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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A researcher reviewed village health worker (VHW) utilization in a primary health care (PHC) program in villages around Farafenni in North Bank division of The Gambia. 47 children 7 years old died between April 1986-March 1987. WHWs could have treated the illnesses (malaria, diarrhea, and acute respiratory infection) that killed 23 (49%) of these children. Yet they treated only 6 of the 23 while other health workers in the region treated 14 children. 3 children received no treatment. Further a traditional healer later treated 3 of those seen by a VHW before death. Parents of a fatally ill child with diarrhea were a bit more likely to take the child to a traditionally healer than a VHW. None of the VHWs referred any of the fatally ill children to the next PHC level. Chronic diarrhea/malnutrition, chronic cough, meningitis, measles, and septicemia caused the death of 20 of the 24 remaining children. A VHW treated only 1 of the 24 remaining children before death. Moreover a VHW saw only 48% of the living children who had experienced illness during the study period. The remaining children went to other health providers. 26% of mothers claimed they had forgotten that VHWs could treat illnesses. In fact, 75% of those who had forgotten did not clearly understand the role of the VHW. They tended to think that the VHW provided only prevention information. 20% could not afford a VHW, yet they paid much more for other health workers. Another 26% said that the VHW was not available at the time. 5% reported the VHW to be unsupportive. The remaining 21% did not know why they did not take their child to a VHW. When the researcher pushed these mothers, 61% gave personal animosity as a reason and 39% did not want to talk about it. In conclusion, the VHWs did not receive adequate training, had limited range of drugs, were poorly supervised, and often not available.
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PMID:Utilization of village health workers within a primary health care programme in The Gambia. 188 Aug 30

In recent decades infectious and parasitic diseases (class 1 according to the International Classification of Diseases-9) constitute 2-3% of causes in the total morbidity structures in the USSR. The main causes of death among diseases of class 1 are tuberculosis (37%), acute enteric infections (30%), septicemia (11%), viral hepatitides (11%), meningococcal infection (4%), measles (2%). The main groups are children aged up to 2 years (48% of fatal cases of diseases belonging to class 1). The territorial irregularity of mortality indices has been revealed.
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PMID:[Infectious disease mortality in the USSR]. 223 6

Clinicopathologic correlations for 71 cases of fatal pneumonia in children were determined. The mechanism of death for these patients was multifactorial. Severe pneumonia alone accounted for 11 deaths (15.5%). Pneumonia associated with sepsis occurred in 42 children (59.2%). Heart failure (8.5%), hypovolemia (4.2%), and nosocomial infection (12.6%) were also seen in children with fatal acute lower respiratory tract infection. Extensive consolidation, squamous metaplasia, and hyaline membranes were present in the lungs of these children. Patients with severe disease must receive, in addition to antibiotics for acute episodes, individualized intensive respiratory and supportive care. Since these types of care are not available in poor communities, vaccination against measles and vitamin A supplementation for malnourished children may ameliorate the conditions that appear to predispose these children to severe or fatal disease.
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PMID:Clinicopathologic studies of children who die of acute lower respiratory tract infections: mechanisms of death. 227 Apr 5

Over a 9 year period (1354-1362), 139, 436 children were admitted to Indira Gandhi Institute of Child Health, Kabul. Of these, 51,212 (46.8%) children were hospitalized with preventable diseases. 74% of the patients were under age 5. Among the infectious diseases, gastroenteritis accounted for nearly 70% of the admissions. Tuberculosis, measles, diphtheria, and typhoid fever were other common infectious diseases. Malnutrition of varying degree was the core problem among the hospitalized children and was seen in nearly 2/3 of the admissions. 20% of them had severe protein energy malnutrition which contributed to higher mortality. Gastroenteritis contributed /2 (51.5%) of the mortality numbers. Septicemia, tetanus neonatorum, and central nervous system infections were associated with high mortality, especially among the neonates. Deaths following 6 target preventable diseases accounted for nearly 1/4 of the deaths (20.4-24.6%) over this period.
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PMID:Pattern of preventable diseases in Afghanistan: suggestions to reduce the morbidity and mortality at IGICH. 251 Nov 41

To focus attention on the problem of infant mortality in Lebanon, data were compiled on infant mortality from 1978 to 1986 at the American University of Beirut Medical Center. Causes of death are analyzed for 602 males and 398 females. 54.9% deaths occurred at 1 month of age and 77.4% died within the 1st year. Autopsies were performed on .7%. 37.7% of all neonatal deaths were due to neonatal diseases such as hyaline membrane disease, asphyxia neonatorum, immaturity, necrotizing enterocolitis, hemorrhage, hemolysis, meconium aspiration, and kernicterus. Better prenatal care would reduce this group, or the administration of corticosteroids to the mother 24-48 hours prior to delivery, as well as rapid resuscitation at birth and prevention of the 5 curses: hypoxemia, hypoglycemia, hypothermia, hypotension, and acidosis. Although unavailable in Lebanon, administration of surfactants through an endotracheal tube would also help. Infections constitute 25.1% of deaths; many are preventable through adequate public health measures and strict personal hygiene, i.e., diseases such as sepsis, pneumonia, meningitis, gastroenteritis, hepatitis, encephalitis, and 1-2 cases of the following: diphtheria, measles, peritonitis, tetanus, tuberculosis, cytomegalis inclusion, herpes, parathyphoid, pertussis, poliomyelitis, and shigellosis. Congenital diseases were 21.6%. In utero diagnosis could prevent some diseases and in utero treatment is possible for hydrocephalus and hydronephrosis. Screening programs postnatally could lead to treatment. 5.9% were malignancies such as leukemia, lymphoma, brain tumors, histocytosis, Wilm's tumor, Ewing sarcoma, and Hodgkin's disease. Early diagnosis is critical if mortality is to be reduced in this group, but medical advances are still needed. 2.9% are miscellaneous diseases such as poisoning, rheumatic diseases, marasmus, Reye's syndrome, nephrosis, rickets, and epilepsy. Most of these diseases are preventable, except for rheumatic inflammation of the heart. Recommended necessary steps to reduce infant mortality are: prenatal care, diagnosis and screening, intrauterine surgery; resuscitation and intensive care centers with modern equipment and trained personnel; national vaccination and screening programs; adequate public health measures and hygiene; parental education; and well-equipped hospitals to serve all regardless of income level.
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PMID:Pediatric mortality: an avoidable tragedy. 251 28

Infant mortality rate (IMR) and its relation to the utilization of health services was studied in twelve villages of ICDS block Rajsamand, Rajasthan from 1st April, 1985 to 31st March, 1986. The total number of births and infant deaths were 386 and 74, respectively during one year, computing 37.44 as birth rate and 191.70 as IMR. Neonatal deaths contributed 51.4%, the most common causes of which were septicemia (28.9%), birth asphyxia (23.6%), extreme prematurity (18.4%) and tetanus neonatorum (13.1%). The common causes of deaths in post-neonatal period were pneumonia (36.1%), diarrhea (25.0%), complications of measles (16.7%) and that of pertussis (8.3%). Extreme under utilization of preventive, promotive and curative MCH services was found to be one of the major factors for very high IMR prevailing in the region.
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PMID:Under utilization of MCH services--the major factor for very high IMR in rural Rajasthan. 275 49

To describe the epidemiologic and clinical features associated with invasive amebiasis in Bangladesh, 85 hospitalized diarrheal patients with hematophagous trophozoites of Entamoeba histolytica in their stools were compared to a control group of 84 hospitalized diarrheal patients without amebiasis. Postmortem examinations were carried out in 22 deaths due to amebiasis. For the patients with amebiasis, there was a bimodal age distribution with peaks at 2-3 years and greater than 40 years, whereas the control patients had a unimodal distribution with the peak at 0-1 year. The sex distribution was equal in childhood but young adults were predominantly female and older adults predominantly male. The clinical features significantly associated with amebiasis were prolonged dysentery, prior measles rash, malnutrition, hyponatremia, hypokalemia, and hypoproteinemia (all P less than 0.05). The case fatality rate in amebiasis was 29%, which was significantly higher than 11% for the controls (P less than 0.05). Postmortem findings included extensive colitis with deep ulcers and complications, including colonic perforation in 2 cases, peritonitis in 4 cases, pneumonia in 9 cases, and septicemia in 5 cases. These results indicate that invasive amebiasis in this population differs from other diarrheal diseases, affecting mainly children greater than 2 years and adults and causing severe and fatal illness characterized by extensive colitis with diverse systemic consequences.
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PMID:Epidemiologic and clinical features of invasive amebiasis in Bangladesh: a case-control comparison with other diarrheal diseases and postmortem findings. 289 90

A significant proportion of the illness and death of diarrhoeal diseases in the developing world is estimated to be due to the diarrhoea associated with measles. During February 1983-January 1984 a prospective study of measles in a hospital in Northeastern Thailand was conducted. A total of 550 cases of measles were studied. Diarrhoea was the most frequent complication of measles, occurring in 233 cases (42.4%). The largest proportion (46.2%) of cases with diarrhoea occurred in May-July. Children with measles aged 6-11 months had the highest frequency of diarrhoea (65.7%). Cases aged 1 year and 0-5 months had diarrhoea rates of 60% and 57% respectively. The proportion of measles cases with diarrhoea decreased with increasing age. Only 9.1% (9/99) of stools sent for bacteriological culture were positive. In three of these Shigella spp. were isolated. The rest were non-typhoid Salmonella (2), enteropathogenic Escherichia coli (2), Vibrio cholera (1), and Vibrio parahaemolyticus (1). Other complications among measles cases were pneumonia in 168 (30.5%), otitis media in 28 (5.1%), convulsion in 13 (2.4%), croup in 9 (1.6%), encephalitis in 4 (0.7%), and sepsis in 1 (0.2%). Seven cases (1.3%) died, 4 from pneumonia, 2 from encephalitis, and 1 from sepsis.
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PMID:Measles-associated diarrhoea in northeastern Thailand. 373 7

To study the etiology of chronic childhood diarrhea among Nigerian children, 142 patients, aged 6 months to 5 years, with diarrhea for at least 1 month, were evaluated; the study took place during January-December 1983 at the Ahmadu Bello University Teaching Hospital, Zaria, Northern Nigeria. Enteropathogenic agents were identified in stools of 90 (63%) patients. Giardia lamblia and Entamoeba histolytica were most commonly detected, representing 41% and 23%, respectively, of all parasitic pathogens. In children with negative stool microscopy, chronic diarrhea was associated with primary lactose intolerance (2 cases), abdominal tuberculosis (2 cases), hyponatremia, low serum albumin, anemia due to sickle cell disease, or Staphylococcus aureus infection. In contrast with chronic diarrhea etiologies reported among children in Europe and North America, infections were the major cause of chronic childhood diarrhea among these children. In general, it is accepted that intestinal infection usually produces acute diarrhea--and that, if the host fails to mount a competent immune response, if there is repeated exposure to infectious agents, or if severe infection damages a substantial proportion of absorptive cells, then severe, protracted diarrhea may result. The high case fatality rate of 9% in this series was associated with specific infectious complications of septicemia, bronchopneumonia, lobar pneumonia and measles. Severe malnutrition also worsened the prognosis in chronic diarrhea. The results indicate that early detection and treatment of amebiasis and giardiasis is a useful approach in the treatment of chronic diarrhea cases among children.
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PMID:Chronic diarrhoea in Nigerian children. 383 11

We have reviewed 107 cases of staphylococcal bacteraemia in order to assess the current clinical spectrum of serious staphylococcal sepsis in Zimbabwe, where staphylococcal bacteraemia is common. Infection was hospital-acquired in 35 cases and community-acquired in 72 cases. The mortality rate was 28%. Most patients were young, with predisposing conditions such as prematurity, protein-caloric malnutrition and measles. The length of the prodromal illness tended to be short and a primary site of infection, usually the lungs or skin, was obvious in 66% of patients. In 30% there was evidence of metastatic spread, usually to meninges, bone, joint and muscle, but endocarditis was uncommon. Metastatic infection was rare when infection was acquired in hospital. Death appeared to be associated with measles, protein-caloric malnutrition, acquisition of infection in hospital, absence of an obvious focus of infection and with inappropriate antibiotic therapy. Aggressive treatment with antibiotics intravenously was the rule. A combination of penicillin and an aminoglycoside was favoured until the nature of the infecting organism was established. Of those patients who died, 38% had received less than 72 h antibiotic therapy. Multiple antibiotic resistance is now widespread in Zimbabwe.
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PMID:Staphylococcal bacteraemia in Zimbabwe 1983. 403 14


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