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PubMed1985

[Analysis--of family-planning in urban low-income brackets based on Daejon and Daegu Cities].

Since the inception of the national family planning program in 1962, the main emphasis has been placed on the provision of contraceptive services and information, education, and communication (IEC) activities through home visits by family planning field workers and through government designated private physicians. This approach has been a powerful management system for the national program, particularly in the rural area. However, new issues in the national family planning program emerged with the subsequent socioeconomic changes since 1962. An increasing number of the rural population began to migrate to the urban area, and, therefore, beginning in the 1970s, more weight had to be given to the family planning service for the urban area; in particular, for those in the low-income brackets. In an effort to increase contraceptive acceptors among the urban low-income people, the government has implemented various special projects for them since 1974, through maximum utilization of community leaders including Tong and Ban Chiefs and mothers' clubs, and family planning workers in their areas. Thus, this paper analyzes the current status of family planning and fertility behavior of urban low-income wives as a part of program evaluation. Also, this paper is based on an analysis of the 1984 Family Planning Survey data, which was conducted in July 1984 and responded to by 600 married women aged 15-44 in the low-income areas of the Daejon and Daegu cities. The survey data revealed that the contraceptive practice rate was 77.0%, which was much higher than 70.3% of the national practice rate in the same year, and the approval rate for the 1 or 2 children of the low-income areas was much higher than that of other urban areas. Based on the results of the analysis, the following recommendations are suggested for the better program implementation: 1) improvement of program management system for recruiting new acceptors in their 20s for birth spacing; 2) development and inducement of innovative incentive schemes and IEC activities for increasing the proportion of the 1 child families; and 3) strengthening the utilization of community resources including mothers' clubs.

Asia↗
PubMed1994

Do women forget their births? A study of maternity histories in a rural area of Senegal (Niakhar).

5068 maternity histories were recorded among women aged 15-89 years in a rural area of Senegal. The quality of the estimates of fertility, child mortality, and perinatal mortality was analyzed for consistency. There was no evidence of any major underreporting of births, deaths, or still births according to age, even among the oldest women. Estimates were compared with comparable values derived from a longitudinal demographic surveillance system (DSS) in the same area. The age patterns of cumulated fertility and mortality derived from the maternity histories were consistent with those of the DSS. Differences in the levels of fertility and mortality with respect to the longitudinal records could be explained by small differences within the selected villages, by selection biases, and by recent trends in demographic parameters. Values of perinatal mortality were also equivalent to those recorded by the DSS. Women did not seem to forget their births to an extent large enough to produce strong biases, even at older ages. However, an analysis of differences by field workers revealed that some 2% of the births and 4% of the deaths may have been omitted, which gives an idea of the potential accuracy of maternity histories for the estimation of fertility and mortality levels.

Africa↗
PubMed2002

Implementation of nutrition education and rehabilitation programs (NERPs) in Viet Nam.

Rigorous assessments of program quality are uncommon in developing countries. We evaluated the quality of the two-week, volunteer-facilitated, caregiver-child rehabilitation "hearth," or nutrition education and rehabilitation program (NERP), sessions in Save the Children's integrated nutrition program in Viet Nam. Field workers observed attendance, food contribution, food preparation, meal consumption, health message delivery, hygiene, and weighing at 240 NERP days at 59 NERP centers during seven months of implementation. Participation in cooking NERP meals (75.8%), washing mothers' and children's hands (75.7% and 81.6%, respectively), and weighing (74.5% on days 1 and 12) were high, but attendance rates (50.3%), food contributions (20.3%), and health message delivery (20.0%) were lower than expected, all with wide variation among communes, ecology, NERP day, and NERP round. Contrary to protocol, food was often delivered to malnourished children who stayed at home to accommodate caregivers' workloads and other constraints. While home-delivery of food prevented caregivers from learning from each other in a group, it did bring "tangible messages" (i.e., a large serving size of a new food) to the doorstep. Health volunteers were wise to stress active learning over repetitive message delivery. In summary, these NERPs were probably typical of previous NERPs although comparable quality measures are lacking. Despite imperfect implementation, the NERP's active-learning and local problem-solving helped achieve measurable impact on growth, diet, morbidity, and empowerment despite uncommon program challenges, such as uncharacteristically low baseline levels of malnutrition and high population dispersion. Regular quality monitoring may enhance impact even further.

Adult↗
PubMed2002

[Impact of war on civilian population health. Republic of the Congo, December 1998-February 2000].

Congo Brazzaville was racked by civil war between 1998 and 2000. Fighting forced a large part of the population to flee from the capital, Brazzaville. Starting in 1999 many people began coming back to the city in dire physical and psychological condition. With little or no press coverage, this return went largely unnoticed by the general public. Volunteers from Médecins Sans Frontières were present not only to provide assistance and care to these war victims but also as to bear witness so that this tragedy should not be forgotten. By means of epidemiological surveys in the field, workers were able to paint a "picture of suffering" and to document the violence and deprivation inflicted mainly on the civilian population. This article summarizes the findings of this investigation.

Adult↗
PubMed2002

[Association of CYP2E1 of PON2311 polymorphisms in neonates with preterm].

The objective is to investigate whether Rsa I polymorphism in the 5'-flanking region of CYP2E1 and PON2311 polymorphism in neonates are associated with preterm. Using standard questionnaires, 194 singleton live born mother-neonate pairs (including preterm cases and term controls) were investigated by the trained field workers with cross-sectional survey at the hospitals in Anqing, Anhui Province, China. Epidemiological and clinical data and blood samples were obtained from 194 mother-neonate pairs. CYP2E1 homozygous wild-type (cut/cut) is not associated with a shortened gestation among neonates, compared with CYP2E1 homozygous mutant-type (uncut/uncut)/CYP2E1 heterozygote (cut/uncut) before and after adjustment confounders. However, PON2 Ser311Ser homozygote is significantly associated with a shortened gestation among neonates. When Rsa I polymorphism in the 5'-flanking region of CYP2E1 and PON2311 polymorphism were considered jointly, a significant shortened gestation was observed among neonates with the combined genotype of CYP2E1 homozygous wild-type and PON2 Ser311Ser homozygote. In conclusion, Rsa I polymorphism in the 5'-flanking region of CYP2E1 in neonates is not associated with preterm, however, PON2311 polymorphism in neonates is significantly associated with preterm. Furthermore, the gene interaction between Rsa I polymorphism in the 5'-flanking region of CYP2E1 and PON2311 polymorphism in neonates is significantly associated with preterm.

5' Flanking Region↗
PubMed2003

Contraceptive knowledge, practices and utilization of services in the rural areas of India (an ICMR task force study).

To obtain information from rural women regarding their contraceptive knowledge, practices and utilization of services, a cross-sectional survey of 117,465 eligible women was carried out in the sampled areas of 28 districts from January 1996 to February 1997. From among the current contraceptive users all of IUD, OC and acceptors of a permanent method in the last one-year (14,276) were interviewed in detailed. In addition a systematically selected sample of 17,082 non users were also interviewed. Overall contraceptive prevalence was 45.2% of which 34.2% had used a permanent method. Among the current users, the contraceptive had been availed mainly from either PHC (31.5%) or hospital (42.1%). Around half the women (53.1%) had received counseling and in 20.3% information regarding other methods. Pelvic examination was done in 39.1% Most of the women (>97%) expressed satisfaction with the method, provider and services. Almost all the women (98.8%) were using a contraceptive method with the knowledge of their husband and had his support for continuing the same. There was no concept of using any family planning method for either postponing the first conception after marriage or spacing between the two child births. A large majority of women (70.5%) used a family planning method for the first time only after completing their desired family size. Among the never users, 73.5% mentioned at least one modern method of family planning available in the national programme and 64.3% mentioned the service source where it would be available. Fewer women in most of the districts mentioned spacing methods as compared to female sterilization. The main reason given for not using any family planning method was "family not complete" (34.6%). There is need to promote spacing methods by policy makers and field workers and motivate couples to accept them.

Adolescent↗
PubMed2003

[Associations of Rsa I polymorphism at the 5' flanking region of CYP2E1 and PON2 148 polymorphism in neonates with preterm delivery].

The objective is to investigate whether Rsa I polymorphism at the 5' flanking region of cytochrome P450 2E1 gene (CYP2E1) and paraoxonase 2 gene polymorphism (PON2 148) in neonates are associated with preterm delivery. Using standard questionnaires, 209 singleton live born mother-neonate pairs (include preterm cases and term controls) were investigated by the trained field workers with cross-sectional survey at the hospitals in Anqing, Anhui Province, China. Epidemiological and clinical data and blood samples were obtained from 209 mother-neonate pairs. CYP2E1 homozygous wild-type (+/+) is not associated with a shortened gestation among neonates, compared with CYP2E1 homozygous mutant-type (-/-)/CYP2E1 heterozygote (+/-) before and after adjustment confounders, however, PON2 Ala148Ala homozygote is significantly associated with a shortened gestation among neonates. When Rsa I polymorphism at the 5' flanking region of CYP2E1 and PON2 148 polymorphism were considered jointly, a significant shortened gestation was observed among neonates with the combined genotype of CYP2E1 homozygous wild-type and PON2 Ala148Ala homozygote. In conclusion, Rsa I polymorphism at the 5' flanking region of CYP2E1 in neonates is not associated with preterm delivery, however, PON2 148 polymorphism in neonates is significantly associated with preterm delivery. Furthermore, the gene interaction between Rsa I polymorphism at the 5' flanking region of CYP2E1 and PON2 148 polymorphism in neonates is significantly associated with preterm delivery.

5' Flanking Region↗
PubMed1992

Arterial hypertension in urban Africa: an epidemiological study on a representative sample of Dakar inhabitants in Senegal.

OBJECTIVE: To assess the prevalence and risk markers of arterial hypertension in the context of a rapidly growing urbanization in Africa. DESIGN: A cross-sectional study was performed on a representative sample of inhabitants of Pikine, an urban suburb of Dakar, Senegal. METHODS: Blood pressure was measured by properly trained field workers at subject homes. A total of 2580 individuals were included, aged > or = to 15 years and with a duration of residence > or = 2 months. Complete data including risk markers were obtained for 2300 subjects. RESULTS: The prevalence of hypertension (World Health Organization criteria) was found to be 10.4%. Due to the young age of the population, nearly half of the cases of moderate-to-severe hypertension were observed in middle-aged subjects. Risk markers of hypertension were age and obesity in both sexes: illiterate and multiparous women also had a higher prevalence of hypertension. Awareness of hypertension was infrequent among the hypertensive subjects: of the 189 subjects who had been labelled hypertensive, 10 were treated with antihypertensive therapy but 111 had normal blood pressure levels without any treatment, suggesting poor-quality prior diagnosis. CONCLUSIONS: Hypertension was found to be frequent in this urban African population. These findings emphasize the need for improvement in the management of hypertension, focusing upon the high-risk groups.

Adolescent↗
PubMed1959

Significance of ecological studies of wild animal reservoirs of zoonoses.

The paucity of information on the ecology of wild animal reservoirs over most of the world is one of the factors that has led to hesitation and failure in controlling these diseases in many areas. Extensive application of ecological studies and methods would not only assist in zoonosis control but might well also lead to the discovery of new diseases, to the acquisition of fundamental knowledge capable of application in other fields of biology, and to the finding of new experimental animals for laboratory work.Although such studies properly require the co-operation of a wide variety of specialists-epidemiologists, ecologists, parasitologists, botanists, geologists and climatologists are among those who may to advantage be called upon-in practice much can be accomplished by a few interested and well-equipped field workers backed by a good museum and laboratory services.

Animals↗
PubMed1959

Methods of water-flow measurement applicable to Simulium control.

For the effective control of the Simuliidae-and for a variety of other public health activities-it is important to determine with reasonable accuracy the rate and volume of flow of the rivers and streams which they infest. The field worker requires for this purpose an instrument that is at once cheap and easy to handle. The author of this paper reviews a number of means and instruments available for water-flow measurement and devotes special attention to the Pitot tube, which is well suited to the conditions encountered in Simulium control schemes.

Animals↗
PubMed1964

ANOPHELES GAMBIAE, A COMPLEX OF SPECIES.

The author reports on some 200 laboratory crossings of 36 strains of Anopheles gambiae from many different parts of Africa which show the existence of five mating-types in what was until recently considered a single species. Three of these mating-types are freshwater forms and have been provisionally called A, B and C. Two are saltwater forms: A. melas, confined to West Africa, and the East African A. merus. Hybrid male sterility is universal when any two of these five forms are crossed, and from some of the crosses grossly abnormal sex-ratios result. From an evolutionary standpoint these five mating-types are probably species or semi-species in view of the fact that they can be found to co-exist sympatrically and still retain their identities. From a practical point of view it may be necessary for the field worker to be able to identify the exact species with which he is dealing before the most efficient means of controlling it can be found.

Africa↗
PubMed1962

Key to the identification of east and central African freshwater snails of medical and veterinary importance.

This identification key has been prepared to enable field workers in eastern and centra Africa to identify the species and subspecies of snails acting as intermediate hosts of various flukes causing bilharziasis and related diseases in man and his domestic stock.The area covered by the key is eastern Africa from the Sudan and Somalia in the north to Southern Rhodesia in the south. The key includes all species and subspecies of the three medically and veterinarily important genera, Lymnaea, Bulinus and Biomphalaria. All other freshwater pulmonates of the area can be identified as to genus only.Those features of the shells and soft parts of snails which are used in identification are discussed in some detail, and indications are given as to methods of collection, preservation and dissection of snails.

Africa↗
PubMed2003

[Reducing the risks in prison surroundings. Between policies and realities, the challenge persists].

Numerous health problems Prison population demographics have dramatically increased during the last thirty years and there is no element that foresees a forthcoming inflection of this tendency. Many studies carried out both in France and elsewhere have assessed the extent of the health problems both on admission to prison and during detention. Difficulties in reducing the risks While available data fully justify the need of a true risk reduction policy, there is an obvious lack of pragmatism and courage in many of the field workers and professionals. Confusion between global prevention, general measures of hygiene and education, and true risk reduction programmes makes the risk reduction policy unclear. The strategy to be adopted All efforts should be dedicated today to make the measures of risk reduction widely available, in particular drug maintenance treatments and condoms, to train prison staff, and to evaluate on a regular basis the clinical practices and their effects. Only a voluntarist and clear health and drug policy, together with a motivated prison staff, including health professional and administration staff, are the keys to success for an efficient risk reduction strategy. It is crucial to implement and to test innovative programs, and to regularly assess all the facets of the risk reduction policy in prisons.

Efficiency, Organizational↗
PubMed2003

Approaches to contact investigations in Texas.

Tuberculosis (TB) spreads when family and social contacts breathe the air exhaled by someone with active TB disease. Contact investigation is the most appropriate strategy to interrupt the transmission and subsequent development of TB. One of the problems associated with contact investigations in an area with a very diverse population has been the inability of investigations to adapt their methods of approach to the different circumstances of each person with TB disease. Through interviews and group discussions with public health field workers and local TB program managers across Texas, the authors have been able to gather information on how contact investigation practices can be customized to overcome barriers specific to different populations in the state and generate a productive outcome. Variables such as culture, language, risk factors, and various settings may require a different investigational approach than the standard, traditional approach to contact investigation. It is anticipated that the concept of customizing contact investigations to meet the needs of specific populations and circumstances will become the practice worldwide, and will be a useful tool in the management of contact investigations.

Communication Barriers↗
PubMed2003

Communicable disease case entry using PDAs and public wireless networks.

Concerns about detecting and responding to attacks with biowarfare agents have resulted in the development of deployable case reporting systems, e.g. RSVP. We implement a proof of concept web-based information system to be used securely from personal digital assistants over public wireless networks, by public health field workers for routine and emergent case reporting. The system collects data for a local health jurisdiction, provides content- and event-based notification, and forwards case reports to the Colorado State communicable disease reporting system (CEDRS). We believe this demonstrates a useful integration of portable and web-based technologies with public health practice.

Colorado↗
PubMedDate not supplied

Musculoskeletal pain, disability and health-seeking behavior in adult Kuwaitis using a validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire.

OBJECTIVE: The WHO-ILAR Community Oriented Program for Control of Rheumatic Diseases (COPCORD) primarily aims to estimate the burden of musculoskeletal symptoms/disorders. We investigated data on musculoskeletal pain, disability and health-seeking behavior in the first community-based COPCORD study in Kuwait. METHODS: The validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire was used in 2,500 randomly selected Kuwaiti households. The target population comprised Kuwaiti nationals aged 15 years and older. Twenty-four trained field workers completed the survey in 8 weeks. Those subjects reporting musculoskeletal pain were identified (Phase 1), and were asked to complete a self-evaluation questionnaire (Phase 2) prior to rheumatological examination (Phase 3). Phase 2 included questions on the site and severity of pain, traumatic events, functional disability, and treatment. Patients marked their pain sites on a mannequin during their interviews. "Sufferers" were defined as those with musculoskeletal pain and no history of trauma. RESULTS: A total of 7,670 adults were interviewed (response rate 88%), of whom 2,057 had musculoskeletal pain not related to trauma. Knees, back, and shoulders were the common sites of pain. Most of the sufferers reported the severity of pain as being moderate to severe. Functional disability was reported in 39.1% of the sufferers. The age-sex population adjusted prevalence rate for musculoskeletal pain was 35.7% in females and 20.2% in males. The most common sources for advice on treatment were physicians in hospitals (68.8%) and general practitioners (30.4%). 82% had prescriptions for their medications, while 19.4% had self prescribed tablets. CONCLUSION: Musculoskeletal pain is a major health problem among Kuwaitis and deserves intense government attention.

Adolescent↗
PubMedDate not supplied

"Instant" new leprosy case-detection: an experience in Bihar State in India.

The National Leprosy Eradication Programme (NLEP) is based on survey, education and treatment, including coverage of all the registered cases with multi-drug therapy (MDT). The Government of India introduced MDT in all leprosy endemic districts through a vertical set-up, and through mobile leprosy treatment units in low endemic districts. Anti-leprosy work has not been uniform in all the states and needed push-start in some, such as Bihar. There have been spurts of leprosy elimination activities and the entire populations of the regions have not been covered because of various administrative reasons and logistic problems. In Singhbhum district of Bihar, a successful attempt was made to cover the maximum population by campaign approach. The strategy was to involve all the field workers of the leprosy programme in the district, supported by a small group of experienced personnel. The campaign, lasting for 39 working days, resulted in detecting leprosy cases equivalent to 64% of cases detected during the previous one full year. The entire operation helped the local staff to gain experience that would be useful for the future of the NLEP, and also provide an insight into working practices. Similar campaign approach can be used in situations where case-detection activities are feeble and the implementation of MDT is slow. If such campaigns are repeated at appropriate intervals, it will be a great support to achieving the goal of leprosy elimination.

Community Health Workers↗
PubMed2004

Impact of snake bites and determinants of fatal outcomes in southeastern Nepal.

Current available data on snake bites in Nepal are based solely on hospital statistics. This community-based study aimed at evaluating the impact of snake bites and determining the risk factors associated with a fatal outcome in southeastern Nepal. A total of 1,817 households, selected by a random proportionate sampling method, were visited by trained field workers in five villages. Extensive data from snake bite victims during the 14 previous months were recorded and analyzed. One hundred forty-three snake bites including 75 bites with signs of envenoming were reported (annual incidence = 1,162/100,000 and 604/100,000, respectively), resulting in 20 deaths (annual mortality rate = 162/100,000). Characteristics of krait bites such as bites occurring inside the house, while resting, and between midnight and 6:00 am were all factors associated with an increased risk of death, as were an initial consultation with a traditional healer, a long delay before transport, and a lack of available transport. An initial transfer to a specialized treatment center and transport by motorcycle were strong protective factors. Among the 123 survivors, wounds required dressing and surgery in 30 (24%) and 10 (8%) victims, respectively, the mean working incapacity period was 15 days, and the mean out-of-pocket expense was 69 U.S. dollars. Snake bite is a major but neglected public health problem in southeastern Nepal. Public health interventions should focus on improving victims' rapid access to anti-snake venom serum by promoting immediate and fast transport to adequate treatment centers, particularly for bites occurring at night.

Adult↗