RESUMO
In Europe before the advent of the acquired immunodeficiency syndrome (AIDS), fatal cases of infection with Cryptococcus neoformans resembling acute meningitis were rarely described and never in young adults. However, rapidly fatal cryptococcal meningitis in young Africans has been known to exist in central Africa for at least 30 years, mainly in the lower area of the Congo River basin. Cases have been reported in this area since 1953, particularly in young patients during the 1950s. It is also known that central African AIDS patients frequently suffer from cryptococcosis, and there is a possibility that earlier clinical reports of encephalitis were actually fatal cases of AIDS in young Africans. It appears possible that the central part of the African continent is the area where human immunodeficiency virus originated.
PIP: Rapidly fatal cryptococcal meningitis has existed in central Africa for more than 30 years, mainly in the lower area of the Congo River basin. Cases have been reported in that area since 1953, especially among young patients during the 1950s. People with AIDS in central Africa also often have cryptococcosis, and it is possible that earlier clinical reports of encephalitis were actually fatal cases of AIDS in young Africans. Before the advent of AIDS in Europe, fatal cases of infection with Cryptococcus neoformans resembling acute meningitis were rare and nonexistent in young adults. The available evidence suggests that HIV may have originated in central Africa, where it had long remained in a specific, but unknown and overlooked habitat. Cryptococcosis infection, cryptococcosis in the Congo River basin, the historical presence of HIV, and HIV in Haiti and among Haitians are discussed.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Meningite Criptocócica/complicações , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , Criança , Congo/epidemiologia , República Democrática do Congo/epidemiologia , Feminino , Haiti/epidemiologia , Haiti/etnologia , Humanos , Masculino , Meningite Criptocócica/epidemiologiaRESUMO
PIP: Operations research (OR) is a major component of the Quality Assurance Project's (QAP) strategy for improving the quality of health care delivery worldwide. QAP's Operations Research Program aims to improve the feasibility, utility, and cost-effectiveness of quality assurance strategies in developing countries. QAP and its field partners work to maximize the utility of each field study's findings. As such, the project hopes to disseminate information on all aspects of important OR projects, from the initial design to implementation and results. Over the course of the project, QAP's staff and their partners will develop studies in 16 technical areas. One key area of interest is the study of client satisfaction with health care delivery. The project currently has two major studies on client satisfaction underway in Niger and Peru. Phase one results from the Niger research and QAP and the Max Salud Institute in Peru are discussed.^ieng
Assuntos
Atenção à Saúde , Países em Desenvolvimento , Pesquisa sobre Serviços de Saúde , Pesquisa Operacional , Pacientes , Satisfação Pessoal , Qualidade da Assistência à Saúde , África , África Subsaariana , África do Norte , África Ocidental , América , Comportamento , Saúde , Planejamento em Saúde , América Latina , Níger , Organização e Administração , Peru , Avaliação de Programas e Projetos de Saúde , Psicologia , América do SulRESUMO
PIP: Women typically do not make decisions about contraceptive use and family planning on their own, and many women often have little, if any, decision-making power in the home. Strategies are therefore needed to empower women, educate family members, and involve men in reproductive health programs. Policymakers should expand the range of male services and encourage the greater use of male contraceptive methods. Furthermore, health programs should include counseling to help men and women improve their communications skills and conduct education campaigns to inform men about the roles they can play in family planning. Men should also learn about the side effects of both male and female methods, since concern over method side effects can frustrate their support of family planning. Appropriate strategies can be tailored to meet individual group needs. Programs in Madagascar, Bangladesh, Honduras, and Nepal are described as examples of how the support of family members can positively affect family planning use and reproductive health.^ieng
Assuntos
Comportamento Contraceptivo , Características da Família , Serviços de Planejamento Familiar , Necessidades e Demandas de Serviços de Saúde , Relações Interpessoais , Medicina Reprodutiva , Educação Sexual , África , África Subsaariana , África Oriental , África do Norte , América , Ásia , Bangladesh , Comportamento , América Central , Anticoncepção , Países em Desenvolvimento , Economia , Educação , Saúde , Honduras , América Latina , Madagáscar , Nepal , América do Norte , Comportamento Social , Fatores Socioeconômicos , Direitos da Mulher , Humanos , MasculinoRESUMO
The introduction of new contraceptive technologies has great potential for expanding contraceptive choice, but in practice, benefits have not always materialized as new methods have been added to public-sector programs. In response to lessons from the past, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP) has taken major steps to develop a new approach and to support governments interested in its implementation. After reviewing previous experience with contraceptive introduction, the article outlines the strategic approach and discusses lessons from eight countries. This new approach shifts attention from promotion of a particular technology to an emphasis on the method mix, the capacity to provide services with quality of care, reproductive choice, and users' perspectives and needs. It also suggests that technology choice should be undertaken through a participatory process that begins with an assessment of the need for contraceptive introduction and is followed by research and policy and program development. Initial results from Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Vietnam, and Zambia confirm the value of the new approach.
PIP: In response to difficulties associated with the introduction of new contraceptive technologies to public sector service systems, the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction has formulated a new model. The strategic approach to contraceptive introduction shifts the emphasis from the promotion of a particular technology to quality of care issues, a reproductive health focus, and users' perspectives and needs. It further entails a participatory approach with collaboration among governments, women's health groups, community groups, nongovernmental providers, researchers, international donors, and technical assistance agencies. The underlying philosophy is that method introduction should proceed only when a system's ability to provide high-quality services exists or can be generated. Since 1993, WHO has provided support for the implementation of this perspective in public sector programs in Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Viet Nam, and Zambia. Preliminary assessments in these countries revealed major structural, managerial, and philosophical barriers to high-quality family planning services. In cases where assessments have indicated the feasibility of new method introduction, this has been implemented through a carefully phased, research-based process intended to encourage the development of appropriate managerial capacity and to promote a humanistic philosophy of care.
Assuntos
Anticoncepção , Atenção à Saúde/métodos , Países em Desenvolvimento , Serviços de Planejamento Familiar/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Organização Mundial da Saúde , África , Sudeste Asiático , Participação da Comunidade , Anticoncepção/métodos , Anticoncepção/psicologia , Anticoncepção/normas , Atenção à Saúde/organização & administração , Serviços de Planejamento Familiar/organização & administração , Liberdade , Implementação de Plano de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Cooperação Internacional , Modelos Organizacionais , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Formulação de Políticas , Desenvolvimento de Programas , Qualidade da Assistência à Saúde , América do SulRESUMO
This article examines gender differentials in the reporting of contraceptive use and offers explanations regarding the sources of these differences. Data from five countries where DHS surveys were conducted recently among men and women are used in exploring these differences. The gap exists in all five countries, with men (or husbands) reporting greater practice of contraception than women (or wives). Results from the bivariate analysis suggest that the gap is attributable to polygyny and to gender differences in how the purpose of contraception is understood, rather than to male extramarital sexual relations. Additionally, gender differences in the definition of certain contraceptive methods and differences in the interpretation of questions about contraception contribute to the observed gap. These findings are also consistent with results of the multivariate analysis.
PIP: An analysis of Demographic and Health Survey data from Central African Republic, Ghana, Haiti, Kenya, and Zimbabwe revealed large gender differentials in the reporting of contraceptive use. In all five countries, men/husbands reported greater practice of contraception than women/wives. This gap ranged from 5 percentage points in Ghana to 25 percentage points in Kenya. The reporting of contraceptive use by only one partner of a couple may result from multiple sexual relationships, secret contraceptive use, or differential perceptions of what constitutes contraception. In these five countries, most of the gender gap was associated with condoms, abstinence, and (in Zimbabwe) the pill. An analysis of these differentials suggests more overreporting of current use among husbands than underreporting among wives. To the extent that polygynous men are more likely than their wives to report use of methods of which the wife would have equal or more knowledge than the husband (e.g., the pill), a polygyny effect is indicated in Zimbabwe. The results for Ghana and Kenya (the only surveys where information on knowledge of the ovulatory cycle is available for husbands) suggest the gap in reporting of periodic abstinence results mainly from husband's inaccurate knowledge of the reproductive cycle and this method. Finally, if all the gaps in condom use between marital partners are attributed to the assumption of the differential role of condom use (pregnancy and sexually transmitted disease prevention), this factor would explain 12% (Haiti) to 38% (Ghana and Zimbabwe) of the net gap in contraceptive prevalence rate estimates. More detailed questioning on the use of condoms and periodic abstinence would improve the reliability of these surveys.
Assuntos
Anticoncepção/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Cônjuges , África , Preservativos/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepção/psicologia , Demografia , Escolaridade , Relações Extramatrimoniais , Serviços de Planejamento Familiar , Feminino , Haiti , Inquéritos Epidemiológicos , Humanos , Masculino , Casamento/etnologia , Modelos Estatísticos , Prevalência , Análise de Regressão , Estudos de Amostragem , Fatores Sexuais , Abstinência Sexual , Infecções Sexualmente Transmissíveis/prevenção & controle , Controles Informais da Sociedade , Cônjuges/psicologia , Cônjuges/estatística & dados numéricosRESUMO
PIP: Condom social marketing (CSM) programs have been extremely successful in Rwanda and Haiti despite political and economic chaos. Hundreds of small sales outlets have been established throughout Rwanda for CSM. Using commercial marketing techniques, affordable pricing, and existing retail networks to promote, distribute, and sell condoms, the AIDS Control and Prevention (AIDSCAP) Project's nonprofit CSM programs have created enormous demand for condoms even in places where resistance to them used to be extremely strong. Overcoming cultural barriers to condom use is one of the great challenges facing CSM programs throughout the world. Cooperation amid chaos, violent civil conflict in Rwanda, and partnerships with communities, nongovernmental organizations, and other community-based organizations are discussed.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Preservativos , Infecções por HIV , Marketing de Serviços de Saúde , Pesquisa , África , África Subsaariana , África Oriental , África do Norte , América , Região do Caribe , Anticoncepção , Países em Desenvolvimento , Doença , Economia , Serviços de Planejamento Familiar , Haiti , América Latina , América do Norte , Ruanda , VirosesRESUMO
The Inter-Health Programme was launched in 1986 by WHO, with the collaboration of a coordination centre (National Public Health Institute, Finland) to control and prevent chronic noncommunicable diseases (CNCDs) among adults. Programmes for action were organized based on the concept that most major CNCDs share common risk factors and that those that are lifestyle related are modifiable through efficient interventions using multifactorial strategies involving community participation and behaviour changes carried out at the primary health care level. Twelve countries from all WHO Regions have joined the programme. A baseline survey was undertaken in all countries with a common protocol, following the criteria and methods employed in the MONICA Project. Altogether 36815 men and women aged 35-64 years were included in the present analysis from the following Inter-Health countries: Chile, China, Cyprus, Finland, Lithuanian SSR, Malta, Mauritius, Russian SFSR, United Republic of Tanzania, and USA. In addition to individual country analysis, centralized analysis was carried out at the Finnish National Public Health Institute and the Department of Community Health, Kuopio University, Finland. Reported here are the mean values of blood pressure, body mass index, and serum total cholesterol as well as specific prevalences of smoking, hypertension, obesity, and hypercholesterolaemia.
PIP: The Inter-Health Program was launched in 1986 by the World Health Organization (WHO) with the collaboration of Finland's National Public Health Institute to control and prevent chronic noncommunicable diseases (CNCDs) among adults. The program consists of interventions designed to modify the levels of the major risk factors of CNCDs in the community through an integrated, community-oriented approach to health promotion and maintenance. 12 countries from all WHO regions have joined the program. The effects of intervention activities were measured by examining changes in the status of risk factors in populations before and after a given intervention. A baseline survey was conducted in all of the Inter-Health countries with a common protocol to identify the relevant risk factors. 36,815 men and women aged 35-64 from Chile, China, Cyprus, Finland, Lithuania, Malta, Mauritius, Russia, Tanzania, and the US were surveyed. This paper reports the mean values of blood pressure, body mass index, and serum total cholesterol as well as specific prevalences of smoking, hypertension, obesity, and hypercholesterolemia.
Assuntos
Doença Crônica/epidemiologia , Inquéritos Epidemiológicos , Adulto , Estudos Transversais , Países Desenvolvidos , Países em Desenvolvimento , Feminino , Indicadores Básicos de Saúde , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Organização Mundial da SaúdeRESUMO
PIP: A study conducted by AVSC International between 1992 and 1995 found that couples around the world go through a highly similar decision-making process when they choose vasectomy as their family planning methods. Study findings are based upon in-depth, qualitative interviews with couples using vasectomy in Bangladesh, Mexico, Kenya, and Rwanda, where the prevalence of vasectomy is relatively low, and Sri Lanka and the US, where it is relatively high. 218 separate interviews were conducted with male and female partners. Concerns about the woman's health were cited by respondents in each country as reasons to cease childbearing and to opt for vasectomy as the means to achieving that end. Also, almost all respondents mentioned varying degrees of financial hardship as contributing to their decision to end childbearing. These findings highlight the concept of partnership in relationships and family planning decision-making, and demonstrate the importance of going beyond traditional stereotypes about gender roles in decision-making. Social influences and the potential risks of using other forms of contraception also contributed to the choice of using vasectomy. The decision-making process and lessons learned are discussed.^ieng
Assuntos
Cultura , Tomada de Decisões , Características da Família , Saúde , Fatores de Risco , Vasectomia , África , África Subsaariana , África Oriental , África do Norte , América , Ásia , Bangladesh , Comportamento , Biologia , Países Desenvolvidos , Países em Desenvolvimento , Serviços de Planejamento Familiar , Quênia , América Latina , México , América do Norte , Ruanda , Sri Lanka , Esterilização Reprodutiva , Estados UnidosRESUMO
PIP: UNAIDS has launched an 'HIV Drug Access Initiative' in the Ivory Coast, Uganda, Chile, and Vietnam; the pilot project will attempt to improve access to HIV drugs. Public and private sector efforts will be coordinated. The Glaxo Wellcome, Hoffman-La Roche, and Virco pharmaceutical companies will participate. Each country will 1) adapt its present system with regard to HIV and 2) establish both an HIV drug advisory board and a non-profit company which will import the drugs. Health ministries within each country will be required to find sources of funding for the programs. Uganda will probably use funds from its sexually transmitted disease (STD) program, which is supported by the World Bank; the Ivory Coast will combine corporate contributions, new tariffs, and non-profit insurance system monies into a 'solidarity fund.' UNAIDS funds will be used for oversight and evaluation. UNAIDS also released a review of 68 studies which examined the impact of sex education on the sex behavior of young people; it indicated that, in 65 of the studies, sex education did not increase the sexual activity of youth. UNAIDS concluded that quality programs helped delay first intercourse and often reduced the number of sexual partners, resulting in reduced rates of STDs and unplanned pregnancy. UNAIDS further concluded that effective sex education should begin before the onset of sexual activity, and curriculums should be focused. Openness in communicating about sex should be encouraged, and social and media influences on behavior should be addressed. Young people should be taught negotiating skills (how to say 'no' to sex and how to insist on safer sex).^ieng
Assuntos
Adolescente , Países em Desenvolvimento , Administração Financeira , Órgãos Governamentais , Infecções por HIV , Cooperação Internacional , Preparações Farmacêuticas , Setor Privado , Educação Sexual , Infecções Sexualmente Transmissíveis , Nações Unidas , África , África Subsaariana , África Oriental , África do Norte , África Ocidental , Fatores Etários , América , Ásia , Sudeste Asiático , Chile , Côte d'Ivoire , Demografia , Doença , Economia , Educação , Infecções , Agências Internacionais , América Latina , Organizações , População , Características da População , América do Sul , Terapêutica , Uganda , Vietnã , VirosesRESUMO
The Centre de Recherche sur les Méningites et les Schistosomes (CERMES) is a research institute depending on the Organisation de Coordination et de Coopération pour la lutte contre les Grandes Endémies--a West African Organization for Public Health--devoted to the studies on schistosomiasis and meningitis. The staff includes 32 persons with 11 scientists and one financial officer. The activities of the CERMES involving schistosomiasis concern three research units: (a) ecology of human and animal schistosomiasis transmission; the CERMES defined the different patterns of schistosomiasis transmission in Niger (involving African dry savana); in this field, we have shown, (i) the existence of important variability in conditions of transmission of S. haematobium and, (ii) natural hybridization between parasitic species of the ruminants (S. bovis and S. curassoni) and genetic interaction between human and animal parasites; (b) definition of morbidity indicators usable for rapid assessment methods, for appraisal of the severity of the disease and for the evaluation of the efficiency of control methods; we have established the correlation between ultrasonographic data and some cheap and simple field indicators; (c) immune response and protective immunity induced by recombinant glutathion S-transferase (Sm28, Sb28 and Sh28) in homologous and heterologous animal models including goats, sheep and non human primates (Erythrocebus patas). In Niger, we participate in all control programs against schistosomiasis to define control strategies, to supervise operations and to participate in their evaluation with external experts. International collaborations constitute a frame including four laboratories in Africa and six laboratories in developed countries (Europe and USA).
PIP: The Centre de Recherche sur les Meningites et les Schistosomoses (CERMES), a research center in Niamey, Niger, affiliated with a West African public health organization, conducts studies in the areas of parasitology, epidemiology, and immunology. Significant variability in factors related to transmission of Schistosoma haematobium have been noted. Experimental research on the Schistosoma-bulinid compatibility and field surveys of the geographic distribution and role of snails in transmission have been essential to the design of parasite control interventions in West Africa. A CERMES-sponsored project, supported by the European Community, is examining urinary schistosomiasis control in the Niger river valley and the impact of treatment on ultrasonically visualized urologic lesions. The Experimental Vaccine Unit seeks to improve the route of administration and choice of adjuvant and to propose a vaccine protocol for field testing. Recombinant proteins have been found to alter the development of the parasite either by inducing a reduction in the parasite burden or an inhibition of the fecundity of the parasite.
Assuntos
Esquistossomose/epidemiologia , Esquistossomose/imunologia , Esquistossomose/parasitologia , Vacinas/imunologia , Animais , Cabras/imunologia , Humanos , Níger/epidemiologia , Primatas/imunologia , Schistosoma haematobium/parasitologia , Organização Mundial da SaúdeRESUMO
The effect of supplementation on growth was tested by means of four similar controlled randomized trials in the Congo (n = 120), Senegal (n = 110), Bolivia (n = 127), and New Caledonia (n = 90). Four-month-old infants were randomly allocated to supplement or control groups. A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored. Both groups were free to eat local food. At 7 mo of age, all infants were still breast-fed in the Congo, Senegal, and Bolivia compared with 47% in New Caledonia. Mean daily consumption of the supplement varied among countries (558-790 kJ/d). Mean length at 4 mo was lowest in Bolivia, higher in Senegal and the Congo, and near the National Center for Health Statistics reference in New Caledonia. The mean 4-7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal (P < 0.05), whereas weight increments did not differ. No significant effect was found in the other countries.
PIP: Findings from this study of the link between nutritional supplementation during breast feeding and infant growth disagree with earlier studies. The effect of nutritional supplementation on growth in length was only modest, but significant only in Senegal and not significant in the Congo, Bolivia, and New Caledonia. It is hypothesized that food supplementation during the 4-7 month period would have a positive effect on linear growth. This study included four controlled randomized trials among 120 infants in the Congo, 110 infants in Senegal, 127 infants in Bolivia, and 90 infants in New Caledonia. The infants were 4 months old when placed in the supplement or control groups. Supplementation included the addition of a cereal-based precooked porridge twice daily for 3 months. Both groups continued to eat local foods. Breast feeding patterns were different in New Caledonia, where only 47% of infants were still breast fed at 7 months of age. Mean daily supplementation varied among countries, from 558 to 790 kJ/day. Mean length was lowest in Bolivia, higher in Senegal and the Congo, and close to the US National Center for Health Statistics reference measures in New Caledonia. The study was conducted in rural parts of Senegal and New Caledonia and periurban parts of Bolivia and the Congo. Supplementation was supervised by field workers. The samples included infants with a length-for-age score of -2.5 or higher and a weight-for-length Z score of -2 or higher at 4 months. Anthropometric measurements were taken at 4 months and 4, 8, and 13 weeks later (at 4.9, 5.8, and 7.0 months of age). 24-hour food recalls were collected monthly for consumption of breast milk, special local infant food, commercial "western" baby food, milk substitutes, family food, water, and other than milk liquids.
Assuntos
Países em Desenvolvimento , Grão Comestível , Crescimento , Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Estatura/fisiologia , Bolívia , Aleitamento Materno , Congo , Feminino , Alimentos Fortificados , Humanos , Lactente , Masculino , Nova Caledônia , Senegal , Aumento de Peso/fisiologiaRESUMO
PIP: This article presents extracts from comments made by young people in various parts of the world about the meaning of the term "safe motherhood." A Ghanian woman noted that young girls, who often bear a heavier workload than boys but receive less food, need to be given the same diet as boys. A young Senegalese mother relayed that she found out she was pregnant when she went to a hospital with stomach pains shortly before her 14th birthday. Until then she had no idea that sexual intercourse led to pregnancy. A Mexican youth cited the problems that accompany adolescent pregnancy and motherhood, and a young woman in India called for delivery of proper medical care to all young mothers and presentation of health education about safe motherhood in schools. An Egyptian youth extolled the benefits of a project that involved young people from rural youth organizations in safe motherhood IEC (information, education, and communication) activities. Previously, adolescents had not received any special attention. Finally, a youth working in a family planning educational booth in Botswana stated that many youth who engage in sexual intercourse at an early age have no idea of the consequences of their actions.^ieng
Assuntos
Adolescente , Coleta de Dados , Estudos de Avaliação como Assunto , Bem-Estar Materno , Medicina Reprodutiva , África , África Subsaariana , África do Norte , África Austral , África Ocidental , Fatores Etários , América , Ásia , Botsuana , Demografia , Países em Desenvolvimento , Egito , Gana , Saúde , Índia , América Latina , México , Oriente Médio , América do Norte , População , Características da População , Pesquisa , Estudos de Amostragem , SenegalRESUMO
Schistosoma mansoni was introduced in the Senegal basin around 1988, due to man-made ecological changes. Since 1991, we investigate a recent but very intense focus, Ndombo, a village near the city of Richard Toll where the outbreak was first described. Four cohorts, each a random sample (+/- 400 subjects each) from this community, were examined and followed up after treatment, starting at 8 month intervals over a 2-year period. Each cohort is examined parasitologically (Kato-Katz), clinically, serologically (circulating antigen and antibody profiles); treated with praziquantel 40 mg/kg; followed up 6-10 weeks, one and two years after treatment; and monitored for water contact patterns and local snail densities. In the first cohort, the prevalence was 91%, with a mean egg count of 663 epg. Prevalences are near 100% in all age groups, but egg counts decline strongly in adults. Antigen detection in serum and urine confirmed that the egg counts genuinely reflect variations of worm burdens, not e.g. of worm fecundity. This is surprising, as in this focus acquired immunity in adults should not have yet developed according to current hypothesis. The antigen detection assays (CAA/CCA) showed high sensitivity and quantitative power, and promising perspectives as a research tool and possibly as a method for non-invasive diagnosis and screening in urine. Epidemiological in subsequent cohorts were highly similar, although seasonal variations were observed possibly due to transmission fluctuations. Anti-AWA and anti-SEA IgE levels increased with age, while IgG4 peaked in the age-group 10 years and correlated well with egg counts.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: A cohort analysis was performed in Ndombo, Senegal, a community of about 4000, in the epicenter of the schistosomiasis outbreak. Four randomly selected cohorts of +or- 400 subjects were surveyed. Each cohort was examined parasitologically, clinically, and serologically (circulating antigen and antibody profiles); treated with praziquantel 40 mg/kg; and followed up at 6-12 weeks and at 1 and 2 years after treatment. The first cohort numbered 422 individuals, of which 91% had positive egg counts, with a mean egg count of 663 eggs per gram feces (epg). Quantitative egg counts in those aged 10-14 were 1409 epg and then declined to 632 epg in the age group 20-29 and to 266 epg in the age group over 40. In cohorts 2 and 3, examined in the spring and autumn, egg counts were substantially lower, particularly in adults, as compared with cohorts 1 and 4, which were both examined in the summer season. 94% of the subjects were positive in the serum circulating anodic antigen (CAA) ELISA, 83% in the serum CAA ELISA, and 95% in the urine circulating cathodic antigen (CCA) ELISA; CAA in urine was less sensitive, and was negative in half of the urine samples. Positivity rates for all assays increased with rising egg counts, and circulating antigen concentrations in both serum and urine correlated well with egg counts. IgE showed a significant increase with age, while IgG4 peaked in the age groups 10-15 and/or 15-19 years. A strong correlation between IgG, IgGl, and IgG4 against both crude antigens with pretreatment egg load was observed. Of the subjects in the first cohort, 61% reported abdominal pain, 33% diarrhea; only 16% showed mild hepatomegaly and only a few children had mild splenomegaly. In the first cohort, 82% of 298 reexamined subjects were still positive for S. mansoni 12 weeks after treatment with praziquantel 40 mg/kg. One year after treatment, cohort 1 showed mean egg counts in children (5-19 years) at 358 epg as compared with 1188 epg pretreatment.
Assuntos
Serviços de Saúde Comunitária , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/imunologia , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Estudos de Coortes , Fezes/parasitologia , Feminino , Humanos , Imunidade , Masculino , Pessoa de Meia-Idade , Contagem de Ovos de Parasitas , Prevalência , Esquistossomose mansoni/tratamento farmacológico , Estações do Ano , Senegal/epidemiologiaRESUMO
PIP: Through the use of case studies from Kenya, Malaysia, Mexico, and Morocco, the influence of environmental degradation on women's livelihoods and fertility is broadly examined. The aim is to show how the environment impacts on women's childbearing decisions, and the consequences. The evidence appears to support the notion that environmental pressures on women will contribute to higher fertility, under conditions of gender division of labor, a very low social status for women, and women's limited educational opportunity. The Kenya experiences were among rural villages in various agro-ecological zones in Embu, on the slopes of Mt. Kenya, and involved coping strategies with poor soils and very little rainfall. The Malaysian research focused on river communities in the rain forests of Limbang River Basin in Sarawak and the logging industry and government regulation of tribal land use rights. In mountainous Tetouan and A1 Hoceimain, Moroccan populations struggle with poor social services and little rainfall. The study areas in Morocco and Kenya had very high population growth, but declining growth rates nationally. The study areas suffered from deforestation, declines in water quality and availability, and soil erosion and depletion. Family planning services would be welcome: 1) when women do not have to solely bear the responsibility for the additional work involved in environmentally degraded areas; and 2) when the value of children is not increased. Policy must recognize that where rigid gender division of labor is prominent, children are a crucial resource for women in the provision of household support. The Morocco case exemplified the extremes of men's refusal to ease women's workloads with time and labor saving technology. Family planning promotion in such situations must be accompanied by provision of alternative resources to address the adverse environmental impacts on women. Blaming women for environmental problems and family planning promotion will fail to gain credibility and the trust of women unless they are provided options.^ieng
Assuntos
Países em Desenvolvimento , Emprego , Estudos de Avaliação como Assunto , Dinâmica Populacional , Crescimento Demográfico , África , África Subsaariana , África Oriental , África do Norte , América , Ásia , Sudeste Asiático , Conservação dos Recursos Naturais , Demografia , Economia , Meio Ambiente , Fertilidade , Mão de Obra em Saúde , Quênia , América Latina , Malásia , México , Oriente Médio , Marrocos , América do Norte , População , PesquisaRESUMO
PIP: Induced abortion remains a relatively uncharted research topic in medical demography, social science, and to a lesser extent, in epidemiology. Up to 20% of the 500,000 maternal deaths which occur annually throughout the world, however, may be a consequence of complications of unsafe abortion procedures. The UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction started a number of studies in 1989 in developing countries on the determinants and consequences of induced abortion. The program's research has produced a wealth of data, with many countries taking important steps to change abortion policy in the interest of improving reproductive health. For example, a study in Mauritius of women hospitalized for abortion revealed that 20% of them had not been using a method of contraception when they became pregnant; a motion was subsequently tabled in the National Assembly to decriminalize abortion. Another study in Chile showed the incidence of induced abortions to be generally under-reported by women and that interventions based upon sound policy can reduce their incidence and improve reproductive health.^ieng
Assuntos
Aborto Induzido , Legislação como Assunto , Política Pública , Pesquisa , África , África Subsaariana , África Oriental , África do Norte , América , Chile , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , Maurício , América do SulRESUMO
"Although techniques for calculating mean survival time from current-status data are well known, their use in multiple regression models is somewhat troublesome. Using data on current breast-feeding behavior, this article considers a number of techniques that have been suggested in the literature, including parametric, nonparametric, and semiparametric models as well as the application of standard schedules. Models are tested in both proportional-odds and proportional-hazards frameworks....I fit [the] models to current status data on breast-feeding from the Demographic and Health Survey (DHS) in six countries: two African (Mali and Ondo State, Nigeria), two Asian (Indonesia and Sri Lanka), and two Latin American (Colombia and Peru)."
Assuntos
Aleitamento Materno , Estudos de Avaliação como Assunto , Modelos Teóricos , Estatística como Assunto , África , África Subsaariana , África do Norte , África Ocidental , América , Ásia , Sudeste Asiático , Colômbia , Países em Desenvolvimento , Saúde , Indonésia , Fenômenos Fisiológicos da Nutrição do Lactente , América Latina , Mali , Nigéria , Fenômenos Fisiológicos da Nutrição , Peru , Pesquisa , América do Sul , Sri LankaRESUMO
PIP: A recent $168 million 5-year cooperative agreement funded by the US Agency for International Development combines elements of its earlier AIDSTECH and AIDSCOM projects under the AIDS Control and Prevention Project (AIDSCAP). Instead of working to effect broad-scale behavior change toward the prevention of HIV transmission, AIDSCAP strategically targets locations for condom distribution, behavior change messages, and the treatment of sexually transmitted diseases. In Lagos and the states of Cross River and Jigawa where the AIDS epidemic is firmly established, for example, AIDSCAP is intervening to increase condom demand and accessibility; alter sexual behaviors which carry a high risk for HIV transmission; and reduce the prevalence of STDs which enhance the transmission of HIV. The project began in fall of 1991 and has expanded to include Ethiopia, Kenya, Malawi, Nigeria, Rwanda, Senegal, Brazil, Haiti, Jamaica, India, and Thailand; limited assistance is also provided to 7 other African countries, 4 Latin America countries, and 1 in Asia. 4 more countries are in the final stages of negotiations to be included in the project. The USAID mission in the host country and the government must invite AIDSCAP involvement in order for the country to attain priority status. Countries are selected based on the HIV prevalence rate, population size and distribution, level of commitment to HIV prevention/control, capacity to respond to the AIDSCAP plan of action, level of other donor support, the USAID Mission's development priorities, and the Mission's commitment of substantial funds from its own budget. Once involved, AIDSCAP is mandated to implement interventions through in-country agencies.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Preservativos , Comportamento Contraceptivo , Atenção à Saúde , Órgãos Governamentais , Infecções por HIV , Acessibilidade aos Serviços de Saúde , Cooperação Internacional , Pesquisa , Comportamento Sexual , Infecções Sexualmente Transmissíveis , Terapêutica , África , África Subsaariana , África Oriental , África do Norte , África Ocidental , América , Ásia , Sudeste Asiático , Comportamento , Brasil , Região do Caribe , Anticoncepção , Países em Desenvolvimento , Doença , Economia , Etiópia , Serviços de Planejamento Familiar , Administração Financeira , Haiti , Planejamento em Saúde , Índia , Infecções , Jamaica , Quênia , América Latina , Malaui , Nigéria , América do Norte , Organização e Administração , Organizações , Ruanda , Senegal , América do Sul , Tailândia , VirosesRESUMO
PIP: The views of a geographer, agricultural scientist, and women's activist focused on the importance of improving women's status and involvement in development. Women in Burkina Faso have shown an ability to organize themselves, but there was insufficient coordination among aid organizations. Researchers and development professionals must broaden and deepen their knowledge about climate, farming methods and traditional natural resource management methods, and women's concerns and occupations. Women need to be engaged in the planning and implementation of natural resource management strategies and in learning about appropriate training and information dissemination methods. The expertise in environmental disciplines is concentrated in developed nations and is needed by Sahelian women. Burkina's environment is replete with droughts, lack of forested areas, and dependence on subsistence farming. Famine and mass migration of men to urban areas have left women in poverty. Women must work 14-16 hours a day to provide food for their families and help husbands with cash crops. About 25% of women die from malnutrition, anemia, repeated pregnancies, malaria, and overexertion, as reported in a 1987 UNICEF study. The literature on women in Burkina Faso has focused only on broad issues of women's status. The few studies of local conditions conducted on a small scale by nongovernmental organizations have revealed that women were 60-80% of the labor force on anti-desertification projects. Women's overwhelming work load prevented even greater participation in environmental protection. Property laws gave land titles to men or the state. Women's groups have set up cereal banks, village pharmacies, and other self help projects pertaining to health, the environment, and agriculture. Women in development individual programs have not sufficiently integrated women and programs were archaic and dispersed. Environmental enforcement was limited.^ieng
Assuntos
Participação da Comunidade , Economia , Estudos de Avaliação como Assunto , Instituições Privadas de Saúde , Pobreza , Direitos da Mulher , Mulheres , África , África Subsaariana , África do Norte , África Ocidental , Burkina Faso , Países em Desenvolvimento , Meio Ambiente , Organização e Administração , Pesquisa , Fatores SocioeconômicosRESUMO
PIP: Mobility affects health because unfamiliar surroundings can cause people to take health risks which they may have avoided in their ordinary environments. The epidemiologic role of mobility in spreading communicable diseases is highlighted by the emergence of a new disease such as HIV infection. The path of HIV can actually be plotted on a map. The disease cannot be stopped at international borders, however, because this is an era of increasing international interdependency. Programs for HIV prevention must consider the mobility circumstance, whether the target population consists of permanent, temporary, or seasonal migrants, non-settling travellers, or involuntary refugees. The vulnerability of each group must be assessed in terms of such issues as exposure, socioeconomic status, and access to health care. Aspects of cultural background, such as language and concepts of sexuality, are important considerations for migrants, as are psychological factors for travellers (pleasure-seeking tourists and relaxation-seeking business travellers) and legal aspects and living conditions for refugees. To date, prevention programs in Brazil, India, Burkina, Faso, Kenya, and Tanzania have targeted truckers. Both national campaigns and specific projects have been addressed to travelers, with high acceptance achieved, for example, in Australia, and, for tourists, in Torbay, England. Migrant male and female prostitutes have been the focus of health services in western European cities in collaboration with the project "AIDS and Mobility." To succeed, collaboration in prevention programs must follow the disease across international borders and cooperation must extend throughout a network of agencies.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Emigração e Imigração , Estudos de Avaliação como Assunto , Infecções por HIV , Refugiados , Migrantes , África , África Subsaariana , África Oriental , África do Norte , África Ocidental , América , Ásia , Austrália , Comportamento , Brasil , Burkina Faso , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Doença , Europa (Continente) , Índia , Quênia , América Latina , Ilhas do Pacífico , População , Dinâmica Populacional , América do Sul , Tanzânia , VirosesRESUMO
"Almost half of...over-45s born in French overseas departments and living in mainland France had plans to return overseas by the year 2000. The desire to return is more clear-cut among the 50 to 54 year olds. The younger people have yet to think seriously about retirement, whilst a number of the oldest individuals have already made definite plans." Data are from a survey carried out in 1992. (SUMMARY IN ENG AND GER AND SPA)