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  1. 1

    Diarrheal diseases.

    Vesikari T; Torun B

    In: Health and disease in developing countries, edited by Kari S. Lankinen, Staffan Bergstrom, P. Helena Makela, Miikka Peltomaa. London, England, Macmillan Press, 1994. 135-46.

    In the early 1980s approximately 4.6 million children under 5 years old died from diarrheal diseases each year in developing countries, and the annual number of diarrheal episodes in this age group was above 1 billion. Rotavirus is the single most important causal agent of acute and profuse watery diarrhea characterized by vomiting and fever. The typical age for rotavirus diarrhea is between 6 and 11 months of age. Enterotoxigenic Escherichia coli (ETEC) are found in 10-50% of cases of acute diarrhea in developing countries. Enteropathogenic E. coli (EPEC) also cause diarrhea in developing countries, but only in the first months of life. Shigellosis commonly refers to dysentery, the clinical picture of which includes fever, abdominal cramps, and bloody diarrhea with frequent, small and mucoid stools. Both S. flexneri and S. dysenteriae 1 are important causes of dysentery in developing countries. Shigellosis is one of the few diarrheal infections in which antibiotics are indicated. The clinical symptoms of Salmonella sp. include fever, abdominal pains, headache, and cough, and clinical signs include coated tongue, splenomegaly, rales in lungs, and relative bradycardia. Typhoid fever is endemic in large parts of the world with an estimated death toll of 500,000-600,000 per year. An estimated 120,000 deaths are caused annually by Vibrio cholerae. Today most cases of cholera are manageable with oral rehydration therapy (ORT). In addition, antimicrobials are routinely given. Case management of acute diarrhea includes treatment of dehydration by oral rehydration solution (ORS). The physiological principles of ORT were established in the 1960s. The World Health Organization formula for ORT is suitable for the management of all types of dehydration. Antimicrobials should be discouraged in uncomplicated acute diarrhea. Several causes of persistent diarrhea have been proposed including: infection with enteroadherent E. coli, enteropathogenic E. coli and Cryptosporidium; and intolerance to foods.
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  2. 2

    Food safety in primary health care.

    Abdussalam M; Kaferstein FK

    WORLD HEALTH FORUM. 1994; 15(4):393-7.

    The fact that food safety is given a low priority in the health care systems of many countries despite an increase in food-borne diseases may be due to a lack of reliable quantitative data on incidence of disease. The World Health Organization (WHO) has linked this increase to intensive methods of livestock production which foster the spread of salmonella and other pathogens. By relying on legislation, regulations, and standards to monitor food commerce, policy-makers have failed to emphasize health education for food handlers and consumers. WHO has proposed a collaborative, intersectoral approach between governments, food industries, and consumers which will emphasize consumer education. WHO has also prepared 10 rules for safe food preparation. Governments can insure the education of consumers and food handlers by using the primary health care (PHC) mechanism for health education. To date, the most intensive involvement of the PHC community has been in efforts to avoid diarrheal diseases through hand-washing, sanitation, and safe storage of water. Insufficient cooking, faulty food storage, and improper reuse of leftovers have all been neglected topics. Food safety efforts at the local level should 1) identify specific food-related practices and behavior relevant to risk factors, 2) change risky behavior and practices through health education, 3) involve the community in making improvements related to food safety, 4) mobilize and coordinate relevant activities of other sectors, 5) report incidences of food-borne illnesses, 6) generate a strong public demand for food safety, and 7) research diseases and cultural practices related to food handling and safety. To achieve these objectives, PHC workers should be trained in the epidemiology of food-borne diseases and the sociocultural characteristics of their area, in health education and community involvement, and in research methodology.
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