Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024530 (malaria)
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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

A study was undertaken to determine disease prevalence of, choice of treatment for, as well as health services utilization by, preschool children living in a rural district of coastal Tanzania. Disease prevalence and choice of treatment were determined through seven-day recall; health services utilization through systematic analysis of Village Health Workers' service records over one calendar year. It was found that the main disease symptoms, i.e. fever, cough, diarrhea, difficult breathing, ear ache and sore throat occurred at frequencies of 15.6, 8.3, 5.7, 2.0, 1.7 and 0.4 episodes respectively, per child per year. Cough, difficult breathing, common cold and ear ache caused about 50% of all episodes of illness. The majority (61%) of all illness episodes were treated in dispensaries, health centres or hospitals. 18.9% were attended by Village Health Workers (VHWs), 14.5% received treatment at home and 3.5% were seen by traditional healers. The use of VHWs was associated with a reduction of home-treatment and reliance on traditional healers for the care of perceived illness. VHW's monthly reports revealed malaria to be the number one health problem both among children and adults, responsible for about 25% of all attendances.
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PMID:The burden of disease among preschool children from rural Tanzania. 338 32

The case is reported of a 40-year-old woman who developed an eosinophilic lung infiltration during malaria prophylaxis with pyrimethamine-sulfadoxine (Fansidar). The patient had a severe condition with cough, fever, chills, dyspnea, weight loss and an unusual but characteristic radiologic picture. Corticosteroid medication was followed by a dramatic improvement in symptoms and complete resolution of the radiographic opacities within a few days. There was no recurrence after cessation of steroids. The authors believe that the cause of this lung disease was an allergic reaction to pyrimethamine-sulfadoxine (Fansidar). Some aspects of drug-induced eosinophilic pulmonary infiltrations are discussed.
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PMID:[Eosinophilic lung infiltration during malaria prophylaxis with pyrimethamine-sulfadoxine (Fansidar)]. 404 13

A joint pilot project between the Ministry of Health and the Dept. of Social and Preventive Medicine, University of Malaya, to test the value of village aides in extending the health care system into isolated Iban communities was begun in May 1979 in the Entabai District of Sarawak. A group of 15 village aides consisting of 11 traditional Iban manangs (medicine men) and 4 youths were trained to provide primary health care including simple curative care, preventive care, and to assist in the detection of malaria. Evaluation carreid out 2 years later showed the following. With regard to curative care, the village aides were each, on the average, treating 70.6 patients/month, the most common complaint being headache (30.4%), which along with abdominal pain, constipation, bodyache, diarrhea, vomiting, fever, worm infections, cough, and sore throat, accounted for 89% of all illnesses seen by them. Subsequent to the introduction of village aides in the project area, the number of seriously ill patients requiring admission to the rest beds of the klinik desa dropped by 43.8% and the number of emergency referrals to the backup divisional hospitals fell by 46.1% showing that patients were coming to the klink desa for treatment at an earlier stage. The 11 traditional Iban manangs, who had recently received training had, on their own accord, drastically reduced the use of traditional Iban modes of therapy in preference for modern medicine. During the 24 months immediately after the introduction of village aides into Entabai, 9 gravity feed water supply systems together with related health packages advocating general cleanliness, the use of latrines, and fences were affected, whereas only 6 such systems were installed in the previous 24 months, indicating that it is likely that the village aides were of some assistance in mobilizing the community with respect to self-help efforts. During the same period, the majority of longhouses in the area successfully established a number of vegetable gardens growing foods for home consumption, and continue to vigorously advocate breastfeeding of infants in opposition to bottlefeeding. During the 23 months after village aides were introduced, a total of 1093 blood films were collected by the 15 village aides, the average number of blood films/village aide being 3.2 blood slides/month. Village aides are socially accepted by the Iban community who utilize their curative skills when mild illness disturb them, but who proceed directly to the klinik desa when more serious illness such as fever strike. The project has established clear lines of communication between the health team and the community, and has stimulated the community to organize itself to achieve an increasingly high level of health through community participation and self-reliance. Plans have been approved in principle to train a further 2000 village aides in primary health care for the state of Sarawak.
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PMID:A primary health care project in Sarawak. 712 43

Drug resistance has made malaria prevention difficult and the new agents are too expensive for widespread use. Primaquine, an established drug for treatment, is potentially useful for prevention. Malaria prophylaxis with primaquine was evaluated in Irian Jaya during one year in Javanese men who were not deficient in glucose-6-phosphate dehydrogenase (G-6-PD). 126 volunteers were randomised to receive 0.5 mg/kg primaquine base or placebo daily (double-blinded), or 300 mg chloroquine base weekly (open). The protective efficacy of primaquine relative to placebo was 94.5% (95% confidence interval 57-99) for Plasmodium falciparum and 90.4% (95% CI 58-98) for P vivax. Attack rates for either parasite did not differ significantly between the chloroquine and placebo groups. Incidence density of physical complaints not associated with parasitaemia was low (17-18 complaints/person-year) and was about the same in all groups except for cough, which was increased in the primaquine group. Complete blood counts were normal and no evidence of hepatic or renal dysfunction was found with primaquine. However, at 50 weeks the primaquine group had a mean methaemoglobin of 5.8% (range 1.4-13%), which declined by half within 7 days of ending prophylaxis. When used daily for one year by men with normal G-6-PD activity, primaquine was well tolerated and effective for prevention of malaria.
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PMID:Randomised placebo-controlled trial of primaquine for prophylaxis of falciparum and vivax malaria. 747 58

African governments are generally plagued with inadequate public health care systems, rapid population growth, low or negative economic growth rates, and shrinking government budgets. How to finance the expansion of health care and improve the quality of services in such a context is one of the most important issues they face. In Guinea-Bissau, the village health post is the most peripheral unit in the health care provider system, offering simple treatments and basic drugs. The system of care at that level is based upon community participation. Villagers provide the necessary materials and labor to build a standard two-room health post, and the government donates materials for windows, door, and hinges, plus simple equipment and an initial stock of drugs estimated to last for six months. The community collects funds to ensure that the initial drug supply is continuously replenished. One or more community members are selected and trained as volunteer village health workers (VHWs) or traditional birth attendants (TBA) in basic training which lasts 15 days, followed by annual 5-day refresher courses. VHWs are educated to treat malaria, diarrhea, conjunctivitis, cough, pain, and wounds, while TBAs are taught how to provide control and prophylaxis during pregnancy, and help in normal child deliveries. By early 1989, 449 units had been established, covering 20-25% of the population, but with large regional variation. This paper reports findings from a three-week field survey conducted in 1989 to gather information on this approach and its potential to mobilize additional resources for the health sector.
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PMID:Prepaid financing of primary health care in Guinea-Bissau: an assessment of 18 village health posts. 749 23

Between 1975 and 1983 health care expenditures in Ghana dropped to a low point as a consequence of the structural readjustment program instituted by the World Bank. During 1975-76 only 15% of available funds were spent on primary health care (PHC), which was officially introduced in the late 1970s. PHC made up 20-25% of the health care expenditures by 1991 with about 25% of health personnel engaged in PHC. 2/3 of health care delivery covered urban areas when 60% of the population lived in the countryside. The district of Ejisu-Juaben in the Ashanti region had high morbidity. Tetanus, polio, whooping-cough, and diphtheria had been brought under control, but measles, diarrhea, and malnutrition were still widespread among children under 5 years old. Malaria, bilharzia, intestinal parasites, respiratory infections, hepatitis, anemia, hypertension, and vitamin A deficiency were also grave problems. AIDS was on the rise. Child mortality amounted to 130/1000 live births and maternal mortality to 1400/100,000 cases. The medical structure of the district comprises 10 health posts (6 governmental and 4 mission). Only 72 villages and 120,000 people are cared for. Each post has a mobile team. In 1993 a new community-based health care program began funded by Save the Children Netherlands. In 60 villages a village health committee existed but they were substandard. They were either reactivated or new committees were set up. Training activities were also started in prenatal care, delivery, care of malnutrition and diarrhea, hygiene, and sanitation. Two years later safe motherhood indicators had improved; postnatal care increased from 16% to 49%; medical deliveries increased from 27% to 37%; the share of families with contraceptive acceptance increased from 7% to 21%; and tetanus vaccination among mothers was estimated to have increased from 27% to 86%.
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PMID:[Primary health care in Ghana: no pay no cure?]. 750 Oct 68

Seven hundred and three Nigerian village children in their first six years of life were subjected to anthropometric measurements and physical examination in early 1988. The heights of 66.9% and weights of 60.5% of them fell below the third percentile of a Nigerian equivalent for international reference population standard. Mid upper arm circumference values indicated moderate to severe malnutrition in over 25% of all 1-5 year old children surveyed. Fever, cough, headache and diarrhoea were the commonest symptoms encountered in the children. Mild pallor of the conjunctival mucosa and physical signs of protein energy malnutrition were commonly seen. Fungal and septic skin lesions were present in 11.45 and 11.1% of the children respectively, whilst rhinorrhoea was seen in 4.7%, otitis media in 6% and pharyngotonsillitis in 3.3%. Thirty four (4.8%) of the children had haemic whereas five had pathological murmurs. Dental calculi were present in 15.8%, umbilical herniae in 18.2%, hepatomegaly in 48.2% and splenomegaly in 23% of the children. Seven (1%) had cerebral palsy. The implication is that malnutrition, sickle cell disease, malaria and other infections are the prevailing causes of morbidity in the preschool aged children surveyed. Desirable improvements include upgrading socio-economic and living conditions and instituting appropriate control measures.
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PMID:Anthropometric measurement in children aged 0-6 years in a Nigerian village. 758 49

Immune response of infants vaccinated under Expanded Programme on Immunization (EPI) was evaluated for measles, poliomyelitis, and tuberculosis in Ifo/Otta area of Ogun State and Badagry area of Lagos State, Nigeria. In the prevaccination evaluation of measles antibody, 59 per cent were protected and 41 per cent were at risk in Ifo/Otta area, while 49 per cent were protected and 51 per cent were at risk in the Badagry area. After measles vaccination, 89 per cent of those evaluated seroconverted and 11 per cent did not in Ifo/Otta area, while in Badagry area, 86 per cent of those evaluated seroconverted and 14 per cent did not. For polio neutralizing antibody evaluated at post-immunization, 91 per cent seroconverted, while 9 per cent did not in Ifo/Otta area, while in Badagry area 66 per cent seroconverted and 34 per cent did not. Tuberculin test was used to evaluate the cellular response to BCG vaccination against tuberculosis. 64 per cent were found protected, while 18 per cent were at risk in both areas examined and 18 per cent dropped out. Using Gomez method to evaluate the nutritional status of the infants, 34 per cent were malnourished in Ifo/Otta area and are mostly immigrants. In Badagry area, 53 per cent were normal while 47 per cent were malnourished and most of the malnourished infants were plagued with diarrhoea, severe cough, high fever or malaria infection. Most of the malnourished in the two areas screened were between 9 and 18 months of age, which is the crucial period in the growing stage of the children.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evaluation of immune response in infants with different nutritional status: vaccinated against tuberculosis, measles and poliomyelitis. 785 39

The dilemma of private practitioners is whether to prescribe or not to prescribe iron supplements on suspicion of anaemia. This cross sectional study was done in an urban squatter settlement with a primary health care centre to assess the significance of symptoms and a history of associated diseases in the diagnosis of anaemia. A total of 321 children were sampled from 1800 children < 5 years of age in a population of 11,000, by systematic random sampling. Mothers were asked about the presence of assumed associated symptoms and diseases which were listlessness, irritability, anaemia, pica, poor weight gain, diarrhoea, acute respiratory infection and malaria in last 3 months. There was significant association between anaemia (Hb < 11 gms%) and irriability (P < .02), anorexia for solid foods (P < .04), pica (P < .001), episode of diarrhoea (P < .001) and poor weight gain (P < .006). There was no significant association between malaria, cold, cough and anaemia. Children with these symptoms complex should receive iron supplements.
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PMID:Anaemia in children: Part II. Should primary health care providers prescribe iron supplements by the observation and presence of assumed symptoms? 786 85


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