Tropical and geographical medicine

Description

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  • 5-year impact
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  • Other titles
    Tropical and geographical medicine
  • ISSN
    0041-3232
  • OCLC
    1767778
  • Material type
    Periodical
  • Document type
    Journal / Magazine / Newspaper

Publications in this journal

  • Tropical and geographical medicine 02/1995; 47(6):310-1.
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    ABSTRACT: Over a period of 12 years, 524 cases of squamous cell carcinoma were seen at the Ahmadu Bello University Hospital, Zaria, Nigeria. The common site affected was the lower limb (54%) followed by the head and neck region. Long standing chronic leg ulcer was the most common predisposing factor. Most tumours arose from post-burn scars, with no previous hospital treatment of the burns.
    Tropical and geographical medicine 02/1995; 47(2):91-3.
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    ABSTRACT: A case of Angiostrongylus costaricensis in a captive C. penicillata in a German zoological garden is described. Clinical symptoms were lacking, the morphological lesions consisted of intestinal granulomas harbouring rhabdidiform larvae. The adult worms were present in the ileo-caecal branches of the mesenteric artery.
    Tropical and geographical medicine 02/1995; 47(3):136-8.
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    ABSTRACT: A retrospective study on the thyroid status of 832 infants, born in Panaga Hospital in Brunei, was conducted. Despite a high degree of ethnic variability, screening for congenital hypothyroidism (CHT) included a fixed T4 and a TSH reference interval, based on a population of Malay infants. We tested their reliability for this heterologous group of infants. New T4 and TSH intervals were determined for each ethnic group and compared, revealing false positive and false negative judgements made during the period of study. Caucasian infants showed significantly higher T4 and TSH serum levels than all other ethnic groups. Regarding T4, most false positive judgements were found among the Malay infants. False negative judgements were detected among the Caucasian female infants. A new reference scheme was recommended, consisting of reference values that are applicable in neonatal thyroid screening of all infants in Panaga Hospital, regardless of their ethnic origin.
    Tropical and geographical medicine 02/1995; 47(6):286-8.
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    ABSTRACT: Two annual follow-up measures of incidence, reinfection after treatment and reversion rates were estimated in a large prospective study of Schistosoma mansoni located in the northern Nile Delta of Kafr El Sheikh. Rates were estimated in a cohort established from a probability sample of the entire rural area of Kafr El Sheikh. Infection was determined by the examination of two Kato stool slides. The weighted first and second annual overall incidence rates were 20.4%, SE +/- 1.4 and 15.9%, SE +/- 1.4, respectively. Geometric mean egg counts in incident cases were 35.6 epg, SE +/- 1.2 and 31.0, SE +/- 1.6 in the first and second follow-ups. Incidence was strongly associated with first round prevalence (r2 = 0.34). Reinfection rates were higher: 33.4%, SE +/- 3.1 and 31.0%, SE +/- 2.1. Reinfection was associated with incidence (r2 = 0.32). Reversion rates were highest in children 0 to 4 years old (61.2%, SE +/- 18.1 and 78.5%, SE +/- 7.0, respectively) and increased from the first to second follow-up: 37.2%, SE +/- 3.4 and 47.0%, SE +/- 3.7, respectively. Patterns of these rates by village community, age and sex are also given over both follow-up examinations and comparison with limited data on rates of S. mansoni infection from previous studies, suggests a stable pattern of transmission over time in the Nile Delta.
    Tropical and geographical medicine 02/1995; 47(6):270-7.
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    ABSTRACT: The pattern of adult medical deaths in Queen Elizabeth Central Hospital, Blantyre, Malawi was documented over a 12 month period between April 1992 and March 1993. Results were compared with mortality data collected from the same wards in the pre-AIDS era in 1973. Tuberculosis and AIDS together accounted for 49% of all medical deaths in 1992-93. Eighty-two per cent of deaths occurred in the age group 13-49 years; tuberculosis, AIDS, gastroenteritis, pneumonia, pyogenic meningitis and septicaemia were the most important causes of death in these young patients. These findings are very different to those observed in the same wards 20 years previously when tuberculosis was responsible for 13% of deaths and there were no deaths due to AIDS. The predicted upsurge in AIDS-related deaths in sub-Saharan Africa in the 1990s will have grave consequences not only for the health sector, but for the social and economic fabric of the countries concerned.
    Tropical and geographical medicine 02/1995; 47(4):171-4.
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    ABSTRACT: 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. A strong independent profession of highly qualified midwives, who care for women with low-risk pregnancies, may contribute to a relatively low caesarean birth rate. Different clinical policies which influence the intervention rate, are discussed for the most frequent reasons to perform caesarean section: dystocia, repeat caesarean birth, breech delivery and foetal distress. 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.
    Tropical and geographical medicine 02/1995; 47(1):19-22.
  • Tropical and geographical medicine 02/1995; 47(4):183.
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    ABSTRACT: There is reason to pay extra attention to women's health. Not only do complications related to reproduction pose risks to women's health; environmental, in particular cultural factors do so as well. The combination of sexual and economic subordination of women in many societies leads to discrimination which has a detrimental effect on the health of women, starting at birth. Violence against women has only recently been recognized as a worldwide problem. Over the past 20 years research and action at all levels have contributed to a better understanding of these problems, and more appropriate identification of interventions to tackle them.
    Tropical and geographical medicine 02/1995; 47(5):186-92.
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    ABSTRACT: Around the artificial reservoir in the Benue River near Lagdo in Northern Cameroon, Schistosoma haematobium and S. mansoni are prevalent. The primary health care structure has been reinforced in recent years, but no special attention has been paid to schistosomiasis. This setting was considered ideal to estimate the contribution of the existing health facilities in the control of morbidity due to schistosomiasis. The patients locally diagnosed as having vesical schistosomiasis, were subsequently examined with a standardized quantitative filtration method. Furthermore, surveys were carried out in the surrounding villages to estimate the age-specific prevalences of vesical schistosomiasis in the health centre's catchment area. The number of heavily infected people is low in the region (12%), but heavy infections represented 64% of the visitors with vesical schistosomiasis at the health centre. The data suggest that the health centre is efficacious in 'passively' detecting the most heavy infections. It was also possible to identify villages with large numbers of heavily infected people from the health centre's records. Finally, a calculation model is presented to estimate the expected number of visitors to the health centre, based on data from the field survey.
    Tropical and geographical medicine 02/1995; 47(1):6-11.
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    ABSTRACT: A case-control study was carried out among 225 cases and 450 controls aged below 60 months between July and September 1991, with the aim of determining measles vaccine effectiveness (VE) under field conditions in Tabora region, Tanzania. VE was found to be 84% (95% confidence interval (CI) 61-93%) among children vaccinated between 9 and 59 months, and 73% (95% CI: 11-92%) in children vaccinated at the age of 6 to 8 months. Loosening the diagnostic criteria and/or establishing vaccination status from vaccine registers rather than Road to Health cards, lowered vaccine effectiveness results. The protective effectivity among children vaccinated from 6 months and above and those vaccinated from 9 months and above, was 79% (95% CI: 55-90%) and 84% (95% CI: 61-93%) respectively. A relatively higher VE was found in children vaccinated at rural health centres and hospitals, 89% (95% CI: 56-97%) compared with dispensaries, 70% (95% CI: 22-88%). It is high time for the current age at vaccination to be reviewed in the country. It should be noted, however, that the present observations and conclusions are based on a study of limited numbers of persons. Repetition at a large scale would seem indicated.
    Tropical and geographical medicine 02/1995; 47(5):197-9.
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    ABSTRACT: The final diagnosis of sickle cell disease (SCD) is established by haemoglobin (Hb) electrophoresis. The test, however, is expensive and absent in most hospitals in Kenya. We studied sensitivity, specificity and cost-effectiveness of the peripheral blood film (PBF) in diagnosing sickle cell anaemia (SCA), the most common type of sickle cell disease (SCD) in Kenya. The PBF can be done even in dispensaries. The study was performed in SCA endemic western Kenya in 767 subjects during 12 months. Hb level, WBC count, PBF, sickle cell test (SCT) and cellulose acetate paper electrophoresis (CAPE) were performed. In the PBF, presence of sickle cells was pathognomonic for SCA. SCA was found in 21, sickle cell trait in 120, and normal genotype in 616 subjects. Sensitivity of the PBF versus SCT and CAPE to detect SCA was 76% with a specificity of 99.7%. The PBF was cheaper than both methods by 31.1%.
    Tropical and geographical medicine 02/1995; 47(2):89-91.
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    ABSTRACT: [NANP]19-5.1 is a recombinant Plasmodium falciparum vaccine consisting of 19 repeats of the sporozoite surface protein [NANP] and the schizont export antigen 5.1. In a previous study, an experimentally infected subject (with a history of malaria exposure and an elevated pre-immunization lymphocyte stimulation index to antigen 5.1) showed parasitaemia but no signs of clinical malaria. In an attempt to find a comparable partially immune population, we tested the vaccine in 194 schoolchildren (6 to 12 years, vaccine and placebo groups of equal size), who already possessed a certain degree of immunity. It was hoped that this immunity would be boosted by the vaccine. During the 12 weeks of observation, no child developed clinical malaria. Analysis of serum taken before and after immunization revealed that, except for eight children, all had considerable levels of antibodies to both antigens. We conclude that the trial should be repeated in younger children who are still vulnerable to clinical malaria.
    Tropical and geographical medicine 02/1995; 47(2):61-3.
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    ABSTRACT: Though the World Health Organization (WHO) has acted to reduce the price of anti-HIV assays for developing countries, the cost of the large-scale testing to be done may still be prohibitive to the health budget of these countries. GACPAT, a modified commercial particle assay, is ten times cheaper than the WHO price of ELISAs. In this study GACPAT was introduced in three district hospital laboratories (DHL) in Tanzania, and the results compared with those on the same sera in a reference laboratory (RL). Sensitivity and specificity were 92.6% and 98.7%, respectively at DHL. It is concluded that GACPAT is a valid, feasible and cheap alternative for ELISA anti-HIV-testing also at district hospital laboratory level.
    Tropical and geographical medicine 02/1995; 47(6):296-9.
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    ABSTRACT: Liquid crystal thermometer (LCT) readings of skin temperatures were compared with mercury thermometer (MT) rectal temperature readings to assess the reliability of LCTs. Temperatures of 498 children were measured at two points in time. LCT skin temperature readings of children 0 to 52 months were on average 0.50 degrees C and 1.97 degrees C lower than MT rectal temperature readings. A strong correlation between temperature differences and LCT readings indicated that the greatest differences occurred at the lower LCT readings. These conclusions indicate LCT skin readings undermeasure temperature. Some of these differences were due to MTs not measuring temperatures below 35 degrees C. Children under 1 year of age had significantly greater differences than any other age group. Their LCT readings were, on average, 1.65 degrees C lower than their MT readings. Using MTs as a standard, LCTs were 100% sensitive and 92% specific for detecting children with hypothermia. LCTs were 38.5% sensitive and 100% specific for detecting fevers. These results suggest that LCTs leave undetected a large proportion of children who have fevers. However, they are sensitive for identifying children with hypothermia. A knowledge, attitude and practice (KAP) study indicated that local mothers can be identified who understand principles and procedures of LCTs, and accept them for health care of their child.
    Tropical and geographical medicine 02/1995; 47(3):130-3.
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    ABSTRACT: Subjects infected with the adult worms of Oesophagostomum bifurcum, diagnosed through semiquantitative detection of characteristic third stage larvae, were treated in the middle of the dry or in the middle of the rainy season with two different dosages of albendazole. A third group was not treated. The pattern of reinfection after treatment was analysed. Transmission of Oesophagostomum infection appeared to be limited to the rainy season and the rate of reinfection was independent of the dose of albendazole received. The impact on transmission of developing stages that might survive in the nodules in the intestinal wall is discussed.
    Tropical and geographical medicine 02/1995; 47(4):160-3.
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    ABSTRACT: A tension exists between objectives of health policy makers to achieve high quality standards of care on one hand, and district multi-crisis reality in sub-Saharan Africa on the other hand where sheer survival of the (public) health system is questioned. The collapsing health services as well as the deteriorating living conditions affect the health status of the population and contribute to an increase in (health) inequalities both nationally and internationally. Constraints and some examples of achievements in district health management in two districts in Northern Province, Zambia, are presented. A strong focus on community-based health care, partnership with communities and accelerated health-system support via strengthening of on-site supervision is advocated. Decentralization and self-reliance are potential tools in flexible crisis management, but require continuity in human resource development and appropriate 'care for the carers'. In order to increase operational efficiency, the need is expressed to conceptualize a practical approach of 'minimum primary health care'.
    Tropical and geographical medicine 02/1995; 47(1):23-9.
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    ABSTRACT: To assess the image quality of radiographic units we developed a set of three relatively simple tests. With this set we investigated the performance of two small film x-ray units and seven dark rooms in chest disease clinics in Egypt. As a reference we performed the same tests at the Consultation Bureau for Tuberculosis and at the Radiology Department of the Medical Centre, Leeuwarden, The Netherlands. The tests revealed deficiencies during several phases of the production of radiographs at the chest disease clinics in Egypt, as well as at the Consultation Bureau for Tuberculosis, Leeuwarden, The Netherlands. The results of the tests were used to advise the radiology units tested on how to improve their quality. We believe, that this set of tests can be applied to any radiography unit to find ways for image quality improvement.
    Tropical and geographical medicine 02/1995; 47(6):239-43.
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    ABSTRACT: Sera from patients with visceral leishmaniasis (VL) (n = 26), healthy residents of Mogadishu (n = 157), inhabitants of a village in an endemic area (n = 276) and healthy Swedes (n = 60) were examined using the direct agglutination test (DAT), immunofluorescence (IF) and ELISA for antibodies against Leishmania donovani. The study was carried out in order to provide baseline data for antibody responses in visceral leishmaniasis as existing in Somalia and to explore which one of these methods would be most suitable for diagnosis of clinical cases as well as for epidemiological population studies in Somalia. All patients had high levels of circulating antibodies, however, lower values were recorded in the early stages of the disease. High reactivity in ELISA was seen first after one year. All three tests distinguished well between sera from VL patients and healthy controls. Approximately 10% of the sera from villagers were reactive above the cut-off levels in the three tests. DAT is the simplest to perform and does not require much equipment. ELISA can be made simple and economic if performed in one serum dilution and read visually. IF requires more expensive and specialized equipment and is not suitable for large scale examination of sera. A complete evaluation of the three tests should also include the analysis of sera from various stages and manifestations of the disease.
    Tropical and geographical medicine 02/1995; 47(2):68-73.
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    ABSTRACT: A 4-year study of Pseudomonas aeruginosa bacteraemia was carried out at the University of Nigeria Teaching Hospital (UNTH) in Enugu, Nigeria. The average age of the patients was 14.7 years. Thirty-three per cent of the patients were between 0-6 months of age, with males being in the majority. Underlying factors/diseases were present in 70.8% of patients, with prematurity, chronic suppurative otitis media and leukaemia being the major ones in infancy and childhood and diabetes mellitus, urogenital disorders and head injuries in adults. Overall mortality was 50% and highest (16.6%) in the 0-6 months age group. Antipseudomonas antibiotics are extremely costly and therefore beyond the financial scope of many people in the developing world. In Nigeria aminoglycosides are the best affordable antibiotics.
    Tropical and geographical medicine 02/1995; 47(5):193-6.

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