[Easttimorstudies] Recently Published Papers on East Timor

[Jennifer Drysdale]

Dear Members
Please feel free to circulate any recently 
published papers. Below and following emails 
include a a few that may be of interest.
Regards
Jen

-----------------------------------------------------------------------------------------------------------------------------

Journal of Paediatrics and Child Health
Volume 42 Page 28  - January 2006
Volume 42 Issue 1-2

ORIGINAL ARTICLE
Survey of childhood malnutrition at Dili National Hospital, East Timor
Ingrid K Bucens1* and Carolyn Maclennan1**

Objectives:  To describe the characteristics and 
short-term outcomes of children with malnutrition 
admitted to Dili National Hospital (DNH), East Timor.

Methods:  A prospective observational survey 
using caretaker interviews and medical record 
review was conducted on the paediatric ward at 
DNH for 12 months from March 2002. Patients were 
children aged 2 months to 12 years, admitted with 
moderate to severe malnutrition as either a primary or secondary diagnosis.

Results:  Malnutrition was present in 31.8% 
(280/880) of paediatric admissions during the 
study period. Sixty-one per cent of the 
malnutrition cases were severe malnutrition 
(weight-for-height below 3 Z-scores and/or 
oedema) and 53.7% were both wasted and stunted. 
The hospital case-fatality rate was 12.9% 
(36/280). Immunization coverage was low, with 39% 
of cases never immunized and 29% incompletely 
immunized according to the national immunization schedule.

Conclusions:  There is a high rate of 
malnutrition among paediatric inpatients at DNH, 
consistent with results of anthropometric surveys 
in the newly independent East Timor. Despite the 
introduction of a standardized protocol following 
WHO guidelines and associated training on the 
management of severe malnutrition, the hospital 
case-fatality rate for severe malnutrition was still high (12.9%).

-----------------------------------------------------------------------------------------------------------------------------

Am. J. Trop. Med. Hyg., 74(3), 2006, pp. 361-366
Copyright © 2006 by 
<http://intl.ajtmh.org/cgi/content/abstract/74/3//misc/terms.shtml>The 
American Society of Tropical Medicine and Hygiene


EFFICACY OF SULFADOXINE-PYRIMETHAMINE IN THE 
TREATMENT OF UNCOMPLICATED PLASMODIUM FALCIPARUM MALARIA IN EAST TIMOR

MATTHEW BURNS, JOANNE BAKER, ALYSON M. AULIFF, 
MICHELLE L. GATTON, MICHAEL D. EDSTEIN, AND QIN CHENG*
Medical Emergency Relief International, London, 
United Kingdom; Australian Army Malaria 
Institute, Brisbane, Queensland, Australia; 
Division of Infectious Diseases and Immunology, 
Queensland Institute of Medical Research, 
Brisbane, Queensland, Australia; Australian 
Centre for International and Tropical Health and 
Nutrition, University of Queensland, Brisbane, Queensland, Australia

The efficacy of sulfadoxine-pyrimethamine (SP) in 
East Timor is unknown. We treated 38 individuals 
with uncomplicated Plasmodium falciparum malaria 
with SP and monitored the outcome for 28 days. 
Recrudescent parasitemia, confirmed by 
genotyping, were detected in three individuals 
resulting in a late treatment failure rate of 
7.9% (95% confidence interval = 1.7–21.4%). The 
results suggest that SP is still efficacious in 
treating uncomplicated P. falciparum malaria in 
East Timor. However, the useful life of SP in 
East Timor may be limited because 80% of the 
parasites in our samples were found to already 
carry double mutations in P. falciparum 
dihydrofolate reductase (S108N/C59R). The data 
from this study also highlights that the presence 
of gametocytes may significantly influence the 
estimate of SP efficacy determined by genotyping.

-----------------------------------------------------------------------------------------------------------------------------

Health Policy Plan. 2006 Mar 24 ncbi.nlm.nih.gov

Rehabilitating the health system after conflict 
in East Timor: a shift from NGO to government leadership.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&itool=PubMed_Citation&term=%22Alonso+A%22%5BAuthor%5D>Alonso 
A, 
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&itool=PubMed_Citation&term=%22Brugha+R%22%5BAuthor%5D>Brugha 
R.
Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK.
Efforts to rehabilitate health systems after 
periods of prolonged conflict have often been 
characterized by poor coordination of external 
actors - multilateral agencies, donors and 
non-governmental organizations (NGOs). This paper 
describes the process and analyses the roles of 
the different stakeholders in the establishment 
of a government-led district health system in 
East Timor, between 1999 and 2002, after decades 
of chronic conflict and Indonesian occupation. 
Future East Timorese policy-makers and health 
professionals began to mobilize in May 1999, in 
preparation for independence. During the 
emergency phase, from September 1999, when 
violence erupted, to March 2000, NGOs played a 
major role in the provision of relief to the 
population, coordinated by United Nations 
agencies. An Interim Health Authority, led by 
local Timorese, was established in March and the 
major donors began to shift funding from NGOs to 
the newly established Ministry of Health. A rapid 
phasing-out of NGOs, accompanied by a sequence of 
steps to build the capacity of Timorese to manage 
the new district health system, was implemented. 
Early evidence shows that health service 
utilization continued to grow during and after implementation.