***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the diagnostic value of provider-initiated symptom screening for tuberculosis ( TB ) and how HIV status affects it . METHODS We performed a secondary analysis of r and omly selected participants in a community-based TB-HIV prevalence survey in Harare , Zimbabwe . All completed a five-symptom question naire and underwent sputum TB culture and HIV testing . We calculated the sensitivity , specificity , and positive and negative predictive values of various symptoms and used regression analysis to investigate the relationship between symptoms and TB disease . FINDINGS We found one or more symptoms of TB in 21.2 % of 1858 HIV-positive ( HIV+ ) and 9.9 % of 7121 HIV-negative ( HIV- ) participants ( P < 0.001 ) . TB was subsequently diagnosed in 48 HIV+ and 31 HIV- participants . TB was asymptomatic in 18 culture-positive individuals , 8 of whom ( 4 in each HIV status group ) had positive sputum smears . Cough of any duration , weight loss and , for HIV+ participants only , drenching night sweats were independent predictors of TB . In HIV+ participants , cough of > or = 2 weeks ' duration , any symptom and a positive sputum culture had sensitivities of 48 % , 81 % and 65 % , respectively ; in HIV- participants , the sensitivities were 45 % , 71 % and 74 % , respectively . Symptoms had a similar sensitivity and specificity in HIV+ and HIV- participants , but in HIV+ participants they had a higher positive and a lower negative predictive value . CONCLUSION Even smear-positive TB may be missed by provider-initiated symptom screening , especially in HIV+ individuals . Symptom screening is useful for ruling out TB , but better TB diagnostics are urgently needed for re source -poor setting BACKGROUND Oxytocin , the st and ard of care for treatment of post-partum haemorrhage , is not available in all setting s because of refrigeration requirements and the need for intravenous administration . Misoprostol , an effective uterotonic agent with several advantages for re source -poor setting s , has been investigated as an alternative . This trial established whether sublingual misoprostol was similarly efficacious to intravenous oxytocin for treatment of post-partum haemorrhage in women not exposed to oxytocin during labour . METHODS In this double-blind , non-inferiority trial , 9348 women not exposed to prophylactic oxytocin had blood loss measured after vaginal delivery at four hospitals in Ecuador , Egypt , and Vietnam ( one secondary -level and three tertiary-level facilities ) . 978 ( 10 % ) women were diagnosed with primary post-partum haemorrhage and were r and omly assigned to receive 800 microg misoprostol ( n=488 ) or 40 IU intravenous oxytocin ( n=490 ) . Providers and women were masked to treatment assignment . Primary endpoints were cessation of active bleeding within 20 min and additional blood loss of 300 mL or more after treatment . Clinical equivalence of misoprostol would be accepted if the upper bound of the 97.5 % CI fell below the predefined non-inferiority margin of 6 % . All outcomes were assessed from the time of initial treatment . This study is registered with Clinical Trials.gov , number NCT00116350 . FINDINGS All r and omly assigned participants were analysed . Active bleeding was controlled within 20 min with study treatment alone for 440 ( 90 % ) women given misoprostol and 468 ( 96 % ) given oxytocin ( relative risk [ RR ] 0.94 , 95 % CI 0.91 - 0.98 ; crude difference 5.3 % , 95 % CI 2.6 - 8.6 ) . Additional blood loss of 300 mL or greater after treatment occurred for 147 ( 30 % ) of women receiving misoprostol and 83 ( 17 % ) receiving oxytocin ( RR 1.78 , 95 % CI 1.40 - 2.26 ) . Shivering ( 229 [ 47 % ] vs 82 [ 17 % ] ; RR 2.80 , 95 % CI 2.25 - 3.49 ) and fever ( 217 [ 44 % ] vs 27 [ 6 % ] ; 8.07 , 5.52 - 11.8 ) were significantly more common with misoprostol than with oxytocin . No women had hysterectomies or died . INTERPRETATION In setting s in which use of oxytocin is not feasible , misoprostol might be a suitable first-line treatment alternative for post-partum haemorrhage Background : Pneumonia is the leading cause of child mortality worldwide . The role of influenza in childhood pneumonia in tropical developing countries is poorly understood . We undertook population -based surveillance among low-income urban preschool children to determine its role in childhood pneumonia . Methods : Longitudinal prospect i ve active surveillance was conducted among r and omly selected households in a poor urban area of Dhaka . Nasopharyngeal washes were collected from 1 in 5 children for influenza culture isolation . Clinical data were collected at clinical presentation and through the illness course . Results : From April 1 , 2004 through December 31 , 2007 , 12,062 children presented in clinic with eligible febrile and respiratory illnesses , from whom 321 influenza isolates were obtained from 2370 nasopharyngeal washes ( 13.5 % ) , representing 16,043 child-years of observation ( adjusted influenza incidence 102 episodes/1000 child-years ) . There were 8198 pneumonia episodes during the period ( pneumonia incidence 511 episodes/1000 child-years ) . Ninety influenza-positive children ( 28 % ) developed pneumonia during their illness . Among influenza culture-positive children , those with pneumonia were younger than those without ( 23.4 vs. 29.7 months , ANOVA : P < 0.001 ) . Pneumonia was more commonly associated with Influenza A ( H3N2 ) than either A ( H1N1 ) or B infections ( age-adjusted relative odds ( RO ) 2.98 , [ 95 % CI : 1.56 , 5.71 ] and 2.75 , [ 95 % CI : 1.52 , 4.98 ] , respectively ) . Influenza was associated with 10 % all childhood pneumonia . Conclusions : Influenza is a major contributor to childhood pneumonia both through high influenza infection incidence and high pneumonia prevalence among infected children . Its contribution to early childhood pneumonia appears under-appreciated in high pneumonia-endemic tropical setting s. Influenza vaccine trials against childhood pneumonia are warranted OBJECTIVE : The goal was to determine the effect of training in newborn care and resuscitation on 7-day ( early ) neonatal mortality rates for very low birth weight ( VLBW ) infants . The study was design ed to test the hypothesis that these training programs would reduce neonatal mortality rates for VLBW infants . METHODS : Local instructors trained birth attendants from 96 rural communities in 6 developing countries in protocol and data collection , the World Health Organization Essential Newborn Care ( ENC ) course , and a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program ( NRP ) , by using a train-the-trainer model . To test the impact of ENC training , data on infants of 500 to 1499 g were collected by using a before/after , active baseline , controlled study design . A cluster-r and omized , controlled trial design was used to test the impact of the NRP . RESULTS : A total of 1096 VLBW ( 500–1499 g ) infants were enrolled , and 98.5 % of live-born infants were monitored to 7 days . All-cause , 7-day neonatal mortality , stillbirth , and perinatal mortality rates were not affected by ENC or NRP training . CONCLUSIONS : Neither ENC nor NRP training of birth attendants decreased 7-day neonatal , stillbirth , or perinatal mortality rates for VLBW infants born at home or at first-level facilities . Encouragement of delivery in a facility where a higher level of care is available may be preferable when delivery of a VLBW infant is expected OBJECTIVE To generate evidence on the effectiveness of household-wide treatment for preventing the transmission of pediculosis capitis  ( head lice ) in re source -poor communities . METHODS We studied 132 children without head lice who lived in a slum in north-eastern Brazil . We r and omized the households of the study participants into an intervention and a control group and prospect ively calculated the incidence of infestation with head lice among the children in each group . In the intervention group , all of the children 's family members who lived in the household were treated with ivermectin ; in the control group , no family member was treated . We used the chi(2 ) test with continuity correction or Fisher 's exact test to compare proportions . We performed survival analysis using Kaplan-Meier estimates with log rank testing and the Mann-Whitney U test to analyse the length of lice-free periods among sentinel children , and we used Cox regression to analyse survival data on a multivariate level . We also carried out a subgroup analysis based on gender . FINDINGS Children in the intervention group remained free from infestation with head lice significantly longer than children in the control group . The median infestation-free period in the intervention group was 24 days ( interquartile range , IQR : 11 - 45 ) , as compared to 14 days ( IQR : 11 - 25 ) in the control group ( P = 0.01 ) . Household-wide treatment with  ivermectin  proved significantly more effective among boys than among girls ( P = 0.005 ) . After treatment with ivermectin , the estimated number of annual episodes of head lice infestation was reduced from 19 to 14 in girls and from 15 to 5 in boys . Female sex and extreme poverty were independent risk factors associated with a shortened disease-free period . CONCLUSION In an impoverished community , girls and the poorest of the poor are the population groups that are most vulnerable for head lice infestation . To decrease the number of head lice episodes per unit of time , control measures should include the treatment of all household contacts . Mass treatment with ivermectin may reduce the incidence of head lice infestation and associated morbidity in re source -poor communities ZusammenfassungPädiatrische Medikamentenformulierungen sind ein wichtiger Fortschritt in der Therapie von afrikanischen Kindern , die an Malaria tropica erkrankt sind . In dieser klinischen Studie wurde die Wirksamkeit , Sicherheit und Verträglichkeit einer neuen pädiatrischen Artesunat-Mefloquin Koformulierung i m Vergleich mit einer Tablettenformulierung evaluiert . Einundsiebzig pädiatrische Patienten am Albert Schweitzer Spital in Lambaréné , Gabun , die an unkomplizierter Malaria tropica litten , wurden nach Körpergewicht stratifiziert , um mit der pädiatrischen ( 10 – 20 kg ; n = 41 ) oder der Tabletten-Formulierung ( 20 – 40 kg ; n = 30 ) therapiert zu werden . Die PCR korrigierte Heilungsrate war 100 % am Tag 28 . Die häufigsten Nebenwirkungen waren Erbrechen ( 17 % ) , abdominelle Schmerzen ( 11 % ) und Cephalea ( 17 % ) . Diese Studie bestätigt die hervorragende Wirksamkeit und gute Verträglichkeit von Artesunat-Mefloquin zur Therapie pädiatrischer Patienten in Afrika . Summary Pediatric drug formulations of artemisinin combination therapies are urgently needed for improving the treatment of children suffering from uncomplicated malaria . The aim of this clinical trial was to evaluate the efficacy , safety and tolerability of a novel pediatric fixed-dose granule formulation of artesunate-mefloquine and a new co-blister tablet formulation . A total of 71 children aged 1–13 years suffering from uncomplicated falciparum malaria were stratified into two groups according to weight : 10–20 kg , pediatric group ( n = 41 ) ; 20–40 kg , tablet group ( n = 30 ) . All the children were treated once daily for three days : the pediatric group received the novel granule formulation , the tablet group received the co-blister tablets . The PCR-corrected cure rate on day 28 was evaluated . There was no reappearance of parasitemia during the follow-up period and the day-28 cure rate was therefore 100 % in per- protocol analysis . In intention-to-treat analysis the cure rates were 95 % in the pediatric group and 97 % in the tablet group . The most frequent adverse events were vomiting ( 17 % ) , abdominal pain ( 11 % ) and headache ( 17 % ) . This study confirms the excellent efficacy and favorable safety and tolerability profile of a novel pediatric artesunate-mefloquine formulation for treatment in African children BACKGROUND Oxytocin , the gold-st and ard treatment for post-partum haemorrhage , needs refrigeration , intravenous infusion , and skilled providers for optimum 
    Output:
    
These articles represent examples of high- quality international emergency research that is currently ongoing in high- , middle- , and low-income countries alike .