HEALTH NEWS

Why .to refer for family planning services. Who .all women and men of reproductive age should ideally be screened,as the opportunity arises, within maternal and child health programmes and health services for adults. In areas where such an approach would be culturally acceptable ,consider opportunistic screening of all adults of reproductive age receiving medical care for other reasons . How . screen by enquiry in a confidential setting . jcan be done by primary care workers with training in how to maintain confidentiality . the home based maternal record ,which contains a section for information on intervals between pregnancies, as well as covering several  pregnancies, constitutes an excellent means of reminding health workers to enquire about the need for family planning. When .as the opportunity arises within maternal and  child health programmes and general medical care. Resource levels required. Low for detection; intervention may require resource levels that are low (ed

Why and how . dental or periodontal disease is a significant cause of suffering and disability in adults in developing countries. Preventive efforts(hygiene fluoridation )need to be targeted to whole population from childhood on. Early detection in adults has, as its primary goals, pain control and preservation of function.unpublihed reports indicate that it is possible to train primary care workers to recognize dental or periodontal disease which can be treated at the local or district level with limited resources (MHleclercq, personal communication, 1989;a yashin, personal communication, 1987). In areas where there is a high prevalence of oral cancer, it appears rational to integrate dental and periodontal screening with oral cancer screening . Resource levels required . low for screening; medium for definitive diagnoses and treatment. Recommendation on use of screening. Recommended to screen all adults; frequency of screening needs to be determined by local resources. Prima

General comments Routine mass screening of pregnant women and newborn infants, and of infants and children on the basis of the immunization schedule, has an important place in strategies for disease prevention and health promotion. Early detection of risks to mothers and children, with effective intervention, con be ecpected to make a substantial contribution to the overall improvement of a population s health in the long run. Routine mass screening of adults, however ,has a more limited place in a primary healthcare system, for several reasons. In the first place , pregnant women and young children are those most liable to suffer severe adverse effects in the absence of early detection and care for many relatively common conditions . furthermore, there are highly effective ways of dealing with many of the most prevalent health problems of mothers and children at relatively low cost, for example , the identification and treatment of asymptomatic urinary tract infection or anaem

Screening of asymptomatic persons is not recommended . early detection of signs and symptoms is recommended .in 1976 , a WHO report on oncho-cerciasis recommended vector control rater than screening for this prevalent cause of blindness (WHO ,1976).a study in sierra leone has described a successful trial of school-based screening for onchocerciases by an ophthalmologist; however this would not be feasible in most developing countries (stilma et al 1983).primary prevention and early detection of persons with symptoms are also the strategies recommended in a publication on the prevention of blindness issued by WHO in 1984 (WHO ,1984).where services are accessible, teaching the public to practice self-referral for symptoms (early detection )is a useful adjunct to primary prevention in endemic  areas. 

Screening of asymptomatic persons is not recommended. As with many endemic parasitic diseases, opportune treatment will not be effective in the long term, without primary prevention (environmental control)to prevent repeated re-exposure. Screening should be seen as an adjunct to environmental control and education of the public to minimize exposure and to promote self-referral for gross haematuria (early detection).in many cases, the population will not have the option of avoiding exposure, for economic reasons ; broad environmental control measures will almost always be required. Enquiry regarding history of haematuria has been used as an initial screen in adults, although gross inspection of urine is more accurate, especially in children ,followed by testing of urine for blood with reagent strips in the case of those found positive on initial screening (mott et al., 1985)

Screening of asymptomatic persons is generally not recommended. Follow –up of case contacts is recommended, as with any highly communicable disease. Mall screening is expensive . in endemic areas, it is more rational to use targeted case-finding by trained primary care workers who have regular contact with the population at risk, together with public education to promote self-referral for early detection of characteristic skin lesion (ganapati et al,. 1984)and the provision of accessible and acceptable general medical services for the population at risk. Skin manifestations are easily identifiable by primary care workers, and by an educated public in endemic regions . ganapati et al. (1984)cite two earlier studies from rural areas in india to support their point that mass screening may add very little to the case detection achieved by other methods such as mall public health education. In settings with access to fairly high-technology laboratory resources, it may be an option to scr

See discussion of HIV testing in prenatal health care. The same general issues apply in the non-pregnant population, except that the rationale for screening is more limited, since the issues of deciding whether to carry        a pregnancy to term or whether to breast-feed are not involved. The primary rationale for screening the asymptomatic  non-pregnant population at elevated risk is either to provide reassurance or to assist HIV infected individuals in planning their lives. even with a negative screening test result, however, reassurance can only be limited in view of the delay between infection and seroconversion. community-wide education and the promotion of safe sexual practices are likely to have a far greater impact on HIV infection than a large-scale screening effort. Thus, our recommendation on HIV screening is uncertain at this time. Emphases should be placed on primary prevention. If testing is done, resources need to be in place for skilled pre-and post-test counseling

Why. Early identification of most STDs other than HIV infection is of proven effectiveness in reducing morbidity and is though to reduce further spread. Many STDs are asymptomatic until serious health damage has occurred and are also highly contagious, even when asymptomatic. STDs other than HIV infection and hepatitis B are generally curable with relatively simple treatments when detected opportunely. Who and when. Regular screening of high-risk groups . intervals between screening will depend on local resources and the education and motivation of the population at risk. groups generally at high risk include heterosexuals with a number of partners or whose partners have a number of partners , homosexual or bisexual men, and prostitutes. In some areas, the criteria for high risk may be broader (see earlier recommendations for screening pregnant woman and adolescents for STDs . How and where. Definitive diagnosis of STDs requires laboratory facilities and thus ,even if primar

Screening of children and adults to prevent and control communicable diseases This chapter discusses infectious diseases that endanger the health of the individual affected and sometimes others in the community. Because this material is generally relevant for all age groups , it was thought most convenient to present this as a separate chapter. Prevention and control of communicable diseases should be integral components of comprehensive primary health care programmes  for each general age group and should not be organized into separate vertical programmes focused on specific diseases. General comments on screening for communicable diseases In general, in dealing with highly prevalent communicable diseases that are a significant public health problem, the screening of asymptomatic persons will play a limited role and should be primarily an adjunct to other measures. Emphasis should be placed on primary prevention (often requiring environmental measures )and on public educatio

Problems of growth and development, including physical, neurological, mental, and psychosocial development. Why .to detect children who are not thriving and developing normally  and refer them for further evaluation and follow –up . follow –up does not necessarily require the services of highly specialized personnel. It may include community based interventions at the primary care level, e.g.,special attention from teacher and families to minimize learning difficulties or deal with emotional problems affecting development. Who . all school age children and adolescents. How and when . All sources agree on the importance of monitoring growth and development at the time of school entrance ( around the age of 5-6years ) . preschool records should be reviewed at that time. The united kingdom child health surveillance programme recommends checking and recording height on a centile chart on school entrance, with further checks during the school years only if a particular concern ar

Care of school- children and adolescents General comments After school entrance, there are a limited number of medical conditions for which routine screening is an important part of health care. Early detection of psychosocial, developmental , and socioeconomic risks should receive the highest priority during the school years. At the most general level, the objective of screening all children should be thought of as identifying the at risk child , which includes the child in an risk household to be more limited for the school age group than it is for younger children, who must be accompanied on their visits for care by a parent or other member of the household. Mass screening of children on entering school provides an opportunity to review preschool (maternal and infant) records, which should contain information on the risk status of households. After that, however, properly trained teachers should be in an excellent position to detect evidence of problems in schoolchildren s ov

Mental, neurological and psychosocial development Why. to provide additional support and counseling to families of children with problems of development, and referral to any special services available in the community , health centre or district, in order to minimize impairments and their consequences. Counseling and referral may involve highly specialized diagnostic and treatment resources. however, emphasis should be placed on primary care measures at the community level ,promotion of parents, skills in child –rearing  according to local norms, and early stimulation of children, s learning capacity. Teenage parents and parents isolated from their extended family may be in particular need of support. How. Restandardization of the denver developmental screening test (DDST)for use in northern china has been the subject of an apparently successful large-scale study (collaborative study group of child develop mental test 1986) such formal developmental testing is , however, expe

Immunization status Why. to immunize against poliomyelitis, diphtheria, pertussis, tetanus, measles, mumps, and rubella, and against tuberculosis (BCG), hepatitis B, and possibly haemophilus influenza B, as indicated by local policies. Inadequate immunization status at different stages may also be an indicator of a child who is generally at risk. How . by a review of the child s health record , which should contain the recommended schedule of immunizations . this can be done quickly by inspecting the home-based child s record or by using a checklist placed at the front of a clinical chart . When . at every routine visit. The immunization schedule determines the timing if routine visit . the immunization schedule determines the timing of routine visits for well-child care and other screening. Immunization schedules vary from country to country, but BCG and hepatitis B vaccine are usually given at birth and other immunization are initiated at the age of 1-2 month . periodic

The home-based childs record appears to be an excellent tool to guide screening activities by health workers and to educate parents. It documents health risks and needs in a way that can facilitate referrals between in addition to the references listed in the footnote to macfarlane et al .(1989)was an important general reference for this section. Different levels of care when necessary ((shah & shah, 1981; shah et al, 1988). The HBCR is a familiar concept, combining immunization records and growth curves with indicators of development at appropriate stages. Recent documents from the united kingdom stress the importance of active enquiry regarding any parental concern about a child s health or development as a means of early detection that can replace many screening tests (butler, 1989; macfarlane et al, 1989). The use of primary care workers to screen young children within well-child programmes is well established. Documents from the working party in the united kingdom sug