Treatment compliance and outcome at an urban primary care clinic.

PIP: An attempt was made to determine treatment compliance and outcome at an urban promary care clinic in Zimbabwe. A research nursing sister sat in on an urban primary care clinic 1 day a week for 10 consecutive weeks recording the address, presenting compliant, physical findings, and treatment ordered, as defined by the clinic sister in attendance, of the first 10 consecutive cases seen on the day of the visit. Approximately 1 week later, she visited the home address and interviewed the mother. It is only possible to give medication for 24 hours at a time in the urban clinics, which entails a daily visit by the mother and child, even for oral medicines. At a child's 1st visit to the clinic, the mother is given a treatment card on which daily attendance, with medication given, ir recorded. Compliance was assessed by simply inspecting the card. 100 primary care consultations were recorded, but 1 record was lost. 99 visits to home addresses were undertaken, and in 83 visits contact was made with mother and child. (( of the 83 children were regarded by their mothers as better and no longer in need of treatment. 79 of the 83 mothers interviewed were satisfied or very satisfied with the treatment provided at the clinic. At least 1 medicine was prescribed to every child at his/her initial clinic visit and in some children up to 4. 86 children recieved an antibiotic or sulphas, or both. The majority of children seen were suffering from upper respiratory tract infections (50) or gastroenteritis, the majority of which were probably viral illnesses. The main factors for the good compliance among the population studied include: short distance from home to clinic; initial consultation took place in the mothers' own language; and the large number of intramuscular injections ordered as part of the treatment. Further education in the management of simple childhood conditions, and particularly in the use of antobiotics, needs to be given to nursing sisters conducting primary care clinics.^ieng

Galactosaemia in three Rhodesian infants.

The clinically relevant types of genetic galactosaemia involve deficiency of galactose-1-phosphate uridyltransferase (EC 2.7.7.12) or galactokinase (EC 2.7.1.6). Specific diagnosis is made by quantitative assay of these two enzymes. Seven Black patients were referred from Harare Hospital, Rhodesia, with features suggestive of galactosaemia. Enzyme assay identified classic homozygous transferase deficiency in 3 of these patients. The incidence in this population was calculated to be 1:52 000.

Measles and the state of nutrition.

The severity of an attack of measles is largely determined by the underlying state of nutrition at the time of the attack. Evidence is presented which suggests that, conversely, measles may be responsible for the precipitation of malnutrition in undernourished children, by a combination of several different mechanisms.

Effectiveness of nursing sisters in primary paediatric care.

A comparison was made of the management, by nursing sisters and a paediatrician, of 76 children attending primary care clinics. In 95% of consultations, the treatment and the presumed outcome of treatment were identical. The nursing sisters identified correctly all children for whom a second opinion was needed. If nursing sisters are responsible for primary care, they can be expected to refer approximately 10% of the children they see.

Domiciliary management of simple femoral fractures in children.

Twenty-six children with a simple fracture of one femur were nursed at home while on gallows traction, under the supervision of health visitors. The average stay in hospital before they were allowed home on traction was 8,5 days. A control group of 28 children with similar fractures, who were nursed only in hospital, spent an average of 34 days in hospital. No complications of treatment were encountered in either group. It is suggested that when there is an efficient health visiting service, children with uncomplicated fractures of the femur can be nursed at home, with benefit to the hospital, the child, and his family.

A trial of oral oxamniquine in the treatment of Schistosoma infection in children.

Oral oxamniquine 800 mg/m2 body surface area/day in divided doses for 2 days, was given to 57 children with schistosomal infections. Haematological and biochemical tests suggest that this drug is safe, even in the presence of significant liver enlargement. Parasitological investigations in 32 children who were followed up for 1 month indicate that oxamniquine is effective in the treatment of S. mansoni infection, but that it has little effect on S. haematobium infection.

Virus particles and gastro-enteritis in Black and White Children in Rhodesia.

Stools from Black and White children with gastroenteritis and from controls were investigated for potentially pathogenic agents by conventional virological and bacteriological methods and by electron microscopy. Isolations were obtained in 30 percent of cases but electron microscopy more than doubled the number of agents found. Orbiviruses were present in 40 percent of all cases, often in combination with other organisms. There was no difference between the Black and White groups.