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PubMed1999

The diagnosis of Plasmodium falciparum infection in Gambian children, by field staff using the rapid, manual, ParaSight-F test.

A rapid immunodiagnostic test for Plasmodium falciparum, the ParaSight-F test, was evaluated in the diagnosis of malaria in 139 children with uncomplicated malaria, who presented at the Medical Research Council's clinic at Basse in Upper River division, The Gambia. The aim was to evaluate the performance and usefulness of the test as a diagnostic method in a malaria-endemic area, when performed by a field worker. Compared with microscopy, the test had a sensitivity of 96.5%, a specificity of 90.5%, a negative predictive value of 94.2% and a positive predictive value of 94.3%. Because of its sensitivity, specificity and simplicity, the ParaSight-F test will be of value in situations where microscopy is not possible.

Animals↗
PubMed2001

Tuberculosis: trends and the twenty-first century.

The global burden of tuberculosis is enormous, even if estimates are somewhat uncertain. The forces counteracting control measures, namely demographic factors, drug resistance, HIV, migration, poverty and marginalization, are enormous as well. With accelerated reforms in tuberculosis programs important progress can be made towards the control of tuberculosis early in the 21st century. This is confirmed by studying reports from countries where control measures have been implemented and sustained. Well-functioning programs can make good use of technological progress, such as improved tools for diagnosis and treatment, when these become available at an affordable cost. It is important now to use the opportunity of increased resources in order to reform tuberculosis programs. The biggest impact on global tuberculosis control in the 21st century can be made in Asia. Success in this part of the world depends on political commitment. Elsewhere, the main forces counteracting control measures are HIV in Africa and multidrug resistance in parts of Europe and the former Soviet Union. Here solutions are still on the drawing board. The long time-frame for tuberculosis control when using the currently recommended strategy, the uncertain impact of "improved" tools on this time-frame and the constant threat that political commitment will not be sustained are reasons why field workers look towards new technology in hope of progress in vaccine research. Here, the prospects are uncertain and the forecasted time-frame is long. Skeptics even doubt that an effective vaccine can be developed. However, when predicting progress it is important to realize that it is for the most part unpredictable.

AIDS-Related Opportunistic Infections↗
PubMed2005

Drug resistance of Mycobacterium tuberculosis in selected urban and rural areas in Bangladesh.

The magnitude of anti-tuberculosis drug resistance in Bangladesh is not precisely known. We studied the drug resistance patterns of Mycobacterium tuberculosis in an urban and a rural area of Bangladesh. A tuberculosis (TB) surveillance system has been set up in a population of 106,000 in rural Matlab and in a TB clinic in urban Dhaka. Trained field workers interviewed all persons > or =15 y at Matlab to detect suspected cases of tuberculosis (cough >21 d) and sputum samples were examined for acid-fast bacilli (AFB). The first 3 AFB positive patients daily from the urban clinic were included. AFB positive cases diagnosed between June 2001 and June 2003 from both settings were cultured and drug susceptibility tests were performed. Of 657 isolates, resistance to 1 or more drugs was observed in 48.4% of isolates. Resistance to streptomycin, isoniazid, ethambutol and rifampicin was observed in 45.2%, 14.2%, 7.9% and 6.4% of isolates, respectively. Multidrug resistance was observed in 5.5% of isolates. It was significantly higher among persons who previously had received tuberculosis treatment of > or =1 month (15.4% vs 3.0%, adjusted OR: 6.12, 95% CI: 3.03-12.34). The magnitude of anti-tuberculosis drug resistance in Bangladesh is high. Further evaluation is needed to explain the high proportion of streptomycin resistant M. tuberculosis. Appropriate measures to control and prevent drug resistant tuberculosis in Bangladesh to reduce mortality and transmission are warranted.

Adolescent↗
PubMed1991

Immunization coverage survey in eight regions of Saudi Arabia.

A study of 1916 children in eight regions in the Kingdom of Saudi Arabia was conducted to find out the immunization coverage of the six expanded programme on immunization (EPI) target diseases. The eight regions surveyed were selected because they showed less than 80% coverage in a previous survey. The WHO cluster sampling technique was employed. The field workers were trained to conduct house-to-house surveys, inspect the children's immunization cards or health registers and complete the data forms. The overall coverage in the eight regions was found to be 97.5% for BCG, 94.3% for DPT and polio and 86.0% for measles. Altogether, 84.8% of the children had completed their immunization schedule by the end of their 1st year of life. The situation improved further in the 2nd year of life to reach 91.9%. The immunization coverage varied from region to region and from one EPI target disease to another. The partially immunized children represented 6-18% while those who did not receive any immunization represented only 0-8%. The drop-out rate between BCG and the third dose of DPT ranged from 1.9% to 9%. The factors behind the success are discussed and recommendations made for further improvement and maintenance of high immunization coverage.

Humans↗
PubMed1997

Morbidity and growth performance of infants in Madura, Indonesia.

Between January 1987 and July 1988, all children born in two villages on the island of Madura, Indonesia were visited weekly by a field worker trained to interview mothers on disease symptoms. The maximum recall period was 1 week. All infants were measured (weight and height) at monthly intervals. Information on growth and morbidity is analysed for infants from birth until the age of 11 months. Morbidity, defined as acute respiratory tract infection (ARI), diarrhoea, fever and other diseases, is analysed over 4-week periods and related to growth performance. In total, there are 1373 4-week reporting periods with morbidity information from birth to the age of 12 months. Of all the diseases recorded (1021), 47% were ARI, 13% diarrhoea, 14% fever and 26% other diseases. The average (SD) duration of diarrhoea was 7 (11) days, ARI 14 (9) days, fever 6 (4) days and 16 (10) days for other diseases. The most striking results in this analysis are: (i) the lack of a relationship between morbidity and growth (either linear or weight) during the 1st 6 months of life; (ii) the existence of a relationship between illness and weight increment for which only ARI showed significant influence for infants of 6 months and more; (iii) the lack of a relationship between morbidity and linear growth performance at all ages; and (iv) the fact that no cumulative effect of disease on growth performance was found to explain the observations.

Acute Disease↗
PubMedDate not supplied

Differences in stunting prevalences calculated from two similar growth references may be large and inconsistent in undernourished children.

BACKGROUND: In 2000, the US Centers for Disease Control and Prevention (CDC) released a set of growth references that address limitations of the internationally recommended 1977 National Center for Health Statistics (NCHS) references. AIM: This study compares length-for-age Z-scores (LA Z-scores), height-for-age Z-scores (HA Z-scores), and age-specific stunting prevalences of undernourished children using the 1977 NCHS versus the 2000 CDC references. SUBJECTS AND METHODS: Data come from > 2000 children from the Cebu Longitudinal Health and Nutrition Study in the Philippines. Anthropometric data were collected bimonthly from birth to 2 years, at 8.5 and 11.5 years, and at 15 years in girls and 16 years in boys. Z-scores and stunting prevalences are compared between references. RESULTS: LA Z-scores were generally lower using the 1977 references, and stunting prevalences were higher from 0 to 2 years, with some crossover. Differences in HA Z-scores after 8.5 years of age were inconsistent in both direction and magnitude by reference and sex, with additional crossover. CONCLUSIONS: When applied to an undernourished population, the two references in question perform differently, with inconsistencies in direction and magnitude of Z-scores and stunting prevalences. The 2000 CDC growth references are clearly an improved tool. However, there are challenges inherent in switching to a new reference that will require the attention of researchers and field workers.

Adolescent↗
PubMed1980

Health risks in ultra-low-volume (ULV) aerial spray of malathion for mosquito control.

A field study was undertaken to evaluate health risks in persons engaged in ultra-low-volume (ULV) aerial application of technical malathion for mosquito control. No specific toxicity signs and symptoms were observed except nausea and irritation of eyes in a few cases. Observations on the ChE activity has revealed a significant depression in plasma at the end of spray operation in labourers employed in loading and unloading of insecticide and in field workers. Red blood cells ChE activity was not affected in any group of subjects. At the end of spray operation the insecticide residue on the grass used as cattle feed were about 315 ppm, which are much above the permissible level. However, 4 days after the application normal levels of the insecticide residues were detected.

Agriculture↗
PubMed1993

Malathion disposition in dermally and orally treated rats and its impact on the blood serum acetylcholine esterase and protein profile.

14C-methoxy-malathion with either pure or 50% E.C. formulated malathion were applied orally or dermally at one tenth of their LD50 to two batches of male albino rats. More than 90% of 14C was released with urine after 24 hours. The rest of 14C was detected in the feces, blood, intestines, liver and kidney in a descending order. No significant 14C was detected in other organs. Comparing the oral pure and formulated malathion treatments, there was no significant variation in the rate of disposition or excretion of 14C-malathion. However, the dermal treatment revealed that the 14C-formulated malathion was released faster than the pure one in urine in the first 24 hours; while the 14C-pure malathion showed relatively higher levels in the feces and blood in the first 24 hours. In a third batch of male albino rats, the effect of the same level of dermal treatment by either pure or 50% E.C. formulated malathion on serum acetylcholine-esterase (A. Ch. E.) activity and serum protein profile was studied. The serum A. Ch. E. activity was found to be inhibited to 40% activity after 6 to 24 hours for both treatments. However, after 96 hours the serum of the pure malathion treated rats showed full recovery of A.Ch.E. activity, while the formulated malathion treated showed only 60% activity. The SDS-PAGE analysis showed a differentiation in the serum protein bands of the 48 hours exposed rats to formulated malathion which was confirmed by the scanned gel profile. The FPLC integrated chromatograms proved an initiation of a new protein band accompanied with rearrangement of the albumin and pre-albumin bands. Thus it can be concluded that, the impact on the blood serum protein profile and A. Ch. E. activity can be used as reliable criteria to detect acute toxicity of malathion and other choline-esterase inhibitors in exposed field workers. Further research is needed to elucidate the specificity and sensitivity of such criteria as biomarkers for human exposure.

Acetylcholinesterase↗
PubMed2003

Applying verbal autopsy to determine cause of death in rural Vietnam.

AIMS: Verbal autopsy (VA) is an attractive method for ascertaining causes of death in settings where the proportion of people who die under medical care is low. VA has been widely used to determine causes of childhood and maternal deaths, but has had limited use in assessing causes in adults and across all age groups. The objective was to test the feasibility of using VA to determine causes of death for all ages in Bavi District, Vietnam, in 1999, leading to an initial analysis of the mortality pattern in this area. METHODS: Trained lay field workers interviewed a close caretaker of the deceased using a combination closed/open-ended questionnaire. RESULTS: A total of 189 deaths were studied. Diagnoses were made by two physicians separately, with good agreement (kappa = 0.84) and then combined to reach one single underlying cause of death for each case. The leading causes of death were cardiovascular and infectious diseases (accounting for 20.6% and 17.9% of the total respectively). Drowning was very prevalent in children under 15 (seven out of nine cases of drowning were in this age group). DISCUSSION: One month seemed an acceptable minimum recall period to ensure mourning procedures were over. A combination VA questionnaire was an appropriate instrument provided it was supported by adequate training of interviewers. Two physicians were appropriate for making the diagnoses but predefined diagnostic methods for common causes should be developed to ensure more replicable results and comparisons, as well as to observe trends of mortality over time. The causes of death in this study area reflect a typical pattern for developing countries that are in epidemiological transition. No maternal deaths and a low infant mortality rate may be the result of improvements in maternal and child health in this study area. Using the VA gave more precise causes of death than those reported at death registration. Although the validity of the VA method used has not been fully assessed, it appeared to be an appropriate method for ascertaining causes of death in the study area.

Adult↗
PubMedDate not supplied

Correlates of illicit drug use in Karen villages in Northern Thailand.

A study was conducted in 31 Karen tribal villages in Northern Thailand in 1999-2000 to address the question of why some villages have a relatively high prevalence of illicit drug use compared with others? Data were gathered from village leaders, residents, and through observations by field workers and the researchers, and included demographic, economic, and infrastructure development, and social and acculturation measures. Overall, few village-level variables were related significantly to drug use in the villages; those that were included: 1) better access to elementary education reported by "high drug" villages (81%) in comparison with "low drug" villages (29%) and 2) high drug villages reported having more alcoholic residents than low drug villages. The findings provide some support for the hypothesis that illicit drug use is positively associated with socioeconomic development, acculturation, and socialization into mainstream attitudes, values, and behaviors.

Acculturation↗
PubMed1985

Effects of season and illness on the dietary intake of weanlings during longitudinal studies in rural Bangladesh.

Longitudinal, quantitative studies of the dietary intake of 70 weanlings between five and 30 months of age from two Bangladeshi villages have been analyzed to determine the effects of season and illness on dietary intake. During 1014 days of observation, all foods consumed by the children were weighed by a field worker present in the home; 24-hour breast milk intake was estimated from 12-hour test weighings. Inter-individual differences explained 29% to 50% of the variance in consumption of selected nutrients and foods during 632 studies conducted when children were free from diarrhea and fever. Multiple linear regressions controlling for inter-individual differences indicated that 60-day seasonal periods explained a significant proportion of the variation in intake. Average energy consumption (kcal/kg/d) was approximately one-third greater during the post-harvest periods than during the pre-harvest monsoon period. Breast milk intake varied similarly even after controlling for age-related decreases. Consumption of rice and wheat, the major non-breast milk sources of energy and protein, had distinct seasonal patterns, thus limiting the overall seasonal variability in cereal intake. Older children, particularly boys, benefited more from the post-harvest relative abundance of food. The intake of most nutrients was significantly depressed by approximately 10% during febrile illnesses. Minor decreases in intake with other illnesses were not statistically significant.

Age Factors↗
PubMed1994

Use of the multiple-day weighed record for Senegalese children during the weaning period: a case of the "instrument effect".

In West Africa, the multiple-day weighed record is the most widely used technique for measuring children's food intakes. The children's eating behavior might be disrupted by the frequent weighings and the presence of a field-worker in the home. We explored the possibility of such an "instrument effect" in a 7-d food survey of 70 Senegalese children aged 10-13 mo. Energy intakes decreased significantly during the food survey (P < 0.0001). The decrease affected both daytime breast milk intake (8%) and solid food intakes (15%). The children's weight gain also decreased from a presurvey value of 6.9 to 2.1 g.kg-1.wk-1, indicating that their intakes during the food survey were lower than their usual intakes. The food-survey methodology was responsible for this "instrument effect." Policy decision-makers should be aware that data collected with the multiple-day weighed record technique might not reflect African children's usual food intakes.

Africa↗
PubMed2003

Childhood diarrhea and observed hygiene behavior in Salvador, Brazil.

Brief biweekly home visits, made as part of a cohort study of diarrhea in young children under age 5 years that was carried out in Salvador, Brazil, in 1998-1999, were used as a low-cost way to collect structured observation data on domestic hygiene behavior. Field-workers were trained to check a list of 23 forms of hygienic or unhygienic behavior by the child or the child's caretaker, if any behaviors were seen during the visit. Children were grouped according to whether mainly unhygienic behavior or mainly hygienic behavior had been recorded. This permitted study of the determinants of hygiene behavior and of its role in the transmission or prevention of diarrheal disease. Observations were recorded on roughly one visit in 20. Households with adequate excreta disposal were significantly more likely to be in the "mainly hygienic" group. The prevalence of diarrhea among children for whom mainly unhygienic behavior was recorded was 2.2 times that among children in the "mainly hygienic" group. The relative risk for prevalence was 2.2 (95% confidence interval: 1.7, 2.8). The relative risk fell to 1.9 (95% confidence interval: 1.5, 2.5) after data were controlled for confounding, but the difference was still highly significant.

Brazil↗
PubMed2006

Agreement between responses to a standardized asthma questionnaire and a questionnaire following a demonstration of asthma symptoms in adults.

Asthma epidemiology relies heavily on standardized questionnaires, but little is known about the understanding of asthma symptoms among adults in the community. In 2004, the authors assessed the level of agreement between responses to a standardized questionnaire and responses to a questionnaire completed by participants after viewing a demonstration of asthma symptoms. The study involved 601 young adults from Chile. The field-workers were trained to explain and demonstrate the asthma symptoms to the participants. The symptoms were wheeze, waking at night with breathlessness, breathlessness following exercise, and waking with cough. The kappa statistic did not exceed 0.4, and the recorded prevalence of asthma symptoms following the demonstration was 30-60% lower than that for the standardized questionnaire. Using bronchial responsiveness as the proxy gold standard, the positive likelihood ratios for wheeze and waking short of breath were higher following symptom demonstration. The low agreement between the standardized questionnaire and the postdemonstration questionnaire and the likelihood ratios' closeness to 1 for the standardized questionnaire decreases the authors' confidence in the appropriateness of this tool for estimating the prevalence of asthma in the community. For etiologic studies of asthma, it may contribute to the lack of consistency between different studies analyzing the same etiologic exposures.

Adult↗
PubMed1997

Impact of national immunization days on polio-related knowledge and practice of urban women in Bangladesh.

Bangladesh began to hold National Immunization Days (NIDs) from 1995 as part of the country's goal to eradicate poliomyelitis by the turn of the century. The NIDs brought together government agencies, the media, voluntary organisations and individual volunteers in social mobilization and service delivery activities. This paper assesses the impact of the first two polio NIDs in terms of the immunization coverage and change in knowledge about the disease among women living in Dhaka city, the capital of the country. Data were collected through pre- and post-NID cross-sectional surveys in a sample of one area of Dhaka city which included slum and non-slum households. Knowledge data were collected from 525 women with at least one child aged less than five years. The oral polio vaccine (OPV) coverage during NIDs was obtained from 720 children. Knowledge of polio as a vaccine preventable disease increased after NIDs among both slum and non-slum women. The knowledge gap between the two groups was significantly reduced. Field workers, who regularly visit women at their homes to promote health and family planning services, were the main source of information for the slum women while television was cited as the most important source of information by non-slum women. The study revealed that 88% of children under five years received at least one dose of oral polio vaccine (OPV) during NIDs, and 67% received two stipulated doses with no significant differences between slum (65%) and non-slum (69%) groups. In addition, 68% of the children contacted during the NIDs were given vitamin A supplementation. The study suggests that strategies like NID can be effectively used to tap into community resources and to generate political commitments for health programmes.

Adult↗
PubMed1989

Sensitivity, specificity and positive predictive value of selected clinical signs and symptoms associated with schistosomiasis mansoni.

The signs and symptoms classically associated with Schistosoma mansoni infection were analysed in relation to their sensitivity, specificity and positive predictive value in identifying S. mansoni patients as well as more severe forms of the disease under field conditions. Data was collected in a survey conducted in a small urban area in the south east of Brazil (14.3% infection in the studied sample with a geometrical mean excretion of 95.5 S. mansoni eggs/gram of faeces). 'Blood in the stool' and a 'palpable and hardened liver' showed the highest positive predictive value; their presence, even in relatively low prevalence areas may be used by the health field workers as an indication of the existence of more advanced clinical forms of the disease.

Brazil↗
PubMed1990

Rotavirus infection and rotavirus serum antibody in a cohort of children from Gaza observed from birth to the age of one year.

Rotaviruses were studied in a cohort of children from Gaza, during their first year of life. Surveillance was effected through visits to the local health clinic by parents and infants, and to a lesser extent, field workers' home visits. The observed rate of diarrhoea (all causes), and of rotavirus-associated diarrhoea was 1.25 and 0.1 episode per child-year, respectively. Of the 130 diarrhoea episodes in the cohort, only 6.9% were rotavirus-associated. Only nine (37.5%) of 24 children in whom rotavirus antigen was detected experienced a bout of diarrhoeal illness. However, 59.2% of cohort children had rotavirus serum antibodies by one year of age. The data indicate that rotavirus excretion in Gazan children tends to be asymptomatic during the first year of life.

Antibodies, Viral↗
PubMed2004

Relation between birthweight and blood pressure among 7-8 year old rural children in India.

BACKGROUND: Fetal malnutrition has been proposed as a cause of higher blood pressure. However, some studies have shown no or little effect of birthweight on blood pressure. Confounding and selection bias have been a problem in some of the studies. The ideal approach for avoiding selection bias is to conduct a prospective cohort study with minimal loss during follow-up. Therefore, the relationship of birthweight with blood pressure was examined in a cohort born during 1992-1993. METHODS: A cohort of 214 babies, born to usual residents in 10 villages of Haryana state in India on weekdays from September 1992 to November 1993 whose birthweight had been recorded by a trained field worker within 24 hours of delivery, were followed up during 2000-2001. During the 7-8 year period, 17 children had died and 12 had migrated. A trained public health nurse examined the remaining 185 children and measured their weight, height, and blood pressure. RESULTS: Mean birthweight was 2.7 kg and 21.1% had low birthweight (<2500 g). Current weight, height, and body mass index (BMI) were associated with birthweight (P < 0.05). Systolic blood pressure (SBP) increased significantly with rise in current weight and height. Relationship of SBP with birthweight seems to be a U-shaped distribution. Compared with the middle birthweight tertile group, in the lowest and highest birthweight groups boys have higher SBP in the higher BMI category (>or=13.5 kg/m(2)) and girls have higher SBP in both lower and higher BMI categories. ANOVA analysis showed that SBP and diastolic blood pressure (DBP) were not significantly different in birthweight tertile groups among boys, but for SBP the difference was statistically significant among girls (P = 0.03). However, multivariate linear regression analysis that included socioeconomic status and current anthropometeric measures (weight, height, BMI) revealed that birthweight is not associated with SBP or DBP, and the interaction between birthweight and gender was also not significant for SBP and DBP (P = 0.09). CONCLUSION: The findings of this population-representative cohort from rural India with 94% follow-up suggest that birthweight is not associated with blood pressure among 7-8 year old children.

Age Distribution↗