The impact of adult deaths on children's health in Northwestern Tanzania

The AIDS epidemic is dramatically increasing mortality of adults in many Sub-Saharan African countries, with potentially severe consequences for surviving family members. Until now, most of these impacts had not been quantified. The authors examine the impact of adult mortality in Tanzania on three measures of health among children under five: morbidity, height for age, and weight for height. The children hit hardest by the death of a parent or other adult are those in the poorest households, those with uneducated parents, and those with the least access to health care. The authors also show how much three important health interventions-immunization against measles, and rehydration salts, and access to health care-can do to mitigate the impact of adult mortality. These programs disproportionately improve health outcomes among the poorest children and, within that group, among children affected by adult mortality. In Tanzania there is so much poverty, and child health indicators are so low that these interventions should be targeted as much as possible to the poorest households, where the children hit hardest by adult mortality are most likely to be found. (Conceivably, the targeting strategy for middle-income countries with severe AIDS epidemics, such as Thailand, or countries with less poverty and better child health indicators might be different.)Health Monitoring&Evaluation,Early Child and Children's Health,Disease Control&Prevention,Early Childhood Development,Public Health Promotion,Adolescent Health,Early Child and Children's Health,Health Monitoring&Evaluation,Street Children,Youth and Governance

Poverty, AIDS, and children's schooling - a targeting dilemma

The authors analyze the relationship between orphan status, household wealth, and child school enrollment using data collected in the 1990s from 28 countries in Sub-Saharan Africa, Latin America, the Caribbean, and one country in Southeast Asia. The findings point to considerable diversity-so much so that generalizations are not possible. While there are some examples of large differentials in enrollment by orphan status, in the majority of cases the orphan enrollment gap is dwarfed by the gap between children from richer and poorer households. In some cases, even non-orphaned children from the top of the wealth distribution have low enrollments, pointing to fundamental issues in the supply or demand for schooling that are a constraint to higher enrollments of all children. The gap in enrollment between female and male orphans is not much different than the gap between girls and boys with living parents, suggesting that female orphans are not disproportionately affected in terms of their enrollment in most countries. These diverse findings demonstrate that the extent to which orphans are under-enrolled relative to other children is country-specific, at least in part because the correlation between orphan status and poverty is not consistent across countries. Social protection and schooling policies need to assess the specific country situation before considering mitigation measures.Children and Youth,Primary Education,Health Monitoring&Evaluation,Public Health Promotion,Street Children,Children and Youth,Street Children,Youth and Governance,Primary Education,HIV AIDS

The elderly and AIDS: Coping strategies and health consequences in rural Tanzania

The elderly are often especially likely to be adversely affected by the death from AIDS of prime-aged adults. The authors use a longitudinal survey of households from northwestern Tanzania in 1991-94 to compare the activities and wellbeing of the elderly in households before and after the death of a prime-aged adult with those of the elderly in households that did not experience the death of an adult. A significant proportion of adults suffering from AIDS return to their parents’ home shortly before death. Time spent by the elderly performing household chores rises following an adult’s death, and their participation in wage employment falls; no evidence is found of increased participation in farm work among the elderly. Evidence shows that the physical well-being of the elderly as measured by body mass index is reduced before the death of an adult relative but recovers thereafter. These results suggest that interventions to prevent a decline in well-being should be focused on the elderly in households with an AIDS patient during the period of illness. Finally, the physical well-being of the elderly in poor and better-off households prior to an adult’s death is compared with that of the elderly in the poorest households that did not experience the death of an adult. The comparison indicates clearly that the poor have the lowest body mass index. Thus, deaths of adults from AIDS are likely to have the largest adverse impacts on the elderly in poor households. A broader group of elderly poor people with pervasive low health status should also be the focus of public policy designed to improve the welfare of the elderly

A Strategy for Health Care in West Africa

This paper discusses major issues in health strategy in West Africa, particularly in the seven countries covered by the Onchocerciasis Control Program: Benin, Chana, Ivory Coast, Mali, Niger, Togo, and Upper Volta. After surveying health status and resources in the region, problems and deficiencies in the health systems are analyzed: limited coverage and impact: inefficient resource use (weak planning and management, unbalanced budget mix, undeveloped referral systems); underutilization of private energies and foreign aid. These deficiencies are explained by lack of tested alternative models, shortages of money, manpower and administration, lacks in available technology, and inadequate understanding about how the health care market works. Elements of a recommended health strategy are set out, including: strengthening the existing infrastructure, reducing costs, using private resources and incentives better, and gradually expanding rural health systems.Center for Research on Economic Development, University of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/101074/1/ECON060.pd

Student Perceptions of the Professional Behavior of Faculty Physicians

This study was conducted to obtain a baseline understanding of the professional behavior of clinical faculty physicians from the medical students’ perspective. Students completed a professionalism evaluation of supervising faculty at the end of each required third-year clerkship over a one year period. Results were analyzed by specific behaviors and across clerkships. Differences were noted in the frequency of the types of problems seen, and varied by clerkship discipline. The most common transgressions of professional behavior reported were the use of derogatory language towards other services or patients and the disrespectful treatment of others. Our study served to provide objective feedback to the faculty about student perceptions of faculty as role models for professionalism while on clinical rotations

The coral core microbiome identifies rare bacterial taxa as ubiquitous endosymbionts

© 2015 International Society for Microbial Ecology All rights reserved. Despite being one of the simplest metazoans, corals harbor some of the most highly diverse and abundant microbial communities. Differentiating core, symbiotic bacteria from this diverse hostassociated consortium is essential for characterizing the functional contributions of bacteria but has not been possible yet. Here we characterize the coral core microbiome and demonstrate clear phylogenetic and functional divisions between the micro-scale, niche habitats within the coral host. In doing so, we discover seven distinct bacterial phylotypes that are universal to the core microbiome of coral species, separated by thousands of kilometres of oceans. The two most abundant phylotypes are co-localized specifically with the corals' endosymbiotic algae and symbiont-containing host cells. These bacterial symbioses likely facilitate the success of the dinoflagellate endosymbiosis with corals in diverse environmental regimes

Leisure Time Physical Activity of Moderate to Vigorous Intensity and Mortality: A Large Pooled Cohort Analysis

Background: Leisure time physical activity reduces the risk of premature mortality, but the years of life expectancy gained at different levels remains unclear. Our objective was to determine the years of life gained after age 40 associated with various levels of physical activity, both overall and according to body mass index (BMI) groups, in a large pooled analysis. Methods and Findings: We examined the association of leisure time physical activity with mortality during follow-up in pooled data from six prospective cohort studies in the National Cancer Institute Cohort Consortium, comprising 654,827 individuals, 21–90 y of age. Physical activity was categorized by metabolic equivalent hours per week (MET-h/wk). Life expectancies and years of life gained/lost were calculated using direct adjusted survival curves (for participants 40+ years of age), with 95% confidence intervals (CIs) derived by bootstrap. The study includes a median 10 y of follow-up and 82,465 deaths. A physical activity level of 0.1–3.74 MET-h/wk, equivalent to brisk walking for up to 75 min/wk, was associated with a gain of 1.8 (95% CI: 1.6–2.0) y in life expectancy relative to no leisure time activity (0 MET-h/wk). Higher levels of physical activity were associated with greater gains in life expectancy, with a gain of 4.5 (95% CI: 4.3–4.7) y at the highest level (22.5+ MET-h/wk, equivalent to brisk walking for 450+ min/wk). Substantial gains were also observed in each BMI group. In joint analyses, being active (7.5+ MET-h/wk) and normal weight (BMI 18.5–24.9) was associated with a gain of 7.2 (95% CI: 6.5–7.9) y of life compared to being inactive (0 MET-h/wk) and obese (BMI 35.0+). A limitation was that physical activity and BMI were ascertained by self report. Conclusions: More leisure time physical activity was associated with longer life expectancy across a range of activity levels and BMI groups

Ghosts in the nursery revisited

In the last decades new research findings have illuminated many of the factors that affect the mental health development of the pre-verbal child. Attachment theory has emerged as a central concept which has great applicability to the clinical field of infant-mental health. The new knowledge base has been utilized by clinical research programs to develop new models of clinical intervention programs with infants-at-risk and their families. This article describes some of the theoretical and research findings which can be translated to, and enhance, traditional child welfare practice. The theoretical considerations are illustrated by case examples.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44244/1/10560_2004_Article_BF00755708.pd