Experience from community based childhood burn prevention programme in Bangladesh: implication for low resource setting.

A comprehensive community-based burn prevention framework was developed for rural Bangladesh taking into consideration the magnitude, consequences of burns, risk factors of childhood burn, health seeking behaviour of parents after a burn injury of a child and the perception of community people. This paper explains the comprehensive framework of the childhood burn prevention programme and describes its acceptability, feasibility and sustainability. A number of methodologies were adopted in developing the framework, such as, (i) building up relevant information on childhood burn and prevention methods, (ii) arranging workshops and consultation meetings with experts and related stakeholders and (iii) piloting components of the framework on a small scale. Lack of supervision of the children, hazardous environment at home and the low level awareness about childhood burn and other injuries were identified as the major attributes of childhood burn in Bangladesh. To address these factors "Triple S" strategies were identified for the prevention framework. These strategies are: Safe environment. Supervision. Skill development. According to these strategies, home safety, community crèche, school safety, formation of community groups and general awareness activities were identified as the different components of the childhood burn prevention framework in rural Bangladesh. The framework was piloted in a small scale to explore its feasibility acceptability and sustainability. The framework was found to be acceptable by the community. It is also expected to be feasible and sustainable as very low cost and locally available technology and resources were utilized in the framework. Large scale piloting is necessary to explore its effectiveness and ability to scale up all over the whole country.

HIV and AIDS in Indonesia.

PIP: Indonesia is the fourth most populous nation in the world, with a population of 184 million in 1993. By the end of December 1993, the Ministry of Health had reported 193 confirmed HIV infections. There have been 34 deaths from AIDS and HIV infections have been reported from 11 of the 27 provinces in the country. Where nationality is known, native Indonesians comprise 51% of HIV infections and non-Indonesians the remaining 49%. Sexual transmission accounts for 96% of cases where the route of transmission is known; route is unknown in 54 cases. Male:female sex ratio is 23:1 for reported AIDS cases and 4:1 for HIV infections for which sex is known. There have been no pediatric cases reported and 96% of those infected for whom age is known are 15-49 years. The present reporting system definitely underestimates the actual number of HIV infections. The window of prevention in the linear growth phase of the epidemic closed in 1992, when Indonesia began to experience exponential epidemic growth. Although the epidemiologic situation is worsening rapidly, a chance remains that HIV can be kept from becoming a major development problem. The government is now addressing the epidemic as a developmental issue, calling for action across sectors and in partnership with nongovernmental organizations and the private sector much earlier than elsewhere. The successful family planning program instituted in response to the population crisis will serve as a model for HIV prevention strategies and programs in Indonesia.^ieng

Risk factors associated with HIV infection in Uganda.

Risk factor data were collected in 1,328 inpatients and outpatients in 1987 in 15 hospitals throughout Uganda; 42% were positive for HIV antibodies by ELISA. Seropositivity was associated with urban residence, sexually transmitted diseases (STD), number of sex partners, and sex for payment or with a person with an AIDS-like illness. Homosexuality and intravenous drug abuse, recognized risk factors in western countries, were not seen as risk factors. By multivariate analysis, urban residence and sex for payment were not independently associated with infection. Among females, number of sex partners, sex with a person with an AIDS-like illness, and numbers of episodes of STDs were significantly associated with seropositivity. In males, similar associations were seen, although number of reported sex partners was not independently associated with infection. These findings support the view that heterosexual contact is the predominant mode of transmission in Uganda and suggest that the main risk factors relate to high-risk heterosexual behavior.

Epidemic listeriosis associated with Mexican-style cheese.

In Los Angeles County, California, 142 cases of human listeriosis were reported from January 1 through August 15, 1985. Ninety-three cases (65.5 percent) occurred in pregnant women or their offspring, and 49 (34.5 percent) in nonpregnant adults. There were 48 deaths: 20 fetuses, 10 neonates, and 18 nonpregnant adults. Of the nonpregnant adults, 98 percent (48 of 49) had a known predisposing condition. Eighty-seven percent (81 of 93) of the maternal/neonatal cases were Hispanic. Of the Listeria monocytogenes isolates available for study, 82 percent (86 of 105) were serotype 4b, of which 63 of 86 (73 percent) were the same phage type. A case-control study implicated Mexican-style soft cheese (odds ratio, 5.5; 95 percent confidence interval, 1.2 to 24.8) as the vehicle of infection; a second case-control study showed an association with one brand (Brand A) of Mexican-style soft cheese (odds ratio, 8.5; 95 percent confidence interval, 2.4 to 26.2). Laboratory study confirmed the presence of L. monocytogenes serogroup 4b of the epidemic phage type in Brand A Mexican-style cheese. In mid-June, all Brand A cheese was recalled and the factory was closed. An investigation of the cheese plant suggested that the cheese was commonly contaminated with unpasteurized milk. We conclude that the epidemic of listeriosis was caused by ingestion of Brand A cheese contaminated by one phage type of L. monocytogenes serotype 4b.

Listeriosis: an uncommon opportunistic infection in patients with acquired immunodeficiency syndrome. A report of five cases and a review of the literature.

Between January 1985 and March 1986, five cases of listeriosis were reported in Los Angeles County in patients with the acquired immunodeficiency syndrome (AIDS). All patients were homosexual men with no other risk factors for AIDS. Two patients had sepsis only, two patients had sepsis and meningitis, and one patient had sepsis and signs of meningitis. Sixty percent of the cases (three patients) had a prior or concurrent gastrointestinal illness. Eighty percent of the cases (four patients) also had no prior history of antibiotic administration. Both of these findings may have predisposed these AIDS patients to be at increased risk for listeriosis. Although listeriosis is an infrequent illness in AIDS patients, people with AIDS or human immunodeficiency virus infection should probably refrain from ingesting food items associated with listeriosis. These food items include improperly pasteurized dairy products, and raw fruits and vegetables not properly washed.