An updated list of the ticks of Ghana and an assessment of the distribution of the ticks of Ghanaian wild mammals in different vegetation zones.

Twenty one species of ticks belonging to five genera of the family Ixodidae (Order Acari, sub-order Ixodida) - Amblyomma, Haemaphysalis, Hyalomma, Ixodes and Rhipicephalus (including the sub-genus Rhipicephalus (Boophilus)) - were collected from 1260 mammals, representing 29 species, 14 families and 6 orders, in four vegetation zones in Ghana during the period 1971-1978. Four other species were collected from humans in 1977. In all, eight species appeared to be new records for Ghana: Amblyomma tholloni Neumann; Dermacentor circumguttatus Neumann; Haemaphysalis houyi Nuttall & Warburton; Ixodes loveridgei Arthur; Ixodes oldi Nuttall; Ixodes vanidicus Schultze; Rhipicephalus complanatus Neumann; Rhipicephalus cuspidatus Neumann. The updated list of tick species in Ghana given here includes 41 species of ixodid ticks and four species of argasid ticks. Most species have been found in neighbouring regions of West Africa but 56 of the 121 different combinations of ixodid tick species and host species found in the collection described here have not apparently been reported before. The new combinations recorded here bring the total number of different combinations of ixodid tick species and mammalian host species now reported in Ghana to 151. The tick species found on wild mammals in Ghana mostly differed from those reported from domestic stock by other authors. The data showed that different tick species occurred in different vegetation zones and that most species displayed a pronounced preference for certain groups of related host species. Some tick species were found in the savanna feeding mainly on large bovids and/or suids; others were found in forests feeding mainly on small bovids, large rodents or small carnivores.

In the rationing of healthcare in indigent African populations, which services should come first?

Governments, worldwide, have enormous difficulties in affording adequate funds for healthcare and its maintenance. In developing populations, almost all of whom are indigent, the diverse health problems being faced with limited funds are insufficiently appreciated. Information is given, for both developed and developing populations, principally those in sub-Saharan Africa, regarding various countries' gross national product (GNP) per capita, the percentage of GNP devoted to health services, and the allocation of health funds per capita. To illustrate the formidable health problems prevailing, some data are given on the magnitudes of morbidity/mortality situations, both for communicable and non-communicable diseases. Some examples are provided which exemplify opposing points of view regarding strongly contesting health claims for priorities in monetary support. Additionally, examples are given of some impoverished countries, which, despite highly adverse circumstances, have achieved enviable health statistics. In this respect it would be highly beneficial were the circumstances and means employed in these and similar contexts given wide publicity.

Faecal occult blood screening for colorectal cancer: is it cost-effective?

Recently published evidence from two large-scale clinical trials conducted in England and in Denmark suggests that faecal occult blood screening for colorectal cancer significantly reduces mortality. However, before screening can be advocated as part of national health policy, its cost-effectiveness must be demonstrated. The English screening trial has been the subject of a detailed economic evaluation over the past 10 years In this paper, cost-effectiveness estimates of screening are presented, based on cost and outcome data combined in a mathematical model developed from the trial's clinical findings The estimates of cost per quality-adjusted life-year gained from colorectal cancer screening show the procedure to be of similar cost-effectiveness to breast cancer screening in the short term. Over the longer term, however, the estimates for colorectal cancer screening appear superior.

Health/ill-health transition in less privileged populations: what does the future hold?

Changes in health/ill-health in response to alterations in environmental factors are recognised. While the phenomenon has been extensively investigated in Western populations, the extent and sequelae of transitions in less privileged populations are less well appreciated. Examples of changes are given, first for Western populations as a comparison but, more particularly, for rural and urban Africans, for African-Americans, and also for Australian Aboriginals, whose mortality rates for chronic degenerative diseases now exceed those of white Australians. Discussion of the likely future of these populations indicates that a lessening of proneness to Western diseases is unlikely.

Causes of admission of African patients to Gelukspan Hospital, North West Province, South Africa.

An enquiry has been made into the causes of admission in 1994 of African patients to Gelukspan Hospital, North West Province, South Africa. The study concerned 3791 patients of whom 3533 (93.2%) were classifiable. Two groups were not included in this number, namely, 1584 'lodgers' (e.g. mothers of infants), and 1868 females admitted for normal pregnancy. Of the 3533 patients, 940 (26.6%) were aged 14 years and younger; 545 (58.0%) these were boys and 395 (42.0%) were girls. The main causes of their admission were pneumonia, gastroenteritis, trauma, poisoning, and infections. Of the 2593 adults, 1418 (54.7%) were males and 1175 (45.3%) females. Among males, chief causes were pulmonary tuberculosis, trauma and accidents, congestive cardiac failure, psychosis, cancer and diabetes. Of the females, chief causes were pulmonary tuberculosis, trauma and accidents, pregnancy related disorders, gastroenteritis, anaemia and pneumonia. Regarding other diseases, 4.5% of adults were admitted for cancer, and 1.8% for diabetes. The general pattern of admissions is similar to that reported in other rural hospitals. The causes of admissions are discussed, regarding; (i) public health improvements occurring, and (ii) means of promoting further improvements by community self-help, and by help from State health and other services.

Urbanisation of developing populations: what are the health / ill-health prospects regarding diseases of prosperity?

PIP: Causes of death and levels of mortality are influenced by social conditions, and, in South Africa, the dichotomy between the level of health enjoyed by the wealthy and that achieved by low-income groups is increasing. Like the Western diet, the South African diet does not meet nutritional standards and contains too much total and saturated fat and insufficient amounts of vegetables and fruit. Tobacco smoking is increasing in developing countries, including South Africa, and is linked to an increase in socioeconomic status despite the fact that it causes cancer and other diseases. Alcohol consumption, which is responsible for one in every six deaths in the US, is also increasing in Africa and will lead to an increase in the incidence of alcohol-related cancers. Whereas inhabitants of the Western world live a sedentary life, rural dwellers in South Africa remain physically active. From this review, it can be predicted that degenerative diseases will continue to affect the White population of South Africa and that the major public health problems associated with poverty will decrease among the African, Indian, and Colored populations, while those associated with prosperity will increase.^ieng