Knowledge and Education as International Commodities

Abstract

The editors have collected together several review essays on subjects related to maternal and child health (MCH). Despite the wide variety of authors, the book is homogeneous and both easy and interesting to read. There are extensive references at the end of each chapter. The subject matter varies from the immense topics of family planning and low birthweight, to the rare entity of infant botulism. The book opens with an excellent and comprehensive review of current major issues in immunization, by J. PAGET STANFIELD (pp. 1-23). He highlights the contrasting problems of immunization in the West-where the possible complications of the procedure are getting greater than the risks of the disease-to those in the Third World, where current research is focused on improvement in take-rate, improved methods of cold storage and on the possibility of preparing heat-stable vaccines. He discusses the current status of the standard vaccines-pertussis, measles, rubella, and others-and mentions those that are less often used, including methods of passive immunization. K. G. EDSTROM (pp. 24-42) from WHO, writes on reproduction in adolescence, covering the aspects of sexually transmitted diseases, teenage pregnancy, maternal and perinatal mortality rates associated with age, induced abortion and the social and educational implications of childbearing at a very young age. PRAMILLA SENANAYAKE (pp. 43-81) writes on family planning in the 1980s, from both the international and individual aspects. She opens with some stark statistics on what awaits many of the world's children in the way of inadequate water, nutrition, medical care and housing. She discusses the threat to the world of population growth and why contraception has such a high drop-out rate. Current research offers nothing new for the immediate future. She then outlines the many factors that influence family planning programmes in different countries, of which politics and religion are the most important. She mentions the use of incentives and disincentives, both the acceptable and unacceptable methods, and also the use of abortion. Two chapters on oral rehydration follow by J. E. ROHDE and L. HENDRATA (pp. 82-98, 99-104). The first describes the enormous toll taken by diarrhoeal diseases, particularly in the Third World, and recounts the discovery of the effectiveness of oral rehydration, its limitations and methods of administration. The second chapter poses the question "Where do we go from here? " and is concerned with the acceptance of oral rehydration in all communities and the necessity for behavioural change from the traditional treatment of diarrhoea of "starvation and rest for the stomach". There is a comprehensive review of the problem of low birthweight by N. TAFARI (pp. 105-127) from Ethiopia. He discusses the enormously improved survival rates for very low birthweight (LBW) infants in the industrial countries, associated with good quality survivors. He points out that neonatal survival of LBW infants can be improved by relatively simple methods, whereas improvement in the quality of the survivors involves expensive technology. Thus doctors in the Third World are faced with the dilemma between no care and high mortality for LBW infants, or an unacceptably high rate of severe neurological handicaps in an increasing number of survivors. He discusses the aetiology of LBW, and gives an interesting historical account of the evidence for and against the influence of maternal nutrition. He finishes by outlining the clinical problems of low birth-weight and its complications. Chapters 7 and 8, by A. S. CUNNINGHAM (pp. 128-168) and J. BIDDULPH (pp. 169-174), are about breast feeding. The former recounts how the protective properties of breast milk were discovered and outlines 5 studies carried out between 1900 and 1936 in North America and the U.K., all of which showed increased deaths in bottle-fed infants from all infections, not only those of the gastrointestinal tract. He outlines further studies carried out after World War II which endorse the earlier work and have been associated with the realization of the immunological content of breast milk. He discusses the effects of breast feeding on long-term health, including dental caries and coronary artery disease. Chapter 8 is a short, but very interesting, account of what can be done by a government campaign to encourage breast feeding. The Government of Papua New Guinea not only initiated education programmes through the media, in schools, and through the health service, but they brought in laws banning advertisements on bottle feeding and the sale of teats and bottles without a prescription! A. W. CHUNG (pp. 175-190) gives a fascinating account of the development of MCH in China since 1950. The 4 principles underlying health work were: to serve the workers, peasants and soldiers; to place the chief emphasis on prevention; to stress cooperation between doctors of Western and traditional medicine; and to rely on mass movements for the carrying out of health work. In 1960, it was realized that the Soviet models, on which they had been working for the preceding years, were not suitable for China and the main advances in MCH occurred between 1960 and 1976. "Barefoot doctors", one-third of whom were women, were introduced at this time and have played an immensely important role in health education and family planning. He outlines maternal and child care in the contrasting environments-urban and rural. In the former, hospital and clinic care are almost universal, but in the rural areas most women are still delivered at home with a traditional midwife to look after her; they all practise the "new method of delivery". Much emphasis is placed on family planning by encouragement of late marriage, spacing of children, use of contraception, sterilization and therapeutic abortion. It is an impressive story. There are two chapters on rare oddities, childhood autism, by V. LOTTER (pp. 191-202) and infant botulism, by L. W. BROWN (pp. 209-217), and a brief outline by the principal authors on appropriate technology. At 15, this book is excellent value and should be on the shelf of every medical school and Ministry of Health library in both the industrial and Third World countries. V. J. Everett See also abstr. 2120.