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Medical missionaries, historically the pioneers in introducing Western medicine into many tropical countries, are today responsible for a significant proportion of health care in several of those countries. Illustrating his theme with references to personal experiences in the former Belgian Congo, the author enlarges on the organization of a church-related comprehensive health care programme based on a chain of rural health centres and satellite dispensaries that brought curative and preventive medicine to the whole population within the area covered. Trypanosomiasis was eradicated, yaws and tuberculosis controlled, cerebral malaria eliminated, worm-loads reduced and nutrition improved. Leprosy was treated within the integrated service as soon as the sulphones became available. Medical auxiliaries and nurse-midwives were trained practically to tackle the local problems. Students from many missions over a wide area went into government, mission and company employ after training. Research concentrated mainly on the solution of pressing local problems, such as onchocerciasis and leprosy, but incidentally investigated interesting clinical phenomena.
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PMID:The contribution of medical missionaries to tropical medicine. Service-training-research. 40 Feb 1

A review of 1987 patients with uveitis seen over an 11-year period in Bendel State of Nigeria has been undertaken; 56% of cases had a posterior/mid-peripheral uveitis, 15.1% a panuveitis, 21.5% an anterior uveitis. Acute anterior uveitis with classical symptoms was rarely seen. Its comparative rarity is presumably due to the absence of HL-A27 in Africans and altered immunological states from malaria and parasitic infections. Identified aetiological factors in anterior uveitis were leprosy (1 patient), tuberculosis (1 patient), herpes zoster (16 patients), and onchocerciasis (3 patients). The great majority of cases of posterior uveitis were of presumed toxoplasmic origin. Further studies are needed to demonstrate its mode of transmission in a population in which toxoplasmosis is endemic. Forest onchocerciasis is not a major cause of uveitis in southern Nigeria in the same way as savanna onchocerciasis is in northern Nigeria. Syphilis seems to play no part in the causation of uveitis in southern Nigeria. Better diagnostic facilities are required to determine the role of sarcoidosis and other possible causative factors. Uveitis is a major cause of blindness in Nigeria.
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PMID:The problem of uveitis in Bendel State of Nigeria: experience in Benin City. 56 37

This review is intended to remind physicians of exotic infections with latency of at least one year that could cause illness in refugees or US citizens exposed in Southeast Asia. Tuberculosis, melioidosis, and leprosy are the major chronic infections of bacterial origin. Intestinal protozoa, roundworms, and flatworms are considered with regard to pathogenic, potential and duration of infection. Malaria, filariasis, and schistosomiasis may be seen on occasion. Paragonimiasis and Chinese liver fluke infections are more common and may simulate other less exotic diseases.
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PMID:Latent and chronic infections imported from Southeast Asia. 64 22

Community participation was found to be an important resource for ascertaining and achieving the project health goals of a multiprofessional health team in Porto Nacional, an Amazon community in Brazil's interior. The project was established in 1968 to provide comprehensive, integrated medical care. The health team consisted of 6 physicians (1 sanitarian, 2 surgeons, 2 internists, and 1 pediatrician), 2 social workers, 1 nurse, and 1 educator. The team assumed operating responsibility for the area's health unit and 50 bed hospital, and worked closely with other local health agencies and providers. To attract financial and technical resources, the team founded a non-profit agency, COMSAUDE, to promote health and educational activities. The area's health problems consisted of a predominance of waterborne and foodborne diseases, an infant mortality rate of approximately 70 deaths/1000 live births, high malaria morbidity, tuberculosis, leprosy, cutaneous leishmaniasis, a moderate incidence of Chagas' disease, and extensive infestation of vermin. The local health unit was well-known and accepted in the community which facilitated the team's activities. At the time of the team's arrival, the vermin problem was causing public concern. Work on controlling this problem appeared an appropriate vehicle to achieve the dual objectives of promoting sanitation activities and becoming familiar with and accepted by the community. A combination of home visits and general meetings with institutional and local leaders mobilized a significant segment of the population. Increased cesspool construction resulted. Among the poorest neighborhoods, residents developed an organization to finance the cost of construction materials. Technical assistance from sanitation aides was provided to rural communities. Municipal health boards were organized to assure maximum utilization of visiting physicians, to conduct health surveys, and to oversee the implementation of recommended preventive health measures. A health board of volunteers was initiated in Porto Nacional to identify health related problems and propose solutions within the scope of the local government. The board was responsible for improvements in sanitation at the market place and the organization of trash collection. Health surveys were conducted utilizing students from local schools as interviewers. The surveys increased community awareness of health problems in addition to providing health data. A center for malnourished children was established which served as a recuperation facility for the children and a nutrition and hygiene education center for mothers. A cooperative housing improvement program was initiated. Residents worked Saturdays gathering construction materials and working on neighbors' houses. The sanitation aides assisted in drawing plans and selecting building, cesspool, and well sites. The team participated in educational activities at the schools, including a controversial sex education/marriage preparation course that was ultimately limited to prospective newlyweds. Based on 8 years of program operation, the authors conclude that community participation is an important development resource and that the process of working together is as important as the results achieved.
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PMID:Community participation in health activities in an Amazon community of Brazil. 69 59

Great streams of tourists flow every year from the Federal Republic to southern countries. The danger of infection with serious tropical diseases such as smallpox, cholera or leprosy is fairly small, statistically speaking. Even exotic parasitoses merit only individual medical interest in the majority of cases. Of greater importance are the cosmopolitan infectious diseases such as typhoid fever, paratyphoid, salmonella enteritis, poliomyelitis, viral hepatitides which are transmitted orally and altogether are imported in no small numbers. The alteration of the mode of living caused by the holiday and frequently a false confidence in the hygienic conditions favor the infection. Almost independent of the behavior of the tourists are the infections produced by insect bites, such as malaria or the leishmaniases, which often end fatally for lack of recognition. Here, a better enlightment of the travelers, the use of prophylactic agents and improvement of diagnosis must be instituted.
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PMID:[Tourism and risk of infection (author's transl)]. 82 9

A case of agranulocytosis due to dapsone administered for the treatment of acne vulgaris is described. Agranulocytosis has previously been reported after administration of dapsone for other dermatological disorders, leprosy, and prophylaxis against falciparum malaria. The frequency of agranulocytoses when dapsone was used for malaria prophylaxis in United States servicemen in Vietnam was sufficient to result in its withdrawal from use for this purpose. Caution should therefore be exercised in the administration of dapsone for conditions for which less toxic agents are available.
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PMID:Agranulocytosis due to dapsone. 90

An outline is given of the pattern of communicable disease in the South Pacific, as far as it is known. Surveillance and research are imcomplete and the World Health Organization is assisting in carrying these out. Reporting and laboratory diagnosis of communicable disease are inadequate and sometimes inaccurate. This is being improved. Medical checks for intending migrants from the South Pacific are, in a number of cases, inadequately performed in the country of origin and this situation should be altered. The risks to surrounding developed countries from migrants, temporary workers and returning travellers are not tremendous but they cannot be neglected and vigilance has to be maintained. Tuberculosis importation does present risks, as does that of typhoid. Malaria importation carries risks for Northern Australia. Leprosy poses little real risk to Australia or New Zealand and neither does filariasis. Cholera would have to be watched for closely should there ever be a South Pacific outbreak, but the developed countries around the South Pacific which are cholera-non-receptive can control occasional cases. Other than malaria, tuberculosis, typhoid and possibly dengue, problems are thus mainly in the diagnosis and treatment of individuals.
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PMID:Communicable disease in the South Pacific Islands, 1. 100 33

A project for total leprosy case detection particularly early leprosy cases was undertaken in Wardha District which has a rural population of about 6 lacs in 905 villages, through an integrated survey with the help of all health workers like Leprosy Technicians, Sanitary Inspectors, Co-ordinators, Malaria Workers, Smallpox Vaccinators and Auxillary Nurse Midwives. The training given to the Non Leprosy Health Worker was for a period of 3 days making them just fit to suspect all leprosy cases. The final diagnosis was to be made by the fully trained Leprosy Technicians. The surveys were conducted in batches of 3 to 4 workers. Surveys were conducted for 4 weeks at a stretch and working for 5 days every week. Every year two such integrated surveys were conducted. From November 1973 to December 1975, four such surveys were undertaken. During the other period, Leprosy Technicians were conducting the normal surveys. It was found that through these integrated survey it is possible to undertake the survey of all the villages once in two years and the case detection rate at the end of the 4th survey was found to be 85.5% of the estimated cases in the rural areas. Normally, it would have taken about 5 years to complete the survey of all the villages by the Leprosy Technicians alone, and the case detection rate could not have been more than 70 to 75%. Through this programme, Leprosy patients in every early stages have been detected. The paper discusses the methods, planning and the results obtained.
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PMID:Integrated surveys as a tool for early case detection in leprosy control programme. 102 30

A glycoconjugate antigen of 27-39 kDa was isolated from a cell-free extract of Leishmania donovani by affinity chromatography using a Concanavalin-A sepharose-4B column and eluted with 0.5 M alpha-methylmannoside. The antigen was recognized specifically by sera from kala-azar (visceral leishmaniasis) patients and did not react with sera from tuberculosis, leprosy or malaria patients. The antigen may therefore be useful in developing a serodiagnostic assay for visceral leishmaniasis.
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PMID:Leishmania donovani: isolation of a concanavalin-A specific antigen and its evaluation for serodiagnosis of visceral leishmaniasis. 128 99

The IFA test developed using Leishmania donovani promastigote and amastigote antigens showed very high antibody titre in clinically and parasitologically established cases (30) of kala-azar, the geometrical mean reciprocal titre (GMRT) being 870 +/- 5.4 and 5370 +/- 1.80 respectively with the two antigens. In contrast, the GMRT of normal subjects of endemic area was only 12.44 +/- 6.19 and 80.35 +/- 1.66 respectively with these antigens. None of the subjects from non-endemic area suffering with other parasitic diseases, such as malaria, filaria, amoebiasis, leprosy or tuberculosis (20 cases each) gave a positive response to any of the antigen. The test holds promise in the diagnosis of Kala-azar.
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PMID:An indirect fluorescent antibody (IFA) test for the serodiagnosis of Kala-Azar. 129 50


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