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OBJECTIVE: To examine the causes of a low cure rate at the district level of a tuberculosis (TB) control programme and to formulate, implement, and evaluate an intervention to improve the situation. METHODS: The study setting was Mzuzu (population 60 000), where the annual smear-positive pulmonary TB incidence was 160 per 100 000 and the human immunodeficiency virus (HIV) seroprevalence was 67% among TB patients. There is one TB treatment unit, but several other organizations are involved with TB control. An examination of case-holding activities was carried out, potential areas for improvement were identified, and interventions performed. FINDINGS: In 1990-91, the cure rate was 24% among smear-positive cases (29% among survivors to end of treatment). Problems identified included a fragmented TB control programme; inadequate training and supervision; suboptimal recording of patients? addresses; and nonadherence to national TB control programme protocols. These problems were addressed, and in 1992-93 the cure rate rose to 68% (relative risk (RR) = 2.85 (95% confidence interval (CI) = 1.63, 4.96)) and to 92% among survivors to the end of treatment (RR = 3.12 (95% CI = 1.84, 5.29)). High cure rates are therefore achievable despite high HIV prevalence. CONCLUSIONS: Simple, inexpensive, local programmatic interventions can dramatically improve TB case holding. This study demonstrates the need for evaluation, training, and supervision at all levels of the programme.

Problem The World Health Organization (WHO) developed a guideline with 10 control measures to reduce transmission of A(H5N1) avian influenza virus in markets in low-resource settings. The practical aspects of guide implementation have never been described. Approach WHO's guideline was implemented in two Indonesian markets in the city of Makassar to try to reduce transmission of the A(H5N1) virus. The guideline was operationalized using a participatory approach to introduce a combination of infrastructural and behavioural changes. Local setting Avian influenza is endemic in birds in Makassar. Two of the city's 22 dilapidated, poorly-run bird markets were chosen for the study. Before the intervention, neither market was following any of WHO's 10 recommended control measures except for batch processing. Relevant changes Market stakeholders' knowledge about the avian influenza A(H5N1) virus improved after the interventions. WHO guideline recommendations for visual inspection, cleaning and poultry-holding practices, as well as infrastructural requirements for zoning and for water supply and utilities, began to conform to the WHO guideline. Low-maintenance solutions such as installation of wastewater treatment systems and economic incentives such as composting were well received and appropriate for the low-resource setting. Lessons learnt Combining infrastructural changes with behaviour change interventions was critical to guideline implementation. Despite initial resistance to behaviour change, the participatory approach involving monthly consultations and educational sessions facilitated the adoption of safe food-handling practices and sanitation. Market authorities assumed important leadership roles during the interventions and this helped shift attitudes towards regulation and market maintenance needs.This shift may enhance the sustainability of the interventions. [TEXT NOT REPRODUCIBLE IN ASCII.] Probleme L'Organisation mondiale de la Sante (OMS) a concu un guide avec 10 mesures de controle permettant de reduire la transmission du virus de la grippe aviaire A(H5N1) sur les marches a faibles ressources. Les aspects pratiques de l'application du guide n'ont jamais ete decrits. Approche Le guide de l'OMS a ete applique a deux marches indonesiens dans la ville de Makassar afin de tenter de reduire la transmission du virus A(H5N1). Le guide a ete utilise a l'aide d'une approche participative pour presenter une combinaison de changements infrastructurels et comportementaux. Environnement local La grippe aviaire est endemique chez les oiseaux a Makassar. Deux des 22 marches a oiseaux delabres et pauvres de la ville ont ete choisis pour l'etude. Avant l'intervention, aucun des deux marches ne suivait les 10 mesures de controle recommandees par l'OMS, a l'exception du traitement des lots. Changements significatifs Les connaissances des parties prenantes des marches sur le virus de la grippe aviaire A(H5N1) se sont ameliorees apres les interventions. Les recommandations du guide de l'OMS en matiere d'inspection visuelle, de nettoyage et de pratiques de conservation de la volaille, ainsi que les exigences infrastructurelles pour le zonage et pour les equipements et l'alimentation en eau ont commence a etre conformes au guide de l'OMS. Des solutions necessitant peu de maintenance, comme l'installation de systemes de traitement des eaux usees, ainsi que des incitations economiques comme le compostage ont ete bien accueillies et s'adaptaient parfaitement au systeme a faibles ressources. Lecons tirees Combiner les changements infrastructurels aux interventions de changements des comportements etait essentiel a l'application du guide. Malgre une premiere resistance au changement 'comportemental, l'approche participative impliquant des consultations mensuelles et des sessions de formation ont facilite l'adoption d'une hygiene publique et de pratiques de gestion d'une alimentation saine. Les autorites des marches ont joue un role de leader important lors des interventions, ce qui a aide a modifier les attitudes envers la reglementation et les besoins en maintenance des marches. Ce changement peut ameliorer la durabilite des interventions. [TEXT NOT REPRODUCIBLE IN ASCII.] Aplicacion de la guia para mercados de alimentos saludables en dos mercados indonesios con el fin de reducir la transmision de la <> Situacion La Organizacion Mundial de la Salud (OMS) desarrollo una guia con 10 medidas de control para reducir la transmision del virus de la gripe aviar A(H5N1) en mercados en entornos con escasez de recursos. Nunca se describieron los aspectos practicos de la aplicacion de dicha guia. Enfoque La guia de la OMS se aplico en dos mercados indonesios de la ciudad de Makassar con el fin de intentar reducir la transmision del virus A (H5N1). La guia se hizo mas funcional a traves un enfoque participativo para introducir una combinacion de cambios tanto en las infraestructuras como en los comportamientos. Marco regional La gripe aviar es endemica en las aves de Makassar. Para este estudio se eligieron dos de los 22 mercados de aves deteriorados y mal gestionados de la ciudad. Antes de la intervencion, ninguno de los dos mercados seguia ninguna de las 10 medidas de control recomendadas por la OMS, exceptuando la de procesamiento en lotes. Cambios importantes Tras la intervencion, se observo una mejora considerable de los conocimientos de los participantes en el mercado sobre el virus de la gripe aviar A (H5N1). Empezaron a aplicarse las recomendaciones de la guia de la OMS en cuanto a inspeccion visual, limpieza y practicas de explotacion avicola. Del mismo modo, los requisitos infraestructurales de distribucion en zonas, suministro de agua y servicios publicos empezaron a adherirse a la guia de la OMS. Las soluciones de bajo mantenimiento como la instalacion de sistemas de tratamiento de aguas residuales y los incentivos economicos como el del compostaje fueron bien recibidos y adecuados para este entorno con escasez de recursos. Lecciones aprendidas La combinacion de intervenciones para realizar cambios en las infraestructuras y en el comportamiento resulto fundamental en la puesta en practica de la guia. A pesarde la resistencia inicial a los cambios de comportamiento, el enfoque participativo con consultas mensuales y sesiones educativas facilito la adopcion de unas practicas seguras de manipulacion de alimentos y de saneamiento. Las autoridades competentes asumieron un importante rol de liderazgo durante las intervenciones, lo que ayudo a cambiar actitudes respecto a las necesidades de regulacion y de mantenimiento de los mercados. Este cambio podria potenciar la sostenibilidad de las intervenciones., Introduction Live bird markets have been implicated in the circulation of avian influenza A(H5N1) virus (1) and are a potential source of viral transmission among humans and animals. (2,3) In [...]

The emergence of pandemic influenza A (H1N1) 2009 in Mexico and the United States, with rapid spread to Europe, Asia, and the Pacific, is testament to the ease of spread [...]

Food markets that offer both poultry meat and live birds either for sale or for slaughter are collectively referred to as live-bird markets (LBMs). LBMs are part of the supply [...]

Many novel infectious diseases have been reported since 1940; most have been zoonoses originating from wildlife (1). Several novel zoonotic viruses, including Hendra virus, Australian bat lyssavirus, and Nipah virus, [...]

ABSTRACT Background Tuberculosis (TB) is a major public health problem in developing countries. Following the disruption to health services in East Timor due to violent political conflict in 1999, the [...]