Tropical and geographical medicine最新文献

Quality assessment and assurance should be concerned not only with technical aspects of health care but also the patient's views. This paper examines patient perceptions of the quality of care through structured interviews and focus group discussions in Port Moresby General Hospital, Papua New Guinea. The results indicated a need for more concern for patient well-being, greater attention to provision of information and improvements in living conditions in the hospital. The findings of this study will be used as a means to improve the patient's experience of surgical care. Similar studies could be performed as a measure of quality in other hospitals in the developing world.

Infection with Strongyloides stercoralis in an immunocompetent host usually remains unrecognized. Sometimes, however, it may cause serious problems in the immunocompromised host due to its enhanced invasiveness. We present here details of three kala-azar patients with fulminating strongyloidiasis manifested by acute diarrhoea with blood and mucus, severe dehydration, cough and dyspnoea with low peripheral blood eosinophils and filariform larvae of S. stercoralis in faeces. No larvae could be detected in the sputum in spite of radiological evidence of infiltration. The impact of albendazole was dramatic with a disappearance of parasites from the faeces and of pulmonary infiltration and an increase in blood eosinophil count. It is emphasized that S. stercoralis infection in kala-azar patients should be considered a serious infection and treated accordingly.

The relationship between splenomegaly and visceral leishmaniasis (VL) was investigated during a cross-sectional study in 2,941 individuals in Baringo District, Kenya, where both malaria and VL are endemic. Spleen size was correlated with presence of malaria parasites in thick blood films and with evidence of present or past Leishmania donovani infection as determined by serology and history. Marked splenomegaly (Hackett grade 3 or greater) significantly correlated with present or previous leishmanial infection (chi 2 = 53.5; p < 0.001) whereas moderate splenomegaly (Hackett grade 1 or 2) significantly correlated with malaria parasitaemia (chi 2 = 73.03; p < 0.001). The presence of antimalarial antibodies did not contribute to the differentiation of the cause of splenomegaly. The diagnostic significance of splenomegaly in this population is discussed.

During the experimental use of fenitrothion to replace malathion for the control of malaria in North West Frontier Province of Pakistan, serious intoxication of Afghan refugee spraymen occurred. A few weeks after commencement of the spraying operations, cholinesterase levels had fallen to 43.8% in personnel mixing the insecticide, and to 60.7% in spraymen, as measured by tintometry. Most of the personnel reported symptoms of overexposure and the spraying operations had to be discontinued. Intoxication of personnel resulted in poor coverage of the target area. High ambient temperatures during Pakistan's spray season discourage the use of full-protective clothing. Fenitrothion intoxication observed in the Afghan refugee programme, and similar experiences in Pakistan in the past, suggest that this insecticide is too toxic for routine use, when the compliance with safety precautions cannot be effectively supervised.

The objective of this research was to assess the barriers to cataract surgical acceptance by blind rural Malawians recognized and referred for surgical correction at district hospitals. Cataract blind recognized and referred for surgery by the ophthalmic assistants in Chikwawa and Nsanje Districts were interviewed 9-12 months after enrolment to determine if they had undergone cataract surgery and to assess factors associated with surgical acceptance. There were significant gender-specific baseline differences between men and women presenting to the ophthalmic assistants. Patients living near the district hospital were also most likely to present to the ophthalmic assistant. Men with lower socioeconomic status were more likely to accept surgery than men with higher socioeconomic status. Men and women who either talked to someone about cataract surgery or knew another aphakic patients were more likely to accept surgery. The best approaches to improving cataract acceptance given existing resources might be to encourage patients undergoing cataract surgery to educate and motivate others to accept surgery and to train existing village level health staff in cataract recognition and referral. Economic barriers and lack of family support are likely to continue to impede improved cataract surgical acceptance, especially among women.

Perinatal mortality rate (PNMR) at Wesley Guild Hospital (WGH), Ilesa, Nigeria, over a ten-year period was retrospectively analysed. The main objective was to determine the trends in the utilization of obstetric care and PNMR in the face of current economic difficulties in Nigeria and to make suggestions for improvement. The average PNMR over the period was 57.8/1000 births. There was a sharp rise in PNMR in 1985 to a peak of 110/1000 in 1987 (p < 0.0001). This was associated with a decline in utilization of maternity services, probably as a result of the introduction of fees for maternity services late in 1984 and increase in economic hardship in Nigeria. Actions are needed to improve enhanced access to obstetric care for the poor. These actions include: improvement in the economic conditions of the people, emphasis on primary health care (PHC) and early referral of high-risk pregnant women to tertiary units.

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.

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.

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.