An orphan enumeration survey was conducted in 570 households in and around Mutare, Zimbabwe in 1992; 18.3% (95% CI 15.1-21.5%) of households included orphans. 12.8% (95% CI 11.2-14.3%) of children under 15 years old had a father or mother who had died; 5% of orphans had lost both parents. Orphan prevalence was highest in a peri-urban rural area (17.2%) and lowest in a middle income medium density urban suburb (4.3%). Recent increases in parental deaths were noted; 50% of parental deaths since 1987 could be ascribed to AIDS. Orphan household heads were likely to be older and less well-educated than non-orphan household heads. The majority of orphaned children were being cared for satisfactorily within extended families, often under difficult circumstances. Caregiving by maternal relatives represents a departure from the traditional practice of caring for orphans within the paternal extended family and an adaptation of community-coping mechanisms. There was little evidence of discrimination or exploitation of orphaned children by extended family caregivers. The fact that community coping mechanisms are changing does not imply that extended family methods of caring are about to break down. However, the emergence of orphan households headed by siblings is an indication that the extended family is under stress. Emphasis needs to be placed upon supporting extended families by utilizing existing community-based organizations. Orphan support programmes may need to be established initially in high risk communities such as low-income urban areas and peri-urban rural areas.
Epidemics of cholera have been frequent in southern Africa since the reintroduction of the disease to the continent in 1970. In late 1992, following a severe drought and an influx of refugees from Mozambique, cholera reappeared in Zimbabwe for the first time since 1985 and rapidly spread through the rural areas of the country. Data relating to symptomatic cholera infection collected during 2 large outbreaks on the eastern border of the country showed that host age and sex were important factors relating to symptomatic infection, as were population density and access to water. Epidemic profiles for the 2 study areas differed in that one of the profiles exhibited a distinct second phase epidemic. This unusual pattern was compared qualitatively with the output of a series of simple mathematical models to examine the contribution of different epidemiological processes to the pattern of disease observed. Model output suggested a complex disease process, in which the dynamics may have been influenced by spatial components. Statistical analysis of these unusual data showed that the observed pattern was independent of the effects of host age or sex, and provided compelling evidence of a marked spatial component of the second phase epidemic.
Vedolizumab is a monoclonal antibody that binds to the gut-specific α4β7 integrin on lymphocytes and prevents lymphocytes entering gut tissues. This gut-selective immunosuppression has been shown to be effective in treatment of active Crohn's disease and ulcerative colitis and to maintain clinical response and remission in patients who neither conventional therapy nor tumour necrosis factor (TNF) inhibitor therapy have helped. It is slow in onset of action, but the gut-selectivity offers the prospect of a safe alternative to systemically active drugs. It is effective in pouchitis, perianal Crohn's disease and children with inflammatory bowel disease. Its different mode of action to anti-TNF therapies makes it an important alternative.
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