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Query: UMLS:C0024530 (malaria)
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Health care in Nicaragua has drastically deteriorated since the United Opposition (UNO) came to power in April of 1990. During the previous decade, when the Sandinistas were in power, Nicaragua saw vast improvement in primary health care. The number of auxiliary health workers, including birth attendants and hygiene and nutrition advisors, increased significantly. With the aid of volunteers, vaccination campaigns succeeded in eradicating polio and in greatly reducing the incidence of measles, tetanus, and typhoid. Malaria and diphtheria were also drastically reduced. But these days, vaccination campaigns have failed to take place or to reach the intended audience, and health clinics have been short on supplies. As a result, the last 6 months have seen a recurrence of all the diseases, some in the form of epidemics. As the new Nicaraguan health minister, Dr. Salmeron, explains, 1300 children have died over the last 8 months due to an outbreak of measles. Furthermore, he says, many more children are ill due to a lack of inoculation or oral rehydration solutions. Salmeron, a middle-of-the-road private practitioner, has been critical of the new government's health policies. The government has said it will close local clinics so that it can concentrate health care in 12 "centers of excellence" -- but these hospitals have yet to appear. Furthermore, not only has the Chamorro government failed in its pledge to bring inflation down to 0, it hasn't been able to stop it from climbing to 100%.month. Health authorities have not received their monthly budgets, there are medicine and supply shortages, and patients are having to share beds. As Salmeron points out, the new government is abandoning one of the most successful health care systems in the Third World.
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PMID:Whither Nicaragua? 226 27

In a clinical trial of stabilized yellow fever vaccine from Institute Pasteur in 77 children aged seven to eight months, fever was the most significant immediate and delayed side effect. Fever occurred in 12 (15.6%) children with in 48 hours of vaccination while it occurred in 10 (12.9%) children within ten days of vaccination. Other recorded side effects were pain at innoculation site in four (5.2%) children and vomiting in one (1.3%) child. Temperature recorded in 20 of the 22 febrile episodes ranged from 37.8 degrees C to 38.6 degrees C. One of the two patients who had temperatures of 39 degrees C and above had malaria parasites in her blood film. All episodes of fever except one responded to antipyretic. There was no episode of febrile convulsion and no feature suggestive of encephalitis. Of the 20 children who had neutralization test carried out against yellow fever virus six weeks after vaccination, the test was positive in post vaccination sera of 12 (60%) children whose pre-vaccination sera were negative. Two others showed evidence of partial protection. Although the seroconversion rate of 60% is less than reported in adults and older children, the result of this study shows that yellow fever vaccine is safe and fairly effective in infants. It is our suggestion that if a larger trial confirms our findings, the vaccine may be incorporated into the expanded programme on immunization (EPI) to be given at the age of seven months after completion of diptheria, tetanus, pertussis and poliomyelitis vaccinations and before measles vaccination is due.
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PMID:Safety and efficacy of yellow fever vaccine in children less thanone-year-old. 227 33

The vitamin A status of 454 pre-school age Congolese children was evaluated by the impression cytology method with transfer (ICT) and by the determination of plasma retinol. The absence of goblet cells and the presence of enlarged epithelial cells indicate a peripheral deficit of vitamin A. A level of plasma retinol lower than 10 micrograms/dl is an indicator of vitamin A deficiency. The subjects were children in good health or suffering from malaria, measles or various infectious diseases. Advantages, disadvantages, sensitivity and specificity of the ICT are discussed. We suggest its use in a mass screening program for vitamin A deficiency in developing countries.
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PMID:Vitamin A deficiency in pre-school age Congolese children during malarial attacks. Part 1: Utilisation of the impression cytology with transfer in an equatorial country. 227 77

Data of pediatric patients screened for HIV-1 infection between 1985 and 1989 were studied retrospectively in one of the major mission hospitals of Kampala (Uganda). Symptomatic HIV-1 infection was mainly acquired perinatally and was diagnosed in 87 per cent in children under 2 years of age. The mortality rate was 40 per cent in pediatric in-patients with symptomatic HIV-1 infection as compared to 12 per cent in overall pediatric inpatients. Symptoms included in the WHO clinical case definition for pediatric AIDS were mainly insensitive, unspecific and demonstrated a low positive predictive value. There was no difference in the prevalence of malaria and measles between HIV-1 positive and HIV-1 negative children.
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PMID:Pediatric HIV-1 disease in a Kampala Hospital. 228 Apr 34

More than 30 million refugees and internally displaced persons in developing countries are currently dependent on international relief assistance for their survival. Most of this assistance is provided by Western nations such as the United States. Mortality rates in these populations during the acute phase of displacement have been extremely high, up to 60 times the expected rates. Displaced populations in northern Ethiopia (1985) and southern Sudan (1988) have suffered the highest crude mortality rates. Although mortality rates have risen in all age groups, excess mortality has been the greatest in 1- through 14-year-old children. The major causes of death have been measles, diarrheal diseases, acute respiratory tract infections, and malaria. Case-fatality ratios for these diseases have risen due to the prevalence of both protein-energy malnutrition and certain micronutrient deficiencies. Despite current technical knowledge and resources, several recent relief programs have failed to promptly implement essential public health programs such as provision of adequate food rations, clean water and sanitation, measles immunization, and control of communicable diseases. Basic structural changes in the way international agencies implement and coordinate assistance to displaced populations are urgently needed.
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PMID:Prevention of excess mortality in refugee and displaced populations in developing countries. 234 41

WHO's "Health for All by the Year 2000" gives as subsidiary objective number 5 "The elimination of measles, poliomyelitis, neonatal tetanus, congenital sequelae of rubella, diphtheria, congenital syphilis and malaria from the European region by the year 2000". This would be attained by a well organized primary care which guarantees effective epidemiological supervision, a vaccination programme with full support, instruction on the risks associated with syphilis, and screening and eventual treatment of pregnant women. It was earlier declared in Norway that congenital rubella should not occur after 1990. Vaccination is carried out; rubella has long been a notifiable disease, and the incidence thereof in females over the age of 15 years is registered in order to ascertain why and how women are nevertheless infected thereby.
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PMID:[Rubella monitoring in Norway]. 236 93

The impact of malarial infection on the humoral immunological response to measles virus antigen was studied in 184 children aged 8-19 months in Guinea-Bissau. Pre- and post-immunization measles serology was performed using dried blood on absorbent paper and the ELISA technique. Blood smears obtained at the time of vaccination and 2 and 4 weeks afterwards were examined for malaria parasites. Pre-vaccination antibodies to measles were found in 44 out of 184 children (24%). Plasmodium falciparum was identified in 62 of the 132 initially non-immune children who completed the study. The rate of seroconversion was 127 out of 132 (96%). Post-immunization measles antibody titres were significantly higher in the vaccinees with P. falciparum than in those without malaria parasites in the blood.
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PMID:Augmented antibody response to live attenuated measles vaccine in children with Plasmodium falciparum parasitaemia. 242 25

The registry of patients at the hospital of Kampene, Zaire, covering the period 1986-87 was examined to determine the hospital's rate of utilization and accessibility, to evaluate mortality, and to ascertain the prevalence of infectious diseases. The 1986 data of the hospital laboratory indicated a high incidence of infectious and parasitic diseases: ancylostomiasis (33.6%); ascariasis (22.9%); schistosomiasis (3.4%); multiple intestinal parasitic infections (10.9%); malaria (43%), often chloroquine-resistant; filariasis (70.8%); and alcohol-acid resistant tuberculosis bacilli (15%). Sexually-transmitted diseases such as vaginitis (80%) were caused by polygamy, prostitution, and promiscuity, HIV serodiagnosis could not be performed because of a lack of equipment. A high infant mortality rate was caused by neonatal tetanus, toxic gastroenteritis, measles (5.1% lethality: 2 died out of 39 cases), and epidemic cerebrospinal meningitis. Malnutrition caused kwashiorkor and avitaminosis. 792 births were registered at the maternity ward in 1986: 52.8% were male and 47.2% were female; 48 (6.1%) were stillborn or died in the following days; 104 (13.1%) were born prematurely; and 24 (3.1%) were twins. Cesarean section was performed in 43 cases (5.4%). There was a total of 15,099 outpatient visits during a 1-year period. The bed occupancy rate of the surgical ward ranged between .7 and .8 during 1987. Recovery and hospitalization days per doctor or health assistant were very high compared to Italian standards. The lethality of malaria was a high 1.8%, but malnutrition rated even higher: 21.4%. The utilization of the hospital was high, Maternal-child protection measures, especially in the area of nutrition, require the training of community health workers and traditional birth attendants; however, cost-benefit considerations limit resources and the implementation of primary health care is curtailed by economic and cultural factors.
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PMID:[Health care organization and health in a region of Zaire]. 248 74

Nearly 40 million journeys abroad were recorded from the Federal Republic of Germany last year. 60-70% of travellers going to southern countries seek medical advice for preventive measures, particularly in Public Health centres. Inquiries for vaccinations are prevalent. Current aspects of immunization against yellow fever, cholera, tetanus, polio, typhoid fever, hepatitis A, hepatitis B, rabies meningococcal meningitis, European tick-borne encephalitis, measles and tuberculosis are discussed. Finally, some remarks on malaria prevention, hygiene, health insurance and information services are given in brief.
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PMID:[Preventive health care in travel, especially vaccinations]. 253 28

This paper provides a detailed analysis of the survival rates and health problems of a cohort of children born during a 5-yr period in part of the city of Ilorin, Nigera. The findings are linked to a demographic and environmental study which indicates that the study area was relatively stable in terms of family structure and population turnover. Most people work in the informal sector, in trading, small scale crafts and service industries. At the time the survey began, in 1979, the provision of piped water supplies to the area was unreliable and sanitation provisions rudimentary. Most of the people had little or no formal education and were very poor. The study indicated that health status had improved over the 5-yr period, compared to a baseline study conducted in 1979. Common causes of child mortality and morbidity included diarrhea, acute respiratory infections, measles, and malaria. The infant mortality rate was 41.5/1000. The availability of clinic care at nominal cost, and the attendance of mothers at the clinic for checkups and immunization, resulted in a higher level of health for their children than otherwise would have been possible. Some problems of primary health care in the area are mentioned, in the light of Nigeria's current budgetary problems, and the utilization of existing strong social support networks to improve health care and environmental sanitation and water supply is suggested.
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PMID:Child health and child care in Okelele: an indigenous area of the city of Ilorin, Nigeria. 262 17


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