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Lancet. 1990 Jul 7; 336(8703):56-7.In response to The Lancet's April 14 editorial on structural adjustment and health in Africa, it is surprising that the World Bank report did not include maternal mortality as a yardstick for monitoring health standards in Africa: maternal mortality seems to be a better index of social and economic development than perinatal or infant mortality. Obstetric performance was reviewed in parts of Nigeria after the introduction of the structural adjustment program (SAP). In the 1970's and early 1980's the Nigerian economy was buoyant, thanks to petroleum exports, but when oil prices slumped the government was forced to introduce SAP. As a result most of the costs that had been borne by the government were gradually passed on to individuals, of all the sectors affected health seems to have been the hardest hit. Looking at factors that might have been responsible for the rising maternal mortality rate in the Zaria area of Northern Nigeria, it was found that between 1983 and 1988 there had been no significant change in the numbers of obstetricians and obstetric residents at the Ahmadu Bello Teaching Hospital; there was a slight rise in the number of midwives. However, the number of deliveries in 1988 was only 46% of the figure for 1983, and the proportion of obstetric admissions that were complicated more than tripled. Maternal deaths at the hospital numbered 48 per year in 1983-85 and 75 in 1988, an increase of 56%. These changes in obstetric indices may not be unrelated to financial policies in hospital care. In 1983 all aspects of maternity care at the hospital were free. In 1985, following the reduction in government subsidy, fees were introduced for some services, leading to a fall in the number of pregnant women attending the hospital. By 1988 patients were asked to pay for their treatment; with the mean interval between admission and surgery increasing significantly and contributing to the high maternal morbidity and mortality rates in Zaria. (Full text modified)
New York, New York, Oxford University Press, 1990. xvii, 423 p.This text on international health covers historical and contemporary health issues ranging from water distribution systems of the ancient Aztecs to the worldwide endemic of AIDS. The author has also included areas not in the 1979 version: the 1978 Alma Ata conference on primary health care, infant and maternal mortality, health planning, and the role of science and technology. The 1st chapter discusses how each population movement, political change, war, and technological development has changed the world's or a region's state of health. Next the book highlights health statistics and how they can be applied to determine the health status of a population. A text on international health would be incomplete without a chapter on understanding sickness within each culture, including a society's attitude towards the sick and individual behavior which causes disease, e.g. smoking and lung cancer. 1 chapter features risk factors of a disease that are found in the environment in which individuals live. For example, in areas where iodine is not present in the soil, such as the Himalayas, the population exhibits a high degree of goiter and cretinism. Others present the relationship between socioeconomic development and health, e.g., countries at the low socioeconomic development spectrum have low life expectancies compared to those at the high socioeconomic end. An important chapter compares national health care systems and identifies common factors among them. An entire chapter is dedicated to organizations that provide health services internationally, e.g., private voluntary organizations. 1 chapter covers 3 diseases exclusively which are smallpox, malaria, and AIDS. The appendix presents various ethical codes.