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PubMed1990

Viral lower respiratory tract infections in Filipino children.

Viral causes of acute lower respiratory tract infection were studied prospectively between 15 June and 31 October 1984 in 312 Filipino children less than 5 years old living in periurban slums and middle-class housing. The cause was based on viral antigen detection, virus isolation, and antibody assays. There were 131 children (41.2%) who were admitted to the hospital, and 150 (47%) had an infiltrate on chest radiograph. A total of 198 viral infections were confirmed in 162 patients (51.9%), 42.3% with single viral infection and 9.6% with mixed (two or more) infection. The infections were measles (21.4%), influenza A (15.9%), parainfluenza types 1, 2, and 3 (8.8%), respiratory syncytial virus (7.1%), influenza B (5.8%), enteroviruses (5.1%), adenoviruses (3.9%), herpes simplex virus (1.6%), and cytomegalovirus (1.3%). Viral infections other than measles were seen in 39.7% of the cases. The presence of viral infection correlated with better nutritional status. Influenza A or B diagnosis was associated with mild forms of acute respiratory tract infection, measles and a preceding rash with severe disease.

Acute Disease↗
PubMed1992

Epidemic meningococcal disease in Nairobi, Kenya, 1989. The Kenya/Centers for Disease Control (CDC) Meningitis Study Group.

An epidemic of meningococcal disease occurred in Nairobi, Kenya, during 1989, outside the "meningitis belt" of sub-Saharan Africa. About 3800 cases occurred between April and November (250/100,000 population). The case-fatality rate was 9.4% among hospitalized patients. Areas that included Nairobi's largest slums had particularly high attack rates. The epidemic displayed an unusual age distribution, with high attack rates among those 20-29 years old. A vaccination campaign was conducted. By early January, the weekly case count had fallen to 25 from a high of 272 (in September). A case-control study estimated the vaccine efficacy to be 87% (95% confidence interval, 67%-95%). A model estimated that the vaccination campaign reduced the number of cases by at least 20%. Multilocus enzyme electrophoretic typing demonstrated that the strain responsible for this large epidemic is closely related to strains that caused other recent epidemics, documenting further spread of what may be a particularly virulent clonal complex of group A Neisseria meningitidis.

Adolescent↗
PubMed1995

Control of sexually transmitted diseases in Haiti: results and implications of a baseline study among pregnant women living in Cité Soleil Shantytowns.

Women attending Haitian slum-based antenatal clinics were evaluated for sexually transmitted diseases (STDs): 110 (11%) of 996 were syphilis seroreactive, 313 (35%) of 903 had trichomoniasis, 110 (12%) of 897 had gonococcal or chlamydial cervical infection (or both), and 418 (47%) of 891 had at least one STD. Syphilis seroreactivity was associated with illiteracy (P = .007), lower socioeconomic status (P < .001), and a history of spontaneous abortion (P = .02). Of 663 evaluated sera, 56 (8%) had human immunodeficiency virus (HIV) antibodies. In multivariate analysis, positive HIV serostatus was associated with syphilis seroreactivity (P = .006), partner's unemployment (P = .002), and history of a previous sex partner (P = .04). Risk factors for gonococcal or chlamydial cervical infection were evaluated. Clinical assessment of cervical discharge, a World Health Organization algorithm, and a decision model based on local risk factors were 64%, 77%, and 89% sensitive, respectively, and 44%, 38%, and 43% specific, respectively, for predicting cervical infection. Alternative treatment approaches should be validated while waiting for affordable, simple, rapid, and accurate laboratory diagnostic tests for gonococcal and chlamydial cervical infections.

Abortion, Spontaneous↗
PubMed1999

Vitamin A administered with measles vaccine to nine-month-old infants does not reduce vaccine immunogenicity.

After a report of reduced seroconversion to measles in infants, aged 6 mo, given vitamin A with their measles vaccination, serious concerns were raised regarding the safety of the WHO's recommendation that infants be supplemented with vitamin A at the time of measles immunization. To determine the impact of coadministered vitamin A on the antibody response to measles vaccine given to infants aged 9 mo, the more common age for immunization in developing countries, we conducted a randomized, double-blind, placebo-controlled trial in an urban slum community in Delhi. Infants (618) were randomly allocated to receive 30 mg vitamin A or a placebo with the measles immunization. Antibodies to measles were measured by ELISA in serum samples obtained at before (baseline) and 12 wk after immunization. Overall, the seroconversion rates did not differ between vitamin A (89.5%) and placebo (87.6%) groups. There were no significant differences in the geometric mean titers in the two groups (ratio of geometric means, 1.19; 95% confidence interval, 0.97-1.46). Among malnourished infants, the geometric mean titer was significantly greater in the vitamin A group compared to the placebo group (ratio of geometric means, 1.57; 95% confidence interval, 1. 18-2.0), but seroconversion rates did not differ. There were no differences in seroconversion rates and geometric mean titers in the two study groups among the well-nourished children. These results indicate that 30 mg vitamin A does not reduce the immune response to the coadministered vaccine and, therefore, can be continued to be given safely in public health programs.

Antibody Formation↗
PubMed2000

Improving dietary intake to prevent anemia in adolescent girls through community kitchens in a periurban population of Lima, Peru.

Peru has high rates of iron deficiency anemia. The prevalence is 35% in nonpregnant women of fertile age and 24.7% in adolescent girls in slums of periurban Lima. The major cause of anemia is low intake of dietary iron. A community-based, randomized behavioral and dietary intervention trial was conducted to improve dietary iron intake and iron bioavailability of adolescent girls living in periurban areas of Lima, Peru. Results show that there was a change in knowledge about anemia and improved dietary iron intake in the 71 girls who completed the study compared with the 66 girls in the control group. Although the 9-mo. intervention was not sufficient to improve hemoglobin levels significantly, there appeared to be a protective effect in maintaining the iron status of girls in comparison with the control group.

Adolescent↗
PubMed2006

Acute phase protein levels, T. trichiura, and maternal education are predictors of serum zinc in a cross-sectional study in Bangladeshi children.

Zinc deficiency is a public health issue in Bangladesh. The objectives were to identify predictors of serum zinc concentration and to assess the prevalence of low serum zinc, in both the whole population, after correcting for the effect of serum C-reactive protein (CRP) (using multiple categories), and the healthy subgroup. A cross-sectional study was conducted among 579 apparently healthy 3-7 y old children from a Dhaka slum, Bangladesh. Using multiple linear regression, the effects of age, gender, serum CRP and alpha 1-antichymotrypsin, reported morbidity, Ascaris lumbricoides and Trichuris trichiura infections, parental education as well as stunting, underweight, and wasting on serum zinc were estimated. Serum zinc (mean +/- SD) was 9.7 +/- 1.1 micromol/L. Elevated serum CRP levels, T. trichiura infection, and stunting were negative predictors of serum zinc, whereas maternal education was a positive predictor. Compared with serum CRP <1 mg/L, CRP levels of 2 to <5, 5 to <10 and > or =10 mg/L were associated with 0.33, 0.73, and 0.89 micromol/L lower serum zinc, respectively. The prevalence of low serum zinc (<9.9 micromol/L) fell from 59.3 to 49.7% in the whole population, after correcting for the effect of CRP and was 50.0% in the healthy subgroup (CRP <2 mg/L). The prevalence of low serum zinc was high but overestimated due to the effect of the acute phase response. Interventions to address low serum zinc in Bangladesh are warranted. Controlling T. trichiura infection and improving maternal education may be important interventions. The use of multiple categories of acute phase proteins and cut-off values that indicate elevated levels warrant further research.

Acute-Phase Proteins↗
PubMed2001

Root shock: the consequences of African American dispossession.

Urban renewal was one of several processes that contributed to deurbanization of American cities in the second half of the 20th century. Urban renewal was an important federal policy that affected thousands of communities in hundreds of cities. Urban renewal was to achieve "clearance" of "blight" and "slum" areas so that they could be rebuilt for new uses other than housing the poor. Urban renewal programs fell disproportionately on African American communities, leading to the slogan "Urban renewal is Negro removal." The short-term consequences were dire, including loss of money, loss of social organization, and psychological trauma. The long-term consequences flow from the social paralysis of dispossession, most important, a collapse of political action. This has important implications for the well-being of African Americans. It also raises important questions about the strength and quality of American democracy.

Black or African American↗
PubMed1992

Evaluation of a controlled 6 months feeding trial on intake by infants and toddlers fed a high energy-low bulk gruel versus a high energy-high bulk gruel in addition to their habitual home diet.

The aim of this study was to determine the intake of 68 slum children (6-24 months old) pair matched for age and nutritional status who were fed an experimental energy dense (1.63 Kcal/ml) wheat flour gruel rendered low-viscosity with catalytic amounts of germinated wheat flour (Amylase-Rich Food, ARF) v. an identical high viscosity control gruel without ARF for a once-a-day ad lib feed in addition to the habitual home diet for a period of 180 days. The mean intake in the experimental group was 124 ml and 199 Kcal v. 31 ml and 50 Kcal in the control gruel group per child/day. The gruel feeds were well accepted and were complementary to the home diet (breastmilk plus some family diet which provided only 420-461 Kcal/day). The experimental and control gruels provided about 20 and 5 per cent of the food energy RDA, respectively. The protein RDA was nearly met by the home diet in both groups. The study demonstrated a simple means to greatly increase the food energy intake in this age group by offering high energy yet low bulk gruels with the help of the ARF technology.

Age Factors↗
PubMed1993

Evaluation of the impact on growth of a controlled 6-month feeding trial on children (6-24 months) fed a complementary feed of a high energy-low bulk gruel versus a high energy-high bulk gruel in addition to their habitual home diet.

Twenty-one pairs of slum children (6-24 months) were pair-matched for age and weight. The experimental group consumed a complementary feed of a high energy (1.63 Kcal/ml), but low bulk wheat gruel providing a mean 199 Kcal/child/day v. the control group which consumed an identical (1.63 Kcal/ml), but high bulk gruel providing a mean 50 Kcal/child/day for a period of 180 days. The home diet (breastmilk+family diet) provided about 470 Kcal/child/day in both groups. A comparative evaluation of growth at commencement and end of study demonstrated that: 1. weight, height, and velocity of growth in weight were significantly better in the experimental group; 2. a comparison by nutritional classifications (Indian Academy of Pediatrics and Waterlow) showed a greater benefit to the experimental group; 3. the energy intake per kg body weight was 73 and 62 Kcal, respectively, in the experimental and control groups at end of study. It is concluded that the much higher intake of the amylase-rich food (ARF) treated gruel in the experimental group was responsible for the substantially better growth.

Case-Control Studies↗
PubMed1993

Quantitation of salivary, urinary and faecal sIgA in children living in different conditions of antigenic exposure.

A sandwich-type ELISA was developed to quantify salivary, urinary and faecal secretory IgA (sIgA). The assay is based on binding of sIgA to microplates coated with anti-SC antibodies and reaction with peroxidase-labelled anti-IgA. The sensitivity of the technique was approximately 5 micrograms/L. Children, 1-6 years old (n = 142), were divided into two groups. Group 1 (n = 80) was composed of children living in a place with presumably low antigenic exposure conditions. Group 2 (n = 62) was composed of well-nourished (2A, n = 53) and malnourished children (2B, n = 9) living in a São Paulo slum with presumably high antigenic exposure. The subgroup 2A had salivary levels higher than group 1 and the ranges were similar to those found in the literature for older children and adults. The same subgroup presented a high incidence of undetectable faecal sIgA; their levels of urinary sIgA did not differ from group 1. The subgroup 2B did not have levels of salivary, urinary and faecal sIgA different from subgroup 2A. Our results suggest that environmental factors influence the ontogenesis of sIgA system.

Antibodies↗
PubMed1995

Antibody titre and avidity in saliva and serum are not impaired in mildly to moderately undernourished children.

Avidities and titres of serum IgA, IgM, IgG, and salivary IgA antibodies for poliovirus type 3, beta-lactoglobulin and E. coli O antigens were analysed in well-nourished (n=58) and mildly to moderately undernourished (n = 18) 1-7-year-old children, living in slums in São Paulo, Brazil, with irregular water supply and no sewage system. The serum titres of antibodies in the undernourished children were not statistically different from the well-nourished ones, except for the IgA anti-beta-lactoglobulin titres which were lower in the youngest undernourished group. In respect to avidity of the serum antibodies, no statistical difference was observed, except that the youngest undernourished children presented avidities of serum IgA anti-E. coli O antigens higher than those of the well-nourished children of the same age range. With respect to salivary titres and avidities no difference was observed between well-nourished and undernourished children. The fact that the undernourished children were not deficient in antibody amount or quality, as measured in this study, suggests that in this respect their immune system was not impaired.

Antibodies, Bacterial↗
PubMed2000

Risk factors for subclinical vitamin A deficiency in children under the age of 6 years.

The present study was carried out to investigate risk factors for subclinical vitamin A deficiency in children under 6 years of age in the urban slums of Nagpur, India. The study included 308 nonxerophthalmic children selected randomly from the study population. On the basis of conjunctival impression cytology the prevalence of subclinical vitamin A deficiency was estimated to be 35.7 per cent. The current study recognised a significant association between female gender, illiterate mother, lower socioeconomic status, more than two children under 5 years of age at home, undernutrition, history of diarrhoea, measles, acute respiratory infections, and subclinical vitamin A deficiency on univariate analysis. Logistic regression analysis identified significance of female gender, more than two children under 5 years of age at home, undernutrition, and measles in the outcome of subclinical vitamin A deficiency. Estimates of attributable risk proportions and population attributable risk proportions for significant and preventable risk factors confirmed their etiological and preventable role in subclinical vitamin A deficiency respectively.

Child↗
PubMed2005

Concurrent outbreak of leptospirosis and dengue in Mumbai, India, 2002.

This prospective study was undertaken to investigate the possibility of a concurrent outbreak of leptospirosis and dengue and to describe the clinical illnesses. From 20 June to 14 November 2002, children who presented to our hospital with a suspected diagnosis of leptospirosis or dengue were admitted. In every child with suspected leptospirosis, a screening latex agglutination test was carried out to detect anti-Leptospira antibodies. The diagnosis of leptospirosis was confirmed by a positive enzyme-linked immunosorbent assay (ELISA) test or microagglutination test. The diagnosis of dengue was confirmed by a positive IgM antibody capture ELISA test. Clinical features in the leptospirosis and leptospirosis-negative groups, and dengue and dengue-negative groups were analysed. Of 90 children screened, 15 (16.7 per cent) had leptospirosis. Two children with Weil's disease died and the remaining 13 responded well to intravenous penicillin. Five clinical features were significantly associated with leptospirosis, namely conjunctival suffusion (p=0.007), haemorrhage (p=0.020), abdominal pain (p=0.011), hepatosplenomegaly (p=0.044), and oedema (p=0.007). As the number of these five features concomitantly present increased, the chances of the child having leptospirosis also increased significantly (p<0.0001). Of 90 children screened, 16 (17.8 per cent) had dengue. All responded well to the treatment and went home. Two clinical features were significantly associated with dengue, namely arthralgia (p=0.020) and thrombocytopenia (p=0.001). If both these features were present, the chances of the child having dengue increased significantly (p=0.001). Our study shows that a concurrent outbreak of leptospirosis and dengue had occurred in the slums of Mumbai city.

Age Distribution↗
PubMedDate not supplied

Socioeconomic and cultural influence in the causation of burns in the urban children of Bangladesh.

This prospective case-control study was conducted on 105 consecutive cases admitted to the burn units of Dhaka Shishu Hospital and Dhaka Medical College Hospital. The same number of controls were selected randomly from the community and matched with respect to age group, sex, and location of residence within the defined metropolitan area during the period January to September 1997. Both the controls and cases were divided into three age groups. Group A (19 controls and 19 cases) included neonates and infants, group B included children from 1 to 4 years, and group C included children from 4 to 12 years. The mean age of the controls in group A was 8.42+/-3.86 months and in group B and C was 5.72+/-4.05 years. The mean age of cases in group A was 4.79+/-4.05 months and in group B and C was 5.08+/-2.87 years. A scoring system was used to analyze 14 socioeconomic and cultural factors, which indicated highly significant differences between controls and cases (P < 0.001), and also between male (P < 0.001) and female (P < 0.001) controls and cases. There were significant differences between controls and cases in group A (P < 0.001), group B (P < 0.01), and group C (P < 0.001). Differences were not significant between males and females within groups A, B, and C for cases or controls (P > 0.05). Regression analysis of the total scores for cases and controls indicated a negative correlation between burns and the socioeconomic variables included in the study. There were highly significant associations between burns and lack of alertness to burns among parents (P < 0.001), clothing of manmade fabrics (P < 0.001), and cooking equipment in the kitchen within reach of children (P < 0.001). There was a significant association between burns and illiteracy of the mother (P < 0.01), housing located in slums and congested areas (P < 0.01), illiteracy of the father (P < 0.02), presence of preexisting impairment in children (P < 0.05), presence of a history of burns among siblings (P < 0.05), and low economic status of the parents (P < 0.05). No significant associations were indicated between controls and cases with respect to number of children in the family (P > 0.1), family pattern (P > 0.1), conjugal bonding between parents (P > 0.5), and sibling's death and disability from burns (P > 0.5). It is evident that an increase in alertness to burns, easy availability of clothing of natural fabrics, keeping cooking equipment beyond the reach of the children, increased literacy among parents and children, and improvement in family income might decrease the incidence of burns in children.

Bangladesh↗
PubMed1995

Risk of diarrheal disease in Ecuadorian day-care centers.

To determine the risk for diarrheal disease (DD) in day-care centers (DCC) for children residing in a poor urban slum area of Quito, Ecuador, compared with that for children from the same environment but cared for in their own residential home (RH), a prospective age-, sex- and locale-controlled study of DD was conducted, including 115 children in DCC and 115 in RH, ages 12 to 42 months. The overall incidence of DD was 46/1000 child weeks. Diarrhea was more common in DCC than in RH (relative risk (RR), 1.75; 95% confidence interval (CI), 1.38 to 2.22; P < 0.001). Poor hygienic practices were more prevalent in DCC than in RH. The use of reused water for child handwashing before eating and for washing raw vegetables was associated with a higher risk of DD in DCC than in RH (RR = 4.08, CI 2.93 to 5.67, P < 0.001; RR = 3.90, CI 2.79 to 5.44, P < 0.001, respectively). These two practices were risk factors in the DCC (RR = 2.74, CI 2.08 to 3.68, P < 0.001; RR = 2.05, CI 1.55 to 2.71, P < 0.001, respectively) when compared with their absence in the same DCC. Shigella (RR = 3.58, CI 1.19 to 10.78, P < 0.02), Aeromonas (RR = 10.47, CI 1.35 to 81.05, P < 0.01), rotavirus (RR = 2.86, CI 1.87 to 4.39, P < 0.001) and Giardia (RR = 1.59, CI 1.00 to 2.59, P < 0.05) were more common in DCC than in RH. More than two-fifths of the Shigella and Aeromonas isolates were resistant to trimethoprim-sulfamethoxazole.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1997

Association of torovirus with acute and persistent diarrhea in children.

OBJECTIVE: To study the etiologic role of toroviruses as a cause of gastroenteritis in humans. METHODS: The design was a case-control study. We compared the rate of torovirus detection in fecal specimens from a selection of children with acute or persistent diarrhea and controls without diarrhea from a study of childhood diarrhea in an urban Brazilian slum. Stool samples were coded and tested in a blinded fashion for the presence of torovirus antigen by enzyme-linked immunosorbent assay, other enteropathogens, toxins and fecal leukocytes. RESULTS: Thirty-three children with acute diarrhea, 41 children with persistent diarrhea and 17 controls were enlisted in the study. Torovirus antigen was detected in 9 (27%) samples from children with acute diarrhea, 11 (27%) samples from children with persistent diarrhea and none of the samples from controls (P < 0.05). In addition the presence of enteroaggregative E. coli was associated with persistent diarrhea and the presence of Cryptosporidium oocysts was common although not significant (P = 0.08); torovirus and Cryptosporidium occurred in different subsets of samples, whereas torovirus and enteroaggregative Escherichia coli were commonly found in combination. CONCLUSIONS: These data indicate that toroviruses, alone or in combination with enteroaggregative E. coli, may play a pathogenic role in acute and possibly persistent diarrhea. Further studies are warranted to determine the etiologic role of toroviruses in gastroenteritis.

Acute Disease↗
PubMed2005

Leptospirosis.

PURPOSE OF REVIEW: Leptospirosis, a spirochaetal zoonotic disease, has been recognized as an important emerging infectious disease in the last 10 years. This review addresses the issues in the epidemiology, diagnosis and clinical management which confront public health responses, and highlights the progress made towards understanding the Leptospira genome, biology and pathogenesis. RECENT FINDINGS: Leptospirosis has spread from its traditional rural base to become the cause of epidemics in poor urban slum communities in developing countries. Mortality from severe disease forms, Weil's disease and severe pulmonary haemorrhage syndrome, is high (>10% and >50%, respectively) even when optimal treatment is provided. Moreover, the overall disease burden is underestimated, since leptospirosis is a significant cause of undifferentiated fever and frequently not recognized. Barriers to addressing this problem have been the lack of an adequate diagnostic test and effective control measures. China and Brazil, countries in which leptospirosis is a major health problem, have completed the sequence of the Leptospira interrogans genome. Together with new genetic tools and proteomics, new insights have been made into the biology of Leptospira and the mechanisms used to adapt to host and external environments. Surface-exposed proteins and putative virulence determinants have been identified which may serve as sub-unit vaccine candidates. SUMMARY: Major progress has been made in the basic research of leptospirosis. Future challenges will be to translate these advances into public health measures for developing countries. Yet the most effective responses may be interventions that directly address the determinants of poverty, such as poor sanitation, which are often responsible for transmission.

Genome, Bacterial↗
PubMed2000

The urban poor in Dhaka City: their struggles and coping strategies during the floods of 1998.

Bangladesh experienced one of the worst floods in recorded history in 1998. This paper focuses on the needs and coping strategies of the urban poor in Dhaka City, which had been very badly affected. The city's roads were completely under water, and most areas were water-logged with drainage and sewage systems blocked. Rising water levels compelled many slum dwellers to move to temporary shelters and relief camps. Women and children were the worst affected. The lack of sanitation facilities and privacy forced women and children to defecate in their own homes. There was an acute scarcity of safe drinking-water, and food prices rose dramatically. Diarrhoea, fever and colds were the most common illnesses affecting the poor. The floods left many of them unemployed, and in some families, the result was increased tension and incidents of domestic violence. In some areas, members felt pressured to repay micro-credit loans. Most NGOs, however, suspended loan repayments. During this period, a committee was set up to co-ordinate and work towards addressing some of the main post-flood problems.

Adaptation, Psychological↗