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In: White KL, Bullock PJ, ed. The health of populations: a report of two Rockefeller Foundation conferences, March and May 1979. New York, Rockefeller Foundation, Sept. 1980. 139-44.The background, planning process, and structure of the McMaster University-Sierra Leone project are described and its progress after 1 year of operation is assessed. It was agreed that the University of Sierra Leone would establish a Department of Community Health in Freetown and would not develop a medical school, while the Ministry of Health would develop a paramedical training school. The Ministry of Health's mandatory 2-year training program for physicians educated abroad would have cooperative links with the Department of Community Health. A senior coordinating committee directly responsible to the president of Sierra Leone would be responsible for subsequent project planning. Establishment of an eduational base in the Department of Community Health is intended to develop expertise in clinical epidemiology, biostatistics, and related areas. Community-based continuing education programs for potential users of the new disciplines at district and chiefdom levels are planned. Considerable progress has been made in the first year, but some anticipated problems have arisen and some necessary local support has wavered. Experience with this project suggests that the size of external aid must be related to the potential for change rather than the health need; factors limiting potential for change may include government commitment, priority for health care, political stability, economic conditions, and societal acceptance. Planning should be flexible and iterative, and should consider recurring costs as well as initial development costs. Initial involvement at the community and village level is essential.
A preliminary pharmacokinetic and pharmacodynamic evaluation of depot-medroxyprogesterone acetate and norethisterone oenanthate.
Fertility and Sterility. 1980 Aug; 34(2):131-9.2 populations attending WHO centers, one in Sweden and one in India, participated in a comparative, pilot trial of 2 increasingly popular injectable progestin-only female contraceptives, Depo-Provera and Norigest. The purpose of the study was to assess the pharmacokinetic and pharmacodynamic properties of the 2 formulations (depot medroxyprogesterone acetate and norethisterone enanthate). Differences were found between Swedish women and Indian women in their reactions to the 2 drugs: 1) Norigest was detectable in blood samples a significantly shorter time after injection of the agent in Indian women than in Swedish women; this difference was not apparent with Depo-Provera. 2) Although there was no difference at the 2 centers in the time of ovulation return for subjects receiving Norigest, 0 of 4 Swedish women ovulated more than 156 days after Depo-Provera injection, whereas all 4 Indian women ovulated within 73 days of Depo-Provera injection; in the Swedish women, the levels of medroxyprogesterone were undetectable at time of return to ovulation, whereas Indian women had levels of .6 ng/ml when ovulation resumed. 3) In both cultures, Depo-Provera users had significantly more episodes of bleeding and spotting than Norigest users. This preliminary report emphasizes the variety of responses possible to injection of different contraceptive progestins among various populations and points to the need for further culturally comparative studies.
Strengthening rural health service delivery project. First progress review meeting on the Diarrheal Disease Control Study.
Mansura, Egypt, [Westinghouse Health Systems], 1980 Jun 2. 38 p.This is the report on a study into the availability, utilization, effectiveness, and cost of sucrose/salt rehydration mixtures and prepackaged rehydrant solutions of glucose, potassium, and bicarbonate. A WHO-sponsored program was established in Egypt in 1977 to distribute prepackaged electrolytes for use in cases of diarrhea. Results have been unsatisfactory because there is distrust and, consequently, underuse of the product. In addition, it is only available at clinics, which are also underutilized by the population. Therefore, since 1978, the Ministry of Health has been conducting a pilot project to distribute the oral rehydrants through rural health care delivery. This program involves teaching home preparation and administration of a salt/sugar solution to mothers, providing packets through medical personnel at clinics, and intravenous treatment in hospitals in severe cases. A comparative study will be undertaken in 2-3 districts of the pilot project to assess the relative benefits of the home-prepared salt/sugar solutions and the prepackaged oral rehydrants. The methodology of the study, plus specific research outputs expected, are outlined. The 2 preparations will be compared as to effectiveness, availability, safety, acceptability, cost, and principal advantages.