PubMed · 7795476
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I C Perry. 1995-06-24. Malaria prophylaxis.. https://doi.org/10.1136/bmj.310.6995.1673a
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The population of Cabo Verde was founded in the fifteenth century (1462), on the basis of slaves brought from the West African coast and a few Europeans, mainly from Portugal. The polymorphism of six red cell enzymes (ADA, AK1, ALAD, ESD, GLO1, and PGD) and ten plasma proteins (AHSG, BF, F13A, F13B, GC, HP, ORM, PLG, TBG, and TF) was studied in a sample of 268 individuals from Cabo Verde (West Africa). There is no statistical evidence of genetic heterogeneity between the two groups of islands which constitute the archipelago, Barlavento and Sotavento. The gene frequency distribution observed in Cabo Verde differs, in many markers, from that of West African populations, suggesting an important European influence. The proportion of Caucasian genes in the population of Cabo Verde has been calculated to be M = 0.3634 +/- 0.0510, and the considerable dispersion of the locus-specific admixture estimates seems to indicate random drift has also played a role in the evolution of the allele frequencies in the archipelago. Partition of the variance of the mean estimate in evolutionary and sampling variance shows the evolutionary variance is more than ten times higher than the sampling variance. When dendrograms are constructed on the basis of different genetic distances, the population of Cabo Verde clusters with Afro-Americans, forming a different group from the populations of the African continent. This is interpreted as a consequence of the importance of Caucasian admixture both in Afro-Americans and in the population of Cabo Verde.
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Situation analyses were conducted by 11 multidisciplinary teams in the West African Prevention of Maternal Mortality (PMM) Network, with technical assistance from Columbia University's Center for Population and Family Health. Data on the functioning and use of facilities were used to identify resource needs and management problems at facilities providing emergency obstetric care in Ghana, Nigeria and Sierra Leone. The researchers looked at the number and distribution of facilities, trends in utilization patterns, time from admission to treatment at facilities, functioning of referral systems, availability of essential supplies, staffing patterns, and staff perceptions of services. Research methods included patient flow studies, inventories of drugs and supplies, and retrospective reviews of hospital records. Qualitative information was also collected through interviews with staff. This paper summarizes the principal findings of the situation analyses. Normal deliveries fell markedly where users' fees were initiated. However, the number of women with complications seen increased at several of these sites. The lack of drugs and supplies at the facilities had an adverse effect on utilization of non-emergency services and on women's survival chances. Users' fees and unavailability of supplies contributed to unacceptably long waiting times between admission and treatment at most sites. These long waiting times were also found to be associated with higher case fatality rates. Staff-to-patient ratios at the sites improved or remained stable, and do not appear to be associated with changes in quality of care. Strategies to address the problems identified include: the establishment of small revolving fund schemes to ensure the availability of supplies; the creation of 24-hr pharmacy services; the establishment of on-call rooms for staff; and the improvement of staff attitudes and morale through various types of training activities. These situation analyses were useful for assessing health system factors contributing to maternal deaths. The information on complicated cases and on hospital functioning provided a marked improvement over previous studies limited to data on deliveries and maternal deaths. Low-cost techniques such as the patient-flow studies and drug and supply inventories provided valuable information which was easily intelligible to program planners. These types of studies are recommended for use prior to the development of projects designed to reduce maternal deaths.