Annales de la Societe belge de medecine tropicale最新文献

Undergraduate medical education didn't undergo major changes since the Flexner report in the beginning of this century and has since been copied without important modifications worldwide. The bulk of the medical education is given by subject specialists and general practice is only marginally covered. The result is that the training of medical doctors has become inappropriate and that a change is urgently needed. The aim is on the one hand to improve the clinical skills of doctors, on the other hand to prepare doctors for enhanced roles and to have some community perspective. Innovations such as problem-based learning and community-oriented education took mainly place in new medical schools. The need to change medical education is however greater in established medical schools, but innovation seems more difficult to reach there, although some successful experiences are described. Most innovations failed to tackle reform of the health system in which new graduates will function. This is probably one of the main reasons for their limited results. Five presentations to the Colloquium illustrate the difficulties and possible successes of change in undergraduate medical education.

Since 1988, the delta of the Senegal River Basin has experienced an exceptional epidemic of intestinal schistosomiasis, following the development of large irrigation projects. Urinary schistosomiasis was also rapidly spreading. The response of the health care system to the epidemics is described. Control was integrated in the existing health care system, according to the general health policy of Senegal. Control was based on passive detection, treatment, health education and information. The availability of praziquantel was assured. Priority was given to the development of health services in general. Initial reports have also attracted different research groups to the area. The variety of epidemiological situations made this area unique for research. Researchers would like to observe untreated communities to study the development of immune mechanisms. Inevitably such approach must lead to confrontation with local health services which should offer ethically and medically correct management of infected individuals and affected communities.

Aedes albopictus and Aedes aegypti are both found on the island. The former, being the probable vector of dengue on the island, is highly anthropophilic. It breeds in domestic environments as well as in natural breeding sites. The latter has a more restricted distribution and is never anthropophilic. Larvae of Ae. aegypti are only found in natural habitats, always associated with Ae. albopictus, but in small proportions. Such an ecology and behaviour for the typicus form of Ae. aegypti are abnormal. Several hypothetic explanations are proposed. Dengue prevention should be based solely on Ae. albopictus control.

To test the hypothesis that Tibetans do not increase their haemoglobin concentration with increasing altitude, haemoglobin concentrations of children aged 6 to 72 months were analyzed. The mean haemoglobin concentrations in the different age groups are significantly lower than the mean concentrations expected at this altitude. Histograms and tests for normality show that the haemoglobin distributions are Gaussian. The probability plots confirm the coefficients of skewness, which indicate a superimposed subpopulation towards the lower range of haemoglobin values. A mixed distribution analysis identifies that the curvilinear deviation found in the probability plot encompasses 10 to 12% of the studied population. Together with the normality of the haemoglobin distributions, we are led to suppose that this is the anaemic population. These figures are considerably lower than those found using recommended cut-off values for this altitude; 40 and 46%. Two possible explanations are put forward: 1) the whole population is submitted to the same factor and hence the whole population should be considered anaemic, 2) Tibetans react differently to altitude than other mountain people and have adapted themselves without increase in haemoglobin.

This report provides an analysis of expenditure on pharmaceuticals at the Alexandra Health Centre and University Clinic (AHC), South Africa. Drug costs increased at a rate higher than for the general expenditure budget. The drug cost per script per department varied from R9.43 for patients attending the diabetic clinic to R0.60 for antenatal care patients. In general, female consultations at the adult outpatient department (AOPD) were more expensive than male's and adult's more than paediatric's. The largest share of drug costs went to adult female patients in AOPD and the smallest share went into preventive and promotive care services. Again the same observations apply for drug costs as percentage of the total costs per clinical department. This study shows that drug costs were a significant contributor to the level of primary health care (PHC) expenditure. We discuss the alternatives to cost-recovery in a concrete situation like the peri-urban community being served by the AHC. It is concluded that in communities similar to Alexandra it would be possible to provide PHC at about R30 per capita per annum with about 15% being spent on pharmaceuticals.

The objective of this study was to determine the relative importance of determinants of fever-episodes in an environment with perennial malaria transmission. In 6 neighbourhoods of Kinshasa with different degrees of urbanization, 120 clusters of children younger than 10 years were selected over a one year period and followed up for 2 weeks each. In the 4,816 children retained for analysis 906 fever episodes were registered, which corresponds to an average incidence rate of 4.9 episodes per child per year. Seven hundred (77.3%) of the fever cases had a positive thick film (IF) but of the 3,289 children with a positive TF only 21.3% presented fever during the observation period. Nevertheless, high parasite densities formed, without neglecting the role of other infectious etiologies, the mayor pathogenic mechanism associated with fever. The risk for a fever episode was, in multivariate analysis, 40 times higher in children with at least one positive TF than in children with a negative TF on both day 1 and day 14, and amongst the ones with a positive TF the risk was 3 times higher in children with a parasitemia above 3,000 trophozoites/microliter blood. The habitat constituted another important independent determinant: the relative risk for fever was 1.48 for non-urbanized neighbourhoods, which probably reflects the low malaria transmission in the urbanized ones, but 2.1 for semi-urbanized against peripheral neighbourhoods, where the parasite index is high. Low socio-economic status, the short dry season and young age formed, in this order, further factors to the take into account.