Biomedical subjects
R G Feachem
Publications and source records attributed to R G Feachem.
Infotech and biotech: learning the lessons.
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Globalization: from rhetoric to evidence.
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Globalisation is good for your health, mostly.
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Why global health matters to US primary care physicians.
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The role of the World Bank in international health: renewed commitment and partnership.
During the course of the past ten years, the World Bank has become the single largest external financier of health activities in low and middle income countries and an important voice in national and international debates on health policy. This article highlights the Bank's new strategic direction in the health sector aimed at: improving health, nutrition, and population outcomes of the poor; enhancing the performance of health care systems; and securing sustainable health care financing. Millions of preventable deaths and treatable illnesses, together with health systems that are inefficient, inequitable and ineffective, have motivated expanded Bank support for the health sector in many of its client countries. The new policy directions and system-wide reforms observed in these countries are the result of both demand and supply factors. It is part of a general shift in the Bank's approach to development assistance, which sees systemic reform as a way to improve the impact and sustainability of investments in health. On the demand side, the Bank is trying to adapt to ongoing political, technological, economic, demographic, epidemiological and social pressures. On the supply side, the Bank's growing international experience and substantial financial resources are used to complement the development assistance provided by other organizations and the global effort to improve health and health systems in low and middle income countries.
Poverty and inequity: a proper focus for the new century.
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Health systems: more evidence, more debate.
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A new century for international public health.
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The World Bank's contribution to tropical medicine: diagnosis and prognosis.
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Adult health: a legitimate concern for developing countries.
Adults, defined here as people between 15 and 59 years of age, in developing countries have a high risk of premature death and suffer from frequent morbidity and high rates of chronic impairment. Their ill health imposes a major burden on health services and large negative consequences on families, communities, and societies. This paper describes the level and impact of adult mortality and morbidity, and highlights some of its characteristics and causes, which in some cases contradict commonly held beliefs. It concludes that "adult health" is a legitimate public health concern for developing countries that is not being addressed. An agenda for remedial research and action is proposed.
Excreta disposal behaviour and latrine ownership in relation to the risk of childhood diarrhoea in Sri Lanka.
A case-control study of environmental and behavioural risk factors for childhood diarrhoea was conducted in Kurunegala district, Sri Lanka. From five hospitals, 2458 children aged less than 5 years and suffering from diarrhoea were recruited as clinic cases, and a further 4140 reporting with complaints other than diarrhoea were recruited as clinic controls. Community-based cross-sectional surveys were also conducted in three of the five areas served by these hospitals, and from these a further 1659 children were recruited as community controls. Children from households where excreta were reported to be disposed of in a latrine were less likely to have diarrhoea than children whose families improperly disposed of excreta. The results obtained from comparisons of cases with clinic controls (adjusted odds ratio [OR] 1.42, 95% confidence interval [CI] : 1.01-1.98), and of cases with community controls (OR 1.35, 95% CI : 0.85-2.13) were in agreement, suggesting that no important selection bias operated on this association. If the observed proportion (91%) of improper excreta disposal among the population could be reduced to 50%, 12% of childhood diarrhoea episodes would be prevented. Although latrine ownership may be a necessary condition for safe excreta disposal behaviour, diarrhoeal morbidity may only be reduced in Sri Lanka if behavioural changes take place concomitant with the construction of sanitation facilities.
A study of the association between improved sanitation facilities and children's height in Lesotho.
The impact of improved sanitation on the anthropometric status of children under 5 years in Lesotho was investigated using children recruited into a case-control study of diarrhoea morbidity. The children's height-for-age Z-scores were used as an indicator of chronic undernutrition. Classifying children as 'stunted' or 'adequately nourished' revealed some evidence of an association between latrine ownership and attained height. After allowing for confounding variables, the odds of stunting were 18 per cent lower among children in households with latrines (95 per cent confidence interval, 36 per cent lower to 3 per cent higher). More powerful analyses, using height-for-age as a continuous outcome variable, revealed that the mean height-for-age Z-score of children from households with a latrine was 0.27 standard deviations higher than that of children from households without a latrine (95 per cent c.i. = 0.12 to 0.42). These results suggest that the anthropometric status of children may be as responsive to improvements in sanitation facilities as diarrhoea morbidity in some settings.
Childhood diarrhoea in Sri Lanka: a case-control study of the impact of improved water sources.
Between January 1987 and March 1988 a case-control study of the impact of improved water sources on childhood diarrhoea was conducted in Kurunegala District, Sri Lanka. Two thousand four hundred and fifty eight cases of diarrhoea were recruited at five of the hospitals in the district. Another 4140 children presenting at the same hospitals with complaints other than diarrhoea were recruited as controls. Data from the five hospitals suggest that children in households drawing their drinking water from handpumps suffer 46% fewer episodes of diarrhoea than children in families using unprotected traditional sources (95% c. i. 29-59%), while children in families using protected traditional wells suffer 35% fewer episodes than children in families using unprotected traditional sources (95% c. i. 27-41%). There were, however, substantial differences between the different hospitals. Among children recruited at one of the hospitals, the reduction in diarrhoea rates associated with the use of improved sources was estimated to be 93% compared with an average of 18% for the other four hospitals. In common with other case-control studies conducted in Malawi and the Philippines, little evidence of confounding of the association between diarrhoea and water supply was observed. Our results suggest that, in Sri Lanka, the use of improved water supplies, including protected traditional wells, rather than unprotected traditional sources may lead to a substantial reduction in diarrhoea morbidity among children under five years of age.
A case-control study of the impact of improved sanitation on diarrhoea morbidity in Lesotho.
A health impact evaluation of the Rural Sanitation Pilot Project in Mohale's Hoek district, Lesotho, was conducted from October 1987 to September 1988. A clinic-based case-control design was used to investigate the impact of improved sanitation on diarrhoea morbidity in young children. The results indicate that under-5-year-olds from households with a latrine may experience 24% fewer episodes of diarrhoea than such children from households without a latrine (odds ratio = 0.76; 95% confidence interval, 0.58-1.01). The impact of latrines on diarrhoea was greater in those households that used more water, practised better personal hygiene, and where the mothers had a higher level of education or worked outside the home. In common with studies conducted in Malawi, Philippines, and Sri Lanka, little evidence was found that the relationship between latrine ownership and diarrhoea was confounded by socioeconomic status or environmental variables. For a sample of cases and controls, data on exposure status (presence or absence of a latrine) that were collected by interview at the clinics agreed closely with those obtained by observation during a home visit.
Health impact evaluation of improved water supplies and hygiene practices in Sri Lanka: background and methodology.
Between January 1987 and March 1988 a Health Impact Evaluation (HIE) of the Rural Water Supply and Sanitation Project (RWSSP) was conducted in Kurunegala District. Four related activities were undertaken: 6598 children were recruited into a case-control study of diarrhoea morbidity conducted in five hospitals; an additional 1649 children from the catchment areas of three of the five hospitals were recruited as a community comparison group; environmental microbiology was performed on water samples collected during 3092 visits to the homes of children recruited into the study; diagnostic stool microbiology was performed for 371 children with diarrhoea and 121 controls. In this paper the seasonality of reported diarrhoea and the socio-demographic characteristics and health-related behaviours of each study group are examined. Cases, clinic controls and the community comparison group were all drawn from the essentially rural settlements typical of the southern part of the dry zone of Sri Lanka. The majority of households in these settlements are Sinhalese buddhist, and the main economic activity is subsitence farming. There was some evidence of differences between the three groups, community recruits tending to come from larger and wealthier households than the children recruited at the hospitals. Issues arising in the design and analysis of this Health Impact Evaluation are discussed. In particular, potential sources of bias are examined and the question of validity investigated.
Enterotoxigenic Escherichia coli in the domestic environment of a Malaysian village.
The membrane-filter assay, GM1-ELISA, and DNA-DNA hybridization assay, were used to detect enterotoxigenic Escherichia coli (ETEC) in samples of water, weaning food, food preparation surface swabs, fingerprints of mothers, and the fingerprints and stools of children under 5 years of age, in 20 households in a Malaysian village. Weaning food and environmental samples were frequently contaminated by faecal coliforms, including ETEC. The membrane-filter assay detected and enumerated faecal coliforms and LT-ETEC in all types of water and weaning food samples. Highest concentrations of faecal coliforms and LT-ETEC were found in weaning food, followed by well-water, stored water and stored drinking water. The GM1-ELISA detected LT-ETEC in weaning food, food preparation surfaces, fingerprints and stool samples. The DNA-DNA hybridization assay detected a larger proportion of STa2-ETEC than the other toxotypes, either singly or in combination. All the assays in combination detected the presence of ETEC in all types of samples on at least one occasion in each household. It was not possible to classify households as consistently more or less contaminated with ETEC. On individual occasions it was possible to show a significant association of the presence of LT-ETEC between the fingerprints of children and their stools, fingerprints of mothers and children, and weaning food and the stools of the child consuming the food.