International journal of epidemiology
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Comparative Study
Factors affecting immunization coverage levels in a district of India.
Immunization coverage is measured to assess the performance of the Expanded Programme on Immunization. In 1988 we conducted a coverage survey among 12-23 month-old children in the North Arcot District (population 5,007,746) in southern India. In each of the 12 towns a 30-cluster sample survey was conducted. ⋯ In the towns, 25, 66, 67 and 59% of BCG, DPT, OPV and measles vaccines had been provided by private agencies showing that availability of vaccines throughout the week and easy access even in payment terms played an important role in achieving higher levels of coverage compared with rural areas where all vaccines are given by Government agencies, free of charge. In the rural areas, significantly large variations in coverage were seen among panchayats--large and peri-urban panchayats had significantly better coverage than small and more rural panchayats. Within any given block (the population unit consisting of 30-40 panchayats served by a Primary Health Centre), there were large variations in the levels of immunization coverage between panchayats.(ABSTRACT TRUNCATED AT 250 WORDS)
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A case-control study has been undertaken in a rural area of The Gambia to evaluate risk factors for death from acute lower respiratory tract infections (ALRI) in young children. On the basis of a post-mortem interview 129 children aged < 2 years were thought to have died from ALRI. These cases were each matched according to age, sex, ethnic group, time and place of death with a child who had died from a cause other than an ALRI and with two live control children. ⋯ Comparison of children who died from causes other than ALRI with the live controls showed a similar pattern of associations and no significant differences were found in any of the risk factors studied between children whose deaths were attributed to ALRI and those whose death was attributed to another cause. Association of death with exposure to smoke during cooking was the strongest risk factor identified. This risk might be altered by reducing smoke exposure during cooking.
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Cross-sectional morbidity recorded during two successive quarterly survey rounds and subsequent 27-months mortality were studied in a random sample of 4238 preschool children in a rural Zairian area. Analysis focuses on morbid patterns, i.e. any combination of the principal signs and symptoms encountered in tropical areas (oedema, marasmus, cough, fever, diarrhoea and tachypnoea). Almost half the children (45-48%) had signs of morbidity, a very high rate. ⋯ The results show that with a few simple questions on major symptoms and a brief examination by paramedical health workers, children with an increased risk of death can be identified. The method can be applied at under-5 clinics. Prognosis is particularly bad in severe malnutrition, especially when associated with diarrhoea, in diarrhoea with cough, cough with fever/tachypnoea and for children who are found sick both in the rainy and the subsequent dry season.