Adaptation of the school health index to assess the healthy school environment in Jordan.

When the Jordan Ministry of Education planned workshops to raise teachers' awareness of the health environment in schools in underdeveloped governorates, a pre-post intervention study assessed the impact of these workshops in changing teachers' perceptions. A total of 193 teachers completed the self-administered Centers for Disease Control and Prevention school health index (SHI) for elementary schools, adapted for this setting using 6 of the 8 original modules. After the workshops, teachers' mean scores on all modules improved significantly, from 49.5% to 55.9% for health and safety/environment policies; 44.2% to 56.5% for health education; 40.3% to 52.9% for physical education; 51.3% to 59.2% for nutrition services; 62.5% to 73.8% for health services; and 55.2% to 68.3% for family/community involvement. The SHI model is implementable in a developing country

Immediate vs. delayed treatment of group A beta-hemolytic streptococcal pharyngitis with penicillin V.

Three hundred six children with probable Group A beta-hemolytic streptococcal pharyngitis were enrolled in a randomized double blind trial to compare the effects of immediate vs. delayed treatment with oral penicillin V. Among the 229 culture-positive patients, 111 were randomly assigned to receive penicillin V immediately and 118 to receive a placebo for 48 to 52 hours followed by penicillin V. Patients were evaluated clinically for 48 to 52 hours following initiation of treatment. The Streptozyme test was used to measure acute to convalescent antibody titer. Both regimens resulted in a greater than 92% cure rate. Early treatment was associated with significantly fewer and milder signs and symptoms on Day 3 and a significantly lower rise in the antibody titer. On the other hand we found 8 (7%) relapses and 18 (16%) early and 14 (13%) late recurrences in this group; all were significantly higher than the corresponding numbers of 2 (2%), 6 (5%) and 4 (3%), respectively, in the late treatment group. This study shows the beneficial effect of early treatment with penicillin V on the clinical course of Group A beta-hemolytic streptococcal pharyngitis. This study also shows that delayed penicillin treatment may be associated with a lower incidence of subsequent Group A beta-hemolytic streptococcal pharyngitis.

Mortality pattern of infants and young children in rural Amman.

PIP: A cross-sectional study describing the clinical; anthropometric; hematological; morbidity; and mortality pattern of 3734 Jordanian infants and young children in rural Ammen was conducted. Waterlow's public health classification was used. Children of the main sample were grouped into A (well nourished) and B (malnourished). Total number of pregnancies the mothers in this study had was 23,545; total number of abortions and stillbirths the mothers had was 2711, and total number of live births was 20,834. Total number of siblings who died in different age groups was 1981. Calculated neonatal mortality rate per 1000 liveborn was 26; postneonatal was 52; infant mortality rate was 78; 1 to 4 years was 11.5 and for age 4 years, the rate was 5/1000 livebirths. No significant differences were observed between Groups A and B except at the 1-4 year age group, which has a mortality rate twice as high in Group B as in Group A, a significant difference at the 1% level. Half of the deaths in the 1st year occurred in the 1st month of life. The socioeconomic and health status of Jordan is reflected in its mortality pattern. The infant mortality rate in this study, 78/1000 is 4.4 times as great as it is in advanced countries. Cook mentioned 3 factors which contribute to the vulnerability of infants to death: 1) relatively high nutritional requirements; 2) transition from breastfeeding to normal family diet; and 3) lack of their own antibodies to infectious organisms. Comparison of mortality rates with other countries were presented.^ieng

Cryptosporidium. A cause of gastroenteritis in preschool children in Jordan.

In this case-control study, we investigated the role of Cryptosporidium in gastroenteritis in children < 6 years old. Six hundred fresh stool specimens were examined for various pathogenic parasites, bacteria, and rotaviruses. Wet-mount preparations, formaline-ether concentrations, and Sheather's floatation techniques were used to recover the parasite oocysts. Permanent stained slides using acid-fast stain and trichrome stains were prepared. Of 300 children with gastroenteritis symptoms, 20 (6.7%) had Cryptosporidium oocysts; seven of the 20 had concomitant infections so they were excluded from the counts. This infection rate is significantly different (Z = 2; p < 0.05) from that found in the control group (1.7%) of children who reported no symptoms. The most frequent symptoms reported beside diarrhea were abdominal pain, cramps, anorexia, nausea, vomiting, and fatigue. Contaminated drinking water is suspected to be the source of infection; other possible factors are discussed.

The duration for which exclusive breast-feeding is adequate. A study in Jordan.

The object of this study was to determine the length of time for which exclusive breast-feeding supported adequate growth in a cohort of infants from families in and around Amman, Jordan. The infants were described as "faltering" if their incremental growth over 4 weeks fell below -2 standard deviations of the increments reported by Fomon in the USA. The infants were examined every 2 weeks until they faltered, or, without faltering, were started on supplementary foods. In general, up to the time of faltering, growth was satisfactory by international standards. The median time of faltering was 6 months. The results support the view that, at least in this relatively well-nourished community, exclusive breast-feeding is satisfactory for 4-6 months. However, further examination is needed of the risk factors that lead to early faltering in some breast-fed children.

Distribution of adult lactase phenotypes in Bedouins and in urban and agricultural populations of Jordan.

Lactose tolerance tests with breath hydrogen determination identified 39 lactose malabsorbers among 162 Jordanian Bedouins (24%), and 111 lactose malabsorbers among 148 subjects from the urban/agricultural zone of western Jordan and Palestine (75%). This highly significant difference supports the hypothesis that milk dependence in nomadic desert populations resulted in selective pressures in favour of the lactase persistence gene. Within the urban/agricultural zone which extends from the desert border in Jordan to the Mediterranean shore, a significant increase in the frequency of lactose malabsorbers (and hypolactasia gene frequencies) from east to west was observed. The suggested genetic cline is problably due to migration from the desert populations to the agricultural zone.

Adaptation of the school health index to assess the healthy school environment in Jordan

When the Jordan Ministry of Education planned workshops to raise teachers' awareness of the health environment in schools in underdeveloped governorates, a pre-post intervention study assessed the impact of these workshops in changing teachers' perceptions. A total of 193 teachers completed the self-administered Centers for Disease Control and Prevention school health index [SHl] for elementary schools, adapted for this setting using 6 of the 8 original modules. After the workshops, teachers' mean scores on all modules improved significantly, from 49.5% to 55.9% for health and safety/environment policies; 44.2% to 56.5% for health education; 40.3% to 52.9% for physical education; 51.3% to 59.2% for nutrition services; 62.5% to 73.8% for health services; and 55.2% to 68.3% for family/community involvement. The SHl model is implementable in a developing country setting to monitor and appraise the environmental components of school health