Effect of zinc supplementation on growth in West African children: a randomized double-blind placebo-controlled trial in rural Burkina Faso.

OBJECTIVE: To analyse the effects of zinc supplementation on growth parameters in a representative sample of young children in rural Burkina Faso. Design Randomized, double-blind, placebo-controlled efficacy trial. Setting Eighteen villages in rural northwestern Burkina Faso. Subjects In all, 709 children aged 6-31 months were enrolled; 685 completed the trial. Intervention Supplementation with zinc (12.5 mg zinc sulphate) or placebo daily for 6 days a week for 6 months. Outcomes Weight, length/height, mid-arm circumference, and serum zinc. RESULTS: In a representative subsample of study children, 72% were zinc-deficient at baseline. After supplementation, serum zinc increased in zinc-supplemented but not in control children of the subsample. No significant differences between groups were observed during follow-up regarding length/height, weight, mid-arm circumference, and z scores for height-for-age, weight-for-age, and weight-for-height. CONCLUSIONS: We conclude that zinc supplementation does not have an effect of public health importance on growth in West African populations of young children with a high prevalence of malnutrition. Multinutrient interventions are likely to be more effective.

[Primary health care and the consequences of a strategy of denial: inefficient and uneconomical management of health problems due to a far-reaching omission of clients' world view, self image and psyche from the context of therapy]. / Primary Health Care und die Folgen einer Verleugnungsstrategie. Ineffizientes und unökonomisches Management von Gesundheitsproblemen durch weitgehendes Ausblenden des Weltverständnisses, des Selbstbildes und der Psyche der Klienten aus dem Behandlungskontext.

In spite of high prevalence rates, non-somatic health problems remain largely neglected in Third World First line health services. Deficits in staff qualification and motivation, clients' lack of readiness to perceive their problems as psychogenic, and "superstitious" beliefs as to their causation, material constraints, and the inapplicability of Western psychotherapeutic techniques in non-Western cultures are quoted as possible explanations. We assess their validity and potential consequences for the quality of service delivery; a different approach towards the training of staff, aiming at the integration of attention to psychological problems into everyday service provision, is discussed.

Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996.

BACKGROUND: Maternal mortality is a sensitive indicator for inequity in health. We describe recent trends in overall and cause-specific maternal mortality ratio among women of German and non-German nationality residing in West Germany. METHODS: Using birth and death register data for 1980-1996 we related 1067 cases of maternal death (ICD 9: 630-676) to 11.2 million live births. We assessed the effects of nationality and of marital status, a proxy for socioeconomic status, controlling for year of death and age of the mother in a Poisson regression model. RESULTS: Maternal mortality ratio in West Germany decreased from 13 per 100000 live births in 1980-1988 to 6.1 in 1989-1996. The crude relative risk for non-German nationality decreased from 1.9 (95% CI: 1.6-2.3) to 1.3 (1.0-1.7); after adjusting for age, year of death and marital status it was 1.7 (95% CI: 1.4-2.1) and 1.6 (95% CI: 1.2-2.1). Unmarried women incurred an adjusted relative risk of 1.8 (95% CI: 1.5-2.3). Non-German women experienced an excess mortality from abortions which largely disappeared in 1989-1996; concurrently, being unmarried no longer conveyed an additional risk to them. The risk status of German mothers developed unfavourably: increasing proportions are unmarried, which continues to be a marker of elevated relative risk in this group. CONCLUSIONS: Our findings suggest continuously improving accessibility and quality of obstetric services, in particular for women of non-German nationality. Still, inequity in maternal risk continues to exist. Maternal risk, however, is not determined by the simple distinction 'German' versus 'non-German'; its association with socioeconomic status extends beyond nationality.

Deaths among women of reproductive age in Cape Verde: causes and avoidability.

SUBJECT: In 1992-93 all deaths (n=97) of women 15 to 49 years old in three islands of Cape Verde were investigated to determine the cause of death, the maternal mortality ratio, the reliability of cause-of-death ascertainment, and the level of avoidability. METHOD: Data were obtained through interviews with the deceased person's family members and other knowledgeable persons (verbal autopsy) and through hospital files. RESULTS: The overall mortality rate was 163 per 100,000 women 1549 years old, and the maternal mortality ratio was 127 per 100,000 live births. A plausible diagnosis could be determined in 77%. The most frequent causes of death were circulatory disorders, external causes, maternal causes, infectious diseases. and neoplasms. CONCLUSIONS: It was estimated that three of four of the deaths were avoidable with locally available resources. Since access to health care in the study area is not a major hindrance, a further decrease of female mortality depends mainly on improved quality of care in health facilities.

Risk factors for perinatal death in Cape Verde.

Risk factors for perinatal death in the Cape Verde islands were assessed among 104 bereaved mothers and 292 mothers of surviving infants in an area-based case-control study in 1992-93. Prospectively gathered information on risk factors was obtained from medical records supplemented with post-partum interviews and anthropometric measurements of mothers and infants. No autopsies were performed. Multiple logistic regression analysis was applied. Out of 23 alleged maternal and two alleged infant risk factors, the following seven proved significantly and independently correlated with perinatal death: first pregnancy (odds ratio [OR] = 2.9); previous hypertensive disease (OR = 4.2); previous perinatal death (OR = 4.6); pre-eclampsia (OR = 7.0); non-cephalic fetal presentation (OR = 17.1); male infant (OR = 2.1) and maternal post-partum fever (OR = 3.1). The perinatal mortality rate was calculated as 37-46/1000 total births. A reduction in the mortality rate warrants antenatal and obstetric care with emphasis on primiparous women; improved detection and treatment of hypertensive disorders and genital infections; and improved intrapartum fetal observation and resuscitation routines.

PIP: Findings are presented from a study conducted to assess the perinatal mortality rate and explore the association between alleged maternal and pregnancy-related risk factors and perinatal death in Cape Verde. Risk factors for perinatal death were assessed among 104 bereaved mothers and 292 mothers of surviving infants in an area-based case-control study during 1992-93 using data on risk factors obtained from medical records, postpartum interviews, and anthropometric measurements of mothers and infants. The following alleged maternal and infant risk factors were significantly and independently correlated with perinatal death: first pregnancy, previous hypertensive disease, previous perinatal death, pre-eclampsia, noncephalic fetal presentation, male infant gender, and maternal postpartum fever. The perinatal mortality rate was calculated to be 37-46/1000 total births. Providing antenatal and obstetric care with emphasis upon primiparous women, improving the detection and treatment of hypertensive disorders and genital infections, and improving intrapartum fetal observation and resuscitation routines will help reduce the level of mortality.

Neighbourhood support to families with a disabled child: observations on a coping strategy of caregivers in a Jamaican community-based rehabilitation programme.

In Jamaica, a low degree of practical helpfulness of neighbours of families with a disabled child has been described. This seems to cast doubt on the World Health Organization's concept of community-based rehabilitation which simply assumes that the community is a source of support. Our study tries to elucidate which reasons, in a Jamaican socio-cultural setting, make neighbours give support to or withhold it from disabled children and their caregivers. A concept of neighbourhood help is identified, according to which help is something to be asked for and provided under exceptional circumstances only. Caregivers claim to give and receive support in child rearing within the limits of this definition, generally irrespective of the presence of a disability. The impression that neighbours are unconcerned can arise when the support needed becomes too extensive to fit into the local definition of neighbourhood help--which is more likely in the case of disabled children.

Neighbourhood support of families with a disabled child: observations on a coping strategy of caregivers in a Jamaican community-based rehabilitation programme

In Jamaica, a low degree of practical helpfulness of neighbours of families with a disabled child has been described. This seems to cast doubt on the World Health Organisation's concept of community-based rehabilitation which simply assumes that the community is a source of support. Our study tries to elucidate which reasons, in a Jamaican socio-cultural setting, make neighbours give support to or withhold it from disabled children and their caregivers. A concept of neighbourhood help is identified, according to which help is something to asked for and provided under exceptional circumstance only. Caregivers claim to give and receive support in child rearing within the limits of this definition, generally irrespective of the presence of a disability. The impression that neighbours are unconcerned can arise when the support needed becomes too extensive to fit into the local definition of neighbourhood help which is more likely in the case of disabled children.(AU)

Evaluation of antenatal risk factors lit Cape Verde.

The prevalence of antenatal risk factors and their association with adverse pregnancy outcome were prospectively studied in the county of Praia, Cape Verde. Of 4693 women registering for antenatal care, 8% were randomly selected from October 1991 through December 1992. Eventually 358 women were observed until puerperium when a physical examination and a structured interview took place. Three out of four women of the cohort were exposed to risk factors according to the existing risk classification in Praia, and 9% presented high risk factors. Thirty two percent of the cohort faced adverse pregnancy outcomes. Adverse pregnancy outcomes were significantly increased among women who presented high risk factors, but 82% of all adverse outcomes occurred among other women. The antenatal risk classification investigated cannot be considered an effective tool for detection of women at risk of adverse pregnancy outcome.

Maternal risk factors for preterm birth and low birthweight in Cape Verde.

BACKGROUND: Fifteen years after the implementation of an antenatal risk screening program in Cape Verde, the first assessment of an association between maternal obstetric characteristics and preterm birth or low birthweight (LBW) infants was undertaken. METHODS: A cohort of 353 systematically selected antenatal clinic attenders in the county of Praia, Cape Verde, was studied prospectively during the period October 1991 through December 1992. The cohort was followed past the perinatal period and information was obtained according to a pretested structured questionnaire. In the analysis of preterm birth and LBW, multiple logistic regression was listed to estimate the relative risks of ll background variables. RESULTS: The prevalence of preterm birth (<37 gestational weeks) was 12%, and the prevalence of LBW infants was 8%. Low birthweight (<2500 grams) was significantly associated with low maternal age (< or = 19 years, RR=3.7); nulliparity (RR=5.2) and obstetric history of previous LBW infant (RR-6.5). The risk of preterm birth was significantly increased if the woman had an obstetric history of hypertension or convulsions (RR=2.6). CONCLUSIONS: In the setting studied, teenage women and women with previous pregnancy hypertension should be given selective attention in antenatal care to achieve improved pregnancy outcome. Primary prevention is needed to lower the prevalence of teenage pregnancies.

Better health data with a portable microcomputer at the periphery: an anthropometric survey in Cape Verde.

A portable microcomputer was programmed to record anthropometric nutritional data from children aged under 7 years in either a clinic or a population survey situation. An alarm sounds when the anthropometric measurements of a child are below a predetermined value; an immediate check thus avoids the need for subsequent data cleaning and discarding of doubtful information. Data cut-off points in the computer can be adjusted to suit the survey or service needs of the situation. A print-out at the end of the clinic session provides immediate feedback for the staff and a record of the nutritional status of the group.In Cape Verde, 14 670 children attending clinics were surveyed; 26% were identified as stunted, 3% as wasted, and 1% as stunted and wasted. While a portable microcomputer can improve precision, speed and motivation, nutrition surveys still depend on accurate scales, careful measurements and competent staff.