Reduced infant mortality: a societal indicator, an emotional imperative, or a health objective?

PIP: We prefer to use the term infant mortality rate (IMR) than infant mortality. IMR is less emotional, causes less anxiety, and implies poverty and hardship while infant mortality signifies dead children. Not all societies consider prevention of infant deaths as their 1st priority albeit still a social and emotional priority. IMR has been used for a century as a health subindex. Further many people consider the IMR as an indicator of adverse economic, nutritional, environmental, and social conditions. The IMR should be used in a more restrictive manner since children can be saved from death yet they continue to experience morbidity and live in poverty. Further those factors which cause infant deaths also affect survivors and their consequences are hard to gauge. To improve on overall health and not just reduction of infant mortality, a local and appropriate health service which the population accepts must have clear objectives and provide continuous prevention and treatment programs for all cohorts of children. Yet many developing countries which would clearly benefit from continuous child health programs do not operate such a health system. Similarly international, bilateral, and other external organizations who support child survival programs must also plan on continuous self sustaining services that are directed to the living as well as the dead. Moreover their priorities should be compatible with national priorities. In conclusion, a global or even national recession that raises absolute or relative poverty or reduces the transfer of resources which are now going to temporary vertical infant death prevention programs will most likely increase IMR and decrease infant health.^ieng

Selective primary health care: the counter revolution.

Primary health care in the WHO sense was triggered indirectly by the failure of the Malaria Eradication Programme. The response to this failure was an ideological change which considered that health services were not purely a way of delivering health care interventions to people but were something important to individuals and groups in their own right. Key changes of this idea called primary health care were linked to qualities such as power, ownership, equity and dignity. Such an ideological change involves the evolution of new forms to reflect the changes in content and some of these structures still require development. The advocates of highly selected and specific health interventions plus the managerial processes to implement them have ignored, or put on one side, the ideas which are at the core of what could be described as the primary health care revolution. They are in this sense counter revolutionaries.

Incidence of hepatocellular carcinoma in New Zealand, 1974-78: ethnic, sex and geographical differences.

The incidence of hepatocellular carcinoma in New Zealand is examined for the period 1974-78. There was a significant north-south gradient for both Maori and non-Maori incidence rates, with the rates in the northern half of the North Island being approximately double those in the South Island. Within each region, Maori rates were approximately three times those of non-Maoris and incidence rates of males were approximately three times those of females. Incidence was particularly high in the Bay of Plenty, Waiapu and Otago hospital board districts. These patterns are generally consistent with available information concerning the distribution of hepatitis B surface antigen (HBsAg) carriage in New Zealand and suggest that HBsAg carriage is likely to be a major risk factor for hepatocellular carcinoma in New Zealand, as it is in other countries.

Phenoxy and picolinic acid herbicides and small-intestinal adenocarcinoma in sheep.

A study of age and sex matched groups of adult female sheep from 88 flat, hill, and high-country farms was conducted in the South Island of New Zealand to investigate the influence of breed and certain environmental factors on the prevalence rate of small-intestinal adenocarcinoma (SIA). 20 678 female sheep aged 5.5-7.5 years were examined at slaughter, 125 cases of SIA were found (6 per thousand) in animals from 61 farms (69%) and the prevalence rate for individual farm groups varied from 0 to 38 per thousand. Differences in tumour rate between breed groups were significant but differences between farm type were not. Exposure to phenoxy (Ph), picolinic acid (Pi) herbicides, or both (PhPi) was associated with significant increases in tumour rate. The increase in rate was significant for exposure to each of the 3 herbicide groups. Exposure to recently sprayed feed stuffs was associated with a significantly larger increase in tumour rate than exposure to less recently sprayed food. There was no difference between tumour rates of sheep exposed to Ph herbicides with or without 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Rates rose significantly with the total number of Ph, Pi, PhPi sprays used on the farm. The variation in rates associated with herbicides is sufficient to explain the breed differences recorded.

Primary health care in the Pacific.

It is widely accepted that a Primary Health Care (PHC) response needs to be separately designed for each individual country, but less emphasis has been given to the need to consider different objectives under different circumstances. During the 1970s and 1980s the island States of the Pacific are facing their era of major movement towards political independence and self-sufficiency, which includes the need to redesign their health systems to fit their priorities and to match their particular geographic, demographic and cultural qualities. The priority problems do not appear to include a fight against poverty or a redistribution of resources in a manner which takes a special account of variations in wealth or socio-economic class. Instead, the next decades may have to mean a quite desperate effort to replace a very high external aid component in their budgets with comparable local resources, and the design of health systems for country units which may be as small as 35,000-50,000 and which are composed of widely dispersed populations living in small groups cut off from each other by sea. Even countries with resources and a reasonable health status cannot remain unchanged and the Pacific is a good model to consider what could be done in health terms in countries which are not poor, but which are unlikely every to be rich. While the island States of the Pacific may be considered to be at present largely unsuccessful in applying international PHC principles, they already have a high health status ranking.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer predictions of New Zealand doctor numbers.

Considerable debate has been generated about "the coming crisis in medical manpower" with most current analyses predicting a large surplus of doctors in the late 1980s. However, predictions can be complex because of potential fluctuations in the input variables due to political and social factors. Variables affecting active doctor numbers include the numbers of medical students graduating each year, immigration, emigration, the proportions of males and females, age at retirement, and extent of part-time work. A computer simulation is described which enables the relative effects of these variables to be compared. It is found that adjustments in the medical school intake have a relatively small short-term effect compared with the effects of adjustments in several of the other variables, particularly immigration numbers.

Diarrheal diseases of infancy in Cali, Colombia: study design and summary report on isolated disease agents.

For public health reasons, it is important that the etiologic agents of early childhood diarrhea be isolated and identified, and that their routes of transmission be defined. This is especially true in tropical and subtropical developing countries, where childhood patterns of exposure to diarrheal disease agents usually differ from those in developed countries, and where diarrheal illness is a frequent harbinger of death among children under five years of age. This artical describes a study designed to identify diarrheal disease agents and transmission patterns in Cali, a large city of western Colombia's fertile Cauca River Valley. The study area, composed of five working-class districts with a total population of some 40,000, appeared to provide an environment fairly similar to those of many other "average" working-class communities in Latin America. Beginning in July 1962, a cohort of 296 children being born in these districts was studied, the period of investigation starting with the date of birth and continuing until each child's second birthday or its premature withdrawal from the study. Weekly home visits were made to establish defecation patterns, feeding practices, and anthropometry. The resulting data were then analyzed in terms of defecation frequencies, occurrence of liquid stools, and the presence of blood, mucus, or pus in the stools. Differences were noted in male and female defecation patterns and in the defecation frequencies of different age groups. Stool specimens for bacteriologic, virologic, and parasitologic examination were collected monthly on a regular basis and weekly when diarrhea occurred. Numerically, viruses were isolated and identified more often than other agents. The most commonly isolated parasite species and viral and bacterial serotypes were G. lamblia (from 222 subjects), echovirus 11 (from 166 subjects), and enteropathogenic Escherichia coli 026:B6 (from 138 subjects). Compared with the findings of several studies in other countries, isolations of shigellae were relatively rare.

A pattern analysis study of weanling diarrhoeal disease of infants.

Methods of pattern analysis based on statistical signal procedures have been applied to (512-day) records of daily defaecation rate obtained in an ensemble of weanling infants. Careful analysis of the records using several different methods has established the potential significance of the signal. A technique of coherent averaging has produced a stable consistent age-dependent baseline of average behaviour, referred to as an average profile. Extensions have been proposed for the application of statistical methods for the acquisition of standard patterns of diarrhoeal behaviour. Numerical low pass filtering the signal allows a dichotomization of cases, the significance of which is confirmed by differences of class average profiles. Removing the class average profile from the records shows that the majority of cases exhibit consistent individual signal patterns; standardized patterns of behaviour can also be discussed. It is tentatively concluded that objective specification of normal and abnormal defaecation behaviour could be based on spontaneous patterns identified in the records. Several methods have been suggested. Methods similar to those applied here would appear, on the evidence of this study, to be applicable to a variety of other longitudinal epidemiological studies.

The early primary immune response to absorbed tetanus toxoid in man: A study of the influence of antigen concentration, carrier concentration, and sequence of dosage on the rate, extent, and persistence of the immune response to one and to two doses of toxoid.

A quantitative study was performed to determine the effect of toxoid concentration and aluminium salt concentration on the primary immune response (PIR) and the secondary response induced by tetanus toxoid in human volunteers. Four toxoid preparations having 5-fold differences in toxoid concentration, aluminium salt concentration, or both, were administered to four comparable groups of human volunteers. Antitoxin titres in the serum of each volunteer were determined at intervals. The PIR was found to be a function of the antigen concentration, the mineral concentration, and the interaction of both. The secondary response was a function of the antigen concentration; increase in mineral adjuvant concentration had no significant effect. The data suggested that the higher the post-secondary response, the slower the rate of decline over the ensuing 10 months. The distribution of primary responses at day 28 tended to be bimodal. The response to the best preparation suggested that a single-dose toxoid might be developed to immunize populations that may be difficult to retrieve for multiple injections.