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PubMedDate not supplied

[Health sector reform in Colombia and its effects on tuberculosis control and immunization programs].

This paper analyzes the effects of health reform in Colombia on public health programs at the local level, particularly the Expanded Program of Immunization (EPI) and the tuberculosis control program. The research was developed in three health districts in two States by analysis of documents, direct observation, and longitudinal follow-up of the transition process. The health districts were unprepared for the change, resulting in insufficient technical skills among staff as well as lack of awareness of important elements in the new system, associated with a reduction in immunization coverage and tuberculosis case detection. Structural problems in the new system included loss of immunization opportunities and lack of examination of tuberculosis contacts. The potentialities of the new system were the local development of a new organizational structure and the improvement of the information system; a limiting factor was exposure of the health system to local political interests. The general conclusion is that the transition period takes far longer than anticipated and requires a much greater information flow to both the local level and the community. There are transitory but also structural maladjustments that require a political response.

Colombia↗
PubMed2003

Contacts of tuberculosis patients in high-incidence countries.

The risk of acquiring infection with Mycobacterium tuberculosis correlates with duration of exposure to an infectious source of tuberculosis. Contact identification is therefore a comparatively high-yield activity. However, in resource-poor settings tuberculin is rarely available, and even where it is available, non-specific cross-reactions to tuberculin resulting from BCG vaccination complicate the interpretation of tuberculin test results. The identification of a putative infection with M. tuberculosis in a contact must result in intervention. Excluding active tuberculosis is mandatory before preventive therapy is provided. This might prove difficult in areas where the most and often only affordable diagnostic means is microscopy. The International Union Against Tuberculosis and Lung Disease (IUATLD) has thus proposed to target preventive therapy to healthy children below the age of 5 years living in the same household as a sputum smear-positive tuberculosis case, with the sole recourse to clinical contact examination. While this approach will lead to treatment of a considerable proportion of uninfected children, the advantages are several-fold: first, these are the easiest identifiable contacts; second, they are particularly prone to progression to disease if infected; third, emerging drug resistance is of little concern at that age; fourth, administration of preventive treatment can be delegated to the source case. This approach is safe, simple, and affordable.

Carrier State↗
PubMedDate not supplied

A model for economic analysis.

The production process model is proposed as a way to guide economic evaluation of health care projects, programs, technology, or research. The model is illustrated with data from the development of a home care computer intervention.

Cost-Benefit Analysis↗