Use of health care services in two rural communities in Tanzania.

This study was undertaken to investigate the pattern of utilization of medical and dental health care services in rural Tanzania. Two hundred adults, 91 men and 109 women aged 20 or over, were interviewed. Nearly all subjects reported using modern dental and medical health care services. Home remedy was the only indigenous method of treatment used for dental problems while for medical problems a traditional healer was the most commonly used indigenous alternative. The use of both indigenous and modern health care services was significantly lower for dental than for medical problems (P < 0.05). It seems that the pattern of utilization of health care services differs for medical and dental problems. This should be taken into account when planning comprehensive health care services for rural African societies.

PIP: In September 1988 a dentist interviewed 91 men and 109 women aged 20 years and older living in 2 villages in Ilala, Tanzania, to study their pattern of utilization of dental and medical care services. Most adults had used modern dental and medical care services. Most adults had used modern dental and medical care services (96% and 98%, respectively). 84% of adults who used modern dental care services used a dentist, 23% a medical practitioner, and 1% a pharmacy. The only traditional method of treating dental problems was home remedy, which was used by men more often than women (30% vs. 18%; p .05). Use of analgesics likely was included among the home remedies. Adults probably did not use traditional healers for dental problems because they cannot alleviate the acute episodic dental pain. Dentists at hospitals using local anesthesia tend to do tooth extraction, the most common dental treatment in Tanzania. Adults were more likely to use both modern and traditional medical care services for medical problems than dental problems (p .05). They tended to use a traditional healer more often for medical problems than home remedies (61% vs. 34%; p .05). The farther people lived from the nearest modern medical health care unit, the greater the likelihood that they used traditional medical care services (92% for those living = or 5 km away vs. 61% for 5 km; p .05). Older adults were more likely to use both traditional dental and medical services (odds ratio [OR] = 3.85 and 2.65, respectively). Men tended to use traditional dental services more often than did women (OR = 3.93). These findings show that village-level modern dental health care has not been accorded a high priority. Existing medical staff at village-level health dispensaries should take on the responsibility for dental health.

Geographic tongue during a year of oral contraceptive cycles.

The geographic tongue of a 23-year-old female student was examined daily for one year. The size, number and location of the lesions were recorded using transparent films. The phase of the oral contraceptive cycle appeared to have a marked effect on the initiation and duration of the circinate lesions, the tongue changes being severest on the 17th day of the cycle. There was a positive correlation between the subjective complaint and the clinical picture of the tongue.

PIP: The number, location and extent of tongue lesions in a 23-year old woman with a tongue disorder called geographic tongue, who was taking the oral contraceptive Marvelon (Organon), were plotted for a year by tracing them daily on transparent film marked with a grid. These lesions appear as desquamation of the filiform papillae forming smooth erythematous patches with elevated white edges, occurring in multiple zones. They often heal on one border while extending on another, hence the apparent migration or "geographic" distribution. The woman developed 123 new lesions during the study period, having only 34 asymptomatic days. Her lesions lasted 1-46 days, with a mean of 7.2 days. there were an average of 2.3 lesions at a time, ranging from 0-8. Lesions developing during the 1st quarter of the oral contraceptive cycle lasted significantly longer than those appearing at other times. The total number of lesions peaked on the 17th day of the pill cycle. Subjective symptoms also were at their maximum on days 16-20 of the cycle. The woman's lesions were typical of previously reported cases: they were usually located on the anterior two-thirds of the dorsal surface, or lateral surface of the tongue. Other family members had experienced this disorder. It was concluded that pill hormones may have influenced the patient's inflammatory response. This is the 1st published association of geographic tongue with oral contraceptive intake.

Effects of low-dose oral contraceptives on female whole saliva.

The composition and flow rate of paraffin-stimulated whole saliva were analysed in 22 women, of whom 11 used oral contraceptives and 11 did not. Ten men served as the controls. The salivary samples were collected during one month (oral contraceptive users and men), or during one menstrual cycle (non-users). The saliva analyses included flow rate, pH, buffer effect, sialic acid, thiocyanate, peroxidase, lysozyme, amylase, immunoglobulins A, G and M, total protein, mutans streptococci, lactobacilli, yeasts and total numbers of aerobic bacteria. The salivary buffer effect of oral contraceptive users was significantly (p less than 0.005) higher than that of non-users. All the other constituents showed intra- and interindividual variation in all groups, but with no apparent hormone-dependency.

PIP: The flow rate and composition of whole saliva were analyzed in 11 women using low dose oral contraceptives in comparison with 11 menstruating women and 10 men. Paraffin-stimulated whole saliva samples were collected Monday, Wednesday and Friday mornings for 1 cycle or 1 month in all subjects, checked for pH and buffer effect (Dentobuff method, Orion Diagnostics, Espoo, Finland, a measure of bicarbonate content) immediately, and frozen for later assay of salivary lysozyme, amylase, peroxidase, thiocyanate, sialic acid, total protein, IgA, IgG, IgM, Mutans streptococci, Lactobacilli, yeasts and aerobic bacteria. The oral contraceptives taken were Marvelon (Organon, Holland) by 4 subjects, Microgynon (Leiras, Finland) by 1, and Trikvilar (Leiras) by 6. The only significant differences between subject groups of cycle phases was a higher salivary buffer effect in oral contraceptive users than that seen in non-users, who resembled male controls. There was a wide individual variation in most values, but less variation in pH and buffer effect. Salivary buffer effect, which is correlated with HCO3-content and salivary flow, is also higher in late pregnancy.

Traditional child health practices in communities in north-west Ethiopia.

PIP: A study in 3 villages in northwest Ethiopia was designed to find the type and extent of health damaging traditional child practices. The result of the survey showed high rates of uvulectomy and milk teeth extraction, and low rates of eyelid incision and female circumcision. More than 84.5% and 98.8% of the mothers surveyed, respectively, reported milk teeth extraction as a useful treatment for diarrhea and eyelid incision in the treatment of eye disease. The damage done by milk teeth extraction includes complications from unhygienic conditions (e.g. ostitis and osteomyelitis). Although many children survive these ill advised procedures and their complications, the considerable damage done to some of the children makes these procedures serious health hazards. Intensive health education with relevant health activities to correct the use of these traditional practices is advised.^ieng

Effect of betel chewing on the frequency of sister chromatid exchanges in pregnant women and women using oral contraceptives.

The incidence of sister chromatid exchange (SCE) was investigated in the lymphocyte chromosomes of betel chewing and non-chewing normal women, pregnant women, and women using oral contraceptives. The frequency of SCE was found to be 7.82 +/- 0.24 and 8.27 +/- 0.27 in non-chewing pregnant women and women using oral contraceptives respectively, which were significantly higher than the mean value of 5.21 +/- 0.18 observed in non-chewing normal women. Betel chewing induced higher SCE in pregnant women and women using oral contraceptives, the frequencies being 11.79 +/- 0.38 and 12.51 +/- 0.44, respectively, which were significantly higher than the SCE frequency of 6.28 +/- 0.21 found in normal betel chewing females.

PIP: Researchers observed the incidence of sister chromatid exchange (SCE) in the lymphocyte chromosomes of 129 healthy adult females. They did this to learn the effect of chewing betel leaf, a carcinogenic substance which is widely chewed in India, on pregnant women and women using oral contraceptives (OCs). The 1st group of 71 nonchewers consisted of 20 controls, nonpregnant women who also did not use OCs; 24 pregnant women; and 27 women using OCs. 58 chewers divided into 16 controls, 19 pregnant women, and 23 OC users formed the 2nd group. Investigators found the frequency of SCE to be 7.82 + or - .24 and 8.27 + or - .27 in nonchewing pregnant women and women using OCs respectively. Both of these frequencies were significantly higher than the mean value of 5.21 + or - .18 noted in the nonchewing controls (p .001). Betel chewing caused higher SCE in pregnant women and women using OCs with frequencies of 11.79 + or - .38 and 12.51 + or - .44 respectively, which were significantly higher than 6.28 + or - .21 SCE frequency found in the controls (p .001). In addition, researchers found a significant correlation between the number of betel leaves chewed and the mean SCE frequency (r =.523, p .01). Based on these observations, it appears that the carcinogenic potential of betel is enhanced by the elevated hormonal profile in pregnant women and OC users. Epidemiologists need to conduct studies to determine if there is an increased likelihood of developing cancer in betel chewing pregnant women and OC users due to increased sensitivity of their lymphocytes to genetic damage compared with nonchewing pregnant women and OC users.

Influence of health education on local beliefs. Incomplete success, or partial failure.

PIP: An example of health education attempted by St. Mary's Hospital Lacor, Gulu, Uganda produced ambivalent results. The Acholi people in the area believe that "ebino" or false tooth, which is what they call the erupting canine teeth in 4-7 month-old infants, causes diarrhea, fever, convulsions and failure to thrive. They therefore remove the tooth buds, using unhygienic conditions, causing such complications as infection, hemorrhage, anemia, osteomyelitis, septicemia, meningitis, tetanus and sometimes death. In 1982 the hospital workers changed their attitude from one of contempt and hostility to acceptance, teaching people about the complications of removing false teeth. Attempts at education have resulted in an increase in late, more seriously ill cases in 1980-82; a great increase in cases brought to the hospital in 1983; followed by admissions sooner after the procedure with only 7% deaths in 1983-84. Recently very young babies have been brought in, having been operated on before any gingival swelling would be apparent. Surveys of hospital personnel showed that a majority of them favor the operation, but prefer it to be done in the hospital with aseptic techniques. The current approach is to express confidence in mothers' natural intelligence and ability to understand the subject presented to them clearly.^ieng

Epidemiologic study of the association between alcohol habits and oral leukoplakia.

In a house-to-house survey in Ernakulam district, Kerala State, 10914 individuals were interviewed for their tobacco and alcohol habits and examined for the presence of oral leukoplakia. Very few females (1.6%) were found to be alcohol users and they were excluded from further analysis. Among 7604 males, 30.4% used alcohol regularly, 25.4% occasionally and 44.2% were non-users. The prevalence of leukoplakia was significantly higher among regular (5.7%) and occasional (3.9%) users than among non-users (2.9%) of alcohol. Alcohol usage was found to be related to age as well as tobacco habits. The prevalence of leukoplakia was higher among alcohol users in each age-group as well as in each tobacco habit category. After age-adjustment the difference between alcohol users and non-users, although reduced, remained significant. For most tobacco habit categories the trend remained similar after age-adjustment except for the mixed habits group, for which there was a reversal of the trend. The alcohol habit may, perhaps, produce discernible effects only in association with other 'weak' etiological risk factors, such as a single tobacco habit of smoking or chewing rather than a 'strong' etiologic factor such as the mixed habits of chewing and smoking.