Risk factors for deaths in children under 5 years old in Bagamoyo district, Tanzania.

We conducted a population based case control study of deaths in children < 5 years old from Bagamoyo District, Tanzania, to evaluate factors associated with death, and factors associated with not utilizing Government health care system. Six hundred and ten children who died between 1 July, 1986 and 30 June 1987 were enrolled as cases; 1,160 healthy control children were selected by multistage random cluster sampling. Twenty-five percent of deaths were ascribed to pneumonia based on "verbal autopsy"; 39% of acute respiratory deaths occurred in children < 6 months of age. In a multivariate analysis, significant independent associations were found with mother as sole decision maker for treatment (O.R = 0.13; 95% C:I. 0.07, 0.22); use of water from village well, pond, or river vs. tap water (O.R. = 11.86; 95% C.I., 5.46, 25.72); the child eating with others (O.R. = 9.42; 95% C.I. 5.68, 15.62) and the child sleeping in the room where cooking is done (O.R. = 2.78; 95% C.I. 1.79, 4.33). Overall only 45% of families utilized Government health care (village health worker, dispensary or health centre) during their child's terminal illness. Families utilizing Government health care were significantly more likely to say that the mother alone could make treatment decision (O.R. = 2.49, 95% C.I. 1.39, 4.46), and to be closer to a dispensary. The main reasons for not utilizing Government health care were 'traditional medicine is better' (41%) and 'no drugs available' (38%).

Comparative efficacy of oral rifampin and topical chloramphenicol in eradicating conjunctival carriage of Haemophilus influenzae biogroup aegyptius. Brazilian Purpuric Fever Study Group.

Persistent conjunctival carriage of the Haemophilus influenzae biogroup aegyptius (Hae) strain (BPF clone) responsible for Brazilian purpuric fever (BPF) has been documented. Topical chloramphenicol is routinely used to treat conjunctivitis in areas affected by BPF in Brazil. Although the BPF clone is susceptible to chloramphenicol, we observed a number of children treated with topical chloramphenicol for conjunctivitis who still developed BPF. During an investigation of an outbreak of BPF in Mato Grosso State, Brazil, we compared oral rifampin (20 mg/kg/day for 4 days) with topical chloramphenicol for eradication of conjunctival carriage of H. influenzae biogroup aegyptius among children with presumed BPF clone conjunctivitis. Conjunctival samples were taken for culture on the day treatment was initiated and a mean of 8 and 21 days later. At 8 days the eradication rates for oral rifampin and topical chloramphenicol were 100 and 44%, respectively (P = 0.003); at 21 days they were 100 and 50% (P = 0.01). Oral rifampin was more effective than topical chloramphenicol for eradication of the BPF clone and may be useful in prevention of BPF.

Comparative efficacy of ceftriaxone and rifampicin in eradicating pharyngeal carriage of group A Neisseria meningitidis.

During an outbreak of meningococcal meningitis in Saudi Arabia, oral rifampicin (four doses in two days) was compared with a single intramuscular dose of ceftriaxone for prophylaxis in family contacts of patients with meningococcal disease. Pharyngeal samples were taken for culture before and 1 and 2 weeks after administration. Both follow-up cultures indicated that ceftriaxone was significantly more effective. At 1 week the eradication rates for ceftriaxone and rifampicin were 97% and 75%; at 2 weeks they were 97% and 81%, respectively. No serious side-effects were associated with either agent. Ceftriaxone may provide an effective alternative to rifampicin for prophylaxis in meningococcal contacts.