What safety net for children?

As our nation attempts to address the multiple health and social needs of children, it is obvious that the so-called safety net of services for children and families is currently not meeting their needs. Within the current dialogue over health care reform, the special needs of children and pregnant women must not be lost. This paper discusses basic components which should be included in any discussion of health care reform. Individualized personal involvement in the solution to the health and social problems of today's underserved children and families is crucial.

Neonatal intensive care admissions: changing profile in Georgia, 1974 to 1982.

Birthweight-specific admission rates were reviewed from 1974 to 1982 for Georgia's five regional perinatal centers. Analysis of birthweight-specific neonatal intensive care unit (NICU) admissions as a proportion of total live births revealed an upward trend for infants weighing 1,000 to 1,499 gm and a downward trend for those weighing 2,000 gm or more. This method revealed no significant trends for infants of weight groups less than 500 gm or 500 to 999 gm. Analysis of birthweight-specific admissions as a proportion of total NICU admissions revealed significant increases for all birthweight groups of less than 2,000 gm, with decreases in admissions for infants weighing more than 2,000 gm. Analysis of mortality data revealed improved survival for infants weighing less than 1,500 gm, but some centers showed increases in neonatal mortality, postneonatal mortality, or infant mortality among infants weighing 2,500 gm or more. During this study, low birthweight infants comprised an increasingly larger proportion of neonatal intensive care admissions. This trend evolved gradually through the process of regionalization and can be directly linked to the cost requirements of regional neonatal intensive care units.

Estimation of incidence of poliomyelitis by three survey methods in different regions of the United Republic of Cameroon.

Surveys were conducted in one urban and two rural regions of the United Republic of Cameroon to estimate the annual incidence of paralytic poliomyelitis. Three different survey methods were used: a review of hospital and clinic registers, a school survey, and a house-to-house survey. The house-to-house survey identified the highest number of lame children and gave estimates of incidence of between 18.8 and 32.6 per 100 000 population in the three regions. The estimates of incidence obtained by the two other survey methods in the urban region did not differ significantly from that obtained by house-to-house survey but, in the rural regions, were significantly lower. It is concluded that house-to-house surveys are a sensitive method of identifying lame children in both urban and rural regions. School surveys and review of hospital and clinic registers, while equally sensitive in urban regions, are less sensitive in rural regions and may significantly underestimate the annual incidence of paralytic poliomyelitis. These limitations should be borne in mind when using the survey methods.