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Biomedical subjects

M Tanner

Publications and source records attributed to M Tanner.

At least 235 records · Page 13Linked to original sources
PubMed1989

From the bench to the field: control of parasitic infections within primary health care.

During the last decade there has been a great increase in the number of countries that have endorsed the primary health care (PHC) policy at national level, set up national guidelines for it and launched its large-scale implementation. In addition, there have been many important developments with regard to appropriate, cost-effective technologies, training concepts and approaches to securing community participation. These achievements have produced numerous encouraging results. However, although the control of parasitic infections integrated into PHC systems has often been initially successful, these achievements could often not be sustained. Using case studies, mainly concerning schistosomiasis, as examples, control technologies and their applicability within PHC are discussed at three levels; the identification of public health priorities, the community-based implementation of control and the process of evaluation and monitoring. There is a great potential for the integration of a substantial part of control activities, particularly morbidity control, into PHC, provided that the aims and sequences of control activities are well matched with the felt needs of the communities concerned. This implies that the biomedical researcher, the epidemiologist and the health planner need to consider the indigenous health perspectives of the affected community. For example, recent progress in the laboratory in the development of vaccines against parasites needs to be complemented by field studies that continuously validate, standardize and assess the applicability of the proposed measures. This kind of interplay will form the basis for participatory approaches in health planning and make it possible for control activities to be integrated into existing PHC structures and to respond to the needs of the communities concerned.

Animals↗
PubMed1989

Evaluation of public health impact of schistosomiasis.

Present knowledge on the "importance"/"impact" of schistosomiasis is reviewed. Due to different methological approaches and outcome measures used as well as the substantial inter- and intra-setting variation of the epidemiology, the public health importance of schistosomiasis appears quite inconclusive for any schistosome species and cannot be generalised. In most studies "importance" is mainly understood as the amount of schistosome-related morbidity and mortality. The consequence of these morbidity patterns are however hardly specified in terms of impact on (i) the physical and socioeconomic development of an affected family/household and on (ii) the economic and social consequences for community development. It follows that impact studies mainly considered individuals as unit of analysis and hardly focused on the family/household-level. Consequently, microeconomic studies were so far not undertaken within the concept of household production models and did not distinguish between market and non-market productivity. Standardized ranking of measured schistosome-related morbidity combined with perception patterns of disease, signs, symptoms and of additional health and community development issues could lead to new approaches on how epidemiological data on the transmission and morbidity of schistosomiasis could be linked with information on health and development priorities of a community in order to estimate the relative impact of the disease.

Animals↗
PubMed1989

Liver disease in rural Tanzania--a diagnostic approach.

In a prospective study on the aetiology of liver disease and its diagnostic approach in a District hospital in rural Tanzania, 48 consecutive patients with evidence of liver disorders were investigated by physical examination, biochemical tests, laparoscopy and histology. Liver cirrhosis (posthepatic, alcoholic) was found in 31%; non cirrhotic alcoholic liver disease in 15%; viral, bacterial and protozoal liver disorders in 33%, and neoplastic liver changes in 21% of all patients. Clinical impression alone coincided with the final diagnosis in 40% of all cases. This figure was increased to 46%, when haematological and biochemical results were included, and to 71%, when laparoscopy (without histology) was used in addition. Laparoscopy was particularly decisive in the diagnosis and further management of cirrhosis, liver abscess and neoplastic liver disorders. The additional information obtained from histology led to the final diagnosis. Histology was specially useful for the diagnosis of alcoholic liver disease, tropical splenomegaly syndrome and non specific reactive hepatitis. The usefulness of laparoscopy as a diagnostic tool in a district hospital is discussed.

Adolescent↗
PubMed1989

Prevalence of dental caries among children in a rural Tanzanian community.

The age specific prevalences of mixed caries were determined in 346 children aged 1 to 15 years in a rural community in Morogoro Region, south-eastern Tanzania. In primary dentition 58.9% of children were caries free while dmf index averages 1.08. In permanent dentition 74.3% were caries free while DMF index averaged 0.43. Permanent dentition showed a constant increase in caries prevalence with age such that over half of 15 year old children had caries experience with a DMF index of 1.2. This relatively low prevalence of caries is associated with low consumption of refined sugars. Recommendations are made to support preventive dental health services and programmes in primary schools and maternal and child health clinics.

Adolescent↗
PubMed1989

Evaluation and monitoring of schistosomiasis control.

This paper attempts to review the process of evaluation in schistosomiasis control with special emphasis on the maintenance phase, in which control and evaluation activities need to be integrated into existing health care delivery services. The conceptual framework of evaluation suggested consists of five levels each asking for its specific indicators: input - process - output - outcomes (effects and coverage) - impact. A review of the literature reveals that many control projects suffer from substantial inconsistencies between initially stated objectives (e.g. transmission and morbidity control) and the indicators used for the impact assessment. Monitoring is considered as a special form of continuous evaluation focusing on the process and the outcomes, thus enabling the timely identification of deficiencies and in turn the strengthening and readjustment of control strategies. Feedback is regarded as an integral part of both evaluation and monitoring and becomes a key element for the maintenance of control. In view of the conceptual changes in schistosomiasis control from the control of transmission to the control of disease, the paper summarizes various direct and indirect morbidity indicators for both urinary and intestinal schistosomiasis that might be applied in evaluation and monitoring approaches. Similarly, indicators for the assessment of transmission or integrated control approaches are outlined. Despite the substantial number of potential indicators there is still a great need for their comprehensive standardization and large-scale field validation before they can be efficiently applied for intra-programme and inter-programme evaluation and comparison. Finally, the proposed indicators for transmission and morbidity control are examined for their application in routine health services and/or by specialized control teams.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Millon Clinical Multiaxial Inventory (MCMI) findings among breast clinic patients after initial evaluation and at 4- or 8-month follow-up.

Twenty-seven patients who subsequently underwent benign biopsy and 41 patients diagnosed to have breast cancer completed the Millon Clinical Multiaxial Inventory (MCMI) after initial examination in a breast problem clinic and again after 4 months or, for CA patients who were completing a course of chemo/radio-therapy, after 8 months. At initial testing, the trend toward fewer moderate-severe disorders among the benign biopsy (BB) group did not reach statistical significance. However, at follow-up, the difference was significant; the BB group showed fewer moderate-severe disorders (7.5%) than the cancer (CA) group (29%). Concordance of two-point peak elevations on scales 1-8, S, C, and P was examined. For the BB group, 56% had the same two high points on both testings, compared to only 27% of the CA group. Test-retest correlations on personality scales were generally lower for the CA group than for the BB group. We concluded that (1) approximately 30% of breast CA patients showed a disruption of psychological adjustment clearly severe enough to merit consideration of a mental health referral; (2) despite the frequency of significant distress, major affective and thought disorders were infrequent among this group; (3) distress associated with breast CA may interfere with the reliable assessment of long-standing personality traits.

Adaptation, Psychological↗
PubMed1987

Chloroquine administration for malaria suppression after abdominal surgery.

Administration of chloroquine after major surgery is indicated in malaria endemic areas. In emergencies it is commonly administered parenterally after the operation. The present study, undertaken at St. Francis Hospital, Ifakara (Kilombero District), Tanzania, compared plasma chloroquine levels after oral and subcutaneous administration of 300 mg of chloroquine base in 14 patients after abdominal, non-bowel-resective surgery and in 12 controls. There were no significant differences in the plasma chloroquine levels of all groups, and the chloroquine concentrations reached suppressive levels for at least 3 days (greater than 0.1 nmol/ml). Oral administration was well tolerated in both patients and controls. In all areas where the Plasmodium strains are still sensitive to chloroquine and where parenteral chloroquine may not be easily available, oral chloroquine represents a cheap, easy and safe alternative for postoperative prophylactic malaria suppression. It can be applied after abdominal non-bowel-resective emergency surgery.

Abdomen↗
PubMed1987

Longitudinal study on the health status of children in Kikwawila village, Tanzania: study area and design.

The paper describes the study area and the project design of a longitudinal study on the health status of children undertaken in Kikwawila village in southeastern Tanzania from 1982 to 1984. This rural village is situated in the Kilombero river plain (270 m above sea level) and extends over 50 km2. A census in 1982 (repeated in 1984) revealed that 1152 (1406) people lived in 260 (299) households of the nucleated roadside settlements of the sectors Kikwawila and Kapolo. The vital statistics showed an infant mortality rate estimate of 198/1000 which was far above the regional (140%) and the national (137%) averages. Over 30 tribes were recorded but 6 tribes formed 84% of the population. The population was predominantly muslim (75%). Most adult inhabitants (90%) were subsistence farmers cultivating an average of 3.7 acres per household. Rice, maize and cassava were the main crops of the area. At the beginning of the study, the village had no village health post, dispensary or health centre and it lacked an adequate and safe water supply. A great proportion of the population (67%) had to rely on water from unprotected hand dug wells and from rivers for domestic purposes. Only half of the households had a simple pit latrine. Even when latrines were present, they collapsed after heavy rains due to loose, unconsolidated soils, termites and the high water table. These difficulties affected the sustained success of sanitation campaigns. The study area represented a typical settlement of the Kilombero valley and was, with regard to most demographic, ethnic, agricultural and health characteristics, considered a suitable pilot area. A primary health care programme based on village health workers was implemented in parallel with complementary community based studies on the causes, interrelations and control measures of the major health problems faced by the community, and possible control measures.

Age Factors↗
PubMed1987

Longitudinal study on the health status of children in a rural Tanzanian community: parasitoses and nutrition following control measures against intestinal parasites.

Three repeated cross-sectional surveys were undertaken among children (1 month to 15 years) of a rural community in southeastern Tanzania. The study was part of a longitudinal project on the interactions among nutrition, parasitic infections and immunity within a primary health care programme emphasizing village health workers. All children underwent interviews and parasitological, anthropometric, anamnestic and clinical examinations. Out of 550-590 children examined each year, a cohort of 170 children could be followed for three consecutive years. Malaria was holo- to hyperendemic in the community, P. falciparum accounting for greater than 90% of the infections. The parasite and spleen rates were 88% and 67%, respectively, and the average enlarged spleen index was 2.0 among children from 2-9 years in 1982. Transmission of malaria was high and stable as indicated by a parasite rate of 80% among infants between 1 month and 1 year during the whole period of study. G. lamblia, hookworm (N. americanus), Strongyloides spp. and Schistosoma haematobium were highly prevalent and annual incidence rates were high, while Entamoeba histolytica, Ascaris and Trichuris were of minor importance. Prevalence and incidence of parasitic infections did not differ by sex. Multiparasitism was very frequent and less than 11% of all children were parasite-free in each year. Not a single child remained parasite-free for three consecutive years. An anthropometric assessment showed a high degree of stunting (35-71%) and a substantial proportion of wasting (3-20%). The growth potential was normal in girls and boys during the whole period of study. There were indications that malaria was the main contributory factor to growth retardation among young children. Hookworm infection did not significantly affect the packed-cell volume of the children, probably owing to the low intensity of infection. Due to the multiparasitism and the lack of parasite-free individuals, single-parasite and single-nutrient effects were difficult to unravel. A latrine campaign followed by a single mass treatment against hookworm (single oral dose of albendazole, 400 mg) and/or G. lamblia (single oral dose of ornidazole, 40 mg/kg) only temporarily affected the prevalence and incidence of G. lamblia, and only resulted in a decrease in the intensity of hookworm infections up to six months after the interventions. As the effects of the latrine campaign and a single mass treatment on the parasite load were only transient, no sustained impact on nutritional variables was observed.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1987

Longitudinal study on the health status of children in a rural Tanzanian community: comparison of community-based clinical examinations, the diseases seen at village health posts and the perception of health problems by the population.

Standardised household interviews among adults and children, open-ended questionnaires, and clinical examinations administered during cross-sectional health status surveys, as well as the registers of village health posts (VHP), were used to assess the pattern of health problems of a rural community in southeastern Tanzania, and their results compared. All four approaches gave very similar results for the two major health problems (fever/malaria and abdominal pain or discomfort) which were mentioned by both children and adults. The parasitological data from the cross-sectional surveys also revealed hyperendemic P. falciparum malaria and a high prevalence and incidence for infections with hookworm (N. americanus), Strongyloides, and G. lamblia. However besides consistently revealing the two major health problems, each approach showed a distinct pattern for the additional health problems: household interviews and open-ended questionnaires resulted in a higher ranking of problems that had not yet been solved by the health care facilities available in the community at the time of the interview. This view was further biased by the fact that the interviews were done by people representing the health professionals. The statistics from the registers of VHP clearly reflected the types of treatment provided by this service. Malnutrition and various eye problems only became evident during the clinical examination of the population. However, the clinical examination did not identify the importance of the abdominal problems in the community. The cross-sectional survey (questionnaires, clinical examination) chiefly showed the health problems affecting the population around the time of the surveys (end of the dry season). Interestingly, the registers of the VHP did not show marked seasonal variations in the morbidity statistics for this community. Both questionnaire approaches and the registers of VHP showed a change in both the morbidity and the disease perception pattern that may reflect the effects of interventions launched at community level (activities of village health workers, mass-treatment against hookworm and G. lamblia). The study indicated that the individual ranking of the major health problems matched with data from health status surveys. It also pointed to the possibility that disease perception patterns could become a tool for community diagnosis and for the monitoring of health care programs.

Abdomen↗
PubMed1987

Serum proteins and zinc as parameters to monitor the health of children in a rural Tanzanian community.

Total protein concentration, zinc, prealbumin, albumin, alpha-1-, alpha-2-, beta- and gammaglobulin concentrations were measured in serum samples collected in three successive years (1982, 1983 and 1984) from children (1 month-15 years) of Kikwawila village, Tanzania. The analysis of a total of 1590 serum samples provided the baseline data for children living in a rural Tanzanian community. The total protein values and the concentrations of betaglobulin were within the range described for Caucasians. Albumin, prealbumin, alpha-1- and alpha-2-globulin concentrations were below these standard values. On the other hand the gammaglobulin concentration was twice as high. The concentrations of total protein, gammaglobulin and prealbumin correlated with age. From 1982 to 1983 a significant decrease of most of the serum components (incl. zinc) was observed, although in children older than 2 years the alpha-1-globulins increased. All values increased again from 1983 to 1984, except for the zinc concentration, which decreased further. The individual fluctuations were analysed by comparing paired values for the children participating in the period 1982-1983, or 1983-1984. The proportion of children showing large fluctuations, sometimes exceeding the selected limits of tolerance, was larger in the period 1982-1983 than 1983-1984. This was consistent with the overall pattern found for all children. The prealbumin level, which has been postulated to be an indicator for malnutrition or borderline malnutrition, was analysed in detail. The values were far below normal values (200-300 mg/l), reaching a plateau with 130 mg/l among 4-6-year-old children. The individual fluctuations indicated a decrease from 1982 to 1983, which was considerable both in terms of the proportion of children showing a decrease (55%) and in the magnitude of the decrease. There was an increase from 1983 to 1984 but this increase did not compensate for the loss in 1983. Prealbumin concentrations showed a slight trend towards decreased values with stunting and wasting. No direct correlation was found between the other biochemical parameters and the parasite or anthropometric data collected at the same time. It was difficult to establish direct relationships between the biochemical parameters, which mainly indicate the health status of the child at the time-point of the survey, and anthropometric parameters which reflect the history of the individual over a long period. No direct correlation could be established between the biochemical parameters and the parasitological data.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1987

A longitudinal study on relations of retinol with parasitic infections and the immune response in children of Kikwawila village, Tanzania.

From 1982 to 1984 170 children of Kikwawila village (Kilombero district, Tanzania) were followed for nutritional (anthropometric measures, hematocrit, serum retinol, prealbumin, and zinc concentrations), parasitological (malaria parasitemia, urinary schistosomiasis, intestinal parasites) and immunological characteristics. Between 2.9% and 12.4% had serum retinol levels less than 100 micrograms/l which indicate deficiency. Retinol concentrations were correlated with age, hematocrits, prealbumin levels and mid upperarm circumferences. The latter correlation may be useful in nutritional surveys and primary health care programs for the identification of populations at risk of retinol deficiency. No association was found between average retinol levels and the presence of parasites, with the exception of malaria. Retinol levels were inversely correlated with malaria parasitemia in 1982, and directly correlated with antibody titers to synthetic sporozoite peptide in 1984. Since retinol, malaria parasitemia, and antisporozoite antibodies increased with age, confounding by age could not be excluded. Six months after administration of ornidazole in a single oral dose of 10 mg/kg, a significant effect on the prevalence of Giardia lamblia was found. Following treatment, average retinol levels were increased in persons with confirmed G. lamblia infections, but not in uninfected or untreated controls.

Adolescent↗
PubMed1987

Food consumption patterns in a rural Tanzanian community (Kikwawila village, Kilombero District, Morogoro Region) during lean and post-harvest season.

A survey on food consumption was undertaken in 32 out of 260 households of a rural Tanzanian community (Kikwawila village, Morogoro Region) during the lean season (February) and the post-harvest season (August) in 1983. The survey revealed that the staples maize, rice and cassava are equally important food items of the diet during the lean season. In August, the post-harvest season, rice dominated the food pattern and often replaced the porridge made from maize or cassava. Green vegetables, especially cassava leaves, were the main relish dish for the majority of households in February. Fish became a daily item of the diet of most families in August. Concentrated energy sources such as fats, oil and sugar were scarce in both survey periods. The diets of all age groups of the population surveyed were highly deficient in energy (mean adequacy 58%) and protein (50%) in February. The FAO/WHO-recommended standards (Passmore et al., 1974) were met for protein in August but energy deficiency was still observed (mean adequacy 65%). The variations in energy intake were not only seasonal, but were also age and sex dependent. Young males (10 to 16 years) followed by the infants (6 months to 3 years) and old females (greater than 60 years) were the groups with lowest adequacy (less than 50%) in February. Males (10 to 60 years) had the greatest energy deficits in August. Iron requirements were generally met in most age groups during both seasons. However, children under 3 years as well as adolescent and adult females (mean adequacy 54-65% in August) were at risk for anaemia. The seasonal pattern of the diet did significantly influence the vitamin A intake. While the requirements were fully met in February, a deficiency was noted in August. The low adequacy (40%) for vitamin A during the post-harvest season could be related to the scarcity of leafy vegetables in the diets. The data are discussed and related to the health problems observed in the community during the post-harvest season for three consecutive years.

Adolescent↗