Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024530 (malaria)
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The provision of essential drugs and the involvement of various potential and existing health care providers (e.g. teachers and traditional healers) are two important primary health care strategies. One local group that is already actively supplying the medication needs of the community is the patent medicine vendors (PMVs), but the formal health establishment often views their activities with alarm. One way to improve the quality of the PMVs' contribution to primary care is through training, since no formal course is required of them before they are issued a license by government. Primary care training was offered to the 49 members of the Patent Medicine Sellers Association of Igbo-Ora, a small town in western Nigeria. Baseline information was gathered through interview, observation and pre-test. A training committee of Association members helped prioritize training needs and manage training logistics. Thirty-seven members and their apprentices underwent the 8 weekly 2-hr sessions on recognition and treatment (including non-drug therapies) for malaria, diarrhoea, guinea worm, sexually transmitted diseases, respiratory infections, and malnutrition, plus sessions on reading doctor's prescriptions and medication counseling. The group scored significantly higher at post-test and also showed significant gains over a control group of PMVs from another town in the district. The Igbo-Ora experience shows that PMVs can improve their health care knowledge and thus increase their potential value as primary health care team members.
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PMID:Primary care training for patent medicine vendors in rural Nigeria. 148 95

In 1992, the worst drought in recorded history hit southern Africa. It especially affected the eastern area of Swaziland where staff at a rural district hospital, Good Shepherd Hospital in Siteki, struggled to treat rising numbers of ill and malnourished people. 10% of the population in this area reached the advanced stage of starvation. Almost 50% did not have enough food to meet their nutritional needs. Women had to travel as far as 15 miles to retrieve water from tankers and sometimes wait for days because other water sources evaporated. Maize did not grow. The subsistence farmers and their families, who made up most of the population, were able to use food stored from the year before, but it only postponed hunger. They sold their cattle (their symbol of wealth), borrowed money, and migrated to cities, leaving children and grandparents to provide for themselves. This area also had an influx of refugees from Mozambique who tended to receive more food than the natives. The incidence, but not the types, of diseases increased much during the drought. These diseases included diarrhea, respiratory infections, measles, marasmus, kwashiorkor, and vitamin deficiencies. The drought did reduce the incidence of malaria, however. Nongovernmental organizations helped with food and in measuring the effects of the drought, e.g., with anthropometric surveys of young children. The international community offered to send Swaziland more than 100,000 tons of cereal, but by December 1992 the cereal had not arrived. The people distributed the limited food to those most in need. The limited maize available for distribution was yellow, but the people were accustomed to white maize and believed yellow maize to be poisonous. When droughts occur, the crux of the problem in developing countries is the pressure exerted by multinational lending institutions to earn foreign currency to pay interest on national debt.
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PMID:Another African disaster. 846 97

A declining trend of breast feeding (BF) was noticed in the early 1970s, but a decade of intensive campaigning by national and international agencies for BF has reversed this. The objective of the present study was to assess the knowledge and attitude amongst teachers before launching an orientation course in maternal and child health care for them. A structured questionnaire was administered to 62 married women teachers of middle socioeconomic background and education. 98% of mothers knew that breast milk was the nutrition of choice up to 4-5 months of age, and 94% mentioned that BF should be started immediately after birth. 94% of subjects knew that colostrum should be given, 95% were aware that protective substances were present in breast milk. 61% were cognizant of the need to continue BF as long as possible. 92% of the subject knew about improved mother-infant bonding owing to BF. Only 60% knew that lactation provided complete protection against pregnancy during the first 4 months. 615 of the mothers deemed BF in public embarrassing. All subjects were aware that unhygienic bottle feeding caused diarrhea, whereas BF offered protection. Many of them felt that BF should be stopped when the mother had tuberculosis (16%), malaria (55%), and diarrhea (60%). 65% of mothers had misconceptions that diluted top milk should be given even after 4 months of age, while 35% were mistaken that commercial preparations of milk were more nutritious than breast milk. 76% had the erroneous knowledge that high consumption of almonds, cashew nuts and other dried fruits increased the volume of breast milk. 94% of the teachers knew that the child should get colostrum, and almost 37% felt that bottle feeding should be entirely avoided. These results point to the urgent need of starting nutrition education programs for working mothers.
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PMID:Perception towards breast feeding amongst working women teachers of a public school in Delhi. 150 Jan 36

Fever is the cardinal symptom of many infections in travellers returning from the tropics and is second in place only to infectious diarrhea. Once the obvious causes of fever in an individual patient have been eliminated, it may be very difficult to find the cause of fever. Fevers can be distinguished by their length of duration and divided into acute fevers i.e. up to 3 weeks duration and chronic fevers i.e. more than 3 weeks duration. Whether fever goes along with leucopenia or a normal white blood cell count on the one hand or with leucocytosis on the other hand is of differential diagnostic value. A schedule based on these two parameters will be presented to simplify differential diagnostic considerations. Two rules of thumb will be stressed: (1) Each febrile illness, even febrile diarrhea, jaundice or meningitis, is to be considered a malaria until it is excluded. (2) Patients returning from tropical areas might suffer from banal infections such as pneumonia, urinary tract infections, cholangitis, etc. as well.
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PMID:[Differential diagnosis of fever after returning from the tropics]. 150 60

Medical reports modelled after the US Peace Corps surveillance form provided mortality and morbidity data of the United Nations Transition Assistance Group in Namibia in 1989-1990. Contingents included Australians, Canadians, Danes, Finns, Kenyans, Malays, Poles, Spaniards, and Britons. Traffic accidents, mostly those on long distance journeys caused 14 of 16 deaths. The fatality ratio was 0.21/million km driven which was considerably higher than that in Switzerland 0.02/million km driven. Even though heavy traffic was not a problem in Namibia, limited experience on unpaved roads; high speeds induced by long and tedious driving; and reduced visibility caused by climactic conditions, fatigue, and alcohol contributed to high fatality. The hospitalization rate of 5.2% (369 patients) was rather high for a young and healthy population. The leading reasons for hospitalization included fever of unknown origin, trauma, and respiratory tract infections. Swiss Medical Unit physicians transferred 25 patients to the State Hospital in Windhoek, most for orthopedic surgery. Injuries, psychiatric problems, and alcoholism resulted in repatriation for 66% of 46 repatriated patients. New consultations for treatment averaged 2.7/person and those for preventive measures averaged 0.8/person. Helicopter pilots was the largest group returning for 2nd visits (56% compared to 1% for logistics staff). The major reasons for attending outpatient clinics included immunizations (18.8%), dental problems (10.5%), and respiratory infections (10.5%). In addition to respiratory infections, other frequent communicable diseases included diarrhea or dysentery, dermatological infections, sexually transmitted diseases, and confirmed or suspected malaria. Preventive measures are needed to reduce mortality due to traffic accidents and the prevalence of psychological and dental problems.
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PMID:Epidemiological experience in the mission of the United Nations Transition Assistance Group (UNTAG) in Namibia. 156 77

Medical advice for the traveller is of increasing importance since in the past decade in industrialized countries there is a steady increase in numbers of travellers and distance travelled. Self medication was evaluated in 193 travellers to malaria-endemic areas. Diarrhoea, fever and headache were the most frequent symptoms. Antidiarrhoeal agents, analgetics/antipyretics, antibiotics and oral contraceptives were the drugs most often used by travellers. One case of mefloquine-resistant and chloroquine-sensitive Plasmodium falciparum malaria acquired in West Africa was reported, another patient took pyrimethamine/sulfadoxine because of suspected malarial fever. The main reasons for drug consumption in travellers to tropical and subtropical areas are functionally divided into 4 groups: vaccination and prophylaxis, medication during the outward and return journey, illness occurring during stay abroad and long-term medication. This classification should be considered when medical advice is given for travellers and is the basis for choosing the contents of a pocket dispensary for travellers.
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PMID:[Self-medication of 193 travelers in the tropics. Recommendations for clinical counseling of tropical travelers and organization of a tropical travel pharmacy]. 158 72

This article reviews preparatory guidelines for international travel with infants and children. Pre-travel immunizations, malaria chemoprophylaxis, and chemotherapy of traveler's diarrhea are reviewed. Dosages and schedules for special vaccines to consider for children are described. Practical advice for air travel and a prolonged overseas stay is offered to ensure safe and healthy international travel with infants and children.
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PMID:Medical considerations for international travel with infants and older children. 162 83

We report a prospective study of travel-associated illnesses observed after their return in 109 French travellers, including 86 tourists. Sixty-three were returning from Africa and 84 percent had been abroad for less than 4 weeks. The percentages of travellers immunized against tetanus, poliomyelitis and typhoid fever were 70, 63 and 36 percent respectively. Malaria prophylaxis was well adjusted to current recommendations in only 19 patients; for 9 patients it was a routine visit. One hundred patients reported 105 diseases. The diagnosis was undetermined in 31 patients, including 19 with diarrhoea and 8 with fever, and it was determined in 74 patients who were found to have malaria (14), cutaneous myiasis (12) or bacterial skin infections (12).
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PMID:[Diseases observed after return from travels outside Europe. 109 cases]. 171 19

Between April 1988-April 1989, researchers followed 4320 0-59 month old children from 31 villages in Mbarara district in southwest Uganda to examine socioeconomic risk factors for child mortality. They used anthropometric data and socioeconomic data collected during interviews. The major causes of death included diarrhea (23%), acute respiratory infections (20%), measles (14%), and malaria (13%). Fathers who had received 7 years education were more likely to have experienced the death of a child than those with more education (p.05), but mother's education did not significantly affect child mortality. The following poverty indicators were also significantly associated with child mortality: candles used for lighting (p=.003), family did not own a cow (p=.004), and lived in the village for 4 years (p=.052). Further children of birth order 5 were more likely to die than those at birth order of =or- 5 (p=.029). In fact, the children with the greatest child survival were those of birth order 3-5. All these indicators remained significant when the researchers added mid-upper arm circumference to a logistic model. The researchers concluded that nutritional status and certain socioeconomic factors are both independent and important predictors of child mortality. They commented further that even though improvement of family income and the household and the development of primary health care would increase child survival, these integrated changes will not occur effortlessly due to harsh economic conditions in Uganda. Policy makers and program managers should note that this study pointed out that differences in parental education, birth spacing, and child nutrition explained differences in mortality rates between households of basically the same socioeconomic status.
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PMID:Determinants of child mortality in south-west Uganda. 173 6

This operational study of the performance of aid post orderlies (APOs) at Taril, Southern Highlands Province, Papua New Guinea, was conducted as a follow up to prior operations research workshops and specific research which highlighted the need for adequate medical care. The assessments of the clinical performance (medical history taking, examination, diagnosis, treatment, and advice) of APOs were made by a trained Huli observer in mid-1988. 86 consultations were recorded for children brought to the aid posts for complaints of cough (40), fever (24), or diarrhea (22) and seen by 7 Tari APOs. Data were evaluated by a medical officer who used the recommended Health Department reference. Diagnosis and Treatment of Common Childhood Illnesses for APOs. Results for each illness are provided. APOs made an adequate diagnosis based on the mild and self limiting symptoms, but the medical histories and examinations were too superficial to assess the severity of the illness. Sometimes the level of treatment was inappropriate, i.e., 70% of the children received appropriate cough mixtures and antimalarials for coughs, but over 50% received inadequate doses of procaine penicillin for their age. Several children were not properly referred to the hospital for management of severe dehydration. Treatments were qualitatively correct for the diagnosis made, but inappropriate doses were often prescribed. Information was rarely given to guardians on the need for repeat medications or the signs of treatment failure. There was ample opportunity to reinforce the importance of immunization, adequate nutrition, malaria control, or personal and food hygiene but APOs did not take advantage of the situation. The results reinforce the need for on-site assessment of paramedical workers who are entrusted with frontline care of patients. It has been found that APOs are often neglected by senior staff; there are complaints from APOs that they feel unappreciated by Health Department staff and the community served. Reference is made to a study of rural health services which found that only 585 of officers in charge of health centers had made any supervisory visit in the 2 months preceding the survey. In some provinces APOs sometimes are given a 1-week inservice training period a year. Structural changes, APO selection procedures, education, inservice training, supervision, and support must be addressed in order to overcome some of the apparent weaknesses in the delivery system. The emphasis is on a problem-based approach and education and continued training.
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PMID:Management of common potentially serious paediatric illnesses by aid post orderlies at Tari, Southern Highlands Province. 175 Feb 53


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