The Effect of Using Sewerage System on Incidence of Acute Diarrhoea on Children under Five Years Old in Bandar-Anzali City in Guilan Province in 2009-Phase I
Author(s)
Morteza Fallah-KarkanHannan Ebrahimi
Zahra Akbarian
Seyyede Zohreh Banihashemi
Maryam Rostamnejad
Matin Daneshyari
Elahe Sayyarifard2
Kaveh Marzbani
Haleh Ahmadnia
Javad Moazzami-Sahzabi
Azadeh Sayyarifard
Shahnam Arshi
Ahmad-Reza Farsar
Mohamad-Reza Sohrabi
Ali-Asghar Kolahi
Keywords
Acute DiarrheaDiarrhea
Epidemiology
Incidence
Sewerage
Sanitation
Bandar-Anzali
Iran
Infectious and parasitic diseases
RC109-216
Internal medicine
RC31-1245
Medicine
R
DOAJ:Internal medicine
DOAJ:Medicine (General)
DOAJ:Health Sciences
Arctic medicine. Tropical medicine
RC955-962
Special situations and conditions
RC952-1245
Internal medicine
RC31-1245
Medicine
R
DOAJ:Internal medicine
DOAJ:Medicine (General)
DOAJ:Health Sciences
Infectious and parasitic diseases
RC109-216
Internal medicine
RC31-1245
Medicine
R
DOAJ:Internal medicine
DOAJ:Medicine (General)
DOAJ:Health Sciences
Arctic medicine. Tropical medicine
RC955-962
Special situations and conditions
RC952-1245
Internal medicine
RC31-1245
Medicine
R
DOAJ:Internal medicine
DOAJ:Medicine (General)
DOAJ:Health Sciences
Infectious and parasitic diseases
RC109-216
Internal medicine
RC31-1245
Medicine
R
Arctic medicine. Tropical medicine
RC955-962
Special situations and conditions
RC952-1245
Internal medicine
RC31-1245
Medicine
R
Infectious and parasitic diseases
RC109-216
Internal medicine
RC31-1245
Medicine
R
Arctic medicine. Tropical medicine
RC955-962
Special situations and conditions
RC952-1245
Internal medicine
RC31-1245
Medicine
R
Infectious and parasitic diseases
RC109-216
Internal medicine
RC31-1245
Medicine
R
Arctic medicine. Tropical medicine
RC955-962
Special situations and conditions
RC952-1245
Internal medicine
RC31-1245
Medicine
R
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Show full item recordAbstract
Backgroun and objective:The scarce water resources and Poor quality drinking water with the lack of a proper sewage collection and disposal system and increasing management problems due to rapid population growth made Islamic Republic of Iran to pay priority attention to the water and sewerage problems of districts in its five-year development plan. In this regard, water and sewerage project in Bandar Anzali became a priority by Guilan province Urban Water and Sewerage Company with the government partnership and World Bank financial support. The objective of this study is to complete the first phase of a two-phase study to determine the impact of using an urban sewerage system on acute Diarrhoea in children under five years of age in Bandar-Anzali in the Guilan province.Materails and methods: The study is a concurrent control before and after field trial which is carried out in two stages: before (phase I) and after (phase II). Sampling for phase I was performed in the middle month of each season, November and February 2009 and May and August 2010. The incidence of acute Diarrhoea was measured with the participation of 2400 mothers of children under 5 years old in the city of Bandar-Anzali in two groups: the intervention group (inside the sewerage system project perimeters) and the control group (outside the project perimeters). Data were collected by local female general practitioners and medical students in each city, under supervision of the community medicine department and by door-to-door interview with mothers. Data were analyzed using the SPSS 11.5 software package and the Pearson Chi-Square was used to compare qualitative variables between groups, and the t-test and One-Way ANOVA was used to compare quantitative variables.Results: The annual incidence of acute diarrhoea in children under five years old was 11.9%. The seasonal pattern of acut diarrheoa incidence was 12.6% in May, 13.3 in August, 11.5% in November, and 10.3% in February respectively. The highest incidence of acute diarrhoea was seen in children from 2 to 5 years of age.Conclusion: The study showed the incidence of acute diarrhoea on children under five years old in Bandar-Anzali city is moderate and it follows a seasonal pattern. The highest rate was seen in summer and the lowest rate in winter. It is expected to decrease with the initiation of the sewerage system program.Date
2013-07-01Type
ArticleIdentifier
oai:doaj.org/article:6b79e179dc964d22a480863e3ecfd1e31680-0192
https://doaj.org/article/6b79e179dc964d22a480863e3ecfd1e3
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Nematode parasites of Brazilian Ciconiiformes Birds: a general survey with new records for the speciesJ. Júlio Vicente; Roberto Magalhães Pinto; Dely Noronha; L. Gonçalves (Instituto Oswaldo Cruz, Ministério da Saúde, 1995-06-01)This report deals with the identification of one hundred and fifty-nine samples of nematodes recovered from Brazilian egrets and herons. Contracaecum microcephalum, C. multipapillatum, C. plagiaticium, Desportesius invaginatus, D. longevaginatus, Desmidocercella ardeae, Eustrongylides ignotus, Porrocaecum reticulatum, Tetrameres micropenis, Capillaria sp., Contracaecum sp., Porrocaecum sp., Procyrnea sp., Tetrameres sp. and Viktorocara sp. were studied. The genus Viktorocara and the species C. microcephalum, C. plagiaticium, D. invaginatus, D. ardeae and P. reticulatum are referred in Brazil for the first time.
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Clínica e terapêutica da doença de ChagasFrancisco S. Laranja; Emmanuel Dias; Genard Nobrega (Instituto Oswaldo Cruz, Ministério da Saúde, 1948-06-01)1 - Baseados na experiência adquirida nos últimos cinco anos em Bambuí, Minas Gerais, onde mais de seiscentos casos de doença de Chagas tém sido estudados, os autores fazem uma revisão das manifestações clínicas desta doença. mencionam alguns dados sôbre a incidência da esquizotripanose e chamam a atenção para a importância social desta moléstia. 2 - Sugerem a seguinte sistematização das fórmas clinicas da esquizotripanose: a) Forma aguda; b) Formas crônicas: 1 - Forma indeterminada (cardiacos potenciais), 2 - Forma cardíaca (cardiopatia crônica). Os autores não encontraram no material estudado em Bambuí casos classificaveis como forma nervosa crônica. 3 - Apresentam evidências de ordem clínica e experimental que justificam admitir-se a cardiopatia crônica da doença de Chagas como entidade clinica definida. 4 - As manifestações da infecção aguda são estudadas à luz da experiência adquirida com os 103 casos agudos diagnosticados em Bambuí. Dois tipos de fenômenos edematosos podem ocorrer em pacientes com esquizotripanose aguda: o edema local, de porta de entrada do parasito, e o edema generalizado (o chamado "mixedema"). A patogenia dêste último é revista e sugere-se que ele seja devido a uma hipoproteinemia. O edema local parece de natureza inflamatória. As manifestações da cardiopatia aguda da doença de Chagas são descritas. Ritmo de galope, aumento da area cardíaca (em alguns casos devido a transudato pericárdico), prolongamento do espaço P-R, alterações primárias da onda T e extra-sístoles ventriculares - constituem os sinais mais importantes para o diagnóstico da cardiopatia aguda. Bloqueio de ramo direito foi encontrado em três casos fatais de cardiopatia aguda, um dos quais apresentou também pronunciado desnivelamento de ST (padrão de injúria). A morte durante a infecção aguda é usualmente precedida por manifestações convulsivas. Na maioria dos casos as manifestações, da infecção inicial regridem e o paciente passa à condição de cronicidade em aparente cura espontânea. Esta, entretanto, parece não ocorrer. 5 - Pacientes com infecção crônica e sem evidências de comprimento cardíaco são classificados como cardíacos potenciais ou forma crônica indeterminada. A infecção em regra permanece ativa e os sinais da cardiopatia podem desenvolver-se mais tarde. 6 - A cardiopatia crônica é usualmente manifestação tardia da infecção. Ela incide em cerca de 50% dos pacientes com infecção crônica. Suas manifestações dependem da extensão das alterações miocárdicas. Palpitações, dispnéia, crises convulsivo-sincopais (bloqueio A-V intenso), precordialgias atípicas e dôr no hipocôndrio direito (congestão passiva do fígado) são os sintomas mais comuns. Alguns casos não apresentam sintomas, o coração não se mostra aumentado e a única evidência da cardiopatia é fornecida pelo eletrocardiograma (cardiopatia assintomática). Irregularidades do ritmo cardiaco, desdobramento da 2ª bulha no foco pulmonar e ritmo de galope são achados auscultatórios frequentes. O aumento do coração é de grau variavel; ele atinge a todas as cavidades cardíacas. Doentes com insuficiência cardíaca em regra apresentam aumento pronunciado do coração. Predominam sinais de dilatação cardíaca sôbre os de hipertrofia. Não se encontram sinais de lesão valvular ou de alterações estruturais dos grandes vasos. A pressão arterial é usualmente normal; em casos de insuficiência cardíaca pode a pressão sistólica estar reduzida e a direfencial ser muito pequena. Sinais de insuficiência valvular funcional são muito comuns em casos com insuficiência cardiaca. Usualmente do tipo direito ou do tipo bilateral, a insuficiência cardiaca raramente assume o tipo insuficiência ventricular esquerda isolada. Na grande maioria dos casos o eletrocardiograma evidencia distúrbios da condução ou da formação do estímulo, ou ambos. Extrasistoles ventriculares, bloqueio de ramo direito, bloqueios A-V de todos os graus e altrações atípicas do complexo ventricular são os achados eletrocardiográficos mais importantes. O bloqueio de ramo direito é excepcionalmente comum neste tipo de cardiopatia e possúe grande valor diagnóstico em areas endêmicas. Os critérios para o diagnóstico diferencial com outros tipos de cardiopatia crônica são expostos. A evolução da cardiopatia crônica é variável, dependendo principalmente da atividade da infecção. A sobrevida é geralmente longa; entretanto, a maioria dos doentes morre antes dos 50 anos de idade. O prognóstico depende principalmente de gráu de aumento do coração e de redução da sua capacidade funcional, do tipo de arritmia presente e do potencial evolutivo da infecção crônica. A morte súbita é muito comum nesta cardiopatia; a maioria dos doentes, porém, morre em insuficiencia cardiaca. Não se dispõe ainda de medicamento eficaz para o tratamento etiológico da doença de Chagas. No tratamento da insuficiência cardíaca da cardiopatia crônica da doença de Chagas obtém-se frequentemente melhores resultados com a estrofantina ou a ouabaina do que com a digital.<br>1 - Based on the experience acquired in the last five years in Bambui, Minas Gerais, where more than six hundred cases of Chagas' disease have been studied, the authors have made a review of the clinical manifestations of this disease. Data on the incidence of schizotrypanosis are reported and the social importance of the disease, which is now being gradually, recognized, is stressed. 2 - The following classification of the clinical forms of the disease is suggested: a) Acute form; b) Chronic forms: 1 - Chronic indeterminate form 9potencial heart disease). 2- Chronic cardiac form (chronic Chagas' heart disease). No nervous manifestations of the kind of those described as the chronic nervous form of schizotrypanosis have been observed in the cases studied in Bambuí. 3 - Clinical and experimental evidences are reported to support the viewpoint that chronic Chagas' heart disease is a well defined clinical entity. 4 - The manifestations of acute infecion are studied in the light of authors' experience with 103 acute cases found in Bambui. Two kinds of edema may occur in patients with acute Chagas' disease: the local edema or edema of portal of entry of the parasite in the organism, and the generalized edema, the so-called "mixedema". The pathogenesis of the last mentioned is reviewed and it is suggested it may be related to hypoproteinemia. The local edema seems to be of inflamatory nature. The manifestations of acute Chagas' heart disease are described. Gallop Rhythm, increase in cardiac shadow (in some cases due to pericardial effusion), prolongation of P-R interval, primary T wave changes and ventricular premature contractions are the more important diagnostic signs of acute Chagas' heart diasease. Right bundle branch block occurred in three fatal cases of acute Chagas' heart disease; in one of them a pronounced ST displacement ("injury pattern") was also present. Death during the acute period of Chagas' disease is usually preceded by convulsions. The manifestations of the acute infection subside spontaneously and gradually in most cases; the disease then goes into the chronic stage and the patients become apparently cured, although still infected. 5 - Patients with chronic infection and without evidences of heart involvement are considered as potencial heart patients and classified in the chronic indeterminate form of the disease. Infection remains in the organism, as a rule under an active form, and signs of heart involvement may devellop later. 6 - Chronic Chagas' heart disease is usually a late manifestation of the infection. About 50% of chonically infected patients present signs of heart involvement. The manifestations of chronic Chagas' heart disease depend upon the severity of myocardial changes. Palpitations, dyspnea, convulsive-syncopal crisis (advanced A-V block) atypical precordial aches and pain in the upper abdominal quadrant (liver congestion0 are the commonest symptoms. Some cases do not present any sumptoms: the heart is not enlarged and the only evidence of myocardial damage is provided by the electrocadiogram (asymptomatic Chagas' heart disease). Irregularities of cardiac rhythm, splintering of second heart sound at the pulmonic area and gallop rhythm are commom auscultatory findings. Heart enlargement involves all the cardiac chambers and is of variable degree. Patients with heart failure usually present pronounced heart enlargement. Signs of cardiac dilatation are predominant over those of cardiac hypertrophy. No signs of valvular deformity or structural changes of the gross vessls are found in this type of heart disease. Blood pressure is normal. Patients with heart failure may present reduced systolic pressure an small pulse pressure. Signs of funcional valvular incompetence are commom in cases with heart failure. Heart failure is usually of right sided type, or is bilateral, being rather uncommon the isolated left sided type of heart failure. In the great majority of cses the electrocardiogram shows disturbances of impulse conduction and/or impulse formation. Ventricular premature contractions, right bundle branch block, A-V blocks of all degrees and atypical alterations of ventricular complexes are the most important electrocardiographic findings. Right bundle branch block is exceedingly common in thos type of heart disease and is of great diagnostic value in endemic areas of schizotrypanosis. Criteria for differential dignosis with other types of chronic heart disease are pointed out. Evolution of chronic Chagas' heart disease is variable, depending chiefly on the activity of infection. Most patients die before 50 years of age. Prognosis depends chiefly on the degree of the enlargement of the heart, on the degree of reduction of the heart's functional capacity, on the type of the existing arrhythmia and on the evolutivity of the infection. Sudden death takes place quite commonly in this type of heart disease but most of the fatal cases die in heart failure. No effective drug is so far available for the etiological treatment of Chagas' disease. Better results are frequently obtained by use of strophantin than with digitalis in the treatment of heart failure of chronic Chagas' heart disease.
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Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006C Machado; R Bochner; JT Fiszon (Centro de Estudos de Venenos e Animais Peçonhentos - CEVAP, Universidade Estadual Paulista - UNESP, 2012-01-01)All snakebites registered in Rio de Janeiro state, Brazil, between 2001 and 2006 were analyzed. Of these, the snake species involved was identified in 2,431 cases, most of which were caused by Bothrops (2,347). Most victims were male (78.4%) and the age group most frequently attacked was between 20 and 39 years (38.4%). As for severity, 1,118 (45.9%) were classified as minor, 748 (30.7%) as moderate, and 209 (8.6%) as severe. Progression towards complete cure occurred in 1,567 patients; 39 had sequelae; three died; and clinical outcomes were not monitored in 822 cases. The time between bite and first medical attention was less than three hours in 74.6% of cases. Most occurred in municipalities with vast areas of preserved Atlantic Forest: Angra dos Reis (208), Rio de Janeiro (197), Parati (186), Teresópolis (134), and Petrópolis (110). Accident frequency was highest between November and April, in which the daily average is practically twice that observed in other months. Although results show that Rio de Janeiro state has a good level of medical care, it could be improved by creating multidisciplinary teams that include doctors, biologists, and nurses. The Vital Network for Brazil helps to promote a stimulating environment for this type of training, with both traditional courses and distance learning. Training hours must be increased to improve the skills of professionals responsible for victim care.