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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



NEWS AND NEW DEVELOPMENTS



Risks to Health Care Workers in Developing Countries [Sagoe-Moses C et al. NEJM 2001;345:538] The authors review the risk of blood-borne pathogens for health care workers in developing countries. It is noted that sub-Saharan Africa accounts for 70% of the HIV-infected population, but only 4% of the worldwide cases of occupationally-acquired HIV infection; by contrast, North America and Europe account for 4% of the world's HIV-infected population and 90% of the documented cases of occupational transmission [CID 1999;28:365]. These results obviously reflect underreporting from a region where there is no incentive to report cases due to the lack of post-exposure prophylaxis, treatment, or the availability of workers' compensation. In fact, the risks are substantially magnified by factors beyond the frequency of HIV infection. They point out that injections are commonly used for treatment due to the belief that this is stronger treatment. In Ghana, for example, 80-90% of patients who visit a health center receive one or more injections each visit. There is also the issue of reuse of nonsterile needles when supplies are low and disposal of hazardous waste is not regulated. It is noted that in Tanzania, birth attendants use plastic bags to cover their hands to avoid exposure to HIV during deliveries because there are no gloves available. Human factors aside, the authors point out that this is a region that cannot afford the loss of its physician work force. WHO statistics indicate that there are less than 10 physicians/100,000 population in 15 sub-Saharan countries compared to nearly 250/100,000 in the U.S. This loss of physicians also represents the loss of a major national investment in training. The authors conclude that budgets for health care should include resources to insure the safety of medical personnel.
Comment: This "Sounding Board" makes an important and timely point regarding the risks associated with medical care in developing countries. Timely because of the enormous evolving effort by diverse medical groups from the U.S. and Europe to facilitate better care of HIV and other infections in the developing world, especially in Africa. The risks associated with these assignments are likely to be underestimated.
posted 8/28/2001





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