Capacity building in health economics opportunities for training in developing countries

This paper provides an overview of the opportunities available for training in health economics in the regions of Africa, Asia and Latin America, following a WHO forum on Capacity Building in Health Economics held in Geneva in December 1995. It describes in brief the training opportunities available throughout Asia, Africa and Latin America. It then gives a detailed resume of courses available for students and professionals at Chulanlongkorn University, Thailand, the University of Cape Town, South Africa and the University of the West Indies, Trinidad. It also describes the international and regional networks which have developed and now provide further opportunities for training. The final section of this paper looks to the future and suggests that although continued financial and academic support will be needed from the countries of the North, the development of regional capacities in health economics should be as much as possible through regional resources, the regional strategies should be an priority.(AU)

A survey of hepatitis B among health workers in Jamaica

One thousand, five hundred and thirty-seven health staff, presenting for hepatitis B vaccination in Jamaica, were surveyed in 1990/91 for hepatitis B markers and/or expose to blood or hepatitis. Antibodies to either hepatitis B surface antigen (HBsAg) or hepatitis B core (HBc) were found in 19.8 percent of 817 persons tested. Males were more likely to have antibodies to Hepatitis B Virus (HBV) than females (29 percent compared with 18 percent, Odds Ratio 1.6;95 percent CI 0.98-2.9). HBsAg was found in 5.3 percent of 562 persons tested compared with 1 percent of blood donors. One or more needlestick accidents were reported by 60 percent of the sample, and blood or liquid splashing on the face was reported by 48 percent. Jaundice and hepatitis were reported by 1.2 percent and 3.5 percent of health staff, respectively. HBaAg carrier status was associated with years of service (p=0.039). Prevalence of antibodies to HBV increased with age (p=0.004) and years of service (p=0.028). The effect of age and years of service appears to be largely independent (r=0.44). This survey reaffirms the importance of health workers being immunized with hepatitis B vaccine, and adhering rigorously to universal precautions in patient care and laboratory practice (AU)

Training of health professionals and community leaders in techniques to promote demand reduction for drugs

The problem of drug and its associated harmful effects on the individuals, their families and the nation has received a great deal of attention during the past decade. Media campaigns, traditional or affective educational programmes and other alternate activities, designed to help individuals achieve total abstinence, or modify their pattern of use were rarely successful at influencing behaviour change. It may be due to unsound methodology used to carry out these intervention programmes. A multidimensional intervention programme involving teaching and training of health professionals together with selected communities, is therefore, suggested. Under this programme, a problem based methodology will be used to resolve the issue of drug abuse through the process of active learning. The major component of this methodology will be to develop techniques for training of health professionals in drug prevention. The trained health professionals in turn will train community leaders who will increase the community's competence to deal with drug abuse. Community leaders together with the support of Neuroscience, Adolescent Development and Drug Research Programme (NADRAP), University of the West Indies, Mona and other such institutes, will be expected to influence the knowledge and behaviour of the individuals in promoting demand reduction for drugs in Jamaica.(AU)

A survey of hepatitis B among health workers in Jamaica - abstract

A convenience sample of 1537 health staff in Jamaica were surveyed in 1990/91 for hepatitis B markers and/or exposure to blood or hepatitis. Antibodies to either hepatitis B surface antigen (HBsAg) or hepatitis B core (HBc) were found in 19.8 per cent of 817 persons tested. HBsAg was found in 5.3 per cent persons tested. One or more needlestick accidents were reported by 60 per cent of the sample and blood or liquor splashing on the face was reported by 48 per cent. Jaundice and hepatitis was reported by 1.2 per cent and 3.5 per cent respectively. Prevalence of antibodies to hepatitis B virus (HBV) increased with age (p = 0.004) and years of service (p = 0.28) while HBsAg carrier status was associated with years of service (p = 0.039). Males were more likely to have antibodies to HBV than females (Odds Ratio 1.63, 95 per cent, CI 0.98 - 2.71). This survey reaffirms the importance of health workers being immunized with hepatitis B vaccine and adhering rigorously to universal precautions in patient care and laboratory practice (AU)

Occupational percutaneous exposure to human immunodeficiency virus (HIV); a decision analysis from a Caribbean perspective - abstract

A decision analysis was conducted to examine whether short-term (42 days) zidovudine should be recommended for Caribbean health care workers (HCWs), following percutaneous exposure to blood, as well as to determine the value of testing "donor" (patient's) blood. The results were compared with a similar analysis based on a North American model. The options analyzed were "TREAT ALL", "TREAT NONE"; and "TEST". In the "TREAT ALL" option, all HWCs receive short-term zidovudine immediately after exposure, "TREAT NONE" option no one receives zidovudine and in the "TEST" option, "donor" blood is tested, and if HIV-positive, zidovudine is given. Each outcome was expressed as a utility; this is a method of quantifying the values that individuals place on health states. The results showed that the "TEST" option is preferred. The value of testing "donor" blood is derived from the fact that the vast majority of HCWs would be reassured by a negative test. Sensitivity analyses indicated that even if the risk of seroconversion or the effectiveness of zidovudine is zero, this option is preferred; thus confirming the above value of testing, rather than merely identifying HCWs who should receive zidovudine. If HIV-seropositivity exceeds 42 per cent, the "TREAT NONE" option is preferred. This was found to be due to the fact that increased numbers of HCWs would be told that they were exposed to HIV-positive blood. The "worrying factor" associated with such an exposure is such that above 42 per cent HIV seropositivity, the "TREAT NONE" option is preferred. In summary, the real value of testing "donor" blood is in identifying those persons who could be told that they were exposed to HIV-negative blood; that is reducing their "worry factor" to zero. If the risk of HIV-positivity exceeds 42 per cent, in particular groups of Caribbean patients, the "TREAT NONE" option is preferred. Because AIDS is a fatal disease, and given that zidovudine is the only available prophylactic agent at present, the drug has a role to play if its effectiveness is greater than zero. In this regard, the approach should be similar to that adopted for developed countries (AU)

Knowledge and understanding of AIDS among health-care workers in Jamaica

Six hundred and fifty questionnaires were sent to Health-care Workers (HCW) in four hospitals to assess the knowledge and understanding on HIV transmission and isolation precautions to be instituted for control and also to ascertain whether any differences in knowledge existed between HCW of teaching and non-teaching hospitals. Five hundred and nine questionaires were returned, a response rate of 79 percent . Questions on HIV transmission via blood transfusion and sexual intercourse and proper disposal of sharp instruments received the highest scores (85-100), embracing all groups of teaching and non-teaching hospitals. The greatest area of misconception and misunderstanding was reflected in responses obtained on isolation precautions (<30) for both teaching and non-teaching hospitals. Our study emphasizes an urgent need for comprehensive, continuous education of HCW on prevention and control of HIV infections in Jamaica (AU)

Het medisch beroep / The medical profession

The medical practice and profession are discussed, including the key profession, current problems and present situation. Changes in profession ideology, profession structure and social context are also discussed. Finally, it is concluded that the medical profession is in a phase where innovation is neccessary. This was typified to be a great challenge

Programa de adiestramiento de asistentes en salud de la comunidad / A community health aide training program

The Department of Social and Preventive Medicine, University of the West Indies, reports on a four-month experimental training program for community health aides drawn from a low to middle socio-economic community. The overall aim was to give the aides a basic minimum training so that they could function as auxiliaries under supervision, relieving highly trained personnel to utilize their skills and training more effectively. The aides who were trained have worked during the past year in various positions, namely: in comprehensive health care programs, in physiotherapy, as field workers in research projects, and in family planning. Evaluation of the program indicates that these workers have performed satisfactorily and that a community health aide can be a very useful member of the health team in our developing communities. (Summary)