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Seropositivity for and intestinal colonization with Entamoeba histolytica and entamoeba dispar in individuals in northeastern Brazil.

In a slum community in northeastern Brazil 20% of a sample population was colonized with Entamoeba histolytica or Entamoeba dispar and 10.6% was colonized with E. histolytica alone. No correlation between seropositivity for anti-Ga1NAc lectin antibody and colonization was found. These results suggest that colonization does not necessarily produce immunity to reinfection.

Acetylgalactosamine↗

Household and family characteristics of street children in Aracaju, Brazil.

AIMS: To describe the family background of street children in Aracaju, Brazil, their parents' perception of street life, and the reasons for the high prevalence of males observed among street children. METHODS: Cross sectional study using semi-structured interviews and qualitative focus group discussions with parents of purposively selected index street children. RESULTS: Fifty eight families were enrolled. Most participants were single parent, female headed families living in slums or low cost housing, with high levels of illiteracy, drug use, unemployment, and a history of migration. Most parents reported receiving financial support from their children and were aware of the dangers of the street. Many parents had lived in the street, worked from an early age, and had been adolescent parents themselves. Parents perceived that the street was more dangerous for girls than for boys. Besides economic reasons, parents highlighted the role of peers and drug use in pulling their children to the street. A total of 187 siblings were identified. Siblings had poor school performance with high school drop out rates. Twenty per cent of the adolescent girl siblings were not living at home. Gender determined the type of work undertaken by children and adolescents. Males worked in the streets and females worked as housemaids, shop assistants, and in restaurants and bars. CONCLUSION: Family disintegration, poverty, drug use, adolescent pregnancy, peer pressure, and socially constructed gender roles determine the characteristics of children in the street. There is an urgent need for increased social support in this area.

Adolescent↗

Solar disinfection of water for diarrhoeal prevention in southern India.

AIMS: To evaluate the efficacy and acceptability of solar irradiation in the prevention of diarrhoeal morbidity in children under 5 years of age, in an urban slum in Vellore, Tamil Nadu. METHODS: A total of 100 children were assigned to receive drinking water that had been subjected to solar disinfection in polyethylene terephthalate bottles. One hundred age and sex matched controls were also selected. Both groups were followed by weekly home visits for a period of six months for any diarrhoeal morbidity. At the end of the follow up period, the acceptability of the intervention was assessed by interviews, questionnaires, and focus group discussions. RESULTS: There was significant reduction in the incidence, duration, and severity of diarrhoea in children receiving solar disinfected water, despite 86% of the children drinking water other than that treated by the intervention. The incidence of diarrhoea in the intervention group was 1.7 per child-year, and among controls 2.7 per child-year, with an incidence rate ratio of 0.64 (95% CI -0.48 to 0.86). The risk of diarrhoea was reduced by 40% by using solar disinfection. In qualitative evaluation of acceptability, most women felt that solar disinfection was a feasible and sustainable method of disinfecting water. CONCLUSIONS: Solar disinfection of water is an inexpensive, effective, and acceptable method of increasing water safety in a resource limited environment, and can significantly decrease diarrhoeal morbidity in children.

Child, Preschool↗

Micronutrients (including zinc) reduce diarrhoea in children: the Pakistan Sprinkles Diarrhoea Study.

AIMS: To examine the effect of the daily use of micronutrients (including zinc) or the same micronutrients plus heat inactivated lactic acid bacteria (LAB), on diarrhoea in children compared to placebo. METHODS: A triple blind randomised clinical trial in an urban slum of Karachi, Pakistan. Micronutrients (including zinc), micronutrients (including zinc and LAB), or placebo, were provided daily for two months to 75 young children (aged 6-12 months) identified at high risk for diarrhoea related mortality on the basis of history of at least one episode of diarrhoea in the preceding two weeks. The longitudinal prevalence of diarrhoea was defined as the percentage of days a child had diarrhoea out of the days the child was observed. RESULTS: Mean longitudinal prevalence of diarrhoea in the micronutrient-zinc group was 15% (SD = 10%) child-days compared to 26% (SD = 20%) child-days in the placebo group and 26% (SD = 19%) child-days in the micronutrient-zinc-LAB group. The difference between the micronutrient-zinc-LAB and placebo groups was not significant. CONCLUSION: The daily provision of micronutrients (including zinc) reduces the longitudinal prevalence of diarrhoea and thus may also reduce diarrhoea related mortality in young children; heat inactivated LAB has negative effects in these children.

Diarrhea, Infantile↗

Impact of massive dose of vitamin A given to preschool children with acute diarrhoea on subsequent respiratory and diarrhoeal morbidity.

OBJECTIVE: To assess the impact of vitamin A supplementation on morbidity from acute respiratory tract infections and diarrhoea. DESIGN: Double blind randomised placebo controlled field trial. SETTING: An urban slum area in New Delhi, India. SUBJECTS: 900 children aged 12-60 months attending a local health facility for acute diarrhoea of less than seven days' duration randomly allocated to receive vitamin A 200,000 IU or placebo. MAIN OUTCOME MEASURES: Incidence and prevalence of acute lower respiratory tract infections and diarrhoea during the 90 days after termination of the enrolment diarrhoeal episode measured by twice weekly household surveillance. RESULTS: The incidence (relative risk 1.07; 95% confidence interval 0.92 to 1.26) and average number of days spent with acute lower respiratory tract infections were similar in the vitamin A supplementation and placebo groups. Among children aged 23 months or less there was a significant reduction in the incidence of measles (relative risk 0.06; 95% confidence interval 0.01 to 0.48). The incidence of diarrhoea was also similar (relative risk 0.95; 0.86 to 1.05) in the two groups. There was a 36% reduction in the mean daily prevalence of diarrhoea associated with fever in the vitamin A supplemented children older than 23 months. CONCLUSIONS: Results were consistent with a lack of impact on acute lower respiratory tract related mortality after vitamin A supplementation noted in other trials and a possible reduction in the severity of diarrhoea.

Acute Disease↗

Simultaneous zinc and vitamin A supplementation in Bangladeshi children: randomised double blind controlled trial.

OBJECTIVE: To evaluate the effect of simultaneous zinc and vitamin A supplementation on diarrhoea and acute lower respiratory infections in children. STUDY DESIGN: Randomised double blind placebo controlled trial. SETTING: Urban slums of Dhaka, Bangladesh. PARTICIPANTS AND METHODS: 800 children aged 12-35 months were randomly assigned to one of four intervention groups: 20 mg zinc once daily for 14 days; 200 000 IU vitamin A, single dose on day 14; both zinc and vitamin A; placebo. The children were followed up once a week for six months, and morbidity information was collected. RESULTS: The incidence and prevalence of diarrhoea were lower in the zinc and vitamin A groups than in the placebo group. Zinc and vitamin A interaction had a rate ratio (95% confidence interval) of 0.79 (0.66 to 0.94) for the prevalence of persistent diarrhoea and 0.80 (0.67 to 0.95) for dysentery. Incidence (1.62; 1.16 to 2.25) and prevalence (2.07; 1.76 to 2.44) of acute lower respiratory infection were significantly higher in the zinc group than in the placebo group. The interaction term had rate ratios of 0.75 (0.46 to 1.20) for incidence and 0.58 (0.46 to 0.73) for prevalence of acute lower respiratory infection. CONCLUSIONS: Combined zinc and vitamin A synergistically reduced the prevalence of persistent diarrhoea and dysentery. Zinc was associated with a significant increase in acute lower respiratory infection, but this adverse effect was reduced by the interaction between zinc and vitamin A.

Acute Disease↗

Influence of socioeconomic conditions on air pollution adverse health effects in elderly people: an analysis of six regions in São Paulo, Brazil.

STUDY OBJECTIVE: To evaluate if the effects of particulate matter (PM(10)) on respiratory mortality of elderly people are affected by socioeconomic status. DESIGN: Time series studies. The daily number of elderly respiratory deaths were modelled in generalised linear Poisson regression models controlling for long term trend, weather, and day of the week, from January 1997 to December 1999, in six different regions of São Paulo City, Brazil. The regions were defined according to the proximity of air pollution monitoring stations. Three socioeconomic indicators were used: college education, monthly income, and housing. MAIN RESULTS: For a 10 micro g/m(3) increase in PM(10), the percentage increase in respiratory mortality varied from 1.4% (95% CI 5.9 to 8.7) to 14.2% (95% CI 0.4 to 28.0). The overall percentage increase in the six regions was 5.4% (95% CI 2.3 to 8.6). The effect of PM(10) was negatively correlated with both percentage of people with college education and high family income, and it was positively associated with the percentage of people living in slums. CONCLUSIONS: These results suggest that socioeconomic deprivation represents an effect modifier of the association between air pollution and respiratory deaths.

Aged↗

A study of the health conditions of child workers in a small scale leather industry in Calcutta.

Forty male children aged between seven and 14 years, working in small scale leather workshops in a slum locality in Calcutta were studied, along with a control group of 40 non-working male children of the same age group, same locality, and the same socioeconomic class. Three specific health problems--namely, low back and ankle pain, dizziness, and tingling pain in the hands were found in a significantly higher proportion in the working children. For height, weight, nutritional state, and general morbidity pattern, however there were no significant differences between the two groups. Possibly the particular sitting posture of the child workers for long working hours and the chemical nature of the glue and solvents used in this industry were responsible for the manifestations in the working children.

Adolescent↗

Association between mite allergen (Der p 1, Der f 1, Blo t 5) levels and microscopic identification of mites or skin prick test results in asthmatic subjects.

BACKGROUND: Mite allergens have been involved in airway sensitization and allergic diseases. Immunoassays for the identification and quantifiction of house dust mite (HDM) allergens are useful to improve the knowledge of regional mite fauna and the remediation of mite allergens in allergic diseases. The present study analyzed the association between levels of HDM allergen and results of mite identification or skin prick test (SPT) in two different areas of Bahia, Brazil. METHODS: Forty-two asthmatic subjects from a rural area (group I; n = 21) and a slum (group II; n = 21) were evaluated through SPT with HDM allergens and had dust samples collected at their homes for mite identification and allergen measurements. RESULTS: Positive SPT to Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis allergens were observed in 42.9, 38.0 and 42.9% subjects from group I and in 47.6, 19.0 and 33.3% subjects from group II, respectively. D. pteronyssinus and B. tropicalis were identified in approximately 76 and 50% of samples from both groups, respectively. D. farinae was identified in 38.0 and 9.5% of samples from groups I and II, respectively (p < 0.005). Der p 1, Der f 1 and Blo t 5 detection were associated with mite identification (p < 0.05). Association between HDM allergen levels over 2 microg/g of dust and positive SPT occurred only with D. pteronyssinus (p < 0.0001). CONCLUSIONS: D. pteronyssinus was the most prevalent mite species in this study followed by B. tropicalis and D. farinae. Immunoassays done to measure mite allergens were associated with mite-species identification. We conclude that these three mite species must be included on panels for the diagnosis of allergic airway diseases in subjects living in such regions.

Adolescent↗

Bronchoconstriction in helminthic infection.

In order to determine whether infection by helminthic parasites can be associated with a state of bronchoconstriction, we evaluated the response to the inhalation of a bronchodilator before and after long-term anthelmintic treatment of children in a urban slum of Caracas, Venezuela. In untreated children, a direct association was found between the degree of helminthic infection and the increase in peak expiratory flow rates caused by the bronchodilator. The elimination of the infections was accompanied by a significant decrease in response to the bronchodilator. These results indicate that helminthic infection could contribute to the development of asthmatic conditions in areas where these parasites are endemic.

Albuterol↗

Nutritional needs assessment of rural agricultural migrants of southern Brazil: designing, implementing and evaluating a nutrition education program.

A nutritional needs assessment was conducted among rural agricultural migrant women (target group) and children (less than 5 years). The study was conducted in Vila Diogo, a slum located on the periphery of Nuporanga, a village in Sao Paulo state, Brazil. A nutrition education program was designed on the basis of evidence obtained from demographic/socioeconomic information of the study population and a nutritional needs assessment of women (target group) and children less than 5 years of age. The nutritional needs assessment consisted of anthropometry, dietary assessment, and nutrition knowledge, attitudes, and beliefs questionnaires. Formative and summative evaluation of the nutrition education program, using appropriately selected criteria and comparisons of nutrition knowledge scores before and after the program, were used to determine program effectiveness. Major findings of the study were: Diets of Vila Diogo residents were generally simplistic, consisting primarily of rice, beans, and coffee with sugar. Vila Diogo women appeared to be at a relatively high risk for vitamin A, iron, calcium, ascorbic, and riboflavin deficiencies, based on comparisons of 24-hour dietary intake data with FAO recommendations. Children (2-5 years) appeared at high risk for vitamin A, iron, and ascorbic acid deficiencies, based on comparisons of 24-hour dietary intake data with FAO recommendations. All children less than 5 years of age had been breast-fed at birth, but more than one half of children had been weaned by the third month. Infant feeding practices during fever and diarrhea were nutritionally detrimental. Women generally recognized a relationship between dietary intake during pregnancy and fetal nourishment. Using weight-for-height index, a significant number of women were probably undernourished; a small percentage of women, however, were overweight or obese. Although children less than 5 years of age did not generally appear malnourished, a relatively large number were stunted in growth. Although Vila Diogo women reported many food taboos during various physiological states (menstruation, pregnancy, immediately post partum, lactation), relatively few food taboos had potentially negative nutritional consequences. For women who participated in the nutrition education program, nutrition knowledge scores after the program showed improvement which was statistically significant at alpha = 0.05, using Wilcoxon signed rank test.

Brazil↗

Assessment of nutritional status using anthropometric methods on 1-4 year old children in an urban ghetto in Lagos, Nigeria.

This study assessed the nutritional status using anthropometry of 1-4 year old children in an urban slum in the Mushin Local Government Area of Lagos State, with a view to determining the impact of urbanization on child health. A total of 365 children were enrolled using multistage random sampling techniques. Anthropometric measurements used were weight and height. Height-for-age, weight-for-height, and weight-for-age Z-scores below -2.00 SD of the reference NCHS standard were used to define stunting, wasting and underweight, respectively. The study revealed a prevalence of underweight of 39.2%, stunting of 34.5% and wasting of 21.9%. The mean of weight-for-age, height-for-age, weight-for-height and mid-upper-arm-circumference were less than the mean of the NCHS reference population. This difference might be due to the socio economic backgrounds of the two populations. Using the modified Wellcome Classification of malnutrition, 37.8% of the children were malnourished. Most subjects came from homes with inadequate water supply and poor refuse disposal methods.

Anthropometry↗

Network of communities in the fight against AIDS: local actions to address health inequities and promote health in Rio de Janeiro, Brazil.

When combined with major social inequities, the AIDS epidemic in Brazil becomes much more complex and requires effective and participatory community-based interventions. This article describes the experience of a civil society organisation, the Centre for Health Promotion (CEDAPS), in the slum communities (favelas) of Rio de Janeiro, Brazil. Using a community-based participatory approach, 55 community organisations were mobilised to develop local actions to address the increasing social vulnerability to HIV/AIDS of people living in squatter communities. This was done through on-going prevention initiatives based on the local culture and developed by a Network of Communities. The community movement has created a sense of "ownership" of social actions. The fight against AIDS has been a mobilising factor in engaging and organising communities and has contributed to raising awareness of health rights. Local actions included targeting the determinants of local vulnerability, as suggested by health promotion workers.

Acquired Immunodeficiency Syndrome↗

[Fighting cholera in shanty-town. Successful experience of a Quebec project adapted to Peru].

Originally designed in Quebec, the MOI project was a collaboration between two professors of social work from Quebec and two members of the Peruvian NGO called SUR in Villa de Salvador, one of poorest slum areas on the outskirts of Lima. The approach is founded on the notion that the body is the primary instrument through which a person can interact with the world around him or her, and that the physical and mental health of an individual exists within the context of healthy conditions of life that must include at least a basic social and health infrastructure as well as healthy hygiene practices on the part of individuals, families and the local community. Preschool children (ages 4-6), study a different part of the body and its proper care each week through classroom observation games. Parents' help is requested to modify unhealthy conditions, at the same time to enrich the children's experience and to mobilize the community to improve health conditions. During the 1991 cholera epidemic, not a single case was counted in the experimental district, despite its clearly socio-economically impoverished status, and despite the fact that the Ministry of Health recorded 86,650 cases in the Lima-Callao district, accounting for about 40% of the total number of cases in the Peru. The prior work made it easier to explain how cholera is spread and what special new measures needed to be taken in addition to the hygiene habits already taught.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The structure of health and illness in a Brazilian favela.

The purpose of this study was to describe the understanding of health and illness within the culture of women living in a favela (urban slum) in southeastern Brazil. The methodology described by Spradley structured the study. Interviews were conducted with 10 informants, and multiple interviews were conducted with the key informant. Analysis yielded a taxonomic structure for the domains of health and illness. Six components play a part in both health and illness: cleanliness, nutrition, doctor visits, herbal remedies (tomar cha), sympathetic magic, and spirituality. Attention to the six components is believed to be necessary in maintaining health. The indigenous components of health can be integrated into health teaching to enhance correspondence between nursing care and the worldview of favela residents.

Brazil↗

Poverty: the main cause of ill health in urban children.

Being poor is in itself a health hazard; worse, however, is being urban and poor. Much worse is being poor, urban, and a child. But worst of all is being a street child in an urban environment. This article will provide some background on the status of street children on a global basis, make linkages between street children and their frequent condition as working and exploited children, and detail the health impacts of the increasing poverty concentrated in poor urban slums and squatter settlements. Although some specific information on street children is provided, the social and economic factors that have a negative impact on the well-being of the broader population of poor, urban children are analyzed. The division between street children and their urban poor counterparts still living within some sort of family support system cannot be sharply defined. Programs and strategies that have been successful in improving the health and well-being of poor children in general and street children in particular are discussed.

Child↗

Description of breastfeeding practices among poorer sections in Calcutta Metropolitan Area and its impact on postpartum infecundity.

Descriptions of breastfeeding practices among residents in slum areas of Kolkata and the influence of breastfeeding on postpartum amenorrhoea is the focus of this study. Three out of four women initiate breastfeeding after one hour of birth and three out of five women squeeze the first milk from the breast before breastfeeding. Though the median duration of breastfeeding is long, the duration of exclusive breastfeeding is much shorter. Breastfeeding during the first six months has a significant negative influence on the rate of return to menses.

Amenorrhea↗

Do street food vendors sell a sufficient variety of foods for a healthful diet? The case of Nairobi.

This study examined whether street food vendors sell a sufficient variety of foods for a healthful diet. It was hypothesized that vendors sold only low-cost food groups to enable the buyer to afford the food while the vendor also made a profit. A structured questionnaire was administered to 580 vendors in three selected locations. Data included product names, ingredients, methods of preparation, and the sex of the vendor. A little more than half of the vendors (53%) sold food of only one group; 44% sold cereals. Overall, 36% of vendors, mostly men, sold only carbohydrate products. The percentage of vendors selling foods of more than one group was higher in the working area (53%) than in the slum area (43%, p < .05), and it was higher in both of these areas taken together than in the lower-middle income area (21%, p < .001). Micronutrient and mixed-nutrient products were associated with female vendors. Although a slight majority of all street vendors sell foods of only one group, women vendors are capable of supplying a sufficient variety of food groups that consumers can afford. It appears that consumer purchasing power dictates the food groups provided by vendors, especially cereal-based-foods. A policy on micronutrient fortification of cereal flours and fats used in popular street food preparation needs to be considered. This could be coupled with consumer and vendor education programs focusing on the importance of healthful diets.

Africa South of the Sahara↗