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Examines the costs and benefits of screening blood for HIV, using data from the Monze District Hospital in Zambia. Blood transfusion at Monze Hospital; Cost per infection prevented; Benefits of HIV screening of blood.

Comments on the efforts of governments worldwide to reform their health sector. Reasons for worldwide trend; Common features of reforms; Issues concerning donor agencies and developing countries.

Discusses the possibility of a universal ranking of disability states. The 1993 World Bank report,' Investing in Health?'; Introduction of disability-adjusted life-year (DALY) as the unit of measure; Controversy over the universality of DALY; Use of quality-adjusted life-year (QALY) in the developed countries; Issue of appropriate use of ranking systems; Reference to a report by T B Ustun et al in the July 10, 1999 issue of 'The Lancet'.

Focuses on the drought in the Monze district of Zambia and on the drought relief effort which began in February 1992. Theileriosis; When agriculture could return to normal; Rainfall for the 1991-92 season; Biggest threat to long-term maize production in the Monze district; Impact of AIDS on the area; More.

Comments on the article on the dangers of the use of thiacetazone published in the November 12, 1994 edition of `The Lancet.' Comparison of the cost-effectiveness of thiacetazone and other tuberculosis drugs in populations with high HIV seroprevalence; Benefits of using rifampicin-containing regimen in HIV positive patients.

The article focuses on a cluster-randomised equivalence trial which assessed whether home-based human immunodeficiency virus (HIV) infection treatment was effective as was facility-based treatment in Jinja, Uganda. The trial, which was conducted in 44 geographical areas in nine strata, was integrated into normal service delivery. Patients were randomly assigned to home care and to facility care. The primary endpoint of the study was virological failure and the margin of equivalence was 9%. Findings revealed that mortality rates between home and facility care were similar.

SummaryBackgroundIn the control of reproductive-tract infections, including sexually transmitted infections (STIs), in low-income and middle-income countries, WHO recommends syndromic management for individuals with symptoms. This intervention was initially developed in areas where prevalence of such infections is high. We investigated the clinical effectiveness and cost of this approach among a group of women with a low prevalence of infection.MethodsDuring a 5-month period, we investigated all women complaining of abnormal vaginal discharge and seeking care at maternal and child health/family-planning centres in Matlab, Bangladesh, for the presence of laboratory-diagnosed reproductive-tract infections and STIs. Syndromic diagnoses made by trained health-care workers were compared with laboratory diagnosis of infection. We then calculated the costs of treating women by means of the recommended WHO algorithm and an adapted algorithm incorporating use of a speculum and simple diagnostic tests.FindingsThe prevalence of endogenous infections among 320 women seen was 30%. Cervical infections (Neisseria gonorrhoeae and Chlamydia trachomatis) were found in only three women. The WHO algorithm had a high sensitivity (100%) but a low specificity (zero for bacterial vaginosis, candida, and Trichomonas vaginalis). The speculum-based algorithm had a low sensitivity (between zero and 59%) but a higher specificity (79-97%). Between 36% and 87% of costs would have been spent on uninfected women.InterpretationThe high rate of overtreatment in the population studied carries both financial and social costs--the latter in potentially exposing women misdiagnosed as having an STI to threats of domestic disruption or even violence. We make recommendations for management programmes in areas of low STI prevalence and low income. [ABSTRACT FROM AUTHOR]