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This overview of health programs and conditions in India reveals that health is related to economic development antipoverty measures, food production and distribution, drinking water supply, sanitation, housing, environmental protection, and education. There are urgent requirements for effective intersectorial coordination. Unprecedented growth of 1 million a year has resulted in slums and shanties--a place of epidemics; urbanization has contributed to environmental pollution impacting on health, and water pollution to water-born diseases. Health services are still insufficient to meet the needs. Sanitation practices contribute to cholera, dysentery, diarrhea, enteric fevers, and malaria. Indian Systems of Medicine and Homeopathy must be active in preventive and health care. Accomplishments include in 1987/8 a decline in leprosy cases attributed to the existence of leprosy control units. 40 AIDS Surveillance Units are actively treating and screening. The Naval Goitre Control Programme's goal is replacement of iodized salt for edible salt by 1992, thereby reducing mental retardation and low birth weight babies. The Family Welfare Programme, targets a New Production Rate of Unity before 2000. A National Technology Mission on immunization and the Universal Immunization Programme plans to be operational in all districts by 1990. Oral rehydration therapy programs dispense free packets to fill the needs of 1 million children under 5 who suffer from diarrhea 3 times a year with 3 million facing death. The Primary Health Care Programme provides iron and folic acid to women with nutritional anemia and Vitamin A to children. Health service developments have been increased.
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PMID:Status of health in India and its future prospects. 226 69

A double blind study of daily doxycycline (100 mg) vs. weekly mefloquine (250 mg) was performed on United States soldiers training in Thailand to assess the effect of doxycycline malaria prophylaxis on the incidence of gastrointestinal infections. During a 5 week period, 49% (58/119) of soldiers receiving doxycycline and 48% (64/134) of soldiers receiving mefloquine reported an episode of diarrhea. Infection with bacterial enteric pathogens was identified in 39% (47/119) of soldiers taking doxycycline and 46% (62/134) of soldiers taking mefloquine. Forty-four percent (59/134) of soldiers receiving mefloquine and 36% (43/119) of soldiers receiving doxycycline were infected with enterotoxigenic Escherichia coli (ETEC), while 9% (12/134) of soldiers receiving mefloquine and 4% of soldiers receiving doxycycline were infected with Campylobacter. Side effects from either medication were minimal. After 5 weeks in Thailand, the percent of non-ETEC strains resistant to greater than or equal to 2 antibiotics increased from 65% (77/119) to 86% (95/111) in soldiers on mefloquine and from 79% (84/106) to 93% (88/95) in soldiers on doxycycline. Doxycycline prophylaxis did not prevent or increase diarrheal disease in soldiers deployed to Thailand where ETEC and other bacterial pathogens are often resistant to tetracyclines.
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PMID:A comparative study of gastrointestinal infections in United States soldiers receiving doxycycline or mefloquine for malaria prophylaxis. 226 64

Travelers to developing countries are at risk of contracting tropical infectious diseases that they or their physicians may be unfamiliar with. Proper pre-travel counsel should be given concerning general health risks that may be encountered abroad, immunizations, malaria prophylaxis and prevention and treatment of traveler's diarrhea. In Rhode Island, expert advice may be obtained at the Traveler's Clinics at the Miriam Hospital in Providence (401-274-3700 or 331-8500, ext. 4075) and the Memorial Hospital in Pawtucket (401-722-6000, ext. 2545). The Miriam Traveler's Clinic is open Wednesday (9-1) and all day Friday while the Memorial Traveler's Clinic is open Tuesday afternoon. These Traveler's Clinics are headed by Drs G.R. Olds and S.M. Opal, respectively.
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PMID:Travel to developing countries: pre-departure medical advice. 234 32

Health advice for international travelers should be individualized, taking into account the itinerary, the lifestyle of the traveler, the duration of travel, the patient's medical history, and other modifying factors. Although patients often seek advice because of immunization requirements, the pretravel visit should consider additional indicated immunizations; health maintenance advice regarding food, drink, and activities; malaria prevention when indicated; and diarrhea management. The traveler should be advised about a basic medical kit and receive information as to where to seek medical advice should serious illness develop while travelling.
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PMID:Immunizations, medications, and common sense for the international traveler. 234 87

Mortality under seven years of age in a rural population in the Gambia in 1982-1983 is analyzed. The population examined is one with a high level of infant immunization but poor access to health facilities. An infant mortality rate of 142 per 1,000 live births and a mortality rate for children aged 1-4 years of 43 per 1,000 are observed. Acute respiratory infections, malaria, and chronic diarrhea with marasmus are shown to be the major causes of death after the first month of life. The authors conclude that very little impact could be made on these rates by expanded immunization efforts.
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PMID:Deaths in infancy and early childhood in a well-vaccinated, rural, West African population. 244 58

This review describes the transmission, clinical picture and immunological abnormalities of HIV infection in children in general, and the special problems of AIDS in African children. The review begins with a thorough introduction to the epidemiology of AIDS. Transmission to children generally involves vertical transmission by placental transfer or transmission of HIV via transfusion of blood and blood products, or by contaminated needles. Casual transfer is unknown, and only a few cases of transmission via breast milk are known. The clinical picture of HIV infection in infants and children differs from that in adults in 3 important aspects: earlier onset, different clinical presentation and existence of AIDS embryopathy. The average onset was 5 months of age. The most common symptoms in young children are chronic interstitial pneumonitis without demonstrable etiology, hepatomegaly, failure to thrive, adenopathy, diarrhea, oral or perineal thrush, eczema and thrombocytopenia. The common opportunistic infections are pneumocystis carinii pneumonia, cytomegalovirus, Epstein-Barr virus, Cryptosporidium diarrhea, pyogenic infections of the middle ear and gram-negative septicemia. Several infections seen in adult AIDS cases are rare in children: mycobacterium avium-intracellulare, toxoplasma gondii, hepatitis B, as well as Kaposi's sarcoma, malignant lymphoma and cardiac abnormalities. The AIDS embryopathy or HIV dysmorphic syndrome is characterized by immunological abnormalities, growth failure, and craniofacial dysmorphism, particularly microcephaly, prominent box-like forehead, hypertelorism, flattened nasal bridge, obliquity of the eyes, blue sclerae and patulous lips. AIDS in African children is extremely difficult to diagnose because of similarities between the presenting symptoms and those commonly seen in sick children there, many of whom are also immune compromised. Where serotesting is available, the picture is complicated by cross reaction between the test agents and some factor found in sera from malaria patients. Seropositivity in some areas is high, increased by the prevalence of transfusion and injection treatments. Diagnosis is made more difficult by lack of laboratory facilities and difficulties in follow-up for pediatric patients. The CDC definitions of AIDS and ARC, and the WHO/CDC definitions of AIDS are appended.
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PMID:Human immunodeficiency virus infection in childhood. 245 15

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

Despite Burma being one of the potentially wealthiest nations in Asia, it is one of the poorest countries in the world. Although health care is free in theory, in reality it must be paid for or purchased on the black market. Many of the hospitals are great distances from the villages; patients end up being housed with their families and sometimes livestock as well. Since family planning is against the law, items like contraceptives can only be purchased on the black market. Burmese life is centered around folk traditions; even births are influenced by the days that they fall on. Malaria, diarrhea, and other infectious disease are the main cause of death of children under 5. UNESCO and other non- governmental agencies assist Burmese villages in setting up health programs and relief programs. Despite overwhelming poverty and disease, the Burmese people still remain friendly and generous.
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PMID:Burma: the royal and golden country. 252 35

This paper provides a detailed analysis of the survival rates and health problems of a cohort of children born during a 5-yr period in part of the city of Ilorin, Nigera. The findings are linked to a demographic and environmental study which indicates that the study area was relatively stable in terms of family structure and population turnover. Most people work in the informal sector, in trading, small scale crafts and service industries. At the time the survey began, in 1979, the provision of piped water supplies to the area was unreliable and sanitation provisions rudimentary. Most of the people had little or no formal education and were very poor. The study indicated that health status had improved over the 5-yr period, compared to a baseline study conducted in 1979. Common causes of child mortality and morbidity included diarrhea, acute respiratory infections, measles, and malaria. The infant mortality rate was 41.5/1000. The availability of clinic care at nominal cost, and the attendance of mothers at the clinic for checkups and immunization, resulted in a higher level of health for their children than otherwise would have been possible. Some problems of primary health care in the area are mentioned, in the light of Nigeria's current budgetary problems, and the utilization of existing strong social support networks to improve health care and environmental sanitation and water supply is suggested.
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PMID:Child health and child care in Okelele: an indigenous area of the city of Ilorin, Nigeria. 262 17

A study was undertaken to determine the knowledge and attitude about breastfeeding amongst auxiliary nurse midwives (ANMs) working in rural Delhi. It was found that all respondents had correct knowledge about age of initiating breastfeeding, feeding of colostrum and superiority of breast milk over commercial milk preparations. About 76% responded that top milk given after 4 months of age should be diluted. A majority of workers mentioned that consumption of dry fruits, high quantity of milk and ghee increases the quantity of breast milk secretion. The percentage of ANMs who thought that breast-feeding should be discontinued if mother is suffering from an illness were: breast cancer (68%), tuberculosis (56%), malaria (50%) and diarrhea (36%). There is need for continuing education of peripheral health functionaries for updating their knowledge.
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PMID:Knowledge attitude towards breast-feeding amongst auxiliary nurse midwives in rural Delhi. 263 Apr 42


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