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The Expanded Programme on Immunization in Togo began in 1980 in the provinces and extended to the whole country in 1984. At the present time, the immunization coverage of children under one year of age is of 43% and 63% for the tetanus immunization of women. The epidemiological impact is being notable on the incidence of measles, tetanus, pertussis and poliomyelitis but efforts are still necessary for mothers' information.
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PMID:[The enlarged program of vaccination in Togo (1980-1990). Realities and perspectives]. 181 30

Contrary to the regular immunization schedule for children, the majority of immunization are done in adulthood in case of special risks only, such as old age, chronic illness or exposure. The protection against a variety of communicable diseases has to be monitored and if necessary to be boosted regularly. Based on the routine vaccination scheme 1991 of the Federal Department of Public Health, the following vaccinations which are commercially available in Switzerland are discussed in this review: diphtheria, Haemophilus influenzae, hepatitis B, influenza, measles + mumps + rubella, meningococci, pertussis, pneumococci, poliomyelitis, tetanus, rabies, tuberculosis, varicella and tick encephalitis. Furthermore, the current recommendations are given for the prophylactic and therapeutic use of immunoglobuline preparations.
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PMID:[Active and passive immunization: 1991 status]. 185 65

Acute respiratory infections cause four and a half million deaths among children every year, the overwhelming majority occurring in developing countries. Pneumonia unassociated with measles causes 70% of these deaths; post-measles pneumonia, 15%; pertussis, 10%; and bronchiolitis and croup syndromes, 5%. Both bacterial and viral pathogens are responsible for these deaths. The most important bacterial agents are Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. The data on bacterial etiology of pneumonia during the first 3 months of life are limited, and almost no information on the role of chlamydia and pertussis in this age period is available. The distribution of viral pathogens in developing countries can be summarized as follows: respiratory syncytial virus, 15%-20%; parainfluenza viruses, 7%-10%; and influenza A and B viruses and adenovirus, 2%-4%. Mixed viral and bacterial infections occur frequently. Risk factors that increase the incidence and severity of lower respiratory infection in developing countries include large family size, lateness in the birth order, crowding, low birth weight, malnutrition, vitamin A deficiency, lack of breast feeding, pollution, and young age. Effective interventions for prevention and medical case management are urgently needed to save the lives of many children predisposed to severe disease.
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PMID:Epidemiology of acute respiratory infections in children of developing countries. 186 76

The major bacterial and viral causes of morbidity and death due to acute lower respiratory infection (ALRI) in the developing world are amenable to control by vaccines. Initially, full use of measles, pertussis, and diphtheria vaccines, in appropriately scheduled programs, can make an immediate contribution to the reduction of severe respiratory infection. Emerging technologies offer the promise of vaccines against bacterial and viral respiratory pathogens that are suitable for infants and children in developing countries. These technologic advances include the use of protein-polysaccharide conjugates of endemic serotypes for Haemophilus influenzae and Streptococcus pneumoniae vaccines and new approaches to the use of purified protein components or attenuated live virus with respiratory syncytial virus and paramyxovirus vaccines. Such vaccines should soon be available for evaluation in developing countries. It is timely to embark upon a program of development, evaluation, and worldwide deployment of vaccines for the control of ALRI.
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PMID:Control of acute lower respiratory illness in the developing world: an assessment of vaccine intervention. 186 86

This paper examines the various ways through which adults' health beliefs and attitudes affect their responses to five major killer diseases during childhood. The data for the study were derived from in-depth interviews conducted between December 1988 and January 1989 in a Yoruba community, Nigeria. The diseases covered in the study include diarrhoea, measles, tetanus, pertussis and fever. It was observed that teething and food related causes were believed to be responsible for diarrhoea; the cause of measles and pertussis was generally unknown; tetanus was usually associated with convulsions; and fever was believed to be caused by roaming in the sun and by constipation. Herbal tea, modern drugs and prayers were the most commonly prescribed treatments for these diseases. It was observed that most mothers used alternative sources of health care, rather than hospitals, clinics and maternity centres, in their treatment of diseases among children. Prominent among the alternative sources were patent medicine stores where there were personalistic social interaction between clients and operators, free consultancy and flexible pricing. Parents' location at the time of a child's sickness, access to good advisers, the perceived seriousness of the sickness and religious beliefs of mothers were important determinants of their response. Avoidance of blame was noted to be a major motivating force in parents' search for potential sources of health care. The paper concludes that although some of the practices might have negative health implications, they could be usefully adapted to the goal of self-reliance in medical care as a strategy for attaining health for all by the year 2000.
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PMID:Response of parents to five killer diseases among children in a Yoruba community, Nigeria. 187 9

Researchers analyzed the relationship between use of primary health care services and child mortality in 16 villages in the communes of Pahou and Avlekete on the Atlantic coast of Benin. The case control study included 74 4-35 month old children who died in 1986-1987 and 230 controls who survived. Overall child mortality stood at 35.9/1000/year. Fever and convulsions, presumably malaria, were the most likely cause of the majority of deaths (38 cases). No protective effect of a village health worker (VHW) visit in the 6 months before death occurred between fever and convulsion cases and other causes of death cases, however. VHWs had visited considerably more controls than cases in the 6 months prior to death (RR ..3; p.05). Indeed the greatest protective effect occurred in children who has been seen by VHWs had visited 71% of all children for a median of 4 visits each. Poor children were only slightly more likely to die than nonpoor children. Children whose weight for age was 75% of the standard for their age has a 4.26 relative risk (RR) of mortality (p.05). Further, when the researchers excluded cases who died within 3 months of the weight measurement, the RR remained high (2.9) and the association significant (p=.08). Measles vaccination between 9-12 months old significantly protected children against mortality (RR .36; p.05). On the other hand, diphtheria, tetanus, and pertussis vaccination did not have a significant protective effect. In conclusion, personal and household contact with a VHW and measles vaccination between 9-12 months improves child survival for 4-35 month old children.
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PMID:Childhood mortality among users and non-users of primary health care in a rural west African community. 191 52

Immunization practice in 32 countries in Europe, North America, Japan, and Australia is reviewed. in most countries, immunization practices are set by the federal government which sometimes works with the private sector. Almost all countries routinely immunize against diphtheria, tetanus, whooping cough, polio, and measles. About half try to prevent rubella, several try to prevent mumps, usually in combination with measles and rubella (MMR). More than half use bacillus Calmette-Guerin (BGG) vaccine to prevent tuberculosis, and a few give Hemophilus Influenza type B polysaccharide. Poliomyelitis vaccine comes in 2 forms: 1) oral live attenuated (OPV) or injectable inactivated (IPV). OPV is more used, but there is a new "enhanced potency IPV." All countries except Japan give DPT in 3 doses during the 1st year of life. OPV is usually given at the same time that DPT is. Measles vaccine or MMR is usually given between 12 and 18 months of age. Primary vaccine failure occurs in 2-5% of people who get measles vaccine, but this may be enough to "sustain transmission." In most countries, the government provides for immunizing children. An exception in the US. In the UK, low coverage has taken place because of concern for adverse reactions (whooping cough) or lack of appreciation of the disease's impact (measles). Coverage against both measles and pertussis has improved in the UK lately. In each developed country, vaccines have had "spectacular" effects. However, there are too many contraindications and there is "undue fear of adverse events." Also, there are surveillance deficiencies, a lack of coordination, and countries vary in their commitment to "reduction/elimination targets." Varicella vaccine, respiratory syncytial virus vaccine, and rotavirus vaccine are being considered for universal use. Attempts are being made to improve the safety of some vaccine.
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PMID:Immunisation practice in developed countries. 196 69

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

Childhood immunization in Iran was assessed by a WHO EPI (World Health Organization, Expanded Program on Immunization) cluster survey method covering 2118 children aged 12-23 months in 1987. Complete immunization was defined as a minimum of 3 DPT (diphtheria, pertussis, tetanus), 3 OPV (oral polio vaccine), 1 BCG (Bacillus Calmette-Guerin), and 1 live attenuated measles vaccine by age 1 year. Iran's Primary Health Care system consists of a rural branch operated by mobile male and female teams, and an urban branch still in the process of changing from cure-oriented care to emphasis on health education, nutrition, and maternal-child health services. Complete immunization coverage by age 1 was better in rural areas, 44.1%, than in urban areas, 28.2%, and Teheran 34.9%. There was no relationship between immunization coverage and infant mortality rate, which is dominated by diarrhea. The reason for better coverage in rural areas is that village workers actively search out, visit and immunize children, while in urban areas provide physicians dominate care, but do not insist on immunization. Furthermore, in Teheran, BCG is not routinely given, which lowered the overall immunization coverage rate there.
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PMID:Primary health care and immunisation in Iran. 206 95

This paper is a partial cost-minimization analysis of preschool immunization delivery in Alberta and Ontario. Public health nurses deliver such immunization in Alberta while in Ontario it is usually provided by private physicians. In constant 1986 dollars, labour costs were 2.9 times higher in Ontario than in Alberta. Alberta and Ontario achieved equal success in preventing diphtheria, tetanus and poliomyelitis in the target population of zero to four years of age. Ontario's pertussis rates were higher than Alberta's from 1980 to 1986 inclusive (p less than 0.01). Rubella rates were higher in Alberta from 1980 to 1986 inclusive (p less than 0.05) but the congenital rubella rates for the same period were not. During 1980, Ontario's measles rate was higher (p less than 0.01) while for 1982 and 1986, Alberta's measles rates were higher. In 1986, Alberta's mumps rate was higher than Ontario's (p less than 0.01). The findings argue in favour of the less costly public health nurse approach to immunization delivery. A more definitive conclusion could have been reached had the provinces maintained more detailed age-specific disease incidence data.
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PMID:Infant and preschool immunization delivery in Alberta and Ontario: a partial cost-minimization analysis. 211 28


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