Factors affecting illness in the developing world: chronic disease, mental health and traditional medicine cures.

This is a case report of a 24-year-old Ethiopian woman with a medical history of hepatosplenic schistosomiasis. She suffers from chronic liver failure and portal hypertension. She has been hospitalised for 'hysteria' in the past but did not receive follow-up, outpatient treatment or psychiatric evaluation. After discontinuing her medications and leaving her family to use holy water, a religious medicine used by many Ethiopians, she was found at a nearby monastery. She was non-communicative and difficult to arouse. The patient was rushed to nearby University of Gondar Hospital where she received treatment for hepatic encephalopathy and spontaneous bacterial peritonitis. Her illness is the result of neglected tropical disease, reliance on traditional medicine as opposed to biomedical services and the poor state of psychiatric care in the developing world.

Raw-fish-eating behavior and fishborne zoonotic trematode infection in people of northern Vietnam.

Raw fish consumption in restaurants, for example, Sashimi style, is popular worldwide. In Vietnam, raw fish dishes are also traditionally prepared and consumed in private households. However, the habits of eating raw or otherwise inadequately cooked fish can be associated with risks of acquiring fishborne zoonotic trematode (FZT) infection. The present study was done in a fish-farming community in Nam Dinh, Vietnam, to obtain information about habits of eating raw fish dishes and risks for human FZT infection. Discussions were held in different groups divided by gender and age on raw-fish-eating behavior. A total of 180 household members were interviewed and their stool samples analyzed to identify risk factors of FZT infection. There was awareness about the risk of liver fluke infections from eating raw fish. However, many older people accepted these risks and continued eating raw fish, as they know effective drug treatment is available. Raw fish dishes are consumed at social gatherings from shared plates and dipping sauces using the same chop sticks. This is likely to pose risks of crosscontamination with FZT metacercariae to different food items as indicated by the finding that 25.8% of household members that stated not to have eaten raw fish were infected. In total, 32.2% fish farm household members were infected with FZT. The odds of FZT infection was 2.3 times higher (p = 0.013) for those eating raw fish than for those who did not eat raw fish. Among the people eating raw fish, those eating raw fish in restaurants had 3.6 times higher odds of FZT infection (p = 0.009) than people eating raw fish at home. A successful program to control FZT must be based on in-depth knowledge on the social and anthropological determinants of people's raw-fish-eating behavior and hygiene practices as well as production of FZT-free fish for human consumption.