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Query: UMLS:C0024530 (malaria)
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To facilitate understanding of the advances in health care in Nicaragua since 1979, this discussion examines them within a historical framework. Nicaragua was occupied by US marines almost continuously from 1909-33. In 1933, their withdrawal left in power the US backed National Guard and the 1st dictator, Anastasio Somoza Garcia. Health conditions under the Somoza regime are difficult to evaluate because lack of data and underreporting were the norm. The health care system under Somoza was administered by 23 separate agencies, including the National Social Security Institute (INSS), a national Ministry of Health, independent local health ministries, and autonomous public hospital governing boards. On July 19, 1979, the dictatorship was overthrown in a popular uprising. Somoza left behind a foreign debt of 1.6 billion dollars, which the Sandinista Front for National Liberation (FSLN) needed to honor to qualify for needed loans. Following Somoza's defeat, the new government faced the problem of how to care for the tens of thousands of persons wounded and how to distribute the aid and medical supplies coming in from other countries. The key to achieving these tasks was popular participation and organization. By the early part of 1980, the new government was addressing more directly the organization of the health care system. Unlike the fragmented services under Somoza, health care in the new Nicaragua fell under the control of a unified Ministry of Health (MINSA). In 1980, the FSLN initiated an intensive campaign against illiteracy, 100,000 young Nicaraguans, called "brigadistas," were trained and sent around the country to teach basic reading and writing. In addition, 1 out of 10 was trained in elementary health principles. They were responsible for educating others about hygiene and basic sanitation as well as distributing antimalarial medication. 5 popular Health Campaigns were waged during 1981 against polio; measles, diphtheria, pertussis, and tetanus; rabies; poor sanitation; and malaria. Since women and children make up about 75% of the population, maternal and child health is a priority. The Sandinistas' approach to diarrhea and dehydration, a major cause of morbidity and mortality in children, has been the creation of over 200 oral rehydration units. The purpose of these units, in addition to the oral replacement of an appropriate salt and glucose solution, is to educate health care workers about the prevention and treatment of diarrheal disease. The education of health care workers also has been a priority. With increased access to health services, there is a chronic shortage of supplies and personnel and capital to build new facilities. International aid has been very important to health. Diverting funds away from Nicaraguan destabilization and toward social needs here in the US would have a positive impact on health services for the people of both Nicaragua and the US.
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PMID:Health care in Nicaragua: a social and historical perspective. 659 13

A retrospective study of 1,003 children permits us to identify precisely rates and causes of mortality in children under 5 years old in a rural holoendemic malaria area of the People's Republic of the Congo. The mortality rates are distinctly lower than those generally observed in tropical Africa. Infant mortality (0-1 year) was found to be 71%, mortality 13%, early neonatal mortality (0-7 days) 41% and mortality between 1-5 years, 49%. Main causes of mortality are those related to pregnancy (prematurity, obstetrical pathology) and with infectious diseases particularly measles. On the other hand, no death seems to be attributable directly to malaria in this study.
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PMID:[Retrospective study on the mortality of children under 5 in a rural district of the region of Brazzaville (People's Republic of Congo). I. Rate and causes of mortality]. 672 59

Information about practices during childbirth and pregnancy has been obtained by interviewing a sample of 100 Dinka women in 7 villages in the Sudd, Southern Sudan. On an average, the women had 4 or 5 living children, and had lost another 4 in pregnancy, delivery on early childhood. Hard work during pregnancy combined with a low-calorie diet probably account for the frequent abortions. Enteritis, malaria, measles and whooping cough are responsible for high mortality before 5 years of age. Maternal mortality can only be estimated, because the traditional birth attendants, Dugems, are reluctant to admit failure. Cessation of menstruation and changes in the breasts are recognized as signs of pregnancy, but in the calculation of the duration of pregnancy the 1st month is excluded. The husband has intercourse frequently with his pregnant wife to help the child's growth. The fear of cephalopelvic disproportion shows itself in prenatal food taboos: fatty foods and sweets are forbidden during pregnancy to avoid dangerously difficult delivery. The Dugem is called in at the onset of labor, which is recognized by regular abdominal pains. No vaginal examinations are done, and the woman delivers in a squatting position. If delivery is delayed or the placenta is retained, a senior Dugem is called. Breastfeeding, which starts immediately after birth, is continued for between 1 to 3 years. Sexual relations are not resumed until the new baby is weaned. Compared with child birth practices reported from other African countries, the traditions of the Sudd have several good points. Setting up maternal and child health clinics with certified midwives will have to wait until literate women are available for training. Training the Dugems to the limit of their capacity should be done now. Sessions should be organized for the senior Dugems, with emphasis on hygiene and the avoidance of harmful customs.
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PMID:Maternity care in the Sudd, southern Sudan. 672 62

Physicians counseling patients who are planning major travels should make sure that baseline immunizations (diphtheria-tetanus-pertussis, polio, measles, rubella) and any necessary boosters are current. In addition, several other immunizations may be warranted (yellow fever, typhoid, and cholera), depending on destination(s) and itinerary, and prophylaxis for malaria may be advisable. As worldwide requirements for immunization do change, the physician should verify current requirements before planning an immunization schedule for a particular patient.
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PMID:Immunization. Around the world in 80 shots. 682 57

Health care problems are discussed by an employee of the Mozambican maternal and child health service. The most serious problems for children are malnutrition, infectious diseases, and a high incidence of illnesses in children under 5. The main objectives of health centers are to improve hygiene, combat tuberculosis, leprosy, and malaria as well as to provide maternal and child health care, including family planning. Trained staff advise pregnant women, and examine prospective mothers for anemia, malaria, and tetanus. Information on proper nutrition is provided, and every mother gets iron and folic acid pills, in addition to the antimalarial drug choloroquine. Incidences of tetanus in newborns have declined sharply in areas where a vaccination program has been carried out. By classifying the risk level of pregnant women, so-called "risk mothers" can be identified. Family planning methods include low-dose oral contraceptives, IUDs (the "spiral"), condoms, and foam. Regular weighing, examination, and vaccination of children is provided until age 5. Infant mortality is high, at least 150/1000 births, most of which are caused by diseases such as untreated diarrhea and measles. Malnourished children get specialized care, and vaccinations against polio, tuberculosis, diphtheria, tetanus, and measles are compulsory as is administration of chloroquine against malaria. Mobile teams of SMI (maternal-infant service) scan the countryside in remote areas where there is no village health center. Health personnel take a 6-month training course before being placed in charge of a village's hygiene, vaccination, and other tasks. The decline in illiteracy rates has resulted in better health of the population. The shortage of qualified health workers has been eased by an increase in the number of nursing and pediatric health care students. Finally, international assistance extended by the world Health Organization, Swedish-African aid organizations, and SIDA are contributing to the praiseworthy efforts of the Mozambican government to improve maternal and child health.
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PMID:[Big venture to improve children's health]. 692 Sep 76

Sodium concentrations and osmolalities of simultaneously obtained venous blood and urine have been determined in a total of 61 children consisting of 18 children with malaria infection, 18 children with measles infection and 25 age- and sex-matched controls. The mean plasma osmolalities in the malaria and measles groups were significantly lower than in the control group (p less than 0.01). There was no difference between the measles and malaria groups either in their plasma osmolality (p greater than 0.20) or urine osmolality (p greater than 0.10). The u/p ratios for both osmolality and sodium concentrations where significantly higher for both the measles and malaria groups than for the matched controls. There was no difference in the u/p values between the malaria and measles groups (0.02 greater than p greater than 0.10). We conclude from these results that measles and malaria infected children demonstrate inappropriate secretion of ADH. Every child with these conditions should be carefully evaluated for the detection of evidence of SIADH. This is more important for children with measles who are frequently anorexic and may need intravenous infusion for maintenance of hydration.
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PMID:Syndrome of inappropriate antidiuretic hormone (SIADH) in measles and malaria infections. 702 95

Childhood hyperpyrexia is associated with serious infections particularly bronchopneumonia, infective diarrhoea, meningitis, measles, urinary tract infections, otitis media, septicemia and sickle cell crisis Hyperpyrexia was found most in children aged 6-12 months followed by children aged 12-18 months. Hyperpyrexia occurred least in children aged 2-6 months. Febrile convulsion was associated with 38% of the cases. Malaria was a cause of convulsion in 27% of children with fever. This appears to contrast earlier reports by Lennox (1953) and Familusi (1971). The study confirms the rarity of hyperpyrexia in children aged 3 months and under. Deaths recorded were in children brought at the late stages of their ill health. Intensive health education is recommended to obviate unnecessary death of children through ignorance and poor knowledge of simple first aid measures.
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PMID:Childhood hyperpyrexia in Benin City, Nigeria. 709 25

A serological survey in the Gezira area of the Sudan confirmed that malaria and schistosomiasis were highly endemic. Of other parasitic infections amoebiasis was common but Toxoplasma was less than found in a previous survey. Poliomyelitis and measles infection were universal and there was an extremely high incidence of infection with hepatitis B. Of arboviruses infection with flaviviruses was frequent and more than with alphaviruses.
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PMID:A seroepidemiological survey in the Gezira, Sudan, with special reference to arboviruses. 721 4

A method is described for assessing quantitatively the relative importance of different disease problems on the health of a population. The impact of a disease on a community is measured by the number of healthy days of life which are lost through illness, disability and death as a consequence of the disease. The measure is derived by combining information on the incidence rate, the case fatality rate and the extent and duration of disability produced by the disease. In Ghana, it is estimated that malaria, measles, childhood pneumonia, sickle cell disease and severe malnutrition are the 5 most important causes of loss of healthy life and between them they account for 34% of healthy life lost due to all diseases. The methodology may be used to help determine the priorities for the allocation of resources to alternative health improvement procedures by estimating the number of healthy days of life which are likely to be saved by different procedures and by relating these savings to the costs of the procedures.
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PMID:A quantitative method of assessing the health impact of different diseases in less developed countries. Ghana Health Assessment Project Team. 723 65

Between 1975 and 1983 health care expenditures in Ghana dropped to a low point as a consequence of the structural readjustment program instituted by the World Bank. During 1975-76 only 15% of available funds were spent on primary health care (PHC), which was officially introduced in the late 1970s. PHC made up 20-25% of the health care expenditures by 1991 with about 25% of health personnel engaged in PHC. 2/3 of health care delivery covered urban areas when 60% of the population lived in the countryside. The district of Ejisu-Juaben in the Ashanti region had high morbidity. Tetanus, polio, whooping-cough, and diphtheria had been brought under control, but measles, diarrhea, and malnutrition were still widespread among children under 5 years old. Malaria, bilharzia, intestinal parasites, respiratory infections, hepatitis, anemia, hypertension, and vitamin A deficiency were also grave problems. AIDS was on the rise. Child mortality amounted to 130/1000 live births and maternal mortality to 1400/100,000 cases. The medical structure of the district comprises 10 health posts (6 governmental and 4 mission). Only 72 villages and 120,000 people are cared for. Each post has a mobile team. In 1993 a new community-based health care program began funded by Save the Children Netherlands. In 60 villages a village health committee existed but they were substandard. They were either reactivated or new committees were set up. Training activities were also started in prenatal care, delivery, care of malnutrition and diarrhea, hygiene, and sanitation. Two years later safe motherhood indicators had improved; postnatal care increased from 16% to 49%; medical deliveries increased from 27% to 37%; the share of families with contraceptive acceptance increased from 7% to 21%; and tetanus vaccination among mothers was estimated to have increased from 27% to 86%.
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PMID:[Primary health care in Ghana: no pay no cure?]. 750 Oct 68


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