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Biomedical subjects

R J Waldman

Publications and source records attributed to R J Waldman.

18 recordsLinked to original sources
PubMed1991

Cholera in Africa: lessons on transmission and control for Latin America.

In January, 1991, epidemic cholera emerged in Peru and spread to 7 other countries of Latin America. Cholera was introduced 20 years ago to Africa, where it spread rapidly to 30 of the 46 countries of the region and by 1990 accounted for 90% of all cases reported to the World Health Organisation. Many lessons from the cholera epidemic in Africa are relevant to efforts to control the disease in Latin America. Public health practices from the past--quarantine and cordon sanitaire to halt introduction of cholera by travellers, and vaccination and mass chemoprophylaxis to control epidemics--are ineffective in preventing spread of the disease. Cholera can be transmitted not only by contaminated water but also by food. Social phenomena such as mass migrations and burial practices may play a greater role than previously understood. While efforts to prevent the spread of cholera have been ineffective, cholera-associated mortality can be decreased with rehydration therapy. Since the current pandemic is unlikely to retreat soon, new strategies are urgently needed to control the spread of cholera through sanitary and behavioural interventions or improved vaccines.

Africa↗
PubMed1990

Prevention of excess mortality in refugee and displaced populations in developing countries.

More than 30 million refugees and internally displaced persons in developing countries are currently dependent on international relief assistance for their survival. Most of this assistance is provided by Western nations such as the United States. Mortality rates in these populations during the acute phase of displacement have been extremely high, up to 60 times the expected rates. Displaced populations in northern Ethiopia (1985) and southern Sudan (1988) have suffered the highest crude mortality rates. Although mortality rates have risen in all age groups, excess mortality has been the greatest in 1- through 14-year-old children. The major causes of death have been measles, diarrheal diseases, acute respiratory tract infections, and malaria. Case-fatality ratios for these diseases have risen due to the prevalence of both protein-energy malnutrition and certain micronutrient deficiencies. Despite current technical knowledge and resources, several recent relief programs have failed to promptly implement essential public health programs such as provision of adequate food rations, clean water and sanitation, measles immunization, and control of communicable diseases. Basic structural changes in the way international agencies implement and coordinate assistance to displaced populations are urgently needed.

Africa↗
PubMed1990

The effective case management of childhood diarrhoea with oral rehydration therapy in the Kingdom of Lesotho.

In Lesotho prior to 1986, diarrhoea was the leading cause of hospital mortality in children less than 5 years of age. At the Queen Elizabeth II Hospital, diarrhoea-related admissions as a proportion of all admissions in children less than 5 years of age declined from 23% in the year prior to the opening of the Oral Rehydration Therapy Unit (ORTU) to 13% in the first nine months of 1987 (p less than 0.05). In addition, the case-fatality ratio of children treated in the ORTU declined from 1.4% in the first quarter of 1986 to zero in the second and third quarters of 1987 (p less than 0.05). In a case-control study conducted to identify reasons for children failing ORTU treatment, factors associated with an increased risk of hospitalization included male gender (odds ratio [OR] = 4.9; 95% confidence limits [CL] = 2.0, 11.9), fever greater than or equal to 38.5 degrees C (OR = 2.0; CL = 1.2, 3.3), undernutrition (OR = 3.2; CL = 1.1, 9.4), and moderate dehydration (OR = 2.3; CL = 1.2, 4.4) or severe dehydration. (OR = 12.1; CL = 3.8, 38.5). Breastfed children less than 2 years of age were at decreased risk of hospitalization (OR = 0.4; CL = 0.2, 0.7). At this major hospital in Lesotho, the standardization of outpatient treatment for diarrhoea with oral rehydration salts (ORS) in the context of an ORTU resulted in a marked decrease in diarrhoea-associated hospitalization and deaths in children less than 5 years of age.

Case-Control Studies↗
PubMed1990

Surveillance and control of meningococcal meningitis epidemics in refugee populations.

Epidemics of communicable diseases pose a direct threat to refugee and internally displaced populations, and could lead to high mortality rates and a disruption of basic health care services. Several large refugee populations live in regions of high meningococcal disease endemicity and their camps are at risk for outbreaks of meningococcal meningitis. Surveillance in these camps allows early detection and control of impending outbreaks. Confirmation of meningococcal disease can be performed under field conditions using simple techniques, such as latex agglutination. Isolates should be obtained for serogroup confirmation and antibiotic sensitivity studies at reference laboratories. Serogroup information is used to determine the risk of widespread epidemic disease and the utility of available vaccines. During epidemics, treatment regimens should be standardized, preferably with an effective single-dose antibiotic. Mass vaccination campaigns should be initiated, the populations at high risk being targeted for vaccination as quickly as possible. When the risk of epidemic disease is deemed to be high, preemptive vaccination may be warranted. Daily surveillance using a simple case definition is essential during an epidemic to determine the effectiveness of control measures and to delineate high-risk groups for vaccination or chemoprophylaxis. Many of these recommendations can be applied also to other populations in developing countries.

Adolescent↗
PubMed1989

Tuberculosis control in refugee settlements.

Tuberculosis and its management in refugees and other displaced persons in temporary settlements poses a challenge to organisations coordinating and providing care in refugee emergencies. This paper offers a consensus of the co-sponsoring agencies on practical recommendations for implementing measures aimed at both interrupting transmission of tuberculosis and treatment of individual patients.

Humans↗
PubMed1989

Loss of maternal measles antibody during infancy in an African city.

Measles epidemics with 20% of the cases under nine months of age continue to occur in Brazzaville, Congo, even though measles vaccination coverage was 77% in the 12- to 23-month age group in 1986. In order to estimate the duration of passive immunity against measles, we conducted a serologic survey of infants aged 2 to 9 months. Measles antibody was measured from capillary blood with the plaque inhibition test. An antibody titre of 40 milli-International Reference Units per ml of serum (mIRU/ml) or less was defined as seronegative. Among the 252 infants studied, the proportion with detectable antibody dropped from 95.8% at 2 months of age to 48.5% at 4 months of age, and to 8.2% in the 7-8 month age group. A simple logistic model with age as the only variable provided an excellent fit to the observed values. Between the ages of 8 and 28 weeks, there was an almost steady decline of approximately 4.7% per week in the proportion of infants who were seropositive. These findings suggest that loss of maternal measles antibody during infancy might be faster than reported in other African populations. Giving measles vaccine to infants before the age of nine months currently recommended by the Expanded Programme on Immunization may be useful in some populations. Further studies of seroconversion and impact on measles are needed.

Age Factors↗
PubMed1989

Measles prevention and control in emergency settings.

Outbreaks of measles continue to be a common occurrence among refugee and famine-affected children in emergency relief camps. Extremely high measles-associated mortality rates have been reported from refugee camps--where undernutrition is common--in several countries over the past 10 years. Mortality from measles is, however, preventable, and immunization against the disease is a high priority in emergency relief programmes, second only in importance to the provision of adequate food rations. All children aged 6 months to 5 years should be immunized with measles vaccine as soon as they enter an organized camp or settlement. Should supplies of measles vaccine be inadequate, children in feeding centres, or those otherwise identified as undernourished, are the top priority for immunization. The occurrence of measles in a camp is not a contraindication to conducting an immunization campaign. Strong coordination by a designated lead agency is needed if such campaigns are to be successful; however, cooperation with the local expanded programme on immunization is essential to ensure that existing cold chain equipment, training protocols, and management manuals are used. If additional equipment is necessary, a complete immunization kit developed by the Office of the United Nations High Commissioner for Refugees, the World Health Organization, and Oxfam can be procured from Oxfam headquarters in the United Kingdom. Vitamin A supplements should be given routinely at the time of measles immunization in situations where malnutrition is severe. Mortality and morbidity in children with clinical measles can be reduced by administering high doses of vitamin A.

Child, Preschool↗
PubMed1988

The epidemiology of measles in a partially vaccinated population in an African city: implications for immunization programs.

A large outbreak of measles was reported in Pointe-Noire, Congo, between October 1984 and March 1985. An investigation was conducted to determine the epidemiology of measles in this community in which, in 1985, 54% of the children 12-23 months of age had documented evidence of vaccination against measles. The investigation included hospital and clinic record reviews and a community survey. Measles has been continuously transmitted in Pointe-Noire since at least 1979, with seasonal epidemics. In early 1984, the expected epidemic did not occur, and at least 1,000 measles hospital admissions and 100 measles deaths were prevented. Between October 1984 and March 1985, 1,942 measles cases were hospitalized, of which 306 (15.8%) died. During the epidemic, the proportion of nonpreventable cases (cases occurring before nine months of age) was 17%, reflecting the change in age distribution of measles cases in childhood since the immunization program started in Pointe-Noire in 1982. From the community survey, it was estimated that 13% of all children under age five years acquired measles in Pointe-Noire in 1985. Vaccine efficacy was calculated from community and hospital samples to be between 78% and 87%. Our findings suggest that increasing vaccination coverage levels to well above 50% is necessary to substantially reduce measles morbidity and mortality in African cities.

Child↗
PubMed1988

Risk factors for fatal diarrhea: a case-control study of African children.

Few studies have determined risk factors for diarrheal deaths in developing areas. The Ministry of Health of Lesotho, southern Africa, reported that 9.5% of children under five years of age who were hospitalized for diarrhea in 1984 died. Of 104 children under five years of age who died during hospitalization for diarrhea, 85% were aged 24 months or younger and had nonbloody diarrhea during the warm season. We conducted two retrospective case-control studies of children aged 24 months or younger admitted for diarrhea at two hospitals in 1983 and 1984, comparing 44 who died with 89 who survived. Eight factors were significantly associated (p less than 0.05) with death at one or both hospitals by univariate analysis: diagnosis of a major infection, age under six months, illness for seven days or more before admission, thrush or stomatitis on admission, severe dehydration, history of vomiting, dehydration that had not improved after 12 hours in the hospital, and fever or subnormal temperature. Multivariate analysis of data from one hospital showed the first three factors to be significantly associated with death. Cases and controls were similar in sex and in degree of malnutrition. This study identified children at high risk for death from diarrhea.

Child, Preschool↗
PubMed1988

An analysis of mortality trends among refugee populations in Somalia, Sudan, and Thailand.

A review of mortality data from refugee camps in Thailand (1979-80), Somalia (1980-85), and Sudan (1984-85) indicates that crude mortality rates (CMRs) were up to 40 times higher than those for the non-refugee populations in the host countries. In eastern Sudan, approximately 5% of the population of eight camps died in the first 3 months of the emergency and daily CMRs as high as 14 per 10 000 were reported. These rates dropped to values comparable with those of the host country within 6 weeks in the Thai camps; however, in Somalia and Sudan this process took 12 months. Mortality rates among under-5-year olds in the early phases, which were as high as 32.6 per 10 000 per day, are six times greater than those in the world's least developed countries during non-emergency times. Among severely undernourished children in one camp in Sudan, the death rate reached 114 per 10 000 per day. Acute respiratory infections, diarrhoeal diseases, malaria, measles, and undernutrition were the causes of most reported deaths, the majority of which could have been prevented by adequate food rations, clean water, measles immunization, and an oral rehydration programme.

Adolescent↗
PubMed1988

Vitamin A supplementation for refugees and famine victims.

Reports about recent famine victims and refugees have described the occurrence of xerophthalmia and resultant blindness related to severe vitamin A deficiency. These populations are subject to high prevalences of childhood protein-energy malnutrition and infectious diseases, pre-existing marginal vitamin A status, and inadequate levels of vitamin A in relief rations. In order to prevent unnecessary morbidity and mortality when any of these risk factors arise, famine victims or refugees should receive vitamin A supplements as an early and essential component of the nutritional support provided by relief agencies. Such supplementation should not await the results of nutrition or blindness surveys but rather should be a standard component of the maternal and child health care provided to the affected population until sufficiency of dietary vitamin A has been clearly established.

Child↗