Abstracts and Reports
EL SALVADOR COMPLETES NATIONAL VACCINATION CAMPAIGN
In El Salvador, the last of three highly suc- cessful vaccination days devoted to immunizing children against poliomyelitis, measles, diphthe- ria, tetanus, and whooping cough took place on 21 April 1985. Some 250,000 or more children were vaccinated, a number comparable to the approximately 220,000 children vaccinated on the first day (3 February 1985) and 270,000 vac- cinated on the second (3 March 1985). The three days, marked by a virtually complete cessation of hostilities, resulted from a coordinated Sal- vadoran effort that was supported by the Pan American Health Organization, the United Na- tions Children’s Fund (UNICEF), and a number of bilateral agencies.
bringing about a suspension of hostilities during the vaccination days. It also played an important role in informing people about the campaign- largely by discussing the need for vaccination during Sunday church services.
Overall, more than 6,000 individuals (health personnel as well as volunteers) who had under- gone brief training attended quickly and effi- ciently to the long lines of people at the posts. Besides administering vaccines to children in the target age group, they also offered tetanus toxoid to all women of childbearing age in an attempt to reduce the incidence of neonatal tetanus.
The goal of this campaign was to vaccinate at least 80% of the country’s roughly 400,000 children under five years of age. The fact that the percentage actually vaccinated fell somewhat short of this figure has led to suggestions that the campaign should be repeated next year in order to further improve immunization cover- age.
Overall, the massive 1985 effort has reflected the interest and concern of the Salvadoran Gov- ernment, particularly the Ministry of Health, and has demonstrated a commitment to improving the health of Salvadoran citizens. Effective real- ization of the National Vaccination Days has also required the cooperation of various national and international organizations, including all local political groups. Government forces and leftist guerrillas suspended hostilities during the vaccination days to allow health teams and the International Red Cross to enter areas of conflict. According to national press reports, not a single disruptive incident occurred at any of the coun- try’s 132 vaccination posts.
The need for accelerated measures to deal with the health problems of Central American children was recognized at a Meeting of the Health Ministers and Social Security Directors of the Central American and “Contadora” coun- tries that was held at Medellin, Colombia, in July 1984. In October of that same year, Na- tional Vaccination Days were made part of a Plan of Action that was drawn up at a meeting of El Salvador’s Ministry of Public Health and Social Assistance, PAHO, and UNICEF.
The health of Central American and Panama- nian children is one of the most serious problems in this subregion. Not only is the problem large-nearly 100,000 children under five die annually-but well-known intervention mea- sures could substantially reduce the toll. It was acknowledged at the Medellin meeting that the seriousness of the problem warranted aggressive public health measures that would produce re- sults by the end of this decade.
The Catholic Church was instrumental in
Several factors were taken into account to ensure the Salvadoran program’s success. The event was planned as a national activity to reach children in all segments of society and was given
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heavy advance publicity in the press and on radio and television. A followup strategy called “chan- neling” was also used extensively. This involved “channeling” people from their homes to the health centers through the active participation of health workers and community leaders who visited each house in a given area once every three months, recorded the vaccination status of pregnant women and young children, and sched- uled appointments for those who required vacci- nations. Followup visits were made to those who failed to keep their appointments. Continued pursuit of this strategy should help El Salvador’s immunization coverage to keep growing in the future _
UNICEF, PAHO, USAID, Rotary Intema- tional, and the Government of Spain, among others, provided material and technical support for the vaccination effort by supplying vaccines, syringes, administrative and technical personnel training, maintenance crews for the cold chain, printed materials, and technical support for the
mass communication activities required. Rural vaccination posts were located in small villages and refugee camps, and urban vaccina- tion posts were set up in health centers as well as in schools, public buildings, parks, and rec- reation centers, depending on how many local children were to be vaccinated. Posts were situated so that parents and children would not have to walk more than a few kilometers. The number of vaccination posts in both rural and urban areas was determined by regional commit- tees.
In sum, it seems clear that national vaccina- tion coverage has been raised significantly as a result of this effort, and it is hoped that the channeling strategy, combined with future na- tional vaccination days, will ensure that cover- age remains high.
Sources: Pan American Health Organization, EPI News- letter 7(2):1-2, 1985; and J. LeMoyne, Salvador halts war for inoculations, New York Times. 22 April 1985.
CANCER INCREASES IN DEVELOPED COUNTRIES
A question often asked but generally left un- answered is whether or not cancer is really in- creasing around the world. The debate has been joined on many fronts. Some have argued that if cancer mortality is indeed higher than in the past, it is largely a consequence of population aging, since cancer is known to be a disease which primarily affects older adults. Others have claimed that therapeutic advances have had a major impact in reducing deaths from cancers at certain sites. And attention has been drawn to the possible impact of epidemiologic research on the causes of cancer. (That is, certain risk factors have been clearly identified for many years, and so it is worth finding out whether this knowledge has been effectively translated into public health action to reduce mortality.)
With mortality data now available from many
developed countries for the early 198Os, it is possible to assess the recent trends in cancer mortality over the last two decades or so. Infor- mation on cancer mortality covering the period 1960-1980 (or even later in some cases) is avail- able to WHO for 28 developed countries, ’ the notable exceptions being the USSR and the Ger- man Democratic Republic. These data cover roughly 75% of the population of this group of countries. A standard demographic technique-
