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PubMed2001

Diagnoses and interactive patterns of infants referred to a community-based infant mental health clinic.

OBJECTIVES: To describe the distribution of symptoms and diagnoses in a community-based infant mental health clinic and to compare play and feeding interactions of referred and nonreferred infants. METHOD: The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0-3) was used to diagnose 113 referred infants (60% were boys). Thirty additional dyads were matched with 30 nonreferred dyads. Feeding, play interactions, and home environment were compared. RESULTS: Two peaks of referral were found: 0 to 6 and 12 to 18 months. The main reasons for referral were eating problems, sleep problems, aggressive behavior, irritability, and maternal depression. The most common DC 0-3 diagnosis was a combination of primary infant disorder, parent-child relationship disorder, and parental psychopathology. Mothers of referred children provided lower levels of sensitivity, support, and structuring of the interaction, and less optimal home environment. The dyadic relationship showed a lower degree of mutuality and higher negative exchanges. Feeding interactions elicited more negative interactions than play. CONCLUSIONS: Infants referred by community health workers showed less optimal mother-infant interactions and had less optimal environment, compared with nonreferred dyads. Symptoms of emotional distress in infancy are best apprehended when assessed in multi-institutional contexts and formulated in a multiaxial approach.

Affective Symptoms↗
PubMed2002

Evaluation of children with recurrent pneumonia diagnosed by World Health Organization criteria.

BACKGROUND: A World Health Organization (WHO) case management approach has been used to identify and treat children with pneumonia worldwide since 1987. Many children are treated repeatedly: 23% of children with pneumonia in our rural Haitian district had met the WHO criteria on two or more occasions; but underlying disease in such children has not been systematically studied. METHODS: We enrolled 103 children who had been diagnosed with pneumonia on 3 or more occasions by community health workers using WHO criteria. We compared them with 138 children similarly evaluated but never diagnosed with pneumonia, matching by health worker and age. We administered questionnaires to parents and performed complete physical examinations, tuberculin skin tests and serologic testing for HIV on all subjects and chest radiographs on case children. RESULTS: Two percent of case children and 1.5% of controls had positive tuberculin skin test reactions. None of the children tested was HIV-seropositive. Ninety-four case children had normal baseline chest radiographs and three had focal infiltrates. A history of wheezing was reported for 79% of case children and 61% of controls (P = 0.002), and wheezing with exercise was reported for 36% and 22%, respectively (P = 0.02). DISCUSSION: Most children in Haiti with recurrent pneumonia diagnosed by WHO criteria do not have evidence of tuberculosis, HIV infection or pulmonary anomalies, but they may be more likely to have asthma, and this should be considered as an alternative diagnosis. This information should help direct evaluation of such children in other settings and prompt further study of asthma in developing countries.

Child↗
PubMed2002

Assessment of a blood pressure measurement training programme for lay observers.

This study assessed a training programme attended by 25 observers, intentionally chosen for their lay status, who were invited to participate in a prevalence of hypertension study. The results highlight the fact that the 14 trainee observers finally selected were comparable to professionals in terms of both the estimated validity of the blood pressure measurement [the mean difference (standard deviation) compared with the expert being -0.4 (1.8) mmHg for systolic blood pressure and 0.0 (1.8) mmHg for diastolic blood pressure] and estimated inter-observer variability (100% of the observers complying with the criteria recommended for professional health-care workers), even though the training given to the former was in no way more comprehensive than or distinct from that recommended for professional health-care workers in community studies.

Adult↗
PubMed2005

Impact of gender and sex work on sexual and injecting risk behaviors and their association with HIV positivity among injecting drug users in an HIV epidemic in Togliatti City, Russian Federation.

OBJECTIVES: Togliatti City is witness to a large epidemic of human immunodeficiency virus (HIV) associated with injecting drug use (IDU). GOAL: This study sought to examine whether risk behaviors and risk factors associated with HIV differed across a sample IDUs by gender and sex work. STUDY: A sample of IDU (n = 423) comprising female sex workers (SWs) (n = 66), non-sex workers (nonSWs) (n = 89) and men (n = 268) were recruited by field workers in community settings. Behavioral and HIV prevalence data were collected. RESULTS: HIV prevalence did not differ across the groups ( approximately 56%), but gender adversely affected some risk factors. A comparison of risk behaviors indicated that SWs were more likely to engage in risky injecting behaviors than either men or nonSWs. They were also more likely to report a history of sexually transmitted infections. CONCLUSIONS: IDUs involved in sex work and IDU nonSWs require specific and targeted interventions to facilitate safer injecting and sexual behaviors.

Adolescent↗
PubMed2007

Safety, acceptability, and tolerability of 3 topical microbicides among heterosexual Kenyan men.

OBJECTIVES: To compare the acceptability, tolerability, and safety of 3 topical microbicide formulations (62% ethyl alcohol in emollient gel and 0.1% and 0.4% benzalkonium chloride on a sanitary wipe) for use on male genitalia. DESIGN: This triple-randomized crossover study among men attending a sexually transmitted disease (STD) clinic in Nairobi, Kenya assigned individuals without clinical evidence of an STD to apply products to the penis in a predetermined random order, each for a 2-week period with a 1-week washout period between each product. Men recorded side effects and were examined for adverse events. RESULTS: Of 39 participants, 33 (84%) completed 6 clinic visits plus 3 home visits by community health workers. Participants reported use of 62% ethanol gel and 0.1% and 0.4% benzalkonium on 99%, 99%, and 96% of daily scheduled applications; 99%, 98%, and 97% of preintercourse applications, and 99%, 94%, and 98% of postintercourse applications. All participants said they would recommend all 3 products to a friend; 72% preferred the 62% ethanol gel, 17% the 0.1% benzalkonium, and 11% the 0.4% benzalkonium. One person developed objective signs of a genital ulcer after 14 days of 0.4% benzalkonium wipe use. CONCLUSIONS: Two of the 3 topical microbicides had minimal reported adverse effects, and no adverse effects were observed during use of the ethanol gel, which was preferred by most men.

Administration, Cutaneous↗
PubMed1980

Rural health care looks to the future. Issues in the institutionalization and management of rural health care: making technology appropriate.

Experimental projects have demonstrated the technical feasibility of systems of accessible, affordable health care. These projects have relied extensively on non-professional community health workers. However, large-scale implementation of these schemes will require new management procedures that are both responsive to rural health needs and congruent with national institutions. This paper identifies the need to establish institutional mechanisms to mobilize essential inputs, promote acceptance by beneficiaries, maintain quality standards, recruit and retain field staff, and achieve accountability for resources. It then outlines methods for developing these institutions. It stresses the need for both formal, bureaucratic organizations and informal organizations of clients. It also identifies the need to consider administrative and institutional resources in determining the appropriateness of a health care technology.

Developing Countries↗
PubMed2004

Effects of a tropical cyclone on the drinking-water quality of a remote Pacific island.

The effect of a cyclone (Ami, January 2003) on drinking-water quality on the island of Vanua Levu, Fiji was investigated. Following the cyclone nearly three-quarters of the samples analysed did not conform to World Health Organisation (WHO) guideline values for safe drinking-water in terms of chlorine residual, total and faecal coliforms, and turbidity. Turbidity and total coliform levels significantly increased (up 56 and 62 per cent, respectively) from pre-cyclone levels, which was likely due to the large amounts of silt and debris entering water-supply sources during the cyclone. The utility found it difficult to maintain a reliable supply of treated water in the aftermath of the disaster. Communities were unaware they were drinking water that had not been adequately treated. Circumstances permitted this cyclone to be used as a case study to assess whether a simple paper-strip water-quality test (the hydrogen sulphide, H(2)S) kit could be distributed and used for community-based monitoring following such a disaster event to better protect public health. The H(2)S test results correlated well with faecal and total coliform results as found in previous studies. A small percentage of samples (about 10 per cent) tested positive for faecal and total coliforms but did not test positive in the H(2)S test. It was concluded that the H(2)S test would be well suited to wider use, especially in the absence of water-quality monitoring capabilities for outer island groups as it is inexpensive and easy to use, thus enabling communities and community health workers with minimal training to test their own water supplies without outside assistance. The importance of public education before and after natural disasters is also discussed.

Clostridium perfringens↗
PubMed1992

Illiteracy, ignorance, and willingness to quit smoking among villagers in India.

During the field work to control oral cancer, difficulty in communication was encountered with illiterates. A study to define the role of illiteracy, ignorance and willingness to quit smoking among the villagers was undertaken in a rural area surrounding Doddipatla Village, A.P., India. Out of a total population of 3,550, 272 (7.7%) persons, mostly in the age range of 21-50 years, attended a cancer detection camp. There were 173 (63.6%) females and 99 (36.4%) males, among whom 66 (M53 + F13) were smokers; 36.4% of males and 63% of females were illiterate. Among the illiterates, it was observed that smoking rate was high (56%) and 47.7% were ignorant of health effects of smoking. The attitude of illiterate smokers was encouraging, as 83.6% were willing to quit smoking. Further research is necessary to design health education material for 413.5 million illiterates living in India (1991 Indian Census). A community health worker, trained in the use of mass media coupled with a person-to-person approach, may help the smoker to quit smoking.

Adolescent↗
PubMedDate not supplied

A survey of microcytic anaemia in paediatric inpatients.

The prevalence of anaemia and microcytosis was studied retrospectively in 662 children aged 6 months to 8 years, admitted to hospital over a 10-month period. Anaemia (haemoglobin less than third centile) was found in 23% of children under the age of 2, 18% of those between 2 and 5 years and 10% between 5 and 8 years. Non-Caucasians (mainly Pakistani) were more commonly anaemic than Caucasians and showed a peak prevalence (31%) in the 3rd, 4th and 5th years. Microcytosis was found in 12% of non-Caucasians but only 2% of Caucasians and also showed a fall in prevalence with increasing age. These data suggest that iron deficiency anaemia may be common in preschool children, especially in the immigrant community. Health workers designing a programme to screen for iron deficiency anaemia should be aware of this age distribution.

Anemia, Hemolytic↗
PubMed1992

Epidemiological studies on measles in Karachi, Pakistan--mothers' knowledge, attitude and beliefs about measles and measles vaccine.

In order to gather information on the factors affecting the spread of measles vaccine in Pakistan, 287 mothers living in Karachi were interviewed concerning their knowledge, attitude and beliefs about measles and measles vaccine. Measles had been highly prevalent, mainly among infants between 9 and 18 months of age. The severity of the illness and the frequency of complications were well known and the importance of immunizations was well recognized. In traditional combined families grandparents had made the decision to take children for immunization, but many mothers had begun to feel that they were responsible for participation in the programme. The vaccine acceptance rate had increased sharply in recent years, primarily due to local health educators' activities and mass media such as TV programmes. The present findings confirm the importance of continuous effort toward promotion of primary health care by collaboration of motivated mothers and community health workers.

Adult↗
PubMed1993

JICWELS' MCH training program in the Aiiku Institute: Asian MCH workshop.

Taking a form of Official Development Aid (ODA), the Japan International Cooperation of Welfare Services (JICWELS) and Imperial Gift Foundation, Boshi-Aiiku-Kai (Aiiku Association for Maternal and Child Health and Welfare) have extended a study program on maternal and child health (MCH) since 1989 on the commission of the Ministry of Health and Welfare. 'Community participation' is the key to the first international study program focused solely on MCH. The purpose of the program is to help to improve the planning and administration in the field of MCH. Through this, the information and experience attained in Japanese MCH activities are introduced especially by participation in community-level activities of 'Aiiku-Han' in which local citizens play a major role. The operation system of the Asian MCH Workshop, contents of the workshop, evaluation and future prospects are discussed.

Asia↗
PubMed2002

Surveillance of work-related disorders in Australia using general practitioner data.

OBJECTIVES: The focus of this paper is to compare the main findings regarding work-related problems managed in general practice with those of other data sources in the occupational and public health arenas that provide some information on work-related disorders in Australia, in order to examine the implications for surveillance and prevention. METHODS: Data on work-related disorders managed in general practice were obtained from a larger study of general practice activity that involved a cluster random sample of all significantly active general practitioners in Australia from 1998 to 2000. These data were compared with other Australian datasets containing information on work-related disorders. RESULTS: Despite a predominance of musculoskeletal conditions in all the data sources, general practitioner data provided a different picture of work-related disorders in the community to workers' compensation information from the National Data Set of Compensation-based Statistics (NDS) and the limited information on work-related disorders available from other studies of general practice and emergency departments. The mix of conditions was different in many aspects, and diseases were much less common in the NDS. CONCLUSIONS: General practitioner data supplement data provided by other sources, particularly the NDS, and make an important contribution to filling some of the gaps in information about work-related diseases and more minor work-related injuries. IMPLICATIONS: General practitioners could prove a useful supplementary source of data on work-related disorders, but the optimal content of, and method for obtaining, these data is not clear.

Accidents, Occupational↗
PubMed1995

A care plan for children with tuberculosis.

Tuberculosis (TB) increased 34.1% among children 5 to 14 years old and 36.1% among those 0 to 4 years old in 1992 (American Academy of Pediatrics, 1994). In light of this resurgence, a care plan for children with TB has been developed. Health care workers, especially community health nurses, must be knowledgeable about the transmission, pathogenesis, diagnosis, and treatment of this disease. Armed with this knowledge, an effective teaching program for nurses must be initiated to interrupt the spread of tuberculosis. The purpose of this paper is to present information regarding the spread of tuberculosis in children, current treatment regimens, a care plan specifically for children, and a description of the nurse's role in the care of the pediatric client with this disease.

Adolescent↗
PubMed2003

Vitamin A supplementation and health outcomes for children in Nepal.

PURPOSE: To compare vitamin A supplementation status of children age 6-60 months to the prevalence of vitamin A deficiency disease, malnutrition, diarrhea, and acute respiratory infection. METHODS: The nutritional status of children was estimated using mid-upper-arm circumference measurements. A trained ophthalmology assistant assessed for clinical signs of vitamin A deficiency disease. A trained female community health worker interviewed mothers about child health status using a standardized questionnaire. RESULTS: Compared to children who did not receive supplements, children who received vitamin A supplements regularly had less malnutrition, diarrhea, and acute respiratory infection, regardless of the number of children per household, age, sex, or father's occupation. CONCLUSIONS: Supplementation with vitamin A is necessary twice a year. Children who received a vitamin A capsule only one time were not as protected as were those children who received vitamin A as a regular twice yearly scheduled dose.

Case-Control Studies↗
PubMedDate not supplied

A community-based approach to the promotion of breastfeeding in Mexico.

A comprehensive education strategy is presented that links training, community education, research, and mass-media efforts to enhance breastfeeding practices. Breastfeeding promotion models, an administrative system, and lessons learned during the project are described. The keys to effective breastfeeding promotion are shown to be accurate information; appropriate education, training, and follow-up; and a supportive administrative system.

Breast Feeding↗
PubMed1996

The Edinburgh Postnatal Depression Scale: validation on a Swedish community sample.

The Edinburgh Postnatal Depression Scale (EPDS) was designed to be used by community health workers to screen for postnatal depression. We report data from a population-based sample of 1655 women who completed the EPDS at 2 months and 3 months postpartum. A total of 128 women were interviewed with the Montgomery Asberg Depression Rating Scale (MADRS) and assessed according to DSM-III-R criteria for major depression. A cut-off score of 11.5 on the EPDS identified all but two women with major depression, giving it a sensitivity of 96%, a specificity of 49% and a positive predictive value of 59%. This study supports the validity of the EPDS shown in earlier studies, and indicates that the scale is a useful screening instrument for identifying postnatal depression in primary health care in Sweden.

Adolescent↗