Developing public health management training capacity in Nicaragua.

The Cooperative for Assistance and Relief Everywhere (CARE) and Centers for Disease Control and Prevention (CDC) Health Initiative in Nicaragua is distinctive in its focus on developing a cadre of in-country trainers whose aim is to equip frontline public health managers with widely applicable tools and techniques to assist them in identifying and solving implementation problems. Since 1999, 137 trainees--37% more than originally planned--have demonstrated competence by completing and presenting applied management projects. Nineteen professors from the preventive medicine faculty at the Autonomous University of Nicaragua also have been trained. The country office now has a cadre of seasoned trainers who can meet the ongoing management training needs of CARE staff and their counterparts in the Ministry of Health and in other nongovernmental organizations.

Smoking prevalence in the United States and Taipei City, Taiwan.

Although there are extensive antismoking efforts in the United States, smoking is a largely ignored health issue in Taiwan. In fact, tobacco advertising has increased dramatically since U.S. tobacco was first imported in 1987. We compared estimates of smoking prevalence of 83,281 Americans and 5,023 persons in Taipei, Taiwan, in 1986-1988. Among men, current smoking prevalence was higher in Taipei (49%) than in the United States (29%). In contrast, former smoking prevalence among men was substantially lower in Taipei (5%) than in the United States (32%). Young adults and those with lower and middle education levels had the highest smoking prevalence in both surveys. Among women, the current smoking prevalence was only 8% in Taipei, compared to 25% in the United States. The former smoking prevalence among Taipei women (1%) was also lower than among U.S. women (18%). Our findings indicate the need for expanding antismoking efforts in Taiwan, especially among men and among persons with lower and middle education levels.

A prevalence survey of behavioural risk factors in Taipei City, Taiwan.

In 1986, we conducted a telephone survey of 2514 residents of Taipei City, Taiwan, to establish baseline prevalence estimates of behavioural risk factors associated with the leading causes of death among adults. Estimates from this survey revealed a high prevalence of sedentary lifestyle (85.6%), seatbelt non-use (67.5%) and motorcycle helmet non-use (31.3%). The smoking rate (26.1%) was similar to that in the US, however, there was almost a tenfold difference between smoking rates in men and women (48.0% versus 5.1%, respectively). Behaviours related to alcohol misuse (binge drinking, chronic heavy drinking and driving and drinking) were also much more prevalent among men than women. This survey demonstrated the feasibility of using the telephone to collect data on the prevalence of behavioural risk factors in a newly industrialized country like Taiwan.

Motor vehicle injuries in Taiwan.

In Taiwan, motor vehicle fatalities have increased significantly in the past two decades and are now a leading cause of mortality, especially among younger age groups. In this paper, we review vital statistics and hospital morbidity data to provide an overview of the problem of motor vehicle injuries in Taiwan and make several suggestions for improving injury surveillance.

The epidemiology of a measles outbreak on a remote offshore island near Taiwan.

In September-October 1985, a measles outbreak occurred among elementary school students on a small offshore island near Taiwan. The outbreak began with nosocomial transmission of measles in a hospital emergency room on the main island of Taiwan. Four distinct generations of transmission occurred among elementary school children an their household contacts. Elementary school children were susceptible to measles because they were born after the last major outbreak, but before measles vaccine was locally available. Low immunization rates and low vaccine efficacy contributed to the spread of measles among preschool-age household contacts.

An outbreak of type A foodborne botulism in Taiwan due to commercially preserved peanuts.

Until recently, botulism was not recognized as an important public health problem in Taiwan. In 1986, an outbreak of type A foodborne botulism resulted in nine cases, two of them fatal. The vehicle in this outbreak was commercially preserved peanuts processed by an improperly equipped, unlicensed cannery. A single batch of peanuts was implicated; however, we could not determine why this particular batch was contaminated. Efforts to recall the product were hampered by a lack of distribution records. Mass media announcements were used to warn the public about the outbreak, and preliminary data suggest the ensuing publicity improved botulism surveillance. The local preference for low-acid preserved foods, increasing consumerism, the shortage of adequately trained inspectors are factors which probably contributed to this outbreak. Stricter enforcement of food sanitation policies are needed to meet the changing situation in Taiwan.

Outbreak of acute hemorrhagic conjunctivitis due to coxsackie A24 variant--Taiwan.

Outbreaks of acute hemorrhagic conjunctivitis caused by enterovirus 70 and several serotypes of adenovirus have occurred in Taiwan since 1971. In 1980-1981, there was a pandemic of acute hemorrhagic conjunctivitis in southeast Asia caused by coxsackie A24 variant (CA24v); however, this virus did not affect Taiwan. In October 1985, CA24v was isolated for the first time from patients with acute hemorrhagic conjunctivitis in southern Taiwan. The following summer, a large epidemic of acute hemorrhagic conjunctivitis due to CA24v occurred. An epidemiologic investigation of patients seen at one ophthalmology clinic in Taipei City revealed that school-age children were the most likely group to introduce illness into households (p less than 0.001) and that males were more often household index cases than were females (p less than 0.01). Multiple case households tended to be more crowded (3.0 vs. 2.5 persons per bathroom; p less than 0.05) and had illness introduced by younger family members (median age of index case = 10 vs. 17 years; p less than 0.01). It is unknown whether this outbreak is an isolated occurrence or represents another resurgence of CA24v in the area.

Outbreak of scombroid fish poisoning, Taiwan.

Fish implicated in outbreaks of scombroid poisoning have usually undergone prolonged storage at an inadequate temperature. We report an outbreak of scombroid poisoning in which fish stored on ice for two days caused illness after standing at room temperature for only three to four hours; fish from the same catch did not cause illness after standing at room temperature only one hour. This outbreak suggests scombrotoxins may be produced more rapidly than previously thought possible.

Estimating health service utilization, immunization coverage, and childhood mortality: a new approach in Uganda.

PIP: Interviews were conducted in the 75 households nearest to each of the 36 rural health facilities in Uganda's Mbale District in order to estimate childhood morbidity/mortality and the utilization of health services. Data were obtained on 2596 children under 5 years of age. There were 50 deaths in the 527 live births in the 12 months preceding the survey, giving an infant mortality rate of 95/1000. There were an additional 51 deaths among the 2069 children 1-4 years of age (25/1000). 34% of deaths among infants and 69% of deaths among children 1-4 years of age were associated with diarrhea. Of the 2495 children 0-4 years of age who were alive at the time of the survey, 506 (20%) had diarrhea in the 2 weeks preceding the survey and there was a diarrhea morbidity rate of 3.2 episodes/year/child. Only 60 (12%) of the children with diarrhea were treated with some form of oral rehydration; 314 (62%) were given drugs obtained from local pharmacies. Finally, only 38% of children 1-4 years of age and 21% of infants under 1 year of age were fully immunized for their age. These findings suggest high rates of childhood mortality and underutilization of preventive health services among households in the immediate vicinity of health facilities. This research approach can be used to facilitate program evaluation, even though the results cannot be generalized to the entire population of the district. It provides local health workers with an opportunity to assess their community's health needs and motivates them to improve health care delivery.^ieng

A seroprevalence survey of hepatitis B markers among Haitians in a southwest Florida farming community.

We determined the seroprevalence of hepatitis B virus markers among 123 Haitian mothers and children in a southwest Florida farming community. Fifty-five per cent of mothers had one or more markers including two who were HBsAg positive. Only seven (10 per cent) children had markers; none were HBsAg positive. Pregnant Haitian women should be screened for HBsAg and infants born to those who are positive should receive immunoprophylaxis. Medical, dental, and laboratory workers caring for Haitian patients should also receive hepatitis B vaccine.

Acute hemorrhagic conjunctivitis, Key West, Florida. An assessment of risk factors for introduction of illness into households and secondary spread during the 1981 epidemic.

From August 22 to November 6, 1981, 989 cases of acute hemorrhagic conjunctivitis were identified in Key West, Florida. The outbreak probably began when an infected 12-year-old Key West resident returned from the Bahamas and transmitted the illness to several neighborhood playmates. The rate of illness was highest for school-aged children, and a high proportion of cases occurred among blacks living in two adjacent low-income housing tracts. A telephone survey of persons living in these two tracts showed that the risk for introduction of illness into a household was 3.8 times greater for families with school-aged children. A study of 100 case households showed that black race, living in the two low-income housing tracts, and having a high ratio of family members per bathroom were variables significantly associated with multiple case households. To limit intracommunity spread of illness, symptomatic children were excluded from school for a period of seven days. The number of reported cases steadily decreased after school exclusion was implemented.

Dengue fever in the United States. A report of a cluster of imported cases and review of the clinical, epidemiologic, and public health aspects of the disease.

In the United States during 1981, fourteen state health departments reported a total of 44 imported cases of dengue fever. Most originated in the Caribbean, where dengue type 4 has reached pandemic proportions. Because the mosquito vector for dengue is abundant throughout the southeast and imported cases continue to occur, the possibility exists for indigenous dengue transmission. We report a cluster of imported dengue type 1 cases in Florida, discuss the clinical, epidemiologic, and public health aspects of the disease, and make recommendations as to how clinicians can assist public health officials in minimizing the risk of indigenous dengue transmission in the United States.

Autogenous vaccine therapy for condyloma acuminatum. A double-blind controlled study.

In an attempt to substantiate claims that autogenous vaccine is an effective form of immunotherapy for condyloma acuminatum, a double-blind cross-over study was carried out on 34 patients, in which autogenous wart vaccine was compared with a placebo vaccine identically prepared from each patient's own normal skin. It was found that the duration of disease was an important determinant of curability in patients with condylomata acuminata (P less than 0.001) and that when this factor was taken into account autogenous wart vaccine was not significantly more effective than the placebo (P = 0.43).