Brazil's response to the polio outbreak in Angola.

PIP: The Brazilian government responded to the poliomyelitis outbreak in Angola by organizing a team tasked at implementing measures that would avoid the risk of importation of wild poliovirus to their country. This team is comprised of representatives from the National Health Foundation of the Ministry of Health and a staff from the Pan American Health Organization. The team enhanced the surveillance of acute flaccid paralysis (AFP) in hospitals of cities that were most likely to have visitors from Angola. In Rio de Janeiro, children under 5 years who were living in areas with the most number of Angolans were administered with oral poliomyelitis vaccine (OPV). Furthermore, the National Immunization Advisory Committee recommended that all people traveling from Brazil to Angola and to other endemic areas should be immunized with at least one dose of OPV prior to traveling. Physicians were also advised to follow certain recommendations that include immediate notification of any AFP case, full investigation, and immunization guidelines for travelers. In addition, all 27 states agreed to review coverage data by municipality so that risk areas or groups can be identified.^ieng

The historical question of acquired immunodeficiency syndrome in the 1960s in the Congo River basin area in relation to cryptococcal meningitis.

In Europe before the advent of the acquired immunodeficiency syndrome (AIDS), fatal cases of infection with Cryptococcus neoformans resembling acute meningitis were rarely described and never in young adults. However, rapidly fatal cryptococcal meningitis in young Africans has been known to exist in central Africa for at least 30 years, mainly in the lower area of the Congo River basin. Cases have been reported in this area since 1953, particularly in young patients during the 1950s. It is also known that central African AIDS patients frequently suffer from cryptococcosis, and there is a possibility that earlier clinical reports of encephalitis were actually fatal cases of AIDS in young Africans. It appears possible that the central part of the African continent is the area where human immunodeficiency virus originated.

PIP: Rapidly fatal cryptococcal meningitis has existed in central Africa for more than 30 years, mainly in the lower area of the Congo River basin. Cases have been reported in that area since 1953, especially among young patients during the 1950s. People with AIDS in central Africa also often have cryptococcosis, and it is possible that earlier clinical reports of encephalitis were actually fatal cases of AIDS in young Africans. Before the advent of AIDS in Europe, fatal cases of infection with Cryptococcus neoformans resembling acute meningitis were rare and nonexistent in young adults. The available evidence suggests that HIV may have originated in central Africa, where it had long remained in a specific, but unknown and overlooked habitat. Cryptococcosis infection, cryptococcosis in the Congo River basin, the historical presence of HIV, and HIV in Haiti and among Haitians are discussed.

Estimates and explanations of gender differentials in contraceptive prevalence rates.

This article examines gender differentials in the reporting of contraceptive use and offers explanations regarding the sources of these differences. Data from five countries where DHS surveys were conducted recently among men and women are used in exploring these differences. The gap exists in all five countries, with men (or husbands) reporting greater practice of contraception than women (or wives). Results from the bivariate analysis suggest that the gap is attributable to polygyny and to gender differences in how the purpose of contraception is understood, rather than to male extramarital sexual relations. Additionally, gender differences in the definition of certain contraceptive methods and differences in the interpretation of questions about contraception contribute to the observed gap. These findings are also consistent with results of the multivariate analysis.

PIP: An analysis of Demographic and Health Survey data from Central African Republic, Ghana, Haiti, Kenya, and Zimbabwe revealed large gender differentials in the reporting of contraceptive use. In all five countries, men/husbands reported greater practice of contraception than women/wives. This gap ranged from 5 percentage points in Ghana to 25 percentage points in Kenya. The reporting of contraceptive use by only one partner of a couple may result from multiple sexual relationships, secret contraceptive use, or differential perceptions of what constitutes contraception. In these five countries, most of the gender gap was associated with condoms, abstinence, and (in Zimbabwe) the pill. An analysis of these differentials suggests more overreporting of current use among husbands than underreporting among wives. To the extent that polygynous men are more likely than their wives to report use of methods of which the wife would have equal or more knowledge than the husband (e.g., the pill), a polygyny effect is indicated in Zimbabwe. The results for Ghana and Kenya (the only surveys where information on knowledge of the ovulatory cycle is available for husbands) suggest the gap in reporting of periodic abstinence results mainly from husband's inaccurate knowledge of the reproductive cycle and this method. Finally, if all the gaps in condom use between marital partners are attributed to the assumption of the differential role of condom use (pregnancy and sexually transmitted disease prevention), this factor would explain 12% (Haiti) to 38% (Ghana and Zimbabwe) of the net gap in contraceptive prevalence rate estimates. More detailed questioning on the use of condoms and periodic abstinence would improve the reliability of these surveys.

Effect of early, short-term supplementation on weight and linear growth of 4-7-mo-old infants in developing countries: a four-country randomized trial.

The effect of supplementation on growth was tested by means of four similar controlled randomized trials in the Congo (n = 120), Senegal (n = 110), Bolivia (n = 127), and New Caledonia (n = 90). Four-month-old infants were randomly allocated to supplement or control groups. A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored. Both groups were free to eat local food. At 7 mo of age, all infants were still breast-fed in the Congo, Senegal, and Bolivia compared with 47% in New Caledonia. Mean daily consumption of the supplement varied among countries (558-790 kJ/d). Mean length at 4 mo was lowest in Bolivia, higher in Senegal and the Congo, and near the National Center for Health Statistics reference in New Caledonia. The mean 4-7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal (P < 0.05), whereas weight increments did not differ. No significant effect was found in the other countries.

PIP: Findings from this study of the link between nutritional supplementation during breast feeding and infant growth disagree with earlier studies. The effect of nutritional supplementation on growth in length was only modest, but significant only in Senegal and not significant in the Congo, Bolivia, and New Caledonia. It is hypothesized that food supplementation during the 4-7 month period would have a positive effect on linear growth. This study included four controlled randomized trials among 120 infants in the Congo, 110 infants in Senegal, 127 infants in Bolivia, and 90 infants in New Caledonia. The infants were 4 months old when placed in the supplement or control groups. Supplementation included the addition of a cereal-based precooked porridge twice daily for 3 months. Both groups continued to eat local foods. Breast feeding patterns were different in New Caledonia, where only 47% of infants were still breast fed at 7 months of age. Mean daily supplementation varied among countries, from 558 to 790 kJ/day. Mean length was lowest in Bolivia, higher in Senegal and the Congo, and close to the US National Center for Health Statistics reference measures in New Caledonia. The study was conducted in rural parts of Senegal and New Caledonia and periurban parts of Bolivia and the Congo. Supplementation was supervised by field workers. The samples included infants with a length-for-age score of -2.5 or higher and a weight-for-length Z score of -2 or higher at 4 months. Anthropometric measurements were taken at 4 months and 4, 8, and 13 weeks later (at 4.9, 5.8, and 7.0 months of age). 24-hour food recalls were collected monthly for consumption of breast milk, special local infant food, commercial "western" baby food, milk substitutes, family food, water, and other than milk liquids.

Patterns of reproduction among the Fang of Nsork (Equatorial Guinea): pregnancies, abortions and child spacing.

Fang women are known to practice virtually no contraception but for them induced abortion is not an acceptable option. Their reproductive behaviour consequently is governed by the ability to conceive, spontaneous intrauterine mortality and child spacing (due to prolonged breast-feeding and sexual abstinence). In a sample of 587 women from one hospital and one clinic in Nsork, there was a positive correlation between maternal age and the number of pregnancies, resulting in a mean of 5.52 pregnancies per female and one child born every 2.5 years. The reported spontaneous abortion rate was 28.6%.

PIP: Data were collected in the only hospital built in the Nsork district of Equatorial Guinea. Group A comprised deliveries at Nsork Hospital from March 1988 to July 1990 (29 months). Maternal age, number of previous pregnancies, and number of fetal losses from the fourth month of pregnancy were recorded. The total sample comprised 157 women aged 15-40 years who had a total of 555 pregnancies. Group B data were collected from May 1987 to December 1988 (20 months) from the prenatal clinic at a primary health post from a total of 430 pregnant women aged 14-45 years. Group A women represented 15.6% of all women in the district between 15 and 39 years of age; Group B, 36.5% between 15 and 44 years of age. There was a high level of prenatal attendances in Group B; however, only 20.2% of clinic visitors gave birth at the hospital. In Group A, the number of reported pregnancies continued to rise in direct relation to the woman's age (correlation coefficient r = .91). The reproductive age range of this population was 15 to 40 years with a mean of 5.52 pregnancies. The average number of reported abortions per female was .48 for each age group (p .05). The total incidence of fetal loss was 28.3%, 23.9% of which was reported by women with one abortion and 4.4% by women with at least two abortions. Group A had effective child spacing, achieved by a combination of sexual abstinence and prolonged breast feeding. Sexual abstinence was practiced after the seventh month of pregnancy until breast feeding ceased, and breast feeding was continued until the newborn was aged 16-21 months. The pattern of child spacing calculated from the regression between mean number of conceptions per woman and maternal age (r = .91, p .05) was around one pregnancy every 30 months. The data represented a population with close to natural fertility, since their reproduction was not deliberately controlled and there was no cessation of reproduction once the desired family size had been attained.

Lymphogranuloma venereum in women.

PIP: This paper describes a sexually transmitted disease, lymphogranuloma venereum (LGV), caused by chlamydial serotypes L1, L2, and L3 and suggests possible treatments. LGV is most prevalent in the tropics of South America, Africa, India, Southeast Asia, and the West Indies. The clinical course of LGV is divided into three stages: primary, secondary, and tertiary stages. Complement fixation, microimmunofluorescence tests, and tissue culturing of chlamydia are the most commonly used diagnostic methods. LGV is more commonly found in urban areas than in rural settings. Acute LGV is more common in men, while chronic LGV is more common in women. Open lesions form at the entry site and systemically spread to infect the lymphatic system and vital organs. LGV may have a variety of symptoms, including the pathologically important lesions from which a diagnostic sample may be taken. Diagnosis may be difficult due to a number of similar organisms which manifest symptoms like LGV. LGV diagnosis is based on one of five methods: radiological examination, positive chlamydial blood tests, isolation of the LGV causing chlamydia, a positive skin test, or histological identification of chlamydia from a tissue biopsy. Tetracycline, doxycycline, or sulphonamides are generally prescribed in a treatment program. Surgery may be required for tertiary cases in which anal or rectovaginal fistulae have formed. Reconstructive genital surgery may also be necessary.^ieng

Macroepidemiology of the HIVs-AIDS (HAIDS) pandemic. Insufficiently considered zoological and geopolitical aspects.

The human immunodeficiency viruses (HIVs)-acquired immunodeficiency syndrome (AIDS) or HAIDS pandemic originated from lentiviruses of nonhuman primates (thus qualifying as a zoonosis) that moved into humans in Africa. The HAIDS patients eventually die of opportunistic infections, all potentially zoonotic. The HAIDS infection remained parochial, first endemically and then epidemically, until the African urbanization that occurred in each of the countries postindependence. The latter included wars and the massive movement of soldiers (virologically naive) from the American continent to Africa and back. The HAIDS viral ecology coincided with African swine fever (ASF) in the Americas. Haiti became the focal point for both infections. Some infected Haitians also became, together with some infected drug addicts in the United States, a source of contaminated human blood for transfusions and production of plasma derivatives.

PIP: Nonhuman primate lentiviruses are the source of the HIV/AIDS (HAIDS) pandemic among humans. Thus HAIDS constitutes a zoonosis. Opportunistic infections which generally are the immediate cause of death in HAIDS patients tend to be zoonoses. Some of these include tuberculosis, cryptococcosis, cytomegalovirus, toxoplasmosis. Pneumocystis carinii, Listeria monocytogenes, and candidiasis. The HAIDS viral ecology paralleled the intense migration of African swine fever into the Caribbean and the continental Americas. Haitian laborers and prostitutes went to Zaire and later returned. Sexual tourism in Haiti and poor Haitian selling their blood for transfusions and production of plasma derivatives to be marketed to developed countries such as the US and France contributed to the spread of HAIDS from Haiti to developed countries. Thus African swine fever and HAIDS originated in this hemisphere from Haiti after being bought to Haiti from Africa. HAIDS began as an endemic regional disease in Africa then became a regional epidemic disease. After African countries gained independence, urbanization increased in Africa which accounted for the spread of HAIDS in each African country. The US and the USSR played their geopolitical games using and/or resulting in famine, war, and disrupted families on the African continent and elsewhere. Thus husbands from 1 continent were moved to armies and labor camps sometimes on another continent. Prostitution spread tremendously to fulfill women's economic needs and men's sexual needs. HAIDS spread along with these events, e.g. Cuba sent troops to Angola where they were mostly stationed near 2 countries with high HAIDS rates, Zaire and Namibia. These troops often returned to Cuba then returned to Africa. During the 1980s, HAIDS prevalence was 45 times higher among Cuban boat refugees and Marielito Cuban immigrants to the US than that claimed for all of Cuba. In fact, their HAIDS prevalence matched that of Cuba's Caribbean neighbors.

Tropical forests: present status and future outlook.

Tropical forests still cover almost 8 million km squared of the humid tropics but they are being destroyed at ever-more rapid rates. In 1989, the area deforested amounted to 142,200 km squared, or nearly 90% more than in 1979. Thus, whereas the 1989 amounted total to 1.8% of the remaining biome, the proportion could well continue to rise for the foreseeable future, until there is little forest in just a few decades. Deforestati on patterns are far from even throughout the biome. In much of the Southeast and Southern Asia, East and West Africa, and Central America, there is likely to be little forest left by the year 2000 or shortly thereafter. But in the Zaire basin, western Brazilian Amazonia, and the Guyana highlands, sizeable expanses of forest could persist a good while longer. The main agent of deforestation in the 'shifted cultivator' or displaced peasant, who, responding to land hunger and general lack of rural development in traditional farming areas of countries concerned, feels there is no alternative but to adopt a slash-and-burn lifestyle in forestlands. This person is now accounting for at least 60% of deforestation, a rapidly expanding proportion. However, he receives far less policy attention than the commercial logger, the cattle rancher, and other agents of deforestation.

[Primary care of low birth weight premature infants in the rural areas of Africa]. / Cuidados basicos de los prematuros de bajo peso en las areas rurales de Africa.

PIP: The Evangelical Medical Center in Nyankunde, Zaire, has had some success in treating low birth weight premature infants despite its lack of mechanical respiratory assistance and permanent parenteral feeding. But the norms and procedures for attending to newborns have varied in recent years due to frequent changes in the hospital's administration. A retrospective study was conducted of the 46 infants weighing 1800g or less who were born at the hospital between January 1985-February 1988 to determine the correlation between feeding, antibiotic therapy, and temperature control and survival of the infants. Feeding was considered accomplished if the infant accepted at least 90 ml/kg of maternal milk through a nasogastric tube on the 1st day with a progressive increase in liquids in the 3 following days. Antibiotic therapy was considered given when gentamycin, penicillin, or ampicillin was administered. The temperature was considered controlled if it was taken at least 4 times daily during the 1st 3 days. 7 of the 46 infants were excluded from the study, 3 because their birth weight was less than 1000 g and 4 for inadequate information. The 3 remaining infants had an average birth weight of 1510 g. Gestational ages at birth ranged from 30-35 weeks. 19 were male and 20 female. 27 (69%) survived and were discharged from the hospital. 8 boys and 4 girls died. The wright of those who died ranged from 1140-1760 g. 21 of the 26 who were fed survived, vs. only 6 of the 13 who were not fed. Almost all the mothers were capable of adequately breast feeding. 19 of the 24 patients receiving antibiotics survived, vs. 8 of the 15 who did not. 25 of the 34 whose temperature was routinely taken survived, vs. 2 of 5 for whom it was not. 17 of the 21 infants receiving all 3 forms of treatment survived (81%), vs. 10 of 18 who received none (56%). More detailed prospective studies are needed to confirm the effectiveness of these simple measures and to evaluate other measures appropriate for rural and poorly equipped maternity centers in developing countries.^ieng

Cesarean section.

PIP: The leading cause of maternal mortality and morbidity in developing countries is the lack of cesarean section deliveries due to the tremendous logistical, cost, and training problems associated with this procedure. This article describes the need for raising cesarean section rates in developing countries and what can be done with existing inadequate health care in these countries to increase these rates. 5 to 10% of all births should be done by cesarean section, yet only 0.3% of births in rural Zaire are cesarean sections. To help educate health officials about women who may need a cesarean section, this article provides: 5 basic warning signs of pregnancy complications, characteristics of high risk women, and women in their 3rd trimester who need to be referred. Crucial factors that delay mothers from getting prenatal care include cultural obstacles and undereducated traditional birth attendants. Complication signs include severe vomiting, swelling of face, feet and hands, vaginal bleeding, headache and fever. High risk mothers are age 18 or 35 years, have had 5 or more previous births, and under 150 cm. in height, experienced an abortion or stillbirth with previous pregnancy or delivered by cesarean section, had previous cephalo-pelvic disproportion or in labor 12 hours, or has chronic medical problems. Third trimester women experiencing or developing hypertensive diseases, non-vertex presentation, severe anemia, multiple birth or antepartum bleeding should be referred to a health center where a cesarean can be done if necessary.^ieng

[Problems posed by HIV infection in women in tropical zones]. / Les problèmes posés par l'infection à virus HIV chez les femmes en zone tropicale.

Retroviruses (mainly H.I.V. 1 and H.I.V. 2) are now largely spread over in Central Africa and Caribbean Islands, particularly in large cities. Their transmission is essentially horizontal and mainly sexual. As a matter of fact, sexual transmission is responsible in about 80% of the cases, leaving only a small percentage to transmission by needle (or by any aggressive material), blood or blood by-products. As far as sexual transmission is concerned, it is essentially heterosexual, in spite of the primary epidemic outbreak in the occidental world that focused interest toward male homosexual group, the first exposed to A.I.D.S. Nowadays we know that heterosexual transmission is important and bi-directionnal, even if transmission female to male has seemed to be more difficult to enlight, as it is common in sexually transmitted diseases. Transmission risk to an heterosexual partner is between 20 and 70%. Virus is present in semen, and in cervico-vaginalis secretions during all menstruation cycle. Vertical transmission, mother to child, through placenta or during delivery is frequent, and is of about 50%. First data on heterosexual transmission have been found in Central Africa, indicating high rates for prostitutes, their "customers", unmarried women with numerous partners, women with an other S.T.D. A.I.D.S. in child has been first described in Haïti and in Zaïre. The very important role played by heterosexual transmission imposed sanitary education and usage of contraceptives which are efficient but difficult to firmly recommended for social and cultural considerations.

PIP: The retrovirus responsible for AIDS began circulating in Africa during the 1970s. Seroepidemiologic studies in Zaire and elsewhere in Central Africa show infection rates of 6-10%, with urban rates even higher and most rural rates close to zero. The modes of transmission are analogous to those of hepatitis B. Homosexual transmission has probably played a small role in Africa. Most epidemiological studies in Central Africa show that almost all seropositive persons are young sexually active adults, with the most affected age groups 20-30 for women and 30-40 for men. The risk of male to female sexual transmission appears to be about 20%, but increases with prolonged relationships. Sperm is able to induce a chronic immunological stimulation and immune perturbations favoring clinical expression of the infection, especially if the sperm comes in contact with the partner's blood because of erosion of the vaginal or anal mucus. Infection of men by women is harder to demonstrate but it cannot yet be confirmed that there are significant differences related to sex. The virus is present in cervicovaginal secretions during the entire menstrual cycle. Seroprevalence rates among prostitutes in Central Africa have increased steadily and are correlated to the time spent as a prostitute and the annual number of clients. Sexually transmitted diseases that disturb the genital mucus appear to favor infection during heterosexual intercourse. In Zaire, 61% of women and 36% of men with AIDS are unmarried. For both sexes, numerous partners appear to increase the risk of infection. Frequent use of prostitutes increases the risk for men. Transmission from mothers to infants can occur during delivery or transplacentally during any trimester of pregnancy. The risk of transmission from an infected mother appears to be about 50%. HIV infection does not appear to have any specific clinical manifestation in the female genital tract. Some studies suggest that the likelihood of 1st trimester spontaneous abortion or of postnatal mortality is increased in infants of seropositive mothers. The clinical characteristics of AIDS in children are not specific and a positive serological test in necessary to confirm the diagnosis. Prevention of HIV infection in the foreseeable future will require health education and the use of condoms, which gained little acceptance in most of Africa.

A comparative description of infant feeding practices in Zaire, the Philippines and St. Kitts-Nevis.

PIP: Infant feeding issues and research commonly portray infant feeding practices as a dichotomous variable; i.e., breastfeeding vs. bottlefeeding. This research establishes the complexity and variability in infant feeding patterns in 3 sites in the developing world. Comparative data are presented on the modes and products used to feed infants in Kinshasa, Zaire; St. Kitts-Nevis, West indies; and Cebu City, Philippines. They demonstrate that in these areas most infants receive some breastmilk. Bottlefeeding is also common but is rarely the exclusive mode of feeding. And the prevalence, manner of use, and role of the bottle varies among the 3 sites. Early supplementation of breastmilk by a variety of liquids, semisolids, and solids is typical of all 3 areas. These findings have important implications for educators and policymakers, as well as for research efforts relating infant feeding practices to infant health outcomes.^ieng

News, views, trends: a world-wide survey of recent developments, fresh ideas and production plans.

PIP: Recent developments in the tobacco industry in several countries are described: 1) in the USSR the policy is not to encourage smoking but to produce pleasant cigarettes which are as harmless as possible; 2) in the US, a survey shows that in 1975 not more than 12.4% of men over age 21 smoked a pipe; 3) in Britain a new cigarette tax structure will cripple the cigarette industry's coupon scheme of which manufacturers make great use to secure brand loyalty; 4) in the Philippines a proposal to print a health warning on cigarette packets and in advertisements might affect cigarette and tobacco taxes, which contribute 47% of government income; 5) in the Netherlands health warnings will be printed on cigarette packs, 6) in Austria there has been an increase of 4.2% in cigarette smoking since late 1975; 7) in Poland anti-smoking officials have proposed that the name of the popular "Sport" cigarette be changed; 8) in Indonesia there has been a recovery in kretek sales; 9) in Denmark cigarette consumption increased 6% from 1974; and 10) in western Europe it has been shown that up to 99% of grocery stores in Ireland sell tobacco products, 91% in Britain, 30% in Austria, 17% in Spain, and 7% in Italy.^ieng