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PubMedDate not supplied

[Armenia: implementation of national program of malaria control].

Malaria has been existing in Armenia since antiquity. In the 1920"s to 1930s, thousands of people suffered from this disease in the country. Enormous efforts were required to prevent further spread of the disease. A network was set up, which consisted of a research institute and stations. A total of 200,000 cases of malaria were still notified in 1934. Rapid development of the health infrastructure and better socioeconomic conditions improved the malaria situation and reduced the number of cases in 1946. Malaria was completely eradicated in Armenia in 1963, and the malaria-free situation retained till 1994. During that period, comprehensive activities were undertaken in the country to prevent and control malaria. Since 1990, following the collapse of the Soviet Union, the situation became critical in many newly independent states. Economic crisis, human migration, worsening levels of health services, and the lack of necessary medicines, equipment, and insecticides significantly affected the malaria epidemiological situation in the country. Malaria cases started to penetrate into Armenia from neighboring countries. In 1994, a hundred ninety six military men contacted malaria in Karabakh, which was unfavorable in terms of malaria, as well on as the border with Iran and along the Araks river. The first cases recorded in Armenia were imported, afterwards they led to the incidence of indigenous cases, given the fact that all the prerequisites for malaria mosquito breeding and development were encountered in 17 regions and 3 towns of the country. In 1995, there were 502 imported cases and in 1996 the situation changed: out of 347 registered cases, 149 were indigenous. The Ministry of Health undertook a range of preventive measures. In 1997 versus 1996, the total number of malaria cases increased 2.3-fold: 841 registered cases of which 567 were indigenous (a 3.8-fold increase). The overwhelming majority of cases were recorded in the Ararat and Armavir marzes. In 1998, there were a total of 1156 cases, of them 542 being locally contacted. The situation became stable thanks to joint efforts of WHO, IFRX, the Armenian Red Cross Society, UNICEF, the Ministry of Health of Armenia and its Government. Under Minister's Decree No. 292 of May 17, 1999, a malaria project implementation office was established in the Masis Sanitary and Epidemiological Surveillance Center of Hygienic and Antiepidemic Surveillance to improve progress of the malaria control programme in Armenia. WHO allocated some 7,700 USD for 5-month maintenance and work of the office. Thus, analyzing the malaria cases registered in 1999 and 1998 indicates a 1.9-fold decrease (616/77). The setting up the malaria programme field office under the Minister's decree was instrumental in planning and implementing activities in situ. In 1999, four cases of tropical malaria were recorded in Armenia. The patients were Armenian pilots who contacted malaria during duty travels: 1 in Sudan and 3 in Congo. The list of pilots making flying to endemic countries was submitted to the Republican Center to implement preventive measures in the future. In Armenia malaria surveillance has been improved to ensure timely detection of all suspected cases and to carry out malaria control activities. In this regard, a seminar was held for 21 entomologists and 12 parasitologists. UNICEF and WHO Armenian offices provided a substantial support to organize seminars. To facilitate the seminars, the manual "Malaria parasitology and entomology" was published and distributed among their participants. On April 19, 1999, the session of the Ministry's Executive Board (Collegium) gave recommendations to reinforce malaria control activities in the country. Decrees No. 256 of May 31, 1999, No. 47 of May 29, 1999, and No. 245 of April 30, 1999, "On malaria and preventive and control activities" were issued by the Ministry of Health, the Ministry of Defense, and the Ministry of Internal Affairs and National Security to serve as a guideline for planning and implementing activities. The Ministry of Agriculture undertook to clean the collective irrigation (drainage) system covering 102 and 77 km in the Ararat and Armavir marzes, the Ministry of Health provided a list of endemic foci where cleaning was a priority. Taking into account the importance of the people's participation in ensuring effective prevention and control, emphasis was laid on health education activities: publication of leaflets, as well as articles in local newspapers, radio broadcasts and TV shows. Throughout the season, the early detection of malaria cases, timely hospitalization (in no later than 1-3 days) for at least 5 days and subsequent treatment under direct supervision of a physician were successfully carried out due to home-to-home visits. Entomological studies conducted in the malaria foci show an increase in the presence and density of a malaria vector in the buildings. As far as treatment is concerned, the overall surface of stagnant waters comprised 2642 ha in 1999 (2733 ha in 1998), including 1285 ha of anophelogenic stagnant waters (2276 ha in 1998). The biggest stagnant water surfaces were in the Ararat and Armavir marzes--2209 ha, where the majority of malaria cases were recorded. A total of 1,283,111 and 559,213 sq. m. of constructions were treated in 1999 and 1998, respectively, out them there were 1,259,637 sq. m. in 5 endemic regions. Stagnant water surfaces were treated with bacticulicides on 250.7 and 743.8 (almost 3 times more) in 1998 and 1999, respectively. In 1999, 740 ha of surface were biologically treated using Gambusia compared to 900 ha treated in 1998. There is no highly qualified diagnostic specialists in many regions of the country, which necessitates the holding of further seminars involving relevant specialists, in all malaria regions. There is a tendency of geographical spread of malaria: malaria cases occur in new regions and dwellings. A country-wide action plan was drafted for 2000, mainly focusing on staff training. With WHO assistance, a seminar was held for 324 specialists from endemic regions. During the first quarter of 2000, 13 cases of tertian malaria were recorded as compared 59 cases during the same period of last year. All these patients contacted malaria in the previous season and demonstrated long incubation periods. Thus, the malaria control plan recommended by WHO and the rational and targeted use of its assistance has shown a 2-fold decrease in the incidence of malaria.

Armenia↗
PubMed2002

Anopheles sacharovi (Diptera: Culicidae): a reemerging malaria vector in the Ararat Valley of Armenia.

In 1994, the first indigenous case of malaria since the 1960s was reported in Armenia, and the number of cases quickly increased in the ensuing years. In 1998, a roll-back malaria program was developed to eliminate the recently established foci of malaria infection and to prevent the reestablishment of malaria in Armenia. As part of this program, we carried out entomological surveys to identify the potential malaria vectors in the Ararat Valley, the area where most of the indigenous malaria cases had been reported. In particular, we attempted to ascertain the presence of Anopheles sacharovi Favre, which is historically the most important malaria vector in Armenia yet which had not been reported since 1965. In 1998-2000, we collected adult mosquitoes and larvae in the city of Masis and in three rural villages of the Ararat Valley. Species identification of the members of the Anopheles maculipennis complex was performed through egg and larval morphology, heteroduplex analysis, and sequencing of the second internal transcribed spacer of ribosomal DNA. Two species of the complex were identified: An. sacharovi, found in all of the study sites, andAn. maculipennis s.s. Meigen, the most common species in the area. The reemergence of An. sacharovi in the study sites shows that the receptivity for malaria is still high in the Ararat Valley and, likely, in other regions of Armenia.

Animals↗
PubMedDate not supplied

[Epidemiological surveillance of parasitic diseases in the republic of Armenia].

Parasitic diseases play a very important role in the regional pathology of Armenia. Malaria was completely eradicated in Armenia in 1963; the malaria-free status was maintained till 1994. At present, the populations of the Ararat, Armavir, and Tavush regions of Armenia are at a potential risk for malaria. Nowadays, 6 species of Anopheles mosquitoes are spreading in Armenia. An analysis of many years' official statistics on the number of individuals infected with intestinal helminthiases and a retrospective analysis of those in 1986-2001 were made to study the current epidemiological laws on intestinal helminthiases. The infection rates of ascariasis, trichocephaliasis, enterobiasis, teniasis, and mixed infection were 4.0 +/- 0.4, 1.2 +/- 0.2, 25.9 +/- 1.0, 0.2 +/- 0.08, and 0.8 +/- 0.2%, respectively. Those of intestinal helminthiasis were higher in rural areas than those in urban areas and in Yerevan. The above fact makes it necessary to work out a new, comprehensive, scientifically-grounded parasitological service adjustable to the present new socioeconomic conditions.

Adolescent↗
PubMed1993

Emergency public health surveillance in response to food and energy shortages--Armenia, 1992.

Living conditions in Armenia have deteriorated since 1988 as a result of an economic blockade related to a territorial conflict between Armenia and a neighboring country. The effects of this blockade--a drastic reduction in available food, heating fuel, gasoline, electricity, health services, drugs, and vaccines--have placed residents of Armenia at increased risk for morbidity and mortality from nutritional deficiencies, infectious diseases, and hypothermia. To assess and monitor the current health and nutritional status of residents of Armenia, the Armenian National Institute of Health, the U.S. Agency for International Development (USAID), and CDC have developed the Emergency Public Health Information Surveillance System (EPHISS). This report summarizes preliminary results for 1992.

Armenia↗
PubMed2000

Metal Contamination in the Republic of Armenia.

/ Air, soil, and water samples were collected throughout the Republic of Armenia both before and after its independence from the Soviet Union in 1991. Reported analyses of those samples indicated that levels of several trace metal concentrations (Ag, Cd, Cr, Cu, Mo, Ni, Pb, Ti, and Zn) exceeded the maximum allowable concentrations established by the former Soviet Union (FSU) and subsequently adopted by Armenia. Although industrial production has declined by more than 80% since the 1980s, the economy is improving and there is potential for a significant increase in the generation of industrial metal emissions. These include automobile emissions, which are now considered to be the primary source of atmospheric lead. Historically, the Soviet Union did not strictly enforce environmental standards, and Armenia is now faced with the resulting environmental problems and the associated risks to public health. Since some trace metal concentrations may be at or near potentially toxic levels, there is a need to accurately assess the extent of metal contamination in order to devise cleanup plans and develop long-term environmental protection and public health strategies in Armenia.

Journal Article↗
PubMed1996

Medical outreach to Armenia by telemedicine linkage.

Telemedicine, an electronic mode of transmitting medical information interactively between remote sites, was launched as an educational support for a 3-year-old medical partnership between Boston University School of Medicine and Emergency Hospital, of Yerevan, Armenia. Emergency Hospital is the first site in Armenia to have an audiographic teleconference capability linking it to a major medical center. Emergency Hospital and Boston University School of Medicine share the remote connection in order to allow educational conferences, peer consultations, and distance learning to take place, thus enhancing the partnership's aims to improve the emergency and trauma care system of Yerevan. To date, eight teleconferences have been transmitted linking 100 physicians, nurses and hospital administrators. The teleconference program provides, in effect, a formal continuing medical education program for Emergency Hospital. It is a key tool of low-cost technology transfer with the potential of broadening resources over the wide territory of the 15 republics of the former Soviet Union. The telemedicine system is comprised of Optel Communications' Remote Viewing System computer hardware and software plus two dedicated AT&T telephone lines. The system has been in use at Boston University School of Medicine for live voice and still image transmission between international sites since 1987. This level of technology suited environmental conditions in Armenia, marked by frequent power outages and unreliability of local telephone connections. A protocol for presentations was established governing length of time, number of visuals per session, visual format, compatibility with interpretive services, congruence with project mission, and adaptability to local conditions that was shown to provide clear and concise delivery of the information necessary. This paper reports the process of development, installation, and initial use of the technology in one nation of the post-Soviet world.

Armenia↗
PubMed2003

Isotopic evidence of the persistent dominance of blood lead concentrations by previous gasoline lead emissions in Yerevan, Armenia.

Recent (1999) blood lead (PbB) isotopic compositions (n=17) of males and females in Yerevan, Armenia, indicate that previous emissions of leaded gasoline still dominate the populace's PbB concentrations 2 years after the country's apparent de facto elimination of leaded gasoline in Armenia. The range of PbB isotopic compositions overlaps those of air and near-road surface soils in Yerevan, and the averages of those isotopic compositions in blood (208Pb/207Pb=2.442; 206Pb/207Pb=1.158) and near-road soils (208Pb/207Pb=2.442; 206Pb/207Pb=1.157) are indistinguishable. Using a proxy for historic leaded-gasoline emissions in Armenia, these analyses suggest that leaded gasoline was, is, and will continue to be via the resuspension of lead-bound soils contaminated by previous depositions from leaded-gasoline emissions, a relatively important source of industrial lead in both Yerevan's atmosphere and its populace. However, the level of lead contamination in the Armenian populace, based on the PbB geometric mean of 4.0microg/dL (n=49) measured in this initial survey, appears to be much lower than recently proposed by the Armenian Ministry of Nature Protection.

Adolescent↗
PubMedDate not supplied

Expanding the role of nurses in Armenia.

The dissolution of the Soviet Union and the declaration of Independence by the Republic of Armenia created the need for significant changes in the healthcare delivery system in Armenia. The desire to raise the level of health care presented challenges and opportunities for nurses within the Republic. Members of the departments of nursing at Boston City Hospital/Boston Medical Center in Boston, Massachusetts, University of Massachusetts Medical Center, Worcester, Massachusetts, and the Emergency Scientific Medical Center of Yerevan, Armenia, joined forces through a grant written by Boston University School of Medicine and sponsored by the American International Health Alliance under a cooperative agreement with the United States Agency for International Development to expand the role of nursing. This article describes the assessment, planning, implementation, and evaluation of changes to the role of nursing and the development of new roles for nurses within a hospital in the capital city of Yerevan.

Armenia↗
PubMed2000

Telemedicine in Armenia.

Telemedicine in Armenia began with the US Telemedicine Space Bridge programme, which was introduced following the disastrous earthquake in 1988. More recently educational programmes have been established between the School of Medicine at Boston University and the Emergency Hospital in Yerevan. There are also telemedicine activities involving the Internet, for example at the Diagnostica Medical Centre in Yerevan. The future integration of telemedicine and telehealth services within the health services in Armenia will produce significant benefits. Current telemedicine activities in Armenia represent models for collaborative projects in other former Soviet republics with the aim of providing greater access to health-care at higher quality and lower cost.

Armenia↗
PubMed2001

Republican Scientific-Medical Library, The Republic of Armenia: progress and programs.

In 1990, the Republican Scientific-Medical Library (RSML) of the Ministry of Health of Armenia in collaboration with the Fund for Armenian Relief created a vision of a national library network supported by information technology. This vision incorporated four goals: (1) to develop a national resource collection of biomedical literature accessible to all health professionals, (2) to develop a national network for access to bibliographic information, (3) to develop a systematic mechanism for sharing resources, and (4) to develop a national network of health sciences libraries. During the last decade, the RSML has achieved significant progress toward all four goals and has realized its vision of becoming a fully functional national library. The RSML now provides access to the literature of the health sciences including access to the Armenian medical literature, provides education and training to health professionals and health sciences librarians, and manages a national network of libraries of the major health care institutions in Armenia. The RSML is now able to provide rapid access to the biomedical literature and train health professionals and health sciences librarians in Armenia in information system use. This paper describes the evolution of the RSML and how it was accomplished.

Armenia↗
PubMed1994

Health care in Armenia today.

Although one of the smallest of the new independent states of the former Soviet Union, the Republic of Armenia has an ancient tradition and a strong ethnic identification, greatly enhanced by the diaspora. In addition to the problems following the dissolution of the Soviet Union, Armenia has had to contend with a draining war in Nagorno-Karabakh and the after-effects of a devastating earthquake in 1988. Humanitarian efforts have ranged from emergency supply deliveries to longer-term sustainable health care partnerships. The United States government, through the Agency for International Development, has organized such partnerships, partially as a result of a multinational mission in 1992 and a subsequent hospital-to-hospital program developed by the American International Health Alliance. We describe the current state of health care in Armenia and some of the problems that need to be addressed to improve health care services to its citizens.

Armenia↗
PubMed1994

The comparative clastogenic activity of mainstream tobacco smoke from cigarettes widely consumed in Armenia.

Whole-body exposure of male albino Swiss mice to the mainstream smoke produced by 10 types of cigarettes widely consumed in Armenia resulted in a significant increase (2.4-5.6-fold) of the number of micronucleated bone marrow polychromatic erythrocytes. The smoke produced by cigarettes manufactured in Armenia, Russia and Bulgaria was more clastogenic than the smoke produced by cigarettes manufactured in the USA. A high direct correlation was observed between the number of micronucleated polychromatic erythrocytes and the content of tar and nicotine.

Animals↗
PubMed2004

An assessment of HIV/AIDS risk in higher education students in Yerevan, Armenia.

Armenia's current sociopolitical and economic instability and the alarming HIV incidence rates in neighboring countries amplify its risk for a national epidemic. The goals of this study were to assess HIV/AIDS knowledge and risk behaviors among higher education students in Yerevan. Knowledge of HIV transmission through sexual intercourse was markedly higher than that on intravenous transmission and prevailing myths; however, HIV/AIDS knowledge was not related to risk behaviors. Tobacco and alcohol prevalence was relatively high. Students reported risky sexual behaviors, including inconsistent condom use, casual sex, and multiple partners. In addition to descriptive statistics delineating gender differences across the target behavioral domains, bivariate and multivariate statistical analyses were used to understand factors that contributed to increased risk, including early age of initiation and the relationship between substance use and risky sexual activity. The study results provide much-needed information for the development of school- and community-based AIDS prevention programs in Armenia.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Salt iodisation and public health campaigns to eradicate iodine deficiency disorders in Armenia.

BACKGROUND: Iodine deficiency disorders (IDD) are endemic in the mountain regions of Armenia. Universal salt iodisation has been chosen as the control measure. OBJECTIVES: (1). To measure the prevalence of iodine deficiency in the Armenian population; (2). to evaluate household use of iodised salt; and (3). to monitor iodised salt promotion strategies. DESIGN: Cross-sectional study on a nationally representative sample of 2627 households, including 3390 children under five and 2649 women of fertile age. Cluster sampling design on four population strata: residents, refugees, rural and urban. RESULTS: Thyroid was palpable in one-third of the women, 6% of them having a visible goitre. Median of urinary iodine excretion in children was 139.5 microg l-1. One-third of the children showed low urinary iodine concentration. Iodised salt was consumed in 66% of the households. The national IDD control programme included modernisation of the Yerevan Salt Factory, legislative regulation of the iodine content of the salt, and public information by the media. CONCLUSIONS: Armenia was still an endemic zone for goitre in 1997. The iodine status of children under five in 1997 was not considered alarming even though 33% of them had low values of urinary iodine. After four years of intervention strategies, the use of iodised salt has increased by 17%. Further efforts should be made to control salt imports and to monitor IDD indicators in vulnerable groups.

Adolescent↗
PubMed2000

Epidemic investigation of diphtheria in the Republic of Armenia, 1990-1996.

While incidence rates of diphtheria steadily declined in Armenia after World War II, reemergence of the disease in 1990 brought about changes in public health practices and identified resource needs. The Armenian Ministry of Health (MOH) routinely collected diphtheria case reports, as a reportable health outcome. Diphtheria incidence rates increased from 0.02/100,000 in 1993 to 1/100,000 (36 cases) in 1994. The distribution of cases showed that the greatest number of illnesses and deaths occurred among persons 5-14 years old, yet incidence rates among persons 1-4 and 5-14 years old were similar (4. 4 cases/ and 4.3 cases/100,000, respectively). During 1990-1996, 9 (75%) of 12 cases who died and 18 (21%) of 84 cases who survived had not been vaccinated. The diphtheria epidemic in Armenia was an important, serious, and signal public health event. The Armenian MOH responded by revising immunization practices (1994), improving epidemic control measures (1995), and soliciting international resources (1992-1996).

Adolescent↗
PubMed2002

Risk factors for depression in the survivors of the 1988 earthquake in Armenia.

Most studies of psychopathology following disasters are concerned with posttraumatic stress disorder (PTSD). The present analyses sought to assess the rate and determinants of depression in adult survivors of the 1988 earthquake in Armenia. Unlike previous studies of earthquakes, the present analyses derive from a well-defined cohort of survivors who underwent diagnostic interviewing to characterize psychiatric morbidity. As part of a cohort study of 32,743 survivors of the 1988 earthquake in Armenia, a stratified population sample of 1,785 persons was interviewed about 2 years following the disaster using a special questionnaire based on the National Institute of Mental Health (NIMH) Disaster Interview Schedule/Disaster Supplement. 52% met the criteria for major depression. Of these, a total of 177 cases of depression with no other psychiatric diagnosis or comorbidity were compared with 583 controls from the same interviewed group who did not fulfill the criteria for any psychiatric disorder. Cases and controls were compared as to data obtained independently at the aftermath of the disaster on a number of exposures and characteristics related to the earthquake. More of the cases involved females (odds ratio [OR] for males 0.7 [95% confidence interval [CI] 0.5-0.9]) and from the city of Gumri, which had some of the worst destruction (OR for residents of Gumri 5.9 [95% CI 4.0-8.8]). Being with someone in the same building at the moment of the earthquake was protective for depression (OR for presence of other people 0.5 [95% CI 0.3-0.6]), and the risk of depression increased with the amount of loss that the family sustained as a result of the earthquake (OR for highest level of loss 2.5 [95% CI 1.3-4.8]). The use of alcohol was protective for depression (OR for those who drink 0.5 [95% CI 0.3-0.8]). In various models of multivariate adjustment and analysis, the increased risk of depression with loss, geographic location, and female gender was maintained. Also, being with someone during the disaster, receiving assistance and support after the earthquake, and alcohol use were protective for depression in these multivariate analyses. Depression is a common sequel to an earthquake. As with our previous study of PTSD, we were able to relate intensity of the disaster and loss to the risk of depression in a general population sample. The role of social support during and after the disaster as a protective mechanism against adverse psychological outcome was highlighted again. Whereas alcohol use in our previous study was not related to PTSD outcome, it is noteworthy that in the present analyses it emerged as a protective factor for depression.

Adolescent↗
PubMed1997

An epidemic of acute postinfectious glomerulonephritis in Armenia.

AIM: To evaluate the presentation and course of acute postinfectious glomerulonephritis (APGN), which has increased dramatically in Armenia after serious deterioration in the living conditions. STUDY DESIGN: Observational study, based on case notes, of a large homogeneous group of patients hospitalised for APGN at one centre over a five year period (1992-6). PATIENTS: 474 patients aged < 16 years with a diagnosis of APGN. RESULTS: The annual number of patients increased tenfold from 19 (average 1992/3) to 196 in 1995. Sixty two per cent were in the age group 4-9 years and 65% were boys. Upper respiratory infections, scarlet fever, and skin infections preceded APGN in 51%, 23%, and 13%, respectively. All patients had haematuria (93% gross), 84% had oedema, and 72% had hypertension. C3 was initially decreased in 95% of the patients examined. Renal function was impaired (serum creatinine > 100 mumol/l) in 29%. Four patients with renal failure had crescentic glomerulonephritis at biopsy; of these, three required temporary haemodialysis. Main extrarenal complications were heart failure (10%) and convulsions (3%). One patient died and five (3%) did not recover completely. CONCLUSIONS: APGN in children is associated with considerable initial morbidity, and long term outcome is not uniformly benign. Outbreaks of APGN may occur anytime in countries such as Armenia that are suffering from a sudden decline in socioeconomic conditions.

Acute Disease↗
PubMed1998

Contraception and induced abortion in Armenia: a critical need for family planning programs in eastern Europe.

OBJECTIVES: The purpose of this study was to determine the number of induced abortions per woman and the reasons for selecting induced abortion among parous Armenian women. METHODS: A consecutive series of 200 women attending an abortion clinic in Yerevan, Armenia, were queried by a physician about their reproductive histories. RESULTS: Women younger than 20 years of age reported a median of 1 and women older than 40 years reported a median of 8 induced abortions in their lifetimes (overall median = 3). Lack of contraceptive information was the major reason cited for not using contraception. CONCLUSIONS: Induced abortion is the major form of birth control among parous Armenian women. Concerted public health campaigns are needed to inform women and their physicians in Armenia and other Eastern European countries about alternative contraceptive methods.

Abortion, Induced↗