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Phytohaemagglutinin (PHA) induced lymphocyte transformation in whole blood and in purified lymphocyte cultures was investigated in Gambian children with acute Plasmodium falciparum malaria or with acute protein-energy malnutrition (PEM). Responses of purified lymphocytes cultured in the absence of autologous plasma were normal, with one exception. Autologous plasma depressed the response of purified lymphocytes to a low dose of PHA in several malaria and PEM patients. In whole blood cultures of 1 day and of 3 day duration, responses of several children with malaria or PEM were less than those of control children. Responses were not related to absolute lymphocyte counts. In 3 day, but not 1 day, cultures from control and malarious children, responses were inversely proportional to neutrophil counts. Cultures of whole blood and of purified lymphocytes in autologous plasma gave comparable results in 58 of 70 patients.
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PMID:Effects of autologous plasma on lymphocyte transformation in malaria and in acute protein-energy malnutrition. Comparison of purified lymphocyte and whole blood cultures. 41 77

This paper reports on a conference on seasonal dimensions to rural poverty. Presentations included specialised papers on climate, energy balance, vital events, individual tropical diseases, nutrition, rural economy, and women, and also multi-disciplinary case studies of tropical rural areas from the Gambia, Nigeria, Mali, Kenya, Tanzania, India and Bangladesh. While care is needed in generalising, the evidence suggested that for agriculturalists in the tropics, the worst times of year are the wet seasons, typically marked by a concurrence of food shortages, high demands for agricultural work, high exposure to infection especially diarrhoeas, malaria, and skin diseases, loss of body weight, low birth weights, high neonatal mortality, poor child care, malnutrition, sickness and indebtedness. In this season, poor and weak people, especially women, are vulnerable to deprivation and to becoming poorer and weaker. Seasonal analysis is easily left out in rural planning. When applied, it suggests priorities in research, and indicates practical policy measures for health, for the family, for agriculture, and for government planning and administration.
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PMID:Seasonal dimensions to rural porverty: analysis and practical implications. 53 28

The assessment of morbidity caused by chronic parasitic infections in the populations of endemic areas has remained difficult and controversial. Contributing to this predicament is the frequent occurrence of multiple infections with agents that can cause a wide range of clinical manifestations, from the frequent symptomless carrier state to overt disease with more or less specific clinical manifestations. In the interpretation of the complex morbidity patterns found in rural populations of tropical countries, it is often difficult to make a clear determination of cause and effect. The situations is further complicated by the low degree of pathognomicity of the clinical manifestations of even the advanced stages of certain parasitic diseases. The paper gives examples that illustrate the interaction between endemic malaria and schistosomiasis as important causes of hepatosplenomegaly. Also shown in the paper are the inter-relationships between the nutritional status and the number of multiple infections with parasites found in African villages as well as the association between habitual coca leaf chewing, malnutrition and hookworm disease in a Peruvian community of mixed ethnic origin. The paper describes micro-epidemiological features of poly-parasitism by comparing the prevalence and intensity of infection with Onchocerca volvulus, Schistosoma mansoni and S; haematobium between sub-groups in the village population who have different sources of domestic water supply. In two African villages with endemic schistosomiasis where mass treatment will be administered, only 25% of the residents with parasitologically confirmed S. haematobium infection and 12% of those with S. mansoni had single infection; the remaining majority had at least one additional patent parasitic infection of public health importance.
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PMID:Epidemiology of poly-parasitism. IV. Combined effects on the state of health. 72 41

Weight, Height, head circumference, chest circumference, arm circumference and triceps skinfold of 223 children under 5 years from the small Mentawai island Sipora/Indonesia have been measured and related to international standards. Beginning from standard values, the anthropometric data decrease during the first 2-3 years, rising again in the following years. Weight for age is 72% of standard at 24 months and 83% at 5 years, height for age 89% at 30 months and 92% at 5 years, weight for height of the boys 82% at 12 months, of the girls 79% at 24 months and 94% for both at 4-5 years, chest/head ratio 95% at 12 months and 100% at 3-5 years. Arm circumference is 83% at 18 months 100% and above already at 3 years. Therefore, fold regains after the minimum of 90% at 18 months and above already at 3 years. Therefore, muscle growth would predominantly be reduced. The weight gain follows approximately the 3rd centile of english girls with a clear depression between 9 and 30 months. The birth weights of 476 children are 3230 g (boys) and 3120 g (girls). Perinatal mortality is low (2.9%), mortality during the first 5 years between 15 and 24%. In the health centre charts of 126 children under 5 years of a selected village (93% of that age group) 463 treatments in 5 years are recorded. The most frequent diagnoses are diseases of the respiratory tract (38% of all treatments), followed by malaria (23%), diarrhoea (19%), ascaris and hookworm infections (7.6%) and skin conditions (6%). Tuberculosis was the cause of treatment in 1.3%. In spite of the temporary growth retardation, as indicated by the anthropometric values, no cases of clinical Protein-Energy-Malnutrition have been observed. Malaria seems to be holoendemic, since all 223 children had a palpable spleen.
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PMID:[Nutritional status and health status of under-fives of the Mentawai island Sipora (Indonesia) (author's transl)]. 74 10

Malnutrition interacting with infectious and parasitic diseases are the main causes of the appalling mortality in childhood in the tropics. The most important single safeguard against these in infancy is breast feeding and the trend now evident to abandon this is a disaster which demands urgent attention. Reasons for this trend are discussed. Efforts to control infectious diseases, other than smallpox, have had little success and the emergence and spread of dengue haemorrhagic fever in S.E. Asia have added new dimensions to the problem. Malaria is still widely prevalent in the tropics and falciparum malaria, holoendemic in much of Africa, remains a major cause of death with its most serious impact on pregnant women and children. The emergence and spread of drug resistant strains of this parasite in parts of the world is a cause for serious concern. Quartan malaria is also an insidious corruptor of health in childhood and commonly causes the nephrotic syndrome. Neonatal jaundice, often associated with G6PD deficiency, is increasing in frequency in urban areas of Africa and now constitutes a significant hazard to the newborn and requires urgent investigation. These problems in tropical paediatrics indicate the need for urgent reappraisal of our role as a profession in the affairs of the tropical developing world.
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PMID:Aspects of tropical paediatrics. 79 3

A nutritional status survey of children aged 0-5 years was carried out in a lake shore district in Malawi. Anthropometric and clinical studies indicated a high overall prevalence (14%) of Protein-Calorie Malnutrition (PCM), particularly among the 1- to 1 1/2-year-olds. Few signs of vitamin deficiencies were seen but iron deficient anaemia was common at all ages, 68% being below the acceptable haemoglobin level. Sixty percent of children had malaria parasitaemia and 25% conjunctivitis. Under-five mortality was estimated to lie between 31 and 44%. Muslim children had a higher mortality and prevalence of PCM and fewer of their fathers had been to school. It is suspected that many cases of undernutrition go unrecognized because of uniform stunting occurs and ages are not known. It is recommended therefore that medical units use a local calendar, similar to that evolved for the survey, in order to estimate ages more accurately.
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PMID:The nutritional status of children ages 0-5 years in Nkhotakota, Malawi. 81 62

To study the relationships between malaria, anemia and malnutrition, 853 school-age children from a high malaria incidence area and an adjacent low incidence area were surveyed in September 1972. For the high incidence area the malaria slide positivity rate was 3.5%, spleen rate 7.6% and malaria (indirect fluorescent antibody) serology positivity 24.7%. Contrasted to this, no positive slides, only 3 palpable spleens and a 3.4% serology positivity rate were found for the low incidence area. Twenty-three percent of those studied were anemic, but the prevalence of anemia was the same in both the high and low incidence areas. However, a selected group of children with known history of recent or actual malaria was found to be more likely to have deficient hematocrit values than were children without such history. Hypochromia and microcytosis were prominent morphologic findings in children with anemia, suggesting a diagnosis of iron deficiency. Weights and heights for age were considerably below those of a U.S. reference population but similar to nationwide Salvadoran figures. In both the high and low incidence groups, 62% had arm circumference values below 90% of standard. The distribution of weight-to-height ratios was also similar for both groups. No difference in nutritional status between the two groups could be found.
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PMID:The prevalence and relationships of malaria, anemia, and malnutrition in a coastal area of El Salvador. 109 Nov 65

Adding family planning and population programs to the list of tropical medicine components expands the definition of what might be called appropriate medicine for the developing countries. This comprehensive definition covers the topics of prime importance to the health and ultimate development of preindustrial societies. These topics are given low priority in all medical education. Nutrition has been left to the schools of public health. Schools of agriculture are interested in the quality and quantity of food production but not in the social and economic complexities of relating food production to the nutritional status of the population to be served. the variables are interdependent. In the world more than 3 billion people live on the margin of existence. High mortality contributes to high fertility rates because living children are the only available form of social security. Food production cannot keep pace. Malnutrition is a factor in at least 1/2 of the 45 million global deaths in those less than 5 years of age. In the Far East and Africa 25-30% of the population are undernourished. During the next 15 years the world may add 1 billion people to its present 4 billion and there may be 8 billion shortly after the year 2000. Of these 6.6 billion would be in developing countries. In Africa, South America, and the Middle East, surveys have shown that 96% of 1000 women in the third trimester of pregnancy and 75% of school children in South India were anemic. At least a 4% annual increase in food production is needed between now and the year 2000 to meet the needs of present malnutrition and projected population growth. The prospects of achieving this are not good. Also, of regional importance are vector borne and macroparasitic diseases and trachoma and yaws. Of universal importance are fecally related diseases and air-borne diseases. Malaria still persists in many areas with an estimated 1 million deaths annually. Recently the World Bank has paid increasing attention to provisions for health. In 1976 about 357 million dollrs is proposed for loans and credits for health-related projcts. Intra- and transnational migration of human populations is steadily increasing and has and will continue to spread disease. The potential for mass epidemics remains. Our global responsibility for training of public health workers from and for developing countries remains. Food, population, and health are the major independent variables in the global equation for the quality of life. The control of transmissible disease remains a vital undertaking for the American health establishment. We live in an increasing interdependent world. Many people and nations look to the U.S. to sustain its leadership in biomedical research and medical and public health education. An interdependent world cannot afford the stresses of ill health, poverty, and explosive population growth. We need resurgence of interest in public health, tropical medicine, and a change in individual and national life styles.
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PMID:Editorial: American medicine and world health 1976. 125 95

Malaria is still a serious health problem in Thailand. Present attempts at controlling the disease by drug treatment and other means remain unsatisfactory. Thus, development of vaccination against malaria is a major research goal of malaria immunology. The objective of this study was to acquire epidemiological base line data for subsequent vaccine trials. A cross-sectional descriptive survey was conducted among 253 local inhabitants during the beginning of the transmission season in July 1989 at Bo Thong District, Chonburi Province, Eastern Thailand where malaria transmission was likely to be moderately high. Following the cross-sectional survey weekly morbidity surveillance was started to detect new cases of malaria by using active and passive case detection at the district hospital, local health centers and at neighboring malaria clinics. Fifty-four percent of the population were male and forty-six percent female: nearly a half (48.3%) were under the age of 15 and 17% under the age of 5 years. Eighty percent of the adults were married. Seventy percent of the subjects interviewed gave a history of malarial illness in the past. Malaria, malnutrition, anemia abnormal hemoglobin diseases and parasitic infestations were the main health problems in the study area. The annual parasite incidence of malaria was 169.4/1,000 population and 77% of parasitemic individuals were asymptomatic, indicating the existence of a semi-immune condition among these subjects. Antibody level to crude parasite antigen increased with age. It is hoped that the information obtained from these field studies may be useful in malaria vaccine trials in the near future.
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PMID:Malaria in a rural area of eastern Thailand: baseline epidemiological studies at Bo Thong. 129 90

The US Centers for Disease Control has published recommendations for and information on public health concerns of populations displaced for disasters, such as civil strife and famine. Most recent relief programs use the sustainable primary health care approach of preventive medicine and refugee involvement. This report lists leading, intermediate, and trailing indicators of famine (e.g. low acreage under cultivation, crop failure, and increased malnutrition rates, respectively). Mortality rates are the best reflection of the health status of displaced and refugee populations. The leading causes of death in these populations are the same leading causes as those in nondisplaced populations in developing countries: malnutrition, diarrhea diseases (even cholera), measles, acute respiratory diseases, and malaria. Much of the excess mortality in refugee and displaced populations is due to synergism between high malnutrition prevalence and increased incidence of communicable diseases. Public health practitioners should be prepared for sudden population displacement by targeting the most important public health problems identified in earlier emergencies that cause considerable mortality. Response preparedness should be an integral component of existing health programs in developing countries. A health information system (HIS), diarrheal disease control, immunization, basic curative care, endemic disease control and epidemic preparedness, and maternal and child health care should be the first programs to be established after an emergency. This report provides detailed program-specific recommendations for rapid health assessment, HIS, nutrition, control of vaccine-preventable diseases, control of diarrheal diseases, malaria control, tuberculosis control, and epidemic investigations. For rapid health assessment, for instance, it has a checklist addressing preparation, field assessment, health information, nutritional status, mortality, morbidity, environmental conditions, and resources available. It provides a sample weekly surveillance reporting form.
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PMID:Famine-affected, refugee, and displaced populations: recommendations for public health issues. 132 13


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