Design of immunization programmes for developing countries.

PIP: Factors to be considered in designing immunization programs in developing countries are summarized. The limiting factors will usually be costs of vaccines, administration equipment and supplies, transport and maintenance of the cold chain. Choices have to be made about the sources of vaccines, whether produced locally or imported, size of vaccine lots and type of package, and quality control of vaccines. Selection of vaccines is treated in a separate appendix, but generally 3 groups are recognized: 1) recommended for general use: smallpox, diphtheria, tetanus, pertussis, BCG, typhoid and measles; 2) recommended for special cases: polio and yellow fever; 3) not recommended for developing countries: rubella, mumps, influenza, cholera; and 4) vaccines in development stage only: arbovirus, rickettsia, trachoma, meningococci, plague and shigella. Schedules for vaccine administration are suggested, such as plans for vaccination every 2 years, plans for 4 courses of vaccinations including 1 at school entry, and special programs such as smallpox campaigns and immunization of adolescent girls and fertile women with tetanus. Finally the importance of recording of vaccinees and assessment of programs is discussed.^ieng

Growth of Guyanese infants of African and East Indian racial origins, with some observations on mortality

Mean heights at various intervals over the first 2 years of life were calculated for Guyanese infants of East Indian ethnic groups who were born in 1964 and attended 14 clinics in rural areas. Compared with East Indians, African infants grew faster and weighed more at all ages, although their mortality experience was greater. It is suggested that Africans have a greater potential size than East Indians as a result of inherited factors. Compared with results from developing countries, weight increments in both ethnic groups were small from the 4th to 15th months, a time when mortality was relatively high. This growth pattern is found in many developing countries and reflects weaning difficulties. Profound changes in population, mortality rates and birth rates occurring in Guyana over the past century are summerised. (Summary)

A seven-year field trial of two typhoid vaccines in Guyana

In 1960 about 72,000 Guyanese schoolchildren, aged five to fifteen years, were divided into three similar groups, one of which acted as a control and was given tetanus toxoid, the second was given an acetone-killed typhoid vaccine, and the third a heat-killed-phenolised typhoid vaccine. Two subcutaneous doses of 0.5ml. of reconstituted vaccines were given five weeks apart. An additional 10,000 children received one dose only. The incidence of typhoid fever, diagnosed by the bacteriological isolation of Salmonella typhi, was followed for seven years after vaccination. In those given two doses, 146 cases of typhoid occurred in the control group and 16 and 49 in the acetone and heat-phenol typhoid vaccine groups, showing protection-rates of 88 percent and 65 percent , respectively. In those given one dose of vaccine the protection was somewhat greater, 22 cases occurring in the control group and 1 and 4 in the groups given acetone and heat-phenol vaccines, respectively. Protection showed little diminution until the fifth year after vaccination. (Summary)

Typhoid antibiotics in British Guiana school children

H, O and Vi typhoid antibodies were estimated in the sera of a sample of British Guiana school children of average age 11 years who had not been previously immunized against typhoid. Of 789 sera, 9.7 percent had titres of 1:80 or over against H antigen and 9.2 percent had titres of 1.2 or over against O antigen. Of 906 sera in which Vi antibodies were estimated 12.0 percent had titres of 1:20 or over by the bacterial antigen technique and 13.1 percent had titres of 1.30 or over by the haemagglutination technique (AU)

Report of an epidemic from chemical poisoning

In the Essequibo county of British Guiana an epidemic of chemical food poisoning occurred from January 16th-23rd, 1962. There were 75 cases and 8 deaths. Epidemiological studies indicated that flour contaminated by Parathion was responsible for the outbreak. Treatment is outlined. A similar outbreak which occurred in the island of Wakenaam in the Essequibo River causing 2 deaths was quickly halted by the seizure of all flour in shops on the day that the outbreak was reported (AU)

Review of the relationship of water supplies to the health of the inhabitants of British Guiana (abstract only)

Owing to the ribbon-like housing developments in the inhabited coastlands and riverain areas it is not, at present, with the exception of Georgetown, economically feasible to deliver piped water to houses. Because of the long distances which must be travelled in order to transport water for drinking and domestic purposes and because the high iron content of many artesian wells which renders such water impalatable, recourse is often had to water from doubtful but more accessible sources. Many householders use the absolute minimum amount requisite for survival. Thirty-two per cent of the artesian wells have also been found to be contaminated. These factors operate to make gastro-enteritis and colitis among the leading causes of death in British Guiana and account for the comparitively high incidence of typhoid fever (AU)

A medical survey of nutrition in British Guiana (abstract only)

The survey was commenced in January, 1958 and continued in the months of February and March. It was limited to the members of labouring class families in the rural areas of Demerara and Essequibo. Over 2,00 individuals of all age-groups were examined. Random samples of adults, adolescents, school children, pre-schools, young children and infants were medically examined to ascertain and determine the usual clinical signs diagnostic of malnutrition. The most frequent observable signs were pigmentation of the conjunctivae, xerosis conjunctivae (almost exclusively in adults), atrophy and fissuring of the mucous membrane of the tongue, xerosis and loss of elasticity of the skin (mainly of the back of the legs), and follicular keratosis of the skin. There was a total absence of these signs in all of the infants examined. Clinical signs of rickets were recognised in only one young child examined. The dentition of over 00 school children was charted. A fairly high incidence of dental caries was revealed as estimated by the caries figure. A remarkable improvement in the health of elementary school children was revealed from comparative studies with the findings of similar surveys conducted by the author in 1950, 1951 and 1952. The improvement is to be largely attributed to the beneficial effects of the distribution of a nutritious snack meal comprised of skimmed milk, food yeast enriched biscuits, and fish-liver oil capsules. The programme was introduce in the latter part of 1954. Dietary studies of approximately 350 families were conducted. The food consumption of each family for a period of one week was studied. All foods were weighed and measured by specially trained health visitors who visited the homes each day. Assessment of the daily per capita dietary nutrients revealed a deficiency of vitamin A and the B-vitamins which is to be correlated with the most outstanding clinical defects discovered (AU)

Assessment of the nutritional status of elementary school children of British Guiana by periodic sampling surveys, and evaluation of the beneficial effects of supplementary feeding

Beneficiaries of the mid-morning snack of skimmed milk, yeast-enriched biscuits and fish liver oil capsules have at the end of a year period shown remarkable improvement in their nutritional health especially in regard to the removal or the modification of the usual classical clinical signs attributed to B. complex and vitamin A deficiencies, of which the dietary of the people is lacking. The East Indian boys in reciept of the snack meals showed a statistically significant increase in their weight gains. Beneficiaries of two other groups showed increased weight gains over those of the controls but the increases were not statistically significant. Many of the beneficiaries have manifested an observable increase in their diffuse energy drive, alertness, keenness and interest in their work. School attendance has considerably improved. (Summary)

Nutritional survey of pupils of elementary schools, Mahaicony District

The results of the 1947 survey reveals that the most pronounced nutritional defect in Mahaicony is the deficiency in the dietary intake of Vitamin A reflected in the fairly high incidence of pigmentation of the conjunctivae and xerosis of the skin of the legs. These findings when compared with the prevailing situation in other areas of the colony do not seem to warrant an intensive nutritional programme at Mahaicony. At the commencement of the programme it was decided by the Nutrition Committee to include in the clinical survey, the examination of infants, pre-school children, children of school age not attending school, expectant and lactating mothers, labourers and other easily accessible groups; but the indications are that these groups if not better, will not be worse, nutritionally, than the school population, which usually exhibits signs of malnutrition best - whenever there is any defect in the dietary (Summary)