Evaluating tetanus neonatorum as a child survival risk in rural Egypt in the absence of reliable cause-of-death registration.

The principal finding of the investigation is that neonatal tenanus is, indeed an important cause of infant death in rural Egypt even though the normal cause-of-death reporting system had not altered health authorities to the problem. The finding is based on a comparison of registration statistics with (anthropological) reconstruction of pregnancies and child survival using the case-history rather than the epidemiological method. The histories go back ten years and refer to 102 women in two villages of Egypt. An incidental finding is confirmation of the known deficiency of infant death reporting, and associated births, with the extra dividend of showing how serious this may be in the neonatal period. Another incidental finding is the identification of induced abortion as a health problem.

PIP: A short-term study of pregnancy, births, and child mortality was conducted in 2 Egyptian villages to assess the reliability of official statistical records that suggest that neonatal tetanus is rarely a cause of death. Through an anthropologic interview technique based on several visits, reproductive histories were collected from 102 women from 3 age groups: 15-29 years, 30-44 years, and 45 years and over. Respondents from village A, in Upper Egypt, had experienced an average of 8.2 pregnancies, while those from village B, in Lower Egypt, reported 7.3 pregnancies. A total of 114 abortions (14% of all pregnancies) and 14 stillbirths (1.7%) were recorded. Official statistics indicate that 82% of infants in village A and 89% of those in village B survived to age 5 years; however, data from the present study suggest that the 5-year survival rates in these 2 villages were actually 56% and 77%, respectively. Moreover, although vital statistics indicate a rate of neonatal tetanus of 1/6 or less, 75% of the 87 neonatal deaths identified in this study were attributed to tetanus neonatorum/septicemia. Prematurity was the cause of an additional 13% of neonatal deaths in this survey compared with 0.1% of such deaths in official statistics. The results of this study indicate that the underregistration of births and deaths may be a major problem in these 2 villages and probably in other villages in rural Egypt. Neonatal tetanus as a cause of infant mortality was more prevalent in village A (39%) than in village B (9%), presumably because of the higher level of socioeconomic development in the latter region. It is estimated that tetanus immunization of eligible women would have reduced neonatal mortality from 193 to 33/1000 in village A and from 51 to 36/1000 in village B.

Control of deaths from diarrheal disease in rural communities. I. Design of an intervention study and effects on child mortality.

From May through October 1980, the "Strengthening Rural Health Delivery" project (SRHD) under the Rural Health Department of the Ministry of Health of Egypt had conducted an investigation into prevention of child mortality from diarrheal disease through testing various modules of Oral Rehydration Therapy delivery mechanisms. In a six-cell design counting a total of almost 29,000 children, ORT was provided both as hypotonic sucrose/salt solution prepared and administered by mothers and normotonic, balanced electrolyte solution in the hands of both mothers and health care providers and the effects on child mortality during the peak season of diarrheal incidence were measured. In addition, utilization and effects of ORT when made readily available through commercial channels was similarly examined. A cost-benefit analysis was performed on the cost of the services as well as on the outcome for each of five study cells using the sixth, the control, as reference. Results showed that early rehydration with a sucrose/salt solution in the hands of mothers, backed by balanced oral rehydration solution in the hands of health care providers proved the most cost-effective means of reducing diarrhea-specific mortality as well as being as safe as prepackaged commercial preparations.

PIP: A study design consisting of 2 control and 4 treatment cells was used to compare the effectiveness of different compositions of oral rehydration fluids and preventing dehydration and ultimately child deaths from diarrheal disease. Specifically, the extent of reduction in child mortality among 3 groups was compared: 1 group used a combination of oral rehdration therapy (ORT) prepared from the home ingredients of sugar and salt and administered by the mother and ("Oralyte") placed in the hands of the health care providers only; and 1 group used "Oralyte" only administered by both mothers and health care providers. Several data collection processes were employed to collect data on both baseline, intermediate (process), and impact (outcome) variables, including household surveys on demographic composition, sources of (drinking) water, incidence of diarrheal disease, knowledge and practice (KP) of mothers on diarrheal disease (DD) recognition and treatment regimen, availability of utensils and supplies necessary for the preparation of rehydration fluid, sodium concentration of randomly selected samples of home prepared rehydration fluids. In all study villages, the clerk in each health station maintained a regular count of the number of preschool children who had died within the preceding week. Age, sex, house number, and father's name were reported for each death. 2760 children (12.1%) of the total population under care in egypt's "Strengthening Rural Health Delivery" project were seen in the course of outpatient clinics during the 6 months of the program, May through October 1980. Overall, the rate of referral to secondary levels of care was almost 11 times higher in the control than treatment villages. From an initial level of about 22/1000 children per 6 months (May through October) in 1976-77, mortality dropped sigififcantly to a mean of 17.5/1000 in 1978-79 and to a mean of a mean of 10.5 by 1980 in the 3 treatment cells. A most important finding was the demonstration that ordinary household sugar and salt together with potassium containing fruits and vegetables or, intheir absence, tea, may serve as the basic ingredients of an alternative to, and temporary replacement of, the more costly and less readily available prepackaged ORS. This is not to suggest that a simple oral rehydration solution made from sugar and salt is as effective as the balanced "Oralyte", yet this simple solution when backed with adeqate supplies of "Oralyte" in the hands of the health care provider becomes a more cost effective means of reducing high child mortality from diarrheal disease than the "Oralyte" alone.

The schistosomiasis problem in Egypt.

This report provides an overview of past and current efforts to control schistosomiasis in Egypt, describes recent trends, and analyzes factors responsible for changes in transmission. For the purpose of long-term planning and developing control strategies, the country has been divided into eight geographic zones: Suez Canal Zone, Sainai, Nile Delta, Guiza, Fayoum, Middle Egypt, Upper Egypt, and the High Dam Lake Zone. Overall control priorities are examined and the strategy for each zone is described. The most recent information on changes in epidemiologic patterns of schistosomiasis in Egypt is mentioned, as well as the introduction of newer therapeutic agents. Lastly, the role of outside funding agencies in supporting schistosomiasis control is examined.