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http://www.webmedcentral.com/images/Header_Logo.giftext/html2011-09-15T15:19:24+01:00http://www.webmedcentral.com/Dr. Devon D BrewerScarification and Male Circumcision Associated with HIV Infection in Mozambican Children and Youth
http://www.webmedcentral.com/article_view/2206
Background: In sub-Saharan Africa, significant numbers of children with seronegative mothers are HIV infected. Similarly, substantial proportions of African youth who have not had sex are infected with HIV. These findings imply that some African children and youth acquire HIV through blood exposures in unhygienic healthcare, cosmetic care, and rituals. In prior research, male and female Kenyan, Lesothoan, and Tanzanian adolescents and virgins who were circumcised were more likely to be infected with HIV than their uncircumcised counterparts. Methods: I examined the association between male circumcision, scarification, and HIV infection in Mozambican children and youth with data from the 2009 Mozambique AIDS Indicator Survey. I excluded from analysis children under age 12 who had HIV seropositive biological mothers. I coded children and youth as exposed to circumcision or scarification only if it had occurred within the prior 10 years.Results: Circumcised and scarified children and youth were two to three times more likely to be infected with HIV than children and youth who had not been circumcised or scarified, respectively. Circumcision and scarification were each associated with HIV infection for both virgins and sexually experienced youth. Males circumcised by medical doctors were almost as likely to be infected as those circumcised by traditional circumcisers. Circumcision and scarification were also independently associated with HIV infection in males.Conclusions: To determine modes of HIV transmission with confidence, researchers must employ more rigorous research designs than have been used to date in sub-Saharan Africa. In the meantime, Mozambicans and other Africans should be warned about all risks of blood-borne HIV transmission, including scarification and medical and traditional circumcision, and informed about how these risks can be avoided.
text/html2010-12-07T21:32:22+01:00http://www.webmedcentral.com/Dr. Devon D BrewerVaginal Tenofovir Gel Trial Results Suggest Substantial Nonsexual HIV Transmission
http://www.webmedcentral.com/article_view/1292
Abdool Karim and colleagues demonstrated that vaginal tenofovir gel provides partial protection against HIV in South African women. However, the study design of their double-blind, randomized, placebo-controlled CAPRISA 004 trial did not allow for determining the mode of HIV acquisition for participants with incident infection. The available evidence suggests substantial nonsexual transmission. Trial participants' reported exposure to HIV through penile-vaginal sex, at the aggregate level, was unrelated to HIV incidence over time. Moreover, the CAPRISA 004 trial data imply a questionably high nominal per act transmission probability for coital acts without a condom (1.8% in the tenofovir gel arm and 3.0% in the placebo arm). Based on the results of dosing studies, the vaginal tenofovir gel appears to be a somewhat inefficient vehicle for delivering tenofovir systemically, thereby serving to prevent HIV acquisition from either blood or sexual exposures. Further analysis of the trial data and making the full trial protocol and data public would allow competing interpretations of the CAPRISA 004 results to be investigated. New trials that include critical design features for determining modes of HIV transmission would provide the most definitive evidence.text/html2011-12-02T18:36:23+01:00http://www.webmedcentral.com/Dr. Raul IseaOn the Long-term Health Care Crisis. A Possible Eradication Scenario
http://www.webmedcentral.com/article_view/2550
The purpose of the present essay is to suggest a possible model to describe the worldwide healthcare crisis, where diseases that have been considered to be eradicated or under our control are re-emerging today.text/html2010-10-05T20:11:16+01:00http://www.webmedcentral.com/Dr. Subhasish BandyopadhyayIncidence of Strongyle infection in cattle and pig with relevance to rainfall in Meghalaya
http://www.webmedcentral.com/article_view/889
A Study was conducted to know the effect of meteorological parameters on strongyle infection in cattle and pig in Meghalaya. Faecal samples, collected from three Govt. farms during years 2001 – 2002, were screened for the presence of strongyle parasitic egg. Incidence of strongle infection in relation to meteorological parameters was done by regression analysis. Occurrence of strongyle infection is 50 per cent dependent on rainfall in Meghalaya. One per cent increase in rainfall predict 0.03 per cent increase in strongyle infection. Minimum and maximum temperature contributed only 20 per cent for the occurrence of the disease. Proper control measures should be undertaken during monsoon season. As strongyle infestation is positively correlated with level of precipitation, anthelmintic coverage should be done during seasonal and occasional off-season precipitation period. text/html2010-10-27T21:42:21+01:00http://www.webmedcentral.com/Dr. John HartCancer Mortality Rates And North-to-south County Position Along The Mississippi River: An Ecological Study
http://www.webmedcentral.com/article_view/1088
Introduction:This study explores the relationship between north-to-south (N-S)geographic positions of counties along the Mississippi River and their cancer mortality rates for a single race.The research hypothesis is that cancer rates increase from N-S. Methods: In this ecological study, archived age-adjusted cancer mortality data were obtained for counties along primarily the western border of the Mississippi River.Counties were numerically ranked from north-to-south with “1” representing the northern-most county and “47” for the southern-most county. Data analysis consisted of correlation and linear regression with the response variable = cancer mortality and the predictor variable = N-S position. Results: A statistically significant relationship was observed between N-S county position and cancer mortality (Pearson: r = 0.568, p < 0.0001; linear regression: t = 4.63, p < 0.0001, parameter estimate = 0.661). Conclusion: In this study, county positions were associated with cancer mortality rates to the extent that the mortality rates increased from N-S. Further research is indicated to explore possible mechanisms involved, such as income and diet.
text/html2011-07-29T18:17:38+01:00http://www.webmedcentral.com/Dr. Weidong ZhangSyphilis Infection Among Drug Users in Different Regions in China: Develop Targeted Intervention Strategy
http://www.webmedcentral.com/article_view/2054
Aim: To understand the sex behaviours and demographic characteristics associated with syphilis infection among drug users in China, to provide useful information for HIV/AIDS prevention and intetrvention strategy.Methods: convenience sampling method or snowball sampling method was used to recruit drug users. Logistic regression was used to analyse independent association between syphilis and risk behaviours.Results: Syphilis prevalence in Guangxi Nanning, Xinjiang Kashi and Guangdong Dongguan were 17.5%, 10.4%, and 9.6%, perspectively. factors significantly associated with syphilis in Guangxi Nanning was: female vs. male (OR 8.50; p=0.001); factors significantly associated with syphilis in Xinjiang Kashi were: female vs. male (OR 7.44; p9 years (OR 3.12; pConclusion: Now, the major mode of HIV transmission in China is sexual transmission, targeted prevention and intervention should focus on at-risk groups.
text/html2012-02-01T19:51:07+01:00http://www.webmedcentral.com/Ms. Judy S CohainIs CDC GBS Protocol for Performing Rectovaginal Culture for GBS at 35-37 Weeks of Pregnancy and Subsequent Antibiotic Prophylaxis for Full Term GBS Positive Women Biased? Critical Analysis of: Centers for Disease Control and Prevention of Perinatal Group B Streptococcal Disease.
http://www.webmedcentral.com/article_view/2953
Protocols recommending routine culture of women at 35-36 weeks pregnancy and treating GBS positive women with IV antibiotics in labor are loosely based on low level observational studies. Penicillin resistant GBS strains have been identified since 2006. All forms of GBS disease: EOS, late onset, adult and symptomatic GBS vaginitis are increasing since the strong enforcement of CDC protocols in the US. The short and long term effects of wide routine prophylactic use of antibiotics on healthy mothers and their newborns have not been analyzed. 35-36 weeks cultures have low specificity. Current CDC protocols appear to have a bias towards routine antibiotic prophylaxis without careful consideration of short and long term effects of their recommendations.text/html2012-02-22T14:17:44+01:00http://www.webmedcentral.com/Dr. Mahantesh B SiddibhaviOral Health Status of Handicapped Children Attending Various Special Schools in Belgaum City Karnataka.
http://www.webmedcentral.com/article_view/3061
Aim: To assess the oral health status of handicapped children attending various special schools. Objective: To assess oral hygiene practice, dental caries and treatment needs, gingival and periodontal treatment needs malocclusion status. Materials and Methods: The study group consisted of 263 subjects out of which 155 were males and 108 females. Results: 67% of subjects used tooth brush to clean their teeth and around 29.3% used finger. 12.8% of subjects were brushing twice a day. Overall females had more mean DMFT score than males. In males it was 3.48 and in females it was 3.98. 13.6% of subject’s required elective orthodontic treatment and 4.62% had severe or handicapping malocclusion. Conclusion: The mean DMFT score was higher in physically handicapped when compared to mentally retarded subjects. Mentally retarded subjects were having poor periodontal status than physically handicapped students.Key Words: Oral Health, Hygiene practice, Handicapped children, Treatment needs.text/html2012-05-14T12:25:30+01:00http://www.webmedcentral.com/Dr. Brijesh SathianImportance of Sample Size Calculation in the Original Medical Research Articles from Developing Countries
http://www.webmedcentral.com/article_view/3371
Sample size calculation is very important for medical research. Because medical data is with uncertainty and most of the studies deals with a small sample and infer about a big population. But most of the researchers from developing countries like Nepal are not aware about this and who aware are not able to use this scientific area. Medical Journals should keep a criterion for publication of manuscripts to the authors that it will not be published, if the sample size calculation is not done. Then only the actual objective of the study will be proved. text/html2012-10-04T19:34:20+01:00http://www.webmedcentral.com/Dr. Kayode I OlayemiComparative Assessment of Immature Survivorship and Developmental Duration of Culex Pipiens Pipiens (Diptera: Culicidae) Mosquito Vector Populations in North Central Nigeria
http://www.webmedcentral.com/article_view/3753
Background
Culex mosquito vectors of human diseases have received relatively lesser attention from mosquito biologists even though the diseases transmitted by these mosquitoes rank foremost among public health challenges worldwide. As a result, very little is known about spatial ecology of these mosquitoes, especially, the dynamics of their larval development; an important factor that governs the success of larviciding measures. This need informed the present study to elucidate spatial variations in survival and developmental rates of Culex pipiens pipiens mosquito populations in North Central Nigeria.
Methods
Day old larvae of Culex pipiens pipiens mosquitoes were collected from four widely-spaced localities in the area namely; Gidan Kwano (A), Bosso (B), Maikunkele (C) and Chanchaga (D). The larvae were reared under laboratory conditions and monitored for immature life-stage survival and developmental rates, following standard procedures.
Results
The results indicated that Total Immature Survival Rate (TISR) was very high (>88%), though varied significantly (P&lt;0.05); ranging from 88.67±7.58% in site C to 95.08±1.68% in site D. While, Pupal Stage (PS) survivorship varied significantly (range = 86.92±12.16 to 97.24±2.48%), those of Total Larval Stage (TLS) (Range = 86.76±7.99% to 93.39±4.48%) were insignificantly different (P>0.05) among the sites. The fastest developing immature population of Cx. p. pipiens in the area was that from site C, which took 8.67±2.03 days. This value was significantly lower than those from other sites; taking as long as 10.10±0.94% days in site B.
Conclusion
These results revealed significant spatial variation in survival and developmental rates of immature Cx. p. pipiens populations in north central Nigeria; and such variations appear to be driven by endogenous factors. This spatial heterogeneity may influence the vectorial importance and ecological adaptations of the species in the area, and therefore demand site-specific larval vector control strategies and intervals in the area.text/html2012-12-12T16:48:12+01:00http://www.webmedcentral.com/Ms. Cynthia HohmannJoint Data Analyses of European Birth Cohorts: Two Different Approaches
http://www.webmedcentral.com/article_view/3869
Background: Combined data analyses of birth cohorts can overcome the fragmentation of individual and inconclusive results obtained by analyses based upon single cohorts only. The European project Environmental Health Risks in European Birth Cohorts (ENRIECO) undertook four combined studies to evaluate the concept of added scientific value through harmonisation and exchange of birth cohort data for common analyses on environmental health risks.
Objectives: Two alternative analytical approaches were evaluated regarding their feasibility, benefits and limitations: (1) the centralised approach (pooled and non-pooled analyses which were centrally conducted by a single case study leader) and (2) the decentralised approach (meta-analysis of summary statistics derived by uniform methods conducted in each cohort).
Methods: Four main steps were identified for database building and analyses: (I) eligibility of cohorts, (II) collection of individual participant data, (III) data verification and (IV) analyses and manuscript preparation.
Discussion: The decentralised approach is recommended if cross-border data transfer is difficult and/or a solid basis of trust and experience still has to be established among partners. The centralised approach is recommended for combined analyses addressing variables with very heterogeneous assessments across cohorts, where a flexible handling of data is essential and trust and work experience between participating partners already exists.
Conclusion: Both approaches were successful, albeit laborious and time-consuming. Transparency through regular updates, presentation of results from interim analyses and the possibility for birth cohort researchers to comment and agree to each step of the analysis process builds trust and forms the basis for a sustainable collaboration.text/html2015-12-22T06:48:43+01:00http://www.webmedcentral.com/Dr. Felix I Woke MD, Ph.DIs Mobile-Health the answer to Anti-retroviral therapy non-adherence in sub-Saharan Africa: A Systematic Review
http://www.webmedcentral.com/article_view/5028
Background: Literatures have shown that mobile phone technology can improve treatment adherence of most chronic diseases, but its impact on ART adherence is not clear. Although the uptake of cell phone in sub-Saharan Africa is high, there are few studies of high evidential value (randomized control trials) on the use of mobile technology to improve ART adherence. This review will examine good evidence from old literatures to determine how mobile technology impact ART adherence in sub-Saharan Africa.
Methods: I extracted information from randomized controlled trails and cohort studies from countries in sub-Saharan Africa on the use of mobile phone technologies on ART adherence. The three main parameters used in this review are methodologies, design and country of study. Among databases looked at are Cochrane, MEDLINE, EMBASE, EbscoHOST and PLoS one. Randomized controlled trail from South Africa, Kenya, Cameroun, and Nigeria and cohort studies from Uganda, Ghana and Mozambique were included in this review.
Results: The literatures reviewed showed that the use of mobile-health improved ART adherence. However, we need to consider what and how support is provided to the patient. The use of contextualized messages, confidentiality, infrastructural problems in sub-Saharan Africa and the doctor-patient relationship need be considered in the use of m-health.
Conclusion: This review recommends and highlights that mobile health is effective in improving ART adherence but is under-utilized. Persons known to the patients and messages that are contextualized are likely to make the best impact. Messages can be motivational, reminders, blood red flags, preventive and educational for both patients and supporter. Through mobile devises adherence can be improved; leading to reduced resistance, morbidity and mortality associated with HIV/AIDS, and improved ART uptake.text/html2020-10-19T05:54:17+01:00http://www.webmedcentral.com/Dr. Felix I Woke MD, Ph.DDiffusion of Innovation and Health Messages during COVID-19 pandemic : A South Africa case study
http://www.webmedcentral.com/article_view/5661
Health messages are indispensable in public health; they are the connection between health experts, researchers and communities. The purpose of this case study is to assess the current health messages used to curb COVID-19 transmission in South Africa. The study also compared the SA health messages to best practices in communicating health messages. The author reviewed the available literature and compared this to the active and real-time management provided by the Department of Health, South Africa (DOHSA), as a response to the COVID-19 pandemic. Despite the effort of the government in massive screening and testing, contact tracing, quarantine and isolation, the number of infections continues to rise. Worse still, considering that the population of SA is among the lowest among the top ten countries, this translates to a higher attack rate. This study found gaps in the health messaging techniques adopted by the Department of Health, South Africa. Messages for the audience were prescriptive on how to prevent COVID-19. The messages lacked innovativeness, creativity and strategy. Community engagement was not satisfactory; the DOHSA rarely communicated supporting evidence from studies on the benefits of COVID-19 preventive measures, and support for behaviour change. The use of real-life experiences of patients and opinion leaders who are survivors of COVID-19 was low.
Even when technologies like Whatsapp and Apps for locating possible contacts became available to fight COVID 19 in SA, the diversities between communities, community health literacy, access to such technologies, print and social media were not given due consideration. Messages, methods and medium of transmission did not reflect the lived realities of the different social system and communities in SA. This study recommends ways to enhance community engagement and understanding around COVID-19 at the district levels. The knowledge, fears, concerns and the needs of communities need to be considered with these messages. Forum to promote and empower communities to participate in developing their health messages are essential to give a sense of social responsibility and ownership. Considering restrictions brought about by social distancing, this study recommends the use of technology to bridge the gap between innovations, communities and government through the use of SMS messages, community radios and social media; some of these are already available in sub-urban areas of SA. Epidemiologists could also guide communities in creating a tailored message based on the lived-experiences of these communities.
text/html2022-02-22T04:28:02+01:00http://www.webmedcentral.com/Dr. Felix I Woke MD, Ph.D A Syndromic Approach to the B.1.1.529, 20K (Omicron) Variant Driven SARS-COVID-19 fourth Wave in Patients in a Private Health Care Setting in South Africa
http://www.webmedcentral.com/article_view/5766
Introduction: The COVID-19 pandemic has had a global impact on travel, tourism, businesses, economies, and capital in general. In South Africa, COVID-19 continues to impact the economy, lives, and livelihood of its citizens. COVID-19 has also brought on some financial pressures on the health sector with poorly resourced communities worse affected. The Omicron variant though associated with low mortality and morbidity still possess danger for many in SA. This study suggests ways in which a collection of peculiar signs and symptoms could be used to make a presumptive diagnosis of COVID-19, specifically of the Omicron variant in a resource-limited setting, so that isolation and treatment can be started empirically to prevent community spread.
Methodology: This case series looks at 12 out of 22 patients seen in a private health care setting in Pretoria, SA. It ascertained clinical signs and symptoms common with the Omicron variant of COVID-19 compared to its preceding variants. Descriptive statistics were used to synthesize the data, and findings reported.
Findings: This study suggests that patients presenting with respiratory or gastrointestinal symptoms with fever and chills, and severe pain in more than 3 sites of the body could be provisionally diagnosed as COVID-19 of the Omicron variant in areas of high prevalence. Such patients could then be treated and isolated until their symptoms subside without expensive laboratory testing in resource-limited settings where the COVID-19 RT-PCR or Antigen testing is unaffordable or unavailable.
Conclusion: A syndromic approach to diagnosis and treatment of COVID-19 of the Omicron variant or sub-variant, and probably newer variants could be adopted in a resource-limited setting to provisionally diagnose treat and isolate patients to prevent rapid community spread and exorbitant cost to the health sector.
Introduction:
Background:
Since the onset of the SARS-CoV-2 (COVID-19) pandemic, South Africa (SA) has recorded more than three million infections and more than ninety thousand deaths (NICD, 2022). South Africa has also seen four different waves driven by different variants of the virus. Variants arise by mutations in the Viral RNA that can sufficiently influence the way the virus behaves; its epidemiology, virulence, demographics, severity of disease, transmissibility, morbidity, and mortality (Bekker & Ntuli, 2021).
According to the NICD (2020), in March 2020 countries around the world including SA became aware of the SARS-COVID-19 Virus. In May South Africa announced the arrival of COVID-19 and in July 2020 entered its first wave, with a peak positivity rate of 27% (NIDC, 2021). The beta variant drove the second wave in SA with increased transmissibility and virulence, it outstripped health systems, including private and public hospital beds, and oxygen supply (Bekker & Ntusi, 2021). The delta and gamma variants were documented in India (October 2020) and Brasil (November 2020) respectively (WHO, 2022).
According to WHO (2022), The third wave in South Africa was driven by the delta variant. It was aggressive, rapidly spreading, and virulent leading to high bed occupancy due mainly to its impact on respiratory function. This led to overcrowded health facilities, increased oxygen demands, and high mortality (Bekker & Ntusi, 2021). The effect of COVID-19 on the respiratory function in the first three waves led to high bed occupancy, morbidity, and mortality due mainly to Acute respiratory distress syndrome, pulmonary embolism, Bronchitis, and COVID Pneumonia (Lee et al.,2021). These 3 waves also impacted adults above 30years mainly (Maluleke, 2020).
When the Omicron variant-driven fourth wave started in SA, little was known about it. The fourth wave in SA arrived when about a quarter of the illegible population was vaccinated. This variant was first discovered in Botswana and then SA (Schreiber, 2021). Islam & Hossain (2021) raised concerns that the mutations in the new Omicron variant would influence laboratory diagnostics, clinical presentations, Immunity gained from existing vaccines, and public health protocols used for the management of the three previous waves. However, as the world slowly learned, the Omicron Variant showed increased transmissibility and caused less severe disease compared to the previous variants (Wolter et al.,2022).
At a societal level, COVID-19 posed a threat to lives, livelihood, economies, and global health. Many Pharmaceutical companies began the production of vaccines for COVID-19 once the impact of this virus became apparent to the world. As vaccines became available in many countries, their uptake improved, and businesses and tourism improved slowly.
However, when SA and Botswana announced the discovery of the Omicron variant (Schreiber, 2021) several countries imposed travel restrictions and border closures as this variant was anticipated to be worse than others (Islam & Hossain, 2021). These measures were taken against SA by the UK and many other countries, even when the government had started rolling out vaccines in many health facilities, targeting citizens with special needs, above 60years of age, people with serious comorbidities, and Health Care Workers (CDC, 2021).
The more Physicians, Pathologists, Laboratories, and other stakeholders in the Health Sector gain knowledge about the COVID-19 virus, they realized that COVID-19 may be with us for a long time. Various stakeholders became interested in cost-saving and management protocols, especially given the rapid spread of Omicron (Cleary et al.,2021).
In the previous three waves, Clinicians observed predominantly symptoms like dry cough, fever, tiredness, difficulty breathing, chest pain, and cases of pneumonia were predominant in hospitalized patients (Moein et al.,2020). As scientists and Clinicians learned more about the Omicron Virus a clinical picture different from the previous variants started to emerge; the omicron virus appeared to have signs and symptoms in specific body systems that differed from the other three variants.
At the start of the Omicron wave, there was a rapid rise in COVID cases in health facilities in Pretoria, Gauteng Province, SA. In a Family Practice in Pretoria, it was observed that within 2 weeks of the fourth wave that there were 22 positive cases, there was no hospitalization, no patients came in with respiratory distress, and no deaths as was with the previous variants and waves. In addition, the clinical presentation was different with severe pain in multiple parts of the body, diarrhea, fever, and chills featuring prominently.
This case series presents the clinical signs and symptoms of patients diagnosed by RT-PCR during the Omicron-driven COVID-19 fourth wave. It demonstrates how patients with the Omicron virus differed in clinical presentation; organ systems affected most, symptomatology, and signs from the preceding waves and variants.
The presenting complaints of the earliest patients seen at the beginning of the fourth wave in a private health care setting in Pretoria, SA was documented and described in this series. This case series aimed to demonstrate what common clinical symptoms patients presented with during the fourth wave, their severity, and duration of illness. It also demonstrated how a syndromic approach could be used to make a presumptive diagnosis of COVID-19, specifically caused by the Omicron variant. This became important as the treatment cost to medical insurance and private individuals increased rapidly during COVID-19 waves.
Problem Statement:
1. What are the differences in clinical presentation between the omicron variants of the SAR-COVID-19 virus from the previous variants?
2. Are there specific symptoms and signs that may have a high positive predictive value for the Omicron variant of the COVID-19 virus?
Aim of study:
1. Demonstrate the differences in the clinical presentation of the Omicron variant compared to previous variants?
2. Highlight the differences in presentation of the Omicron Variant compared to the other strain that can assist clinicians to adopt a syndromic approach to its diagnosis.text/html2023-07-06T01:48:58+01:00http://www.webmedcentral.com/Dr. Felix I Woke MD, Ph.DTravel Clinic and 10 Travel Checklist: One Health Medical Center Pretoria CBD 0123224541
http://www.webmedcentral.com/article_view/5825
Introduction: International travel can be exciting but poses health challenges peculiar to an individual or country. Travel consultation is advisable before setting off to a new city or country. The steps taken for a safe trip begin with preparations from home to the mode of travel and the travel destination and continue until a safe return home. However, the trip's impact remains with the traveller for years after return in the form of chronic diseases acquired during the sojourn (for example, lime disease) to any traumatic events experienced during travel (as in post-traumatic stress disorder). Conditions in the country of travel, including climatic conditions, common diseases, type of food available and activities during travel are important determinants of the health precautions and care needed. Hiking, horse riding, marathons and swimming all require different precautions. The following health advice applies to most travellers.
Discussion: The 10 Travel Check-list
1. Water: Water is an inevitable need of a traveller. Travellers interact with water in different ways and hence can acquire water-related diseases. Examples of ways travellers can acquire water-related diseases are; Water-borne (Amoebic Dysentery and Cholera), waster-bath (Typoid, yaws and relapsing fever), water-bred (Malaria, Yellow Fever and Trypanosomiasis) and water-based (Schistosomiasis and Dracunculus). These diseases are prevalent in areas of the world without pipe-borne water. Suggested ways to prevent water-related diseases are; brushing teeth and drinking only boiled/bottled water. Avoid ice made from un-boiled tap water. Drink only sealed carbonated beverages, beer, and wine (Pimazoni-Netto & Zanella, 2014). Other ways of preventing these diseases are; avoiding swimming in rivers and stagnant water and staying away from pools of water around living areas.
2. Food: Reduce the risk of gastrointestinal infections by avoiding unpeeled fruits or fruits not peeled by others. Avoid raw vegetables, unpasteurized ("raw") dairy products, raw meat, fish, shellfish and other unfamiliar food. Exercise caution while eating unknown meals because of the danger of diarrhea and allergic diseases.
3. Communicable Diseases: In certain areas, insects (mosquitoes, flies, fleas, bugs, and lice) and arthropods (ticks and mites) can transmit serious diseases like yellow fever and malaria. Avoid bites by using insect repellants, treated mosquito nets, long sleeve shirts and trousers. Reduce time spent outdoors, stay on the last floor of the hotels, and check skin regularly for insect bites. Avoid walking bare-footed; avoid stagnant waters, dogs, cats and pets. Practice safe sex always (HIV and other STIs).
4. Vaccines & Prophylaxis: Some countries have specific diseases that may require vaccination by law, like Yellow Fever which occurs in most tropical areas of the world, and travellers from these areas or returning from these areas must possess proof of vaccination before entering the country of destination. Other vaccines for the safety and convenience of the traveller are also important and can prove invaluable (like Typhoid, Pneumococcal, Meningitis, and Cholera, Hepatitis A). Some diseases require prophylaxis; a good example is malaria (Walldorf et al. 2017). Most common travel diseases have vaccines available in SA; please consult and enquire about all the compulsory and recommended vaccines for the destination country.
5. Medical Insurance: Medical insurance may or may not provide cover at the travel destination- Medical insurance must be engaged before travel if unsure. Travel insurances are also available at most travel agencies.
6. Emergency Medications: Travellers must take some emergency medications during travel; for example, medications for diarrhoea, pain, allergy and vomiting (Bobroff, 2010). Identify the closest health facility on arrival at the destination and write down emergency numbers for the country, including police, fire and ambulance services.
7. Chronic Health Problems: Discuss chronic health problems with a treating doctor before travel. Extra medication or treatment adjustment may be needed. Medications should be in the hand luggage for access and safety. Persons with chronic diseases may require adjustments in treatment and eating habits (e.g. Diabetes) and may be susceptible to new health problems and complications during travel with exposure to new food (Pimazoni-Netto & Zanella, 2014). Generally, stick to known food items and use new products sparingly
8. Medical Problems Associated with Air, Water and Road Travel: The mode of transport may be associated with peculiar health problems. Air travel-related problems include jet lag, motion sickness, ear, lung and sinus barotraumas, leg clots and problems with low oxygen pressure (lung disease and heart attacks) (Das & Suma, 2008). It is advisable to contact the hostess immediately if anyone feels sick during a flight. During road travel, all road safety measures must be taken to avoid accidents and an international driver's license is required to drive in the destination country. Avoid or take care with outdoor activities with the risk of accidents during travel. The activities must consider the driver's age, health status and chronic medication side effects. For a visitor in a new destination, risky activities must be avoided, especially those that may lead to accidents and hospitalization.
9. During Travel: Sit comfortably, loosen tight clothing and take a walk/stretch every 2hrs of flight (Ker & Kerr, 2002). It is important to have chronic medications within reach, as adherence to prescribed medications must continue unless advised otherwise by a health professional.
10. The Returned Traveler: A returned traveller with a flu-like illness, fever, diarrhoea, and headache must consult immediately. Travel diseases may manifest acutely in hours like Barotrauma, Jetlag and Pulmonary embolism (Gorbach, 2010). They can present sub-acutely in days like Malaria, Lyme disease, Babesiosis, hemorrhagic fever and diarrhea diseases. It can also take months or years to manifest, like schistosomiasis and Falciparum Malaria (Mwaiswelo et al., 2020). A returned traveller presenting with fever and diarrhoea must consult and volunteer the travel history so that investigations can focus on the common diseases in the country of travel.
Conclusion: While travelling is a good exercise for families, partners and friends, it is, however, important that all must return in good health. Travel health starts with anticipation and planning for the possible condition at the travel destination, and such planning can only be possible with a clear understanding of the possible health needs of the traveller, epidemiology of common diseases and health peculiarities of the destination of choice; this is the services One Health Travel Center, and other travel clinics offer to all travellers to ensure a safe and enjoyable stay in whichever destination chosen.
References
Bobroff, L.B. (2010) 'Remembering to take your diabetes medications', EDIS, 2010(6). doi:10.32473/edis-fy1206-2010.
Das, K.V. and Suma, T.K. (2008) 'Motion sickness, problems due to air travel and road accidents', Textbook of Medicine, pp. 106–106. doi:10.5005/jp/books/10921_21.
Gorbach, S.L. (2010) 'Diarrhea in a returned traveler from Mexico', Infectious Diseases, pp. 1154–1155. doi:10.1016/b978-0-323-04579-7.00257-4.
Kerr, A. and Kerr, K. (2002) 'Sit-to-stand and sit-to-walk',Physiotherapy, 88(7), p. 437. doi:10.1016/s0031-9406(05)61283-7.
Mwaiswelo, R.O.et al., (2020) 'Sickle cell disease and malaria: Decreased exposure and asplenia can modulate the risk from Plasmodium falciparum', Malaria Journal, 19(1). doi:10.1186/s12936-020-03212-w.
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