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PubMed1993

Base-line village health profiles in the E.Y.N rural health programme area of north-east Nigeria.

In order to document the health profile of rural farming communities not yet reached by the EYN Rural Health Programme, based at Garkida, Nigeria, four villages were surveyed by a Sheffield medical student who lived for several weeks in each village, working alongside local women. Villagers helped in separate surveys of village environment and water sources, of compound (household) hygiene, of male heads of compounds, of women of childbearing age, and of children. Stagnant rain-water ponds and widespread animal faeces litter were the main village environmental hazards and hardly any satisfactory pit latrines were seen. One person in nearly 2000 surveyed treated the drinking water. Infant mortality was estimated at 200 per 1000. Commonly reported health problems included abdominal pain, coughs and colds, filariasis, diarrhoea, scabies, worms, blood in stool, fever, back pain and eye infections. In each village fewer than 20% of the men and fewer than 10% of the women had received any education. Average completed family size was 6 or 7 children per woman with 3 other non-surviving children. The causes of malaria and of diarrhoea were each known by fewer than 10% of mothers in each village. About a quarter of the under fives had suffered from diarrhoea in the past fortnight, a quarter had received any immunisation and one fifth were at least mildly malnourished. One quarter of children aged 6-12 years attended school.

Adult↗
PubMed1994

Maternal and socioeconomic factors and the risk of severe malnutrition in a child: a case-control study.

OBJECTIVE: To examine the relation of maternal and socioeconomic factors with the development of severe malnutrition in young children. DESIGN: A case-control study. SETTING: A large diarrhoea treatment centre in a metropolitan city. SUBJECTS: Cases were 125 severely malnourished children, aged < 36 months, having weight-for-age < 55% of the United States National Center for Health Statistics (NCHS) median values. Controls (n = 125) were recruited concurrently matching for gender, disease type (i.e. diarrhoea or dysentery) and age stratum, having weight-for-age > 60% of NCHS median values. INTERVENTION: Mothers of the children were interviewed to record personal history and various socioeconomic variables and examined for height and weight. RESULTS: Maternal factors such as illiteracy, mothers' employment outside, lack of breastfeeding and maternal malnutrition (as indicated by low body mass index, weight or height); and selected socioeconomic indicators such as poor family income, use of unprotected surface water or unhygienic latrine were found to be significantly associated with severe malnutrition in their children. In multivariate analysis, maternal illiteracy and lack of breastfeeding were associated with approximately fourfold increased risk of severe malnutrition in their children. A strong positive association of employment of mothers outside homes with fivefold increased risk was surprising and may reflect a complex social problem of poor urban mothers; malnourished mothers were 2.5 times more likely to have severely malnourished children. CONCLUSION: The findings confirm the well-known association of lack of maternal education and breastfeeding with severe malnutrition of their children. Maternal malnutrition may be a useful indicator to identify at-risk families with severely malnourished children. However, its causal association, though plausible, cannot be inferred from the study.

Breast Feeding↗
PubMed1993

Awareness of diarrheal disease control in rural and urban areas of Bihar.

Awareness regarding different aspects of prevention and treatment of diarrheal diseases among parents in rural and urban areas of Patna district were studied. Survey was done in 245 households from 30 villages of Bihta block and about 275 households from 30 different mohallas of Patna town. All aspects were poorly known to the rural community, particularly the illiterates and a large segment of literates of Bihta block. Rural people were significantly less aware than their urban counterparts regarding value of prolonged breast feeding, spoon feeding rather than bottle feeding, using hand pump and tap water for drinking and using latrine for nightsoil disposal in preventing diarrhea. Utility of measles immunization in prevention of diarrhea was unknown to the community. Generally parents thought antidiarrheal drugs a must for treatment. Knowledge regarding ORS and its use in diarrhea and vomiting was very poor and significant difference (p < 0.001) in awareness was observed between educated and illiterates. Majority parents did not know the correct method of preparation and uses of ORS and SSS. Due to high literacy rate and health consciousness, the educated and majority of literate parents of Patna town were better aware, more factual and had rational view regarding causes, method of prevention, fundamentals of use of ORS and home management of diarrhea in children, although certain aspects are yet to be cleared to them.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude to Health↗
PubMed1994

Observations on handwashing and defecation practices in a shanty town of Lima, Peru.

Following a two-year cohort study of diarrhoeal diseases in children aged 0-35 months from a shanty town in Lima, 62 families were chosen for detailed observation of hygiene practices. All handwashing and defecation episodes which occurred during a 10-hour observation period (8am-6pm) were recorded. The youngest child in each family was selected as the index child for observation. Handwashing was seen on 483 occasions with 71% of the index children and 80% of mothers observed at least once. The use of clean water, soap and the thoroughness of the handwashing varied according to the purpose, with "better" behaviour observed more frequently when the person was preparing to go out. Forty-five index children (72%) were observed to defecate at least once. Infants defecated in their diapers or clothes; toddlers defecated more indiscriminately around the home area. Handwashing after defecation was rare (11% of occasions) and usually without soap. Faeces were often left accessible to children and animals (42% of occasions), especially when defecation occurred around the home/yard, and the data suggested this occurred more frequently in "higher" diarrhoea households. Stools deposited on the floor were usually just swept aside, covered with earth or eaten by dogs. Those deposited outside the home were frequently left untouched during the observation period or similarly cleared. Soiled clothes were usually left or washed separately, and stools in potties were thrown in latrines. These results suggest hygiene interventions might focus on clearance of stools from home surroundings, increased utilisation of potties and separate washing of soiled clothes.

Child, Preschool↗
PubMed1993

Protozoal abortion in a herd of cattle concurrently infected with Hammondia pardalis.

Protozoal infection was diagnosed as the cause of abortion in a large drylot dairy herd located in northeastern Mexico. Diagnosis was made on the basis of finding encephalitis, myocarditis, protozoal cysts, and protozoal tachyzoites in aborted fetuses. The blended ration fed to the cows had been contaminated by the feces of a large resident population of feral domestic cats that used components of the blended ration for den sites (stored hay) or as a latrine (grain). The cows that aborted contained tissue phases of a protozoan infective for domestic cats. The morphologic features of the oocyst and biologic features of the protozoan were identical to those of Hammondia pardalis.

Abortion, Veterinary↗
PubMed1993

Perception of a schistosomiasis control project in rural Kenya by the beneficiaries.

A schistosomiasis control project was implemented in Mwea Rice Irrigation Scheme in Central Kenya between late 1983 and December 1988 by Kenya Medical Research Institute scientists in collaboration with the National Irrigation Board. The aim of the project was to control schistosomiasis through provision of alternative water sources, bath and laundry units, latrines, chemotherapy and health education. The community participated fully. Five years later in December 1988, 203 household heads were interviewed on their perception of the control project in terms of purpose, project ownership and management, benefits, continuity and their knowledge of schistosomiasis transmission cycle. 61% of the respondents were females and 39% males. 92% of them said that the purpose for the project was to treat, control and prevent bilharzia from spreading, and to promote good health. Slightly over 50% said that the project belonged to them but that they would have liked to be more involved in its management. 74% said that they are able to save time because the facilities are now nearer to them; whilst 79% felt that they were saving money because they did not have to buy drugs since they felt healthier. 99% said that they thought that bilharzia has been controlled, and 82% said that their children looked healthier. 95% said that they could see the project surviving for a long time period suggesting that it was self sustaining and they were willing to start a maintenance of facilities fund. Overall, the community appreciated the social, economic and health benefits derived from the control project.

Communicable Disease Control↗
PubMed1993

Involvement of a community in schistosomiasis control: a Kenyan experience.

This paper illustrates how community participation was achieved in a study that was carried out between 1983-1988 whose general objective was to reduce the transmission of schistosomiasis in a rice irrigation scheme in Kenya. A community of 2,219 people was mobilized through health education, to effect changes in behaviour regarding water contact, water use and faecal disposal. Health education, alternative water sources, latrines and mass chemotherapy with praziquantel were the schistosomiasis control strategies utilized in this study. By the end of 2 years, the canals were cleared of their thick vegetation, water, sanitation, bathing and washing facilities were constructed, water contact with infective waters was reduced, faecal contamination of water was reduced, the people's knowledge on schistosomiasis increased and the rate and intensity of schistosomiasis infection was reduced. The study demonstrated that it is possible to fully involve the community in disease control efforts.

Adult↗
PubMed1993

Sustainable urban development and human health: septic tank as a major breeding habitat of mosquito vectors of human diseases in south-eastern Nigeria.

Septic tank mosquitoes in Abia State University Okigwe, south-eastern Nigeria were studied using exit traps between November 1988 and April 1989. The results were revealing and striking. Apart from the common septic tank mosquitoes, Culex p. quinquefasciatus, Cu. cinereus and Aedes aegypti, which have been previously commonly found breeding in ammonia and nitrate-rich waters of latrines and septic tanks, the other species, Cu. horridus, Cu. tigripes and Aedes vittatus, have not been commonly reported as colonizing septic tanks in Nigeria. Three out of these six mosquito species observed are vectors of human diseases: Aedes aegypti and Aedes vittatus are vectors of Yellow fever and Cu. p. quinquefasciatus is a potential vector of Bancroftian filariasis and a world-wide vector of various arboviruses. The fact that these mosquito vectors are able to breed in highly polluted waters of septic tanks during the harsh dry months when most surface water bodies are dry is epidemiologically important. The breeding of these mosquito vectors of human diseases around human dwellings indicates an intense man-vector contact creating a high level risk to the crowded urban population. The public health implications of this urbanization/modernization problem and solutions are discussed.

Aedes↗
PubMed1995

An outbreak of hepatitis A in school children at Nakhon Si Thammarat, southern Thailand.

Hepatitis A antibody prevalence in Southeast Asia has markedly declined among children and adolescents. Therefore increasing a number of susceptible populations could result in an outbreak or epidemic. This paper reports an intensive study of an outbreak of hepatitis A in a primary school children during an endemic at Nakhon Si Thammarat, Southern Thailand. Eighty-nine children were inspected randomly from the total of 269 students, age ranged from 7-12 years old. The school children and parents were interviewed for their illness. Serological tests for antiHAV IgM and antiHAV (total antibody) were performed by ELISA. There were 36 cases of clinical acute hepatitis were positive for antiHAV IgM because of serological tests were performed nearly 4 months later. Seventy of 89 children tested were positive for antiHAV and 16 of them were positive for IgM class. Seven of 16 children with antiHAV IgM positive were asymptomatic. The significant risk factors for children with positive antiHAV were occurrence of hepatitis patients in the family and no latrine (p < 0.01). Endemic transmission in this outbreak occurred rapidly. Therefore preventive measures are essential in reducing the infection rate. In addition to personal hygiene, immunoprophylaxis with either immunoglobulin or HAV vaccine is recommended.

Chi-Square Distribution↗
PubMed1995

Intestinal parasitic infections among rural farming communities in eastern Sierra Leone.

A study carried out in four rural, mainly farming villages in the Gorama Chiefdom, Kono District, Eastern Sierra Leone revealed that intestinal helminth infections are prevalent in this area of Sierra Leone. Out of the 1164 persons of all ages who were examined, 853 (73.5%) proved positive for at least one intestinal helminth infection. Ascaris lumbricoides was the most common helminth encountered (37.5%), followed by hookworms, 12.9%; Trichuris trichiura, 12.6%; Schistosoma mansoni, 5.6%; Strongyloides stercoralis, 3.8%; tapeworms 1.0%, and multiple infections were common. Adults used poorly built pit latrines, while children defecated indiscriminately and unsupervised around houses and in the nearby bush. In addition, in most of the villages, domestic water was obtained from polluted streams and rivers. Only one village had protected pipe borne water supply. The high prevalence of intestinal helminth infections in this area results from constant infection and reinfection caused by poor sewage disposal, poor environmental health, and the low socioeconomic status prevailing in these communities.

Adolescent↗
PubMed1995

Observations on handwashing practices of mothers and environmental conditions in Ona-Ara Local Government Area of Oyo State, Nigeria.

During baseline survey before developing an educational intervention programme for modifying behaviours toward improved home management of diarrhoea, handwashing practices and environmental conditions of 549 mothers and health care-providers of 638 children aged less than 5 years in Ona-Ara Local Government Area (LGA) were observed. The aims of the study were to describe the patterns of maternal handwashing behaviour in relation to disposal of faeces and feeding of children, and to describe environmental conditions of the households. Handwashing behaviours after cleaning a child who has just defecated and after disposal of faeces were observed in 29.3% episodes, while handwashing before feeding the child occurred in 12.4% of observations. Handwashing in relation to these events occurred more frequently in periurban than in rural villages (p < 0.001). These differences may be due to higher education of the periurban women compared to their rural counterparts. Handwashing was apparently not associated with distance from the water source or with the age groups of the children. Environmental observation revealed the presence of uncovered food (13%), human faeces (17%), animal dung (71%), animals (82%), and unprotected pit latrines (11%) in and around the house. There were significant rural-periurban differences in environmental conditions of the rural and periurban areas. It is recommended that the characteristics of areas selected for intervention be considered and important sub-group differences be identified before planning and implementing of such interventions.

Adult↗
PubMed1996

Health information for district level planning: a cross-sectional household survey in rural Kenya.

Health care planning and management in sub-Saharan Africa is being decentralised, and health information systems need to meet new needs. This study in rural Kenya explored the feasibility of a cross-sectional household health interview survey to help district-level health planning. Heads of 390 households were interviewed about health-related factors like housing standard, water supply, sanitation, recent illness, and health care use. Half of all households lived on farming. Access to water sources was poor, but latrine coverage was high. Of all disease episodes 26% were respiratory, 18% gastrointestinal and 10.5% malaria. Rates of illness episodes were low (1.0 day of illness/person/30 days), and 40% of episodes were taken to a modern service provider like a dispensary, health centre or hospital. The survey generated much information on household characteristics, illness episodes and action taken, data that was not available through the routine health information system. Survey costs were estimated at 15 US cents per resident in the project area, a large proportion of which was absorbed by computerized data processing, but may be reduced to about half. If conducted once every three or four years, a survey of this kind would be affordable within the ordinary recurrent district health budget and would provide useful planning and management information.

Adolescent↗
PubMed1996

[Cholera in Goma, July 1994. Bioforce].

In 1994, between July 14 and July 20, around one million of Rwandan refugees fled to the North Kivu region of Zaire. In spite of the existence of favorable conditions for cholera, it was necessary to wait until the laboratories isolated the first strain of cholera, on July 20 and 21, before the international community took action in one of the most important outbreaks of cholera known. The total number of cases of cholera was 36 471, of which half occurred between July 21 and July 27, reaching a peak on July 26. The average overall mortality was 28 per 10,000 in the second half of July, and 5 per 10,000 in the first half of August. 85 percent of the deaths are associated with diarrhea and 60 percent of these deaths with diarrhea are caused by cholera, the other being caused by dysentery. From July 24 to September 17, the Bioforce laboratory (French army) carried out 396 coprocultures : it isolated 78 strains of cholera (Vibrio cholerae 01, biotype El Tor, serotype Ogawa, resisting at O129, without indole), and 77 strains of shigella (Shigella dysenteriae type 1). There were several causes of this outbreak, among which the most important was the lack of water : during the first week, the average available of water was been evaluated at 200 ml per day per person ; the other causes of this outbreak were the impossibility to dig latrines, the lack of hygiene, the level of health and the promiscuity among the refugees. One of the modalities to limit this outbreak of cholera would probably have been to anticipate the subsequent cases and deaths by a massive international response adapted to this risk, as soon the Rwandan refugees began to flood in Goma.

Cause of Death↗
PubMed1996

African diary.

You must all be wondering how we are getting on with the health centre, I must confess that it's not very fast! Well, anyone who has lived in Africa will not be surprised, things always go slowly. We spent six weeks in England, and virtually nothing happened, although we had left money and instructions. Somebody had begun to dig a deep hole for latrines that we had not asked for. Colin went and had a look and decided it can be made deeper and turned into a well, luckily we got back in time to make the change! We did want toilets constructed but the flush type for in-patients, well it was nearly right. The minister who is supposed to be organising people to work, has had visitors almost ever since we came back and has not found anyone to get on with the building. Some people are busy building new classrooms for the junior school that were not even mentioned before we left.

Adaptation, Psychological↗
PubMed1997

[Impact of improved sanitary conditions and domestic hygiene on the incidence of ascaridiasis and ancylostomiasis in children two to four years old in the rural zones of Ivory Coast].

The purpose of this study is to assess the impact of improvement measures for hygiene and water supply, installation of latrines and health education on the incidence of ascaridiasis and ankylostomiasis with 2 to 4 years old children in some villages of southern Côte d'Ivoire. The method used is the comparison of children carrying parasites before and after intervention. Initially in 1988, the stools of all children aged from 2 to 4 were collected and examined in order to look for the presence of parasites in the stools. Two identical inquiries were made in 1990 and 1992. The results show a reduction of the rate of incidence for ascaridiasis by 75% and ankylostomiasis by 82%. They demonstrate the importance of an appropriate evacuation of excreta, of an education of mothers and of domestic hygiene in the process of prevention of children parasitosis.

Ancylostomiasis↗
PubMed1997

Risk factors of low dietary vitamin A intake among children in the Sudan.

We examined the determinants of dietary vitamin A intake among Sudanese children, information which is important for designing effective interventions based on the dietary approach. Children under the age of two years were at greater risk of consuming a diet low in vitamin A compared with children who were five years or older. Compared with children from relatively affluent households, those from poorer households were about twice as likely to consume low levels of carotenoid or preformed vitamin A. Low vitamin A intake was also significantly associated with lack of running water, a latrine, radio, or television in the household, and inversely associated with maternal or paternal illiteracy and with cleanliness of the child subjectively assessed by the interviewer. As expected, breastfed children in the first two years of life were likely to consume lower levels of preformed vitamin A and carotenoid from food (excluding breast milk) compared with non-breastfed children. Low vitamin A intake was more prevalent in the dry months of the year. Efforts to increase accessibility to vitamin A containing food, combined with nutrition education campaigns and public health programmes directed at improving sanitation and reducing infection are necessary as part of the long-term solution to the problem of vitamin A deficiency.

Age Factors↗
PubMed1997

Diarrhoea morbidity in an urban area of southwest Ethiopia.

A diarrhoea morbidity survey was conducted in children between the ages of six and 59 months in Jimma town, southwest Ethiopia. Nearly 37% of the 820 children surveyed had one or more episodes of diarrhoea over a period of one month preceding the study. Although several factors showed significant association with diarrhoea morbidity on bivariate analysis, child's age, immunisation status, father's ethnicity, family income and availability of latrine were the only significant variables on multivariate analysis. Based on the study results feasible intervention measures are recommended.

Analysis of Variance↗
PubMed1997

Village health and sanitary profile from eastern hilly region, Nepal .

A report on the health and sanitary status from Boya Village Development Committee (VDC) is presented as studied by a team of Nepali and Japanese investigators in 1996 and 1997. The purpose of this study was to find out the health and sanitary status in a remote hilly village in eastern Nepal. Data were collected from questionnaire and from a temporary field clinic. The number of households having latrine increased significantly (P < 0.05) in one year period but without significant impact on the reduction of intestinal helminth infection (P > 0.05). Ascaris lumbricoides was the commonest intestinal parasite followed by hookworm and others. Public piped water was accessible to 32.6% households while remaining 48.4% and 19.0% were using Dhara (natural tap) and Kuwa (sallow well) water, respectively. No association between the type of water source and gastro-enteritis was observed. The overall hygienic condition was poor. More than half of the residents first consult Dhami-Jhankri and Bijuwa (traditional/faith/shamanic healer) and believe on Devi-Deuta (local deities/divine spirit) and Bhut-Pret and/or Bayu (devils) and Boksi (witch) instead of visiting Health Post. Approximately one quarter of residents were smoker while two-third had habit of drinking alcohol. Medical complaint rate significantly increased from 59.6% in the year 1996 to 71.2% in 1997 (P < 0.01) and was attributed to conjunctivitis epidemic during second visit. Majority of complaints were gastrointestinal. People belonging to Tibeto-Burman ethnic group were found to consume meat relatively more frequently than Indo-Aryan.

Chi-Square Distribution↗