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Biomedical subjects

A R Walker

Publications and source records attributed to A R Walker.

At least 91 records · Page 5Linked to original sources
PubMed1997

Effects of transition on bowel diseases in sub-Saharan Africans.

In populations in sub-Saharan Africa, transitional changes in patterns of morbidity and mortality are taking place, with decreases in the diseases of poverty and infection, but rises in chronic diseases of prosperity, associated, however, with greater longevity. Remarkably, bowel diseases - appendicitis, diverticular disease, colon cancer - while nearly absent in rural areas, have very low incidences in urban dwellers, despite rises in risk factors, including a decreasing intake of fibre-containing foods. Currently, there is no explanation for the phenomenon, which stands in marked contrast to the considerable rises which have occurred in dental caries, obesity in women and diabetes.

Africa South of the Sahara↗
PubMed1997

Ten-year follow up of a cohort with rheumatic heart disease (RHD).

BACKGROUND: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) occur at among the highest rates in the world in Aboriginal Australians of the Northern Territory. AIMS: To follow-up a previously-described cohort of Aboriginal children with RHD, in order to understand better the outcome of ARF and RHD in this population, and to identify areas where the impact of these diseases might be lessened METHODS AND RESULTS: Of a cohort of 33 children seen between 1980 and 1984, 27 survived until July, 1984. Twenty-five of the survivors were followed up for a mean of 10.6 years to a mean age of 24.1 years. The two deaths during follow-up were both due to RHD. Six people underwent valve replacement surgery; all were clinically healthy when last seen. Complications included two thromboembolic events and two episodes of endocarditis. Deterioration of RHD severity was associated with ARF recurrences (relative risk 3.6; 95% CI 1.7-7.6), and resolution of RHD was associated with having only mild valve lesions initially (risk difference 0.58; 95% CI 0.30 to 0.86). During follow-up, valve lesions tended either to resolve or to become more complex and severe, with a higher proportion of aortic valve lesions and multiple valve lesions. Of seven children with suspected past ARF, excluded from the original cohort because of normal cardiac findings at the time, three developed RHD, including one who died due to RHD and two with moderate or severe valve lesions. CONCLUSIONS: In Aboriginal Australians, poor outcomes of RHD are common, and are associated with ARF recurrences and early onset of more severe valve lesions. A coordinated ARF and RHD control programme is needed in this region, using a centralised register of patients, and concentrating on strategies to improve adherence to secondary prophylaxis regimens, better clinical care (including newer surgical techniques) and education of patients, families, and health staff.

Adolescent↗
PubMed1997

Coronary heart disease: outlook for Africa.

In Africa, coronary heart disease (CHD) is near absent in rural areas, and very uncommon in urban centres, where many Africans are in an advanced stage of transition. Among town dwellers intakes of food, especially fat, have risen and intakes of fibre-containing foods have fallen. Mean serum cholesterol level is almost double that of rural populations living traditionally. Obesity in females has risen enormously. Prevalence of hypertension exceeds that in the white population. The same applies to the practice of smoking in males, but not in females. The level of physical activity has fallen generally. With these increases in risk factors we can expect urban Africans to attain the high mortality rate for CHD now experienced by Afro-Americans. Prevention by urging reversion to previous life-style behaviour is a non-starter. However, as long as Africa remains impoverished, a major rise in CHD is unlikely.

Africa↗
PubMed1997

Pica.

Pica is the compulsive eating of non-food substances over a sustained period of time. It remains an intriguing, little understood occurrence, with a potential for both positive and negative outcomes. In this review information is given on the history of the phenomenon, its prevalence among children and women, and its relation to iron and zinc deficiency. A number of examples of pica practice are reported from Africa.

Adolescent↗
PubMed1997

Moderate to mild malnutrition in African children of 10-12 years: roles of dietary and non-dietary factors.

In all Third World populations, among preschool and schoolchildren, low weight- and height-for-age, i.e. below the 5th centile of US NCHS reference standards, are common, affecting 10-50%. Orthodoxly, shortfalls are attributed largely to insufficiency of food. In an attempt to throw more light on the situation regarding African schoolchildren, studies have been made on series of pupils, aged 10-12 years, at three rural schools in North West Province, South Africa. Of 396 pupils, 126 (31.8%) were below, and 270 (68.2%) above the 5th centile. Enquiries were made on each pupil's diet and meal pattern, their class position and games aptitude, and, regarding home characteristics, their family size, Parent(s) working, and the latter's interest in education. With minor exceptions, no significant differences in odds ratios were found between respective groups below and above the 5th centile. Evidently, there are multiple influencing factors. Hence, among children of school-age, there must be caution against overblaming undernutrition, and of overrating the health disadvantages from mild to moderate malnutrition. For definition clarification, long-term observations are necessary.

Anthropometry↗
PubMed1997

Causes of death in a rural hospital in South Africa.

OBJECTIVES: To determine the causes of death at Manguzi Hospital, in rural North Kwa-Zulu, over a three year period, July 1992 to June 1995. DESIGN: A retrospective study using hospital records. SETTING: Rural hospital. SUBJECTS: Of admissions, total deaths numbered 1,275 (703 males, 572 females), of which 143 were from accidents and trauma. MAIN OUTCOME MEASURES: Deaths. RESULTS: Of children under five years there were 430 deaths (34% of the total); 236 (55%) were from perinatal causes. Infections, chiefly gastro-enteritis, caused 124 (29%) of deaths. Of children five to 12 years, there were 39 deaths (3% of the total); 12 (44%) died from infections. Of adolescents and adults aged 13 to 59 years, there were 377 deaths (29% of the total); of these, accidents and trauma caused 88 (23%), and infectious diseases 82 (22%). In the elderly, 60 years and over, there were 429 deaths (34% of the total); infectious diseases predominated, 103 (24%). In this age group, there were 71 deaths (17%) from cerebrovascular disease; 63 (15%) from cardiac failure; 46 (11%) from cancer, but none from coronary heart disease. Of the 143 non-natural deaths, 30 (21%) were from assault, and 28 (20%) from motor vehicle and pedestrian accidents. CONCLUSION: The high proportion of deaths from infections, as likewise reported from other rural hospitals, emphasizes the need for increased public health endeavours for furthering immunizations, health education, provision of water and sanitation, and tuberculosis control programmes.

Adolescent↗