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In a prospective study spanning 12 1/2 years (July 1983 to December 1995), 272 children with nephrotic syndrome seen at the University of Nigeria Teaching Hospital Enugu, Nigeria, were followed up and reviewed at the end of the study period. The demographic, clinical and laboratory features, response to treatment and prognosis were documented. Nephrotic syndrome made up 1.34% of all paediatric admissions. There were 164 males and 108 females giving a male to female ratio of 1.5:1. The ages ranged from 2 to 16 years, with a mean of 7.9 +/- 3.4 years and peak age of 5-7 years. The major clinical features were generalized oedema (100%), hypertension (23%), fever (20%), oliguria (10%) and cough (7%). Haematuria was present in 26%, mean serum albumin was 16 +/- 5, 1 gm/L, serum cholesterol 9.53 +/- 1.6 mmol/L Malaria parasitaemia was present in 38.7% and 9 patients (3.3%) had sickle cell disease (SS). Treatment with diuretics, pooled plasma, prednisolone or cyclophosphamide in various combination achieved 63.9% remission. Mortality was 5.5% being mainly due to chronic renal failure, hypertension and infections. The study calls for more trials in the use of steroids and cyclophosphamide in the treatment of childhood nephrotic syndrome in the tropics.
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PMID:Childhood nephrotic syndrome in Enugu, Nigeria. 1107 Jul 50

The present population in South Africa, roughly 43 million inhabitants, is made up of Africans (77.2%), whites (10.5%), Coloureds (mixed race) (8.8%) and Indians (2.5%). In 1900 the infant mortality rate (IMR) among Africans was 330 per 1,000 live births; this has now fallen to 50-60. In Soweto, a primarily African city, IMR averages 20-25. Life expectancy in the past was only 25-30 years; by 1995, this reached 63 years. However, this could fall again due to the rapidly spreading HIV/AIDS epidemic. Life expectancy could fall to 40-45 years by 2010 with the AIDS epidemic being the cause of half of all deaths--a disastrous change from the previous relatively commendable public health situation. Formerly, the most common causes of deaths in young people were infections, diseases associated with malnutrition and gastroenteritis. Adults died almost solely from infections, including typhoid, dysentery, malaria and tuberculosis (TB). Even though diseases associated with malnutrition are less common today, many infections still remain a major problem, particularly TB, which is increasing. As late as 1970, Africans who reached 50 years had longer life expectancy than whites due to the low prevalences of the chronic diseases of lifestyle. This is no longer so, due to the recent rises in non-communicable disorders/diseases, principally obesity in women, hypertension, diabetes, stroke and the cancers of prosperity. In the not so distant future, the level of control of HIV/AIDS related diseases will be the major health/disease regulating factor among Africans. Among white, Coloured and Indian populations, there have been falls in the mortality rates of the young and, despite rises in lifestyle diseases, increases in life expectancy are continuing. For all populations other important public health regulatory factors include water supply, sanitation, clinic/hospital services and personal environmental factors, employment, dietary pattern and intake, smoking practices and alcohol consumption and physical activity, particularly in urban dwellers. Unfortunately, public health expenditure, also a highly regulating factor, has fallen from 8.2% of the gross domestic product in 1994 to 4.1% in 2000.
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PMID:Changes in public health in South Africa from 1876. 1146 13

Prenatal care has been implemented in developing countries according to the same mode as applied in industrialized countries without considering its real effectiveness in reducing maternal and neonatal mortality. Several recent studies suggest that the goals should be revisited in order to implement a program of prenatal care based on real scientific evidence. Based on the current literature, we propose a potentially effective content for prenatal care adapted to the context of developing countries. Four antenatal consultations would be enough if appropriately timed at 12, 26, 32 and 36 weeks pregnancy. The purpose of these consultations would be: 1) to screen for three major risk factors, which, when recognized, lead to specific action: uterine, scare, malpresentation, premature rupture of the membranes; 2) to prevent and/or detect (and treat) specific complications of pregnancy: hypertension, infection (malaria, venereal disease, HIV, tetanus, urinary tract infection); anemia and trace element deficiencies, gestational diabetes mellitus; 3) to provide counseling, support and information for pregnant women and their families (including the partner) concerning: severe signs and symptoms of pregnancy and delivery, community organization of emergency transfer, delivery planning. These potentially effective actions can only have a real public health impact if implemented within an organized maternal health system with a functional network of delivery units, if truly quality care is given, and if the relationships between health care providers and the population are based on mutual respect. Sub-Saharan African women use prenatal care extensively when it is accessible; this opportunity must be used to implement evidence-based actions with appropriate and realistic goals.
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PMID:[Potential role of prenatal care in reducing maternal and perinatal mortality in sub-Saharan Africa]. 1197 82

India is the second most populous country of the world and has changing socio-political-demographic and morbidity patterns that have been drawing global attention in recent years. Despite several growth-orientated policies adopted by the government, the widening economic, regional and gender disparities are posing challenges for the health sector. About 75% of health infrastructure, medical man power and other health resources are concentrated in urban areas where 27% of the population live. Contagious, infectious and waterborne diseases such as diarrhoea, amoebiasis, typhoid, infectious hepatitis, worm infestations, measles, malaria, tuberculosis, whooping cough, respiratory infections, pneumonia and reproductive tract infections dominate the morbidity pattern, especially in rural areas. However, non-communicable diseases such as cancer, blindness, mental illness, hypertension, diabetes, HIV/AIDS, accidents and injuries are also on the rise. The health status of Indians, is still a cause for grave concern, especially that of the rural population. This is reflected in the life expectancy (63 years), infant mortality rate (80/1000 live births), maternal mortality rate (438/100 000 live births); however, over a period of time some progress has been made. To improve the prevailing situation, the problem of rural health is to be addressed both at macro (national and state) and micro (district and regional) levels. This is to be done in an holistic way, with a genuine effort to bring the poorest of the population to the centre of the fiscal policies. A paradigm shift from the current 'biomedical model' to a 'sociocultural model', which should bridge the gaps and improve quality of rural life, is the current need. A revised National Health Policy addressing the prevailing inequalities, and working towards promoting a long-term perspective plan, mainly for rural health, is imperative.
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PMID:Current health scenario in rural India. 1204 9

The Indian government's plan to introduce the new long-acting contraceptive Norplant in the National Family Planning Program under pressure from the US government is opposed because Norplant has not been adequately tested. The government has reduced the funding for the national program for eradication of malaria and tuberculosis, but it is proposing to finance a Norplant based population project for the State of Uttar Pradesh. The powers that can turn a deaf ear to the possible hazards of Norplant. Implanted in the arm of a woman, the chemical is released into the bloodstream providing contraception for 5 years. Severe adverse reactions include depression, heart disease thromboembolism, high blood pressure, and ovarian cysts. Many such long-acting contraceptives are being developed including injectables, vaccines, nasal sprays, and vaginal rings with potential permanent impairment to fertility. One of the major objectives of the Family Planning Program is the improvement of the health status of women, but the introduction of Norplant would harm healthy young women. Therefore, the group Saheli and others in the campaign demand: 1) that plans for introduction of Norplant in the Family Planning Program be halted immediately; 2) that the introduction of any other long acting invasive contraceptive such as Net-En, vaginal ring, nasal spray, and anti-fertility vaccine be banned, both on the grounds of inadequacy of the health services and loss of user controls; 3) that information on the safety aspects of Norplant and the basis on which the Drugs Controller has granted his approval be made public; 4) that each and every one of the hundreds of women who still have the implant should be located, and the implant removed; and 5) that all hormonal contraceptive preparations be banned in the social marketing program as their use involves extensive monitoring.
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PMID:Norplant campaign in India. 1228 26

In order to accelerate welfare and nutrition programs for women and children in tribal, hilly, and backward areas of India, the government of India has accepted the National Program of Integrated Services. Delivery of these services is coordinated by the Integrated Child Development Services (ICDS). The package of services for prenatal women include physical and obstetrical exams; serial recording of weight, blood pressure, hemoglobin, and urinalysis; tetanus immunization; iron (60 mg) and folic acid (.5 mg) tablets; food supplements; identification and referral of high-risk mothers; and health education on antenatal care, breast feeding, child rearing, and family planning. Postnatal women received 2 home visits within 10 days of delivery and make 1 visit after 1 month of delivery. These visits cover general health, breast feeding, delivery records, infant health, and birth control measures. Food supplementation continues for nursing mothers. All women 15-44 years of age receive health and nutrition education. Specially organized courses, campaigns, home visits by anganwadi workers, cooking demonstrations, and mass media emphasize simple messages regarding health and nutrition. Areas that are covered include family welfare; antenatal, intranatal, and postnatal care; breast feeding; immunization; prevention of such common communicable diseases as malaria, tuberculosis, and leprosy; weaning and supplementary feeding; improvement of children's nutritional status; balanced diet; food storage, preparation, cooking, and serving; eye and ear care; personal and environmental hygiene; sanitation; management of acute respiratory infections; management of diarrhea; and control and treatment of internal parasites. The mobile food and extension units of the Department of Food are utilized. Pregnant and nursing mothers belonging to families of landless agricultural laborers, of marginal farmers, of the scheduled caste, of the scheduled tribe, and of poorer sections of the community are chosen for this program. Special care is given to pregnant women who: are pregnant for the 1st, 3rd, or 4th time; have gained less than 6 kg; are younger than 18 or older than 35; have had frequent or twin pregnancies; have a history of miscarriage or preterm delivery; are anemic; or have a history of edema, hypertension, or seizure. Personnel, who are monitored, receive training supplemented by reorientation and continuing education.
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PMID:Health and development of mothers through system of ICDS. 1228 36

Highly effective medicinal herbs are being used successfully in China to treat malaria, for example, using Ching Hao Su, an extract from wormwood. There are 5000 varieties of medicinal herbs cataloged, some more effective than western drugs. China's barefoot doctors investigate diseases and collect effective drugs, one of which is Muching which has been highly effective in treating chronic bronchitis. Salvia miltiorrhiza, used in ancient times to activate blood circulation, is used to treat coronary artery diseases and has proved effective in 87% of angina pectoris cases. Medicinal herbs are used to treat burns, hypertension, and cancer and, although the herbs are readily available and inexpensive, they work slowly. Using medicinal herbs, a Shansi Medical College affiliated hospital successfully treated over 800 cases of extra-uterine pregnancy and, in 90% of the cases, no surgery was performed. Treatment showed medicinal herbs checked bleeding, improved circulation, and eradicated blood clots. Research is being conducted with herbal prescriptions to find safer, more effective and convenient contraceptives for men and women. A breakthrough for the Institute of Medicine of the Chinese Academy of Medicine Sciences was seen in the successful cultivation of gastrodia elata which has been used for 2000 years to treat dizziness, headaches, and infantile coma.
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PMID:China: a new medicine born of tradition. 1230 32

This article is an abridgement of a background paper for the Working Group on the Health Consequences of Contraceptive Use and Controlled Fertility of the US National Academy of Sciences Committee on Population. The possible biomedical mechanisms connecting young maternal age and primarity with infant mortality are reviewed. Most of the data concerning causes of death comes from small clinical studies or special purpose population studies. Low birth weight is associated with a higher risk of mortality, morbidity, and developmental problems in infants. Infants born to young mothers in the US are at risk of low birth weight, prematurity, and perinatal death. In 5 Latin American sites, infants born to mothers who were less than 20 years old were between 1.3 and 1.9 times as likely to die as newborn infants as were those born to mothers 20 to 24 years old. The risk was about as large for postneonatal deaths, too. Primiparity and young maternal age could be associated with low birth weight and infant deaths for many reasons. These include: 1) mother-fetus competition for macronutrients; 2) micronutrient deficiencies; 3) infections; 4) pregnancy-induced hypertension; 5) malaria; and 6) delivery complications. The mechanisms that most affect infant health and for which there is the strongest evidence are pregnancy-induced hypertension, intrauterine growth retardation, and placental malaria. There appears to be a connection between age and primiparity.
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PMID:How are young maternal age and primiparity related to infant health? 1234 96

A symposium held 3-5 May 1990 commemorated the anniversary of the "Network" by presentations on the health aspects of reproduction in Africa. Prof. Sambra Diarra of the Ivory Coast presented a paper on "Health of Reproduction in Africa, Bi-Dimensional Problems: Biomedical and Social." He stressed the need to emphasize both maternal (MM) and infant mortality (IM) in Africa, where MM rates are 640/100,000 and IMR are 130/1000, because they remain so high. Prof. Fadel Diadhiou of Senegal followed with a paper on "Operations Research on Women's Reproductive Health in Africa." The major themes were that problems in reproductive health have resulted because of the fragmentation between the ecosystem and development and the lack of research is due to the isolation of institutions that lack human and material resources. The 3rd presentation by Prof. Mouhamadou Fall of Senegal on "The Health of Children and the Perspectives for Senegal," focused on the increasing infant and child mortality rates in Senegal (238/1000 in 1981) due to the combination of factors caused by the mother-child syndrome. These are: 1) congenital malformations caused by incest, young or advanced age of mothers; 2) diseases of the mother that cause fetal mortality: diabetes, arterial hypertension, eclampsia; 3) lack of breastfeeding and illiteracy of mothers; 4) public health diseases such as measles, malaria, diarrhea; 5) streptococcic infections and their complications such as anemia and tuberculosis. The last presentation made by Prof. Eusebe Alihonou from Benin on the "Perspectives and Priorities of Reproductive Health in Africa," concluded that the research priorities in Africa should be on health systems that lower utilization rates of services and resources and on epidemiological studies that identify health problems and analyze the risk factors. The Symposium concluded that the research priorities should be: maternal morbidity and mortality; adolescents and reproduction and the morbidity and mortality of infants and children.
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PMID:[Network of researchers on the health aspects of reproduction]. 1234 30

In Senegal, adolescents live in a socioeconomic climate that is between traditional society with its well-structured rites and customs and an extroverted modern society. They are often plunged into uncertainty and into a search of themselves. With a weak and not-yet-determined personality, sexuality erupts into their life experience. In Senegal, adolescent fertility, once encouraged by tradition, has become a social phenomenon which challenges all those interested in problems of youth. Major risks throughout the pregnancy and the puerperium confront adolescents. Complications may include grave vomiting, preeclampsia, hypertension and hemorrhaging, and more severe malaria than normal due to pregnancy. 12.9% of adolescent pregnancies end in miscarriage, 5.8% in premature births. Low birth weight and fetal death are also risk factors of adolescent pregnancy. Incomplete physical development exacerbates childbirth among adolescents, often leading to cesarean section, infection, and hemorrhaging. A combination of several risks appearing unexpectedly during pregnancy and during and after delivery can lead to a tragic death. During 1988-1989 at the gynecologic-obstetric clinic of the Aristide Le Dantac University Hospital Center of Dakar, adolescents comprised 8.1% of maternal deaths. If adolescents survive pregnancy, they may suffer after effects, e.g., genital scar tissue or psychological disorders. Infertility can also be an after effect. An unwanted pregnancy ended by illegal induced abortion can also lead to infertility. 2% of adolescents attending the clinic have common infections and/or sexually transmitted diseases (STDs). These infections almost always are a result of poor hygiene of the genital region. Family life education should prepare adolescents for sexuality and contraceptive use. Barrier methods can best prevent STDs and AIDS. Other contraceptive methods require compliance with strict rules. Emergency contraception should be reserved for cases of rape or incest. Prevention of unwanted pregnancies is the best means to prevent infanticide which is relatively common among youth leaving rural areas.
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PMID:[The adolescent manages fertility badly. Uncertainty and pursuit of self in a society in transition]. 1234 47


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