[Incidence of psychological problems and mental disorders in Los Sin Techo, a very poor slum in Caracas].
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The epidemiology, clinical features, nutritional status, and causative agents of diarrhea were studied in 289 Bangladeshi children (147 boys and 142 girls) 2-5 years old. The use of improved diagnostic tests for amebiasis enabled for the first time analysis of the contribution of Entamoeba histolytica to total diarrheal illness in this community setting. The average incidence rate of diarrhea was 1.8/child-year, and the average number of diarrheal days was 3.7 days/child-year over an average observation period of 2.8 years/child. Seventy-five percent of the diarrheal episodes were < or = 2 days in duration. Persistent diarrhea was relatively uncommon (0.2% of the children) and chronic diarrhea was observed in only one episode. Compared with malnourished and/or stunted children, better-nourished children experienced significantly fewer diarrheal episodes. The diarrheal incidence rate for children with blood group A was significantly less that that of the children with blood groups O and AB. The most frequent bacterial enteropathogens isolated from diarrheal stool specimens were enterotoxigenic Escherichia coli (9%) and Aeromonas species (9%), followed by Plesimonas shigelloides (4%) and Shigella flexneri (3.8%). Rotavirus was the most common viral agent isolated from diarrheal stool samples (5%). Giardia lamblia, Cryptosporidium parvum, and E. histolytica were identified in 11%, 8.4%, and 8%, respectively, of the diarrheal stool specimens. Dysentery was observed in 7.7% of all diarrheal episodes. The most common pathogens isolated from dysenteric stool were S. flexneri (11.6%), Aeromonas sp. (10%), E. histolytica (8.7%), Campylobacter jejunii (5.8%), P. shigelloides (4.3%), and A. caviae (4.3%). The overall incidence rate of E. histolytica-associated diarrhea was 0.08/child-year. Visible blood and hemoccult test-detected blood loss was found in 7% and 25%, respectively, of cases of E. histolytica-associated diarrhea. Children who had recovered from a diarrheal episode with E. histolytica, but not E. dispar, had half the chance of developing subsequent E. histolytica-associated diarrhea, consistent with the development of species-specific acquired immunity. In conclusion, the use of modern diagnostic tests demonstrated that E. histolytica contributed to overall morbidity from diarrheal illness. Understanding the etiology, frequency, and consequences of acute diarrhea in children from a developing country should aid in the design of interventions to improve child health.
A cross-sectional study was conducted among 208 adults (114 males and 94 females) aged 16-70 years, selected by systematic random sampling method in Lok Nayak Colony, Delhi to assess the knowledge and attitude towards tuberculosis (TB). Literacy rate was 28.4%. Only 174 (83.6%) heard of tuberculosis mainly from neighbours (64.9%) and friends (62.1%). Only 2.3% knew that TB was caused by a germ. Literates were more aware than illiterates regarding some signs and symptoms of TB i.e breathlessness (p=0.002), low grade fever (p=0.02), loss of appetite (p<0.001) and factors favouring TB e.g. overcrowding (56.4%) and poor diet (45.4%). Only 12.6% knew about the duration of treatment for 6-8 months and 1.7% knew about preventive role of BCG. Tendency to discriminate TB patients was evident from the findings e.g 71% respondents agreed upon isolating TB patients from the family, 74.1% on avoiding the patient in food sharing, on quitting job by the patient (33%), prohibiting marriage of the patient (27.6%), shunning him from attending social functions (18%), etc. Extensive health education directing towards attitudinal change by community involvement is needed to create awareness and remove myths about TB in such colonies.
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Many economic analyses of immunization programmes focus on the benefits in terms of public-sector cost savings, but do not incorporate estimates of the private cost savings that individuals receive from vaccination. This paper considers the implications of Bahl et al.'s cost-of-illness estimates for typhoid immunization policy by examining how community-level incidence estimates and information on distribution of costs of illness among patients and the public-health sector can be used in the economic analysis of vaccination-programme options. The findings illustrate why typhoid vaccination programmes may often appear to be unattractive to public-health officials who adopt a public budgetary perspective. Under many plausible sets of assumptions, public-sector expenditure on typhoid vaccination does not yield comparable public-sector cost savings. If public-health officials adopt a societal perspective on the economic benefits of vaccination, there are many situations in which different vaccination programmes will make economic sense. The findings show that this is especially true when public decision-makers recognize that (a) the incidence of typhoid fever is underestimated by blood culture-positive cases and (b) avoided costs of illness represent a significant underestimate of the actual economic benefits to individuals of vaccination.
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This investigation deals with the dietary intakes and growth in early childhood in poor communities. Five hundred and forty five children, 9-36 months of age, and their caretakers (mothers) were selected randomly and invited to participate in the study. The food and nutrient intake of children was assessed using a 10-item food frequency and amount questionnaire (FAQ). The anthropometric nutritional status was assessed by the indices height-for-age (H/A), weight-for-age (W/A), weight-for-height (Wt/Ht) and MUAC, according to Indian and NCHS standards. The results showed that the intake of cereals, pulses, roots, green leafy vegetables (GLVs), other vegetables, fruits, sugar, fats and oils among children was grossly inadequate. The nutrient intake for energy was 56% of the current RDA. Anthropometric analysis revealed that the children were grossly undernourished. Seventy five per cent children were underweight (<-2 SD), while 35% severely undernourished (<-3 SD). Approximately, 74% children were having short stature (chronic malnutrition) with 39% severely stunted. Nineteen per cent children were excessively thin (wasted). The data regarding the degree of malnutrition among children demonstrated that 9.6% girls in 9-36 months of age had severe malnutrition as compared to 6.5% males. The maximum prevalence of severe malnutrition was in the age 31-36 months (10%) followed by 9.6% in 13-18 months. The moderate degree of malnutrition was around 30 to 33% in age group 13-36 months. The evidence from the study provides a strong basis to suggest low food intake as the main cause of under/malnutrition and growth retardation (stunting) in early childhood in poor communities.