Bulletin of the Pan American Health Organization最新文献

Because of Haiti's poverty and poor health infrastructure, together with the global emergence of drug-resistant tuberculosis (TB), questions were raised about the U.S. military's practice of returning Haitian migrants with active noninfectious tuberculosis (TB) to Haiti. As a result, the pilot study reported here assessed the TB treatment completion rate of 38 Haitians (24 with TB and 14 contacts) who voluntarily requested repatriation from Guantánamo Bay (GTMO), Cuba, in November 1994. Six weeks after repatriation, four of the study subjects had been lost to follow-up, 18 had received follow-up treatment, and 16 were delinquent in receiving treatment. The reasons given for failing to get treatment varied: 7 (21% of the 34 followed) were asked to pay for clinic visits, leaving them without medication; 5 (15%) were asked to return at a later date; and 4 (11%) had not sought treatment. A second follow-up visit five months later failed to locate three additional subjects. Of the 31 followed, 17 (55%) completed chemotherapy, while the remaining 14 (45%) discontinued treatment two to three months prior to the completion date despite extensive education and a promised monetary reward. On the basis of these findings it was strongly recommended that migrants with TB remain at Guantánamo until their treatment completion date, a recommendation that was adopted.

The study reported here, seeking to develop a simple, practical, sensitive, and inexpensive technique for microbial diagnosis of tuberculosis, used a combination of biphasic media and microculture techniques to augment the sensitivity of traditional culture methods. A total of 540 sputum samples (5 mL each) were obtained from 180 patients with suspected tuberculosis in Mexico City. These samples were treated with Hanks reagent, neutralized with 25% HCl, and centrifuged. In each case the resulting residue was combined with liquid media (Sula medium or a phosphate-buffered control solution) and was inoculated into a bottle containing a solid medium (Löwenstein-Jensen-Holm or Middlebrook). A silicone-coated slide appropriate for culture of hydrophobic mycobacteria was inserted in each bottle, and the cultures (examined weekly) were incubated at 37 degrees C until the first macroscopic bacterial growth was detected or for up to eight weeks if none was detected. When such growth was detected, or at the end of eight weeks, each slide was withdrawn from the bottle, sterilized, stained by Kinyoun's method, and examined microscopically. Following 2-4 weeks of incubation, macroscopic bacterial growth was detected in 71 bottles and was confirmed by microscopic examination of the corresponding slides. No macroscopic bacterial growth was found in any of the remaining 469 bottles, but microscopic growth was observed on 77 of the slides examined after eight weeks. The authors conclude that this method represents a noteworthy improvement over standard culture methods in terms of bacterial isolation and suggest that its case, economy, and practicality make it suitable for application in developing countries.

An epidemiologic study was conducted in San Cayetano, a village in the province of Corrientes, Argentina, to determine the prevalence of intestinal parasitoses in children. Eighty-eight households were randomly selected. Stool samples were collected from 207 children (72% of the school-age population and 12% of the total village population) over a period of six consecutive days, and were subjected to microscopic examination. Of the samples examined, 170 (83%) contained one or more parasites, of which the most frequently found was Blastocystis hominis (in 43% of the samples). Other parasites and commensals detected included Giardia lamblia (29%), hookworms (27%), Entamoeba coli (27%), Enterobius vermicularis (4%), Strongyloides stercoralis (2%), and Ascaris lumbricoides, Trichuris trichiura, Taenia saginata, Isospora belli, Iodamoeba bütschlii, and Balantidium coli (each 0.5%). The high observed prevalence of intestinal parasitoses indicates active parasite transmission in San Cayetano as a result of poor environmental hygiene-ascribable largely to a lack of public water supply, sewerage, and waste removal services.

Acute respiratory infections (ARI), the leading class of ailments causing people to seek health care, rarely require antibiotics. Nevertheless, many physicians prescribe them needlessly. Hence, reducing the unnecessary use of antibiotics is one aim of any ARI control program. To help determine whether this aim might be achieved through a combination of refresher training for family physicians and public education campaigns, two 1991 interventions were carried out in four health areas (designated A, B, C, and D) in the city of Havana, Cuba. In each area, 10 clinics staffed by family physicians were selected through simple random sampling. In two areas (A and B), a refresher training program on ARI for health personnel was instituted at each clinic, while in areas A and C a community education program was set up. No intervention was carried out in area D. Simultaneously, from January through December 1991 trained individuals visited and administered a standard questionnaire every 15 days to 1,600 families (40 per clinic) systematically selected by random sampling. The aim of this procedure was to record the number of ARI episodes occurring among children under 5 years old, the treatment chosen in these cases, and whether antibiotics were employed. The results showed that when the two interventions were initiated, antibiotics were prescribed for 26%, 20%, 11%, and 19% of the mild ARI cases occurring in areas A, B, C, and D respectively (P > 0.05). In the period immediately following the interventions, antibiotic prescription rates declined by 26% and 63% in areas A and B, while increasing by 2% and 48% in areas C and D. Overall, prescription of antibiotics in the intervention areas A and B combined decreased by 54% (95% CI: 31-69%). These data suggest that a refresher training program for health personnel can rapidly reduce the unnecessary prescribing of antibiotics for ARI cases, but that public education alone does not appear effective.

The work reported here sought to describe the feeding patterns of Chilean children up to 18 months old and their relation to nutritional status. To this end, a survey was conducted in 1993 of 9330 Chilean children under 18 months old who were receiving care through the National Health Service System-which provides care for 75% of all children under age 6. The children, whose mothers or caretakers were interviewed, constituted 94% of a sample selected at random from 102 of the 320 urban health clinics located throughout the country. The interview served to identify the type of feeding (exclusive breast-feeding, breast-feeding plus bottle-feeding, breast-feeding plus solid food, exclusive bottle-feeding, or bottle-feeding plus solid food) and to determine the nutritional status of the participants in terms of standards used by the United States National Center for Health Statistics and the World Health Organization. Children were deemed at risk of malnutrition if they had z scores on the weight-for-age distribution between 1.0 and 2.0 standard deviations below the US/WHO standard and as actually malnourished if they had z scores of over 2.0 standard deviations below the standard. The survey found exclusive breast-feeding prevalences of 86.5%, 66.7%, and 25.3% among infants 1, 3, and 6 months old. Some 12.1% of the participants were found to have a weight-for-age deficiency, 30.7% exhibited a height-for-age deficiency, and 35.7% were found to be over-weight. The prevalence of weight-for-age and height-for-age deficiencies were found to be considerably higher among bottle-fed children than among breast-fed children. In general, the results demonstrated the benefits of exclusive breast-feeding through the first 6 months of life, the need to complement exclusive breast-feeding with solid food after that time, and the superior nutritional status of breast-fed children within the age groups studied.