A mass campaign too often? results of a vaccination coverage survey in the dikgale-soekmekaar district

Objectives. To determine the routine and mass immunisation coverage in children aged between 12 and 23 months in the Dikgale-Soekmekaar district, Northern Province, South Africa. Design. Cross-sectional community-based vaccination prevalence survey using a two-stage cluster sampling technique. Methods. Data on the vaccination status of the children were obtained from the vaccination document of each child or by means of a vaccination history if the vaccination document was not available. A structured interview based on a field-tested questionnaire was conducted with one caretaker of each child. Results. Each of the routine programme vaccines reached a coverage level of more than 90%, except for measles (85%) and Haemophilus influenzae (Hib) 1, 2, 3 (8%, 5% and 2% respectively). Seventy-nine per cent of all children were fully immunised through the routine services. The two polio mass campaign rounds reached coverage levels of 80% and 57% respectively. The measles campaign reached 75% of the study population. The overall measles coverage rate (routine and mass campaign) was 96%. Conclusions. The routine immunisation service in the district functions very well. The polio mass campaign in the district was redundant. However, the measles campaign increased the coverage rate in the population to 96%, which exceeds the theoretical herd immunity level of 92 - 95%. This may have averted a measles outbreak in the district. (South African Medical Journal: 2003 93(1): 65-68

Implementing evidence-based medicine in general practice: a focus group based study

BACKGROUND: Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM) in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners) to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work. METHODS: We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants. RESULTS: A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice), commercial and consumer organisations on the meso-level (institutions, organisations) and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community). Existing barriers and possible strategies to overcome these barriers were described. CONCLUSION: In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed

Monitoring the referral system through benchmarking in rural Niger: an evaluation of the functional relation between health centres and the district hospital

BACKGROUND: The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger. METHODS: Strict and controlled application of existing clinical decision trees in a sample of rural health centres allowed the estimation of the corresponding need for and characteristics of curative referrals in rural Niger. Compliance of referral was monitored as well. Need was matched against actual referral in 11 rural districts. The referral patterns were registered so as to get an idea on the types of pathology referred. RESULTS: The referral rate benchmark was set at 2.5 % of patients consulting at the health centre for curative reasons. Niger's rural districts have a referral rate of less than half this benchmark. Acceptability of referrals is low for the population and is adding to the deficient referral system in Niger. Mortality because of under-referral is highest among young children. CONCLUSION: Referral patterns show that the present programme approach to deliver health care leaves a large amount of unmet need for which only comprehensive first and second line health services can provide a proper answer. On the other hand, the benchmark suggests that well functioning health centres can take care of the vast majority of problems patients present with

Vaccination coverage in 14-year-old adolescents: documentation, timeliness, and sociodemographic determinants

Chloro complexes IrCl2(η5-C5Me5)[P(OR)3] (1) (RMe, Et) were prepared by reacting dimer [IrCl2(η5-C5Me5)]2 with phosphites in alcohol. Treatment of 1 with R1NHNH2 gave monohydrazine complexes [IrCl(η5-C5Me5)(R1NHNH2)(P(OR)3)]BPh4 (2, 3, 4) [R1H (2), Me (3), Ph (4)]. Bis(hydrazine) complexes [Ir(η5-C5Me5)(R1NHNH2)2(P(OR)3)](BPh4)2 (5, 6) were prepared by reacting chloro complexes first with AgOTf and then with an excess of hydrazine. Oxidation with Pb(OAc)4 at -40°C of both mono- and bis(hydrazine) complexes afforded phenyldiazene derivatives [IrCl(η5-C5Me5)(PhNNH)(P(OR)3)]BPh4 (7) and [Ir(η5-C5Me5)(PhNNH)2(P(OR)3)](BPh4)2 (9). Bis(aryldiazene) [Ir(η5-C5Me5)(PhNNH)2(P(OR)3)](BPh4)2 (9, 10) were also prepared by allowing hydride IrH2(η5-C5Me5)[P(OR)3] (8) to react with aryldiazonium cations [ArN2]BF4. The complexes were characterised spectroscopically and by X-ray crystal structure determination of [IrCl(η5-C5Me5)(NH2NH2)(P(OEt)3)]BPh4 (2b) and [IrCl(η5-C5Me5)(CH3NHNH2)(P(OEt)3)]BPh4 (3b)