Lepra infantil: Estudio clinico y epidemiologico en dos servicios de dermatología del Paraguya. Periodo 2005-2011 / No disponible

Introducción: La lepra en niños es más frecuente de lo que se solía pensarse, sobre todo en países tropicales y subtropicales, como el Paraguay. Pediatras y dermatólogos deberían pensar en esta enfermedad para realizar de esta manera un diagnóstico precoz con el tratamiento específico. Objetivos: Generales: Conocer las características epidemiológicas y clínicas de la lepra infantil en dos Servicios de Dermatología del Paraguay. Específicos: Establecer las características epidemiológicas de la población en estudio. Determinar la frecuencia, tipo, características clínicas y estados reaccionales relacionando con el índice bacilar. Describir el manejo terapéutico que recibieron estos pacientes y su evolución. Material y Método: Diseño del estudio: Retrospectivo, observacional de cortetransversal. El estudio se lleva a cabo en la Cátedra de Dermatología del Hospital de Clínicas, Facultad de Ciencias Médicas-Universidad Nacional de Asunción y en el Servicio de Dermatología del Hospital Nacional de Itauguá, ambos de Paraguay. Población de estudio: Pacientes de ambos sexos dentro de la definición de edad pediátrica de la OMS (0-18 años) con diagnóstico confirmado de Lepra, durante el periodo de enero de 2005 a octubre de 2011. Criterios de inclusión: Todos los pacientes en edad pediátrica diagnosticados clínicamente y con confirmación anatomopatológica. Criterios de exclusión: Pacientes lepra que no estén comprendidos en la edad pediátrica en el momento del diagnóstico y que no tengan confirmación anatomopatológica. Fuentes de información: Historias clínicas de pacientes con diagnóstico de lepra.Resultados: Total de pacientes con lepra en ambos servicios fue de 416, y de éstos 9 estaban en edad pediátrica (2.2%). Predominio de pacientes de sexo masculino; la franja estaria más afectada es la de los escolares con 5 casos (56%) El IB osciló entre negativo a 3+. Seis de los nueve casos presentaron formas multibacilares, siendo la lepra lepromatosa la forma más frecuente. La evolución fue buena en todos los casos y tres desarrollaron leprorreacciones. Fue predominante la localización facial de las lesiones. Conclusiones: Los niños con lepra constituyen un grupo significativo de enfermos donde los contactos familiares probablemente representen un rol importante en su desarrollo. Las publicaciones actuales muestran un aumento de la incidencia de la lepra en niños (AU)

Background: Leprosy among children is more common than usually thought, especially in tropical and subtropical countries like ours. Pediatricians and dermatologists should consider this disease for so early diagnosis with specific treatment. Objectives: General: To determine the epidemiological and clinical characteristics of Hansen’s disease in children in two Dermatology Services of Paraguay. Specific: To establish the epidemiological characteristics of the study population. Describe the frequency, type and clinical characteristics of Hansen’s disease. Relate the bacillary index with the type of reactions. Describe the therapeutic management of these patients. Material and Methods: Study design: Retrospective, observational cross-sectional. The study was conducted at the Department of Dermatology, Hospital de Clinicas, Faculty of Medical Sciences, National University of Asuncion and the Dermatology Service of the National Hospital Itauguá, both of Paraguay. Study population: Patients of both sexes within the definition of pediatric by the WHO (0-18 years) with confirmed diagnosis of leprosy during the period January 2005 to October 2011. Inclusion criteria: All pediatric patients clinically diagnosed with Hansen’s disease and pathologic confirmation. Exclusion Criteria: Patients with Hansen’s disease not included in the pediatric age at the diagnosis and who have no pathological confirmation. Information sources: Clinical records of pediatric patients with clinical diagnosis of Hansen’s disease, confirmed by smear and pathology. Results: Total patients with leprosy in both services was 416, and of these 9 children had Hansen’s disease (2.2%). Predominance of male patients, the most affected age group is school children with 5 cases (56%). The IB ranged from negative to 3+. Six of the nine cases had multibacillary forms (MB), the diagnosis of HL being the most frequent. The evolution was good in all cases and only three developed reactions. Facial location of the lesions was predominant. Conclusions: Children with leprosy are a significant group of patients where family contacts are likely to represent an important role in its development. Theexisting literature shows an increased incidence of childhood leprosy (AU)

Availability of childhood social services in leprosy settlements in southern Nigeria.

BACKGROUND: Children of leprosy patients deserve social services such as free education, health care services including HIV/AIDS prevention like others. The extent to which these children benefit from such services is not clear. One expects that since they are exposed to health hazards in settlements that they would benefit immensely from preventive health care and other services. Study investigates the extent to which such services are available to them. METHODS: Study was carried out in 3 purposively selected leprosy settlements, Uzuakoli in Abia State, Ohaozara in Ebonyi State and Ogbomoso in Oyo State using 86 children from 10 years and above who are available during study. Structured questionnaire and interview schedule were instruments used. Data were analyzed with Stat Pac Gold package. RESULTS: Provision of social services to children of leprosy patients studied is limited. Only 13 (16.5%) of the children said their parents did not pay school fees. The rest paid. However, despite payment of fees, higher proportion of children in Abia State 43 (95.6%) more than in Oyo State 36 (87.9%) went to school P = .03. About 42 (97.7%) of children in Abia State and 30 (83.3%) in Oyo State lack knowledge of HIV prevention. Neither reproductive health services including HIV/AIDS prevention nor prophylactic treatments are available to them. CONCLUSION: In view of above results, increased social services including HIV/AIDS prevention, prophylactic treatments and health promotions are recommended.

Care and development of children in tribal areas.

PIP: About 53 million people (8% of the population) of India belong to various tribes in about 400 tribal communities. These groups live in different ecological geoclimatic conditions throughout India ranging from the Sub-Himalayas to the islands in the Bay of Bengal and in the Arabian Sea. They also differ in distinct biological traits and cultural and socioeconomic background. Due to cultural patterns which vary from tribe to tribe, they are all at different stages of social, cultural, and economic development. Since the tribes live in isolated and inaccessible areas, it is hard to implement health care and nutrition activities, elementary education, and preventive promotive health care. The government does plan to provide rural day care for 0-3 year old children. The Integrated Child Development Services (ICDS) Scheme reaches 2197 of 5143 tribal development blocks. ICDS activities include immunization of children and mothers, health education, and supplementary nutrition. The government also promotes primary health care in tribal areas. Despite these efforts, child welfare and development in tribal areas have not improved. Recently nongovernmental organizations have joined child welfare and development efforts in tribal areas. The Jigyansu Tribal Research Center has compiled a long list of recommendations to improve child welfare and development efforts in tribal areas including improving preventive activities especially those that target specific local diseases such as cerebral malaria and leprosy, introduction of traditional herbal medicines, and comprehensive data collection.^ieng

[Big venture to improve children's health]. / Stora satsningar för att förbättra barnens hälsa.

PIP: Health care problems are discussed by an employee of the Mozambican maternal and child health service. The most serious problems for children are malnutrition, infectious diseases, and a high incidence of illnesses in children under 5. The main objectives of health centers are to improve hygiene, combat tuberculosis, leprosy, and malaria as well as to provide maternal and child health care, including family planning. Trained staff advise pregnant women, and examine prospective mothers for anemia, malaria, and tetanus. Information on proper nutrition is provided, and every mother gets iron and folic acid pills, in addition to the antimalarial drug choloroquine. Incidences of tetanus in newborns have declined sharply in areas where a vaccination program has been carried out. By classifying the risk level of pregnant women, so-called "risk mothers" can be identified. Family planning methods include low-dose oral contraceptives, IUDs (the "spiral"), condoms, and foam. Regular weighing, examination, and vaccination of children is provided until age 5. Infant mortality is high, at least 150/1000 births, most of which are caused by diseases such as untreated diarrhea and measles. Malnourished children get specialized care, and vaccinations against polio, tuberculosis, diphtheria, tetanus, and measles are compulsory as is administration of chloroquine against malaria. Mobile teams of SMI (maternal-infant service) scan the countryside in remote areas where there is no village health center. Health personnel take a 6-month training course before being placed in charge of a village's hygiene, vaccination, and other tasks. The decline in illiteracy rates has resulted in better health of the population. The shortage of qualified health workers has been eased by an increase in the number of nursing and pediatric health care students. Finally, international assistance extended by the world Health Organization, Swedish-African aid organizations, and SIDA are contributing to the praiseworthy efforts of the Mozambican government to improve maternal and child health.^ieng

Community participation in health activities in an Amazon community of Brazil.

This article describes community participation in a comprehensive eight-year health program at Porto Nacional, a town in Brazils Amazon region. The authors discuss various techniques employed to encourage community participation, indicate methods used to resolve low-key conflicts in a positive manner, describe the major contributions made by community participation in this program, and present a number of conclusions considered applicable to other communities in this part of Brazil.

PIP: Community participation was found to be an important resource for ascertaining and achieving the project health goals of a multiprofessional health team in Porto Nacional, an Amazon community in Brazil's interior. The project was established in 1968 to provide comprehensive, integrated medical care. The health team consisted of 6 physicians (1 sanitarian, 2 surgeons, 2 internists, and 1 pediatrician), 2 social workers, 1 nurse, and 1 educator. The team assumed operating responsibility for the area's health unit and 50 bed hospital, and worked closely with other local health agencies and providers. To attract financial and technical resources, the team founded a non-profit agency, COMSAUDE, to promote health and educational activities. The area's health problems consisted of a predominance of waterborne and foodborne diseases, an infant mortality rate of approximately 70 deaths/1000 live births, high malaria morbidity, tuberculosis, leprosy, cutaneous leishmaniasis, a moderate incidence of Chagas' disease, and extensive infestation of vermin. The local health unit was well-known and accepted in the community which facilitated the team's activities. At the time of the team's arrival, the vermin problem was causing public concern. Work on controlling this problem appeared an appropriate vehicle to achieve the dual objectives of promoting sanitation activities and becoming familiar with and accepted by the community. A combination of home visits and general meetings with institutional and local leaders mobilized a significant segment of the population. Increased cesspool construction resulted. Among the poorest neighborhoods, residents developed an organization to finance the cost of construction materials. Technical assistance from sanitation aides was provided to rural communities. Municipal health boards were organized to assure maximum utilization of visiting physicians, to conduct health surveys, and to oversee the implementation of recommended preventive health measures. A health board of volunteers was initiated in Porto Nacional to identify health related problems and propose solutions within the scope of the local government. The board was responsible for improvements in sanitation at the market place and the organization of trash collection. Health surveys were conducted utilizing students from local schools as interviewers. The surveys increased community awareness of health problems in addition to providing health data. A center for malnourished children was established which served as a recuperation facility for the children and a nutrition and hygiene education center for mothers. A cooperative housing improvement program was initiated. Residents worked Saturdays gathering construction materials and working on neighbors' houses. The sanitation aides assisted in drawing plans and selecting building, cesspool, and well sites. The team participated in educational activities at the schools, including a controversial sex education/marriage preparation course that was ultimately limited to prospective newlyweds. Based on 8 years of program operation, the authors conclude that community participation is an important development resource and that the process of working together is as important as the results achieved.