How do health workers see community participation?

A survey of health workers in Rwanda suggested that they were somewhat reluctant to accept the involvement of lay people in the promotion and implementation of primary care programmes. Various obstacles to community participation were identified by the health workers, who, however, suggested general rather than specific remedies for the situation as they saw it.

PIP: A questionnaire was distributed to the 30 health centers of the Butare Health Region in southern Rwanda in a study exploring health workers' perceptions about community participation. 29 replies were received, covering 23% of staff at the peripheral level. Asked to categorize various aspects of community participation on the basis of their importance, the workers gave the following order of priorities: identifying one's own problems, paying for drugs, community management of the ambulance, choosing basic health workers, suggesting a health program and helping to evaluate results, working on the environment, helping to manage the community health center, maintaining the health center, and suggesting better hours for consultations. 83% of health workers responded that communities should not take the initiative in health promotion activities. Poverty and a lack of financial resources for drugs, treatment, and environmental improvement; ignorance about the value of participation and of health care in general; and taboos, customs, and traditions producing resistance to change were cited by almost all of the health workers as potential and actual obstacles to community participation. It was suggested that people who can not pay for treatment be helped by the community or through credit. Moreover, almost all respondents endorsed continuing education for all people through discussions and home visits. Overall survey findings suggest that the respondents are rather opposed to the involvement of laypeople in promoting and implementing primary care programs. There was confusion about the notion of community, with the health workers tending to underestimate people's potential for action and reaction, and to insist upon the need for a hierarchical structure. No concrete picture emerged as to what should be done.

Female prostitutes: a risk group for infection with human T-cell lymphotropic virus type III.

In July, 1984 33 female prostitutes in Rwanda and 25 male customers of prostitutes were assessed clinically and for their T-lymphocyte subsets and frequency of antibodies to human T-cell lymphotropic virus type III (HTLV-III). 27 healthy males who denied contact with prostitutes, 33 healthy women who were not prostitutes, and 51 Rwandese prostitutes seen in 1983 served as controls. Only 6 prostitutes were symptom-free (group I), 13 had unexplained generalised lymphadenopathy (LAP) (group II), and 14 had LAP and constitutional symptoms (group III). Mean OKT4/OKT8 ratio in groups II and III was significantly lower than that in group I or in female controls. HTLV-III antibodies were detected in 29 of 33 prostitutes, 4 female controls, 7 male customers, and 2 male controls. In male customers, HTLV-III seropositivity increased according to the number of different sexual partners per year. This study suggests that in Central Africa prostitutes are a high-risk group for HTLV-III infection.

[Orbital involvement in acute sinusitis in children]. / Les atteintes orbitaires des sinusites aiguës chez l'enfant.

We review the literature on orbital involvement in acute sinusitis in children. Because of the potential severity of the disease which may be life threatening a vigorous treatment is required. Hemophilus Influenzae is a major cause of orbital cellulitis followed by Staphylococcus Aureus and group A streptococcus. Because of the emergence of Ampicillin-Resistant H. Influenzae strains in Belgium, chloramphenicol should be included in the initial therapy in combination with a penicillinase resistant semisynthetic penicillin. Therapy is adjusted as soon as the results of bacterial culture are known. Surgical establishment of sinus or abscess drainage is required if the child is severely ill or failed to respond to medical treatment. A treatment protocol is proposed.

[Current therapy of juvenile nasopharyngeal angiofibroma]. / La thérapeutique actuelle de l'angiofibrome juvénile naso-pharyngien.

The nasopharyngeal angiofibrom continues sometimes to challenge the otolaryngologists because of the difficult radical surgery owing to the deep anchorage of the tumor in the base of the skull. In these cases, when possible, the embolization followed by surgery or the radiotherapy are the two better treatments. Without embolization, radiotherapy must be preferred because of the life threatening surgery that cannot eradicate the tumor.

Treatment of ankylostomiasis with levamisole.

The authors communicate their experience in the treatment of ankylostomiase with levamisole; with a dose of 2.5 mg/kg body weight they achieved a positive result in two-thirds of the cases in a series of 119 without any toxic side effects.