RESUMEN
OBJECTIVES: A study was undertaken to assess the prevalence of hepatitis B infection in selected residential child care facilities in Natal. DESIGN: All residents at three facilities in the Durban and Pietermaritzburg areas of KwaZulu-Natal were tested for markers of hepatitis B infection as part of a broader health status assessment. RESULTS: One hundred and ninety-five children between the ages of 3 and 194 months (78 +/- 47) were studied. Overall 66.2% of children had evidence of past exposure to hepatitis B virus. Of these 14.9% were positive for hepatitis B surface antigen, 13.3% for hepatitis B e antigen, 47.7% for hepatitis B surface antibody and 59.5% for hepatitis B core antibody. Relative rates of infection increased with age from 18.2%, 20% and 27.8% in the 1st, 2nd and 3rd years of life respectively to 72.2% and 88.2% in the 4th and 5th years of life. Relative rates of infection increased with duration of stay from 40% by the end of the 1st year to 100% by the end of the 5th year. CONCLUSIONS: This study has demonstrated a very high rate of infection with hepatitis B virus and a high prevalence of hepatitis B surface antigenaemia in residential care facilities. It has also shown that the infection is horizontally transmitted within these facilities, that infection increases with duration of stay, that there is a dramatic increase in infection rates after the 3rd year of life, that the highest carrier rates are occurring in children between the ages of 2 and 4 years, and that the vast majority of carriers are highly infectious. These children are not only at risk themselves for the long-term complications of this disease but also constitute an important reservoir of hepatitis B infection within the larger community. There is an urgent need for uniform national guidelines for the screening and management of children in residential care facilities and children being prepared for adoption or foster care. There is also a need for a wider investigation into conditions at residential care facilities previously designated for black children in this country.
Asunto(s)
Adopción , Niño Institucionalizado , Cuidados en el Hogar de Adopción , Hepatitis B/epidemiología , Adolescente , Negro o Afroamericano , Población Negra , Portador Sano , Niño , Preescolar , Femenino , Hepatitis B/etnología , Hepatitis B/inmunología , Anticuerpos contra la Hepatitis B/análisis , Antígenos del Núcleo de la Hepatitis B/inmunología , Antígenos de Superficie de la Hepatitis B/inmunología , Antígenos e de la Hepatitis B/inmunología , Virus de la Hepatitis B/inmunología , Humanos , Lactante , Tiempo de Internación , Masculino , Prevalencia , Sudáfrica/epidemiologíaRESUMEN
A study of the anthropometric status of under-5-year-olds was conducted in the Nqutu district of KwaZulu by means of a representative community-based sample and concurrent samples from primary health care clinics, preschools and primary schools. The first objective of this exercise was to determine the extent of acute nutritional stress in the district as an indication of the appropriateness of food relief efforts in the region. The absence of wasting and the high prevalence of stunting (37.5%) in the community-based sample suggested that the main problem is chronic socio-economic underdevelopment, rather than a severe or immediate lack of food. The fact that fewer than 20% of households are in any way reliant on domestic production for their maize requirements explains why the recent drought has not had a greater impact on the nutritional status of this vulnerable group. This study confirms that the more recent emphasis of the National Nutrition and Social Development Programme on social development is appropriate. An equally important objective of this study was to evaluate the usefulness of clinics, preschools and schools as sites for the collection of anthropometric data and the development of nutritional programmes. This preliminary attempt to develop the methodology for district-based nutrition surveillance suggested that all these sites have limitations both in respect of data collection and community access. The implications of using these sites and the developments needed to improve their usefulness in a future nutrition surveillance system are discussed.
Asunto(s)
Fenómenos Fisiológicos Nutricionales Infantiles , Encuestas Nutricionales , Estado Nutricional , Antropometría , Niño , Preescolar , Análisis por Conglomerados , Femenino , Humanos , Lactante , Masculino , Población Rural , Vigilancia de Guardia , Sudáfrica/epidemiologíaRESUMEN
A community paediatric geographical information system using hospital-based inpatient data was created to monitor longitudinal child health trends, to define paediatric priorities and to generate research ideas and interventions in a large and very fragmented health ward. This epidemiological tool has been used to describe measles admission trends over a 4-year period (1987-1990), which included a severe measles epidemic. The examination of these trends in progressively finer geographical categories has identified a number of areas with a particularly high incidence of measles and has provided useful guidelines for subsequent community-based research. The demonstration of low vaccination coverage in areas designated as high incidence areas by this system suggests that these trends are accurate and that they can reliably be used for routine measles surveillance. The use of this system for measles surveillance on a prospective basis is expected to enable workers in this area to identify any increase in measles incidence rapidly, to pinpoint where this increase is occurring, and to make it possible to respond in a more focused manner to outbreaks when they occur.
Asunto(s)
Sistemas de Información , Sarampión/prevención & control , Niño , Métodos Epidemiológicos , Humanos , Sarampión/epidemiología , Vigilancia de la Población/métodos , Sudáfrica/epidemiologíaRESUMEN
A repeat vaccination coverage survey has been conducted in the Edendale/Vulindlela district of KwaZulu. The survey data were processed using the Coverage Survey Analysis System (COSAS) developed by the World Health Organisation (WHO) through its Expanded Programme on Immunisation (EPI). A modified random cluster sampling method was used to select 281 children between the ages of 12 and 23 months. Of the children surveyed, 83% were in possession of Road-to-Health cards (RTHCs). The best estimate of overall coverage for doses up to and including the second doses of polio and diphtheria, pertussis and tetanus (DPT) was 85% or higher, but estimates for polio 3 and measles, at 72% and 67% respectively, remain suboptimal. Stratification of coverage into urban, peri-urban and rural categories revealed that the major contribution to the fall-off in coverage, after the second dose of polio and DPT, came from children in the peri-urban category with estimates of 52% for polio 3 and 38% for measles. The fact that coverage in the peri-urban population for doses up to and including polio 2 was 78% or higher indicated that the peri-urban influence responsible for this drop-out effect occurred between the approximate ages of 5 and 8 months. This identified populations in informal peri-urban settlements as a priority group for urgent intervention and further study. The estimation of missed opportunities at visits when vaccinations are normally given, found in this survey to occur in 17% of children, was a useful feature of COSAS and provided a basis for a specific intervention.
Asunto(s)
Vacunación/estadística & datos numéricos , Análisis por Conglomerados , Humanos , Lactante , Vacuna Antisarampión , Vacuna Antipolio de Virus Inactivados , Población Rural , Sudáfrica , Población UrbanaRESUMEN
Recent epidemics of poliomyelitis and measles in the Edendale/Vulindlela district of KwaZulu spurred an investigation into the causes of vaccination failure. Vaccination coverage achieved by routine clinic services and by two mass campaigns was assessed. The validity of routine clinic vaccination records was also determined. Using a modified 30 x 7 random cluster sampling technique, 224 children aged 1-5 years were studied. Of these, 62% had a 'Road to Health' card. Best estimates show that 87% had had BCG, 62% three doses of diphtheria, pertussis and tetanus and polio, and 55% measles vaccine. The mass campaigns raised coverage for measles by 26%, and that for polio by 27%. Coverage estimates made from routine clinic data were consistently 13-25% higher than from this survey. This discrepancy is unfortunate, since it could lead to complacency if certain targets are apparently achieved using only clinic records, and points to the need for regular population-based surveys in all but the best organised health services. Inadequate vaccination coverage alone can explain the epidemics of polio and measles. The reasons for this, in the presence of an adequate clinic infrastructure, need to be assessed urgently to prevent further outbreaks.