Tropical and geographical medicine最新文献

A 15-year-old male presented on three occasions with fever, aggressive behaviour, poor sleep and mixed affective and schizophreniform symptoms in association with falciparum malaria. The symptoms resolved promptly following anti-malarial treatment. Prophylaxis with proguanil prevented recurrence of the illness.

In a countrywide survey of amoebiasis, a total of 12,457 persons in 97 communities was stool examined by formol-ether concentration technique. The overall prevalences of Entamoeba histolytica infections, as measured by rate of cyst-passers, in schoolchildren and non-school communities were 15.0% and 3.5%, respectively. Slightly more females (18.4%) than males (14.2%) were infected among schoolchildren (p < 0.05) but the difference was not significant among non-school communities (p > 0.05). There was a tendency but not a statistically significant decline of cyst-excretion with increasing age. So far as our survey goes, the influence of altitude on the prevalence of amoebiasis appeared not to be significant. Health education, improvement of sanitation and personal hygiene are suggested as realistic measures to reduce the transmission of this parasite.

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'.

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.

Coproculture is used in northern Togo and Ghana in the research on Oesophagostomum bifurcum, a common parasite of man in these regions. Prior to a follow-up study to investigate patterns of reinfection in Oesophagostomum and hookworm, it was attempted to evaluate the relevance of counting larvae for the assessment of the intensity of infection at the population level. Of 102 samples, one egg count (Kato-smear) and three coprocultures were carried out. Frequency distributions of counts of larvae of Oesophagostomum and of hookworm isolated in three coprocultures, showed log-normality. There was a highly significant correlation between egg counts and the combined number of Oesophagostomum and hookworm larvae (Spearman rank correlation test, r = 0.74, p < 0.01). It is concluded that the mean larval counts of three coprocultures can be interpreted quantitatively, as normally done for egg counts. A quantitative classification of larval counts is proposed.

This is an early descriptive report of the 'Epidemiology 123' project in Egypt which makes use of large probability sampling methods. These results focus on Schistosoma mansoni infection in the northern Nile Delta Governorate of Kafr El Sheikh. A probability sample of 18,777 persons, representing the rural population of the entire Governorate, was drawn. The sample was designed not to exclude villages based on location or presence of health care facilities and to include representation of the smaller ezbas or hamlets. The objective was to obtain detailed estimates on age and sex specific patterns of S. mansoni infection, and to provide a baseline for prospective studies. Stool specimens were examined by the Kato method. The estimated prevalence of S. monsoni infection in the rural population was 39.3% (SE +/- 3.3) in 44 villages and ezbas after weighing for the effects of the sample design. The estimated geometric mean egg count per gram stool (GMEC) was 72.9 (SE +/- 7.3). Prevalence and GMEC varied considerably by village and ezba, with ezbas having a significantly higher prevalence. Villages and ezba specific prevalence was strongly associated with GMEC (r2 = 0.61, p < 0.001). The prevalence of S. mansoni infection increased by age to 55.4% (SE +/- 3.2) at age 16, without significant change in the adult ages. There was no gender difference until age six, after which males were consistently higher until middle age, when the differences converged. The age and sex specific pattern of GMEC varied widely, however, when the GMEC data were collapsed into five year age groups, GMEC peaked at 81.5 (SE / + - 12.1) epg in the 10 to 14 year age group. These estimates provide the basis for evaluating control measures for reducing prevalence, intensity of infection, and transmission.

Immediate type allergy towards house dust and house dust mites was measured in 188 dust-sensitive asthmatic patients in and around Calcutta by using the skin prick test. Of the 131 positive patients, 82% reacted to Dermatophagoides mites, 80% to D. farinae, 46% to D. pteronyssinus, and 43% to both species of mites. Sixty-two per cent of the positive patients showed strong skin reaction to D. farinae as compared to 32% to D. pteronyssinus. Skin reaction (positive/strong) was highest in D. farinae as compared to other allergens tested in the present study. Skin test results were also analysed in relation to patients' age, sex and duration of disease.

The prevention of epilepsy in tropical Africa is highly desirable because of the morbidity, mortality and social ostracisation that is associated with the disease. Such prevention depends on the identification of the aetiologies of epilepsy endemic to the region. There is a need for prospective epidemiological research to elucidate further the role of filariasis, cysticercosis, cerebral malaria and trypanosomiasis in the aetiology of epilepsy in tropical Africa.