Materials, methods and results of the Norplant training program.

Norplant subdermal implants for contraception were introduced into UK clinical practice in October 1993. Use of Norplant requires providers to learn additional skills. A training program designed to give providers to opportunity to obtain these skills was designed and implemented through the co-operation of Hoechst Roussel, JHPIEGO and members of the UK medical profession. Uptake of training for Norplant provision has been widespread and Norplant has been established as a realistic contraceptive choice for women in the UK. Introduction of Norplant in the UK has raised many issues that go beyond clinical considerations.

Control of deaths from diarrheal disease in rural communities: II. Motivating and monitoring the community.

In 1980 the Ministry of Health of Egypt undertook a short term investigation into means and methods to reduce the annually excessive number of preschool child deaths from Diarrheal Disease. This investigation sought to identify ways to overcome constraints related to logistics, supplies, and community participation. The unifying theme of this study was to examine the feasibility of stressing Oral Rehydration Therapy (ORT) instead of the then conventional parenteral treatment and heavy use of antibiotics. Study cells were arranged to test feasibility of placing responsibility for the intervention primarily with rural mothers, secondly with itinerant nurses. Appropriate health education programs, revised supervision and data collection systems were developed and implemented. Results limited to mortality indicators demonstrating that mothers could affect a significant decrease in the diarrhea-specific death rate were reported in an earlier paper. In this paper a more comprehensive presentation of various survey data associated with the investigation are presented. These data show that mothers were indeed able to recognize diarrheal disease and institute early and effective treatment, and that they developed remarkable skills of preparing safe oral rehydration fluids from home supplies of sugar and salt. In addition, the data show that health service staff increasingly gained confidence in ORT as demonstrated by increasing rates of utilization of the method, and as mothers indicated ORT to be the preferred method of treatment of diarrheal disease.

Nutrition intervention: an evaluation of six studies.

Six nutrition intervention studies were evaluated in the context of a predetermined methodology covering several categories of evaluative criteria. After a presentation of reasons for including each study, a summary is presented of the results of each study in light of the present investigators' evaluation and secondary analyses. Nutrition intervention programs can have a positive effect on health indices of infants and children, but much can be done in future nutrition projects to improve project design and thereby assist and facilitate more meaningful evaluations of nutrition intervention. To this end, a set of points for consideration by those designing nutrition intervention projects is provided.

Evaluation of Aedes albopictus tissue culture for use in association with arbovirus isolation.

The susceptibility and sensitivity of Aedes albopictus cell cultures to five different primary and four different low-passage arboviruses were tested. Yellow fever, West Nile, Ilesha, eastern equine encephalitis, and Flanders viruses replicated in A albopictus tissue cultures. Replication was determined by the ability of selected tissue culture fluids to infect suckling mice, and by recovery from tissue culture fluid of progressively increasing amounts of complement-fixing (CF) antigen with time. Virus persistence was demonstrated with Nodamura, western equine encephalitis, and Mayaro viruses, but multiplication was not proven; neither persistence nor multiplication was demonstrated with a Kemerovo group virus. When yellow fever and Ilesha viruses were simultaneously inoculated into A albopictus culture, CF antigen for each was consistently detected. In a more detailed comparative study of field specimens, 12 unpassaged strains of yellow fever virus were tested for infectivity in A albopictus tissue culture, Vero cells, and baby mice. Higher titers of virus were detected (0.8--2.3 log ID50 per ml) in Vero cell culture than in A albopictus tissue culture or baby mouse systems. These results suggest the feasibility of using A albopictus cells in association with the primary isolation of arboviruses.