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Biomedical subjects

R H Morrow

Publications and source records attributed to R H Morrow.

At least 19 recordsLinked to original sources
PubMed2002

Interventions for control of road traffic injuries: review of effectiveness literature.

OBJECTIVE: In 1998, road traffic injuries were estimated to be the 9th leading cause of loss of healthy life globally and are projected to become the 3rd leading cause by 2020. The majority of this burden can be located in the developing world where most of the projected increase will occur. Yet health systems are least prepared to meet this challenge in these countries. At the same time, there are effective interventions for road traffic injuries being implemented in the developed world. An extensive review of the literature reveals more than 16 different interventions in four categories that have been implemented. Renewed testing of these and new interventions will take both time and funds--resources that are scarce in developing countries. As a result, it is imperative to study the effectiveness of those interventions already tested and attempt to evaluate their potential implementation in developing countries. METHOD: Literature review to identify effective interventions and the magnitude of the effects. RESULTS: Four broad classes of interventions can be identified from the literature; health education/awareness, legislation, product design and environmental modifications. CONCLUSION: The issues for the developing countries are affordable, infrastructure and sociocultural in implementation of these strategies. The road traffic injuries are also underreported and hence under represented at the priority setting stage. Road safety should be high on the agenda as it can save a lot of lives and disability. Public health professionals should assess and advocate road safety in developing countries.

Accidents, Traffic↗
PubMed2000

Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial.

BACKGROUND: No satisfactory strategy for reducing high child mortality from malaria has yet been established in tropical Africa. We compared the effect on under-5 mortality of teaching mothers to promptly provide antimalarials to their sick children at home, with the present community health worker approach. METHODS: Of 37 tabias (cluster of villages) in two districts with hyperendemic to holoendemic malaria, tabias reported to have the highest malaria morbidity were selected. A census was done which included a maternity history to determine under-5 mortality. Tabias (population 70,506) were paired according to under-5 mortality rates. One tabia from each pair was allocated by random number to an intervention group and the other was allocated to the control group. In the intervention tabias, mother coordinators were trained to teach other local mothers to recognise symptoms of malaria in their children and to promptly give chloroquine. In both intervention and control tabias, all births and deaths of under-5s were recorded monthly. FINDINGS: From January to December 1997, 190 of 6383 (29.8 per 1000) children under-5 died in the intervention tabias compared with 366 of 7294 (50.2 per 1000) in the control tabias. Under-5 mortality was reduced by 40% in the intervention localities (95% CI from 29.2-50.6; paired t test, p<0.003). For every third child who died, a structured verbal autopsy was undertaken to ascribe cause of mortality as consistent with malaria or possible malaria, or not consistent with malaria. Of the 190 verbal autopsies, 13 (19%) of 70 in the intervention tabias were consistent with possible malaria compared with 68 (57%) of 120 in the control tabias. INTERPRETATION: A major reduction in under-5 mortality can be achieved in holoendemic malaria areas through training local mother coordinators to teach mothers to give under-5 children antimalarial drugs.

Antimalarials↗
PubMed2000

Applying burden of disease methods in developing countries: a case study from Pakistan.

OBJECTIVES: Disability-adjusted life-year (DALY) and healthy life-year (HeaLY) are composite indicators of disease burden that combine mortality and morbidity into a single measurement. This study examined the application of these methods in a developing country to assess the loss of healthy life from prevalent conditions and their use in resource-poor national contexts. METHODS: A data set for Pakistan was constructed on the basis of 180 sources for population and disease parameters. The HeaLY approach was used to generate data on loss of healthy life from premature mortality and disability in 1990, categorized by 58 conditions. RESULTS: Childhood and infectious diseases were responsible for two thirds of the burden of disease in Pakistan. Condition-specific analysis revealed that chronic diseases and injuries were among the top 10 causes of HeaLY loss. Comparison with regional estimates demonstrates consistency of disease trends in both communicable and chronic diseases. CONCLUSIONS: The burden of disease in countries such as Pakistan can be assessed by using composite indicators. The HeaLY method provides an explicit framework for national health information assessment. Obtaining disease- and population-based data of good quality is the main challenge for any method in the developing world.

Cost of Illness↗
PubMed1999

Resolution and resurgence of schistosoma haematobium-induced pathology after community-based chemotherapy in ghana, as detected by ultrasound.

Community-based treatment is recommended for endemic populations with urinary schistosomiasis; however, the optimal target group for treatment and retreatment interval have not been established. Using ultrasound, this study identified subpopulations whose lesions were most likely to respond to treatment and characterized resurgence of pathology. Ultrasound examination of 1202 infected patients was followed by chemotherapy with praziquantel. A sample of 698 patients was followed for 18 months after treatment. Nearly all types of bladder pathologies resolved after treatment, regardless of patient's age or intensity of initial infection. However, many patients' upper urinary tract pathologies (62.5%) did not resolve. During the 18-month follow-up period, reappearance of severe bladder pathologies was rare, and <10% of persons had resurgence of mild bladder pathologies. For this population, retreatment is not needed annually but might be cost effective if given several years later. Confirmation from other areas is required before general policies can be formed.

Adolescent↗
PubMed1999

Steady state assumptions in DALYs: effect on estimates of HIV impact.

OBJECTIVE: The disability adjusted life year (DALY) and the healthy life year (HeaLY) are both composite indicators of disease burden in a population, which combine healthy life lost from mortality and morbidity. The two formulations deal with the onset and course of a disease differently. The purpose of this paper is to compare the DALY and HeaLY formulations as to differences in apparent impact when a disease is not in an epidemiological steady state and to explore the implications of the differing results. DESIGN: HIV is used as a case study of a major disease that is entering its explosive growth phase in large areas of Asia. Data from the global burden of disease study of the World Bank and World Health Organisation for 1990 has been used to compare burden of disease measures in the two formulations. SETTING: The data pertain to global and regional estimates of HIV impact. RESULTS: The DALY attributes life lost from premature mortality to the year of death, while the HeaLY to the year of disease onset. This results in very large differences in estimates of healthy life lost based upon the DALY construct as compared with the HeaLY, for diseases such as HIV or those with a strong secular trend. CONCLUSION: The demonstration of the dramatic difference between the two indicators of disease burden reflects a limitation of the DALY. This information may directly influence decision making based on such methods and is critical to understand.

Africa South of the Sahara↗
PubMed1998

Measuring the burden of disease: healthy life-years.

OBJECTIVES: This paper presents the background and rationale for a composite indicator, healthy life-year (HeaLY), that incorporates mortality and morbidity into a single number. HeaLY is compared with the disability-adjusted life-year (DALY) indicator, to demonstrate the relative simplicity and ease of use of the former. METHODS: Data collected by the Ghana Health Assessment team from census records, death certificates, medical records, and special studies were used to create a spreadsheet. HeaLYs lost as a result of premature mortality and disability from 56 conditions were estimated. RESULTS: Two thirds of HeaLYs lost in Ghana were from maternal and communicable diseases and were largely preventable. The age weighting in DALYs leads to a higher value placed on deaths at younger ages than in HeaLYs. This spreadsheet can be used as a template for assessing changes in health status attributable to interventions. CONCLUSIONS: HeaLY can aid in setting health priorities and identifying disadvantaged groups. The disaggregated approach of the HeaLY spreadsheet tool is simpler for decision makers and useful for country application.

Cost of Illness↗
PubMed1997

Utility of tuberculin and anergy skin testing in predicting tuberculosis infection in human immunodeficiency virus-infected persons in Thailand.

SETTING: Chiang Rai, the northernmost province of Thailand, where extensive human immunodeficiency virus (HIV) transmission has resulted in a rapid increase in tuberculosis. OBJECTIVE: To assess the utility of tuberculin and anergy skin testing to identify latent Mycobacterium tuberculosis infection in HIV-infected persons. DESIGN: A cross-sectional study and analysis were conducted to examine reactivity to tuberculin and two control antigens (mumps and candida) in HIV-negative and HIV-positive blood donors and female sex workers. RESULTS: HIV-positive persons had markedly decreased tuberculin reactivity; 14%, 19%, and 40% had an induration of > or = 10 mm, > or = 5 mm, > or = 2 mm, respectively, while 51% of 525 HIV-negative persons had an induration of > or = 10 mm (P < 0.001). Mumps and candida positivity (reactions of > or = 3 mm) were found in 94% and 78% of HIV-negative persons compared with 72% and 61% of HIV-positive persons, respectively (P < 0.001). Although HIV-positive persons had markedly less tuberculin reactivity even at higher CD4+ cell counts (> 400 cells/microL), reactivity to mumps and candida was present in more than half of HIV-positive persons with low CD4+ cell counts (< or = 200 cells/microL). Reaction to control antigens did not predict tuberculin reactivity. CONCLUSION: In this setting, tuberculin and anergy skin testing have a low predictive value in detecting M. tuberculosis infection in HIV-infected persons, and therefore such testing has a limited role in identifying HIV-infected persons who may benefit from tuberculosis preventive therapy programs.

AIDS-Related Opportunistic Infections↗
PubMed1996

Costs and financing of improvements in the quality of maternal health services through the Bamako Initiative in Nigeria.

This paper reports on a study to assess the quality of maternal health care in public health facilities in Nigeria and to identify the resource implications of making the necessary quality improvements. Drawing upon unifying themes from quality assurance, basic microeconomics and the Bamako Initiative, locally defined norms were used to estimate resource requirements for improving the quality of maternal health care. Wide gaps existed between what is required (the norm) and what was available in terms of fixed and variable resources required for the delivery of maternal health services in public facilities implementing the Bamako Initiative in the Local Government Areas studied. Given such constraints, it was highly unlikely that technically acceptable standards of care could be met without additional resource inputs to meet the norm. This is part of the cost of doing business and merits serious policy dialogue. Revenue generation from health services was poor and appeared to be more related to inadequate supply of essential drugs and consumables than to the use of uneconomic fee scales. It is likely that user fees will be necessary to supplement scarce government budgets, especially to fund the most critical variable inputs associated with quality improvements. However, any user fee system, especially one that raises fees to patients, will have to be accompanied by immediate and visible quality improvements. Without such quality improvements, cost recovery will result in even lower utilization and attempts to generate new revenues are unlikely to succeed.

Data Collection↗
PubMed1995

Health policy approaches to measuring and valuing human life: conceptual and ethical issues.

To achieve more cost-effective and equitable use of health resources, improved methods for defining disease burdens and for guiding resource allocations are needed by health care decision makers. Three approaches are discussed that use indicators that combine losses due to disability with losses due to premature mortality as a measure of disease burden. These indicators can also serve as outcome measures for health status in economic analyses. However, their use as tools for measuring and valuing human life raises important questions concerning the measurement of mortality and the multidimensions of morbidity; valuing of life, particularly regarding weighting productivity, dependency, age, and time-preference factors; and conflicts between equity and efficiency that arise in allocation decisions. Further refinement of these tools is needed to (1) incorporate national and local values into weighting; (2) elaborate methods for disaggregating calculations to assess local disease patterns and intervention packages; and (3) develop guidelines for estimating marginal effects and costs of interventions. Of utmost importance are methods that ensure equity while achieving reasonable efficiency.

Cost of Illness↗
PubMed1992

Ultrasound in schistosomiasis--a critical look at methodological issues and potential applications.

This is the concluding paper of a series on the use of diagnostic ultrasound in the investigation of schistosomiasis. An earlier chapter in the volume discussed standardization of the methodology, and of recording, when ultrasound is used for epidemiological purposes. The present paper discusses some other requirements for obtaining ultrasound data which can be used to make valid comparisons within and between studies. Since there is an inherent variability in the interpretation of results from ultrasound images, quality control and the training of observers are both essential. It is also necessary to collect more information for each endemic setting about possible concomitant diseases which might lead to misinterpretation of results. Furthermore, the analysis of the data obtained must be uniform if valid comparisons are to be made. A final section considers applications of ultrasonography in research and control programmes. The technique should make it possible to obtain a better understanding of the extent and distribution of organ damage due to schistosomal infection in different geographical areas, and of the way in which lesions develop over time, or may regress in response to treatment. Since ultrasonography will always remain a relatively labour-intensive and expensive technique, it is necessary to establish, in different settings, how its findings correlate with the results of parasitological, serological and biochemical tests. The ultimate aim is to build up a body of information on the potential of ultrasonography, in combination with other procedures, in the various possible approaches to morbidity control.

Clinical Protocols↗
PubMed1991

The role of clinical epidemiology in establishing essential national health research capabilities in developing countries.

Health research directly relevant to the needs of the people of developing countries is essential for equity in development as well as for improving health planning and management. the international Commission on Health Research for Development has stressed the need to strengthen the capacity of developing countries, no matter how poor, to carry out essential national health research (ENHR). Clinical epidemiologists in developing countries can significantly contribute to the manpower available for ENHR. They play a major role in the provision and practice of appropriate health care by contributing to the critical assessment of priority health problems and by carrying out scientific evaluation of new and conventional intervention tools. In clinical epidemiology units in developing countries, transdisciplinary collaboration with social scientists and health economics has enhanced the capacity to do research that would influence decision-making and health policy, even as links with ministries of health and other ENHR-committed networks are being strengthened. The potential for carrying out ENHR will be multiplied as national and regional training centers for clinical epidemiology in selected developing countries are established.

Delivery of Health Care↗
PubMed1988

Epidemiological study designs appropriate for investigating interactions between HIV infection and tropical diseases.

Infections with the human immunodeficiency virus(es) (HIV) are likely to have a profound impact on the health of those in many parts of Africa over the next several decades. If there are adverse interactions between HIV infections and the endemic tropical diseases the overall impact of the HIV epidemic will be worse than that predicted based on observations on the natural history of HIV infections in developed countries. With the exception of tuberculosis, the evidence for such interactions is presently lacking, but this may be largely due to the dearth of informative studies. In this paper we outline the kinds of epidemiological studies required to investigate such interactions and discuss some of the problems associated with the investigations.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Epidemiological evidence for the role of falciparum malaria in the pathogenesis of Burkitt's lymphoma.

Nearly all epidemiological characteristics of Burkitt's lymphoma (BL) can be explained on the basis of relationships of BL to the intensity of the host response to Plasmodium falciparum. The major epidemiological associations are: the high degree of geographic correlation between the incidence rate of BL and the intensity of P. falciparum transmission, both at a global level and within individual countries; the close correlation between the age incidence of BL and the age of acquiring maximum levels of antimalarial immunoglobulin; the relative protection from BL by residence in urban areas, where levels of malaria transmission are lower, compared with rural areas; the decline in BL incidence in areas where death rates due to malaria have declined and, within such areas, a differential decline in BL incidence in people making better use of health facilities; the older age of onset in patients who have migrated from low-intensity to high-intensity malaria areas as compared with patients born in the high-intensity areas - the higher absolute age-specific incidence rate in those above age ten in this immigrant group being consistent with the hypothesis that intense malaria infection and consequent host defence response serve as the major triggering event in the pathogenesis of the lymphoma; the inverse geographic correlation between the average age of onset of BL and the intensity of falciparum malaria infection. An inverse association of BL with sickle-cell trait (AS haemoglobin) would provide strong evidence for the role of intense falciparum malaria, but most studies to date have not achieved statistical significance. Time-space clustering and reports of seasonal variation in BL incidence would indicate that a precipitating factor operates over a relatively short time-span, at least in some areas. Combining the evidence concerning cytogenetics, Epstein-Barr virus (EBV) and falciparum malaria, the following three-phase model for the oncogenesis of BL could account for virtually all the currently known facts and be tested by further laboratory and field studies: Primary infection with EBV, perhaps early and intense, leads to the immortalization of large numbers of B lymphocytes. Severe falciparum malaria then leads to an intense host response with particular proliferation of the EBV-infected B lymphocytes. Finally, the great increase in the B lymphocytes provides a much higher statistical opportunity for the emergence of the cytogenetically abnormal BL cell.

Adolescent↗
PubMed1984

The application of a quantitative approach to the assessment of the relative importance of vector and soil transmitted diseases in Ghana.

The vector and soil transmitted parasitic infections produce a highly diverse group of diseases in terms of the importance of their impact upon human populations and in terms of the control methods that might limit that impact. In Ghana a method was developed for quantitatively assessing the relative importance of different disease problems by estimating the amount of healthy life lost through illness, disability and death as a result of each disease. The quantitative assessment is derived from information on incidence rate, case fatality rate and the extent and duration of disability produced by the disease. The method may be used to help decide the priorities for the allocation of resources to alternative procedures or programmes by calculating the amount of healthy days of life which may be saved by different approaches and then relating these savings to the costs of the approaches. Each of the vector and soil transmitted parasitic diseases in Ghana had special characteristics that influenced the estimates of their relative importance. Attribution of death due to malaria posed special problems, but even with the most conservative estimate malaria was the single most important cause of loss of healthy life of all diseases in Ghana. For schistosomiasis there is such great uncertainty concerning how much disability or mortality that results from infection that the relative importance of schistosomiasis could not be usefully estimated; thus research into the extent of disability and death caused by schistosomiasis should have a very high priority if rational allocation of resources for its control is to be achieved. Onchocerciasis, though not generally considered an important cause of mortality, is an important cause of chronic severe disability. The importance of ascariasis and hookworm remain uncertain both because of the lack of information as to the extent of disability and mortality that they produce and the lack of data in Ghana as to their prevalence and intensity of infection. Guinea worm was of little importance from the national point of view, but was highly important in focal areas. Trypanosomiasis would appear to be of minor importance because its incidence was quite low, but for an epidemic disease such as trypanosomiasis the importance must be estimated based on what would occur if there were not effective surveillance and control methods. Diverse though this group of parasitic diseases is a common thesis is that each has been relatively neglected in relation to its importance and for each a considerable reduction in loss of healthy life should be achievable at reasonable cost.

Animals↗