Analysis of cost and coverage of government financed primary health care services in Tanzania.

A method for cost analysis is presented and applied to Primary Health Care Services in Tanzania. Primary care utilization figures are combined with budget and cost data to arrive at estimates of per capita and per visit cost. Data for analysis of geographical coverage, health care needs, and utilization are most readily available for the MCH sector of Primary Health Care Services, the most important health care sector in LDCs, which is used in this paper as a proxy for estimating health care needs and utilization. The importance of separating appropriately identified investment costs from recurrent costs is illustrated. Speedy implementation of health care for all requires assistance for investment costs, the recurrent costs of appropriately designed Primary Health Care Services being within the reach of developing nations themselves.

Variations in the frequency of fetal hemoglobin-bearing erythrocytes (F-cells) in well adults, pregnant women, and adult leukemics.

Fetal hemoglobin (HbF) in adult life is usually restricted to a few erythrocytes called F-cells. Their presence can be detected and the quantity of HbF per F-cell estimated by pericellular immunodiffusion reactions with anti-HbF. In normal adults F-cell frequency (range: 1 F-cell per 25 erythrocytes to 1 per 6800) and the mean amount of HbF per F-cell (range: approximately 14 to 28% of mean cell hemoglobin), although they are variables, remain constant over many months. Frequencies are similar in men and women. For a given individual, F-cell lifetimes are probably similar to those of other erythrocytes. F-cell production is not appreciably influenced by short term exposure to high altitude (approximately 4300 m) hypoxia. F-cell frequencies are briefly but substantially increased in many women during midpregnancy. In some women, presumptive 5- to 15-fold increases in F-cell production result in observed 3- to 7-fold increases in F-cell frequency during the 23rd to 31st weeks of gestation. These increases in F-cell frequency arise from selective alterations in maternal erythropoiesis and not from transplacental bleeding from the fetus. Substantial increases in F-cell frequency also occur in most adults with acute leukemia. In both pregnancy and leukemia, F-cell contributions of HbF are sufficient to account for modest elevations found in hemolysate HbF levels.

Fetal hemoglobin restriction to a few erythrocytes (F cells) in normal human adults.

During adult life, the quantity of fetal hemoglobin (HbF) present in F cells--that is, rare erythrocytes which are reactive with rabbit antiserum to human HbF during microscopic immunodiffusion--is sufficient to account for all of the small quantity (less than 0.7 percent) of HbF normally present in whole blood. Thus, erythrocytes are normally heterogeneous with respect to the presence of HbF.