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In pre-colonial times, health in some Pacific countries was good compared with that of Europe. Illnesses such as scrofula, rheumatism, and filariasis often received herbal treatment. More recently, however, traditional diet throughout the region have been replaced by canned fish, biscuit, white flour products, and sugar-laden food. New illnesses and diseases have emerged in Pacific countries since European intrusion. Though malaria is still the primary cause of death in Vanuatu, diabetes, hypertension, obesity, and coronary heart disease are prime health concerns in most Pacific countries. In Kiribati, health educators use materials in discussion groups and schoolteachers use special materials on AIDS in their teaching, Calendars are produced in cooperation with national nutrition and family planning (FP) groups and agencies that highlight health topics such as AIDS and vitamin-A deficiency. Material produced by the Vanuatu health education unit features nutrition, the environment, FP, and AIDS and other sexually transmitted diseases. The government's Women's Affairs Department the International Labor Organization and other agencies are involved in FP and family life education. In Fiji and the Solomon Islands, nutrition has been highlighted in health education campaigns. In both countries surveys indicated alarming levels of diet-related disease. Another important nutrition project in the Solomon Islands is the village education program. At a training center, trainers conduct 15 practical courses for mobile workers, community workers, and village resource persons. Under this program, 60 village-level workshops are held each year focusing on nutrition, cooking, and gardening. Nutrition is now a major focus of health in the Pacific. The health, nutrition, education, fisheries, and agricultural sectors work with other agencies for success through community participation and through an integrated approach.
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PMID:Popular participation in community health programmes. 818 58

This brief editorial argues in favor of making acquired immunodeficiency syndrome (AIDS) a notifiable disease. According to the World Health Organization (WHO), AIDS will cause more deaths in sub-Saharan Africa than anywhere else in the world over the next 3 years. More children will die from AIDS than from malaria or from measles. The number of cases of tuberculosis, in association with human immunodeficiency virus (HIV), will also rise, creating an uncontrollable pandemic under present policies. The argument that notification requirements will drive AIDS underground (Dr. Prozesky of the Medical Research Council at the launch of the AIDS Bulletin) is indefensible. Patients who have contracted syphilis or gonorrhea, with regard to privacy and confidentiality, are questioned about sources of their infection; however, preventive action follows that protects public health. This cannot be left as a personal option (G Stewart, Nursing Times, 1993, Vol 89, No 26). Group rights collide with individual rights; however, groups as well as individuals have human rights. The greater responsibility is to public health, rather than to individual sensitivity.
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PMID:Should AIDS be notifiable? 826 78

Onchocerciasis is commonly known as River Blindness and affects about 18 million people around the world. It is transmitted by black flies that breed in river and stream rapids and transmit the parasitic microfilariae, Onchocerca volvulus, to people who live and work near such rivers. Infection with the microfilariae results in blindness or visual impairment for 1 or 2 million people. The microfilariae migrate to superficial tissues and may invade any part of the eye and ocular structure. Living worms cause little damage, however, their death triggers a localized inflammation which can lead to blindness. Sclerosing keratitis, a severe corneal involvement, is the major cause of blindness from the disease. The World Health Organization (WHO) Expert Committee on Onchocerciasis has estimated that 9% of the disease is found in Africa, the rest occur in Yemen and Latin America. Treatment with ivermectin is contraindicated for pregnant and lactating women, children under 5 years of age, asthmatics, and people with other diseases. The WHO Onchocerciasis Control Program in 11 countries of West Africa has eliminated the risk of onchocerciasis by aerial spraying of black fly breeding sites only from 1 country. A single annual oral dose (150 mg/kg) of ivermectin can reverse early lesions in the cornea. Ivermectin must be taken annually to sustain protection against blindness, thus its incorporation into primary health care along with malaria, AIDS, trachoma, xerophthalmia, and cataract is most cost effective. Nigeria and Tanzania have optometry schools, and optometrists can play a significant role in onchocerciasis control and blindness prevention programs by training local health care workers to distribute invermectin in vision screening programs.
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PMID:Onchocerciasis and other eye problems in developing countries: a challenge for optometrists. 824 90

Adjuvant research has improved the ability of biotechnology to generate novel vaccines. Numerous strategies for enhancing the immunogenicity of synthetic peptides and proteins have been identified. This overview focuses on adjuvant development and vaccine delivery systems that provide new tools for amplifying the effectiveness of ongoing malaria and AIDS vaccine development programs. In addition, some of the complex challenges and issues that have become associated with the delivery of modern vaccines in man are outlined. As adjuvant research continues to open new opportunities in vaccine development, there is renewed expectation that further generations of safe and potent vaccines will be possible against a broad spectrum of infectious agents and cancer.
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PMID:Novel adjuvant strategies for experimental malaria and AIDS vaccines. 836 43

In developing countries, more than 14 million children under 5 years old die each year. The leading causes of death for these children are diarrhea, respiratory infections, malaria, and diseases that can be prevented through immunization. Pediatricians must treat many children in developing countries, often afflicted with several diseases simultaneously, while operating under the shortage syndrome--shortage of money, staff, equipment, buildings, and time. Reasons for such high child mortality are numerous. Maldistribution of resources contributes greatly to ill child health and to child mortality, e.g., most resources are targeted for urban areas and are used to please the elite while the poor live in overcrowded, unsanitary slums. Further, 75% of the health budget funds goes to hospitals, mostly in urban areas, which helps just 10% of the population while the remaining 25% goes to primary health care which serves the other 90% of the population. Unmet needs for family planning services also play a role in child ill health. Wealth is needed for good health, but most people in developing countries are poor. Female literacy and access to basic education are essential for improved child survival. Research shows that reduced child mortality is a prerequisite to falling birth rates. Children in developing countries have a quadruple burden: underdevelopment, social disruption, AIDS, and the Third World debt. Successful delegation of delivery of essential child health services to adequately trained and supported auxiliary health personnel operating from community health clinics increases coverage of child health services. All health personnel must encourage breast feeding and empower parents with knowledge so they can confidently care for their children. Pediatricians need to communicate to decision-makers and economic planners what they need to implement to improve child survival.
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PMID:Priorities and practice in tropical paediatrics. 846 Nov 71

Ethiopia has charming people, some of the world's most remarkable buildings, and Africa's only exportable cuisine. Communism has collapsed, General Mengistu has gone into exile on a farm in Zimbabwe, and President Mele's interim government rebuilds Addis Ababa while preparing for elections. Many serious health, environmental, and structural problems, however, plague this country. Mengistu's 600,000 soldiers were accompanied by 50,000 prostitutes. Now dispersed throughout Ethiopia, they fuel the spread of HIV. 7% of the adult population is HIV-positive, AIDS-related tuberculosis is rapidly increasing, malaria is endemic in many areas with chloroquine resistance being common, and meningitis may be on the rise. The population continues to grow under the overall contraceptive prevalence of 2% and a total fertility rate of 7.7. Where food production and the environment are concerned, Ethiopia has received food aid for the past 15 years and lands are being rapidly deforested and eroded. Ethiopia needs to redress the structural constraints by which food supplies from districts of surplus fail to reach districts of deficit. Abundant land exists which could be cultivated for crops, given the necessary fertilizers, pesticides, and technology.
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PMID:Letter from Ethiopia. 847 20

In order to assess renal pathology, 92 clinically well-documented cases of nephrotic syndrome (NS) in adults (median age: 29) were systematically biopsied upon admission to the University Hospital of Kinshasa, between 1986 and 1989. All biopsies were paraffin embedded and histologically assessed by the routine methods of light microscopic examination. Histologic lesions were classified according to standard criteria. Focal and segmental glomerulosclerosis (FSG) was found in 41% of patients. The remaining 59% included minimal epithelial disease or minimal change nephropathy (MCN) responsive to corticosteroid therapy (14%), proliferative glomerulonephritis (PGN) (11%), membranous glomerulopathy (MGP) (10%), amyloidosis (10%), membrano-proliferative glomerulonephritis (MPGN) (8%), and "end stage kidney" (ESK) (7%). These results strikingly indicate the high prevalence of FSG. In comparison with previous findings from the same milieu, there is a seven-fold increase of this entity (41% versus 6%). The findings herein reported define a new histologic profile of NS in Zaire, characterized by the predominance of FSG. While in the past the vast majority of NS (52%) were putatively related to the intercurrent parasitic diseases, among which malaria was the chief etiology, similar associations were less important. Instead, no definite causative agent emerged for this apparently idiopathic condition. Further epidemiological and morphological intercorrelation studies, as well as the studies aimed at the relationships with AIDS, are in progress, with the purpose of identifying putative etiologies and risk factors responsible for the increase of FSG in Zaire.
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PMID:Focal and segmental glomerulosclerosis in nephrotic syndrome: a new profile of adult nephrotic syndrome in Zaire. 848 81

A survey on intestinal parasites in a rural area of Tanzania revealed the presence of eight protozoa and seven helminths in 287 subjects (81.8%). The prevalence of Entamoeba histolytica and Ascaris lumbricoides was higher in HIV-negative than in HIV-positive patients (P < 0.01; P < 0.04) (25.1% and 12.5% for E. histolytica; 10.5% and 3.7% for A. lumbricoides). On the other hand, Cryptosporidium parvum, Isospora belli and Strongyloides stercoralis prevalence was higher in HIV-positive than in HIV-negative patients (P < 0.01). The prevalence of these two opportunistic protozoa was also higher in AIDS patients than in HIV-positive patients without AIDS. Specific anti-C. parvum IgG were detected by ELISA in 18% and 56% of HIV-negative and positive patients, respectively, confirming the high number of contacts between this parasite and humans. Specific anti-Encephalitozoon cuniculi and anti-Encephalitozoon hellem IgG were detected by IFA in 18% and 19% of subjects, respectively, without any correlation with HIV and malaria infections.
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PMID:Opportunistic and non-opportunistic parasites in HIV-positive and negative patients with diarrhoea in Tanzania. 852 81

Mankind has been stricken with "major" epidemic diseases throughout its history. The most serious among them immediately threaten man's life e.g. plague, cholera, smallpox, typhus, and dysentery, besides, there are others which take a slower course e.g. lues, leprosy, leishmaniasis, tuberculosis, and malaria. Yet, the "lesser" epidemic diseases like diphtheria, scarlet fever, mumps, pneumococcosis, influenza, and most recently AIDS may also turn into "major" ones. Originally, man exclusively depended on his genetic makeup for protection, and being particularly prone to attacks of disease he was subject to natural selection. Thus, only one human species survived, the homo sapiens. Interbreeding achieved biologic adaptation and created a balanced genetic polymorphism. Advancing in his degree of civilization, man formed groups, developed clothing, fire, houses, and tools, and his increasing cultural awareness allowed him to migrate from the tropical climates to more temperate, and less disease-infested zones. Immigration and wars, and the accompanying infections jeopardized and diminished entire populations and eradicated highly developed cultures like that of the American Indians. The plague, coming from Asia, and lues, from America, as well as cholera, influenza, and smallpox spread around the whole globe. Fear and terror led to irrational conclusions and triggered persecutions. The attitude of accepting disease as a God-sent fate (Hiob), or a God-sent punishment suppressed reasonable measures against disease. The necessary official measures have increasingly restricted liberty, and this patronizing treatment needs to be opposed with a higher sense of responsibility. Medical art has developed from more healing towards prophylactic and predictive medicine, which prognosticates the individual susceptibility to particular infections, and other risk factors.
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PMID:[Effect of major epidemics on cultural awareness]. 857 53

To assess knowledge, attitudes, and perceptions about bancroftian filariasis, 104 residents of an endemic area in Haiti were interviewed. Questions focused on 1) whether people understood the relationship between infection and disease, 2) recognition of the role that mosquitoes play in transmission, 3) perceived importance of hydrocele and elephantiasis in relation to other recognized diseases, and 4) the willingness of the community to participate in a control program. Fewer than 50% of residents had heard of filariasis and only 6% of those surveyed knew that it was transmitted by mosquitoes. In contrast, all persons knew of the clinical conditions of hydrocele and elephantiasis. Hydrocele was thought to be caused by trauma (60%) or trapped gas (30%); elephantiasis by walking bare foot on soil or water (37%) or by use of ceremonial powder that had been sprinkled on the ground (23%). Of 76 respondents, 53% and 38% thought that hydrocele could be treated through surgery or a drug, respectively, whereas 86 respondents, 85% and 15% believed that either surgery or a drug could be used to treat elephantiasis. In this context, persons were not referring to a specific drug; rather, they believed a drug existed (possibly in some other country) that could cure these conditions. Hydrocele and elephantiasis ranked second to acquired immunodeficiency syndrome as perceived health problems, most likely because residents believed treatment for conditions such as malaria, intestinal worms, anemia, and diarrhea was easily obtained. Responses were influenced by age, sex, and symptoms, but none of these effects were statistically significant except that persons with hydrocele or elephantiasis were more likely to have sought treatment than persons without these conditions (P = 0.0006). The survey results indicate that awareness of the causes of disease, the relationship between infection and disease, and goals of treatment must be heightened through community-based education campaigns to increase the possibility of acceptance and support of control programs.
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PMID:A survey of knowledge, attitudes, and perceptions (KAPs) of lymphatic filariasis, elephantiasis, and hydrocele among residents in an endemic area in Haiti. 860 Jul 70


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