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The seeking of healthcare for childhood illnesses was studied in three rural Nigerian communities of approximately 10,000 population each. The aim was to provide a baseline understanding of illness behaviour on which to build a programme for the promotion of prepackaged chloroquine and cotrimoxazole for early and appropriate treatment of childhood fevers at the community level. A total of 3117 parents of children who had been ill during the 2 weeks prior to interview responded to questions about the nature of the illness and the actions taken. Local illness terms were elicited, and the most prevalent recent illness and the actions taken. Local illness terms were elicited, and the most prevalent recent illnesses were 'hot body' (43.9 per cent), malaria, known as iba (17.7 per cent), and cough (7.4 per cent). The most common form of first-line treatment was drugs from a patent medicine vendor or drug hawker (49.6 per cent). Only 3.6 per cent did nothing. Most who sought care (77.5 per cent) were satisfied with their first line of action, and did not seek further treatment. The average cost of an illness episode was less than US$2.00 with a median of US$1.00. Specifically, chloroquine tablets cost an average of US 29 cents per course. Analysis found a configuration of signs and symptoms associated with chloroquine use, to include perception of the child having malaria, high temperature and loss of appetite. The configuration positively associated with antibiotic use consisted of cough and difficult breathing. The ability of the child's care-givers, both parental and professional, to make these distinctions in medication use will provide the foundation for health education in the promotion of appropriate early treatment of childhood fevers in the three study sites.
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PMID:Treatment of childhood fevers and other illnesses in three rural Nigerian communities. 1152 65

During his life in the army in 1252 - 1261, Luo Tianyi wrote down case records taken from his patients, including soldiers, military officials and their relatives. In addition to infectious diseases such as malaria, dysentery, vomiting and diarrhea and seasonal epidemics, he also treated psychosis, digestive disorders, cold damage, beriberi, coughing and cold in the legs and external diseases such as eye diseases, boils and carbuncles, hernia. The therapeutics he applied included recipes, pills, powders, pastes as well as acu - moxibustion.
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PMID:[Effective case records of Luo Tianyi in the army as recorded in Wei Sheng Bao Jian (hygienic precious minor)]. 1162 77

BACKGROUND: In a population-based epidemiological study in Ngaoundere, Cameroon, we studied cross-sectional child morbidity and the cost of necessary investigation and treatment. METHODS: Three teams of two to three health workers visited haphazardly selected households in all major housing quarters. We asked permission to enter for a health survey. Children with cough, fever or weight loss as well as sick adults were offered free-of-charge local hospital examination and treatment. RESULTS: From 177 households with 1777 persons, 51 (2.9%) persons were referred. Thirty-five of them had an undiagnosed disease threatening individual health and in many cases also public health. Seven were hospitalised, including three adults with tuberculosis. Malnutrition was diagnosed in nine small children. Four patients had AIDS, seven had malaria. Average total cost for ambulant patients was 15 USD, for hospitalised patients 110 USD.In the households, almost half of the women 16-50 years of age had no schooling. Two per cent of women and nine per cent of men were daily smokers. Coughing children were more likely than non-coughing children to live in a household with at least one smoker (OR = 3.58, 95% CI 1.72 to 7.46), and they generally lived in more poor households (P = 0.018). Twelve of 16 children with weight loss were referred from households with a high poverty score. CONCLUSIONS: Adult smoking and poverty affect children's health. The cost of hospitalisation or long-lasting therapy is beyond the means of most ordinary families. Diseases with severe consequences for public health, like tuberculosis, AIDS and malaria should have national programs with free, decentralised examination and treatment. Access to generic drugs is important. A major educational effort is needed to improve public health.
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PMID:Cross-sectional study of morbidity, morbidity-associated factors and cost of treatment in Ngaoundere, Cameroon, with implications for health policy in developing countries and development assistance policy. 1195 91

Despite recognition of acute respiratory distress syndrome in both falciparum and vivax malaria, disease-related changes in pulmonary function have not been defined, and underlying mechanisms are not well understood. Respiratory symptoms, pulmonary function, pulmonary phagocytic cell activity, and longitudinal changes were examined in 26 adults with uncomplicated falciparum, vivax, and ovale malaria after treatment. Self-limiting cough occurred in both falciparum (36%) and vivax or ovale (53%) malaria. In infection with each malaria species, admission measures of airflow and gas transfer were lower than predicted, and mean lung (99m)technetium-sulfur-colloid uptake was significantly increased. Changes were most evident in falciparum malaria, with treatment resulting in initial worsening of airflow obstruction and gas transfer. Altered pulmonary function in malaria is common and includes airflow obstruction, impaired ventilation, impaired gas transfer, and increased pulmonary phagocytic activity, and its occurrence in both vivax and falciparum malaria suggests that there may be common underlying inflammatory mechanisms.
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PMID:Pulmonary manifestations of uncomplicated falciparum and vivax malaria: cough, small airways obstruction, impaired gas transfer, and increased pulmonary phagocytic activity. 1200 Oct 51

Child survival in Cameroon is measured in the 1991 Demographic and Health Survey and found to be substantially improved. The survey includes a sample of 3871 women aged 15-49 years and a sample of 814 husbands. Community services data is also collected. Child mortality is reported as declining from 198 to 126 deaths per 1000 births during 1976-91. Infant mortality is shown to decline to 65/1000. Mortality of children aged 1-4 years is 66/1000. 79% receive prenatal care from some source, and 70% receive a dose of tetanus toxoid vaccine during pregnancy. A health professional is present at delivery for 64% of pregnant women. 52% of children aged 12-23 months have a health card, and 41% have tuberculosis, polio, diphtheria, pertussis, tetanus, and measles immunization. One in five still does not have any immunization. 62% of children with mothers who have at least a secondary school education are immunized. Diarrhea morbidity in the two weeks preceding the survey is 18% for children aged under 5 years. 9% have a cough and rapid breathing, and 23% have a fever. Child mortality among children aged 1-5 years is due to diarrhea (27%), malaria (23%), measles (27%), and respiratory infections (16%). Only 3% of children aged under 5 years has acute malnutrition. One in four are stunted, which reflects prolonged or chronic undernutrition. The total fertility rate is 5.8 children per woman, which is a 10% decrease from 1978. The lowest fertility is among women in the main cities of Yaounde and Douala (4.4 children) and among women with a secondary or higher education (4.5). Over 50% of women have sexual intercourse before the age of 16 years, and 50% are married before the age of 17 years. 50% of married women have their first child at the age of 19 years. Contraceptive usage is 16% among women in any union, of which 25% is use of a modern method. Only 1 in 25 women use an effective method, but this rate is double the rate in 1978. Total fertility would be 10% if unwanted fertility were avoided. Most men and women want large families.
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PMID:Improved child survival in Cameroon. 1228 22

In the 1980s, the existence of an estimated 8 million cases of tuberculosis (TB) indicated that the National Tuberculosis Program (NTP) had failed to reduce prevalence from the 1950s. Consequently, a multidrug short-course chemotherapy was proposed to provide more aggressive treatment along with training of staff and intensive supervision. The strengths of the NTP are that it is a need-based program, that it is integrated into the general health system, that it uses cheap diagnosis and treatment technology, that it has monitoring and evaluation systems, and that it considers epidemiological trends. To have a major impact on the epidemiology of TB, 70% of cases have to be eliminated continuously for 15-20 years; thus short-term reduction of prevalence will not suffice. The sociological components of NTP comprise simple and cheap preliminary diagnosis; symptoms compelled people to seek institutional help (although 50% were dismissed with cough mixture) and this proportion was used for passive case detection; and NTP's home treatment proved to be cheap and easily accessible, allowing patients to continue their normal life. Domiciliary therapy was socially more acceptable, promising higher patient compliance. Another social aspect of NTP was the high levels of default: incorrect diagnosis and failure to inform patients about the necessity of prolonged treatment. Social problems encountered in implementation had to do with treating TB as a component of an interdisciplinary approach, combining it with family planning and malaria eradication programs, which were given precedence in resource allocation. The technical programs of disease and population control overpowered the socially sensitive NTP, and as a result, TB control has failed. This meant that in urban clinics 80% of cases were lost because of organizational reasons. Another major social issue is that 50% of the people live below the poverty line, and the problem of default can only be resolved if their living conditions are improved.
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PMID:National Tuberculosis Programme: a social perspective. 1228 87

Each year, at least 4 million African children die before they reach their fifth birthday, and 70% of the deaths are caused by pneumonia, diarrhea, malaria, measles, malnutrition, or, more commonly, a combination of these. Despite the fact that sick children often have more than one condition, busy clinics tend to treat only the one that is most obvious. With much of the effort of the past two decades directed to diarrhea, health workers have been taught their clinical skills in a piecemeal, rather than an integrated, fashion. In response to this problem, the World Health Organization and the UN Children's Fund developed a training course for the integrated management of childhood illnesses (IMCI) in 1993. IMCI is now being used in Uganda, Tanzania, and Zambia, and other African countries are preparing to institute it. IMCI relies on a straightforward clinical assessment and classification of illness that does not require the use of a laboratory. IMCI identifies general danger signs that may call for hospitalization of the child and then bases its assessment on the presence of 1) cough and difficulty breathing, 2) diarrhea, 3) fever, 4) measles, 5) ear infection, and 6) malnutrition. All sick children are screened for all of these conditions because IMCI capitalizes on the presence of the child in the clinic (vaccinations are also given if necessary). Training for IMCI involves 11 days, half of which are spent in clinical practice and demonstration and half in the classroom. Each country must adapt the IMCI guidelines and training course to meet its specific needs. Such adaptation provides an opportunity for collaboration among disease-specific programs; it stimulates a review of technical and clinical guidelines; and it provides an opportunity for the health system to focus on its essential drug needs, referral care, and supervisory system.
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PMID:The integrated management of childhood illness. 1229 34

The main causes of death in rural areas of the Faritany of Toamasina during 1986 are identified and classified by order of importance for the entire population as well as for vulnerable groups such as preschool children and reproductive-aged women. The 10 leading causes of death of infants and children under age 5 years are coughs and fevers, as well as thoracic pains; vomiting and diarrhea; age factors; high, intermittent fevers and chills; protein-calorie malnutrition; convulsions; other high fevers; cough of long duration; sudden death; and measles. Leading causes of death for women aged 15-49 years include coughs and fevers, as well as thoracic pains; high, intermittent fevers and chills; vomiting and diarrhea; other high fevers; delivery complications; cough of long duration; malnutrition; abortion or miscarriage; sudden death; and postpartum illnesses. Over 60% of deaths reported for children aged 0-5 years could have been prevented through a broader vaccination program, oral rehydration therapy, nutrition education and growth monitoring, and the preventive treatment of malaria. Priority focus should be given to respiratory infections.
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PMID:[Causes of mortality in a rural area in the Faritany of Toamasina in 1986]. 1229 43

Algorithms which specify procedures for proper diagnosis and treatment of common diseases have been available to primary health care services in less developed countries for the past decade. Whereas each algorithm has usually been limited to a single ailment, children often present with the need for more comprehensive assessment and treatment. Treating just one illness in these children leads to incomplete treatment or missed opportunities for preventive services. To address this problem, the World Health Organization has recently developed a Sick Child Algorithm (SCA) for children aged 2 months-5 years. In addition to specifying case management procedures for acute respiratory illness, diarrhea/dehydration, fever, otitis, and malnutrition, the SCA prompts a check of the child's immunization status. The specificity and sensitivity of this SCA were field-tested in Kenya and the Gambia. In Kenya, the Malaria Branch of the US Centers for Disease Control and Prevention tested the SCA under typical conditions in Siaya District. The Quality Assurance Project of the Center for Human Services carried out a parallel facility-based systems analysis at the request of the Malaria Branch. The assessment which took place in September-October 1993, took the form of observations of provider/patient interactions, provider interviews, and verification of supplies and equipment in 19 rural health facilities to determine how current practices compare to actions prescribed by the SCA. This will reveal the type and amount of technical support needed to achieve conformity to the SCA's clinical practice recommendations. The data will allow officials to devise the proper training programs and will predict quality improvements likely to be achieved through adoption of the SCA in terms of effective case treatment and fewer missed immunization opportunities. Preliminary analysis indicates that the primary health care delivery in Siya deviates in several significant respects from performance standards (not counting respirations in the presence of a cough as the primary complaint, not checking for dehydration in cases of diarrhea, and checking immunization records in only 51% of the 235 cases observed). The report is scheduled for completion in early 1994 and will likely provide data vital to the successful adoption of the SCA.
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PMID:QAP collaborates in development of the sick child algorithm. 1234 42

A total of eighty-one consecutive cases of Kala-azar admitted in all four medicine units of Mymensingh Medical College Hospital during the period from January 2002 to mid August 2002 were included in this study. The number of the patients clearly indicates that the burden of Kala-azar in this region is significant and expanding, which constituted 1.90% of total admission in all 4 medicine units during this period. Majority of the patients were of 20-29 years of age. Male to female ratio was 1.38:1. Maximum number of the patients were of poor socio-economic group with history of housing made up of mud and having close proximity with cattle house. Fever and splenomegaly (100%) were the predominant features. Hepatomegaly was found in 91.36% of the cases. Other clinical manifestations were weight loss (79.01%), normal or increased appetite (65.43%), generalized weakness (72.84%), pallor (69.13%), cough (25.92%), jaundice (17.28%), abdominal Pain (12.34%), hyperpigmentation (9.88%), ascites (4.94%) and bleeding manifestations (4.94%). Notable concomitant illnesses were urinary tract infection (7.40%), pulmonary tuberculosis (3.70%), malaria (1.23%), scabies (4.94%), heart failure (3.70%) and chronic liver disease (2.47%). Due to wide diversity of clinical presentations, clinical features of kala-azar should be evaluated in details which will pave the hidden cases into light.
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PMID:Clinical profile of Kala-azar in adults: as seen in Mymensingh Medical College Hospital, Mymensingh, Bangladesh. 1271 42


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