A tribute to aid workers.
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In the first 3 weeks after the 1976 earthquake in Guatemala a system for collecting, analysing, and disseminating information of medical importance was instituted in the disaster area. Data on cases of selected diseases, number of available hospital beds, and medical supplies were collected, and reported epidemics were investigated. The system functioned well despite the limited numbers of trained personnel. Collection and analysis were quick enough for data to be used immediately in decision-making. No epidemics of communicable diseases were observed in the affected area. The number of dog bites in Guatemala City increased but no cases of rabies were reported. The success of the surveillance system in Guatemala suggests that immediate use of epidemiological methods should be an integral part of disaster relief.
Weight-gain in 35 slightly undernourished Australian Aboriginal infants was studied in hospital (49 admissions) during a blind controlled trial of a pre-hydrolysed low-lactose milk preparation and reconstituted full-cream milk powder. Infants fed the lactose hydrolysed milk gained 70% more weight than those receiving normal milk. Better weight-gains were achieved in those on the lactose hydrolysed milk irrespective of percentage standard weight for age, the presence of diarrhoea on admission to the trial, and stool sugar concentrations. The use of low-lactose milk should be considered in nutritional aid programmes for undernourished children throughout the world.
In the disaster relief programme for Kampuchean refugees in Thailand, epidemiological techniques were incorporated into the health-planning process during the first 2 weeks of the refugee influx. The findings influenced not only health care in the first refugee camp but also the delivery of medical services in subsequent camps. The mortality rate in the first week of refugee settlement was 9.1/10 000/day, and fell to 0.71/10 000/day by the fifth week. Children aged 4 and under had the highest risk of death. Fever/malaria was the main cause of morbidity and mortality. Simple epidemiological techniques, if initiated early in the relief effort, can influence medical decisions and lead to more effective use of health resources.
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Drought and the cattle raiding associated with a breakdown of civil order caused a famine in Karamoja, Uganda, during 1980. In November-December, 1980, a study of mortality, nutritional status, and dietary conditions was undertaken in south Karamoja. Of 309 randomly selected children less than or equal to 110 cm in height 4.8% had acute malnutrition (less than 80% reference median weight-for-height). Interviews in 150 randomly selected households revealed that the crude mortality rate and the infant mortality rate during the previous year were increased almost 5-fold and 10-fold, respectively, above 1969 census data. Food supplied by the World Food Program was eaten the previous day by only half the families which were not self-sufficient in food. Relief officials' hopes that the 1981 cereal harvest might end the dependence on international aid were tempered by reports of further drought. Agricultural yield and food supplies should thus be monitored to assess the need for more international aid.
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Analyses of relief food used in Ethiopia showed that, because of food refinement, 6 out of 10 samples of cereals contained too little potassium and magnesium to cover daily needs. Malnutrition is often associated with gastrointestinal infections, which lead to further deficiency of these electrolytes. Potassium and magnesium are required for protein synthesis, growth, and tissue repair. Since protein supplies are often marginal, relief food should contain sufficient potassium and magnesium to allow optimum utilisation of dietary nitrogen sources. This may be achieved by using coarse qualities of cereals, by supplementing cereals with legumes, and by avoiding cooking procedures that extract these salts from the cereals.
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The Gaza Strip now has limited self-rule. Its people inherit a health-care system provided by four sectors--the Israeli government, the UN Relief and Works Agency, non-governmental organisations, and private facilities. They also inherit a legacy of health indices comparing unfavourably with those of Israel, huge numbers of refugees, a looming water crisis, civil unrest, and a health care expenditure bill (as a proportion of gross domestic product) that will be unsustainable. Four plans have been drawn up for health services in autonomous Gaza but none is exactly right.
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