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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

A major sporozoite surface antigen, the circumsporozoite protein, has been identified in all four malaria parasites affecting humans and in numerous species causing malaria in rodents and simians. The corresponding genes have been cloned and sequenced, and considerable similarities are apparent. An extensive central region of these proteins consists of tandemly repeated sequences of four to 16 amino acids. The sporozoite protein of Plasmodium falciparum has 37-41 repeats of four amino acids: NANP (asparagine-alanine-asparagine-proline). Most sera from people in endemic areas that react with sporozoites also recognize the dodecamer (NANP)3. Conjugated to a carrier, (NANP)3 is an excellent immunogen for rabbits and mice. NANP has recently served as the basis for two experimental malaria vaccines tested in volunteers. One of these vaccines, (NANP)32 tet32, was genetically engineered in Escherichia coli; the other consisted of the synthetic peptide (NANP)3 conjugated to tetanus toxoid. Most peptide-immunized volunteers developed antipeptide/sporozoite antibodies; however, there was no booster effect, and only one of three individuals was completely protected. For optimal protection, future vaccines must not only contain the B cell epitope but also induce T helper cells and cytotoxic T cells producing interferon-gamma, which has been shown to inhibit the development of liver-stage parasites.
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PMID:Antisporozoite vaccine for malaria: experimental basis and current status. 266 1

Infant mortality statistics in developing African countries are reviewed. According to the World Health Organization (WHO) surveys, there was an overall decrease in infant mortality from 1960-1986, although the infant mortality rate in the African region remains higher than in other WHO regions (119.4, compared with 40.6 in the European region, 11.8 in the Eastern Mediterranean region, 110.2 in the South- Eastern Asia, 49.7 in the American Region, and 44.5 in the Western part of the Pacific ocean). In infants younger than 28 days old, mortality is associated with pregnancy and labor complications, congenital birth defects, and birth trauma. In Algeria, Sierra Leone, Nigeria, Mozambique, Malawi, and Zimbabwe, 70-90% of all deaths were caused by tetanus (70-80% of African women give birth at home without any medical help). In a 1 month to 1 year old age group, the leading cause of mortality is diarrhea (52% in Sudan, 29.2% in Sierra Leone); other causes of death are measles (15.8%), acute respiratory diseases (14.3%), malaria (8.5%), and infectious meningitis (6%). In a 1-4 years old age group, leading cause of mortality is nutritional deficiencies (9%). In addition to medical causes, infant mortality is also associated with a number of socioeconomic factors: insufficient nutrition of mothers, heavy physical work during pregnancy, young age of mothers and short interval between pregnancies, lack of proper medical care during pregnancy and labor, and early switching to infant formula not following proper hygienic recommendations.
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PMID:[Child mortality in the developing countries of Africa]. 271 15

Most travellers to tropical countries are young adults aged between 25 and 44; they tend to be of average or high socioeconomic status, to have a university education and to live in urban areas. The number of countries visited is high (111). Half the travellers go to Senegal, Ivory Coast and French Guiana. Asian countries are underrepresented among the clients of the Bordeaux centre because they do not require yellow-fever vaccination. The main reasons for travel are pleasure (73%) and business (23%). The length of stay is closely correlated with the reason for travel. Considerably more people travel in the winter period. The most frequently performed vaccinations are yellow fever, tetanus and poliomyelitis, in roughly equal numbers. A major role of a vaccination centre in the eyes of the public is to provide travellers with information and advice. A specialist centre of this kind, kept regularly informed about epidemiological developments around the world, is best equipped to advise on effective malaria prophylaxis. The centre's health-education role extends to all risks associated with travelling, in particular the sexually transmitted diseases and specifically tropical diseases, and also the consequences of changes in climate or altitude and failure to take general hygiene precautions. Computerized data banks accessible to the general public are certainly an information medium for the future, but at present are still underused.
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PMID:[Vaccination protection and advice to travellers. Statistical data on the activity of the International Vaccination Center of Bordeaux (France) in 1988]. 280 May 59

The perinatal mortality rate in India averages 66.3/1000 live births. 60% of all infant deaths occur during the 1st month, making the neonatal mortality rate 76/1000 in rural areas and 39/1000 in urban areas. These rates have remained static since 1974. Over 90% of all deliveries occur at home and are conducted by untrained birth attendants. The major causes of perinatal deaths are immaturity/low birth weight, birth asphyxia/trauma, neonatal infections, and congenital malformations. Neonatal tetanus alone is responsible for 230,000-280,000 deaths a year. Hypoxia, low birth weight, and tetanus are preventable, if primary perinatal care is provided and high-risk pregnancies are recognized and referred to facilities where fetal monitoring and neonatal care are available. It is proposed to train all of the country's 5 million traditional birth attendants by 1990 to deliver primary perinatal care. By 1990 also there will be 1 village health guide for every 1000 people. All traditional birth attendants must know how to give mouth-to-mouth resuscitation, and the infrastructure for an adequate referral system must be established. In order to reduce the incidence of low birth weight, the Integrated Child Development Service Scheme proposes that all pregnant women receive a dietary supplement of 500 calories and 25 gm protein, and that pregnant women be given a 2-hour midday rest period. The control of malaria and intestinal infections with chloroquine and antibiotics would do much to reduce low birth weight. Simple technologies for measuring birth weight indicators, such as chest circumference or mid-arm circumference, require only a tape measure. Finally, technics of mass communication must be utilized to spread knowledge of perinatal and neonatal care.
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PMID:Strategies to reduce perinatal and neonatal mortality. 306 42

Some 8% of Swiss citizens travel in the developing countries annually. Advising these travellers is an important task for the physician, though the most frequent infections are the less serious travellers' diarrhea and common colds. To some extent the more serious tropical diseases can be avoided by appropriate measures, e.g. vaccination (against yellow fever, tetanus, polio etc). and by chemoprophylaxis (malaria). Individual fitness for travel should be checked prior to any journey abroad, and special advice must be given to travellers with special risks (e.g. pregnant women, infants, persons with chronic diseases, diabetics etc.). Most important during a stay in the tropics is a sensible way of life with enough sleep, general hygiene, especially with regard to food, and avoidance of untreated water. Further safety measures are recommended for bathing, strong sun exposure, mountaineering above 10,000 ft and in general for exposure to special health risks. Recognition of risks and their avoidance is often the best prophylaxis.
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PMID:[Health advice before travel to tropical countries]. 308 75

Infant and early childhood mortality in Senegal's Sine-Saloum region was investigated through use o f data from a 1982-83 family health survey. The survey involved interviews with 1894 married women 15-44 years of age living in extended family residential units in rural areas. Given evidence of substantial underreporting of early deaths, at least among children born before 1980, an adjustment factor was applied to the survey data. Infant mortality was estimated to be about 113/1000 live births and mortality before age 5 years was 263/1000. Strong mortality differentials, particularly after infancy, were noted according to the 2 socioeconomic variables included in the analysis: type of house and father's occupation. The probability of dying at ages 1-4 years was 50% higher among children living in traditional homes than among those in modern homes as well as among children whose fathers' were engaged in primary sector occupations (farming, livestock, fishing). Infant mortality showed no sex differential, while mortality at ages 1-4 years was 18% higher among females. Diarrheal and respiratory diseases were the 2 leading causes of death, killing at least 15% of all children by 5 years of age. Tetanus was an important cause of death during infancy, while measles and malaria were significant causes only after the 1st birthday. For all causes of death, the effect of socioeconomic status is higher in early childhood than in infancy, presumably because of the protective effect of breastfeeding. 82% of children who died had fever during their terminal illness, 51% had diarrhea, 39% had a cough, and 14% a rash. At least some mortality in this area might be prevented through treatment of these symptoms. However, calculating the degree to which particular interventions such as oral rehydration for diarrhea would reduce mortality is a complex task, requiring knowledge of replacement mortality, effectiveness of interventions, and the numbers of mothers who would utilize them.
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PMID:Infant and early childhood mortality in the Sine-Saloum region of Senegal. 319 59

Eleven volunteers were injected with an anti-malaria (Plasmodium falciparum) sporozoite vaccine candidate consisting of a synthetic peptide, Ac-Cys-(NANP)3, coupled to tetanus toxoid (TT) and adsorbed to aluminum hydroxide. Two of the volunteers had no previously known exposure to TT. Eight volunteers made detectable antipeptide, anticircumsporozoite protein or antisporozoite antibodies, whose titers increased after multiple injections in four individuals. The maximum antisporozoite titer obtained in an immunofluorescence assay was 1280. In those individuals who produced antipeptide antibody, the overall correlation between IgG anti-Ac-Cys-(NANP)3 antibody in enzyme-linked immunosorbent assay and IgG antisporozoite reactivity in immunofluorescence was highly significant. However, the fine specificity of antibody varied among volunteers with two individuals producing mostly antipeptide antibody. Anti-TT antibody responses increased in all volunteers with the exception of that person who had the highest pretrial anti-TT titer; this individual was one of the two pre-TT-immunized volunteers who failed to produce anti-Ac-Cys-(NANP)3 or sporozoite antibody. For the two non-TT preimmunized volunteers, one produced an antisporozoite fluorescence titer of 320; the other made no detectable antibody against either Ac-Cys-(NANP)3 or sporozoites during a primary response. For the three volunteers monitored, after the first injection, significant T cell proliferative responses to (NANP)3 were observed, which increased up to 4 wk after immunization, when a second injection was given. Responsiveness then declined to background levels and did not reappear after further immunizations. In contrast, a marked TT-specific proliferation was observed for the duration of the study.
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PMID:Assessment in humans of a synthetic peptide-based vaccine against the sporozoite stage of the human malaria parasite, Plasmodium falciparum. 327 19

In 1978 a campaign of vaccination against tetanus was conducted in a savannah biotope of Burkina Faso (Garango). The effects of 1 or 2 tetanus toxoid injections and of concomitant malnutrition and malaria infection were assessed by measurements of specific antibody and cell-mediated responses. None of these 2 variables did interfere with the development of anti-tetanus immunity. In 1983, 5 years later, similar results were obtained, giving evidence that in spite of malnutrition and malaria, factors known for their immunosuppressive action, a good degree of specific protection was acquired. This local survey revealed also that multiple schemes of vaccination, 1 to 5 injections of vaccine over 5 years, had been performed by unidentified operators. The issues raised by such incongrous, costly and possibly detrimental practices are discussed within the frame of national vaccination policies.
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PMID:[Humoral immunity, 5 years after anti-tetanus vaccination, in a group of malaria-infected and malnourished African children]. 328 86

Histopathological studies in rats and dogs have indicated that hexachlorobenzene (HCB) has immunotoxic properties. Rats exposed to low doses of HCB showed proliferation of high endothelial venules in lymph nodes and accumulation of macrophages in lung alveoli, while lymphoid hyperplasia of the splenic white pulp occurred at higher doses. In dogs, HCB administration produced hyperplasia of lymphoid tissue in the stomach. Functional assessment showed that cell-mediated immunity (delayed-type hypersensitivity response), and humoral immunity (primary and secondary antibody responses to tetanus toxoid) even more, were enhanced in the rat, while macrophage function was unaltered. Stimulation of these immune responses occurred at a dietary level as low as 4 mg/kg HCB following combined pre- and postnatal exposure; at this dose, conventional parameters for hepatotoxicity were unaltered. The developing immune system of the rat therefore seems particularly vulnerable to HCB. In contrast to the immune stimulation observed in the rat, HCB has been reported to suppress the humoral and cell-mediated immunity as well as the resistance to protozoan (malaria and leishmania) infections and to tumour-cell challenges in the mouse; effects have been observed at a dietary HCB level of 5 mg/kg. However, recent data have suggested that HCB has some potential to stimulate the immune system of the mouse also, since increased resistance was shown to a viral infection and to a tumour-cell challenge. Strain differences or the presence of immunosuppressive contaminants in the HCB preparations used do not seem to explain these apparently contrasting results. Although further studies are needed to resolve this discrepancy, current data provide strong enough evidence to classify HCB as a potent immunotoxic chemical.
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PMID:Immunotoxicity of hexachlorobenzene. 329 35


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