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PubMed1997

Rise in sexually transmitted diseases during democratization and economic crisis in Mongolia.

In 1990, democratic changes and loss of Soviet economic subsidies led to enormous social upheaval in Mongolia. The objective of this study is to map sexually transmitted disease (STD) trends in Mongolia from 1983-1995 and review human immunodeficiency virus (HIV) surveillance data since 1987. Data for syphilis show a decreasing trend from 1983-1993 with a decline in cases from 70 to 18/100,000 population, followed by a rise in cases to 32/100,000 population in 1995. Data suggest a 1.5-3.0 fold higher rate of syphilis for ages 15-24 than for any other group. Data for gonorrhoea show an upward trend in the rate of cases, from 51/100,000 population in 1983 to 142/100,000 in 1995. The majority of cases are aged 15-44. Trichomonas rates also show an upward trend in the number of cases, from 47/100,000 population in 1983 to 155/100,000 cases in 1995. Like gonorrhoea the majority of cases are in the 15-44 year age range. For children aged 0-14, the 1983-1993 rate remained below 4.5/100,000; however, in 1994 and 1995 the rate increased reaching 53 and 48/100,000 respectively. Since 1987, more than 176,000 HIV tests have been done with only one confirmed positive result. Rises in STD rates coincide with deterioration in STD services and reduced active surveillance, suggesting that these data reflect a minimum estimation of the problem. Changes in business and social circumstances may have resulted in increasing HIV and STD risk behaviour.

Adolescent↗
PubMed1997

The use of wide-mesh gauze impregnated with lambda-cyhalothrin covering wall openings in huts as a vector control method in Suriname.

An alternative vector control method, using lambda-cyhalothrin impregnated wide-mesh gauze covering openings in the walls of the houses was developed in an area in the Eastern part of the interior of Suriname. Experimental hut observations showed that Anopheles darlingi greatly reduced their biting activity (99-100%) during the first 5 months after impregnation. A model assay showed high mortality both of mosquitoes repelled by the gauze as well as of those that succeeded in getting through it. A field application test in 270 huts showed good acceptance by the population and good durability of the applied gauze. After introducing the method in the entire working area, replacing DDT residual housespraying, the malaria prevalence, of 25-37% before application dropped and stabilized at between 5 and 10% within one year. The operational costs were less than those of the previously used DDT housespraying program, due to a 50% reduction in the cost of materials used. The method using wide-mesh gauze impregnated with lambda-cyhalothrin strongly affects the behavior of An. darlingi. It is important to examine the effect of the method on malaria transmission further, since data indirectly obtained suggest substantial positive results.

Animals↗
PubMedDate not supplied

Distribution and trends of HIV infection in blood donors of four metropolitan cities.

Screening for HIV infection has been made mandatory for every unit of blood collected for transfusion in major cities of the country, having facilities for such screening. Results of HIV screening among blood donors received from the 4 Metropolitan cities of Delhi, Bombay, Calcutta and Madras have been analysed year wise from 1989 to 1991 to determine the magnitude and trends of HIV infection in different categories of blood donors and the seropositivity rates seems to be increasing over time. Universal coverage of HIV screening for donated blood has not been fully achieved and the justification and urgency for achieving complete coverage is highlighted.

Adult↗
PubMed1992

Rising trend of HIV infection with special reference to blood donors.

This paper describes the experience in testing for antibodies to the human immunodeficiency virus (anti-HIV) at a private institution. A total of 31,003 persons were tested between August 1986 and June 1990 including 20, 321 blood donors. The other 10,712 were visitors to the Ohso International Commune (OIC), a commune for followers of Osho Rajneesh. Another 133 patients, 45 of whom had been repeatedly transfused, were also tested. Thirty two persons tested positive-22 blood donors, 4 visitors to OIC and 6 patients. The seropositivity of unselected blood donors was O of 273 donors in 1986, 1 of 2836 in 1987 (0.04%), 2 of 5373 in 1988 (0.04%), 11 of 7201 in 1989 (0.15%) and 8 of 4640 in the first half of 1990 (0.17%). Since non-professional blood donors represent a sample of the general population, a rise in seropositivity in the former may imply a rise in the latter.

Adult↗
PubMed1989

Human immunodeficiency virus type 1 (HIV-1) infection among female prostitutes in Borno State of Nigeria: one year follow-up.

Serological investigations on female prostitutes resident in Borno State in northeastern Nigeria have shown that the seroprevalence of HIV-1 infection has increased 9.81%--fold in one year. The highest sero-prevalence rates were found amongst prostitutes who had not benefited from previous health education campaigns. Prostitution appears to be on the increase in spite of AIDS probably because of the difficulty in finding alternative means of making a living. Attempts to halt the spread of HIV infection are hampered by the fact that most prostitutes are indifferent to the use of condoms and do not appreciate the importance of protecting themselves from the risks of HIV infection. Their frequent mobility also poses a problem as it makes it difficult for them to benefit from health education campaigns. The prevalence of HIV-1 infection among female prostitutes in Borno State (as indeed in other States in Nigeria) is likely to rise sharply in the next few years unless serious efforts are made to intensify health education campaigns targeted at the high risk groups.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Integrating health services into an MCH-FP program in Matlab, Bangladesh: an analytical update.

This is a follow-up to a 1984 study that analyzed the relationship between areal variation in the contraceptive prevalence time series and in the intensity of maternal and child health (MCH) services of the Matlab Family Planning Health Services Project. Results based on 69 months of observation suggested that the addition of MCH components to a program with basic MCH and comprehensive family planning services had no incremental impact on family planning efficacy. However, basic MCH services, involving clinical back-up to family planning and child care since the beginning of the program in Matlab, may have contributed to clients' faith in the clinic staff and the overall efficacy of the Matlab program. In the 18 months that followed the cut-off date for this analysis, contraceptive prevalence increased markedly in the study areas. The present analysis repeats the earlier one for the extended time series to determine if the intensification of health services in Matlab contributed to this secondary increase in prevalence, and to ascertain whether the MCH service regimes have long-run differential impacts. Results for the 87-month time series are similar to those of the previous analysis, suggesting that the introduction of additional MCH inputs in the Matlab service area over the 1982-83 period had no incremental impact on the contraceptive prevalence rate time trend.

Bangladesh↗
PubMedDate not supplied

Integrating health services into an MCH-FP program: lessons from Matlab, Bangladesh.

Since 1977 the International Centre for Diarrhoeal Disease Research, Bangladesh, has conducted a field experiment in family planning and MCH in its Matlab research station. The project began with an emphasis on family planning and MCH services were added in stages. This paper uses time series regression methods to address the question of whether the addition of health services contributed to family planning efficacy in Matlab in a program launched with minimal MCH services. The results show that some MCH interventions increased contraceptive prevalence, some decreased it, and others had no effect. The broader significance of these findings for implementing integrated programs is discussed.

Bangladesh↗
PubMedDate not supplied

The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania.

A national household survey of 4,861 women aged 15-44 on reproductive health issues was conducted in Romania in 1993. The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. After abortion became legal, the total fertility rate dropped to below replacement level, while the induced abortion rate doubled. Contraceptive prevalence increased 20 percent, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70 percent of the increase. Limited sex education and contraceptive information, mistrust and misinformation about modern methods, a lack of adequately trained providers, and a shortage or uneven distribution of contraceptive supplies are major reasons for the continued high rates of unintended pregnancy.

Abortion, Induced↗
PubMed1994

Effort and achievement in national family planning programmes.

New data show that national family planning programmes have made impressive progress in the last 25 years. Fertility rates have been reduced dramatically, but during the current decade even greater achievements will be called for.

Family Planning Services↗
PubMed1993

Role of primary health care in the control of schistosomiasis. The experience in Riyadh, Saudi Arabia.

The control programme for schistosomiasis in Saudi Arabia was started in 1975 as a central vertical programme. With the adoption of the primary health care approach a pilot scheme that integrated the control of all endemic diseases, including schistosomiasis, within the functions of primary health care centres was carried out. In Riyadh, the scheme was started in 1984 when subcentres for the control programme were established as a first step for complete integration. A training programme was extended to personnel in primary health care centres, including physicians, nurses, and health inspectors with the help of experts from World Health Organization (WHO). A survey of the population at risk in areas with high prevalence was done regularly accompanied by treatment of cases. Snail control was an important activity of the health inspectors with a three months repeat of the control procedures. The result of this programme is a significant reduction in the prevalence of both urinary and intestinal schistosomiasis, from 13.2% in 1983 to 0.17% in 1989. Among the 7453 water sources surveyed in 1989, only 7 were positive for snails (0.1%). About two thirds of those who were affected were expatriates coming from areas of high prevalence of schistosomiasis. Details of the control programme and its impact on the control of the disease are presented in this paper.

Animals↗
PubMed1994

HIV infection among pregnant women. A worsening situation in Maiduguri, Nigeria.

A serosurvey of 1,233 pregnant women aged 15-41 years, and attending antenatal clinics in Maiduguri, Nigeria from July 1991 to February 1993 showed that 28 (2.3%) of the women were positive for HIV antibodies. Twenty-four (1.9%) were positive for HIV-1 only, 1 (0.08%) was positive for HIV-2 only and 3 (0.24%) were reactive for both HIV-1 and HIV-2. The overall seroprevalence rose gradually from 2.1% in 1991 to 2.3% in 1992, and to 2.6% so far in 1993. From July 1992 to February 1993 6 children aged 24 hours to 8 months were found HIV-positive in the same hospital where this survey was carried out. The only known risk factor for HIV infection applicable to the pregnant women studied was heterosexual intercourse.

Adolescent↗
PubMed1994

Lessons from Cuba: mass campaign administration of trivalent oral poliovirus vaccine and seroprevalence of poliovirus neutralizing antibodies.

The immunogenicity of trivalent oral poliovirus vaccine (TOPV), which is less effective in tropical than in temperate areas, may potentially be improved in several ways, including increasing the number of doses. Little information is available on TOPV when more than 6 doses are given. The situation in Cuba provides a unique opportunity to relate the seroprevalence of neutralizing antibodies to the dose of TOPV because Cuba has not reported culture-confirmed poliomyelitis since 1973 and TOPV is only administered in twice yearly 1-week mass immunization campaigns. Sera from 2000 children nationwide were studied for neutralizing antibody among children who received 0, 2, 4, 6 and 8 doses of TOPV. These doses were administered in the period 1989-91, when TOPV (from the USSR) was being used with 500,000, 200,000, and 300,000 median tissue-culture-infecting doses (TCID50) for types 1, 2 and 3, respectively--the 5:2:3 formulation. Seroprevalence of neutralizing antibody after two TOPV doses was 91.5% for type 1, 90.8% for type 2, and 45.9% for type 3. Seroprevalence of type-3 neutralizing antibody after 6 doses remained low (73.4%), but increased to 83.5% after 8 doses (P < 0.05). Although 16.5% of the children remained unprotected for type-3 infection even after 8 doses, mass campaign immunization strategies were sufficient to eradicate the transmission of wild poliovirus in Cuba. Because the seroprevalence of type-1 neutralizing antibody was high (91.5%) after two campaign doses, additional studies using different formulations are needed to determine whether simultaneous improvement in the type-3 response to two campaign doses can be achieved.

Antibodies, Viral↗
PubMed1993

Schistosomiasis mansoni in Burundi: progress in its control since 1985.

Described is the evolution of the schistosomiasis control programme in Burundi since 1985. A single round of selective population chemotherapy was carried out in the Rusizi Plain and the Bugesera focus from 1985 to 1990. The prevalences and intensities of infection as well as the number of symptomatic cases detected in general health services decreased considerably. Annual sample surveys in the treated areas showed, however, that these improvements were rapidly reversed by reinfection of the demographically changing population. Since repeated selective population chemotherapy was not sustainable in the long term, a primary health care approach was adopted. In areas with good access to basic health services, approximately 10% of all schistosomiasis cases now receive treatment annually through this approach. Yearly selective chemotherapy in primary schools in suburban Bujumbura reduced the prevalence of schistosomal infection among pupils from 23% to 9% over the period 1984-90, and this programme has now been extended to highly endemic areas in Imbo-Sud. Focal snail control produced disappointing results, and emphasis has therefore shifted towards health education and environmental control of transmission.

Adolescent↗
PubMed1996

Trends in HIV-1 and HIV-2 prevalence and risk factors in pregnant women in Harare, Zimbabwe.

The spread of the human immunodeficiency virus (HIV) and the resulting morbidity and mortality are major public health challenges with adverse social and economic implications. The pregnant population serves as an important marker of the extent of the problem in the sexually active low risk categorized population. Furthermore, a high HIV prevalence among women of childbearing age contributes to neonatal and infant mortality through perinatal transmission and also a large number of uninfected children become orphans. The objective of the present study was to determine the HIV prevalence rate and the risk factors in pregnant women attending antenatal care clinics in the Greater Harare area of Zimbabwe. Women presenting for antenatal care in four maternity clinics between May 1994 and June 1995 were tested for HIV-1 and HIV-2 antibodies following informed consent, counselling and completion of a questionnaire. Of the 1.168 women, 30.4 pc tested HIV-1 positive, with prevalence rates ranging from 23.6 pc at a lower density clinic, 28.6 pc in a medium density clinic, 30.7 pc in a higher density clinic and 33.2 pc at the referral maternity hospital. HIV-2 was present in 7.6 pc of the women. The 20 to 29 years age group had the highest HIV prevalence of 35 pc, (Odds Ratio (OR) = 2.4; 95 pc CI-1.33 to 4.32). Single pregnant women were more likely to test positive, (OR = 2.1; 95 pc CI = 1.2 to 3.7). Thirty five pc of the women reported previous use of condoms and in those where condom use was reported in casual relationships, there was a higher risk of HIV (OR 6.1; 95 pc CI = 2.1 to 17.3). Reported use of intravaginal herbs was associated with HIV risk (OR 1.4; 95 pc CI = 1.1 to 1.8; p < 0.03). History of genital ulcer (OR = 2.3), discharge (OR = 2.4), rash (OR = 2.7), genital ulcer with PID (OR = 5.8) was significantly associated with HIV infection. Present findings indicate a 30.4 pc HIV prevalence rate for a sample of 1,168 pregnant women in Harare. This rate is much higher than the 18 pc HIV prevalence rate reported for 1,008 pregnant women in the same Greater Harare area in 1990. We conclude that there is need for further innovative and aggressive community based as well as institutional interventions aimed at reducing HIV risk. Prevention strategies should include a wide range of socially contextualized initiatives.

Adolescent↗
PubMed1996

The epidemiology of HIV-1 infection in Peru, 1986-1990.

OBJECTIVE: To determine the extent of the HIV-1 epidemic in Peru. DESIGN: Part of a national serosurvey in Peru. METHODS: Between January 1986 and December 1990, 140,976 serum samples were tested for HIV-1 antibody. RESULTS: HIV-1 antibody was found in a high percentage of serum samples provided by 4300 homosexual men (26%), 2204 male sexually transmitted disease patients (10%), 145 drug users (13%), 269 hemophiliacs (10%), and 146 unlicensed female prostitutes (10%). In addition, the prevalence of HIV-1 infection increased substantially among these groups between the beginning and end of the survey period. A low but rising prevalence of HIV-1 antibody was found during this period among serum samples provided by 83,526 blood donors and 11,101 military personnel:total period prevalence, 0.25 and 0.32%, respectively. CONCLUSION: These data indicate that HIV-1 infection is epidemic in Peru among groups at high risk of sexually and parenterally transmitted diseases, and that the risk of infection appears to be low but possibly increasing among the general population.

Disease Outbreaks↗
PubMed1996

Marked reduction of anemia during pregnancy over a 10-year period in Montserrat.

Anemia during pregnancy is associated with adverse outcomes including maternal and perinatal mortality. However, health education and other public health strategies seeking to reduce its prevalence have usually met with only limited success. The study reported here surveyed anemia of pregnancy on the island of Montserrat in 1980, 1985, and 1990. This involved examination of clinic and hospital records for over 90% of all women giving birth on Montserrat in 1980 and 1985, as well as 80% of those giving birth in 1990. This examination showed a dramatic reduction in the prevalence of anemia at the time of the first prenatal visit (a drop from 82% of the study women in 1980 to 23% in 1985 and 19% in 1990) and also a marked drop at three days postpartum (from 91% in 1980 to 41% in 1985 and 39% in 1990). Logistic regression analyses indicated that after controlling for three possible confounding factors (maternal age, parity, and weeks of gestation at first prenatal visit) the difference between the risk of developing anemia during pregnancy in 1980 as compared to 1985 or 1990 was still highly significant. The reasons for the observed drop in anemia's prevalence during the survey period are not entirely clear, partly because of the retrospective nature of the study. However, better nutrition resulting from improvement in the standard of living on Montserrat during the survey period could have been important, as could changes in health education and food supplementation activities.

Adolescent↗