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PubMed1998

[Malaria in infants in a rural area of maritime Guinea (Guinea Conakry). II. Development of antimalarial antibodies and malaria during the first year of life].

A transversal investigation carried out on 551 children and a longitudinal study of 55 infants showed the disappearance of maternal anti-plasmodium antibodies during the first year of life. Out of 212 new-borns surveyed for one year, 59 (28%) were infested by Plasmodium, but never during the first two months of life. This infestation was not related to the age of the infant nor to the season. For 46% of cases, infestation was completely asymptomatic, for 18% of cases respiratory signs were present and for 20% digestive signs not specific to malaria. Fever was present in 14 cases (24%) and isolated in 6 cases. Only 7 infants received a specific antimalarial treatment. Evolution under medical surveillance was favourable in all cases. These findings prove the difficulties inherent to the diagnosis of malaria, especially in the absence of laboratories for diagnosing other infections--such as typhoid--which do not appear in sanitary statistics. The findings also raise the question as to the efficiency of systematic antimalarial treatment in case of fever in the infant or child. Asymptomatic parasitemia can be explained by the existence of antitoxic immunity different from antiplasmodia immunity.

Aging↗
PubMed2005

A rural and regional community multi-specialty residency training network developed by the University of Western Ontario.

BACKGROUND: Traditionally, specialty vocational/residency training is totally done in tertiary care university-hospital settings, making it very difficult for specialty residents to learn about the joys and challenges of rural and regional patient care. DESCRIPTION: The University of Western Ontario's Multi-Specialty Community Training Network (MSCTN) was developed to provide specialty residents with the opportunity to do part of their postgraduate vocational training in rural and regional practice settings. The network involves 10 medical school departments/divisions and 7 rural/regional communities. From 1997 to 2004, 174 residents have completed 287 months of rural/regional training. EVALUATION: Residents rated their overall learning experience at 6.41 on a 7-point scale. Nineteen of the 39 graduating residents have chosen to practice in rural and regional underserviced communities. CONCLUSION: Rural/regional specialty postgraduate vocational training rotations can provide excellent learning experiences. Preliminary results indicate that this exposure encourages many specialty residents to establish rural and regional practices.

Data Collection↗
PubMed2001

Children's height, health and appetite influence mothers' weaning decisions in rural Senegal.

BACKGROUND: In many developing countries, breastfed children have a lower nutritional status than those weaned from 12 months of age. Reverse causality, that is, earlier weaning of healthy and well-nourished children, is a possible explanation. METHODS: Maternal reasons for early and late weaning were investigated in a cohort of 485 rural Senegalese children using structured interviews during two rounds at the ages of 18--28 and 23--33 months, respectively. Length, weight and height were assessed, and dates of weaning were monitored. RESULTS: The mean duration of breastfeeding was 24.1 months (quartiles 21.9 and 26.3). Two-thirds of mothers of breastfed children under 2 stated that they would wean at the age of 2, while for breastfed children aged 2 years, a 'tall and strong' child was the most prevalent criterion. The main reasons for weaning prior to 2 years (N = 244) were that the child ate well from the family plate (60%), that the child was 'tall and strong' (46%) and maternal pregnancy (35%). The main reasons for weaning later than the age of 2 were: a 'little, weak' child (33%), food shortage (25%), illness of the child (24%) and refusal of family food (14%, N = 120). Children breastfed above the age of 2 because they were 'small and weak' had lower mean height-for-age and a greater prevalence of stunting than children breastfed late for other reasons (P < 0.0001). CONCLUSION: The habit of postponing weaning of stunted children very likely explains why breastfed children have lower height-for-age than weaned children in this setting.

Age Factors↗
PubMed2004

Temporal trends in the prevalence of diabetes mellitus in a rural community in Sri Lanka.

In developing countries the prevalence of diabetes mellitus is reported to be lower in rural areas compared to urban areas. This difference has been attributed to lifestyle factors associated with the higher socio-economic status of those living in urban areas. However, recent clinical observations indicate that the prevalence of diabetes is on the increase even in the rural sector. The aims of the present study were to objectively assess whether the prevalence of diabetes has increased in a named rural community in Sri Lanka during a period of ten years and whether there has been a change in the socio-economic status of the community during this period. The study was conducted on a sample of 220 subjects randomly selected from an adult population of 25,605 residents in a rural area in central Sri Lanka. Each of these subjects had the fasting blood sugar estimated and the height, weight, resting blood pressure and socio-economic parameters, such as the level of education, occupation and monthly income, recorded. These data were compared with those of a similar study conducted by the main author in the same community ten years ago. The results revealed that the age-standardised prevalence of diabetes had increased from 2.5% in 1990 to 8.5% in 2000 (p = 0.008) and that this was accompanied by an increase in the monthly income, level of education and body mass indices. Since nearly 70% of all Sri Lankans live in villages, continuation of the present trend would result in a dramatic increase in the number of patients with diabetes in the future. Suitable strategies should be implemented to arrest this trend and manage a large number of patients with diabetes in the future.

Adult↗
PubMed2006

Blood pressure survey in two communities in the Volta region, Ghana, West Africa.

BACKGROUND: The prevalence of hypertension appears to be increasing in the developing world. A study published in 2003 showed a crude prevalence of 28.3% in the capital city of Accra, Ghana. The prevalence of hypertension in many rural areas of the developing world is not known. OBJECTIVES: 1) To survey two rural populations for hypertension; 2) to identify factors that may be associated with hypertension; 3) to assess the level of control of hypertension. STUDY DESIGN/SETTING/PARTICIPANTS: 287 volunteers surveyed during market day in two villages in the Volta region of Ghana. Blood pressures were obtained after obtaining demographic and historical information. All individuals age > or = 17 were included in the analysis. Hypertension was defined as a blood pressure > or = 140/90 mm Hg on two separate occasions. RESULTS: The prevalence of hypertension in the populations surveyed was 32.8%. Factors associated with hypertension that reached statistical significance (P<.05) included family history of hypertension, consumption of akpeteshie, location of blood pressure assessment, and consumption of non-smoked fish (inverse association). More than 80% of those with a history of hypertension had an elevated blood pressure at the time of screening. CONCLUSIONS: The proportion of hypertension in the rural populations surveyed is higher when compared to true prevalence studies and is most likely due, in part, to selection biases. The low hypertension control rates identified in people with a history of hypertension would need to be considered when determining whether to expand hypertension screening programs or to improve access to treatment for those with known hypertension in these resource-limited areas.

Adult↗
PubMed2002

The role of demographic surveillance systems (DSS) in assessing the health of communities: an example from rural Ethiopia.

Longitudinal demographic surveillance systems (DSSs) in selected populations can provide important information in situations where routine health information is incomplete or absent, particularly in developing countries. The Butajira Rural Health Project is one such example, initiated in rural Ethiopia in 1987. DSSs rely on regular community-based surveillance as a means of vital event registration, among a sufficient population base to draw meaningful conclusions about rates and trends in relatively rare events such as maternal death. Enquiries into specific health problems can also then use this framework to quantify particular issues or evaluate interventions. Demographic characteristics and trends for a rural Ethiopian population over a 10-y period are presented as an illustration of the DSS approach, based on 336 000 person-years observed. Overall life expectancy at birth was 50 y. Demographic parameters generally showed modest trends towards improvement over the 10-y period. The DSS approach is useful in characterising populations at the community level over a period of time, providing important information for health planning and intervention. Methodological issues underlying this approach need further exploration and development.

Adolescent↗
PubMed1993

Collaborating to develop a community-based health service for rural homeless persons.

In the current healthcare environment, public health nursing administrators are called on to create and manage programs and services while reducing cost and improving access. Public health science provides a framework on which to base program planning and management. Using this approach, the authors describe the establishment of a health services center to meet an identified gap in service to homeless persons in a rural area.

Community Health Centers↗
PubMed1994

Early sporogonic development in local vectors of Plasmodium falciparum in rural Cameroon.

In ongoing studies on experimental transmission of Plasmodium falciparum in the city of Yaounde gametocyte carriers are daily being identified among dispensary patients with malaria-like complaints. This species comprises 93% of all parasitemias and because of the selection criteria most patients have it as a recent infection. 17% of all P. falciparum-positives carry detectable gametocytes with little difference between youngsters and adults. Blood of adult carriers is taken and infection of Anopheles gambiae mosquitoes is attempted by membrane feeding; the establishment of infection is judged by the presence of oocysts.

Animals↗
PubMed1989

Determinants of community-based coverage: periodic vitamin A supplementation. Aceh Study Group.

Factors related to preschool child receipt of vitamin A during the first year of a semi-annual vitamin A capsule delivery program were investigated in 229 villages in Aceh, Indonesia. Coverage was higher in villages which were more rural and less economically developed. Highest performance was achieved by village distributors who represented the local status quo in this rural area (farmers, or non-farmers with minimum education) rather than more upwardly mobile, highly educated residents. Household or child-level characteristics were not associated with coverage. This information may be useful for planning direct service programs in the community.

Agriculture↗