Mortality and use of health services surveys in rural Zaire.

The Combatting Childhood Communicable Disease (CCCD) project is a comprehensive public health programme designed to reduce child mortality by 25% through the use of the following strategies: vaccination, oral rehydration therapy, and prompt treatment for malaria. To evaluate this programme, cross-sectional surveys were conducted in neighbouring health zones in Zaire in 1984 to determine the use of selected medical services by the population and to estimate the child mortality rate before the CCCD programme began. A reinterview survey was conducted on a subsample of women previously interviewed to determine the reliability of the mortality estimates. In both health zones 84-85% of women used antenatal services, 45% of children under age 6 who had had fewer were treated with an anti-malarial drug, 19-22% of children age 12-23 months had been vaccinated against measles, and virtually no children who had had diarrhoea were treated with oral rehydration therapy. Women's underreporting of births and deaths resulted in low estimates of mortality in both surveys. The reinterview survey provided more accurate estimates of mortality and led to a better understanding of the factors influencing underreporting. The estimated infant mortality rate was 74 deaths per 1000 livebirths; and the probability of dying before age 5 was 191 per 1000. Because births and deaths reported with incomplete dates were excluded from analysis, the mortality rates from the reinterview survey are underestimates. Given the difficulty in obtaining accurate estimates of mortality, primary importance should be given to developing and improving routine health information systems that measure changes in health status and provide information to evaluate programmes.

[The Expanded Program on Immunization in the WHO African region: current situation and implementation constraints]. / Le PEV dans la région africaine de l'OMS: situation actuelle et contraintes de mise en oeuvre.

The expanded Programme on Immunization in the African region was launched in 1978 and by the mid-eighties, all countries had established national immunization programmes. A mid decade evaluation, conducted in 1985, indicates that the regional immunization coverage was still under 20% for all antigens. For this reason, member states agreed to accelerate the programme. They adopted a resolution declaring 1986 the "African Immunization Year" and pursued implementation of various accelerated efforts until 1990. During the acceleration phase, the political commitment was strong, with the involvement of top national officials and First Ladies in launching the immunization campaign in many countries. The resources required were supplied mainly from external funding agencies. As a result, sixteen countries reached the 80% immunization coverage rates for antigens administered to the infants and remarkable progress has been achieved in the control of the EPI priority diseases. Concerning polio eradication, at least fourteen countries, representing 20% of the regional population have reported zero incidence of poliomyelitis for two consecutive years, during the period 1991-1993. In five of these countries independent teams of international and national experts assessed the quality of the epidemiological surveillance and confirmed that polio cases may have been eliminated. This suggests that a polio-free zone has emerged in the southern part of Africa, where most of these countries are located. In the meantime, an outbreak of poliomyelitis (with 28 cases confirmed by isolation of type 1 poliovirus) was reported from one country (Namibia) where no cases had been reported for the last few years. It is still unclear whether poliovirus was imported or the virus continued to circulate without causing paralytic cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Measles vaccination in Africa: by how much could routine coverage be improved?

Assuming that the level of Bacille Calmette Guerin (BCG) coverage gives a measure of access to immunisation services, it is possible to derive what fraction of infants are not immunised against measles due to under-utilisation of existing services (rather than unavailability of services). According to the most recent official statistics, the overall coverage for measles vaccine is 53% in Africa (10% lower than for BCG). This difference amounts to 3 million African children who will not be vaccinated against measles this year even though they probably have access to immunisation services.

Yellow fever: a decade of reemergence.

Since the 1980s, yellow fever has reemerged across Africa and in South America. The total of 18 735 yellow fever cases and 4522 deaths reported from 1987 to 1991 represents the greatest amount of yellow fever activity reported to the World Health Organization (WHO) for any 5-year period since 1948. There is an excellent vaccine against yellow fever. At present, a high proportion of travelers to at-risk areas are reported to be immunized, reflecting widespread knowledge about the International Health Regulations. In South America, yellow fever remains an occupational hazard for forest workers, who should be immunized. However, Aedes aegypti mosquitoes are now present in urban areas in the Americas (including southern parts of the United States), and there is concern that yellow fever could erupt in explosive outbreaks. In Africa, a large proportion of cases have occurred in children. The WHO, the United Nations Children's Fund (UNICEF), and the World Bank have recommended that 33 African countries at risk for yellow fever add the vaccine to the routine Expanded Programme on Immunization; studies show that this would be highly cost-effective. To date, financing yellow fever vaccine has been a major problem for these countries, which are among the poorest in the world. For this reason, WHO has launched an appeal to raise $70 million for yellow fever control in Africa.

Ebola hemorrhagic fever: lessons from Kikwit, Democratic Republic of the Congo.

The outbreak of Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo, clearly signaled an end to the days when physicians and researchers could work in relative obscurity on problems of international importance, and it provided many lessons to the international public health and scientific communities. In particular, the outbreak signaled a need for stronger infectious disease surveillance and control worldwide, for improved international preparedness to provide support when similar outbreaks occur, and for accommodating the needs of the press in providing valid information. A need for more broad-based international health regulations and electronic information systems within the World Health Organization also became evident, as did the realization that there are new and more diverse partners able to rapidly respond to international outbreaks. Finally, a need for continued and coordinated Ebola research was identified, especially as concerns development of simple and valid diagnostic tests, better patient management procedures, and identification of the natural reservoir.