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1.  Community based rehabilitation: a strategy for peace-building 
Background
Certain features of peace-building distinguish it from peacekeeping, and make it an appropriate strategy in dealing with vertical conflict and low intensity conflict. However, some theorists suggest that attempts, through peace-building, to impose liberal values upon non-democratic cultures are misguided and lack an ethical basis.
Discussion
We have been investigating the peace-building properties of community based approaches to disability in a number of countries. This paper describes the practice and impact of peace-building through Community Based Rehabilitation (CBR) strategies in the context of armed conflict. The ethical basis for peace-building through practical community initiatives is explored. A number of benefits and challenges to using CBR strategies for peace-building purposes are identified.
Summary
During post-conflict reconstruction, disability is a powerful emotive lever that can be used to mobilize cooperation between factions. We suggest that civil society, in contrast to state-level intervention, has a valuable role in reducing the risks of conflict through community initiatives.
doi:10.1186/1472-698X-2-6
PMCID: PMC139991  PMID: 12417012
2.  Policy mapping for establishing a national emergency health policy for Nigeria 
Background
The number of potential life years lost due to accidents and injuries though poorly studied has resulted in tremendous economic and social loss to Nigeria. Numerous socio-cultural, economic and political factors including the current epidemic of ethnic and religious conflicts act in concert in predisposing to and enabling the ongoing catastrophe of accident and injuries in Nigeria.
Methods
Using the "policymaker", Microsoft-Windows® based software, the information generated on accidents and injuries and emergency health care in Nigeria from literature review, content analysis of relevant documents, expert interviewing and consensus opinion, a model National Emergency Health Policy was designed and analyzed. A major point of analysis for the policy is the current political feasibility of the policy including its opportunities and obstacles in the country.
Results
A model National Emergency Health Policy with policy goals, objectives, programs and evaluation benchmarks was generated. Critical analyses of potential policy problems, associated multiple players, diverging interests and implementation guidelines were developed.
Conclusions
"Political health modeling" a term proposed here would be invaluable to policy makers and scholars in developing countries in assessing the political feasibility of policy managing. Political modeling applied to the development of a NEHP in Nigeria would empower policy makers and the policy making process and would ensure a sustainable emergency health policy in Nigeria.
doi:10.1186/1472-698X-2-5
PMCID: PMC126243  PMID: 12181080
Nigeria; Injuries; Emergency; Health; Policy
3.  Paediatric referrals in rural Tanzania: the Kilombero District Study – a case series 
Background
Referral is a critical part of appropriate primary care and of the Integrated Management of Childhood Illness (IMCI) strategy. We set out to study referrals from the aspect both of primary level facilities and the referral hospital in Kilombero District, southern Tanzania. Through record review and a separate prospective study we estimate referral rates, report on delays in reaching referral care and summarise the appropriateness of pediatric referral cases in terms of admission to the pediatric ward at a district hospital
Methods
A sample of patient records from primary level government health facilities throughout 1993 were summarised by age, diagnosis, whether a new case or a reattendance, and whether or not they were referred. From August 1994 to July 1995, mothers or carers of all sick children less than five years old attending the Maternal and Child Health (MCH) clinic or outpatient department (OPD) of SFDDH were interviewed using a standard questionnaire recording age, sex, diagnosis, place of residence, whether the child was admitted to the paediatric ward, and whether the child was referred.
Results
From record review, only 0.6% of children from primary level government facilities were referred to a higher level of care. At the referral hospital, 7.8 cases per thousand under five catchment population had been referred annually. The hospital MCH clinic and OPD were generally used by children who lived nearby: 91% (n = 7,166) of sick children and 75% (n = 607) of admissions came from within 10 km. Of 235 referred children, the majority (62%) had come from dispensaries. Almost half of the referrals (48%) took 2 or more days to arrive at the hospital. Severe malaria and anaemia were the leading diagnoses in referred children, together accounting for a total of 70% of all the referrals. Most referred children (167/235, 71%) were admitted to the hospital paediatric ward.
Conclusions
The high admission rate among referrals suggests that the decision to refer is generally appropriate, but the low referral rate suggests that too few children are referred. Our findings suggest that the IMCI strategy may need to be adapted in sparsely-populated areas with limited transport, so that more children may be managed at peripheral level and fewer children need referral.
doi:10.1186/1472-698X-2-4
PMCID: PMC111197  PMID: 11983024
4.  Human rights in the biotechnology era 1 
Backgound
The concept of Human Rights has become the modern civilising standard to which all should aspire and indeed attain.
Discussion
In an era characterised by widening disparities in health and human rights across the world and spectacular advances in biotechnology it is necessary to reflect on the extent to which human rights considerations are selectively applied for the benefit of the most privileged people. Attention is drawn particularly to sub-Saharan Africa as a marginalised region at risk of further marginalisation if the power associated with the new biotechnology is not used more wisely than power has been used in the past. To rectify such deficiencies it is proposed that the moral agenda should be broadened and at the very least the concept of rights should be more closely integrated with duties
Summary
New forms of power being unleashed by biotechnology will have to be harnessed and used with greater wisdom than power has been used in the past. Widening disparities in the world are unlikely to be diminished merely by appealing to human rights. We recommend that a deeper understanding is required of the underlying causes of such disparities and that the moral discourse should be extended beyond human rights language.
doi:10.1186/1472-698X-2-3
PMCID: PMC107797  PMID: 11960562
5.  Cross-sectional study of morbidity, morbidity-associated factors and cost of treatment in Ngaoundere, Cameroon, with implications for health policy in developing countries and development assistance policy 
Background
In a population-based epidemiological study in Ngaoundere, Cameroon, we studied cross-sectional child morbidity and the cost of necessary investigation and treatment.
Methods
Three teams of two to three health workers visited haphazardly selected households in all major housing quarters. We asked permission to enter for a health survey. Children with cough, fever or weight loss as well as sick adults were offered free-of-charge local hospital examination and treatment.
Results
From 177 households with 1777 persons, 51 (2.9%) persons were referred. Thirty-five of them had an undiagnosed disease threatening individual health and in many cases also public health. Seven were hospitalised, including three adults with tuberculosis. Malnutrition was diagnosed in nine small children. Four patients had AIDS, seven had malaria. Average total cost for ambulant patients was 15 USD, for hospitalised patients 110 USD.
In the households, almost half of the women 16–50 years of age had no schooling. Two per cent of women and nine per cent of men were daily smokers. Coughing children were more likely than non-coughing children to live in a household with at least one smoker (OR = 3.58, 95% CI 1.72 to 7.46), and they generally lived in more poor households (P = 0.018). Twelve of 16 children with weight loss were referred from households with a high poverty score.
Conclusions
Adult smoking and poverty affect children's health. The cost of hospitalisation or long-lasting therapy is beyond the means of most ordinary families. Diseases with severe consequences for public health, like tuberculosis, AIDS and malaria should have national programs with free, decentralised examination and treatment. Access to generic drugs is important. A major educational effort is needed to improve public health.
doi:10.1186/1472-698X-2-2
PMCID: PMC113745  PMID: 11955291
6.  High-tech and low-tech orthopaedic surgery in Sub-Saharan Africa 
Background
Zambia's governmental health system suffers from shortage of surgical supplies and poor management skills for the sparse resources at hand. The situation has been worsened by the dual epidemics of HIV disease and tuberculosis. On the other hand the private medical sector has benefited greatly from less bureaucracy under the goverment of the Movement for Multi-party Democracy.
Discussion
The Zambian-Italian Orthopaedic Hospital in Lusaka is a well organized small unit providing free treatment of physically disabled children. The running costs are met from the fees charged for private consultations, supplemented by donations. State of the art surgical techniques are being used for congenital and acquired musculo-skeletal abnormalities. Last year 513 patients were operated upon free of charge and 320 operations were performed on private patients.
doi:10.1186/1472-698X-2-1
PMCID: PMC77401  PMID: 11914165

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