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Query: UMLS:C0024530 (malaria)
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A researcher reviewed village health worker (VHW) utilization in a primary health care (PHC) program in villages around Farafenni in North Bank division of The Gambia. 47 children 7 years old died between April 1986-March 1987. WHWs could have treated the illnesses (malaria, diarrhea, and acute respiratory infection) that killed 23 (49%) of these children. Yet they treated only 6 of the 23 while other health workers in the region treated 14 children. 3 children received no treatment. Further a traditional healer later treated 3 of those seen by a VHW before death. Parents of a fatally ill child with diarrhea were a bit more likely to take the child to a traditionally healer than a VHW. None of the VHWs referred any of the fatally ill children to the next PHC level. Chronic diarrhea/malnutrition, chronic cough, meningitis, measles, and septicemia caused the death of 20 of the 24 remaining children. A VHW treated only 1 of the 24 remaining children before death. Moreover a VHW saw only 48% of the living children who had experienced illness during the study period. The remaining children went to other health providers. 26% of mothers claimed they had forgotten that VHWs could treat illnesses. In fact, 75% of those who had forgotten did not clearly understand the role of the VHW. They tended to think that the VHW provided only prevention information. 20% could not afford a VHW, yet they paid much more for other health workers. Another 26% said that the VHW was not available at the time. 5% reported the VHW to be unsupportive. The remaining 21% did not know why they did not take their child to a VHW. When the researcher pushed these mothers, 61% gave personal animosity as a reason and 39% did not want to talk about it. In conclusion, the VHWs did not receive adequate training, had limited range of drugs, were poorly supervised, and often not available.
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PMID:Utilization of village health workers within a primary health care programme in The Gambia. 188 Aug 30

Researchers analyzed the relationship between use of primary health care services and child mortality in 16 villages in the communes of Pahou and Avlekete on the Atlantic coast of Benin. The case control study included 74 4-35 month old children who died in 1986-1987 and 230 controls who survived. Overall child mortality stood at 35.9/1000/year. Fever and convulsions, presumably malaria, were the most likely cause of the majority of deaths (38 cases). No protective effect of a village health worker (VHW) visit in the 6 months before death occurred between fever and convulsion cases and other causes of death cases, however. VHWs had visited considerably more controls than cases in the 6 months prior to death (RR ..3; p.05). Indeed the greatest protective effect occurred in children who has been seen by VHWs had visited 71% of all children for a median of 4 visits each. Poor children were only slightly more likely to die than nonpoor children. Children whose weight for age was 75% of the standard for their age has a 4.26 relative risk (RR) of mortality (p.05). Further, when the researchers excluded cases who died within 3 months of the weight measurement, the RR remained high (2.9) and the association significant (p=.08). Measles vaccination between 9-12 months old significantly protected children against mortality (RR .36; p.05). On the other hand, diphtheria, tetanus, and pertussis vaccination did not have a significant protective effect. In conclusion, personal and household contact with a VHW and measles vaccination between 9-12 months improves child survival for 4-35 month old children.
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PMID:Childhood mortality among users and non-users of primary health care in a rural west African community. 191 52

Mortality of infants aged 0-30 months was studied in a subdistrict of the eastern Ivory Coast with a population of 240,000 inhabitants. A cluster sample of the type recommended by the World Health Organization for evaluating progress of the expanded program of immunizations consisted of 2 samples with 30 clusters of 70 children each, 1 taken in urban Abengourou and the other in rural cantons of the subprefecture of Abengourou. A standardized questionnaire was administered to all the mothers about their births within the last 3 years. Supplementary questionnaires concerning all deaths of children of the sample mothers were interpreted by 3 physicians who agreed on a probably diagnosis in each case. The survey covered 2375 infants under 1 year and 1825 aged 12-30 months. The total mortality was 103 deaths in the total sample and 70 for infants aged 0-11 months, for a rate of 29.4%. The difference between the urban rate (31.7%) and the rural rate (26.8%) was not significant. The rate varied significantly by sex for deaths due to malnutrition (11 boys, 1 girl), and pneumopathies (6 girls, 1 boy). Mortality varied significantly according to treatment received and place of death. 55% received traditional treatment and 45% modern treatment. 53% died at home, 36% at a health center, and 9% at the home of a healer. Among infants aged 0-27 days, the cause of death was tetanus for 8, prematurity for 12, neonatal distress for 5, neonatal jaundice for 5, and infection for 2. Among infants aged 1-11 months the cause of death was malaria for 10, meningitis for 7, tetanus for 2, diarrhea for 9, pneumopathy for 3, measles for 4, whooping cough for 2, and unknown for 1. Among infants aged 12-30 months the cause of death was malaria for 11, malnutrition for 12, meningitis for 3, pneumopathy for 4, measles for 1, and sickle cell anemia for 2. Malaria was the single most important cause of death followed by malnutrition for the overall sample. In urban and rural areas respectively, the proportions of infants correctly vaccinated for their age groups were 78.1% and 76.0% for those under 11 months; 92.3% and 80.6% for those 12-17 months; 78.3% and 76.6% for those 18-23 months; and 66.5% and 71.4% for those 24 months and over. Mortality rates varied very significantly by vaccination status. 70 of the children dying had not been vaccinated. Their mortality rate was 19.6%, compared to .5% for children in process of vaccination, 1.1% for children incompletely vaccinated, and .9% for children correctly vaccinated.
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PMID:[Infant mortality and its causes in a sub-district of the Ivory Coast]. 196 15

Even though Kenya stopped requiring tuition for primary school in the early 1970s, parents still must pay for books, pencils, and uniforms and contribute to a building fund. Enrollment for 8 year olds stands around 92%. The Aga Khan Health Services (AKHS) in Kisumu, Kenya recognizes the potential for improving the health status of children by using primary schools as a vehicle for health education. Its schools program sees school children as providers of health care for younger siblings. The program incorporates children's education, health, and health education. School children learn about health and pass on the information at home. For example, school children check to see if basic public health measures are done at done, e.g., covers for latrines. Teachers encourage students to bring younger siblings to monthly monitoring sessions. Here they learn to interpret growth charts and to determine who need immunizations. Since many primary school students are teenagers and teenage pregnancies are common, sex education is being considered. A comic book called Pied Crow distributed to every primary school addresses social issues, such as AIDS. Malaria killed 20 children in 1987, but by 1991 it killed only 2-3 children in Kisumu. Infant mortality in 1984 stood between 194-236/1000 and by 1987 AKHS reduced it 145.5-177. WHO's expanded program on immunization still does not serve most children, however, mainly because 25% of Kenyans live 5 miles from a rural health facility. Therefore measles still is the leading cause of death in children followed by acute respiratory failure. Some teachers become community health workers and other teachers interact with them. Community health workers partake in child growth monitoring activities and health education. Some areas around Kisumu now have piped water and AKHS has a well digging program. These activities have resulted in a substantial reduction in diarrhea.
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PMID:Child health and education in Kenyan schools programmes. 201 16

Each year approximately 137 million children are born, 70 million of them in countries where the mortality rate for under-fives exceeds 100 per 1,000. In worst-off Afghanistan 300 per 1,000 children under five die. We review some of the most common causes of this catastrophy: diarrhoea, acute respiratory infections, measles, malaria, and neonatal tetanus. All of the numerically significant contributors to under-five mortality are treatable and/or preventable by simple and inexpensive methods. Medical personnel from industrialized countries, and there is an increasing need for transfer of financial resources from highly developed to developing countries. The living conditions of children in the third world involve many factors that are detrimental to both physical and mental health. In order to effect a change, all countries and societies must become involved.
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PMID:[Children and diseases in the Third World]. 204 59

The health situation in Nigeria is typical of tropical Africa. It is characterised by high childhood and maternal mortality and a relatively short life expectancy. Mortality in childhood in due mainly to diseases like malaria, measles, poliomyelitis, tetanus, diarrhoea and acute respiratory tract infections. Diseases like filariasis, schistosomiasis and leprosy which are now readily controlled by drugs cause considerable morbidity in later life. Although the technology and tools (particularly vaccines and drugs) for the control of most of these diseases are now available, it has not been possible to make optimal use of them in Nigeria and other tropical African countries because of unfavourable social and economic conditions. The non-availability of drugs most needed for healthcare and disease control has been found to be due not only to insufficient funds but also to the use of the limited funds on expensive drugs that have little bearing on the disease pattern. The Essential Drug Programme initiated by the World Health Organisation, now adopted by Nigeria and about 100 other countries mostly in the Third World, aims to correct this unsatisfactory drug supply situation by ensuring that the available funds are used to provide those drugs needed by the large majority of the people and are made available at all times at prices that most people can afford. The Bamako Initiative in the African Region of the World Health Organization is also designed to ensure regular availability of drugs particularly to primary healthcare facilities. Seed drugs are provided to the health institutions either by the National Government or through external aid. These are sold to patients at a small profit margin. The proceeds are then used to replenish stocks and the small profit used to improve services in the health centre. The introduction of these programmes in Nigeria has improved drug availability considerably in the past couple of years and should soon start yielding further dividend in the form of measurable improvement in the health situation.
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PMID:Drug supply in Nigeria. 204 36

The recognized high mortality from measles in Africa is considered to be partly due to the flare-up of concomitant malaria infection. In 1987 there was a measles epidemic in the Rufiji Delta, Tanzania, in spite of recent vaccination campaigns. A comparative study was therefore conducted on the densities of malaria parasites in children during the acute stage of measles (67 consecutive cases, aged 5 months-19 years). The period of study was March-June, the peak season for malaria transmission. For each measles patient, a blood film was concomitantly taken from an asymptomatic age-matched child from the same village. Of 67 children with measles, 17 (25%) had parasitaemia ranging from 8 to 2480 parasites microliter-1 blood. Out of 67 asymptomatic control children 59 (88%) had parasitaemia ranging from 8 to 3400 parasites microliter-1 blood. This study indicates that malaria densities were lower during the acute stage of measles than in healthy children. The contribution of malaria to mortality in children with acute measles may be questioned.
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PMID:A study on malaria infection during the acute stage of measles infection. 205 25

Researchers interviewed 194 mothers of children 1-2 years old in Port Moresby, New Guinea to determine why childhood immunizations are not completed. They also looked at the baby clinic books to see if the children received the completed doses of vaccines. 87% did not know why children should be immunized. Moreover only 13% believed immunizations could prevent disease. Further 86.6% could not list any of the diseases that immunizations target. 11.9% did correctly report measles, tuberculosis, polio, and pertussis, however. On the other hand, 3 (1.5%) mothers incorrectly believed immunizations protect against malaria, diarrhea, and malnutrition. The relationship between lack of knowledge and noncompletion of immunization was not significant, however (p=.07). 76.8% reported very rude behavior on the part of the health staff. 15.5% went so far to say that the health staff often reacted aggressively towards them. Only 7.7% reported kind of behavior. Mothers who perceived health staff attitudes as negative tended not to return to the clinic with their children for the 3rd dose (p=.002). DPT and polio vaccine coverage declined consistently from 94% (1st dose) to 79% (3rd dose). Nevertheless 3rd dose coverage was considered rather high. Since hospital delivery was almost universal in Port Moresby and hospital staff routinely administer the BCG vaccination prior to discharge, BCG coverage was high (96%), however. Emphasis in the national immunization program should be on changing health staff attitudes leading to improvements in the social interaction between patients and health staff.
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PMID:Possible reasons for non-completion of immunization in an urban settlement of Papua New Guinea. 205 99

A total of 740 consecutive children aged between 6 months and 12 years who presented with acute encephalopathic illnesses during a three year period were assessed both clinically and by laboratory investigations. Cerebrospinal fluid was examined for the presence of cells or other abnormal substances, and any organisms were cultured. Blood examination included white cell count and estimations of haemoglobin, urea, glucose, and electrolyte concentrations and serum alanine aminotransferase and aspartate aminotransferase. A firm diagnosis was established in 278 patients (38%). Pyogenic meningitis (n = 134), measles encephalopathy (n = 38), and electrolyte imbalance (n = 23) were important causes in this group, cerebral malaria (n = 4) was uncommon and there were no cases of Reye's syndrome. The diagnoses of the remaining 462 were combined under the heading 'acute unexplained encephalopathy'. Altogether 394 of the 462 patients underwent virological investigations for arboviruses and 92 (23%) had one or more indicators of Japanese encephalitis. No other arboviruses could be isolated. Throat swabs from 187 patients with acute unexplained encephalopathy were studied on monkey kidney tissue cell lines of which 14 were positive (8%). These were identified as adenovirus, parainfluenza, influenza, poliomyelitis, Coxsackie, and echovirus; in two cases the virus was untypable. Japanese encephalitis is an important cause of acute childhood encephalopathy in this region. Clinical features of the illness may be mimicked by several disorders which require specific treatment. Thirty four of the 92 died (37%).
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PMID:Virological investigations of acute encephalopathy in India. 203 25

The acquired immune deficiency syndrome (AIDS) is fundamentally the same disease in all parts of the world, but the prevalence of microorganisms in an environment governs the patterns of disease arising from reactivated latent infections, invading pathogens and opportunistic infections. AIDS in Africa has certain characteristic presentations. Enteropathic AIDS is most common: Cryptosporidium and Isospora belli are identified in up to 60% of patients, but it is uncertain whether they are the causes of diarrhoea. Pneumocystis carinii pneumonia is rare. Tuberculosis, both pulmonary and extrapulmonary, is the supreme complicating infection. Herpes zoster is frequently the first clinical presentation, and has a 95% positive predictive value for HIV positivity. Measles may be more frequent in infants born to HIV-infected mothers, and appears to be worse in HIV-infected children. There is accelerated progress of both diseases in patients infected by HIV and Mycobacterium leprae. Salmonellosis is frequent. There is no direct interaction between malaria and HIV, but, by being a potent cause of anaemia, malaria enhances transmission of HIV to children through blood transfusion. HIV-positive subjects are liable to new or reactivated visceral leishmaniasis with dissemination to unusual sites. Cerebral toxoplasmosis is common. There are no apparent interactions between HIV and helminths, although there is one report of hyperinfection with Strongyloides stercoralis. Cryptococcal meningitis has high frequency. Infections with Histoplasma encapsulatum are common in tropical America, but there has been no increase of frequency of H. duboisii in Africa since the advent of AIDS.
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PMID:Opportunistic infections in AIDS in developed and developing countries. 220 Nov 7


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