Diabetes mellitus on the Zambian Copperbelt.
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Biomedical subjects
Publications and source records attributed to J R Armstrong.
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Haemophilus influenzae is an unusual corneal pathogen and an unusual cause of corneal ulcers in Western society. In previous reports corneal complications from H. influenzae have been secondary to a conjunctivitis. The first case of a primary H. influenzae corneal ulcer as a complication of therapeutic contact lens wear is presented. Since other uncommon bacteria have been reported as causes of contact lens related corneal ulcers, the bacteriology of contact lens related corneal ulcers is reviewed. Ophthalmologists need to be aware that H. influenzae infections in adults are becoming more frequent.
Eradication of tuberculosis from a herd of 5,000 head of beef cattle with a long history of infection was achieved in a 5-year period using the single caudal fold tuberculin test in conjunction with segregation of breeders of different ages and selective slaughter of problem groups. The major problem which had to be overcome to achieve eradication was the occurrence of anergic tuberculous animals. All animals in the group were slaughtered when it was apparent testing was not successful. Testing was very effective in eliminating TB from cattle under the age of two years. Incomplete musters and breakdown of segregation caused reinfection of clean groups in the early stages.
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Two simple methods for determining malaria parasite density which require only the examination of a thick blood film were compared with a more accurate method which involves determination of the red blood cell count and measurement of the level of infection in red blood cells by examination of a thin blood film. In one method, the number of parasites present per white blood cell is counted and this figure multiplied by 8000 (an average white blood cell count per microliter) to give the parasite density. In the other method, the number of parasites present per high power microscope field is determined and the parasite density calculated from this value and the assumed volume of blood present in one high power field. The latter method proved to be more accurate than that based on determination of the parasite/white blood cell ratio, probably because the variability in the volume of blood used in preparation of thick blood films was less than the variability of the white blood cell count in the population studied.
Study of the effects of malaria chemoprophylaxis given during pregnancy on birthweight and investigation of the influence of birthweight on child survival suggest that, in a rural area of The Gambia, chemoprophylaxis given during pregnancy might reduce infant mortality by about one-fifth in the children of primigravidae but by less than 5% in the children of multigravidae. In malaria endemic areas, primigravidae should be protected against malaria not only for their own sake but also for that of their infants.
This study investigates the provision of general medical and foot care, the barriers to access for foot care, and the awareness of foot risks in an urban diabetic population. A survey composed of 26 questions was mailed to 2375 diabetic patients in the San Francisco Bay area who are members of the American Diabetes Association (ADA). Three hundred ninety-two surveys were returned for a response rate of 16%. Of the 392 respondents, 7 (1.8%) indicated that they were not receiving any medial care for their diabetes, with another 15 (3.8%) receiving general medical care from an alternative health care provider. Among the respondents, 87 (22%) did not have their feet examined by any health care provider. The remainder of the patients were receiving foot care from a health care provider with 191 (48.7%) under the care of a provider other than a podiatrist. Of those not receiving any foot care, 53 (61%) reported that they did not seek any pedal care because they do not have any apparent foot or leg problems. Another 12 (13.8%) indicated that they did not know whom to see for their lower extremity problems. Lack of insurance or inability to afford medical care was the main reason that prevented 7 (8%) of the patients from receiving routine foot care. With respect to the patient's knowledge of diabetes-associated foot disorders, the majority (72%-79%) knew that poor circulation, neuropathy, ulcers, painful leg and foot conditions, infection, and amputation were associated with diabetes. From all the surveyors, 106 (27%) reported that they were not advised or educated on the potential lower extremity complications of diabetes by their health care provider. The results of this study indicate that in an urban population of diabetic patients, all of whom were members of ADA, a significant number are not adequately educated on the importance of routine foot care.