Knowledge, attitudes and public health response towards plague in Petauke, Zambia.

In 2001, two plague outbreaks were reported in Zambia, one of which occurred in Petauke, Eastern Province, resulting in high morbidity and mortality. Of the community respondents, 43.4% did not know the aetiology of plague. Although rats and fleas were frequently mentioned, many respondents did not know how these were related to plague. Local belief that the plague outbreak was the result of witchcraft was prevalent. Use of rodenticides was not preferred as these were reports of they being used for poisoning people. The public health response was initially slow by both the community and also the formal health sector. Once the diagnosis of plague was made, fears of witchcraft dispelled and collaboration not only between the formal health sector and the community, but also between Zambian health workers and their Mozambican counterparts developed, and it was possible to control the outbreak.

An evidence-based approach to benchmarking the fairness of health-sector reform in developing countries.

The Benchmarks of Fairness instrument is an evidence-based policy tool developed in generic form in 2000 for evaluating the effects of health-system reforms on equity, efficiency and accountability. By integrating measures of these effects on the central goal of fairness, the approach fills a gap that has hampered reform efforts for more than two decades. Over the past three years, projects in developing countries on three continents have adapted the generic version of these benchmarks for use at both national and subnational levels. Interdisciplinary teams of managers, providers, academics and advocates agree on the relevant criteria for assessing components of fairness and, depending on which aspects of reform they wish to evaluate, select appropriate indicators that rely on accessible information; they also agree on scoring rules for evaluating the diverse changes in the indicators. In contrast to a comprehensive index that aggregates all measured changes into a single evaluation or rank, the pattern of changes revealed by the benchmarks is used to inform policy deliberation aboutwhich aspects of the reforms have been successfully implemented, and it also allows for improvements to be made in the reforms. This approach permits useful evidence about reform to be gathered in settings where existing information is underused and where there is a weak information infrastructure. Brief descriptions of early results from Cameroon, Ecuador, Guatemala, Thailand and Zambia demonstrate that the method can produce results that are useful for policy and reveal the variety of purposes to which the approach can be put. Collaboration across sites can yield a catalogue of indicators that will facilitate further work.

The referral process and urban health care in sub-Saharan Africa: the case of Lusaka, Zambia.

Much of the current reform of urban health systems in sub-Saharan Africa focuses upon the referral system between different levels of care. It is often assumed that patients are by-passing primary facilities which leads to congestion at hospital outpatient departments. Zambia is well advanced in its health sector reform and this case study from the capital, Lusaka, explores the patterns of health seeking behaviour of the urban population, the reasons behind health care choices, the functioning of the referral system and the users' evaluations of the care received. Data were collected across three levels of the system: the community, local health centres and the main hospital (both in- and out-patients). Results showed those who by-passed health centres were doing so because they believed the hospital outpatient department to be cheaper and/or better supplied with drugs (not because they believed they would receive better technical care). Few users were given information about their diagnosis or reason for referral. The most striking result was the degree of unmet need for health services and the large number of individuals who were self-medicating due to lack of money rather than the minor nature of their illness. The current upgrading of urban health centres into 'reference centres' may provide a capacity for unmet need rather than decongesting the hospital outpatient department as originally intended.

The effect of chloroquine on rat liver cytochrome P-450 is mediated at the level of transcription

This paper looks at the effects of chloroquine administration on the turnover of rat liver cytochrome P-450 mRNA. It is suggested from this work that the effect of chloroquine on rat liver cytochrome P-450 is mediated at the level of transcription. It was noted from these studies that there was a marked decrease in the yield of membrane-bound polysomes from chloroquine-treated rats

Infertility; lower abdominal pain and backache in gynaecology practice: social and cultural perspectives

This paper deals with a 10 months prospective study into the complaints of lower abdominal pains and backache during regular gynaecology clinic sessions at the University Teaching Hospital in Lusaka. The causes and certain contributing factors are outlined. Social and cultural factors influencing the perception and presentation of pain by the patients are also discussed and emphasized