Cost saving with ultrasonography in a developing country district hospital.

OBJECTIVE: To estimate the potential monetary reduction induced by the introduction of an ultrasound unit in a major district hospital in a developing country. DESIGN: Propective study. SUBJECTS: Patients referred with abnominal diseases and pregnancy. SETTING: Wad Medani Teaching Hospital, Central Sudan. RESULTS: Local specialists referring the patients stated that an estimated 792 radiologic procedures would have been carried out to obtain the same amount of information as achieved by ultrasound. Such procedures budgeted approximately 8100 US dollars, in terms of equipment, material and personnel by 1987 rates. Such savings have benefited all departments of the hospital. CONCLUSION: The authors consider this as evidence for the fact that despite its initial high investment (15,000 US dollars), availability of ultrasound virtually reduced expenditure on other radiological diagnostic procedures. This is of special benefit for the limited budgets of hospitals in non-industrialised countries.

Inter-observer variance in ultrasonographical assessment of Schistosoma mansoni-related morbidity in young schoolchildren.

49 Sudanese schoolchildren aged 6-9 years with Schistosoma mansoni infection were ultrasonographically examined by two independent observers in a double-blind fashion. The first observer recorded normal appearance of the liver in 23 cases, whereas the second observer recorded the appearance as normal in 33 cases. There were 23 concordant observations. For Grade I periportal fibrosis (PF), 13 observations were concordant. PF Grade II was rarely observed (2 versus 3 cases), and Grade III was not recorded at all. In total, 38 out of 49 observations were concordant (77.5%). These preliminary data from two ultrasound observers, from observations on a limited number of patients, can be seen as an indication of a potential inter-observer variation of around 20% for the distinction between the absence of PF and a low level of PF.

Smaller health areas for a better service.

An analysis of Sudan's health system revealed a lack of sound leadership for village-level providers. The district-based peripheral health system was failing to meet an increased demand for leadership and management support. Some of the principal factors explaining this state of affairs were population growth, increased numbers of health units, long distances and transport difficulties. With a view to solving these problems, the country was divided into smaller health areas around rural hospitals and similar physician-led facilities. A decentralized system based on the principles of primary care was established in these areas under health area management teams. Setbacks encountered in giving effect to the policy have led to proposals for a new implementation strategy.

PIP: Despite Sudan's commitment to primary health care, considerable health system weaknesses still existed in the late 1980s. For example, the health system was still operating under the organizational structure established by the former colonists and most of the allocated funds supported hospitals and salaries. The communities did not participate in primary health care activities and instead depended on official and outside funding. Lack of leadership and management support for health workers in the villages were perhaps the leading factors explaining the weaknesses. Its district-based system collapsed in the late 1970s due to population growth, transport problems in these large districts, creation of urban and rural councils to conduct administrative and decision making functions, separation of preventive and curative services (preventive services under local governments and curative services under the Ministry of Health [MOH]), decline in the national economy and in political commitment to health, increased numbers of physician specialists, and reduced numbers of physicians willing to go to rural areas. The MOH joined with Gezira University in Wad Medani, Sudan to develop a new health care policy. The National Council for Health adopted the new policy in December 1987. It decentralized the health system into 175 health areas around rural hospitals or health centers. Each area had a health area management team. The new policy was based on primary health care, community participation, and sound managerial processes. Since there was no clear national implementation plan, the regional health authorities tried to implement the new policy. Few regions did so successfully. Thus Sudan suggested that each region first implement the policy in 2-3 areas. Health workers would learn some lessons from this phase which they can apply to expand the system.

Field study of different oxamniquine dose for Schistosoma mansoni in Gezira, Sudan.

Two hundred and ninety-six individuals of whom 126 were children and 170 adults with positive stool for Schistosoma mansoni were randomly given oxamniquine treatment in a dose of either 20, 40 or 60 mg/kg body wt. They were followed in the field for ova excretion at 1, 3 and 6 months for adults and at 1, 3, 6 and 8 months for children. The cure rates in adults at 6 months are 93%, 87% and 73% for the 60, 40, 20 mg/kg-1 treatments in order. For children the cure rates at 6 months are 36%, 58% and 63% and at 8 months are 16%, 21% and 26% for corresponding doses. There is no difference in egg reduction for those not cured between the three treatments at 6 months. It is concluded that oxamniquine need not be given in the previously recommended 60 mg/kg body wt. A choice between 40 and 20 mg/kg body wt is suggested with the 40 mg/kg body wt to be reserved for individuals leaving the endemic area, and the 20 mg/kg body wt for those continuing to stay there with substantial exposure for reinfection. The overall proper cure rates for children with a possible advantage of the low treatment in the long term for this age group is noted.