clove and Infections

Efforts to develop effective and regionally-appropriate emergency care systems in sub-Saharan Africa are hindered by a lack of data on both the burden of disease in the region and on the state of existing care delivery mechanisms. This study describes the burden of acute disease presenting to an emergency unit in Mahajanga, Madagascar.. Handwritten patient registries on all emergency department patients presenting between 1 January 2011 and 30 September 2012 were reviewed and data entered into a database. Data included age, sex, diagnosis, and disposition. We classified diagnoses into Clinical Classifications Software (CCS) multi-level categories. The population was 53.5% male, with a median age of 31 years. The five most common presenting conditions were 1) Superficial injury; contusion, 2) Open wounds of head; neck; and trunk, 3) Open wounds of extremities, 4) Intracranial injury, and 5) Unspecified injury and poisoning. Trauma accounted for 48%, Infectious Disease for 15%, Mental Health 6.1%, Noncommunicable 29%, and Neoplasms 1.2%. The acuity seen was high, with an admission rate of 43%. Trauma was the most common reason for admission, representing 19% of admitted patients.. This study describes the burden of acute disease at a large referral center in northern Madagascar. The Centre Hôpitalier Universitaire de Mahajanga sees a high volume of acutely ill and injured patients. Similar to other reports from the region, trauma is the most common pathology observed, though infectious disease was responsible for the majority of adult mortality. Typhoid fever other intestinal infections were the most lethal CCS-coded pathologies. By utilizing a widely understood classification system, we are able to highlight contrasts between Mahajanga's acute and overall disease burden as well as make comparisons between this region and the rest of the globe. We hope this study will serve to guide the development of context-appropriate emergency medicine systems in the region.

Topics: Acute Disease; Adolescent; Adult; Child; Child, Preschool; Emergency Medical Services; Female; Humans; Infections; Madagascar; Male; Mental Health; Referral and Consultation; Wounds and Injuries; Young Adult

As undisturbed habitat becomes increasingly rare, managers charged with ensuring the survival of endangered primate species must increasingly utilize disturbed and degraded habitats in species survival plans. Yet we have an imperfect understanding of the true long-term viability of primate populations in disturbed habitat, and census data can be misleading because density is not necessarily correlated with habitat quality and population viability in predictable ways. Here we present clinical laboratory data on hematology, serum biochemistry, fat-soluble vitamins, minerals, iron analytes, viral serology, and parasitology of diademed sifaka (Propithecus diadema), derived from the capture of 26 individuals spanning eight groups and two habitats (undisturbed vs. disturbed and fragmented) at Tsinjoarivo, Madagascar. Blood from fragment individuals had significantly lower values for several factors: white blood cell counts, bilirubin, total protein, albumin, calcium, sodium, chloride, manganese, zinc, iron and total iron-binding capacity. Several biochemical variables were higher in immature individuals, probably due to active growth. The large number of interhabitat differences suggests that habitat disturbance has an impact on physiological health within this population, perhaps reflecting dietary stress and/or immunosuppression. These results, combined with previous data showing altered diet, slower juvenile growth, and reduced activity in disturbed forest fragments, suggest that fragment sifakas may be less healthy than continuous forest groups. Finally, Tsinjoarivo sifakas have extremely low blood urea nitrogen (perhaps reflecting protein limitation) and selenium levels relative to other lemurs. Despite their survival and reproduction in the short term in fragments, these sifakas may represent a riskier conservation investment than conspecifics in undisturbed forest, and may be more susceptible to environmental stressors. However, more data on the fitness consequences of these biochemical differences are needed for a better interpretation of their impacts on long-term viability prospects.

Topics: Animals; Blood Proteins; Blood Urea Nitrogen; Ecosystem; Endangered Species; Female; Health Status; Infections; Iron; Leukocyte Count; Madagascar; Male; Minerals; Selenium; Strepsirhini; Vitamins

A retrospective study was conducted to assess mortality rates at the Befelatanana Women's Hospital from January 1st 1988 through December 31st 1997, define trends, study causes and identify problems encountered during treatment and those related to the referral system, in order to improve prevention and patient management. and method. Birth and death registries, operation reports and patient charts were analyzed. All maternal deaths wether of direct or indirect obstetrical origin were considered.. There were 997 cases of maternal death among 91, 032 births, i.e. 1.09% or 1,245 maternal deaths per 100,000 live births. Among direct obstetrical causes of death (93%), 65.8% involved infectious complications and 22.9% renal and vascular complications.Other causes were anesthesia accidents and thrombolic events. Among the direct obstetrical causes, complicated delivery was responsible for 57.4% of the deaths and 42.6% of the abortions. Indirect obstetrical causes were due to malaria (68.6%), heart disease (21.4%) and asthma (10%).. This high rate of maternal death illustrates the serious situation of obstetrics in our region. Our aim is to reduce this rate by promoting the Birth Place Without Risk program and improving management conditions. Implementation of this ambitious program requires implication of political decisions makers convinced of the importance of improving women's conditions and the health care system in Madagascar.

Topics: Asthma; Cause of Death; Female; Heart Diseases; Hospitals, University; Humans; Infections; Madagascar; Malaria; Maternal Mortality; Obstetric Labor Complications; Obstetrics and Gynecology Department, Hospital; Pregnancy; Pregnancy Complications; Retrospective Studies

The main causes of death in rural areas of the Faritany of Toamasina during 1986 are identified and classified by order of importance for the entire population as well as for vulnerable groups such as preschool children and reproductive-aged women. The 10 leading causes of death of infants and children under age 5 years are coughs and fevers, as well as thoracic pains; vomiting and diarrhea; age factors; high, intermittent fevers and chills; protein-calorie malnutrition; convulsions; other high fevers; cough of long duration; sudden death; and measles. Leading causes of death for women aged 15-49 years include coughs and fevers, as well as thoracic pains; high, intermittent fevers and chills; vomiting and diarrhea; other high fevers; delivery complications; cough of long duration; malnutrition; abortion or miscarriage; sudden death; and postpartum illnesses. Over 60% of deaths reported for children aged 0-5 years could have been prevented through a broader vaccination program, oral rehydration therapy, nutrition education and growth monitoring, and the preventive treatment of malaria. Priority focus should be given to respiratory infections.

Topics: Africa; Africa South of the Sahara; Africa, Eastern; Africa, Northern; Cause of Death; Demography; Developing Countries; Disease; Economics; Health Services Needs and Demand; Infections; Madagascar; Mortality; Population; Population Characteristics; Population Dynamics; Respiratory Tract Infections; Rural Population