Leutscher Peter D C, Bagley Sandra W
The United States Peace Corps, Medical Unit, BP 620, Antananarivo, Madagascar.
J Travel Med. 2003 Sep-Oct;10(5):263-7. doi: 10.2310/7060.2003.2690.
The United States Peace Corps has nearly 8000 Volunteers (PCVs) working in more than 70 countries, predominantly in the developing part of the world. The volunteers are challenged by many new and unfamiliar health problems, as a result of change in living conditions during their service. The goal of this study was to assess the health problems of PCVs in Madagascar, and to use this information to evaluate the effectiveness of the current PCV health support program.
PCVs, finalizing their 2 years of service, were enrolled in the study. Data were retrieved from individual Peace Corps service medical records, the close of service (COS) physical evaluation, and a PCV questionnaire, which elicited additional self-reported health problems and concerns.
Sixty-nine PCVs took part in the study. Median age at COS was 24 years (95% CI 23-26 years), and the male/female ratio was 1 : 3.6 (15 males and 54 females). Skin, gastrointestinal and respiratory infections constituted the three most common reported health problems. Among the registered parasitic infections were ova and parasites in the stool (42.0%), confirmed and presumptive malaria (15.9%) and schistosomiasis (11.6%). Female PCVs more frequently reported dermatologic manifestations than male PCVs: postadolescent acne (48.2% vs. 13.3%) and telogen hair loss (33.3% vs. 6.7%). Amenorrhea, as the most commonly reported menstrual alteration during service, was reported by 15 (27.7%) female PCVs.
The PCVs in Madagascar encounter a broad range of health-related problems, most of which are preventable infectious diseases. Reinforcement of the preservice personal health-training curriculum later during service is needed. Reported dermatologic and menstrual disturbances in female subjects may be associated with stress-related estrogen imbalance. More studies are warranted to assess the stress impact of long-term travel on the female physiology.
美国和平队有近8000名志愿者在70多个国家工作，主要分布在世界的发展中地区。由于服务期间生活条件的改变，志愿者面临着许多新的和不熟悉的健康问题。本研究的目的是评估马达加斯加和平队志愿者的健康问题，并利用这些信息评估当前和平队志愿者健康支持项目的有效性。
即将结束两年服务期的和平队志愿者参与了本研究。数据来自个人和平队服务医疗记录、服务结束时的体格检查以及一份和平队志愿者问卷，该问卷收集了额外的自我报告的健康问题和担忧。
69名和平队志愿者参与了研究。服务结束时的中位年龄为24岁（95%可信区间23 - 26岁），男女比例为1 : 3.6（15名男性和54名女性）。皮肤、胃肠道和呼吸道感染是报告的最常见的三种健康问题。登记的寄生虫感染包括粪便中的虫卵和寄生虫（42.0%）、确诊和疑似疟疾（15.9%）以及血吸虫病（11.6%）。女性和平队志愿者比男性和平队志愿者更频繁地报告皮肤表现：青春期后痤疮（48.2%对13.3%）和休止期脱发（33.3%对6.7%）。闭经是服务期间报告的最常见的月经改变，15名（27.7%）女性和平队志愿者报告了闭经。
马达加斯加的和平队志愿者面临广泛的与健康相关的问题，其中大多数是可预防的传染病。需要在服务后期加强服务前的个人健康培训课程。女性受试者报告的皮肤和月经紊乱可能与压力相关的雌激素失衡有关。有必要进行更多研究来评估长期旅行对女性生理的压力影响。
