Hepatitis B - Honduras Research

www.imagine.org

Prevalence of the

Hepatitis B chronic carrier state&= #13;

among pregnant women in

Honduras, and prevention of vertical

transmission

Part 1

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Xr5Jz6mHKCMaZNMjUTr3znRaBOjIXZWBp1voQpqCu6qdQjW7Rv4VQabkBuPPNqrVyTZbVOi2zsrK cF0nqMd/cG1AN5RlFVz15SarN6wCPVbazDFJdBX8qnq6HKMFVVSmSuVBNgBncq2qoM2vcxZAJtSj Qzo/p7e6Es/bMuBiy8ialXG9tEnEfbbS0rKrvhRcI2WgSRqIa8kpIRibHgkF6Ho6k3JTFFlIpdGV dgi2GSuoUveK7WY6qAJUqZZuyPMHH88I63AZLwuOzVj4ummNiXtdvPhXXc318KcKOjNVgXKkmrls qlwM662DfrbgSoVyStzFyjo2NA8FmJkMlJyXprIFwVRdL8iO59O9i69JwPZpgR4XV42kiBViNB05 s0P0Otki/Lws/gbYLlqzsrJyr/KnIOMagX5R/eeFve7wOF9yNMpPQ/g/uF62gixUkJuRm0uuWdfr XVZBwU1X/ZN1U1npNblkab4um+0KX7P1/w8P2talpV3pjAAAAABJRU5ErkJggk== ------=_NextPart_01C648DF.029DCA00 Content-Location: file:///C:/D809C636/Hepatitis_B_Honduras_Aureli_2006_files/slide0006.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Hepatitis B - Honduras Research - Francesco Aureli

Honduras – Physical Geography

•

•= Area: 112,090 sq km

•= Terrain: Mostly mountainous, with narrow coastal plains •C= limate: Subtropical in lowlands and temperate in the mountains

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Honduras – Demographics

•= Population: 6,823,568

•= Median age: 19 years (Italy: 41.4)

•= Population growth rate: 2.24%

•= Birth rate: 31.04 / 1000

•= Death rate: 6.64 / 1000

•Total fertility rate: 3.97 children / fertile aged woman

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Honduras – Economy

•= GDP per capita: $2,600 (only Nicaragua, Cuba and Haiti have a lower GDP in the Western Hemisphere)

•= Population below poverty line: 53%

= •= Unemployment rate: 27.5%= 3;

•=

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Honduras – Health Indicators

•= Life expectancy at birth: 66.15 years

•Infant mortality rate: 42 / 1000 live births (USA: 7.1) •= Maternal mortality rate: 108 / 100,000 live births (USA: 9.9)

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Hepatit= is B in Honduras

•= WHO classifies Honduras as a moderately endemic country (2% to 7% prevalence)

•= It is unclear, however, how these estimates were made (local health authoritie= s lack reliable data)=

•= Only epidemiological survey to date suggests ~ 3% of pregnant women are chronic carriers

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Eradica= tion Efforts

•

•= Hepatitis B vaccine (Engerix) has been made part of the Expanded Program for Immunizations (EPI) in Honduras= 3;

•

<= span style=3D'color:white;mso-color-index:0'>•= First dose given at 6 to 8 weeks of age

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Vertical Transmission

•Transmission from mother to child = (almost always at t= he time of birth)

•Risk of the child becoming chronic carrier = = depends on mother’s serology:
If mother is HBsAg+ only: 10-30%
If mother is also HBeAg+: 70-90%

•To protect the child, the first dose of the= = vaccine must be giv= en as close as possible to the time of birth

•

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•To determine the prevalen= ce of chronic hepatitis b infection, as indicated by the = presence of HBsAg, among pregnant women•

•To assess the risk level = of vertical transmission, given the HBeAg status of women found to be HBsAg carriers

•

•To assess the efficacy in Honduras of Engerix, a recombinant hepatitis b vaccine, to prevent vertical transmission

Aims

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What a= re we going to accomplish?

•Reliable data, to help formulate health policy <= /span>

•Prevention of vertical transmission <= /div>

•Referral of HBsAg+ mothers to the Ministry of Health = for epidemiological follow-up

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Our lo= cal partner

•= The Instituto Hondureño del Seguro Social

•

-Autonomous institution, providing pensions = and healthcare

-Covers close to a million hondurans (400,00= 0+ workers and 500,000+ dependents)

-Has hospitals in the two largest urban cent= ers = (Tegucigalpa and San= Pedro Sula)

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Data collection and management

•4000 pregnant women followed at th= e = Hospital de Especialidades and the Hospital Re= gional del Norte •Basic demographic information, blo= od for HBsAg and HBeAg determinations

•= Establishment of a serum bank

•= Design and development of a research database

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Main intervention
Preventing vertical transmissi= on

•

•First dose of vaccine to be administered within = 24 hours of birth

•= Long-term follow up of vaccinated babies

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Our contribution – Analytical

•

•= Study design

•= Project Implementation

•= Database design

<= span style=3D'color:white;mso-color-index:0'>•= Statistical and cost-effectiveness analysis

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Our contribution – Material

•Equipment:
Freezer (serum bank)
Computers

•Cost of serological testing:
HBsAg; HBeAg

•Vaccine

•Personnel:
Research assistant,= full time
Research assistant,= part time
Data entry clerk, p= art time

•Analytical software

•

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Challenges for Norther= n NGOs Working

in Developing Countries

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Part 2

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The Challenges

•Assessment of the re= al needs

•

•Identification and consultation of local partners:

• -Decide objectives toge= ther

• -Build up mutual trus= t

• -Share information

• -Share responsibilities (asses capacities of partners)

• -Create transparency= 3;

•

•Analysis of the cultural, economical, ecological and social implication of the initiative

•

•Adoption of an holis= tic approach

•

•Coordination with local authorities and other act= ors working in the same territory/sector = ;

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The Challenges

•Attention to collusi= on and corruption

•

•Involvement and agreement of local communities (do = not create high expectations)

•

•Clarity about project goals (while the implementation has to remain flexible to respond to undefined variables and changing circumstances)

•

•Clarity= about organisational structure and schedule

•

•Attenti= on to sustainability

•

•Estimat= ion of the costs

•

•Development of local= experti= se

•

• Monitoring and evaluation=

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We choose to go to the moon. <= /div> We choose to go to the moon in this decade and= do the other things, not because they are easy, b= ut because they are hard, because that goal will = serve to organize and m= easure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to pos= tpone, and one which = we intend to win…

<= /span>John Fitzgerald Kennedy

<= /span>September 12, 1962

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_RSW() { if( !g_supportsPPTHTML || IsNts() || ( !g_scaleInFrame && (!IsWin("PPTSld") || !parent.IsFullScrMode()) ) ) return var padding=3D0; if( IsWin("PPTSld") && parent.IsFramesMode() ) padding=3D6 cltWidth=3Ddocument.body.clientWidth-padding cltHeight=3Ddocument.body.clientHeight-padding factor=3D(1.0*cltWidth)/g_origW if( cltHeight < g_origH*factor ) factor=3D(1.0*cltHeight)/g_origH newSize =3D g_origSz * factor if( newSize < 1 ) newSize=3D1 s=3DSlideObj.style s.fontSize=3DnewSize+"px" s.posWidth=3Dg_origW*factor s.posHeight=3Dg_origH*factor s.posLeft=3D(cltWidth-s.posWidth+padding)/2 s.posTop=3D(cltHeight-s.posHeight+padding)/2 if( g_scaleHyperlinks ) ScaleHyperlinks( factor ) } function _InitAnimations() { animRuntimeInstalled =3D ''+document.body.localTime !=3D 'undefined'; isFullScreen =3D (window.name =3D=3D "PPTSld") && !parent.IsFramesMode(); g_animUseRuntime =3D g_showAnimation && animRuntimeInstalled && !(isFullSc= reen && parent.IsSldVisited()); if( g_animUseRuntime ) { collSeq =3D document.all.tags("seq"); if( collSeq !=3D null ) { for(ii=3D0;ii numSlds ) gSldJumpIdx =3D numSlds; if ( gSldJumpIdx >=3D 0 ) { if ( gSldJumpIdx =3D=3D 0 ) gSldJumpIdx =3D 1; var jumpTo =3D parseInt(gSldJumpIdx); gSldJump =3D 0; gSldJumpIdx =3D ""; win.GoToSld( parent.GetSldList().mList[jumpTo-1].mSldHref ) } } } function _KDH() { if( event.keyCode =3D=3D 8 ) { event.returnValue =3D 0; parent.GoToPrevSld(); } } function DocumentOnClick() { if( IsNts() || parent.HideMenu() ) return; if( ( g_allowAdvOnClick && !parent.IsFramesMode() ) || (event && (event.keyCode=3D=3D32) ) ) parent.GoToNextSld(); } var g_supportsPPTHTML =3D SupportsPPTHTML(), g_scaleInFrame =3D 1, gId=3D""= , g_bgSound=3D"", g_scaleHyperlinks =3D false, g_allowAdvOnClick =3D 1, g_showInBrowser = =3D 0, gLoopCont =3D 0, gUseSldTimings =3D 1; var g_showAnimation =3D g_supportsPPTHTML && SupportsPPTAnimation() && ( (w= indow.name=3D=3D"PPTSld" && !parent.IsFramesMode()) || g_showInBrowser );va= r g_animManager =3D null; var g_animUseRuntime =3D false; var g_animItemsToHide, g_animInteractiveItems, g_animSlideTime; var g_animMainSequence =3D null; var ENDSHOW_MESG=3D"End of slide show, click to exit.", SCREEN_MODE=3D"Fram= es", gIsEndShow=3D0, NUM_VIS_SLDS=3D23, SCRIPT_HREF=3D"script.js", FULLSCR_= HREF=3D"fullscreen.htm"; var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO= tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true window.gPPTHTML=3DSupportsPPTHTML() var gMainDoc=3Dnew Array(new hrefList("slide0002.htm",1,-1,1),new hrefList(= "slide0001.htm",1,-1,1),new hrefList("slide0003.htm",1,-1,1),new hrefList("= slide0023.htm",1,-1,1),new hrefList("slide0006.htm",1,-1,1),new hrefList("s= lide0005.htm",1,-1,1),new hrefList("slide0007.htm",1,-1,1),new hrefList("sl= ide0008.htm",1,-1,1),new hrefList("slide0010.htm",1,-1,1),new hrefList("sli= de0012.htm",1,-1,1),new hrefList("slide0013.htm",1,-1,1),new hrefList("slid= e0026.htm",1,-1,1),new hrefList("slide0011.htm",1,-1,1),new hrefList("slide= 0014.htm",1,-1,1),new hrefList("slide0015.htm",1,-1,1),new hrefList("slide0= 016.htm",1,-1,1),new hrefList("slide0018.htm",1,-1,1),new hrefList("slide00= 19.htm",1,-1,1),new hrefList("slide0020.htm",1,-1,1),new hrefList("slide002= 7.htm",1,-1,1),new hrefList("slide0028.htm",1,-1,1),new hrefList("slide0025= .htm",1,-1,1),new hrefList("slide0021.htm",1,-1,1)); /********************************************* Frameset functions These functions control slide navigation and state of the frameset. **********************************************/ function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) {=09 var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix =3D CalculateMHTMLPrefix();=20 function CalculateMHTMLPrefix() { if ( document.location.protocol =3D=3D 'mhtml:') {=20 href=3Dnew String(document.location.href)=20 Start=3Dhref.indexOf('!')+1=20 End=3Dhref.lastIndexOf('/')+1=20 if (End < Start)=20 return href.substring(0, Start)=20 else=20 return href.substring(0, End)=20 } return ''; } function GetTags(base,tag) { if(g_supportsPPTHTML) return base.all.tags(tag); else return base.getElementsByTagName(tag); } function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP= refix+GetHrefObj( gCurSld ).mNtsHref ) } function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() } function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() } function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() } function SetHasNts( fVal ) { if( gHasNts !=3D fVal ) { gHasNts=3DfVal UpdNavPane() } } function ToggleOtlText() { gOtlTxtExp=3D!gOtlTxtExp UpdOtlPane() } function ClearMedia() { // Clear any sounds playing before launching another browser window. Other= wise, // in fullscreen mode, you'll continue to hear the sound in the frames mod= e. if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() {=20 if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { =20 obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else =20 return gCurSld } function GetNumSlds() { =20 if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; PPTSld.location.replace(MHTMLPrefix+obj.mSldHref) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 PPTSld.location.replace(MHTMLPrefix+href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; =09 var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('

' + ENDSHOW_MESG + '

') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); /********************************************* Navigation button implementation There are 2 types of buttons: ImgBtn, TxtBtn implemented as function objects. They share a similiar interface so the event handlers can call SetActive, for example, on a button=20 object without needing to know exactly=20 what type of button it is. **********************************************/ //---------------------------------- function ImgBtn( oId,bId,w,action ) //---------------------------------- { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0=20 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { =20 obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0=20 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } =20 } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } //----------------------------------------- function TxtBtn( oId,oeId,action,chkState ) //----------------------------------------- { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { =20 this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) {=20 if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } =20 } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1=20 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() {=20 b =3D gBtnArr[this.mBorderId]=20 if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() {=20 b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState /********************************************* Context menu implementation _CM() is the function that's hooked up to the oncontextmenu event. Once we're asked to show the menu, we first build it by creating DIVs on-the-fly. Then we position it=20 within the screen area so it doesn't get clipped. Creating the DIVs using createElement() means we don't have to write out any extra HTML into the slide HTML files. **********************************************/ var sNext=3D"Next",sPrev=3D"Previous",sEnd=3D"End Show",sFont=3D"Arial",sAr= row=3D"Arrow",sFreeform=3D"Freeform",sRect=3D"Rectangle",sOval=3D"Oval" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) =09 CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; 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charset="windows-1252" Hepatitis B - Honduras Research - Francesco Aureli ------=_NextPart_01C648DF.029DCA00 Content-Location: file:///C:/D809C636/Hepatitis_B_Honduras_Aureli_2006_files/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" ------=_NextPart_01C648DF.029DCA00 Content-Location: file:///C:/D809C636/Hepatitis_B_Honduras_Aureli_2006_files/filelist.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C648DF.029DCA00--

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2	"Prevalence= of the" Prevalence of the Hepatitis B chronic carrier state among pregnant women in Honduras, and prevention of vertical transmission
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5	Honduras – Physi= cal Geography Area: 112,090 sq km Terrain: Mostly mountainous, with narrow coastal plains Climate: Subtropical in lowlands and temperate in the mountains
6	Honduras – Demog= raphics Population: 6,823,568 Median age: 19 years (Italy: 41.4) Population growth rate: 2.24% Birth rate: 31.04 / 1000 Death rate: 6.64 / 1000 Total fertility rate: 3.97 children / fertile aged woman
7	Honduras – Econo= my GDP per capita: $2,600 (only Nicaragua, Cuba and Haiti have a lower = GDP in the Western Hemisphere) Population below poverty line: 53% Unemployment rate: 27.5%
8	Honduras – Health Indicators Life expectancy at birth: 66.15 years Infant mortality rate: 42 / 1000 live births (USA: 7.1) Maternal mortality rate: 108 / 100,000 live births (USA: 9.9)
9	Hepatitis B in H= onduras WHO classifies Honduras as a moderately endemic country (2% to 7% prevalence) It is unclear, however, how these estimates were made (local health authorities lack reliable data) Only epidemiological survey to date suggests ~ 3% of pregnant women = are chronic carriers
10	Eradication Eff= orts Hepatitis B vaccine (Engerix) has been made part of the Expanded Pro= gram for Immunizations (EPI) in Honduras First dose given at 6 to 8 weeks of age
11	Vertical Transm= ission Transmission from mother to child (almost always at the time of birt= h) Risk of the child becoming chronic carrier depends on mother’s serology: If mother is HBsAg+ only: 10-30% If mother is also HBeAg+: 70-90% To protect the child, the first dose of the vaccine must be given as close as possible to the time of birth
12	Aims= To determine the prevalence of chronic hepatitis b infection, as indicated by the presence of HBsAg, among pregnant women To assess the risk level of vertical transmission, given the HBeAg status of women found to be HBsAg carriers To assess the efficacy in Honduras of Engerix, a recombinant hepatit= is b vaccine, to prevent vertical transmission
13	What are we goi= ng to accomplish? Reliable data, to help formulate health policy Prevention of vertical transmission Referral of HBsAg+ mothers to the Ministry of Health for epidemiolog= ical follow-up
14	Our local partn= er The Instituto Hondureño del Seguro Social Autonomous institution, providing pensions and healthcare Covers close to a million hondurans (400,000+ workers and 500,000+ dependents) Has hospitals in the two largest urban centers (Tegucigalpa and San Pedro Sula)
15	Data collection= and management 4000 pregnant women followed at the Hospital de Especialidades and t= he Hospital Regional del Norte Basic demographic information, blood for HBsAg and HBeAg determinati= ons Establishment of a serum bank Design and development of a research database
16	Main interventi= on Preventing vertical transmission First dose of vaccine to be administered within 24 hours of birth Long-term follow up of vaccinated babies
17	Our contributio= n – Analytical Study design Project Implementation Database design Statistical and cost-effectiveness analysis
18	Our contributio= n – Material Equipment: Freezer (serum bank) Computers Cost of serological testing: HBsAg; HBeAg Vaccine Personnel: Research assistant, full time Research assistant, part time Data entry clerk, part time Analytical software
19	Challenges for = Northern NGOs Working in Developing Countries
20	The Challenges<= /a> Assessment of the real needs Identification and consultation of local partners: -Decide objectives together -Build up mutual tru= st -Share information -Share responsibilit= ies (asses capacities of partners) -Create transparency= Analysis of the cultural, economical, ecological and social implicat= ion of the initiative Adoption of an holistic approach Coordination with local authorities and other actors working in the = same territory/sector
21	The Challenges<= /a> Attention to collusion and corruption Involvement and agreement of local communities (do not create high expectations) Clarity about project goals (while the implementation has to remain flexible to respond to undefined variables and changing circumstance= s) Clarity about organisational structure and schedule Attention to sustainability Estimation of the costs Development of local expertise Monitoring and evaluation
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