Ascaris lumbricoides as the etiology to acute pancreatitis has never been described in Denmark, whereas in India it is a common cause. In most cases symptoms lead to investigations with high diagnostic sensitivity end specificity. Treatment with antihelminthics and ERCP is efficient. A case of a 25 years-old pregnant woman with acute pancreatitis caused by Ascaris lumbricoides is reported.
The 1st phase of the Ministry of Health of Zambia's US$4 million mass education campaign for the prevention of acquired immunodeficiency syndrome (AIDS), carried out in 1988-89 with help from Sweden and Norway, appears to have been highly effective. 95% of rural residents are now aware of AIDS, and the majority know the disease has no cure. In urban areas, the "Times of Zambia" and the "Zambia Daily Mail" have presented AIDS educational messages on their front pages. In rural areas, residents have been reached through marketplace performances and use of the existing primary health care infrastructure. In addition, health workers have received extensive training on counseling AIDS patients and their relatives as well as contact tracing. AIDS will soon be part of the science curriculum in Zambian schools and more street performances are being organized. Presumably as a result of the AIDS education campaign, the number of reported cases of other sexually transmitted diseases has declined--in Lusaka, example, reported cases dropped from 109,496 in 1987 to 101,286 in 1988. There has also been a dramatic increase in the demand for condoms, although part of this may reflect family planning program efforts. By July 1989, Zambia had a total of 2104 reported cases of AIDS.
The University of Zimbabwe and two universities in Sweden conducted a study in Masvingo Province in Zimbabwe to examine maternal deaths. There were 168 and 85 maternal deaths per 100,000 live births in rural and urban areas, respectively. 90% and 85% of maternal deaths in rural and urban areas, respectively, were preventable. Mother-related preventable factors were no prenatal care, lack of social support, and delay in seeking help. Traditional birth attendant-related preventable factors were delay in referring mother to health care, inability to understand the severity of the complication, and administration of the wrong treatment. Local clinic-related preventable factors included inadequate resources, poor communication, and poor training of health care staff. Hospital-related preventable factors were delayed treatment, wrong diagnosis, wrong treatment, no supplies, and inadequate skills. Lack of prenatal care was common among many women who died from pregnancy- or childbirth-related complications. More than 33% of maternal deaths in rural areas occurred because there were no means for transport to the nearest clinic or hospital. Women who were single, divorced, separated, or self-supporting during pregnancy were more likely to die due to lack of social support. Other risk factors were high rate of unwanted pregnancies, age 35 or above, previous fetal death or miscarriage, and parity 7 or above. The leading causes of maternal death in rural areas included hemorrhage (25%), sepsis after unsafe abortion (15%), and puerperal sepsis (13%). In urban areas, they were eclampsia (26%), sepsis after unsafe abortion (23%), puerperal sepsis (15%), and hemorrhage (10%). 50% of the maternal deaths occurred outside of a health facility. More than 50% had already delivered 5 times. Recommendations to reduce maternal deaths were community-based health education on the risk factors of pregnancy and childbirth, improved health facilities, better training of health personnel, and improved family planning programs.
The purpose of the study was to explore the encounters with the health care system in Sweden of women from Somalia, Eritrea, and Sudan who have been genitally cut. A qualitative study was performed through interviews with 22 women originally from Somalia, Sudan, and Eritrea who were living in Sweden. The women experienced being different and vulnerable, suffering from being abandoned and mutilated, and they felt exposed in the encounter with the Swedish health care personnel and tried to adapt to a new cultural context. The results of this study indicate a need for more individualized, culturally adjusted care and support and a need for systematic education about female genital cutting for Swedish health care workers.
Health workers in several areas of the world have tried to reduce the spread of sexually transmitted diseases by treating everyone in the targeted group even if they do not exhibit symptoms. In 1981-1982, health workers treated prostitutes regularly in Nairobi, Kenya to curtail gonorrhea. Some researchers believe that mass treatment to control chancroid is more viable since the genital ulcers grant HIV a pathway. In fact, an epidemiologist with AIDSTECH believes chancroid and syphilis are the most promising diseases for testing and evaluating selective mass treatment. Between 1952-1969, health workers administered single doses of penicillin to 50 million people infected with yaws in 45 countries. These WHO and UNICEF sponsored global campaigns almost eradicated it, but it reappeared recently. Further health workers regularly treat prostitutes in some areas of Indonesia with penicillin. In 1976-1977, health workers treated several hundred migrant farm workers and prostitutes in California to prevent the spread of syphilis. In 1 year, syphilis fell 27% among the migrants and 51% among the prostitutes. Further, the 2nd year of the campaign, health workers tried more diligently to find cases, yet there were fewer reported syphilis cases. In Greenland, during the 1960s, the results of small scale mass treatment for gonorrhea (penicillin and probenecid) were not as promising as the California results, however. Gonorrhea prevalence fell from 10-1% in 6 months, but it climbed again after mass treatment ended. 1 problem with mass treatment is cost. For example, 1 injection of ceftriaxone to treat chancroid costs US$7. Other problems include side effects, drug resistance, and increased susceptibility to other infections. Issues to consider for mass treatment are the degree of a disease's infectiousness and the ability to control it with a single dose.
20 years of instability in government in Uganda has lead to an economic collapse and a breakdown in the health care system. The water system failed, hospitals and equipment collapsed, and doctors and medical personnel left the country. Many children who die or are disabled are victims of lack of education. UNICEF has joined with local religious organizations to fight this problem and educate communities on good health practices, especially immunization for children. Use of the mass media is an important part of this program and private print as well as government television and radio are used. The scouts and guides program with UNICEF trained 1000 on immunization service and they will train 10,000 parents. A child health care center developed, with the assistance of UNICEF, conducts workshops in child survival and trains nurses and medical students. An expert panel sets up curricula for schools which includes the following issues: nutrition, water, sanitation, immunization, common diseases, family health, social problems, accidents, and primary health care. This program has been tested in 20 primary schools, and is expected to become country wide. The Child-to Child program is a world-wide group that teaches school age children to become aware of their health. It also promotes public awareness of child health including physical, mental, and social needs. This program has set up many activities including the following: workshops with teachers, students, parents, and others for health education, hospital visits to children, school cleaning competitions, artist workshops, contracts in other countries such as Norway, time on government television and radio, and book publication.
Many East African mountains are characterized by an exceptionally high biodiversity. Here we assess the hypothesis that climatic fluctuations during the Plio-Pleistocene led to ecological fragmentation with subsequent genetic isolation and speciation in forest habitats in East Africa. Hypotheses on speciation in savannah lineages are also investigated. To do this, mitochondrial DNA sequences from a group of bush crickets consisting of both forest and savannah inhabiting taxa were analysed in relation to Plio-Pleistocene range fragmentations indicated by palaeoclimatic studies. Coalescent modelling and mismatch distributions were used to distinguish between alternative biogeographical scenarios. The results indicate two radiations: the earliest one overlaps in time with the global spread of C4 grasslands and only grassland inhabiting lineages originated in this radiation. Climatically induced retraction of forest to higher altitudes about 0.8 million years ago, promoting vicariant speciation in species inhabiting the montane zone, can explain the second radiation. Although much of the biodiversity in East Africa is presently threatened by climate change, past climatic fluctuations appear to have contributed to the species richness observed in the East African hot spots. Perceiving forests as centres of speciation reinforces the importance of conserving the remaining forest patches in the region.
Global climate change around 3-4 Myr ago is thought to have influenced the evolution of hominids, via the aridification of Africa, and may have been the precursor to Pleistocene glaciation about 2.75 Myr ago. Most explanations of these climatic events involve changes in circulation of the North Atlantic Ocean due to the closing of the Isthmus of Panama. Here we suggest, instead, that closure of the Indonesian seaway 3-4 Myr ago could be responsible for these climate changes, in particular the aridification of Africa. We use simple theory and results from an ocean circulation model to show that the northward displacement of New Guinea, about 5 Myr ago, may have switched the source of flow through Indonesia-from warm South Pacific to relatively cold North Pacific waters. This would have decreased sea surface temperatures in the Indian Ocean, leading to reduced rainfall over eastern Africa. We further suggest that the changes in the equatorial Pacific may have reduced atmospheric heat transport from the tropics to higher latitudes, stimulating global cooling and the eventual growth of ice sheets.
Comment In: Nature. 2001 May 10;411(6834):142-311346771
Previous studies have established cross-cultural methods to screen for ageing- related dementia and susceptibility genes, in particular Alzheimer's disease (AD) among the Canadian Cree, African Americans and Yoruba in Nigeria. We determined whether the Community Screening Interview for Dementia (CSID), translated into Kikuyu, a major language of Kenya, could be used to evaluate dementia of the Alzheimer type. Using two sets of coefficients of cognitive and informant scores, two discriminant function (DF) scores were calculated for each of 100 elderly (>65 years) Nyeri Kenyans. When the cut-off points were selected for 100% sensitivities, the specificities of the DF scores were remarkably similar (93.75%) in the Kenyan sample. We propose the adapted CSID can be utilised to detect dementia among East Africans. We also show that apolipoprotein E epsilon 4 allele frequencies were high (approximately 30%) and not different between normal subjects and those with probable AD. There was no evidence to suggest years of education or vascular factors were associated with dementia status.