During the past year, a group has argued that unsafe injections are a major if not the main mode of HIV-1 transmission in sub-Saharan Africa. We review the main arguments used to question the epidemiological interpretations on the lead role of unsafe sex in HIV-1 transmission, and conclude there is no compelling evidence that unsafe injections are a predominant mode of HIV-1 transmission in sub-Saharan Africa. Conversely, though there is a clear need to eliminate all unsafe injections, epidemiological evidence indicates that sexual transmission continues to be by far the major mode of spread of HIV-1 in the region. Increased efforts are needed to reduce sexual transmission of HIV-1.

The Lancet, Volume 363, Number 9407 07 February 2004

Summary Noma (cancrum oris) is a devastating gangrenous disease that leads to severe tissue destruction in the face and is associated with high morbidity and mortality. It is seen almost exclusively in young children living in remote areas of less developed countries, particularly in Africa. The exact prevalence of the disease is unknown, but a conservative estimate is that 770 000 people are currently affected by noma sequelae. The cause remains unknown, but a combination of several elements of a plausible aetiology has been identified: malnutrition, a compromised immune system, poor oral hygiene and a lesion of the gingival mucosal barrier, and an unidentified bacterial factor acting as a trigger for the disease. This review discusses the epidemiology, clinical features, current understanding of the pathophysiology, and treatment of the acute phase and sequelae requiring reconstructive surgery. Noma may be preventable if recognised at an early stage. Further research is needed to identify more exactly the causative agents.

The Lancet Infectious Disease, Volume 3, Number 7 01 July 2003

In response to the excellent review of noma by Denise Baratti-Mayer and colleagues, 1 I would like to stress the importance of this disease. Noma is indeed a devastating disease of the poorest among the poor in Africa, which might be generally prevented by aid programmes aimed at more and better water, food, (health) education, hygiene, vaccination, and medicines, and which should attract more attention from the general public and doctors in the western world. In Africa, bright colours seem to compensate for, and distract from, poverty and disfigurement.

The Lancet Infectious Disease, Volume 4, Number 2 01 February 2004

The demand for people living with HIV and AIDS in Africa to access treatment cannot be ignored. At the same time the challenges to meeting this demand are many. They include the shortfalls in health services and lack of knowledge about treatment, making decisions about newer regimens, and the risk of resistance to antiretrovirals highlighted in the paper by Stevens et al (p 280).

The BMJ, BMJ 2004;328:241-242 (31 January), doi:10.1136/bmj.328.7434.241

The link between expenditure on health and health outcomes is not straightforward. Despite burgeoning health budgets, few countries in the developed world can claim to be delivering universally high quality, equitable health care. Could they have something to learn from less developed countries, whose meagre resources have long ensured that cost effectiveness is a dominant consideration?

The BMJ, BMJ 2004;328:241-242 (31 January), doi:10.1136/bmj.328.7434.241

Page 1 of 21: 1 2 3 4 5 6 7 8 9 10 Next>>