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Featured researches published by Norbert Hirschhorn.


Social Science & Medicine | 1995

The effect of a national control of diarrheal diseases program on mortality: The case of Egypt

Peter Miller; Norbert Hirschhorn

The National Control of Diarrheal Diseases Project (NCDDP) of Egypt began in 1981, became fully operational nation-wide by 1984, and concluded in 1991. The project was designed as a campaign to lower mortality from diarrheal disease in children under five by at least 25% within five years. The principal strategy employed was to improve case-management of diarrhea through rehydration and better feeding: through assured production and distribution of oral rehydration salts, education of families through mass media and health workers through training programs, and creation of rehydration corners throughout the established primary health care and hospital network. A detailed plan for evaluation and research was designed at the start of the project. By its own terms, the NCDDP appears to have succeeded in improving case management; by several local and national mortality surveys, overall infant and childhood mortality fell by at least one-third with the majority proportion in diarrheal deaths. The declines coincided with the peak of NCDDP activities and results in improved case-management. The detailed analyses of this monograph seek to demonstrate that: (a) the mortality decline and the diarrheal mortality decline in particular were actual events; (b) that case-management improved with plausible sufficiency to account for most of the diarrheal mortality reduction; and (c) that changes in other proximate determinants to lowered mortality, such as host resistance or diarrheal incidence, do not plausibly account for the magnitude of the reductions seen. Data are also presented on general socio-economic changes in the decade of the Project. We conclude that improvements in primary care delivery and the use of mass media would have been facilitating factors to NCDDP efforts, while the overall deterioration of economic status would have tended to reduce the benefits. The monograph details the strengths and weaknesses of the available data, and also makes recommendations for sustained efforts in the control of diarrheal diseases.


The Lancet | 1992

Hypernatraemia surveillance during a national diarrhoeal diseases control project in Egypt

I.M. Fayad; MoamenaA. Kamel; Norbert Hirschhorn; M. Abu-Zikry

The nationwide introduction of oral rehydration therapy to Egypt has led to improvement in diarrhoea case management and a fall in infant and child mortality. With the wider use of oral rehydration solution (ORS) prepared from packets, the incidence of hypernatraemia (serum sodium greater than 150 mmol/l) in inpatients with dehydration seen at Abu El-Reeche Hospital, Cairo, increased between 1980 and 1984. Systematic surveillance of hypernatraemia in the outpatient rehydration unit began in late 1984, and we report trends in hypernatraemia and analyses of key variables affecting its incidence in dehydrated children. In 1980, 17 of 100 children sampled had hypernatraemia and 2 had severe hypernatraemia (ie, serum sodium greater than 165 mmol/l). The frequency in inpatients peaked at 49% of 222 children in 1984 (19% with severe hypernatraemia). Between 1986 and 1989, at least 1000 dehydrated outpatients were surveyed each year; by 1989 the incidence of hypernatraemia had fallen to around 10% (2% severe hypernatraemia). The rise and decline coincided with increasing use of ORS and then increasing ability of mothers to mix the solution correctly. Hypernatraemia was positively related to the quantity of ORS taken, severity of dehydration, nutritional status, and the cooler season, and negatively related to age and duration of diarrhoea. Explanations for our findings include improved use of ORS and better case-management. Good practice promoted through the mass media has facilitated these changes; if the standard of ORS use is not maintained, there may be a case for reducing the sodium content of ORS.


Journal of Tropical Pediatrics | 1991

After Rehydration: What Happens to the Child?

Samia Riyad; Mahmoud El Moughi; Ahmed Abd El Rehim Wahsh; Norbert Hirschhorn

Three-hundred infants and toddlers with diarrhoea were followed up for 5 days after initial rehydration with oral rehydration solution (ORS). When an average of 300-340 ml per day was given at home (520 ml if the diarrhoea was watery), only two children required re-hospitalization; one other child died whose voluminous losses should not have been treated at home. Fifteen per cent of the children still had watery diarrhoea and vomiting by the fifth day, perhaps as a result of multiple drug therapy. Continued feeding, especially breast milk and cereal grains, should reduce the duration of diarrhoea and vomiting (and perhaps the number of drugs). The amount of time a mother can spend giving ORS ultimately limits the amount a child receives.


Journal of Tropical Pediatrics | 1988

The clinical epidemiology of acute diarrhoeal disease in Egyptian children.

Shafika Nasser; Nazzek Nossair; Samia Riyad; Ahmed Nagaty; Nabil Nasser; Norbert Hirschhorn

We have used a method of surveillance for diarrhea that examines day-point prevalence in sentinel communities in children under 3 years of age in Egypt. The data have been most helpful in designing aspects of the National Control of Diarrheal Diseases Project. We found diarrhea to be most prevalent and most serious in children under 24 months of age in rural areas and in summer and autumn. Children spend on the average 11% of their year with diarrhea nearly 2/3 of which is watery. Mothers are increasingly using oral rehydration therapy; and they are more likely to seek medical help when signs of dehydration occur. The majority of chilren were given less food during diarrhea and about 1/3 are taken off breast milk for a week or more if diarrhea persists. 4 rural and 1 sub-urban community were surveyed for this study from July 1983 to October 1984. Methods included a census to identify households and members a canvass to identify children who had diarrhea within the past 24 hours and a follow-up survey of all children identified with diarrhea in the canvass stage by interviewing the mother. Monthly day-point prevalences over time were also done in 5 communities. Canvassers were mostly local people. (authors modified)


The American Journal of Clinical Nutrition | 1980

The treatment of acute diarrhea in children. An historical and physiological perspective

Norbert Hirschhorn


Health Policy and Planning | 1987

Deranged distribution, perverse prescription, unprotected use: the irrationality of pharmaceuticals in the developing world

Stephen J Fabricant; Norbert Hirschhorn


The Lancet | 1966

Hypoglycaemia in Children with Acute Diarrhoea.

Norbert Hirschhorn; John Lindenbaum; W. B. Iii. Greenough; S. M. Alam


Health Policy and Planning | 1989

Are we ignoring different levels of mortality in the primary health care debate

Norbert Hirschhorn; Mark Grabowsky; Robin Houston; Robert Steinglass


The Journal of ambulatory care management | 1978

Quality by objectives: a model of quality of care assessment and assurance for ambulatory health centers.

Norbert Hirschhorn; Joel Lamstein; Susan F. Klein; Jeanne McCormack; Timothy N. Warner


Journal of Tropical Pediatrics | 1975

Logical-Flow Diagrams in the Training of Health Workers

Norbert Hirschhorn; Joel Lamstein; Ronald W. O'connor; Kevin M. Denny

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Nazzek Nossair

American University in Cairo

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