Health status of the children in a high density town near Harare, Zimbabwe.

OBJECTIVES: To determine the health status of the children for conditions associated with poverty. DESIGN: Cross sectional. SETTING: Households in Chitungwiza, a dormitory town of Harare, Zimbabwe. SUBJECTS: 181 children less than five years of age in 1990 and 162 in 1993. MAIN OUTCOME MEASURES: Nutritional status and illness experienced by children. RESULTS: A total of 191 (90.0%) mothers breast fed for more than a year. Thirty two (24.2%) children more than six months old in 1990 and 24 (18.9%) in 1993 were offered less than three meals a day. Illnesses were most common (90.9%) in children aged six to 11 months old and decreased after this. Diarrhoea and coughs accounted for most of this excess (87.9%). Coughs alone affected 33.8% of children of all ages. Knowledge of making rehydration sugar/salt solution was wrong in 23.9% of mothers. Appropriate immunization was given to 85% of children in 1993. Twenty one (14.9%) children in 1990 and 15(12.2%) in 1993 were under 80% weight for age. Thirteen (8.7%) children in 1990 and 16 (10.8%) in 1993 were stunted. CONCLUSION: Breast feeding was generally satisfactory but the number of meals offered to a fifth of the children aged more than six months was inadequate. Instructions for making rehydration sugar/salt solution, on composition and quantity to be given should be made easily available so that the rate of mothers with wrong knowledge of making the sugar salt solution could be decreased. Children of age six to 11 months need to be kept warm to avoid coughs and need to be brought up in hygienic conditions to avoid diarrhoea.

Malaria in Zimbabwe: comparisons of IFAT levels, parasite and spleen rates among high, medium and lower altitude areas and between dry and rainy seasons.

OBJECTIVES: To study the extent of malaria prevalence among children at various elevations above sea level and in children during the dry and rainy seasons in Zimbabwe. DESIGN: Cross sectional. SETTING: Primary and secondary schools. SUBJECTS: The number of children (aged about eight years in Grade Three and 13 years in Form One) examined in November 1992 was 103 in Chitungwiza (above 1,200 m), 94 in Gokwe (900 to 1,200 m) and 96 in Sasame (under 900 m). In April 1993 it was 86 in Chitungwiza, 78 in Gokwe and 81 in Sasame. MAIN OUTCOME MEASURE: Indirect Fluorescent Antibody Test (IFAT) levels, parasite and spleen rates. RESULTS: No splenomegaly was detected in children in schools above 900 m. While no parasitaemia was detected in children in schools above 1200 m, one (0.6%, 95% CI to -0.6 to 1.7) child and 37 (20.9%, 95% CI 14.9 to 26.9) children in schools between 900 and 1,200 m and below 900 m, respectively, had parasitaemia. The IFAT levels were lowest in children in areas above 1,200 m and increased significantly with decreasing altitude (x2 for linear trend 332, p < 0.001). The parasite rate in the rainy season (39.5%, 95% CI 28.9 to 50.2) was significantly (p < 0.001) higher than that in the dry season (5.2%, 95% CI 0.8 to 9.7). No significant differences in the IFAT levels (p = 0.208) and in the spleen rates (p = 0.180) were observed between the dry and rainy seasons. Sixty five percent of all children in schools above 1,200 m visiting rural areas used no protective measures against malaria. All children in schools under 900 m reported that their homes were sprayed, but very few other prophylactic measures (seven children used antimalarial drugs and 15 children used a net) were reported. CONCLUSIONS: Malaria acquisition is uncommon above 900 m and the people in these areas are highly vulnerable to malaria.

PIP: There is only limited transmission of malaria in Zimbabwe's high plateau region, but malaria can nonetheless occur during the rainy season and be imported from lower areas. The areas of the country below 900 m are endemic for malaria, while the areas at 900-1200 m have malaria of low endemicity. Findings are reported from a cross-sectional study conducted to assess the extent of malaria prevalence among primary and secondary school children at various elevations in Zimbabwe and during the dry and rainy seasons. Participating children were approximately age 8 and 13 years. 103 children were examined in Chitungwiza in November 1992, 94 in Gokwe, and 96 in Sasame. In April 1993, the numbers of children examined were 86 in Chitungwiza, 78 in Gokwe, and 81 in Sasame. Findings are based upon indirect fluorescent antibody test (IFAT) levels, and parasite and spleen rates. No splenomegaly was detected in children in schools at elevations higher than 900 m. Parasitemia was not detected in children in schools above 1200 m, but was identified in 1 child at 900-1200 m and in 37 children under 900 m. IFAT levels were lowest in children in areas higher than 1200 m and increased significantly with decreasing altitude. The parasite rate during the rainy season was significantly higher than that during the dry season. No significant differences were observed in the IFAT levels and spleen rates between the dry and rainy seasons. 65% of all children in schools above 1200 m visiting rural areas used no protective measures against malaria, while all children in schools under 900 m reported that their homes were sprayed, but very few other prophylactic measures were reported.

Education, occupation and health status of people of age five years or more living in a high density urban area in Zimbabwe.

OBJECTIVE: To find out the education, occupation and health status of people aged five years or more living in a high density urban area in Zimbabwe. DESIGN: Cross sectional. SETTING: Households in Chitungwiza. SUBJECTS: Persons of age five years or more available in a household at the time of the survey. In 1990 and 1993, 822 and 1,023 people were surveyed, respectively. MAIN OUTCOME MEASURES: Educational level, employment, rate of smoking, nutritional status, blood pressure level, and rate of disability. RESULTS: After the age of 24 years, more males than females were observed in both periods. A much higher proportion (x2 = 20.34, df = 1, p < 0.001) of women were in informal employment in 1993 (28.6%) than in 1990 (12.9%). Meanwhile, about an equal proportion of men were in the informal sector in both periods (12.0% and 10.4% in 1990 and 1993, respectively). For females of age 15 years or more, fewer (40.8%) had attained secondary education than males (76.4%) in 1990 (x2 = 50.2, df = 1, p < 0.001). Overall, 208 (36.1%) men and eight (1.3%) women of age 15 years or more smoked. Raised blood pressure for both sexes increased significantly with age (x2 for linear trend = 20.21 for men and 65.81 for women, df = 1, p < 0.001 for both sexes). More women of age 45 years or more had raised blood pressure than men (x2 = 4.67, df = 1, p = 0.031). Many more women (8.0%) than men (0.7%) had a Ponderal Index of greater than 27 (x2 = 19.33, df = 1, p < 0.001). A total of 12 (1.5%) persons were disabled. CONCLUSION: Raised blood pressure and obesity mainly affected women and interventions to improve their health is recommended.

Can our people afford to live? The effect of changing economic conditions on high density urban dwellers around Harare, March 1992 to June 1993.

The Department of Community Medicine with the assistance of fourth year medical students have been monitoring the basic cost of living of high density urban dwellers near Harare from March 1992 to June 1993. The cheapest diet able to provide sufficient calories, protein and vitamin A for a standard family of five people was calculated, and also the average cost of rent, rates, essential travel and schooling for a month. Sixty to 80 people were interviewed on each of four occasions. The cost of basic foods increased by over 50 pc from $157.50 in March 1992 to $349.20 in June 1993, and the cost of rents, rate, transport and schooling from $230.63 to $268.43 in the same period. This gave an average total monthly cost of $388.18 in March 1992 and $617.63 in June 1993. Minimum costs were calculated by using the mean cost of rent and rates etc.--2 standard errors. This increase in the basic cost of living is compared with the wages of security guards and the implications regarding the affordability of health care.

Cancer of the oesophagus in Zimbabwe.

Data for oesophageal cancers were requested from the Cancer Registry of Zimbabwe for the three years 1986-1988. There were 437 cases notified compared with 783 cases recorded in the Government's Statistical returns. There was a ratio of 6.9 males to one female accounting for 13.2 pc of all reported cancers in males and 1.7 pc of cancers in females. Prevalence increased with age to a rate of around 83 per hundred thousand in men aged 55 and older and 19 per hundred thousand in women over 65 years old. Notifications are only received from the Central Hospitals in Harare and Bulawayo. Addresses were not available for 31 pc of patients so that geographical variations could not be determined accurately. However, higher rates occurred in Harare and in the Mashonaland Provinces. It is recommended that cancer notifications should be obtained from all Government, Mission and Private hospitals in Zimbabwe.

Age at menarche and the weight-for-height index.

The use of nominal and adjusted weight-for-height values using Tanner-Whitehouse standards and US National Center for Health Statistics (NCHS) standards was evaluated in a sample of 800 black rural primary schoolchildren aged 12-17 years. The study showed that nominal weight-for-height values for adolescents need adjusting to control for pubertal physiological developments when using Tanner-Whitehouse standards or NCHS reference series. It is suggested that in nutritional studies involving adolescents, especially in developing countries, the age at menarche be determined to ensure accurate calculation of the weight-for-height index and correct classification of children by the index, and that researchers should mention in their methodology whether the weight-for-height values presented are nominal values or adjusted values.

The health status of rural primary schoolchildren in Central Zambia.

In a study of 528 rural primary schoolchildren in Central Zambia, it was found that the health status of the schoolchildren was not good as indicated by inadequate nutrition, a high prevalence of S. haematobium (18%), hookworm (33%), and malaria (43%) infections. There were no statistically significant differences in prevalence of undernutrition between girls and boys and there were no significant trends with age. The treatment and control of hookworm disease, urinary schistosomiasis and malaria deserve a high priority in this area. As for malaria, until an international programme on its control can be developed, the acquisition of protective immunity is of paramount importance. This study shows how the use of 'simple' screening procedures can provide information to direct health education and other disease control measures in school health programmes. As the economic situation in Zambia is not good, the best hope for improvement of the children's health lies with environmental improvement in sanitation, water supplies and provision of basic health education.

Child growth and duration of breast feeding in urban Zambia.

STUDY OBJECTIVE: The aim was to investigate the relationship between duration of breast feeding and growth of children. DESIGN: The study was a survey of randomly selected clusters of households. SETTING: The study was community based and took place in an urban township with a population of over 43,000 people in Lusaka, the capital city of Zambia. PARTICIPANTS: The sample consisted of 438 children aged 0 to 59 months surveyed between October 1984 and June 1986. Due to missing information, 394 children were used in the analysis. MEASUREMENTS AND MAIN RESULTS: After controlling for confounding variables, duration of breast feeding was found to be associated with height for age among children in their first two years of life, but not in the later years of life. There was no significant protective effect of breast feeding on undernutrition and acute malnutrition as measured by weight for age and weight for height. CONCLUSIONS: The findings suggest that, in this community, duration of breast feeding is strongly associated with the linear growth experiences of children and the association changes with the infant's age. One strong risk factor suspected to be responsible for the poor growth performance of children in this study is the low nutritional quality of the weaning foods which are used to supplement breast milk during the lengthy weaning period.

Malaria in an urban and a rural area of Zambia.

Children in Lusaka and in a rural area in central Zambia were examined during November 1984 and April 1985 to assess the effect of urbanization on malaria transmission. Of 423 urban children examined in November, 2.4% had scanty parasitaemia, and low titres of malarial antibodies were found in 46%. These proportions increased in April to a parasite rate of 10.3% and malaria antibodies were detected by indirect fluorescent antibody tests (IFAT) in 62%. The presence of malaria antibodies was positively associated with journeys outside the main towns. Examination of paired sera from the 2 periods showed an association between a history of malaria and an increased antibody titre, but failed to show an association between travel outside the main towns and conversion from a negative to a positive IFAT. The spleen rate in children under 15 years old in Lusaka was 3%, indicating hypoendemic malaria. In rural children the parasite rate was 10% and 27% in the 2 seasons, respectively, and over 97% of the children had malaria antibodies. The spleen rate was 20%, indicating mesoendemic malaria. It is concluded that there is only low transmission of malaria in Lusaka so that many people do not develop resistance and are therefore at risk of severe attacks if they do become infected. Possible measures to protect the urban population are discussed.

Colloquia on radiation, arms race, chemical and biological warfare.

The 9th IPPNW Congress addressed radiation hazards and effects in several colloquia, one of which is reported here. This paper also reports on colloquia on the arms race and on chemical and biological weapons (CBW).

Ninth World Congress of International Physicians for the Prevention of Nuclear War: 'No more Hiroshimas'.

The Ninth (1989) World Congress of International Physicians for the Prevention of Nuclear War was held in Japan, at Hiroshima on 7-10 October, and at meetings in Nagasaki on 11-12 October and in other centres such as Kyoto in the following week.

Some risk factors for transmission of malaria in a population where control measures were applied in Zambia.

A total of 224 patients living in Lusaka, the capital city of Zambia, were treated for malaria in the University Teaching Hospital (UTH) and surveyed to determine the relationship between parasitaemia, malaria antibodies and travel outside Lusaka. Comparisons of those with parasitaemia or antibodies with those without suggested an increased risk among those who travelled out of Lusaka to high transmission areas and also among those who live in areas of Lusaka where transmission is considered to be high. This study shows that even if there is transmission of malaria in Lusaka, much of the malaria is contracted outside the city. Specificity and positive predictive values for the variables considered showed that these variables may be useful in a clinical situation in determining whether the patient has malaria or not. It is also suggested that these variables should be taken into consideration in assessing possibilities of malaria transmission in towns where control measures were once applied.

The role of some risk factors of exposure to malaria in determining the outcome of the immunofluorescent antibody test in an urban population.

Data obtained previously were analysed to assess the relative importance of variables which relate to the risk of exposure to malaria in explaining the level of indirect fluorescent antibody (IFAT) reactions observed among the urban study population. In the analysis specific activities, notably travelling out of the main towns, season when out of the main towns, length of period since having been out of the main towns, and history of having had malaria in the last year, were of help in predicting the level of IFAT reaction. Sensitivity and specificity values of history of malaria, history of having been out of the main towns, and serological results were higher in older people in both periods and were highest in the March-April 1985 survey period.

A case-control study of stillbirths at a teaching hospital in Zambia, 1979-80: serological investigations for selected infectious agents.

Sera were obtained from 266 mothers of singleton stillborn babies (cases) and 266 mothers of live-born babies (controls), matched for parity, who delivered at the University Teaching Hospital, Lusaka, Zambia, between October 1979 and April 1980. Tests were performed on 262 samples from cases and 261 from controls. The microhaemagglutination assay for Treponema pallidum (MHA-TP) was reactive in 54% of cases and 29% of controls; the rapid plasma reagin (RPR) 18-mm circle card test was reactive at a dilution of 1:16 or greater in 29% of cases and in 3.5% of controls. Both these differences are highly significant.Sera from cases and controls were further examined for evidence of cytomegalovirus, human (alpha) herpesvirus, hepatitis B virus, toxoplasma, and plasmodium infections. The only difference between sera from cases and controls was that cytomegalovirus antibody titres >/= 1:1024 occurred more often among cases. There was no relationship between antibody titre and birth weight.The results of this study emphasize the importance of screening pregnant women for syphilis. Treatment of those found to be infected should help prevent stillbirths due to syphilis.