Double-blind, multi-centre trial to compare a once-daily combination of trimethoprim and sulfamethopyrazine with ampicillin 4-times daily in patients with urinary infections.

Sixty-eight patients with urinary infection were allocated at random to receive treatment with either 500 mg ampicillin 4-times daily or a trimethoprim (250 mg)/sulfamethopyrazine (200 mg) combination given once daily after a double, loading dose on the first day. All patients complained of urinary symptoms and showed significant bacteriuria, E. coli being the pathogen most frequently recovered. Clinical and microbiological assessments were carried out on entry and, as a rule, after 3 to 4 days and 1 to 2 weeks of treatment. In the 35 patients receiving trimethoprim/sulfamethopyrazine, 40 (95%) of the 42 original infecting organisms were eradicated. In the 33 patients on ampicillin, the eradication rate was 32 (89%) out of 36 organisms. The course of urinary symptoms was similarly favourable in the two groups. Overall response was considered as 'excellent' or 'good' in 89% of the patients receiving the combination preparation and in 82% of those given ampicillin. Clinical and biological tolerance was satisfactory under both regimens. A longer follow-up control should confirm the value of the new combination in the treatment of urinary infections.

Developing an Index to Measure Health System Performance: Measurement for Districts of Nepal.

Various frameworks for measuring health system performance have been proposed and discussed. The scope of using performance indicators are broad, ranging from examining national health system to individual patients at various levels of health system. Development of innovative and easy index is essential to measure multidimensionality of health systems. We used indicators, which also serve as proxy to the set of activities, whose primary goal is to maintain and improve health. We used eleven indicators of MDGs, which represent all dimensions of health to develop index. These indicators are computed with similar methodology that of human development index. We used published data of Nepal for computation of the index for districts of Nepal as an illustration. To validate our finding, we compared the indices of these districts with other development indices of Nepal. An index for each district has been computed from eleven indicators. Then indices are compared with that of human development index, socio-economic and infrastructure development indices and findings has shown the similarity on distribution of districts. Categories of low and high performing districts on health system performance are also having low and high human development, socio-economic, and infrastructure indices respectively. This methodology of computing index from various indicators could assist policy makers and program managers to prioritize activities based on their performance. Validation of the findings with that of other development indicators show that this can be one of the tools, which can assist on assessing health system performance for policy makers, program managers and others.

Mortality statistics from national censuses: a low cost viable method.

Information related to mortality is pivotal for evidence based policy and planning, resource mobilization and impact of intervention. This information is essential to monitor trends in health situation of the population, detect new epidemics, encourage research into avoidable causes of death, evaluate the success of control programs, and improve accountability for expenditures on disease control. Sixty percent of the countries of the world don't provide enough information on vital events and complete and representative information. Apart from vital registration system, other methods for getting mortality data are in current practices, such as facility based information system, censuses, household survey, research demographic surveillance sites, epidemiological studies and sample vital registration system, which complement the national health information system. All methods have their limitations. Piggy backing of national censuses for mortality statistics would follow the principle of Sample Registration System (SRS) using verbal autopsy tools to generate the mortality data just after the censuses. This method can be the suitable/useful mortality measuring system representing the population by age, sex, location and causes of death with less effort and at a lower cost. This method can be used to verify mortality data collected from other sources and/or for adjustment of existing mortality data.