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Biomedical subjects

R G Feachem

Publications and source records attributed to R G Feachem.

At least 37 records · Page 2Linked to original sources
PubMed1989

Disability from dracunculiasis: effect on mobility.

A study was conducted in northeastern Imo State to define the disability and restriction of mobility associated with dracunculiasis. The study was part of an evaluation of the UNICEF-assisted Drinking Water Supply and Sanitation Project in Imo State, Nigeria. A sample of household units (100 in year 1, 195 in year 2) was visited every two weeks to determine who was affected by dracunculiasis and to characterize the extent of related disability. The average duration of symptoms was 12.7 weeks (range 3-29 weeks). Fifty eight per cent of all episodes of disease resulted in severe disability (with the individual unable to leave the compound) lasting a mean of 4.2 weeks (range 2-12). The mean period of severe disability was significantly higher for those aged 50 years and over than for those less than 50 years old. In the area studied, the disease occurred during the peak yam and rice harvest time and the period of preparation for the planting season. This is the first study to document systematically and prospectively the marked restriction of normal activity in affected individuals and the long duration of the disability. These findings can assist in improving estimates of the costs associated with dracunculiasis and of potential economic benefits if the disease were eradicated.

Activities of Daily Living↗
PubMed1989

The use of nutritional status as a second outcome measure in case-control studies of environmental risk factors for diarrhoeal diseases.

Case-control studies are typically used to study the effect of several factors on the risk/incidence rate of a single disease. This paper describes a particular situation in which it is of interest to study the effect of a factor--improved sanitation facilities--on the risk/incidence rate of two 'diseases'--the incidence rate of diarrhoea and the risk of undernutrition. The conditions under which it is valid to perform an analysis of the association between the risk factor (unimproved sanitation) and a second outcome variable (undernutrition) are examined. If the effect of exposure status (improved/unimproved sanitation facilities) on the propensity to report an episode of diarrhoea is independent of the effect of nutritional status it appears that such an analysis may be valid. There must also be no interaction between the risk factor (unimproved sanitation) and the second outcome (undernutrition) with respect to their effects as risk factors for the first outcome variable (diarrhoea incidence rate).

Bangladesh↗
PubMed1989

Persistent diarrhoea in a rural area of Bangladesh: a community-based longitudinal study.

As part of a health impact evaluation of a water supply and sanitation project in a rural area of Bangladesh, diarrhoeal morbidity was recorded in children 0-4 years of age using weekly recall in household interviews, during the period March 1984 to December 1987. During the baseline year, 1984, the incidence rate of all diarrhoea episodes (3.8 episodes per child per year), and those defined as persistent, duration greater than 14 days (0.6 episodes per child per year), showed a similar age distribution, peaking in the 12-23 month age group. Sixteen per cent of all episodes were classified as persistent, and this proportion was greatest in the 0-5 month age group (25%). Children suffering at least one episode of persistent diarrhoea in 1984 also experienced a higher incidence of acute diarrhoea (less than = 14 days duration) than those suffering acute diarrhoea only (4.2 versus 3.7 episodes per child per year). Persistent diarrhoea showed a similar seasonal pattern to that of all episodes. Rates of abdominal pain, isolation of Shigella spp and a diagnosis of dysentery were significantly higher in persistent episodes than in acute episodes. Closer follow-up of children during 1986 and 1987, through the recording of all periods of absence of the child from the home, showed that overall diarrhoea incidence rates were little affected when absence was taken into account, but that the incidence of persistent diarrhoea and the proportion of episodes classified as persistent were significantly reduced. The implications of this methodological problem are discussed.

Acute Disease↗
PubMed1989

Infant feeding and risk of severe diarrhoea in Basrah city, Iraq: a case-control study.

A case-control study of the relationship between feeding mode and risk of hospitalized diarrhoea in infants (aged 2-11 months) in Basrah city was conducted between September 1983 and May 1984. A total of 597 cases were recruited from among infants admitted with diarrhoea to the major paediatric hospital in the city, while 723 controls were recruited from among healthy infants attending any of the seven maternal and child health clinics in Basrah. A variety of potentially confounding variables were controlled in the analysis. For infants aged 2-5 months, breast-feeding alone or breast-feeding plus food were the least risky feeding modes. Bottle-feeding was dangerous and bottle-feeding alone was associated with a risk of 55 among infants aged 2-3 months, and 37 among infants aged 4-5 months, relative to exclusive breast-feeding. For older infants (6-11 months), the risks of hospitalized diarrhoea were not significantly different among different partial breast-feeding modes, but non-breastfeeding was dangerous, especially exclusive bottle-feeding. Food intake was associated with a reduced risk of severe diarrhoea among bottle-fed infants but not with an increased risk among breast-fed infants. Among bottle-fed infants, no association was found between risk of severe diarrhoea and method of bottle-cleaning. Previous breast-feeding conferred no current protection.

Bottle Feeding↗
PubMed1989

Identifying health problems and health research priorities in developing countries.

When we were invited to prepare this background paper on the health problems of the developing countries for the Commission on Health Research for Development, our first thought was to compile and organize available data on the causes of morbidity and mortality affecting different age groups in various populations. It soon became clear that this would not be especially useful. There are major gaps in the available data, particularly from the poorer countries and for people above 5 years of age. The data that are available are often of poor or uncertain quality, collected from unrepresentative or undefined subpopulations, and not strictly comparable due to different definitions and data-collection methods. Additionally, in the absence of agreed definitions and analytical frameworks, it is not clear what could or should be done with the data on health problems so amassed. More fundamentally, we have come to doubt whether the current array of epidemiological concepts and tools is sufficient for the task. We therefore decided that, while giving an overview of current knowledge on levels and trends of morbidity and mortality, the emphasis of this paper should be more towards concepts, methods, and data deficiencies. In Section 1, we set out definitions and frameworks for considering health problems and health research; we review recent conceptual models for the analysis of the determinants of child survival; and we outline a framework, focusing on modifiable determinants of health and life-cycle health effects, which is used in subsequent sections. In Section 2, relationships between national and societal level determinants and health are reviewed and then set aside. In Section 3, we review available data on world patterns and trends of morbidity and mortality, highlighting the data deficiencies and lacunae. In Section 4, we follow the life of a woman in a developing country and examine the health problems, and their determinants, which she and her children face. In Section 5, we draw these strands together and, having reviewed current approaches to prioritizing health problems and suggested some ways in which they could be improved, in Section 6 identify several research priorities, emphasizing the need for methodological research. This paper was commissioned in March 1987; prepared in draft and presented to a meeting at Chateau de Bossey, Geneva, Switzerland during 15-17 July; and revised and completed in September 1987. It is in no sense definitive or final.(ABSTRACT TRUNCATED AT 400 WORDS)

Developing Countries↗
PubMed1989

Tubewell water consumption and its determinants in a rural area of Bangladesh.

As part of the evaluation of a water supply, sanitation and hygiene education project in rural Bangladesh, the consumption of water from the improved supplies was estimated from an observational study. Women volunteers observed and recorded all water collection activities of each group of households using a handpump over a 2-day period. Data from questionnaire surveys on household characteristics were related to per capita use of water. The mean household water consumption rate was 43 l per capita per day. Univariate analyses showed that several factors were significantly associated with water consumption, including family size and age structure, occupation, distance from the house to the handpump, the number of people served by a handpump, and possession of luxury items. Multiple regression analysis showed that several factors remained associated with per capita consumption, although their predictive value was low. The method of measuring water consumption, and the policy implications of the findings, are discussed.

Bangladesh↗
PubMed1988

Epidemiology and tropical public health: current and future contributions with particular emphasis on the role of the London School of Hygiene and Tropical Medicine.

This paper presents a forward look at the contribution of epidemiology to public health in developing countries and pays particular attention to the present and future role of the London School of Hygiene and Tropical Medicine. Three types of epidemiology are distinguished for the purposes of the paper: micro-epidemiology, desk epidemiology and macro-epidemiology. Micro-epidemiology, the application of epidemiology to particular health problems in particular settings, is illustrated through examples in both child and adult health. More emphasis on acute respiratory infections in children, maternal and neonatal health, and adult health in general is advocated. The contributions of desk epidemiology are illustrated through examples of the exploration of the effects of confounding and mis-classification. Continued attention to theoretical and methodological issues is essential if the quality and cost-effectiveness of field studies are to continue to improve. Macro-epidemiology is concerned with the absolute and relative contributions of particular causes or diseases to the overall burden of ill-health in a population. It is a young field in which important advances may be made in the 1990s. Its results are highly relevant to policy making and resource allocation in the health sector. In conclusion, the relationship between epidemiologists in developed and developing countries is briefly discussed and some recommendations are made.

Adolescent↗
PubMed1987

The epidemiology of acute diarrhoea in a rural community in Imo State, Nigeria.

As part of an evaluation of a water supply and sanitation project, a baseline cross-sectional study of diarrhoea, and its putative risk factors, was conducted in 5 villages in Imo State, Nigeria. Data were collected from 4641 and 5920 persons during surveys in the dry and wet seasons, respectively. 8 d period prevalence rates for diarrhoea ranged from 5 to 50%, with the highest rates occurring in the 6 to 23 month age group. Diarrhoea was associated with up to 75% of all illnesses in young children and with about 20% in adults. Risk factors included lower socio-economic status, an unclean domestic environment, use of non-purified water, absence of soap, and feeding methods other than exclusive breast-feeding in the early months of infancy. These results suggest that the education component of water supply and sanitation projects should emphasize personal and domestic hygiene and infant feeding.

Adolescent↗
PubMed1987

The bacteriological quality of traditional water sources in north-eastern Imo State, Nigeria.

Monthly bacteriological water testing of traditional water sources (ponds, rivers, unprotected springs and traditional wells) used by five villages in northeastern Imo State, Nigeria, was conducted during the period January 1983 to August 1985. The membrane-filtration technique was used to detect faecal coliforms (FC) and faecal streptococci (FS). Evidence of faecal pollution was seen throughout the year for all water sources. During the study period, the monthly geometric mean counts per 100 ml of water (all sources combined) ranged from 760 to 17877 for FC and from 678 to 17394 for FS. The peak period of faecal pollution occurred during the transition between the dry and wet seasons and in the early wet season. During this peak pollution season (February-May), the geometric mean counts were 2.5-7.2 times higher than in the remaining part of the year for all source types except rivers, with ponds being the most heavily polluted. Preliminary findings on the sensitivity and specificity, in this tropical environment, of the standard membrane-filtration technique for enumerating FC are presented. The implications of the findings of this study for the environmental control of waterborne and hygiene-related diseases are discussed.

Developing Countries↗
PubMed1987

Comparison of five assays for the heat-labile enterotoxin of Escherichia coli.

Enzyme-linked immunosorbent assay (ELISA), DNA-DNA hybridisation, Vero cell assay, the Biken test and a new membrane-filter method were compared in the detection of heat-labile enterotoxin (LT) of Escherichia coli. Six subcultures of each of 50 strains of E. coli from the Biken collection were evaluated "blind" in the laboratory. The combined results of the most reproducible tests (ELISA and DNA-DNA hybridisation) were used to calculate the sensitivity and specificity of the other assays. The Vero-cell assay had a high sensitivity (98%) but a lower specificity (91%). The Biken and membrane-filter assays had sensitivities of 58-71% and 77-84% respectively, depending on the type of antiserum used. Only one false positive result was obtained with the Biken test; specificity of the membrane-filter assay was 94-95%. The membrane-filter assay, with anti-cholera toxin, is specific and reasonably sensitive. It has particular advantages over DNA-DNA hybridisation and the Biken test, and it may prove suitable for screening large numbers of E. coli isolates in epidemiological studies in developing countries.

Animals↗
PubMed1987

Feeding and nutritional status among infants in Basrah City, Iraq: a cross-sectional study.

Feeding histories were collected on 772 randomly selected infants visiting Maternal and Child Health Clinics in Basrah city between October 1983 and May 1984. Weight-for-age data on 557 of these infants (72 per cent) were also obtained. Over 90 per cent of infants were breast-fed initially, and prevalence rates of breast-feeding during infancy were higher among infants of low socioeconomic status (LSES) than those of high socioeconomic status (HSES). Exclusive breast-feeding declined sharply during the first 6 months of life. Supplementation of breast-feeding with bottle-feeding was common, especially among HSES infants. Methods of cleaning infant feeding bottles were more hygienic among HSES than LSES families. Comparison of the weight-for-age of infants on different feeding modes in the 2-7 months age group showed that exclusively breast-fed infants were slightly, but significantly, heavier than partially breast-fed or non-breast-fed infants. Mild faltering of weight-for-age with age was observed, relative to the NCHS median reference weight.

Age Factors↗
PubMed1987

The effects of distance and season on the use of boreholes in northeastern Imo State, Nigeria.

A study was conducted in a rural area of northeastern Imo State to examine the effect of distance and season on the use of boreholes, provided at a borehole-to-population ratio of 1 to 440. The type of water source used by households varied according to season. In the water-scarce dry season, 98% of households used borehole water: 64% as their sole source, a further 26% as their main source, and 8% as a secondary source. The use of borehole water as the main source was little influenced by distance until the household-to-borehole distance reached approximately 2 km. The situation was different in the wet season when the availability of water sources was much greater. In this season, rainwater was the main water source for 64% of households. Borehole water was the main source for only 31% of households. In the rainy season, the use of borehole water as the main source showed a significant decrease with increasing household-to-borehole distance. The provision of one borehole for 400-500 people was associated with a high rate of use as the main water source only in the dry season. However, the use of boreholes as either a main or alternative source was high in both seasons and it is possible that those households that used boreholes as an alternative source used the water for drinking.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Promotion↗
PubMed1986

Membrane filter assay for detection of enterotoxigenic Escherichia coli in epidemiological studies.

A membrane filter assay is described for detection of heat-labile toxin (LT) production by Escherichia coli. Bacterial colonies were isolated on a membrane filter which was then incubated on an agar medium containing anti-cholera toxin. LT produced by bacterial colonies diffused through the membrane filter, complexed with the antiserum, and formed a zone of precipitation in the agar. Requirements for reagents and materials were simple. The membrane filter assay showed good agreement with both the ganglioside-enzyme-linked immunosorbent assay and the DNA-DNA hybridisation assay and may prove to be an important technique for the study of the epidemiology of enterotoxigenic E coli in developing countries.

Cellulose↗
PubMed1986

The impact of physico-chemical stress on the toxigenicity of Vibrio cholerae.

The expression of toxigenicity by Vibrio cholerae, before and after exposure to various conditions of salinity, pH and cation composition and concentration, has been measured. Exposure to these conditions did not select for hyper- or hypo-toxigenic strains. This suggests that toxigenic V. cholerae O1 are unlikely to lose their toxigenicity when exposed to environmental stress and that V. cholerae toxin production is not a response to the stresses included in this study. These results are consistent with an aquatic reservoir for toxigenic V. cholerae O1.

Cholera Toxin↗