Integration of schistosomiasis-control activities into the primary-health-care system in the Gizan region, Saudi Arabia

A few decades ago, the prevalence of Schistosoma haematobium infection in the human inhabitants of the Gizan region of Saudi Arabia was very high (43%-91%). A vertical programme for the control of the disease, by case finding, treatment of infected individuals and by chemical snail control, was begun in 1974 and led to significant reductions in prevalence in most areas. In 1989 the control activities were gradually integrated into the primary-health-care (PHC) system. Several schools in the area recently participated in the detection of ova (among schoolchildren and neighbouring communities) and organized health-education sessions. The records taken during the vertical and PHC programmes indicate that there were more diagnoses and higher chemotherapy coverage in the latter. The PHC programme has maintained the overall prevalence of infection at an extremely low level (< 1%) and the infection has been completely eradicated in several areas. The participation of schools proved to be particularly useful in terms of population coverage and health education.

A view from the grass roots

A 14-member study team learned firsthand about promotion of family planning and maternal and child health (FP/MCH) in China while in the country during August 17-30, 1997. The self-funded team was headed by JOICFP Chairman Masao Sawaki and included representatives of the public health and preventive health field as well as an official from a Japanese university. The team first traveled to Fangshan District of Beijing where implementation of JOICFP's Integrated Project (IP) began in 1996. A fifth-cycle project area, Fangshan is receiving assistance from IPPF through JOICFP for a period of 3 years. The team moved north to Inner Mongolia Autonomous Region to observe IP activities in Tumud Left Banner of Hohhot City, a second-cycle project area which received support between 1987 and 1989. The third area visited was Yunnan Province in the south, where they observed activities in Jiangchuan County, a third-cycle area which was supported between 1990 and 1992. The comparison between the pilot area and original project areas was rewarding for the team, which noted that activities had continued to expand with support from the people after the 3-year funding period had ceased. In Inner Mongolia, the team noted how parasite control has been effectively used to gain community participation in activities. The project has expanded from 2 towns with a population of 50,000 to cover 19 towns with 343,000 people. In Jiangchuan Country, the IP has expanded from 5 towns with 108,000 people to cover 12 towns with 240,000. Prior to the project launch in 1989, the infant mortality was 60/1000 live births and the hospital delivery rate was 45%. These had improved to reach 23.3/1000 and 87%, respectively, as of 1996.

STD services for women at truck stop in Tanzania: evaluation of acceptable approaches

AIDS continues to be the commonest cause of death in Tanzania among those aged between 15 and 45 years. Both ulcerative and non-ulcerative sexually transmitted diseases have been identified as major co-factors in HIV transmission. Certain groups including long distance truck drivers and their sexual partners have been reported as having a disporportionate effect on the transmission dynamics of STD including HIV, in a population. In 1993 African Medical and Research Foundation decided to add an STD component to their HIV/AIDS prevention programme along the Tanzania-Zambia highway which had been targeting truck drivers and their sexual partners through peer education and condom distribution since 1989. A study to evaluate the acceptability and feasibility of four different approaches of delivering STD services, was conducted over a period of one year. The approaches for delivering STD services were: special STD services offered twice a week at a site and at hours of the women's choice, special outreach services once every three months, or STD services integrated into the nearest Primary Health Clinic. Drugs were provided at three of the four interventions. 1,330 women at seven truckstops, participated in the evaluation study. The women were generally satisfied with all approaches that included the provision of drugs. The most expensive and ineffective way of treating STD was by not providing drugs. These findings confirm the fact that it is feasible to provide STD services to women at high risk in HIV high transmission areas. These women would utilise STD services provided in a manner that suits them if mobilised and encouraged by their peer educators.

An integration programme of poverty alleviation and development with family planning

The State Council (the central government) recently issued a Circular for Speeding Up the Integration of Poverty Alleviation and Development with the Family Planning Programme during the Ninth Five-year Plan (1996-2000). The Circular was jointly submitted by the State Family Planning Commission and the Leading Group for Poverty Alleviation and Development. The document sets the two major tasks as solving the basic needs for food and clothing of the rural destitute and the control of over-rapid growth of China's population. Practice indicates that a close Integration Programme is the best way for impoverished farmers to alleviate poverty and become better-off. Overpopulation and low educational attainments and poor health quality of population in backward areas are the major factors retarding socioeconomic development. Therefore, it is inevitable to integrate poverty alleviation with family planning. It is a path with Chinese characteristics for a balanced population and sustainable socioeconomic development. The targets of the Integration Programme are as follows: The first is that preferential policies should be worked out to guarantee family planning acceptors, especially households with an only daughter or two daughters, are the first to be helped to eradicate poverty and become well-off. They should become good examples for other rural poor in practicing fewer but healthier births, and generating family income. The second target is that the population plans for the poor counties identified by the central government and provincial governments must be fulfilled. This should contribute to breaking the vicious circle of poverty leading to more children, in turn generating more poverty. The circular demands that more efforts should focus on the training of cadres for the Integrated Programme and on services for poor family planning acceptors.