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PubMed2001

Exclusive breast-feeding is rarely practised in rural and urban Morogoro, Tanzania.

OBJECTIVE: To investigate and compare feeding practices among infants of less than 7 months of age in a rural and an urban area in Tanzania. DESIGN: Cross-sectional, questionnaire-based interview of mothers and focus group discussions with extension workers and community leaders. SETTING: Eleven villages in a rural district and 10 wards in an urban district in the Morogoro region, Tanzania, west of Dar es Salaam. SUBJECTS: Probability samples of mothers with infants of less than 7 months of age from each area). RESULTS: Exclusive breast-feeding was rarely practised in either the rural or urban areas investigated. However, the urban mothers initiated breast-feeding earlier, discarded colostrum less frequently, breast-fed exclusively for a longer period, gave breast milk as the first feed more often and delayed the introduction of solid foods for longer than their rural counterparts. The rural mothers, on the other hand, breast-fed their previous infants slightly longer than the urban mothers. CONCLUSIONS: The better performance of urban mothers could be partly due to sustained breast-feeding support in hospital settings and other campaigns which may not have reached the rural areas. In both the rural and urban areas more efforts are needed to encourage exclusive breast-feeding, to avoid premature complementation and, in the case of the urban areas, to protect extended breast-feeding.

Adult↗
PubMed2006

Viral etiology of pneumonia in a cohort of newborns till 24 months of age in Rural Mirzapur, Bangladesh.

Limited information is available on the etiology of acute lower respiratory infection (ALRI) particularly pneumonia in the rural community of developing countries since most etiological studies are carried out in the hospital settings. This study examined the etiology of pneumonia among young children in a rural community of Bangladesh. A cohort of 252 newborns was followed till 24 months of age during 1993-1996. Community health workers (CHWs) identified cases of ALRI during household surveillance and recommended hospitalization. On admission, nasopharyngeal aspirates (NPA) and blood were collected for bacterial and viral identification, and chest x-rays were done. Multiple regression analysis identified factors associated with a viral etiology. Physicians diagnosed 67 pneumonia; 45% of NPA were positive for viral agents of pneumonia, and respiratory syncytial virus (RSV) was predominant (81%); 6 of 48 blood cultures were positive. X-ray was done for 58 cases; 52% had pneumonic consolidation. Of the RSV cases, 33% were found in children without pneumonic consolidation. Children living in a one-room house were 3 times more likely to develop viral pneumonia (odds ratio (OR) = 3.67, CI 1.05-12.83) than children living in a larger house. Counseling on avoiding crowding where a newborn is accommodated might reduce pneumonia incidence.

Bangladesh↗
PubMed1988

Travellers' diarrhoea among children returning to the United Kingdom from visits abroad.

Between January 1984 and March 1986, 10 children aged between 7 and 56 months were admitted to Queen Elizabeth Hospital for Children in London with chronic travellers' diarrhoea, after visiting the Indian subcontinent, France or Morocco. All the children were born in the United Kingdom and had been in good health before their journey abroad. On return to England most of these children were malnourished and two of them (twins) had a post-infective, tropical malabsorption-like syndrome. There was a high incidence of positive stool cultures and, on small intestinal biopsy, histological abnormalities were present in six. Children from the United Kingdom travelling abroad are at risk of developing severe travellers' diarrhoea, with serious consequences to their health and nutrition. There is a need for intensive parental education before travelling and this could be achieved through community health workers.

Bacterial Infections↗
PubMed2002

Reported practices of primary care physicians in the diagnosis and management of dementia.

The shortage of geriatric specialists in the US may require that primary care physicians (PCPs) receive more education on diagnosing and managing dementia since the number of older Americans with dementia will increase from about five million in 2010 to up to 14 million in 2050. Thus, we administered a brief, anonymous questionnaire to determine PCPs' diagnostic, referral, and management practices to a convenience sample of 142 PCPs in Arkansas. We reworded a Scottish survey to conform to terminology used in the US and added items on referral practices. The PCPs who reported difficulty establishing the diagnosis of dementia had more difficulty telling the diagnosis (O.R = 3.59, p < 0.004). The PCPs were less likely (p < 0.001) to tell the patient if they suspected dementia (73%) than if they were sure the patient had dementia (88%). In both cases, they were more likely to tell the family (92% & 100%, respectively), although this difference was not statistically significant. The PCPs discussed disease progression and driving risks with patients and families, but few referred them to social workers or community agencies. Findings support training PCPs in the diagnosis and management of persons with dementia and providing tools to improve care.

Arkansas↗
PubMed1985

Fourier transform infra-red spectroscopy applied to hazardous waste: I--Preliminary test of material analysis for improvement of personal protection strategies.

Many chemicals, when mixed, can produce potentially hazardous effects which are harmful to human health and to the environment such as heat, pressure, fire, explosion, violent reaction, and toxic dusts, mists, fumes, and/or gases. Waste chemicals handled on a remedial action site are analyzed by simple chemical methods for compatibility. Because it is difficult to base worker and community protection programs on this limited knowledge of material content, extreme precautions must be taken to ensure safety to all working on or living near hazardous waste remedial action sites. The approach used in this study involved the application of Fourier transform infra-red spectroscopy (FTIR) to the analysis of samples taken from the Chem-Dyne remedial action hazardous waste site. The data generated are compared to the results obtained using compatibility and GC-MS analysis procedures. Illustrations are given of improved personal protection strategies, based on drum material composition obtainable by FTIR. The requirements for further testing are defined.

Environmental Exposure↗
PubMed1989

Hypothesis: old people would benefit from a patient-held standardized primary health care record.

While many advances have been made in primary health care, for old people it has lagged behind other areas. The case is made for the adoption of a standard primary-care record for people aged over 70 years to be retained by the patient and attached behind the front door, where it would be available to ambulance crews, deputizing doctors and other community health workers. It would also be of value to the elderly patient when travelling or registering with a new doctor. Such a focus on information would facilitate communication between professional workers and increase productivity.

Aged↗
PubMed1999

Coverage and cost of iodized oil capsule distribution in Tanzania.

Distribution of oral iodized oil capsules (IOC) is an important intervention in areas with iodine deficiency disorders (IDD) and low coverage of iodized salt. The mean reported coverage of 57 IOC distribution campaigns from 1986-1994 of people aged 1-45 years in 27 districts of Tanzania was 64% (range 20-96%). This declined over subsequent distribution rounds. However, due to delayed repeat distribution, only 43% of person-time was covered, based on the programme objective of giving two IOC (total 400 mg iodine) at 2-year intervals. Three different capsule distribution strategies used in 20 distribution rounds in 1992-1993 were analyzed in depth. Withdrawal of financial support for district distribution expenses under the 'district team' strategy, and the subsequent change to integrated 'primary health care' distribution, increased delays and capsule wastage. The third, more vertical strategy, 'national and district teams', accomplished rapid distribution of IOC about to expire and subsequently a return to the initial 'district team' allowance strategy was made. Annual cost of 'district team' distribution was 26 cents per person (400 mg iodine/2 years). Cost analysis revealed that the IOC itself accounts for more than 90% of total costs at the levels of coverage achieved. IOC will be important in the elimination of IDD in target areas of severe iodine deficiency and insufficient use of iodized salt, provided that high coverage can be achieved. Campaign distribution of medication with high item cost and long distribution intervals may be more cost-effectively performed if separated from regular PHC services at their present resource level. However, motivating health workers and community leaders to do adequate social mobilization remains crucial even if logistics are vertically organized. Insufficient support of distribution expenses and health education may lead to overall wastage of resources.

Adolescent↗
PubMed2003

Changing health-seeking behaviour in Matlab, Bangladesh: do development interventions matter?

It is generally assumed that socioeconomic development interventions for the poor will enhance their material and social capacities to prevent ill health and to seek appropriate and timely care. Using cross-sectional data from surveys undertaken in 1995 and 1999 as part of the BRAC-ICDDR,B Joint Research Project in Matlab, Bangladesh, this paper explores patterns of health-seeking behaviour over time, with the hypothesis that exposure to integrated socioeconomic development activities will enhance gender equity in care-seeking and the use of qualified medical care. While there is tentative evidence of greater gender equity in treatment choice among households benefiting from development interventions, a preference for qualified medical care is not apparent. Findings reveal a striking and generalized rise in self-treatment over the 4-year period that is attributed to the economic repercussions of a major flood in 1998, and greater heath awareness due to the density of community health workers in Matlab. Also noteworthy is the substantial reliance on informal and often unqualified practitioners (over 20%) such as pharmacists and itinerant drug sellers. Factors associated with the type of health care sought were identified using logistic regression. Self-care is associated with female gender, the absence of low cost health services and illnesses of relatively short duration. Medical care, on the other hand, is positively predicted by male gender, geographic location, greater socioeconomic status and serious illness of long duration. The paper concludes by emphasizing the importance of enhancing local capacities to determine whether self-treatment is indicated, to self-treat appropriately, or in cases where health care is sought, to judge provider competence and evaluate whether treatment costs are justified. The provision of pharmaceutical training to the full spectrum of health care providers is also recommended.

Bangladesh↗
PubMed1987

Boarding home residents: new underclass in the mental health system.

Boarding homes have proliferated in recent times, spawned by the deinstitutionalization movement. This study explored the realities of living in these homes by using a quantified assessment procedure to examine their programs and policies. Findings suggest an absence of support and stimulation for the residents of homes and a need for outreach and advocacy on the part of social workers in community mental health practice.

Activities of Daily Living↗
PubMed1991

Weight gain variation in infants of an impoverished community: Bellanse, Haiti.

Maintaining adequate growth remains one of the most difficult tasks for infants in developing countries. A cohort of rural infants (n = 354), median age four months, were weighed every 6-7 weeks over an 18-month period. Some 179 infants (51%) with weight information over at least 12 months were included in the study. The association between weight gain up to 6 months of age, and between 6 and 23 months of age, and factors amenable to prevention were assessed using weighted multiple linear regression. Infants whose mothers understood the 'Road to Health' chart had a weight gain that was 123 g/month (95% confidence interval (CI): 2-245) higher up to six months of age and 31 g/month (95% CI: 6-57) higher between 6 and 23 months of age compared to infants whose mothers did not seem to understand the chart. The weight gain between 6 and 23 months was also 28 g/month (95% CI: 3-54) higher for infants fully vaccinated at 11 months compared to not fully vaccinated children. It was 47 g/month (95% CI: 16-78) higher for infants living in two-parent families compared to children of a single-parent family. The results of the study suggest that maternal comprehension of the 'Road to Health' chart may contribute to more adequate weight gain.

Adult↗
PubMed2005

Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, and growth in South African infants.

Growth faltering, anemia, and multiple micronutrient deficiency are common during infancy in developing countries. This South African trial was part of a multicenter study aimed at testing the efficacy of multiple micronutrient supplementation on growth, anemia, micronutrient status, and morbidity during infancy across 4 countries. A total of 265 infants aged 6-12 mo were individually randomized to 1 of 4 intervention groups: a daily multiple micronutrient supplement (DMM), a daily placebo supplement (P); a multiple micronutrient supplement 1 d of the week and placebo supplement on the other days of the week (WMM), and a daily iron supplement (DI). For 6 mo, the blinded supplements were provided to mothers at monthly health clinic sessions, and consumption was verified during weekly household visits by community health workers, when morbidity was also checked. Weight and height of the infants were measured monthly, and blood samples were taken at the beginning and at the end for assessing the infants micronutrient status. There were no significant differences in nutritional status of the groups at baseline with 40% of infants with anemia (hemoglobin < 110 g/L), 16% vitamin A deficiency (plasma retinol < 0.7 micromol/L), 47% zinc deficiency (plasma zinc < 10.7 micromol/L), 2% underweight, and 11% stunting. There was no difference in growth or morbidity between the micronutrient supplemented groups and the P group during the 6-mo study. The DMM was the most effective intervention tested, not only for improving anemia but also for improving iron, zinc, riboflavin, and tocopherol status.

Adult↗
PubMed1997

The impact of Hymenoptera venom allergy on occupational activities.

The objective of this study was to investigate the impact of allergy to hymenoptera venom on the occupational activities of patients undergoing immunologic treatment for insect sting anaphylaxis. The design was a cross-sectional study conducted in a sample of 500 out of 1,500 patients undergoing venom immunotherapy for insect sting reaction in 13 allergy clinics in Israel. A self-administered questionnaire was used to collect data about demographic characteristics of patients, severity of the allergic reaction and adverse effects on occupational activities. Of the 204 respondents who were part of the labour force, 48.5% reported adverse effects on routine occupational activities. The factors with a significant influence on the probability of adverse occupational effects were: (1) patient's type of work (blue collar vs. white collar: OR = 3.22, p < 0.001: army vs. white collar: OR = 5.28, p = 0.001); (2) severity of the allergic reaction (severe reaction vs. mild/moderate reaction: OR = 2.34, p = 0.007). Our findings suggest that severe insect sting allergy has an adverse impact on patients' occupational activities. This factor requires special attention by the medical community. Social workers and occupational physicians should collaborate in the assessment and management of these patients.

Adolescent↗
PubMedDate not supplied

Trust and collaboration in the prevention of sexually transmitted diseases.

High rates of sexually transmitted diseases (STDs) are sustained in communities by a relatively small group of people, referred to as the core of transmission. Definitions of the core vary but inevitably include people who are socially marginalized and who distrust people in authority, such as public health practitioners and university researchers. Having an effect on a marginalized group usually depends on effective collaboration with people they trust. Researchers from the University of North Carolina School of Public Health developed a trust-based collaboration with community members of a rural county in North Carolina to implement an STD prevention program that, in turn, relied on trust in local social networks. As part of the STD prevention demonstration project, the research team established a community resource group made up of local African Americans who helped design, implement, and evaluate the intervention. The group identified 21 women to whom others in the community turned for advice on sex and STDs. These women were trained as lay health advisors to disseminate information and skills for preventing STDs among their social networks. Through face-to-face structured interviews before and after the intervention, the authors measured improvements in STD treatment and prevention behaviors. The proportion of people practicing each of the targeted behaviors improved during the evaluation period. In addition to disseminating information through their own social networks, the lay health advisors demonstrated new skills and a desire to interact with local care providers to influence the provision of care for STDs for low-income African Americans in this county. Each participant in the collaboration played a role in establishing or building upon trust with others. These trusting relationships were critical for empowering a marginalized group at high risk for STDs.

Adolescent↗
PubMed2002

Children at risk of developing dehydration from diarrhoea: a case-control study.

To identify the factors related to dehydration from diarrhoea, a hospital-based case-control study was carried out among under-2-year-old Bangladeshi children. The study compared 80 cases who had 'some' or severe dehydration with 160 age-matched controls who had 'no signs' of dehydration. All the cases and controls were examined and the mothers were interviewed in the hospital and followed at home on the 14th day of illness. Thirty-eight factors were studied for their probable influence on the development of dehydration. In bivariate analysis, 17 factors were found to be associated significantly with the development of dehydration and were treated with stepwise logistic regression analysis. A combination of vomiting, oral rehydration therapy at home, mother's dirty finger nails, and residing more than 3 km away from the hospital provided the maximum sensitivity (77.5 per cent) and specificity (91.2 per cent) for predicting development of dehydration. These prognostic factors would be helpful for community health workers to identify children at risk of developing diarrhoea-associated dehydration, and preventive strategies could be designed to alter the prognostic factors.

Bangladesh↗
PubMed2005

Prevalence and correlates of stunting among primary school children in rural areas of southern Pakistan.

Protein-energy malnutrition is one of the leading causes of childhood morbidity and mortality in developing countries. The purpose of the present study was to measure the prevalence of stunting and its correlates among school children aged 6-12 years in the rural areas of southern Pakistan. We selected 1915 children aged 6-12 years enrolled in 32 primary schools in rural Sindh, Pakistan. Trained community health workers conducted child height and weight measurements and collected information from the parents. The Z-scores for the distribution of height-for-age, weight-for-age, and weight-for-height relative to those of National Center for Health Statistics/Center of Disease Control and prevention (NCHS/CDC) reference population were calculated. Out of 1915 children, 300 (16.5 per cent) were stunted. Female children compared to males were more likely to be stunted (prevalence ratio (PR) = 1.26; 95 per cent confidence interval (CI): 1.02-1.53). Children older than 7 years were more likely to be stunted (PR, 1.40; CI, 1.14-1.72). Fathers who were working as government employees (PR, 1.71; CI, 1.05-2.79), shopkeepers (PR, 2.00; CI, 1.22-3.26) and farmers (PR, 1.43; CI, 0.93-2.22) were more likely to have children who were stunted when compared to landlords. In rural areas of southern Pakistan, sex of child, age of the child, and father's occupation may be considered as important risk factors for stunting among school children aged 6-12 years.

Age Distribution↗
PubMed2006

Implementation and evaluation of a neonatal educational program in rural Nepal.

A needs assessment at Tansen Mission Hospital established gaps in knowledge, skills and attitudes of health professionals, contributing to the high neonatal mortality in Nepal. This study was designed to implement and evaluate the effectiveness of an educational program in Newborn Care, using best evidence teaching methods and content. Pre intervention, an audit of newborn care practices and documentation was performed using a structured checklist. Intervention consisted of four teaching sessions each involving short lectures and interactive skills stations. Post intervention, participant satisfaction, knowledge, competence and performance were evaluated. In 80 per cent of responses (n=30), participants evaluated the program as very good or excellent. Matched pair pre and post education MCQ scores compared knowledge, with significant improvement in all groups (nurses, doctors and community health workers). Competence was evaluated by an Objective Structured Clinical Examination with mean scores (+/-SD) ranging from 65 per cent (7.0) to 87 per cent (7.3). Performance was examined by pre and post-intervention audit of records. Significant changes in practice included a 100 per cent increase in measuring length and head circumference, charting percentiles and documentation of structured history and examination in the Newborn Care Notes. Administration of vitamin K at birth increased by 71 per cent, assessment of hypoglycaemia risk by 94 per cent and those at risk of hypoglycaemia having a blood sugar level measured increased by 58 per cent. These results led to consideration of appointment of a postgraduate educator. Even with limitations in educating and implementing change in a resource limited rural setting, a short, interactive education program can have positive educational outcomes and can change practice. Sustainability is dependent on staff employing continuing education.

Female↗