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Evidence behind the WHO Guidelines: Hospital care for children: What is the appropriate empiric antibiotic therapy in uncomplicated urinary tract infections in children in developing countries?
Journal of Tropical Pediatrics. 2007 Jun; 53(3):150-152.Urinary tract infection (UTI) is an important cause of morbidity and mortality in children. Studies from developing countries show that the around 10% of children with febrile illnesses have UTI . Studies have shown a higher UTI prevalence of 8-35% in malnourished children. The risk of developing UTI before the age of 14 is ~1% in boys and 3-5% in girls. Due to lack of overt clinical features in children less than 2 years, appropriate collection of urine samples and basic diagnostic tests at first-level health facilities in developing countries, UTI are not generally reported as a cause of childhood mortality. If poorly treated or undiagnosed, UTI is an important cause of long-term morbidities such as hypertension, failure to thrive and end-stage renal disease. Unfortunately, many of the organisms responsible for UTI in developing and industrialized countries have become resistant to first-line antimicrobials. It is thus necessary to establish the type of pathogen and antimicrobial sensitivities in the local environment in order to treat the UTI with the appropriate antibiotic. (excerpt)
Contact. 1983 Oct; (75):1-16.Investigates health planners' assumptions about community particiation in health care. Primary health care aims to make essential health care accessible to all individuals in the community in an acceptable and affordable way and with their full participation. It is the strategy propagated by the World Health Organization to provide health for everyone by the year 2000. Community participation is seen as the key to primary health care and has raised many assumptions and expectations among health planners. Community people are seen as a vast untapped resource which can help to reduce the cost of health care by providing additional manpower. It is also expected that community people want to participate in their own health care because they wish to serve their community and to have a part in decisions which affect them. In the early 1970's, programs were developed out of church-related efforts. They pioneered many of the ideas which became principles of primary health care. The church-related programs were nongovernmental and therefore flexible. They had the same goal of letting the community take responsibility for their own health care; program planners were primarily medical people trained in Western medicine. The planners were concerned with the plight of the poor. However, the programs tended to reflect planners' hopes for, rather than the community's understanding of, the community health problem. The author concludes that the assumptions that planners make about their programs need to be critically analyzed. Investigations need to be made into community perceptions and expectations of their role in health programs. Studies need to be undertaken to identify the potentials and problems of community participation and the record of established community health care programs needs to be examined.