Gene/Protein Disease Symptom Drug Enzyme Compound
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This study shows that a total of 36 notifiable diseases account for nearly all the reported deaths in Nigeria. When ranked by magnitude, measles, malaria, pneumonia, tetanus, dysentery and tuberculosis together account for 85% of all deaths. The objective of this paper is to gain an insight into the geographical distribution of deaths arising from these six leading diseases using the administrative states as the spatial framework. The data were obtained from the Statistical Unit of the Federal Ministry of Health and the emerging pattern of mortality is highlighted. An attempt is also made to identify factors that explain the observed variations among the states and the contiguous geographical regions in the country.
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PMID:Spatial distribution of mortality from leading notifiable diseases in Nigeria. 851 11

The American Civil War represents a landmark in military and medical history as the last large-scale conflict fought without knowledge of the germ theory of disease. Unsound hygiene, dietary deficiencies, and battle wounds set the stage for epidemic infection, while inadequate information about disease causation greatly hampered disease prevention, diagnosis, and treatment. Pneumonia, typhoid, diarrhea/dysentery, and malaria were the predominant illnesses. Altogether, two-thirds of the approximately 660,000 deaths of soldiers were caused by uncontrolled infectious diseases, and epidemics played a major role in halting several major campaigns. These delays, coming at a crucial point early in the war, prolonged the fighting by as much as 2 years.
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PMID:Infectious diseases during the Civil War: the triumph of the "Third Army". 851 69

A 27-year old female from Nairobi was admitted to the medical wards of the Kenyatta National Hospital in May 1991. She presented with a 4-week history of productive cough, fever, weight loss, and night sweats. She acknowledged a history of contact with a patient known to have pulmonary tuberculosis. She has never received a blood transfusion. She was single and para 3 + 0. Examination revealed a sick patient, with moderate pallor, fever of 38 degrees Celsius, and who was wasted with moderate dehydration and oral thrush. There was no finger clubbing, lymphadenopathy, or pedal edema. Chest examination revealed bilateral basal pneumonia. The spleen was palpable 4 cm below the costal margin; the liver was not enlarged. The rest of the examination was normal. On admission, complete blood count showed a haemoglobin of 5.4 g/dl, total white cells were 12.5 x 10-9/L, with 82% polymorphonuclear cells and 18% lymphocytes, erythrocyte sedimentation rate (ESR) was 85 mm/hour, and platelet count was normal. The anemia was normocytic, normochromic, and no malaria parasites were seen. Urea and electrolytes and liver function tests were normal. Sputum showed no acid fast bacilli on Ziel-Neelson Stain. HIV-1 antibodies were positive by enzyme-linked immunosorbent assay (ELISA) and Western blot. Bone marrow aspirate revealed a hypercellular marrow with reversed M:E ration, dyserythropoesis, reticulum cell hyperplasia, plentiful golden yellow pigment, and clumps of Histoplasma capsulatum. Chest X-ray showed bilateral basal pneumonia. She was treated with antibiotics and intravenous fluids, but she remained febrile, her general condition progressively deteriorated, and she died a week after admission. Treatment for histoplasmosis had not been commenced, and no postmortem examination was carried out.
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PMID:Disseminated histoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS): a case report. 851 33

The seroprevalence of HIV-1 and in-patient mortality in children with common pediatric illnesses was studied. Between October 1990 and July 1991 at the Department of Paediatrics and Child Health, University Teaching Hospital (UTH), Lusaka, Zambia, mothers of all pediatric admissions were interviewed and counselled for enrollment of their children into the study. Of a total of 1323 children seen, 1266 children (600 female and 666 male) were enrolled into the study. Pneumonia (28 per cent), malaria (24 per cent), malnutrition (18 per cent), and diarrhoea (10 per cent) constituted over 80 per cent of the total admission diagnoses. Tuberculosis (5 per cent) was the fifth commonest cause of admission (61 out of 1266 children). A total of 354 out of the 1266 (28 per cent) children were found to be seropositive for HIV-1 compared to a seroprevalence rate of 9 per cent in children attending accident and emergency for traumatic injuries (P=0.001). High HIV-1 seroprevalence rates were found in children with tuberculosis (69 per cent), malnutrition (41 per cent), pneumonia (28 per cent). and diarrhoea (24 per cent). The overall mortality in hospital among HIV-seropositive children (19 per cent) was significantly higher than those who were HIV-seronegative (9 per cent) (P = < 0.0001).
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PMID:Impact of the human immunodeficiency virus type-1 on common pediatric illnesses in Zambia. 860 43

The study, which is based on data from a household level health survey conducted in early 1993 in the rural areas of the districts of Western Area and Port Loko of Sierra Leone, examines the coverage of an Expanded Program on Immunization (EPI), infant and child mortality, and disease symptoms in children who died under age five in the study area. The results of the study indicated that the infant and child mortality rate per thousand live births declined from about 162 in the mid 1980s to about 77 in 1993. This decline was associated with immunization coverage which considerably increased by 1993, reaching as high as above 60% of the eligible children. The study further reveals that the major symptoms of disease at the time of death of an infant or a child were fever, cough, troubled breathing, and diarrhea in that order. While fever and cough could reflect the persistence of malaria and pneumonia-two major causes of infant and child deaths not covered by existing EPI-the study also revealed that many children failed to take full doses of immunization. Similarly, inadequate coverage of domiciliary oral rehydration therapy (ORT) might have been the reason of high incidence of diarrhea-related deaths. Simple medical technologies to eliminate many of the existing major causes of infant and child mortality in rural Sierra Leone are now available. Perhaps, a strengthened primary health care service, including an extensive rural health care network, aimed at eliminating these diseases, would go a long way in reducing infant and child mortality to irreducible minimum.
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PMID:Immunization coverage and child mortality in two rural districts of Sierra Leone. 877 43

Diarrhoea, pneumonia, measles, malaria and malnutrition account for more than 70% of deaths and health facility visits among children under 5 years of age in developing countries. A number of programmes in WHO and UNICEF have developed an approach to the integrated management of the sick child, which is being coordinated by WHO's Division for the Control of Diarrhoeal and Acute Respiratory Disease. Integrated clinical guidelines have been developed and a training course for health workers in outpatient (first level) health facilities has been completed. In addition to case management of these diseases, the course incorporates significant prevention of disease through promotion of breast-feeding, counselling to solve feeding problems, and immunization of sick children. Other materials to train and support health workers are also being developed: an inpatient case management training course, medical school curricular materials, a drug supply management course, and materials to support monitoring and reinforcement of skills after training. A planning guide for interventions to improve household management of childhood illness is also being developed. Since management of the sick child is a cost-effective health intervention, which has been estimated to have a large impact on the global burden of disease in developing countries, the completion of these materials and their wide implementation should have a substantial impact on child mortality.
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PMID:Integrated management of the sick child. 890 67

Verbal autopsy uses a caretaker interview to determine the cause of death. We conducted a study of the major causes of child death in Namibia to determine the validity of this method. A questionnaire, including signs and symptoms of the diagnoses of interest was administered to the caretaker in 135 deaths of children < 5 years old who were identified from hospital records. The 243 diagnoses included malnutrition (77), diarrhoea (73), pneumonia (36), malaria (33), and measles (24). Sensitivity and specificity of various algorithms of reported signs and symptoms were compared to the medical diagnoses. An algorithm for malnutrition (very thin or swelling) had 73 per cent sensitivity and 76 per cent specificity. An algorithm for cerebral malaria (fever, loss of consciousness or convulsion) had 72 per cent sensitivity and 85 per cent specificity, while for all malaria deaths the same algorithm had low sensitivity (45 per cent) and high specificity (87 per cent). For diarrhoea, loose or liquid stools had high sensitivity (89 per cent), but low specificity (61 per cent). Cough with dyspnoea or tachypnoea had 72 per cent sensitivity and 64 per cent specificity. An algorithm for measles (age > or = 120 days, rash) had 71 per cent sensitivity and 85 per cent specificity. The study results suggest verbal autopsy data can be useful to ascertain the leading causes of death in childhood, but may have limitations for health impact evaluation.
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PMID:Validation study of a verbal autopsy method for causes of childhood mortality in Namibia. 900 66

Data collected from 200 children admitted to a hospital on the Kenyan coast who met a broad definition of severe acute respiratory infection (ARI) indicated that simple clinical signs alone are unable absolutely to distinguish severe ARI and severe malaria. However, laboratory data showed that marked differences exist in the pathophysiology of unequivocal malaria and unequivocal ARI. Children in the former group had a higher mean oxygen saturation (97 vs. 94, P < 0.001), mean blood urea level (5.3 vs. 1.9 mmol/L, P < 0.001) and geometric mean lactate level (4.5 vs. 2.1 mmol/L, P < 0.001), and lower mean haemoglobin level (5.3 vs. 9.0 g/dL, P < 0.001) and base excess (-9.4 vs. -2.6, P < 0.001) than those in the latter group. Using these discriminatory variables it was estimated that up to 45% of children admitted with respiratory signs indicative of severe ARI probably had malaria as the primary diagnosis. Radiological examination supported this conclusion, indicating that pneumonia characterized by consolidation was uncommon in children with respiratory signs and a high malarial parasitaemia (> or = 10,000/microliters). There is no specific radiological sign of severe malaria. In practice, all children with respiratory signs warranting hospital admission in a malaria endemic area should be treated for both malaria and ARI unless blood film examination excludes malaria. In those with malaria and clinical evidence of acidosis, but no crackles, antibodies may be withheld while appropriate treatment for dehydration and anaemia is given. However, if clinical improvement is not rapid, antibiotics should be started.
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PMID:Clinical overlap between malaria and severe pneumonia in Africa children in hospital. 901 8

The antimicrobial spectrum of azithromycin and clarithromycin suggests a number of further uses for these newer macrolides. Favorable clinical and bacteriologic responses have been reported with both antibiotics in children with community-acquired pneumonia. Response rates were high for overall patient populations and for subgroups with infection caused by Mycoplasma pneumoniae and Chlamydia pneumoniae. Treatment with azithromycin or clarithromycin has resulted in a reduction in mycobacteremia and an improvement in clinical symptoms in adult AIDS patients with disseminated Mycobacterium avium-intracellulare complex. Prophylactic treatment with azithromycin may prevent M. avium-intracellulare complex, especially when combined with rifabutin. Preliminary evidence suggests that both azithromycin and clarithromycin in multidrug combinations may effectively eradicate Helicobacter pylori and that azithromycin may be useful in treating bacterial gastritis caused by Campylobacter species. Trachoma and infections caused by Bordetella pertussis and Ureaplasma urealyticum are other possible future indications for the newer macrolides. Limited clinical evidence also suggests that azithromycin may be effective in the prevention and treatment of malaria.
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PMID:Future indications for macrolides. 910 59

During US military operations in Somalia, mefloquine, a drug for malaria chemoprophylaxis, was not approved for use in pregnant women. Some female soldiers inadvertently used mefloquine before becoming aware of their pregnancy. A registry was established to follow the outcomes of these pregnancies. Questionnaires were administered at the time the pregnancy was diagnosed, after termination or delivery, and at 1 year after birth. Seventy-two soldiers were eligible for the registry. There were 17 elective abortions, 12 spontaneous abortions, 1 molar pregnancy, and 23 live births. The outcome for 19 soldiers was unknown. An unexpected high rate of spontaneous abortions was observed. All infants were healthy at birth, with no major congenital malformations. One infant died at 4 months of viral pneumonitis. At 1 year of age, 13 infants were reported to be healthy, with normal cognitive and motor development. This study provides additional postmarketing data that mefloquine does not cause gross congenital malformations.
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PMID:The effects of inadvertent exposure of mefloquine chemoprophylaxis on pregnancy outcomes and infants of US Army servicewomen. 929 47


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