Combating protein-energy-malnutrition in a rural/peri-urban southern African black population

PROTEIN-ENERGY-malnutrition (PEM) is a major cause of morbidity and mortality in young children in Africa. In South Africa, in 1987, to help combating and preventing PEM in the rural black population, the Gold Fields Nutrition Unit was inaugurated at the Medical University of Southern Africa. In 1987-9, 442 patients (rural/peri-urban) plus their mothers or child carers were admitted, and 406 attended as outpatients. Average age was 15.4 +/- 7.6 months, weight 7.0 +/- 1.6kg, stay in hospital, 12 +/- 10.8 days, and daily weight gain during treatment was 31 +/- 48g. Mothers mainly were young and unmarried. Primary causative factors were infections, ignorance, and insufficiency of food. Since results from rehabilitation are usually poor, mothers and carers were taught how best to prepare meals using local foodstuffs. The interventions included teaching and demonstrations of how to grow vegetables, maintain an orchard, a fowl-run, and improve kitchen and laundry facilities. In 1990, in a follow-up of 73 patients, no deaths had occurred within a 12 month period. This far better than usual outcome is being furthered by setting up satellite nutrition clinics.

Histopathology of attachment sites of Amblyomma variegatum and Rhipicephalus appendiculatus on zebu cattle of varying resistance to ticks

Mature, unimproved East African Zebu cattle (Bos indicus) naturally exposed to ticks from birth were ranked for resistance to ticks by repeated whole-body counts of infesting ticks. Four cattle of high resistance, four of low resistance and two of intermediate resistance were artificially infested with nymphs of Amblyomma variegatum and Rhipicephalus appendiculatus. Two Friesian cattle (Bos taurus) with less exposure to ticks were similarly infested. Biopsies of tick attachment sites were examined histologically. All attachment sites showed acute inflammatory lesions, and sites of both tick species on high resistance cattle showed delayed hypersensitive reactions with intra-epidermal pustulation and significant increases in the numbers of granulocytes. The predominant cells infiltrating attachment sites on high resistance cattle were eosinophils with A. variegatum and neutrophils with R. appendiculatus. Such differences need to be taken into account in developing immunological tests for selecting cattle for resistance but there are sufficient common features of reactions to the two infesting tick species to justify dermal hypersensitivity tests.

Limitations of faecal chymotrypsin as a screening test for chronic pancreatitis

Faecal chymotrypsin was measured in patients with chronic pancreatitis and in healthy black urban and rural control subjects. In the patients, significantly lower values of faecal chymotrypsin were obtained (mean (SD) 2.4 1.79 U/g stool) whereas in urban control subjects, values were within the normal range (mean (SD) 13.2 (11.9)). In rural black control subjects, however, the faecal chymotrypsin value was significantly lower (mean (SD) 7.1 (5.1)) than in urban black control subjects. It is suggested that faecal pH may influence faecal chymotrypsin values. The mean faecal pH in rural black subjects (pH 6.14) was significantly lower than that in urban control subjects (pH 6.77) and in patients with chronic pancreatitis (pH 6.61). Moreover, mean faecal chymotrypsin is high (20.0 U/g stool) at a pH greater than 7. Between pH 6 and 7 the mean value drops to 8.6 U/g stool and below pH 6 mean faecal chymotrypsin is in the abnormal range (4.4 U/g stool). Hence, low values for faecal chymotrypsin may be due to lower faecal pH (less than 6) in healthy control subjects. For diagnostic purposes, the faecal pH value should be determined if a low faecal chymotrypsin value is obtained.

Body image and eating behaviour in interethnic adolescent girls

Reports of major dissatisfaction among adolescent girls over body shape and their associated eating behaviour, prompted determining anthropometric and questionnaire studies on series of rural and urban black, Indian, and white girls aged 14-19 years. Variables were concern over weight, desired weight loss, also practices regarding binge eating, fasting, vomiting and laxative use. Black girls have low weight-for-age, yet experience more obesity than white girls; yet weight reduction, although desired, is seldom seriously attempted. Indian girls have low weight-for-age, principally for genetic, not social class, reasons; they also, even some underweight, desired weight reduction. White girls are also dissatisfied, although less acutely than girls in the US. The current attitudes of South African adolescent girls, apart from extremes, are unlikely to seriously prejudice their health.

Rehydration of guaiac-based faecal occult blood tests in mass screening for colorectal cancer. An economic perspective

Owing to dehydration during storage, faecal occult blood tests have been found to lose sensitivity; accordingly, test rehydration before development has been advocated, although this practice has yet to be subjected to an economic evaluation. In this paper, the results from two major screening trials in Sweden and England, one using rehydration and the other not, are so evaluated, based on a costing model developed within the English trial. The higher sensitivity resulting from rehydration was found to be accompanied by losses in specificity, such that, although more cancers are detected, the costs of screening and of cancer detection are actually considerably higher under the rehydration regimen than with non-hydration.

The hospital costs of diagnostic procedures for colorectal cancer

Diagnosis for colorectal cancer is commonly made using either colonoscopy or double contrast barium enema techniques. To data, little attention has been paid to the comparative costs of these two procedures and the paper presents estimates of hospital costs for each, using data from the colorectal study being undertaken in Nottingham, U.K. Consideration is also given to procedure sensitivity and the frequency of referral to the alternative technique in cases of incomplete diagnosis. The paper presents the conditions under which a given technique may be considered cost-superior to its alternative but concludes that the absence of conclusive clinical trial data and other considerations precludes the identification of a definitively optimum technique from the economic point of view.

Interethnic physiological and pathological diversities in southern African populations

The African continent accommodates a diversity of races--Arabs, Berbers, Nilo-Saharan, Bantu, Pygmies, as well as immigrant white and Indian populations, especially in Central, East and Southern Africa. In these populations and sub-populations, differences prevail in physiological variables, in biological disorders, in measurements made by laboratory and associated means, and in disease patterns. A salient question is: which differences will persist, and which become modified or even disappear as a result of progressive urbanisation, a rise in prosperity, and changes in lifestyle, particularly when these occur in populations previously poor or who have lived in a rural traditional manner.

The costing of nursing care: a study of 65 colorectal cancer patients

Nursing care is a major factor in the cost of most medical treatments. This paper reports on two alternative techniques for estimating the costs of nursing care, in the context of colorectal cancer treatment on a surgical ward in the University Hospital, Nottingham. The simpler, but cruder, technique is based on average patient costs, whilst the other is patient-specific and incorporates the use of nursing dependency data. Results from the two estimation methods are compared and the implications for the proper costing of nursing care are discussed.

Alternative pathways for hydrogen disposal during fermentation in the human colon

Hydrogen gas, which is produced during fermentation in the human colon, is either excreted in breath or metabolised by gut bacteria through a variety of pathways. These may include methanogenesis, dissimilatory sulphate reduction, and acetogenesis. To determine which of these routes predominates in the large intestine, stools were taken from 30 healthy subjects and incubated as 5% (w/v) slurries with Lintner's starch. In 23 of 30 subjects, methane production was the main method of hydrogen disposal. In the remaining seven, high rates of sulphate reduction were recorded together with raised production of H2S. All samples showed relatively low rates of hydrogen evolution and of acetate formation from CO2 and H2. Sulphate reduction and methanogenesis seem to be mutually exclusive in the colon and this is probably linked to sulphate availability. Sulphate reduction, methanogenesis, and acetogenesis were strongly influenced by pH. Sulphate reduction was optimal at alkaline pH values whereas methane production was maximal at a neutral pH and acetogenesis favoured acidic conditions. Faecal H2S values were related to carriage of sulphate reducing bacteria. These data show that a number of competing pathways for hydrogen disposal are possible in the large gut and that a variety of factors such as colonic pH and sulphate availability can determine which of these mechanisms predominates.

Obesity in black women in Soweto, South Africa: minimal effects on hypertension, hyperlipidaemia and hyperglycaemia

Studies were made on 50 South African urban black obese women aged 25-40 years, with Body Mass Index (BMI) (Kg/m2) of 29.5 or more, and on 50 non-obese women with BMI of 25 or less. In the two groups, mean triceps skinfolds were 25.5mm and 17.8mm, respectively. Hypertension (greater than or equal to 160/95mm Hg) was present in 6 and 4 women (12% and 8%), hypercholesterolaemia (greater than or equal to 5.2mmol/l) in 5 and 3 women (10% and 6%), hypertriglyceridaemia (greater than or equal to 1.8mmol/l) in 5 and 3 (10% and 6%), and hyperglycaemia (greater than or equal to 7.8mmol/l) in 2 and 1 women (4% and 2%). One or more adverse sequelae were present in 11 (22%) obese and in 9 (18%) of non-obese women, proportions not significantly different. Dietarily, mean daily intakes were--Kcals 2273 and 2240, protein 73g and 70g (12.9% and 12.5% energy), fat 65g and 67g (25.7% and 26.9% energy), carbohydrate 349g and 330g (61.4% and 60.5% energy), and dietary fibre, 12g and 13g. In this low socioeconomic and low fat dietary context, obesity in the black women studied was not specifically evocative of deleterious sequelae of obesity.

What causes appendicitis?

Appendicitis was rare in the past and still is in traditional Third World populations. It began to increase a century ago, peaked about 1950, and has now fallen to about half its previous incidence. As to causation, dietetically, it was contended that the increase was promoted primarily by an associated fall in dietary fiber intake. The recently advanced hygiene hypothesis considers the increase to have stemmed from improvements in hygiene, generally; these limited exposure to enteric infections and modified response to virus infections, thereby triggering appendicitis. Major uncertainties still prevail over the promotive and precipitating factors of the disease. It is doubtful whether individuals can take any action to avoid appendicitis.

The occurrence of ephemeral fever in Kenya, 1968-1988

Ephemeral fever occurs in Kenya in epidemics which have been associated with periods of unusually heavy and prolonged rainfall. The epidemics persist for 2-3 years and involve most of the country. They occur in the same years as epizootics of Rift Valley fever, which is a mosquito-borne Phlebovirus infection. Sporadic outbreaks of the disease have been associated with local heavy rains; though one outbreak occurred during a dry period. Culicoides spp. were generally present in large numbers at the site of the outbreaks. Seroconversions were detected in sentinel cattle, when there had been no apparent clinical disease.