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Prenatal care, the most important factor determining the outcome of pregnancy, is limiting in developing countries either because of no or inadequate facilities or underutilization. WHO estimated that only 29-36% of African, 20-61% of Asian and 69-89% of South American births have maternity care. Existing services and underutilized because of illiteracy, the most important factor, cultural practices, religious practices, and the subordinate status of women. Care in developing countries is exemplified by describing prenatal care in urban University College Hospital, Ibadan, Nigeria, in a rural town of 30,000 in Western Nigeria and in the Ibarapa District in 1989, and care by TBAs. Routine care provided in the rural clinics included Talqvist hemoglobin count, history to determine Sickling, iron, folic acid and antimalarials if available, and referral to the weekly consultant clinic if the woman is under 5 ft in height, primigravid and 36 weeks gestation, uncertain of dates, has discrepancy in fundal height for dates, is ill or has history suggestive of abnormal pregnancy. Pregnant women usually used the clinic for antenatal care, but only 45% delivered in maternities. The review ends with brief discussions of management of malaria, anemia, hemoglobinopathy, malnutrition and teenage pregnancy. Anemia, common to all, is managed by transfusion of packed cells with administration of a loop diuretic to prevent hear failure.
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PMID:Antenatal care in developing countries. 220 29

Morbidity and mortality due to malaria and marasmic kwashiorkor were determined from hospital records in the University of Calabar Teaching Hospital over five years. Malaria was found to be a significant cause of morbidity but was responsible for only 3.5% of the deaths that occurred during the period. This represents 0.3% of all infant deaths and 2.0% of deaths in children aged 1-4 years. The percentage of malaria deaths, 4.4% (1983), 5.2% (1984), 3.0% (1985) and 1.9% (1986), respectively showed a downward trend but went up again to 2.8% (1987), probably due to the treatment failures ascribed to chloroquine in the area. Malnutrition on the other hand, resulted in 174 deaths as opposed to 42 deaths due to malaria in children under six years of age. More of these deaths due to malnutrition (40.8%) occurred in children aged 2-3 years, just as the case with malaria (33.3%). 20.7% of these deaths occurred in infants. These results suggest that the pride of place, as a number one killer, goes to malnutrition while malaria is a serious cause of morbidity.
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PMID:A retrospective study of malaria and malnutrition in the University of Calabar Teaching Hospital, Calabar, Nigeria. 229 27

More than 30 million refugees and internally displaced persons in developing countries are currently dependent on international relief assistance for their survival. Most of this assistance is provided by Western nations such as the United States. Mortality rates in these populations during the acute phase of displacement have been extremely high, up to 60 times the expected rates. Displaced populations in northern Ethiopia (1985) and southern Sudan (1988) have suffered the highest crude mortality rates. Although mortality rates have risen in all age groups, excess mortality has been the greatest in 1- through 14-year-old children. The major causes of death have been measles, diarrheal diseases, acute respiratory tract infections, and malaria. Case-fatality ratios for these diseases have risen due to the prevalence of both protein-energy malnutrition and certain micronutrient deficiencies. Despite current technical knowledge and resources, several recent relief programs have failed to promptly implement essential public health programs such as provision of adequate food rations, clean water and sanitation, measles immunization, and control of communicable diseases. Basic structural changes in the way international agencies implement and coordinate assistance to displaced populations are urgently needed.
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PMID:Prevention of excess mortality in refugee and displaced populations in developing countries. 234 41

The inter-relationship of malnutrition and infections is generally accepted as being synergistic, one promoting the other. Nevertheless, numerous published reports are available which highlight the contrary, that is, antagonism of poor nutrition to infections. This presentation is a review of such publications with emphasis on malaria and malnutrition in the tropics. The data presented suggest that the effect of poor diets on human malaria is related to the level of protein and energy intake, which in turn have important bearings not only on clinical nutrition but also on nutrition policy and planning, particularly in famine and famine relief. The data highlight the necessity for the integration of nutritional programmes and anti-malarial activities in areas where famine and malaria co-exist.
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PMID:Infections in the malnourished: with special reference to malaria and malnutrition in the tropics. 243 27

The registry of patients at the hospital of Kampene, Zaire, covering the period 1986-87 was examined to determine the hospital's rate of utilization and accessibility, to evaluate mortality, and to ascertain the prevalence of infectious diseases. The 1986 data of the hospital laboratory indicated a high incidence of infectious and parasitic diseases: ancylostomiasis (33.6%); ascariasis (22.9%); schistosomiasis (3.4%); multiple intestinal parasitic infections (10.9%); malaria (43%), often chloroquine-resistant; filariasis (70.8%); and alcohol-acid resistant tuberculosis bacilli (15%). Sexually-transmitted diseases such as vaginitis (80%) were caused by polygamy, prostitution, and promiscuity, HIV serodiagnosis could not be performed because of a lack of equipment. A high infant mortality rate was caused by neonatal tetanus, toxic gastroenteritis, measles (5.1% lethality: 2 died out of 39 cases), and epidemic cerebrospinal meningitis. Malnutrition caused kwashiorkor and avitaminosis. 792 births were registered at the maternity ward in 1986: 52.8% were male and 47.2% were female; 48 (6.1%) were stillborn or died in the following days; 104 (13.1%) were born prematurely; and 24 (3.1%) were twins. Cesarean section was performed in 43 cases (5.4%). There was a total of 15,099 outpatient visits during a 1-year period. The bed occupancy rate of the surgical ward ranged between .7 and .8 during 1987. Recovery and hospitalization days per doctor or health assistant were very high compared to Italian standards. The lethality of malaria was a high 1.8%, but malnutrition rated even higher: 21.4%. The utilization of the hospital was high, Maternal-child protection measures, especially in the area of nutrition, require the training of community health workers and traditional birth attendants; however, cost-benefit considerations limit resources and the implementation of primary health care is curtailed by economic and cultural factors.
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PMID:[Health care organization and health in a region of Zaire]. 248 74

Neonatal and perinatal mortality is directly linked to the health of the mother immediately after birth. Numerous international scientific meetings among them the 45th session of the Mixed Committee of WHO in January 1985, have dealt with this issue. Maternal mortality is defined as the death of the mother 42 days after delivery. Perinatal mortality includes delayed fetal death and early neonatal death. Delayed fetal death often occurs in newborns weighing under 1000 gm. Usually perinatal mortality is defined as the number of delayed fetal deaths and early neonatal deaths among those weighing over 1000 gm/1000 live births. The neonatal mortality level corresponds to the number of deaths of children born alive at 4 weeks/1000 live births. Postnatal mortality means the death of children born live up to 1 year of age. Infant death means death under age 1. Infant mortality level is defined as deaths of infants that survive for a whole year. The major problems of infant health include diarrheal diseases normally requiring vaccination and malnutrition during the first month of life. In Bangladesh, Lesotho, and Mexico, the mortality level ranges between 32.8 to 135/1000 live births. Neonatal mortality makes u 42-63% of infant mortality. The perinatal period comprises the period between 28th week of pregnancy and the 7th day of life. Diarrhea and respiratory infections contribute to perinatal mortality. In developing countries, maternal mortality related to pregnancy of women aged 15-45 occurs most often. 2-10 maternal deaths/1000 live births to as high as 20/1000 are current estimates. In Nigeria, among adolescents, the rate is 50-70 deaths/1000 live births. 124 perinatal deaths that occurred in 1970 and 1973 in India were analyzed yielding these percentages: insufficient birth weight 32%, asphyxia 19%, obstetrical trauma 18%, congenital anomalies 7%, tetanus of the newborn 3%, and others 21%. In Africa and Southeast Asia tetanus-related neonatal mortality amounts to 10-30/1000 live births and the total annual toll reaches 750,000 to 1 million globally mostly because of nonsterile instruments. 90% of tetanus incidence in Romania was eradicated by vaccination. Preventive measures can reduce mortality: education of women on health and hygiene, avoidance of heavy labor during pregnancy, family planning services, aseptic techniques, vaccination against tetanus and other infectious diseases, chemical prophylaxis against malaria, improved obstetrical care, consolidated support system, and community participation.
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PMID:[The role of maternal care in reducing perinatal and neonatal mortality in developing countries]. 251 16

Alterations of the gallbladder wall is a well known sonographic sign of acute cholecystitis. But thickening of the gallbladder wall is also found in patients without intrinsic gallbladder disease. We present our experience on this regard in patients with cirrhosis, acute viral hepatitis, infectious mononucleosis, halothane hepatitis, fulminant hepatic failure, malaria due to plasmodium falciparum, heart failure, severe malnutrition due to gastric obstruction, septicemia, pyogenic hepatic abscess, amoebic hepatic abscess and in a 14 years old patient with fracture of the skull-acute anemia-shock. Most of these diseases affected the liver directly or indirectly. Knowledge of these alterations of the gallbladder wall in these circumstances are important in order to avoid a the erroneous diagnosis of acute cholecystitis.
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PMID:[Ultrasonographic changes in the gallbladder wall in non-gallbladder diseases]. 253 57

A malariometric survey carried out among the upper Bonda tribals of Koraput district showed that malaria is the major cause of morbidity followed by worm infestation and malnutrition. A total of individuals 1,409 (32.2% of the population) were sampled and 771 were found positive for malaria parasites. Plasmodium falciparum was the predominant parasite (73.7%) followed by P. vivax (10.6%) and P. malariae (5.2%) among the positive cases. Mixed infection was observed in 10.5 per cent of positive individuals. The infant parasite rate was 60.0 per cent and the average enlarged spleen among the children between 2-9 yr was 2.11. The age specific parasite rate indicated high degree transmission and high level of acquired resistance among the tribals.
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PMID:Malaria & other common ailments among upper Bonda tribals in Koraput district, Orissa. 262 97

Major causes of anaemia in pregnancy in tropical Africa are malaria, iron deficiency, folate deficiency and haemoglobinopathies: now there is added also the acquired immune deficiency syndrome (AIDS). Anaemia is often multifactorial, with the different causes interacting in a vicious cycle of depressed immunity, infection and malnutrition. Anaemia progresses through 3 stages: compensation, with breathlessness on exertion only; decompensation, with breathlessness at rest and haemoglobin (Hb) below about 70 g/litre; cardiac failure, with Hb below about 40 g/litre. Without treatment, over half of the women with haematocrit less than 0.13 and heart failure die. Maternal anaemia, malaria and deficiencies of iron and folate cause intrauterine growth retardation, premature delivery and, when severe, perinatal mortality. Surviving infants have low birthweights, immune deficiency and poor reserves of iron and folate. They have entered already the vicious cycle of infection, malnutrition and impaired immunity. Treatment with blood transfusions is even more hazardous since the advent of AIDS, and should be limited to saving the life of the mother. Treatment of malaria is complex as chloroquine-resistant strains are now common. Prevention remains relatively easy with proguanil and supplements of iron and folic acid and is highly cost-effective in the improvement of maternal and infant health; it is more important than ever as it avoids the unnecessary exposure of women and infants to HIV transmitted through blood transfusion.
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PMID:Tropical obstetrics and gynaecology. 1. Anaemia in pregnancy in tropical Africa. 269 76

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


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