Bulletin of the World Health Organization
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As measles continues to exact a high toll on infant mortality, particularly in developing countries, optimal strategies for the control of the disease are under discussion. As part of this debate, the place of 2-dose measles immunization schedules is reviewed regarding their potential as a strategy to improve measles control. To date, WHO has not recommended the use of a 2-dose schedule. ⋯ Long-term safety should be determined through studies of adequate size. Programmes already using 2-dose schedules are encouraged to evaluate their impact on disease incidence, cost, vaccine usage, and effect on coverage. Until further evaluation is complete, a high and timely coverage with one dose of measles vaccine in all areas remains the first priority for all immunization programmes.
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Bull. World Health Organ. · Jan 1993
Review Comparative StudyHealth care in China: a rural-urban comparison after the socioeconomic reforms.
This article provides an overview of the current Chinese health care system with particular emphasis on rural-urban differences. China's post-1978 economic reforms, although they improved general living standards, created some unintended consequences, as evidenced by the disintegration of the rural cooperative medical system and the sharp reduction in the number of "barefoot doctors", both of which were essential elements in the improvement of health status in rural China. ⋯ These changes have disproportionately affected the rural health care system, leaving the urban system basically intact, and have contributed to the rural-urban disparity in health care. Based on recent data the article compares current rural-urban differences in health care policy, systems, resources, and outcomes, and proposes potential solutions to reduce them.
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Bull. World Health Organ. · Jan 1993
[Yellow fever epidemic in the extreme North of Cameroon in 1990: first yellow fever virus isolation in Cameroon].
Some two years ago, suspicious cases of yellow fever (YF) were reported in northern Cameroon. A deadly epidemic broke out during the second half of the rainy season (from 15 September to 22 December 1990) with 180 known cases, of which 125 died. The real figures could have been between 5000 and 20,000 cases with between 500 and 1000 deaths. ⋯ The under-10 age group represented 63% of the IgM carriers. An entomological study was carried out at the same time. It permitted the capture of Aedes aegypti, A. furcifer, A. luteocephalus and the identification of numerous potential larval sites, at times still in the productive phase of A. aegypti which is considered to be the principal vector.(ABSTRACT TRUNCATED AT 250 WORDS)
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Described in an analysis of the cost to the Ministry of Health of providing district health services in Malawi, with particular emphasis on the district hospital. District resource allocation patterns were assessed by carefully disaggregating district costs by level of care and hospital department. A strikingly low proportion of district recurrent costs was absorbed by salaries and wages (27-39%, depending on the district) and a surprisingly high proportion by medical supplies (24-37%). ⋯ Unit costs by hospital department varied considerably by district, with one hospital being consistently the most expensive and another the cheapest. A total of 3-10 new outpatients could be treated for the average cost of 1 inpatient-day, while 34-55 could be treated for the average cost of 1 inpatient. The efficiency of hospital operations, the scope for redistributing resources districtwide, and the costing methodology are discussed.
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Bull. World Health Organ. · Jan 1993
Randomized Controlled Trial Comparative Study Clinical TrialAntibiotic therapy for bacterial meningitis in children in developing countries.
We carried out a study to investigate the effectiveness of chloramphenicol alone as a treatment for bacterial meningitis. A total of 70 consecutive children aged > 3 months with bacterial meningitis, who had been admitted to the paediatric hospital of the All India Institute of Medical Sciences, were randomized to receive chloramphenicol alone or chloramphenicol + penicillin. The two groups were matched with each other. ⋯ The mean duration of intravenous therapy, the number of intravenous cannulae used per patient, and the incidence of thrombophlebitis were significantly higher for the group that received the combination therapy. Also, the cost of using chloramphenicol + penicillin was four times higher than that of chloramphenicol alone. Hence, chloramphenicol alone was as effective as chloramphenicol + penicillin and much cheaper and more convenient to use.