Showing papers in "Tropical Doctor in 1981"

Some aspects of drug use in Ethiopia.

Abstract: Self medication seems to be a big problem in Ethiopia. Most of the drugs can be obtained over the counter. Under the existing drug laws, sedatives, tranquillizers and other central nervous system depressants are the only drugs that need a doctor’s prescription. This study was undertaken a t Ammanuel Pharmacy, in Addis Ababa. The sample surveyed had no geographical or population limits though most of the patients came from Addis Ababa and its immediate environs. All the incoming orders for drugs for a period of six months were recorded. The drug orders accompanied by a prescription were designated as “prescription orders” and those orders without a prescription as “over the counter (OTC) orders”. Therapeutic agents were classified into nine drug groups. Topical applications, vaccines and sera, anaesthetics, dyes or radiopaque agents, and parenteral electrolyte preparations were not incorporated in this study.

Oral replacement therapy in rural Bangladesh with home ingredients.

Abstract: Diarrhoea is one of the most common symptoms of disease in the developing world (Walsh and Warren 1979). It is estimated that annually there are over 5 0 0 million episodes of diarrhoea in children under 5 years of age in Africa, Asia and Latin America. This results in five to eighteen million childhood deaths per year (Rohde 1978). Diarrhoea can cause or exacerbate malnutrition (Gordon et a / . 1968). In fact, most diarrhoea1 deaths in developing countries may be due to a cyclical process involving both diarrhoea and malnutrition. This is particularly significant in Bangladesh, where malnutrition due. to low caloric intake in young children is common (Institute of Nutrition and Food Science 1977). The role of oral therapy in the treatment of diarrhoea is well established (Cash 1979). However, despite its obvious advantages over intravenous therapy in a village situation, its application still presents problems with education and the availability of materials in some developing countries. Home measurements of salt and sugar to make oral solutions have been proposed to solve some of these problems, but serious errors have been reported with these methods when standard teaspoons or “finger pinches” have been used (Cutting 1977, Ransome-Kuti and Bamisaiye 1978). To avoid these problems, packets, special spoons and special containers have been proposed (Sedgwick and Cutting 1976, Morley and King 1978, Hendrata 1978, Nalin 1978). Ali of these modifications introduce unfamiliar materials not available in the home which would seriously complicate the spread of this treatment in predominantly rural societies such as that which exists in Bangladesh. Some also remain sceptical that village women can be taught to make

Incidence of ectopic pregnancy in Benin City, Nigeria.

Abstract: A study of 100 consecutive cases of ectopic pregnancy managed over a 21-month period in the University Department of Obstetrics and Gynaecology is reported. The results show that this is a common gynaecological emergency in the community. Although pelvic inflammatory disease appears to be an important aetiological factor, a significant proportion showed no evidence of previous pelvic sepsis. The usual surgical treatment of cases in our unit is, where possible, total salpingectomy rather than salpingo-oophorectomy.

Use and misuse of 4-aminoquinoline antimalarials in tropical Africa and re-examination of itch reaction to these drugs.

Abstract: A total of 1059 persons from 14 different locations in Ibadan (the most populous city in tropical Africa) were interviewed to determine whether they had had itch reaction with each of the 12 4-aminoquinoline preparations (one amodiaquine hydrochloride 11 chloroquine). The various trade and pharmacological names are listed in a table. Respondents were asked for what purpose the listed drugs were used: treatment of an attack of malaria fever; prevention of malaria; and other conditions or illnesses. The respondents were also asked how often each subject had an attack of malaria: monthly every 3 months every 6 months once a year once every 2-3 years less often than this never. Inquiry was made regarding details of the itch reaction since there was particular interest in the pruritus which judging from previous studies constitutes the 1 reaction most likely to make 4-aminoquinolines unpopular. Chloroquine sulphate tablets the 8th most popular preparation was the 6th on the list of itching incidence. There appeared to be no difference in the incidence of itching after chloroquine sulphate injection. Avloclor tablets chloroquine phosphate injection tablets and Malarex and Aralen tablets gave a comparatively low incidence of itch reaction--3.4% and 1.4% respectively within the population studied. The incidence of itching after these 4-aminoquinoline preparations may also be estimated in the population sampled by finding the mean percentage of the subjects who itch within those who admitted taking each preparation mentioned in the questionnaire. The corrected percentage incidence gave an estimated mean of 28% compared with a mean incidence of 11% when projected to the whole population sampled. Most of the people (90%) used the 4-aminoquinoline antimalarials to treat an attack of malaria fever; 23% take them for prophylaxis and 7% in the population used the drugs for nonmalarial ailments. The misuse of the drugs for nonmalarial ailments may be related to their potency in treating malaria. In sum the itch reaction failed to conform to a simple clinical pattern.

Seroepidemiology of malaria: age-specific pattern of Plasmodium falciparum antibody, parasite and spleen rates among children in an endemic area in peninsular Malaysia.

Abstract: A seroepidemiological study was carried out on Orang Asli (Aborigines) children who lead a semi-nomadic life in the deep jungles of Ulu Kelantan, Malaysia. Out of a total of about 190 children below 14 years, 143 were studied. Blood was collected from finger pricks on standard "strip type" filter papers for indirect fluorescent antibody (IFA) tests with Plasmodium falciparum antigen. A positive reaction at 1:10 dilution in infants and young children was considered positive and the reasons are given. The P. falciparum antibody prevalence rate was 84.6% compared to 81.8% spleen and 43.4% parasite rates. Both P. Falciparum and P. vivax were present in children. The age-specific patterns of antibody, spleen and parasite rates were those of a hyperendemic community. There was a positive correlation between antibody and spleen rates up to the age of 9 years. In older children, the antibody rates increased while the spleen and the parasite rates dropped.

Surgery in Rural Tanzania

Abstract: INTRODUCTION Tanzania is a large 370,000 sq. miles and extremely poor country, and by western standards, medical care is at best inferior and at worst rudimentary. Poor roads and unreliable public transport make communications difficult and allow only a proportion of those in need of medical attention actually to obtain it. The country is divided into 17 regions plus the capital city Dar-Es-Salaam -and these regions are subdivided into districts. Each district has its hospital and this forms the cornerstone of the health service establishment. It receives patients from local health contres and village dispensaries as well as those able to arrive independently and thus sees and treats a wide variety of conditions. It can refer patients to a consultant hospital for more sophisticated management, though the scarcity of these centres (only three in the entire country) and the poor communications make such referrals uncommon in practice. Dareda Hospital, where I worked, was a fairly typical district hospital serving Hanang District in the Arusha region. It had originally been a mission hospital under the care of the Medical Missionaries of Mary an Irish-based organization. It was designated a District Hospital in 1971 and was then taken over by the Government of Tanzania, though much of its administration was still performed by the Medical Missionaries of Mary. The hospital had a bed complement of approximately 150 though the in-patient total was often more than 200, the additional patients being accommodated in whatever free space was available. There were two other resident expatriate doctors and three Tanzanian Medical Assistants. The latter had undergone a 2

Ayurvedic medicine and primary health care.

Abstract: In developing countries a combination of traditional healing and modern medicine seems to be the most promising and appropriate solution to the existing health care problems. In India there are 3 major systems of indigenous medicine: ayurvedic the Hindu medical system; Unani the ancient Greek system of medicine brought to India by the Moslems; and the siddha system a specialized branch of ayurvedism. Folk practitioners are prevalent to the extent of almost 70/1000 population. It has been reported that about half of them would welcome instruction in Western medicine. At this time over 100 medical colleges in India are producing 12-13000 qualified conventional medical practitioners each year. The total number of conventional physicians in India is some 140000. Additionally there are some 160000 ayurvedic registered practitioners 25000 unani practitioners and 15000 siddha practitioners. There thus exists a considerable potential reservoir of health personnel for primary health care work. Ayurvedic medicine is based on the philosophy of balance and equilibrium being maintained within the body and treatment is through attention to drugs diet and exercise. Ayurvedic medicine stemmed from the earlier Yajur-Veda about 700 B.C. the mystic origins of Hindu medicine. In regard to education student entrance requirements are an intermediate science degree plus Sanskrit. The duration of the course is the same as for conventional medicine 4-1/2 years and it follows the same pattern of preclinical paraclinical and clinical stages of 1-1/2 years each. This is followed by a year of internship and the granting of a license to practice. Postgraduate courses are well established and recognized. The delivery system also parallels the conventional system with dispensaries primary health centers small district hospitals and teaching hospitals attached to villages. There is a degree of integration beginning at the primary health center level where of for example 3 doctors 1 is in ayurvedic practitioner. There is a clear attempt to equate coordinate and integrate both ayurvedic and conventional medicine by giving equality in education delivery and research. Another potential reservoir of health personnel is the village folk practitioner. They appear to be prevalent to about 1/100 or fewer villages and offer yet further scope for an extension of modern health care. Although the potential in numbers of these practitioners is great the problems of training them in modern techniques is somewhat more complicated since not all would want such training. Greater progress could be made if different systems of health care would increase their efforts to coordinate and even integrate their policies.

Neurological syndromes, management and prognosis in sickle-cell anaemia.

Abstract: Since sickle-cell disease was described by Herrick in 1910, it has been recognized that the manifestations of the disease are protean. Involvement of the nervous system was first described by Sydenstricker et al. (1923) and since then some reviews have been published (Scott and Ferguson 1966; Adeloye and Odeku 1970; Portnoy and Herion 1972). Although it is now well known that the heterozygote genotypic sickle haemoglobin state (AS) is relatively innocuous compared with the homozygous SS states, complications including neurological ones may also occur. This paper reviews briefly the neurological syndromes which may arise as complications of the sickle-cell disease (SS, SC, and sickle-beta thalassaemia) and the sickle-cell trait (AS). The clinical manifestations in terms of “crises” and anaemia are less severe in SC and sickle-beta thalassaemia than in SS disease.

Quartan malaria nephropathy.

Abstract: Few maladies exceed chronic renal failure in the manner in which it holds the developing world to ransom. The grim realization that no one on the face of the earth has been able to provide facilities for all his patients with chronic renal failure makes the situation even more depressing for the developing world. In this part of the world the prevalence of chronic renal disease is increased one-hundredfold. There is little doubt that the high prevalence of the malady is to be blamed on malaria though local problems in each locality may have already played their part. It is equally certain that the practical difficulties of eradicating malaria, particularly from Africa, are going to perpetuate this problem for many years to come. Recent developments in our knowledge of the aetiology and mechanisms of glomerular injury have produced a ray of hope for possible eventual control. These studies have had a wider application than malaria and it is to be hoped that they will continue in order to provide some urgently needed answers in this very desperate area of medicine. A relationship between malaria and chronic renal disease has been suspected for many centuries. Evidence has accumulated through the years to confirm this relationship. Recently a revival of interest in the subject has produced significant advances particularly from new research techniques. The evidence for a relationship can be summarized as follows: (1) Nephropathy has been produced by quartan malaria in experimental animals, and similar lesions have been observed during quartan malaria fever therapy in humans. (2) High prevalence is confined to malarious areas and a decline in incidence has been observed to follow malaria eradication. (3) A very high incidence of quartan malaria parasitaemia has been demonstrated in sufferers, especially children, and malaria antibodies are significantly raised in patients if malarial soluble complex deposits are present in the glomerular basement membrane. The malaria parasite is not directly involved in glomerular injury, but its presence in the body of the victim is associated with a specific soluble antigen in the serum. This antigen is associated with a rise of serum malaria antibodies particularly the IgM type. It is significant that parasitaemia persists despite this rise and may well indicate an antigen-excess situation. In this immunological state soluble (antigenantibody-complement) complexes form and persist in the circulation. During the passage of blood through the kidneys the soluble complexes get trapped in the glomerular basement membrane. This trapping is associated with glomerular injury quartan malarial nephropathy. A number of patients so affected recover completely, but some progress to chronic renal disease and failure.

A Simple Continuous-Flow System for EMO and OMV Inhalers:

Abstract: the aspirate or touch preparation has been made. with the wholly sterilized microscope held by the and stained on the spot to decide whether to go on surgeon himself. with the operation. The specimen can be examined by the surgeon still gloved and gowned, the microREFERENCES scope being mounted on a convenient stand, or held McArthur J (1968) J . frop. Med. H ~ ~ . 7, N ~ . 4 to the surgeon’s eye by an assistant, or perhaps even Williams E (1974) Eosr Afr. J . med. Res. 2, No. 2

Mobile under-fives clinic in Ekpoma, Nigeria.

Abstract: Since 1977, mobile under-fives clinics have been held in Ekpoma, a rural community in Bendel State, Nigeria. Analysis of the data obtained in the six-month period, October 1979 to March 1980, indicate that the bulk of diseases seen could be prevented through health education, immunization, malarial chemoprophylaxis, and regular monitoring of weight. Mobile clinics could fill this need in rural areas where fixed clinic facilities are absent or inadequate. Employment and training of auxiliary health workers to carry out routine consultations and treatment will enhance the role of the doctor in the team as teacher, consultant, and organizer. It is hoped that other suggestions and recommendations made in this paper indicate practical steps that will improve the work of the mobile clinics.

Other health personnel in health educational activities in an under-fives clinic in Northern Nigeria.

Abstract: A basic health service is a network of peripheral, intermediate, and central health establishment, staffed by adequately trained professional and auxiliary personnel, capable of performing effectively a group of functions essential to the health of the people (WHO 1969). I n the Third National Development Plan for Nigeria, 1975-80, a Basic Health Unit refers to a network comprising one comprehensive health centre (30 beds), four health centres (48 beds), five mobile clinics and twenty health clinics to serve a target population of 50,000 within an administrative Division or District (Federal Republic of Nigeria 1975). The Plan will substantially provide the infrastructure necessary to achieve the Federal Government's aim of total health coverage of the nation by stages. At the moment, about 25% of the population receive some form of health care and this coverage was expected to reach 40% by 1980. In this Plan, the training of other health professionals and auxiliaries has been intensified. Due to scarce resources, staff and materials must be matched at appropriate levels so as to maximize the overall health benefits to the community. This will also help to establish a health care system that is best adapted to the local conditions and the level of our health technology (Howard 1978). In any busy out-patients department (OPD) in Nigeria, the consulting staff, be they doctors or nurses, are so overworked that they have very little time for well-planned health education activities, which should have been important components of their work schedules. This is necessary because communicable diseases form the bulk of the consultations, treatment, and admissions (Fig. 1) . In the 1979 studies, well babies formed only 7% of the study population while protein calorie malnutrition (PCM). resoiratory infections. and gastroenteritis ' were the leading causes of morbidity. From studies in similar populations, infant mortality rates varied between 50 and 150 per 1,000 total live births, while the childhood mortality rate was as high as 350 per 1,000 children under five years of age (Malumfashi Project 1975). Because of such statistics as found in the Under5 Clinic in Samaru Health Centre, in Northern Nigeria, we devised a plan whereby clinic attendants and auxiliaries were trained to play specific roles in the health team concept of a comprehensive health service. The concept of enrolling anyone capable of helping us in improving health was used at varionis levels according to their training, experience, and particularly their health educational roles. 1. The Records Unit. This is usually where the babies and their mothers make the first contact with the clinic and the impressions gained here are of the utmost importance for the acceptance of modern medicine. Both first and surnames are easily interchangable among the Hausas, and this poses a problem in correct identification and documentation on subsequent visits. For example, Isa Uthman may re-register as Uthman Isa on a second visit. It is impressed upon the records clerk that checks should be applied to prevent errors. He has the added responsibility of impressing upon the mothers the necessity of presenting the small retrieval cards. Valuable time is lost when these are not produced and issuing of temporary cards leads to discontinuity in treatment schedules.

Reflections on the passage of Strongyloides fülleborni to human infants in mothers' milk.

Abstract: Brown and Girardeau ( 1977) have documented the transmission of infective-stage larvae from mother to child in maternal milk on the fourth post-partum day at a mission hospital in Bulape, Zaire. This finding is significant for a number of reasons. It is the first proven transmission of nematode parasites in human mothers’ milk, although similar transmission was known to exist in pigs, seals and other mammals. It is significant that it was Strongyloides fiilleborni, formerly believed to parasitize only the nonhuman primates (monkeys, chimpanzees, orang-utans), but found by Pampiglione and Ricciardi (1971, 1972a,b) in many different human populations in widely separated areas of Africa. Those residing in heavy rain-forest areas (notably several pygmy groups) were most heavily infected (around 50%). For those of us practicing medicine and nursing in those regions this finding has profound implications for our health teaching, public health, dispensary and in-hospital patient care. I felt a need to study these implications for my clinical practice and teaching, but this study-search has produced more questions than conclusions. It is hoped that through sharing information and questions others may also contribute to the solution of some very practical problems. The first thought was that since neonates are being infected during the first week of life, the obvious solution was to treat the pregnant women with a vermifuge. However, all vermifuges work on a principle of differential toxicity for the host and the parasite, killing the worms while only inconveniencing the host. The problem is that they are also toxic to the intrauterine child. How toxic to the child would the milk of a treated post-partum mother be?

Book Review: A Monograph on the Genus Gnathostoma and Gnathostomiasis in ThailandA Monograph on the Genus Gnathostoma and Gnathostomiasis in Thailand by DaengsvangSvasti. (Tokyo: Southeast Asian Medical Information Center1980 pp 85 price not stated)

Abstract: The Rise and Fall of Malaria in Europe by L J Bruce-Chwatt and J de Zulueta. (Oxford & c.: OUP for WHO I980 p p 240 illustrated % I 2.00) A book about malaria in Europe is bound to be compared to the classical work of Hackett. This is recognized throughout their new book by BruceChwatt and de Zulueta; indeed the first in a series of interesting plates presents their distinguished predecessor. Their task is perhaps easier than writing a new Hamlet, as the protagonists the maculipennis group-are still with us and their continuing but decreasing malefactions can be recounted. The authors are successful because they have a good story to tell, ending with a striking success in recent years. They also deal in a scholarly fashion with the historical background, producing an interesting explanation of the gradually increasing severity of malaria over the centuries in spite of its relative mildness in classical times, due probably to the slow spread northwards of the more effective vectors and parasites after the last ice age. They record the probable ravages of malaria in all the countries of Europe before the discovery of the parasite and its vector, but admit that much is uncertain; fevers that may or may not have been malaria were treated with bark which may or may not have contained quinine. For the readers of this journal the next stage of the story is of most interest. What lessons has success in Europe for countries where the disease is still a problem? Two points stand out clearly. The turning-point in Europe came with the introduction of DDT, especially in the more malarious countries of south-east Europe. There is no doubt that nonspecific changes in the environment reduced malaria in the north, and that specific anti-malarial measures were effective in Italy even before DDT. But in many countries they were expensive and relatively ineffective, though their possible value today may need to be re-examined. They are not likely to offer an easy solution in the more malarious tropical countries. The second point brought out by the authors is that the successful attacks followed widely different patterns in different countries, usually including a strong central organization; on the other hand community involvement at the periphery was vital for success. The malariologist must not learn only one approach. “There are nine and ninety ways of constructing tribal lays and every single one of them is right.” This book is beautifully written, easy to read, and the reviewer detected few misprints. As well as being a scholarly record of success, it will also be of value to those aiming to achieve the fall of malaria outside Europe. M J COLBOURNE

Psychiatric disturbances associated with systemic lupus erythematosus and pemphigus vulgaris.

Abstract: non-affected children and 6-1496 of adults living in similar conditions. Parasitaemia is often light and may be intermittent so that a very diligent search may be necessary for its demonstration. Parasites may appear in the blood without relevant symptoms at all, or alternatively with only a minimal upset of the general health Plasmodium falciparum or less frequently Plasmodium vivax may be concurrently present but research has shown that Plasmodium mafariae is responsible for the renal lesion. Features additional to the nephrotic syndrome are: hypertension (35% of adult cases), congestive cardiac failure consequent on hypertension and haematuria. Pregnancy progressively worsens the functional state of the affected kidneys.

Aetiology and control of chronic pyogenic osteomyelitis in Ile-Ife, Nigeria.

Abstract: Fifty-six patients suffering from chronic osteomyelitis, who attended the University of Ife Teaching Hospital, Ile-Ife, Nigeria, between November 1976 and December 1977 were studied. Poor hygiene, ignorance, sickle cell disease, and minor trauma in the form of cuts, abrasions, insect bites, and thorn-pricks were the main predisposing factors. Open fractures resulting from road accidents, and infection following surgical procedures, contributed to a lesser extent and may well become the main source of chronic bone infection in the near future. Measures are suggested for the control of the disease.

Acute appendicitis, and urban disease in Africans.

Abstract: Acute appendicitis is the commonest cause of the acute surgical abdomen in Britain. The available evidence indicates that acute appendicitis is, or has been, universally rare prior to the adoption of western standards of living (Ellis 1973). The aims of the present study were to confirm or otherwise the widespread belief that acute appendicitis is in fact more common in urban Africans and to see i f there were any particular forms of employment in which this disease is more common.

Book Review: Diagnosing Helminthiasis through Coprological ExaminationDiagnosing Helminthiasis through Coprological Examination by ThienpontD, RochetteF and VanparijsO F J. (Beerse, Belgium: Janssen Research Foundation1979 pp 187)

Abstract: Sanitation in Developing Countries Edited by A Pacey. (Chichester, New York, Brisbane, Toronto: John Wiley 1978 p p 238 $9.75) This volume of edited papers brings the proceedings of the 1977 international conference, which was held at Pembroke College, Cambridge, under the joint auspices of Oxfam and the Ross Institute of Tropical Hygiene, to a wider audience. This conference was one of the first international and interdisciplinary meetings on non-sewered waste disposal. Many well known authorities contributed to the collected papers and the editing of the volume has been excellently undertaken by Arnold Pacey. The thirteen chapters deal with four ongoing themes: the relationship between sanitation and health; latrine technology; the implementation of improvements in excreta disposal; and the treatment and recycling of wastes. The reader is able to acquire factual knowledge, previously rather difficult to obtain, and also enter into the developing concepts and conclusions of experts working in their field. These authorities include doctors, sanitary engineers and sociologists, so that the subject is treated as a whole. The contents are extremely interesting and very relevant to all interested in primary health care, a key component of which is an effective form of acceptable, low-cost sanitation, especially in the rural and urban low-cost areas. Aqua privies, pit latrines, composting latrines, bucket latrines, vaults and night soil collection are all presented in separate chapters. Biogas systems are included in the chapter on night soil as an economic resource. A further chapter is specifically focused on the technology to serve the urban poor. Once the specific systems have been mastered it is necessary to turn back to the early chapter on the choice of technology, as that chapter is probably the most important in relation to decision-making. It includes excellent papers on the criteria for evaluating excreta disposal techniques, data on nonconventional waste disposal options, and how an appropriate technology was chosen for Botswana. An unexpected bonus lies in the last four pages of text. These are presented as a key to the excreta disposal methods discussed in the volume and are divided into dry systems with on-site treatment, and wet systems with off-site treatment. The key lists the types of latrines and then gives the page references under four columns consisting of diagram, technical aspects, institutional aspects and associated treatment processes. This is a most useful form of cross-referencing. The presentation is excellent and this volume presents a mass of detail and information about a subject which is, sometimes, neglected by many in a most readable and interesting way. Without doubt it will be added to the “necessary reading” List of many courses, both graduate and undergraduate.

Progress of work in the Sudan for abolition of female circumcision.

Abstract: A voluntary association the Babiker Badri Scientific Association for Womens Studies (BBSAWS) was formed in 1980 with the objective of abolishing female circumcision in the Sudan. This Association is undertaking a 3-year project of village welfare work and includes efforts to abolish genital mutilation. Workshops were organized and held at the General Assembly Buildings Khartoum Sudan in March 1981. Visual aids used at the workshops were well prepared and slides were shown illustrating the loss of sensitive tissue as a result of the mutilation. For many participants this was the 1st time that such knowledge had been presented to them in such a way. Many were convinced of the urgent need to take action to remedy the situation. The Chief Imam of Khartoum promised to instruct the preachers of 14000 mosques throughout the Sudan to preach against the practice. A declaration was drawn up and about 300 women promised not to permit their daughters to be circumcised and to work for the abolition of the practice. The Sudanese need all possible financial assistance to help them continue this important work until the custom has been abolished.