Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017160 (gastroenteritis)
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A study has been made of 3,745 Bedouin and 9,422 Jewish babies born in 1972-73 to residents of the Beersheba district of southern Israel (the Negev). Newborn infants weighing less than 1 kg were excluded. Thirty-seven percent of the Bedouin babies were born at home; their mothers tended to be older and of higher parity than those choosing to deliver in hospital. Less than 6% of Bedouin mothers had been to school, compared with 90% of the Jews; 30% were aged under 20 or over 34 years, compared with 18% of the Jews, and 23% were having their seventh or later baby, compared with 12% of the Jews. Mean birth weight of babies born in hospital was about 200 g lower in Bedouin than in Jews, and 11.4% of Bedouin and 6.5% of Jewish infants weighed less than 2.5 kg. There was little variation in complications of labor between the 1,959 Bedouin and 8,877 Jewish women delivered in Beersheba's Soroka Medical Center. The cesarean section rate was 1.8% in Bedouin and 4.3% in Jews, while in 0.3% of Bedouin and 1.4% of Jews labor was induced. Monozygous twinning rates were similar in the two ethnic groups (4.8 and 4.5 sets/1,000 deliveries, respectively) but dizygous twinning was twice as common among the Bedouin as among the Jews (13.0 vs 6.0 sets/ 1,000). Male births accounted for 0.526 and 0.512 of the total in Bedouin and Jews, respectively. Perinatal mortality rates for hospital births were 31.1 and 18.3/1,000 in Bedouin and Jews, respectively. Infant deaths among Bedouin (31.0/1,000) were underreported; the rate was 16.8/1,000 for Jewish infants. Although rates of all specific causes of death were higher in Bedouin than in Jews, patterns of mortality in subgroups based on birth weight, sex, twinning and maternal age were quite similar in the two ethnic groups. There were six reported deaths from tetanus among Bedouin babies. For the cohort of babies born in 1972, admissions to the Soroka Medical Center pediatric wards were recorded in 366 (195.5/1,000) Bedouin and 787 (174.3/1,000) Jewish babies younger than the age of one year. Bedouin admission rates were higher than those of Jews for gastroenteritis (119.1 and 64.5/1,000 respectively), infectious and parasitic diseases (29.4 and 21.9), malnutrition (25.6 and 8.0) and external causes (10.1 and 4.4). Admission rates for bronchitis and pneumonia were, however, lower among Bedouin than Jews in the first six months of life.
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PMID:Maternal, perinatal and infant health in Bedouin and Jews in southern Israel. 87 68

The verbal autopsy (VA) is an epidemiological tool that is widely used to ascribe causes of death by interviewing bereaved relatives of children who were not under medical supervision at the time of death. This technique was assessed by comparison with a prospective survey of 303 childhood deaths at a district hospital in Kenya where medically confirmed diagnoses were available. Common causes of death were detected by VA with specificities greater than 80%. Sensitivity of the VA technique was greater than 75% for measles, neonatal tetanus, malnutrition, and trauma-related deaths; however, malaria, anaemia, acute respiratory-tract infection, gastroenteritis, and meningitis were detected with sensitivities of less than 50%. There may have been unwarranted optimism in the ability of VAs to detect some of the major causes of death, such as malaria, in African children. VA used in malaria-specific intervention trials should be interpreted with caution and only in the light of known sensitivities and specificities.
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PMID:Childhood deaths in Africa: uses and limitations of verbal autopsies. 135 14

Trends and levels of pediatric deaths in the Children's Emergency Room of the University College Hospital in Ibadan Nigeria, were studied for the years 1978-86 and related to admission diagnoses. Admission records were available only for 1978 and 1981 -86. 17,033 children were admitted during the study years, including 9794 males, 7037 females, and 202 whose sex was not recorded. The sample included 11,076 children whose admission records were completed. Excluded were 3507 patients transferred to the pediatric wards for further care and 2446 children for whom the outcome of admission was unknown. Monthly and yearly mortality trends show a progressive decline except for 1984 when slight increase occurred. The overall decline from 238 deaths/1000 admissions in 1981 to 178 and 179 in 1985 and 1986, respectively, was, however, statistically significant. The lowest average monthly mortality rates were recorded in June-September and the highest in January-April. Neonates accounted for 26.4% of all admissions and children aged 1-12 months for 29.5%. 30.5% of admissions were 1-5 years old and 13.4% were 5-15. The ratio of males to females for all age groups was 1.39:1. 20.6% of neonatal admissions, 24.7% of those 7-12 months old, and 27.2% of those 13-24 months old died. The mortality rate was considerably lower for children 2 and over and 2-6 months. Measles and tetanus ranked 4th and 11th among diagnoses and had the highest fatality rates of 32.6% each. 61.6% of tetanus cases were in neonates, who had a case fatality rate of 36.4%. Measles accounted for 13.1% of all deaths and tetanus for 5%. Malnutrition cases had a fatality rate of 27.3%, and 7.%% of all deaths were due to malnutrition. Jaundice, gastroenteritis, and bronchopneumonia were the 3 leading causes of admission proportion of all deaths due to gastroenteritis and bronchopneumonia declined from 30.7% in the early 1970s to 16% in the series. 10% of all deaths were due to jaundice, although it had a relatively low case fatality rate. Low birth weight had the lowest fatality rate of the 10 leading causes of admission, 6.1%.
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PMID:Mortality pattern at a children's emergency ward, University College Hospital, Ibadan, Nigeria. 211 28

The registry of patients at the hospital of Kampene, Zaire, covering the period 1986-87 was examined to determine the hospital's rate of utilization and accessibility, to evaluate mortality, and to ascertain the prevalence of infectious diseases. The 1986 data of the hospital laboratory indicated a high incidence of infectious and parasitic diseases: ancylostomiasis (33.6%); ascariasis (22.9%); schistosomiasis (3.4%); multiple intestinal parasitic infections (10.9%); malaria (43%), often chloroquine-resistant; filariasis (70.8%); and alcohol-acid resistant tuberculosis bacilli (15%). Sexually-transmitted diseases such as vaginitis (80%) were caused by polygamy, prostitution, and promiscuity, HIV serodiagnosis could not be performed because of a lack of equipment. A high infant mortality rate was caused by neonatal tetanus, toxic gastroenteritis, measles (5.1% lethality: 2 died out of 39 cases), and epidemic cerebrospinal meningitis. Malnutrition caused kwashiorkor and avitaminosis. 792 births were registered at the maternity ward in 1986: 52.8% were male and 47.2% were female; 48 (6.1%) were stillborn or died in the following days; 104 (13.1%) were born prematurely; and 24 (3.1%) were twins. Cesarean section was performed in 43 cases (5.4%). There was a total of 15,099 outpatient visits during a 1-year period. The bed occupancy rate of the surgical ward ranged between .7 and .8 during 1987. Recovery and hospitalization days per doctor or health assistant were very high compared to Italian standards. The lethality of malaria was a high 1.8%, but malnutrition rated even higher: 21.4%. The utilization of the hospital was high, Maternal-child protection measures, especially in the area of nutrition, require the training of community health workers and traditional birth attendants; however, cost-benefit considerations limit resources and the implementation of primary health care is curtailed by economic and cultural factors.
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PMID:[Health care organization and health in a region of Zaire]. 248 74

Over a 9 year period (1354-1362), 139, 436 children were admitted to Indira Gandhi Institute of Child Health, Kabul. Of these, 51,212 (46.8%) children were hospitalized with preventable diseases. 74% of the patients were under age 5. Among the infectious diseases, gastroenteritis accounted for nearly 70% of the admissions. Tuberculosis, measles, diphtheria, and typhoid fever were other common infectious diseases. Malnutrition of varying degree was the core problem among the hospitalized children and was seen in nearly 2/3 of the admissions. 20% of them had severe protein energy malnutrition which contributed to higher mortality. Gastroenteritis contributed /2 (51.5%) of the mortality numbers. Septicemia, tetanus neonatorum, and central nervous system infections were associated with high mortality, especially among the neonates. Deaths following 6 target preventable diseases accounted for nearly 1/4 of the deaths (20.4-24.6%) over this period.
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PMID:Pattern of preventable diseases in Afghanistan: suggestions to reduce the morbidity and mortality at IGICH. 251 Nov 41

To focus attention on the problem of infant mortality in Lebanon, data were compiled on infant mortality from 1978 to 1986 at the American University of Beirut Medical Center. Causes of death are analyzed for 602 males and 398 females. 54.9% deaths occurred at 1 month of age and 77.4% died within the 1st year. Autopsies were performed on .7%. 37.7% of all neonatal deaths were due to neonatal diseases such as hyaline membrane disease, asphyxia neonatorum, immaturity, necrotizing enterocolitis, hemorrhage, hemolysis, meconium aspiration, and kernicterus. Better prenatal care would reduce this group, or the administration of corticosteroids to the mother 24-48 hours prior to delivery, as well as rapid resuscitation at birth and prevention of the 5 curses: hypoxemia, hypoglycemia, hypothermia, hypotension, and acidosis. Although unavailable in Lebanon, administration of surfactants through an endotracheal tube would also help. Infections constitute 25.1% of deaths; many are preventable through adequate public health measures and strict personal hygiene, i.e., diseases such as sepsis, pneumonia, meningitis, gastroenteritis, hepatitis, encephalitis, and 1-2 cases of the following: diphtheria, measles, peritonitis, tetanus, tuberculosis, cytomegalis inclusion, herpes, parathyphoid, pertussis, poliomyelitis, and shigellosis. Congenital diseases were 21.6%. In utero diagnosis could prevent some diseases and in utero treatment is possible for hydrocephalus and hydronephrosis. Screening programs postnatally could lead to treatment. 5.9% were malignancies such as leukemia, lymphoma, brain tumors, histocytosis, Wilm's tumor, Ewing sarcoma, and Hodgkin's disease. Early diagnosis is critical if mortality is to be reduced in this group, but medical advances are still needed. 2.9% are miscellaneous diseases such as poisoning, rheumatic diseases, marasmus, Reye's syndrome, nephrosis, rickets, and epilepsy. Most of these diseases are preventable, except for rheumatic inflammation of the heart. Recommended necessary steps to reduce infant mortality are: prenatal care, diagnosis and screening, intrauterine surgery; resuscitation and intensive care centers with modern equipment and trained personnel; national vaccination and screening programs; adequate public health measures and hygiene; parental education; and well-equipped hospitals to serve all regardless of income level.
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PMID:Pediatric mortality: an avoidable tragedy. 251 28

A rural development project carried out in Southern Zimbabwe for 5 years was aimed at improving nutrition, combatting diseases, educating villagers about proper hygiene, improving water quality, and assessing the development and nutritional status of children under 5. The community investigated consisted of 10,000 people or 1,439 families with an average of 7 persons per family. The main staple of their diet was maize, and malnutrition was prevalent. Water holes infested with bilharzia were the source of drinking water for both man and animal. The project succeeded in vaccinating 90% of preschool children against whooping cough, diphtheria, tetanus, polio, measles, and tuberculosis. A control district was chosen to compare the developmental data obtained by the Cole Slide Rule Calculator of 229 children under 5 with those of 242 children in the project. Malnutrition was studied in 200 children hospitalized in the children's ward of a district hospital, 1/3 of whom were less than 1 year old. Gastroenteritis, giardiasis and amebiasis were prevalent among them (37%), as were upper respiratory infections (27%), pneumonia (12%), and skin infections (7%). Nonspecific gastroenteritis was found in 86% of children under 2. Most over 2 were severely undernourished. A nutritional rehabilitation village called Hutano Village was established in 1982 to function as a nutritional center, staffed by a full-time health worker and an assistant. In the 1st 9 months of its existence, 114 children were taken in, and the mothers received instruction in vegetable gardening, raising chickens and rabbits, hygiene, and family planning. The average attendance runs to 25 children and 15 to 17 mothers. In spite of successful medical intervention in malnutrition cases, the relapse of children into an undernourished state remains a difficult issue, whose cause lies in inadequate water supply, poor soil, lack of resources, and low family socio-economic status.
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PMID:[Improved health in Zimbabwe's rural areas as a result of the rural development project]. 648 96

The child in Nigeria is loved and pampered but food may be scarce or inadequate in nutrients, and he/she has overcrowding and poor sanitation to deal with as well as a maze of conflicting and hybrid values and way of life. Statistics show that in black Africa 1 child out of 5 will survive up to his 5th birthday. The infant mortality rate is high primarily because of inadequate nutrition and communicable diseases. The 10 most common diseases in Africa from 4 sample countries, i.e., Ethiopia, Nigeria, Uganda, and Kenya are: malaria; gastroenteritis, measles; respiratory tract infections; malnutrition; intestinal worm, anemias; tetanus; meningitis; and tuberuclosis. All these diseases are preventable, but prevention is more difficult because there are few health workers and inadequate facilities. 80 pediatricians and a few unrecognized pediatric trained nurses look after about 40 million children in Nigeria. Nutrition plays a prominent role in both growth and development. Local food may be plentiful but some families are unable to balance their diets. There is malnutrition or undernutrition because of ignorance, poverty, and feeding habits. In Africa the effect of malnutrition is most marked during weaning. In a traditional African society a child does not lack for love and affection. There are no unwanted pregnancies, no motherless children, no unmarried women, for the extended family system absorbs many of these shocks. The circumstances of the family are related to the incidence of child abuse, which is increasing. Children are used as cheap labor by both parents and guardians. In the current 5-year development plan, the government is making a bold step in health care. Some of the major goals of this 4th 5-year development plan in health care delivery include: rapid expansion of facilities to achieve 100% primary health care coverage by the year 2000; emphasizing preventive care; decentralization so that the local government areas are implementation units; modification of the health care system to suit local conditions and resources; and crash training programs for various health personnel. Suggestions of this author include the following: the full implementation of the health plan; education; school health service; the provision of school children with 1 balanced meal per school day; the preparation of inexpensive baby foods with local foodstuff demonstrated to mothers' groups; and the development of day care centers.
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PMID:Nigeria: child health. 655 Mar 10

Lessons learned from Haiti's integration of a training program for traditional birth attendants with the maternal and child health and family planning program are reported. The available data on illness and deaths reveal that Haiti has continuing problems of gastroenteritis, malnutrition, tuberculosis, malaria, and tetanus. The latter is of particular interest since neonatal tetanus derived from umbilical cord contamination continues to affect up to 10-20% of Haitian newborns in rural areas lacking health programs. Neonatal tetanus has largely disappeared in the Artibonite Valley due to a mass immunization program for the entire population, including young women, against tetanus. In the Albert Schweitzer Hospital program for indigenous midwives in Artibonite Valley, at least 36 midwives were reached on a regular basis in 1968 -- less than 1/3 of the midwives operating in the Artibonite Valley. There was a rapid decline in neonatal tetanus admissions during the period following 1968. This decline has been attributed to the use of rural health auxiliaries in immunizing the women in the hospital district, but indigenous midwives may have played a role. By 1970, the Albert Schweitzer Hospital program had grown from 36 midwives regularly attending midwife classes to 175 registered with the program during 1970. Although direct supervision proved difficult due to lack of communication and transport to the scene of delivery, some deliveries were observed and indirect supervision by the community became evident. An important finding of the traditional midwife training program of the Albert Schweitzer Hospital was the amount of time required for an indigenous midwife to have referred 50 newborns to the hospital for BCG vaccination. At the end of the 1st year of this program, only 2 midwives reached this goal. Another surprise was the increase in demand for "cord cut" services at the outpatient clinic rather than increased use of the nearby maternity unit. The elimination of neonatal tetanus as a cause of infant mortality was the most important outcome of the maternal and child health component of the community health program.
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PMID:Traditional midwives, tetanus immunization, and infant mortality in rural Haiti. 667 3

The state of child health in Singapore from 1914 to the present is discussed. In 1914 there were 225 reported cases of tetanus neonatorum out of 7420 births and 340 deaths from gastroenteritis with an infant mortality rate (IMR) of 292.9/1000 live births. In 1936 the IMR was 167.74 and in 1962 it was still high at 31.2. Causes of death included tetanus neonatorum, gastroenteritis, tuberculosis, and poliomyelitis. Diphtheria immunization had lowered the rate of mortality from this disease. The 1st priority in improving infant health after 1962 was lowering the IMR, especially by treating the newborn. The 2nd priority was infections. Oral Sabin was introduced against polio and programs for tetanus, whooping cough, and measles vaccinations were begun as well; compulsory diphtheria innoculation began in 1963. Malnutrition was identified as a cause in high childhood morbidity and mortality, relating to a decrease in breastfeeding to only 29% with only about 4% continuing after 3 months; this also caused diarrhea and gastroenteritis. A Breast Feeding Mothers Group was established to help mothers and to support a breast milk bank. In addition the birthrate was very high, 2.8% with very young and elderly mothers giving birth in large numbers and constituting poor obstetric risks. In 1966 the government established a national family planning program. This program, together with nutrition education, improved housing and promotion of breastfeeding has raised the nutrition level. By 1976 the IMR had fallen to 11.8 and the neonatal mortality rate (NMR) was 8.4, both of which were lower than rates in the US, UK, Australia, and New Zealand. In 1981 the IMR fell to 10.8 and the NMR to 7.7. Although deaths from infections and diseases have dropped, those from congenital anomalies and malignancies such as leukemia have not changed. Health education has had an effect on lowering mortality rates from accidents. Rates of death from dengue hemorrhagic fever have been lowered but not abolished by mosquito surveillance, as is the case with other viral infections such as measles. With bacterial infections the latest problem is the existence of antibiotic-resistant strains. Further efforts must emphasize health rather than the reduction of mortality and mental and emotional morbidity must receive more attention as well.
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PMID:Child health in Singapore--past, present and future. 713 9


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