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Query: UMLS:C0024530 (malaria)
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The family welfare program in India over the past 10.5 years has been devoted to disseminating knowledge and education about the use of family planning methods. It has had the aims of advancing basic human rights, achieving a balance between population, resources, and the environment, and helping people attain a higher quality of life. The policies have evolved from family planning and mass sterilizations, to family welfare, to the present family health. Maternal mortality in India constitutes a major proportion of world maternal mortality and averages 400-500/100,000 live births. The main causes are anemia, hemorrhage, and abortion. Malaria during pregnancy severely compromises the health of mothers and contributes to increased abortion and low birth weight infants. The general pattern for mothers is to become pregnant 8-9 times and to produce 6 live births, of which 4-5 survive. Infant survival is affected by a number of factors, including birth spacing. Maternal mortality in India is high due to poor nutrition from early ages. 15-20% of pregnant women are shorter than 5 feet, and the dietary intake of women is deficient by 500-600 calories. Delays also contribute to maternal mortality: delay in provision of care, in reaching the health center, and in receiving adequate treatment. The Safe Motherhood Program is aimed at improving maternal and child health: preventing at-risk pregnancies, increasing contraceptive prevalence from 40% to 60% by 1995, managing anemia and health through coverage of prenatal care for 75% of reproductive age women by 1995, increasing birth attendant deliveries to 80% of births by 1995, and providing full immunization for all infants. Village-based services will be improved by training personnel to recognize signs of danger, increasing the ratio of health personnel to 1/100 population, and establishing health centers for every 5000 population. There would be one primary health center for every 30,000 population. First level referral obstetric care would be available for every 500,000 population: surgery, anesthesia, medical treatment, support functions, manual assessment, blood replacement, at-risk management, and special neonatal care. Training and service delivery must be closely linked. 21 high-risk districts or states have been identified as needing upgrades services. Facilities will be improved throughout the system, but particularly in targeted districts. Health personnel must follow at all times the 5 "C's": clean hands, clean surfaces, clean blades, clean cord ties, and clean cord stump.
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PMID:Safe motherhood programme. 813 84

Health research used to be the exclusive domain of clinicians and medical specialists, who focused attention on the biomedical causes of disease. Socioeconomic and environmental considerations that have important bearing on the ill health of rural African women were rarely integrated with the methodology constructed to investigate disease patterns. However, it is becoming increasingly clear that physical environmental factors and malnutrition have important effects on women's health in rural Africa. I validated this assumption in an empirical study of 441 people (n = 294 women) in 15 different rural localities in Ghana. Apart from women-specific problems relating to biological health needs during pregnancy, childbirth, and lactation, sexually transmitted diseases, abortion, and mental health, environmental factors had a great impact on women's well-being in the study area. Sixty-two percent of the women reported that the endemic disease malaria is the most prevalent disease as far as they were concerned. Other community and household health hazards were found; for example, cooking over an open fuel wood stove resulted in an almost 50% greater chance of stillbirth among pregnant women.
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PMID:Women's health status in Africa--environmental perspectives from rural communities. 840 28

A community-based incidence case-referent study was undertaken in a rural and an urban setting in Zimbabwe in order to define risk factors associated with maternal deaths at family, community, primary and referral health care levels. Referent subjects were drawn from place or area of delivery for each consecutive maternal death. Using a multiple source confidential reporting network for all maternal deaths, the maternal mortality rate for the rural setting was 168/100,000 live births and that for the urban setting was 85/100,000 live births. A model for interacting factors contributing to maternal mortality was designed. Haemorrhage and abortion sepsis were the major direct causes while malaria was the leading indirect cause in the rural setting. In the urban setting, eclampsia, abortion and puerperal sepsis were the leading causes of maternal deaths. It was found that all situations associated with diminished, or absent social support, that is, being single (Odds Ratio = 4.7, 95% CI = 2.2-9.8) divorced, widowed, one of several wives, cohabiting, or self-supporting carried an increased risk for maternal mortality, especially in the rural area. Income and level of education for index and referent subjects were comparable, probably because of the limited part of the population under study that belonged to a more affluent class. Distribution of cases and referents by religious-affiliation was also comparable. Age > 35 years and parity > 6 were significant risk factors for maternal mortality in the rural setting, whereas bad reproductive history with reported stillbirth or abortion constituted a high risk both in the city and in the rural areas (Odds Ratios 4-6).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Maternal mortality in rural and urban Zimbabwe: social and reproductive factors in an incident case-referent study. 851 49

The present study included 426 patients with acute renal failure age range 7 months to 85 years, during 8-year period (1984-1992). Medical, surgical and obstetric causes were responsible for ARF in 68.3, 17.8, and 14% of cases respectively. The main aetiological factors encountered were volume depletion secondary to gastrointestinal fluid loss (35.2%), acute glomerulonephritis (10.3%), nephrotoxin (8.6%), falciparum malaria (4.2%), obstructive uropathy (13%), post-abortal (10.5%), and miscellaneous factors (1.4%) of patients. The overall mortality was 19.2%. Thus our observation revealed that diarrhoeal diseases (35.2%), obstructive uropathy (13.3%), and septic abortion (10.5%) were the main causes for ARF in medical, surgical, and obstetric groups respectively. In contrast to our studies, acute renal failure associated with diarrhoeal diseases, septicaemia, falciparum malaria and septic abortion are rare in European countries.
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PMID:Acute renal failure in eastern India. 864 59

4187 pregnant women with parasitemia attending 4 prenatal care clinics in rural Mangochi District, Malawi, were assigned to 1 of 4 regimens of antimalarial treatment and/or prophylaxis and followed through delivery. The aim was to examine maternal fever and to evaluate side effects and the frequency of adverse reproductive outcomes for their possible association with malaria or the antimalarial drug regimens. The regimens were 3 regimens for chloroquine (CQ), 1 of which was the current standard of care in Malawi, and a mefloquine (MQ) regimen. 25% of the pregnant women claimed to have had at least 1 febrile episode before their first prenatal care visit. Blood smear tests revealed the parasitemia prevalence rate at enrollment to be 44.4%. The sensitivity of fever to identify parasitemic pregnant women was 24%. Fever's specificity was 71%. Only high density parasitemia (10,000 parasites/sq m) was associated with fever (44.9% vs. 25.4% for no parasitemia; odds ratio [OR] = 2.54; p 0.000001). Other significant factors associated with high fever were low parity, enrollment in the rainy season, HIV seropositivity, use of antimalarial prophylaxis before enrollment, high socioeconomic status, normal maternal height and weight, and literacy. The sensitivity of first or second pregnancy to identify parasitemic women was 71%. Its specificity was 57%. About 60% of women from both CQ and MQ treatment groups had side effects after a treatment dose. About 25% had side effects after a prophylactic dose. The leading side effects were itching, dizziness, and gastrointestinal disturbances. There were few serious side effects. Among all women, the spontaneous abortion rate was 1.2% and the stillbirth rate was 3.9%. Women in the CQ and MQ treatment groups had similar abortion and stillbirth rates. Based on these findings, the researchers concluded that using fever as a means to identify parasitemic women is unreliable. They recommend antimalarial treatment and/or prophylaxis for all pregnant women, but when resources are limited it should be administered to women in their first or second pregnancy.
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PMID:Malaria treatment and prevention in pregnancy: indications for use and adverse events associated with use of chloroquine or mefloquine. 870 37

In an attempt to assess concepts of disease, we questioned 33 Ethiopian Jews (Falashas) in Ethiopia about 13 diseases: 8 western and 5 cultural syndromes (in the Amharic language): birrd (cold), wugat (stabbing chest pain), moygnbagegn (neurologic disorder), mitch (sunstroke), and attent hono kere (retained fetus becoming bone). Disease causation was often attributed to spirits and the sun. None of the interviewees understood the cause of: a) epilepsy, most attributing it to spirits and recommending smelling match smoke as treatment, b) prolonged labor, attributed by most to the evil kole spirit and is managed by traditional birth attendants; and c) abortion, believed to be caused by exposure to sun or cold. Less than 20% linked malaria to mosquitoes. Most correlated splenomegaly with malaria. Hepatitis was believed to be caused by a bird or bat flying around the affected person. Multiple factors were linked to diarrhea, including a journey in the sun. Moygnbagegn is the only condition treated by venisection from brachial veins; wugat is treated by "cupping". Modern medicine was recommended by < 30% of those questioned for epilepsy, splenomegaly, hepatitis, and Ethiopian cultural diseases. It was recommended most for malaria (52%), sexually transmitted diseases (55%), and diarrhea (69%).
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PMID:Traditional beliefs and disease practices of Ethiopian Jews. 875 85

Alternative drugs to chloroquine are required to prevent the deleterious effects of malaria in pregnancy. Fear of potential toxicity has limited antimalarial drug use in pregnancy. Animal toxicity studies have documented teratogenicity when antimalarials are administered at high dosages. Excepting the tetracyclines, there is no evidence to suggest that, at standard dosages, any of the antimalarial drugs are teratogenic. Primaquine is not recommended because of the potential risk of haemolytic effects in the fetus. Rates of spontaneous abortion and birth defects were comparable in pregnant women taking mefloquine, compared with chloroquine-proguanil, or pyrimethamine-sulfadoxine prophylaxis, in the first trimester of pregnancy. Standard doses of quinine do not increase the risk of abortion or preterm delivery. Therapeutic mefloquine does not provoke hypoglycaemia. There is no evidence in the literature to support the hypothetical risk of kernicterus in the newborn, following exposure to antimalarial drugs containing sulphonamides or sulphones prior to delivery. Documentation of the safety of doxycycline, halofantrine, and the artemisinin derivatives in the treatment of malaria in pregnant women is currently limited.
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PMID:The safety of antimalarial drugs in pregnancy. 893 76

Relapsing fevers occur worldwide and are characterized by recurrent episodes of fever and spirochetemia. In central, eastern, and southern Africa, the disease is often caused by Borrelia duttonii, which is transmitted by the soft tick Ornithodors moubata. We conducted a field investigation in September 1994 at a hospital in Mitwaba, southern Zaire, which was the only medical facility within 150 km. The introduction of a rapid blood-smear staining technique allowed us to demonstrate that 4.3%-7.4% of the 25-50 new outpatients seen each day had relapsing fever. Because of the absence of malaria in this area, these patients account for most of the febrile patients. The incidence of relapsing fever among all pregnant women in the maternity ward was estimated to be 6.4%, and this condition often led to maternal death or to spontaneous abortion. The 16S rRNA gene of B. dutonii was sequenced after the spirochete was isolated from patients' blood samples and directly from Ornithodoros tick vectors. In this region of Africa, relapsing fever should now be considered an important public health priority.
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PMID:A focus of tick-borne relapsing fever in southern Zaire. 924 47

Poor quality medical care in some countries is an important concern, because of a lack of sterile equipment and lack of screening of blood products The safest time for travel is 18-24 weeks--after the risk of miscarriage and unpleasant nausea, but before problems such as premature labour Women with a previous history of miscarriage or ectopic pregnancy should be advised against travelling to countries where medical care is poor After 28 weeks a doctor's letter may be required before an airline will allow a pregnant woman to fly On board an aircraft, pregnant women should walk around the cabin at least once an hour to minimise the risk of deep vein thrombosis Malaria in pregnancy can be severe for both mother and fetus: chloroquine and proguanil have a long safety record Mefloquine is contraindicated in the first trimester and doxycycline should be avoided during pregnancy.
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PMID:Pregnancy and travel. 945 Apr 66

A cross-sectional study conducted in Kassala, Sudan, investigated knowledge about malaria among 333 students and 38 teachers at 5 secondary schools in this malaria-endemic town. The overall malaria knowledge score was 13.9 (+or- 1.7) out of a possible maximum of 18. There were no significant differences in scores between students and teachers or males and females. Of concern, however, was the high frequency of incorrect responses for the following items: malaria is caused by eating unripe sweet sorghum (33.7%); one is predisposed to malaria by attacks of common cold (56.6%); chloroquine injections are more effective for treatment than are tablets (28.6%); malaria can be treated with the beverage Aradaib (22.6%); iv fluids are essential for treatment of a malaria attack (36.7%); and malaria can be prevented by taking multivitamins (48.0%). In addition, 28.3% of respondents believed that chloroquine can cause abortion, and only 47.4% of students and teachers were aware that malaria is more serious in primigravidas than multigravidas. These findings indicate an urgent need for health education campaigns in the schools and community to modify misconceptions about malaria.
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PMID:Knowledge and misconceptions about malaria among secondary school students and teachers in Kassala, eastern Sudan. 951 76


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