An evaluation of training in family health for medical students and internes in Sri Lanka.

The results of an evaluation of an integrated training programme in family health for medical students and intern medical officers in Sri Lanka are presented. The course objectives were translated into expected student competences in specific tasks and the responses of the internes obtained using a semi-structured questionnaire. While the course had reinforced the students' awareness and commitment on the need for actively promoting family health it had not provided the expected competences in many tasks to the level of confidence that was anticipated. A number of deficiencies in the training programme in medical school as well as during the medical internship become evident and these have been discussed with the respective authorities with a view to effecting satisfactory improvements.

A comprehensive scheme of health manpower development for Nepal.

How does a land-locked, mountainous, newly emergent country produce the manpower to serve the essential health care needs of its population? The absence of a tradition of medical education, a paucity of medical personnel and the major problems of deployment and communication pose immense challenges to health manpower producers. The policies, plans and programmes of the Government of Nepal to develop appropriate levels of manpower and the discernible problems and prospects faced by the Institute of Medicine are examined. The institutional framework that has been established for an ongoing monitoring and evaluation of the processes and some of the successes achieved have been described.

Epilepsy in Sri Lanka: public awareness and attitudes.

Public awareness and attitudes toward epilepsy were surveyed in Sri Lanka using a self-administered questionnaire. The respondents belonged to seven different occupational categories--school children, teachers, university students, medical students, student nurses, army personnel and adult education participants. The results showed that the knowledge was deficient in many aspects among all the groups and the attitudes towards epilepsy and epileptics were marginally positive. The knowledge appeared to be most widespread with regards to symptomatology and least in the areas of aetiology and treatment. A significant proportion of the respondents seemed to harbour mythical beliefs about the disease. The study indicates the need for better utilization of the health and educational infrastructure of the country in educating the public and special groups.

An analysis of internship training in Sri Lanka.

The internship period is a critical phase in the continuum of training provided to medical students. An analysis was made of the tasks the intern medical officers in Sri Lanka are engaged in during their period of training in different clinical disciplines. Data was collected by direct observations by trained observers for a continuous period of 10 days and self-reporting by the interns at the two teaching hospitals and four of the provincial hospitals where interns are posted. The reliability of the data was high. The results indicated the wide differences in the learning experiences of the interns in important aspects of patient care in the different training situations. The non-availability of any guidelines to the consultants with respect to the training intended is another deficiency. The study shows an urgent need to implement a planned and monitored internship programme in the country.

Poliomyelitis surveillance: the model used in India for polio eradication.

Poliomyelitis surveillance in India previously involved the passive reporting of clinically suspected cases. The capacity for detecting the disease was limited because there was no surveillance of acute flaccid paralysis (AFP). In October 1997, 59 specially trained Surveillance Medical Officers were deployed throughout the country to establish active AFP surveillance; 11,533 units were created to report weekly on the occurrence of AFP cases at the district, state and national levels; timely case investigation and the collection of stool specimens from AFP cases was undertaken; linkages were made to support the polio laboratory network; and extensive training of government counterparts of the Surveillance Medical Officers was conducted. Data reported at the national level are analysed and distributed weekly. Annualized rates of non-polio AFP increased from 0.22 per 100,000 children aged under 15 years in 1997 to 1.39 per 100,000 in 1999. The proportion of cases with two adequate stools collected within two weeks of the onset of paralysis increased from 34% in 1997 to 68% in 1999. The number of polio cases associated with the isolation of wild poliovirus decreased from 211 in the first quarter of 1998 to 77 in the first quarter of 1999. Widespread transmission of wild poliovirus types 1 and 3 persists throughout the country; type 2 occurs only in Bihar and Uttar Pradesh. In order to achieve polio eradication in India during 2000, extra national immunization days and house-to-house mopping-up rounds should be organized.

A new paradigm for international disease control: lessons learned from polio eradication in Southeast Asia.

OBJECTIVES: This study evaluated the impact of international coordination on polio eradication in Southeast Asia. METHODS: Active surveillance systems for acute flaccid paralysis were assessed. Analyses focused on surveillance proficiency and polio incidence. RESULTS: Ten countries coordinated activities. Importations occurred and were rapidly contained in China and Myanmar. Countries that have been free of indigenous polio transmission for at least 3 years include Sri Lanka, Indonesia, Myanmar, and Thailand. In the remaining endemic countries--India, Nepal, and Bangladesh--poliovirus transmission has been substantially reduced; however, these countries still harbor the world's largest polio reservoir. CONCLUSIONS: Unprecedented international coordination in Southeast Asia resulted in dramatic progress in polio eradication and serves as a paradigm for control of other infectious diseases such as malaria and tuberculosis.