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Query: UMLS:C0024530 (malaria)
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Researchers analyzed data on 2608 women attending one of four prenatal clinics in Mangochi District in Malawi during 1987-1990 to study the relationship between maternal HIV infection, placental malaria infection, and infant mortality. 5.8% (138) of the women were HIV-1 seropositive. HIV-1 seroprevalence increased from 2.3% to 5.8% between 1987 and 1993. Infants born to HIV-1 positive mothers were much more likely to die during the first year of life than those born to HIV-1 negative mothers (235/1000 vs. 144/1000 live births; p 0.001). The excess deaths occurred during the postneonatal period (49 vs. 44, p = 0.3, for neonatal mortality, compared to 186 vs. 100, p 0.001, for postneonatal mortality). In the postneonatal period, diarrhea or gastrointestinal illness was more common as a cause of death among infants of HIV-1 positive mothers than those of HIV-1 negative mothers (8.7% vs. 3.6%; relative risk = 2.4; p = 0.0002). The researchers stratified the effect of maternal HIV infection on postneonatal death according to birth weight and placental malaria infection to control for potential confounding. They found that, when compared with normal birth weight infants born to seronegative mothers with no placental malaria infection, low birth weight infants born to HIV-1 positive mothers with placental malaria had an 11.49 increased odds of dying during the postneonatal period. The multivariate analysis showed that an infant born to an HIV-infected mother with placental malaria was 4.5 times more likely to die during the first year of life than an infant born to a mother with only placental malaria and 2.7-7.7 times (depending on birth weight) more likely to die than an infant born to a mother with only HIV infection. These findings suggest that malaria chemoprophylaxis during pregnancy would reduce the likelihood of HIV transmission from mother to infant in addition to reducing the burden of malaria infection during pregnancy, malaria-associated low birth weight, and their subsequent effect on child survival.
AIDS 1995 Jul
PMID:Maternal HIV infection and infant mortality in Malawi: evidence for increased mortality due to placental malaria infection. 754 17

Dapsone is used to treat several systemic inflammatory diseases, many of which have head and neck manifestations, such as leprosy, systemic lupus erythematosus, rhinosporidiosis, relapsing polychondritis, dermatitis herpetiformis, pemphigus vulgaris and bullous pemphigoid. It has also been recently used prophylactically alone or in combination against malaria and in AIDS patients against Pneumocystis carinii infections. This is significant to the otolaryngologist-head and neck surgeon since approximately 40% of AIDS patients will have head and neck manifestations. Thus, the likelihood that otolaryngologists will be treating patients who are taking dapsone regularly is significant. We present a case of a 16-year-old female who presented with a presumptive diagnosis of discoid lupus for biopsy confirmation of her disease. Induction of general anesthesia was complicated by methemoglobinemia, an uncommon side effect of dapsone. We will discuss recognition and prevention of this side effect, its potential anesthetic implications, complications and treatment.
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PMID:Dapsone-induced methemoglobinemia: an anesthetic risk. 755 44

Pediatric practice in the next millennium will require greater knowledge of new morbidities, such as acquired immunodeficiency syndrome and social and behavioral disorders, reemergent old disorders, such as tuberculosis, and disorders rarely seen of late in the United States but now being brought here by recent immigrants, such as malaria and other parasitic diseases. Diversity in ethnic and cultural backgrounds and beliefs will continue to increase, and it will need to be understood to prevent and treat diseases of children effectively. Although the current antagonism toward immigrants may lead to a decrease in this particular source of diversity, changes in family structure--such as divorce, gay and lesbian couples as parents, and corporate pressure on families--will continue, requiring pediatricians to understand and to accept this diversity if they are to be the health care providers of children. The increased isolation of individuals from society and separation from families of origin will require pediatricians to be more active in communities and schools and to participate with other disciplines and social support groups. At the same time, the advancement of science and technology will continue to drive what the pediatrician does. Increased survival of children who previously had fatal illnesses will mean more emphasis on care of children who have chronic illnesses. Pediatricians will need to be partners with others in the exciting new fields of risk assessment and prevention of psychosocial disorders.
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PMID:Child health 2000: new pediatrics in the changing environment of children's needs in the 21st century. 756 61

The health system in Cuba guarantees accessibility to the entire population, and it is free of charge. Cuba's health figures are on a par with developed countries that have 20 times the budget. Each year around 4000 students start their medical training at 23 different universities. Since 1980 there has been a training course for family doctors. By 1995 22,000 of them have been trained covering 90% of the population. Their main work is preventive: health promotion and offering basic curative care. The family doctors are backed up by 400 polyclinics, where specialists offer their services to about 30,000 people. Life expectancy is 77 years and infant mortality a mere 9 per 1000 live births. Malaria has been eradicated and dengue fever successfully reduced. Leading causes of mortality are cardiovascular diseases, neoplasms, accidents, and homicides. Up to now only 1089 people have been diagnosed as HIV positive. From a mere epidemiological point of view, strict isolation could contain the epidemic in a closed society. In practice, however, the island opened the doors to tourism, with a side effect of increasing prostitution. Condoms or any contraceptives are in short supply. Nevertheless, the number of abortions is low, less than 1 per 100 deliveries. The reason is that all women whose expected menstruation is late by two weeks are offered a microaspiration in the polyclinic. 700 regulations are performed for every 5000 fertile women. Pregnancy tests are not performed as they are not available. The country is experiencing a difficult period because of the collapse and loss of support from the Soviet Union; over 30 years' trade embargo by the United States and the gradual change from a centrally planned economy towards more of a free market system. Family planning and AIDS seem two topics that need further exploration. Even if their system is under strain, health indices do not show a deterioration in health yet.
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PMID:Cuba: plenty of care, few condoms, no corruption. 758 May 57

A successful short-term solution to transmission of AIDS in Western Africa by migrants involves provision of accessible and acceptable basic health and social services to migrants at their destination. The aim is to establish a sense of security and community, which is a health requirement. When migrants are excluded from community life or victimized as carriers of HIV infections, they will be driven by basic survival needs and dysfunctional social organization, which results in the rapid spread of HIV. Closing borders and mass deportation may not be an option. The long-term solution is population policy, environmental protection, and economic development. The focus on mapping the spread of AIDS must shift to a consideration of the migrant social conditions that make them vulnerable to AIDS. The issue of migration and AIDS will be addressed at the First European Conference on Tropical Medicine in October 1995 in Hamburg, Germany. In Uganda, HIV seroprevalence rates ranged from 5.5% among the stable population to 12.4% among internal migrants moving between villages to 16.3% among migrants from other areas. A World Bank project is operating in Western Africa, which traces seasonal male migration from the Cameroon to Liberia, Senegal to Nigeria, and from the Sahel to the coast during dry seasons. National border rules may influence the routes but not the extent of migration. A major destination place is Cote d' Ivoire, which has 25% of total population comprised of migrants from other countries and one of the highest HIV prevalence rates in Western Africa. On plantations prostitutes are brought in. Each prostitute serves about 25 workers. The pattern of sexual mixing contributes to the high HIV rates. Female migration is smaller and usually concentrated in prostitution at place of destination. Illiteracy and poverty drive women migrants into the trade. Their frequent health problems are malaria, pelvic pain, menstrual irregularity, vaginal discharge, and genital sores. Drugs are bought on the streets or from friends and may be of questionable efficacy. Health services may be sought upon return to the home country.
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PMID:Migration and AIDS. 747 52

The results of a study of residents' knowledge about malaria and antimalarial drugs and of their treatment-seeking behavior in a rural area of western Kenya are reported. The investigation was conducted in 2 villages where malaria is holoendemic. Samples of 20-25 women were interviewed to discover their views about the main causes, symptoms, and treatments of malaria as well as measles, difficulty in breathing, and diarrhea. The study subjects were generally well-informed about the symptoms of the disease. Malaria was perceived as a relatively mild illness, much less severe than acquired immunodeficiency syndrome, measles, difficulty in breathing, and diarrhea. A total of 23 families completed an 8-week follow-up period, during which 230 separate illness episodes were reported. Only 23.1% of the patients who sought treatment did so at a health center, the remaining were treated at home. Most illnesses for which they sought treatment at a health center were self-diagnosed as malaria (82% vs. 60%; p 0.05). Self-treatment was extremely common: of 138 episodes of febrile illness, 60% were treated at home with herbal remedies or medicines purchased at local shops, and only 18% received treatment at a health center or hospital; no treatment was sought by the remainder. Commercially available chloroquine preparations were perceived as more effective than either antipyretics or herbal remedies for the treatment of malaria, and injections were regarded as more effective than oral medications. 4-aminoquinolines were used to treat 58% of febrile illnesses, but in only 12% of the cases was a curative dose of or= 25 mg/kg body weight employed. Even attendance at a health center did not ensure adequate treatment because of the common practice of sharing medication among family members. Increased attention should be paid to the role of home treatment of malaria when policies are being developed for the management of febrile illnesses in Sub-Saharan Africa.
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PMID:Self-treatment of malaria in a rural area of western Kenya. 774 95

At a global level, there is an urgent need for vaccines against major diseases which are not yet vaccine-preventable. This particularly includes bacterial and viral diarrhoeal diseases, acute respiratory infections, AIDS, malaria, schistosomiasis and meningococcal meningitis. There is also a need for more efficient vaccines against tuberculosis, for a new measles vaccine effective in the young child in the presence of residual maternal antibodies. Therefore, research aiming to define new ways to selectively induce protective responses which would fulfill the needs of immunization programmes, not only in terms of efficacy but also in terms of practicality, represents a real priority. Along this line, modern immunology should be a significant source of new tools to achieve the goal of developing a series of new vaccines which may potentially help to prevent millions of child deaths.
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PMID:Research priorities for vaccines to be used at a global level. 775 2

Over a period of 10 years, a hospital in rural Africa slowly built an integrated primary and secondary health care program to the point where it has more than 40 elements. In its initial stage (1982-84), hospital staff and community participants were trained, the number of mobile clinics was increased, community participation was sought, and health education was emphasized. During 1985-86, 92 village health committees were organized with 70 trained Village Health Workers (VHWs). This led to a rapid increase in vaccination rates, the use of oral rehydration therapy, and training of traditional birth attendants. In 1987-88, 14 VHW were trained to use basic medical kits and distribute medicines. By 1990, 18,000 of the 72,000 outpatient treatments were administered by VHWs. In 1987, the hospital made a community diagnosis and increased the size of its advisory board (which became 60% female). Because the community identified food, water, and poverty as its priorities, the hospital took steps to improve the food supply, the water supply, and the financial position of the women. In 1989-90, the primary health care (PHC) project added the components of family planning, a weaning food production unit, food coupons, food for work, grain banks, a trust fund, literacy classes, health stamps, a mobile malnutrition clinic, subsidized fertilizer and seed, low-cost care for victims of AIDS, new malaria treatment schedules, and a housing association. The PHC program has resulted in a reduction in under-five deaths from the national average of 330/1000 to 145/1000 (other areas have reduced deaths to 270-300/1000. The program is also becoming increasingly cost-effective, costing about 6 pounds per capita over 10 years for a population of 50,000. Country-wide implementation of the PHC program would require only 30% of the present health budget.
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PMID:Integrated health programmes. 777 93

Pathogenic organism can be considered as pro-oxidant agents because they produce cell death and tissue damage. In addition organism can be eliminated by specific cell defense mechanism which utilize in part, reactive oxygen radicals formed by oxidative stress responses. The cause of the necessarily defense process results in cell damage thereby leading to development of inflammation, a characteristic oxidative stress situation. This fact shows the duality of oxidative stress in infections and inflammation: oxygen free radicals protect against microorganism attack and can produce tissue damage during this protection to trigger inflammation. Iron, a transition metal which participates generating oxygen free radicals, displays also this duality in infection. We suggest also that different infectious pathologies, such as sickle cell anemia/malaria and AIDS, may display in part this duality. In addition, it should be noted that oxidative damage observed in infectious diseases is mostly due the inflammatory response than to the oxidative potential of the pathogenic agent, this last point is exemplified in cases of respiratory distress and in glomerulonephritis. This review analyzes these controversial facts of infectious pathology in relation with oxidative stress.
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PMID:[Oxidative stress and infectious pathology]. 779 23

This paper opens by briefly tracing the development of vaccines from Edward Jenner's work in 1796 to the present. The proportion of deaths from communicable diseases in developed and developing countries is discussed, and it is noted that, in 1990, communicable diseases killed 575,000 people in industrialized countries and 16 million people in developing countries. In developed countries, there were no deaths from measles, malaria, tetanus, or pertussis, and only seven from diarrheal disease as compared to 1,006,000, 926,000, 505,000, 321,000, and 2,866,000, respectively, in developing countries. By the end of the century, AIDS will overshadow the communicable disease profile. Annual mortality figures from bites by rabid animals, snakes, insects, etc. are also grossly underreported. A look at the common biologicals used in developing countries shows that at least eight bacterial and eight viral vaccines are in common use globally. The origin and indications for each vaccine are tabulated. Data on anti-serum vaccines, plasma-derived preparations, and biological response modifiers (available in industrialized countries) are similarly tabulated. Consideration of the industrial production of immunogens in developing countries reveals that most production relies on outdated technology. Vaccines exhibit suboptimal performance in these settings either due to factors relating to individual vaccines or to community circumstances. Individual vaccines which exhibit inadequate potency in adverse circumstances include liquid vaccines and lyophilized vaccines and prophylactics. This situation is exacerbated by unsatisfactory vaccine administration practices, malnutrition, and cases of immunosuppression. Suboptimal performance at the community level is due to procurement procedure, the cost of vaccines, poverty, population growth, failures in the cold chain, lack of trained personnel, religion and gender bias, and political factors, such as war. A suitable remedial action plan requires integrated action at the international, national, and community levels. Such an effort would be aided by improved mortality data collection techniques and by multidisciplinary research to update indigenous manufacturing technology.
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PMID:Human immunization in developing countries: practical and theoretical problems and prospects. 788 21


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