Adjustment, social sectors, and demographic change in Sub-Saharan Africa.

PIP: This discussion concludes that the economic crises of the 1980s resulted in a halt to the social and economic development of sub-Saharan Africa. Employment, health, and education sectors all deteriorated under structural adjustment programs (SAPs) and poor economic performance. SAPs are considered inadequate solutions to long-term problems. Economic crises were found to affect countries differently in their demographic impact. Delayed demographic transition occurred both through economic development as a prerequisite and as a result of poor economic development. Case studies of each country are considered the appropriate geographic unit of analysis of demographic change rather than regional or comparative studies. The economic crises in sub-Saharan Africa occurred due to both external (commodity prices, high real interest rates, and decreasing net capital flows) and internal distortions (strategies of development such as import substitution, neglect of the agricultural sector, and government control of prices and trade). The unfavorable external context reduced export prices and earnings while increasing the costs of imports. Internal controls were detrimental to farmers. During the 1970s and 1980s African countries experienced declines in both the volume and value of exports, increases in import volume, and imbalances in the balance of payments. Large domestic borrowing and foreign borrowing was done by governments, which was at the expense of the private sector. Economic management and corruption were rampant. SAPs restrained demand, reduced public expenditures, adjusted exchange rates, contracted the size of the public sector, liberalized trade, deregulated the interest rate, stimulated domestic production, and used market forces for balancing optimum allocation of resources. SAPs were the fix for trade imbalances and government debt. Development was slowed or stopped. During 1980-87 spending on health care, education, and infrastructure was drastically reduced. These already weak sectors were further weakened. Inflation rose. Public sector employment was reduced. Wages declined, which resulted in a massive demoralization, unemployment, and poverty. Manpower development was threatened by declines in education.^ieng

[Etiologies of chronic polyarthritis in Lomé (Togo)]. / Etiologies des polyarthrites chroniques à Lomé (Togo).

Medical records were reviewed retrospectively to determine the causes of chronic polyarthritis in patients attending a hospital outpatient clinic in Lomé (Togo). Among 2812 patients seen over 44 months, 70 (2.5%; 28 female, 42 male) had polyarthritis of at least three months' duration. Twenty-six patients (17 female, 9 male), with a mean age of 30 years at disease onset, had isolated, nondestructive polyarthritis mainly involving the distal appendicular joints and responsible for short-lived flares usually adequately controlled by nonsteroidal antiinflammatory agents alone; antinuclear antibodies were looked for in 16 of these patients with positive results in eight. The favorable outcome and negative tests for rheumatoid factors differentiated this condition from rheumatoid arthritis. None of the 26 patients had systemic manifestations possibly suggestive of connective tissue disease. Diagnoses in the 44 remaining patients included gout (n = 15), spondyloarthropathy (n = 12), rheumatoid arthritis (n = 12), juvenile chronic arthritis (n = 2) and human immunodeficiency virus infection (n = 3). These data confirm that rheumatoid arthritis is infrequent in West Africa. The leading cause of chronic polyarthritis in Lomé may be mild isolated nondestructive polyarthritis reminiscent of adult-onset oligoarthritis with antinuclear antibodies. Long-term follow-up and immunological evaluation of patients with this condition can be expected to provide valuable pathogenic and nosologic information.

Impact of selective primary care on childhood mortality in a rural health zone of Zaire.

Following the introduction of intensified child survival activities, use of health services for children increased markedly: measles vaccination reached 74% of children aged 12-23 months, and the use of oral rehydration therapy for the treatment of diarrhoea had increased. During the same period, childhood mortality declined by 33% for children aged 1-4 years. Data on cases of measles in the local hospital reveals that the pattern of measles epidemics characteristic of the years preceding programme implementation was altered in the years following programme implementation. The mean annual number of inpatient measles cases declined from 108 before the programme to 36 after its start. The high correlation between the number of inpatient measles cases and mortality at ages 6-35 months suggests that the programme reduced mortality largely by reducing the incidence of measles. Primary health care activities, supported in part by the Combatting Childhood Communicable Diseases Project, is estimated to have reduced mortality at ages 6-35 months by at least the 18-23% associated with the change in the incidence of measles and may have been responsible for the full 28% reduction recorded between 1980-1984 and 1985-1989.

Note on the reliability and validity of mothers' retrospective reports of their children's birthweights.

Using data from the 1973, 1976, and 1982 National Survey of Family Growth Studies, mothers' retrospective reports of their children's birthweights are compared across surveys and with vital registration data. Comparisons focus on estimated levels for blacks and whites, and on the effects of possible determinants. Despite the fact that nonresponse is more common for blacks, especially for births occurring at dates more distant from the surveys, results show that retrospective reports of low birthweight (less than 5.5 pounds) provide valid and reliable estimates of trends and differentials.

[Demo-economic aspects of forced migration from Nigeria: the case of Southeast Togo]. / Les migrations des expulses du Nigeria aspects demo-economiques cas du sud-est Togo.

PIP: The objectives of this paper are to examine the demographic and socioprofessional characteristics of migrants; to determine the principal motives of migration and the environmental factors that encourage migration from Nigeria; to define the socioeconomic realities of the life of migrants in Nigeria; and to present the migration situation on both the individual and group levels. Southeast Togo is discussed. A survey questionnaire was prepared and adminstered to the sample population in 5 villages. 75 male migrants and 25 female migrants were interviewed. They had been forced out of Nigeria and were over 15 years of age; women whose husbands had been interviewed were excluded. Data collection began in August of 1983. The study is not purported to be representative of all those forced to leave Nigeria, but simply has allowed quantitative analysis concepts to be applied. It was hypothesized that the extent of male migration was more important than that of females. The Apple II and IBM PC computers were used. It is concluded that the key to greater demographic stability lies in the general improvement of the economic and social situation. Rural development should be the focus of attention. Improving the quality of life and the progress of knowledge are determing factors of development. Agriculture represents an economic potential that may increase income and contribute to the well being of people. In the Southeast poor rain conditions can be dealt with by irrigation methods. A diversification of activities in rural areas is hoped for. Population studies are indispensible in order to obtain a clear concept of the functioning of societies. An optimist, active approach is urged.^ieng