Tropical and geographical medicine最新文献

An unusual case of malaria with Plasmodium vivax is reported which had complications classically seen with Plasmodium falciparum malaria. The complications were cerebral malaria, disseminated intravascular coagulation and adult respiratory distress syndrome.

To study the clinical features in patients with falciparum malaria and the influence of chloroquine chemoprophylaxis on these features, a prospective study was carried out of all non-immune patients with falciparum malaria between 1979 and 1988. Three hundred and sixty-one consecutive non-immune patients with falciparum malaria who were seen at the outpatient-department for Tropical Diseases, Royal Tropical Institute, and Division of Infectious Diseases and Tropical Medicine of the University Hospitals of the University of Amsterdam, The Netherlands. Compliance with the recommended malaria prophylaxis was claimed by 47% (168/361); 24% (86/361) had not taken any chemoprophylaxis. The first group had a milder illness, less often parasitaemia > or = 1% and suffered less from complications. Comparison of the clinical features in patients who did not take prophylaxis and those who, during recommended prophylaxis, appeared to be infected with a chloroquine-resistant strain strengthened the evidence of a protective effect of chloroquine. Complications occurred in 14% of patients; pregnant women were at higher risk of complicated malaria; the case-fatality rate was low (0.3%). It is concluded that chloroquine prophylaxis still may have--depending on the degree of chloroquine-resistance--a protective effect on the clinical features and this modulating effect needs to be further investigated.

Research was carried out on the medical, i.e. somatic and mental, and social complaints of refugees in The Netherlands. This research consisted of a literature study and a retrospective and prospective, or cross-sectional patient study. The most important assumption which formed the base of the study was: refugees who underwent torture present the same medical and social complaints as refugees who were not tortured but underwent other forms of organized violence. For the cross-sectional study 156 refugees from the Middle East were interviewed. Not only was investigated whether the nature and extent of organized violence influenced the presentation of the refugees' medical and social complaints, but also whether other characteristics such as legal status and length of stay in The Netherlands were related with the refugees' medical and social complaints. The same data were sought for in literature. The results confirm the main assumption, as well as show that factors other than the traumatic experiences in the country of origin are related with the health problems of refugees. Although many studies in literature demonstrated that a relatively high percentage of refugees present a post traumatic stress disorder (DSM-III-R) these findings could not be confirmed. It is concluded that refugees undergo a sequence of traumatic experiences and stress before, during and after their flight into exile. Various pre- and post-migration factors are responsible for the presentation of aspecific physical and mental complaints and social problems of refugees.

Female genital schistosomiasis has been neglected as a disease entity during a period when considerable progress has been achieved for schistosomiasis as such. The pathophysiology and immunology are imperfectly understood, appropriate diagnostic tools are not at hand, therapeutic rationales do not exist, the natural history is not well known and women's perception of their illness has never been studied. Based on the findings of a systematic analysis, made by an inventory of research needs on women and tropical diseases, it has been possible to highlight individual and public health hazards of female genital schistosomiasis, such as the disease being a possible cofactor for te spread of the human immunodeficiency virus. This paper gives an example of how a gender perspective on a well-known parasitic disease can bring new challenges to the research community and the public health sector.

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.

To assess prevalence of hair dyspigmentation, decurling, thinness and frailty, a random sample of more than 4,000 preschoolers, representative for a large area in Northern Zaire, was examined clinically and anthropometrically. Isolated dyspigmentation, isolated thinness and the combination of both were the most frequent signs (> 5%). Prevalence of hair signs did not differ according to sex or season. Peak prevalence was found between ages 6 and 18 months, suggesting a relationship with weaning. Most hair signs, studied separately or as combinations, increased gradually with lowering weight-for-age (WFA) or weight-for-height but not with height-for-age. Isolated dyspigmentation, however, was unrelated to WFA or marasmus. All signs occurred also in children with 'normal' WFA (SD > -2). In these children, hair signs were associated with the presence of clinical muscle wasting.

In African and other Third World countries, 20-50% of schoolchildren lie under the 5th centile of US National Center for Health Statistics (NCHS) growth reference standards for weight- and height-for-age. Such lesser growth, orthodoxly, categorizes those affected as malnourished, at greater risk of disease, of lesser intelligence, and in need of nutritional supplementation. Questions arising include: 'Are there limitations to the application of NCHS reference standards?' In African schoolchildren, is lesser growth attributable largely, or marginally, to insufficient food intake? How powerful are the non-dietary influencing factors? What are the associated disadvantages to health? Conversely, could lesser growth around puberty even be beneficial respecting possible lessening of subsequent risk of degenerative diseases? Discussion indicates that there are numerous complexities in the whole subject of anthropometry, malnutrition and its stigmata, and interventions, dietary and non-dietary, in the youth of poor populations. In view of the invariably low health funds available in Third World countries, only intervention measures of proven significance to pupils' health warrant implementation.