1528

Misguided advice on vaccines, Cameroon SIR,-The activities of the World Federation of Doctors Who

Respect Human Life-an organisation claiming 300 000 members in over sixty countries, based in Belgium-may be putting at risk the lives of children in Cameroon. In advice to some influential church leaders they have expressed the opinion that tetanus vaccination targeted on young women of childbearing age is not logical, and they have strengthened a prevailing suspicion that the injections contain some sort of contraceptive, which would thus be given under false pretences. As a result some communities in western Cameroon have come to believe that schoolgirls and young women were being sterilised by the health authorities against their will. Vaccination teams have been stoned by villagers, and on one occasion vaccinators were saved from an even worse fate by the intervention of a responsible village headman. Confidence in immunisation has been badly undermined. As a consequence preventable deaths from neonatal tetanus must have occurred more frequently, and vulnerability to other preventable diseases may well have been raised as well, because of reduced vaccination coverage. How can an organisation of doctors who respect human life (how about the rest of us?) square a concern with the survival of the fetus with ill-conceived advice from a desk in Belgium that has the effect of giving babies born in Cameroon an even slimmer chance of survival? J Hendrickxstraat 112, 2900 Schoten, Belgium

A. A.

VAN

GELDERMALSEN

Community-based maternity-care programmes SIR,-Dr Fauveau and colleagues (Nov 9, p 1183) demonstrate a very important association between implementation of maternity care (in this case, trained midwives at village level with access to referral services) and substantial reduction in obstetric morbidity in the community. They conclude that "the principal causes of obstetric deaths that were reduced by the programme were, in order of decreasing importance, complications of abortion, post-partum haemorrhage, post-partum sepsis, obstructed labour, and eclampsia". Regrettably, two facts necessary for complete understanding of the relevance of these conclusions for public policy are not clearly specified. First, Fauveau et al do not explicitly state that the reduction in deaths was due to emergency treatment of badly done abortions, and not to the provision of early, safe menstrual regulation services. Second, had such services been available, the women who were saved from death need not have suffered severe morbidity and, possibly, continuing sequelae such as infertility. Although menstrual regulation services are provided by the government of Bangladesh, and although project staff were supportive, these services were not provided because of the so-called Mexico City policy of the US Bush administration. Other such instances abound. The US government should be held accountable for needless suffering and deaths of uncounted thousands of women Safe abortion is one of the simplest, lowest cost, and direct ways to reduce maternal mortality and morbidity. All of us committed to safe motherhood have an obligation to recognise safe abortion as a necessary and very powerful means to directly reduce 25-50% of maternal morbidity and mortality. Without safe services, at least 200 000 women per year will continue to die needlessly. ADRIENNE

GERMAIN,

Vice President, International Women’s Health Coalition

SANDRA MOSTAFA KABIR, International Women’s Health Coalition, 24 East 21 Street, New York 10010, USA

President, Bangladesh Women’s Health Coalition

SIR,-Dr Fauveau and colleagues mention that hardly any community-based intervention studies have reported the effect of community-based maternity-care programmes on maternal mortality. I would like to record two examples from areas in which I have worked in West and East Africa.

In a semirural area in the tropical rain forest region of south-east Nigeria, maternal mortality fell by 50% after the introduction of a training and support programme for traditional birth attendants.’ 1

There was also an increased uptake of childhood immunisation. In a rural area (Attat) of Ethiopia, health care preventative programmes have incorporated better education, especially for women, better antenatal care, and better use of community health care workers, including trained traditional birth attendants and the use of a maternity waiting area. These areas are similar in construction to the patient’s home but are built close to the hospital so that difficulties of travel and consequent delay are avoided when urgent management of labour is neededWomen with a poor obstetric history, such as a previous ruptured uterus or no livebom children, are advised by the health-care team to reside in the maternity waiting area for the last few weeks of pregnancy. In the area covered by the health care programmes there was also a substantial reduction in crude birth rate, from 38 to 16-6 per thousand population, and in infertility rate, from 159 to 77 per thousand fertile women, between 1982 and 1990.3 These decreases are attributable to an immunisation programme with more children surviving and to the use of natural family planning. Birmingham Maternity Hospital, Queen Elizabeth Medical Centre, Edgbaston, Birmingham B15 2TG, UK

JOHN KELLY

1. Brennan M Training traditional birth attendants. Postgrad Doctor 1989; ii: 16-18. 2. Poovan P, Kifle F, Kwast BE. A maternity waiting home reduces obstetric catastrophes. World Health Forum 1990; 11: 440-45 3 Webster F Evaluation of the public health and development programme Attat Hospital, 1982 to 1990, Attar Hospital, Ethiopia, 1990.

Product patents SIR,-If the Department of Trade and Industry (DTI) is keen to defend the interests of the tobacco industry on trade grounds, irrespective of damage to health (Malcolm Dean, Nov 30), one might presume that the same Ministers and civil servants would be shouting from the roof tops to promote an industry that provides 2 billion a year in UK exports and improves the health of millions. But one would be wrong. On Dec 19,1991, the European Council of Ministers will discuss a European Commission proposal to encourage further pharmaceutical research and development by restoring the dwindling patent protection period on new medicines. The effective patent life has been eroded to an average of less than 10 years for products that take on average [,130 million to develop. The EC plan calls for up to 16 years’ effective patent life to be achieved by means of a supplementary patent certificate (SPC). The DTI, however, is going to the talks proposing to limit the period to 13 years. It is to be hoped that the UK will review its position and fall into line with the majority of EC states, supporting the EC 16 year proposal. Nothing less will ensure that industry in Europe, and the UK in particular, maintains its lengthy and costly research into long-term problems such as Alzheimer’s disease, AIDS, and, of course,

smoking-related cancers.

Association of the British Pharmaceutical 12 Whitehall, London SW1A 2DY, UK

Industry,

Resource allocation and

JOHN GRIFFIN, Director

underprivilege

SIR,-The Jarman underprivileged area index is being increasingly used as a basis for resource allocation in the National Health Service. The index scores, both for family health service (FHSA) and district health (DHA) authorities, have lately been sent to district departments of public health by the Department of Health in London.’ In Rotherham the DHA and the FHSA are coterminous, so we were surprised to see that the Jarman index score was -415 for our DHA but -603 for the FHSA. Examination of scores for 32 co-terminous DHA/FHSAs shows that Rotherham is not alone (figure). The Jarman index is calculated by normalising area scores for eight variables by an arcsine square-root transformation, and standardising the transformed values with the means and SDs of the transformed values of the variables for all the areas for which the

Product patents.

1528 Misguided advice on vaccines, Cameroon SIR,-The activities of the World Federation of Doctors Who Respect Human Life-an organisation claiming 3...
181KB Sizes 0 Downloads 0 Views