implications of these results are discussed in relation to blood screening, routine medical practice, sero-epidemiological surveys, and the follow-up of patients admitted to therapeutic trials.

Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose. [ABSTRACT FROM AUTHOR]

Brazil, the Russian Federation, India, China and South Africa -- the countries known as BRICS -- are currently undergoing a deep epidemiological transition that is mainly driven by rapid economic growth and technological change. The changes being observed in the distribution of the burden of diseases and injuries -- such as recent increases in the incidence of road traffic injuries -- are matters of concern. BRICS may need stronger institutional capacity to address such changes in a timely way. In this paper, we present data on road traffic injuries in BRICS and illustrate the enormous challenge that these countries currently face in reducing the incidence of such injuries. There is an urgent need to improve road safety indicators in every country constituting BRICS. It is imperative for BRICS to invest in system-wide road safety interventions and reduce the mortality and morbidity from road traffic injuries. [ABSTRACT FROM AUTHOR]

The seroprevalence of Trypanosoma cruzi infection among children is a sensitive indicator for assessing the effectiveness of programmes for control of Chagas disease. In this study we report the result of a cross-sectional serological survey carried out among schoolchildren living in a poor rural area in central Brazil. Eluates of blood collected on filter-paper were tested for anti-T. cruzi antibodies using immunofluorescence, haemagglutination, and enzyme-linked immunosorbent assays. The overall seroprevalence of T. cruzi infection was 7.9%, which compared with the findings of the national survey carried out in 1975-80 indicates that a twofold-to-threefold reduction in prevalence has occurred over the last 10 years. This is consistent with a reduction of transmission in the area, probably related to vector control efforts. Based on our results, the incidence of new cases was estimated to be 44 per annum in the study region. In rural areas with a scattered population, surveillance of T. cruzi transmission by serological screening of children at school entry is more practical and economical than entomological evaluation for assessing both the risk of transmission in the community and the efficacy of vector control measures. A sample size of around 1000 schoolchildren is sufficient to detect prevalences as low as 2%, and such an approach would be practical and applicable to most areas where Chagas disease is endemic.

In 1987, a mass immunization campaign against measles was carried out in the greater metropolitan region of São Paulo, Brazil. During a ten-day period, 4,194,174 children from 9 months to 14 years old, representing 86% of the target population, were vaccinated regardless of their previous vaccination status. Four months later, the prevalence of measles antibodies was evaluated through a random seroepidemiological survey. The survey included all children in greater São Paulo between one month and 14 years old, irrespective of campaign participation. Blood samples were collected on filter-paper and tested for measles antibody by indirect immunofluorescence. Negative or doubtful cases were tested again using an immunoenzymatic assay (ELISA). Of the 8661 samples included in the study, 8146 (94.1%) were positive for measles antibody. In children aged one year or more a significant difference in antibody prevalence was observed when comparing those who were vaccinated during the mass immunization (98.0%) with those who did not participate in the campaign (91.3%). In addition, after the immunization, a marked and immediate decrease was observed in incidence rates for measles cases notified to the State Secretary of Health, falling from 222/100,000 inhabitants in 1987 to 2.7/100,000 in 1988. These data suggest that mass immunization can serve as an additional strategy for the rapid control of measles in developing countries.

A broad-based national breast-feeding programme was launched in Brazil in 1981 that was preceded by an evaluation of infant feeding habits in two metropolitan areas of the country. This paper reports the initial findings of an evaluation of the programme in Greater São Paulo that was carried out in 1987, 6 years after the programme started. The method employed was analogous to that used before the start of the programme in 1981. For this purpose, a representative sample of mothers who were attending child care services open to all income groups were interviewed, together with a number of health professionals. A total of 497 mothers with children aged 0-12 months were covered. A recall interview was also administered on the duration of breast-feeding for all children born to the mothers since 1981. As a result of the programme, the mean duration of breast-feeding rose from 89.4 days to 127.5 days and of feeding only breast-milk from 43.2 days to 66.6 days. The proportion of previous children who were breast-fed for more than 6 months rose from 18.9% for those born in 1981-82 to 37.7% for those born in 1984, when the programme activities were at their highest, and slipped back again to 27.6% in 1985-86.