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Query: UMLS:C0024530 (malaria)
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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

A pilot safety and immunogenicity trial of the malaria vaccine SPf66 has been undertaken in 150 Gambian infants. No significant systemic side effects were recorded but modest local reactions were seen after the administration of a third 1.0 mg dose. SPf66 produced in Colombia was more immunogenic than SPf66 produced in the USA and a 1.0 mg dose of each vaccine gave higher antibody levels than a 0.5 mg dose. However, antibody levels fell rapidly after administration of the third dose of vaccine and showed little change over the following malaria transmission season. The incidence of clinical malaria was higher among children who received SPf66 than among children who received inactivated polio vaccine, the effect being most marked among children who received 1.0 mg Colombian SPf66. As the trial was not designed to measure the effect of SPf66 on morbidity from malaria, the significance of this finding is uncertain.
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PMID:A pilot safety and immunogenicity study of the malaria vaccine SPf66 in Gambian infants. 750 25

The European-American exchange of infectious diseases was responsible for the demographic havoc of the native population in the New World after 1492. Prior to this date medical writers describe the presence in Spain of viral diseases like influenza, parotitis, smallpox, measles, poliomyelitis, and rabies; there were also rickettsiasis, diphtheria, salmonellosis, plague, tubercolosis, leprosy, malaria, scabies and tinea. In America, before European arrivals, there were no records of human viral diseases, though there were records of rickettsiasis, treponematosis--pinta, yaws and syphilis--leihsmaniasis, amibiasis and perhaps leprosy. With the discovery of America in 1492, Columbus's sailors were contaminated by yaws and spread this disease into Europe. In 1493 influenza, as a zoonosis, was introduced into Santo Domingo and was responsible for the annihilation of the natives of the Antilles in less than a quarter of a century; in 1518 smallpox was also introduced in Santo Domingo and then to the American continent by negro slaves: by the same means measles were introduced in 1531. The previous existence or introduction of other infectious diseases in America is also discussed.
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PMID:The European-American exchange. 752 30

During December 1993 to November 1994, in the Upper River Division of The Gambia, 630 infants aged 6-11 months at time of first dose received three doses of malaria vaccine SPf66 or injected polio vaccine (IPV) and were followed up at home during the rainy season using active and passive case detection methods to determine the protective efficacy of SPf66 against clinical episodes of malaria due to Plasmodium falciparum. The researchers were able to use data on only 547 children (316 SPf66/231 IPV) to determine efficacy. The definition of clinical malaria was fever (37.5 degrees Celsius or higher) and a parasite density of at least 6000/mcl. The two groups were essentially the same in terms of mortality, health center admissions, parasite rates, or any other index of malaria. Health workers identified 347 clinical episodes of malaria during the three months of surveillance. SPf66 vaccine had a protective efficacy against first or only clinical episode of malaria of 8% (p = 0.5). Its protective efficacy was 3% against all clinical episodes of malaria. The results of this trial were different than those from earlier reports on SPf66 efficacy from South America and Tanzania. Possible reasons accounting for the different findings were a mistake in coding syringes for the third dose, substantially less intensity of malaria infection in The Gambia than South America, younger children in The Gambia than in Tanzania, genetic differences in the populations, and difference in length of follow-up. In conclusion, protection against malaria during the rainy season after immunization with SPf66 vaccine in infants aged 6-11 months did not occur.
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PMID:Efficacy trial of malaria vaccine SPf66 in Gambian infants. 749 Oct 59

Immune response of infants vaccinated under Expanded Programme on Immunization (EPI) was evaluated for measles, poliomyelitis, and tuberculosis in Ifo/Otta area of Ogun State and Badagry area of Lagos State, Nigeria. In the prevaccination evaluation of measles antibody, 59 per cent were protected and 41 per cent were at risk in Ifo/Otta area, while 49 per cent were protected and 51 per cent were at risk in the Badagry area. After measles vaccination, 89 per cent of those evaluated seroconverted and 11 per cent did not in Ifo/Otta area, while in Badagry area, 86 per cent of those evaluated seroconverted and 14 per cent did not. For polio neutralizing antibody evaluated at post-immunization, 91 per cent seroconverted, while 9 per cent did not in Ifo/Otta area, while in Badagry area 66 per cent seroconverted and 34 per cent did not. Tuberculin test was used to evaluate the cellular response to BCG vaccination against tuberculosis. 64 per cent were found protected, while 18 per cent were at risk in both areas examined and 18 per cent dropped out. Using Gomez method to evaluate the nutritional status of the infants, 34 per cent were malnourished in Ifo/Otta area and are mostly immigrants. In Badagry area, 53 per cent were normal while 47 per cent were malnourished and most of the malnourished infants were plagued with diarrhoea, severe cough, high fever or malaria infection. Most of the malnourished in the two areas screened were between 9 and 18 months of age, which is the crucial period in the growing stage of the children.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evaluation of immune response in infants with different nutritional status: vaccinated against tuberculosis, measles and poliomyelitis. 785 39

International travels are increasingly frequent. Beside malaria prophylaxis, the general practitioner will review several vaccinations.e Tetanus and poliomyelitis vaccines should be administered once every ten years. It will often be useful to give a protection against hepatitis A, and less often, against typhoid fever. The yellow fever vaccine, which may be required or recommended to visit several African and South American countries, is injected only by officially recognised centres. For some travels, vaccination against hepatitis B, meningococcal meningitis or, rarely, against rabies may be considered. The vaccine against cholera will never be administered, due to its lack of efficacy and high frequency of side effects. Travellers diarrhoea will be discussed, and a "pocket" treatment prescribed. Finally, general information will be provided, including those on STD.
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PMID:[Vaccinations and useful advice for travelers]. 793 82

Despite improvements in infant mortality, 500,000 infants die every year in the Americas. In Costa Rica, child mortality dropped from 68/1000 live births in 1970 to 20/1000 in 1980 as a result of improved hygiene and nutrition, immunization, and treatment. In most other countries of the Americas, infant mortality rates have declined substantially mainly because of public health programs. Educational levels of mothers and per capita national product also exert a notable influence on infant mortality. Poverty inflicts health problems: 177 million children are malnourished, and 40% of children in developing countries are undernourished, a state of affairs responsible for almost 60% of infant deaths. Breast-feeding plays a vital role in the first year of life by providing high quality nutrition and immunological protection, and emotional bonding between the mother and the child. Unfortunately, breast-feeding prevalence and duration is on the decline in developing countries. Safe drinking water and good sanitation are crucial in preventing and reducing child mortality. Women who become pregnant at either extreme of the reproductive age are exposed to higher maternal and pediatric risks; so are multiparous women, and women with short birth intervals. Most child deaths between the ages of 1-4 are preventable by health intervention: the main causes are diarrheal and respiratory diseases, malnutrition, and vaccine-preventable infectious diseases. Intestinal infections cause almost 5 million child deaths a year, and oral rehydration therapy is the most effective preventive measure. Vaccination is the most effective means of preventing measles, polio, tetanus, diphtheria, tuberculosis, and pertussis. In many countries, malaria has resurfaced with some 250-300 million new cases every year. Children and pregnant women are especially vulnerable to suffer serious complications. There were a quarter million cases of cholera in the Americas between early 1991 and August, 1992. AIDS is also a threat to child health because of the rising numbers of infected mothers and pregnant women.
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PMID:Children's health in the developing world: much remains to be done. 814 86

The Consultative Group of the Children's Vaccine Initiative (CVI) held its annual meeting at WHO headquarters in Geneva in November 1992. The CVI meeting provided evidence of solid progress in development of a thermostable oral poliomyelitis vaccine and a single-dose tetanus toxoid vaccine. Researchers were able to stabilize the vaccine for several days at 37 degrees Celsius; this could make a more thermostable oral poliomyelitis vaccine available to the public before the end of the decade. One research project had solved the problem of stability of microencapsulated tetanus toxoid at 37 degrees Celsius. Based on recent research, it appears that microspheres for delivery of tetanus toxoid vaccines (of different sizes and/or compositions) can induce long-lasting immunity. The Consultative Group hopes that experts will conduct the industrial development of these vaccines within 3 years. A comprehensive database of the world's capacity to produce children's vaccines is being compiled, and investment strategies will assure that affordable vaccines are available for all children of the world. For the past 13 years, WHO has supported research at the Mahidol University in Bangkok, Thailand, to develop a safe, immunogenic, live, attenuated, tetravalent vaccine against the 4 strains of dengue virus. Formal Phase 1 and Phase 2 clinical trials have proved the vaccine to be safe and immunogenic in humans, thus bringing the Dengue Vaccine Development Project to a successful conclusion. Researchers are preparing to test the vaccine under actual field conditions for its efficacy in preventing dengue and dengue hemorrhagic fever among children in endemic communities. Participants in the Ministerial Conference on Malaria held in Amsterdam, the Netherlands, in October 1992 adopted a World Declaration on the control of malaria which will serve as a blueprint for action in the 1990s for a partnership of malaria-endemic and malaria-free countries.
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PMID:Children's vaccine initiative. 818 73

The itinerary of international travelers will largely determine the amount of pretravel counseling, number of immunizations and type of malaria prophylaxis they will need. The countries visited are also the best predictor of traveler's diarrhea. Only yellow fever and cholera vaccines are required for entry into certain countries; the latter generally given only to satisfy entry requirements. Polio vaccine is important for some areas and is frequently neglected. For most malarious areas, chloroquine once per week is recommended. Mefloquine should be prescribed weekly for travelers going to chloroquine resistant malarious areas. Traveler's diarrhea is best prevented by avoiding high risk foods and beverages. Antibiotics, generally not recommended for prophylaxis, are very effective in treatment. Travelers should be reminded to advise physicians of their travel history during future medical encounters so that otherwise exotic tropical diseases, possibly contracted during travel, may be considered in diagnoses.
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PMID:Counseling the international traveler. Update '93. 831 7

By 1995, measles, mumps, and rubella were eliminated from Finland, acellular vaccines for pertussis were showing great promise, and the global eradication of poliomyelitis by the year 2000 looked possible. The meningococcus was replacing Haemophilus influenzae type b as the main cause of childhood meningitis, and 75 countries were vaccinating their children against hepatitis B. The United States recommended varicella vaccination for children, effective vaccines were available for hepatitis A, and new vaccines for rotavirus and cholera were being tested; malaria and HIV offer a continuing challenge.
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PMID:Update on immunization. 868 May 9


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