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Health is a cherished human value shared across geopolitical and sociocultural divides. It is thus a sad indictment on our global morality that despite enormous biomedical advances and global economic prosperity in the past few decades, huge disparities in health status persist between and often within countries. The Public Health movement, notwithstanding an apparent metamorphosis from the ‘Old’ to the ‘New’, has largely failed to narrow the health divide between wealthy and poor nations. In no sphere is this disparity more obvious than that of infectious diseases. Thirty per cent of the global burden of disease and a quarter of all deaths are still attributed to infectious diseases, and more than 95% of these deaths occur in the developing world where poverty is prevalent (Gwatkin et al. 1999; Folch et al. 2003). more...

A multi-centre study to determine whether community-directed distributors (CDDs) are capable of carrying out additional healthcare and developmental activities in their communities was carried out in Cameroon, Nigeria, Sudan, Uganda and Togo to ascertain the potential effects of their involvement on the implementation of community-directed treatment with ivermectin (CDTI). Both quantitative and qualitative methods were used to collect data from households, community-directed distributors, community leaders, and health workers. The results showed no major decrease in the CDDs' performance in CDTI: On the contrary, the involvement of CDDs in other health and development activities motivated them to perform their CDTI functions better. However, the results did not show any significant increase in therapeutic coverage of ivermectin distribution. The expansion of the CDDs' experience to include additional healthcare and development related activities would be of interest to onchocerciasis control programmes – it will strengthen CDTI sustainability through greater integration. more...

Since its inauguration in 1995, the African Programme for Onchocerciasis Control (APOC) has made significant progress towards achieving its main objective: to establish sustainable community-directed treatment with ivermectin (CDTI) in onchocerciasis-endemic areas outside of the remit of the Onchocerciasis Control Programme in West Africa (OCP). In the year 2000, the programme, in partnership with governments, non-governmental organizations and the endemic communities themselves, succeeded in treating 20,298,138 individuals in 49,654 communities in 63 projects in 14 countries. Besides the distribution of ivermectin, the programme has strengthened primary healthcare (PHC) through capacity-building, mobilization of resources and empowerment of communities. The community-directed-treatment approach is a model that can be adopted in developing other community-based health programmes. The approach has also made it possible to bring to the poor some measure of intervention in some other healthcare programmes, such as those for malaria control, eye care, maternal and child health, nutrition and immunization. CDTI presents, at all stages of its implementation, a unique window of opportunity for promoting the functional integration of healthcare activities. For this to be done successfully and in a co-ordinated manner, adequate funding of CDTI within PHC is as important as an effective sensitization of the relevant policy-makers, healthworkers and communities on the value of integration (accompanied by appropriate training at all levels). Evaluation of the experiences in integration of health services, particularly at community level, is crucial to the success of the integration. more...

This article describes the evolution of the partnership, between various health and developmental agencies, that has sustained the campaign against river blindness in Africa. The international community was oblivious to the devastating public-health and socio-economic consequences of onchocerciasis until towards the end of the 1960s and the beginning of the 1970s. Then a 'Mission to West Africa', supported by the United Nations Development Programme, and a visit to the sub-region by the president of the World Bank culminated, in 1974, in the inauguration of the Onchocerciasis Control Programme in West Africa (OCP). OCP was a landmark event for the World Bank as it represented its first ever direct investment in a public-health initiative. The resounding success of the OCP is a testimony to the power of the partnership which, with the advent of the Mectizan Donation Programme, was emboldened to extend the scope of its activities to encompass the remaining endemic regions of Africa outside the OCP area. The progress that has been made in consolidating the partnership is discussed in this article. The prospects of adapting the various strategies of the African Programme for Onchocerciasis Control, to entrench an integrated approach that couples strong regional co-ordination with empowerment of local communities and thereby address many other health problems, are also explored. more...

Factor XII plasma levels were investigated with several methods in patients with hemophilia A and B and von Willebrand syndrome. There seem to be some families with hemophilia A or von Willebrand syndrome, who have an additional, congenital, partial lack of factor XII (Hageman factor). The mode of inheritance is independent of the other coagulation disorder. Frequently, the first indication of an additional factor XII deficiency is the disproportionate prolongation of the activated partial thromboplastin time (PTT) as regards the factor VIII level. The average factor XII level in patients with hemophilia A and von Willebrand syndrome is significantly lower than in normal subjects or patients with hemophilia B. It cannot be excluded that the frequently low levels of factor XII in patients with severe hemophilia are acquired and probably due to liver cell damage. more...