Tropical and geographical medicine
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High caesarean birth rates are an issue of international public health concern. Determinants of caesarean birth are reviewed in order to formulate strategies to reduce these high rates. ⋯ The risks and safety of caesarean birth differ from place to place in this world. As the relative safety of the procedure is an important factor contributing to the rise of caesarean birth, the fact that this has only been achieved in some parts of the world should restrict the indications to perform the operation in the best interests of pregnant women.
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To assess prevalence of hair dyspigmentation, decurling, thinness and frailty, a random sample of more than 4,000 preschoolers, representative for a large area in Northern Zaire, was examined clinically and anthropometrically. Isolated dyspigmentation, isolated thinness and the combination of both were the most frequent signs (> 5%). Prevalence of hair signs did not differ according to sex or season. ⋯ Isolated dyspigmentation, however, was unrelated to WFA or marasmus. All signs occurred also in children with 'normal' WFA (SD > -2). In these children, hair signs were associated with the presence of clinical muscle wasting.
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During a two year community-based investigation of mortality 3.5% of the deaths to individuals over the age of 5 years were reported by bereaved relatives to have occurred to epileptics and 77% of these deaths were thought to have occurred whilst the patient was in status epilepticus. This prompted us to determine the prevalence of epilepsy in this rural population by interviewing 7,450 residents of a pre-defined study area. ⋯ Anti-convulsant prophylaxis is available at the district hospital but this service is only sporadically used by epileptics in this population. Uncontrolled and poorly managed epilepsy may result in an increased risk of premature mortality among epileptics living in this community.
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Comparative Study
Infant-feeding practices in urban and rural communities of the Sudan.
Infant-feeding and weaning practices were investigated in a multistage randomly selected sample of 1,039 Sudanese mothers who represented six of the nine States of the Sudan. The majority (77.9%) believed that breast milk was best for their babies, emphasizing the previously reported high breast-feeding rate in Sudanese mothers. Food supplementation started by 6 months in 82.5% mainly in urban middle and high classes (UMC and UHC) compared to urban poor class (UPC) and the rural group (RG; p < 0.001). ⋯ About half the children (52.8%) were weaned abruptly, mainly among UPC and RG. The first food item of choice for weaning was fresh goat's or cow's milk (77.6%), followed by powdered or formula milk (16.1%). The commonest second preferred food was a starch gruel (39.1%) made either of rice (24.5%) or fermented sorghum.
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Review Case Reports
Strongyloides stercoralis infection in a non-immunosuppressed tourist with involvement of the central nervous system.
In the present case report a 50-year-old woman is presented with a Strongyloides stercoralis infection after a one-month stay in Sri Lanka. She showed a severe involvement of the central nervous system without a correlation of an immunosuppression. Strongyloides stercoralis is regarded as the cause of the cerebral involvement. Other possible causes are also discussed.