Articles: health.
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We recognize that many of the issues raised are not simple. Our proposal calls for the same thoughtful deliberation applied in other settings to be brought to bear on reproductive health care. Some have already tried alternative approaches. ⋯ In developing policy we should consider the impact on the legal and ethical rights and obligations of both patient and physician. For every course, we should evaluate both immediate and long-term efficacy, the consequences for the doctor-patient relationship, and the consequences for medical integrity. In the midst of the present regulatory and fiscal turmoil affecting health care, we urge physicians to be careful and deliberate in the policies they embrace and the actions they take.
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J Diarrhoeal Dis Res · Mar 1996
Knowledge, attitude, practice, and prescribing pattern of oral rehydration therapy among private practitioners in Nigeria.
To determine the knowledge, attitude, and practice of oral rehydration therapy (ORT) among private medical practitioners in Enugu, Nigeria, 91 doctors were interviewed using a structured questionnaire. All the doctors had heard of ORT and believed in its efficacy. The commonest source of information on ORT was the medical school (44%). ⋯ Antibiotics were commonly used, although most (76%) doctors believed that viral infections were a common cause of childhood diarrhoea. All the respondents would recommend continued breastfeeding during diarrhoeal episodes. The study revealed a high rate of inappropriate drug use and a deficiency in the knowledge and practice of ORT.
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The combined effects of increasing demand for health services and declining real public resources have recently led many governments in the developing world to explore various health financing alternatives. Faced with a significant decline during the 1980s in its real per capita expenditures, the Kenya Ministry of Health (MOH) introduced a new cost sharing programme in December 1989. The programme was part of a comprehensive health financing strategy which also included social insurance, efficiency measures, and private sector development. ⋯ The 1989 outpatient registration fee led to an average reduction in utilization of 27% at provincial hospitals, 45% at district hospitals, and 33% at health centres. In contrast, phased introduction of the outpatient treatment fee beginning in 1992, combined with somewhat broader exemptions, was associated with much smaller decreases in outpatient utilization. It is suggested that implementing user fees in phases by level of health facility is important to gain patient acceptance, to develop the requisite management systems, and to orient ministry staff to the new systems.
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This article presents a general review of the major trends in the conceptualization, development, and success of case-control methods for the study of disease causation and prevention. "Recent work on nested case-control, case-cohort, and two-stage case control designs demonstrates the continuing impact of statistical thinking on epidemiology. The influence of R. ⋯ Fisher's work on these developments is mentioned wherever possible. His objections to the drawing of causal conclusions from observational data on cigarette smoking and lung cancer are used to introduce the problems of measurement error and confounding bias."