Health care provider choice: the North West Province of Cameroon.

Health care is provided in many developing countries free of any charge at the point of delivery. This is attributed to the fact that health care is one of the basic human rights. While modern health care in public health units is free, patients in rural areas continue to use either self-care, traditional healers or both. In Cameroon, the idea of integrating traditional and modern medical practices is discussed by both traditional and medical practitioners. However, it is not very clear what influences the household's choice of one or the other. Within a health district, where there are many providers, the question as to whether or not there is a possibility of choice open to all is posed. This article reports on a study undertaken in a rural health district that shows that there are many factors that influence the choice of health care. Among these factors is quality of care which is the most important factor influencing the choice of health care provider. As quality of care increases in governmental health centres, their choice probability also increases. Other factors include: the time spent seeking treatment; household income and size; distance; and, cost of health care. Those with higher incomes tend to choose private health units and those with larger families tend to choose government health units. Other socio-cultural factors, difficult to model, appear to also influence the choice of providers. It is concluded that since household income influences the choice of private health units, policies targeting poverty alleviation should be instituted in the rural areas to provide households with income. This will enable them widened access to private health care and enable government to redeploy its scarce resources to maintain and extend services to needy areas.

PIP: In Cameroon, the idea of integrating traditional and modern medical practices is discussed by both traditional and medical practitioners. It is not clear, however, what influences the household's choice of one or the other approach to medical care. This paper reports findings from a study of data collected in a household interview survey undertaken in Ndop, a rural health district in the North West Province of Cameroon during July-November 1992 which finds that there are many factors which influence the choice of health care. Quality of care is the most important factor influencing the choice of health care provider. As the quality of care increases in governmental health centers, choice probability also increases. Other factors include the time spent seeking treatment; household income and size; distance; and cost of health care. Those with higher incomes tend to choose private health units and those with larger families tend to choose government health units. Other difficult to model sociocultural factors appear to also influence the choice of providers. It is concluded that since household income influences the choice of private health units, policies targeting poverty alleviation should be instituted in the rural areas to provide households with income. This will enable widened access to private health care and enable government to redeploy scarce resources to maintain and extend services to needy areas.

Seasonality of births in the North West Province, Cameroon: implications for family planning programme.

This article presents an analysis of the seasonal variation of births between 1978 and 1987 (10 years) in the North West Province. A total of 157,316 births were recorded during the 10 years in question. Highest delivery peaks noticed in the second half of the year for 8/10 years. This gives conception peaks between October and March. Minimum for all the 10 years taken together occurs in July while maximum occurs in September. Considering 40 weeks as normal gestation period, conception peak for the 10 years taken together occurs in December. This peak is related to the festivities that take place within this month. The findings have important implications for family planning. Family planning education needs to be intensified during the period of highest conception or that which leads up to it.

PIP: This article presents an analysis of the seasonal variation of births between 1978 and 1987 (10 years) in the North West Province. Data was collected from registered births in health centers and hospitals within the province. A total of 1573 births were recorded during the 10 years in question; this averaged to be 1311 births/month. Highest delivery peaks were noticed in the 2nd half of the year for 8/10 years. This gives conception peaks between October and March. The minimum delivery peak occurs in July while a maximum peak occurs in September. Considering 40 weeks as a normal gestation period, the conception peak for the 10 years taken together occurs in December. This peak is related to the festivities that take place within this month. From 1978-1985, birth and fertility rates/1000 increased from 10.2/1000 in 1978 top 15.4/1000 in 1985 and from 42/3/1000 in 1978 to 15.4/1000 in 1985 and from 42.3/1000 in 1978 to 64.2/1000 in 1985, respectively. In 1986, a decrease in birth and fertility rates was observed; in 1987 the birth rate dropped from 14.6 (1986) to 14.5 while the fertility rate dropped from 61.0 in 1986 to 60.6 in 1987. The findings have important implications for family planning. Family planning education needs to be intensified during the period of higher conception of that which leads up to it.

Oral poliovirus vaccine in tropical Africa: greater impact on incidence of paralytic disease than expected from coverage surveys and seroconversion rates.

During the first 5 years of a poliomyelitis control programme in Yaounde, Cameroon, a maximum of 35% of children aged 12-23 months were estimated to have received three doses of trivalent oral vaccine. Despite this low immunization coverage and low seroconversion rates, which were determined concurrently, the estimated incidence of paralytic poliomyelitis decreased by 85%.A detailed study of immunized children and of children living in the same households suggests that community spread of the vaccine virus and cross-immunity may have partly been responsible for the dramatic decrease in the incidence of paralytic disease, and that competing non-polio enterovirus infection was not a cause for the low seroconversion rates. These results suggest that immunization coverage and seroconversion rates alone are not sufficient criteria for determining the effectiveness of control programmes that use oral poliovirus vaccine in tropical Africa; surveillance of the incidence of paralytic disease must also be carried out.