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PubMed2006

[Evaluation of antenatal peregrination in a sample of postpartum women in Rio de Janeiro, Brazil, 1999/2001].

The access to obstetric care in the city of Rio de Janeiro, Brazil, was evaluated in this study. The aim of this article was to determine the social, demographic and obstetric factors associated with the antenatal search for health services, in a sample of 6,652 postpartum women. It was observed that 1/3 of patients have to search for services in more than one hospital, not uncommonly in 3 or more. It is important to consider that only 1/5 of these patients are transferred by ambulance. The factors associated with this peregrination were: place of residence, birth weight, age, skin color, marital status and residence in places where garbage is not picked up. There was no association with schooling; Kotelchuck modified index, obstetric risk, water source and residence in slums.

Adolescent↗
PubMed2006

Drug consumption and violence in female work Zapallal--Lima/Peru.

The study design was descriptive, correlational, cross-sectional, and qualitative. The objective was to identify sociodemographic and labor risk factors for drug consumption and types of violence in the workplace related to drug consumption, as well as to understand the perception of female workers regarding the relationship between drug consumption and workplace violence. We surveyed 125 women workers of four slums in the area of Zapallal, Lima, Peru, interviewing 16 women who experienced workplace violence. Among the participants, 52.8% consumed alcohol and 6.4% illegal drugs. Catholic women were at risk for consuming alcohol, while participants under 20 years of age were at risk for consuming illicit drugs. In this group, 17.6% of the women experienced verbal violence, 9.6% physical violence and 1.6% were sexually harassed in the workplace. Women victims of verbal violence have a risk for consuming illicit drugs. These women perceived themselves as a vulnerable group for violence in the workplace and weak for defending themselves. They expressed fear or shame in reporting cases of violence.

Adolescent↗
PubMed1993

A developing country's university oriented toward strengthening health systems: challenges and results.

OBJECTIVES: The Aga Khan University in Karachi has a mission to educate leaders and to contribute to the development of health systems for Pakistan amid challenges of scarcity and complexity. METHODS: Its key activities are (1) to design and test urban and rural health system prototypes, (2) to develop faculty in medical and nursing postgraduate community health sciences programs, and (3) to design and implement community-based undergraduate medical and nursing curricula. RESULTS: The university has developed equity-based, cost-effective primary health care prototypes in Karachi slums. With government counterparts it has tested village-, facility-, and district-level interventions in a poor rural district. Federal policymakers have taken models from each for widespread replication. The university is training 49 medical and 19 nursing faculty for postgraduate programs in community health sciences. Most faculty retain institutional leadership positions, including teaching community-based, problem-solving, community health sciences as 20% of the medical and nursing undergraduate curriculum. CONCLUSIONS: The mission and experience of the Aga Khan University in population-based health systems design and health sciences education can guide universities in both developing and developed countries.

Child, Preschool↗
PubMed1999

Income inequality and homicide rates in Rio de Janeiro, Brazil.

OBJECTIVES: This study determined the effect of income inequality on homicide rates in the state of Rio de Janeiro, Brazil. METHODS: We conducted an ecological study at 2 geographical levels, municipalities in the state of Rio de Janeiro and administrative regions in the municipality of Rio de Janeiro. The association between homicide and income inequality was tested by multiple regression procedures, with adjustment for other socioeconomic indicators. RESULTS: For the municipalities of Rio de Janeiro State, no association between homicide and income concentration was found an outcome that can be explained by the municipalities' different degrees of urbanization. However, for the administrative regions in the city of Rio de Janeiro, the 2 income inequality indicators were strongly correlated with the outcome variable (P < .01). Higher homicide rates were found precisely in the sector of the city that has the greatest concentration of slum residents and the highest degree of income inequality. CONCLUSIONS: The findings suggest that social policies specifically aimed at low-income urban youth, particularly programs to reduce the harmful effects of relative deprivation, may have an important impact on the homicide rate.

Adolescent↗
PubMed1999

The unwritten story of women's role in the birth of occupational health and safety legislation.

Women's role in the formation of trade unions and development of collective bargaining, as well as in labor's historical struggle to improve day-to-day working conditions, has been conspicuously underplayed, if not ignored. Yet, when one reviews the history of the reduction of working hours, prohibition of child labor, elimination of homework in tenement slums, reform of factory legislation, and investigations into accidents precipitating early workers' compensation legislation, the literature is rich with women's investigative reports and studies on unhealthy and unsafe working conditions. This was the case from the late 19th century in North America up until the 1950s and the Cold War. The women's movement and political activities requiring factory reforms then seemed to go underground, re-emerging in full force during the 1960s. Women's involvement in the environmental movement, especially in the United States, has been significant in politicizing occupational health as well. Their efforts led to the 1970 passage of the U.S. Occupational Health and Safety Act.

Canada↗
PubMedDate not supplied

[Use of pacifiers in children: patterns and determinants].

Although pacifiers are commonly used by Brazilian children and are potentially harmful, there are no studies about their patterns and determinants. These were investigated in a cross-sectional study of 354 children under two years of age living in two slum areas of Pelotas, southern Brazil. Most children (79%) were pacifiers users, 15% had never used them, and 6% had used them in the past. Among users, 38% spent most of the time sucking a pacifier. For two-thirds of the children, pacifiers were offered on the very first day of life. Pacifier use was most common among younger children,among those of low-schooling mothers and among non-breastfed infants.

English Abstract↗
PubMed1988

Evaluation of community-based rehabilitation in Punjab, Pakistan: I: Use of the WHO manual, 'Training disabled people in the community'.

The WHO community-based rehabilitation programme has been tested in a village and a slum area in Pakistan. House-to-house surveys by physicians identified medical diagnoses and impairments and handicaps according to the ICIDH. Volunteer local supervisors from the communities were taught to identify and train disabled persons according to the CBR manual. The effect of training was evaluated after 1-2 years by an occupational therapist, using questions from the same manual. Of the 82 persons followed up, 80% showed improvement in function. The prevalence of disablement identified by the local supervisors and of handicap identified by a physician agreed well, and was of the order of 5%.

Community Health Services↗
PubMed1981

The single drug user and his audience.

Observations on youth life in a slum of Tel-Aviv revealed a situation in which one youngster smokes hashish while he is surrounded by his nonuser friends. Symbols of reliance on friends are the essence of this interaction. The situation denies a group pressure on this drug user. The individual's needs in social bonds, expressed in the interaction, suggests a direction for an intervention program focused on the drugged personal needs.

Adolescent↗
PubMed2005

Grip strength as an index for assessment of nutritional status of children aged 6-10 years.

The purpose of this study was to evaluate the use of grip strength as an index of nutritional status in 6-10 y old children. Seven hundred and eighty seven children (364 boys and 423 girls) in the age group of 6 to 10 y were selected from private and municipal schools, orphanages and slums in the cities of Mumbai and Pune, India. Grip strength was measured using the dominant hand. Height, weight, mid-arm circumference and triceps skinfold were also measured in all subjects. A significantly high correlation (p<0.01) was observed between grip strength and age for both sexes. Boys had a higher grip strength than girls at all ages. Grip strength was significantly correlated with height, weight, mid arm circumference, triceps skinfold, arm fat and arm muscle areas (p<0.01). Stepwise multiple regression analyses showed height, weight, triceps skinfold and age to be independent variables influencing grip strength. Grip strength was found to be a specific measure of lean body mass (75 to 94%), but sensitivity was quite low (about 25%). The positive predictive value was variable, ranging from 54.6 to 21.5%. The specificity, sensitivity and positive predictive values were very high when compared with arm muscle area. Grip strength may have a potential value as an additional test for nutritional assessment in field situations and clinical settings.

Body Height↗
PubMed2004

Environmental exposure and leptospirosis, Peru.

Human infection by leptospires has highly variable clinical manifestations, which range from subclinical infection to fulminant disease. We conducted a population-based, cross-sectional seroepidemiologic study in Peru to determine potential relationships of environmental context to human exposure to Leptospira and disease associated with seroconversion. Three areas were studied: a flooded, urban slum in the Peruvian Amazon city of Iquitos; rural, peri-Iquitos villages; and a desert shantytown near Lima. Seroprevalence in Belen was 28% (182/650); in rural areas, 17% (52/316); and in a desert shantytown, 0.7% (1/150). Leptospira-infected peridomestic rats were found in all locales. In Belen, 20 (12.4%) of 161 patients seroconverted between dry and wet seasons (an incidence rate of 288/1,000). Seroconversion was associated with history of febrile illness; severe leptospirosis was not seen. Human exposure to Leptospira in the Iquitos region is high, likely related both to the ubiquity of leptospires in the environment and human behavior conducive to transmission from infected zoonotic sources.

Adolescent↗
PubMed2005

Egg positive rate of Enterobius vermicularis and Taenia spp. by cellophane tape method in primary school children in Sivas, Turkey.

The aim of the present study was to find out the number of students with enterobiasis and/or taeniasis in primary schools of Sivas. Among the 2,029 students in 6 primary schools, 316 (15.6%) were positive to Enterobius vermicularis eggs and 32 (1.6%) were positive to Taenia spp. eggs by the cellophane tape method. The egg positive rates of E. vermicularis and Taenia spp. ranged from 9.4% to 27.2% and from 0.8% to 2.6% respectively among six schools. The egg positive rate of E. vermicularis was found to be significantly different among these schools (chi2 = 31.96, P < 0.05), whereas there was no significant difference between the schools for Taenia spp. (chi2 = 4.37; P > 0.05). The rate (18.7%) of E. vermicularis in the urban slum regions was higher than the rate (11.5%) in the urban central regions (chi2 = 19.20; P < 0.05). Above results demonstrate that the egg positive rate of E. vermicularis and Taenia spp. was still prevalent among primary school children.

Animals↗
PubMed1993

Is anemia an accurate predictor of vitamin A status in Pakistani children?

Serum retinol and hemoglobin levels were determined in 532 children aged 6-60 months living in urban slums of Karachi, Pakistan. Overall 67% (358 of 532) of children had hemoglobin levels of less than 11 g/dl, the World Health Organization definition of anemia for this age group. Estimations for red blood cell indices (hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red blood cell count) were done on a sample of 391 children to classify anemia morphologically. A similar percentage (69.8% [273 of 391 children]) of anemia was found in this group. The anemia was predominantly microcytic and hypochromic. Normocytic normochromic anemia was present in only 16.5%. Serum retinol levels were significantly correlated with hemoglobin (P < 0.002), hematocrit (P < 0.01), and red blood cell (P < 0.001) levels. However, anemia was found to be a poor predictor (positive predictive value [PPV] = 2.5%) for the presence of vitamin A deficiency (retinol < 10 micrograms/dl). The PPV increased to 54% if 20 micrograms/dl, which is an indicator of marginal vitamin A status, was used as the cutoff point. The sensitivity of the hemoglobin test was found to be 75% in correctly identifying vitamin A deficiency when retinol levels of 10 micrograms/dl and 20 micrograms/dl were both used as the cutoff points for deficiency. The specificity for the hemoglobin test varied from 33% to 40% when levels of 10 micrograms/dl and 20 micrograms/dl were used as the cutoff points for vitamin A deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1993

Mycoplasma pneumoniae and Chlamydia trachomatis in acute lower respiratory infections in Filipino children.

The role of Mycoplasma pneumoniae and Chlamydia trachomatis in acute lower respiratory infection (ALRI) was studied by serologic analysis of 216 Filipino children less than five years old living in periurban slums and middle-class neighborhoods. Diagnostic antibody responses to M. pneumoniae and C. trachomatis were observed in 18 (8.3%) and five (4.3%), respectively, of the cases with ALRI. These bacteria are not susceptible to the antimicrobial treatments currently recommended for the treatment of ALRI in developing countries.

Acute Disease↗
PubMed1997

Isolation of Cryptosporidium parvum and Cyclospora cayetanensis from vegetables collected in markets of an endemic region in Peru.

Cryptosporidium parvum and Cyclospora cayetanensis are protozoan pathogens that cause prolonged diarrhea in both immunocompetent and immunocompromised hosts. Cryptosporidium parvum can be transmitted via the fecal-oral route, while the exact mechanisms of transmission of Cyclospora cayetanensis have not been fully determined. Humans appear to be the sole host for the latter and a distinct seasonality has been observed in endemic areas around the world. Samples of vegetables were collected at several small markets in a periurban slum in Peru during the seasons of high and low incidence. The vegetables were washed, the supernatants were collected and centrifuged, and the pellets were resuspended in a solution of 2.5% potassium dichromate. Pellets were examined using direct microscopic observation, acid-fast staining, and immunofluorescent assays for C. parvum and Cyclospora cayetanensis oocysts. Samples were collected during three time periods: the season of low incidence, the beginning of the season of high incidence, and end of the season of high incidence. Of the total vegetables examined, 14.5% contained C. parvum oocysts and 1.8% had Cyclospora oocysts. Thus, market vegetables may provide a route by which Cryptosporidium and Cyclospora can be transmitted. Our study also suggests that washing vegetables does not completely remove Cryptosporidium and Cyclospora oocysts.

Animals↗
PubMed1999

Prevalence and immune response to Entamoeba histolytica infection in preschool children in Bangladesh.

Entamoeba histolytica infection was present in 5% and E. dispar in 13% of asymptomatic 2-5-year-old children from an urban slum of Dhaka, Bangladesh. Entamoeba dispar-infected children were no more likely than uninfected children to have serum antibodies to lectin. In contrast, all children infected with E. histolytica had serum antibodies to lectin. This anti-lectin response included antibodies against the carbohydrate recognition domain, which have been demonstrated in animal models to confer passive protection from amebiasis. Antibodies to lectin persisted in the sera of 17 children with E. histolytica infection over one year of follow-up, during which time E. histolytica infection cleared without treatment in 15, and with anti-amebic medication in two. We conclude that half of the children in this population have serologic evidence of amebiasis by five years of age, and that an anti-lectin serum antibody response is associated with limitation of E. histolytica infection to the colon.

Animals↗
PubMed2001

Household epidemiology of Entamoeba histolytica infection in an urban community in northeastern Brazil.

The natural history of infection with Entamoeba histolytica was studied in 2 slum communities in northeastern Brazil. Twenty-eight index patients colonized with E. histolytica were identified. Three stool specimens from the index patients and their household contacts were gathered over a 45-day period and tested for E. histolytica by means of a specific enzyme-linked immunosorbent assay-based detection kit. The detection kit is an antigen capture assay that has been shown to be highly specific for E. histolytica and does not detect nonpathogenic Entamoeba dispar or other enteric organisms. Blood samples were also collected at the start of the study, at 45 days, and at 6 months and analyzed for E. histolytica-specific antibody. High rates of colonization were seen in the family units. Colonization was self-limited, with 85% of colonized patients clearing their infections within 45 days. Reinfection appeared to be low during this time; however, previous seropositivity did not prevent colonization.

Adolescent↗
PubMed2001

Determinants of immunisation coverage among children in Mathare Valley, Nairobi.

OBJECTIVE: To establish the factors that determine the levels of immunisation coverage among children under five years in Mathare Valley. DESIGN: A cross-sectional study describing the situation at a point in time. SETTING: Mathare Valley slum with a population of 50,000 people in the city of Nairobi. SUBJECTS: The study population was mothers with children under five years in Mathare Valley and had been resident there for a period not less than five years prior to the study. OUTCOME MEASURES: Level of immunisation coverage among children in the study population and the factors that contribute to the low immunisation coverage. RESULTS: Knowledge on immunisation was high with 90% of the respondents able to define immunisation. The attitude on immunisation was positive (74.4%) and immunisation coverage stood at 62.2%. Age, level of education, attitude and knowledge on immunisation among the residents were significant determinants of immunisation coverage. CONCLUSION: Immunisation coverage was lower than the national average in Mathare Valley. Advanced mother's age, low level of education and relative lack of knowledge on immunisation were responsible for the low coverage.

Child Health Services↗
PubMed2002

Bacteriological qualities of indoor and out-door drinking water in Kibera sub-location of Nairobi, Kenya.

OBJECTIVES: To compare the bacteriological quality of out-house (tank or standpipe) water and in-house drinking water (storage containers) and determine the risk factors influencing it. DESIGN: A cross-sectional study. SETTING: The study was carried out in Kibera slums located 7 km southwest from the Nairobi City centre. SUBJECTS: Water samples from twenty outside tanks/standpipes and sixty from in-house water storage containers. MAIN OUTCOME MEASURES: Pour plate method was used to enumerate total bacterial counts in water, while the multiple tube technique was used to determine faecal coliform (FC) and faecal streptococci (FS) numbers. A questionnaire and environmental observation were used to determine the risk factors influencing bacteriological quality of water. RESULTS: The mean total bacterial counts (TBC) for out-house water was 46.6 per 100 ml while that for in-house water was 818.2 per 100 ml. Faecal coliforms were isolated from 7 (35%) standpipes and 57 (95%) in-house storage containers. The mean faecal coliform count was 93 and 103.4 per 100 ml for out-house and in-house water, respectively. The counts were significantly higher in the latter. Faecal streptococci were isolated from 2 (10%) standpipes and 37 (61.7%) in-house storage containers. The mean faecal streptococci counts were 35 and 65 per 100 ml for out-house and in-house water sources, respectively. Escherichia coli was isolated in 2 (10%) of out-house water and 30 (50%) of in-house. Of these, four were enteropathogenic, serotype 011 from one out-house water source and serotypes 011, 011, 0112ac from in-house water sources. CONCLUSIONS: Bacteriological contamination of water at the source with a further deterioration between the collection points and homes was observed. A defective water delivery system and inadequate environmental sanitation were a potential source of contamination for out-house water. Scoops were a major source of contamination for stored water.

Colony Count, Microbial↗