Apartheid medicine. Health and human rights in South Africa

Human rights and health care under apartheid in South Africa were studied. Human rights violations, such as detention without charge or trial, assault and torture in police custody, and restriction orders, have had devastating effects on the health of persons experiencing them. These violations have occurred in the context of a deliberate policy of discriminatory health care favoring the white minority over the black majority. South Africa's medical societies have had mixed responses to the health problems raised by human rights violations and inequities in the health care system. The amelioration of health care for all and prevention of human rights violations depend on ending apartheid and discrimination and greater government attention to these problems.

Prenatal screening

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Selective primary health care: strategies for control of disease in the developing world. IX. Poliomyelitis

Poliomyelitis is an acute viral disease primarily afflicting children. It can be very mild, permanently crippling, or fatal. In the developed nations, poliomyelitis is controlled by the use of trivalent vaccines: killed virus administered by injection and/or attenuated virus administered orally. The latter is cheaper. A combination of the two may be required in some tropical countries. In many developing nations poliomyelitis remains endemic and prevalent, especially in children; 37,747 cases were reported to the World Health Organization in 1979, but greater than 200,000 cases probably occurred. Socioeconomic improvement and public health measures (i.e., immunizations) remain the major strategies for control. While global eradication may be a more distant goal, poliomyelitis could be controlled better. Effective programs for control include safe, efficacious, and inexpensive vaccines; methods for successful management of vaccine delivery systems; commitment and training of health personnel; public education; commitment of funds; and research to improve vaccines and their delivery. The major obstacle to control of poliomyelitis is failure to immunize an adequate number of susceptible children. Development of strategies for immunization is crucial to elimination of poliomyelitis as a major world health problem.

Recommendations for a national policy on poliomyelitis vaccination

Declining numbers of adequately vaccinated persons, new data about the comparative safety and effectiveness of live, attenuated and killed poliomyelitis-virus vaccines, increased consumer awareness of adverse reactions and pressure from manufacturers seeking protection from liability were factors leading the Institute of Medicine to re-examine poliomyelitis vaccination programs. The relative merits of live and killed virus vaccines as immunizing agents were reviewed within the context of the 60 to 70 per cent level of poliomyelitis vaccination now reached in the United States. Until about 90 per cent of persons are adequately immunized, the continued use of live-virus vaccines for infants is recommended, with provision that certain categories of persons receive killed-virus vaccine. Vaccination with attenuated live virus of children 11 to 12 years old is suggested to reduce vaccine-associated disease when they become parents of vaccinated infants. Recommendations are made on education, research, liability and informed consent as they pertain to prevention of polyomyelitis.

Observations on patients with neural-tube defects in a metropolitan hospital clinic: an epidemiological history

A survey of the population of the Spina Bifida Service (107 patients) of Georgetown University Hospital, Washington, D.C., and of a control population in the same hospital revealed that, although situated in an ethnically heterogeneous area, Service patients with a history of neural-tube defects in siblings or family significantly more often had ancestors on both sides from the British Isles than did either isolated cases or the controls. In addition, of 107 families reviewed, nine had more than one affected child, nine had a positive family history for neural-tube defects, and nine of the patients and seven of an estimated total of 220 siblings had an unrelated major birth-defect. These incidences are among the highest published so far. Contrary to other surveys, there was no deficiency of twinning among the sibships, nor of males among the Spina Bifida Service patients. These observations indicate the desirability of studying each population of patients with neural-tube defects in order to provide more realistic counseling and so that clues may be gathered as to the genetic mechanisms and environmental factors which led to the production of such defects.