Biomedical subjects

S R Huttly

Publications and source records attributed to S R Huttly.

52 records · Page 3Linked to original sources

PubMed1989

Testis cancer: post-natal hormonal factors, sexual behaviour and fertility.

The relationship of risk of testis cancer, and subdivisions of the tumour by histology, to variables which may be related to hormonal status, sexual behaviour and fertility was investigated in data from a case-control study with 259 cases and 2 sets of controls. No consistent association was found between testis cancer risk and age at puberty, need to shave, obesity, alcohol intake, animal fat intake, and sexual behaviour. There was a significant excess of seminomas in very tall men. Testis cancer cases showed lower fertility than controls according to various measures, but this reflected the greater frequency of cryptorchidism among cases compared to controls. Among non-cryptorchid subjects there was no clear evidence that infertility was associated with risk of testis cancer.

Adolescent↗

PubMed1989

Disability from dracunculiasis: effect on mobility.

A study was conducted in northeastern Imo State to define the disability and restriction of mobility associated with dracunculiasis. The study was part of an evaluation of the UNICEF-assisted Drinking Water Supply and Sanitation Project in Imo State, Nigeria. A sample of household units (100 in year 1, 195 in year 2) was visited every two weeks to determine who was affected by dracunculiasis and to characterize the extent of related disability. The average duration of symptoms was 12.7 weeks (range 3-29 weeks). Fifty eight per cent of all episodes of disease resulted in severe disability (with the individual unable to leave the compound) lasting a mean of 4.2 weeks (range 2-12). The mean period of severe disability was significantly higher for those aged 50 years and over than for those less than 50 years old. In the area studied, the disease occurred during the peak yam and rice harvest time and the period of preparation for the planting season. This is the first study to document systematically and prospectively the marked restriction of normal activity in affected individuals and the long duration of the disability. These findings can assist in improving estimates of the costs associated with dracunculiasis and of potential economic benefits if the disease were eradicated.

Activities of Daily Living↗

PubMed1989

Persistent diarrhoea in a rural area of Bangladesh: a community-based longitudinal study.

As part of a health impact evaluation of a water supply and sanitation project in a rural area of Bangladesh, diarrhoeal morbidity was recorded in children 0-4 years of age using weekly recall in household interviews, during the period March 1984 to December 1987. During the baseline year, 1984, the incidence rate of all diarrhoea episodes (3.8 episodes per child per year), and those defined as persistent, duration greater than 14 days (0.6 episodes per child per year), showed a similar age distribution, peaking in the 12-23 month age group. Sixteen per cent of all episodes were classified as persistent, and this proportion was greatest in the 0-5 month age group (25%). Children suffering at least one episode of persistent diarrhoea in 1984 also experienced a higher incidence of acute diarrhoea (less than = 14 days duration) than those suffering acute diarrhoea only (4.2 versus 3.7 episodes per child per year). Persistent diarrhoea showed a similar seasonal pattern to that of all episodes. Rates of abdominal pain, isolation of Shigella spp and a diagnosis of dysentery were significantly higher in persistent episodes than in acute episodes. Closer follow-up of children during 1986 and 1987, through the recording of all periods of absence of the child from the home, showed that overall diarrhoea incidence rates were little affected when absence was taken into account, but that the incidence of persistent diarrhoea and the proportion of episodes classified as persistent were significantly reduced. The implications of this methodological problem are discussed.

Acute Disease↗

PubMed1989

Lack of impact of a water and sanitation intervention on the nutritional status of children in rural Bangladesh.

The nutritional impact of a water and sanitation intervention in a rural community of Bangladesh, comprising the provision of handpumps, construction of latrines and hygiene education was assessed. During 3 years, the quarterly anthropometric measures of about 200 children aged 12-35 months from the intervention community were compared with those of a similar number of children from a control area. The interventions reduced the incidence of diarrhoea by 25 per cent among the children less than 5 years of age. There was no significant difference in nutritional status, however, between the two groups of children. Moreover, within the intervention area, indicators of water and latrine use were not significantly related to the children's nutritional status. This suggests that either the obtained reduction of diarrhoea was not large enough to have an impact on nutritional status or that diarrhoea is not an important cause of malnutrition in this community.

Bangladesh↗

PubMed1989

Infant feeding and risk of severe diarrhoea in Basrah city, Iraq: a case-control study.

A case-control study of the relationship between feeding mode and risk of hospitalized diarrhoea in infants (aged 2-11 months) in Basrah city was conducted between September 1983 and May 1984. A total of 597 cases were recruited from among infants admitted with diarrhoea to the major paediatric hospital in the city, while 723 controls were recruited from among healthy infants attending any of the seven maternal and child health clinics in Basrah. A variety of potentially confounding variables were controlled in the analysis. For infants aged 2-5 months, breast-feeding alone or breast-feeding plus food were the least risky feeding modes. Bottle-feeding was dangerous and bottle-feeding alone was associated with a risk of 55 among infants aged 2-3 months, and 37 among infants aged 4-5 months, relative to exclusive breast-feeding. For older infants (6-11 months), the risks of hospitalized diarrhoea were not significantly different among different partial breast-feeding modes, but non-breastfeeding was dangerous, especially exclusive bottle-feeding. Food intake was associated with a reduced risk of severe diarrhoea among bottle-fed infants but not with an increased risk among breast-fed infants. Among bottle-fed infants, no association was found between risk of severe diarrhoea and method of bottle-cleaning. Previous breast-feeding conferred no current protection.

Bottle Feeding↗

PubMed1989

Tubewell water consumption and its determinants in a rural area of Bangladesh.

As part of the evaluation of a water supply, sanitation and hygiene education project in rural Bangladesh, the consumption of water from the improved supplies was estimated from an observational study. Women volunteers observed and recorded all water collection activities of each group of households using a handpump over a 2-day period. Data from questionnaire surveys on household characteristics were related to per capita use of water. The mean household water consumption rate was 43 l per capita per day. Univariate analyses showed that several factors were significantly associated with water consumption, including family size and age structure, occupation, distance from the house to the handpump, the number of people served by a handpump, and possession of luxury items. Multiple regression analysis showed that several factors remained associated with per capita consumption, although their predictive value was low. The method of measuring water consumption, and the policy implications of the findings, are discussed.

Bangladesh↗

PubMed1988

Is the incidence of testis cancer related to trauma or temperature?

The position of the testes reduces their temperature but makes them vulnerable to trauma. Patients with testis cancer frequently report prior testicular trauma, but this trauma may have triggered diagnosis of the tumor rather than been aetiological. In this study, the frequencies of various prior traumatic and temperature exposures in 259 patients with testis cancer were compared with their frequencies in two sets of control patients who did not have testis cancer. Particular effort was made to prevent bias. Testis cancer was not significantly associated with any temperature or trauma exposure and the confidence limits of the findings excluded substantially raised risks. The evidence suggests that raised temperatures and traumas commonly encountered in everyday life are not important risk factors for testis cancer. The possible aetiological roles of extreme trauma sufficient to cause atrophy, and of the trauma and raised temperature which can occur in cryptorchidism, however, need investigation by other methods.

Adolescent↗

PubMed1987

The epidemiology of acute diarrhoea in a rural community in Imo State, Nigeria.

As part of an evaluation of a water supply and sanitation project, a baseline cross-sectional study of diarrhoea, and its putative risk factors, was conducted in 5 villages in Imo State, Nigeria. Data were collected from 4641 and 5920 persons during surveys in the dry and wet seasons, respectively. 8 d period prevalence rates for diarrhoea ranged from 5 to 50%, with the highest rates occurring in the 6 to 23 month age group. Diarrhoea was associated with up to 75% of all illnesses in young children and with about 20% in adults. Risk factors included lower socio-economic status, an unclean domestic environment, use of non-purified water, absence of soap, and feeding methods other than exclusive breast-feeding in the early months of infancy. These results suggest that the education component of water supply and sanitation projects should emphasize personal and domestic hygiene and infant feeding.

Adolescent↗

PubMed1987

The bacteriological quality of traditional water sources in north-eastern Imo State, Nigeria.

Monthly bacteriological water testing of traditional water sources (ponds, rivers, unprotected springs and traditional wells) used by five villages in northeastern Imo State, Nigeria, was conducted during the period January 1983 to August 1985. The membrane-filtration technique was used to detect faecal coliforms (FC) and faecal streptococci (FS). Evidence of faecal pollution was seen throughout the year for all water sources. During the study period, the monthly geometric mean counts per 100 ml of water (all sources combined) ranged from 760 to 17877 for FC and from 678 to 17394 for FS. The peak period of faecal pollution occurred during the transition between the dry and wet seasons and in the early wet season. During this peak pollution season (February-May), the geometric mean counts were 2.5-7.2 times higher than in the remaining part of the year for all source types except rivers, with ponds being the most heavily polluted. Preliminary findings on the sensitivity and specificity, in this tropical environment, of the standard membrane-filtration technique for enumerating FC are presented. The implications of the findings of this study for the environmental control of waterborne and hygiene-related diseases are discussed.

Developing Countries↗

PubMed1987

Prenatal and familial associations of testicular cancer.

In a case-control study of testis cancer 259 cases with testicular cancer, 238 controls treated at radiotherapy centres and 251 non-radiotherapy hospital in-patient controls were interviewed about some possible prenatal and familial risk factors for the tumour. For firstborn men, the risk of testis cancer increased significantly according to maternal age at the subject's birth, and this effect was most marked for seminoma. The association with maternal age was not apparent for cases other than firstborn. The risk of testis cancer was also significantly raised for men from small sibships and of early birth order. These results accord with the theory that raised maternal levels of available oestrogen during the early part of pregnancy are aetiological for testicular cancer in the son, although other explanations are possible; there is evidence that seminoma risk may particularly be affected.

Adult↗

PubMed1987

Testicular cancer and antecedent diseases.

A case-control study of the aetiology of testicular cancer was conducted using information obtained by interview and from case-notes of 259 cases with testicular cancer and two sets of control patients -238 men with diagnoses other than testicular cancer attending the same radiotherapy centres as those attended by the cases, and 251 hospital in-patients not attending radiotherapy departments. Logistic regression analyses were performed, after stratifying by age and region of residence, to estimate the relative risks (RRs) associated with various aspects of prior medical history. The risk of testicular cancer was found to be raised for men with a history of cryptorchidism (RR based on comparison with all controls = 6.3; P less than 0.001), inguinal hernia (RR = 1.6; P = 0.14), mumps orchitis (RR = 12.7; P = 0.006), atopy (RR = 1.8; P = 0.03), and meningitis (RR = 3.0; P = 0.21). Inguinal herniorrhaphy before the age of 15 years was particularly a risk factor for seminoma, whereas the relative risks were similar for seminoma and teratoma for the other factors. The results add to the growing evidence that congenital abnormalities involving the process of testicular descent and closure of the processus vaginalis are risk factors for testicular cancer, and that some types of testicular damage later in life may also be important. The findings of associations with previous atopy and certain infections suggest a possible second aetiological mechanism - that immunological abnormalities may be associated with an increased risk of testis cancer.

Adolescent↗

PubMed1987

The effects of distance and season on the use of boreholes in northeastern Imo State, Nigeria.

A study was conducted in a rural area of northeastern Imo State to examine the effect of distance and season on the use of boreholes, provided at a borehole-to-population ratio of 1 to 440. The type of water source used by households varied according to season. In the water-scarce dry season, 98% of households used borehole water: 64% as their sole source, a further 26% as their main source, and 8% as a secondary source. The use of borehole water as the main source was little influenced by distance until the household-to-borehole distance reached approximately 2 km. The situation was different in the wet season when the availability of water sources was much greater. In this season, rainwater was the main water source for 64% of households. Borehole water was the main source for only 31% of households. In the rainy season, the use of borehole water as the main source showed a significant decrease with increasing household-to-borehole distance. The provision of one borehole for 400-500 people was associated with a high rate of use as the main water source only in the dry season. However, the use of boreholes as either a main or alternative source was high in both seasons and it is possible that those households that used boreholes as an alternative source used the water for drinking.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Promotion↗

PubMedDate not supplied

The Imo State (Nigeria) Drinking Water Supply and Sanitation Project, 1. Description of the project, evaluation methods, and impact on intervening variables.

A health impact evaluation was conducted in conjunction with the Imo State Drinking Water Supply and Sanitation Project in Nigeria. The project consisted of a package of water supply, sanitation, and health and hygiene education given by village-based workers. The evaluation was a quasi-experimental study covering pre-, peri- and post-intervention periods. Data were collected from 3 intervention and 2 control villages. Baseline surveys indicated that the intervention and control areas were similar with respect to most socio-demographic variables. Use of the improved water supply was high, although this was influenced by borehole-to-population ratios and household-to-borehole distances. Water collection time was consequently greatly reduced. Data from a small sample of households showed that borehole water became heavily contaminated during collection and storage, and that there was no significant change in consumption of water per person. Adults in 46% of household units in the intervention area were using ventilated improved pit latrines by the end of the study period. Use by young children (2-5 years old), however, was low. Limitations in the success of the health education component of the project were found. Although changes were found in knowledge, attitudes and practices related to water and sanitation, and in management of childhood diarrhoea, this occurred in both the intervention and control areas.

Health Education↗

PubMedDate not supplied

The Imo State (Nigeria) Drinking Water Supply and Sanitation Project, 2. Impact on dracunculiasis, diarrhoea and nutritional status.

Morbidity due to dracunculiasis (guinea worm disease) and diarrhoea in persons of all ages, and nutritional status of young children, were used as health impact indicators in the evaluation of the Imo State Drinking Water Supply and Sanitation Project in south-eastern Nigeria. Data were collected using repeated cross-sectional surveys and longitudinal follow-up. The study area was found to have a low level of endemicity of dracunculiasis. While no impact could be demonstrated on overall period or point prevalence rates in the cross-sectional surveys, a prospective longitudinal survey showed a significant reduction in the percentage of person-fortnights positive for dracunculiasis in areas served by the project, while the control areas showed no such change. In the cross-sectional surveys it was found that, in the project villages, those persons drinking only borehole water had significantly lower period prevalence rates one year later than others. Moreover, those living further from the nearest borehole had higher rates of dracunculiasis. An impact of the project on diarrhoea morbidity was found only in limited sub-groups of the population. A greater association with water availability rather than quality was suggested for rates in young children. The prevalence of wasting (less than 80% weight-for-height) among children aged less than 3 years decreased significantly over time in all 3 intervention villages; there was no such decline in the control villages.

Child, Preschool↗

PubMedDate not supplied

Reduction in diarrhoeal diseases in children in rural Bangladesh by environmental and behavioural modifications.

The impact of a water, sanitation and hygiene education intervention project on diarrhoeal morbidity in children under 5 years old was evaluated in a rural area of Bangladesh. Data were collected throughout 1984-1987, covering both pre- and post-intervention periods, from an intervention and a control area. The 2 areas were similar with respect to most socio-economic characteristics and baseline levels of diarrhoeal morbidity. The project showed a striking impact on the incidence of all cases of diarrhoea, including dysentery and persistent diarrhoea. By the end of the study period, children in the intervention area were experiencing 25% fewer episodes of diarrhoea than those in the control area. This impact was evident throughout the year, but particularly in the monsoon season, and in all age groups except those less than 6 months old. Within the intervention area, children from households living closer to handpumps or where better sanitation habits were practised experienced lower rates of diarrhoea. These results suggest that an integrated approach to environmental interventions can have a significant impact on diarrhoeal morbidity.

Bangladesh↗

PubMedDate not supplied

Controlled trial of three approaches to the treatment of severe malnutrition.

Domiciliary treatment of severely malnourished children could have economic and practical advantages over other methods. We compared three approaches in a controlled trial. 437 children in Dhaka (< 60% weight-for-height, and/or oedema) aged 12-60 months were sequentially allocated to treatment as inpatients, to day-care, or to care at home after one week of day-care. Institutional and parental costs incurred to reach 80% weight-for-height were compared. Costs for inpatient, day-care, and at-home groups averaged 6363, 2517, and 1552 taka (60 taka = UK pound 1). Mortality was low (< 5%) in all three groups. Day-care treatment approached inpatient care for speed of recovery at less than half the cost, but it was unpopular with parents. The at-home group took significantly longer to attain 80% weight-for-height than the other groups, but did so at the lowest average cost. Parental costs were highest for the at-home group as no food supplements were provided; nevertheless this was the most popular option. We conclude that at-home management of severely malnourished children after 1 week of inpatient care is a cost-effective strategy.

Child, Preschool↗