740

QUALITY OF CARE INDICATORS AT ELEVEN IMMUNISATION CENTRES IN NIGER STATE, NIGERIA

data excluded, resulting in varying denominators. †Criteria of epidemiological unit, Niger State Ministry of Health.

*Mlsslng

conjunction with the African Child Survival Initiative/Combatting Childhood Communicable Diseases project of the US Agency for International Development) of how far health workers complied with standards of care in maternal and child health activities. The assessment was by on-site observation using standard forms, interviews with staff, reviews of registers and equipment, and interviews with mothers. A random sample of thirty government health facilities was visited (50% of the total) but the results presented here refer to the eleven facilities which were providing childhood immunisation services on the day of the assessment. Three were implementing mass immunisation days and eight were providing routine immunisation services. The mass immunisation drug centres performed significantly less well than the routine service centres on several indicators of quality of care (table). The study identified problems during mass immunisation activities that could offset some of the advantage gained by serving larger numbers of children. For example, the mass immunisation centres were less likely to maintain vaccines at correct temperatures or to use sterile needles and syringes and were more likely not to ensure that all children had immunisation records and that mothers were told about return dates for future immunisations. Health workers reported that immunisation services had been interrupted for up to two weeks when health workers, equipment, or transport were redistributed for mass immunisation day activities in other areas. The Niger State Ministry of Health is strongly committed to the immunisation programme and has tried to interest coverage through the use of immunisation days at local level. This strategy cannot be judged adequately by observations on only 59 immunisations. However, the results do suggest that more attention should be paid to difficulties with service delivery during mass immunisation activities. The increased intensity of activities during mass campaigns may be at the cost of quality, maternal knowledge, and compliance with the recommended immunisation schedules. During a campaign, there is often little time and few resources to evaluate activities. However, the assessment procedures used here were simple, quick, and can be conducted by local staff. As 1990 begins, many countries may be encouraged to embark on mass campaigns. A reassessment of performance standards during such campaigns is warranted. International Health Program Office, Centers for Disease Control, Atlanta, Georgia 30333, USA

J. W. BRYCE

Division of Immunization, Centers for Disease Control

F. T. CUTTS

Niger State Ministry of Health, Minna, Nigeria

S. SABA

Hair analysis for

drugs of abuse

SIR,- Traces of many drugs are laid down in hair during keratinisation and remain embedded throughout its life. The absence of drug metabolism in hair and the fairly uniform hair growth rate of about 1 cm per month may provide a historical account of drug use from analyses on hair samples. In a court case our opinion was sought about whether a former heroin addict had been heroin-free two years previously, no medical examination or laboratory tests having been done at that time. Physical examination and urine testing for drug abuse’ merely confirmed that the man had been drug-free during the previous few days. A sample of hair (full length) was divided into 2 cm sections from the scalp end. The sections were weighed and incubated overnight at 55°C in hydrochloric acid to extract any free morphine from the hair. After neutralisation the extracts were analysed for morphine by solid phase radioimmunoassay (Coat-a-Count; D. P. C., Los Angeles). 12sI-labelled morphine competes for a fixed time with morphine in the sample for morphine-specific antibody sites. The isolated antibody-bound fraction is then measured in a gammacounter. A calibration curve is used to give a measure of morphine present in the sample, from which the morphine concentration in the hair can be calculated. Hair from three known heroin addicts and from three drug-free volunteers was tested in the same way. There was a striking difference between morphine concentrations in hair from the heroin addicts and those from drug-free volunteers and from the man whose heroin status was at issue: Subjects

Distance of hair sample from

scalp (cm)

Morphine In sample (ng/mg)

0-2 2-4 4-6 0-2 2-4 4-6 0-2 2-4

300 23-0 219 7-8 11-3 15-0 8-8 99

Morphine positive A

B

C

Morphine-free D E F Unknown

Random 2 Random 2 Random 2

0-2 0-2 0-4

cm cm cm

drug status 0-2 2-4 4-7

0-8 0-8 0-6

We gave our confident opinion that the man had not been a heroin addict over the previous 6 months. Although there have been reports of hair analysis for drugs of abusez-4 this is the first time to our knowledge that such information has been used in the courts. It is not yet clear whether such tests have a future in diagnosis or in monitoring treatment compliance: however, there would seem to be considerable potential in forensic work and research (eg, in follow-up studies which have hitherto relied upon self-reporting). Clinical Research and Treatment Unit. Bethlem Royal Hospital, Beckenham, Kent BR3 3BX,UK, and Maudsley Hospital

JOHN STRANG

Pathology Laboratory, Bethlem Royal Hospital

ANDREW MARSH NEVILLE DESOUZA

Drug Dependence

1. Editorial. Screening for drugs of abuse. Lancet 1987; i: 365-66. 2. Baumgartner AM, Jones PF, Baumgartner WA, Black CT. Radioimmunoassay of hair

for

determining opiate-abuse histories. J Nucl Med 1979; 20: 748-52. D, Cassani M, Pigliapochi M, Vanzetti G. Hair as a sample m

3. Valente

morphine and cocaine addiction. Clin Chem 1981; 27: 1952-53. 4. Puschel K, Thomasch P, Arnold W. Opiate levels in hair. Forensic 1. Seaman J, Poore P. Good intentions, unfortunate consequences. Lancet

1987; i: 1334.

181-86.

assessing

Sci Int 1983, 21:

Hair analysis for drugs of abuse.

740 QUALITY OF CARE INDICATORS AT ELEVEN IMMUNISATION CENTRES IN NIGER STATE, NIGERIA data excluded, resulting in varying denominators. †Crit...
146KB Sizes 0 Downloads 0 Views