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Biomedical subjects

R Tonglet

Publications and source records attributed to R Tonglet.

33 records · Page 2Linked to original sources
PubMed1996

Health information systems for leprosy control programmes: a case for quality assessment.

A qualitative study was carried out aimed at checking the level of understanding and the actual use of the indicators recommended in leprosy control programmes by either the World Health Organization or the International Federation of Anti-Leprosy Associations. Two successive questionnaires were sent to 268 leprosy control programme managers. The first one concerned information about the main characteristics of the programme, the information system in operation, and the data regarded as indispensable or useful for programme monitoring. The respondents to the first questionnaire (n = 64) proposed an extraordinarily wide range of indicators, mainly ill-defined. The respondents to the second questionnaire (n = 37) to whom a limited list of precisely defined indicators was submitted did not succeed in reaching a complete agreement on any of these indicators. Although the question of programme monitoring has been dealt with at an international level for years, there is an urgent need for a real agreement of international agencies and managers of leprosy control programmes on the indicators to be used. Programme managers in the field are obviously open to the idea of greater intervention by international organizations to improve data collection and to encourage standardization of computerized information systems.

Communicable Disease Control↗
PubMed1995

The role of the Zairian Health Services in the Rwandan refugee crisis.

In July 1994, a stream of Rwandan refugees entered the southern part of North Kivu Region, Zaire. The public health consequences of this crisis for the host population and health services have not been analysed up to now. The lack of human and financial resources did not prevent Zairian health structures and personnel from taking care of the many refugees settled outside the camps, following their arrival. The public health consequences of the crisis for the local population should be considered an integral part of the disaster.

Child, Preschool↗
PubMed1994

Biological risk factors for fatal protein energy malnutrition in hospitalized children in Zaire.

Biological markers were used in an attempt to predict mortality in children admitted to the hospital in Kivu, Zaire, for protein energy malnutrition. Data for 39 children who died (16.4%) showed significantly lower levels of albumin (1.61 vs. 2.53 g/dl; p < 0.001), transferrin (82.1 vs. 167.7 mg/dl; p < 0.001), and transthyretin (6.49 vs. 9.87 mg/dl; p < 0.001), but not or retinol-binding protein, than for the 199 survivors. Since albumin and transferrin were correlated, a Cox model was used to see whether albumin or transferrin has a significant predictive value independent of transthyretin. The relative risk predicted by each indicator was of the same order of magnitude, approximately 4. We conclude that specific biological markers help to discriminate among hospitalized subjects at risk and to identify those in need of more intensive nutritional support to prevent early death.

Biomarkers↗
PubMed1993

Serum albumin concentration, arm circumference, and oedema and subsequent risk of dying in children in central Africa.

OBJECTIVE: To measure the prognostic value of clinical, anthropometric, and biological indicators of protein energy malnutrition in hospitalised children. DESIGN: Hospital based follow up study from admission to discharge or death of a cohort of children. SETTING-Paediatric hospital in Zaire. SUBJECTS: 1129 children consecutively admitted between August 1986 and October 1988. MAIN OUTCOME MEASURES: Height, weight, arm circumference, skinfold thicknesses, serum albumin concentration, and mortality. RESULTS: Mortality was higher in wasted children and in those with a mid-upper arm circumference < 125 mm, a serum albumin concentration < 16 g/l, and oedema. After multivariate analysis, serum albumin concentration was the best predictor of subsequent risk of dying. Mid-upper arm circumference and oedema, however, still contributed considerably to evaluation of mortality. CONCLUSIONS: In this specific environment of central Africa an isolated clinical sign such as oedema is not enough to detect children with a high risk of dying among those admitted to paediatric wards with severe protein energy malnutrition. Measurement of additional indicators such as arm circumference and serum albumin concentration seems to be of crucial importance.

Anthropometry↗
PubMed1993

Evaluation of immunization coverage at local level.

Two simple methods were employed for evaluating immunization activities in three rural health districts of Zaire, with a view to improving service delivery. One method involves the use of cumulative frequency graphs for monitoring progress at the health centre level towards the achievement of coverage targets. The other requires a clinic-based audit and a population-based survey of children aged 12-23 months to ascertain whether they have been immunized against measles at the appropriate time. These approaches can help to identify operational problems and to motivate the people in charge of immunization at local level.

Child, Preschool↗
PubMed1993

[Value of nutritional indicators for the prognosis of intrahospital mortality in children in Kivu].

From 1986 to 1988, 1,129 children were hospitalized in Lwiro (South-Kivu, Zaïre) 3/4 of which were severely malnourished. Anthropometric, clinical and biological indicators were measured at admission. Observed mortality rate was 17.4%. Survival curves differ significantly for each anthropometric parameter measured at inclusion. In multivariate analysis, weight for age calculated with local reference or arm circumference is significantly associated with survival. The addition of serum albumin concentration to the multivariate model, shows this variable to be important. However, the use of an anthropometric indicator, such as weight for age or arm circumference is still important because it maintains an independent and significant effect on survival.

Adolescent↗
PubMed1992

Efficacy of low oral doses of iodized oil in the control of iodine deficiency in Zaire.

BACKGROUND: About one billion people worldwide are at risk for iodine deficiency. Despite existing programs of prophylaxis, the prevention of iodine deficiency is still a challenge throughout the developing world. We studied the efficacy of low doses of iodized oil in an area of severe iodine deficiency in Zaire. METHODS: Seventy-five subjects with visible goiter were randomly assigned to receive a single oral dose of placebo or either 0.1 or 0.25 ml of iodized oil, corresponding to 0, 47, and 118 mg of iodine, respectively. The mean ages of the subjects in the three groups were 23, 22, and 22 years, respectively, and the ratios of males to females were 0.25, 0.32, and 0.19. Efficacy was assessed by evaluating goiter size and measuring urinary iodine and serum thyroid hormone concentrations for 12 months. RESULTS: Goiter size decreased in most of the subjects who received either dose of iodized oil. Their urinary iodine concentrations were normal for six to nine months and their serum thyroxine and thyrotropin concentrations were nearly all normal throughout the study period. There were no side effects, even in subjects whose serum thyroxine concentrations had initially been low. In the placebo group, neither goiter size nor any of the biochemical values changed. CONCLUSIONS: The oral administration of a single small dose of iodized oil is capable of correcting iodine deficiency for about a year. This method of supplementation is likely to be more effective, efficient, and acceptable than the administration of either intramuscular or large oral doses of iodized oil.

Administration, Oral↗
PubMed1992

[Community health workers are capable of determining reliably the target population for health programs].

The target population is a key concept for the planning and evaluation of health services. However, in developing countries, health professionals in the field are often uneasy with the determination of the population denominator. In Zaire, where reliable demographic data are hardly available, we make use of two different methods aimed to the determination of the size of the target population: (1) an exhaustive population based survey performed by trained interviewers, and (2) a rapid census of the target population performed by community health workers. This paper presents both the results of a demographic survey organized in 1984, and two consecutive census performed by community health workers in 1986 an 1988, in the same area (Northern-Kivu, Zaire). Our results suggest that community health workers under close supervision are able to perform rapidly and at low cost a reliable collection of the demographic data needed for the implementation and monitoring of health programmes at the local level.

Adolescent↗
PubMed1992

The causal model approach to nutritional problems: an effective tool for research and action at the local level.

Reported are the results of a case study from Kirotshe rural health district, Northern Kivu, Zaire, where a workshop on the causal model approach to nutrition was organized in 1987. The model has since been used in the field for research design, training of health professionals, nutrition intervention, and community development. The rationale behind this approach is reviewed, the experience accumulated from Kirotshe district is described, and the ways in which the causal model contributes to comprehensive health and nutrition care are discussed. The broad range of possible policy implications of this approach underlines its usefulness for future action.

Child, Preschool↗
PubMed1990

The reduction of the leprosy endemicity in northeastern Zaire 1975/1989.

The leprosy endemy in Uele, North Eastern region of Zaire has declined considerably since the 1950's, particularly since 1975. The hypothesis is advanced that the most important causal factor has been the distribution of dapsone for many years, through a vertical programme. The gradual increase of dapsone resistance has been taken care of by the introduction of combined, multidrug therapy in the 1980's. The cost per patient detected and treated rises in inverse proportion to the decline in endemy; therefore, the time has come for the integration of a leprosy control in the primary health care strategy. However, central specialized teams financed by voluntary organisations should be maintained to assure training of personnel, to give advice in diagnosis, prevention and treatment of complications, to provide drugs and to assist in rehabilitation.

Dapsone↗
PubMed1990

[The evaluation of an anti-leprosy program in Uélés (1975-1989)].

Foperda, who took over and continued the work initiated in 1924 by the Congo Red Cross, is responsible for the programme of fight against leprosy in the Ueles region (Zaire). Important results have been obtained since 1975 in the framework of a specialised medical service. These results are exposed and discussed herebelow. The evolution of the endemic leprosy in the region under survey allows to contemplate new trends for the pursuit of the programme in the coming years (controlled integration within polyvalent health services).

Democratic Republic of the Congo↗