CONTENTS OF VOL. 34, No. 1, 2009

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VOL. 34. 1, 2009

SPECIAL ISSUE ON HEALTH IN THE MAGHREB, THE MIDDLE EAST AND AFRICA.

MANKIND has always been the focus of the studies that are based on different perspectives of various scientific disciplines. Our attention in this special issue is to draw attention to the degrees of success and to the problems encountered by the health planner in the Maghreb, the Middle East and Africa, and to produce ways to provide information for the related research and health care in the future. Governments should as far as possible involve local communities and not just insurance companies, who see patients as customers.

JAMES R COCHRANE: the potential of religious entities for strengthening public health systems in crisis

ABSTRACT: Formal health systems differ in their performance and reach across Africa and the Maghreb, and while some of them are relatively stable, many others face serious crises, even collapse. Diseases, such HIV and AIDS, TB and malaria, put huge stress on health systems, but mental health, violence and abuse, injury and trauma are also major public health problems. In the face of the needs, and because of the scope and scale of the issues, the health of the public cannot be the concern only of those charged with running national health systems and their international support structures, however important they might be. On the ground, in practice, in Africa as much as anywhere, many others undertake initiatives that are crucial to the health of the public. Among them are a great many religious or faith-based entities that provide for health promotion, care, support and treatment. Sometimes they work in collaboration with or are an integral part of national health ministries, but in many parts of Africa much of their work is invisible, ignored or actively resisted.
    The argument of this paper, based on research done by the international, transdisciplinary and collaborative African Religious Health Assets Programme (ARHAP), is that those planning for the formal delivery and maintenance of health for their populations, whether at local, national or regional level, must do all that is feasible to make visible the work in health of religious entities of one kind or another, support them both materially and in terms of human resources wherever possible, and otherwise find mutually productive ways of aligning their assets with those of the public health system.
    Surely, much works against such an alignment: Mistrust by people on the ground of national leaders or their policies and priorities, or by public health professionals of unscientific ideas and practices among religious leaders, for example. Mistrust is further complicated by differing, even competing views of what constitutes health and well-being, which may undermine particular interventions or even cause recipient populations to reject them. Competition for scarce resources and personnel provides another field of contention and conflict, even between facilities that are formally integrated into a national health system such as church hospitals and government hospitals. One way of dealing with such mistrust on the part of health planners is to pay attention to the assets that religious entities bring to the health of the public, through an appreciative understanding of what these assets are and how they may be built upon, recognizing that such assets are both tangible (material, organizational, operational, institutional) and intangible (access, local credibility, compassionate agendas, spiritual resources, and so on). The paper outlines some of the dimensions of what it means to pay attention to religious assets for public health, including the rationale of an asset based approach, a focus on vitality rather than pathology, the importance of local ways of understanding health and well-being, the role of boundary leaders, and the strengths of people who congregate.

PAYMAN SALAMATI, MOJGAN KARBAKHSH, SAEED SADEGHIAN, MANSOUREH TOGHA, REZA ROTAMI, MANELIE SADEGHI: health status in Iran

ABSTRACT: The Islamic Republic of Iran is a middle income country. The UNDP data showed the human development index in Iran was 0.777 in 2006 and Iran is located as 84th country in the world.
    Based on EMR and WHO data, main health indicators were as follow in Iran in 2004-2005: under five mortality rate was 36 per 1000 live births, total fertility rate was 2.1 per cent, adult literacy rate was 81.3 per cent, life expectancy at birth was 71 years and DPT vaccination per centage was 95 per cent.
    In this article, the authors searched valid international and national sources of evidence-based medicine using related keywords. We reviewed present health status of Iran and thereafter we discussed about above mentioned diseases in the country.

ABUL FADL MOHSIN EBRAHIM: severe spinal injury: a case study

ABSTRACT: This article addresses a scenario involving a certain Mr T.K., a 26 year-old man who was involved in a motor vehicle accident and sustained a severe injury to the spinal cord at the C3 level (3rd cervical vertebral level). Unable to breathe, to move his hands or legs and to speak because of the tube in his mouth, he was nevertheless able to understand events around him. He was admitted into the Intensive Care Unit (ICU) for ventilation. A decision had to be made as to how long to ventilate Mr T.K., since his long-term prognosis was of course very poor and in view of the fact that it would also be very expensive to ventilate such patients on a prolonged basis. The article attempts to provide guidelines in the light of Fiqh al-Tibb al-Islami (i.e. medical jurisprudence on this specific case which pertains directly to end-of-life ethical dilemmas.

CHRISTINA HELLMICH: A case of ‘unmet need’? Barriers to women’s use of modern contraceptives in the republic of Yemen

ABSTRACT: This paper identifies barriers to adoption and continued use of modern family planning methods in the Republic of Yemen. The evaluation of key findings from group discussions and in-depth interviews with Yemeni women is done in combination with an analysis of the statistical data from the Demographic and Health Survey of 1997, illustrating the complex interplay of barriers related to the strength of the motivation to avoid pregnancy; knowledge of methods of contraception; misinformation and perceived side-effects; culture, religion and women’s status; and quality of care and provider bias. The paper concludes with an assessment of the research findings with regard to their implications for policy formulation and programme development.

KARIMA ELFAKIRI, SAFWANE MOUWAFAQ, MOHAMMED AMINE, MOHAMED CHERKAOUI, ABDELLATIF BAALI, ABDELMOUNAIM ABOUSSAD: perception des soins de sante primaire chez les parents d’enfants consultant au niveau des centres de sante de Marrakech

RESUME: Les soins de santé primaires constituent le pilier de l’offre des soins d’un système de santé. Leur évaluation par les bénéficiaires permet d’approcher la perception du système de soins, d’en estimer la qualité afin de proposer des recommandations en vue d’améliorer les services des soins de santé primaires.
Matériel et méthodes: Nous avons mené une étude transversale à visée descriptive dont la population cible était les parents consultant pour problèmes de santé de leurs enfants dans les centres de santés de la région de Marrakech. L’échantillon était de 200 personnes. Le questionnaire évaluait les caractères socio-démographiques, le recours aux soins de santé de base au cours des 12 derniers mois avant l’enquête de Juillet 2008, le coût, le financement et la perception du système de soin. Les données ont été saisies et analysées à l’aide du logiciel SPSS 10.
Résultats: notre étude a montré que 148 (74%) parents ont répondu être satisfaits ou très satisfaits des soins de santé primaires, 91 (45,5%) ont jugé la structure de soin adaptée; 133 (66,5%) ont jugé le médecin suffisamment comptétant pour leur prise en charge; 188 (94%) parents ont basé le choix de la strucure de soin sur la proximité; 158 (79%) parents ont déclaré vouloir retourner au centre de santé et 147 (87%) le coneillerait à un proche ou à un ami.
Conclusion: L’étude a relevé une satisfaction globale de la prise en charge des enfants dans les centres de santé qui restent souvent le seul recours d’une grande partie de la population appartenant à une classe sociale défavorisée. Les éléments apportés par notre étude suggèrent que l’identification et l’attachement de la population aux centres de santé est indéniable ce qui offre une assise solide pour redynamiser nos services de soins de santé primaire.

YASSINE AL MABROUKI & ABDELMOUNAIM ABOUSSAD: L’enfance maltraitee au Maroc etat des lieux et perspectives

RESUME: Dans un monde où la mondialisation conforte les riches dans leur richesse et continue à enfoncer les pays sous-développés dans leur indigence, les décalages du niveau de vie, les inégalités sociales s’accentuent, la prostitution et la délinquance se développent. Autant dire que la najeure partie du monde est vouée à l’exclusion et à la marginalisation, contribuant ainsi à l’émergence d’une enfance en situation difficile. Ce sont les enfants, être faibles de nature, qui paient le lourd fardeau des instabilités politiques et économiques du monde adulte.
    Au Maroc, il existe réelle prise de conscience collective de ce fléau mondial. En effet, la situation de l’enfant et la nécessité de le protéger ont été depuis quelques années classées parmi les préoccupations des pouvoirs publics et des organismes non gouvernementaux.
    Cette mise au point propose un diagnostic général de la situation des enfants vulnérables, un aperçu des avancées du dossier de la stratégie nationale de prise en charge des enfants maltraités et une discussion des difficultés et le défi humanitaire soulevé par ce dossier à l’échelle nationale.

NORMAN SOLOMON: Judaism and public health

ABSTRACT: In this paper I shall review Jewish traditions with regard to matters that now feature on public health agendas. Israelite and Jewish history between them cover some 3,500 years, during which perspectives on the world have changed greatly. Public health issues were always there, but very often the language in which they were expressed was the language of purity or holiness rather than that of health and safety. This is certainly true of the four topics I shall discuss, instances of which are dealt with explicitly in the most ancient source of Judaism, the Five Books of the Torah;* the four are contagious diseases, sexual hygiene, sewage and diet.

* ‘Torah’ here means the first five books of the Hebrew scripture, viz. Genesis, Exodus, Leviticus, Numbers and Deuteronomy. These are the highest authority in Judaism, understood as the word of God.

GRÉGOIRE MERCIER: La prise en charge des cancers de l’enfant au Sénégal et au Maroc

RÉSUMÉ: Les cancers de l’enfant constituent un groupe hétérogène de maladies graves dont le pronostic s’est spectaculairement amélioré dans les pays industrialisés. Huit fois sur dix, ils touchent un enfant habitant un pays à ressources limitées où ils sont assortis d’un pronostic défavorable. Il est important de militer pour une meilleure prise en charge de ces patients, pour des raisons à la fois épidémiologiques, éthiques et humanitaires. Nous rapportons ici un travail bibliographique et de terrain dont l’objectif était d’analyser la prise en charge des cancers de l’enfant au sénégal et au Maroc afin de proposer des pistes d’amélioration adaptées à la situation unique de chaque pays. Ce travail montre que, malgré de fortes contraintes de ressources, une analyse fine et systématique de la situation permet toujours de proposer des leviers d’amélioration pragmatiques.

HENRY A. AZAR: Albucasis: A transcriber or the great arab surgeon?

ABSTRACT: Albucasis (also Abulcasis, Abū al Qasim Khala ibn ‘Abbās al Zahrāwī (c. 326H/936- 404H/1013) is the author of Kitāb al-Tașrīf, an encyclopaedic work of 30 medical treatises, the last being his text on Surgery and Instruments. Albucasis’s background and education, and an overview of on Surgery and Instruments are discussed in a separate unpublished paper.
    In this article I will address the issue whether or not Albucasis was merely a transcriber of Book VI of Paul of Aegina (Paulus Aegineta) (fl. Alexandria AD 640), the author of an extant seven book medical encyclopaedia, Epitom medicae libri setem. Paul is said to have practised medicine at Alexandria, where he remained after the Arab conquest of Egypt.

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