Your search found 14 Results
Effect of exclusive breastfeeding on selected adverse health and nutritional outcomes: a nationally representative study.
BMC Public Health. 2017 Nov 21; 17(1):889.BACKGROUND: Despite growing evidence in support of exclusive breastfeeding (EBF) among infants in the first 6 months of birth, the debate over the optimal duration of EBF continues. This study examines the effect of termination of EBF during the first 2, 4 and 6 months of birth on a set of adverse health and nutritional outcomes of infants. METHODS: Three waves of Bangladesh Demographic and Health Survey data were analysed using multivariate regression. The adverse health outcomes were: an episode of diarrhea, fever or acute respiratory infection (ARI) during the 2 weeks prior to the survey. Nutritional outcomes were assessed by stunting (height-for-age), wasting (weight-for-height) and underweight (weight-for-age). Population attributable fraction was calculated to estimate percentages of these six outcomes that could have been prevented by supplying EBF. RESULTS: Fifty-six percent of infants were exclusively breastfed during the first 6 months. Lack of EBF increased the odds of diarrhea, fever and ARI. Among the babies aged 6 months or less 27.37% of diarrhea, 13.24% of fever and 8.94% of ARI could have been prevented if EBF was not discontinued. If EBF was terminated during 0-2 months, 2-4 months the odds of becoming underweight were 2.16 and 2.01 times higher, respectively, than babies for whom EBF was not terminated. CONCLUSION: Children who are not offered EBF up to 6 months of their birth may suffer from a range of infectious diseases and under-nutrition. Health promotion and other public health interventions should be enhanced to encourage EBF at least up to six-month of birth. TRAIL REGISTRATION: Data of this study were collected following the guidelines of ICF International and Bangladesh Medical Research Council. The registration number of data collection is 132,989.0.000 and the data-request was registered on September 11, 2016.
Confirmed malaria cases among children under five with fever and history of fever in rural western Tanzania.
BMC Research Notes. 2011 Sep 13; 4(1):359-364.Background: The World Health Organization recommends that malaria treatment should begin with parasitological diagnosis. This will help to control misuse of anti-malarial drugs in areas with low transmission. The present study was conducted to assess the prevalence of parasitologically confirmed malaria among children under five years of age presenting with fever or history of fever in rural western Tanzania. A finger prick blood sample was obtained from each child, and thin and thick blood smears were prepared, stained with 10% Giemsa and examined under the light microscope. A structured questionnaire was used to collect each patient's demographic information, reasons for coming to the health center; and a physical examination was carried out on all patients. Fever was defined as axillary temperature = 37.5°C. Findings: A total of 300 children with fever or a history of fever (1 or 2 weeks) were recruited, in which 54.3% (163/300, 95%CI, 48.7-59.9) were boys. A total of 76 (76/300, 25.3%, 95%CI, 22.8 - 27.8) of the children had fever. Based on a parasitological diagnosis of malaria, only 12% (36/300, 95%CI, 8.3-15.7) of the children had P. falciparum infection. Of the children with P. falciparum infection, 52.7% (19/36, 95%CI, 47.1-58.3) had fever and the remaining had no fever. The geometrical mean of the parasites was 708.62 (95%CI, 477.96-1050.62) parasites/µl and 25% (9/36, 95%CI, 10.9 -39.1) of the children with positive P. falciparum had = 1001 parasites/µl. On Univariate (OR = 2.13, 95%CI, 1.02-4.43, P = 0.044) and multivariate (OR = 2.15, 95%CI, 1.03-4.49) analysis, only children above one year of age were associated with malaria infections. Conclusion: Only a small proportion of the children under the age of five with fever had malaria, and with a proportion of children having non-malaria fever. Improvement of malaria diagnostic and other causes of febrile illness may provide effective measure in management of febrile illness in malaria endemic areas.
American Journal of Tropical Medicine and Hygiene. 2007 Nov; 77(5):793-794.The World Health Organization (WHO) estimates that Streptococcus pneumoniae is responsible for up to one million deaths annually among children less than five years of age. Pneumococcus is a leading cause of bacterial pneumonia, meningitis, and sepsis. However, due to diagnostic challenges, the burden of pneumococcal disease is largely invisible. In this issue of the journal, Abdullah Brooks and others uncover the substantial disease burden affecting children living in an impoverished urban community in Dhaka, Bangladesh. This is the most rigorous study of the pneumococcal disease burden in an Asian setting. The overall incidence of invasive pneumococcal disease among children less than five 5 years of age was 447 episodes per 100,000 child years, which is comparable to incidence rates found among children coming to hospitals in rural African settings and more than five times higher than rates seen prior to widespread vaccination in the United States, a setting in which blood cultures are frequently performed on febrile children. Before this study, direct evidence for the high pneumococcal disease burden in Asia lagged behind that for Africa, despite the importance of pneumonia as a leading cause of childhood mortality in both regions. (excerpt)
Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever.
Tropical Medicine and International Health. 2006 Aug; 11(8):1238-1255.The current World Health Organisation (WHO) classification of dengue includes two distinct entities: dengue fever (DF) and dengue haemorrhagic fever (DHF)/dengue shock syndrome; it is largely based on pediatric cases in Southeast Asia. Dengue has extended to different tropical areas and older age groups. Variations from the original description of dengue manifestations are being reported. The objectives were to analyse the experience of clinicians in using the dengue case classification and identify challenges in applying the criteria in routine clinical practice. Systematic literature review of post-1975 English-language publications on dengue classification. Thirty-seven papers were reviewed. Several studies had strictly applied all four WHO criteria in DHF cases; however, most clinicians reported difficulties in meeting all four criteria and used a modified classification. The positive tourniquet test representing the minimum requirement of a haemorrhagic manifestation did not distinguish between DHF and DF. In cases of DHF thrombocytopenia was observed in 8.6--96%, plasma leakage in 6--95% and haemorrhagic manifestations in 22--93%. The low sensitivity of classifying DHF could be due to failure to repeat the tests or physical examinations at the appropriate time, early intravenous fluid therapy, and lack of adequate resources in an epidemic situation and perhaps a considerable overlap of clinical manifestations in the different dengue entities. A prospective multi-centre study across dengue endemic regions, age groups and the health care system is required which describes the clinical presentation of dengue including simple laboratory parameters in order to review and if necessary modify the current dengue classification. (author's)
Efficacy and safety of artemether-lumefantrine (Coartem) tablets (six-dose regimen) in African infants and children with acute, uncomplicated falciparum malaria.
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2005; 99:459-467.Approximately one million children die from malaria each year. A recently approved artemisinin-based tablet, Coartem (co-artemether), comprising artemether 120 mg plus lumefantrine 20 mg, given in four doses, provides effective antimalarial treatment for children in many sub-Saharan countries. However, this regimen is considered insufficient for non-immune infants and in areas where multidrug-resistant Plasmodium falciparum predominates. This open-label study assessed the efficacy and safety of co-artemether administered to 310 African children weighing 5—25 kg, with acute, uncomplicated falciparum malaria. Six doses of coartemether were given over 3 days, with follow-up at 7, 14 and 28 days. Treatment rapidly cleared parasitemia and fever. The overall 28-day cure rate was 86.5%, and 93.9% when corrected by PCR for reinfection. Cure rates at 7 and 14 days exceeded 97.0% (uncorrected) and, on day 28, were similar in infants (5 -<10 kg) previously exposed to malaria infection (partially immune: 88.6% uncorrected; 93.3% corrected), and in those who were non-immune (82.5% uncorrected; 95.0% corrected). Adverse events were mostly mild. There was no electrocardiographic evidence of cardiotoxicity. The co-artemether six-dose regimen, treating acute uncomplicated falciparum malaria in African children, achieved rapid parasite clearance and a high cure rate. Treatment was generally safe and well tolerated. (author's)
Progress in development and use of antiviral drugs and interferon. Report of an informal consultation, Geneva, Switzerland, 13-15 March 1995.
Geneva, Switzerland, WHO, Division of Emerging and Other Communicable Diseases Surveillance and Control, 1995. 30 p. (WHO/EMC/LTS/95.1)Considerable progress has been made in the development of antiviral agents. Several new compounds have become available to physicians over the past few years and many more are under development. Many of the recently developed agents represent incremental improvements related to improved pharmacokinetic and/or tolerance profiles. One of the reasons behind this progress has been the fight against the epidemic of HIV infection and its sequelae, with a resulting expansion in antiviral drug research. Other viral diseases have benefited from this increased interest, but with these successes problems of toxicity and viral resistance have also been encountered. Although there has been significant progress in the field, much still needs to be done to control and treat viral infections. There is a need to develop more effective vaccines and antiviral agents, to be alert in monitoring resistance and in devising strategies to overcome this problem, and to develop a better understanding of the epidemiology and pathogenesis of many viral infections. An international group of experts met at WHO to assess today's state of the art in this field and to offer recommendations for the future. (excerpt)
Geneva, Switzerland, WHO, Division of Emerging and Other Communicable Diseases, 1997. , 30 p. (WHO/EMC/ DIS/97.7)Ebola virus causes the acute viral syndrome known as Ebola haemorrhagic fever (EHF). Named after a river in northern Zaire (now Congo) where it was first discovered in 1976, Ebola is morphologically related to the Marburg virus recognized in 1967, but is antigenically distinct. EHF is a severe disease, with or without haemorrhagic symptoms, characterized by person-to-person transmission through close contact with patients, dead bodies or infected body fluids. The potential for explosive nosocomial infection in health care centres with poor hygiene standards constitutes its main threat to public health. The case fatality rate of EHF is over 50%; there are no individual preventive treatments or vaccines available although supportive care, particularly proper rehydration, significantly reduces the number of deaths. The epidemic potential of EHF can be prevented through proper management in health care centres, such as rapid investigation and strict follow-up of contacts, patient isolation and the rigorous use of universal precautions. (excerpt)
Atlanta, Georgia, United States Centers for Disease Control and Prevention [CDC], National Center for Infectious Diseases, Division of Viral and Rickettsial Diseases, Special Pathogens Branch, 1998 Dec. , 198 p.This manual describes a system for using VHF Isolation Precautions to reduce the risk of transmission of VHF in the health care setting. The VHF Isolation Precautions described in the manual make use of common low-cost supplies, such as household bleach, water, cotton cloth, and plastic sheeting. Although the information and recommendations are intended for health facilities in rural areas in the developing world, they are appropriate for any health facility with limited resources. The information in this manual will help health facility staff to: 1. Understand what VHF Isolation Precautions are and how to use them to prevent secondary transmission of VHF in the health facility. 2. Know when to begin using VHF Isolation Precautions in the health care setting. 3. Apply VHF Isolation Precautions in a large-scale outbreak. (When a VHF occurs, initially as many as 10 cases may appear at the same time in the health facility.) 4. Make advance preparations for implementing VHF Isolation Precautions. 5. Identify practical, low-cost solutions when recommended supplies for VHF Isolation Precautions are not available or are in limited supply. 6. Stimulate creative thinking about implementing VHF Isolation Precautions in an emergency situation. 7. Know how to mobilize community resources and conduct community education. (excerpt)
Clinical diagnosis and assessment of severity of confirmed dengue infections in Vietnamese children: is the World Health Organization classification system helpful?
American Journal of Tropical Medicine and Hygiene. 2004; 70(2):172-179.Classification of dengue using the current World Health Organization (WHO) system is not straightforward. In a large prospective study of pediatric dengue, no clinical or basic laboratory parameters clearly differentiated between children with and without dengue, although petechiae and hepatomegaly were independently associated with the diagnosis. Among the 712 dengue-infected children there was considerable overlap in the major clinical features. Mucosal bleeding was observed with equal frequency in those with dengue fever and dengue hemorrhagic fever (DHF), and petechiae, thrombocytopenia, and the tourniquet test differentiated poorly between the two diagnostic categories. Fifty-seven (18%) of 310 with shock did not fulfill all four criteria considered necessary for a diagnosis of DHF by the WHO, but use of the WHO provisional classification scheme resulted in considerable over-inflation of the DHF figures. If two separate entities truly exist rather than a continuous spectrum of disease, it is essential that some measure of capillary leak is included in any classification system, with less emphasis on bleeding and a specific platelet count. (author's)
Efficacy of chloroquine, amodiaquine, sulphadoxine-pyrimethamine and combination therapy with artesunate in Mozambican children with non-complicated malaria.
Tropical Medicine and International Health. 2004 Feb; 9(2):200-208.This paper reports a two-phase study in Manhic¸a district, Mozambique: first we assessed the clinical efficacy and parasitological response of Plasmodium falciparum to chloroquine (CQ), sulphadoxine– pyrimethamine (SP) and amodiaquine (AQ), then we tested the safety and efficacy in the treatment of uncomplicated malaria, of three combinations: AQ + SP, artesunate (AR) + SP and AQ + AR. Based on the WHO (1996, WHO/MAL/96.1077) in vivo protocol, we conducted two open, randomized, clinical trials. Children aged 6–59 months with axillary body temperature =37.5 degrees C and noncomplicated malaria were randomly allocated to treatment groups and followed up for 21 days (first and second trial) and 28 days (first trial). The therapeutic efficacy of AQ (91.6%) was better than that of SP (82.7%) and CQ (47.1%). After 14 days, 69% of the strains were parasitologically resistant to CQ, 21.4% to SP and 26% to AQ. Co-administration of AQ + SP, AR + SP and AQ + AR was safe and had 100% clinical efficacy at 14-day follow-up. The combination therapies affected rapid fever clearance time and reduced the incidence of gametocytaemia during follow-up. (author's)
JAMA. 2003 Jul 16; 290(3):317-319.An epidemic of Ebola hemorrhagic fever has sputtered along unabated since October 2001 in the dense jungles that span the northern border between Gabon and Congo, raising questions about how health officials respond to outbreaks of the deadly infection. (excerpt)
Diagnosis and management of febrile children using the WHO / UNICEF guidelines for IMCI in Dhaka, Bangladesh.
Bulletin of the World Health Organization. 2001; 79(12):1096-105.In Dhaka, Bangladesh, a study was conducted to determine the effectiveness of WHO’s integrated management of childhood illnesses (IMCI) guidelines in identifying children with bacterial infections in need of antibiotics. A systematic sample of 669 sick children aged 2-59 months was enrolled in the study. Weight, tactile, measured temperature, and respiratory rate were obtained from each patient. The study revealed that had IMCI guidelines been used to evaluate the subjects, 78% of those with bacterial infections would have received antibiotics, including the majority of children with meningitis (100%), pneumonia (95%), otitis media (95%), urinary tract infection (83%), bacteremia (50%), dysentery (48%), and skin infections (30%). It was also noted that the fever module identified only one additional case of meningitis. Children with bacteraemia were more likely to be febrile, feel hot and have history of fever than those with dysentery and skin infections. Fever combined with parental perception of fast breathing provided a more sensitive fever module for the detection of bacteraemia than the current ICMI module. In an area of low malaria prevalence, the IMCI guidelines provide antibiotics to the majority of children with bacterial infections, but improvements in the fever module are possible.
POPLINE. 2001 Mar-Apr; 23:3.Nearly 1 in 3 children born in Sierra Leone's diamond-rich Kenema district died last year before turning 1 year old, according to a recently released report. Issued by Sierra Leone's Health and Sanitation Ministry and the International Rescue Committee (IRC), the report came on the heels of a mortality survey in the West Central African country. The UN International Children's Emergency Fund (UNICEF) previously reported that Sierra Leone's infant mortality level of 157 newborn deaths per 1000 births is the world's highest. The new study, however, demonstrates that the rate in Kenema is almost twice that level. Robin Nandy of IRC called the findings “a public health catastrophe”. Additionally, the survey revealed an overall death rate for Kenema that was 3 times the normal level for sub-Saharan Africa--44 deaths a year per 1000 people. UNICEF estimated in 1999 that the overall mortality rate in Sierra Leone was much lower--24 deaths per 1000 people--though even that number is considered among the world's highest mortality rates. Most of the deaths were attributed to common illnesses that are easily treatable, with ailments involving fever proving to be the most fatal. Malaria was the leading cause of death, followed by diarrheal disease and respiratory infections. Nandy called the findings worse than anticipated since Kenema was fairly peaceful last year, compared to considerable fighting the year before. She said that IRC assumes death rates are even higher in areas where conflict continues. With a fertility rate of 6.3 children per woman, Sierra Leone is on course to double its population of 5.2 million in only 26 years and triple its human numbers in 50 years. (full text)
Lancet. 2000 Oct 28; 356(9240):1499.At least 60 people have died in an outbreak of Ebola hemorrhagic fever in northern Uganda. It was suspected that the epidemic might have started in early August 2000, but it only came to the attention of health officials in mid-September. A total of 165 cases have since been reported. It is still unknown to everyone where the virus originated. According to observations, outbreaks typically occur when people come into contact with infected animals and then spread the virus through person-to-person contact. The virus is shed in urine, saliva, blood and other body fluids, and excretions. Those family members, hospital workers, and others caring for the patients with the fever were also at risk of contracting the disease. Up to the present, the epidemic has remained contained to the Gulu region 360 km north of the capital of Kampala.