The prevalence,intensity and ecological determinants of helminth infection among children in an urban and rural community in Southern Malawi

Rapid urbanisation and poor town planning in Malawi has been associated with poor environmental hygiene and sanitation. The aim of the present study was to investigate the prevalence, intensity and some potential risk factors of intestinal helminth infections among children aged 3 – 14 years in an urban and rural community in Southern Malawi. A randomised cross-sectional survey was conducted in July, 1998. Data were collected through questionnaire interview regarding socio-demographic and environmental conditions from households in both areas. Stool samples were collected from 273 children in the urban community and 280 in the rural. There was a significant difference (p<0.001) in the prevalence of helminth infections between the urban and rural communities, 16.5% and 3.6% respectively. Most of the infections were light (93.2% for Ascaris lumbricodes, 85.7% for hookworm). Large variance to mean ratios of egg intensity within age groups and the total study population suggested a high degree of aggregation of the parasites in the communities. Multiple logistic regression analysis showed that certain groups of children in the urban community were much more likely to develop helminth infection. They included children who had pools of water/sewage around houses (OR = 3.0, 95% CI = 1.4 ñ 6.5), did not wear shoes (OR a 7.1, 95% CI = 2.7 – 19.2), did not attend school (OR = 2.8, 95% CI = 1.2 ñ 6.5), had mothers who had 4 to 8 years of education (OR = 5.2, 95% CI = 2.0 – 14.0), had mothers below 35 years of age (OR = 4.09, 95% CI = 1.39 – 16.28) and living in an urban community (OR = 5.3, 95% CI = 2.6 – 12.1). Efforts to reduce helminth infections should focus on reducing exposures.     

Progress in the prevention and control of diarrhoeal diseases since Independence

Acute diarrhoeal diseases constitute one of the major health problems among young children in India. It was estimated in 1978 that 1.5 million children under the age of 5 years die due to diarrhoea every year, which declined to 0.6-0.7 million in the estimate revised in 1992. A similar declining trend has also been noted in hospitalized cases in Calcutta (present Kolkata) during 1980-95 as well as from other parts of India. Even today, cholera epidemics occur regularly in India. The cholera epidemic caused by a novel strain of Vibrio cholerae, designated as V. cholerae 0139 Bengal in 1992 and multidrug-resistant shigellosis in eastern India in 1984 are matters of grave concern. The launching of the National Diarrhoeal Diseases Control Programme (CDD) in 1978, based on a three-tier approach, is of great importance. The rate of use of oral rehydration salt (ORS) solution and oral rehydration therapy (ORT) remain suboptimal in India. In spite of the launching of the 'Ganga Action Plan' and the 'National River Action Plan', India faces a major problem of diarrhoeal diseases. Lack of safe water supply, poor environmental sanitation, improper disposal of human excreta and poor personal hygiene help to perpetuate and spread diarrhoeal diseases in India. Since diarrhoeal diseases are caused by 20-25 pathogens, vaccination, though an attractive disease prevention strategy, is not feasible. However, as the majority of childhood diarrhoeas are caused by V. cholerae, Shigellae dysenteriae type 1, rotavirus and enterotoxigenic Escherichia coli (E. coli) which have a high morbidity and mortality, vaccines against these organisms are essential for the control of epidemics. A strong political will with appropriate budgetary allocation is essential for the control of childhood diarrhoeal diseases in India, a formidable task in a country with a population of over 1 billion.     

Response-oriented measuring inequalities in Tehran: second round of UrbanHealth Equity Assessment and Response Tool (Urban HEART-2), concepts and framework

Background

Current evidence consistently confirm inequalities in health status among socioeconomic none, gender,ethnicity, geographical area and other social determinants of health (SDH), which adversely influence health ofthe population. SDH refer to a wide range of factors not limited to social component, but also involve economic, cultural,educational, political or environmental problems. Measuring inequalities, improving daily living conditions, andtackling inequitable distribution of resources are highly recommended by international SDH commissioners in recentyears to ‘close the gaps within a generation’. To measure inequalities in socio-economic determinants and core healthindicators in Tehran, the second round of Urban Health Equity Assessment and Response Tool (Urban HEART-2)was conducted in November 2011, within the main framework of WHO Centre for Health Development (Kobe Centre).

Method

For ‘assessment’ part of the project, 65 indicators in six policy domains namely ‘physical and infrastructure’,‘human and social’, ‘economic’, ‘governance’, ‘health and nutrition’, and also ‘cultural’ domain were targetedeither through a population based survey or using routine system. Survey was conducted in a multistage random sampling,disaggregated to 22 districts and 368 neighborhoods of Tehran, where data of almost 35000 households(118000 individuals) were collected. For ‘response’ part of the project, widespread community based development(CBD) projects were organized in all 368 neighborhoods, which are being undertaken throughout 2013.

Conclusion

Following the first round of Urban HEART project in 2008, the second round was conducted to trackchanges over time, to institutionalize inequality assessment within the local government, to build up community participationin ‘assessment’ and ‘response’ parts of the project, and to implement appropriate and evidence-based actionsto reduce health inequalities within all neighborhoods of Tehran.     

The future of cardiothoracic surgery in India

The population of India had just crossed one billion mark when we entered the new millennium and open-heart operations were carried out in 42,000 cases last year which is in sharp contrast of 42 operations/million population as compared to 1700/annum/million in USA. Cardiovascular diseases are major contributors to mortality and morbidity in India. Each year between 48,000 and 128,000 children are born in India with congenital heart diseases. In 1999, 6750 operations were done for congenital heart diseases. Though excellent results were achieved, but enough surgeries could not be done. There are more than one million rheumatic heart diseases in India and 50,000 new episodes are added every year. Well over 100,000 valve replacements have taken place during the last two decades. But the cost of valve replacement surgery is beyond common man's reach. There is need to set up an agency to provide heart valves at a subsidised rate. The rapid escalation of coronary heart disease in India is a matter of concern. In 1980, coronary by-pass surgery made up less than 10% of the work that was done by a cardiac surgeon. Today it is more than 60%. At present only 25,000 coronary by-pass operations and 12,000 coronary angioplasty procedures are done in a year. The Human Organs Transplantation Act though passed in 1994, but still only 50 heart transplants have been performed. The past two decades have seen remarkable changes in cardiac surgery in the country. The public hospitals need to be upgraded. The time has come for the MCI to permit joint training programmes between public and private hospitals. As insurance sector has come to the field, so a dramatic growth of health care facilities is expected. Until now, cardiac surgery in our country has developed in an unplanned manner. Progress has been the result of individual initiative. While significant progress has been made, it has not reached the nation's needs. With a planned approach, co-ordinated by IACTS, we can do better.     

《中国心血管健康与疾病报告2021》要点解读

随着社会经济的发展,国民生活方式的变化,尤其是人口老龄化及城镇化进程的加速,居民不健康生活方式问题日益突出,心血管疾病（CVD）危险因素对居民健康的影响更加显著,CVD患病率和发病率仍在持续增高。2019年农村和城市CVD死亡人数分别占总死亡人数的46.74%和44.26%,每5例死亡者中就有2例死于CVD。推算中国CVD现患人数为3.3亿,其中脑卒中1 300万,冠心病1 139万,心力衰竭890万,肺源性心脏病500万,心房颤动487万,风湿性心脏病250万,先天性心脏病200万,下肢动脉疾病4 530万,高血压2.45亿。2019年中国心脑血管疾病的住院总费用为3 133.66亿元。CVD负担持续加重,特别是农村地区。由于医疗资源配置的不平衡、对疾病的认识较低及治疗的顺从性较差等原因,近几年农村地区冠心病和脑血管病的死亡率持续超过城市地区。同时也应看到,中国在CVD的防控方面也在不断进步,吸烟率下降,高血压控制率不断上升,临床诊疗水平和基础研究也有大幅进步,社区防治工作取得了一定成果,疾病后的康复工作愈发受到重视,医疗器械研发处于高速发展阶段。     

Epidemiology of type 2 diabetes in Indians

Prevalence of diabetes is increasing globally. India have the maximum increase during the last few years. Type 2 diabetes mellitus is the commonest form of diabetes. The prevalence of type 2 diabetes mellitus is 2.4% in rural population and 11.6% in urban population. Prevalence of impaired glucose tolerance is also high in the urban population. Subjects under 40 years of age have a higher prevalence of impaired glucose tolerance than diabetes. The important risk factors for high prevalence of diabetes include: High familial aggregation, obesity specially central one, insulin resistance and lifestyle changes due to rapid urbanisation. Diabetes Research Centre, Madras carried out many studies regarding the risk factors involved in causing type 2 diabetes mellitus. The results of these studies are mentioned here in this article to have a glimpse of overall risk factors involved in causation of diabetes mellitus.     

Diabetes Mellitus in India: The Modern Scourge

India has a high prevalence of diabetes mellitus and the numbers are increasing at an alarming rate. In India alone, diabetes is expected to increase from 40.6 million in 2006 to 79.4 million by 2030. Studies have shown that the prevalence of diabetes in urban Indian adults is about 12.1%, the onset of which is about a decade earlier than their western counterparts and the prevalence of Type 2 diabetes is 4–6 times higher in urban than in rural areas. The risk factors peculiar for developing diabetes among Indians include high familial aggregation, central obesity, insulin resistance and life style changes due to urbanization. Screening for gestational diabetes and impaired glucose tolerance among pregnant women provides a scope for primary prevention of the disease in mothers as well as in their children. The problems of obesity and impaired glucose tolerance (IGT) (important predisposing factors) are not confined to adults alone but children are also increasingly getting affected. Most long standing macro and micro vascular complications are also more common among Indian diabetics as compared to other races and ethnic groups. A strong familial clustering of diabetic nephropathy among Indian Type 2 diabetics has also been noted. Clustering of cardiovascular risk factor like Syndrome X is common among urban Indians. The rising incidence of diabetes and its complications are going to pose a grave health care burden on our country. Timely effective interventions/measures and screening tests for complications at the time of diagnosis becomes imperative not only for early detection, but also to prevent progression to end stage disease. Screening for gestational diabetes among pregnant women would also go a long way in primary prevention of the disease. Life style changes/interventions and drugs like rosiglitazone are the current strategies that can prevent and/or delay the onset of diabetes. Simple interventional strategies like “Eat less, Eat on time and Walk more” can go a long way in preventing these chronic disorders among present as well as in the future generations.Key Words: Type 2 diabetes, Central obesity, Insulin resistance, Gestational diabetes, Waist hip ratio, Familial aggregation     

Basic amenities and health in urban India

We have examined the findings from various studies and corroborated other evidence that the large and continuous increase in India's urban population, and the concomitant growth of the population residing in slums and shanty towns, has resulted in over-straining of infrastructure and a deterioration in public health. Inadequate civic amenities, lack of purchasing power, and lack of knowledge and awareness among the urban poor have resulted in urban poverty which is very different from its rural counterpart. While a few policies have specifically targeted the urban poor, these have been neither sufficient nor effective. Also, the deteriorating health status of urban people needs urgent attention because many of the recent health problems can take an epidemic form if neglected. A resurgence of malaria, dengue and tuberculosis indicates that much of the poor health emanates from a lack of basic amenities such as sanitation, clean water and housing, coupled with a lack of awareness about the need to take precautionary measures against preventable and infectious diseases. To tackle these problems effectively, it is important for policy-makers to recognize that certain groups are more susceptible to ill health than others; they are vulnerable to the severe impact of illnesses and also the likely sources of infection for the population at large. There is an urgent need for research on the factors that prevent the urban poor from availing the services provided to them. It is possible that this is due to the lack of awareness-generating policies which should accompany any supply-side policies such as the provision of basic facilities (e.g. Sulabh Sauchalaya). To reduce the private costs as well as the negative externalities of ill health, it may be necessary to target such populations by cost-effective strategies based on holistic research on all the factors that determine well-being.     

Recognising sleep apnoea

Most people spend a third of their lives sleeping, and thus, sleep has a major impact on all of us. As sleep is a function and not a structure, it is challenging to treat and prevent its complications. Sleep apnoea is one such complication, with serious and potentially life-threatening consequences. Local studies estimate that about 15% of Singapore’s population is afflicted with sleep apnoea. The resulting sleep fragmentation may result in poor quality of sleep, leading to daytime sleepiness. Sleep apnoea may also be the underlying cause of high blood pressure, memory loss, poor concentration and work performance, motor vehicle accidents, and marital problems. Evaluation involves a sleep study, followed by patient education, and an individualised step-wise management approach should be explored. Many patients will require follow-up for a long period of time, as management options may not offer a permanent cure; other contributory causes may arise at different phases of their lives, compounded by genetic and hormonal issues, ethnicity and the modern hazards of a fast-paced society.     

新形势下的医院创新与发展

坚持政府主导和市场机制相结合的原则,积极稳步推进医疗卫生体制改革,加大政府卫生投入,我国人口已达到13亿,60岁以上的老年人口1.33亿,占总人口的10.2%,并以每年3%的速度增长。我国在工业化尚未完成的时期即进入老龄化国家行列,是我国现代化面临的一个巨大难题。预计到2020年,我国的城镇化比例将上升到50%,大约有3亿农村人口转为城镇人口。人口老龄化和城镇化的快速发展,将对医院的发展提出更高的要求。     

Intestinal parasitic infections in man: a review

Intestinal parasites of importance to man are Enterobius vermicularis, the soil-transmitted helminthes (STH)--Ascaris lumbricoides Tricburis trichiura, bookworms (Necator americans/Ancylostoma duodenale) and Strongyloides stercoralis and the protozoa Entamoeba histolytica and Giardia duodenalis. Other protozoa such as Cryptosporidium sp. and Isopora sp. are becoming important in causing prolonged diarrhea in immunocompromised patients. It is estimated that almost 1 billion, 500 million and 900 million people worldwide are infected by the major nematode species--A. lumbricoides, T. trichiura and hookworms respectively. Most of the infections are endemic and widely distributed throughout poor and socio-economically deprived communities in the tropics and subtropics. Environmental, socio-economic, demographic and health-related behavior is known to influence the transmission and distribution of these infections. In giardiasis, one study indicates that age < or = 12 years and the presence of family members infected with Giardia were risk factors for infection. Most of the infections occur in children and both genders are equally affected. Epidemiological studies of STH infections have shown that the prevalence and intensity of infection are highest among children 4-15 years of age. The frequency of distribution of STH infections is over-dispersed and highly aggregated. areas reinfection can occur as early as 2 months post-treatment, and by 4 months, almost half of the population treated become reinfected. By 6 months the intensity of infection was similar to pretreatment level.     

城乡儿童自我药疗现状及影响因素分析

目的了解城乡儿童自我药疗现状及存在问题,并分析影响安全自我药疗的因素。方法利用调查问卷调查新乡市及其所辖县城、乡村18 岁以上的女性,通过拦截方式获得调查对象。利用Epidata 3.0 软件录入数据,运用SAS 9.2 软件对数据进行统计学分析。3 地区自我药疗的相关情况利用频数、构成比等进行统计描述,3 地区特征分布的比较利用χ2检验,并利用多因素Logistic 回归分析影响认知得分高低的因素。结果收回家庭中有儿童者的有效问卷共1 045 份。84.90%市区对象、88.00%县城对象和88.65%乡村对象曾给孩子自我药疗。给孩子自我药疗的最主要原因是病情较轻,3 地区分别占53.27%、57.40%和60.16%,用药的主要依据是自身经验,3 地区分别为56.25%、54.21%和40.65%。给儿童服药前,不经常阅读说明书的比例较高（市区：29.12%,县城：37.13%,乡村：39.34%）,且3 地区间差异无统计学意义（χ2=8.0625,P =0.089）,3 地区在是否按时给孩子用药、忘记给孩子用药时的处理等其他给儿童服药行为方面差异有统计学意义（P <0.05）。城乡、受教育程度、职业、身体状况、家庭月收入与自我药疗行为认知得分有关。结论城乡儿童自我药疗率均较高,儿童安全自我药疗行为和认知与城乡、受教育程度、职业、身体状况、家庭月收入有关,政府应针对不同地区、不同人群进行相关健康教育。     

Who profits from tobacco sales to children?

It is estimated that more than 3 million American children under 18 years of age consume 947 million packs of cigarettes and 26 million containers of smokeless tobacco yearly. These tobacco products account for annual sales of $1.26 billion. Approximately 3% of tobacco industry profits ($221 million in 1988) derive directly from the sale of cigarettes to children, an activity that is illegal in 43 states. Approximately half of the tobacco industry's profits, or $3.35 billion annually, derives from sales to people who became addicted to nicotine as children. Tax revenues to the federal ($152 million) and state ($173 million) governments from cigarette sales to children dwarf governmental expenditures on smoking and health. We describe how dozens of communities have effectively enforced laws that prohibit the distribution of tobacco to children and offer some suggestions for increasing efforts to prevent nicotine addiction.     

Children in Conflict Zones

The nature of war has changed dramatically. Today''s conflicts happen where people live and they take a brutal toll on children. Heavy bombardment and destruction in war creates a humanitarian crisis where there is lack of adequate food, clean water and medicine. The consequences of war can have major impact on the health of children for years to come. Traumatic events can have a profound and lasting impact on the emotional, cognitive, behavioral and physiological functioning of an individual. Depending on the circumstances, the psychosocial impacts of disasters can range from mild stress reactions to problems such as anxiety, depression, substance abuse and post traumatic stress disorders (PTSD).Key Words: Conflict zone, Children, Child health, Street childrenConflict zone refers to war or political instability that disrupts essential services such as housing, transportation, communication, sanitation, water, and health care which requires the response of people outside of the community affected [1]. Over thirty wars are now being waged around the world. One out of four children worldwide live in these dangerous situations. In the First World War, civilians accounted for 5 per cent of casualties. In the Second World War the figure rose to 48 per cent. Today, up to 90 per cent of casualties are civilians - an increasing number of these are women and children. Some 17 million children have been displaced by war, more than 2 million children have been killed due to armed conflict and three times as many have been seriously injured or permanently disabled since 1990 [2]. More than 1 million children have been separated from their parents or orphaned.The nature of war has changed dramatically. Its horrors are no longer experienced only by soldiers fighting on front lines and battlefields. Wars are being fought not between countries but within them. In addition, children are being deliberately recruited as combatants. This has been made easier by the proliferation of light weapons. Assault rifles are light, cheap and widely available. Coupled with the rapid social change which often precedes or accompanies war, armed conflict leads to a breakdown in the family support systems, which is so essential to a child''s survival and development. During crisis government protection and community support systems also slip away. As a result, children are being denied the protection promised to them in the ‘Convention on the Rights of the Child’. War violates every right of a child - the right to life, the right to be with family and community, the right to health, the right to the development of the personality and the right to be nurtured and protected.     

Water pollution and health.

Water is the important constituent of life support system. No one can live and even dream to live without water. Most of our water bodies have become polluted due to industrial growth; urbanization and man-made problems mainly the result of population growth. Poor sanitation and contaminated drinking water arising from human activity and natural phenomena create serious problems in human health. The chief sources of water pollution are sewage and other waste, industrial effluents, agricultural discharges and industrial wastes from chemical industries, fossils fuel plants and nuclear power plants. They create a larger problem of water pollution rendering water no longer fit for drinking, agriculture and, as well as for aquatic life. More than 2.6 billion people--40% of the world's population--lack basic sanitation facilities and over one billion people still use unsafe drinking water sources. As a result thousands of children die everyday from diarrhoea and other water, sanitation and hygiene-related diseases and many suffer and are weakened by illness.     

辽西地区汉族城乡男性儿童青少年体型比较

目的了解和研究辽西地区汉族城乡男性儿童青少年的体型发育规律和特点,为体质人类学补充必要的资料。方法采用Heath-Carter体型法,对辽西地区7~19岁汉族城乡男性儿童青少年1323名(城男657,乡男666名),进行体型比较。结果辽西地区汉族城男的体型均值3.9~3.5~3.4,属中间型,乡男的体型均值3.6~2.5~3.7,属外胚层-内胚层均衡体型。身高、体重城男大于乡男,平均身高相差5.93 cm(u=6.24,P<0.01),平均体重相差5.75kg(u=6.93,P<0.01),三因子平均值比较,内因子:城男>乡男,外因子:城男<乡男,以上差异无显著性意义(P>0.05),中因子:城男>乡男,且差异显著,经t检验,7岁、8岁、11岁、13岁、15~18岁同龄城乡男生体型差异显著(P<0.01)。体型频数在各年龄各体型中的变化,提示辽西城市汉族男生体型分布较散,农村汉族男生体型分布在内胚层和外胚层的体型较多。结论辽西地区汉族乡男比城男矮瘦,城男比乡男皮下脂肪发达,骨骼、肌肉强健,辽西地区男生体内脂肪含量高。     

Needs assessment of caregivers of children with disabilities in resource-limited settings

Objective: This study aimed to identify and classify the needs of caregivers of children with disabilities living in resource-limited settings and develop a framework for need assessment.Participants and Methods: This study was conducted in the Maha Sarakham Province, Thailand, with 15 caregivers caring for children with disabilities recruited from hospitals, the Association for the Disabled, and primary health centers. Semi-structured interviews were conducted in local dialects, recorded, transcribed, converted into standard Thai, and then into English for thematic analysis. Meaning units corresponding to caregivers’ needs were extracted, interpreted, coded, and hierarchically organized into subcategories by comparing similarities and differences among the extracted codes. The subcategories were further grouped and abstracted into categories, and then domains of caregivers’ needs were formed.Results: Nineteen categories were identified across five domains of caregivers’ needs: health and medical, welfare, educational, social, and informational. Although basic medical treatment was covered, specific support, such as referral to a specialist, rehabilitation, or psychological support, was limited. Financial support and relief from the care burden are the main welfare needs. Educational needs were identified to provide knowledge to children and to offer respite to their caregivers. Social needs revealed ethical problems that arose because of strong rural community ties, making it difficult to maintain privacy. Informational needs were intertwined with the other four domains. In rural areas, where parents of children with disabilities migrate to cities to find work, the special needs of grandparents who were primary caregivers of the children needed to be addressed.Conclusion: This study provides a conceptual framework for comprehensive needs assessment and policy development for caregivers of children with disabilities living in resource-limited settings.     

Diabetes mellitus in India: The modern scourge

India has a high prevalence of diabetes mellitus and the numbers are increasing at an alarming rate. In India alone, diabetes is expected to increase from 40.6 million in 2006 to 79.4 million by 2030. Studies have shown that the prevalence of diabetes in urban Indian adults is about 12.1%, the onset of which is about a decade earlier than their western counterparts and the prevalence of Type 2 diabetes is 4–6 times higher in urban than in rural areas. The risk factors peculiar for developing diabetes among Indians include high familial aggregation, central obesity, insulin resistance and life style changes due to urbanization. Screening for gestational diabetes and impaired glucose tolerance among pregnant women provides a scope for primary prevention of the disease in mothers as well as in their children. The problems of obesity and impaired glucose tolerance (IGT) (important predisposing factors) are not confined to adults alone but children are also increasingly getting affected. Most long standing macro and micro vascular complications are also more common among Indian diabetics as compared to other races and ethnic groups. A strong familial clustering of diabetic nephropathy among Indian Type 2 diabetics has also been noted. Clustering of cardiovascular risk factor like Syndrome X is common among urban Indians. The rising incidence of diabetes and its complications are going to pose a grave health care burden on our country. Timely effective interventions/measures and screening tests for complications at the time of diagnosis becomes imperative not only for early detection, but also to prevent progression to end stage disease. Screening for gestational diabetes among pregnant women would also go a long way in primary prevention of the disease. Life style changes/interventions and drugs like rosiglitazone are the current strategies that can prevent and/or delay the onset of diabetes. Simple interventional strategies like “Eat less, Eat on time and Walk more” can go a long way in preventing these chronic disorders among present as well as in the future generations.     

Transforming consumer health informatics through a patient work framework: connecting patients to context

Designing patient-centered consumer health informatics (CHI) applications requires understanding and creating alignment with patients’ and their family members’ health-related activities, referred to here as ‘patient work’. A patient work approach to CHI draws on medical social science and human factors engineering models and simultaneously attends to patients, their family members, activities, and context. A patient work approach extends existing approaches to CHI design that are responsive to patients’ biomedical realities and personal skills and behaviors. It focuses on the embeddedness of patients’ health management in larger processes and contexts and prioritizes patients’ perspectives on illness management. Future research is required to advance (1) theories of patient work, (2) methods for assessing patient work, and (3) techniques for translating knowledge of patient work into CHI application design. Advancing a patient work approach within CHI is integral to developing and deploying consumer-facing technologies that are integrated with patients’ everyday lives.