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PubMedDate not supplied

Implications of directly observed therapy in tuberculosis control measures among IDUs.

Tuberculosis (TB) is a rapidly growing problem among injecting drug users (IDU), especially those infected with human immunodeficiency virus. The authors review IDUs' responses to current TB control strategies and discuss the implications of their findings for the proposed implementation of directly observed therapy (DOT), a method for ensuring that patients take prescribed medication. Field workers carried out 210 ethnographic interviews with 68 IDUs in a Brooklyn, NY, community during 1990-93. Case studies suggested that many IDUs are uninformed about TB and often misinformed about their personal TB status. Ethnographic interviews and observations indicated that the threat of TB-related involuntary detainment may lead IDUs to avoid TB diagnostic procedures, treatment for TB, or drug abuse treatment, and to avoid AIDS outreach workers and other health-related services. IDUs who tested positive for the purified protein derivative (PPD) of TB sometimes have left hospitals before definitive diagnoses were made, because of a perceived lack of respectful treatment, fear of detention, or lack of adequate methadone therapy to relieve the symptoms of withdrawal from drugs. Current TB diagnosis and treatment systems are, at best, inadequate. The threat of TB-related detention discourages some IDUs from seeking any type of health care. There is an urgent need to educate IDUs about TB and to educate and sensitize health care providers about the lifestyles of IDUs. DOT may help in servicing this difficult-to-serve population, particularly if techniques are incorporated that have been developed for other successful public health interventions for IDUs.

Adult↗
PubMed1993

Dracunculiasis in Burkina Faso: results of a national survey.

National surveys using active reporting are essential steps in the global dracunculiasis eradication programme. All the known villages of Burkina Faso were visited at the end of 1990 by teams of field-workers who organized meetings with local informants in order to enquire about all cases of the emergence of Guinea worms during the past twelve months. The annual incidence for 1990 was then calculated using recent demographic data. Data collected were validated by a second survey of a random sample of 221 villages. The national coverage rate was 99.3% of villages; 42,227 cases were reported. The annual incidence for 1990 was 46.4 cases per 10,000. There was a pronounced heterogeneity in the spatial distribution of endemic foci, with a concentration of cases in the north and centre of the country. In Burkina Faso, dracunculiasis has a heterogeneous distribution with a pronounced concentration of cases in the North and Centre that reach mesoendemic incidence rates.

Burkina Faso↗
PubMed1995

Estimation of chronic disease load in a rural area of Haryana.

A key informant based survey was done in 1992 to enlist cases of chronic disorders in a rural area of Haryana. Thirty-nine villages selected purposely from a block were surveyed by a trained field worker. He made contacts with key informants like dais, anganwadi workers, health workers, teachers, village elders, etc, to enlist known cases of chronic disorders. In all 812 cases of chronic disease were encountered in 28844 population (28.2/1000). Prevalence of chronic disorders was more in higher age group. Males outnumbered females in younger age group and vice versa for higher age group. Asthma, poliomyelitis, mental illness/retardation were more prevalent in males while hypertension, obesity were reported more in females. Tuberculosis, diabetes, hypertension and asthma were significantly more prevalent in higher age group while poliomyelitis was reported more in children. Consultation rate was high in tuberculosis, asthma, hypertension and diabetes.

Adolescent↗
PubMed1996

Effect of removing Ascaris on the growth of Guatemalan schoolchildren.

OBJECTIVE: To determine whether successful deworming for 6 months in children with high levels of Ascaris improves physical growth. SUBJECTS: Two hundred twenty-eight children (mean age, 9.7 years) in a highland Indian town in Guatemala. DESIGN: Children were randomly assigned to receive albendazole or placebo at baseline and 12 weeks. Children and field workers were both blind to the group assignment. OUTCOME MEASURES: Children's heights, weights, and mid-upper-arm circumferences were measured at baseline and 12 and 24 weeks. Fecal egg counts were taken at 0, 2, 12, 14, and 24 weeks to estimate the helminth burden (eggs per gram of feces [epg]). RESULTS: Baseline helminth prevalences were Ascaris, 91%, and Trichuris, 82%. Ascaris intensities were high: half of the children had moderate burdens (10 000 to 50 000 epg), and 25% had heavy burdens ( > 50 000 epg). Trichuris burdens were light (72% < 1000 epg). The albendazole and placebo groups did not differ at baseline in epg, age, anthropometry, or socioeconomic status. The two rounds of treatment successfully reduced the Ascaris burdens but had less effect on Trichuris. At 6 months the treatment group showed a small gain in weight (0.18 kg) compared with the placebo group but no improvement in height or mid-upper-arm circumference. CONCLUSIONS: The successful removal of ascaris in a population of school-aged children with relatively high loads may have modest effects on weight gain. Ascaris is one of the most common infections in school-aged children, but its effect on the host may be less than that of other helminths.

Albendazole↗
PubMed1996

Nutritional status of children: validity of mid-upper arm circumference for screening undernutrition.

OBJECTIVES: To determine the nutritional status and validity of mid upper arm circumference (MAC) in diagnosing malnutrition among preschool children. DESIGN: Cross-sectional household survey. SETTING: 47 villages in District Ambala, Haryana. SUBJECTS: 3747 children aged less than six years. METHODOLOGY: Trained field workers recorded age, weight, length/ height and MAC of children. Prevalence of underweight, stunting, and wasting were calculated in reference to National Centre for Health Statistics (NCHS) standards. Sensitivity and specificity of MAC for detecting underweight, wasting and stunting among children aged 1 to 4 years were determined. RESULTS: At the cut-off level of < -2.00 SD of Z-scores, 48.8% children were stunted, 49.6% were underweight and 9.1% were wasted whereas 47.6% children had neither wasting nor stunting. Prevalence of severe stunting, underweight, and wasting (Z-score < -3 SD) was 18.1%, 11.5% and 0.6%, respectively. Undernutrition showed a significant rise after 12 months of age (p < 0.0001). Stunting and underweight were significantly more among girls compared to boys (p < 0.01) but wasting was not significantly different in them. Compared to the conventional MAC cut off levels of < 13.5 cm and < 12.5 cm, sensitivity and specificity in our setting were optimum at < 13.5 cm for detection of wasting and < 14.0 cm for diagnosis of underweight and stunting, and < 13.0 cm for detection of severe wasting and < 13.5 cm for diagnosis of severe underweight and severe stunting. CONCLUSIONS: Almost every second child was undernourished. Optimum cut off level of MAC in our setting were higher than the conventional cut off points for detection of undernutrition among children.

Anthropometry↗
PubMed1996

[Is vector control needed in the fight against sleeping sickness? A biomathematical approach].

Vector control and the detection (followed by treatment) of infected individual are the two methods currently available for the control of sleeping sickness. The basic reproduction rate of a compartmental model (Kermack and McKendrick) is used to analyze and compare the two strategies. The model shows that when there is a long first stage characteristic of an endemic situation, the detection of sick individuals is more efficient than vector control. This higher efficiency of detection decreases in a epidemic situation. In this case vector control in the form of a decrease in vector density and/or an increase in vector mortality is relatively more efficient than detection. Because it is squared in the basic reproduction rate, the probability of a tsetse blood meal on humans is an important and sensitive parameter in the study of control strategies. This sensitivity has been observed previously and empirically by field workers. When the probability of a tsetse blood meal on humans is above a certain value, vector control becomes warranted or even necessary.

Animals↗
PubMed1977

The identification of infants at risk of malnutrition in Kingston, Jamaica.

A longitudinal study was carried out on the growth, health and environment of Kingston infants from birth to 1 year of age. In an attempt to identify children at risk of malnutrition, the records of all the children in the 10th percentile for weight at 12 months of age were examined to determine whether they differed in their health, care or social background from the remaining children. Small birth weight children tended to remain in the 10 percentile. High birth order, poor standard of housing, incompetent mothers, repeated attacks of gastroenteritis, poor clinic attendance and poor milk intake were all significantly associated with being underweight at 12 months of age. These factors were inter-related, and the more factors present in each child the smaller the child tended to be. It was hoped that identifying the presence of these factors may assist field workers to give priority to the children most at risk of malnutrition. The need for home visiting in the delivery of health care is highlighted.

Body Weight↗
PubMedDate not supplied

Paralytic poliomyelitis in a rural area of north India.

BACKGROUND: Paralysis due to poliomyelitis is common in rural areas. The extent of paralysis, type and place of treatment and effect of local treatment on children with poliomyelitis was assessed in a house-to-house survey conducted between 1990 and 1991 in a rural area of north India. METHODS: Trained field workers conducted a house-to-house survey in 9 villages of Haryana with a total population of 22,883. All cases of deformity and muscular weakness suspected to be due to poliomyelitis were examined and details regarding immunization, diagnosis, treatment and follow up were recorded. The late consequences of neglect as well as inappropriate medical advice were also assessed by physical examination and direct questioning of the parents. RESULTS: Thirty-seven cases of paralytic poliomyelitis were identified indicating a prevalence rate of 1.6 per 1000 population. Of these, 97% were paralysed before they were 2 years old and 60% had a history of intramuscular injections preceding paralysis. Only 14% of them had received either partial or complete immunization. The majority of families preferred to take treatment from traditional healers or in city hospitals but not from primary health centres. CONCLUSION: Despite the national immunization programme, paralytic poliomyelitis continues to be a significant problem in the villages surveyed. Primary health centres are an unreliable source of epidemiological data for paralytic poliomyelitis as villagers do not prefer to visit them for treatment of the disease. Injections given for treatment of fevers in rural areas may play a role in precipitating paralytic poliomyelitis. These findings highlight the urgency of a broad-based primary health care approach at primary health centres. Traditional healers and private practitioners should be trained to provide physiotherapy to children with polio and educated about the importance of not giving injections to children with minor fevers.

Adolescent↗
PubMed1997

The Senegal pertussis trial: safety and surveillance of adverse reactions.

In the Senegal pertussis trial, common adverse reactions were actively monitored during the pilot phase II study, while the frequency of severe adverse reactions was monitored as a secondary objective within the phase III efficacy trial. Since the trial was conducted in Niakhar, an area in rural West Africa under intensive surveillance, the safety monitoring during the study was incorporated within the general surveillance system. This was a two-step procedure: detection of a potential reaction by a field worker, followed by confirmation report by a physician. The frequency of severe reactions was low among both pertussis vaccine groups, receiving either the two-component acellular vaccine or the whole-cell vaccine currently used in the Senegal Expanded Programme on immunisation. Among severe reactions, only persistent crying was found to be at a significantly higher rate in the whole-cell group. Common adverse reactions were more frequent in the whole-cell group.

Crying↗
PubMed1997

The influence of quality of care upon contraceptive use in rural Bangladesh.

Efforts to develop quantitative indicators of quality of care for family planning services, and to evaluate its role in contraceptive behavior, remain at an early stage. The present study, based upon an analysis of prospective data from a sample of 7,800 reproductive-aged rural Bangladeshi women, provides empirical evidence on the importance of quality of care for contraceptive practice. The results demonstrate that the perceptions of women regarding the quality of field-worker care were significantly related to the probability of subsequent adoption of a family planning method. Women who were not using a method and who scored high on an index of perceived quality of care were 27 percent more likely to adopt a method subsequently, compared with women with a low score. Effects were even more pronounced for contraceptive continuation; high quality of care was associated with a 72 percent greater likelihood of continued use of any method of contraception.

Adult↗
PubMed1997

Modifiable risk factors for coronary heart disease among young people in Addis Ababa.

We report results of a cross-sectional survey of modifiable risk factors for coronary heart disease among young people (15-24 years of age) in Addis Ababa, conducted in 1994/95. A city-wide random sample of 1,436 (851 females and 585 males) young people participated in the study. Interviews using structured questionnaires, weight, height and blood pressure measurements were conducted using trained and supervised field workers. Current smoking was 11.8% for males and 1.1% for females. About 34% of the respondents consumed alcoholic beverages regularly, but 7.0% of these took more than 100 grams of alcohol per week. High fat intake and sedentary life-styles were registered in 4.5 and 8.4% of the respondents, respectively. About 6.0% of the females and 0.7% of the males were obese. The prevalence of elevated blood pressure (diastolic BP > 90 mmHG) was 7.1%. The prevalence of modifiable risk factors among young people in Addis Ababa indicates that there is need for initiation of primary preventive activities as soon as possible.

Adolescent↗
PubMed1997

Macronutrient intake and cardiovascular risk factors in older coloured South Africans.

A cross-sectional analytical study was undertaken to investigate the macronutrient intake and cardiovascular risk factor profile of community-dwelling older coloured (mixed descent) South Africans. A sample of 200 subjects aged 65 years and above in Cape Town was randomly drawn using a two-stage cluster design. Trained field workers interviewed subjects to obtain demographic, dietary and life-style data, to draw fasting blood samples for the analysis of plasma lipids, and to take anthropometric measurements. Nutrient intake was assessed using a validated quantified food frequency questionnaire. Blood pressure was measured according to the guidelines of the American Heart Association. The mean daily energy intake was 7984 (3245) kJ and 6979 (2219) kJ for men and women, respectively. Twenty-nine per cent of the subjects had energy intakes less than two-thirds of the RDA. Dietary fat intake comprised 32.4% of total energy intake, which is in line with the prudent dietary guidelines. The inadequate fibre intake (mean = 17(8) g/day) was attributed to the low consumption of fruit and vegetables. Anthropometric assessment indicated that the women tended towards overnutrition, while the men appeared to be undernourished. Lipid profiles fell within the lower end of the moderate risk band for cardiovascular disease and a high prevalence of hypertension (71.7%) was identified. The survey findings indicate a need for health promotion activities to encourage increased physical activity levels and an increased consumption of vegetables, fruit, wholegrain cereals and low fat dairy products in this population.

Black or African American↗
PubMed1997

Evaluation of an algorithm for the integrated management of childhood illness in an area with seasonal malaria in the Gambia.

Most of the 12.4 million deaths occurring every year among under-5-year-olds in developing countries could be prevented by the application of simple treatment strategies. So that health professionals who have had limited training can identify and classify the common childhood diseases, WHO developed a treatment algorithm (the Integrated Management of Childhood Illness (IMCI) or Sick Child algorithm), a prototype of which was tested in 440 Gambian children aged between 2 months and 5 years. The children were first assessed by a trained field worker using the algorithm, and then by a paediatrician whose clinical diagnosis was supported by laboratory investigations and, when indicated, a chest X-ray. Compared with the paediatrician's diagnosis, the sensitivity and specificity of the draft IMCI algorithm were, respectively, 81% and 89% for the detection of pneumonia, 67% and 96% for dehydration, 87% and 8% for malaria parasitaemia (any level), 100% and 9% for malaria parasitaemia (above 5000 parasites/microliter), 100% and 99% for measles, 31% and 97% for otitis media, and 89% and 90% for malnutrition. Among the children admitted by the physician, 45% had been recommended for admission by the algorithm. Intermittent fever, chills and sweats did not help in discriminating between malaria and non-malarious fevers; shivering or shaking of the body had a sensitivity of only 35%. While the algorithm dealt with the majority of presenting complaints, the most common problems not addressed by the chart were skin rashes (21%), mouth problems (8%), and eye problems (6%). The draft IMCI algorithm proved to be effective in the diagnosis of pneumonia, gastroenteritis, measles and malnutrition, but not malaria where its use without microscopy would result in considerable over-treatment, especially in a low transmission area or during a low transmission season in countries with seasonal malaria. The current algorithm would benefit from expansion to cover management of localized infections as well as skin, mouth and eye problems.

Algorithms↗
PubMed1998

Incrimination of Schistosoma spindale as a causative agent of farmer's dermatitis in Assam with a note on liver pathology in mice.

Cercarial dermatitis of paddy field workers in Assam is very common. However, it is not known which species of animal schistosomes, is its causative agent in Assam. Studies in two dermatitis affected villages of Dibrugarh district revealed that cercariae of Schistosoma spindale were involved in its aetiology. Indoplanorbis exustus was the only snail species found infected with apharyngeate brevifurcate schistosome cercarie. Experimental infection of the laboratory animals with the dermatitis causing schistosome cercariae revealed that duckling and chicken were refractory to infection. However, Swiss albino mice were successfully infected. The number of adult flukes per infected mice ranged from 6-321 (mean intensity = 68.1; S.D. = +/- 112.96). Histopathological study of infected mice liver revealed that there was mild inflammation of infected portal triads towards the presence of male flukes in the intra hepatic portal vessels. Kuppffer cells showed hyperplasia and contained large amounts of black pigment. No eggs or egg granulomas were detected in the liver parenchyma. There was no evidence of thrombophlebitis, septal fibrosis or pipe stem fibrosis.

Agricultural Workers' Diseases↗
PubMed1998

Tetanus toxoid immunization coverage among women in zone 3 of Dhaka city: the challenge of reaching all women of reproductive age in urban Bangladesh.

Neonatal tetanus is still an important public health problem in both urban and rural Bangladesh, with an estimated 41,000 cases occurring annually. This article analyses the coverage of tetanus toxoid (TT) immunizations among women of reproductive age in Zone 3 of Dhaka City in 1995. Although 85% of women with a child under 1 year of age had received two TT immunizations, only 11% of women of reproductive age had obtained the complete series of five TT immunizations and only 52% of women of reproductive age had received one or more TT immunizations. Access to TT immunization, as defined by having had at least one such immunization, was lower among women aged over 30 years and also among those aged under 20 years, especially those who were not yet married or who had not yet become pregnant. Characteristics associated with TT immunization status included the following: educational level of the woman, distance from the nearest immunization centre, and level of contact with family planning field workers. Additional characteristics that influenced women's TT immunization status included age, marital and working status, recency of migration from rural to urban area, and number of children. The relationships were complex and varied depending on the number of TT immunizations received (one or two) and on the type of analysis being carried out (bivariate or multivariate). The findings point to the need for a broad-based campaign to promote access to TT immunization as well as to promote the completion of all five TT doses in Bangladesh. Reducing missed opportunities for promotion of immunization as well as targeting home visitation of women in need of additional immunizations constitute further approaches to improving coverage. Although TT coverage rates were only marginally lower among women in slum households, such women were more likely than those in non-slum households to be pregnant and hence more likely to bear a baby at risk of neonatal tetanus. Furthermore, the environment of slum households, where deliveries normally take place, is more conducive to the development of neonatal tetanus among unprotected neonates; a strategy of focusing on slum households is therefore also needed.

Adolescent↗
PubMed1978

[Continuing education for social workers in the field of gerontology (author's transl)].

This article reports on a first attempt to integrate advanced training programs for social workers in the field of psycho-social gerontology into university curricula. The report concentrates on experience and problems to transmit and translate gerontological research results for the use of practitioners. Especially effective proved the integration of social workers as "experts-in-practice" into open-curricular-learning and their participation in application oriented research.

Adult↗
PubMed1989

The relationship of child protection worker attitudes to attrition from the field.

Child protection workers in 33 states and the District of Columbia participated in a survey conducted by the C. Henry Kempe National Center for the Prevention and Treatment of Child Abuse and Neglect to determine the attitudes and attributes of workers who terminate their careers in child protection. A year after the survey, telephone follow-up was done to identify respondents to the survey who had left the child protection field. Attributes and attitudes were then linked directly to whether workers had terminated or continued child protective service. Just 8.0% (15 of 187) of the workers had left the field. There were few differences between workers that departed and those whose services were retained. Both were generally dissatisfied with their profession at the time of the survey. The shrinking social service labor market and worker investment in the field are discussed as factors impeding turnover among child protection workers.

Attitude↗
PubMed1994

A numerical investigation into the flow field around a worker positioned by an exhaust opening.

A numerical investigation has been made into the flow behaviour near a worker in the vicinity of an exhaust opening. The flow field is that induced by the withdrawal of air through the exhaust opening and hence a wake forms between the worker and the opening. Both laminar and turbulent flow regimes are considered. The numerical technique adopted is the control volume, finite-difference method with the k-epsilon model used to model the turbulent flow. The problem has been considered in two dimensions in order to gain a greater understanding of the flow behaviour but the numerical method adopted could be extended to investigate three-dimensional effects. An investigation is made into the effects upon the flow of the distance of the worker from the exhaust opening for different operating conditions. The results show that if the worker is close to the exhaust opening then the flow is steady and a small area of recirculating flow exists in the wake of the person. However, if the worker is situated some distance away from the opening then the flow field is unsteady with vortex shedding occurring in the persons wake.

Air Pollutants, Occupational↗