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Biomedical subjects

L Brabin

Publications and source records attributed to L Brabin.

At least 37 records · Page 2Linked to original sources
PubMed1995

Reproductive tract infections and abortion among adolescent girls in rural Nigeria.

Few studies from developing countries have investigated reproductive tract infections or other indicators of sexual health among unmarried adolescent girls in rural areas. We have obtained baseline demographic, clinical, and microbiological data on reproductive tract infections and induced abortion in girls in a rural area of southeast Nigeria, in order to assess the need for health care for adolescents. 868 females attended for interview and examination: 458 aged 20 and above and 410 aged 12-19, the latter representing 93.4%of the adolescent population. 43.6% of those < 17 and 80.1% aged 17-19 years were sexually active and at least 24.1% had undergone an induced abortion; only 5.3% had ever used a modern contraceptive. Vaginal discharge was reported by 82.4%, though few sought treatment. 94.1% of sexually active adolescents and 97.6% of sexually active women 20 years old or over were gynaecologically examined and screened for reproductive tract infections. Of those aged less than 17, 19.8% had symptomatic candida and 11.1% trichomonas infections. Among those aged 17-19 years, chlamydia was detected in 10.5%, and symptomatic candidosis in 25.6%; this was the group most likely to have any infection (43.8%). 42.1% of sexually active adolescents had experienced either an abortion or a sexually transmitted disease. Syphilis was the only infection for which the incidence clearly increased with age. Health-care services for adolescents in this community are needed and should include sex education, contraceptive provision (especially barrier methods), and access to treatment for reproductive tract infections. Investments in health for this age group will have an effect on subsequent reproductive health.

Abortion, Induced↗
PubMed1992

Pelvic inflammatory disease: a clinical syndrome with social causes.

Prevalence of pelvic inflammatory disease (PID) reflects community and individual risk factors. Cultural and behavioural factors influence community prevalence of sexually transmitted disease (STD), illegal abortion, puerperal sepsis and contraceptive usage--all of which influence risk of PID. The relative importance of these factors will vary by region. Individual risk factors for the ascent of a lower genital tract infection are still poorly understood but are thought to be behavioural and immunological. Prevention of PID must be undertaken at several levels. At primary level, it requires a reduction in community risk. At secondary level, individual risk can be modified by ensuring diagnosis and treatment of STD before damage of the upper genital tract occurs. More attention to cultural factors should increase the potential for prevention at both levels.

Female↗
PubMed1992

Raising awareness about reproductive morbidity.

Lack of awareness of the extent and effect of reproductive morbidity on the health and quality of life of women in developing countries is evident at national, community and individual levels. Raising awareness at national level requires population-based, epidemiological information which must be validated. At community level, public opinion mediates women's actions when they are sick and fear of social consequences provides a barrier to treatment. Individually, women find it difficult to talk about sexual reproductive health and its management. Methodologies currently being developed for raising awareness at all levels are described.

Awareness↗
PubMed1992

Gender-planned health services.

Gender-planned health services are planned on the basis that women and men play different roles in society and have different medical needs. The feminist movement has provided a broad charter of rights for women, reflecting women's needs, but these have yet to be translated into operational programmes. National programmes for women would allow co-ordination of broad-based programmes to improve women's health and social position. To change social norms discriminating against women will require changing male attitudes. Health programmes for males have received little attention, except from family planning organizations, although in most countries, males have a high rate of accidents, infections and parasitic disease. Controlled studies are required to evaluate the benefits of gender-planned health services.

Developing Countries↗
PubMed1992

Prevention of PID: a challenge for the health service.

The control of sexually transmitted diseases (STD) will reduce the prevalence of pelvic inflammatory disease (PID). In most developing countries, treatment services are limited, coverage of the infected female population is inadequate and women seeking treatment are likely to be mismanaged. Family planning clinics do not usually provide routine screening for non-pregnant women. Screening only at family planning clinics would result in failure to treat some high-risk individuals, especially unmarried adolescents. The use of simplified protocols in the community has been recommended, but these may underestimate the problems of contact tracing, provide no systematic screening and induce passivity in the patient. For pregnant women, STD control has targetted syphilis, which does not cause PID. An integrated service for the management of reproductive health is required, and the development of women's clinics is suggested, using well-trained nurses and affordable technologies.

Community Health Services↗
PubMed1992

The cost of successful adolescent growth and development in girls in relation to iron and vitamin A status.

The role of iron and vitamin A in adolescent growth and development is not well described. During adolescence iron requirements are increased, reaching a maximum at peak growth, but after menarche, menstrual iron loss must also be replaced. An observed rise in retinol-binding protein concentrations at puberty level 4 indicates a role for vitamin A in sexual maturation. Iron and vitamin A deficiencies may slow the tempo of growth. Conversely, for girls on marginal diets, an extended catch-up growth period may lead to depletion of these nutrients. The costs of achieving growth may also include cephalopelvic disproportion in girls becoming pregnant and increased risk of menorrhagia.

Adolescent↗
PubMed1990

Sex differentials in susceptibility to lymphatic filariasis and implications for maternal child immunity.

This paper reviews epidemiological data to see if there are sex differentials in prevalence, density and clinical pathology due to lymphatic filariasis. Of 53 studies from Africa, South East Asia, the Indian Subcontinent and The Americas, 43 showed a lower mean prevalence of infection in females than in males. Prevalence is consistently lower in women of reproductive age and this is statistically significant in 16 of 32 studies classified by age and sex. Density of infection is also lower in the reproductive age but may be higher in children and in older women. Clinical disease is also lower in women and pathology has a later age of onset and rise to peak prevalence than in males. The paper assesses the evidence that lower rates of infection and clinical pathology are due to less exposure of females to infective vectors. It seems unlikely that exposure alone could account for these differences which are observed for both bancroftian and brugian filariasis, irrespective of periodicity. Several investigators have suggested that females have increased resistance to infection and this is supported by serological studies showing high antibody positivity to adult worm antigens in females. The review concludes that the association with the reproductive years suggests a pregnancy-associated mechanism. This has important implications for maternal-fetal interactions and maternal filarial infection may influence the development of immunity in children.

Age Factors↗
PubMed1990

Failure of chloroquine prophylaxis for falciparum malaria in pregnant women in Madang, Papua New Guinea.

Six hundred and twenty pregnant women, living under conditions of year-round transmission of malaria in a rural coastal area of Madang, Papua New Guinea (PNG), were followed while attending mobile antenatal clinics and receiving chloroquine prophylaxis (300 mg base weekly). Whole blood chloroquine concentrations measured by ELISA from samples collected at delivery indicated a high level of drug compliance in regular attenders. Susceptibility is increased in primigravidae to Plasmodium falciparum but not to other malaria species, with the peak prevalence occurring at nine to 16 weeks gestation. The incidence of P. falciparum infection per person-month was 20% for primigravidae, 25% for those gravida 2, 17% for those gravida 3 or greater, and 14% for non-pregnant nulliparae. Some 8.7% of primigravidae and 9.5% of those gravida 2 had persistent infections. Prophylactic chloroquine is required in this pregnant population because of altered host immunity during pregnancy, but is reduced in efficacy because of chloroquine resistance. Despite this, a missed clinic attendance resulted in a two-fold increase in incidence for all pregnant women, indicating that chloroquine was having some effect.

Animals↗
PubMed1990

Malaria and glucose 6-phosphate dehydrogenase deficiency in populations with high and low spleen rates in Madang, Papua New Guinea.

Previous studies in Madang have demarcated 2 groups of women, one with high spleen rates (HS group) and the other with low spleen rates (LS group). An association between glucose 6-phosphate dehydrogenase (G6PD) deficiency and low spleen rates was investigated in 196 HS and 106 LS group men. Prevalence was 12.2 and 9.4%, respectively. Parasite and spleen rates were lower in deficients in the HS group. Differences in prevalence between HS group villages were observed which may be related to the interaction of G6PD deficiency with other haemoglobinopathies such as ovalocytosis. An effect on malaria endemicity at the village level may only occur when G6PD deficiency is a predominant trait.

Animals↗
PubMed1990

Factors affecting the differential susceptibility of males and females to onchocerciasis.

The evidence for male/female differences in prevalence, density of infection and clinical disease due to onchocerciasis is reviewed and related to what is known about differential exposure of females to infective vectors. Sex differentials are most marked in savanna areas of high transmission, and in these areas, worm burdens are lower from early childhood in females--as are ocular lesions. In forest areas, sex differences are less marked and ocular lesions are similar in men and women. Sex differences are most evident under conditions of high transmission and it is suggested that females are more resistant to infection than males. There is little substantive evidence that onchocerciasis is less frequent in females on the basis of exposure but controlled exposure and immunological studies, analysed by age and sex, are needed to confirm this. Little is known about onchocerciasis in pregnancy but increased resistance could influence the risk of transmission of infection from mother to child in highly endemic areas. Onchocerciasis in pregnancy is also likely to affect immune response to tetanus toxoid vaccination in mothers and birthweight of children. The disease therefore represents an important public health problem for women and their offspring.

Adolescent↗
PubMed1989

Patterns of migration indicate sexual transmission of HTLV-I infection in non-pregnant women in Papua New Guinea.

The prevalence of infection with human T-cell leukaemia virus (HTLV-I) was studied in Madang Province on the north coast of Papua New Guinea. Serum specimens collected from non-pregnant women in 17 villages were tested for anti-HTLV-I by gelatin particle agglutination screening and confirmed by immunofluorescence and Western blotting. Overall, 13.9% of subjects were antibody-positive, with the prevalence of antibodies varying from less than 10% to 30% in villages situated less than 10 km apart. Two groups of migrant women were identified, and in both a parity-related increase in antibody prevalence which occurred only after marriage suggested that the predominant mode of transmission in migrant women was sexual. There was no parity-associated increase in anti-HTLV-I in indigenous women, and in contrast to migrant women, nulliparous indigenous women had a high prevalence of antibody (16.8% vs. 0%; p = 0.005). Vertical transmission cannot be excluded in indigenous women. No correlation was detected between the prevalence of anti-HTLV-I and a variety of indices of malarial infection.

Emigration and Immigration↗
PubMed1989

Factors affecting the prevalence of infection with hepatitis B virus among non-pregnant women in the Alexishafen area of Papua New Guinea.

The prevalence of hepatitis B viral markers was studied in 673 women of childbearing age in 17 villages (12 indigenous and five plantation villages) on the north coast of Papua New Guinea. Some 7.9% of women were HBsAg positive and 41.3% were positive for anti-HBs. There was significant variation in prevalence between villages, ranging from 0 to 13.9% for HBsAg and 26.0 to 71.0% for all markers. The 12 indigenous villages were classified into three groups according to language (Austronesian or non-Austronesian), location (inland or coastal), and marriage patterns. The prevalence of hepatitis B was significantly higher in Austronesian than in non-Austronesian villages (P less than 0.01), and it remained significant after controlling for age differences and for possible effects on prevalence caused by women marrying into the three village groups from other areas. Interactions between malaria and hepatitis B were also investigated. Non-Austronesian villages with the highest spleen rates had the lowest prevalence of hepatitis B infection, and there was no correlation with parasitaemia. These results may reflect a lower exposure of women to hepatitis B infection in non-Austronesian villages, or may indicate different genetic or immunological responses to infection between Austronesians and non-Austronesians.

Adolescent↗
PubMed1988

High and low spleen rates distinguish two populations of women living under the same malaria endemic conditions in Madang, Papua, New Guinea.

In a malariometric survey of 594 non-pregnant women living in 17 villages in Madang Province, Papua New Guinea, village groups were identified with average spleen rates of less than 35%, 40-49% and greater than or equal to 50%, with no difference in parasite rates between groups. Most villages where a non-Austronesian language was spoken had high spleen rates, but the association was not consistent. Some women were not indigenous to the study area and to control for the effects of migration on spleen rates, women were grouped according to their area of origin. This analysis, which cuts across village groups, identified 2 subpopulations, one with a high, and the other with a low spleen rate (relative risk 2.23; P less than 0.0001). Persistent splenomegaly was observed more frequently in the high spleen rate population (P less than 0.025) which also showed a significantly increased spleen size (P less than 0.01). The existence of 2 subpopulations living under the same conditions of malaria endemicity, but with different splenic responses to malaria, suggests an altered host immune response to malaria in the high spleen rate group. The absence of intermarriage between these two subpopulations indicates genetic differences distinguish them.

Adult↗