Gene/Protein Disease Symptom Drug Enzyme Compound
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Infant and early childhood mortality in Senegal's Sine-Saloum region was investigated through use o f data from a 1982-83 family health survey. The survey involved interviews with 1894 married women 15-44 years of age living in extended family residential units in rural areas. Given evidence of substantial underreporting of early deaths, at least among children born before 1980, an adjustment factor was applied to the survey data. Infant mortality was estimated to be about 113/1000 live births and mortality before age 5 years was 263/1000. Strong mortality differentials, particularly after infancy, were noted according to the 2 socioeconomic variables included in the analysis: type of house and father's occupation. The probability of dying at ages 1-4 years was 50% higher among children living in traditional homes than among those in modern homes as well as among children whose fathers' were engaged in primary sector occupations (farming, livestock, fishing). Infant mortality showed no sex differential, while mortality at ages 1-4 years was 18% higher among females. Diarrheal and respiratory diseases were the 2 leading causes of death, killing at least 15% of all children by 5 years of age. Tetanus was an important cause of death during infancy, while measles and malaria were significant causes only after the 1st birthday. For all causes of death, the effect of socioeconomic status is higher in early childhood than in infancy, presumably because of the protective effect of breastfeeding. 82% of children who died had fever during their terminal illness, 51% had diarrhea, 39% had a cough, and 14% a rash. At least some mortality in this area might be prevented through treatment of these symptoms. However, calculating the degree to which particular interventions such as oral rehydration for diarrhea would reduce mortality is a complex task, requiring knowledge of replacement mortality, effectiveness of interventions, and the numbers of mothers who would utilize them.
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PMID:Infant and early childhood mortality in the Sine-Saloum region of Senegal. 319 59

A review of mortality data from refugee camps in Thailand (1979-80), Somalia (1980-85), and Sudan (1984-85) indicates that crude mortality rates (CMRs) were up to 40 times higher than those for the non-refugee populations in the host countries. In eastern Sudan, approximately 5% of the population of eight camps died in the first 3 months of the emergency and daily CMRs as high as 14 per 10 000 were reported. These rates dropped to values comparable with those of the host country within 6 weeks in the Thai camps; however, in Somalia and Sudan this process took 12 months. Mortality rates among under-5-year olds in the early phases, which were as high as 32.6 per 10 000 per day, are six times greater than those in the world's least developed countries during non-emergency times. Among severely undernourished children in one camp in Sudan, the death rate reached 114 per 10 000 per day. Acute respiratory infections, diarrhoeal diseases, malaria, measles, and undernutrition were the causes of most reported deaths, the majority of which could have been prevented by adequate food rations, clean water, measles immunization, and an oral rehydration programme.
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PMID:An analysis of mortality trends among refugee populations in Somalia, Sudan, and Thailand. 326 Aug 31

Although the prevention of infection through immunization is a central goal of maternal-child health programs in all developing countries, it is important to recognize that the role of vaccines varies greatly from country to country, from infection to infection, and from vaccine to vaccine. Immunization strategies must be as responsive to local disease patterns, needs, and opportunities as to technological advances in the creation, production, storage, and delivery of vaccines. This paper outlines the present state of the art for vaccines against measles, pertussis, poliomyelitis, tetanus, and tuberculosis. Other childhood infections in the tropics in need of a vaccine are the enteric infections, serious bacterial infections, vertically transmitted viral infections, and parasitic infections such as malaria. Immunization technologies related to the cold chain, delivery techniques, and adjuvants are constantly improving. Gains have also been made in outcome evaluation and disease surveillance. Ultimately, the success of the immunization effort depends on community participation and awareness.
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PMID:Recent advances in immunization. 331 42

In 1984 a rare opportunity arose to document the effects of contact on a previously isolated population in Papua New Guinea. The Hagahai, a small group of hunter-horticulturalists, remained hidden from government and mission influence until the early 1980s. Prior to that time, indirect contact through trade with neighboring peoples facilitated the entry of introduced infectious diseases. In late 1983 the Hagahai sought medical aid at a mission station, an event which accelerated their contact with the common epidemic diseases of the highlands. A wide variety of genetic, linguistic, ethnographic and medical data have been collected which document the historical sequence of events contributing to the current rapid demographic decline among the Hagahai. Serological evidence demonstrates the endemicity of Bancroftian filariasis, malaria, C. diphtheriae, cytomegalovirus, HTLV-1, the Ross River arbovirus and several viruses associated with the common cold. Recent epidemics include mumps, influenza A, and hepatitis B. They have not yet been affected by TB or measles, among others. Infanticide contributes to an estimated infant mortality rate of 568/1000. With a crude birth rate of 38 and a crude mortality rate of 51, the Hagahai appear to be dying out. The provision of adequate health care to these people is extremely problematic and beyond the capacity of the existing system.
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PMID:Health in the early contact period: a contemporary example from Papua New Guinea. 339 25

Ethiopia is a country of 45 million people in northeast Africa. With a stagnant, agriculture-based economy and a per capita gross national product of $110 in 1984, it is one of the world's poorest nations. 70% of the children are mildly to severely malnourished, and 25.7% of children born alive die before the age of 5. Life expectancy is 41 years. The population is growing at the rate of 2.9%/year, but only 2% of the people use birth control. After the 1974 revolution, the socialist government nationalized land and created 20,000 peasant associations and kebeles (urban dwellers' associations), which are the units of local government. The government has set ambitious goals for development in all sectors, including health, but famine, near famine, forced resettlement programs, and civil war have prevented any real progress from being made. The government's approach to health care is based on an emphasis on primary health care and expansion of rural health services, but the Ministry of Health is allocated only 3.5% of the national budget. Ethiopia has 3 medical schools -- at Addis Ababa, Gondar, and the Jimma Institute of Health Sciences. Physicians are government employees but also engage in private practice. A major problem is that a large proportion of medical graduates emigrate. Ethiopia has 87 hospitals with 11,296 beds, which comes to 1 bed per 3734 people. There are 1949 health stations and 141 health centers, but many have no physician, and attrition among health workers is high due to lack of ministerial support. Health care is often dispensed legally or illegally by pharmacists. Overall, there is 1 physician for 57,876 people, but in the southwest and west central Ethiopia 1 physician serves between 200,000 and 300,000 people. In rural areas, where 90% of the population lives, 85% live at least 3 days by foot from a rural health unit. Immunization of 1-year olds against tuberculosis, diphtheria-pertussis-tetanus, poliomyelitis, and measles is 11, 6, 6, and 12% respectively. Infectious diseases dominate the medical scene in Ethiopia. In 1984, tuberculosis accounted for 11.2% of hospital admissions and 12.2% of deaths. The leading cause of childhood mortality in 1984 was diarrhea (45%). Malaria, trypanosomiasis, schistosomiasis, leishmaniasis, and meningococcal meningitis are endemic. Intestinal parasitism is rampant, and the nationwide prevalence of leprosy is 3/1000. Venereal diseases were the 9th most common cause of hospital outpatient visits in 1984, but AIDS is rare. The leading noninfectious diseases are rheumatic and syphilitic heart disease, hypertension, diabetes mellitus, hepatoma, and elephantiasis. Ethiopia has the highest number of cases of nonfilarial elephantiasis -- an estimated 350,000 cases -- in the world. Aside from a large influx of money, the most necessary changes to improve the health system are lowering the salaries of doctors and nurses, reorienting physician training toward primary health care, increasing the quality of existing health services, more efficient management, and better coordination between the Ministry of Health and the voluntary organizations.
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PMID:Health and medical care in Ethiopia. 271 Jan 85

General screening investigations with various antigens were carried out with a view to further specific investigations being carried out on the Cape Verde Islands concerning infectious diseases. Serological positive reactions were found in Mumps, Adeno, PLT, Cytomegaly, Herpes, Para-influenza 1, 2, 3, Influenza A and B, Mycoplasmosis, RS-Virus, Gonorrhoea, Hepatitis A and B, R. conori, Malaria, Syphilis, Brucella abortus, Brucella melitensis, Varicella, Legionella, Picornavirus, Measles, German Measles, Listeriosis, Toxoplasmosis and Amoebic dysentery.
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PMID:Serological screenings of various infectious diseases on the Cape Verde Islands (West Africa). 344 44

In serological investigations undertaken in two hospitals in Nigeria a total of 188 blood samples were examined and the following positive reactions for various diseases found: malaria 100%, leishmaniasis 9.5%, biharziasis 2.1%, yersinia 16.4%, Legionella pn. 9%, gonorrhea 6%, syphilis 6.9%, measles 65.4%, rubella 84%, cytomegalic 78.2%, herpes simplex 67%, varicella 30.8%, Resp. sync. virus 34.6%, influenza A 57.4%, influenza B 73.9%, para-influenza 1, 2, 3, 20.7%, 16.5%, 52.6%, adenovirus 25%, Mycoplasma pneumoniae 33.5%.
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PMID:Serological testing of human blood samples for infectious diseases in the Abeokuta and the Minna Hospitals/Nigeria. 344 50

Since 1983, war in Nicaragua has slowed improvements in health which had developed rapidly from 1979-82. The rate of war-related deaths among Nicaraguans now exceeds that of the United States citizens in either the Vietnam War or World War II. Forty-two of the 84 documented war-related casualties among Nicaraguan health workers have been deaths. This high case fatality rate reflects the targeting of health workers by contra troops. The number of staff and services of the public medical system decreased by approximately 10 per cent from 1983 to 1985. Population movements, the establishment of new settlements, and war-related destruction of the primary health infrastructure are associated with recent epidemics of malaria, dengue, measles, and leishmaniasis. The estimated rate of infant mortality in Nicaragua, which had declined from 120 per 1,000 in 1978 to 76/1,000 live births in 1983, has since shown no further decline. Internationally mandated protections enjoyed by civilians and health workers during times of war do not appear to operate in this so-called "low intensity" conflict. Further declines in infant mortality, prevention of epidemics, and improvement in other health indicators will likely await the cessation of military hostilities.
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PMID:Health-related outcomes of war in Nicaragua. 356 59

A goal of a pilot project in Tanzania's Bagamoyo District was to achieve a 30% reduction in mortality due to acute respiratory infection (ARI) in children under 5 years of age in the 1983-86 period. The project utilized village health workers who were trained to refer seriously ill children to dispensaries and to educate mothers on the early recognition of signs and symptoms of infection. To differentiate the impact of the ARI control program from other effects, the district's villages were randomly divided into intervention and control villages; however, control villages received a deployment of trained village health workers in the 2nd year of the project, thereby changing them into phase II intervention areas. In the 1st year (June 1983-June 1984), there were 260 deaths from ARI among children under 5 years (mortality rate, 32.4/1000) in the intervention area compared with 325 deaths (mortality rate, 40.1/1000) in the control area--a significant difference of 19.2%. In the 2nd year (July 1984-June 1985), there were 266 deaths in the intervention area (29.2/1000) and 347 deaths (35.0/1000) in the control area, for a difference of 9.9%. 51% of the deaths recorded in the 2 years for which data are available involved males; 54% occurred during the 1st year of life. The most significant direct causes of death were pneumonia (35%), malaria (23%), diarrhea (14%), and malnutrition (9%), while important indirect causes were measles (12%) and convulsions (10%). Only 33% of deaths in the control area compared with 54% in the intervention area were treated with antibiotics. To strengthen the success of the intervention program, control of diarrheal diseases and malnutrition are being added.
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PMID:Acute respiratory infections in children under five years. Control project in Bagamoyo District, Tanzania. 360 35

The immune response of young Nigerian children to a full course of infant immunizations was studied in relation to their nutritional state at the time of vaccination. No significant correlations were found between anthropometric measurements made at the time of vaccination and the antibody response to triple, polio, measles, meningococcal and typhoid vaccines. Significant correlations were found between serum pre-albumin levels and the response to group A meningococcal polysaccharide vaccine and between serum albumin levels and the response to group C meningococcal polysaccharide vaccine. These correlations may reflect the depressive effect of malaria both on serum albumin and pre-albumin levels and on immune responsiveness to meningococcal polysaccharides. No significant correlations were found between nutritional state at the time of BCG vaccination and the development of a positive tuberculin reaction five weeks later. We conclude that under-nutrition has little or no effect on the immune response to vaccines used in routine infant immunization programmes.
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PMID:The immune response to vaccination in undernourished and well-nourished Nigerian children. 363 2


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