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Biomedical subjects

G Stroh

Publications and source records attributed to G Stroh.

At least 19 recordsLinked to original sources
PubMed2003

Assessment of neonatal tetanus elimination in an African setting by lot quality assurance cluster sampling (LQA-CS).

Neonatal tetanus (NT) elimination, < 1 case per 1,000 live births (LB), was assessed at district level in Zimbabwe using a combined lot quality assurance-cluster sampling survey (LQA-CS). Three of the highest risk districts were selected. NT was considered eliminated if fewer than a specified number of NT deaths (proxy for NT cases) were found in the sample determined using operating characteristic curves and tables. TT2 + vaccine coverage was measured in mothers who gave birth 1-13 months before the survey and women aged 15-49 years. NT was considered as eliminated, TT2+ coverage was 78% (95% CI 71-82%) in women aged 15-49 and 83% (95% CI 76-89%) in mothers. The survey cost 30,000 US dollars excluding costs of consultants. NT incidence was below the elimination threshold (< 1/1,000 LB) in the surveyed districts and probably in all districts. LQA-CS is a practical, relatively cost effective field method which can be applied in an African setting to assess NT elimination status.

Adult↗
PubMed2001

Can an out-of-hospital cervical spine clearance protocol identify all patients with injuries? An argument for selective immobilization.

STUDY OBJECTIVE: We sought to determine the sensitivity of the Fresno/Kings/Madera emergency medical services (EMS) selective spine immobilization protocol in identifying patients with potential cervical injuries. We also sought to determine whether the protocol was safe in the out-of-hospital setting. METHODS: We conducted a retrospective chart review of all patients discharged from 5 trauma-receiving hospitals in Fresno County with the diagnosis of cervical spine injury between July 1, 1990, and June 30, 1996. All of these patients transported to the hospital by EMS personnel were selected for the study group. Medical records of those patients not immobilized were further investigated to identify protocol violations or deficiencies. RESULTS: There were 861 patients with significant cervical injuries during this time span. EMS personnel brought 504 patients to the hospital, of which 495 arrived in cervical spine immobilization. Of the remaining 9 patients, 2 refused immobilization, and 2 could not be immobilized; 3 injuries were missed by the protocol criteria, and 2 injuries were missed because of protocol violations. Of these last 5 patients, 1 patient had an adverse outcome, 2 injuries were considered unstable, 4 patients were older than 67 years, and one patient was 9 months old. CONCLUSION: The Fresno/Kings/Madera EMS selective spine immobilization protocol is 99% (95% CI, 97.7% to 99.7%) sensitive in identifying patients with cervical injuries for immobilization. Those patients not identified were at extremes of age. These results suggest that selective immobilization may be safely applied in the out-of-hospital setting but should be used with caution at extremes of age.

Adolescent↗
PubMed1998

Cluster survey evaluation of coverage and risk factors for failure to be immunized during the 1995 National Immunization Days in Egypt.

BACKGROUND: In 1995, Egypt continued to experience endemic wild poliovirus transmission despite achieving high routine immunization coverage with at least three doses of oral poliovirus vaccine (OPV3) and implementing National Immunization Days (NIDs) annually for several years. METHODS: Parents of 4188 children in 3216 households throughout Egypt were surveyed after the second round of the 1995 NIDs. RESULTS: Nationwide, 74% of children are estimated to have received both NID doses, 17% one NID dose, and 9% neither NID dose. Previously unimmunized (47%) or partially immunized (64%) children were less likely to receive two NID doses of OPV than were fully immunized children (76%) (P < 0.001). Other risk factors nationwide for failure to receive NID OPV included distance from residence to nearest NID site >10 minute walk (P < 0.001), not being informed about the NID at least one day in advance (P < 0.001), and residing in a household which does not watch television (P < 0.001). Based on these findings, subsequent NIDs in Egypt were modified to improve coverage, which has resulted in a marked decrease in the incidence of paralytic poliomyelitis in Egypt. CONCLUSIONS: In selected situations, surveys can provide important information that is useful for planning future NIDs.

Child, Preschool↗
PubMed1998

Persistent low immunization coverage among inner-city preschool children despite access to free vaccine.

OBJECTIVE: To compare vaccination coverage among children 19 to 35 months of age from public housing developments where a free vaccine outreach program was in place with children residing elsewhere in the city. DESIGN: A household survey using a multistage cluster sampling method to compare community areas which accounted for 80% of measles cases during 1989 (high-risk stratum), areas which accounted for the remaining 20% of cases (low-risk stratum), and public housing developments (public housing stratum) having free, on-site vaccination services. SETTING: Inner-city Chicago households, April to May 1994. OUTCOME VARIABLES: Antigen-specific and series-specific coverage based on written records. RESULTS: Based on evaluation of 1244 children, citywide coverage for four doses of diphtheria-tetanus-pertussis vaccine, three doses of polio vaccine, and one dose of measles-containing vaccine (4:3:1) was 47% [95% confidence interval (CI), 40% to 55%]. Coverage was significantly lower among children residing in public housing (23%; 95% CI, 18% to 28%) compared with those residing in high-risk strata (45%; 95% CI, 38% to 52%) and low-risk strata (51%; 95% CI, 43% to 60%). Compared with white children (53%), coverage for the 4:3:1 series was lower among African-American children in public housing (29%) or outside public housing (36%). Moreover, 11% (95% CI, 8% to 14%) of children residing in public housing had never received any immunizations. CONCLUSIONS: African-American children throughout Chicago, particularly in public housing, remain at increased risk for vaccine-preventable diseases and should be targeted further for vaccination services. Vaccination coverage remains low several years after a major outbreak of measles and implementation of a free vaccine outreach program. Cluster surveys may be useful for monitoring vaccination coverage in high-risk urban settings.

Chicago↗
PubMed1993

Using survey data to assess neonatal tetanus mortality levels and trends in developing countries.

Demographic and health surveys are a useful source of information on the levels and trends of neonatal mortality in developing countries. Such surveys provide data on mortality occurring at 4-14 days of life, which is a sensitive indicator of neonatal tetanus mortality. We analyze birth history data from 37 national surveys in developing countries to assess the quality of neonatal mortality data and to estimate levels and trends in mortality occurring at 4-14 days. It is shown that mortality at 4-14 days has declined considerably during the last decade in most developing countries, concomitant with development and expansion of programs to reduce neonatal tetanus. These declines show that reductions in neonatal tetanus mortality probably have been an important contributor to the decline of neonatal and infant mortality during the 1980s.

Adolescent↗
PubMed1990

An evaluation of lot quality assurance sampling to monitor and improve immunization coverage.

Quality assurance sampling techniques with small samples offer a method of monitoring performance of health services in small health areas, and of identifying areas with poor performance in which remedial actions need to be targetted. Lot Quality Assurance Sampling methods were used to assess the coverage resulting from three immunization campaigns in rural and urban areas in the mountains of Peru. Application of these methods in 12 health areas with populations of 538 to 15 780 by Ministry of Health personnel proved feasible and could be used to identify areas with poorer vaccination coverage. Further discussion about possible reasons for poor coverage led to corrective actions in these health areas and an improvement in overall coverage from 78% to 88% in a three-month period. These quality assurance methods are a useful supervisory tool to improve health programme performance.

Child, Preschool↗
PubMed1987

Measurement of mortality from neonatal tetanus in Burma.

Surveys to determine mortality from neonatal tetanus were conducted in March and April 1985 in accessible areas of Burma, where pregnant women had been immunized with tetanus toxoid and, for comparison, also in areas where such immunization had not been given. Neonatal mortality rates were three times greater in areas where tetanus toxoid immunization had only recently or had not yet been introduced by the national expanded programme on immunization. Analysis of the data indicates that the impact on reduction of neonatal mortality from tetanus of three interventions (immunization of pregnant women with tetanus toxoid; delivery in hospital; or birth at home attended by a trained health worker) was greatest for immunization.

Health Surveys↗
PubMed1986

A therapeutic feeding programme. I: Theory and practice of feeding.

Feeding problems are often commented on in the literature, but very little has been reported on the systematic examination of these problems. In the present study feeding disturbances were treated as part of a full diagnostic and treatment programme for disturbed children in a small residential psychiatric unit. The feeding programme was based on the early work of Clancy and colleagues in Australia, and consisted of offering the child food in a set situation by the same 'feeder'. A one-way screen was used for observation and video-recording. Three children are described in detail, and a striking effect was the immediacy of change in their feeding disturbances. It is stressed that early feeding difficulties of disturbed children can give rise or contribute to ever-widening faulty development.

Autistic Disorder↗
PubMed1986

A therapeutic feeding programme. II: Links with language and learning.

The feeding programme described in Part I of this study produced immediate change in the eating patterns of disturbed children, who then became available for learning and language development in a way they had not been previously. The authors give a broad outline of the principles and practice of functional learning, and the educational technique they used. They describe the language development of one child in detail, and the methods used. Follow-up details are also given for the three children described in Part I of the study.

Adolescent↗
PubMed1985

Observations on the application of EPI cluster survey methods for estimating disease incidence.

The present study attempted to assess the incidence of target diseases of the Expanded Programme on Immunization (poliomyelitis, tetanus, measles, pertussis, neonatal tetanus, diphtheria), using cluster samples and a household interview form. The results suggest that this method can indeed serve to estimate the incidence of these diseases with reasonable precision and may also be used to demonstrate reduction in incidence for the more common diseases. Analysis of 37 surveys for poliomyelitis and neonatal tetanus in India revealed a relative uniformity in the design effect (i.e., the ratio of the variance for the cluster estimate to the variance for the binomial estimate) for diseases with low incidence and prevalence. Diseases with higher prevalence tend to have a larger design effect, which may be indicative of the epidemic and "clustered" nature of the disease. A large design effect, therefore, does not necessarily indicate a need for a larger sample size, particularly if precision is acceptable. There is no one single design that is ideal for all surveys of disease incidence and decisions must be made in the light of local conditions and available resources.

Child↗
PubMed1978

School achievement: risk factor in teenage pregnancies?

A review of live births, spontaneous fetal deaths, and induced abortions in residents of Upstate New York ages 12--17 shows that pregnancy rates increased during the period 1971 through 1974. This increase was attributable to pregnancies ending in induced abortion while live births remained relatively stable. White teenagers had a higher frequency of induced abortions than non-white teenagers, but induced abortions increased more rapidly among non-whites over the four-year period. School achievement as reflected by highest grade completed at the end of pregnancy was related to risk of pregnancy as well as to election of induced abortions. The distribution of pregnancies by age and school grade suggests that an increased risk of pregnancy is associated with below average but also, and unexpectedly, with above average grade attainment. Incongruity of age and school achievement may identify groups of teenage schoolgirls with special needs for preventive programs.

Abortion, Illegal↗
PubMed1976

Reported live births following induced abortion: two and one-half years' experience in Upstate New York.

Thirty-eight live births following induced abortion were recorded in Upstate New York between July, 1970, and December, 1972. Twenty-six followed saline-induced abortion; twelve of these occurred at one hospital, and eight were associated with one physician. Underestimation of gestation and exchange of inadequate volumes of amniotic fluid and hypertonic saline produced concentrations insufficient to cause intrauterine death. Viable infants with iatrogenic central nervous system damage from salt poisoning are a possible consequence of improperly planned saline-induced abortions. These births provide further evidence for encouragement of contraception and early termination of unwanted pregnancy.

Abortion, Induced↗