IN ASSOCIATION WITH:
THE MINISTRY OF HEALTH, ZAMBIA
THE DREYFUS HEALTH FOUNDATION OF NEW YORK
A GRANT FROM THE IBM CORPORATION
EDITORIAL BOARD:
Dr. J.C. L. Mwansa, Microbiologist: University Teaching Hospital
Dr. Andrew L.Mbewe, Consultant Paediatrician: Kitwe Central Hospital
Dr. Oliver Bowa, Surgical Anatomist: University of Zambia Surgery Department
Ms. Regina Shakakata, Health Information & Promotions Officer:
World Health Organisation-Zambia
Dr. Katele Kalumba: Minister of Health, Zambia
Dr. Mannasseh Phiri, Chief Medical Officer: Company Clinic, Kitwe
Mrs. Norah Mumba, Medical Librarian (Ag): University of Zambia Medical Library
ADDRESS:
Zambia Health Information Digest
Medical Library
University of Zambia
School of Medicine
P.O. Box 50110
Lusaka, Zambia
Telephone: 260-1-250801
Fax: 260-1-250753
Email: medlib@unza.zm
TECHNICAL TEAM:
UNIVERSITY OF ZAMBIA MEDICAL LIBRARY
Project Coordinator:
Norah Mumba
Data Input:
Jane M. Phiri
Sepo Kusiyo
Circulations:
Kenneth Chanda
Lovelee Mwengwe
ACKNOWLEDGEMENTS:
COMMUNICATIONS FOR BETTER HEALTH -DREYFUS HEALTH
FOUNDATION
&
COMMONWEALTH REGIONAL HEALTH COMMUNITY SECRETARIAT
FOR EAST, CENTRAL AND SOUTHERN AFRICA HEALTH
INFORMATION DISSEMINATION(CRHCS- ECSA)
The Zambia Health Information Digest is produced to provide current information to health workers who have little access to current health related publications and information.
SOURCE:
The abstracts of journal articles published in this quarterly Digest are obtained from the
MEDLINE databases provided by the Dreyfus Health Foundation of New York. Abstracts are also selected from a database of Zambian health articles, which is continually being compiled at the UNZA Medical Library. Readers are encouraged to send in their work for inclusion in this Zambian health information database.
Computer equipment has been supplied through a grant from the IBM Corporation. Subjects that are prominently reflected on the Medical Library's MEDLINE search requests and information on prevalent health conditions seen in Zambia are published. Other health related subjects are also included.
The Health Sciences Centre Library of the University of Florida, our cooperating
partners, will supply photocopies of the full text articles to the University Medical Library on request, which in turn will be supplied to readers on request. When available in the library, articles will be photocopied at a nominal cost.
Production costs are supported by The Dreyfus Health Foundation of
New York. Full articles on unsafe abortion are provided by courtesy of
Commonwealth Regional Health Community Secretariat for East, Central
and Southern Africa (CRHCS), who have also contributed generously to
the expansion of the Digest. We encourage readers to submit requests for articles highlighted in the Digest.
CUSTOM SEARCHES:
Using the MEDLINE compact disc databases, custom searches can be done
on any health issue to obtain the most up-to-date information available.
Readers are encouraged to submit requests for searches on relevant
health problems which they face. Requests should be sent to the
Medical Library, attention Norah Mumba.
In situations of armed conflict, nutrition becomes more topical. In 1995, war is reported to have been directly or indirectly affecting 550 million people in 35 countries. The risk for malnutrition and deficiencies is made worse by the loss of means of production, of food stocks, of commerce and by banditism as military operations target water plants and health facilities as means of deliberately hurting civilians.
Malnutrition has other effects on such as the interactions identified between protein-energy malnutrition and parasite infections in Central Africa. HIV-related diarrhoea and resultant wasting also has nutritional implications. There have been some explorations to establish whether or not there is some link between prolonged breastfeeding and malnutrition.
Nutrition is of concern not only with regard to children but also to adults and particularly the elderly.
A clear understanding of protein-energy malnutrition (PEM), parasite infection and their interactions is essential in formulating health and development policies. We studied the prevalence of PEM indicators and the prevalence and/or intensity of infection in 558 Zairian children aged 4 months to 10 years. Multivariate analyses were used to estimate relationships between PEM indicators and parasitic infection. Stunting was found in 40.3% of children, wasting in 4.9% and kwashiorkor in 5.1%. The risk of stunting was significantly higher in children with Ascaris lumbricoides. The risk of wasting was higher in children with A. lumbricoides or Trichuris trichiura, whereas the risk of kwashiorkor was high with T. trichiura but very reduced in those with A. lumbricoides. Plasmodium infection was not related to nutritional indicators. These relationships highlight important interactions, both synergistic and antagonistic, between nutrition and parasites in central Africa.
Tshikuka JG. Gray-Donald K. Scott M. Olela KN. Relationship of childhood protein-energy malnutrition and parasite infections in an urban African setting. Tropical Medicine & International Health. 2(4):374-82, 1997 Apr.
Case management of kwashiorkor
- OBJECTIVES:
(1) To improve case management of kwashiorkor at seven Nutritional Rehabilitation Centres (NRCs) through 2-4 weekly paediatric supervisory visits. (2) To evaluate the impact of the use of routine tube-feeding and a micronutrient supplement (Nutriset).- DESIGN:
An intervention project with descriptive clinical data in which Nutriset was introduced halfway through the project, and routine tube-feeding at one NRC was compared to no tube-feeding at a similar one.- SETTING: NRCs located at two central hospitals, two district hospitals and three rural clinics in southern Malawi.
- SUBJECTS:
1625 consecutive kwashiorkor admissions from January-December 1995.- RESULTS:
The overall case-fatality rate was 24.2% (393/1625), varying by facility level (central 30.5%, district 25.8% and rural 7.5%), reflecting different severity of cases. From ELISA testing and a clinical protocol, we estimate that 21.7% (353/1625) of these kwashiorkor cases were HIV-infected, including 121 breastfed children. Routine tube-feeding was associated with better weight gain (8.24 g/kg/d) than no tube-feeding (4.51 g/kg/d) at central NRCs, but with no reduction in mortality (31.4% vs 30.3%). The introduction of Nutriset was associated with improved weight gain (6.06 vs 4.66 g/kg/d) and a lower mortality (20.8 vs 25.8%), but was confounded by seasonal factors.- CONCLUSIONS:
From a clinical perspective, HIV infection has transformed kwashiorkor in this part of Africa. Routine tube-feeding was associated with improved body weight gain in the treatment of kwashiorkor. The benefit of paediatric supervision was limited by the infrequency of visits, by constraints of health worker motivation, by a lack of resources and by the severity of disease. Efforts need to focus-not just on case management protocols-but on how to actually improve clinical practice in this setting.
Brewster DR. Manary MJ. Graham SM. Case management of kwashiorkor: an intervention project at seven nutrition rehabilitation centres in Malawi. European Journal of Clinical Nutrition. 51(3):139-47, 1997 Mar.
Efficacy of outreach nutrition rehabilitation centres
- OBJECTIVE:
There is still controversy about the efficacy and cost-effectiveness of outreach nutrition rehabilitation centres (NRCs) for severely malnourished children. We wanted to compare the mortality rates and nutritional status of severely malnourished children admitted to rural NRCs in Gabu region, Guinea Bissau, with other severely malnourished children who were not rehabilitated and stayed in their villages.- DESIGN:
Retrospective cohort study over a 3-year period. Mortality rates and nutritional outcome compared for children who were admitted to rural NRCs and those who were not rehabilitated. Selection for admission to the NRCs was based on availability of places only.- SETTING:
19 health areas of the Gabu region, Guinea Bissau, West Africa. SUBJECTS: 1038 severely malnourished children (< 60% weight-for-age using NCHS standards) aged 6 to 47 months. 354 were rehabilitated in NRCs and 684 received no rehabilitation.- RESULTS:
Up to 36 months follow-up the relative risk of death in the rehabilitated group was 0.75 [95% confidence interval (c.i.) = 0.57-0.99], equivalent to a 25% reduction in mortality. The difference in mortality between the two groups was much higher during the first 3 months [P < 0.02, relative risk = 0.59 (95% c.i. = 0.39-0.91)]. Rehabilitated children had a higher mean weight gain in the first 3 months (1.63 compared to 0.56 weight-for-age standard deviation score, P < 0.001), and weight gain differences lasted up to 18 months (P < 0.01).- CONCLUSIONS:
Low-cost, outreach NRCs are effective both in the short term and in the mid-term to improve the nutritional situation and reduce the mortality of severely malnourished children.
Perra A. Costello AM. Efficacy of outreach nutrition rehabilitation centres in reducing mortality and improving nutritional outcome of severely malnourished children in Guinea Bissau. European Journal of Clinical Nutrition. 49(5):353-9, 1995 May.
Nutritional assessments, food security and famine
The widely held view that malnutrition is a late indicator of famine is challenged on the basis of evidence that people often deliberately reduce their food intake as an early response to inadequate food security. This broadens the possible interventions in response to high malnutrition rates to include measures to support livelihoods under threat of collapse. In the late stages of famine, social disruption and distress migration often result in a degraded health environment which may raise the threshold of nutritional status associated with an increased mortality risk. It is important to assess the underlying causes of malnutrition and the associated health risks.At present, the main objective of nutrition surveys is usually to obtain a reliable estimate of the prevalence of malnutrition among children under five years of age, with little analysis of the underlying causes of malnutrition. Experience from the 1984-85 famine in Darfur led to the development of an alternative approach to nutritional assessment which could be applicable elsewhere in Africa. The combination of quantitative and qualitative methods was particularly valuable as a means of gaining a wider and deeper understanding of the nature of the nutritional situation.
Young H. Jaspars S. Nutritional assessments, food security and famine. Disasters. 19(1):26-36, 1995 Mar.
Mortality of severely malnourished children
- OBJECTIVE:
To determine a simple model to calculate the number of deaths which could be expected in a therapeutic feeding centre from the height, weight and oedema of children on admission.- DESIGN:
Admission weight, height, presence of oedema of the children and outcome were prospectively recorded.- SETTING:
Data were recorded in 18 feeding centres set-up during emergency operations in Africa. Ten of the feeding centres were selected, a priori, as reference centres and eight centres as test centres.- SUBJECTS:
Data for 3858 children were recorded. 837 children absconded from the centres and were excluded from the analysis. Analysis was performed on data from 2753 children who left the centre after recovery and 268 children who died during treatment.- INTERVENTIONS:
The relation between the risk of death and, anthropometric measurements and presence of oedema has been determined in a previous paper. The maximum likelihood estimate of the constant of the model was determined from global analysis of the data of the reference centres. The model was applied to the data of the reference and test centres.- RESULTS:
The model to predict the individual probability of death was: P(death) = 1/(1 + exp[-(20.63 - 9.99 1n(weight/height1.74) + 1.36 oedema)]) The predicted number of deaths was close to the recorded number of deaths for each reference centre. For three of the eight test centres there was a significant excess of observed deaths over predicted.- CONCLUSION:
This model can be easily used by the supervisor of a centre to assess the expected number of deaths during treatment of malnutrition from simple measurements on children that are routinely taken on admission and thus help to determine the nature of variation in observed mortality rates.
Prudhon C. Golden MH. Briend A. Mary JY. A model to standardise mortality of severely malnourished children using nutritional status on admission to therapeutic feeding centres. European Journal of Clinical Nutrition. 51(11):771-7, 1997 Nov.
Armed conflicts, health & health services in Africa
Because of war, between the 1980s and early '90s Africa suffered about 5 million excess deaths and economic losses estimated at US $13 billion per year. In 1995, war was directly or indirectly affecting 550 million people in 35 countries. Besides violent deaths, injuries and disabilities, displacements of population increase the risk for acute respiratory infections, diarrhoeas, epidemics and parasitic disease. The risk for malnutrition and deficiencies is made worse by the loss of means of production, of food stocks, of commerce and by banditism.Childhood protein-energy malnutrition & parasite infectionsMilitary operations target water plants and health facilities as means of deliberately hurting civilians. Economic crisis curtails the budgets of the social sectors and, together with social distress, undermines national capacities. The delivery of health care is hampered right when hazards and vulnerabilities increase, with general greater risk of illness and death. With the cessation of hostilities, the need for curative and preventative health activities increases and is a matter of emergency, as equitable access to services is important for peace. Repatriation of refugees, demobilization of soldiers and demining require special health activities.
War leaves behind new hazards and vulnerabilities such as landmines, wide availability of weapons, artificial concentrations of population, loss of national capacities and psychological disorders. All this interacts tragically with Africa's wider epidemiological realities of poverty, food insecurity, proneness to natural disasters and endemic diseases.
Loretti A. Armed conflicts, health and health services in Africa. An epidemiological framework of reference. Medicine, Conflict & Survival. 13(3):219-28, 1997 Jul-Sep.
A clear understanding of protein-energy malnutrition (PEM), parasite infection and their interactions is essential in formulating health and development policies. We studied the prevalence of PEM indicators and the prevalence and/or intensity of infection in 558 Zairian children aged 4 months to 10 years. Multivariate analyses were used to estimate relationships between PEM indicators and parasitic infection.Epidemiological aspects of diabetesStunting was found in 40.3% of children, wasting in 4.9% and kwashiorkor in 5.1%. The risk of stunting was significantly higher in children with Ascaris lumbricoides. The risk of wasting was higher in children with A. lumbricoides or Trichuris trichiura, whereas the risk of kwashiorkor was high with T. trichiura but very reduced in those with A. lumbricoides. Plasmodium infection was not related to nutritional indicators. These relationships highlight important interactions, both synergistic and antagonistic, between nutrition and parasites in central Africa.
Tshikuka JG. Gray-Donald K. Scott M. Olela KN. Relationship of childhood protein-energy malnutrition and parasite infections in an urban African setting. Tropical Medicine & International Health. 2(4):374-82, 1997 Apr.
Diabetes is a worldwide public health problem made more acute in Africa by low socio-economic standards. Cases with an unusual clinical course are frequent and probably related to tropical diabetes, a syndrome that has not yet been precisely defined.Public health aspects of emergencies & refugee situationsThis study reports the results of a prospective study carried out in Cameroon on 550 diabetic patients attending the Yaounde Central Hospital who were followed between December 1990 and July 1994. They were classified according to WHO criteria into 136 insulin-dependent diabetes mellitus (IDDM) (24.7%), 405 non-insulin- dependent diabetes mellitus (NIDDM) (73.7%) and 9 diabetes secondary to other diseases (1.6%). No cases of malnutrition-related diabetes mellitus (MRDM) were found, but 18 subjects were considered to have so-called "African diabetes".
Investigation of the cohort showed epidemiological and clinical features markedly different from those of Caucasian diabetic subjects. The age of onset in IDDM occurred in all age groups, with a mean (+/- SD) close to that of NIDDM (40.9 +/- 4.8 years vs 49 +/- 10.9; P <0.001). A clear male preponderance was found (M/F sex ratio = 1.63), as it has been reported in most studies from sub-Saharan Africa, in contrast with the slight female predominance noted in the Sahel and Saharan countries. An increased prevalence of young and non-obese NIDDM was also found. Seventy-nine NIDDM cases (19.5%) were detected in individuals under 40 years of age, including 31 with normal weight. Many atypical features were noted: IDDM in obese patients, NIDDM in ketotic subjects and patients with varying insulin requirements, all of which led to difficulties in classifying many diabetic patients according to current practices. All these uncommon features are concordant with the nature of tropical diabetes, including not only MRDM but also African diabetes which occurs in individuals older than MRDM patients who show no signs of malnutrition. Thus, tropical diabetes is apparently a syndrome with aetiological heterogeneity which requires further definition through clinical, genetic and immunological studies.
Ducorps M. Ndong W. Jupkwo B. Belmejdoub G. Poirier JM. Mayaudon H. Bauduceau B. Epidemiological aspects of diabetes in Cameroon: what is the role of tropical diabetes? Diabetes & Metabolism. 23(1):61-7,1997 Feb.
Populations affected by armed conflict have experienced severe public health consequences mediated by population displacement, food scarcity, and the collapse of basic health services, giving rise to the term complex humanitarian emergencies. These public health effects have been most severe in underdeveloped countries in Africa, Asia, and Latin America. Refugees and internally displaced persons have experienced high mortality rates during the period immediately following their migration.Presentation & outcome of HIV-1 infection in hospitalised infantsIn Africa, crude mortality rates have been as high as 80 times baseline rates. The most common causes of death have been diarrheal diseases, measles, acute respiratory infections, and malaria. High prevalences of acute malnutrition have contributed to high case fatality rates.
In conflict-affected European countries, such as the former Yugoslavia, Georgia, Azerbaijan, and Chechnya, war-related injuries have been the most common cause of death among civilian populations; however, increased incidence of communicable diseases, neonatal health problems, and nutritional deficiencies (especially among the elderly) have been documented. The most effective measures to prevent mortality and morbidity in complex emergencies include protection from violence; the provision of adequate food rations, clean water and sanitation; diarrheal disease control; measles immunization; maternal and child health care, including the case management of common endemic communicable diseases; and selective feeding programs, when indicated.
Toole MJ. Waldman RJ. The public health aspects of complex emergencies and refugee situations. Annual Review of Public Health. 18:283-312, 1997.
There is limited information on HIV infection in children in West Africa. This prospective case series study was done to determine the size of the problem and the feasibility of selective screening for infection based on clinical presentation. It involved infants and other children admitted to the Children's Emergency Ward and Paediatric Medical Ward of the University of Maiduguri Teaching Hospital, Nigeria, from the beginning of September 1992 to the end of September 1994.Moderate to mild malnutrition in African childrenClinical evaluation followed by serologic tests (ELISA and Western blot techniques) was undertaken. Descriptive study; frequencies were compared using chi 2 test for Fisher's exact test as appropriate. One hundred and ninety nine (10.9%) of 1,822 admissions were screened. One hundred and fifty eight (79.4%) were ELISA negative and 17 (8.6%) ELISA and WB positive; a further 10 (5%) were ELISA positive but WB indeterminate and 14 (7%) were ELISA positive but WB negative in 12 or untested in two. All the infections were HIV-1. Sixteen (39%) patients (nine WB positive, three WB indeterminate and four ELISA positive only) are dead, 14 from HIV-related illnesses, two (4.9]) are alive and 23 (56.1%) lost to follow up; 11 of the HIV-related deaths involved infants.
Presence of persistent diarrhoea, prolonged fever, oral thrush, hepatosplenomegaly, diagnosis of tuberculosis and severe malnutrition with gastroentereritis, and multiple (> 3) diagnosis on admission were significantly (p < 0.05) associated with WB confirmed HIV-1 seropositivity and could serve as indicators for selective screening. HIV-1 infection in hospitalised infants and children has become an important problem in Nigeria, presentation in infancy is associated with a high case fatality rate, and the practice of selective screening based on clinical presentation would appear to be feasible.
Akpede GO. Ambe JP. Rabasa AI. Akuhwa TR. Ajayi BB. Akoma MA. Bukbuk DN. Harry TO. Presentation and outcome of HIV-1 infection in hospitalised infants and other children in north-eastern Nigeria. East African Medical Journal. 74(1):21-7, 1997 Jan.
In all Third World populations, among preschool and schoolchildren, low weight- and height-for-age, i.e. below the 5th centile of US NCHS reference standards, are common, affecting 10-50%. Orthodoxly, shortfalls are attributed largely to insufficiency of food. In an attempt to throw more light on the situation regarding African schoolchildren, studies have been made on series of pupils, aged 10-12 years, at three rural schools in North West Province, South Africa.Determinant of wasting in Zambians with HIV-related diarrhoeaOf 396 pupils, 126 (31.8%) were below, and 270 (68.2%) above the 5th centile. Enquiries were made on each pupil's diet and meal pattern, their class position and games aptitude, and, regarding home characteristics, their family size, Parent(s) working, and the latter's interest in education. With minor exceptions, no significant differences in odds ratios were found between respective groups below and above the 5th centile. Evidently, there are multiple influencing factors. Hence, among children of school-age, there must be caution against overblaming undernutrition, and of overrating the health disadvantages from mild to moderate malnutrition. For definition clarification, long-term observations are necessary.
Walker AR. Walker BF. Moderate to mild malnutrition in African children of 10-12 years: roles of dietary and non-dietary factors. International Journal of Food Sciences & Nutrition. 48(2):95-101, 1997 Mar.
Wasting in African AIDS patients is severe, and its aetiology is probably multifactorial: persistent diarrhoea, poverty and tuberculosis may all contribute. We report a cross-sectional study of body composition measured anthropometrically in 75 adult patients with HIV-related persistent diarrhoea in Lusaka, and its relationship to gastrointestinal infection and systemic immune activation assessed using serum neopterin and soluble tumour necrosis factor receptor (sTNF-R55) concentrations. Patients as a group were generally severely wasted (mean body mass index (BMI) 15.8 kg/m2, range 11-22), but the severity of wasting was related neither to oesophageal candidiasis nor to intestinal infection.The reality of despair: AIDS in MalawiIn men but not women, all measures of nutritional status were negatively related to serum sTNF-R55 concentration (fat-free mass in men, r = -0.64; 95% CI: -0.80, -0.41; p < 0.0001). Some wasted patients had cutaneous features of malnutrition, again associated with higher sTNF55 concentrations, and two had peripheral oedema. The diarrhoea-wasting syndrome in this part of Africa seems to be associated with evidence of high cytokine activity in men, rather than oesophageal candidiasis or any particular intestinal opportunistic infection. This immune activation requires further investigation in the context of the sex difference we have observed.
Kelly P. Summerbell C. Ngwenya B. Mandanda B. Hosp M. Fuchs D. Wachter H. Luo NP. Pobee JO. Farthing MJ. Systemic immune activation as a potential determinant of wasting in Zambians with HIV-related diarrhoea. QJM. 89(11):831-7, 1996 Nov.
While completing a recent medical elective in the Central African country of Malawi, medical student Dale Needham learned firsthand that HIV/AIDS represents a true pandemic in Africa. By the end of 1993, Malawi had the continent's highest per capita number of cumulative reported AIDS cases. Although Canadian physicians have had their own struggles helping patients with HIV/AIDS, many more battles are being fought in countries like Malawi, where financial resources are limited. In Africa, HIV-positive people of all ages suffer incredibly from diseases such as protein energy malnutrition, tuberculosis and cryptococcal meningitis. Primary health care programs, education in the primary schools and community awareness and support are partial answers to the pandemic.
Needham D. The reality of despair: AIDS in Malawi. CMAJ. 155(1):91-2, 1996 Jul 1.
Is prolonged breastfeeding associated with malnutrition?
- BACKGROUND:
A growing body of literature suggests that prolonged breastfeeding (typically defined as beyond the first year of life) may be a risk factor for malnutrition.- METHODS:
To examine the extent to which continued breastfeeding is a risk factor for malnutrition, we used multiple regression techniques to relate current breastfeeding status to weight and stature in children < 36 months old whose mothers participated in one of 19 Demographic and Health Surveys (DHS) conducted between 1987 and 1989.- RESULTS:
The data from 9 of 11 countries outside sub-Saharan Africa (SSA) indicated that among older children, those still breastfed are shorter and lighter than those no longer breastfed. These differences, which reached statistical significance in five countries, become apparent at 12-18 months of age. In contrast, in five of eight SSA countries, younger still breastfed children are significantly shorter and lighter than those no longer breastfed, but, the differences are largely diminished among older children. These basic patterns were not altered by adjustment for family sociodemographic characteristics, health care utilization, and recent child illness.- CONCLUSIONS:
Important differences in nutritional status associated with continued breastfeeding are observed throughout the developing world, and are not likely due to confounding by family sociodemographic characteristics, health care utilization or recent child illness. A unifying interpretation of the observed relationships is that child size is somehow related to the decision to wean, and that whereas in SSA, the biggest children are weaned first, in non-SSA countries, the smallest children are weaned last.
Caulfield LE. Bentley ME. Ahmed S. Is prolonged breastfeeding associated with malnutrition? Evidence from nineteen demographic and health surveys. International Journal of Epidemiology. 25(4):693-703, 1996 Aug.
Bacteraemia in malnourished rural African children
During a 5-month study period, 323 of 863 (37.5%) children below 5 years of age admitted to Shongwe Mission Hospital in rural South Africa were malnourished, two-thirds severely so. The incidence of bacteraemia in malnourished children was 9.6%, 11.8% in those severely malnourished and 5.8% in nutritional dwarfs. The predominant organisms retrieved were Gram-negative enteric bacilli (48.5%). Amongst the severely malnourished, who empirically receive intravenous ampicillin and gentamicin, 95.8% of all isolates were sensitive to this antibiotic combination. The case fatality rate of severely malnourished bacteraemic children was 20.8%. In malnutrition categories overall, the case fatality rate for bacteraemic children (22.6%) was significantly greater than in those without bacteraemia (9.3%). In hospitals with limited resources, full identification of bacteria may not be necessary, provided that regular surveillance for emerging resistance is conducted.
Reed RP. Wegerhoff FO. Rothberg AD. Bacteraemia in malnourished rural African children. Annals of Tropical Paediatrics. 16(1):61-8, 1996 Mar.
Adult malnutrition
The recent recognition of the problem of adult malnutrition requires methods for specifying the severity of undernutrition. The measurement of mid upper arm circumference (MUAC) can now be used as a screening method for underweight (normally assessed from the BMI) or as an additional criterion with the BMI to identify the preferential loss of peripheral tissue stores of fat and protein.By analysing and extrapolating anthropometric data from nine detailed adult surveys from Asia, Africa and the Pacific a series of MUAC cut-off points have now been identified to allow the screening of individual adults under extreme conditions, e.g. during famine. Grade 4 malnutrition is now specified for those with a MUAC < 200 mm for men and < 190 mm for women since these MUAC values correspond to the loss of fat stores at BMI of < 13. Food supplementation is clearly needed in these individuals. Extreme wasting (grade 5 malnutrition) corresponds to MUAC values of < 170 and < 160 mm for men and women respectively. These adults have extremely low BMI, i.e. about 10, have lost most, if not all, of their protein stores and are at a high risk of imminent death. These individuals will need immediate special feeding regimens to ensure their survival. The sex-specific MUAC values corresponding to BMI of 16, 13 and 10 can now therefore be used for rapid screening and the choice of remedial action.
Ferro-Luzzi A. James WP. Adult malnutrition: simple assessment techniques for use in emergencies. British Journal of Nutrition. 75(1):3-10, 1996 Jan.
Urinary ioxide excretion in relation to other nutritional parameters
- OBJECTIVE:
There is currently no coordinated policy on the epidemiology and control of iodine deficiency disorders (IDD) in many parts of Africa even where these disorders are endemic. Assessment of the urinary iodine excretion is believed to give the best index of the prevalence of IDD in the community. This study aimed to establish whether: (i) the breast-fed child of an iodine replete mother was protected from IDD and, (ii) infants at risk of IDD and in need of immediate iodine supplementation could easily be identified through simple screening methods.- DESIGN:
Randomized, cross-sectional study.- SETTING:
A tertiary care infant welfare clinic in Ibadan, South-western Nigeria, a geographical area recognised to be outside Nigeria's endemic goitre belt (goitre prevalence < 5.0%).- SUBJECTS:
68 healthy mother-child pairs. The children were all aged 9-18 months and breast-fed almost exclusively.- INTERVENTIONS:
Nil.- METHODS:
The relationships of anthropometric, iodine status (casual urinary iodine (I) and iodine/creatinine ratio (I/Cr)) and nutritional indices (weights, haematocrits) of the mothers with those of their breast-fed children were assessed, as well as how these parameters differed between the children classified on the basis of their mid-upper arm circumference, MUAC, as: borderline malnourished, MUAC < 13.5 cm and, (B) well nourished, MUAC > 13.5 cm.- RESULTS:
The maternal values for I and I/Cr were significantly (p < 0.001) greater than those of their breast-fed infants, although the respective mother-child pair values correlated positively (I, r 0.47; I/Cr, 0.21; both p < 0.05). There was thus a gradient in iodine status between the mother and her breast-fed infant that is unfavourable to the growing child; the latter may thus require iodine supplementation in spite of the fact that the mother is iodine replete. Among the children, those considered well nourished (Group B) had similar iodine status parameters as those considered poorly nourished (Group A) suggesting that malnutrition alone should not be the determinant of the prioritization (or otherwise) of iodine supplementation in a population with coexistent iodine deficiency and malnutrition. Mean values for (I) in all the children (9.9 micrograms/dl) fell in the iodine deficiency range ( < 10 micrograms/dL), although all the mothers were iodine replete (mean urinary (I) 14.5 micrograms/dL), despite the fact that all resided in a non iodine deficient area.- CONCLUSION:
The study suggests that: (i) the breast-fed child of an iodine replete mother resident in a non-iodine deficient area may be iodine deficient and in need of iodine supplementation; (ii) malnutrition, as defined by the simple community screening method of measuring the MUAC, will not accurately identify those infants in immediate need of iodine supplementation. These observations have important implications for planning IDD control programmes in Africa.
Akanji AO. Mainasara AS. Akinlade KS. Urinary iodine excretion in mothers and their breast-fed children in relation to other childhood nutritional parameters. European Journal of Clinical Nutrition. 50(3):187-91, 1996 Mar.
AIDS & malnutrition in rural Ivory Coast
To assess the role of human immunodeficiency virus (HIV) infection in malnutrition in African children, clinical examination and serologic tests were performed in 183 undernourished children at the Protestant Hospital of Dabou which is located in a semi-urban area of Cote d'Ivoire.Malnutrition was noted in 18% of children admitted to the Pediatric Department including 70.5% with marasmus. Serologic tests were positive for HIV in 46 of the 183 children, i.e. 25.1%. The type of malnutrition was not significantly different in seropositive children. Breast feeding was more common in the seropositive than seronegative group (59% vs 39%) (p<0.05). Follow-up at the nutrition center was poorer quality and less effective in seropositive than seronegative children. The results of this study demonstrate the important role of HIV infection first as a cause and second as an impediment for management of malnutrition in Black Africa.
Mutombo T. Keusse J. Sangare A. [AIDS and malnutrition in a pediatric semi-rural milieu of Ivory Coast]. Medecine Tropicale. 55(4):357-9, 1995.
Physical activity, illness and nutritional status
- BACKGROUND:
From Africa, our knowledge on how malnutrition and diseases influence the ability to work is limited. In a one-year population-based study, we investigated the effects of nutritional status, illness and socioeconomic factors on the activity pattern in a rural population in southern Ethiopia.- METHODS:
From July 1991 to June 1992, 226 people (109 men and 117 women) from the Elka na Mataramofa village in the Rift Valley were examined every 3 months. Information on the occurrence of illness and measurement of nutritional status were collected every 3 months. At the same time we interviewed each person for seven consecutive days to assess the pattern of activities.- RESULTS:
Men and women had a mean estimated energy expenditure (SD) of 2937 kcal (951) and 1977 (513) kcal, respectively. The mean body mass index (BMI) (SD) was 19.7 (2.3) for men and 20.0 (2.6) for women. Men showed a significant seasonal variation in estimated energy expenditure that was highest during the pre-harvest time. Women did not show such a seasonal variation. In a multivariate analysis, sex, age, state of nutrition, period prevalence and severity of diseases and seasonality influenced estimated energy expenditures.- CONCLUSIONS:
Both low BMI and illness are significantly associated with low estimated energy expenditure. Most likely, this represents an example of the vicious circle of malnutrition, disease and activity that affects subsistence farming communities. Development work that improves the state of nutrition and health of the adult population may therefore enhance the work performance of rural populations.
Alemu T. Lindtjorn B. Physical activity, illness and nutritional status among adults in a rural Ethiopian community. International Journal of Epidemiology. 24(5):977-83, 1995 Oct.
Noma: a neglected scourge of children in sub-Saharan Africa
Poverty is the single most important risk indicator for noma (cancrumoris), a severe gangrene of the soft and hard tissues of the mouth, face, and neighbouring areas. The risk factors associated with an increasedprobability of noma developing include the following: malnutrition, poor oral hygiene, and a state of debilitation resulting from human immunodeficiency virus (HIV) infection, measles, and other childhood diseases prevalent in the tropics.There are many similarities between noma and necrobacillosis of the body surface of wallabies (Macropus reforgriseus), and it is proposed that noma results from oral contamination by a heavy load of Bacteroidaceae (particularly Fusobacterium necrophorum) and a consortium of other microorganisms. These opportunistic pathogens invade oral tissues whose defences are weakened by malnutrition, acute necrotizing gingivitis, debilitating conditions, trauma, and other oral mucosal ulcers.
The current escalation in the incidence of noma in Africa can be attributed to the worsening economic crisis in the region, which has adversely affected the health and well-being of children through deteriorating sanitation, declining nutritional status and the associated immunosuppression, and increased exposure to infectious diseases. Prevention of noma in Africa will require measures that address these problems, and most importantly, eliminate faecal contamination of foods and water supplies. [References: 47]
Enwonwu CO. Noma: a neglected scourge of children in sub-Saharan Africa. [Review] Bulletin of the World Health Organization. 73(4):541-5, 1995.
Food and the gut
A.R.P. Walker pioneered the research into the association between food, gut function and disease patterns in southern Africa. His attention to ways in which dietary differences can explain geographical differences in disease patterns has led to the realisation that civilisation and modern food technology can exert a strong influence on dietary practices, gut function and disease tendencies.Recognition that South African blacks have a very low incidence of colonic problems such as diverticulitis, adenomatous polyps and carcinoma drew attention to the possibility that the traditional African diet, with a high fibre content, may maintain colonic health and prevent disease in old age. This review explores some of the mechanisms that may account for these differences and also examines ways in which malnutrition alters gut function. To quote Walker's conclusions: 'There is a need, indeed a duty, for writers on nutrition to devote a portion of their space to the nutritional lessons to be learned from the past, from war-time experiences and from present day Third-World populations.'
O'Keefe SJ. A.R.P. Walker Lecture. Food and the gut. [Review] South African Medical Journal. 85(4):261-8, 1995 Apr.
Nutritional assessments, food security & famine
The widely held view that malnutrition is a late indicator of famine is challenged on the basis of evidence that people often deliberately reduce their food intake as an early response to inadequate food security. This broadens the possible interventions in response to high malnutrition rates to include measures to support livelihoods under threat of collapse. In the late stages of famine, social disruption and distress migration often result in a degraded health environment which may raise the threshold of nutritional status associated with an increased mortality risk.It is important to assess the underlying causes of malnutrition and the associated health risks. At present, the main objective of nutrition surveys is usually to obtain a reliable estimate of the prevalence of malnutrition among children under five years of age, with little analysis of the underlying causes of malnutrition. Experience from the 1984-85 famine in Darfur led to the development of an alternative approach to nutritional assessment which could be applicable elsewhere in Africa. The combination of quantitative and qualitative methods was particularly valuable as a means of gaining a wider and deeper understanding of the nature of the nutritional situation.
Young H. Jaspars S. Nutritional assessments, food security and famine. Disasters. 19(1):26-36, 1995 Mar.
Wasting among under fives in Nchelenge, Zambia
The purpose of the study was to compare the use of absolute cut off values of the mid-upper arm circumference (MUAC) with age- and sex-adjusted z scores of the MUAC in the identification of acute undernutrition (wasting) in children up to 60 months of age.In Nchelenge, northern Zambia, 275 children from the community, selected by a two-stage cluster sampling procedure, and 105 hospitalized children with protein energy malnutrition (PEM) individually matched for age, sex, village and under-five clinic attendance with 104 controls, were clinically and anthropometrically (weight, height, MUAC) examined. zScores for weight for height and MUAC were calculated and PEM was classified according to a modified Wellcome scheme.
For community prevalence rates of wasting in various age groups, MUAC < or = -4 z scores more closely paralleled W/H < or = -2 z scores than MUAC <125 mm. To identify individual children with wasting, MUAC < or = -2 z scores gave a better sensitivity than MUAC <125 mm. In hospitalized PEM children, z scores appeared to offer no advantages over absolute MUAC values in identifying the presence of wasting. Applicability of the MUAC and optimal cut off values may differ according to the setting in which the MUAC is to be applied.
Gernaat HB. Dechering WH. Voorhoeve HW. Absolute values or Z scores of mid-upper arm circumference to identify wasting? Evaluation in a community as well as a clinical sample of under fives from Nchelenge, Zambia. Journal of Tropical Pediatrics. 42(1):27-33, 1996 Feb.
Clinical features of HIV seropositive Zambian subjects
Data was collected from 1595 anti-HIV positive patients out of which 90% of the patients were from the Copperbelt province, and the rest from five out of the eight other provinces of Zambia. One-hundred and one positive HIV patients were less than 2 years of age, 69 were aged 2 to 14 years and 1418 were aged above 15 years.The male to female ratio was about 1:1 at all ages, except that there was an excess of males below 5 years. Of the four most frequent symptoms or signs, loss of weight or malnutrition was regarded in about 50% of seropositive patients at all ages; generalized lymphadenopathy was seen in at least 35% of all age groups and most frequently at 2-14 (60%); chronic watery diarrhoea was most common at less than 2 years (44%) and least common in older children (17%); chronic chest infections had highest frequency in children 2-14 years (59%) and lowest in adults (32%). Intensive education of children before they are sexually active is the best hope for controlling the epidemic.
Siziya S. Mwendapole R. Fleming AF. Clinical features of HIV seropositive Zambian subjects. African Journal of Medicine & Medical Sciences. 24(2):173-8, 1995 Jun.
HIV type-1 & common paediatric diseases in Zambia
The seroprevalence of HIV-1 and in-patient mortality in children with common pediatric illnesses was studied. Between October 1990 and July 1991 at the Department of Paediatrics and Child Health, University Teaching Hospital (UTH), Lusaka, Zambia, mothers of all pediatric admissions were interviewed and counselled for enrollment of their children into the study.Of a total of 1323 children seen, 1266 children (600 female and 666 male) were enrolled into the study.Pneumonia (28 per cent), malaria (24 per cent), malnutrition (18 per cent), and diarrhoea (10 per cent) constituted over 80 per cent of the total admission diagnoses. Tuberculosis (5 per cent) was the fifth commonest cause of admission (61 out of 1266 children).
A total of 354 out of the 1266 (28 per cent) children were found to be seropositive for HIV-1 compared to a seroprevalence rate of 9 per cent in children attending accident and emergency for traumatic injuries (P=0.001). High HIV-1 seroprevalence rates were found in children with tuberculosis (69 per cent), malnutrition (41 per cent), pneumonia (28 per cent). and diarrhoea (24 per cent). The overall mortality in hospital among HIV-seropositive children (19 per cent) was significantly higher than those who were HIV-seronegative (9 per cent) (P = < 0.0001).
Chintu C. Luo C. Bhat G. DuPont HL. Mwansa-Salamu P. Kabika M. Zumla A. Impact of the human immunodeficiency virus type-1 on common pediatric illnesses in Zambia. Journal of Tropical Pediatrics. 41(6):348-53, 1995 Dec.
Rotavirus gastro-enteritis in hospitalised children
The clinical and epidemiological aspects of rotavirus diarrhoea were studied in hospitalized children with acute diarrhoea in Lusaka, Zambia. Two hundred and fifty-six (24.0%) of 1069 children admitted to the study were shedding rotavirus.The rotavirus-positive rate was highest in children less than 1 year of age (37.0%) and it was also high in those less than 6 months old. Rotavirus diarrhoea was seen throughout the year with a higher rotavirus-positive rate in the dry season. In rotavirus-positive diarrhoea patients, more children were dehydrated (82.4%) than in the rotavirus-negative group (56.2%). Rotavirus infection was more common in the children with normal nutritional status (27.6%, 162/588) than in those with malnutrition (19.3%, 93/482). The associated case fatality rate in the rotavirus-positive group was 6.4%, significantly less than in the rotavirus-negative group (OR 0.44, 95% CI 0.24-0.79), and mortality cases were seen only in children less than 2 years old.
Mpabalwani M. Oshitani H. Kasolo F. Mizuta K. Luo N. Matsubayashi N. Bhat G. Suzuki H. Numazaki Y. Rotavirus gastro-enteritis in hospitalized children with acute diarrhoea in Zambia. Annals of Tropical Paediatrics. 15(1):39-43, 1995.
Early cessation of breastfeeding as a major cause of severe malnutrition
One hundred and ten consecutive children under two years of age were admitted because they were affected by severe Protein Energy Malnutrition. They were investigated to know the precipitating cause of their condition.68 (62%) of them had a history of early weaning from the breast before 2 years, which was followed by a drastic drop of the growth curve. 16 (15%) of them adopted unilateral breast feeding. The study confirms the danger of stopping breast feeding before two years.
This contrasts with other findings from Uganda, Zambia and Botswana which indicate that prolonged breast feeding is associated with higher prevalence of malnutrition in children. Further studies from other countries are necessary and opportune since the basic socio-economic conditions of the population, especially when these are as low as the case in Dodoma Region.
Serventi M. Dal Lago AM. Kimaro DN. Early cessation of breast feeding as a major cause of severe malnutrition in under twos: a hospital based study--Dodoma Region, Tanzania. East African Medical Journal. 72(2):132-4, 1995 Feb.
Population bases surveys of nutritional status
We studied the design effects for population-based surveys that estimated the prevalence of wasting and stunting malnutrition in Malawi, Zambia, Indonesia, and Nepal, and studied the magnitude of different types of malnutrition clustering within villages. Weight, height, and midupper-arm circumference were measured on all children or on systematic samples of children in randomly selected villages.Design effects ranged from 0.53 for low height-for-age in Zambia to 6.12 for low weight-for-age in Nepal. If all sampled clusters were of size 30, as is often the case for nutrition surveys, design effects would have ranged from 0.44 for low height-for-age in Zambia to 2.59 for low midupper-arm circumference in Zambia.
Malnutrition did cluster within villages. Stunting malnutrition clustered less than did wasting malnutrition. Nutrition surveys using clusters of 30 can sample fewer clusters than currently recommended if basic prevalence and cluster information are available prior to sample selection.
Katz J. Sample-size implications for population-based cluster surveys of nutritional status. American Journal of Clinical Nutrition. 61(1):155-60, 1995 Jan.
Physical growth of under five children in Nchelenge District
This study focuses on the physical growth of children aged 0-60 months in Nchelenge District, northeast Zambia. By means of a two-stage clustered and random sampling method, 193 households were selected. Weight, height, and mid-upper-arm circumference (MUAC) of children 0-60 months were measured. Underweight, stunting, and wasting were defined as weight for age, height for age, and weight for height (W/H), respectively, < or = 2 z scores below the median of the National Center for Health Statistics (NCHS) reference population.Among 250 children, prevalence rates of 30% underweight, 69.2% stunting, and 4.4% wasting were found, with the highest rates at age 12- < 24 months. Prevalence of stunting, underweight, and wasting in children aged 0- < 6 months and 6- < 12 months suggested that a substantial proportion of infants were premature and/or small for gestational age. The literature suggests that prematurity and intrauterine growth retardation may be quite common in Africa, and this may have important implications for the interpretation of growth data and under nutrition rates. Use of the MUAC < 125 mm as an indicator of wasting resulted in higher estimates of wasting compared to W/H < or = -2 z scores, and seemed unsuitable as a screening test for wasting in this Zambian population.
Gernaat HB. Dechering WH. Voorhoeve HW. Physical growth of children under five years of age in Nchelenge, Zambia: results from a district survey. American Journal of Physical Anthropology. 100(4):473-85, 1996 Aug.
It should be considered criminal in all jurisdictions - national and international - that at the end of the 20th century, States and other powerful political and economic actors, nationally and internationally, have not taken the decisions and actions necessary to end systematic and historical violations of the wide range of human rights (economic, cultural, civil, social and political) of huge sectors of humanity who struggle, survive and die in varying degrees of endemic poverty and misery.
Since World War II, many more people have been killed by malnutrition, hunger and disease (i.e. systematic violations of human rights) than by the combination of all the wars and all the repressive regimes that have systematically violated political and civil rights.
Seventeen million people in developing countries die each year from such curable infectious and parasitic diseases as diarrhoea, measles, malaria and tuberculosis.' Many times more people struggle and survive in perpetually violatory conditions; even by World Bank estimates, over three billion people survive' on a daily income of US$2, or less.
Adding to the urgency and complexity of properly addressing these issues, a disproportionate percentage of the victims of these violations are women, children indigenous peoples, and other vulnerable sectors of societies. These deaths and sufferings due to imposed conditions of poverty have rarely been analysed or understood as violations of human rights.
12 December 1998 will mark the 50th anniversary of the Universal Declaration of Human Rights (UDHR), the most widely known internal human rights agreement. Government, inter-governmental agencies(such as the United Nation), and national and international non-governmental organisations (NGOs) will carry out activities to mark this date.
50th anniversary should provide a time to celebrate the important advances made to universalise the notion that all humans have rights. Since World War II, tens of thousands of citizen organisations have cropped up at international, national and community levels to popularise the notion that all human have rights, and to carry out education and advocacy work.
The importance of these advances cannot be understated. However, the 50th anniversary is also a time to focus on important questions that governments, other international actors, and the human movement have yet to properly address.
All rights:
Most human rights work to date has focused on certain
political and civil rights, to the exclusion of other political
and civil rights and a wide range of economic, social and
cultural rights. This work has ignored the fact that the
UDHR itself enshrines a broad range of economic, social
and cultural rights; implicitly, this work has ignored the
principle of international law that all human rights are
indivisible.
Human rights work has avoided investigating the often times organic relation between poverty (overlapping violations of numerous rights) and repression (a systematic violation of certain political and civil rights). In many countries there has existed/exists a vicious cycle between poverty (violation of numerous rights) and repression(Violations of political and civil rights).
A common scenario is that poor people, and social justice, development and religions workers educate themselves about their rights. They then organise to protest and fight against the rights violations that characterize their lives. Then, the State, often with the support of powerful private sector interests and foreign governments, responds with repression, so as to preserve the undemocratic, unjust status quo.
What has been lacking, in much human rights work, is that while it has investigated and denounced the use of repression (political and civil rights violations), it has not investigated the prior economic, social and cultural rights violations, nor the wide range of actors that contribute to all violations.
All Actors:
Most human rights work has aimed at holding only the state
accountable for rights violations (political and civil, for the
most part) that occur within its boarders. The actions of
other states, and inter-state and private actors often
contribute directly and indirectly to a wide range of human
and environmental rights violations, whether in their home
countries, or in other countries.
Though these other actors often act with impunity, they are rarely held accountable to the people whose rights they may have violated. An example of an inter-state actor contributing to human rights violations in a country would be that of the International Monetary Fund forcefully pressuring the government of a dependent, perhaps indebted, nation to impose political, legal and economic programmes on its people that increase violations of their rights.
An example of a non-state actor violating human rights would be that of a powerful transnational company or bank contributing directly or indirectly through its actions to violations of human rights in a foreign country.
An example of a state actor contributing to human rights violations in another country would be that of one country providing funding, training and/or weaponry to a foreign government (and/or private sector paramilitaries) that is systematically violating the rights of its own people.
Investigating and determining the human rights responsibility of other actors does not negate the responsibility of the state for its contribution to violations, but rather focuses attention on, and proportions responsibility to all other actors that contribute directly and indirectly to violations.
Whether or not the stat was the only actor capable of violating or guaranteeing respect for the rights of its citizens in 1948, it is clearly the case today that other actors impact on human rights as much as, or to a greater man rights as much as, or to a greater degree than, a majority of the existing nation states. While the State will continue to play a central role in how citizens rights are respected, or not, other actors must be held accountable to citizens worldwide whose rights are often negatively affected by their actions.
It is incumbent on the wide range of development, environment, social justice, religious and human rights organisations to understand this, and then bring human rights analysis and actors, holding each actor accountable for its proportion of responsibility in human rights violations.
Challenges - common cause, common language:
The 50th anniversary of the UDHR, thus, provides a focal
point for creative activities in he North, South, East, and
West, to debate and discuss numerous challenges.
One challenge is for organisation working on human rights, development, environment and social justice issues, at the community, national and international levels, to work more closely together.
An example of how human rights work has been compartmentalised might be that of defending the rain forest' in a country such as Guatemala. Environmental groups' might focus on saving' the forest and the atmosphere, ignoring why it is that poor people of Guatemala are obliged to slash and burn forests just to survive, ignoring how the actions of national and international actors, of national and international actors, controlling the unjust economic/development model, contribute directly to the destruction of the environment. Development groups' might focus on how the reigning development/economic model creates and perpetuates poverty, but will not analysed poverty, as a systematic violation of economic, social and cultural rights, which often leads, organically, to systematic political and civil rights violations.
Human rights groups' might focus exclusively on the State's use the of repression (political and civil rights violations) against activists working to end poverty (violation of numerous rights), ignoring the prior and systematic violation of economic, social and cultural rights (poverty) of the poor sectors, and ignoring how other actors (IMF, WB, other governments etc) contribute directly and indirectly to the violations of economic, cultural and social rights and of political and civil rights.
For these intertwined issues, the international human rights regime provides agreements, law analysis and language that can help overcome the oftentimes false separations between these areas of work.
A cultural and political challenge for all groups working on the interrelated issues is to educate about, and overcome, the accepted truth' that there always has been poverty and there always will be': that poverty is somehow a natural (if not lamentable) phenomenon, as opposed to being the result of economic, legal, political and military decisions taken by humans, states and their many different institutional actors.
And, it is an elemental challenge to make more funding available for groups that are working on the wide range of human rights issues, holding the wide range of actors accountable.
Conclusions:
Human rights work makes it clear that the wide range of
violation is neither inevitable nor natural, but arises from
deliberate policies, decisions, and actions. In its demand for
explanations and accountability, the human rights
movement, conceived in the broad sense as set out in this
article, exposes the hidden priorities and power structures
behind the violations. Thus, addressing all rights, in terms of
their economic, political and social context, and holding all
actors accountable, constitute critical steps towards
challenging the conditions that create and tolerate poverty.
There is much human rights work to be done -at community, national and international levels- to address and reform national and international legal, economic and political systems that remain profoundly unjust.
Now is the time for the wide range of development, social justice, religious, human rights and environmental groups to form working alliances to address these issues. Now is the time to plan creative educational and political activities to mark the date of the 50th anniversary of the UDHR.
Quoted from: Third World Resurgence
The study showed that teenage sexual activities were mainly determined by age, early maturity and levels of knowledge on reproductive biology. The levels of sexual knowledge were further related to the sources of and access to relevant information, location of the school and teenagers' sex.
Below were the study highlights:
Teenagers reported significantly high level of knowledge on
sexuality; 89 per cent knew of what was involved in sexual
intercourse while 90 per cent had correct knowledge of the
process leading to pregnancy in a girl.
The levels of correct knowledge were higher among older
teenagers. Older youth and those from urban schools and higher
levels of correct information on sexual intercourse than their
younger and rural counterparts.
With regard to sexual practice the study showed that:
Overall, only about one out of every five teenagers were
sexually active.
Boys reported more sexual experience than girls. Most of the teenager sexual activities were spontaneous. Sixty four per cent of those who engaged in sex had not planned for it.
Family Planning Knowledge and Use:
Knowledge of Family Planning methods was related to availability of
correct and adequate information. The correctness of this information
was further related to its sources.
Results from the study showed that:
Teenagers had high levels of family planning knowledge. About
70 per cent were familiar with methods of preventing
pregnancies. The condom and the pill were the widely known
methods. However, when correct knowledge of contraceptive
use was summed up and scored against incorrect knowledge,
only once out of every for pupils in intervention schools had
correct knowledge before intervention. The radio and magazine were the most quoted sources of family planning information (30 per cent), followed by teachers (15 per
cent), clinics (11 per cent) and parents (10 per cent). After
intervention, magazines and teachers became the most
important sources (22 per).
From the study it is clear that use of contraceptive among teenagers
depends on several factors. Among the key ones are their availability,
correct and adequate knowledge of their reproductive biology. According to the study:
From: CRHCS Summary of an intervention study on selected aspects of teenage reproductive health - Zimbabwe
To show off, the Engineer called to his dog. "T-Square, do your stuff." T-Square trotted over to a desk, took out some paper and a pen and promptly drew a circle, a square, and a triangle. Everyone agreed that was pretty smart.
The Accountant said his dog could do better, and said, "Slide Rule, do your stuff." Slide Rule went out into the kitchen and returned with a dozen cookies. He divided them into 4 equal piles of 3 cookies each. Everyone agreed that was good.
The Chemist said his dog could do better still, so he called his dog and said, "Measure, do your stuff." Measure got up, walked over to the fridge, took out a quart of milk, got a 10 ounce glass from the cupboard and poured exactly 8 ounces without spilling a drop. Everyone agreed that was great.
The Government Worker called to his dog and said, "Coffee Break, do your stuff!" Coffee Break jumped to his feet, ate the cookies, drank the milk, dumped on the paper, sexually assaulted the other three dogs, claimed he injured his back while doing so, filed a grievance for unsafe working conditions, put in for Workers Compensation and went home on sick leave. Everyone agreed that was absolutely bloody typical!
Samba said he was concerned with the low number of women in senior positions in the organisation, prompting him to direct senior staff to identify and develop a pool of qualified women for possible employment in senior positions.
He said the employment of women has been on the agenda of the executive board of the organisation for the past three years. The last African regional committee meeting in Sun City, South Africa, passed a resolution emphasising the need to improve the participation of African women in the work of the organisation.
Employment of women has been Samba's priority since he assumed office in 1995 with two of the five divisional directors and three of the heads of unit in the body being women. Five of the WHO representatives in the African region are also women.
From: HEALTH-L, THE ZAMBIAN ELECTRONIC MAILING LIST ON HEALTH ISSUES
INTRODUCTION:
The disease has not only infected adults, but has infected almost 3 million children, 90% of them in Africa. After the first few cases had been reported from the South West Region of Uganda as "Slims Disease" in the 1980's, physicians in other countries in Africa began to see similar cases. In Zambia the first cases were reported in 1983, although unusual medical phenomena, such as severe allergies to antituberculous drugs, had begun happening a lot earlier than 1983.
HIV/AIDS is, for most of the cases seen, a Sexually Transmitted Disease and occasionally may be transmitted in blood where blood has not been screened before transfusion. The disease HIV/AIDS is so devastating that, like a pregnancy, it begins to show sooner or later. It infects mostly adults who are sexually active and in their productive and reproductive phases of life. There is no cure, although palliative therapies such as antibiotics for infections, immune system stimulants, good diet and healthy life-style do prolong life.
Tragic as the disease is, it has forced all of us to begin to open up to the reality of our reproductive lives, in order to address the pandemic and prevent its tragic consequences on individuals, families, communities and nations. We all have to talk about it. Apart from the tragedy of HIV/AIDS pandemic, we also know that mothers are dying from childbirth in large numbers. Every maternal death is a tremendous loss to the family, community and nation.
Maternal deaths are due to pregnancy-related causes such as bleeding, increased blood pressure in pregnancy, infections and other conditions which, if well treated, will prevent the death from occurring. The product of the pregnancy should be a live healthy infant. In Africa the infant mortality rate is high; e.g. Zambia with a mortality rate of 109 deaths for every 1000 live births.
The World Health Organisation and other United Nations agencies as well as member states of the African Region endorsed and committed themselves to supporting the implementation of the Programme of Action, following Cairo. Since 1994 there is no looking back, and most countries are trying to put in place more coordinated approach to the implementation of reproductive health services. There have been several fora, in the 1970's and 1980's, which have attempted to articulate women's rights, women's health and other empowerment issues.
These are normal developmental stages of life during which children need information, be it basic, -- as we have often heard it called "the birds and the bees". The needs of the young child can be met easily, using messages that are tailored to his or her levels of curiosity. The parent at this stage is the best source of information and it is from this relationship between parent and child that a door for future, deeper dialogue is opened.
In some intercountry studies, conducted with support from the "Commonwealth Regional Health Secretariat", teenagers seem to know more about the real dangers of pregnancy, e.g. 95% knew that a boy aged 13 to 19 years could impregnate a girl and 80% that a girl could become pregnant on her first sexual encounter. This is one group it has been shown that knowledge empowers their subsequent behaviour, thereby making it a useful tool allowing for decisions based on informed choice, to delay sexual activity.
Health services in general cater more for the woman and child. Men generally do not frequent clinics that are usually termed maternal child health clinics. In sharp contrast, attendance to the sexually transmitted diseases clinic, men are more predominant, yet STI's are a shared problem between men and women. It is also not often that men are able to accompany their wives to antenatal clinics or to the labour ward for certain logistic and cultural reasons. Male involvement in all aspects of the reproductive cycle is still a great challenge to communities and health services.
Health services are being challenged to incorporate reproductive health concerns in their work plans so that:
Zambia for instance has been blessed with an overwhelming number of partners interested in Reproductive Health issues. Family planning had already been in motion for 20 years prior to the renewed interest. This formed the pivotal programme, on which the next step was Safe Motherhood with Adolescent Health concerns now also being addressed. The advice is one step at a time, over a period of time in order to meet the real needs of countries.
2) COMMENTS: (Send us your thoughts and letters about this digest or any health related issue facing Zambia today and we may even print them!)
3) ADDRESS YOU WOULD LIKE US TO SEND ARTICLES TO:
Name-------------------------------------------------------------------
Title--------------------------------------------------------------------
P.O Box----------------------------------------------------------------
Street Address-------------------------------------------------------
City/Town-------------------------------------------------------------
4) SEND THIS FORM (OR A COPY) AND YOUR LETTERS TO THE FOLLOWING ADDRESS:
Zambia Health Information Digest
Medical Library
University of Zambia, School of Medicine
Tel: 01-250801
Fax: 01-250753
P.O. Box 50110
Lusaka, Zambia
medlib@unza.zm
[ZHID Table of Contents] [Medical Guide Table of Contents] [Zamnet][UNZA][UNZA Library]
Last updated October 23, 1998