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A retrospective study was carried out from January to September 1990 in a factory that manufactures textiles in Eldoret, Kenya. Over the study period, 1400 factory workers had 303 episodes of illness resulting in a loss of 720 productive man-days. This is an incidence of 289 episodes of illness per 1000 workers per year. On average, each episode of illness resulted in 2.4 man-days loss. Of all the episodes of illness, 58.8% were attributable to infective and parasitic diseases, 10.9% to respiratory system disorders and 21.7% to other conditions. Malaria constituted 53.1% of all episodes of illness, acute respiratory infection (ARI) 10.9%, physical injuries 5.6%, gastro-enteric illnesses 3.4% and other conditions 21.7%. For the productive man-days lost, 53.2% were attributable to malaria, 12.8% to ARI, 5.7% to physical injuries and 28.3% to other conditions. Abortions and worm infections resulted in loss of 7.0 man-days per episode of illness, diarrhoea 3.2, myalgia 3.0, ARI 2.8, eye diseases 2.7 and the rest below the average of 2.4 days. Apart from the physical injuries, there were no other occupational illnesses in the textile factory workers. Episodes of illness that occur during the last and the first week of the month constitute 61.0% of all illnesses. Mondays had 24.4% of the episodes of illness, Sundays 7.9% with the other days of the week constituting an average 13.5%.
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PMID:The pattern of morbidity and its effects on productivity of factory workers in Kenya. 129 19

This article is a transcript of the 58th Joseph Price Oration, delivered by Egon Diczfalusy (MD, PhD) at the 10th Annual Meeting of the American Gynecological and Obstetrical Society, held in Carlsbad, California on September 5-7, 1991. In his speech, Diczfalusy discussed the international community's moral obligation to promoting reproductive health, which hinges primarily on contraceptive prevalence. WHO figures indicate that 85% of the world's births, 95% of the world's infant deaths, and 99% of the world's maternal deaths take place in developing countries. While a women in a developed country has a 1 in 1750 chance of dying from pregnancy-related causes, the risk is 1 in 24 for a woman in Africa. The goals of reproductive health are well-known: reducing the unmet need for family planning, increasing family planning services and methods; lessening maternal, infant, and child mortality and morbidity; and reducing the prevalence of STDs. An investment of $2/capita would eliminate most maternal deaths in the developing world. An additional $2/capita spending increase in developing countries would also immunize all children, eradicate polio, and provide the drugs necessary to cure all cases of diarrheal disease, acute respiratory infection tuberculosis, malaria, schistosomiasis, and STDs. But the most important element with respect to reproductive health is increasing contraceptive prevalence. Over the next decade, yearly world population increments will approach 97 million. 94% of this growth will take place in developing countries. As Diczfalusy explains, the technology and resources to solve these problems exists. At bottom, the obstacle to overcoming the problems is the lack of political will.
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PMID:Contraceptive prevalence, reproductive health, and international morality. 156 58

The PRICOR Project developed extensive lists of essential tasks and activities for the effective delivery of child survival interventions (PRICOR Thesaurus): case management of acute respiratory infection, malaria, and diarrhea; growth monitoring and promotion; maternal health; and child spacing. It later helped managers and researchers in the use of the Thesaurus to conduct comprehensive systems analyses of these interventions in Colombia, Costa Rica, Haiti, Niger, Indonesia, Pakistan, Peru, Philippine,s Senegal, Togo, Thailand, and Zaire. These analyses confirmed that researchers and program managers can indeed study service delivery through systematic review of health worker performance. Further this evaluation of primary health care (PHC) systems in 12 countries identified repeat program deficiencies. For example, counseling by health workers to clients was consistently weak. The tended to not explain to mothers proper home treatment, describe danger sings, or ask them to repeat instructions to assure that mothers understood them. Further health workers did not necessarily tell mothers during treatment about their child's nutritional status, type of vaccine being administered, of why they prescribed oral rehydration therapy. This lack of client education is especially significant since, in PHC, the health workers and the caregiver should be partners in achieving successful results. Deficiencies also existed with supervision. For instance, supervisors did not always monitor health workers, rectify errors, or solve problems. Further researchers compare supervisors' perceptions of health worker performance with actual performance. Supervisors tended to overstate performance. Nevertheless these analyses did identify practical solutions to many program deficiencies. In fact, most solutions did not depend on resources availability, PRICOR techniques to design and implement strategies for sustained improvement in PHC in developing countries.
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PMID:The Quality Assurance Project: introducing quality improvement to primary health care in less developed countries. 178 83

In Germany maternal mortality related to pregnancy, birth and child-bed is only about 11 women/100,000. In some African countries mortality is up to 100 times as high, UNICEF reported in 1991. The causes of high infant and maternal mortality are poverty, inadequate hygiene, and lack of preventive medical care and timely treatment of diseases for 60% of the population in the least developed countries. Countries in sub-Saharan Africa currently have the world's highest population growth rates of 3-4%/annum. Diarrheal and respiratory diseases are the most common causes of death, but recently tuberculosis has reappeared. Acute respiratory infection (ARI) causes at least 4 million deaths/year or 11,000/day. Each year about 800 million malaria infections occur worldwide. Although antimalarial drugs have reduced mortality, resistant Plasmodium strains have made therapy difficult. Schistosomiasis is endemic in 74 countries: about 200 million people are infected and more than 600 million people are at risk. Central and East Africa are the areas worst affected by the AIDS pandemic. In some cities more than 1/4 of men and women in the 20-40 age group are infected with HIV. Up to 90% seroprevalence rates have been found among female prostitutes. Perinatal transmission is becoming prevalent where 20% or more of the pregnant women are infected. In some regions of Africa prevalence rates can reach 505 and more for the adult population. By the early 1990s AIDS will be the leading cause of mortality in the 20-40 age group in some regions. A 1991 forecast for the Mbeya Region of Tanzania predicted that the 15-44 year age group would decline from 41% to 37% during 1988-94, while infant mortality may increase by 50-100/1000 live births. The only control measures of HIV transmission remain the avoidance of infected blood or infected medical equipment, and prevention is through education and information.
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PMID:Strategies to maintain health in the Third World. 179 44

A researcher reviewed village health worker (VHW) utilization in a primary health care (PHC) program in villages around Farafenni in North Bank division of The Gambia. 47 children 7 years old died between April 1986-March 1987. WHWs could have treated the illnesses (malaria, diarrhea, and acute respiratory infection) that killed 23 (49%) of these children. Yet they treated only 6 of the 23 while other health workers in the region treated 14 children. 3 children received no treatment. Further a traditional healer later treated 3 of those seen by a VHW before death. Parents of a fatally ill child with diarrhea were a bit more likely to take the child to a traditionally healer than a VHW. None of the VHWs referred any of the fatally ill children to the next PHC level. Chronic diarrhea/malnutrition, chronic cough, meningitis, measles, and septicemia caused the death of 20 of the 24 remaining children. A VHW treated only 1 of the 24 remaining children before death. Moreover a VHW saw only 48% of the living children who had experienced illness during the study period. The remaining children went to other health providers. 26% of mothers claimed they had forgotten that VHWs could treat illnesses. In fact, 75% of those who had forgotten did not clearly understand the role of the VHW. They tended to think that the VHW provided only prevention information. 20% could not afford a VHW, yet they paid much more for other health workers. Another 26% said that the VHW was not available at the time. 5% reported the VHW to be unsupportive. The remaining 21% did not know why they did not take their child to a VHW. When the researcher pushed these mothers, 61% gave personal animosity as a reason and 39% did not want to talk about it. In conclusion, the VHWs did not receive adequate training, had limited range of drugs, were poorly supervised, and often not available.
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PMID:Utilization of village health workers within a primary health care programme in The Gambia. 188 Aug 30

In The Gambia co-trimoxazole is used widely to treat children with an acute respiratory infection (ARI). Because malaria may sometimes be mistaken for ARI, some children with malaria are treated with co-trimoxazole. Therefore, we investigated the sensitivity of Gambian isolates of Plasmodium falciparum to this drug. Six days after the start of treatment with co-trimoxazole 3.3% of blood films of 65 asymptomatic subjects were positive, and 7.7% were positive after 21 d. One of 10 patients with ARI and malaria treated with co-trimoxazole had a positive blood film 3 d after the start of treatment but was negative thereafter. All 10 patients recovered satisfactorily. Thirty 'wild' isolates of P. falciparum were tested in vitro against co-trimoxazole at a ration of 5 parts sulphamethoxazole (SMZ) to 1 part trimethoprim (TMP). The mean EC50s, using a 36 h assay, were 1.2 x 10(-7) and 2.5 x 10(-8) M for SMZ and TMP respectively. When a [3H]hypoxanthine incorporation assay was employed, values of 5.7 x 10(-7) M for SMZ and 1.2 x 10(-7) M for TMP were obtained. These values are well below the peak plasma concentration. Our findings suggest that co-trimoxazole is effective against falciparum malaria in The Gambia. However, if it were to be used widely, the parasite would be likely to develop resistance to this and other dihydrofolate reductase inhibitor antimalarials.
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PMID:Sensitivity of Plasmodium falciparum in The Gambia to co-trimoxazole. 194 36

The fact that economic progress has a bearing on health can be seen in most developing countries where widespread poverty causes poor health and high mortality. Childhood mortality is highest in Africa and in Southern Asia. The rate of decline in mortality has decreased in these areas since the 1950s. In Sri Lanka, approximately 5% of the children 5 years old die, yet yearly 1/3 of the children 5 Afghanistan and a few West African countries die. In less developed countries, adult mortality is high: in places where the life expectancy of a 15-year-old is under 50 years, 30-40% will die before age 60. 80-90% of the deaths from water and food borne diseases are accounted for by diarrhea and dysentery, and 60-70% of the deaths from airborne diseases by pneumonia and bronchitis. Present estimates from 4 localities indicate that measles, malaria, tetanus, and acute respiratory infection account for more than 90% of all child mortality. Various estimates suggest that there are 100-300 million cases of malaria and 1-2 million malaria-related deaths annually. Estimates indicate a ratio of abortions varying between 9/1000 live births in East Africa to 325/1000 live births in Latin America. 1986 WHO data indicate that induced abortion is responsible for 7-50% of all maternal deaths in developing countries. More than 90 countries now that operational diarrheal disease control programs, 47 countries are producing oral rehydration solutions, 8450 health personnel have been trained in diarrhea program supervisory skills, and oral rehydration use rates are slowly rising.
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PMID:Identifying health problems and health research priorities in developing countries. 266 49

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

Some Nicaraguans living in Costa Rica are in refugee camps. The types and rates of infectious diseases in the Pueblo Nuevo refugee camp were measured by examining medical records for 1985 and performing stool and blood testing. The incidence of infections was 320 episodes per 1000 persons per year. Respiratory infections represented 63% of all illnesses and pulmonary tuberculosis was high. Malaria was not found in blood samples and no childhood illnesses preventable by immunizations were recorded in the records. Intestinal parasites were found in 56% of the persons examined, considerably higher than the 15% prevalence noted in surveys of Costa Rica as a whole. Trichuris trichiura was found in 40% of the positive stool samples. The deficient hygienic conditions and overcrowding in the camp are responsible for the high rates of infections and the continued presence of infections many of which probably were acquired in Nicaragua. Improvement of hygienic conditions can be accomplished by involving the refugees in education, cleaning and identifying problem areas. Adequate sanitation and improved water supply, and reducing overcrowding are also recommended.
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PMID:Infectious diseases in a Nicaraguan refugee camp in Costa Rica. 292 7

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


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