RESUMO
A case-control study of mortality from acute respiratory infections (ARI) among children under five years of age was conducted in Naucalpan, an urban-suburban area of Mexico City, and in rural localities of Tlaxcala, Mexico. The study found that ARI deaths tended to occur in the poorest neighborhoods; 78% of the deceased study subjects were infants under six months old; and 68% of the deaths occurred at home. Comparison of the data for cases (fatalities) and control children who had severe ARI but recovered showed that failure to receive antibiotics was associated with death (odds ratio 28.5, 95% confidence interval 2.1-393.4). This antibiotic effect was controlled for numerous potentially confounding factors. It is evident that antibiotics had a much greater effect in the early days of the illness than later on. In general, the findings strongly support PAHO/WHO primary health care strategies--including such strategies as standardized management of severe ARI cases--that seek to reduce childhood ARI mortality.
Assuntos
Antibacterianos/uso terapêutico , Infecções Respiratórias/mortalidade , Antibacterianos/administração & dosagem , Estudos de Casos e Controles , Pré-Escolar , Fatores de Confusão Epidemiológicos , Humanos , Lactente , Análise por Pareamento , México/epidemiologia , Infecções Respiratórias/tratamento farmacológico , Fatores de Risco , População Suburbana , População UrbanaRESUMO
A national serosurvey was conducted in Mexico from March to October 1986 to identify predictors of dengue transmission and target areas at high risk of severe annual epidemics. A total of 3,408 households in 70 localities with populations less than 50,000 were randomly sampled, and serology was obtained from one subject under age 25 years in each household. When comparing exposure and infection frequencies across the 70 communities, the authors found that median temperature during the rainy season was the strongest predictor of dengue infection, with an adjusted fourfold risk in the comparison of 30 degrees C with 17 degrees C. High temperatures increase vector efficiency by reducing the period of viral replication in mosquitoes. The proportion of houses in a community with larva on the premises was significantly associated with the community proportion infected (odds ratio (OR)adj = 1.9; 95% confidence interval (CI) 1.4-2.5), as was the proportion of households with uncovered water containers present (ORadj = 1.9; 95% CI 1.4-2.7). Because these factors have effects beyond the individual household and subjects infected from them create a risk for other subjects, both analyses of effects and organization of control efforts must be at the community level. A predictive model was constructed using the community level risk factors to classify communities as being at high, medium, or low risk of experiencing an epidemic; 57% of these communities were correctly classified using this model.
Assuntos
Dengue/epidemiologia , Adulto , Aedes/isolamento & purificação , Animais , Dengue/imunologia , Dengue/transmissão , Ecologia , Humanos , Larva/isolamento & purificação , México/epidemiologia , Razão de Chances , Distribuição Aleatória , Fatores de Risco , Estações do Ano , TemperaturaRESUMO
Dengue epidemics in three Mexican cities were investigated with retrospective surveys and virus isolations from acute cases. These epidemics were part of the continuing extension of dengue in Mexico since 1978 after 15 years without transmission. Serotype 1 dengue infection predominated in all epidemics, but in one city, type 2 strains were also isolated. The following findings were consistent in all three cities: 1) illness history provided evidence of presence of infection months before the epidemic became evident, 2) there was a very sharp and progressive increase of dengue illness attack rates by age, 3) there were no interpretable relationships between illness and the presence of different types of breeding sights in the home, 4) socioeconomic status was strongly negatively related to illness, and 5) geographical factors not related to the other measured variables had a strong effect on illness rates reflecting the focality of transmission. In addition, there was evidence of a strong protective effect against illness by the use of mosquito netting or the presence of screens on houses, but these relationships were not universal to all three cities.
Assuntos
Dengue/epidemiologia , Surtos de Doenças , Adolescente , Adulto , Fatores Etários , Idoso , Animais , Criança , Pré-Escolar , Dengue/microbiologia , Dengue/transmissão , Vírus da Dengue/classificação , Vírus da Dengue/isolamento & purificação , Humanos , Lactente , México , Pessoa de Meia-Idade , Controle de Mosquitos , Estudos Retrospectivos , Fatores de Risco , Sorotipagem , Fatores SocioeconômicosRESUMO
To describe the causes of growth failure in a developing country, we studied family food availability, anthropometric measurements of preschool children, and family and neighborhood socioeconomic conditions in a stratified random sample of Cali, Colombia families. The influences on preschool child growth of food availability, neighborhood socioeconomic conditions, and family socioeconomic conditions were separated statistically. Neither food availability nor other family factors were related directly to growth, but neighborhood factors did have a strong relationship to growth. Children decreased progressively from 97.5 percent of expected weight in the top one-sixth of neighborhoods we studied to 89 per cent in the botton one-sixth. Food availability, although not related to growth, was strongly related to family factors. The top one-sixth of families had 115 percent of FAO (Food and Agricultural Organization) protein allowances, while the bottom one-sixth had only 75 per cent. These finding are inconsistent with food availability or family factors being the prinicipal causes of growth retardation. They are consistent with neighborhood determined factors, possibly enteric infections, being the principal cause of growth retardation in preschool children in Cali.
Assuntos
Alimentos , Crescimento , Saneamento , Estatura , Peso Corporal , Pré-Escolar , Colômbia , Transtornos do Crescimento/etiologia , Humanos , Fenômenos Fisiológicos da Nutrição , Fatores SocioeconômicosAssuntos
Diarreia Infantil/epidemiologia , Diarreia/epidemiologia , Eliminação de Resíduos , Abastecimento de Água , Adolescente , Criança , Pré-Escolar , Colômbia , Surtos de Doenças , Feminino , Humanos , Lactente , Masculino , Eliminação de Resíduos/métodos , População Urbana , Poluição da Água/prevenção & controleRESUMO
An example of how follow-up of related cases of diarrhea by epidemiologically-oriented health promoters can result in important public health measures is described. The follow-up of related cases involved a search for an outbreak in which a population with a high attack rate could be defined in order to increase the likelihood of a successful investigation by means of a cross-sectional retrospective study design. Then, through standard epidemiologic techniques, the risk factors to be studied were selected and a questionnaire was designed and executed. The results of this investigation demonstrate that greater meticulousness in pursuing epidemiologic principles is required for success in diarrhea outbreak investigations in developing countries than in developed countries despite the fact that controllable contaminations discoverable by these techniques are much more frequent in the former. In the present investigation it was found that flavored drinks packaged in plastic by a process assuming increasing importance in food distribution were causing diarrhea because of unhygienic manufacturing procedures. A concomitant bacteriologic study helped confirm the epidemiologic findings, and bacteriologic cultures at different points in the manufacturing process suggested a solution to the contamination problem found.
Assuntos
Diarreia/transmissão , Surtos de Doenças , Criança , Colômbia , Diarreia/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Manipulação de Alimentos , HumanosAssuntos
Diarreia/prevenção & controle , Adolescente , Adulto , Criança , Pré-Escolar , Colômbia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Programas Nacionais de SaúdeRESUMO
In a 4-week period in early 1976 in a poor, working class area of Cali, Colombia, the prevalences of diarrhea, vomiting, common cold, and head lice in schoolchildren were measured in relation to classroom size and to the condition of the school toilets. The study found that unhygienic toilet conditions were related to diarrhea, and it was estimated that if all schools could reach the modest level of hygiene of the two schools with the relatively best facilities, diarrhea would be reduced by 44% and vomiting by 34%. Toilet hygiene was found to be unrelated to colds or head lice, which have similar social class distributions to diarrhea and vomiting. Crowding was found to be related to a small percentage of the prevalences of vomiting, head lice and colds.