Acceptability of rice-based and flavoured glucose-based oral rehydration solutions: a randomized controlled trial.

The acceptability of prepackaged rice-based (Oresol-R) and flavoured (Oresol-F) glucose-based oral rehydration salts (ORS) solutions was compared with that of standard glucose-based ORS (Oresol-G) in a randomized field trial. Additionally, it is determined if presenting rice-based ORS as a solution that would help stop diarrhoea (Oresol-K) enhanced its acceptability. A total of 437 non-dehydrated children aged less than five years presenting to health centres with acute diarrhoea were randomly assigned to the three ORS groups. Acceptability was determined by the amounts of ORS consumed at home by children still with diarrhoea on 24- or 48-hour follow-up. The amounts of ORS consumed by children given Oresol-R (54 [95% CL 38-70] mL/kg/24 h) and Oresol-F (47 [24-70]) were similar to the amount of Oresol-G (44 [32-56]). ORS consumption was not affected by the child's age, nutritional status, feeding before the episode, duration of diarrhoea at health centre visit, maternal education and previous ORS use. Informing the caretaker that rice-based ORS would help stop diarrhoea did not lead to increased consumption of the solution (Oresol-R 54 [38-70] mL/kg/24 h; Oresol-K 50 [32-68]). Solution preparation was likewise similar among the treatment groups. Reactions to the different ORS types were generally favourable but did not differ between the groups.

Promoting operational research on insecticide-treated netting: a joint TDR/IDRC initiative and call for research proposals.

The evidence in favour of insecticide-treated nets for reducing mortality from malaria among Africa children is becoming compelling. In order to support the next step in the development of this promising intervention the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and the International Development Research Centre (IDRC) decided to launch a joint initiative on operational research. In the first step, 3 reviews on the essential aspects of net technology, programme implementation and programme promotion were commissioned and will be published soon as a book. Secondly, expert opinion was sought regarding priority topics for research. Finally, a first round of research projects was funded and a call for more proposals is being widely advertised.

Improving vaccination coverage in urban areas through a health communication campaign: the 1990 Philippine experience.

From March to September 1990 the Philippine Department of Health, with the assistance of the HEALTHCOM Project, carried out a national mass-media communication campaign to support routine vaccination services. The essential elements of the campaign strategy were as follows: focusing on measles as a way to get mothers to bring their children to the health centre; emphasizing logistic knowledge in the mass-media messages, in particular popularizing a single day of the week as "vaccination day" and giving clear information about the age for measles vaccination; and focusing on urban areas, which had lower vaccination rates than rural areas. Evaluation of the effects of the campaign indicates an increase in vaccination coverage and a substantial increase in the timeliness of vaccination that can be attributed to improvement in carers' knowledge about vaccination. Furthermore, most of the observed increase in knowledge was related to exposure to the mass-media campaign. There was no evidence of any programmatic change that could account for the increase in vaccination or evidence that increased health education efforts at health centres could account for the change in knowledge. These results indicate that when countries meet certain conditions--a high level of access to the media, sufficient expertise and funds available to develop and produce high-quality radio and television advertisements, and a routine system that is able to serve the increased demand--a mass communication campaign can significantly improve vaccination coverage.

PIP: The Philippine Department of Health conducted a national mass media communication campaign during the period March-September 1990 to support routine vaccination services. The campaign focused upon measles as a way to get mothers to bring their children to the health center, emphasized logistic knowledge in the mass-media messages, and focused upon urban areas with lower vaccination rates than rural areas. Examples of logistic emphasis include designating one day per week as vaccination day and giving clear information about the age for measles vaccination. An increase in vaccination coverage and a substantial increase in the timeliness of vaccination were observed which may be attributed to the improvement in carers' knowledge about vaccination. Most observed increase in knowledge was related to campaign exposure. There was no evidence of any programmatic change which could account for the increase in vaccination or evidence that increased health education efforts at health centers could account for the change in knowledge. These results indicate that when countries meet certain conditions, a mass communication campaign can significantly improve vaccination coverage. Conditions include access to media, expertise, and funds to produce and air high quality television and radio spots, and a routine system capable of handling the increased demand.

The impact of the Healthcom mass media campaign on timely initiation of breastfeeding in Jordan.

Initiation of breastfeeding within several hours after a child's birth increases the likelihood of exclusive breastfeeding and longer duration of breastfeeding. However, common beliefs among mothers and health-care providers and routine hospital practices can constrain timely breastfeeding initiation. This article examines the impact of a mass media breastfeeding campaign in Jordan within the context of other activities occurring during and after the child's birth. The campaign had a positive impact on all mothers' knowledge, and on timely initiation of breastfeeding for home and public hospital deliveries, but not for those in private hospitals. The findings indicate that a communication campaign can bring about change in breastfeeding initiation behavior, but that providing mothers with information should be but one part of an integrated program to ensure that hospital and midwife policies and practices support timely initiation.

PIP: The study aim was to examine the role of mass communication in increasing timely initiation of breast feeding after a birth in Jordan through 1) a 2-day seminar on lactation management for health professionals, and 2) 2 intensive television and radio campaigns aired between May 15 and July 15, 1989 and from mid-March through April 1990. Surveys were conducted before the media campaign in August and September 1988 and after in July and August 1990. 930 interviews were carried out in 1988 among mothers under 35 years of age with a child under 2 years of age; and 777 women with children under 20 months of age in 1990. Sample were weighted because of differences. The results showed that breast feeding significantly from 90.5% to 97.2%. Among breast feeding mothers, timely initiation increased significantly from 40% to 54%; timely initiation increased significantly only in public hospitals and home births. Knowledge about initiation of breast feeding within 6 hours of the birth increased from 51% to 75%. Only 5% of mothers were unexposed. There was a low, significant correlation between campaigns exposure in 1990 and knowledge. Logistic regression analysis, controlling for demographic predictors of breast-feeding initiation, showed that changes in initiation were related to media exposure in general and exposure to the campaigns. Women with high media exposure were significantly more likely to initiate breast feeding within 6 hours of the birth, if the birth was after the media campaign. Significant predictors of breast-feeding initiation were rooming in, delivery without use of anesthesia, withholding of supplementary feedings during the first 3 days, health personnel's advice to the mother about breast-feeding initiation, and a day or early evening birth. Surprisingly, a strong positive predictor of timely initiation was a mother's having received formula to take home. Those less likely to initiate breast feeding within the first 6 hours were urban mothers and those with a first child; although both urban and rural mothers showed increased timely initiation, there were larger increases outside the city and among experienced mothers. Delayed initiation was influenced more by policies and routine practices than individual impacts. Independent predictors of timely initiation, that were interrelated, were parity, residence, and where the child was born, which when controlled for, showed that rural, experienced mothers showed a significantly greater change in timing behavior. Caution is urged in applying these findings to other countries, or applying these findings to supplementation or duration of breast feeding. A careful media campaign must also be supported with appropriate hospital policies and routines.

Measles vaccination and childhood mortality in rural Bangladesh.

To ascertain whether measles vaccination was associated with reduced mortality rates in rural Bangladeshi children, the authors conducted a case-control study in four contiguous areas, two of which had participated in an intensive measles vaccination program which began in the spring of 1982. Cases were 536 children who had died in the four-area region at the age of 10-60 months between April 1982 and December 1984. Two age- and sex-matched controls were selected from the four-area region for each case; each control had survived at least through the date of death of the matched case. Measles vaccination was associated with a 36% (95% confidence interval 21%-48%) proportionate reduction in the overall rate of death and a 57% (95% confidence interval 43%-67%) reduction in the rate of deaths directly attributed to measles or ascribed to diarrhea, respiratory illness, or malnutrition. The association of measles vaccination and reduced mortality remained unchanged after the authors restricted controls to children who had survived at least one year after the deaths of their matched cases. Moreover, children vaccinated in 1982 exhibited a sustained reduction in the rate of death in 1983 and 1984. The authors concluded that measles vaccination was associated with a pronounced and sustained reduction in the rate of death among children in this study.

Long-term complication of measles in rural Bangladesh.

A small retrospective study carried out in rural Bangladesh identified respiratory illness, diarrhoea and conjunctival dryness as complications of measles. A case-fatality rate of 1.3% was recorded. Association between length of diarrhoea and conjunctival dryness was noted. However, no difference was observed in the anthropometric data between cases and controls. The data suggest an association between measles, diarrhoea and clinical evidence of vitamin A deficiency, but fail to show an effect on growth in this small series.

Salmonellosis at rural and urban clinics in Bangladesh: epidemiologic and clinical characteristics.

The authors studied the frequency of diarrheal illness associated with non-typhi Salmonella at two clinics in Bangladesh for the years 1977-1979. Non-typhi salmonellae were isolated from 0.29% of fecal specimens or rectal swabs in an urban area and 0.26% of similar specimens in a rural area; the frequency of isolations peaked in the summer months. Isolations of Shigella and Vibrio cholerae were much more common than Salmonella. Only two of 50 Salmonella isolates were resistant to more than one antibiotic. None of 13 isolates tested produced an enterotoxin. S. java and S. virchow accounted for 64% of all the isolates. Patients with diarrheal illness associated with isolation of Salmonella frequency had vomiting (88%), watery diarrhea (78%), abdominal pain (61%), and fever (39%), but the clinical features of the illnesses and the socioeconomic backgrounds of the patients could not be distinguished from those of matched controls who were attending the same clinic. The infrequency of Salmonella infection in an area where several other bacterial and viral enteric diseases are hyperendemic requires further investigation.

Ectopic pregnancy and prior induced abortion.

We compared the prior pregnancy histories of 85 multigravid women with an ectopic pregnancy and 498 multigravid delivery comparison subjects. We found a relationship between the number of prior induced abortions and the risk of ectopic pregnancy: the crude relative risk of ectopic pregnancy was 1.6 for women with one prior induced abortion and 4.0 for women with two or more prior induced abortions; however, use of multivariate techniques to control confounding factors reduced the relative risks to 1.3 (95 per cent confidence interval, 0.6-2.7) and 2.6 (95 per cent confidence interval, 0.9-7.4), respectively. The analysis suggests that induced abortion may be one of several risk factors for ectopic pregnancy, particularly for women who have had abortions plus pelvic inflammatory disease or multiple abortions.