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Biomedical subjects

N Hirschhorn

Publications and source records attributed to N Hirschhorn.

At least 19 recordsLinked to original sources
PubMed1995

The effect of a national control of diarrheal diseases program on mortality: the case of Egypt.

The National Control of Diarrheal Diseases Project (NCDDP) of Egypt began in 1981, became fully operational nation-wide by 1984, and concluded in 1991. The project was designed as a campaign to lower mortality from diarrheal disease in children under five by at least 25% within five years. The principal strategy employed was to improve case-management of diarrhea through rehydration and better feeding: through assured production and distribution of oral rehydration salts, education of families through mass media and health workers through training programs, and creation of rehydration corners throughout the established primary health care and hospital network. A detailed plan for evaluation and research was designed at the start of the project. By its own terms, the NCDDP appears to have succeeded in improving case management; by several local and national mortality surveys, overall infant and childhood mortality fell by at least one-third with the majority proportion in diarrheal deaths. The declines coincided with the peak of NCDDP activities and results in improved case-management. The detailed analyses of this monograph seek to demonstrate that: (a) the mortality decline and the diarrheal mortality decline in particular were actual events; (b) that case-management improved with plausible sufficiency to account for most of the diarrheal mortality reduction; and (c) that changes in other proximate determinants to lowered mortality, such as host resistance or diarrheal incidence, do not plausibly account for the magnitude of the reductions seen. Data are also presented on general socio-economic changes in the decade of the Project. We conclude that improvements in primary care delivery and the use of mass media would have been facilitating factors to NCDDP efforts, while the overall deterioration of economic status would have tended to reduce the benefits. The monograph details the strengths and weaknesses of the available data, and also makes recommendations for sustained efforts in the control of diarrheal diseases.

Causality↗
PubMed1995

Relationship of pesticide spraying to signs and symptoms in Indonesian farmers.

OBJECTIVES: This study assessed correlations between exposure to pesticides and signs and symptoms of pesticide toxicity among Indonesian farmers. METHODS: Detailed observations were recorded of spray frequency and pesticide handling, dermal exposure, and the chemicals used. Symptoms of acute illness were reported by the farmers, and signs of poisoning were observed by the interviewers at the time of spraying or within a few hours after it. RESULTS: The spray practices substantially exposed the farmers to pesticides. Signs and symptoms occurred significantly more often during spraying than during nonspraying seasons. Twenty-one percent of the spray operations resulted in three or more neurobehavioral, respiratory, and intestinal signs or symptoms. The number of spray operations per week, the use of hazardous pesticides, and skin and clothes being wetted with the spray solution were significantly and independently associated with the number of signs and symptoms. A dose-effect relationship was found between the neurobehavioral signs and symptoms and the use of multiple organophosphates. CONCLUSIONS: For farmers in the tropics, fully protective garb is too hot and too costly to maintain; farmers thus accept illness as a necessity. Integrated pest management has previously been demonstrated to reduce pesticide use with no loss of crop yield. The frequency of spraying should be reduced through widespread training in integrated pest management, and also the licensing and sale of the most hazardous pesticides should be regulated.

Adult↗
PubMed1992

Hypernatraemia surveillance during a national diarrhoeal diseases control project in Egypt.

The nationwide introduction of oral rehydration therapy to Egypt has led to improvement in diarrhoea case management and a fall in infant and child mortality. With the wider use of oral rehydration solution (ORS) prepared from packets, the incidence of hypernatraemia (serum sodium greater than 150 mmol/l) in inpatients with dehydration seen at Abu El-Reeche Hospital, Cairo, increased between 1980 and 1984. Systematic surveillance of hypernatraemia in the outpatient rehydration unit began in late 1984, and we report trends in hypernatraemia and analyses of key variables affecting its incidence in dehydrated children. In 1980, 17 of 100 children sampled had hypernatraemia and 2 had severe hypernatraemia (ie, serum sodium greater than 165 mmol/l). The frequency in inpatients peaked at 49% of 222 children in 1984 (19% with severe hypernatraemia). Between 1986 and 1989, at least 1000 dehydrated outpatients were surveyed each year; by 1989 the incidence of hypernatraemia had fallen to around 10% (2% severe hypernatraemia). The rise and decline coincided with increasing use of ORS and then increasing ability of mothers to mix the solution correctly. Hypernatraemia was positively related to the quantity of ORS taken, severity of dehydration, nutritional status, and the cooler season, and negatively related to age and duration of diarrhoea. Explanations for our findings include improved use of ORS and better case-management. Good practice promoted through the mass media has facilitated these changes; if the standard of ORS use is not maintained, there may be a case for reducing the sodium content of ORS.

Child, Preschool↗
PubMed1991

After rehydration: what happens to the child?

Three-hundred infants and toddlers with diarrhoea were followed up for 5 days after initial rehydration with oral rehydration solution (ORS). When an average of 300-340 ml per day was given at home (520 ml if the diarrhoea was watery), only two children required re-hospitalization; one other child died whose voluminous losses should not have been treated at home. Fifteen per cent of the children still had watery diarrhoea and vomiting by the fifth day, perhaps as a result of multiple drug therapy. Continued feeding, especially breast milk and cereal grains, should reduce the duration of diarrhoea and vomiting (and perhaps the number of drugs). The amount of time a mother can spend giving ORS ultimately limits the amount a child receives.

Dehydration↗
PubMed1990

Effect of diarrhoeal disease control on infant and childhood mortality in Egypt. Report from the National Control of Diarrheal Diseases Project.

The effect of the National Control of Diarrheal Diseases Project, started in 1983, on infant and childhood mortality in Egypt was assessed by means of national civil registration data, nationwide cluster sample surveys of households, and local area studies. Packets of oral rehydration salts are now widely accessible; oral rehydration therapy is used correctly in most episodes of diarrhoea; most mothers continue to feed infants and children during the child's illness; and most physicians prescribe oral rehydration therapy. These changes in the management of acute diarrhoea are associated with a sharp decrease in mortality from diarrhoea, while death from other causes remains nearly constant.

Cause of Death↗
PubMed1984

A focused approach to quality of care assessment in family planning.

An approach to quality of care assessment for family planning based on management-by-objectives has been tested in 18 clinics. Key indicator standards were developed by the family planning agencies themselves and objective survey instruments designed to measure performance against the standards. Results were made available quickly to each clinic and led to operational changes in the majority, with evidence of improved performance and willingness to use evaluation of care as a means for clinic management. Analyses of the aggregated data showed wide variations in performance over several indices of care.

Adult↗