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Even though Kenya stopped requiring tuition for primary school in the early 1970s, parents still must pay for books, pencils, and uniforms and contribute to a building fund. Enrollment for 8 year olds stands around 92%. The Aga Khan Health Services (AKHS) in Kisumu, Kenya recognizes the potential for improving the health status of children by using primary schools as a vehicle for health education. Its schools program sees school children as providers of health care for younger siblings. The program incorporates children's education, health, and health education. School children learn about health and pass on the information at home. For example, school children check to see if basic public health measures are done at done, e.g., covers for latrines. Teachers encourage students to bring younger siblings to monthly monitoring sessions. Here they learn to interpret growth charts and to determine who need immunizations. Since many primary school students are teenagers and teenage pregnancies are common, sex education is being considered. A comic book called Pied Crow distributed to every primary school addresses social issues, such as AIDS. Malaria killed 20 children in 1987, but by 1991 it killed only 2-3 children in Kisumu. Infant mortality in 1984 stood between 194-236/1000 and by 1987 AKHS reduced it 145.5-177. WHO's expanded program on immunization still does not serve most children, however, mainly because 25% of Kenyans live 5 miles from a rural health facility. Therefore measles still is the leading cause of death in children followed by acute respiratory failure. Some teachers become community health workers and other teachers interact with them. Community health workers partake in child growth monitoring activities and health education. Some areas around Kisumu now have piped water and AKHS has a well digging program. These activities have resulted in a substantial reduction in diarrhea.
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PMID:Child health and education in Kenyan schools programmes. 201 16

Each year approximately 137 million children are born, 70 million of them in countries where the mortality rate for under-fives exceeds 100 per 1,000. In worst-off Afghanistan 300 per 1,000 children under five die. We review some of the most common causes of this catastrophy: diarrhoea, acute respiratory infections, measles, malaria, and neonatal tetanus. All of the numerically significant contributors to under-five mortality are treatable and/or preventable by simple and inexpensive methods. Medical personnel from industrialized countries, and there is an increasing need for transfer of financial resources from highly developed to developing countries. The living conditions of children in the third world involve many factors that are detrimental to both physical and mental health. In order to effect a change, all countries and societies must become involved.
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PMID:[Children and diseases in the Third World]. 204 59

The health situation in Nigeria is typical of tropical Africa. It is characterised by high childhood and maternal mortality and a relatively short life expectancy. Mortality in childhood in due mainly to diseases like malaria, measles, poliomyelitis, tetanus, diarrhoea and acute respiratory tract infections. Diseases like filariasis, schistosomiasis and leprosy which are now readily controlled by drugs cause considerable morbidity in later life. Although the technology and tools (particularly vaccines and drugs) for the control of most of these diseases are now available, it has not been possible to make optimal use of them in Nigeria and other tropical African countries because of unfavourable social and economic conditions. The non-availability of drugs most needed for healthcare and disease control has been found to be due not only to insufficient funds but also to the use of the limited funds on expensive drugs that have little bearing on the disease pattern. The Essential Drug Programme initiated by the World Health Organisation, now adopted by Nigeria and about 100 other countries mostly in the Third World, aims to correct this unsatisfactory drug supply situation by ensuring that the available funds are used to provide those drugs needed by the large majority of the people and are made available at all times at prices that most people can afford. The Bamako Initiative in the African Region of the World Health Organization is also designed to ensure regular availability of drugs particularly to primary healthcare facilities. Seed drugs are provided to the health institutions either by the National Government or through external aid. These are sold to patients at a small profit margin. The proceeds are then used to replenish stocks and the small profit used to improve services in the health centre. The introduction of these programmes in Nigeria has improved drug availability considerably in the past couple of years and should soon start yielding further dividend in the form of measurable improvement in the health situation.
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PMID:Drug supply in Nigeria. 204 36

Researchers interviewed 194 mothers of children 1-2 years old in Port Moresby, New Guinea to determine why childhood immunizations are not completed. They also looked at the baby clinic books to see if the children received the completed doses of vaccines. 87% did not know why children should be immunized. Moreover only 13% believed immunizations could prevent disease. Further 86.6% could not list any of the diseases that immunizations target. 11.9% did correctly report measles, tuberculosis, polio, and pertussis, however. On the other hand, 3 (1.5%) mothers incorrectly believed immunizations protect against malaria, diarrhea, and malnutrition. The relationship between lack of knowledge and noncompletion of immunization was not significant, however (p=.07). 76.8% reported very rude behavior on the part of the health staff. 15.5% went so far to say that the health staff often reacted aggressively towards them. Only 7.7% reported kind of behavior. Mothers who perceived health staff attitudes as negative tended not to return to the clinic with their children for the 3rd dose (p=.002). DPT and polio vaccine coverage declined consistently from 94% (1st dose) to 79% (3rd dose). Nevertheless 3rd dose coverage was considered rather high. Since hospital delivery was almost universal in Port Moresby and hospital staff routinely administer the BCG vaccination prior to discharge, BCG coverage was high (96%), however. Emphasis in the national immunization program should be on changing health staff attitudes leading to improvements in the social interaction between patients and health staff.
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PMID:Possible reasons for non-completion of immunization in an urban settlement of Papua New Guinea. 205 99

Operational research studies of the immunization systems in Conakry, Guinea, conducted in 1988-89 following a series of mass campaigns, aided in the formulation of a comprehensive strategy for achieving high, sustained vaccination coverage. The first, an evaluation of service quality, found that only 30% of children who presented for treatment of diarrhea or malaria were screened by health center staff for their vaccination status; when injections were given, a sterile syringe and needle were used only half the time. In the second study, in-depth interviews with health workers revealed a lack of awareness of the importance of involving the community in immunization programs. In the third study, the focus group discussion technique was used to obtain users' perspectives on vaccination services. Mothers were supportive of vaccination, but lacked knowledge about the vaccination schedule and some complained about long waiting times, high costs of vaccines, a lack of rapport with health workers, and the occurrence of abscesses after vaccination. Finally, a KAP survey found that only 19% of eligible children had been completely vaccinated; an additional 19% had a sufficient number of contacts with the health center to be fully vaccinated, but had missed at least one opportunity. Factors associated with initial receipt of vaccine included higher socioeconomic status, hospital delivery, and the perception that vaccination was affordable, while the mother's educational level, employment status, and experience with the vaccination service were the key determinants of completion of the series. Taken together, these studies indicated a need for increased community involvement and efforts on the part of health personnel to reduce the number of missed opportunities for vaccination, especially in the curative sector.
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PMID:Application of multiple methods to study the immunization programme in an urban area of Guinea. 207 15

A double-blind comparative study of Fanismef-mefloquine/sulfadoxine/pyrimethamine (MSP) and Lariam-mefloquine (MEF) for the treatment of falciparum malaria, was carried out at malaria clinics in Kanchanaburi, in western Thailand, in the years 1987 and 1988. The cure rates obtained were 96% for the MSP group and 93% for the MEF and there was no significant difference. Vomiting and diarrhea were common side effects in both the MSP and MEF groups. Less common side effects were epigastric pain, minor skin rashes and dizziness. Significant differences in vomiting and epigastric pain only occurred in the patients who did not have these symptoms before treatment: vomiting MSP 23%, MEF 8%, epigastric pain MSP 22% and MEF 11%.
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PMID:Phase III double-blind comparative study of Fansimef and Lariam for the curative treatment of Plasmodium falciparum infections in Thailand. 207 82

The retrospective analysis, on a twelve months' period, of 146 files of patients suffering from malaria at the National University Hospital in Cotonou helps conclude what follows: the gastro-intestinal manifestations are frequent and represent 41% of adult malaria cases. Most of the time, they are characterized by vomiting (32.9%), followed by abdominal pains (20.5%). Diarrhoea is less frequent and represents only 6.8% of the cases. Those signs may be unusually acute and be mistaken for a possible surgery emergency or have serious consequences on the general health of the patients. They can, for instance, involve shock. The anoxaemia of tissues involved by microcirculation troubles is the main factor of the pathogenesis of those manifestations. A specific cure only can entail the disappearance of those signs and restore normal blood circulation conditions.
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PMID:[Digestive manifestations of malaria in adults in an endemic zone]. 208 3

In this article it is outlined the work of doctor Bustamante in fighting against diseases such as yellow fever, typhus, malaria, and smallpox; and the development and impel that this professional gave to preventive and social medicine is pointed out. It is established that health care professionals currently must not only highly studied and prepared, as they should manage all features related with public health, but also change-men-and-women who are capable to influence future generations, which will be the responsible in relocating men at the equilibrium point concerned to their health. Said equilibrium point is not only modified in its biopsychosocial aspect, but also its essence is deeply affected. This paper is a warning to physicians to fight together in response to humanity, that has set their confidence in them, as the current problem of drugs and dependence to drugs unhinges everything wholeness. To doctor Suarez is intolerable that, in spite of technological advances in the world, yet exist deaths caused by pneumonia or diarrhea. The hazards of the century are frightened: nuclear war and AIDS; but the characteristics that have distinguished human species and allowed its survival and superation are trusted: mental activity, ability of judgement, and consciousness; which are valuable for a deep philosophic discussion that allows us to continue our advance. An enumeration of the medicine achievements in this century is made.
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PMID:[Health challenges as the second millenium is ending. Conceptual epidemiology, social pathology, medicine and professional ethics]. 208 47

Recently introduced chloroquine resistant malaria has altered the clinical picture and complicated the overall management of malaria. 113 adults with proved malaria admitted at Harare Central Hospital, Zimbabwe, were evaluated to determine the incidence, nature, relationship to morbidity and mortality and response to treatment of the complications due to malaria. 47.7 pc (52 of 109) patients had relatively chloroquine resistant malaria. 87.4 pc (99 of 113) had complications whose percentage frequency of occurrence were: Anaemia 51.2 pc, diarrhoea and/or vomiting 42.2 pc, cerebral malaria +/- fits 39.2 pc, renal insufficiency +/- hyperkalaemia 26.4 pc, hypoglycaemia 15.6 pc, jaundice 15.2 pc, neuro-psychiatric 15.0 pc, shock 10.6 pc, concurrent sepsis 8.9 pc, pulmonary oedema 3.5 pc and hyperpyrexia 1.7 pc. Multiple complications in the same patient were common. The combination of cerebral malaria and renal insufficiency had the worst mortality (p less than 0.001). All patients dialysed, however, survived. Non-iron deficiency anaemia, 91.7 pc (51 of 55) and diarrhoea and/or vomiting, were common, worsened morbidity but not mortality (p = 0.555). A seriously-ill patient with malaria should be suspected of having complications and chloroquine resistance and should be referred promptly to a centre with facilities for dialysis. Anti-malaria drugs should be mixed in a dextrose solution and iron supplements should not be given routinely.
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PMID:Complications of seasonal adult malaria at a central hospital. 209 79

A study was conducted to determine the knowledge and attitude about breastfeeding amongst adolescent school girls (n = 74) studying in an urban public school in Delhi. A pretested semi-structured questionnaire was administered. The majority of respondents had correct knowledge about the age of initiation of breast feeding (76%), introduction of semi-solid foods (61%), feeding of colostrum (58%) and superiority of breast milk over commercial preparations of milk (81%). Most believed wrongly that consumption of dry fruits (89%) and high intake of milk and pure ghee (78%) would increase breast milk secretion. The percentages of girls wrongly believing that breast feeding should be discontinued if mother was suffering from tuberculosis, malaria and diarrhea were 96, 85 and 81 respectively. There is need for including adolescent girls in continuing education activities about maternal and child health.
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PMID:Knowledge and attitude amongst well-to-do adolescent school girls towards breast feeding. 209 75


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