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This overview of health programs and conditions in India reveals that health is related to economic development antipoverty measures, food production and distribution, drinking water supply, sanitation, housing, environmental protection, and education. There are urgent requirements for effective intersectorial coordination. Unprecedented growth of 1 million a year has resulted in slums and shanties--a place of epidemics; urbanization has contributed to environmental pollution impacting on health, and water pollution to water-born diseases. Health services are still insufficient to meet the needs. Sanitation practices contribute to cholera, dysentery, diarrhea, enteric fevers, and malaria. Indian Systems of Medicine and Homeopathy must be active in preventive and health care. Accomplishments include in 1987/8 a decline in leprosy cases attributed to the existence of leprosy control units. 40 AIDS Surveillance Units are actively treating and screening. The Naval Goitre Control Programme's goal is replacement of iodized salt for edible salt by 1992, thereby reducing mental retardation and low birth weight babies. The Family Welfare Programme, targets a New Production Rate of Unity before 2000. A National Technology Mission on immunization and the Universal Immunization Programme plans to be operational in all districts by 1990. Oral rehydration therapy programs dispense free packets to fill the needs of 1 million children under 5 who suffer from diarrhea 3 times a year with 3 million facing death. The Primary Health Care Programme provides iron and folic acid to women with nutritional anemia and Vitamin A to children. Health service developments have been increased.
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PMID:Status of health in India and its future prospects. 226 69

Within a 2 month period 131 Ethiopian immigrants were admitted for treatment at a general hospital in Jerusalem. There were 52 patients with malaria, 13 with typhoid fever, 24 with pneumonia, seven with tuberculosis, nine with shigella and 11 with campylobacter. Over three-quarters of these patients were anaemic. In the majority of cases anaemia was normocytic and was most probably secondary to malaria and other intercurrent infections. The prevalence of diffuse non-toxic goitre was 7% in children and 19% in adults with a male to female ratio of 4:13. A positive rapid plasma reagin (RPR) test was found in 4% of sera tested and a positive HBsAg in 13%. IgG antibodies to HBc antigen were found in 75% of subjects. All patients with infectious diseases responded to therapy and, despite their poor condition at arrival, there were no fatalities and no late sequelae. The high HBsAg carrier state calls attention to the risk of vertical transmission by infected mothers and underlines the need for active immunization of infants at risk. The high prevalence of untreated tuberculosis and malaria poses a potential public health hazard, but with the current systematic screening of this population leading to identification and effective treatment of affected subjects, chances for the practical eradication of malaria and tuberculosis are excellent. Finally, the large scale transfer of a population from rural Africa to a modern and largely urban society presents a unique opportunity for a prospective study of the impact of environment on the emergence of diseases which plague modern society such as diabetes, atherosclerotic cardiovascular disease, hypertension and cancer.
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PMID:Medical problems in Ethiopian refugees airlifted to Israel: experience in 131 patients admitted to a general hospital. 346 61

A total of 14,740 schoolchildren in seven provinces of Shoa Administrative Region in Central Ethiopia were surveyed for the prevalence of goitre, xerophthalmia and anaemia. Haemoglobin and packed cell volume were assessed in 966 children in one province while an in-depth study was conducted on 344 children in the same province and two others. Goitre, xerophthalmia (Bitot's spots) and clinical anaemia were observed in 34.2, 0.91 and 18.6% respectively of the children. Most biochemical variables were within the normal range while those of haemoglobin (Hb), mean corpuscular Hb concentration (MCHC) and urinary I excretion were lower, and mean corpuscular volume, mean corpuscular Hb (MCH), and immunoglobulins G and M were higher. Hb was strongly correlated with retinol, ferritin, MCHC, MCH, packed cell volume and erythrocyte count while retinol formed a triad with transthyretin (TTR) and retinol-binding protein (RBP) which were all correlated with one another. Total and free thyroxin and total and free triiodothyronine were positively correlated as were the concentrations of the total and free hormones. Thyrotropin (TSH) was negatively correlated with total and free thyroxin and positively correlated with free triiodothyronine. Thyroxin and triiodothyronine in both free and combined forms were all correlated with thyroxin-binding globulin which in turn was negatively correlated with the triad retinol, RBP and TTR. The triad was also negatively correlated with C-reactive protein. Urinary I excretion was positively associated with total thyroxin and negatively associated with TSH. The anaemia found was not nutritional in origin but due to the effect of infestation with intestinal parasites and malaria.
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PMID:Interrelationship between vitamin A, iodine and iron status in schoolchildren in Shoa Region, central Ethiopia. 826 Apr 84

This paper attempts to show how leading contemporary disciplines influenced the discovery of Chagas' disease and the formation of the early disease concept. Chagas was among the first generation of Brazilian trained scientists who incorporated modern principles of tropical medicine in its research. Thus, Chagas was familiar with characteristics of vector borne tropical diseases such as malaria and yellow fever. The detection of a hitherto unknown trypanosome in the gut of a reduviid bug prompted him to search for a related vector borne disease. Among the disciplines that were influential on Chagas' discovery and early disease description were pathology, entomology and parasitology. Parasitology as a new discipline was of crucial importance to tropical medicine and had a political dimension in the context of colonial medicine. Hence, leading scientists in tropical medicine were located in European countries and in the United States of America. One of these was the German Schaudinn School of Protozoology. The early description of American Trypanosomiasis can also be seen as a reflection of the Schaudinn School of Protozoology which dominated Chagas' scientific orientation towards parasitology with regard to the interpretation of the observed phenomena of the life cycle and the morphology and biology of T. cruzi. The first Chagas' disease concept was based on research of the biology and entomology of the trypanosome and its vector as well as on pathological studies of fatal cases. This concept was characterized by a confusion of some of the chronic forms of the disease, as iodine deficiency and goitre were endemic in some rural regions in Brazil. Therefore, early concepts of the disease faced strong opposition and even raised doubts about its existence.
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PMID:The discovery of Chagas' disease and the formation of the early Chagas' disease concept. 964 26

During this period, malaria, pneumonia, dysentery and enteritis, and acute infectious diseases, including plague, typhoid fever, dysentery, cholera, smallpox, infectious epidemic meningitis, malaria, tsutsugamushi and endemic diseases such as goitre were the important causes of death. In parasitology, the most important discovery was lung fluke, followed by research achievement in clinical and basic sciences. In Taiwan, studies on poisonous snake were proceeded rather early. The special medical system in this period included the Gynecological Hospital and medical insurance system. In the medical staff, not a few Japanese were included. Dr. Du Congming, who made great contributions to medicine in Taiwan, may be viewed as the father of medicine in Taiwan. A Journal of Taiwan Medical Association was published in Taiwan by the said Association.
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PMID:[Medicine in Taiwan during the period of Japanese occupation]. 1161 76

The implementation strategy for health for all (HFA) in China is presented as a targeted effort toward the rural population which makes up 900 million of the total 1160 million population. The WHO objective of HFA by 2000 was accepted by China in 1983 and 1986. Socioeconomic development has improved considerably since 1949. Targets were established 1) to double the 1980 gross national product (GNP) and guarantee food, clothing, and shelter between 1981 and 1990; 2) to quadruple the 1980 GNP between 1991 and 2000, and 3) to attain the average income per capita of medium-developed countries. The political system is the Communist Party of China (CPC). The Chinese People's Political Consultative Conference, which is comprised of members of the CPC and other individuals from democratic and other organizations, fills an advisory role. The National People's Congress is the highest organ of state power and serves to legislate, supervise, and make decisions in some matters including personnel. The Standing Committee exercises state power when the Congress is not in session. It is a 1-chamber system (state administration, judicial system, and chamber system) and members of the People's Congress do not resign. Since 1949, the health system has grown to 209,000 medical and health institutions, 2.6 million hospital beds, 4.9 million medical and health workers, an average life expectancy that has increased from 35 years to 69 years, an infant mortality rate that has declined from 20% to 5.1% from 20%, and a maternal mortality that has declined from 150/10,000 to 9.4/10,000. Diseases such as cholera and smallpox have been eliminated and other diseases such as malaria and goiter have been brought under control. A cooperative medical and health care system which was established in the 1960s was replaced with a fee system in the 1980s, which has led to medical care problems for the rural poor. At present there is a rural medical insurance system and a cooperative health system with 3 tiers (health clinic, township hospital, and county professional hospitals). In 1990, there were village clinics in 87% of the villages. In 1990, central government and local management are implementing the objectives stated in 1) Program Objectives of Global Goals for Health by 2000 in Rural Areas, 2) Management Procedures for Primary Health Care, and 3) Evaluation Standards of Health for All by 2000. Implementation began in 1989-90, and stage 2 is to begin in 1991-95, and stage 3 in 1996-2000. The problems that will be encountered are investment, population growth, and personnel training.
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PMID:The rural health care system in China. 1228 35

Focus in this discussion of Bhutan is on the following: the history of the demographic situation; the government's overall approach to population problems; population data systems and development planning; institutional arrangements for the integration of population within development planning; the government's view of the importance of population policy in achieving development objectives; population size, growth, and natural increase; morbidity and mortality; fertility; international migration; and spatial distribution. Almost no demographic information was available in Bhutan until the 1st census was conducted in 1969, but the UN estimated the total population at 750,000 in 1950, increasing to 857,000 in 1960. The 1969 census placed the population at 939,774 and subsequently the population is estimated to have increased to 1.2 million by 1975. The government has not formulated an explicit, overall population policy, but it seeks to modify various demographic variables. The overall population size is considered inadequate to meet the labor force and development needs of the nation and efforts to control fertility are underway only in the few areas where population growth rates are relatively high. A formalized structure for the collection of population information and data has been established only recently. By 1975-80 the mortality rate is reported to have declined to 20.6/1000. Infant mortality declined from an estimated 210/1000 during 1950-55 to 167/1000 during 1970-75 and 156.3 by 1975-80. The main causes of death are believed to be gastrointestinal diseases and respiratory ailments, with a significant incidence of tuberculosis, malaria, goitre, and venereal disease. The government considers the situation with regard to morbidity and mortality to be unacceptable. The crude birthrate was estimated to reach a level of 41.3/1000 by the early 1980s. Despite the relatively high fertility levels, the government appears to consider these rates as satisfactory. The shortage of indigenous labor force and the sparse population in various regions are largely responsible for this perception. There is little emigration from the country and the government perceives the situation with regard to emigration as not significant and satisfactory. The level of immigration, although not exceedingly large in total numbers, is generally perceived to be significant and satisfactory in view of the current economic and manpower needs of the country. The population is unevenly distributed over more than 4500 settlements with the distribution closely following the character of the terrain, climatic conditions, and land productivity. The government perceives the spatial distribution of the population as inappropriate, especially in terms of the development needs of the country.
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PMID:Bhutan. 1231 44

In this paper, the etiological factors affecting infertility among the Azande tribe of Central Africa are reviewed. Of those factors reviewed, including venereal disease, leprosy, sleeping sickness, endemic goitre, nutrition, voluntary contraception, and malaria none is sufficient to account for a lowering in the fertility rate. The data collected is estimated to be accurate but very limited. The author, however, concludes that there is 1) a low child/adult ratio; 2) a marked female preponderance; and 3) a high infant and child mortality rate. Finally, the people of the tribe are reproducing themselves, though not so prolifically as their former preponderance in this region, or comparison with fertility levels in neighboring tribes, would lead one to expect.
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PMID:Dearth of children among the Azande: preliminary report. 1233 86

In this cross-sectional study, 8,481 women aged 15-49 who had at least one pregnancy outcome were considered. This study aimed to examine the characteristics of Filipino women having had a pregnancy loss, and to test the association between domestic violence and pregnancy loss. To control for the confounding effect of the number of pregnancies, the sample was divided into seven groups classified by the number of pregnancies. The risk factors considered were demographic characters (age and partner's age, marital status, and place of residence), socioeconomic status (education and partner's education, having a paid helper at home, having a say in how income was spent), domestic violence (physical abuse and forced sex), sexual behavior of partner, whether the pregnancy was wanted, and disease history (tuberculosis, diabetes, hypertension, malaria, hepatitis, kidney disease, heart disease, anemia, goiter and other medical problems). The major risk factors were found to be physical abuse, region, faithfulness of partners, hypertension, hepatitis, kidney disease, anemia, and the other medical problems, respectively. The risk of pregnancy loss for the women suffering domestic violence was 1.59 (95% CI 1.28-1.97) times higher than for the women who did not. Women aged 15-19 years had a much higher risk of pregnancy loss than the other age groups (OR = 1.49, 95% CI 1.22-1.82). There were similar risk for women aged 20-24 years (OR = 1.08, 95% CI 0.94-1.25) and 35-39 years (OR = 1.05, 95% CI 0.92-1.19). No association emerged with marital status, socioeconomic status, forced sex, the number of partners, unwanted pregnancy, tuberculosis, diabetes, malaria, heart disease, and goiter. Although women's age, partner's age, residence, women's education, partner's education, and paid helper at home were significantly associated with pregnancy loss, they were likely to be confounders rather than risk factors.
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PMID:Pregnancy loss in the Philippines. 1297 77

With acknowledged difficulties in achieving satisfactory compliance rates for the large-scale delivery of many antiporositic drugs, the use of medicated salt has often been seen as a useful way to improve the level o f treatment in target populations. Iodinated salt is said to have contributed to a decline in endemic goitre, and salt medicated with chloroquine and/or other antimalorials, or with diethylcarbomazine, has been widely used in public health programmes against malaria and filariosis respectively. In this article, however, David Payne suggests that chloroquinized salt programmes may have been a major factor in promoting chloroquine resistance in Plasmodium falciparum.
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PMID:Did medicated salt hasten the spread of chloroquine resistance in Plasmodium falciparum? 1546 62


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