An outbreak of poliomyelitis in Andhra Pradesh (South India)

An outbreak of poliomyelitis that occurred in the year 1992 in Telangana region of Andhra Pradesh, South India was investigated to understand the reasons for persistence of poliomyelitis in the general population and for the outbreak in Andhra Pradesh in particular. The study comprised of a detailed investigation of epidemiological and clinical features, serology and vaccination status and a case control study to calculate vaccine efficacy by matched pair analysis. The outbreak occurred after a relative quiescence of 3 years. The age group of the patients ranged from 2 months to 5 years, 26.5% being infants and 70.2% being children between 1 and 5 years. The outbreak was mainly caused by Type 1 poliovirus. Vaccine efficacy was found to be 70%. Antibody response was not high in cases. Seventy six per cent of the children with poliomyelitis were unvaccinated. Ignorance of the mothers and family interference were the main causes for not vaccinating the children. The study indicates the need to increase the vaccination coverage and inclusion of children upto 5 years in the programme. Absence of vaccination is the major risk factor for the outbreak. The persistence of poliomyelitis in older children, low antibody response and suboptimal vaccine efficacy point out the problem of achieving control with OPV in tropical countries and suggest the need for alternate strategies. Better health education strategies need to be developed.

Funding of health research in India

An overview of financing of health research in India is presented based on data for the year 1987-88, collected from nearly 298 institutions involved in health research. Only 8 per cent of the funds was derived from foreign sources. Distribution of research funds was highly skewed. Research activity seemed to have concentrated in a few specialty institutes located in the four metropolitan cities. Research activities apparently matched the national health priorities, reproductive health being the most frequently reported area of research. The study concludes that since health is primarily a service sector, its research needs are not fully appreciated. As a result, research allocation in the health sector is lower, as compared to that for many other developmental sectors. The paper highlights some of the implications of this lopsided distribution to research capacity building in the country.

Family planning programmes: lessons from management interventions

The family planning programme in India has had many ups and downs. It has also taken many forms: the clinical model, for instance, was followed by the extension approach.In this article, Nirmala Murthy traces a brief history of the programme and compares the experiences of Karnataka and Uttar Pradesh where management interventions were introduced at the instance of the World Bank, and Maharashtra where they were initiated from within the Health Department. Management interventions were successful in Maharashtra, but failed in Karnataka and Uttar Pradesh. The author explains the reasons for the two very different outcomes and recommends that, to be fruitful, management interventions should form a part of the management development strategy.