'Fatalism', accident causation and prevention: issues for health promotion from an exploratory study in a Yoruba town, Nigeria.
(9/709)
As countries experience the 'epidemiological transition' with a relative decline in infectious diseases, accident rates tend to increase, particularly road traffic accidents. The health promotion interventions intended to prevent or minimize the consequences of accidents have been developed in predominantly Western, industrialized countries. Although some of these solutions have been applied with success to less developed countries, there are also good reasons why such solutions are ineffective when tried in a different context. Health promotion as developed in the West has a particular ideological bias, being framed within a secular, individualist and rationalist culture. Different cosmologies exist outside this culture, often described as 'fatalist' by Western commentators and as obstructing change. Changing these cosmologies or worldviews may not fit with the ethic of paying due respect to the cultural traditions of the 'target group'. Health promotion is therefore faced with a dilemma. In addition to different worldviews, the different levels of development also mean that solutions formulated in richer countries do not suit poorer countries. This paper uses a small exploratory study in a Yoruba town in Nigeria to examine these points. Interviews with key informants were held in March 1994 in Igbo-Ora and data were extracted from hospital records. Levels of accidents from available records are noted and people's ideas about accident prevention are discussed. Recommendations as to the way forward are then proposed. (+info)
Oral contraceptives and oral antibiotics: interactions and advice in an accident and emergency setting.
(10/709)
OBJECTIVE: (1) To determine what advice, if any, would be given by accident and emergency (A&E) doctors to women who were taking the combined oral contraceptive pill (OCP) if they had been issued with broad spectrum antibiotics and (2) after an audit programme had been instigated, whether appropriate advice was given to such women. METHODS: A questionnaire was circulated to 12 doctors working in the Exeter A&E department to assess their level of knowledge in prescribing antibiotics to women taking the OCP. Notes of women aged 15-50 who had been prescribed broad spectrum antibiotics were examined to see if a contraceptive history had been taken. If the patient was found to be taking the combined OCP it was noted whether documented advice had been given about using an additional form of contraception. Six months later after two education sessions had been held, prescriptions and notes were examined. A patient education leaflet was produced to be given to these women, indicating what additional precautions should be taken after having been prescribed antibiotics. SETTING: The A&E department of a busy district general hospital. SUBJECTS: Women aged 15-50 who had been issued with broad spectrum antibiotics. RESULTS: The level of knowledge in regard to contraceptive advice given to women taking the OCP among doctors working in an A&E department was poor. However, after educational sessions and the production of a patient information leaflet, there was an improvement in women receiving correct advice. CONCLUSIONS: The clinical significance of drug interactions between oral contraceptives and antibiotics indicates the importance of asking a full contraceptive drug history of any woman of childbearing age and documenting this in the notes. Regular audit of this topic is needed to keep it at the front of doctors' minds. (+info)
Deaths among children aged < or =5 years from farm machinery runovers--Iowa, Kentucky, and Wisconsin, 1995-1998, and United States, 1990-1995.
(11/709)
Children who reside on family farms are exposed to unique hazards. Young children may be present where work is being done and may wander into areas where machines are operating or may be passengers on these machines. This report describes four fatal incidents in Iowa, Kentucky, and Wisconsin in which young children were run over by farm machinery, summarizes national mortality data to characterize this problem, and provides recommendations for expanded prevention efforts. (+info)
Who dies from what? Determining cause of death in South Africa's rural north-east.
(12/709)
Information on cause of death is essential for rational public health planning, yet mortality data in South Africa is limited. In the Agincourt subdistrict, verbal autopsies (VA) have been used to determine cause of death. A VA is conducted on all deaths recorded during annual demographic and health surveillance. Trained lay fieldworkers interview a close caregiver to elicit signs and symptoms of the terminal illness. Each questionnaire is reviewed by three medical practitioners blind to each other's assessment, who assign a 'probable cause of death' where possible. Of 1001 deaths of adults and children identified between 1992 and 1995, 932 VAs were completed. The profile of deaths reflects a mixed picture: the 'unfinished agenda' of communicable disease and malnutrition (diarrhoea and kwashiorkor predominantly) are responsible for over half of deaths in under-fives, accidents are prominent in the 5-14 age-group, while the 'emerging agenda' of violence and chronic degenerative disease (particularly circulatory disease) is pronounced among the middle-aged and elderly. This profile shows the social and demographic transition to be well underway within a rural, underdeveloped population. Validation of VA findings demonstrate that the cause of death profile derived from VA can be used with confidence for planning purposes. Findings of note include the high death rates from kwashiorkor and violence, emerging AIDS and pulmonary tuberculosis, and circulatory deaths in the middle-aged and young elderly. A deeper understanding of the causal factors underlying these critical health problems is needed to strengthen policy and better target interventions. (+info)
Incidence of weapon injuries not related to interfactional combat in Afghanistan in 1996: prospective cohort study.
(13/709)
OBJECTIVE: To examine the descriptive epidemiology of weapon injuries not directly attributable to combat during armed conflict. DESIGN: Prospective cohort study. SETTING: Nangarhar region of Afghanistan, which experienced effective peace, intense fighting, and then peace over six months in 1996. SUBJECTS: 608 people admitted to Jalalabad hospital because of weapon injuries. MAIN OUTCOME MEASURES: Estimated incidence of injuries from combat or otherwise (non-combat injury) before, during, and after the fall of Kabul. RESULTS: Incidence of non-combat injury was initially 65 per 100 000. During the intense military campaign for Kabul the incidence declined dramatically, and then differentially increased dependent on injury subcategory-that is, whether injuries were accidental or intentional and whether they were inflicted by firearms or fragmenting munitions. Non-combat injuries accounted for 51% of weapon injuries observed over the study period. Civilians were more likely to have non-combat injuries than combat injuries. CONCLUSIONS: Weapon injuries that are not attributable to combat are common. Social changes accompanying conflict and widespread availability of weapons may be predictive of use of weapons that persists independently of conflict. (+info)
How much risk does a woman with active epilepsy pose to her newborn child in the puerperium? A pilot study.
(14/709)
Much attention in the literature has recently been paid to women's issues in epilepsy but most of the literature stops in the delivery room or at the first moment of suckling. Although it is commonly supposed that a woman who continues to have active epilepsy during the puerperium will pose a risk to her child, little assessment of how great a risk this is has been carried out. We present an audit of the puerperal experiences of 187 women with epilepsy counselled before birth in our women's clinic and contrast this with a number of women with epilepsy seen for the first time in the puerperium (and therefore uncounselled). The audit suggests that in counselled women the risk is very low (women with Juvenile Myoclonic Epilepsy may be particularly at risk, as may women with tonic-clonic seizures that occur without warning, plus those with automatisms or who have prolonged post-ictal confusion). Some women with controlled epilepsy prior to conception may lose that control during the puerperium so even women with well controlled epilepsy should adopt precautions in the puerperium. The only baby to die (or be seriously injured) in the puerperium born to a woman with epilepsy was killed in the mother's first seizure. (+info)
Determinants of mortality among children in the urban slums of Dhaka city, Bangladesh.
(15/709)
The growing slum population in the developing world is an increasing challenge for local health authorities. Little is known of the patterns of disease occurrence including treatment types offered in this population. The paper describes reported child mortality and its determinants, including the main diseases affecting children and treatments, in the slum population of Dhaka city, Bangladesh. 1500 households in three slum communities were included in a cross-sectional survey. Reported death rates in the households per 1000 children (0-107 months) within the last year from the interview were 20.5 for boys and 27.0 for girls. More girls than boys died in infancy (age < 12 months). The most frequent reported causes of deaths were tetanus in infancy and diarrhoea among children aged < or = 12 months. Vaccination coverage (DPT, polio, measles and BCG) was 73% for children < 3 years of age. The results showed that gender difference in mortality may have been influenced by the patterns of treatment received during sickness and the choice of treatment was determined by the financial ability of the households. Household income, children's vaccinations, TT immunization of mothers and personal cleanliness appeared to be significantly associated with child mortality. Despite the relatively high vaccination coverage for this population, child mortality remained alarmingly high, indicating that socioeconomic and environmental conditions must be improved to substantially reduce morbidity and mortality in this population. (+info)
The impact of the major causes of death on life expectancy in Italy.
(16/709)
BACKGROUND: This study aims to evaluate the contribution of the reduction in major cardiovascular diseases (CVD), malignant neoplasms (MN), accidents and AIDS mortality to the gains in life expectancy observed during the decade 1985-1994, as well as to calculate and compare the potential gains due to the partial or total elimination of these causes. METHODS: Mortality data from the Italian Mortality Data Base were analysed by the method of decomposition of changes in life expectancy and the partial multiple decrement life table technique. RESULTS: In Italy, considering the decade 1985-1994, the gain in life expectancy at birth was 2.27 years for men and 2.16 for women. The major contribution to this increase was the reduction in CVD mortality followed by fewer deaths from accidents and MN. Conversely, AIDS caused a loss in the length of life of adults. Major potential gains in life expectancy at birth could be obtained by the elimination or even partial reduction of CVD and MN mortality. When working life (15-64 years) is considered, the relative importance of the causes changes. The elimination of accidents and AIDS would result in increased life expectancy longer than that associated with a 50% reduction in CVD. CONCLUSIONS: The findings of this study provide useful information which could contribute to a more effective allocation of resources for research activity and public health programmes. (+info)