International cooperation in support of homeopathy and complementary medicine in developing countries: the Tuscan experience.

Health is a fundamental human right which contributes to reducing poverty, and encourages social development, human safety, and economic growth. International initiatives have fallen far short of their goals. This paper describes collaboration between the region of Tuscany and Cuba, Western Sahara, Senegal and Serbia. These have introduced various forms of Complementary and Alternative Medicine, including homeopathy and Traditional Chinese Medicine into primary healthcare particularly obstetrics, and into veterinary medicine. Complementary and traditional medicine can represent a useful and sustainable resource in various fields of health care. Inclusion in the public health system must go hand in hand with scientific evaluation.

The pathway followed by psychotic patients to a tertiary health center in a developing country: a comparison with patients with epilepsy.

The objective of this study was to describe and compare the pathways followed by Malay patients with psychoses (schizophrenia and schizophreniform disorder) and Malay patients with epilepsy to a tertiary health center in the northeastern area of peninsular Malaysia. There were 60 patients in each group. The most popular pathway for both groups was first contact with traditional or alternative healers. Consultation with Malay traditional healers (bomohs) and/or homeopathic practitioners (44.2%) was significantly higher for psychotic patients (61.7%) than for patients with epilepsy (26.7%) (chi(2)(2)=15.609, P<0.001). Direct access (24.2%) was the second most popular pathway and almost equally followed by both groups of patients. The third and last pathway was initial contact with private general practitioners and government doctors, respectively. Patients with epilepsy dominated the last two pathways. The treatment delay (TD) was significantly longer in epileptic than psychotic patients regardless of their visit to a bomoh and/or homeopathic practitioner (P<0001) or not (p<0.01). The socioeconomic status of psychotic patients also was significantly better than people with epilepsy (chi(2)=9.957, chi(2)(4), p=0.041).

Prostate Cancer Screening Perception, Beliefs, and Practices Among Men in Bamenda, Cameroon.

Prostate Cancer (CaP) is the most commonly diagnosed cancer among Cameroonian men. Due to inadequate infrastructure, record keeping, and resources, little is known about its true burden on the population. There are rural/urban disparities with regards to awareness, screening, treatment, and survivorship. Furthermore, use of traditional medicine and homeopathic remedies is widespread, and some men delay seeking conventional medical treatment until advanced stages of CaP. This study examined the perceptions, beliefs, and practices of men in Cameroon regarding late stage CaP diagnoses; identified factors that influence screening decision; and ascertained how men decided between traditional or conventional medicine for CaP diagnosis and treatment. Semistructured focus groups were used to collect data from men in Bamenda, Cameroon. Qualitative data analysis was used to analyze transcripts for emerging themes and constructs using a socio-ecological framework. Twenty-five men participated in the study, with an average age of 59. Most of the participants had never received a prostate screening recommendation. Socioeconomic status, local beliefs, knowledge levels, awareness of CaP and screening methods, and stigma were prominent themes. A significant number of Cameroonian men receive late stage CaP diagnosis due to lack of awareness, attitudes, cultural beliefs, self-medication, and economic limitation. To effectively address these contributing factors to late stage CaP diagnosis, a contextually based health education program is warranted and should be tailored to fill knowledge gaps about the disease, dispel misconceptions, and focus on reducing barriers to utilization of health services.

Medical quackery in Nigeria; why the silence?

BACKGROUND: This paper examines the magnitude and scope of medical quackery practice in 21st Century Nigeria and wonders why there is so much complacency in tackling the problem. It also proffers solutions to the malady. METHODS: Definition and brief history of medical quackery both in the developed world and Nigeria is given. The scope of the practice in Nigeria is then examined. RESULTS: Medical quackery is rampant in Nigeria; Culprits cut across the whole strata of medical and health practitioners. The so called alternative/natural health practice has particularly assumed great popularity lately and the Federal Government seems to turn the other way in spite of their unsubstantiated, largely placebo 'Cures'. Homeopathy, in particular, is a medical quackery per excellence and should be banned. Law Enforcement Agents, Medical Practice Licensing Board and other Health Professions Licensing Boards, Nigeria Medical Association and other Health Profession Associations should take this problem seriously. Legislations should be made where they have not been made and enforced where they have been made and various professional bodies should not hesitate to sanction their erring members who deviate from acceptable practice. The government will also do well in addressing the key problems of poverty and illiteracy as these are twin brothers that promote the practice and acceptance of medical quackery. CONCLUSION: Unless concerted efforts are taken by all stake holders, especially the government, in tackling the health care problems in Nigeria, the decay in the system will continue and medical quackery will continue to thrive.

[Trends in Google searches on complementary and alternative medicine]. / Tendencias de las búsquedas en Google sobre terapias de medicina alternativa y complementaria.

BACKGROUND: The aim of this article is to evaluate the interest in complementary and alternative medicine (CAM) therapies using Google Trends in spanish-speaking countries. METHODS: An observational study was conducted using GoogleTrends. The search volume of 34 CAM therapies in spanish were evaluated globally and in 21 spanish-speaking countries. Also, the relationship between the median of the most popular searches and the gross domestic product (GDP) per capita in each of the countries was evaluated using Spearman's test. RESULTS: A decreased trend in search volume was observed in homeopathy, herbal medicine, acupunctureand sensory therapies; and an increasing trend in chiropraxy. A direct association was observed between the GDP per capita and the median between the most popular CAM therapies, this relationship was no significant (p = 0.432). CONCLUSIONS: The interest in CAM therapies shows temporal and geographic variations that must be studied in depth. These results can be used for the establishment of an international monitoring for the use of CAM therapies.

Introducción: el objetivo de este artículo es evaluar el interés de la población en terapias de medicina alternativa y complementaria (MAC), a través de la herramienta Google Trends y en países de habla hispana. Métodos: se realizó un estudio observacional mediante la herramienta Google Trends. Se evaluaron las tendencias de búsqueda de 34 terapias de MAC en español, de manera global y en 21 países de habla hispana. Se evaluó la asociación entre la mediana de búsquedas de las terapias más populares y el producto interno bruto (PIB) per cápita en cada país, mediante la prueba de Spearman. Resultados: se observa una tendencia descendente en el volumen de búsquedas de homeopatía, medicina herbaria, acupuntura y terapias sensoriales; así como una tendencia ascendente de la quiropraxia. Además, al analizar los países se observó una asociación directa entre el PIB per cápita y la mediana de la búsqueda de las terapias de MAC más populares, pero esta no fue significativa (p = 0.432). Conclusiones: el interés de terapias de MAC presenta variaciones temporales y geográficas que deben estudiarse a profundidad. Estos resultados pueden ser de utilidad para establecer una vigilancia internacional al respecto.

Health seeking behavior of couples with secondary infertility.

OBJECTIVE: To determine the factors affecting the health-seeking behavior of couples with secondary infertility in Karachi. DESIGN: A descriptive case series. PLACE AND DURATION OF STUDY: The data was collected from women attending infertility clinics in five tertiary care hospitals in Karachi from March to June 2003. PATIENTS AND METHODS: All currently married women, between the age of 15-35 years, with at least one previous conception, irrespective of outcome, attending an infertility clinic and consenting to participate in the study, were included. Women with corrective surgery on vagina and uterus, and cases of primary infertility, were excluded. Multiple logistic regression models were used to determine the association of various factors, affecting the health-seeking behavior, with statistical significance set at p < 0.05 for the covariates and the interaction terms between various factors. RESULTS: The women consulted multiple health care providers for treatment of secondary infertility. The main reasons for seeking treatment were couple s wish (54.2%), family pressure (22.6%) and want of a son by husbands or in-laws (20.4%). The most commonly sought providers were physicians (74.7%), Traditional Birth Attendants (TBA, 39.5%), Spiritual healers (26%), Hakeems (23%) and Homeopaths (17.2%). Most of the women who consulted non-physicians were illiterate (69.4%) as compared to those who consulted a physician (37.8%, p-value = 0.00). The non-physicians were more commonly consulted by women belonging to low socioeconomic group. The posttreatment complications were more common among women who consulted non-physicians. CONCLUSION: Pressure from husbands and in-laws compels women for consulting multiple providers. Health seeking behavior for infertility is affected by the literacy and socioeconomic status of the women.

Comparative study on the efficacy and acceptability of two contraceptive pills administered by the vaginal route: an international multicenter clinical trial.

The efficacy and acceptability of two widely used oral contraceptive tablets, one containing 250 mg levonorgestrel and 50 micrograms ethinyl estradiol and the other containing 150 micrograms desogestrel and 30 micrograms ethinyl estradiol, administered by the vaginal route were compared in 1055 women studied over 12,630 woman-months of vaginal contraceptive pill use. This multicenter clinical trial was performed in nine countries of the developing world by the "South to South Cooperation in Reproductive Health," an organization founded by scientists from the Third World working in the area of reproductive health, and the study was developed and coordinated by one of these centers. The findings of this study confirm the efficacy of both these tablets when administered by the vaginal route. Involuntary pregnancy rates at 1 year of 2.78 for subjects in the levonorgestrel group and 4.54 for subjects the desogestrel group showed no statistically significant difference between the two groups. However, total discontinuation rates of 47.01 for subjects in the levonorgestrel group and 56.33 for subjects in the desogestrel group showed a statistically significant difference between the two groups, and discontinuation rates attributable to prolonged bleeding of 0.6 for subjects in the levonorgestrel group and 3.2 for subjects in the desogestrel group were also significantly higher in the group of subjects using the desogestrel vaginal contraceptive pill. Blood pressure remained at admission values throughout treatment. A statistically significant weight increase from admission values occurred in both groups of subjects.

PIP: Efficacy and acceptability of 2 combined oral contraceptive pills administered vaginally are summarized. This is the 1st collaborative trial published by the South to South Cooperation in Reproductive Health. 1055 women participated in 12,630 cycles, in 9 countries, from June 1988 to May 1991. The pills were commercially available tablets containing 50 mcg ethinyl estradiol and 250 mg levonorgestrel (Schering AG, Sao Paulo, Brazil), or 30 mcg ethinyl estradiol and 15 mcg desogestrel (Organon, Sao Paulo, Brazil). Subjects were aged 17-39 younger and of lower parity from Mexico and Dominican Republic and older from Egypt and China. All had at least 1 pregnancy. 675 participated for 6 months, 470 for 1 year, 364 for 18 months, and 210 for 2 years. The 1-year discontinuation rate averaged 47.01% for the levonorgestrel group and 56.33% for the desogestrel group (p = 0.0061); 2-year discontinuation rates were 48.01% and 69.36, respectively, explained in part by higher involuntary pregnancy rates and prolonged bleeding rates in the desogestrel group. The most common medical reasons for stopping contraception were unplanned pregnancy, vaginal or vulval irritation, nausea, vaginal discharge and headache. Vaginal irritation was reported by 1%, 9 in each group. There were 32 pregnancies, 14 in the levonorgestrel and 18 in the desogestrel group. 17 were in missed pill cycles and the rest were method failures, 6 in the levonorgestrel group and 9 in the desogestrel group. The Pearl index varied from 0 in Nigeria to 12.24 in Mexico, and was 2.45 for levonorgestrel vs. 3.74 for desogestrel. There was a wide variation in discontinuation rates by center: Brazil and China had few, while many women from Dominican Republic, Mexico and Zambia left the study. Bleeding problems were common complaints, more so in the desogestrel group. There were 363 women with intermenstrual bleeding (only once in 80%), 148 with spotting (only twice in 65%). Bleeding duration was significantly less in pill cycles than baseline, pressure. Women gained an average of 1 kg over 2 years, more in the desogestrel group. The pregnancy rate of 2.78 is within the range reported for levonorgestrel rings.

The frontier of modern Western medicine in Nepal.

Using the concepts frontier and interface the introduction and spreading of modern Western medicine in Nepal and its relations to other medical systems are described and analyzed. Medical systems do not prevail in the same degree in all places; we may call the geographic areas of concentration the core areas or center(s) of medical systems and the remaining areas their periphery. The frontier of a medical system is defined as that part of the periphery where the presence of the system is increasing. The place of the frontier, its width and the forms in which a medical system appears at its frontier are determined by both internal dynamics and contextual factors. In non-socialist countries like Nepal the dynamics of modern Western medicine are characterized by three tendencies: centralization, expansiveness and a commercial and capitalist character. Some important contextual factors which have been shaping the frontier in Nepal are: migration, including tourism, labor-migration and trade; the role of foreign aid and geographical conditions. The situation at the frontier has an important influence on the nature of the interface between modern Western medicine and other medical systems. In the article Faith-healing, Ayurvedic medicine, Homeopathy and Tibetan medicine are described briefly and the interface between them and modern Western medicine is looked into.

Acute lower respiratory infections in rural Bangladeshi children: patterns of treatment and identification of barriers.

A study conducted in rural Bangladesh examined the patterns of health seeking behavior, mothers' recognition of symptoms, the perceived causes and barriers to timely treatment of acute lower respiratory infections (ALRI). A total of 194 children under 5 years of age suffering from ALRI in an intensive maternal child health and family planning area was prospectively followed. About 62% of the mothers sought allopathic treatment for their children within 24 hours of case detection. No treatment of any kind was sought in 45 (23.2%) cases. Most of the mothers could recognize the different symptoms of ALRI. Cold was reported as the most common cause of ALRI. No significant difference was observed in the reported symptoms or perceived cause of the disease between those who sought no treatment and those who sought allopathic, homeopathic, spiritual or combined treatments. Failure to recognize severity followed by work loss were the most common reasons identified for not seeking any medical care. Whether or not a mother sought allopathic treatment was not associated with the child's age, sex, mother's age, mother's education, duration of illness, birth order, housing type or distance from the health center. The study indicates the potential value of giving parents clear guidelines on recognition of severity of symptoms of ALRI and motivating them to seek treatment quickly when these symptoms present. Health service providers should be aware of the heavy work loads which rural women have and the severe time constraints which deter them from seeking timely treatment from the appropriate sources.

Unidentified drugs in traditional medications causing toxic epidermal necrolysis: a developing country experience.

BACKGROUND: Drugs are by far the most common cause of toxic epidermal necrolysis (TEN), but unidentified drugs and chemicals present in herbal and traditional medications may also be responsible for this reaction, which manifests as widespread epidermal detachment of the skin and mucous membrane. In contexts in which a subject has used an herbal or traditional medication, it is very difficult to diagnose the condition, identify the offending agent, and prevent the disease from recurring. METHODS: This prospective study was conducted at a tertiary burn center between July 2004 and October 2012. All patients were referred to this unit by the local department of medicine at least one week after the eruption of vesicles. On arrival, all patients demonstrated a severe form of disease with features of sepsis and electrolyte imbalance (SCORTEN scores of ≥4). All non-fatal cases were followed to observe long-term sequelae and recurrences. RESULTS: About 34% of patients had developed the condition after ingesting traditional herbal medications and were unable to identify the responsible drug by name. Nineteen (66%) of the 29 patients referred to the unit with TEN died within the first week after being transferred. Nine patients achieved complete recovery, and one developed corneal haziness and alopecia. One patient experienced recurrence within three months but recovered. CONCLUSIONS: Illiteracy and financial vulnerability were major factors in driving patients towards the use of traditional medications, which were often prepared and preserved improperly. Mortality and other complications could be reduced by the prompt recognition of the condition, immediate withdrawal of the culprit drug, and quick referral to proper care.

Effects of a health care provider intervention in reduction of sexual risk and related outcomes in economically marginal communities in Mumbai, India.

BACKGROUND: The present study assessed the effectiveness of a brief narrative intervention implemented by trained biomedical and Ayurveda, Yoga, Unani, Siddha, Homeopathy (AYUSH) providers from three low-income communities in Mumbai, India. METHODS: A quasi-experimental research design compared attitudinal and behavioural changes among a cohort of 554 patients presenting gupt rog ('secret sexual illnesses') to biomedical and AYUSH providers who were trained in the narrative intervention model (NIM; referred to as 'narrative prevention counseling' in the intervention manual) with those providing standard care (untrained in NIM). Data were analysed using multivariate and longitudinal statistical models. RESULTS: Patients who received treatment for gupt rog from trained providers reported receiving a significantly higher number of services than those receiving services from untrained providers (mean 8.9 vs 7.6 services, respectively; P<0.001). In addition, a higher number of patients seeing the trained providers no longer had gupt rog problems than those seeing untrained providers (42% vs 25%, respectively; P<0.001). Patient-reported sex with a partner who was not the wife decreased significantly from baseline to follow-up for the entire sample but was significantly greater among patients receiving treatment from trained AYUSH providers (from 27% at baseline to 2% at follow up) compared with untrained providers (from 18% at baseline to 5% at follow up; P<0.001). CONCLUSIONS: The results support the effectiveness of brief narrative intervention in primary care settings for reducing sexual risk and associated vulnerabilities among married men.

Emerging economies' need for cheap, efficient health care makes Western anti-homeopathy rhetoric irrelevant: observations from the Canadian Homeopathy Conference, October 2011.

Large-scale use and acceptance of homeopathy in Cuba, Latin America, and India raises questions about the relevance of campaigns mounted against homeopathy in the United Kingdom, Australia, and other nations of the developed world, especially as the developing economies of Asia and Latin America are set to outstrip those of the developed world.

Can interventions improve health services from informal private providers in low and middle-income countries?: a comprehensive review of the literature.

BACKGROUND There is a growing interest in the role of private health providers in low- and middle-income countries (LMICs). Informal private providers (IPPs) provide a significant portion of health care in many LMICs, but they have not received training in allopathic medicine. Interventions have been developed to take advantage of their potential to expand access to essential health services, although their success is not well measured. This paper addresses this information gap through a review of interventions designed to improve the quality, coverage, or costs of health services provided by IPPs in LMICs. METHODS A search for published literature in the last 15 years for any intervention dealing with IPPs in a LMIC, where at least one outcome was measured, was conducted through electronic databases PubMed and Global Health, as well as Google for grey literature from the Internet. RESULTS A total of 1272 articles were retrieved, of which 70 separate studies met inclusion criteria. The majority (70%) of outcomes measured proximate indicators such as provider knowledge (61% were positive) and behaviour (56% positive). Training IPPs was the most common intervention tested (77% of studies), but the more effective strategies did not involve training alone. Interventions that changed the institutional relationships and contributed to changing the incentives and accountability environment were most successful, and often required combinations of interventions. CONCLUSION Although there are documented interventions among IPPs, there are few good quality studies. Strategies that change the market conditions for IPPs-by changing incentives and accountability-appear more likely to succeed than those that depend on building individual capacities of IPPs. Understanding the effectiveness of these and other strategies will also require more rigorous research designs that assess contextual factors and document outcomes over longer periods.

Documentation of a heroin manufacturing process in Afghanistan.

The present article documents an authentic process of heroin manufacturing in Afghanistan: white heroin hydrochloride produced using simple equipment and a small quantity of chemicals. The quantities of chemicals actually used corresponded to the minimum needed for manufacturing heroin. The only organic solvent used was acetone, and only a very small quantity of it was used. Because the chemicals used in the demonstration were from actual seizures in Afghanistan, some of the chemicals had been disguised or repackaged by smugglers. Others had been put into labelled containers that proved to be counterfeit, and some glass containers used were not the original containers of the manufacturer displayed on the label. The brown heroin base prepared as an intermediate step in the process shares some of the characteristics of the South-West Asia type of heroin preparations often seized in Germany. The final product of the documented heroin manufacturing process was white heroin hydrochloride, which shares the key characteristics of the white heroin occasionally seized in Germany and other countries in Western Europe since 2000. The present article demonstrates that this kind of heroin can be produced in Afghanistan.

Medical pluralism and homoeopathy: a geographic perspective.

PIP: Homeopathy, a system of healing developed in the late 18th century, is grounded on the "law of similars" and calls for treating clusters of symptoms using a single remedy in minute doses. Interest in alternative therapies has been stimulated by the apparent success of China in integrating Western and indigenous medical manpower into 1 health care system in a model that is under scrutiny by health officials in other settings lacking adequate medical manpower. Studies of medical pluralism have ignored the spatial distribution of alternative systems of curing and the role of Western medicine itself in the development of medical pluralism. Mapping of the spatial distribution of homeopathic practitioners in India from 1937, 1961, and 1963-64 shows that they were concentrated in certain areas and scarce in others. Almost 18% of all rural medical practitioners in India were homeopaths, indicating that whereas medical pluralism exists in all parts of India, its constituents vary in different areas. Bengali physicians in the late 19th and early 20th centuries attempted to harmonize homeopathic principles with those of Hindu culture and were largely responsible for its spread outside Bengal.^ieng

[Tests for early diagnosis of pregnancy]. / Testes para diagnostico precoce de gravidez.

PIP: Kits for pregnancy tests available on the market and their prices in Brazil are listed. Those based on the agglutination inhibition reactions can be used 8-10 days after determining the absence of menstruation, when the levels of chorionic gonadotropin range from 1500 to 3500 IU/1. A colorimetric test based on a chemical reaction is also available, and can be used 15 days after determining the absence of menstruation. The kits and their manufacturers are: Gravindex (Johnson), Teste de Gravidez (Roche), Pregnosticon Planoteste (Organon), Pregnosticon All-in (Organon), and Uni-test (Novaquimica) (colorimetric test).^ieng

Practice of oral therapy: role of village practitioners.

PIP: In September 1978, ICDDR,B started a community training project in Chandpur, Bangladesh. Because there are few doctors in Bangladesh, village practitioners perform many of the services of community health care. In March, 1979, a 7-day training session was conducted for village practitioners in diarrhea, and its management; nutrition; and, health education. Before the training, a KAP study was conducted with the following results: 12% had formal medical education; 60-75% have general education between grade 9 or 10 passed; and, about 90% practice allopathic medicine alone or in combination with homeopathic or indigenous methods. More than 60% have been practicing medicine for 6-10 years. About 70% attend patients from 5-10 villages, but receiving patients from more than 10 villages is not uncommon. Almost half of the practitioners have pharmaceutical shops of their own. Every month, on an average, 58% attend 3-10 cases.^ieng

Airing method-specific advertisements.

PIP: The Turkish Family Health and Planning Foundation initiated the commercial marketing of contraceptives in 1989 as part of a Contraceptive Social Marketing (CSM) program to make available low-cost contraceptives. In 1988 modern methods were used by 31% and traditional methods by 32.3%, while 36.6% used no contraceptives. Only 6.2% were current pill users mainly because of health reasons since high-dose pills dominated the market. A 1990 survey among urban consumers indicated a 94% awareness of contraceptive methods, 76.1% of current use, and preference for the IUD. The side effects of the pill were cited for disliking it, and the condom was rated higher. The CSM project aims at popularizing low-dose pills by explaining the differences and benefits regarding high-dose pills. It collaborated with manufacturers: Schering, Wyeth, Organon, and Eczacibasi Ilac. In 1991 a TV and radio advertisement campaign started that involves the low-dose products Microgynon, Triquilar, Desolet, Lo-Ovral, and Tri-Nordial. The introduction of the Okey condom by Eczacibasi Ilac. In June 1991 also entailed extensive promotion with newspaper ads and TV spots after getting official permission. 1.3 million condoms were sold in the 1st 2 months in 13,000 retail outlets, and 4 million more were projected to be sold. A shift of the attitude of supermarket owners allowing stocking of condoms and the support of the Turkish Ministry of Health, USAID, and the Turkish Radio and Television Bureau has facilitated the CSM project implementation that will profoundly affect family planning in Turkey.^ieng

A post-Cairo profile. The Population Council.

PIP: The Population Council has been in the vanguard of the population field since its founding in 1952. The Council first focused on research in demography and reproductive physiology in order to increase the expertise of developing countries. Over the years, the Council's mission broadened as did its size and budget. It is staffed by several hundred people, with just over half located in the New York headquarters. The Council's work is guided by a mandate statement drafted in 1993, which proclaims that it seeks to improve reproductive health and strives to achieve a sustainable balance between people and resources. The previous emphasis on demography has been eased, but too rapid population growth is still a prime concern. Two issues papers codified the Council's contributions to the population field. John Bongaarts's paper on population demonstrated that family planning programs alone cannot slow population growth because of the population momentum and the desire for large families. Social investments in health care, education, and poverty reduction are needed for smaller families. The second paper, on reconsidering the rationale of family planning programs, argued for reducing unwanted fertility by helping people meet their own goals in a healthful way. The Council also develops and tests contraceptives, aids governments in designing effective population policies, and trains population specialists from the developing countries. Research is being carried out in male contraceptive development and physiology, since only an estimated 8% of the world's contraceptive development budget is spent on male contraceptive methods. Scientists and researchers are burgeoning in the developing world whose knowledge acquired in the developed countries is complemented by their own research projects. The Council's regional offices around the world are multidimensional. The offices are headed by professionals from the region striving for excellence in population study.^ieng

Private health care providers in rural Bangladesh.

PIP: Information is presented on the private health care providers of rural Bangladesh. Medical manpower and facilities were studied in 121 randomly selected administrative units of Bangladesh in 1976. 43 were found to have facilities for medical care. 2120 private health practitioners were identified, of whom 38.7% were qualified or unqualified allopathic practitioners, 35.9% were full time practitioners, and 1.3% (excluding traditional midwives) were female. Allopathic practitioners charged more than other practitioners for treatment of pneumonia or diarrhea, homeopathic practitioners charged the least, and the fees of Ayurvedic, Unani, and spiritual healers were intermediate. This and other studies indicate that the allopathic system of medicine is the most popular in rural Bangladesh despite its higher costs. Estimates of the number of qualified allopathic doctors working in rural areas of Bangladesh based on the survey sample give a doctor-to-patient ratio of 1:29,000. The ratio of other medical practitioners to the 76 million rural population is 1:1000. It is argued that such private health care providers should be incorporated into government health care programs because of their accessibility to rural people.^ieng