Articles: disease.
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Bull. World Health Organ. · Jan 1999
Clinical Trial Controlled Clinical TrialA clinical training unit for diarrhoea and acute respiratory infections: an intervention for primary health care physicians in Mexico.
In Tlaxcala State, Mexico, we determined that 80% of children who died from diarrhoea or acute respiratory infections (ARI) received medical care before death; in more than 70% of the cases this care was provided by a private physician. Several strategies have been developed to improve physicians' primary health care practices but private practitioners have only rarely been included. The objective of the present study was to evaluate the impact of in-service training on the case management of diarrhoea and ARI among under-5-year-olds provided by private and public primary physicians. ⋯ Most aspects of the case management of children with diarrhoea improved among both groups of physicians after the course; the proportion of private physicians who had five or six correct elements out of six increased from 14% to 37%: for public physicians the corresponding increase was from 53% to 73%. In ARI case management, decisions taken on antimicrobial therapy and symptomatic drug use improved in both groups; the proportion of private physicians with at least three correct elements out of four increased from 13% to 42%, while among public doctors the corresponding increase was from 43% to 78%. Hands-on training courses thus seemed to be effective in improving the practice of physicians in both the private and public sectors.
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Review Case Reports
Abdominal wall pain caused by cutaneous nerve entrapment in an adolescent girl taking oral contraceptive pills.
The etiology of chronic abdominal pain can be elusive. The diagnostic workup, therefore, often includes superfluous and expensive tests, as well as invasive procedures which do not contribute to the final diagnosis. Studies have shown that some patients suffer from prolonged pain in the abdominal wall and often are misdiagnosed and treated as having a visceral source for their complaints. ⋯ After the involved cutaneous nerve was selectively blocked by subcutaneous infiltration, the pain disappeared immediately and completely. Recognition of this apparently unusual condition can lead to gratifying results. It is proposed that oral contraceptive therapy may have caused changes in the abdominal wall which led to nerve entrapment and the ensuing severe, prolonged pain.
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This paper begins with a review of the problem of teen pregnancy in the United States. Domestic trends are compared with those of other developed countries. Antecedents of the problem are discussed. ⋯ An analysis of the different ways in which the problem can be framed and the implications for solutions of the problem follow. Examples of promising teen pregnancy and STD/HIV/AIDS prevention programs are provided. The paper ends with a recommendation for an eclectic approach to framing the problem and possible solutions.
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Bull. World Health Organ. · Jan 1999
Comparative StudyLong-term morbidity and mortality following hypoxaemic lower respiratory tract infection in Gambian children.
Acute lower respiratory infections (ALRI) are the main cause of death in young children worldwide. We report here the results of a study to determine the long-term survival of children admitted to hospital with severe pneumonia. The study was conducted on 190 Gambian children admitted to hospital in 1992-94 for ALRI who survived to discharge. ⋯ Children in Gambia who survive hospital admission with hypoxaemic pneumonia have a good prognosis. Survival depends more on nutritional status than on having been hypoxaemic. Investment in oxygen therapy appears justified, and efforts should be made to improve nutrition in malnourished children with pneumonia.
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Bull. World Health Organ. · Jan 1999
Mass vaccination with a two-dose oral cholera vaccine in a refugee camp.
In refugee settings, the use of cholera vaccines is controversial since a mass vaccination campaign might disrupt other priority interventions. We therefore conducted a study to assess the feasibility of such a campaign using a two-dose oral cholera vaccine in a refugee camp. The campaign, using killed whole-cell/recombinant B-subunit cholera vaccine, was carried out in October 1997 among 44,000 south Sudanese refugees in Uganda. ⋯ Mass vaccination of a large refugee population with an oral cholera vaccine therefore proved to be feasible. A pre-emptive vaccination strategy could be considered in stable refugee settings and in urban slums in high-risk areas. However, the potential cost of the vaccine and the absence of quickly accessible stockpiles are major drawbacks for its large-scale use.