RESUMEN
A number of private voluntary organizations provide mobile eye services to underserved populations in the developing world. This paper seeks to determine what segment of the population makes use of mobile vision clinics and whether the clinics are identifying significant eye conditions previously undetected by local eye care providers. The population studied were those attending the 1989 vision screening project conducted in rural Costa Rica by members of Volunteer Optometric Services to Humanity (VOSH). Sources of data include patient records of clinic attendees (N = 1530), patient interviews, and Costa Rican census data. Most of the clinic attendees were female (56.9%), over 35 years of age, and literate (71.1%). The three most commonly stated occupation categories were (1) housewife; (2) agriculture, forestry, or fishery worker; and (3) student. Over one-half reported having had a previous eye examination. Presbyopia and low hyperopia were the predominant refractive conditions encountered. Over one-third of patients presented with visual acuities 6/15 (20/50) or worse, and one-third of this group had never had an eye examination. Three-quarters of the patients required prescription lenses and over 20% had cataract. The dispensing of presbyopic corrections to first time patients is clearly the most valuable service provided by the clinics. Teaming up with mobile cataract camps may improve the access to surgical care for patients with cataract. It is important that mobile vision projects target future efforts toward those likely to be missed by conventional screenings.
Asunto(s)
Atención a la Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Unidades Móviles de Salud , Trastornos de la Visión/terapia , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Costa Rica/epidemiología , Estudios de Evaluación como Asunto , Oftalmopatías/epidemiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Trastornos de la Visión/epidemiología , Trastornos de la Visión/prevención & control , Selección Visual , Agudeza VisualRESUMEN
OBJECTIVE: Acute diarrhea is the leading cause of pediatric morbidity and mortality worldwide. Oral rehydration treatment can prevent death from dehydration, but does not reduce the duration of individual episodes. Homeopathic treatment for acute diarrhea is used in many parts of the world. This study was performed to determine whether homeopathy is useful in the treatment of acute childhood diarrhea. METHODOLOGY: A randomized double-blind clinical trial comparing homeopathic medicine with placebo in the treatment of acute childhood diarrhea was conducted in León, Nicaragua, in July 1991. Eighty-one children aged 6 months to 5 years of age were included in the study. An individualized homeopathic medicine was prescribed for each child and daily follow-up was performed for 5 days. Standard treatment with oral rehydration treatment was also given. RESULTS: The treatment group had a statistically significant (P < .05) decrease in duration of diarrhea, defined as the number of days until there were less than three unformed stools daily for 2 consecutive days. There was also a significant difference (P < .05) in the number of stools per day between the two groups after 72 hours of treatment. CONCLUSIONS: The statistically significant decrease in the duration of diarrhea in the treatment group suggests that homeopathic treatment might be useful in acute childhood diarrhea. Further study of this treatment deserves consideration.
Asunto(s)
Diarrea/terapia , Homeopatía , Enfermedad Aguda , Preescolar , Diarrea Infantil/terapia , Método Doble Ciego , Humanos , Lactante , Nicaragua , Oportunidad Relativa , Resultado del TratamientoRESUMEN
This report describes the breastfeeding and weaning practices of rural women in two Mexican towns and the cultural beliefs upon which these practices are based. Interviews and focus group discussions were used to collect information. Women thought breastfeeding preferable to bottle-feeding. Eighty percent initiated breastfeeding and 69% gave colostrum. Breastfeeding was discontinued early (mean age 4 months). The mean age at which children were introduced to other liquids was 2 months (range 0-5 months) and to solids, 4 months (range 1-8 months). Women's decisions regarding infant feeding were influenced most by custom and advice from doctors and family members. In some instances medical advice conflicted with traditional practices. These findings suggest important avenues for intervention in hospital practices, education for health care workers, and in the development of health promotion services.
PIP: The impact of culture and community factors on breast feeding and weaning practices is examined by means of interviews among 35 rural women aged 16-43 years from Jalisco, Mexico, and by means of focus group discussions. Breast feeding practices are gleaned from information provided by mothers on their youngest child aged 2 weeks to 17 months for a 24 hour period prior to the interview. All study infants were given breast milk, supplements of water, and other liquids from birth. Fresh or powdered cow's milk was the usual supplement, except for 5 infants who received commercial formula. Boiled water was used in rehydrating powdered milk. Breast milk substitution was a bottle or cup given 2-4 times daily. The introduction of solid foods was made at 1 month to 8 months of age. Foods ranged from beans, tortillas, bread, pasta, fruit, chicken soup, flavored gelatin, to soft drinks. Between 9 months and 23 months, toddlers were fed the same foods in addition to vegetables, beef, fish, egg, cookies, and prepackaged cold cereal. The reasons given for not breast feeding were illness of the mother, a breast problem, insufficient milk, or an ill child. Colostrum was given for the following reasons: doctor's advice, the best interests of the baby, a woman's preference, custom, and no reason. Colostrum was not given for a variety of reasons including, for example, when the doctor advised against it or when a woman was ill or had a breast problem. In the three focus groups (27 persons), breast feeding was mentioned as preferable because of the added protection given the baby, the convenience of the mother, and the exchange between mother and infant. Other important factors were the improved health of the baby, the absence of cleanliness problems, and the milk was the right temperature. Exclusive breast feeding was recommended for a duration of 3-9 months. Breast feeding was withheld for 4-5 hours if a child had vomiting or diarrhea, or had been in the sun too long. Weaning was considered appropriate anytime between 2 months and 12 months of age. Weaning occurred when the mother was unable to continue or the child wanted to stop or had teeth. There was disagreement about how quickly to complete the process of weaning. Food was introduced at 2 to 6 months of age when milk was not enough to satisfy the child's hunger.
Asunto(s)
Lactancia Materna , Países en Desarrollo , Población Rural , Destete , Adolescente , Adulto , Alimentación con Biberón , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactante , Alimentos Infantiles , Recién Nacido , Masculino , MéxicoRESUMEN
While providing health care in rural Bolivia, 349 children under 4 years old were seen. Height and weight were measured and demographic data obtained. The purpose was to describe the prevalence of malnutrition and its associated socioeconomic factors. The sample included Mataco Indians and Bolivians of European or of mixed descent. Using international standards, 21% of the children had weight below the fifth percentile for age; 27% had height below the fifth percentage for age; 17% were below the fifth percentile for weight/height. Malnutrition was more common in younger children (peak prevalence in 1-2 year olds). Malnutrition was associated with race and water source, but not with family size, literacy, immunizations, meals per day, or deaths in family. Attempts to improve nutrition should focus on the youngest children.
PIP: The authors measured height and weight and obtained demographic data for 349 children under 4 years of age in rural Bolivia for the purpose of describing the prevalence of malnutrition and its associated socioeconomic factor. The sample included Mataco Indians and Bolivians of European or of mixed descent. On the basis of international standards, 21% had weight below the 5th percentile for age; 27% had height below the 5th percentile for age; and 17% were below the 5th percentile for weight/height. Malnutrition was most common in younger children, with a peak prevalence among 1-2 year olds. Malnutrition was associated with race and water source, but not with family size, literacy, immunizations, meals per day, or deaths in the family. These findings suggest that attempts to improve nutrition should focus on the youngest children.
Asunto(s)
Trastornos Nutricionales/epidemiología , Salud Rural , Bolivia/epidemiología , Fenómenos Fisiológicos Nutricionales Infantiles , Preescolar , Femenino , Humanos , Lactante , Masculino , Factores SocioeconómicosRESUMEN
This paper reports an evaluation of the risk of tuberculosis infection in school children in the sanitary jurisdictions of Jalisco, Mexico. It also compares the official figures of incidence of smear-positive pulmonary tuberculosis with those estimated with this epidemiological indicator. The study included 6,469 first grade children, six to seven years old, from 95 state schools. We skin-tested 4,260 of them with 2 TU PPD. Sixty per cent of the children tested were vaccinated with BCG. This proportion varied between the jurisdictions: from 43 per cent in Tepatitlan to 70 per cent in Ameca. The rate of tuberculosis infection was 6.3 per cent, with differences between children with a BCG scar and those with no scar (7.4% and 4.4%, respectively). We also found differences in the annual risk of infection between the jurisdictions. The annual risk was 0 per cent in Lagos de Moreno and 1.60 per cent in Ameca. With the exception of two jurisdictions, the incidence of smear-positive pulmonary tuberculosis estimated with this indicator is several times higher than that officially reported.
Asunto(s)
Tuberculosis/epidemiología , Vacuna BCG , Áreas de Influencia de Salud , Niño , Humanos , Incidencia , México/epidemiología , Riesgo , Tuberculosis/prevención & controlRESUMEN
Using a modified cluster sample design, skin tests with two TU PPD were performed on 4,083 first-grade children (mean age 6,7 years) in the state of Jalisco, Mexico, to estimate the annual risk of infection from Mycobacterium tuberculosis. The proportion of PPD reactions (a diameter of 10 mm or more of induration) was 7.6% in the Guadalajara metropolitan area and 5.5% in the rest of Jalisco. In the total sample, the proportion was 7.4% among children with scars attributed to BCG vaccine and 4.5% in children without BCG scars. The weighted proportion of children with PPD reactions of 10 mm or more was 6.8% statewide. The average annual risk of infection estimated from the group that had not received BCG vaccine was 0.82%. The results suggest that the incidence of smear-positive pulmonary tuberculosis is almost 10 times greater than the number of cases registered annually in Jalisco.
Asunto(s)
Tuberculosis/epidemiología , Vacuna BCG , Niño , Humanos , Incidencia , México/epidemiología , Riesgo , Prueba de Tuberculina , Tuberculosis/prevención & controlRESUMEN
PIP: El Salvador has a long history of human right abuses and a record of violations of medical neutrality and international humanitarian law. A civil war broke out between the Salvadorian armed forces and a guerrilla opposition, the Farabundo Marti Liberacion Nacional (FMLN) in 1979. To investigate and report on specific allegations of abuses of human rights and medical neutrality by both sides in the conflict, a medical mission visited El Salvador in early June, 1989. It was sponsored by Physicians for Human Rights. The delegation consisted of 5 physicians, an attorney, and an observer from the staff of the Select Committee on Hunger of the US House of Representatives. The mission explored violations of medical neutrality. It investigated the reported obstruction of civil health personnel and of the delivery of supplies to people living in congested rural areas, refugees, and displaced persons, allegations of assault, intimidation, harassment, and torture of health workers; reports of attacks on hospitals and clinics; and the impact of 19 years civil war on El Salvador's medical institutions. The Salvadorian public health system has been seriously damaged by the civil war. A network of "community health promoters"--Salvadorians trained to give simple prevention and curative care--has begun. This network serves primarily those in contested areas. Nearly all roads in rural areas are controlled by military road blocks. Health workers have reported military interference with vaccination campaigns. The Salvadorian army harasses people they believe support the FMLN and obstructs their access to the communities. In February, 1989, the Atlacatl Battalion of the Salvadorian army attacked FMLN medical personnel. The Nongovernmental Human Rights Commission of El Salvador claims to have identified 40 different kinds of torture. Medical education has suffered from budgetary restrictions and from the hostility of the Salvadorian government.^ieng