Critical Reviews in Tropical Medicine: Volume 2

283 Pages·1984·4.868 MB·English

by  David S. Rowe (auth.), R. K. Chandra (eds.)

CRITICAL REVIEWS IN
TROPICAL MEDICINE
Volume 2
Editorial Advisory Board
B. Greenwood, Banjul, The Gambia
L. Mata, San Pedro, Costa Rica
V. Ramalingaswami, New Delhi, India
D. S. Rowe, Geneva, Switzerland
N. S. Scrimshaw, Cambridge, Massachusetts, U.S.A.
C. E. Gordon Smith, London, England
K. S. Warren, New York, New York, U.S.A.
J. C. Waterlow, London, England
A Continuation Order Plan is available for this series. A continuation order will bring delivery of
each new volume immediately upon publication. Volumes are billed only upon actual shipment. For
further information please contact the publisher.
CRITICAL REVIEWS IN
TROPICAL MEDICINE
Volume 2
Edited by
R. K. Chandra
Memorial University of Newfoundland
St. John's, Newfoundland, Canada
PLENUM PRESS· NEW YORK AND LONDON
The Library of Congress cataloged the first volume of this title as follows:
Main entry under title:
Critical reviews in tropical medicine.
Includes bibliographical references and index.
1. Tropical medicine. I. Chandra, Ranjit Kumur. [DNLM: 1. Tropical medicine
Periodical. WI CR216Yj
RC961.5.C74 1982 616'.00913 82-15129
ISBN-13: 978-1-4612-9689-8 e-ISBN-13: 978-1-4613-2723-3
DOl: 10.1007/978-1-4613-2723-3
©1984 Plenum Press, New York
Softcover reprint of the hardcover 1st edition 1984
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Contributors
J. AZOCAR, Center for Microbiology and Cellular Biology, Venezuelan
Institute for Scientific Research, Caracas IOIOA, Venezuela
REZA BEHIN, World Health Organization, Immunology Research and Training
Center, Biochemistry Institute, University of Lausanne, 1066 Epalinges,
Switzerland
R. K. CHANDRA, Department of Pediatrics, Janeway Child Health Centre,
Memorial University of Newfoundland, St. John's, Newfoundland,
Canada AlA lR8
G. C. COOK, Department of Clinical Tropical Medicine, London School of
Hygiene and Tropical Medicine, London WClH 7HT, England
TIM DYSON, Department of Population Studies, London School of
Economics, London WC2A 2AE, England
JACQUES LOUIS, World Health Organization, Immunology Research and
Training Center, Biochemistry Institute, University of Lausanne, 1066
Epalinges, Switzerland
DILIP MAHALANABIS, Kothari Centre of Gastroenterology, The Calcutta
Medical Research Institute, Calcutta-700027, India
J. A. O'DALY, Center for Microbiology and Cellular Biology, Venezuelan
Institute for Scientific Research, Caracas IOIOA, Venezuela
DAVID S. ROWE, Special Programme for Research and Training in Tropical
Diseases, World Health Organization, 1211 Geneva 27, Switzerland
G. P. TALWAR, National Institute of Immunology and Department of
Biochemistry, All India Institute of Medical Sciences, New Delhi
11 000 29, India
DEVHUTI VYAS, Health Sciences Centre, Memorial University of
Newfoundland, St. John's, Newfoundland, Canada AlB 3V6
DEREK WAKELIN, Department of Zoology, University of Nottingham,
Nottingham NG7 2RD, England
v
Preface
At the present time there are renewed global efforts to control the major tropical
infections and to stem the tide of malnutrition, the two serious, often intertwined,
problems that contribute to much of the morbidity and mortality in under
privileged populations. Many international organizations have joined hands with
national governments and with the private sector to search for new approaches to
problems that beset much of the developing world, including countries in the
tropical region. This volume continues the tradition of the previous publication in
the Series. A variety of fare is offered to readers: explanations of the activities
and achievements of the UNDP/World Bank/WHO Special Programme for Re
search and Training in Tropical Diseases; and studies of infant mortality,
schistosomiasis, trypanosomiasis, helminths, lactase deficiency, oral rehydration
therapy, functional consequences of iron deficiency, and fertility control. Au
thoritative state-of-the-art reviews provide a critical analysis of recent data. I
hope the Series will continue to prove useful to all those working in the tropics
and to those in the industrialized countries whose awareness of physical health
problems of the Third World is relatively limited.
R. K. Chandra
St. John's, Newfoundland
VlI
Contents
Chapter 1. The Special Programme for Research and
Training in Tropical Diseases .................. .
DAVID S. ROWE
1. Origins, Objectives, and Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2. The Modus Operandi of the Programme. . . . . . . . . . . . . . . . . . . . . . 3
2.1. Scientific Working Groups. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.2. Research Strengthening Group. . . . . . . . . . . . . . . . . . . . . . . . . 7
2.3. The Scientific and Technical Advisory Committee. . . . . . . . . 7
2.4. Joint Coordinating Board. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.5. The Executing Agency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.6. Budget............................................ 9
3. Research and Development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
3.1. Malaria........................................... 10
3.2. Schistosomiasis..................................... 15
3.3. Filariasis.......................................... 16
3.4. African Trypanosomiases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.5. Chagas' Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3.6. Leprosy........................................... 21
3.7. Leishmaniasis...................................... 23
3.8. Epidemiology...................................... 25
3.9. Biomedical Sciences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3.10. Biological Control of Vectors. . . . . . . . . . . . . . . . . . . . . . . . . 27
3.11. Social and Economic Research ... . . . . . . . . . . . . . . . . . . . . . 28
4. The Strengthening of Research Capability. . . . . . . . . . . . . . . . . . . . . 30
5. Field Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
6. Collaboration with Other Funding Agencies. . . . . . . . . . . . . . . . . . . 34
ix
x Contents
7. Collaboration with Industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
8. Information on the Programme's Activities. . . . . . . . . . . . . . . . . . . . 35
9. An Interim Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Chapter 2. Infant and Child Mortality in Developing
Countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
TIM DYSON
1. Introduction............................................. 39
2. Measuring Early-Age Mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3. Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
3.1. Vital Registration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
3.2. Censuses and Surveys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.3. Surveillance Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
4. The Age Pattern of Mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
5. Early-Age Mortality Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
5.1. Africa............................................ 49
5.2. Latin America. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
5.3. Asia.............................................. 53
5.4. Summary.......................................... 54
6. Early-Age Mortality Trends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
6.1. Africa............................................ 54
6.2. Latin America. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
6.3. Asia.............................................. 56
6.4. Summary.......................................... 58
7. Early-Age Mortality and Levels of Per Capita Income. . . . . . • . . . . 59
8. Intracountry Variation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
8.1. Regional Variation.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
8.2. Urban-Rural Variation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
8.3. Maternal Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
8.4. Birth Order, Birth Interval, and Maternal Age. . . . . . . . . . . . 63
8.5. Breast-Feeding..................................... 64
8.6. Birth Weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
8.7. Single or Multiple Births. . . . . ..... . . . .. . ... . .. ... . .. . 66
8.8. Sex of Child. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
9. Causes of Early-Age Deaths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
10. Synergistic Interrelations with Malnutrition. . . . . . . . . . . . . . . . . . . . 68
11. Further Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
11.1. Water and Toilet Facilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
11.2. Health Service Availability ........................... 70
11.3. Climatic Seasonality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Contents xi
12. Infant versus Child Mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
13. Conclusion.................... . . . . . . . . . . . . . . . . . . . . . . . . . . 72
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Chapter 3. Oral Rehydration Therapy. . . . . . . . . . . . . . . . . . . . . . 77
DILIP MAHALANABIS
1. Introduction............... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
2. Evolution of ORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
2.1. Early Empirical Use of ORT . . . . . . . . . . . . . . . . . . . . . . . . . . 78
2.2. Glucose-Linked Enhanced Sodium Absorption and Its Early
Application in ORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
2.3. A Critical Look at the Scientific Basis of ORT . . . . . . . . . . . 80
2.4. Oral Rehydration Formulation. . . . . . . . . . . . . . . . . . . . . . . . . 81
3. ORT in the Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
4. ORT and Feeding Practices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
5. ORS as an Absorption-Promoting Drug. . . . . . . . . . . . . . . . . . . . . . . 86
5.1. Clinical Studies Supporting the Postulate. . . . . . . . . . . . . . . . 87
5.2. Future Prospects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Chapter 4. Functional Consequences of Iron Deficiency:
Nonerythroid Effects. . . . . . . . . . . . . . . . . . . . . . . . . . . 93
R. K. CHANDRA AND DEVHUTI VyA S
1. Immunocompetence and Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
1.1. Immune Responses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
1.2. Iron Status and Incidence of Infections. . . . . . . . . . . . . . . . . . 100
1.3. Iron Administration, Bacterial Growth, and Infection. . . . . . 103
2. Gastrointestinal System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
3. Thermoregulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
4. Physical Work Capacity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
4.1. Respiratory and Cardiovascular Adjustments .... . . . . . . . . . 106
4.2. Human Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
4.3. Animal Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
4.4. Additional Comments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
5. Cognition and Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Xli Contents
Chapter 5. Hypolactasia: Geographical Distribution,
Diagnosis, and Practical Significance. . . . . . . . . . . . 117
G. C. COOK
1. Geographical Distribution of Primary (Genetically Determined)
Hypolactasia and Persistence of Lactase . . . . . . . . . . . . . . . . . . . . . . 117
1.1. Distribution of PL in the Indian Subcontinent ............ 118
1.2. Distribution of PL in Northern Africa. . . . . . . . . . . . . . . . . . . 119
1.3. Distribution of PL in Europe. . . . . . . . . . . . . . . . . . . . . . . . . . 120
1.4. Incidence of PL in Southeast Asia, the Pacific,
and Australia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
1.5. Incidence of PL in Children in Population Groups with a
High Incidence of Adult Hypo1actasia. . . . . . . . . . . . . . . . . . . 121
2. Explanations for the Survival of PL. . . . . . . . . . . . . . . . . . . . . . . . . . 122
2.1. The Culture-Historical Hypothesis. . . . . . . . . . . . . . . . . . . . . . 122
2.2. The Calcium-Absorption Hypothesis. . . . . . . . . . . . . . . . . . . . 122
2.3. The Water-Absorption Hypothesis. . . . . . . . . . . . . . . . . . . . . . 123
2.4. The Weaning-Time Hypothesis ........... ; . . . . . . . . . . . . 123
2.5. The Linkage-Disequilibrium Hypothesis. . . . . . . . . . . . . . . . . 123
2.6. The Rotavirus Receptor and Uncoating Hypothesis. . . . . . . . 123
2.7. Protection against Colonic Infections. . . . . . . . . . . . . . . . . . . . 124
2.8. Resistance to Systemic Infections. . . . . . . . . . . . . . . . . . . . . . 124
2.9. Synthesis of the Various Hypotheses. . . . . . . . . . . . . . . . . . . . 124
3. Genetics and Possible Undesirable Effects of PL . . . . . . . . . . . . . . . 125
3. 1. Atherosclerosis..................................... 125
3.2. Cataract Formation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
4. Secondary (Acquired) Hypolactasia . . . . . . . . . . . . . . . . . . . . . . . . . . 125
4.1. Small-Intestinal Infections and Malignancy. . . . . . . . . . . . . . . 126
4.2. Malnutrition....................................... 126
4.3. Dietary Depression of Lactase Concentration. . . . . . . . . . . . . 127
4.4. Miscellaneous Small-Intestinal Diseases. . . . . . . . . . . . . . . . . 127
5. Clinical Significance of Hypolactasia ........ . . . . . . . . . . . . . . . . 128
5.1. Symptoms Attributable to Hypolactasia. . . . . . . . . . . . . . . . . . 128
5.2. Effect on Other Nutrients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
5.3. Lactose and Milk Supplements in the Presence of
Hypolactasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
5.4. Alleviation of Symptoms Associated with Hypolactasia. . . . . 130
5.5. Management of Portal-Systemic Encephalopathy in
Hypolactasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
5.6. Advantage of Hypolactasia in Reducing Intestinal Lead
Absorption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130