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The main feature article in this issue looks at the acceptability of the Female condom in Zambia. The article stresses female condom addresses the issue of power relations in male/female relationship. In a country such as Zambia were sexuality is just only beginning to be discussed the acceptability of the female condom hinges on how both men and women look at the sexual relationships. The author observe female condom acceptability is sometimes based on gender beliefs about who holds the responsibility for contraception, social stigma surrounding women's use of contraception encouraging promiscuity or who should be allowed sexual pleasure.
Articles dealing with Diarhorea, Cholera, Measles and Poliomemylitis give an idea on the management and prevention of these afflictions in our soicety. The focus has been main on prevention as well their management once infection has already occurred.Finally, included in this issue is menopause, a condition affecting women over 45 years with symptoms that stimulate TB among Zambian women making this an interesting study.We hope you enjoy reading through this issue.
- OBJECTIVE:
To examine the impact of HIV on infectiousness of pulmonary tuberculosis (TB).- DESIGN:
A cross-sectional tuberculin survey carried out among household contacts of HIV-1 positive and negative patients with bacteriology confirmed pulmonary TB. Contacts were also examined for active TB.- SETTING:
Index cases were recruited from patients attending the University Teaching Hospital in Lusaka, Zambia and household contacts were examined during visits to their homes within Lusaka. PATIENTS,- PARTICIPANTS:
A total of 207 contacts 43 HIV-positive patients, and 141 contacts of 28 HIV-negative patients with pulmonary TB were examined.- MAIN OUTCOME MEASURES:
Proportion of contacts of HIV-positive and negative index cases with a positive tuberculin response (diameter of induration > or = 5 mm to a dose of 2 tuberculin units). RESULTS: Fifty-two per cent of contacts of HIV-positive pulmonary TB patients had a positive tuberculin response compared with 71% of contacts of HIV-negative patients (odds ratio, 0.43; 95% CI, 0.26-0.72; P< 0.001). This difference persisted after allowing for between-household variations in the tuberculin response. Tuberculin response in the contact was related to age of contract, intimacy with the index case and crowding in the household. However, the effect of HIV status of the index case was not confounded by these variables. Tuberculin response in the contact was also related to the number of bacilli seen in the sputum smear of the index case, which partially explained the effect of HIV status of the index case. Active TB was diagnosed in 4% of contacts of HIV-positive and 3% of contacts of HIV-negative cases, respectively (P = 0.8). CONCLUSIONS: HIV-positive patients with pulmonary TB may be less infectious than their HIV-negative counterparts and this may partly be explained by lower bacillary load in the sputum.
Nine-year follow-up study of a plasma-derived hepatitis B vaccine in a rural African
setting
Tabour E; Cairns J; Gerety RJ; Bayley ACNational Cancer Institute,
National Institutes of Health, Bethesda, MD 20892
J Med Virol (UNITED STATES) July 1993, 40 (3) p240-9
One hundred and one of 255 recipients of a plasma-derived hepatitis B vaccine were evaluated in 1990, 9 years after the first vaccine dose in a study in Zambia to evaluate the efficacy of one, two or three doses. In 1983, 2 years after the first vaccine dose, antibody to the hepatitis B surface antigen (anti-HBs) had been detectable in 90 of those 101 participants (89%). In 1990, anti-HBs was still detectable in 72 of 101 (71%), and was present at a protective level (> or = 10 mlU/mL) in 68 of 101 (67%). Although the original vaccine study elicited a protective level of antibody in a greater percentage of children and adolescents than in adults, there were no significant differences among the three groups at 9 years. (in 1990, anti-HBs was still detectable in 52 of 70 [74%] who had no serologic markers of the hepatitis B virus in 1981, and a protective level was detected in 47 of 70 [67%]). A protective level of anti-HBs was detected in 1990 in 26 of 36 (72%) recipients of three doses and in 23 of 31 (74%) recipients of two doses; the slightly lower prevalence among recipients of one dose (19 of 34 [56%]) was not statistically significant. (ABSTRACT
Seroprevalence of human immunodeficiency virus type 1 infection in Zambian children with tuberculosis
Chintu C; Bhat G; Luo C; Raviglione M; Diwan V; Dupont HL;Zumla A
Department of Paediatrics, University Teaching Hospital, Lusaka, Zambia
Pediatr Infect Dis J (UNITED STATES) June 1993, 12 (6) p499-504
Descriptions in the medical literature of human immunodeficiency virus type 1 (HIV-1) in children with tuberculosis (TB) are scanty. This study determined the seroprevalence of HIV-1 in 237 hospitalized children between the ages of 1 month and 14 years with a clinical diagnosis of TB (125 males and 112 females) and in 242 control children (149 males and 93 females). The overall HIV-1 seroprevalence rate in patients with TB was 37% (88 of 237) compared with 10.7% (26 of 242) among the control group (P < 0.00001: odds ratio 5.37, 95% confidence interval = 3.21 < 5.37 < 9.47). HIV-1 seropositivity in children with TB ranged from 53% (31 of 58) in the 12- to 18-month age group to 14% (9 of 61) in the 10- to 14-year olds. The risk of TB attributable to HIV infection was 29%. The predominant clinical presentation in both seronegative (84.6%) and seropositive (89.7%) groups was that of pulmonary TB and there were no significant differences in clinical presentation between the two groups of patients. Only 54.8% of the patients attended follow-up clinics regularly whereas 32% were lost to follow up within 3 months. Bacillus Calmette-Guerin vaccination coverage was 87.3% among TB patients and 90.5% in the controls. No significant differences in B. Calmette-Guerin vaccination rates between the seronegative and seropositive children were seen. Coinfection with HIV and TB in children is now one of the major public health problems in Zambian children.
Cutaneous hypersensitivity reactions due to thiacetazone in the treatment of tuberculosis in Zambian
children infected with HIV-1
Chintu C; Luo C; Bhat G; Raviglione M; DuPont. H; Zumla A
Department of Paediatrics, University Teaching Hospital, Lusaka, Zambia
Arch Dis Child (ENGLAND) May 1993, 68 (5) p665-8
Tuberculosis is one of the most common infections in Zambian adults and children infected with HIV. In Africa, cutaneous hypersensitivity reactions attributed to thiacetazone during treatment of tuberculosis in adults infected with HIV-1 have been well documented. This study monitored adverse drug reactions during treatment for tuberculosis over an 18 month period (1 April 1990 to 31 October 1991) in 237 children with a clinical diagnosis of tuberculosis (125 boys and 112 girls; 88/237 (37%) infected with HIV-1) and 242 control children (149 boys and 93 girls; 26/242 (11%) infected with HIV-1).Twenty-two (9%) of the 237 children with tuberculosis developed hypersensitivity skin reactions during the course of treatment. Adverse skin reactions were seen more often in children infected with HIV than in those who were not (odds ratio 11.65, 95% confidence interval 3.07 to 34.88). These represented 19 (21%) of 88 children infected with HIV and three (2%) of 149 children not infected with HIV. These skin reactions occurred after a period of treatment ranging between two and four weeks among 14 children receiving the HST (isoniazid, streptomycin, thiacetazone) regimen and eight children receiving the HSTR (isoniazid, streptomycin, thiacetazone, rifampicin) regimen. Twelve (55%) of the 22 children who reacted adversely to treatment developed the Stevens-Johnson syndrome. All 12 of these children with the Stevens-Johnson syndrome were infected with HIV. The mortality among these children who developed the Stevens-Johnson syndrome was 91% (11 of 12 died within three days of the onset of the reaction).
Case definitions for paediatric AIDS: the Zambian experience
Chintu C; Malek A; Nyumbu M; Luo C; Masona J; DuPont HL; Zumla A
Department of Paediatrics, University Teaching Hospital, Lusaka, Zambia
Int J STD AIDS (ENGLAND) Mar-Apr 1993, 4 (2) p83-5
For the purpose of surveillance of the acquired immunodeficiency syndrome (AIDS) in developing countries, the World Health Organization (WHO) has recommended criteria for the clinical case definition of AIDS in adults and children. In a preliminary examination of children in Zambia a number of patients with obvious AIDS did not fit the published WHO case definition for paediatric AIDS. Based on this the Zambia National AIDS Surveillance Committee designed local criteria for the clinical case definition of paediatric AIDS.We compared the Zambian criteria with the WHO criteria for the diagnosis of paediatric AIDS by studying 134 consecutively admitted children to one of the paediatric wards at the University Teaching Hospital in Lusaka. Twenty-nine of the patients were HIV-1 seropositive and 105 were HIV-1 seronegative. Among the 29 HIV-seropositive and 105 were HIV-1 seronegative. Among the 29 HIV-seropositive patients, the Zambian criteria identified 23, and the WHO criteria identified 20 children as having AIDS. The 105 HIV-seronegative children were classified as having AIDS in 9 cases by the Zambian criteria and in 38 cases by the WHO criteria.
These results give the Zambian criteria for the diagnosis of AIDS sensitivity of 79.3%, a specificity of 91.4% and a positive predictive value of 86.8% compared to a sensitivity of 69%, specificity of 64% and a positive predictive value of 38% for the WHO criteria. The current WHO criteria are inadequate for the diagnosis of paediatric AIDS. The need to refine the WHO criteria for the diagnosis of paediatric AIDS is discussed.
Low and Stable HIV seroprevalence
in pregnant women in Shaba province, Zaire
Magazani K; Laleman G; Perriens JH; Kizonde K; Mukendi K; Mpungu M; Badibanga N; Piot PJ
Defic Sydro (UNITED STATES) Apr 1993, 6 (4) p419-23
Sentinel serosurveillance for HIV infection has been carried out in Shaba province, Zaire, among consecutive pregnant women attending antenatal clinics from 1989 to 1991. There were four surveillance cities (three urban and one semiurban), at which a total of 13 surveillance studies were made of 4,205 women. Overall, 3.1% were HIV seropositive. There were no significant differences in HIV seroprevalence between surveillance sites, and HIV seroprevalence did not increase at any of the surveillance sites during the 2-year period of study.Since changes in the population studied did not occur between surveillance studies, it is believed that the observed stable trend reflects stable HIV seroprevalence rates in the general adult population of the surveillance sites. Collateral HIV seroprevalence data were available from 8,725 blood donors at 20 sites (six urban, 14 rural) in the province, who had an overall HIV seroprevalence of 4.6%. The higher HIV seroprevalence rate among blood donors was probably due to selection bias, since HIV seroprevalence rates in two blood banks, which relied nearly exclusively on replacement donors, were 2.7 and 2.8%, our best estimate for HIV seroprevalence in the three cities where blood banks exists and where no surveillance studies were carried out. The stable and relatively low HIV seroprevalence rates in Shaba province are in sharp contrast with the rapidly increasing and much higher rates in neighboring Zambia and other East African cities. Reasons for this discrepancy are unclear, and their elucidation may yield critical information for HIV prevention programs
Chemotherapy of African AIDS diarrhoea: a preliminary study
Kelly P; Buve AMonze; District Hospital, Zambia
AIDS (UNITED STATES) Jan 1993, 7 (1) p91-3
- OBJECTIVE:
To determine whether combined chemotherapy with tinidazole, thiabendazole and cotrimoxazole is more effective than placebo in treatment of AIDS diarrhoea in Zambia.- DESIGN:
Single-blind prospective comparison in consecutive patients, randomized alternately to placebo or chemotherapy.- SETTING:
A district hospital in Zambia.- PATIENTS:
Sixty-four HIV-seropositive patients with chronic diarrhoea were considered for inclusion in the study. Of these, 25 patients were not eligible for randomization (in 13 cases because of spontaneous remission); 11 were randomized, but excluded from the analysis (seven failed to attend for a scheduled visit and four died), leaving 28 patients who completed the study.- MAIN OUTCOME MEASURES:
Proportion of diarrhoea-free days in the 7 days following treatment, as determined by daily stool counts.- RESULTS:
There were 38 diarrhoea-free days out of 89 (43%) in the placebo group, and 39 out of 72 (54%) in the chemotherapy group; this difference was not statistically significant.- CONCLUSIONS:
The high level of spontaneous remission probably indicates a natural fluctuation in stool frequency and demonstrates the need for placebo-controlled studies in any assessment of therapy for AIDS diarrhoea.
Prophylaxis for opportunistic infections in patients with HIV Infection
Gallant J E, Moore R D, Chaisson R E.
Annals of Internal Medicine 1994: 120(1): pp. 932-944
To review the efficacy of chemoprophylaxis for opportunistic infections in persons infected with human immunodeficiency virus (HIV). Type of intervention Treatment/prevention Specific interventions included in the review. The prophylactic use of anti-microbial agents in patients with HIV infection. Participants included in the review All patients who were HIV positive. Outcomes assessed in the review Incidence of infection in patients receiving prophylactic treatment. Organisms studied included pneumocystis carinii, toxoplasma gondii, various fungal infections, mycobacterium avium complex, mycobacterium tuberculosis, herpes simplex virus and several other bacterial infections. Study designs of evaluations included in the review Controlled clinical trials, uncontrolled trials, retrospective studies and prospective observational studies.What sources were searched to identify primary studies? Medline 1985-1993, English language. Relevant abstracts from the International Conferences on AIDS, the Inter-science Conferences on Antimicrobial Agents and Chemotherapy and the National Conference on Human Retroviruses and Related Diseases. Criteria on which the validity (or quality) of studies was assessed Importance was given in descending order to controlled trials, uncontrolled trials and retrospective studies and prospective observational studies. Results of the review Seven groups of infections are discussed separately. Include a synthesis of data into a detailed table of treatment recommendations. Indications for primary prevention for other infections such as M.avium complex should be considered in relation to the progression of HIV and CD4 counts.
A discussion of interaction of a number of the treatment regimens is included in the narrative. Was any cost information reported? Some cost benefit analysis are reported. Included in the synthesis of the data are recommendations related to the efficacy and cost effectiveness of utilising a primary prophylactic approach for some infections (eg: Pneumocystis carinii) as opposed to the treatment of acquired infections such as the majority of fungal infections. Author's conclusions A growing number of infections related to acquired immunodeficiency syndrome are preventable with currently available agents. Issues of drug interactions, toxicity, and cost-effectiveness will become increasingly important in the management of patients with advanced HIV disease
School-based programs to reduce sexual risk behaviors: a review of effectiveness
Kirby D, Short L,
Collins J, Rugg D, Kolbe L, Howard M, Miller B, Sonenstein F, Zabin LS.
Public Health Reports 1994: 109(3): pp.339-360
Objective:
- To synthesise, in a qualitative way, research on the effectiveness of school based programmes to reduce sexual risk behaviours.
- To identify the distinguishing characteristics of effective programmes.
- To identify important research questions to be addressed in the future Type of intervention/Prevention.
Specific interventions included in the review
School based programmes to reduce sexual risk behaviours. Participants included in the review. Males and females of school age. Outcomes assessed in the review Reported sexual or contraceptive behaviour or their outcomes (pregnancy rates, birth rates or sexually transmitted disease (STD) rates). Study designs of evaluations included in the review Experimental or quasi-experimental studies and national surveys. What sources were searched to identify primary studies? Computer searches of appropriate data bases; review of journals commonly publishing articles on this topic, and contact with other researchers in the field. Only research that had appeared or had been accepted for publication in a peer-reviewed journal was considered. Criteria on which the validity (or quality) of studies was assessed Not stated. How were the inclusion criteria applied? Decision were made by a panel of experts established for the review. How were judgements of validity (or quality) made?Results of the review National surveys (7 studies):
- Initiation of sexual activities. Studies show inconsistent results and suggest that the impact of sex education instruction might vary with the topics covered and the age of the students.
- Use of contraception. Results varied both with the particular study and with the time interval of contraceptive measure. Four of the five survey data sets produced some positive significant relationships between participation in a sex or AIDS education program and either contraceptive use or specifically condom use, while the fifth data set revealed a possible indirect effect through greater knowledge
Specific Program evaluation (16 studies):
- Abstinence programmes. There is insufficient evidence to determine whether school-based programs that focus only upon abstinence delay the onset of intercourse or affect other sexual or contraceptive behaviours.
- Sexuality and AIDS-STD education programmes. Initiation of intercourse (5 evaluations). There is no evidence that programmes significantly hasten the onset of intercourse and some programmes can delay the initiation of sexual activity.
Frequency of sexual activity (4 studies). These measured the impact of the programme upon frequency of sexual activity, among those who had already initiated intercourse. None of the programmes significantly increased or decreased the frequency of intercourse.
Use of contraceptives (8 studies). Some, but not all, programmes increased contraceptive use.- Only two programmes increased contraceptive use. Only two of the eight programmes significantly increased contraceptive use among all sexually experienced youths.
- Five studies combined education and reproductive health services (close to or with the schools).
The presence of reproductive health services was found to:
- Neither hasten the onset of intercourse or increase the frequency,
- Have mixed effects on contraceptive use,
- Be less critical than the presence of a strong educational component.
It is unclear whether school-based or school-linked reproductive health services, either by themselves or in addition to education programmes, significantly decrease pregnancy or birth rates. In order to understand which characteristics are necessary for behavioural change the characteristics of the 8 effective programmes were compared with the characteristics of the ineffective programmes.
Effective Programme Characteristics:
- Had a narrow focus on reducing sexual risk-taking behaviours that may lead to HIV-STD infection or unintended pregnancy.
- Used social learning theories as a foundation for programme development. These programmes went beyond cognitive level: they focused on recognising social influences, changing individual values, changing group norms and building social skills.
- Provided basic, accurate information about the risks of unprotected intercourse and methods of avoiding unprotected intercourse through experimental activities designed to personalise this information.
- Included activities that address social or media influences on sexual behaviours.
- Reinforced clear and appropriate values to strengthen individual values and group norms against unprotected sex.
- Provided modelling and practice in communication and negotiation skills.
The programmes reviewed did not hasten intercourse in older students, while evidence for younger students is less consistent. Some programmes can increase the use of condoms or other contraceptives. The curricula that effectively delayed the onset of intercourse, increased the use of condoms or contraception and reduced sexual risk behaviours had six common characteristics as listed above. The published literature does not provide any good evidence indicating whether programmes focusing only on abstinence delay the onset of intercourse or reduce the frequency of intercourse. There is insufficient direct evidence to determine whether any of these educational or clinic programmes actually decreased pregnancy rates, birth rates or incidence of STD or HIV infections. There is evidence from two studies that some programmes delayed the onset of intercourse, reduced the number of sexual partners and reduced the frequency of intercourse or increased the use of protection.
Sexual health education interventions for young people: a methodological review
Oakley A, Fullerton D, Holland J, Arnold S, France-Dawson M, Kelley P, McGrellis S
British Medical Journal 1995: 310: p.158-62
To locate reports of sexual health education interventions for young people, assess the methodological quality of evaluations, identify the subgroup with a methodologically sound design and assess the evidence with respect to the effectiveness of different approaches to promoting young people's sexual health.Type of intervention Prevention Specific interventions included in the review Sexual health education/information Participants included in the review Young people aged 0 to 19 years, which included high school students, university students and runaway adolescents at a residential shelter.
Outcomes assessed in the review
The methodological quality of evaluations was assessed along with the study outcomes, which were changes in knowledge, attitudes or sexual behaviour. Study designs of evaluations included in the review Controlled trials What sources were searched to identify primary studies? The following databases were searched from 1982 to 1994: Social Science Citation Index (BIDS) MEDLINE Psychlit Eric Health Education Authority's Unicorn database National HIV/AIDS Prevention Information Service database. Hand searches from 1982 to 1994 of the following journals were carried out: Health Education Research Health Education Journal Health Education Quarterly AIDS Education and Prevention, The Journal of School Health Family Planning Perspectives bibliographies of located studies were searched and contact with other researchers in the area were made.Criteria on which the validity (or quality) of studies was assessed
There were 8 methodological quality criteria, which the studies were rated on: clear definition of aims; a description of the intervention package and design sufficiently detailed to allow replication; inclusion of a randomly allocated control group; provision of data on number of participants recruited to the study and control groups; provision of pre-intervention data for the study and control groups; provision of post-intervention data for the study and control groups; attrition rates reported for the study and control groups; findings reported for each outcome measure as described in the aims of the study. However, evidence on effectiveness generated by studies meeting 4 core criteria was assessed.The 4 core criteria were: employing randomly allocated control groups or control groups shown to be equivalent to the study groups before intervention on sociodemographic characteristics and measures used as outcome variables; providing pre-intervention data; providing post-intervention data; reporting on all outcomes; How were the inclusion criteria applied? Not stated How were judgements of validity (or quality) made? Two reviewers with backgrounds in quantitative social science independently assessed each study. Any disagreements were discussed and resolved with a third reviewer and by discussion with the members of the study's steering group. How were the data extracted from primary studies? Not stated Number of studies included 73 outcome evaluations (of which only 12 were controlled trials and met the core quality criteria) How were the studies combined? A narrative review How were differences between studies investigated? Not stated Results of the review Of the 73 reports of evaluations of sexual health interventions examining the effectiveness of these interventions examining the effectiveness of these interventions in changing knowledge attitudes or behavioural outcomes, 65 were separate outcome evaluations. Of these 65 studies 45 (69%) lacked random control groups, 44 (68%) failed to present pre-intervention data and 38 (59%) failed to present post-intervention data, 26 (40%) omitted to discuss the relevance of loss of data caused by drop outs. Only 12 (18%) of the 65 outcome evaluations were judged to be methodologically sound. Only 3 of the methodologically sound evaluations were (judged by the reviewers to be) effective in showing an impact on young peoples' sexual behaviour. Was any cost information reported? No
Author's conclusions
The design of evaluations in sexual health intervention needs to be improved so that reliable evidence of the effectiveness of different approaches to promoting young people's sexual health may be generated. CRD commentary This review presents information about the methodology needed to evaluate health education interventions and so judge the effectiveness of sexual health education. What are the implications of the review Evaluations of sexual health interventions need to be improved in order to obtain reliable evidence about the effectiveness of different interventions. Record status This record is a structured abstract written by CRD reviewers. The review has met a set of quality criteria.
After three months, a random sample of initial acceptors who never returned for re-supply ("discontinuers") and initial acceptors who returned for re-supply at least once ("continuers") were asked to participate in separate focus group discussions. In addition, 10 partners of female condom users were invited for individual in-depth interviews.
Motivation to try the female condom:
Continuers expressed several reasons for trying the female condom. Around half were on oral contraceptives, but negative side-effects like
heavy bleeding and dizziness put them off and caused them to consider the female condom. Most of the women who came back at least once found the female condom to be clean, safe and good protection against STDs. Continuing or not with the female condom correlated highly with their partners' appreciation of the method. Most of the discontinuers were apparently not self-motivated: 70% of them said the nurses told them to try it for various reasons. Some had an STD, while others were encouraged to try it as an interim method whilst breastfeeding or awaiting the provision of long-term contraceptives like the Norplant implant.
Advantages of the female condom:
The users said they liked the female condom because it offers double protection, against pregnancy and STDs, and it is safer than the male condom because it is stronger and protects better against STDs, covering the "lips of the vagina". Most women were pleased because they finally had a method they could control, and, unlike other family planning methods, the female condom has no side-effects. Women also appreciated the female condom because it was not messy; the ejaculate remains in the condom and can be removed after intercourse.
A few also said that its "lightness" increased sexual sensitivity and they thought it might be possible to re-use it. Some women preferred the female condom because it made their vaginas feel warm, making sex very pleasurable. Some users experienced an unexpected prolonged male orgasm.
The partners of the continuers were positive about the method: they said it was better than the male condom because it "it now was the responsibility of the woman to ensure that the condom was in place before sex". They also liked it because it was strong and they thought it could be re-used and was a good method for family planning and prevention of STDs.
Problems and disadvantages of the female condom:
Both continuers and discontinuers reported problems with the condom. Sixty-five percent of the continuers said sex was just as enjoyable, but some said the inner ring was uncomfortable on insertion, but all right once in place. Others said the ring caused the woman to be conscious and made intercourse less enjoyable. The outer ring also caused some discomfort, because it pushed inside the vagina during intercourse.
Recommendations for follow-up research include the further exploration of continuation rates and women's use patterns. For instance, are women using the female condom as dual protection against STDs? If so, are they doing this with their regular partners or only outside of their conjugal relationships? These findings show that attitudes towards the female condom are sometimes based on gender beliefs about who holds the responsibility for contraception, social stigma surrounding women's use of contraception encouraging promiscuity or who should be allowed sexual pleasure. Still, the strongest reason for discontinuation was the unwillingness of the male partner. If this method is to be widely introduced, its introduction should be accompanied by an education campaign to combat social stigma already associated with male and female condoms, especially in men.
Gladys Nkhama and Tamara Fetters
CARE International Zambia
P.O. Box 36238, Lusaka, Zambia.
E-mail: care@zamnet.zm
What are the causes of diarrhoeal diseases?
A major cause of diarrhoeal diseases is dirty living conditions, which allow dangerous germs to get into a person's stomach or intestine. The germs which cause diarrhoeal diseases can get into someone:
How can we prevent diarrhoea?
Obey the following simple rules of hygiene:
What is the sign that a person has diarrhoea?
He passes loose or watery stools three or more times in a day.
What causes cholera?
What are the common sources of Cholera infection?
How is Cholera different from other diarrhoeal disease?
Cholera spreads fast and strikes large numbers of people at a time. When this happens, there is a cholera epidemic.
If there is a cholera epidemic, how can we stop it from spreading?
If someone has cholera, what are the signs?
If a child has measles and is not treated, what can the disease do to him?
Measles makes his mouth sore, and this will:
When a child has polio, what are the signs?
The signs are:
If a child shows signs of polio, what should be done?
Take him to the health worker or doctor immediately.
It is better to prevent the child from having polio by ensuring that he is vaccinated than to try to help him after he has been struck by the disease.
"Menopause is the period during which a woman's menstrual cycle ceases normally at an age of 45 to 50". Unlike Aids, sexual reproductive health, high blood pressure, diabetes and other, menopause is an issue that has not been talked about in Zambia. Yet women go through it ignorant of the meaning of the changes in their bodies. While some women go through this period agonising over the changes some women pass through it with no symptoms at all. "I was confused and did not understand what was happening to me. I had night sweats and hot flashes. I suspected I had TB or was infected with HIV. But when I went to see my doctor all the tests turned out negative". "One day as I was at home with my children, a known teenage relation of mine suggested that I could be going through menopause," said Colonel Joyce Puta a medical person. Surprisingly she did not know what menopause was all about. It had to take a teenager to open her eyes to what was going on in her body.
Yet another woman, Dolores Long, went through menopause with no difficulties at all. "I was lucky and totally surprised because it was simpler than I expected. I thought it would get complicated. My periods just disappeared. I had no symptoms and no depressions," Dolores said. She did not go through any psychological problems like thinking that was the end of her child bearing times. Most of her friends have been affected psychologically because they thought this was the end of an era in their lives. They have had embarrassing hot flashes and sweating at night. For her, she believes it was easy because as a young woman her cycle was regular and she never had any problems. "I don't know anything about menopause. What is it?," asked Mumba Phiri a young Lusaka woman in her 30s. A mother of my colleague said it was embarrassing for her when she had to give a presentation at a workshop and suddenly there were these hot flashes and she was fanning herself. She does not even know what to expect when her time for it comes. Col. Puta who gave a presentation on menopause on Radio Christian Voice said most women agonised with menopause to an extent of going through many doctors when presented with a wealth of general premenopausal symptoms. "There is no typical perimonopausal symptoms, just like there is no typical puberty. Sometimes it can worsen premenstrual symptoms". Col. Puta says perimonopausal symptoms are symptoms that are experienced silently by women in their 40s. THE SYMPTOMS...
WHAT TO DO....
Exercise, even though moderate, may be the single best thing for physical and emotional health.
It is important to eat a balanced diet which includes vegetables, fruits, whole grains (brown bread, oats), proteins and starches.
Drink at least 2.5 to 3 litres of water in 24 hours. There is need to educate both young and old women in detail about menopause. Just a definition of menopause in a biology class at school is not enough. That is why young women do not know what to expect or women over 40 don't know what it is that hit them. That's why, in matters of health and everything, the creature cannot afford to do without the creator.
We truly need God all the days of our lives, Young or old. We can only find rest in God. Are you a menopause victim? REMEMBER TO REST AND WAIT UPON THE LORD, THE GREATEST PHYSICAN, WHO ALONE CAN HANDLE MENOPAUSE EVEN WHERE EARTHLY DOCTORS FAIL.
Pray without ceasing. "They that wait upon the Lord shall renew their strength. They shall mount up with wings as eagles". Trusting in the Lord for strength and asking your cares upon him will help you go through this period of menopause.
Times of Zambia, Saturday, August 7, 1999
Workshop 1 under the title: Using Existing Internet.
Medical information services and getweb was aimed at librarians and faculty interested in learning how to access useful medical information on the Internet. The focus was on the systems developed by Satellife and Healthlink. Participants also learnt how to use the Internet to retrieve data efficiently and effectively.
AIM
The aim of this paper is to report what the Medical Librarians learnt at the conference and workshops and make observations and recommendations for introducing Internet and Telemedicine Associations in Zambia.
CONCLUSION
The conference and workshops were not only worth while but educative and a great challenge to heads of health institutions in Zambia. It provided
an opportunity for Medical Doctors and Librarians to get an overview on the use of information technology in the delivery of health care.
RECOMMENDATIONS
Dear Sir/Madam,
In reference to the above article, I am recommending your Health articles especially the presentation on AIDS Pandemic. I am a teacher at Frances School in Emmasdale Lusaka, teaching "Human Biology and Chemistry" Besides, I run the Anti-AIDS Club within the School; but I don't have enough material to support the club. I have got a Diploma in Public health and I am fully registered by the Medical Council of Zambia. Faithfully yours, Mainza Collins
This website gives a list of an A-Z site index, heatlh index, internet directories and Zambian health institutions. Full text documents are also include. It has an HIV/AIDS resources directory which have comprehensive lists of research publication, newspaper articles and press releases, journals , statistics, current information and news. The site also has links to several databases such as medline, popline etc.
If you have any querie/observations to make about the website please send a message to:
UNAIDS Information Centre
20 Avenue Appia
1211 Geneva, Switzerland
e-mail: UNAIDS
Organisations and individuals interested in receiving further information and supporting advocacy for microbide development many contact:
The Alliance for Microbide Development
6930 Carroll Avenue, Suite 830
Takoma Park, MD 20912, USA
FAX: 1-301-5926;
e-mail: P Harris
Reproductive Health Technologies Project
1818 N Street NW, Suite 450
Washington, DC 20036, U.S.A.
e-mail: Bassshowers
Microbides as an alternative Solution
c/o Center fro Family and Community Health
140 Warren Hall, University of California
Berkeley, CA 94720-7360, USA
email: BC Young
Information on social marketing campaigns can be obtained from:
Society for Family Health (SFH)
P.O.Box 50770, Lusaka, Zambia.
Phone: 266332/3, 289005
Fax: 286726
Email: Society for Family Health
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:
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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
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Content: a) Excellent b) Good c) Fair d) Poor
Presentation: a) Excellent b) Good c) Fair d) Poor
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Last updated February 10, 2000