Approaches to control sexually transmitted diseases in Haiti, 1992-95.

Despite major obstacles, activities to control sexually transmitted diseases (STDs) were initiated in Haiti in 1992 in collaboration with local nongovernmental organizations. The approaches included review of available local data, assessment of STD case management practices and constraints, and development of specific STD control activities at the primary health care level, such as systematic screening of all pregnant women for syphilis and improved comprehensive syndrome-based STD case management. The activities included conduct of local studies, presentation and dissemination of results to key audiences, training of health care providers, improvement of local capacities, and consensus-building on implementation of STD control approaches. STD awareness and case management improved considerably; for example, 69% of the clinicians interviewed reported correct STD treatments in the north-eastern primary health care centres in 1995, compared with < 10% in 1992. At the end of the project, national STD case management guidelines were developed by consensus between the various organizations and the Ministry of Health. Lessons learned included the importance of local data generation and of communication and collaboration with various institutions for consensus-building, the need for continued training, and field supervision to ensure behaviour change among STD care providers. A national STD control programme should be implemented as soon as possible in both the public and private sector. External funding will remain critical to control this important public health problem in Haiti.

PIP: Mid-1992 was a time of considerable political and socioeconomic instability in Haiti. Haiti's first democratically elected president had been ousted by a military junta and both political crimes and human rights abuses abounded. No national sexually transmitted disease (STD) control program was in place and almost no data were available on the magnitude and scope of STDs in the country. In this context, and despite many obstacles, STD control activities were planned with the hope of eventually developing a national STD control program. US Agency for International Development-funded AIDSCAP HIV/AIDS/STD prevention initiatives were first launched in Haiti in mid-1992 in collaboration with local nongovernmental organizations (NGOs). Direct collaboration with the de facto government was not allowed until democracy was restored in October 1994. The authors describe the STD control approaches and interventions initiated under these circumstances, with lessons learned for potential application outside of Haiti. Approaches included a review of available local data, an assessment of STD case management practices and constraints, and the development of specific STD control activities at the primary health care level, such as the systematic screening of all pregnant women for syphilis and improved comprehensive syndrome-based STD case management. Local studies were conducted, with the salient results presented to key audiences; health care providers were trained; local capacities improved; and consensus built upon the implementation of STD control approaches. STD awareness and case management improved considerably, with national STD case management guidelines developed at the end of the project through consensus between various organizations and the Ministry of Health.

Adoption of oral rehydration therapy among Haitian mothers.

The paper reports findings from a study of mothers' knowledge and use of oral rehydration therapy (ORT) for childhood diarrhea in a mixed urban and rural population in Haiti. From the perspectives of the adoption of a medical innovation and the decision to use it in various situations, we assessed the differential exposure to information about the treatment and identified sociocultural factors which predict ORT knowledge, utilization, and choice between alternative methods of preparation (packaged mix versus home recipe). Three hundred and twenty mothers and caretakers of preschool children were given a questionnaire to compare respondent characteristics and attributes of recent episodes of child diarrhea in relation to knowledge and use of ORT. The data were analyzed with multiple regression techniques to determine which factors had independent effects on 6 outcome variables. Significant effects were found for urban/rural residence; literacy; economic position; use of medical services; conjugal status; and the explanatory model of the effect of ORT. No characteristics of diarrheal episodes had predictive effects in the multivariate analyses.

Growth monitoring as entry point for primary health care.

PIP: In Haiti, more than 755 of the children under 5 are malnourished, the infant mortality rate is about 125/1000. In the 70's, the medical community devised centers d'Education et de rehabilitation nutritionelle (CERNs) which focused on nutritional rehabilitation by education of the mothers. CERNS were very expensive and not very effective because mothers rarely returned for follow-up care and because they treated children who were already malnourished. In the mid-70's, Petit Guave attempted to set up an outreach program similar to the one that the Hospital Albert Schweitzer created. This program included preventative care, nutrition, and family planning services. Workers visited individual families to educate them in health care. Petit Guave paid special attention to children under 5 by keeping growth monitoring records. Infant mortality rates fell by almost 25% and child mortality was halved in this time. Growth monitoring was performed monthly. A lack of supervision caused the initially successful program activities to decline severely. In Bell Anse, volunteers monitored villagers weekly by operating rally posts. This program features extensive participation by the mother and nutritional education discussions. Children were immunized at the rallies. After 12 months, death rates decreased and growth rates increased significantly. Further operational research is needed in the form of supervision, community control, effectiveness of workers, and values of the incentives of the program.^ieng