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PubMed1989

Inflammatory bowel disease in rural sub-Saharan Africa: rarity of diagnosis in patients attending mission hospitals.

One hundred and eighteen missionaries working on 75 mission stations or hospitals in 24 sub-Saharan African countries provided information about their medical practice in the preceding year of 1981. Details were collected of the total number of patients seen and admitted during the year, and the number of cases of bloody diarrhoea, typhoid and inflammatory bowel disease. Over 1 million outpatients and about 190,000 inpatients were treated. These included 12,859 cases of bloody diarrhoea, of whom 1,914 had typhoid. Twenty-two cases of inflammatory bowel disease were also reported. Histological support was least available in West Africa and only 25% of hospitals had access to this facility. Nevertheless, the frequency with which inflammatory bowel disease in sub-Saharan Africa is difficult and limited by access to diagnostic facilities. It is likely to be some time before reliable estimates of the incidence and prevalence of Crohn's disease and ulcerative colitis in the rural African population can be made.

Africa, Eastern↗
PubMed2003

Implementation of WHO guidelines on management of severe malnutrition in hospitals in Africa.

OBJECTIVE: To investigate the problems, benefits, feasibility, and sustainability of implementation of WHO guidelines on management of severe malnutrition. METHODS: A postal survey invited staff from 12 African hospitals to participate in the study. Five hospitals were evaluated and two were selected to take part in the study: a district hospital in South Africa and a mission hospital in Ghana. At an initial visit, an experienced paediatrician reviewed the situation in the hospitals and introduced the principles of the guidelines through a participatory approach. During a second visit about six months later, the paediatrician reviewed the feasibility and sustainability of the introduced changes and helped find solutions to problems. At a final visit after one year, the paediatrician reassessed the overall situation. FINDINGS: Malnutrition management practices improved at both hospitals. Measures against hypoglycaemia, hypothermia, and infection were strengthened. Early, frequent feeding was established as a routine practice. Some micronutrients for inclusion in the diet were not locally available and needed to be imported. Problems were encountered with monitoring of weight gain and introducing a rehydration solution for malnutrition. CONCLUSION: Implementation of the main principles of the WHO guidelines on severe malnutrition was feasible, affordable, and sustainable at two African hospitals. The guidelines could be improved by including suggestions on how to adapt specific recommendations to local situations. The guidelines are well supported by experience and published reports, but more information is needed about some components and their impact on mortality.

Africa↗
PubMed2004

'Wanted: 16 nurses of the better educated type': provision of nurses to South Africa in the late nineteenth and early twentieth centuries.

This paper is based on research in progress focusing on the histories of mission hospitals in the rural communities of KwaZulu Natal, while also building on earlier research into the pluralism of medical systems within the South African Cape. Sources have been drawn from a range of historical documents, including medical and nursing journals, the archives of a number of medical missionary societies and of the Overseas Nursing Association, but the research has also been informed by oral histories of a broad cross-section of health professionals who practised in South Africa. A large literature search included a number of biographies and institutional histories. The paper will be divided into three parts--the first provides a brief background to colonialism and the early nursing history of South Africa; the second looks in more detail at the role played by missionary nurses in establishing nursing as a profession and providing training opportunities for African nurses. The final part contrasts missionary nursing with the supply of, and work done by nurses from the Overseas Nursing Association operating within their quite specific, colonial remit. This will show how the two contrasting professional spheres--one reflecting a fairly short-term commitment, the other, a much broader, 'vocational' involvement--may be seen to represent quite different colonial attitudes, and ultimately quite diverse outcomes.

Colonialism↗
PubMed1991

Assessment of risk for HIV-1 infection for missionaries in sub-Saharan Africa.

North American mission boards (N = 82) with programs in sub-Saharan Africa were surveyed to identify practices affecting risk of human immunodeficiency virus type 1 (HIV-1) infection among international staff. Thirty-four percent of participating boards thought risk for HIV-1 infection in missionaries in Africa was greater than it was for the general US population, and 53% considered it greater for overseas medical staff serving in the region than for domestic health care workers. Nevertheless, only 24% of boards had formal AIDS education programs for overseas health care workers, and 19% for nonmedical personnel going abroad. Medical care provision and acquisition were considered high-risk activities; 42% of boards with a known policy acknowledged that disposable injection equipment was routinely reused, 68% indicated that immunizations were provided abroad, and 60% admitted that inoculations were administered by indigenous health care workers. The most frequently cited specific suggestion for decreasing the risk of HIV-1 infection overseas was the implementation of a walking blood bank program. We conclude that current practices and logistic constraints make HIV-1 transmission possible. Risk reduction strategies include more comprehensive health education programs, greater adherence to universal precautions, less dependence on the indigenous Third World health care system, and implementation of innovative programs for health care delivery.

Acquired Immunodeficiency Syndrome↗
PubMed2000

[Early days of the Ocean Road Hospital in Dar es Salaam: from mission hospital to government hospital].

On 1 October 1997 Ocean Road Hospital in Daressalam commemorated one hundred years of its existence. As early as 1888 a provisional hospital had been set up in Zanzibar by the German Lutheran Church to serve the needs of the Germans living and working on the East African coast. But when the British established their protectorate over Zanzibar in 1890, the hospital was moved to Dar es Salaam. As cooperation between Mission hospital and Government authorities proved difficult, the German colonial administration was determined to build an hospital of its own. Lack of funds delayed the construction of the building which had to be built on a more modest scale than originally planned. But when the hospital was inaugurated in October 1897, people were impressed both by its functional usefulness and aesthetic attraction. The history of the German Government Hospital reflects the political context of the time as well as the progress of medicine in combatting endemic diseases. While patients were often segregated by race--the Government Hospital in Daressalam almost exclusively reserved for Europeans--all were benefitting from the results of medical science. For Robert Koch the hospital (and its laboratory) served as basis for his research in the field of malaria, black water fever, sleeping sickness, and relapsing fever. It was from Africa that the embarked on his journey to Stockholm to receive the Nobel Prize in December 1905. During the First World War Ocean Road Hospital, as it was called from now on, was taken over by the British. Since independence, the Tanzanians are in charge. It is presently the only tumor hospital of the country, closely cooperating with the German Cancer Research Center (DKFZ) in Heidelberg. Restoration of Ocean Road Hospital, completed at the beginning of this year, was made possible by a grant of the Federal Republic of Germany.

Endemic Diseases↗
PubMed2003

Protective association of genetic variation in alcohol dehydrogenase with alcohol dependence in Native American Mission Indians.

OBJECTIVE: Two alcohol dehydrogenase genes (ADH2 and ADH3 on chromosome 4) and one aldehyde dehydrogenase gene (ALDH2 on chromosome 12) exhibit functional polymorphisms. The goal of this study was to determine whether any associations exist between the ADH2, ADH3, and ALDH2 polymorphisms and alcohol dependence in a group of Native Americans. An additional goal was to determine if any associations exist between these polymorphisms and the endophenotype, maximum number of drinks ever consumed in a 24-hour period. METHOD: Mission Indian adults (N=340) were recruited for participation from reservations in southern California. Each participant completed an interview with the Semi-Structured Assessment for the Genetics of Alcoholism. A blood sample was collected from each participant for genotyping at the ALDH2, ADH2, and ADH3 loci. RESULTS: Sixty percent of all participants (72% of men and 53% of women) met lifetime DSM-III-R criteria for alcohol dependence. A significant difference in the ADH2 allele distributions was found between alcohol-dependent and non-alcohol-dependent participants. Those with alcohol dependence were significantly less likely to have the ADH2*3 allele (odds ratio=0.28) and significantly more likely to have the ADH2*1 allele (odds ratio=2.00) than those who were not alcohol dependent. Individuals with ADH2*3 reported a lower number of maximum drinks ever consumed in a 24-hour period, compared to those without this allele. CONCLUSIONS: These results are consistent with genetic linkage studies showing protective associations for alcohol dependence and related behavior on chromosome 4 and suggest that ADH2 polymorphisms may account for these findings. These results also highlight the utility of evaluating protective factors in populations with high rates of alcohol dependence.

Adolescent↗
PubMed1990

Inflammatory bowel disease in the rural Indian subcontinent: a survey of patients attending mission hospitals.

39 missionaries working at 38 separate mission hospitals or clinics in Bangladesh. India, Nepal and Pakistan completed questionnaires about their clinical practice during the previous year, 1980. Data were collected about gastrointestinal disorders, including coeliac disease, tropical sprue, bloody diarrhoea, amoebiasis, typhoid, cholera, inflammatory bowel disease and diverticular disease. More than 386,000 out-patients and over 56,000 in-patients were treated with an estimated 12,272 cases of bloody diarrhoea, 7,310 of amoebiasis, 2,113 of typhoid and 872 cases of intestinal tuberculosis, 74 cases of inflammatory bowel disease were diagnosed, of which 56 were ulcerative colitis and the remainder were said to have Crohn's disease. Surgery was performed in 28 hospitals, but only 10 (26%) had a histology service. Inflammatory bowel disease appears to be a relatively more common cause of diarrhoea in the Indian subcontinent than in sub-Saharan Africa (z = 5.47, p less than 0.001). The proportion of patients with bloody diarrhoea who have ulcerative colitis Crohn's disease was similar throughout the region. The rate of cases having ulcerative colitis rather than Crohn's disease was greater in India (z = 3.1, p less than 0.005), and in Bangladesh (z = 3.2, p less than 0.005), than in Pakistan (z = 1.28, NS) or Nepal and Bhutan (z = 0, NS). The relative risk of Indians developing ulcerative colitis rather than Crohn's disease is 2.6 (95% confidence limits 1.4-4.8, NS). This may reflect diagnostic difficulties in distinguishing Crohn's disease from intestinal tuberculosis, but it may also shed light on similar differences now being reported in migrant groups in Western Europe.

Bangladesh↗
PubMed2002

Preventing tuberculosis among health workers in Malawi.

OBJECTIVE: Following the introduction of guidelines for the control of tuberculosis (TB) infection in all hospitals in Malawi, a study was carried out to determine whether the guidelines were being implemented, the time between admission to hospital and the diagnosis of pulmonary TB had been reduced, and the annual case notification rates among health workers had fallen and were comparable to those of primary-school teachers. METHODS: The study involved 40 district and mission hospitals. Staff and patients were interviewed in order to determine whether the guidelines had been adopted. In four hospitals the diagnostic process in patients with smear-positive pulmonary TB was evaluated before and after the introduction of the guidelines, with the aid of case notes and TB registers. In all hospitals the proportion of health workers registered with TB before and after the guidelines were introduced, in 1996 and 1999, respectively, was determined by conducting interviews and consulting staff lists and TB registers. A similar method was used to determine the proportion of primary-school teachers who were registered with TB in 1999. FINDINGS: The guidelines were not uniformly implemented. Only one hospital introduced voluntary counselling and testing for its staff. Most hospitals stated that they used rapid systems to diagnose pulmonary TB. However, there was no significant change in the interval between admission and diagnosis or between admission and treatment of patients with smear-positive pulmonary TB. The TB case notification rate for 2979 health workers in 1999 was 3.2%; this did not differ significantly from the value of 3.7% for 2697 health workers in 1996 but was significantly higher than that of 1.8% for 4367 primary-school teachers in 1999. CONCLUSION: The introduction of guidelines for the control of TB infection is an important intervention for reducing nosocomial transmission of the disease, but rigorous monitoring and follow-up are needed in order to ensure that they are implemented.

Adolescent↗
PubMed1999

Medical surveillance of multinational peacekeepers deployed in support of the United Nations Mission in Haiti, June-October 1995.

BACKGROUND: Multinational peacekeepers, both military and civilian, often deploy to areas of the world where significant health threats are endemic and host country public health systems are inadequate. Medical surveillance of deployed personnel enables leaders to better direct health care resources to prevent and treat casualties. Over a 5-month period, June to October 1995, a medical surveillance system (MSS) was implemented in support of the United Nations Mission in Haiti (UNMIH). Information obtained from this system as well as lessons learned from its implementation and management may help decrease casualty rates during future multinational missions. METHODS: Over 90% of UNMIH personnel (80% military from over 11 countries and 20% civilian from over 70 countries) stationed throughout Haiti participated in the MSS. A weekly standardized reporting form included the number of new outpatient visits by disease and non-battle injury (DNBI) category and number of personnel supported by each participating UN medical treatment facility (MTF). Previously, medical reporting consisted of simple counts of patient visits without distinguishing between new and follow-up visits. Weekly incidence rates were determined and trends compared within and among reporting sites. The diagnoses and numbers of inpatient cases per week were only monitored at the 86th Combat Support Hospital, the facility with the most sophisticated level of health care available to UN personnel. RESULTS: The overall outpatient DNBI incidence rate ranged from 9.2% to 13% of supported UN personnel/week. Of the 14 outpatient diagnostic categories, the three categories consistently with the highest rates included orthopaedic/injury (1.6-2.5%), dermatology (1.3-2.2%), and respiratory (0.9-2.2%) of supported UN personnel/week. The most common inpatient discharge diagnoses included suspected dengue fever (22.3%), gastro-enteritis (15%), and other febrile illness (13.5%). Of the 249 patients who presented with a febrile illness, 79 (32%) had serological evidence of recent dengue infection. Surveillance results helped lead to interventions that addressed issues related to field sanitation, potable water, food preparation and vector control. CONCLUSIONS: Despite hurdles associated with distance, language, and communications, the MSS was a practical and effective tool for UNMIH force protection. UN requirements for standardized medical surveillance during deployments should be developed and implemented. Furthermore, planners should recognize that if ongoing medical surveillance and related responses are to be effective, personnel should be trained prior to deployment and resources dedicated to a sustained effort in theatre.

Female↗
PubMed1984

St. Peter Claver.

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Black or African American↗
PubMed2006

"Evolutionist and missionary," The Reverend John Thomas Gulick (1832-1923). Part I: cumulative segregation--geographical isolation.

During the late 19th and early 20th centuries, the American missionary and naturalist John Thomas Gulick (1832-1923) was one of the most well-known and influential evolutionists, anticipating in his research and writing, later proposals of geographical isolation, population genetics, genetic drift, and the founder principle in speciation. In over 20 publications based on studies of non-adaptive geographical variation in several hundred species of snails in the genus Achatinella, collected in the valleys of Oahu in the Sandwich Islands (Hawaii), Gulick provided evidence for the formation of new species from varieties and the importance of geographical (non-adaptive) isolation in species diversification. Gulick's theory of the species-differentiating effects of isolation was regarded by many as a more complete theory of speciation than Darwin's, and by others as correcting a fundamental deficiency in Darwin's theory, namely how groups of organisms diversify one from another. Gulick also saw organisms as active participants in, and in interaction with, their environment, for which he coined the term coincident selection, anticipating the Baldwin effect/organic selection. With his concepts of cumulative segregation (geographical isolation), indiscriminate isolation (the Founder effect) and coincident selection (the Baldwin effect), we should recognize Gulick as one of the earliest and most original and innovative evolutionary biologists.

Animals↗