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Biomedical subjects

F Cutts

Publications and source records attributed to F Cutts.

33 records · Page 2Linked to original sources
PubMed1994

Measles in secondary school children: implications for vaccination policy.

The reported incidence of measles in children of secondary school age rose in 1992, after a progressive decline between 1988 and 1991. This rise was maintained in 1993. Several school and community based outbreaks of measles have occurred in the United Kingdom. This paper reports the investigation of an outbreak of measles based in a secondary school, which took place in 1992. Thirty clinical cases were detected among the school's 840 pupils and 10 sporadic cases occurred outside the school. Twenty-one of the school cases provided samples of serum, in 19 of which measles IgM was detected. The overall attack rate was 3.6%, with no significant differences attributable to age and sex. Vaccine efficacy was about 90%. This outbreak is one of the first to be described in the United Kingdom, although other countries (notably the United States) have reported measles in teenagers. The small degree of spread in the community may reflect the current high uptake of measles, mumps, and rubella vaccine and the catch up campaign that took place in 1988. The feasibility and cost effectiveness of various policy options to prevent future outbreaks in secondary schools are now being evaluated.

Adolescent↗
PubMed1994

Effects of a maternity waiting home on adverse maternal outcomes and the validity of antenatal risk screening.

OBJECTIVES: To evaluate the effect of a maternity waiting home (MWH) on adverse maternal outcomes and the validity of antenatal risk criteria in predicting dystocia. METHOD: A hospital-based cohort study was conducted at a district hospital in Zimbabwe. Information on the presence of antenatal risk factors, stay at an MWH, and mode and outcome of delivery was collected for each woman delivering at the hospital during 1989-1991. RESULTS: The risk of obstructed labor was 16 times higher for those not attending an MWH (n = 2915) than for those who did attend an MWH (n = 1573) (1 vs. 0.06%, P < 0.005). Among the non-users, 0.3% suffered a ruptured uterus compared with none of the MWH users. The presence of any one of the antenatal risk criteria used in Zimbabwe had a sensitivity of 78%, a specificity of 51% and positive predictive value of 25% for predicting dystocia. CONCLUSION: MWHs and antenatal risk screening are policy options for safe motherhood programs in settings where emergency obstetric services are not easily accessible.

Developing Countries↗
PubMed1994

A 'post-honeymoon period' measles outbreak in Muyinga sector, Burundi.

In Muyinga sector, Burundi, an area with good vaccination levels against measles and recent low incidence of measles, a major outbreak of measles in 1988 raised questions about the efficacy of the immunization programme. To help answer these questions, we 1) reviewed programme data on doses of measles vaccine administered, vaccine coverage, and measles incidence, and 2) conducted a census of the affected area to examine vaccine efficacy and measles mortality. We found that between 1980 and 1988 in Burundi, 1) measles vaccine coverage by age 1 had increased from 0% to 55%, 2) the incidence of reported measles cases declined from 12.1/1000 to 6.2/1000, 3) reported measles mortality dropped from 0.18/1000 to 0.08/1000, and 4) the interepidemic period had increased from 25 to 35 months. In the census, the best estimate of measles vaccine efficacy administered at 9 months of age was 73%. Measles increased the risk of death by 2.5-fold with the effect limited to the first month after measles. This outbreak demonstrated the 'post-honeymoon period' epidemic predicted by mathematical models in which outbreaks occur among accumulated susceptibles in a partially immunized population. Understanding this phenomenon is important in providing a basis for improved strategies of measles control. Such outbreaks present new challenges to newly maturing immunization programmes in improving skills in surveillance, outbreak investigation, and public relations.

Burundi↗
PubMed1994

Obsessive-compulsive disorder: prediction of outcome from behavioural psychotherapy.

Prediction of outcome after behavioural psychotherapy was determined in 178 outpatients with obsessive-compulsive disorder. For women (n = 103), factors significantly associated with good outcome included paid employment at time of assessment, having a co-therapist and low initial ratings on global phobia, work and home activity impairment and the compulsion checklist. In men, the only factor to approach statistical significance as a predictor of outcome was solitary abode, associated with "less improved" status.

Adolescent↗
PubMed1991

Assessing diarrhoea-induced dehydration at the community level.

A community based study of children under 5 years of age in Nampula, Mozambique, assessed children with diarrhoea for the 12 signs and symptoms of dehydration listed in the World Health Organization's Diarrhoea Treatment Chart and for the additional indicators of observed thirst and reported fever. The point prevalence of diarrhoea was 13.1%. The signs and symptoms of dehydration reported by carers were compared with signs detected on physical examination at the time of the interview. The presence of four or more stools, a history of drinking either more or less than usual, and reported fever in the preceding 24 h had the highest sensitivities. Individual symptoms with the highest specificity were decreased urine output, vomiting, and the passing of 10 or more stools during the 24 h preceding the interview. The combination of fever or vomiting had a sensitivity of 68.3% and a specificity of 55.9%, whereas a combination of vomiting or drinking more than usual or fever had a sensitivity of 87.8% and a specificity of 34.1%. These findings are compared with the results of similar studies conducted in different clinical and cultural settings.

Child, Preschool↗
PubMed1990

The use of evaluation to improve the Expanded Programme on Immunization in Mozambique.

Reported are the results of an evaluation of process indicators and outputs for the Expanded Programme on Immunization (EPI) in Mozambique which were used to modify immunization strategies from 1985 to 1987. In 1986 according to cluster sample surveys, 84% of children in Maputo, the capital, were fully vaccinated. In other cities in the country, vaccination coverage increased from an average of 36% in 1985 to 55% in 1987. The major determinants of low vaccination coverage were provision of vaccination services at health centres on less than 3 days per week; missed opportunities; and vaccinating too early or with too short an interval between doses. The results of sentinel site surveillance in Maputo indicated that EPI had a marked impact on neonatal tetanus and to a lesser extent on poliomyelitis and measles. Evaluation led to changes in EPI policy in Mozambique (e.g., adoption of a uniform national vaccination schedule and discontinuation of the use of expired vaccine) and strategies (elaboration of different strategies for urban areas, rural areas, and displaced people). Also, performance was improved by involving programme managers and implementors in evaluation, and by providing timely and widespread feedback of results to policy-makers, peripheral health workers, and the community.

Child↗
PubMed1988

Evaluating the management of diarrhoea in health centres in Mozambique.

An evaluation of the health centre management of paediatric cases of diarrhoea, comprising observation of the consultation, interview of the guardian immediately afterwards and home follow-up was performed in one rural and three urban areas of Mozambique. Oral Rehydration Therapy was advised for 83% of patients, of whom 71% received ORS packets. Eighty-seven per cent of mothers followed up stated that they had given ORT, but only 37% had a solution present at the time of interview. The main weakness in case management was the lack of health education, especially about the quantity of fluid to give, which was reflected in the mothers' belief that ORT is a medicine to 'stop the diarrhoea' and their consequent administration of it like a syrup, one teaspoonful three times a day. The results of the evaluation have facilitated the design of more appropriate health education and health worker training materials and methods.

Child, Preschool↗
PubMed1985

Community participation in Afghan refugee camps in Pakistan.

Community participation is regarded by many as the key to the primary health care (PHC) approach; that is the most essential factor in determining the success of failure of a PHC programme. In September 1983, UNICEF and Save the Children Fund (SCF) signed an agreement for a pilot PHC project in Badaber refugee camp, Pakistan, as the first phase in development of PHC in areas settled by Afghan refugees, under the supervision of the United Nations High Commission for Refugees (UNHCR) ant the government of Pakistan. This paper reviews the factors enhancing and inhibiting the formation of a community, describes how community participation was achieved in Badaber and discusses the prospects for replication of the model in the 86 camps in North West Frontier Province which are funded by UNHCR.

Afghanistan↗
PubMedDate not supplied

Calibration and use of an in-house anti-measles IgG standard serum.

For the purpose of research a large quantity of anti-measles IgG working reference serum was needed. A pool of sera from five teenagers was prepared and named Alexandre Herculano (AH). In order to calibrate the AH serum, 18 EIA assays were performed testing in parallel AH and the 2nd International Standard 1990, Anti-Measles Antibody, 66/202 (IS) in a range of dilutions (from 1/50 to 1/25,600). A method which compared parallel lines resulting from the graphic representation of the results of laboratory tests was used to estimate the power of AH relative to IS. A computer programme written by one of the authors was used to analyze the data and make potency estimates. Another method of analysis was used, comparing logistic curves relating serum concentrations with optical density by EIA. For that purpose an existing computer programme (WRANL) was used. The potency of AH relative to IS, by either method, was estimated to be 2.4. As IS has 5000 milli international units (mIU) of anti-measles IgG per millilitre (ml), we concluded that AH has 12,000 mIU/ml.

Adolescent↗
PubMedDate not supplied

Comparison of a commercial enzyme immunoassay with plaque reduction neutralization for maternal and infant measles antibody measurement.

The most practicable assay for measurement of measles IgG (mIgG) in large numbers of sera is an enzyme immunoassay (EIA). To assess how EIA results would agree with those by the gold standard method of plaque reduction neutralization (PRN) we compared the results from the two methods in 43 pairs of maternal and umbilical cord sera, and sera from the corresponding infants when aged 11-14 months. In maternal-cord sera, the differences between mean antibody levels by EIA or PRN were not statistically significant, though in individual sera, differences could be large. However, agreement was less good for infants sera, in which levels of mIgG were very low. The conclusions of a study of transplacental transport of mIgG would not be affected by the use of either technique. When studying waning immunity in infants, PRN should be the method of choice, while results from studies using EIA should be interpreted with caution.

Antibodies, Viral↗