The impact of a public health department's expansion from a one-step to a two-step refugee screening process on the detection and initiation of treatment of latent tuberculosis.

OBJECTIVES: To determine, subsequent to the expansion of a county health department's refugee screening process from a one-step to a two-step process, the change in early loss to follow-up and time to initiation of treatment of new refugees with latent tuberculosis infection (LTBI). STUDY DESIGN: Quasi-experimental, quantitative. METHODS: Review of patient medical records. RESULTS: Among 384 refugees who met the case definition of LTBI without prior tuberculosis (TB) classification, the number of cases lost to early follow-up fell from 12.5% to 0% after expansion to a two-step screening process. The average interval between in-country arrival and initiation of LTBI treatment was shortened by 41.4%. DISCUSSION: The addition of a second step to the refugee screening process was correlated with significant improvements in the county's success in tracking and treating cases of LTBI in refugees. Given the disproportionate importance of foreign-born cases of LTBI to the incidence of TB disease in low-incidence countries, these improvements could have a substantial impact on overall TB control, and the process described could serve as a model for other local health department refugee screening programs.

Mass treatment of trachoma with azithromycin 1.5% eye drops in the Republic of Cameroon: feasibility, tolerance and effectiveness.

AIMS: An epidemiological study carried out in 2006 indicated a high prevalence of blinding trachoma in the Kolofata Health District, Far North Region, Republic of Cameroon. As a result, the national blindness control programme of Cameroon instituted a trachoma elimination programme using the SAFE strategy. METHODS: A campaign to treat the entire district population with azithromycin 1.5% eye drops was undertaken in February 2008. To measure the effectiveness of treatment on the prevalence of active trachoma, two epidemiological studies were conducted on a representative sample of children aged between 1 and 10 years. The first study was performed just prior to the treatment campaign and the second study was performed 1 year later. RESULTS: The prevalence of active forms of trachoma (trachomatous inflammation--follicular (TF) + TF/trachomatous inflammation--intense (TI)) dropped from 31.5 (95% CI 26.4 to 37.5)% before treatment to 6.3 (95% CI 4.1 to 9.6)% 1 year after treatment-a reduction of nearly 80%. There were no reports of serious or systemic side effects. Tolerance was excellent and no treatment was interrupted. CONCLUSION: Mass treatment with azithromycin 1.5% eye drops is feasible, well tolerated and effective.

Immediate nonallergic psychotic reaction to intramuscular procaine penicillin.

BACKGROUND: Though little known by medical personnel, an immediate nonallergic psychotic reaction to intramuscular procaine penicillin has been reported occasionally from many countries since 1951. MATERIALS AND METHODS: A case report describes a patient whose violent behavior, provoked by this reaction, resulted in legal action taken against him. Two other nonviolent cases are presented and are followed by a review of the literature. RESULTS: Signs and symptoms of this reaction that appears to be to the procaine component resemble a pressor response and are therefore contrary to the signs and symptoms of an anaphylactic reaction. Anxiety, hallucinations, hypertension, and tachycardia are characteristic. The reaction is self-limited. Long-term psychologic sequelae might be averted by adequate reassurance. CONCLUSIONS: The importance of procaine penicillin as an essential drug in many parts of the world should not be diminished; however, recognition of acute nonallergic psychotic reactions is of paramount importance to assure proper patient management and to avoid misinterpretation of aggressive behavior.

Early childhood feeding practices in northern Cameroon.

Following the identification of differences in disease patterns among infants from households of different social groups (Moslem and non-Moslem) in northern Cameroon, 534 mothers and their children 0-23 months old were studied to determine early childhood feeding practices in the 2 groups. Several significant differences were revealed. Compared with non-Moslem infants, Moslems were more likely to be given animal milk instead of breast milk before the age of 3 d. On average, millet pap was introduced to Moslem babies between their 1st and 2nd months and to non-Moslem babies between their 3rd and 4th months. Moslem mothers more commonly prepared pap with oil or cow butter as an ingredient. Moslem mothers also planned to wean their children at an earlier age than non-Moslems and were less likely to report boiling their children's drinking water. Moslem mothers of infants less than 5 months old were likely to believe their breast milk was insufficient. The implications of these findings on the higher incidence of infant diarrhoea, stunting and early childhood death among Moslems are discussed.

Family planning and tradition: a view from northern Cameroon.

Sometimes efforts to improve the quality of life can hasten the destruction of a whole way of life, in which case the "beneficiaries" can lose much more than they gain. This presents health workers and planners with difficult choices.

PIP: In the rural Kolofata district of northern Cameroon, children are seen as an asset because they insure adequate prosperity for their family through the accomplishment of many tasks while they are young and through the care given to their elderly parents when they grow up. In this part of the world, there is an abundance of fertile land and sources of water, and housing and fuel are readily available. This area is totally undeveloped in terms of transportation, communication, health, and education (in which there is little interest). People of many ethnic groups and 3 major religions live a harmonious life steeped in tradition, cultural taboos, and sorcery. While modern methods of contraception are nonexistent here, traditional behaviors control population growth. For example, most women withhold colostrum from their infants. Women whose infants have died may withhold breast feeding altogether and provide inappropriate substitutes. A high incidence of neonatal tetanus and sepsis is exacerbated by many traditional practices such as using unsterilized millet stalk to cut the umbilical cord. Mothers spit in their babies faces to show affection, allow the babies to drink their bath water, and expose infants to dense cooking smoke. In addition, neonatal scarification and unsterile uvulectomy increase opportunities for infection. Limits to conception include extended breast feeding and polygamy. These practices which seem to be so disadvantageous may have developed to encourage the survival of only the fittest. When modern health professionals try to replace "harmful" practices with "beneficial" ones, they are greeted with skepticism. It is difficult to condemn this response, especially when the health professionals espouse population control measures to a population whose very cultural existence is already threatened. Health programs must be flexible and be guided by close, careful regard for the history, beliefs, and traditions of the people being advised, or even forced, to accept changes.

Infant disease patterns in northern Cameroon.

The epidemiology of common diseases of infants seen in district health service clinics in a culturally heterogeneous population in northern Cameroon was studied. Significantly higher incidences were found for respiratory tract infection in infants of non-Moslem households, and for diarrhoea in infants of Moslem households. A subsequent interview survey of parents of children aged 0-5 years revealed a higher prevalence of smokers and millet stalk kitchens in the compounds of non-Moslems. Other possible risk factors were explored. The findings indicated that in this area the influence of culture on disease in infants is strong, and epidemiological differences among cultural groups should be considered in the design of disease control programmes in the community.

Caring for neonatal tetanus patients in a rural primary care setting in Nigeria: a review of 237 cases.

Two-hundred-and-thirty-seven consecutive cases of neonatal tetanus treated in a rural health facility in Nigeria were reviewed. In spite of a high proportion of short incubation cases, a relatively simple, low-cost protocol yielded results compatible with those obtained in tertiary care settings in Africa. An incubation period of 6 days or less was the strongest predictor of mortality. Other prognostic factors were related to cord care and affected boys more than girls. Incidence was 40 per cent greater during the rainy season than during the dry season.