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At least 19 recordsLinked to original sources
PubMed1992

Famine-affected, refugee, and displaced populations: recommendations for public health issues.

During the past three decades, the most common emergencies affecting the health of large populations in developing countries have involved famine and forced migrations. The public health consequences of mass population displacement have been extensively documented. On some occasions, these migrations have resulted in extremely high rates of mortality, morbidity, and malnutrition. The most severe consequences of population displacement have occurred during the acute emergency phase, when relief efforts are in the early stage. During this phase, deaths--in some cases--were 60 times the crude mortality rate (CMR) among non-refugee populations in the country of origin (1). Although the quality of international disaster response efforts has steadily improved, the human cost of forced migration remains high. Since the early 1960s, most emergencies involving refugees and displaced persons have taken place in less developed countries where local resources have been insufficient for providing prompt and adequate assistance. The international community's response to the health needs of these populations has been at times inappropriate, relying on teams of foreign medical personnel with little or no training. Hospitals, clinics, and feeding centers have been set up without assessment of preliminary needs, and essential prevention programs have been neglected. More recent relief programs, however, emphasize a primary health care (PHC) approach, focusing on preventive programs such as immunization and oral rehydration therapy (ORT), promoting involvement by the refugee community in the provision of health services, and stressing more effective coordination and information gathering. The PHC approach offers long-term advantages, not only for the directly affected population, but also for the country hosting the refugees. A PHC strategy is sustainable and strengthens the national health development program.

Aged↗
PubMed1992

Pediatric AIDS and perinatal HIV infection in Zaire: epidemiologic and pathologic findings.

HIV infection in women and children is a special problem in Zaire and in other countries where heterosexual transmission is predominant. Nearly half of the cases of HIV infection are in women 15 to 30 years old and as many as seven infected infants may be born each year. Whether or not infected at birth, these children have mothers, and often fathers, who are infected and likely to die while they are still very young. Such orphaned children, as well as those whose families cannot provide adequate food and health care, add to the problematic economies of developing countries. The problems of children of HIV-infected mothers in developing countries may be compounded further by factors directly related to their mother's disease. Infected mothers who are sick may produce insufficient levels of antibodies and be unable to provide their children with adequate natural passive immunity before birth. Their infants may also receive inadequate levels of breast-milk-derived antibodies possibly enhancing their already increased susceptibility to perinatal infections, and lastly, the volume of breast milk produced by these mothers may be inadequate for the nutrition of these infants. All these factors may further compromise the already difficult task of distinguishing those infants of HIV-infected mothers who are ill because they are infected from those who are ill because of their mother's disease. Regardless of the mechanisms accounting for the increased vulnerability of infants of HIV--seropositive and AIDS-afflicted mothers to perinatal infections, infant mortality can be expected to increase significantly as a direct consequence of the progression of the HIV pandemic throughout Africa and possibly other developing countries; this in populations already with a total under five-years-of-age mortality rate exceeding 15%. The association of chorioamnionitis with HIV seropositivity and with the clinical status of the mother seems to suggest that impaired maternal immunity increases the risk of premature birth, its consequent lower birth weight, and to HIV or other perinatally acquired infections. The identification of women at higher risk of chorioamnionitis and their treatment might provide a means to decrease the risk of premature delivery and possibly reduce the rate of HIV transmission to their infants. The pathologic changes in organs of infants and children with HIV infection require in-depth, systematic study to better define the natural history of perinatal HIV disease and infection.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Nurse-midwifery in rural Pakistan.

Pakistan is a relatively new nation of predominantly Islamic influence. Like many developing countries, it is plagued by extensive communicable diseases, malnutrition, inadequate sewage systems, and illiteracy. Religious beliefs and cultural influences impact heavily on access to health care and on maternal-child health outcomes. This paper examines the major maternal-child health problems encountered, as well as implications for midwifery practice in an Islamic country.

Child↗
PubMed1992

Measures to reduce the infant mortality rate in Tanzania.

Tanzanian health problems reflect those in other developing countries where the standard of living is low and housing and sanitation are inadequate. The major cause of infant mortality can be attributed to preventable diseases such as gastroenteritis, acute respiratory infections and malnutrition. In spite of the fact that various efforts have been made to extend primary health care coverage, particularly in rural areas, the scarcity of economic resources impedes the implementation of many health programmes. However, only by maintaining primary health care as a major part of the country's development strategy can the needs of both rural and urban people be met.

Child Health Services↗
PubMed1990

Maternal mortality audit in a Zimbabwean province.

A maternal mortality audit was introduced in the Midlands Province (Zimbabwe) in order to identify which avoidable factors were involved most frequently. During the two-year study period, the maternal mortality rate was 137 per 100,000 total births. The main causes of death were uterine rupture, eclampsia, haemorrhage and caesarean section related accidents. An avoidable factor was identified among 87% of these deaths involving the health system in 57% of the cases and the patient in 33%. Access to the health facilities and transport problems only played a minor role.

Cesarean Section↗
PubMedDate not supplied

Sustained protection against mortality and morbidity from malaria in rural Gambian children by chemoprophylaxis given by village health workers.

Mortality and morbidity from malaria were measured in children for a one-year period in a rural area of The Gambia 3-4 years after the introduction of a primary health care programme into some villages in the study area. Among children resident in primary health care villages who received treatment for febrile illnesses from a village health worker resident in their village there was no reduction in overall mortality or in morbidity from malaria compared with levels found in villages without a primary health care worker. However, among children aged 3-59 months who received malaria chemoprophylaxis from a village health worker in addition to treatment there was a 49% reduction in mortality and a 73% reduction in attacks of clinical malaria. The level of protection against malaria achieved by chemoprophylaxis given by village health workers 3-4 years after the chemoprophylaxis programme was started was as high as that obtained shortly after the introduction of the primary health care programme.

Antimalarials↗
PubMed1990

Reduction in pneumonia mortality and total childhood mortality by means of community-based intervention trial in Gadchiroli, India.

In a community-based intervention trial to reduce childhood mortality from pneumonia the intervention area included 58 villages (6176 children aged 0-4 years) and the control area 44 villages (3947 children) in Gadchiroli, India. The interventions included mass education about childhood pneumonia and case-management of pneumonia by paramedics, village health workers, and traditional birth attendants (TBAs) who were trained to recognise childhood pneumonia and treat it with co-trimoxazole. Parents sought treatment, and coverage was 76% without active case-detection efforts. The case-fatality rate among the 612 cases treated by health workers was 0.8%, compared with 13.5% in the control area. After a year of intervention pneumonia-specific childhood mortality was significantly lower in the intervention than in the control area (8.1 vs 17.5 deaths per 1000 children under 5 years); the difference between the areas was greatest in children under 1 year. The differences in infant mortality (89 vs 121 per 1000) and total under-5 mortality (28.5 vs 40.7 per 1000) were highly significant. Mortality from other causes remained similar in the two areas but neonatal mortality due to birth injury and prematurity was significantly lower in the intervention area, presumably owing to the combination of better maternal and neonatal care by the TBAs trained in the project and the availability of treatment for pneumonia. The cost of co-trimoxazole was US $0.025 per child per year ($2.64 per child saved).

Administration, Oral↗
PubMed1991

The effect of insecticide-treated bed nets on mortality of Gambian children.

Insecticide treatment of bed nets ("mosquito nets") may be a cheap and acceptable method of reducing the morbidity and mortality caused by malaria. In a rural area of The Gambia, bed nets in villages participating in a primary health-care (PHC) scheme were treated with permethrin at the beginning of the malaria transmission season. Additionally, children aged 6 months to 5 years were randomised to receive weekly either chemoprophylaxis with maloprim or a placebo throughout the malaria transmission season. We measured mortality in children in PHC villages before and after the interventions described, and compared this with mortality in villages where no interventions occurred (non-PHC villages). About 92% of children in PHC villages slept under insecticide-treated bed nets. In the year before intervention, mortality in children aged 1-4 years was lower in non-PHC villages. After intervention, the overall mortality and mortality attributable to malaria of children aged 1-4 in the intervention villages was 37% and 30%, respectively, of that in the non-PHC villages. Among children who slept under treated nets, we found no evidence of an additional benefit of chemoprophylaxis in preventing deaths. Insecticide-treated bed nets are simple to introduce and can reduce mortality from malaria.

Antimalarials↗
PubMed1990

Safe motherhood: cesarean section or symphysiotomy?

The place of symphysiotomy in the management of cephalopelvic disproportion is discussed on the basis of the existing literature, reviewing maternal mortality and morbidity after symphysiotomy and the vaginal delivery rate in a subsequent pregnancy after a previous symphysiotomy. These are compared with the outcome of cesarean section performed in similar circumstances.

Cesarean Section↗
PubMed1991

Levels and determinants of early neonatal mortality in Natal, northeastern Brazil: results of a surveillance and case-control study.

An institution-based surveillance and nested case-control study was conducted in Natal, Northeastern Brazil to estimate the level and determinants of early neonatal mortality. The early neonatal mortality rate was 25.5 per 1000 live-birth, 75% of early neonatal deaths were premature low birthweight infants, and the mortality rates were 591 and 318 per 1000 respectively, for preterm small for gestational age (PT-SGA) and preterm appropriate for gestational age (PT-AGA) infants. Mortality was 50 per 1000 for term low birthweight, and 8.6 for term normal birthweight AGA infants. In addition to prematurity and low birthweight, the main risk factors associated with early neonatal death were maternal smoking, complications during pregnancy or intrapartum, and inadequate antenatal care. The associations were weaker for prepregnancy factors such as single marital status or low maternal body weight, and no significant associations were observed with socioeconomic status. These findings suggest that in this population, efforts to reduce early neonatal death should focus on improved maternal care and the prevention of prematurity.

Brazil↗
PubMed1990

Health beliefs related to diarrhea in Haitian children: building transcultural nursing knowledge.

Regardless of where they live or under what circumstances, mothers throughout the world seem to have a compelling desire to provide the best possible health care for their children (Huston, 1979). Haitian mothers living in the Dominican Republic were no exception. The health beliefs and practices of these mothers related primarily to diarrhea among their children which demonstrated a concern and resourcefulness that is commendable. The results of this study clearly indicate the importance of transcultural nurses conducting culturally relevant research as a basis to develop sound health programs in developing countries. Diarrhea was identified as the single most important threat to a child's health in these communities. That mothers did not know about the correct ingredients and/or proportions for oral rehydration solutions (Western views) was of interest. Although the Dominican government makes some commercial packets of ORS, most of the women interviewed did not have ready access to this product. This finding reflected the need for transcultural nurses to offer to teach mothers how to make ORS using the sugar, salt, and water they had available. Since the mothers' perception that diarrhea was a dangerous threat to their children's health, was verified by childhood mortality statistics in the bateys, it would seem that ORS could make a significant impact on the health status of the children. Breastfeeding also was a major health belief factor associated with the treatment of diarrhea. Even though the majority of mothers believed breast feeding should be continued if a child had diarrhea, a number believed it should be discontinued. Nurses working with CHWs will need to emphasize the importance of breastfeeding and help them to develop creative ways of communicating this information to the mothers. The second most dangerous threat to the child identified by the mothers was respiratory ailments. This suggests a new area of concentration for future research and training of CHWs. A host of new questions related to respiratory problems such as health beliefs, causative factors, course of disease, traditional treatments, mortality rate, etc. need to be investigated. When transcultural nurses plan health care programs for women and children in other cultures, it is important to recognize the concerns mothers have for their children, and their intense desire to nature and care for them. In this study, mothers willingly participated and demonstrated active interest in learning to use methods to improve the health and well being of their children. It is well documented (Lieban, 1977) that established health beliefs are not automatically discarded when new knowledge is made available, but that exploration and incorporation of new information when presented in a culturally relevant framework does occur. An understanding of local beliefs surrounding health is fundamental to the development of appropriate transcultural nursing interventions.

Adult↗
PubMed1992

Birth kits for safe motherhood in Bangladesh.

Tetanus infection remains the leading cause of high neonatal mortality in Bangladesh. Birth kits which instruct and assist in a clean, safe birth are seen as a key measure in reducing the high incidence of neonatal deaths. A multisectoral programme has developed a simple kit and tested its potential for distribution to pregnant women. Initial results are positive and development is continuing.

Adult↗
PubMed1991

Safe motherhood: a challenge to midwifery practice.

The principal way of achieving maternal health and safe motherhood is to expand the specific functions and/or categories of midwifery personnel. This includes strengthening knowledge and skills to improve the quality and quantity of care. Success would ensure that for millions of women the prospect of childbirth would be one of joy rather than misery.

Delivery of Health Care↗
PubMed1990

Light on maternal mortality in India.

In order to investigate the degree and causes of maternal mortality in Anantapur District, Andhra Pradesh, India, detailed enquiries were made at the grass roots and the records of health facilities were examined. The number of maternal deaths proved to be much higher than would have been revealed by a perusal of official data alone. Many women in a serious condition died on the way to hospital or soon after arrival because the means of transport were too slow or otherwise unsuitable. Maternal mortality rates varied substantially from place to place, reflecting differing levels of economic development and the presence or absence of primary health centres and subcentres.

Adolescent↗
PubMed1991

Cranial base hemorrhage. A technique for controlling the uncontrollable.

In the management of trauma, control of life-threatening hemorrhage must be accomplished expeditiously if morbidity is to be decreased and mortality prevented. Hemorrhage from the inaccessible cranial base, especially when transected vessel stumps are not available for direct control, can be the most demanding, life-threatening, surgical emergency. We present our experience in utilizing an autologous bone grafting technique to successfully control severe hemorrhage from the base of the skull. In our review of the literature to date, we have been unable to ascertain whether this modality has been previously used.

Bone Transplantation↗
PubMed1992

Development of health surveillance in Togo, west Africa.

Since 1988, the Ministry of Health (MOH) of Togo, with technical assistance from CDC, has systematically adapted and strengthened its health information system (HIS) to enable improved monitoring of trends in diseases. The previous system had been hampered by complicated, lengthy reporting forms; incomplete and delayed receipt of reporting forms; absence of mortality reporting; slow, cumbersome manual compilation and analysis methods; and lack of standard case definitions. To simplify the adaptation process, the system was divided into three main activities: data collection, data compilation and analysis, and dissemination of reports and follow-up action. Public health authorities in Togo have built on existing strengths and successfully adapted the HIS to focus on national morbidity and mortality prevention priorities.

Communicable Disease Control↗