Bulletin of the Pan American Health Organization最新文献

The prevalence of bottle propping (permitting an infant to drink from a bottle unattended) and the determinants of this practice at 1 week and 4 months of life were studied in a selected sample of urban women in Hermosillo, Mexico. The sample (n = 165) consisted of mothers planning to breast-feed who gave birth to healthy infants at one of two public hospitals. Data were obtained by interviewing women shortly before they were discharged from the hospital and at about 1 week and 4 months postpartum. Among those mothers giving liquid breast milk substitutes to their infants, the percentage practicing bottle propping increased from 27% at 1 week (n = 20/74) to 67% at 4 months (n = 87/130). Women who practiced bottle propping at 1 week were significantly more likely to continue this practice at 4 months. Bottle propping was significantly more common, both at 1 week and 4 months, among women who had completely weaned their infants than among those who were still combining breast and formula feeding. Multivariate logistic regression indicated that 1-week risk factors for bottle propping were low socioeconomic status, being a multiparous single mother, and being a young mother (< or = 18 years old) with a female infant, while 4-month risk factors were complete weaning, delivery in a "nursery" (versus a "rooming-in") hospital, and lack of support by the mother's partner for breast-feeding. While the possible health risks associated with early bottle propping have not been well defined, the extent of the practice observed in this study suggests that such risks deserve further investigation.

While it seems likely that dengue fever (DF) has existed in French Guiana for at least one century, data on outbreaks are sketchy before temporary eradication of the dengue vector mosquito Aedes aegypti and its reestablishment in the early 1960s. Dengue cases were serologically confirmed for the first time in 1965, and since then dengue epidemics have occurred at two to six year intervals, the most important occurring in 1968-1969, 1970, 1972, 1976, 1982, 1986, and 1992. Three of the four dengue virus serotypes (dengue-1, dengue-2, and dengue-4) have been implicated in these outbreaks. During the 1992 epidemic, which appears to have begun in 1991 and extended into 1993, cases of dengue hemorrhagic fever (DHF) were confirmed for the first time. In all, at least 40 DHF cases and several deaths were associated with this epidemic. This development has raised considerable concern about the public health threat posed by DHF in French Guiana. Such concern is only heightened by the fact that while vector control is the sole means of preventing or combating dengue outbreaks, it has proved difficult to maintain vector populations at low levels with the control measures currently employed.

This review article seeks to highlight the significance for the Caribbean of major parasitic infections associated with AIDS, encourage awareness of these opportunistic parasites, and promote familiarity with appropriate diagnostic techniques and their clinical relevance. Specific agents considered include Pneumocystis carinii; Toxoplasma gondii; the enteric coccidians Cryptosporidium spp., Isospora belli, and Cyclospora cayetanensis; the hemoflagellates Leishmania spp. and Trypanosoma cruzi; the fungi Histoplasma capsulatum and Cryptococcus neoformans; the nematode Strongyloides stercoralis; and the mite Sarcoptes scabiei. These disease agents can be divided into two groups, the immune-regulated "endogenous" parasites (the protozoans P. carinii and T. gondii, and possibly the roundworm S. stercoralis) and intracellular parasites (including the enteric coccidia, hemoflagellates, and fungi). Both in the Caribbean and elsewhere, the endogenous parasites (particularly P. carinii and T. gondii) are the most troublesome for AIDS patients, partly because they are likely to be transmitted and establish a benign immunoregulated presence early in the subject's life. Indeed, health management programs for AIDS patients often routinely include P. carinii prophylaxis, since nearly all such patients who survive long enough are expected to experience an episode of acute P. carinii infection. In contrast, there is no known epidemiologic association between AIDS and strongyloidiasis in the Caribbean, and the prevalence there of potentially opportunistic hemoflagellates such as Leishmania spp. and Trypanosoma cruzi is relatively low.

This article describes the basic strategies employed by Cuba's Diarrheal Disease Control Program (DDCP) to reduce acute diarrheal disease (ADD) mortality among infants and young children from 1962 through 1993, together with the diarrheal disease trends recorded in these years. An initial control effort, the Program to Combat Gastroenteritis, began operating in 1963. Since then, in one form or another, increasingly effective efforts have consistently lessened ADD mortality. Among other things, these efforts have concentrated on providing improved sanitation, effective health education, proper nutrition (including promotion of breast-feeding and food hygiene), and adequate health care (which in recent times has placed increasing emphasis on oral rehydration therapy and primary care). Largely as a result, recorded infant ADD mortality fell from 12.9 deaths per 1,000 live births in 1962 to 0.3 in 1993, while recorded mortality from this cause among children 1-4 years old dropped from 6.4 deaths per 10,000 children in this age group in 1962 to 0.1 in 1993. Besides describing the work performed through 1993, the author also outlines plans for the period through 1999 that are directed at maintaining and perhaps augmenting these gains.

This article reviews literature on the epidemiology, pathogenicity, and control of HIV and Mycobacterium tuberculosis coinfection. Regarding pathogenicity, immune system deterioration makes HIV-infected people more likely to develop active tuberculosis on primary or secondary exposure to the bacillus or to suffer reactivation of latent infections, and to experience considerably higher rates of extrapulmonary manifestations, relapses, and death. Regarding epidemiology, as of 1990 there were an estimated 3 million people coinfected with HIV and M. tuberculosis, with some 300,000 active tuberculosis cases and 120,000-150,000 tuberculosis deaths occurring annually among those coinfected. Over 500,000 coinfected people are thought to reside in the Americas, over 400,000 of them in Latin America. In general, the impact of coinfection is evident. Relatively high and increasing prevalences of HIV infection have been detected among tuberculosis patients around the world, and tuberculosis has become a frequent complication of AIDS cases. Moreover, there is no longer any doubt that coinfection obstructs tuberculosis prevention and control. Among other things, it affects BCG vaccination policies, suggests the need to administer preventive chemoprophylaxis to HIV-infected individuals at high risk of harboring or contracting tuberculosis infections, and complicates both detection and treatment of active tuberculosis cases. The recent proliferation of M. tuberculosis strains resistant to multiple drugs, most notably in the United States, compounds the problem. Tuberculosis prevention and control are still technically and economically feasible. However, more must be done to establish surveillance programs with laboratory support. More research is needed to determine what case prevention measures are best-suited to current circumstances and the HIV/AIDS presence. More effective preventive treatment regimens that are well tolerated, well complied with, and do not pose the risk of multiresistance need to be devised. More health workers need to be trained to suspect tuberculosis and to conduct timely and appropriate tests confirming this diagnosis. And finally, more must be done to standardize the types and durations of the various curative treatment regimens employed.