Asia Pacific Journal of Public Health

This article summarises current AIDS and HIV infection epidemiology, population risk behaviour factors, local public health and governmental responses to AIDS and cooperative strategic plans for a Pacific “War on AIDS” among the United States Public Health Service and the Pacific jurisdiction public health agencies. The Pacific Island Health Officers Association is comprised of the Republic of Palau, the Government of Guam, the Commonwealth of the Northern Marianas Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, American Samoa and the State of Hawaii.

In the last two decades, there have been dramatic developments in the field of occupational health. With it, the importance of occupational health training and education is greatly appreciated.

In a worldwide questionnaire survey on occupational health teaching in schools of medicine, 69.9% of the schools have some form of occupational health teaching for medical undergraduates. The total number of hours varies considerably but on average is 32.7 hours. Some occupational health teaching might however have been classified under other subject headings.

In the Asia-Pacific region, several postgraduate degree courses were recently established. Continuing educational courses and short courses are on the rise. To take advantage of the existing primary health care systems, special courses for public health workers and primary health care personnel have been conducted. In the past, interest in occupational health education and training tended to be overshadowed by advances in epidemiology and pathogenesis of occupational diseases. Based on our experience over the past few years, occupational health training and education will gather greater momentum worldwide and in the Asia-Pacific region in particular.

The feasibility and effectiveness of community participation in the planning and delivery of health care services among the Hanunuo Mangyans in the Philippine highlands is described. The Hanunuo are swidden cultivators and one of seven indigenous ethnic minorities in the forested interior of Mindoro island. Previous Mangyan studies have shown that they have poor health, are generally malnourished and continually susceptible to communicable diseases. The need to develop viable strategies to counter their health problems is pressing since Mindoro suffers from insufficient health care facilities and personnel, and health services are rarely available to Mangyans. Baseline surveys on the health and nutritional status of the Hanunuo population in the project site indicated that the following illnesses are most prevalent: upper respiratory tract infection, skin diseases, parasitism, anaemia and malaria. The more significant health problems of the Hanunuo include poor environmental sanitation, lack of medical personnel and drugs, inadequate knowledge of curative and preventive care, lack of adequate prenatal care, poor nutritional status and lack of health education. Also described are the participation of the community in project planning and decision making, the training workshops and resource manual for the community volunteers, the coverage areas and assigned tasks of the health workers, and the organisation of village health committees.

In the mid 1970s an emphasis on protein mainutrition shifted to an emphasis on energy deprivation as the crux of the world's nutrition problems. While energy is indeed critical, and clinically pure protein deficiency (i.e. kwashiorkor) relatively uncommon, mild to moderate protein deficiency may be a significant and widely overlooked problem. Studies of dietary intake on an individual level show that foods high in protein are particularly subject to skewed intra-familial distribution, with adult males receiving a disproportionate share. Women and children of ten fail to meet their protein requirements even when consuming adequate or near-adequate amounts of energy. A number of studies suggest that the functional effect of such subclinical protein deficiency is a decreased immunological response, resulting in increased frequency and severity of illness in a group already at risk: women and children in the developing countries. Without underestimating the importance of energy staples, protein intake in these vulnerable groups warrants renewed attention.

Measles immunisation of nine-month-old Thai children has been part of the national health programme since 1984. In this study we compared the seroconversion rate following measles immunisation in nine-month-old Thai children with the older age groups, i.e. 10 to 14 months of age, to see whether revaccination at over 12 months of age is necessary. In 223 children, 204 had no measles haemagglutination inhibition antibody before measles vaccination. The seroconversion rates in children aged nine to ten, 11 to 12, and 13 to 14 months were 96.1%, 94.5% and 100% respectively with no difference statistically.

Prevalence of Human Immunodeficiency Virus (HIV) infection among 12, 000 intravenous (i.v.) drug users in New South Wales (NSW) was estimated to be very low in 1985. However, a large increase of HIV infection in this population group could result within a short period.

The NSW government amended existing legislation to permit the sale and possession of sterile needles and syringes. A programme to promote the sale of needles and syringes was launched jointly with the Pharmacy Guild of Australia (NSW Branch) in December 1986. Favourable changes in pharmacists' attitudes were noted four months later. The distribution scheme became an important component of the NSW prevention programme.

There are 2, 039 retail pharmacies throughout NSW. The number of sterile needles and syringes sold through these outlets increased from 4, 200 in January 1987 to 51, 000 in November 1987 with a total of 422, 000 dispensed over this period. The percentage of Pharmacy Guild members involved in the programme increased from 0.5% to 22.5%, covering 38% of the state by November 1987.

During 1987, HIV infection among i.v. drug users remained low. This suggests that the needles and syringes distribution programme contributed significantly towards limiting the spread of HIV infection among i.v. drug users.

Community Oriented Primary Care (COPC) has been demonstated to be a worthwhile approach to health care. Medical educators, however, have been slow to respond with curriculum changes that will facilitate the entry of medical school graduates into COPC. This paper describes a programme at the University of Washington that has a COPC focus with emphasis on care to the medically unders-erved. Analysis of this study's evaluation strategy suggests improvements to be incorporated into future research.¹

This article describes the conceptual framework and methodology through which the State of Hawaii formulated its health policies in keeping with the National 1990 Health Objectives. In light of the need of other members of the world community of nations to pursue such a path in achieving the WHO Goal of Health For All (HFA) by the year 2000 as articulated at Alma Ata ten years ago, the strategy and community development process described represents a potential model for consideration in the quest by other countries to formulate health goals, strategies and an action plan.