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An integrated primary health-care and provitamin A household food-production program: Impact on food-consumption patterns.
Food and Nutrition Bulletin. 2001; 22(4):370-375.Food diversification is a long-term food-based strategy to address vitamin A deficiency. In order to improve the vitamin A status of preschool children in a rural South African community, a home-based food-production program targeting provitamin A-rich foods was integrated with a community-based growth-monitoring system. This integrated system provided the infrastructure needed for nutritional education and promotion of the food-production program. Dietary intake was collected by 24-hour recall at baseline and 12 and 20 months after implementation of the food-production program. At baseline, the median intake of vitamin A was 150 µg RE. One year after implementation, the vitamin A intake increased to 1,133 µg RE in children from households with a project garden and to 640 µg RE in control children. Eight months later, vitamin A intake was 493 µg RE in children from households with a project garden and 129 µg RE in control children. We concluded that a home-based food-production program resulted in a significant increase in vitamin A intake. Home gardens should therefore be promoted, but they should focus on foods needed to address specific nutrient deficiencies. (author's)
WORLD HEALTH FORUM. 1993; 14(2):118-9.The idea that pragmatism is preferable to humanitarianism is an extreme example of Machiavellianism. Dr. Martin praises Maurice King's ideas as the only way to achieve the sustainable development of the planet. Halfdan Mahler equated them to a proposal for mass euthanasia of children in the south. Dr. Martin has chosen to ignore that, during the past 3 decades, experts from the north have regarded almost all the countries of the south from a Malthusian viewpoint, considering population growth as the cause of poverty, rather than the other way round. Dr. Martin is timid about writing prescriptions for the north, where 15-20% of the world's population consumes 70-80% of its resources. It is too simplistic to presume that public health interventions are responsible for the present demographic and ecological crisis and that the tide of disaster can be turned if men of the north stop international public health interventions. He ignores the refusal of the countries of the north to make adequate contributions to ecologically sustainable development, the grossly unjust north-south terms of trade, the hemorrhage of resources from the south to the north, the economic, social, political and military domination of the north over the south, and the sharp contrast between the elite classes and the vast masses in the countries of the south. The population problem of the south is serious, and the Malthusian approach should give way to strategies aimed at encouraging oppressed people to have smaller families. Viable programs should be devised to improve socioeconomic conditions, and the Alma-Ata approach to primary care should be implemented. The time has come for the north to have a deeper understanding of the threat posed by rapid population increase in the south in a wider intersectoral context.
In: The health of adults in the developing world, edited by Richard G.A. Feachem, Tord Kjellstrom, Christopher J.L. Murray, Mead Over, Margaret A. Phillips. New York, New York, Oxford University Press, 1992. 161-207.The consequences of adult ill-health are greater than previously believed. These consequences go beyond suffering and grief and consist of indirect adverse effects on society which increase the cost of adult ill-health in developing countries. At the household level, family and friends try to reduce the effects of an illness or injury afflicting an adult household member. Work colleagues increase their workload to pick up the slack of the ill or injured colleague. An unhealthy labor force results in slow work schedules and less specialization of employee job descriptions. These coping processes reduce the effects of illness, but are costly. Yet traditional empirical studies do not examine them. Anticipatory coping mechanisms to mitigate adverse consequences of adult ill-health include formal and nonformal insurance mechanisms, both of which bear high costs. Informal insurance mechanisms include high fertility and extended families and social networks. Formal mechanisms are investment and savings and formal health insurance. Further, adult ill-health harms children more than child ill-health harms adults. thus, the total ill-health burden of children is greater than originally surmised. Household costs of adult ill-health are effect on production and earnings, on investment and consumption, and on household health and consumption and psychic costs. At least 70% of hospital resources in developing countries goes to adult and elderly patients. A considerable proportion of primary care costs is also dedicated to adults. Even though researchers agree that disease affects income, this effect is preceded and overshadowed by the effect of disease on health status, of health status on functional capacity, and of functional capacity on productivity. In conclusion, adult ill-health restricts development in societies burdened by adult ill-health.
DEVELOPMENT DIALOGUE. 1985; (2):56-68.The central question to be addressed when discussing the adequacy and relevance of pharmaceutical action in a country, or in the world generally, is what are the objectives of such pharmaceutical action. The central and overwhelmingly preeminent objective is to restore the health of suffering and sick people. There is consensus among practitioners worldwide that health services in 3rd World countries have followed an urban-centered, hospital-based pattern. The consumption has, therefore, followed a similar pattern. In 1979, the urban hospitals of Thailand, both public and private, accounted for 30% of the total drug consumption, or an estimated US$85 million. The urban population within reach was less than 15% of the total population. The primary health care (PHC) policies adopted at Alma Ata resulted in the establishment of a special PHC unit in 1981 and a number of pharmaceutical studies were undertaken at the time. In 1982, the urban hospitals' share of drug consumption had slightly decreased. Overconsumption of unnecessary products by urban elites leaves the poor majority underserved and bearing very high levels of morbidity for which no treatment is accessible, despite the availability of drugs in the country as a whole. During 1969-81, there has been a 10-fold increase of the pharmaceutical market.
[Unpublished] 1985. Presented at the Annual Meeting of the Population Association of America, Boston, Massachusetts, March 28-30, 1985. Also published in: Economic Development and Cultural Change 34(4):755-82. 1986 Jul. 26,  p.Mortality is assumed to be strongly reduced by medical care, however, the effects of medical services on health are often underestimated because some of the same factors which lead to an increased demand for primary health care (PHC) services are also associated with increased morbidity and mortality. Consequently, understanding the determinants of the demand for medical services is important for evaluating health outcomes. This paper estimates the parameters of a simple model of the demand for health services using data from the Bicol Multipurpose Survey data from the Philippines. The parameters of the demand for key components of PHC--outpatient, prenatal, delivery, well-child, and infant immunizations--are estimated. Findings suggest that the quality of the care may be very important, but that economic factors as deterrents to using medical care--inaccessibility, cash costs, and lack of income--may not be of paramount importance. Finally, it is shown that the provision of free services in rural areas may not insure that the services reach the poorest people. (author's modified)