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Iron deficiency is prevalent in childhood in the developed and developing countries. Programs of presumptive therapy, mass supplementation and food fortification have been introduced in many countries. The unresolved debate over the interaction of iron and infection in the clinical setting prompts re-evaluation of these practices. Situations of iron overload are associated with increased susceptibility to certain infections, although the exact mechanisms may vary with the main pathology. Iron treatment has been associated with acute exacerbations of infection, in particular malaria. In most instances parenteral iron was used. In the neonate parenteral iron is associated with serious E. coli sepsis. In one country, with endemic malaria, parenteral iron was associated with increased rates of malaria and increased morbidity due to respiratory disease in infants. In contrast in non-malarious countries studies of oral iron supplementation have if anything shown a reduction in infectious morbidity. Methodological problems in the latter reports indicate the need for further controlled prospective studies with accurate morbidity recording if informed recommendations are to be made.
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PMID:Iron and infection: the clinical evidence. 187 85

As part of a multi-disciplinary research programme undertaken by the Papua New Guinea Institute of Medical Research near the town of Madang, northern PNG, a three-year study of mortality was conducted in a rural population of approximately 16,500 people. From early 1982 the area was under continuous demographic surveillance which continued for the three years of the study. All deaths which occurred in this period were investigated by interviewing relatives of the deceased and examining any available health service records. Respiratory diseases were the commonest cause of death, with pneumonia accounting for 20% of deaths in children under 10 years of age, and pneumonia and chronic obstructive lung disease (COLD) together accounting for a third of all deaths. Deaths from COLD were more common in the study population than in PNG hospitals and health centres. The proportion of deaths caused by malaria in children under 10 years was estimated to be between 4 and 17%. Mortality rate in the first year of life were determined by following up a cohort of 1015 births occurring in the first 20 months of the study. Of the 1002 live births, 46 died in the first 12 months of life, giving an infant mortality rate of 45.9% live births. Other mortality and demographic rates were consistent with data reported from the 1980 PNG National Census, suggesting that the study population belonged to an advantaged rural area. Demographic features found in this population were a high birth rate, a relatively low crude death rate, and a rate of natural population increase of 2.8% per annum. The methodological difficulties associated with the measurement of malaria mortality have important implications for the evaluation of future malaria vaccines. The methods employed in this study are critically discussed, and recommendations made for future studies.
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PMID:Mortality in a rural area of Madang Province, Papua New Guinea. 260 69

The mean annual rate of decline of the probability of dying 5 years of age in developing countries is 2.5%. Nevertheless disease accounts for a considerable proportion of premature deaths. The leading causes of death in these countries, in order, include respiratory disease, diseases of the circulatory system, low birth weight, diarrhea, measles, injuries, malnutrition, and neoplasms. These conditions represent diseases of poverty and affluence. Respiratory infections are common among 5-year old children and cause a high proportion of child deaths. Circulatory diseases tend to be limited to adults. Control of hypertension, diet, smoking prevention, and exercise can prevent circulatory diseases. The risk of dying in infancy and childhood and of developmental disabilities is higher among low birth weight infants than those who weigh 2500 gm. In Bangladesh, 50% of infants weight 2500 gm. Low birth weight is the underlying cause of death for many infants who die of respiratory infections and diarrhea. Oral rehydration can successfully treat most diarrhea cases. Malnutrition and diarrhea tend to occur together and feed off each other. In fact malnourished people are more susceptible to all infections. Malnourished children suffer from disabilities in development and growth. The greatest sufferers of measles are infants and malnourished children. Immunization of all =or 9-month old infants would eradicate measles. Children and young adults are at the highest risk of injuries. Lung cancer is on the rise in developing countries due to the increase of tobacco smoking. Various means of controlling malaria are use of mosquito nets, antimalarial drugs, reduction of mosquito breeding places, and pesticides. The new infectious disease, AIDS, has emerged as a considerable health problem in developing countries. High priority research areas are vaccines for Streptococcus pneumonia, Plasmodium app., rotavirus, Salmonella typhi (Ty21a), and Shigella spp.
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PMID:Disease problems in the Third World. 269 79

The "Health Transition" describes the medical consequences which accompany the demographic transition and development. In many Asian countries, as the infectious diseases of infancy decline, such as diarrhea, acute respiratory disease, measles and malaria, so too, do infant mortality rates. As a consequence of falling infant mortality rates and declines in fertility, the age pyramid has become more rectangular. No longer is nearly half of the population under the age of 15 years. Diseases of adults are beginning to become predominant: trauma, heart disease, cancer, stroke and diabetes. Life expectancy has increased along with costs of the health care system. As a fraction of per capita gross domestic product, health care is beginning to become a major national expense. It is ironic that the one vector-borne infectious disease likely to bridge the health transition in tropical countries is dengue. As evidenced by the experience of Singapore and Taiwan, modern housing and commercial development provide more, rather than fewer breeding places for Aedes aegypti. Greater affluence often means less compliance with mosquito control programs. Meanwhile, the dengue viruses, heeding some unknown genetic imperative, cause ever more severe disease. Modern Asian societies must count dengue as a real and enduring threat. To prevent costly hospitalizations and a sense of social disorder, effective measures must be adopted to achieve a significant reduction of Aedes aegypti populations. Sustained dengue control requires source reduction which, in turn depends upon imaginative leadership, skilled man power, legislative authority, an authentic national research program and intersectoral cooperation. A leadership role beckons for new actors in the control of Aedes aegypti: large municipalities, environmental agencies and the private sector.
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PMID:Dengue in the health transition. 784 46

Two thousand eight hundred ninety-eight children younger than 5 years old were investigated during a 2-year period in a rural area of The Gambia for possible pneumonia, meningitis or septicemia. After clinical examination and appropriate investigations, 1014 children were diagnosed as having pneumonia, 31 as having meningitis and 100 as having septicemia. Nine hundred seven children had a final diagnosis of malaria including 702 who satisfied the World Health Organization criteria for a diagnosis of pneumonia. A bacterial etiology was established in 115 (11%) patients with a final diagnosis of pneumonia, in 25 (81%) with meningitis and in 29 (29%) with suspected septicemia. Overall the pneumococcus was the leading pathogen identified among children with pneumonia and meningitis and ranked third among those with septicemia. However, during the wet season, when malaria transmission was highest, 50% of blood culture isolates obtained from children satisfying the World Health Organization criteria for a diagnosis of pneumonia were Salmonella or coliform species, and the pneumococcus and Haemophilus influenzae type b accounted for only 43% of isolates. Thus enteric bacteria may be as important as those bacteria more usually associated with respiratory disease among children presenting with a clinical picture of pneumonia during the wet season. This finding has important implications for case management and surveillance for antibiotic resistance.
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PMID:Importance of enteric bacteria as a cause of pneumonia, meningitis and septicemia among children in a rural community in The Gambia, West Africa. 819 May 37

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

Protozoa of the phylum Apicomplexa, including the genera Plasmodium, Babesia, Toxoplasmosis, and Cryptosporidium, are a group of closely related organisms that seldom cause pulmonary disease. All but Babesia are members of the subclass Coccidiasina ("Coccidians"). (The fungal organism Coccidioides immitis, a frequent cause of pulmonary disease in endemic areas, was first believed by Rixsford and Gilchrist to be a member of the subclass Coccidiasina; hence its name, meaning coccidioidal-like). Some species, such as Toxoplasma gondii, occasionally cause pulmonary disease by directly infecting lung parenchyma, whereas others, such as Cryptosporidium and Microsporidium, can be occasionally visualized in respiratory secretions or lung biopsy specimens, but their role in causing respiratory disease in human beings is more questionable. In contrast, pulmonary disease associated with infections caused by Malaria and Babesia is often the result of a systemic inflammatory response.
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PMID:Pulmonary disease in selected protozoal infections. 919 76

Until the late 1960s, health professionals most often recommended that people with diarrheal disease take antidiarrheal drugs and refrain from eating for at least 24 hours. At the same time, work was underway on the development of oral rehydration therapy (ORT), which was subsequently adopted in 1971 to complement the limited supply of intravenous treatment for thousands of patients in West Bengal. The success of ORT in treating diarrheal disease led to the establishment of the World Health Organization's (WHO) Program for the Control of Diarrheal Diseases in 1980, and the subsequent broader access to packets of oral rehydration salts in health facilities. WHO was also involved in efforts to control acute respiratory infections, establishing the Acute Respiratory Infections Program to validate the use of clinical signs for diagnosis and evaluate the impact of the approach. Since WHO's maintenance of these two parallel single-disease programs resulted in some duplication of effort, they were merged in 1990 to form the Division of Diarrheal and Acute Respiratory Disease Control. The division's mandate was later modified and expanded in 1996 in the creation of the Division of Child Health and Development responsible for the control of diarrheal diseases, acute respiratory infections, and other childhood killers like measles, malaria, and malnutrition.
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PMID:From disease control to child health and development. 965 18

Iron deficiency is prevalent in children worldwide. Programmes of presumptive therapy, mass supplementation and food fortification have been introduced in many countries. The continuing unresolved debate over the interaction of iron and infection in the clinical setting indicates the need for firm guidelines for these practices. Iron overload is associated with increased susceptibility to certain infections, although the exact mechanisms may vary with the main pathology. Iron treatment has been associated with acute exacerbations of infection, in particular malaria. In Papua New Guinea parenteral iron was associated with increased rates of malaria and increased morbidity due to respiratory disease in infants but not in school children. Several subsequent studies in Africa using oral iron showed deleterious effects. In most instances cited, immunity was compromised, and therapeutic doses of oral iron were used. Knowledge of malarial endemicity, immunity with respect to age and the prevalence of haemoglobinopathies is important in planning interventions. A fine balance needs to be struck in the timing and dose of oral iron if informed recommendations are to be made. In parallel with supplementation studies, the effects of iron chelation on infection are being reported increasingly. Such therapy is clearly protective against malaria and some other infections but may predispose to fungal and Yersinia infections.
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PMID:Iron and infection in the tropics: paediatric clinical correlates. 987 73

The continuing unresolved debate over the interaction of iron and infection indicates a need for quantitative review of clinical morbidity outcomes. Iron deficiency is associated with reversible abnormalities of immune function, but it is difficult to demonstrate the severity and relevance of these in observational studies. Iron treatment has been associated with acute exacerbations of infection, in particular, malaria. Oral iron has been associated with increased rates of clinical malaria (5 of 9 studies) and increased morbidity from other infectious disease (4 of 8 studies). In most instances, therapeutic doses of oral iron were used. No studies in malarial regions showed benefits. Knowledge of local prevalence of causes of anemia including iron deficiency, seasonal malarial endemicity, protective hemoglobinopathies and age-specific immunity is essential in planning interventions. A balance must be struck in dose of oral iron and the timing of intervention with respect to age and malaria transmission. Antimalarial intervention is important. No studies of oral iron supplementation clearly show deleterious effects in nonmalarious areas. Milk fortification reduced morbidity due to respiratory disease in two very early studies in nonmalarious regions, but this was not confirmed in three later fortification studies, and better morbidity rates could be achieved by breast-feeding alone. One study in a nonmalarious area of Indonesia showed reduced infectious outcome after oral iron supplementation of anemic schoolchildren. No systematic studies report oral iron supplementation and infectious morbidity in breast-fed infants in nonmalarious regions.
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PMID:Iron and its relation to immunity and infectious disease. 1116 May 94


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