Impact of a tetanus toxoid immunization mass campaign on neonatal tetanus mortality in Aceh Province, Indonesia.

Neonatal tetanus mortality declined dramatically in Pidie district (Aceh Province) Indonesia between 1984 and 1987. Baseline and follow-up survey results demonstrated an 85% reduction in neonatal tetanus mortality during this period, from 32.1/1000 live births to 4.9/1000 live births. During 1985 a tetanus toxoid mass campaign was conducted in Pidie district which resulted in 84% of women 10-45 years of age receiving two tetanus toxoid injections. Analysis of the results of the two surveys provides very strong evidence of the impact of the tetanus toxoid mass campaign on neonatal tetanus mortality.

The village health worker program in Afghanistan.

PIP: The questions of policy and operation encountered during a program for training and placing health workers in villages in Afghanistan are discussed. In the spring of 1976, the Ministry of Public Health and the United States Agency for International Development (USAID) decided to support several experiments in creating an alternative health delivery system. The 1st group of 11 village health workers (VHWs) completed training in May 1977. A total of 137 WHWs were trained. The new pro-Soviet government that took power in Kabul in April 1978 decided to eliminate the VHW program for political rather than technical reasons. Although the program's termination prevented the results of this effort from being observed for very long, many of the issues that arose and their solutions are of interest. It was generally agreed that VHWs would be selected by their villages, but there were several options as to guidelines for selection. The Ministry provided the guidelines for qualification but accepted the final selection decision of the villagers, even if some of the guidelines were violated. A major area of disagreement was the potential effect of a decision to allow VHWs to dispense drugs. The VHW did not receive a salary from the Afghan government but was permitted to sell prepackaged drugs at a small profit. The VHWs were very eager to learn. The VHW curriculum initially emphasized the training of VHWs to perform those skills listed in the manuals. Practical work was given the highest priority.^ieng

The front line health worker: selection, training, and performance.

Iranian villagers with basic literacy were recruited, selected, trained, and deployed as Village Health Workers (VHWs) to rural areas of Iran. VHW clinical visit records and activities logs were analyzed to determine levels and nature of effort achieved in the field. Within six months of deployment, the number of patient visits to VHW treatment services constituted 53% of the target population. Within ten months of deployment, the number of family planning acceptors rose from 8% to 21% of the population at risk. Improvements to water supplies have been effected in 50% of target villages. Sanitary improvements have been made to 35% of the houses and 88% of toilets in those villages. Demographic characteristics, class rank, and place of residence of VHWs appear unassociated with village differences in levels of achievement. However, availability of material resources and actual time spent by VHWs on the job may be factors influencing the differences in outcome between villages.

Antibiotic use and abuse among physicians in private practice in Shiraz, Iran.

From 120 practicing physicians in Shiraz, Iran, 40 were selected to identify their attitude toward the use of antibiotics. A young, healthy man who complained of mild fever and cold symptoms was referred to them and 37 of them prescribed inappropriate doses of antibiotics. It is assumed that the behavior of the physicians is based on pressure by the patient to receive more medicine, particularly antibiotics.