Social science & medicine. Part D, Medical geography最新文献

This paper is a report on continuing research on colonial public health measure in South Asia from the 18th to 20th centuries. Accounts of smallpox variolation and vaccination in South Asia are examined from 1700 to 1865. The transition from variolation to vaccination is examined in four phases: variolation, variolation-vaccination, limited vaccination, and intensified vaccination.

This study examines the difficulties in instituting a viable system to provide health care facilities in Pakistan. Distribution patterns of existing facilities reveal serious inadequacies related to planning deficiencies, lack of capital, and disregard for socio-cultural factors. Whenever possible, health service development planning must be based on the needs of the population.

Malaria has plagued India since antiquity. In the 20th century both man-made and physical environments have contributed to the establishment of different malaria intensity zones. A 1948-Malaria Distribution Map of India indicated Malaria-free, Endemic and Variable Endemic zones. The Malaria-free zone was associated with higher elevations, e.g. the Himalayas and coastal lands. The Endemic zone was considered to be places where the average annual rainfall exceeded 80cm. A malaria control program was started in India immediately after independence in 1947. Spraying of Anopheles-killing insecticides was the main control activity. Although, the disease was largely controlled by 1965, resurgence took place from several pockets. Now, two west-central states, Gujarat and Madhya Pradesh are also showing signs of resurgence. Monsoon rains, higher humidity, vegetation, tribal habitats and rice-cultivation have definitive associations with the disease in those two states. Eradication will have to await the discovery of an effective vaccine, but the disease can be drastically controlled by the mid-eighties with the existing techniques.

This study examines another example of the reappearance of malaria in India. After the discontinuation of insecticide spraying operations, and the complacency observed on the part of malaria workers and staff, malaria receptivity increased rapidly in areas where A. culicifacies is the vector. This paper examines some of the environmental impacts of a water resource related development project in the surrounding rural settlements in the state of Tamilnadu, India with reference to a recent renewal of malaria transmission in that region. The incidence of malaria was particularly noticed in the population of many river villages, migrant workers on the project and tourists visiting a dam site.

Factors favoring the increase of rural malaria in the area appear to be: irrigation, agriculture, terrain features of the reservoir region, the nature of breeding places, the malaria transmission season, and the anopheline population. Other factors found to be related were: the role of malaria carriers in the area. the type of population at risk, the degree of contact of the population with certain terrain features, dwelling types and other socio-economic activities of the affected population. Certain occupation characteristics and population movements also have an important bearing in the incidence of malaria.

Dengue hemorrhagic fever (DHF) is a viral disease which has spread throughout Southeast Asia over the past 25 years. Ae. aegypti is the main vector of the disease. The location of DHF outbreaks, the number of infected individuals, and the diffusion of the disease are related to several socio-economic, environmental and host factors. A number of writers have discussed the relationships between DHF outbreaks and rainfall in different parts of Southeast Asia. A review of the literature suggests that there are positive correlations between the two variables in Burma, Thailand and the Philippines, all of which have one wet season and prolonged “dry periods”, but that the relationships in countries closer to the equator, such as Peninsular Malaysia and Singapore, where there are two wet seasons, are unclear. In two case studies of Selangor and Johore in Peninsular Malaysia for the period 1973–1977, the relationships between DHF cases and moisture surpluses and deficits, the latter derived from Thornthwaite's method for calculating the water balance, are investigated on a monthly basis. It is shown that there is an increase in DHF cases following the March to May wet season and that the size of the increase is positively related to the size of the moisture surplus. The importance of moisture deficits is also underscored. There is, however, an apparent lack of association between DHF cases and rainfall during the second wet season, September–November, of each year. It is suggested that relationships between DHF and rainfall should be sought for a sequence of years, and that investigations must be based on a more sophisticated measure of moisture availability than raw monthly rainfall data. Topics for further research are outlined.

Analysis of data on perinatal mortality, 1972–1976, in the greater Hobart metropolitan region (Tasmania) indicates significantly higher death rates in two areas where other measures of social disadvantages are shown to occur.

Results from a 1976 ophthalmological survey in the Northern Territory of Australia showing prevalence rates of active trachoma among Aborigines are analysed in respect to environmental conditions. The communities surveyed have been grouped by criteria of similarities of locality, climate, dwellings, diet, water sources, sanitation and employment opportunities. Both parametric and non-parametric analyses of the trachoma morbidity yield high correlations with marginal changes in these environmental factors.

Small scale studies in New Zealand have found a higher incidence of diabetes mellitus in Maoris than in Europeans. In an attempt to determine the morbidity of this disease at a national level the 1971 Census included a question to be answered only by those under treatment for diabetes. This data was used to define the spatial patterns of diabetes morbidity in the total population, and in the Maori and non-Maori races. For the total population the patterns of the sexes were similar with a significantly high incidence area across the northern half of the North Island, where the majority of the Maoris reside. Low morbidity generally prevailed elsewhere. The racial patterns were the reverse of each other especially in the North Island.

Districts with an elevated Maori morbidity had a low disease incidence in non-Maoris. The accuracy of this Census data was evaluated by comparison with the findings from previous epidemiological studies of this disease in New Zealand.

It has long been recognised that inequalities exist in the availability of primary medical care. Less well known, however, are the distributional inequalities that exist in the secondary sector. This paper examines the relationships between hospital resource allocation, the presence of medical resources and need in New Zealand's 29 hospital boards in 1976. Although the relationship between resource allocation and need was positive, it was found to be tenuous, with bed numbers, political pressure and the system's inertia being the more important determinants of allocation levels.

In the course of several years of nutritional research in East Java specific vitamin and mineral deficiencies were found to be more widespread than undernutrition. Appropriate nutritional technologies were sought to cure xeropthalmia and goitre and it was found that the villagers could cure themselves by eating a mixture of papaya and cassava leaves and rubbing their necks with tincture of iodine respectively. These treatments were field tested and an audio-visual nutritional education programme was devised to disseminate information on self-treatment. Some of the practical difficulties encountered in setting up these and one other programme which failed are discussed.