Maternal-child health and family planning: user perspectives and service constraints in rural Bangladesh

This article presents a microanalysis of interactions between female fieldworkers and women in rural Bangladesh, and a discussion of the broader organizational constraints that hamper service delivery. It is argued that the fieldworker, herself a rural woman, is faced with considerable demand for both maternal-child health (MCH) and reproductive health care services, but that operational constraints prevent her from realizing her potential in both of these areas. Qualitative data show that, in the eyes of rural women, contraceptive use and health care are intricately intertwined, and that this association often raises a range of questions that the worker cannot address competently. A number of specific operational barriers--worker densities, staff motivation, supervision, technical competence, supplies--are identified. These barriers reflect a general institutional weakness in the Ministry of Health bureaucracy that prevents it from organizing itself to deliver user-oriented health and family planning services while maintaining adequate and appropriate standards of care.

Report of an outbreak of diarrhoeal disease caused by cholera followed by rotavirus in Manipur

An outbreak of acute diarrhoeal disease between August and October 1985 in 3 districts of Manipur state was investigated amongst 9,29,077 population at risk. The overall attack rate and case fatality rate were 0.2% and 0.9% respectively. Hospital records revealed that 58.8% of cases occurred amongst older children above 5 years of age. V.cholera was isolated from 25.3% of cases sampled. Interestingly, increased frequency in weekly admission of cases amongst children during first two years of life increased in the beginning of October when the original peak of diarrhoeal outbreak was about to decline. The October peak was caused by rotavirus which could be detected from 50.0% of diarrhoeal children in this age group. This possibly reflected beginning of the usual rotavirus diarrhoea season in the locality.

Planning for primary health care: the case of the Sierra Leone National Action Plan

The National Action Plan for Primary Health Care, a planning document of the Sierra Leonean Ministry of Health for the restructuring of the country's rural health services, is analyzed in its social, economic, and historical context. It appears to be an attempt of the national government to gain control over the highly devolved health care delivery system, but the state has neither the political will nor the power to achieve this goal. The utility of the document is therefore in doubt, which raises two important questions: Whose interests does this plan serve, and at whose cost?

Morbidity pattern in children below three years attending a rural health centre in Haryana

Morbidity pattern of children below three years attending a rural health centre was studied prospectively for one year. All children were first examined by a doctor and the diagnoses made were compiled and analysed. The common morbidity conditions found were pyoderma (23.65%), respiratory infection (21.18%), diarrhea (20.05%), unspecified fever (11.75%), ear infection (6.58%) and eye infection (5.46%). The maximum episodes of morbidity were recorded in summer season (39.22%) followed by rainy (31.36%) and winter season (30.16%).

Impact of an essential drugs programme on availability and rational use of drugs

Availability and rational use of drugs was assessed in a random sample of 19 peripheral health units in two governorates in Democratic Yemen in which an essential drugs programme has been operational for the past few years. Findings were compared with those from seven health units in one governorate in which no such programme had been started. On average, 27 essential drugs were available in the programme area, compared with 17 in the control area. Programme areas carried on average 1 non-essential drug, compared with 17 in control areas. Average stock was adequate for 4 weeks in programme areas and for 1 week in control areas. Health workers in the programme area scored slightly, but not significantly, better in a test on theoretical knowledge on rational drug use. However, programme areas differed considerably from control areas in patterns of drug use, with fewer injections (24.8% vs 57.8% of prescriptions) and fewer antibiotics (46.3% vs 66.8%) being prescribed in programme areas, which also had fewer drugs per prescription (1.5 vs 2.4). The programme has significantly improved the availability and rational use of essential drugs in peripheral health units.

Health care for some: a Nigerian study of who gets what, where and why?

The persistent underdevelopment of health in the Third World belies the optimism of the "Health care for all by the year 2000" campaign. In order to understand the underdevelopment of health, it is essential to examine the historical evolution of specific health systems. These ideas are developed in a case study of health care in Kano State, Nigeria. The nature and contemporary development of the health care system, which includes state voluntary agency and private sector outlets for Western scientific medicine and a large and varied traditional medicine sector, are examined. Although the deepening health care crisis may potentially spur a reconsideration of priorities and strategies, past experience suggests that a stubborn retention of a pared-down and increasingly unjust version of the present system is more likely.

Health care in Africa

This is the third and last article reporting professional exchange tours between American nurses and nurses of other countries. In this article, the health care system of Kenya is discussed and comparisons made between this system and our own. Out of this comparison come several insights into our own way of doing things and possibilities for improving them. "Health Care in the Soviet Union" appeared in the April 1984 issue of The Nurse Practitioner. "Health Care in China" appeared in the May 1984 issue of the journal.

Supply of essential drugs for church hospitals in Ghana

Based on the results of an inquiry, answered by 39 out of the 53 rural Church hospitals and clinics in Ghana, a list of 34 indispensable drugs was compiled. At a cost of less than US $600 000 it is possible to provide all Church health institutions (30% of all health facilities in Ghana) with these 34 essential drugs for one year (at 1982 prices). When the drugs are prepacked in Units, distribution can easily be carried out from a very limited number of distribution points, without the need for extensive logistic provisions such as trucks, stores, personnel and security checks.

Maternal and abortion related deaths in Bangladesh, 1978-1979

The incidence and causes of pregnancy-related deaths are unknown for most of Asia; only local area studies have been done for Bangladesh. Between December 1978 and May 1979, we interviewed 118 health workers in 63 hospitals and 732 non-hospital facilities to identify case reports of maternal and abortion-related deaths in Bangladesh. Of 1933 pregnancy-related deaths identified, 498 (25.8%) were due to induced abortion. Abortion mortality rates varied significantly in the 18 administrative districts; the highest were in Dinajpur and Chittagong, the most northern and southern districts, and the lowest in Comilla and Noakhali. We used an earlier study of maternal mortality to estimate that about 21,600 pregnancy-related deaths occur each year in Bangladesh. We estimate that about 7.5% of all pregnancy-related deaths were identified in this survey. We infer from these data that safe and effective fertility control, including abortion performed by adequately trained health workers in both in- and out-patient facilities, might be the most appropriate first step in preventing pregnancy-related deaths in Bangladesh.

Oral rehydration therapy for treatment of rotavirus diarrhoea in a rural treatment centre in Bangladesh

In November 1977, an enzyme-linked immunosorbent assay for detecting rotavirus antigen was introduced in the laboratory of a rural treatment centre in Bangladesh. During the next 40 days rotavirus without other pathogens was found in the stools of 216 (45%) of 480 children under age 5 years who visited the centre with a gastrointestinal illness. 188 (87%) of these children were treated with oral rehydration alone, using the solution currently recommended by the World Health Organisation, while 28 (13%) also required some intravenous rehydration; there were no deaths. Oral rehydration treatment was judged successful in 205 (95%) of the rotavirus patients and was not associated with any serious side effects. Oral rehydration treatment, with this solution, has been used extensively and successfully in the treatment of enterotoxin-mediated diarrhoea and can also safely be used for treating rotavirus diarrhoea in infants and young children.

Women, doctors, and family health care: some lessons from rural Java

The following article describes traditional health care systems of rural Indonesian women. It distinguishes the central from the peripheral aspects of systems that women have developed to meet their own needs and contrasts them with modern health care systems. It suggests what can be done to keep the valuable features of each approach.

Family allowance and family planning in Chile

Family allowances designed to promote maternal and child health and welfare could be self-defeating if they stimulated otherwise unwanted births, as often assumed. That assumption, with its public health and demographic implications, needs testing. An attempt to test it was made in Chile in 1969--1970 through interviews with 945 wives receiving an allowance and 690 non-recipients. Recipients practiced contraception significantly more than did non-recipients. This was not explained by wives' educational attainment or employment, the couples' earnings, or number of living children, but was associated with a 50 per cent greater utilization of professional prenatal care by recipients during the most recent pregnancy; women with such care (regardless of allowance status) were 75 per cent more likely than others to control their fertility. Prenatal care was probably sought more by recipients in part because an additional stipend was provided as soon as pregnancy was confirmed, usually at clinics with integrated family planning. Greater family income, attributable to the allowance, probably also contributed to the recipients' better prenatal attention and to contraceptive practice. Noteworthy, too, was the finding that with the number of living children controlled, contraceptive practice was significantly greater amoung couples who had never lost a child.