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Tuberculosis (TB) and human immunodeficiency virus (HIV) infection make each other's control significantly more difficult. Coordination in addressing this "cursed duet" is insufficient at both global and national levels. However, global policy for TB/HIV coordination has been set, and there is consensus around this policy from both the TB and HIV control communities. The policy aims to provide all necessary care for the prevention and management of HIV-associated TB, but its implementation is hindered by real technical difficulties and shortages of resources. All major global-level institutions involved in HIV care and prevention must include TB control as part of their corporate policy. Country-level decision makers need to work together to expand both TB and HIV services, and civil society and community representatives need to hold those responsible accountable for their delivery. The TB and HIV communities should join forces to address the health-sector weaknesses that confront them both.

Relapse rates are acceptably low following successful DOT with a twice weekly rifampicin-containing regimen, irrespective of HIV status and previous treatment history. Mortality is substantially increased among HIV-infected patients even following successful DOT and this requires further attention.

The Global Plan to Stop TB 2006-2015 is a road map for policy-makers and managers of national programmes. It sets out the key actions needed to achieve the targets of the Millennium Development Goals relating to tuberculosis (TB): to halve the prevalence and deaths by 2015 relative to 1990 levels and to save 14 million lives. Developed by a broad coalition of partners, the plan presents a model approach combining interventions that can feasibly be supplied on the ground. The main areas of activity set out in the plan are: scaling up interventions to control tuberculosis; promoting the research and development of improved diagnostics, drugs and vaccines; and engaging in related activities for advocacy, communications and social mobilization.Scenarios for the planning process were developed; these looked at issues both globally and in seven epidemiological regions. The scenarios made ambitious but realistic assumptions about the pace of scale-up and implementation coverage of the activities. A mathematical model was used to estimate the impact of scaling up current interventions based on data from studies of tuberculosis biology and from experience with tuberculosis control in diverse settings.The estimated costs of the activities set out in the Global Plan were based on implementing interventions and researching and developing drugs, diagnostics and vaccines; these costs were US$ 56 billion over 10 years. When translated into cost per disability adjusted life year averted, these costs compare favourably with those of other public health interventions. This approach to planning for global tuberculosis control is a valuable example of developing plans to improve global health that has relevance for other health issues.

South Africa is one of the countries most severely affected by the global HIV/AIDS pandemic. The effects of increased numbers of sick patients on rural district hospitals are not well documented. This study summarizes the changes in number and type of hospital admissions to the medical wards of a small rural district hospital in Northern KwaZulu/Natal, South Africa, between 1991 and 2002. For the same 2-month period, across the study period total admissions rose by 228 to 626 patients with no increase in hospital staff or capacity. Length of inpatient stay fell from 10.9 to 7.9 days, and inpatient mortality rose from 8% to 20%. The median age of female patients fell from 50 to 34 years, and the median male patient's age fell from 45 from 39 years over the study period. After 1991, tuberculosis became the most frequent diagnosis, and in 2002 it was the leading cause of death. The HIV epidemic has increased the number of medical hospital admissions, primarily infectious diseases such as tuberculosis, lower respiratory infection, and diarrheal illness. Comprehensive strategies are needed to reduce the community burden of disease and minimize the impact of HIV on the health services.

Public Health Action (PHA) The voice for operational research.Published by The Union (www.theunion.org), PHA provides a platform to fulfil its mission, 'Health solutions for the poor'. PHA publishes high-quality scientific research that provides new knowledge to improve the accessibility, equity, quality and efficiency of health systems and services.

pitals in sub-Saharan Africa. This provided the opportunity for a detailed study that would assess the performance of pediatric in-patient care in those hospitals, as a group and individually, and provide data that could improve care goals. In particular, documenting the most common mortalities and associated case-fatality rates for children aged <5 years would allow MSF to focus on those diseases at most need of attention.The study will also add to the scarce literature on pediatric in-patient mortality in sub-Saharan Africa, as only a few reports on the topic could be found in the medical literature. One rural district hospital in Kenya reported an under-fi ve in-patient mortality rate of 8%. 3 This hospital was comparable to one of the MSF hospitals. Another study from Kenya of 14 fi rst referral care district hospitals showed under-fi ve in-patient mortality rates ranging from 4% to 15%. 4 However, no information has been found in relation to hospital settings, especially those in insecure contexts where health care systems have collapsed and where MSF frequently works.The aim of this study was to report on the causes of mortality and case-fatality rates for children aged <5 years in eight MSF-supported hospitals in Africa. Specifi c objectives were to determine: 1) the overall and individual mortality rates for the eight hospitals, 2) the 10 most common causes of mortality in all hospitals combined, and 3) the case-fatality rates for these diseases. METHOD DesignThis was a retrospective analysis of routinely collected program data for the year 2010. SettingsMSF supports hospital care in settings where in-patient care is not readily available or accessible due to insecurity or post-confl ict where infrastructure has been destroyed by war.This study was conducted in all eight public hospitals where MSF Operational Centre Brussels (OCB) was providing support, seven of which were located in sub-Saharan Africa and one in Northern Africa. Some hospitals were district hospitals serving a rural population, while others were in extremely remote areas and two were located in highly insecure environments. Three hospitals were entirely run by MSF staff and were under MSF's management, while the other fi ve were Ministry of Health structures where MSF support was integrated at various levels. Setting: Eight pediatric hospital in-patient wards in remote, rural and/or insecure areas in Africa. Objectives: To describe, in children aged <5 years, 1) overall and individual mortality rates, 2) the 10 most common causes of mortality, and 3) their case-fatality rates. Design: Retrospective analysis of routinely collected standardized program data for 2010. Results: During 2010, 21 357 children aged <5 years were admitted and 1520 died, resulting in an overall inpatient mortality rate among under-fives of 7%. This remained the same after considering the three most common causes of mortality per hospital. One hospital with a neonatal unit showed a mortality rate of 14%. Of the 10 most common causes of mortality in the eight hospi...