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PubMed1993

Variation in attractiveness of human subjects to malaria mosquitoes (Diptera: Culicidae) in The Gambia.

During experimental hut trials to assess the efficacy of insecticide-treated bednets against malaria mosquitoes, we observed that human subjects varied consistently in their attractiveness to mosquitoes. Attractiveness was assessed by estimating the numbers of wild Anopheles gambiae Giles mosquitoes entering a hut in which a man was sleeping, and the numbers of human-bloodfed An. gambiae sensu lato collected from each hut each morning. Five trials were carried out at Wali Kunda in rural Gambia during 2.5 yr. During each 6-wk trial a man slept under a bednet in each of the six huts. Morning collections of mosquitoes from the room, enclosed verandas, and window traps of each hut provided estimates of the number of mosquitoes that had entered during the night. Blood meals were analyzed using an ELISA technique to identify those mosquitoes feeding on humans. Specimens were collected by field workers, not the subjects; therefore, sampling was independent of the subjects' ability to catch mosquitoes. Moreover, the trials were designed to measure the relative attractiveness of individual sleepers to mosquitoes, allowing for other sources of variation (i.e., among huts, bednets, nights, and day of the week). Attractiveness of men to mosquitoes differed significantly among individuals as indicated by the consistent differences between the numbers of mosquitoes entering each man's hut and the numbers feeding on each man. However, the two measures of attractiveness were apparently independent of each other: subjects who attracted consistently high numbers of vectors into their hut did not necessarily have high numbers of mosquitoes feeding on them. These findings support the view that some individuals within a community are at greater risk from mosquito-borne pathogens than others.

Adult↗
PubMed1999

Dietary vitamin A intakes of preschool-age children in South India.

The vitamin A intake of children aged 1-3 y (n = 683) was assessed using a quantitative food-frequency questionnaire in a vitamin A intervention study in South India. Trained field workers interviewed mothers about their children's usual consumption of common sources of vitamin A and collected information on portion sizes using standard cups. Mothers were asked to state the number of months in a year during which specific seasonal foods were available. Information about current breast-feeding was also obtained. Vitamin A intakes from nonbreast milk sources were extremely low at all ages. The median intake of total vitamin A, beta-carotene and retinol was 121, 100 and 21 retinol equivalents (RE), respectively. Maternal education and socioeconomic status (SES) were positively associated with total vitamin A and retinol intakes. Girls had significantly lower intakes than boys even after adjusting for differences in age, maternal education, SES and breast-feeding status. Breast-feeding was common, but declined to 60% by 24 mo and to 15% by 36 mo. Vitamin A intakes from nonbreast milk sources increased with age only for currently breast-fed children, who tended to be of lower SES. After taking into account the potential contribution of breast milk by using published estimates, nonbreast-fed children met only 60% of the Indian recommended dietary allowance (RDA; 250 RE/d), whereas breast-fed children met approximately 90% of the RDA during y 2 of life.

Anthropometry↗
PubMed2000

Efficacy and acceptability of two iron supplementation schedules in adolescent school girls in Lima, Peru.

To assess the efficacy and acceptability of a daily and intermittent iron supplementation, a double-blind, placebo-controlled trial was conducted in a public school located in periurban Lima, Peru. Adolescent girls (n = 312), 12-18 y old, were randomly assigned to one of the following three groups: 1) 60 mg iron as ferrous sulfate daily from Monday to Friday; 2) 60 mg iron as ferrous sulfate 2 d/wk and 3 d placebo (intermittent); 3) placebo, from Monday to Friday. Field workers gave the girls supplements during school hours for 17 wk; 296 girls completed the trial. Girls took 94% of the expected dose of 85 pills. Few side effects were reported. Postintervention, hemoglobin (Hb), serum ferritin (SF) and free erythrocyte protoporphyrin (FEP) were improved significantly in the iron-supplemented groups compared with placebo (P<0.05). Daily supplements led to higher Hb increases than intermittent supplements (P<0.05), but SF and FEP were similar between the two groups. Thus, both iron supplementation schedules were efficacious in preventing iron deficiency in adolescent girls through the school system, and the daily schedule was better than the intermittent schedule at increasing Hb values and reducing anemia.

Adolescent↗
PubMed2004

Growth and diet quality are associated with the attainment of walking in rural Guatemalan infants.

The attainment of gross motor milestones is an important indicator of motor development in early life; however, little is known about factors affecting gross motor development in children from developing countries. The purpose of this study was to examine the relation of nutritional factors (physical growth and dietary intake) and morbidity during the first year of life to the age of walking without support. Multivariate regression models were used to analyze data collected prospectively between 1991 and 1999 in rural Guatemala. Attainment of children's gross motor milestones was assessed monthly by trained field workers using the 17-milestone Gross Motor Development Scale, morbidity was assessed by biweekly recall, and dietary intakes were measured at 9 and 12 mo of age using repeated 24-h dietary recalls. Median age of walking was 15 mo (range 10-24 mo; n = 174) with no differences by gender. Models were adjusted for birth order, gender, gestational age, maternal age and education, socioeconomic status, and community. Growth in length (-0.57 +/- 0.27 mo length for age Z-score; P = 0.04) and weight (-0.54 +/- 0.19 mo weight for age Z-score, P = 0.005) during the first year of life, rather than size at birth, predicted age of walking. Animal protein intake from complementary foods, while low (mean < 1 g/d) overall, was positively associated with earlier age of walking (P = 0.02). Morbidity during infancy was not associated with age of walking. These findings indicate the importance of prevention of postnatal growth retardation and improvement of diet quality for children's gross motor development.

Birth Order↗
PubMed1995

A normative study of child development using a culture-appropriate test battery in rural Haryana, India.

A culture-appropriate and simple test battery consisting of 67 test items was developed and field tested in Haryana, India, in 1987-89. Trained field workers administered the tests to 3731 preschool children in 47 randomly selected villages of a district, irrespective of their physical/mental status. Centile age values were constructed for various developmental milestones included in the cultural-appropriate test battery. The locally relevant, simple, and low cost developmental tests and reference values will be used for early detection of developmental disabilities at primary care level.

Child↗
PubMed2001

Comparison of safety of glucose oral rehydration solution and maize oral rehydration therapy for home management of diarrhoea in Kenya.

Safety margins and variability in the composition of glucose and maize-based oral rehydration therapy (ORT) prepared by mothers in a rural district of Western Kenya, are reported here. In a 2-year longitudinal field study, packets containing glucose ORS and a home solution made with maize and table salts, were provided to the mothers of 6180 children in Kakamega District in two separate sub-locations. Experienced and trained field workers supported by community registered nurses provided training for the preparation and use of ORT during weekly visits to every household. On four occasions separated by 4-6 months, a 5 per cent random sampling was done of the home-prepared solutions actually used for the treatment of children with diarrhoea. The water used for preparing ORT was also sampled. Samples of 174 glucose-based ORT, 148 maize-salt ORT, and 201 samples of water were analysed. Only 2 per cent of the maize-based ORT were above 120 meq/1 sodium (i.e., the safe range of sodium concentration) compared to 17.8 per cent for glucose solutions (p < 0.001). Home water samples contained substantial amounts of salt, which could unpredictably affect the final composition of the ORT solutions. We conclude that maize-salt ORT had a better margin of safety than glucose-based ORS.

Child, Preschool↗
PubMed2004

Risk factors for vitamin A deficiency among preschool aged children in Pohnpei, Federated States of Micronesia.

In 1993, the Department of Health of the Federated States of Micronesia (FSM) conducted a population-based stratified random survey among 355 children aged 24-48 months in Pohnpei, one of the four FSM States. The objective was to determine the prevalence, and explore risk factors for vitamin A deficiency (VAD). Trained field workers collected data from a range of demographic, dietary and socioeconomic variables related to the children. The serum retinol concentration was 19.4 +/- 7.5 microg/dl (mean +/- SD), and the VAD prevalence (serum retinol <20 microg/dl) 53.1 per cent. The significant independent risk factors, determined by logistic regression, were: mother's work at home, sibling <2 years older, rural household located on the main island, early weaning, and child anemia, controlling for pipe water and electricity in the household. If compared with a reference of apparently healthy children of similar age in the USA, the distribution of serum retinol among young Pohnpei children was shifted entirely to low levels. We conclude that eliminating the pervasive VAD problem in Pohnpei would require a multi-pronged tactical approach that combines dietary improvement strategies with the ongoing supplementation effort.

Child, Preschool↗
PubMed1989

Strategies for developing innovative programs in international medical education. A viewpoint from Africa.

Postgraduate medical education is an important factor in Africa's present emphasis on health care as a basis for socioeconomic development. Such education must be relevant to the realities of health problems in Africa. The priority of most African governments is training in traditional health care management and in fields related to community- and problem-based medicine. Presently, opportunities for such training exist in only seven centers throughout Africa. A model health care system, offered by most national governments, is described. This system, which includes district, provincial, and central levels of care, delivers over 80% of health services, and it is within such a system that nationals returning from postgraduate medical education abroad will function. Problems currently associated with these systems are the shortages of expertise in the areas of management, logistics, informatics, and resources mobilization, as well as the generally low literacy of the community. Africa also needs more teachers in the basic sciences, further development of biomedical research, courses in continuing education, particularly for field workers in isolated areas, short courses on investigative techniques, and goal-oriented research aimed at solving public health problems in the student's country.

Africa↗
PubMed1999

Long term global evaluation of a national AIDS prevention strategy: the case of Switzerland.

OBJECTIVES: The Swiss Aids prevention strategy has been subject to a continuous process of evaluation for the past 12 years. This paper describes the conceptual approach, methodology, results obtained and contribution to policy-making of that evaluation. DESIGN: The evaluation is on-going, global with respect to all components of the strategy, and utilization-focused. Each successive phase of the evaluation has included 10-20 studies centred either on aspects of process, of outcome or of environmental context. Findings are synthesized at the end of each phase. METHODS: Both quantitative and qualitative methods are used. Studies generally have one of three functions within the overall evaluation: assessment of trends through surveys or other types of repeated studies; evaluation of specific areas through a series of studies from different viewpoints; in-depth investigation or rapid assessment through one-off studies. Various methods of triangulation are used to validate findings. RESULTS: The evaluation has allowed for: the observation of behavioural change in different populations; the availability of scientific data in controversial fields such as drug-use policy; an understanding of the diversity of public appropriation of prevention messages. Recommendations are regularly formulated and have been used by policy-makers and field workers for strategy development. CONCLUSIONS: The global approach adopted corresponds well to the evaluation requirements of an integrated long-term prevention strategy. Cost is low relative to the extent of information provided. Such an evaluation cannot however address the question of causal relationship between the strategy and observed changes. The evaluation has contributed to the development of a culture of evaluation in Swiss AIDS prevention more generally.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Mortality of HIV-1, HIV-2 and HIV-1/HIV-2 dually infected patients in a clinic-based cohort in The Gambia.

OBJECTIVE: To assess and compare the mortality rates of patients with HIV-1, HIV-2 or both infections (HIV-D) in the same population. DESIGN: Clinic-based cohort study. METHODS: HIV-seropositive patients aged 15 years and older who attended the Medical Research Council clinics in Fajara between May 1986 and September 1997 were recruited. Clinical assessment using the Karnofsky score, CDC cell staging, WHO staging, and CD4 cell counts was performed at baseline. Patients attended clinic every 3 months; if they did not attend, they were visited at home by field workers to ascertain survival status. No patient was on antiretroviral therapy during the study period. RESULTS: Data from 1519 HIV-positive adult patients were analysed. A total of 746 patients had HIV-1, 666 HIV-2, and 107 patients had HIV-D. A total of 828 patients (55%) died, and 161 (11%) were lost to follow-up. The median follow-up was 12 months (range 0-128). CD4 cell counts were available for 894 patients. Compared with HIV-1, the adjusted hazards ratio for mortality in the CD4 cell count category 500 cells/microl or greater was 0.50 for HIV-2 (95% CI 0.28-0.88) and 1.27 (95% CI 0.51-3.7) for HIV-D. Among those with CD4 cell counts less than 500 cells/microl the mortality rates in HIV-2 and HIV-D were similar to those in HIV-1. DISCUSSION: HIV-2-infected patients with CD4 cell counts of 500 cells/microl and greater had a significantly lower mortality rate than HIV-1-infected patients. HIV-2-infected patients with advanced disease had the same poor prognosis as patients with HIV-1. Dually infected patients had mortality rates similar to HIV-1.

Adolescent↗
PubMed2004

Hereditary Punctate Palmoplantar Keratoderma (PPK) (Brauer-Buschke-Fischer Syndrome).

We describe the first case of a sixty-five-year-old male field worker from India, having lesions of hereditary punctate palmoplantar keratoderma with an autosomally dominant pattern of inheritance. Associations included nail abnormalities in the form of longitudinal ridging, onychorrhexis, onychoschizia, trachyonychia and notching, which has been reported only on one previous occasion. The article also presents a brief review of the literature.

Aged↗
PubMed2006

Dietary habits of the Somali population in Liverpool, with respect to foods containing calcium and vitamin D: a cause for concern?

BACKGROUND: A large percentage of Liverpool Somalis have vitamin D deficiency and low calcium excretion. The dietary habits of Liverpool Somalis were investigated with respect to food items containing calcium and vitamin D. METHODS: A questionnaire, administered by a Somali field worker, assessed the intake of food of 60 adult (45 females and 15 males; mean age 42 years) and 10 child (seven females and three males; mean age 10 years) Somali volunteers. Questions concerned personal details, health (bone and muscle problems) and dietary habits including the frequency of consumption of food items containing substantial amounts of calcium and vitamin D. Results Most subjects reported bone and muscle pain. Eating habits reflected traditional customs. Foods containing substantial amounts of calcium and vitamin D were consumed infrequently. Milk was only consumed in tea. Those self-reporting bone pain consumed eggs, cheese and beans rarely. CONCLUSION: The food choices of these individuals with regard to bone health is a cause for concern and indicates a likelihood of low calcium and vitamin D intake.

Adult↗
PubMed2006

Community incidences of respiratory infections in an actively followed cohort of children <1 year of age in Manhiça, a rural area of southern Mozambique.

OBJECTIVE: To estimate the community incidence-rates of respiratory infections among infants in Manhiça, southern Mozambique, and to determine risk factors associated with these infections. METHODS: A cohort of children <1 year of age were visited at home every week until they turned one. During the visits, field workers recorded signs/symptoms of respiratory infections and tested the children for malaria parasites when they had fever. RESULTS: Between 1 July 1998 and 30 June 1999, 1,044 children contributed with 23,726 weeks at risk. Children met the criteria for acute respiratory infection in 19.2% of the visits, for lower respiratory infection in 0.9% and for severe lower respiratory infection in 0.2%. The crude incidence rate measured for acute respiratory infections was 23.0, that for lower respiratory infection was 0.9 and that for severe lower respiratory infection was 0.2 per 100-person-week-at-risk. The risk of acute and lower respiratory infection was inversely related to age. Females were at significantly lower risk for all three conditions than males. A trend of increased risk of severe lower respiratory infection was noted among children born during the rainy season (adjusted rate ratio = 1.95, P = 0.122 in only 47 episodes). Malaria was strongly associated with an increased risk of all three respiratory infections [rate ratio of 2.35, 10.90 and 13.82 (P < 0.001) in the adjusted analysis, respectively]. Thirty-five children died during the follow-up period; 20% of them from lower respiratory infection. Conclusions Respiratory infections are a major cause of morbidity and mortality among infants in rural Mozambique. Our study provides a better understanding of the associated determinants.

Acute Disease↗
PubMed2006

Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial.

OBJECTIVES: To evaluate the effectiveness of point of use water treatment with flocculent-disinfectant on reducing diarrhoea and the additional benefit of promoting hand washing with soap. METHODS: The study was conducted in squatter settlements of Karachi, Pakistan, where diarrhoea is a leading cause of childhood death. Interventions were randomly assigned to 47 neighbourhoods. Households in 10 neighbourhoods received diluted bleach and a water vessel; nine neighbourhoods received soap and were encouraged to wash hands; nine neighbourhoods received flocculent-disinfectant water treatment and a water vessel; 10 neighbourhoods received disinfectant-disinfectant water treatment and soap and were encouraged to wash hands; and nine neighbourhoods were followed as controls. Field workers visited households at least once a week from April to December 2003 to promote use of the interventions and to collect data on diarrhoea. RESULTS: Study participants in control neighbourhoods had diarrhoea on 5.2% of days. Compared to controls, participants living in intervention neighbourhoods had a lower prevalence of diarrhoea: 55% (95% CI 17%, 80%) lower in bleach and water vessel neighbourhoods, 51% (95% CI 12%, 76%) lower in hand washing promotion with soap neighbourhoods, 64% lower (95% CI 29%, 90%) in disinfectant-disinfectant neighbourhoods, and 55% (95% CI 18%, 80%) lower in disinfectant-disinfectant plus hand washing with soap neighbourhoods. CONCLUSIONS: With an intense community-based intervention and supplies provided free of cost, each of the home-based interventions significantly reduced diarrhoea. There was no benefit by combining hand washing promotion with water treatment.

Adolescent↗
PubMed2006

Prevalence and correlations of lower urinary tract symptoms, erectile dysfunction and incontinence in men from a multiethnic Asian population: Results of a regional population-based survey and comparison with industrialized nations.

OBJECTIVE: To determine, in a population-based survey, the prevalence of lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and incontinence in community-dwelling men in multiethnic Malaysia, as currently available Western demographic data might not be applicable in the Asian population. SUBJECTS AND METHODS: A cross-sectional population-based survey was carried out in the State of Penang, Malaysia, with a target population of men aged > or = 40 years. Using a multistage study design, random systematic sampling was used to represent the target population, who were weighted based on ethnicity and rural-urban ratios so as to represent the general population distribution. Trained field-workers conducted direct interviews and administered the American Urological Association Symptom Index (AUA-SI), the International Index of Erectile Function (IIEF-5) questionnaire and questions on incontinence based on the International Continence Society 2002 definition. RESULTS: In all, 418 men aged > or = 40 years were interviewed, of whom 353 completed the AUA-SI questionnaire (84.5% response rate). The prevalence of mild, moderate and severe LUTS was 80.6%, 6% and 0.3%, respectively. The prevalent symptoms were frequency and nocturia. There was moderate and severe ED in 45.9% of men, whereas incontinence was reported by 8.2%. The AUA-SI correlated strongly with age (R = 0.291, P < 0.001), IIEF-5 (R = - 0.265, P < 0.001) and diabetes mellitus. CONCLUSION: The prevalence and severity of LUTS, ED and incontinence increased with age in this multiethnic Asian population, in which ED correlated strongly with LUTS. Compared to the Western population, the prevalence of LUTS was significantly lower, while the prevalence of ED and incontinence were comparable.

Adult↗
PubMed1998

A methodology for sampling and accessing homeless individuals in Melbourne, 1995-96.

A methodology for sampling homeless populations in inner Melbourne was developed to study their health status and prevalence of tuberculosis. This paper describes the design, development and implementation of the project. The results of health status and tuberculosis analysis are published elsewhere. Involvement and interaction with local service providers and agencies to homeless people was central to the project throughout. A definitional construct of homelessness was developed, drawn from local and overseas literature and contemporary local experience. The study's aim was to obtain a representative sample of homeless individuals in various levels of accommodation and a convenience sample of those who were unaccommodated (streets and parks). A comprehensive sampling frame of accommodation options was constructed from available databases, and systematic sampling applied to produce a sample of 396 beds, from which 284 participants were enrolled. Convenience sampling of unaccommodated homeless individuals produced 100 participants. All agreed to undergo a comprehensive questionnaire, blood and Mantoux testing, the latter being completed successfully in 94%. Commonsense, cultural sensitivity and a non-threatening approach were critical to the success of the project and the security of the field workers. The methods described attempt to address recognised difficulties of sampling from homeless populations and should be reproducible both in the future and elsewhere. Potential for selection bias remains the main threat to validity, which the described methodology combined with adequate resources should help to address.

Health Surveys↗
PubMed2004

Spousal physical violence against women during pregnancy.

OBJECTIVE: To determine the prevalence of physical violence during pregnancy and the factors associated with it. DESIGN: A population-based, multicentre, cross sectional household survey. SETTING: Rural, slum and urban non-slum areas of Bhopal, Chennai, Delhi, Lucknow, Nagpur, Trivandrum and Vellore, in India. PARTICIPANTS: A total of 9938 women who were 15 to 49 years of age and living with a child younger than 18 years old. METHODS: Probability proportionate to size sampling of households was performed in three strata. Trained field workers administered a structured questionnaire. Women who reported domestic violence were asked about violence during pregnancy. Outcome variables included six violent behaviours: slap, hit, kick, beat, use of weapon and harm in any other way. Moderate to severe violence was defined as experience of any one or more of the following behaviours: hit, beat or kick. Odds ratios were calculated for risk and protective factors of violence during pregnancy using logistic regression. MAIN OUTCOME MEASURES: Physical spousal violence. RESULTS: The lifetime experience, during pregnancy, of being slapped was 16%, hit 10%, beat 10%, kicked 9%, use of weapon 5% and harmed in any other way 6%. Eighteen percent of women experienced at least one of these behaviours and 3% experienced all six. The overall prevalence of moderate to severe violence during pregnancy was 13%. Logistic regression showed that the factors determining whether a woman experienced moderate to severe violence during pregnancy were: husband accusing wife of an affair (OR 7.1; 95% CI 5.1 to 9.8), dowry harassment (OR 4.1; 95% CI 2.8 to 6.1), husband having an affair (OR 3.7; 95% CI 2.8 to 4.8), husband being regularly drunk (OR 3.2; 95% CI 2.6 to 4.1), low education of husband (OR 2.8; 95% CI 1.4 to 5.6), substance abuse by husband (OR 2.6; 95% CI 1.3 to 5.5), no social support (OR 1.8; 95% CI 1.1 to 3.0), three or more children (OR 1.6; 95% CI 1.2 to 2.1) and household crowding (OR 1.1; 95% CI 1.0 to 1.2). CONCLUSION: In this study, 12.9% of women experienced moderate to severe physical violence during pregnancy. Suspicion of infidelity, dowry harassment, husband being regularly drunk and low education of husband were the main risk factors for violence during pregnancy.

Adolescent↗
PubMed2006

Ethical considerations for clinical photography in the global South.

Clinical photography is an important tool for teaching practitioners and field workers about the clinical manifestations of famine and undernutrition, particularly with respect to the Global South. Current international guidelines for clinical photography are not consistently applied or enforced, which has led to violations of privacy and rights, particularly for patients and victims of disaster in the Global South. Combining existing clinical photography guidelines from the North with ongoing clinical ethics debates in the South, this paper explores approaches to establishing photography guidelines throughout the world that will be sensitive to the privacy and dignities of all patients and victims of emergencies.

Clinical Trials as Topic↗