Geir Gunnlaugsson

Epidemic cholera in Guinea-Bissau: The challenge of preventing deaths in rural West Africa

OBJECTIVESnAn epidemiologic investigation was conducted to identify factors associated with cholera mortality in a rural African setting and interventions likely to prevent deaths in future epidemics.nnnMETHODSnThe authors reviewed surveillance data from rural Biombo, Guinea-Bissau, interviewed family members of persons who died of cholera, and conducted a case-control study in the catchment area of a health center with a high case:fatality ratio (CFR).nnnRESULTSnForty-three deaths occurred among the 1169 persons who reported to health centers with cholera during the epidemic (CFR = 3.7%). Delayed rehydration and over-hydration probably contributed to 10 of these deaths. An additional 19 cholera deaths occurred outside health centers. In the case-control study, persons with cholera who died were 5.4 times (95% CI = 1.0-53.4) more likely to be in poor health or intoxicated at illness onset than persons with cholera who survived. Fatal cases were 6.0 times (95% CI = 1.1-60.8) more likely to not attend the health center than survivors.nnnCONCLUSIONSnThe low overall CFR in Biombo, compared to CFRs reported during other epidemics in sub-Saharan Africa, suggests that medical care provided at rudimentary rural health centers prevented numerous deaths. Additional deaths may be prevented by strengthening the infrastructure of health services in the rural areas and by enhanced public education regarding the need for persons with cholera to promptly seek medical care.

Health education and cholera in rural Guinea-Bissau

OBJECTIVEnThe study was undertaken to explore local ideas about cholera and the diffusion of official health educational messages for cholera prevention and to assess whether such messages contributed to changed behavior in the population.nnnMETHODSnDuring the ongoing cholera epidemic in 1994 in Guinea-Bissau, West Africa, a roster of all adult residents in a rural community was established. From this roster of 458 adults, 53 of 60 randomly chosen residents were interviewed for qualitative data on cholera and its prevention.nnnRESULTSnLocal preventive rituals performed contributed to high awareness of the epidemic. Radio and word-of-mouth communication were the most important sources of information on cholera, whereas posters and television did not effectively reach the population. All persons with cholera rapidly sought care. Thirty-four (64%) of 53 participants recalled at least one preventive measure; specifically, treatment of water with lemon was mentioned by 21 (40%) of respondents. None of the respondents could explain how cholera is transmitted to humans.nnnCONCLUSIONSnTo improve compliance with recommended preventive measures, these should take local conceptions of diseases into account and be few in number, practical, and effective. The impact of the radio could be increased if those who hear the message are urged to spread the recommendation, especially to women who take care of food, water, and general hygiene in the household.

Applied Ethics and Allocation of Foreign Aid: Disparity in Pretensions and Practice

type=main xml:id=dpr12156-abs-0001> We explore the applied ethics of development aid and humanitarian assistance, and juxtapose these with claimed objectives and factors that influence the choice of recipients. Despite some diversity among donors, ethical considerations appear not to be a prominent factor for allocation of aid. Although recipients’ need is not entirely ignored, donors’ self-interest and herd behaviour, and recipients’ merits and voting in the United Nations, play crucial roles in allocation decisions. Likely to be shunned are complex emergencies and fragile states, the overlapping settings for action of development and humanitarian aid. Donors should take to heart and put into practice that allocation of aid is an ethical endeavour that should rest on proper needs assessment, established objectives and adopted agreements.

Review shows that Icelandic society is taking firmer steps to tackle the diverse forms of child abuse and neglect that its children are exposed to

This review examined and summarised the research published on child abuse in Iceland, which was mainly in the countrys native language, to make the findings more accessible to English speakers. It specifically focused on child rearing and the physical, emotional and sexual abuse, neglect and intrafamilial conflicts suffered by children at the hands of their parents and other carers.