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  • Accurate identification of FAS prevalence is challenging bec

    2019-06-13

    Accurate identification of FAS prevalence is challenging because of the global use of several different diagnostic criteria; different methods of case ascertainment; low confidence of health professionals making the diagnosis; and little access to normative data (eg, for assessment of sentinel facial features or neurodevelopmental impairment) for many specific ethnic populations. Because of restricted availability of primary data, this Article only provides prevalence estimates for FAS. FAS is characterised by severe neurodevelopmental impairment and distinctive facial dysmorphology; however, in addition to FAS, PAE could cause a spectrum of disorders, including neurodevelopmental impairment without facial features. Although FAS is the most easily recognised condition in the spectrum, it represents only the tip of the iceberg of the adverse effects of PAE, and hence the global prevalence reported here is just part of the story. Data from special populations (eg, Indigenous women, adolescents, women with low socioeconomic status, women with HIV, and women with an alcohol use disorder) were deemed not to be generalisable to the general angiotensin ii receptor blockers of their respective countries, and hence were excluded from the analyses. This approach emphasises the important public health message that alcohol use in pregnancy and FAS are not restricted to disadvantaged groups, but occur throughout society, regardless of socioeconomic status, education, or ethnicity. However, because high prevalence is reported in many of the excluded studies, estimates of regional and global prevalence might be conservative.
    Typhoid, one of the classic infectious diseases afflicting humanity, is still a relatively common illness in many lower-income and middle-income countries (LMIC). The disease is associated with chronic fever that, if not treated, can lead to complications such as intestinal perforation or neurological problems. The diagnosis of typhoid is complicated because clinical presentation can be non-specific and can resemble a number of other diseases, such as malaria, typhus, and various viral infections. The current typhoid diagnostic kits are relatively unreliable, and microbial culture from blood or other bodily secretions of the main bacterial aetiological agents serotype Typhi and serotype Paratyphi A remains the gold standard. Microbial culture requires the availability of adequate laboratory facilities, including blood and microbial culture equipment, and appropriate bacteriological expertise. Unfortunately, these are not always present in LMIC settings and the incidence of typhoid in many regions, particularly Africa, remains relatively undefined. Nevertheless, more than 20 million cases of typhoid have been estimated globally, most of which are caused by Typhi, with between 200 000 and 600 000 deaths. However, the estimates are compromised by limited epidemiological information and restricted geographical coverage, as well as the problems with diagnosis. Interest in typhoid has increased in recent years, driven by a number of factors. Multidrug resistance has been increasingly reported as a characteristic of Typhi isolated in the past decade and from different parts of the globe. Although there is historical evidence that typhoid has been established in south and southeast Asia for decades, there have been increasing reports angiotensin ii receptor blockers of typhoid in different African countries, potentially associated with multidrug resistance. Furthermore, a particular haplotype of Typhi, known as H58 or 4.3.1, has been linked to the spread of multidrug resistance, and this strain might be driving typhoid into new geographical areas where typhoid was previously absent or under reported. Multidrug resistant Typhi respond more slowly to antibiotic treatment, and such strains might be stimulating an increased use of antibiotics (and indirectly promoting multidrug resistance) in the community, where antibiotics are freely available without prescription. Additionally, a new generation of typhoid vaccines, based on conjugate technology and the Vi capsular antigen of Typhi, are being developed and have been licenced in some countries.