Judy Lewis

Protective measure use and symptoms among agropesticide applicators in Sri Lanka

Sri Lankan farmers use large amounts of pesticides to control the pests affecting their vegetable crops. Improper use of pesticides by farmers has resulted in poisoning of occupational origin. This paper examines the use of protective measures by pesticide applicators and its relationship to their illness symptoms. The data were collected by interviewing a stratified random sample of 150 farmers from predominantly vegetable growing areas of the Matale district during 1990/91 using structured questionnaires. These data were supplemented with secondary data and observation of all stages of pesticide application. Scales were constructed to measure the domains of material style of life, awareness and use of protective measures, and illness symptoms experienced by pesticide applicators. It was found that most of the farmers were aware of the protective measures to be used when applying pesticides. There was, however, no significant positive relationship between awareness and use of protective measures. The main reason for not using protective measures was discomfort. The most common symptoms reported by pesticide applicators were faintish feeling, headache and dizziness. A significant negative relationship was observed between use of protective measures and symptoms exhibited within four hours of application. It is recommended that protective materials adapted to the climate and socio-economic conditions of farmers be developed, and that farmers be encouraged to use these protective materials through appropriate educational efforts and incentives.

Maternal and congenital syphilis in rural Haiti

OBJECTIVES A study was conducted to assess the prevalence of maternal syphilis and estimate the rate of congenital syphilis in five rural villages surrounding Jeremie, Haiti. METHODS This research was a retrospective observational study. Data were extracted from the Haitian Health Foundations public health database and verified through original clinical paper records, death certificates, midwife reports, and discussions with community health workers. Data were analyzed by chi-square analysis, bivariate correlations, and two-tailed t-test for independent samples. RESULTS Of the 410 women tested for syphilis, 31 (7.6%) were sero-reactive. Average gestation at time of testing was 25 weeks, which correlated with entry into prenatal care at an average of 23 weeks. Women who tested positive during pregnancy were more likely to have had a negative pregnancy outcome than those who did not (chi square = 16.4; P < 0.0001). The estimated rate of congenital syphilis in the region was 767 per 100,000 live births. CONCLUSIONS Maternal syphilis is prevalent in rural Haiti. This prevalence combined with late entry into prenatal care contributes to adverse pregnancy outcomes and a high estimated rate of congenital syphilis. More research is needed on congenital syphilis and prenatal-careseeking practices of rural Haitian women in order to understand the impact of maternal syphilis in the region and improve pregnancy outcomes.

Prevalence, awareness, treatment and control of hypertension in a rural Nicaraguan sample

The prevalence, awareness, treatment and control of hypertension were assessed in 1303 persons who attended a free vision care clinic in rural Nicaragua. The prevalence of hypertension was 37.8% in men and 43.2% in women. Hypertension was found to be a highly prevalent disease in this group, and presumably in the local population, with low levels of awareness and control.

Promoting interdisciplinary collaboration in health research in developing countries: lessons from the triangle programme in Sri Lanka

The Triangle Programme (1989-1992) aimed at strengthening the institutional capacity for health social science research and intervention in Sri Lanka through the promotion of appropriate international and national partnerships. First, it involved an international partnership (Triangle 1) among two universities in the developed world, i.c. University of Antwerp in Belgium and the University of Connecticut in the USA, and one university in the developing world, i.c. the University of Peradeniya, Sri Lanka. This partnership facilitated the transfer of knowledge, experience, skills across national boundaries and the North/South divide. Second, it developed a national/local partnership (Triangle 2) among the Faculties of Arts, Agriculture and Medicine at the University of Peradeniya by involving them in a joint programme of health social science research and training covering the entire range of activities from proposal development to dissemination of research results. Focusing on the latter aspect (Triangle 2) this paper reviews the results of the programme from the angle of cross-fertilization of disciplines through their collaboration in applied health research in a developing country setting.

No Family Left Behind: The Example of Community-Based Pneumonia Care in Haiti

The Haitian Health Foundation (HHF) in Jeremie, Haiti conducted an intervention combating childhood bacterial pneumonia. HHF treated 60,000 episodes of respiratory illness in 15 years. The same care model is used for vaccinations, exclusive breastfeeding, diarrheal disease, congenital syphilis, and newborn care.

Peptide YY: A Gut Hormone Associated with Anorexia during Infectious Diarrhea in Children

OBJECTIVE To evaluate the effects of diarrhea on appetite among Peruvian children age 12 to 71 months and to assess whether elevated plasma levels of peptide YY, tumor necrosis factor (TNF)-alpha, and interleukin (IL)-1beta contribute to anorexia in this population. STUDY DESIGN A total of 46 Peruvian children with diarrhea and 46 healthy controls underwent an observed feeding trial that was repeated when cases were healthy. Blood samples were obtained from 30 cases and 30 controls at the first trial and from 30 cases at the second trial and assayed for peptide YY, TNF-alpha, and IL-1beta. RESULTS In the cases, mean consumption was less when sick than when healthy. The mean plasma level of peptide YY was higher for cases than controls and higher for cases when sick than when healthy. TNF-alpha levels were higher in cases than controls at visit 1 and also higher in cases when sick than when healthy. There were no differences in IL-1beta levels between cases and controls or between cases when sick and healthy. Peptide YY levels in children with diarrhea correlated with the likelihood of them eating less when sick than when healthy. CONCLUSIONS Elevated serum peptide YY may be a mechanism for anorexia in children with diarrhea.

Institutionalizing community-focused maternal, newborn, and child health strategies to strengthen health systems: A new framework for the Sustainable Development Goal era

BackgroundStronger health systems, with an emphasis on community-based primary health care, are required to help accelerate the pace of ending preventable maternal and child deaths as well as contribute to the achievement of the Sustainable Development Goals (SDGs). The success of the SDGs will require unprecedented coordination across sectors, including partnerships between public, private, and non-governmental organizations (NGOs). To date, little attention has been paid to the distinct ways in which NGOs (both international and local) can partner with existing national government health systems to institutionalize community health strategies.DiscussionIn this paper, we propose a new conceptual framework that depicts three primary pathways through which NGOs can contribute to the institutionalization of community-focused maternal, newborn, and child health (MNCH) strategies to strengthen health systems at the district, national or global level. To illustrate the practical application of these three pathways, we present six illustrative cases from multiple NGOs and discuss the primary drivers of institutional change. In the first pathway, “learning for leverage,” NGOs demonstrate the effectiveness of new innovations that can stimulate changes in the health system through adaptation of research into policy and practice. In the second pathway, “thought leadership,” NGOs disseminate lessons learned to public and private partners through training, information sharing and collaborative learning. In the third pathway, “joint venturing,” NGOs work in partnership with the government health system to demonstrate the efficacy of a project and use their collective voice to help guide decision-makers. In addition to these pathways, we present six key drivers that are critical for successful institutionalization: strategic responsiveness to national health priorities, partnership with policymakers and other stakeholders, community ownership and involvement, monitoring and use of data, diversification of financial resources, and longevity of efforts.ConclusionWith additional research, we propose that this framework can contribute to program planning and policy making of donors, governments, and the NGO community in the institutionalization of community health strategies.