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Biomedical subjects

M J Toole

Publications and source records attributed to M J Toole.

34 records · Page 2Linked to original sources
PubMed1993

Mortality rates in displaced and resident populations of central Somalia during 1992 famine.

Famine and civil war have resulted in high mortality rates and large population displacements in Somalia. To assess mortality rates and risk factors for mortality, we carried out surveys in the central Somali towns of Afgoi and Baidoa in November and December, 1992. In Baidoa we surveyed displaced persons living in camps; the average daily crude mortality rate was 16.8 (95% CI 14.6-19.1) per 10,000 population during the 232 days before the survey. An estimated 74% of children under 5 years living in displaced persons camps died during this period. In Afgoi, where both displaced and resident populations were surveyed, the crude mortality rate was 4.7 (3.9-5.5) deaths per 10,000 per day. Although mortality rates for all displaced persons were high, people living in temporary camps were at highest risk of death. As in other famine-related disasters, preventable infectious diseases such as measles and diarrhoea were the primary causes of death in both towns. These mortality rates are among the highest documented for a civilian population over a long period. Community-based public health interventions to prevent and control common infectious diseases are needed to reduce these exceptionally high mortality rates in Somalia.

Adolescent↗
PubMed1992

Development of health surveillance in Togo, west Africa.

Since 1988, the Ministry of Health (MOH) of Togo, with technical assistance from CDC, has systematically adapted and strengthened its health information system (HIS) to enable improved monitoring of trends in diseases. The previous system had been hampered by complicated, lengthy reporting forms; incomplete and delayed receipt of reporting forms; absence of mortality reporting; slow, cumbersome manual compilation and analysis methods; and lack of standard case definitions. To simplify the adaptation process, the system was divided into three main activities: data collection, data compilation and analysis, and dissemination of reports and follow-up action. Public health authorities in Togo have built on existing strengths and successfully adapted the HIS to focus on national morbidity and mortality prevention priorities.

Communicable Disease Control↗
PubMed1990

Prevention of excess mortality in refugee and displaced populations in developing countries.

More than 30 million refugees and internally displaced persons in developing countries are currently dependent on international relief assistance for their survival. Most of this assistance is provided by Western nations such as the United States. Mortality rates in these populations during the acute phase of displacement have been extremely high, up to 60 times the expected rates. Displaced populations in northern Ethiopia (1985) and southern Sudan (1988) have suffered the highest crude mortality rates. Although mortality rates have risen in all age groups, excess mortality has been the greatest in 1- through 14-year-old children. The major causes of death have been measles, diarrheal diseases, acute respiratory tract infections, and malaria. Case-fatality ratios for these diseases have risen due to the prevalence of both protein-energy malnutrition and certain micronutrient deficiencies. Despite current technical knowledge and resources, several recent relief programs have failed to promptly implement essential public health programs such as provision of adequate food rations, clean water and sanitation, measles immunization, and control of communicable diseases. Basic structural changes in the way international agencies implement and coordinate assistance to displaced populations are urgently needed.

Africa↗
PubMed1990

The effective case management of childhood diarrhoea with oral rehydration therapy in the Kingdom of Lesotho.

In Lesotho prior to 1986, diarrhoea was the leading cause of hospital mortality in children less than 5 years of age. At the Queen Elizabeth II Hospital, diarrhoea-related admissions as a proportion of all admissions in children less than 5 years of age declined from 23% in the year prior to the opening of the Oral Rehydration Therapy Unit (ORTU) to 13% in the first nine months of 1987 (p less than 0.05). In addition, the case-fatality ratio of children treated in the ORTU declined from 1.4% in the first quarter of 1986 to zero in the second and third quarters of 1987 (p less than 0.05). In a case-control study conducted to identify reasons for children failing ORTU treatment, factors associated with an increased risk of hospitalization included male gender (odds ratio [OR] = 4.9; 95% confidence limits [CL] = 2.0, 11.9), fever greater than or equal to 38.5 degrees C (OR = 2.0; CL = 1.2, 3.3), undernutrition (OR = 3.2; CL = 1.1, 9.4), and moderate dehydration (OR = 2.3; CL = 1.2, 4.4) or severe dehydration. (OR = 12.1; CL = 3.8, 38.5). Breastfed children less than 2 years of age were at decreased risk of hospitalization (OR = 0.4; CL = 0.2, 0.7). At this major hospital in Lesotho, the standardization of outpatient treatment for diarrhoea with oral rehydration salts (ORS) in the context of an ORTU resulted in a marked decrease in diarrhoea-associated hospitalization and deaths in children less than 5 years of age.

Case-Control Studies↗
PubMed1990

Surveillance and control of meningococcal meningitis epidemics in refugee populations.

Epidemics of communicable diseases pose a direct threat to refugee and internally displaced populations, and could lead to high mortality rates and a disruption of basic health care services. Several large refugee populations live in regions of high meningococcal disease endemicity and their camps are at risk for outbreaks of meningococcal meningitis. Surveillance in these camps allows early detection and control of impending outbreaks. Confirmation of meningococcal disease can be performed under field conditions using simple techniques, such as latex agglutination. Isolates should be obtained for serogroup confirmation and antibiotic sensitivity studies at reference laboratories. Serogroup information is used to determine the risk of widespread epidemic disease and the utility of available vaccines. During epidemics, treatment regimens should be standardized, preferably with an effective single-dose antibiotic. Mass vaccination campaigns should be initiated, the populations at high risk being targeted for vaccination as quickly as possible. When the risk of epidemic disease is deemed to be high, preemptive vaccination may be warranted. Daily surveillance using a simple case definition is essential during an epidemic to determine the effectiveness of control measures and to delineate high-risk groups for vaccination or chemoprophylaxis. Many of these recommendations can be applied also to other populations in developing countries.

Adolescent↗
PubMed1989

Tuberculosis control in refugee settlements.

Tuberculosis and its management in refugees and other displaced persons in temporary settlements poses a challenge to organisations coordinating and providing care in refugee emergencies. This paper offers a consensus of the co-sponsoring agencies on practical recommendations for implementing measures aimed at both interrupting transmission of tuberculosis and treatment of individual patients.

Humans↗
PubMed1989

Measles prevention and control in emergency settings.

Outbreaks of measles continue to be a common occurrence among refugee and famine-affected children in emergency relief camps. Extremely high measles-associated mortality rates have been reported from refugee camps--where undernutrition is common--in several countries over the past 10 years. Mortality from measles is, however, preventable, and immunization against the disease is a high priority in emergency relief programmes, second only in importance to the provision of adequate food rations. All children aged 6 months to 5 years should be immunized with measles vaccine as soon as they enter an organized camp or settlement. Should supplies of measles vaccine be inadequate, children in feeding centres, or those otherwise identified as undernourished, are the top priority for immunization. The occurrence of measles in a camp is not a contraindication to conducting an immunization campaign. Strong coordination by a designated lead agency is needed if such campaigns are to be successful; however, cooperation with the local expanded programme on immunization is essential to ensure that existing cold chain equipment, training protocols, and management manuals are used. If additional equipment is necessary, a complete immunization kit developed by the Office of the United Nations High Commissioner for Refugees, the World Health Organization, and Oxfam can be procured from Oxfam headquarters in the United Kingdom. Vitamin A supplements should be given routinely at the time of measles immunization in situations where malnutrition is severe. Mortality and morbidity in children with clinical measles can be reduced by administering high doses of vitamin A.

Child, Preschool↗
PubMed1988

An analysis of mortality trends among refugee populations in Somalia, Sudan, and Thailand.

A review of mortality data from refugee camps in Thailand (1979-80), Somalia (1980-85), and Sudan (1984-85) indicates that crude mortality rates (CMRs) were up to 40 times higher than those for the non-refugee populations in the host countries. In eastern Sudan, approximately 5% of the population of eight camps died in the first 3 months of the emergency and daily CMRs as high as 14 per 10 000 were reported. These rates dropped to values comparable with those of the host country within 6 weeks in the Thai camps; however, in Somalia and Sudan this process took 12 months. Mortality rates among under-5-year olds in the early phases, which were as high as 32.6 per 10 000 per day, are six times greater than those in the world's least developed countries during non-emergency times. Among severely undernourished children in one camp in Sudan, the death rate reached 114 per 10 000 per day. Acute respiratory infections, diarrhoeal diseases, malaria, measles, and undernutrition were the causes of most reported deaths, the majority of which could have been prevented by adequate food rations, clean water, measles immunization, and an oral rehydration programme.

Adolescent↗
PubMedDate not supplied

Population-based nutritional risk survey of pensioners in Yerevan, Armenia.

Armenia, a republic of the former Soviet Union, currently suffers from hyperinflation of its currency, a five-year country-wide blockade, and a war with Azerbaijan. Pensioners 60 years of age or older may be at high risk for significant nutritional deficits. We drew a stratified systematic sample (with a random starting point) of 456 pensioner names from all eight administrative regions in Yerevan, the capital of Armenia. We administered a questionnaire that gathered data including self-reported weight and height, demographic characteristics, living conditions, medical and dietary history, income, and aid received from various sources. The survey yielded 381 of 456 (84%) completed interviews. Ninety-one percent reported their diet had gotten worse during the past six months, including less variety (83%) and quantity (85%) of food. Seventy-six percent reported they did not have enough money to buy food, and 91% had cut the size of their meals or skipped meals. Forty-five percent reported a weight loss of > or = 5 kg in the previous year. After we adjusted for potential confounders, weight loss of > or = 5 kg was associated with illness affecting eating (adjusted odds ratio [OR] = 2.2, 95% confidence intervals [CI] = 1.4, 3.4), not having received aid (adjusted OR = 2.2, 95% CI = 1.1, 4.1), and cutting the size of or skipping meals (OR = 2.7, 95% CI = 1.1, 6.7).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗