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  1. 1
    Peer Reviewed

    Treatment of tuberculosis: Is our knowledge adequate?

    Bhalla A

    Indian Journal of Medical Sciences. 2002 Feb; 56(2):73-78.

    Tuberculosis remains a global problem inspite of the excellent drugs available to cure it. According to an estimate in 1995 there were 9 million cases of tuberculosis worldwide and 3 million deaths. Tuberculosis was declared a global emergency by WHO in 1990 as it had reemerged in countries where it was supposed to be on a decline. Global explosion of HIV infection coupled with chaotic treatment of tuberculosis, the world today is threatened with untreatable epidemic of tuberculosis. Inappropriate and inadequate treatment leads to acquired drug resistance, which may result in treatment failure and spread of resistant organisms to other persons. The only way to prevent this is uniformity in the treatment of such patients both in governmental programs and private practice. In India under national tuberculosis control program 1.5 million cases are detected every year but still 1200 cases die due to it daily. The reason for this could be lack of compliance by the patients, faulty drug distribution, emergence of MDR-TB and inappropriate prescriptions of anti TB drugs due to lack of knowledge regarding the guidelines. Our study was aimed at finding out the knowledge, attitude and practice of resident doctors and consultants treating tuberculosis in two medical institutes in two different states of India. (author's)
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  2. 2

    CDD in Kenya: policy and research on home treatment.

    Spain P

    Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1991 Jun. [10] p. (Occasional Operations Papers; USAID Contract No. DPE-5969-Z-00-7064-00)

    The paper presents results from diarrheal disease control (CDD) activities in Kenya. A World Health Organization Diarrheal Diseases Household Case Management Survey of 23,884 children under 5 years of age indicates a high use of recommended fluids before and during episodes of diarrheal illness. ORT use was high, while ORS use and volume were low, with better diarrheal management practiced in Western Kenya. Children with diarrhea in districts with CDD communication program are more likely to receive proper care. For home treatment of diarrhea, the Kenyan Food and Fluids Panel recommends mothers to use uji, a locally available porridge, liberal quantities of plain water, fresh fruit juices, fermented milk, and coconut water; exclusive breastfeeding for the 1st 4 months of life; continued feeding of at least 5 times/day during diarrhea; and improved, targeted communication for behavior change especially among mothers of at-risk children. Additional research on food, feeding, communications, and marketing ORS was also recommended. Principal research findings of the survey are discussed in detail. Messages most effective in improving the management of diarrhea include emphasizing feeding during diarrhea, stressing the use of nutritional fluids, continued hesitation of ORS promotion until 1.2- liter packets become generally available through the health system, and emphasizing the rare need for drug therapy of diarrhea. Recognizing signs suggesting the need for health facility treatment should be reinforced.
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  3. 3

    Undoing the curse of neo-natal tetanus.

    Robbins K

    CHILD SURVIVAL ACTION NEWS. 1988 Apr; (9):1-2.

    Present thinking regarding the control of neonatal tetanus (NT) suggests that the accepted protocol in the past, i.e., immunizing pregnant women with tetanus toxoid (TT) during antenatal care, is not sufficient in countries where antenatal care may be unavailable. Current control strategies, experts, and official World Health Organization (WHO) recommendations now indicate that efforts should reach beyond immunization of pregnant women and the training of traditional birth attendants in hygienic cord care practice to immunization of all women of childbearing age. Babies continue to die form NT because it is so difficult to reach women during pregnancy for immunization. Lack of commitment to expanding immunization programs as Who recommends stems in part from failure at both national and local levels to acknowledge the extent of the neonatal tetanus problem. NT is vastly underreported for several reasons: cultural practices often include the seclusion of women and their babies during the period after birth; people in developing countries have a fatalistic attitude because so many children die within the 1st year of life; newborns are rarely taken to health centers for treatment; health workers may fail to report NT for fear that their superiors will blame them for failure to immunize or for poor care of the umbilical cord; Western medicine and research has a curative rather than a preventive focus; and gathering information on NT by asking mothers to recall deaths of newborns with symptoms of NT is difficult because many women are ashamed or otherwise unwilling to report the event. The WHO believes that conventional reporting systems in developing countries identify only 2-4% of actual NT cases. Without sound documentation of the problem, it is difficult to gain financial and political commitment to eradicating NT. The VIII International Conference on Tetanus that occurred in Leningrad during 1987 outlined WHO's recommendation for a mixed strategy to control and eliminate tetanus: immunize all women of childbearing age, with special emphasis on pregnant women and women known to belong to high risk groups; assure hygienic delivery and umbilical care through training and supervision of birth attendants; and investigate cases to determine what action could have prevented them.
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  4. 4

    Measles: summary of worldwide impact.

    Assaad F

    REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):452-9.

    This summary of the worldwide impact of measles discusses epidemiology, reported incidence, clinical severity, community attitudes toward measles, and the impact of immunization programs on measles. Measles, 1 of the most ubiquitous and persistent of human viruses, occurs regularly everywhere in the world except in very remote and isolated areas. Strains of measles virus from different counties are indistinguishable, and serum antibodies from diverse population have identical specificity. Yet, the epidemic pattern, average age at infection, and mortality vary considerably from 1 area to another and provide a contrasting picture between the developing and the developed countries. In the populous areas of the world, measles causes epidemics every 2-5 years, but in the rapidly expanding urban conglomerations in the developing world, the continuous immigration from the rural population provides a constant influx of susceptible individuals and, in turn, a sustained occurrence of measles and unclear epidemic curves. In the economically advanced nations, measles epidemics are closely tied to the school year, building up to a peak in the late spring and ceasing abruptly after the summer recess begins. Maternal antibody usually confers protection against measles to infants during the 1st few months of life. The total number of cases of measles reported to WHO for 1980 is 2.9 million. Considering that in the developing world alone almost 100 million infants are born yearly, that less than 20% of them are immunized against measles, and that various studies indicate that almost all nonimmunized children get measles, less than 3 million cases of measles in 1980 is a gross underestimate. There was adecrease in the global number of reported cases of measles during the 1979-80 period due primarily to the reduction in the number of cases in the African continent and, to a lesser extent, in Europe. It is premature to conclude that such a reported decline is real and that it reflects the beginning of a longterm trend. The contrast between the developed and the developing worlds is most marked in relation to the severity and outcome of measles. Case fatality rates of more than 20% have been reported from West Africa. It has been estimated that 900,000 deaths occur yearly in the developing world because of measles, but data available to WHO indicate that the global case fatality rate in the developing world approaches 2% (in contrast to 2/10,000 cases in the US), and the actal mortality may be greater than 1.5 million deaths per year. The advent of WHO's Expanded Program on Immunization has brought about an awareness of the measles problem. Whenever and wherever measles vaccine has been used effectively on a large scale, a marked reduction in the number of cases has been recorded.
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