Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698076949523.pdf (Guyana)
INTRODUCTION The annual report provides of Health general during by the Ministry undertaken 1992. information on departmental and programme activities The departmental and the Department of Standards are provided problems activities include and Technical the establishment Services Statistical Unit, Services of the Health Planning nt health data on significa !n relation to specific Dental Health, Vector es, the report describes Control, ffiV/AIDS, Hansen's in the area of Maternal Disease Control, activities and programm and Child Health, Pharmacy This report is not complete a general picture of the range of activities which are involved in the delivery but it provides of Health Care.
EXECUTIVE SUMMARY The Ministry coverage provide levels in most areas, health greater of Health pursued and assess its traditional the situation and sought activities with a view to expanding activities to areas of the country.

to maintain the care coverage in the many unserved and under-served Programme under 5, immunization.

the capacity children stretched malaria, particular attention included of the year, continuing significantly.
gastro the cholera areas which received and resources In the last quarter of the Ministry enteritis in epidemic By the end of the year, the Ministry as a result in strategy to considerable momentum and change increased improved the commitment health sector.
had begun to adjust and anticipate of the change in the political the increase administration in and in the interest of reorganization of systems and procedures Permanent Secretary HEALTH PLANNING The Health Planning in the LJniL The unit also supervises stren!

!theninu their management Unit is still ._ - '- skills the Statistics using data .

- in its embry onic stages with the Director Unit and has begun to train senior as the sole staff member manager, in !TD-!'

T,>Jl:0!
T,>Jl:0!

::TS WHIE\1:D 1�, t1Nc1'.il \';1\S, A•'1;t;lfh1t ll:,"ln P.\IV; 'a1i>,.

,,_.,>ll .t !

:1<1111• ,•I �Ill<'.

\;�-· wuic i\.llN!lllry ;,, wu,nm:ii:1.11t.

:11>1.1 '-lwn:111<111n� ' 1ht: s� Heilkh Pt:>ruun, iNlff'11'1'••,:e>.f fa.

"'llliat ltw -'<'flllu.

'1 .-f mtl!Urli.H,•�'1111<11 �flblll��O'ICl'•!�\lmmlY"�� lb< Ullt .. iilklns'r ...,., ; lft.iWUS<Olll \bl�l lliWfl'IWk,n �lll(M U.Ubh,:,p Ji,>,'�ud plfhl.l{ ;11111 Vff>.Uf "'-1'.

'l � :;,,," .,..,AL ,:s:s or st:cross UR f .>JU.


:R,E ltlililliHID�•t-,llmf hu:llh ,ruv.

;w,n1,?f\l � j!.._ ,<.Jf"> pti1,cy deasio.• _. illfi'ffflN �-ffin1Me d2a ,md me� o.

-.

:.-m�lltt --k-.

!ril41n·t.

-T4e �- .-t' °"' '.ilnlllU1 hill'I bem 1q1&qlid and r;rt.

:� � 1-iwth P',:m Ii.'!


tl'lt hMTJI �- Th•� <>ii;,;imt fflll)"f�'ll.,n• 111.11'..e tu:n i,Jl:!l(lru,d Dru: tt, r,,:m1, t\11\$11.1'\lltu� ,,,m< J•pm� ·""'' <114 OOI wbnul :lus n:q\111',d mfl'!l'fflllQnn 11),;r( .s 11.cl,,;tr wmnuum,nt lfl the�=�,•!

-:::�nk7.�; � ,u,11<1•", n;rn tim,:,.11c1;,.;111Cv.,.!i.,.tilll,;kS.

: T.,, a� ..,_dll!l ,rn,rulwp wtuth l'.111.!
.,qa,-.-.1 i;, d,ml���lv'.l.iariapc:ncr �Sya,mi ('.\U-SIJD•I(> impro,,� a:lli,nvd IUIOOJll'<m.,,..-_ deci!riaa� '111.-�• lift III lrt,.,.puk llNIT IIEALTII STAIISTICS INTRODl TTION 1992. the Heahh Statistics Unit continued to concentrate mainly on the following areas of During its works:- I ) Maintaining the 1992 coverage levels 2) Expanding activities to provide wider coverage where possible; �OFFICIAL NOTIFICATION OF BIRTHS Statistics data on binhs The Health processing in the country.
of information on binhs by Place of Occurrence.

Perspective the Regional/Geographic Unit, in the course occurring its programme continued Thus the distribution The emphasis in Table 1 and also on Chart l. of 1992, continued of collecting to be the collection and of births could be seen in All births notified lns1i1utions by Age-group by Type of binh.
to the unit during the year have beeil edited, coded and put on worksheets by binhs, Rate, etc., which is critical Information 011 Mortality The main concern is the declining in deliveries reflect decline reason.

is due more 10 the latter has over the years been a source number or to under-rep actual of births reported of some concern and in cases controversy.

to the unit and whether such declines oning of births.
It would appear that the decline for the measurement ofimmunization Stafus, Infant In 1992. the number of births recorded, live births births recorded The still were 396. as received was 14,537. were Of these 14, 141 (97.3%) The total level_ shown in Chart 3 the total number of live binhs recorded as Low birth weights was 2,677 ( 18.9%).

At a regional number of Low binh weights ranged from l in Region 8 to 1,237 in Region 4 as 2 · Table I.
BIRTHS OCCURRING IN REGIONS, 1992 BY INSTITUTION REGIONS INST DOM TOTAL ___ IO----------------------- 828 ----------------- 56 --------------- ---------��.
:!_ _ _________ TOT AL --------------- -------- --------'---------- ------------------�---------- ------ 14,537 -------- ------- 1,684 12 853 INST -INSTITUTIONS DOM -DOMICILIARY OFFICIAL NOTIFICATION OF DEATHS During 1992 .. the unit continued The c0/ iec1ion of information on Deaths was done by Place of Occurrence.

to collect and process data on Deaths occurring in the country.
number of deaths is the declining Mercy Hospital reported An area of concern show:-St. Joseph Amsterdam Hospital unit for the whole country; all deaths and 9.

-246, totaling totaling 1,568 as against the total This comparison 1,350. s. No notifications of deaths at the hospital number ofDeath forms sent to the shows tha1 the unil is not notified of from hospitals in Region 5.

7 were received reported to the unit.


Three (3) hospitals -239, Georgetown Hospital- 1,083 and New 3 Table 2 10 LEADING CAUSES OF DEA TH -ALL AGES .l.

Ci.;:r,t;hrm·asi..

:ular J)j,,.;t;.

;a:-.1,;:sc 430 •438 2.

EmJ.-ocritl!t.!

Inunmiit·,· 1..\.

Metabolic I)isonkr:- Disca:--i.::s ,).

Cou<liiions on�!im1ting ll1 the peno<l perinatal 5 DiscilSi:S of th.

: olhi.

::r p;ms or :-.ys!cm the U.igcsrivi.

: 240 · 259 270 • 279 760 • 779 410 •414 510 .

579 6.

Di .

.
579 6.

Di .

.

;,i:ases of pulmonar y i..:ir..:ul:1- tion auJ other fonns of h�art <lis.

;:asc .JCI5 · 429 i.

Other <lisi.-:ascs tory sy�tem ,)f the respira­ 466.

480 • 519 8.

Dbea,,c fonnluµ of the t>lood organs nud blood 9.
111 280 • 289 001 • 009 401 • 405 177 132 93 86 79 78 64 55 50 40 Tablel DEATHS REPORTED TO HEALTH STATISTIC$· JJNf[ BY REGIONS -1992 REGIONS HOSPITAL OOMICll.ARY TOTAL 59 68 781 10 59 68 781 217 35 252 I JO ----�--------�-�--�-------�-�----�--------���------·�----��-�-----------�--- 179 107 72 Total 1.243 1,350 ---·----------------- 107 IMMUNIZATION RETURNS The Statistics Unit continued to the Unit was processed, children ages O - 4, that is the most susceptible a greater emphasis was placed cm the analysis of vaccines given to sub-group o(t:be nations children.
to process data on Immunizalilm, While all information subntitted NOTIFICATION OF CO:M:MUNICABLE DISEASES During 1992 the Health S information Unit collected, Diseases.

on communicable/Notifiable tatistics collated, analysed and administered all The Reports of weekly Centre (CAREC), has improved.

totals The unit and cumulative to PAHO/WHO and t:be Caribbean Epidemiology was able to send atfall,reports to CAREC for 1992.

5 All notifications number of cases of the rnrious diseases notified worksheets.
for 1990-1992. to Statistics Unit coded and transferred were edited, received Table 5 shows the The total for Malaria 10 June January -1991 was reported for the period January to September and for 1992 - Pulmonary Tuberculosis decreased in !991 and increased in 1992 by 48 cases.

, under 5 years and over 5 years has increased in 1992, but this figure is still under Gastroenteritis reported.

Hospital This total does not even include a proportional treats part of Region 4 population.
notifications from Georgetown Hospital since the Diarrhoea increased in l 992, but this figure also is under reported.

Among the gastroi the 3-year 1991 and decreased period.

ntestinal dysentery diseases decreased in I 992. notified, the figures in 1991 and increased over show that Arnebiasis has decreased ed in in l 992; Typhoid Fever increas Overall, Statistics the reporting L:nit Diseases will be working along with the Epidemiologist of Communicable system needs to be improved.
The Health towards this improvement for I 993.

The main difticulties faced by the Statistics Unit during 1992 was:- Staff, Staff to complete ( I) Reluctance on the pan of the Hospital the Nursing especially (2) Inaccuracies to despatch (3)Failure and Health Depanment in the reports; repons to the Medical Records Statistics Unit on time.

the Midnight Census; In 1992, the unit implemented Aishalton.

Lethem.

of the rapid turnover because Aishalton Mabaruma and Pakera Hospitals, no reports of staff.
But to date the system at Hospitals that were not doing census it was re-implemented repons, such as at Mibicuri Hospital and were received from Pakera The unit will do some on the job training on its site visits to the hospitals.
PRIMARY Hl;.AL TH CARE To meet the Ministry's Policy groups at the National of presenting and monitorin the Primary g services of the various Health Care System was and District level, population d. introduce This system being submitted is maintained to the Health Statistics Centres Unit.

by all Health throughout the country with a monthly report An average of 77% monthly reports were received, checked and filed.
6 arrangements principles At present, fundamental the form of quarterly information for decision and annual making.
are being made to have this information could be appropriately of information system compureriied so that the put in place for feedback in reports to those who provide the basic data and to users of such REGIONAL HEALTH SERVICES MATERNAL AND CHILD HEAL TH PROGRAMME The year under review started with the usual M.C.H activities region, Facility which were ccnducted in all the services staff conscientiously.

despite to take health care to the population.


the conditions to more than one Health provided MATER!\AL HEALTH in Pre-Natal mothers attending under 20 weeks were also on the increase.

for 19962 as canpared The Family Sparing clinics with 1991 Haemoglohm levels admitted clinics under I 0 for 1992 than 1991 and all methods increase: were recorded and there was a drop in the still deliveries were available.
more birth ra in 1992 compared There was an increase Those admitted m ore clients grams showed a slight domiciliary with 1991.

Region probably due to the number of midwives operating recorded the highest in this area.

4, East Coast Demerara number of iomiciliary deliveries.

CHILD HEALTH at the Child Health The attendance the food supplements continues to be low priority activities.

being supplied on the clinics clinics showed a increase.

to some health facilities This increase in the regions.
as staff have now become engaged due to \\IIS probably School health schedule, in other Quarterly population E.P.I evaluation and to ascertain meetings were conducted to assess the immunizatiim that targets were being met status of the 0-1 There was a high percentage to the Measles month activities workers used this m onth of activities O.P.

V. Tl.is was probably :11easles.

which was aimed at eliminating due Health to susceptillle clients.
other antigens in all the antigens to administer in the regions of coverage except 7 ll\L\t lJSIZA TION Vaccines follows.- were available in adequate supplies throughout 1992.

The quantities ra:med were as DPT 0 p \.

1vleasles BCG T.T OT Yellow Fe1·er Doses 120.000 Doses !60.000 Doses 32.000 27.

000 Doses 75,000 Doses 35.000 Doses 3 5.000 Doses Quanerl\' population E P I evaluation and to ascenain meetings that targets were conducted to assess the immunization SlliiUs of the 0-1 were being met.
The 1992 targets was as (olfows:- Target B.CG.

DPT OP\" Measles 1991 1992 or 9L6% or 84.18"/o 17,267 15.820 14,536 14A38 or 83.6% I 3.951 or 80.7% 18,137 or 87.6% or 79.3% or 87% or 73 .4% 15,891 14,377 15,813 13,308 seen.

there was a high percentage As can be was probablv Immunization to administer due to the Measles with the view other antigens of coverage month activities Health of eliminating to susceptible measles.

clients.
clients.

in the regions to accelerate Measles workers used this monmofactivi ties in all the antigens execpt O .. P.V.

This At the end of this campaign were reponed illnesses an measles and blood samples were taken.

The results were as follows:- surveillance of rash system was set up.

A total of 43' cases Sample taken Discarded t ; I I Negative 26 3 Rubella Dengue Allergy 2 l As can b: obser :ed.

there was an increase cases of rubella campaign samples ,c1,d 25 of measles were detected.
positive in the number of cases of rash illness after die were detected from samples taken, but no positive • 8 Health Education Health Education CenlreS.

activities continued at Health TRANSPORTATION to be a problem in the hinterla This continues years it was recommended that fuel be supplied activities nd regi>ns as fuel is ver, costly.

For the ensuing from tllie E.P.I.

p rog,amme to effect E.P.L COMMUNITY RESOURCE PERSONS Resource Person continue to work i.n areas identified with Nutritional problems.
The Community These persons monor illnesses be commended for their sterling these persons be given a tangible have been doing a good job canying out their home \'isits and advising parents on in the family and referring clienlS They must to the health workers at the Centres.

aal it is recommended that contribution done.


sum as remumeranon for their wod: to the health system, BUILDINGS Many of the Health Facilities done, so that Health Workers in the regions need up-grading or mahuinance work needs to be could work in a more tonducive atmollphere.

Target B.C.G.

O.P.V.

D.P.T.

Measles TRAINING 1991 1992 17),67 91.6"/o 83.6% 84.18% 80.7% 18,137 87.6% 87.1% 79.3% 73.4% education In-service included, E.P.I., Monitoring.
to health professionals in the regions continued The topics dealt with AR.I., Primary Health Care Infur1mtion system, C.D.D: and Growth Eighty (80) persons were trained.

COMMUNITY RESOURCE PERSONS Resource The Community problems.
parents on minor illnesses They must be commended tbr their sterling Persons (CRP's) have been in the family and refening These persons continued to work in areas identified 'with Nutriti onal doing a good job carrying out their home visits clien ts to the heaih workers and advising at the Centres.

contribution to the health system.


9 \ The MCH clinic attended ante-natal cenm:s these services continue clinics to monitor other services the health of pregnant womai, during 1992. ii !095 women for infants and the elderly were also offered at the health were utilized by 3251 men 5049 women O\ffthe age of 20.

DEPARTMENT Of STANDARDS AND TECHNICAL SERVICES /LABORATORY.

X-RAY, DENTAL} MISSION STATEMENT and monitor To establish Svstem must function the top decision makers in the Ministry.
norms and standards and to serve as a channel within which all compooents of the Health Care for issues from the heads of technical Services to BACKGROUND to the establishment During the vear I 992, this Department respect it was not given any priority within resources ad hoc manner by some departments.

in institutions standards was dormant fbr yet another year.

continued to be manned by me Director alome With of norms and standards, the Ministry.
this activity was constrained rminly because Coupled with this.. was the lack of skilled human to effect the necessary work.

In terms of monitoring of saandards, this W11S done in an The Private Hospital Inspecro,ate that should monitor during The main activities technical services department in the Ministry X-Ray.Physiotherapy, the Ministry.

Dentistry are Regional within The Technical Laboratory, the year in which this department and Pharmacy.
was involved were in refationto the report tbroogh this Services that should HOSPITAL LABOR:\ TORU:S REGIONAL LABORATORY SERVICES the year, many of the laboratories suffered ftom inadequacy of human and material are 8 laboratories for which the Ministry during 1992.

The non-functional status of Health has responsibility, of the labol'IIOfies was as a result oflack year, few of them were headed by qualified only 5 Of those that were functional during the Throughout resources.
There were ttnciiom!l of persrn•nel.

Medical laboratories of these laboratories f.:chnologists had qualified In this regard, only technologists.

Technicians Multipurpose Laboratory New Amsterdam, West Demerara and Suddie Aides also played a major role i11 the running cases ofSkeldon andLethem hospital.

10 � TRAINlNG achievement during In October a programme One significant development.

throughout six months programme.

the public health system.


A I 992, was in the area of trailing and human resource was started to upgrade lfle skills oflaboratory aides total of seventeen ( 17) Laboratory Aides embarked on the XRAY There are 9 X ray severly affected conducted see appendix 3 for details.

units with the MOH' s system but the delivey by shonage of staff: To improve the situation, af serivice from there units were was ttaining of X ray technician and ended in November 1992.
There was also an imufeqate of films and stock drugs PHARMACY The Government Pharmacy is the maj�r supplier System.

Every health care institution pharmaceuticals of personnel.

better whom it was hoped would assist in this department after upgradilg their skills.

was pervasive in the health care system.

off than the other This situation regions.

provides a pharmacy service.


During l 992, inadequacy of pharmaceutical throughout the of Public Health Shonage was less acute in some areas for e.g., Rq;ioo No.

6 which seemed to be prompted the tnieing of pharmacy assistants Anothtr major problem was in the area PHYSIOTHERAPY SERVICES Int rod \!.lliQll Services, The Phv,,otllerapy many difficulties which persisted pertormance of the various Georgetown.

Guyana.

Ministry of Health.

continued of the to plague the Services.


The following is an overview of the units which comprise the Physiothel'l9'Y Services, Ministry to fuaction favorably inspite of Health.

STAFFING To ensure that the various Depanments effectively, l 992 the Physiotherapy deliver it is imperative Services patient quality care.

can performance the fulldions required of them that the staffing needs of these Departaents be addressed urgently.
was once again affected by limital skilled In personnel necessary to EQUIPMENT/MAINTENANCE AND PURCHASE General obtaining spare parts.

Reasons for this difficulty heing: equipment maintenance was done routinely except for the difficulties experienced in 11 I.

Manufacturing over fifteen to twenty date of the equipment( most of the equipment years ago and many companies now do llOf e:mt.

have been bought 2.

Origin of the equipment.

to access spares.


difficult a few were assembled in Russia and Geomny which made it 3.

Those acquired through gifts were without handbooks or manuals.

These was no purchase in the last fifteen to twenty years inspite Services.
Physiotherapy made by the Ministry of Health for Physiotherapy equipmem or supplies of the orders and needs short listed by the Head of the PTOLEMY REID REHABILITATION CENTRE The ph;vsiotherapy the entire services year of 1992 and these extended offered were both Therapeutic Department at the Ptolemy and Extra Curricular.

Reid Rehabilitation Centre to the Convalescent Home in Durban Backlands.
delivered services for The SPORTS CLINIC -HOMESTRETCH AVENUE was manned by two (2) Physiotherapy During 1992 the Sports Clinic supervision necessary treated.

sometimes for a Physiotherapist However.

difficult due to the severe to maintain.

,if a Senior Physiotherapist.
Clinic Since the Sports to be on duty so that patients Assistams under the is a "first contact clinic, it is can be adequatdy assessed and of p hysiothenpists this was staff shortage, primarily FUTPRE OF THE SPORTS CLINIC was started during the 1970s when it became increasingly along with the regular wide range of patients seen at the Physiotherapy difficult to treat at the to continue The Sports Clinic Sports personnel Department allowed through the Principal that its needs are met promptly.
or curtain dividin,: and supplies equipment \,,,lls Public Georgetown at its present Physiotherapist Hospital location s, the sign , the access will be dealt with promptly ft is therefore suggested that the clinic of the Ministry of Health be under the management This would ensure and To this end it is hoped that the matters of the treatment room, and its various needs in relation the efficient running of the clinic to the clinic to by the Ministry of Health.
;;aw participants patients The clinic youngest oldest patient weight lifter.

The from a wide range of sports ofVlll)'ing ages and of both sexes.

were a 13 year old male football player and a 9 year s seen were a 69 year old golfer and a 71 year old calisthenic old male athlete.
The participant/former *The most frequently s from calisthenics, arts, martial seen were injuries from football, lawn tennis, rugby, swimming, table tinnes, grass track and motor cricket, and basketball, athletics, weight lifting, racing, power lifting, body drumming., volleyball, with fewemumber building.

12 badminton.

jobbing, dominoes.

the clinic walking, chess, squash and cycling.

boxing, dancing, netball.


golf, gait racing, (seen fur the first time at *Common injuries miniscus injuries back), and contusions were muscle and ligament strains (mainly of the lower extremity and *Unusual conditions Lumbosacral Venebra.

"Writer's of the Venebra.

Patello Compression Disc.

Intervenebral seen durinu 1992 were Beniim TIJillors.

hernia, Cramp'', Belvic Inflam�at0!1' Disease.


Venous Statis, Femoral Over-use Syndrome and Cervical transitional Anterior Prolapsed CQNCLITSIQN The vear 1992 was a fair one for the Physiot equipment patients.

urgently However.

addressed.

and staff.

the depanment the shonage herapy Depanment.


Despite problems and functioned efficiently and ffovided a high level of care for needs to be to be a pressing continues of Physiotherapists DENTAL PROGRAMME OBJECTIVES I.To pmvide appropriate and prosthodontic professional dental and para-professio nal staff.

care to the population through preventive.

restorative.

surgical ormodontic.


periodontic, endodomic, both the Nalional Health Service utilizing 2.To acquire capable and train appropriate professionals such services to the population.

of providing and para..: pru!essional in sufficient numbers.

13 ITE\l ,± TARGET SET FOR YEAR TARGET ACHIEVED ANALYSIS OF SCCCESS OR FAILURE I. Prfvfntivi: a Flouride programme measure�: mouth rinse -one area.

Not achieved Due to lal± of plastic bottles ., - C11ratiyf a.Oral surgery mea�uri:s: .
Due to lade of anaesthetic I 0% achieved needles, etc.

b.Periodontics.

5% achieved J.

Training a.Dental 2( Staff Auxillary School ' Due to lack of materialsf111Struments etc.

6 studenls graduated The main problems of the departments are:­ Budget allocation is very limited ' Trained personnel the job.

leaving TOTAL EXTRACTIONS DONE AT NATIONAL DENTAL CENTRE: 1992 JANUARY, FEBRUARY, 1992 "v1ARCH, l 992 tl'RlL 1992 \L\'L 1992 J, NE.

l992 J vl Y. l 992' AliGUST, 1992 SEPTEMBER.

1992 OCTOBER.
1992 OCTOBER.

l 992 NOVEMBER.

DECEMBER.

1992 1991 TOTAL 1,822 l.004 1,805 2.426 2,153 1,655 988 208 No anesthetic/needles, etc l,094 I.

773 Ll.11 16,445 l4 CONTROL OF COMMUNICABLE DISEASES for the Control The Di,:fsion AIDS amd Hansens Following Disease.

�re the summaries Diseases includei;Epidemiolob'Y, of Communicable Each of these Units has a manager who reports to the Director of the activities of each of these umis_ Vector Control.
EPIDEMIOLOGY DEPARTMENT This department was re-established in ApriL 1992 after se11eral vears with out the employment of a full time Epidemiologist.

With the threat of Cholera hovering over Guyana.

most of the activities were directed and establishmen diseases and man3!fl!Tlent of acute diarrhoeal to cholera to the surveillance.

t of a mechanism to respond when it arrived.

Workshop :\ massive health education drive l,2,3,4,5,6 and !O.
in Region I. were held in Regions was undertaken and seminars CHOLERA In November I 992. an epidemic of cholera Sub-Region end oft he year, a total of 556 cases of Cholera were reported.

brolr.eout in Mabaruma.

of Region l. Later there was an outbreak on the Essequibo Coast.

region 2 At the NATIONAL Ams PROGRAMME The '\kdium Term Plan 1992-1997 The main strategies include:- for AIDS was rorrnally launched on March 13.

1992, Surveillance Management !.


Programme 2.Epidemiological and Control 3.Prevention 4_ Prevention of transmission materials/equipmen intected of perinatal 5 _ Prevention o.Provide health care to STD/HIV infected 7_ Provide 8.Reduce socio-economic through t support to STD/HIV infected transmission of sexual transmission blood/blood product impact of STD/HIV/AIDS pCfSOIIS and AIDS cases persoos and AIDS cases Regionalisation in Regions and 9.

3.4.5.6 of the programme continued apace.


Regional AlDSCommittee were established Epidemjolo11ical Surveillance Efforts were made to strengthen the laboratory facilities in Regions \·1 and VIL 15 The L,,<:: of filter paper for testing of population in remote areas (Led1em) has started.

SemireJ sur1·eillance for HI\' among ante-natal persons is in progress.

Infonnation Education.


Communication .-\ comprehensive package of Education the .\linistr1 on .-\IDS Education has been prepared for use in Schools and is with Rap sessions/lectures complex: Beacon Foundation.

Leary Church Conference.

Eve session distributed and the farm were held with workers at G.P.S.

's Head Office -Georgetown .

- of Agriculture: Education Annual Police Officers' was material on HIV/AIDS Staff at \1inistrv Groups and Clubs.
at everv Two .-\IDS Linkage Educators were at work continuing activities with paresits:, Teacher's Association.

was established with the Youth Services Unit of the Minislry of Labour.

World ,\[DS Dav 1992.

"Theme I st December.

1992.

Activities Health.

Teixeira.

Ms Gail Cultural presentation in front of Guyana Stores i\linister "AIDS A COMMUNITY included Radio orogrammes Church being the Guest Speaker.

-Quiz Catch; Limited, of Health.


Ms. Gail Teixeira COMMITMENT' World AIDS Day message by the Senior was observed on of Minister Man in the Street; a Rally and SIJeet, with the Honourable Prevention of Transmission and Treatment STD/HJV{AIDS Treatment protocol is being studied by Health Care Workers for implementation.

Phvsical facilities in Region If 5 for treatment of IDV/ AIDS patients have been improved.

The follow-up of social shonage of STD/HIV workers cases and contact at the GUM Clinic.
tracing have started in a limited manner because of 16 AIDS IN <,llYANA January • March January · March April · June July "' S0plo1nhcr October · December fotal No.

01' Cose� by_ Trans!lili.wm rvlalc 16 29 22 J() 106 l lEMOPI !ILIAC TRANSFUSION !VDU CIIILD !IETEROSEXUAL HOMOSEXUAL BISEXUAL UNKNOWN TOTAL .

.

.

.

- .

.

.

.

--· --- ..

Female ,� 14 I IJ 18 54 .

2 I () 2-W 65 3() 37 J'lO i .

-I I. I ::: .

- , -=- - · "' cc X - C - :c; - C' C - C' C' C' - C' I - =, en C' .

.

.
.

.

· < - I - � ·" ' " , ' .,,. "'

- § "' , C' - ' C' £ - -< 0 -0 I 0 - "' '"' - - D -r;- I I .

, - - = ' .- D er.

<r , 0 0 · , :O - C , .

.

--i ro NATIONAL LABORATORY FOR INFECTIOUS DISEASES Equiprr.enL pro\·ided The position is the same as at the end of 1991.

Tm.t is, all items of equipment by the E.E.C.. PAHON/HO and Ministry of Health a.iein working order except a)one (I) Varion ELISA Reader and b)one small vacuum pump A replacement Reader is in use The pump is being serviced.
has been requested reader from PAHO/WHO.

In the meanwhile a second Vanon Performance: 1991 figures in brackets Tests Done Coofinne d Positives VDRL-B.TS 3355 (3550) 195(114) Others 17.796 (15,234) 3,074 (1,545) HB A -B.T.S 4,094 (3,726) 83 ( 104) Others 768 ( 139) 79 (37) HIV -B.T.S 4.025 (4.044) 65 (48) Others 1,695 (784) 312(151) Q,1a!it:, (Qn trol There is internal External Atlanta control on a four monthlv basis.
Control Quality for HIV is one bv CAREC on a semi-annual from kits and the laboratory bass, and for VDRL by C.D C using controls daily, panel control Du Porn ()"ick test kits for HIV, have been supplied to New Amlterdarn and Suddie.

During the vear.
During the vear.

the Laboratorv activitv and report implemented a decision to test alHIV samples for VDRL/RPR HIV Sl 'R_VEILLANCE During 1991. sentinel There -v.as no target surveillance in Geornetown and environs -see appe ndix 5 for sentinel continued surveillance results - 1992 to be the main activitv.

group survey.
group survey.

Sentinel Surveillance Results -1992 (F:gures (also percentage for 1991 are in brackets) with I 991) differential Tested Confirmed Positive Low Risk group 1,085 (832) 23 (9) (+1.0) High Risk group 24 ( 107) 7 (43}{-1 LO) B. T S. ( control) 4,081 (4,044) 69 (48)( �o.s > a)The low risk group was composed from the G RP.A mainly of ante-natal mothers and some persons sampled b)At about the middle The fitures laborarnr: The ,v,,1ern at the GU.M.
clinic for the identification/sampling beha\x•;ir of 1992. s for I 992 cannot amples from the high risk will be reviewed therefore be considered came to the as a reliable High Risk picture.

with high risk of persons group no longer in 1993. c) In 1992. onlv the Blood Transfusion samples confirmation clinics of an ELISA positive Service came to National result were used as the control .

Laboratorv for Infectious obtained.

from private group, since the Diseases already mainlv donors for I. F A .
d)A n ew approach to the surveillance of hinterland/mining workers will be developed in l 993.

Private Laboratories known.

four private As far as is the ELISA method supplemental testin1.1 - laboratories and the DuPont HIV-CHEK Positive results the GUM clinic � .

or directlv were engaged throu1.1h either in HIV testing during obtained were 1992, using both for submitted to N.L.

I.D.

fhe following Figures are not available from the others.
total number of tests have been submitted by two of the private laboratories Tests Carried-ou t Confirmed Positive 5,945 40 20 II VECTOR CONTROL SERVICE OBJECTIVE ··Take positive prerequisite to economic steps to reduce the incidence of malaria both as a health measure and as a development in areas of high endemicity and of economic importance The Vector Health.

Control Services is a Sub-division of the Communicable Divisioo in the Ministry of It is directlv responsible for the Control of Malaria.
Filariasis.

and Aedes Afgypti.

This service the field hinterland m Health s,.·ste provides operations.

planning, It also provides tropical co-ordination.

administration, supervision diseases support aad technical to in the for the population the Regional facilities free areas.

through systems for the Malllria diagnostic and coastland.
and surveillance The malaria programme CH.W's and laboratory of outbreaks for control receives technicians especially and collaborates in the hinterland with the Armed Forcesand .

areas support from other Health Services Pers0111el such as Medex.

other agencies Status report - 1992 The number falc1parum.

and 15.83 l (39 8%) to Plasmodium of diagnosed cases were 39.

702 of which 23,717 vivax and 154 (0.38) (59.

7%) were due to Plasmodium due to mixed infection.


These cases were 5 <l2% less than those in 1991.

This decrease vivax cases The age group most affected reported.

by bo.th of P. was among5t the number P. falcipamm am P. vivax was 15-29.

Males represented vtvax.

(30%) of persons affected by falciparu m and 20.9) oftho.1e afrecte d by P Attempts respective Regions, ofinse,:tic1de were made at stratification which were previously benefit.
(DDT) would be greatest of the programme in order to give prioii:y to areas within free of the disease and' in critical ueas where the use Residu.

;: House Spraying was carried out ro a minimum in focus areas with lie following results in the hinterland The main vector persists.

Cases were epidemiologically is identified classified as being introduced on the ooastal areas.

as An.

darlingi, still on the Coast land An.


aquasalis The majority coastlandes of the cases diagnosed at the Central who returned t o their home from the hinterland were from Malaria Lab in Georgetowi, areas.

21 The presence or there was h>th rccq1tivity An.

aguasalis, a proven and vulnernhility on the coast Cnscs were diagnn<1<.

"\1 vector of malaria in appmprimc 1ha1 �orui.ilions, mean I lhc coasl within Falcipanrm 24 Vivax I I Mixed TOTAL Given these conditions.
introduced investigated had blood smears parasitologically the majoritv examined of persons from houses where cases were dassified Fever cases in their immediate neighbourhood as being were also IMPORTED CASES OF MALARIA a)Region !

',;o I b)Georgetown SPECIAL PROJECT 89 cases Border - 4 cases (2 Suriname, Guiana, (from Venezuela/Guyana Delta Amacuro -area) l French I Venezuela).

From September This project with the highest emergency of malaria incidence I 99'.'.

a project provides for: .


Funds were provided commenced assistance funded by S.LM.A.P to the programme ofUS$50,000.00 those areas 1,7, and 8 - in Regions for a total Drugs ,1) Anti-malaria Reagents b)Laboratory c 1 � .

Supplies .1boratory d) Stationerv e I Repairs to infrastructure This prn1ect was invaluable will conclude at the end of February 10 the programme and enhanced the during otlered 1993 The assistance in the above regions.
activities this period During the _vear 1992, deaths with Malaria were reponed from the foHowing Regions.

associated Region l 6 G/town Nil I Hospitalization Regi011 of severe malaria patients was routine during this period.

Cases hospitaliz ed bv Region I 1 G/town 93 persons 185 26 105 16 27 76 166 TROPICAL DISEASE LABORATORY is managed Challet}.

technologist This laboratory Pascale Another (l\lr A Bovie) During and serological tests.
by two technicians This technologist from Central left in October 1992 when her contract Medical the year this laboratory came to an end.

to assist in her place hematological, carried out various was then assigned laboratory and was supervised by a PAHOrfechnologist (\Is biochemical.
309 Number of Patients seen: Amount of tests 704 Skin scrapings 4 t ( 18 positive done: aniasis) for cutaneousleishm AEDES AEGVPTI CONTROL INTRODUCTION The entire fever coastland is infested with Aedes Aegypti, the vector for dengue fever and yellow OPERATIONS nt of all containe rs holding The treatnlt' Due to J sho1 •age of staff, wards within index ,ti Tice Aedes Aegypti b)The average in the area population UL V fogging was also carried areas.
out in selected water was carried out during Georgetown the �,ear for treatment was selected depending upon in Georgeto,,11, Also.

vario:.1s containers treated.

buildings with high concentration of persons dwelling daily were i!15pfcted and Hotels Schools Cinemas Ministries Hospitals 138 visits 64 visits 22 visits 60 \isits 28 visits the year 1992 weekly (;\fondav.

During filariasis smears were examined and 122 ( 5 .2%) were found to be positiw from 8.00 pm to 11.00 pm).

A total with the parasite.


Wednesday and Thursday clinics were held at the Vector Control Depanment for :\iicro­ of2.344 RESEARCH A study to compare with CA REC collaboratio·, the available diagnostic toob for lymphatic filariasis was carried OOI in ENTOMOLOGY UNIT The Entom(fogy in (,uvana diseases information.
nd advice Unit continued to assist This was undenaken by providing in the elfons towards of vector-borne entomological the control both epidemiology/ Contml Services for operational to the Guyana Vector decision-making.

FAL!l\ .\::iilJ' STUDIES al Funher progress continued on the systematic of the mosquitoes of Guyana.

In continued to explore and place emphasis on the systematic on the other general activiries of mosquitoes rather than on the Anopheles.
1992. the depanment studies We are still time can be considered premature.

in the process of confumed determination and therefore derails at this bl In I 992. we embarked on preliminary studies on the vector was placed intermediate of hosts of Schistosomiasis both species and their biology distribution of these studies will in Guyana.

Emphasis including The details some details on aspects on the identification of their be available in the 1993 Annual Repon.
HANSEN'S DISEASE CONTROL PROGRAMME This repon c,·,vers possible the period based on the objectives carried January to December 1992.

The acti,ities out are as far as set out in the Project Document 1988-1992.

24.

LONG TERM OBJECTIVES To enhance and leprosy health the eftectiveness control ser.ices eventually by initiating leading and accelerating the process to the eradication of the existing medical services in the treatment control ofleprosy ofttie disease.
ofleprosy patients into the general ACHIEVEMENTS OF TARGETS were fairlv well met.

There was an increase with the figure problems prevented for 1991 (36) No pilot the projects from getting - Targets ' as compared certain contributed in t!ie number of new patients proj�t for integration as also off the ground.

surveys.

for 1992 (48) was implemented These constraints set for contact examinations and school to a marked shortfall in the targets patients at the end of No.

of domiciliary year No.


of domiciliary surveill No.

of patients No.

of patients ance on patient released released from treatment from surveillance 30 169 44 51 NEW CASES cases No.

of .... No.

of consultant clinics No.

ofrura!

( 14 locations) No.

of contact Proportion clinics held held.


of disabled examinations among new cases done 319 1:48 48 102 180 sessions PREY AL ENCE RATE l'' 1.!ar '88 '89 '90 '91 Popul;;(iou 756,000 756,000 756,000 756,000 '92 756.000 Pn .. "\-ak1ti ..... 0.16 0.13 0.10 0.11 0.1 CONCLL'SlON of integration have been fairly well executed.

The objective targets Hansen's Disease and short term therapy seems to be mueh preferred.
Complaints has not been realised and needs to be addressed attitude There is a general improved seriously of Guyanese has been good.

All other to Since the introduction register there of MDT in December.

1981 and the releases has been a marked fall in prevalence rates being 0.25 in 1992. of many pnients from the FOOD AND DRUG DEPARTMENT O\'ER\lEW as the Regulatory Agency, continued its mandate to ensure and nutritionally acceptable foods.

safe and efficacious drugs and good The Food and Drugs Department.
safe.

sound.

wholesome quality potable ... . '

Accordinulv.

its supporting Safetv.

water reach the consumer .

its dvnamic it continued of 1977. to achieve regulations has orchest To this end the department role to administer and enforce the Food Mid Dn1g Act and its primary objective rated the following of consumear Protection sub-programmes.

and I } Good quality 2)Food Contamination Monitoring Control 3)Drug Quality 4)Water Qualitv Control 5)Pesticide Monitoring.

Residue The accomplishm analvtica!


services services consu!t�wry ent of the Programme and Sub-programmes and The enforcement standard.

of mandatory activities.

and inspectorate revolved around tile areas of education prog,ammes.

The departmen t's total through-put perusal e,:· the data as presented in Table I. for January to December.
l 992 could be �ined from the worthwhile It is there was dramatic decrease failed to achieve targete Chemistry, non-function Microbiology Drug Chemistry, and the to note that as a result of the numerous constraints plaguing the depanment.

in the various analytical activities over the past year.
They have d goals and many of them including and Forensic Drug Microbiology the Food Chemistry, Water Laboratory work being carried out by the Food and Water have Ileen practically ing with a minimum of analytical Excise Laboratories.

HIGHLIGHTS Education P rogramme During the nine months of the year.

( 18) eighteen department basic aspects requirements of food hygiene.

for food factories.

for employees ofa number of food factories.


Workers were educated on food poisoning, personal hygiene and minimum food safety seminars were held by this 26 2 Unlabtelled and unlicensed foods ,vas effected to remove labeled, ..\ campaign improperly and blown cans and expired monosodium sauce and ground glutamate spices damaged.

.

tomato foods.

were seized and prohibit the sat� of unliceosed, unlabelled.

rusrv painted and rec.du, :rowns.

improperly packaged.

Quantities of foods inclu ding riilkpowder.


cassaretp, sardines.

cassava ketchup, oatmeal.

mustard and destroyed by officers.

3 Factori es ordered closed food factories ot/28) twenty-eight operating ..\ total unsatisfactorv \1illing Company be operating others under grossly and Ricks and Sari Industries insanitary conditions, substandard Limited.

factory records or unsafe products.

were ordered found during inspection.


were found to have produced conditions to cease opera tion as a result of the National This illcluded Some faCIDries were tound to were inadequate.

while 4 Import Control Food and drugs Inspectors that foods entering necessary the country are safe.

All Customs documents the me scrutinised and by Customs Office;s. Physical stamps and sampling are affixed prior were done by Inspectors to processing when necessary.
Impon: Control worked in close collaboration with CuS1Drns Officers to ensure examination Otlicers are stationed Inspectors also make frequent the labels and the condition at Springlands \\'harf and Timehri at various International examining Airport.

Food and Drugs the qmlity of Foods.

wharves, checks of packaging materials.

5.

National Food Safety and Control Committee This committee and enforcement expedited countrywide.

is convened activities.


once a month various to a plan and co-ordinate This ensured that a unifonn and hanno.uious programme is Food Safet\· 6.

Technical Committee of this department form part ofthe Standards \)lficers , ,t· the Guyana of food standards.

,,rnrnorion National Bureau of Standards, Council and thus participate and Technical Committee and in lihe formulation 7.
Training of Food Inspectors One Food Inspector was relation to the "Strengthening of food Cootrol exposed to a 2 weeks FAQ Sponsored Woibhop in Barbados in Capabiliti es in responccto Cholera".

The Senior health Welfare Canada for a period of six (6) weeks.

Food and Drugs Inspector was attached to the Health prO!eetion of Branch 27 PHYSICAL METHODS LABORATORl There are I IO) ten pieces are non-functioning.
of major analytical instruments housed at this department, ail of which (HP LC) (A A) chromatograph are as follows: liquid These instruments I High performance ii & iii .\tomic absorption Sepectrophotometers llltravioler I\' (UV) v Gas Chromatograph ( G v1 Infra-red v11 Gas Chromatograph ,·111 X-rav diffraction spectrometer 1x 'luclear " Sepectrophotometer (GC -MS) \isible C) -Mass spectrometer Gas liquid chromatograph magnet resonance spectrometer otometers spectroph (NM R) (I R) ENTRAL BOARD OF HEAL TH Board of Health The Central its staff complement records/Clerk.
continued its operations during 1992.

The department maintained which comprises the Secretary to the Board one (l J Typist/Clerk and one The life of the last Board came to an end in October.

appoimment yet fuH1· constituted Amsterdam The nominee Cabinet's Ministr\' of the new Board was not received namely failed to name a representative Organs for the National Congress Cabinet Development.

for the 199 l and formal .ipproval the end of June.

1992.

Then Board is not .


;pproval of Regional since two organisations of New the Mayor and Town Council of Local Democratic and the Guyana Pandits These positions of the Board.

are still to be filled did not approve Council until by the to sit on the board.

was submitted after of the representative named The amendments to the legislation Secretary charging into the Act.

was not put into effect since this would have to be incorporated by the Board was not complete for the The proposal Section.
by Cabinet by the board and which was approved to get guidance services was unable of fees for certain on the Administrative which was approved rendered d since the the residents of Cholera in Region There was an outbreak and educate advise the shortage permanentlv Officer went into the area to assist with the assistance residents of Environmental .
There was also an out-break and monitor a - No I two EHO's spent and control on the prevention Health Officers no officer could have been 2 months of the disease.

Again, there placed in the area to because of in Region 2 and the Chief Environmental of the only two officers who service the situation, take water samples, Coast.

Essequibo Health educate Squatting with the situation.
to take action again these persons has become the order of the days and officers are finding This is due to the number of areas to be covered difficult it extremely by one officer.

The process to attend to cope in very much drawn out and it involves officers having 28 coun ever so often to deal with one care.
AH in all 1992 was a favorable year for the Board and we look for.ward for a better year in 1993 X-RAY SERVICES FACILITY \1abaruma Suddie Charit, West Demerara Regional Hospital FUNCTIONAL ST A Tl3S Non Functional Functional Functional during most of Functional ( year) Leonora Functional Georgetown Hospital functional 1 Fon Wellington Non Functional Banica Lethem STAFFING FACILITY Mabaruma Sudd:e Functional Non Functional STAFF Nil I Radiographer I X-Ray technician (Pursuing studies in Radiography) I Darkroom Technician 29 ML<:i o;-,.
MALARIA CASES IN REG!O'.

'l # 7 1988 1989 l990 1991 1992 PF P\' PF\' 2926 I J 73 20 4119 1655 135,7 924 !054 37 21 2394 2570 14 1059 577 2 2616 2343 4978 !638 S\IE.\RS .

.\CTIVE TAKEN PASSIVE 20462 11060 11020 12645 8694 6382 318J 1792 1012 7283 29156 17442 14203 14437 8295 TABLE: 1,1 -NUMBER OF PREGNAJl,TW�o:N AlTENDED (FIRST AND VISrJSt ANTENATALSERVlCES-YEAR 1992 HEALTH CENTRES NO.

OF PREGNANT WOMEN A Tl'E'IDED Reuion # ":.


Rl'einn # J R•oion 1' ,I ({;EORGETOWN) Reeion # -I (EAST COAST) R•oinn" ,I (EAST BA:-IK) R•oion • -I (Mt:NICIPALl Reeion # 5 Rt'!

!iOl1 ,:/.

(1 Rt-eion r; I 0 320 :?.030 l.593 '.

::29S 950 I .607 i .

:tso J.

(J(,5 I ,IJ1)5 30 TABLE l.2 NUMBER 7 PERCENTAGE OF AT-RISK PREGNANTWO�IEN ATTENDED -A.AGE !YEARS) HEAi.TH CEl'ffRES NO.

Re-J!ion # 2 4 R<-�ion # 3 24 Region# -I IG.

'town) 12 Rt>�on # -I (E/Coust) 10 Re-!


!ion # -I (E/Birnk) 11 Rec:ion ff -I (Munidpul) 13 Region #5 14 Region #6 IJ Re!µon # 10 4 UNDER 15 15 � 17 % NO.

'• NO.

15.0 23 12.2 76 12.1 ".

'� 35 .... •.. ' 7.!

3.7 -1.7 :=-.8 15.

2-1.0 .J.3 ,ti 6.0 9.9 134 17.3 139 9.8 380 8.1 58 t::?.".'

1J6 7.0 S2 1.2 �7 1.2 248 0.8 193 0.4 228 1.2 165 U.8 158 1.03 110 O.J 392 60 IU 106 0.75 1.601 11.3 1.083 8.0 TABLE 1.3 • NUMBER 7 PERCENT AGE OF AT-RISK PREGNANT WOMEN ATTENDED• Ii GRA VIDITY· HEALTH CENTRES NO.
% '<0.

1ST HH Re�ion# 2 81 Re�ion#3 ;49 Re-gion # -t (G/Tnwn) 460 Region# -I (E/Coost) 685 Reg:ion 256 Re�fon .t -I f'.\i[unidpul) �60 Region 379 .

Region# 6 Rej!fun# 10 239 # -t (E/Bonk) if .5 34 25.3 27.0 153 29.0 120 JO.II 173 27,0 140 29.0 [86 28.07 127 - - 27.09 114 3,!09 .

:?2.05 UU7 o_,.o 11.0 i.5, -.5 7.5 15.0 l L5 9 .

.i .

13, 0.4 TABLE 1A • !\'UMBER & PERCENTAGE OF PREGNANT WOMEN ATTENDED FOR FIRST T'ME BEFORE 20TH WEEK OF GESTATION HEAL TH CENTRES NO.
& % OF WOMEN Rt'gion ff 2 Re�ion # 3 Rec:ion # -I (GN>rJ!

{"town t Region #-1 ([ast Cou�r) Re�ion # 4 (Ea."

Bonk) Re�ion # -I (Municipal) Rtgion#5 Rei:don#6 Re�ion # JO NO.

94 791 -189 668 260 192 JJ� l.191 279 U99 •.-o 29.0 39.0 JI.II 29.ll6 l7.J 12.ll 2::.0 39.0 Jl.O 30.� TABLE l.5 'I UMBER AND% OF PREGNANT WITH WOMEN WITH ABNORMAL TEST RfSULT FOR HAEMOGLOBIN AT 1ST VISIT NO.

& % OF WOJl:EN WITH HB.

LEVEL 10 G/DL HE.\L TH CENTRES '10.

OF WOM£NTESTED NO.

% NO.

256 r;.


J Region r; 2 Rt·l!ion nJ Region,:::-' (Gl'Ol"l!t'tO\\ Rrl!ion H--' (East Cna�I) Region#-' ( Ea!t!t Bank) Region Regir,n.;.

5 Region P 6 Re!

!ion P-10 i:; -4 (Municipal) L-P5 1.2-io 1.JJO 687 1.1124 l,-P6 1.886 705 I 25 80.
435 50.4 538 93.0 82.117 820 283 74.2 348 92.0 269 92.0 76.0 951 265 78.0 11.1179 79.0 3,986 '% 25.3 42.5 36.4 H.6 40.1 23.5 22 40.8 39.11 35.5 TABLE 1.6-NU�IBER AND% OF PREGNANT WOMEN ATTENDED AT TERM WITH ADEQUATE FREQUENCY OF VISITS HEALTH CENTRES NO.

OF WOMEN SEEN UP TO 32ND WEEK VISITS UP TO TERM AT TERM NO.

% NO.

% NO.

WITH 4+ VISITS NO.WITHS+ 122 666 n) '1'i 1 Rt•!

!ion Rl'cion # J Region P -I ( Gt•ort!t'ton Region r:f. -i L J.26 ( Ea�t Coast) Region R- -I (East Bauk) Rl'gion #-' (.
'\1unidpai) Rec;ion # :- # 6 Re.gion Region# 10 l.227 283 1.J 1£, 558 IJ� 3118 40 402 33 60.4 308 17 14 46.2 606 54.0 525 47.0 670 54.6 507 41.3 156 55.1 129 46.11 986 332 IJ7 219 75.0 878 59.4 100.

71.

226 - 174 67.0 40.5 - 56.

5.7..iJ 3,548 62.0 2,764 48.1 32 --- TABLE 1.7.

NO.

OF BIRTHS DELIVERED DISTR!BLTlON l"I THE DISTRICT 1¥ OUTCOME WITH PElCENTAGE HEAi.TH CENTRE i+ 4 (G,-tou-n) Rf.

'�Olt # 2 Rl'!

!IDn # 3 Rtt!.inn Re.!

!lnn !

: � ( EiC oast) Re;.n " 4 ( Rt.

'2:iun fi -I (Munidf)30 Re!


!ion ff 5 Rl"!

!itm ,; 6 ff 10 Rt"2ion EiBankt STILL BIRTH� P�I .

• TOT.

fT ... TOTAL LIVE BIRTHS DELl\'ERIES TOT.

FT.

P)I••., ., % UNI .

21Jff ')8.6 .

6 HMI .

58" ; 'N.� .

117 .,�.« "·" .

.

.

1)9.lt0.J" 270 ,HS (1111 .

120 1)5 ; ')6 294 6 i'90 tr .

270 34• 120 .

.

.

.

IA 4 .

.

J .

o.:- .

.

.

.

I. .

.

.

.

l,HJJ I.HJJ '19.

I 11.43 .

O.J ·rARU: !.


I -NI 1\IBf R Ot nils I VISffS IN YEAR nm t'I' ;;1,11v1n:s llllHRIBI \Hrll l'F.RCEl'ffAGE IIION RY l\ffTIIOll IIY AU.

('I.IFNTS.

HEAi.TH (.F.,,.TR•:s NO.

!lt' 1ST VISITS ORAL ll1D NO.

0,11 NO.

% {%1 lllSTRIBllTIO" BY METIIOIJ INJ.

COND.

NO, �·rl NO.

OTHER �-i, NO.

1�- If 2 ff4'$1JUii- H� I ..J.14 Rt·1.dou # J Mt"t!inn ti .J (t;<'Ot't,.lf.•hmn) I.J47 U .J n:,1)1,t C't1WliO 2.Jl6 R\·cion Ri·!

!it1n ti .J ( Re,,;.m # 4 (Munkljml) Rrc.iun 1#.


5 R£"td«mU6 # I U R,·uiun lt.J(j 1.297 1.526 - E»si Bunl.l 1.22.� 1211 J�.

(I lff �.l 11') 34.� 2•) �74 43.0 14 1.

(14 �ll 39.11 (,J 676 SD.2 �J 4.11 llJ 16.11 2ll Y91 41.6 13 11.6 6�4 28.1 JII 34� 41.0 24 l.8 184 ll.D 125 !159 !\I.ft - .

326 311.CI 16 H77 57.4 I 0.116 411 27.0 60 �A M 17.

I �JI 172 12.7 IN3 IJ,6 Hi5 13.0 367 l�.8 15.0 168 211.

I.Q 196 18 4.0 177 11-� NO FIGURES AVAILABLE �19 41 13 1.0 !

(.
(.

)� 44 611 5.0 98 8.11 u•�ou, 4661 4<..J IJ6 l,J 2,� lY,4 Hf6 117 Ul!I 14,1 ABUc 2.2 · NUMBER OF FIRST VISITS IN YEAR FOR FP SERVIC'ES RY ALL CLIENTS WITH PERCENTAGE DIS T RIBliT!ON BY AGE IIFA I. Tl I ('f.NTRES NO.

(lt' 1ST VlSlrS [; ( ·ow�1) Rrgiu11 # 2 Rn!inn f!

J ti .J (G 'fnn Hj R,::!inn Rt·�ion.

# -4 ( Re�iun J.i.

-I ([, Uani.}

R(•f!ion fr ,-1 (Mn11idp:11) R«-!

!iOII JI � lh':!iou :I l• lk�inn It 111 J..J5 I.Jl4 I.J4" ?.Ju.

1t-kt 1,IP>" 15.!t, l.:!

!5 1-- 20-34 1% NO.

2n 'W. "


• 32 ').J 2 ... ,, 134 111.0 (.tr2J lflfl 12.J 1.1154 :?Hit 12.113 uma "'"'A f:?J 1-15 !

':i 1 ft�, 1 1;;(1 14.?

61>H I'"!

11.J 1.113 -�.O (%1 ll1S'TR!8l1TION BY AGE (YEARSI 35 ... NO.

.." NO UNKNOWN '"'* HI.fl JI 7fd lf)7 12.l iH.l 12� ().J 244 1115 (J.llJ I :'H 19.fl fr.J.O 21', 20.•• 0.8 J 2f1 1.4 II.!

1 11.

ti!!

2 H ,--· .


!.-1 f.(1 H NO H(;l'IH� .\\'All h'J It 11,-1 213 15.tt \ 111 I f(dJ l.l 1--·-----· -·#-- - lft.O:t:h --··-------- 1,2-1'> L!A --- IHtt t5.0 RH ... JhH '"J.2 1.3�8 U.� .---�· WJ � u.:: IJk't -·-#· II,� ·-. '

CHILD CARE SERVICES TABLE J.l NUMBER OF CHILDREN (CJ.59 MOS) A TIEN OED (FIRST CLINIC VISIT�· HEALTH CENTRE AGE{MOSJ R•Kltm # 2 R•11hon u 3 Rt'alon # 4 (Oetn·tl"ttnvn) (R�t Cmud) Rt·W.on # .f Rt:f!
:1011 # .. ( [11:i;I Bmtk) Rtr1,tlon # -I (Mu11h'ip,1I) Rt•�ion #� fl,·u;iou # '• fh•l!iOII # fO U-ll 182 Ulil 1M2 l.�93 1.2cm 2.

7.311 1.1�9 J,988 l,7CiU ll -59 789 �.

@6 �.1?7 ,,.264 1,70!

7,tJ7 2.Hl 6,250 5,925 TABLE 3.l -TOTAL NUMBER Of CLINIC VISITS BY CHILDREN {1�59 MOSJ ANO AVERAGE NUMBER OF VISITS PER CHILD 17,976 39,C,JII H �:A l,TH CENTI!

lo: TO"l'AL 0-11 MOS A\'G.i('IIIU> \l�ITS TOTAL VISITS 12 • �•J MOS AVG.ICIIII.O l,Hu-1 # 2 # J Rt•i!ii)h Rt·�iOH 11, ... 26 Rep,tion # _, fGt.
'1M'�tonn) R�l!N>H ti -1 ( 'lust ( ·on"t) 11,IIH I 15JHIJ lk,::km ti -I ( E1,sf Bunk) Rre_ion tt -I (Mu11idri1I) �.

!i92 I0.�33 l{t·l,!io11 7,02(• Rq�ion ti(, IO Rc:�iu111/ 17,49') 5,•)�0 # � ,, ,,.Af ... 2 ...

,., 12.J')l 111,1111(, 15.881 15..JH'l 5,771) �N.

')'J9 9,26H 7 5 5 5 � r, � J .. .

H�.

'Jft-4 5 1117.HJ" - J J l J � 2 J 5 2 J TABLE 3.-1, NUMBER AND PERCENTAGE OF CHILDREN (0· �'J MOS) ATTENDED WITH SPECIFIC 111 NE!>'SiCONDITION FIRST REPORTED IN YE�R .

, DIARR 0' ... NP.
, DIARR 0' ... NP.

ARI �lo SCABIES �·O No.

WOR�IS MEASLES ' '.lo Nu.

No. "'

,.

-· IIULTH CENTRE n) # -I (G,•ur�t'lo\\ Rl·ginnt.

2 Rq!ion#.3 Rt•J.

!ion Rt'j!ion tr -I ( Rt'u.ion Rt'µ.inn # .t {l\"Ju11kip111) ff 5 Rt·cion Rt!.

!ion # 6 tt 1H Rt·ginn N" ,-,, (.t, "'N 16:i J.I 7"' .. , 383 6.1 1049 629 "''·-1293 215 5.-1 412 L2 56(1 117 l Ill J.9 539 fl -I (Ea,t Baul,;) [;1st Coust) 16.

776 217 1911 o.�,5489 15 7,0 I �Jl J'/2 17.ll 582 28 Ll 7.5 -42".'
l),J .J<,2 7.-1 ' - 14 H.I' 14.8 /1511 7.4 590 IOA 161 4.08 241 <i.n 152 LS 128 7.6 277 19. l 213 AVAILARL£ - 301 NO FIGIIRES 5(,.

- 2.8 2165 LI 245 ,,.7 - 6.1 ' L2 9Ji - .

22.'

1.2 .

. '

.

- - - ' - SERVICES f'OR ADULTS AND ELDERLY (211 YRS & OVER) TABLE 5.1 · NUMBER OF PERSONS (20 YRS & OVER) ATTENDED FOR FIRST l'IME IN YEAR, BY AG£ AND SEX 6� M .

844 HEALTH CENTRE 20 - 44 45 .

64 F M F M F M - .

.

- .

- 17211 .�o 781 J6� ••l6io .

- .

.

.

- - .

.

- .


R('ginn #2 Region #3 Rt�ionH4 (Georgetown) .

.

- Regl11n #-1 (E11sr Coast) Region #-I (Ea>I Bank) Region #-I (Munkifml) Rt•gion Rcl,!icm H(1 R, .. �itrn #10 .

- .

.

- .

- - 4J7 IOJJ - .

.

- .

.

1n l35 l�llJ �1)9 .

.

- .

- - :!H� i• ,.01 7ij 170:S 2761 ff77 .

.

#5 H61 .

.

.

. '

UNK F TOTAL F M .

1698 .

�2 - .

.

- - :111�6 - .

- .

.

- .

- .

.

.

.

.

.

5� .


- .,� ll:17 �•uv TABLE �.2 -AVF:RAGE Nl!�IBFR ot· CI.INIC VlSll S PF:R PERSON (20 YRS,� OVER) ll EA LTII ( ENTRF.

H>r ,\ I. V !SITS AVG.

NO.

OF VISITS PER PERSON 11) #2 rl.l Rc;J.:ion Rq"�ion lk�ion #-1 ((;(•ot·�1..·frm fkuinu If-It 1:�,,, { 'oo;,.t) tl4 ( Eo ... 1 IJan�• Kt•J!,11111 Rq1Jon 1q {1H1mkipol) ff$- R,·µlnn tH, R1:l,!ion #Io R<'ulou NO REPORTS J0,�1)8 NORt:PORTS .. .
.. .. .. " NOT APPLICABl,E NO REPORTS 111.1125 211,623 2 I I TABLE 5.5-NUMBER AND PERCENTAGE OF PERSONS (20 YRS& OVER• A TIENDED REFERRED TO SPECIAUSTIIIOSPITA L HEALTH CENTRE NO.

& % OF PERSONS RF:fF.RRF.D U-2 Rt.'f.

!io11 #J Rt•J!lon #..t (G,•orf.

!t'lmrn) Rq.

!ia-n Rt•gion Cmi.tiO #-I ( E:,st Rt>J,!ion #4 { F.a.t.t Bank; R\•gion R('f.

!itm #5 Rt·gion Rt"f.?,ion #-I (!\lnukipuh hf• #10 NO.

1-16 111c, NO RF:l'OIH Rf.

('EIVY,D .l.


I NO REPORT RECEIVED " " " " .. .. " .. " " " " " " " I'> I(,� 0.2 1.2 I :-;:!

_: I II !

I I ' I - I' i ' C< >Ml't >NI NTIACTl\'11 Y --· l>r-1.1cu1L'111;.·nt ,.uppli1.>, 1.11· dn1g� mid 1r, \;h, i l'Rl:Sl·:NT ST:\ll IS (>Bl!

( 1w11r.\l<li1:·1 i·;irn1 ,,r pb,1nn.r:c111i,:�1b tu 1.1ll I l !u,lg.d.ir: RESC >I IHCIS 1 )f!ig fo,t.
suppllc;, Pr,:\ Department -:,,u1,plics unJ al1 anJ !Ht.<t.bciil on lhc b-1sis lif lhc bs.,·nhul Phmma1,:ctH1c:1b \\ ere orJ1.v-rcd lh..: Plmnurn.

:y wilh a huJgc!

"ohlulnc.J Sccrctar:'.t.

Mimslf\ supplies \\en.

: :m:u,gcmr.:11!

itsdf tloc� coultl noly h: of th,: Pennaiwnt h�· ihc prior tippru,aI Durinl!

1bc ,,::u· of I h.·a1lh Ilic hmJ:r 1hrough tlhtaim.

'<l not ,,1x:rm,: l'11hhc I k:allh li1L'ililic"> nm h-..

!h;.'

i'v1i111s1n of I h.::1llh \\ hen tht:y urc needed uc.:d,.
'�l 2 B1b!t.1al that au:: in mnouuts Cm,: JJ l'wj;.·.;I.

I k:,Hh thioug..h lldlh ..:.g.

l'AIIO.

Mah:mal & Child I _!NJCf'I· IIJJl l Oi!l'I l i<knw!i1ms I )1-.tdliu1iot1 Thi� is pn:SL1ttly rc\iucstcd ph:1m1acc,1tiL·ab in a 1im1.

:h fociliti1..·s: h� and lhl'sc Pri\ak' Jund and �tir scrvk1..'s ,1diri1i1..'s I :ire useJ 1..·�;h;d a privulc i:> s.lilsfoc!Or contract,ir.

ro Jdl\'cr y :-.in(.

'.c !he Minism· !he \mious hcnltl1 !lWlllH.

'f Jone u�i11g This <tmmgc1111.


:nl {:,; ,ll\ nf cu:-.l of Thi.• nHmagcmcut focilihdcd kepi fi1r1m•r1.·than Jni!

allachc<l nli.llnh:mincc (lfJ:!.I.UliXd is sysh.

:m Orders l:w thi.· use of ti :>Chcdulc_ me not J(td.1�s There is m1 ofthc <lbulholion \·i.·lnde 10 !hb i I )rug: Scki.

:!mn There lS pn.

:�11!1) im Es.scntiul l)mg l,i;.t \\hid1 \\ a .. l.;vclopct1 of the nci.:ds.

MJni:">lry of I k,1lth Drug.

C1H1imiHi.-.

: tiy !he E!

'lscuti,d .

'i I Sl.

:11..-c!mu l\f l ,,11 H11� �·rvii.·i:;;.


ho1.Jk:, unJ 1nn�ivincE.)

up !p dt!h,.'

pu!, n;!\ir�n.

:e )ruil,s lo llX.'\.

'I real mcdii.

:al Drug i11li.mm1tit111 n.·!Cn:ni.,,\:'l:i, (com of drugs wfuch favournhlc 2 Sckelion costfhc11efi1.

Cot;l/ctlCCtivc nmo;;.

anJ lxmc!it/risk J Sdcdion Sl:dions 01'il1c ull JXlpuliihun.

or <lrug:-.

lo mccl ncr:t!

'i of 38 .j Drug tmcnlor� Con!rnl Thi'.\ i!i.

l'<impu!ctii.et!

honJ ha" hcl.


"11 upg.r:1tk.·,1.l ni:cd In \.Xk'lHl and thr \\ hok :-.-yo;lc!ll miJ imprmi.·J_ the sysh:m uf the Malt1lcna01 .. ·c tll' an 1tp lo ,.hth.· l11!ti1111alion I.I )ula Ctltl') pcrsn1111d There i:-1 .i Syst1,;1H in Ol\kf lt., i!l'l!Cml.

; to tCJX'l"lS rn:.mug�· ,:lk�tl\'dy the stocl..s. 1 luthmrnlion shi:cls for I >aia Entr:, :1 St1l1v.

:1te l'itt:kuic 1 >t1.1� lttfonnntion ,L l 1rn<l\\ 1litk.

'him: an.'

JI lM ,.

:omputihle 5, Sl!lliottcr y Drn� l\1lic,· lm!'kmt.�n!
:tlion Drn(I. Po)ic,· ;,, More c!lieleul 11:.c l,r r�sm1r1.'t.'s.

of l )rug.

Polkv r1.-cnuu11cndcd l }tug Utili7,;!1lo11.

arc beiog.impkmcnk<l.

h,· I.Rt1li<�nul Th·c I.l �pid1.•miolo�icnl Jain m1p1,:cls V�lri<itts the !DH commlHmls prohlcm is i.:ust;:tiuuhility.

ttccJs crn1l"c:rt.'1H.

:c ean he ,;cnsili1.1.-J.

!111<l to ht ht.·1J to lh1.'


h:uclits al1'ti to l'<mhihu!c /\ uotiow1I �} 1Jmt ult s!m;L hoJJi.--rs 01· �m .. ·h ;.i 1x1Jfo,, ,, lm:rc:1'>,'(l lx,1clils io the J1.-vdopmc11t of �;nc.Cll111ll!l1Hii�·.

lo ull ,;cdi(1f1.

'i of the: studk·s 1 I )rug UM!

fl'\'il'\\ ' lntcmotloo,il mtJ Hq,ii<•iwl I xchm1gt: o(info111wtiv11.

� ro lkv,,:1,ipand m,un!nin .-;!

;1ndanh ur and Pt!\ :1t,: 11hattrntt,.·cttticut S�dor 1 !o!

'>Jlitul and nthtr rt·lalc.J at lhc Puhfa: Phamrncic!-1 S1.
'r,·ic:cs_ Al lht..• present lintC' Plwnm11..'iid:.

Mt111:1gcmcnt.

ut krn,t lwt1 ;;1,•11iN urc uuJcrgning.

Uttln.-rsih' !miniug in I fo promoll' gn::.,;:tkr 1..,., joh snlisfotlion shit\ �c11irn , l ,!pg.r.iJing �!all Udi, t:n ti!"

ll1(i1 \ti\\ artt<.

i,:t·:-.

,,1.;1, moH' cffic1t:nl .

f"rn1m11,1;1 5 i " 7 rt I .i;.·cuccs 22(, I ntp1.1 l'hc n1!u...-of tht''>t· ( l'iS� \\Crc prttn·-;scd I .icL'Hccs- .111101111 duri11g 1.9 !

2.

-;11, I Hor PS.$-l :1.15.:!ll8 lc�l ln \HI 11�):!


:'vli,-.l·,:11:uw(lih _J -< c ,s: � f .,- • , ;::: • ANALYSIS 01 Sl ICCFSS OR 1-1\ILl lRF ,m1.� (I) Radiogrnphcr 1111e (I) X-R:1;, ,1iw (I} I lurk Rm1111 Tc1.·lrniciun Tcch11ici.u1 TAIHil'.T SI·: I WR Tl IL YEAR Stun Reguh'e,neots: #2 -Suilifo: Rt.•,.tinH -h\O (:!

; 1{;1Jiogrnphcrs; -one ( l) X-ih1y � 0111.� ( I 1 llml ltuom I c·vhnidun ·1·'-..;hoil.

'iim Clirnil): -om: ( 1 } X-Ray Ti.

:drnici:.111 Nil Nom: annlabk #3 -We,!


D1:mc.n.1tu Rv�lon � IV,o {:O Hodiu.,.r11phi:-r1t -dnc (I} X�lfoy -one (I} !

)�irk Rtuim T11..·r.

:lrnki:111 ·1 cclmidm1 Rcgfotli.

!11 lospitul: 1111c {I) Rrn.liop,rnphi:r tine ( l) X-N.U) l1..'<:lu1kia11 t•ll� )utk �oofn Tct.

:hui"•io11 ( I J I (ag.)

1..conom: -one (I) X-Ray Tcchnidm1 Nil None m ailablc #4 - ( h�l1rµch," 11 Friodpu) Ralliol,l.mphi:r !fodiogrnpbi:r ( 14) Rndinµr:iphcrs R(·�ion -,,ne ( 1 ; -m1c ( l ).
S..:nit>r -li.mrh:i.:n -c1glll � sis (6J X-R.:1y (}<J X-Rn�-·1 cdmkirn1s l._,'\.

'hniciaus RiKtiogra11hcr Radiogrupl11.

:r one (I) Ptin�ipal one t f} Senior l\\o (2) Rudioe,ruphcn.

(-1) X-Rn� lcdmh:iam, lhn.

:c l\\tl (] t X-Rt1\ !raiw •.

'C four (4) l>arkm<lm Tcchnici:m!i ·1·cch1tki�m;i/l{t1�lingrnplu.

:r -si-..: (h) J )arkroo1n ·1·L'1.:ll11i1.

:fons NII, th.
:fons NII, th.

: Rt1<ling.mphcr assigned !hen n.:sigm•d Rr�ion #6 -Ni:\\ /\msti:1dnm • h\ o c::) Rm.li1J·gn1plt;;rs l\diicvtxL course in X·R:1�· fl-clmiques w, I }nrkn)om Tcchnicit1n c0111plck<l � one ( I J X�Rm 'I i.:clmid11n NIL #'s 7 &: H • I b1 ti�:1 Rt•1,do11 - u111.

: (I) X-l(:1,1, r.,,,J111it'1:111 Muhi11ur1x1:-i1,,' X-Ruy ·1 cdm1cim1 from !

'l1J1 Dct:1.:mh,.

:L i.:oursL: - I 1.•drnicwn graduai...;d # 9 � l Rt·1.don -um.· I j '.

Mulliprnrl(� l\.

"Clmici::H t.'th1.

'm J(){)'!<'» ai.


:hii:\Cd lAR< il'l SET I'< 11< Tl IF YFAR TAlWH ACI UEVl'I> I1l!ie•1u:: ANALYSIS< lF SIJCCESS < >I< !lfr.

1·;\ILI ldcntilicutlou tntimng Ora<ln,tlc of a Oon.-nunc11t in HaJiulu�y, Mc .. ticttl t)tlkcr li)r l'()S!• Not Jone 'J'rnming Prn1,;.11c ofX-Hm l t.·i:hnii.

:iaih luslirnti<)ns !�tr (fo, cmm...:111 ,mtl J\chic\·i.

::d Trnming, conultl'ilccJ jt)l)2 in Non:mh .. ·L I 't'il 1..:umpktc .. l m Nm.;ml)l;r.

l'li ba\ i: a Radiology butch nf Is!


\'CHr s1tt<lc11t:> for 1hc l )iplrnnn in l1urlly m.:lm;\l!d Butch ctmi;ii..ts of<inc X-Rt\� r1..-chni1;ian Suonlkli.l X .. Ru> filmit T 1> huve in st<x;k ull si/:es lhrouglttoul the y.:,,, Nlll ac::hievc<l PtucHr;ipg Chtmic@l"' Shor1ugi:t QX)lCrit..i1ce<l 17* x 14" x 14'' an<l 15" s. 12"_ thmu�hout tht.

: yc<lI' 1..."Sp.-ciaUy - To mainlnln an n<lct1_uatc supply <luring the rear_ Partly a;h�,,c:J AGThb DruWC.mtrld To have atl s1-.

:cit1l ex.LUn�rudinns.


adcquut«: supply of rdl contra�1/agcnt!i for Nol uclrieved There: is tin manwd PfOC\.

'ti!ing clwnUeu1s.

uhtHtduncc o( autmnati1: pn...:e. ... Slng chcmtcals t,111 no Many c:011lrwd e'.

'l.amhu1tiou, ,,ere nol duuc duuu� tht: y1..."Ur.

� 8cc;k•11 Wt1t'b �1·1·fornHil!f!i' t4 2 Su!ldic 2,ooo 1x11ivnt• tt1 t'"" )(�!

{,w1,1�t �1)1 42 '!

'hl:ii Wt!!)

... luw" IO sh111·1J1�e ol' l\lml'> 1llhi i:t�H�tJtm u ol'"•J!iit!BhmL 7 > 0.
ITEM# lARl ,ET SET H lR YE,\R TI\ROET I\C!III,VED I Pn .. ,·rntin mra�Yr""' ANALYSIS OF SlJCCJ�<;S OR Fl\11,l!RE " nouri<lc month liu;.c 1wogr.tmu11c � one Not acl1lc,c<l I lu1.� l<t lm:k flf 1-,}u�tic llt,Uk-"N !lft'll.

h.Mou,klolinn of 1m9',r wnh.-r �yiUcm.

Nol uch�-v>,;tl I >m.· fn lad; of lhtt•lgtJ \::":.i(-'hmtl(W i.;, Jfo11..k� :it'-•ult«1t11: pr.&1jn11m11C.

N,il i.whiu,·'3\I i .�d.

or mul..:ffill J.flouridc s,p,1i..'1n.

k!1din1 llf'l•gnuum.


: t{,r ull ,,mer Nolttehk:\"'00 l>uc lo tw.-k offon..ign exchunge 2 Cura,tln nw:u,11re�; a Oml ""'!."�·.

h.PeriOdonticN.

I 0% t10bi<v.

:d lls.b!

(o tud.

; <11' tillat:h-1ht.1le 1u.-cdlcs... etc So/o u�hk.•-vcd l)uc lo luck of M.i:terials/insinuncnls ck.

c.Opi:rulivi: th.,1li.'>l�·.

()o/o ac:hlc,·c<l No nmk.-riols ek.

d.EnJontic�tMithodunlicK ( >n11odotdic.

Oo/o uchic\.

'W �} mulcrinl� 1.'(c.

·' Tninlna of atnff: a.I >i.

:ntal Au'\illm-y Sdtool.


IOCt'Vi1 (1 �tudcnls �rtt.1,mt«l b.Denial A�sista11l.

Nol nt.·hicYcd 1 }t:li:mxJ lo J(J'){, i.:.

Ovcr!k!uw of dentist (gmdualc lrnining.

l<vcl).

Not kUU\\11 d ( >vi..�� trainill� of dcnli�1 Not kmm-u ( 1x1st grnduafc) c.Continuing educ..itiotL Not nd1i.m,d Plmn1cd 1hr I<)() .

'l 4J • � Rreicmafisa111icui; l<cgmn # I Ri:g.ion # � Region # :l Region#� Region# 5 Region# 6 to HJ Re(?ino #7 5.

M•in!mam:<IR<l!!!

!t of Buildin11, Eggiflfflffl!, i'a;,h :n:hicn.'<!


a.Extension of pull\..-ur·s \\aitin!

; room.

- 1 �ntuJ l.\.

'1Hrc NationuJ Achieved Succcs:4lli l> Maintenance ofDcnlul cqulpmcnt.

Pnrtly achicvcJ Ni:ed more foreign cum ... ·ncy to ht1y rmrt.<>.

etc C. Scuing up N.ll.C.

new J)cpm·1incn1 (X�Ruy) ;ii Nol uchii:vcJ No /tlfL·ig11 csch.nli_1.!.

:/ht1dgc1 <l.

Prmilhodnutics.. .

cudodontir.:.!

!, Nl)I ochicvcd Nn fi.


)reig11 c"chungc/hu<lgct C. Upgrntc ornl surgery m1J pcriu..kmtics Jcpar!n1cu1 npcrutivc Not m::hicvcd 6.

Create New PO!it Senior Dental Surgeon Dcnt<tl S..:nlor AdmlmslmtiYc �lHfi,-l Ki,.1,:{1Yf Assistant 1\ssistan!

Nol uducYc<l Not m:hicYc<l Nui !tchit,,Yi..'d Nu!

m.:hilwcd J kuhd I lcalth E<lm.

:.ation for :-.dtool t'.hildrcn, Nnl uchievcd 7 H No foreign c:,.

;clumgc/htH.lgct Estimate : .uhirnlts:<l Plunni:d hul ;ihmhlon..:li 1-ii.:caus1.

: of un llmd.
: of un llmd.

'i ·1 fi.lllSJXlflttli{;n Not m.:hic ...-cd Nn t\1n�h 44 _ .,.

_ _ __ Z i :::: \ # · " � .

: I.-� . "'

j < ;.

;; � � .

I � ..,.

-C l - cl I C. " - N - - .., c .

g , , - - � �� VI � ii - 1 ,:;: ii"0 !· ·g, i z in � i l!

I 1 ... .& 9 !

i i '!

- J;; 1!

� • - � � � � £ .

:- :l:: Y.

_; - - · - · - - - - - - - � � - !I I I ] - , • V " 7, - -- "'- - - 1 - g " - - - - -:: , - -n , Cf .., " 1 " < � !'

;; • � ,• J. .

.

i !

:j i!?

;; ' � • • !

� '· a I .

.

, .


, I ; A studv was done among males who anended of STD during new c�mplaint the GlJM Clinic, 13 July to September.

HoS\)ital Georgerown with a were to- !

992.

The objeciwes the period a) Determine their profiles Sociological b) Ascertain existing sexual practices and c} Assess their of :\IDS knowledge on the Studv Conclusion Radio and Television should the lay public.

Information should prevail still AIDS Education style and stable infection in Guvana.
be exploited as the means of dismination removing in Guyana.

Promotion of AIDS inIDnnation which the fillacies of health sexual life 1owards be simple and directed needs to be intensified indicated are strongly among those at risk groop for STD family relationships to Condoms through the year 1992, 53-240 During were purchased whom we were grateful.

Associati Secretariat.

on and are issued condoms were issued PAHO/\\IHO and there remaining All condoms upon request.
are stored at the Guyana Responsible Parenthood and Regional Committees from GUM Clinic, to all the regions.

of this amoont 36,000 was issued fr011 G.R.P.A amount to Management Programmes planned by the Regional AIDS Committees were given the usual support.

oft he National AIDS Committee were held bi-monthly.

Dr. John Farley, CAREC Meetings Consultant and strategy early in the year to review existing visited for implementing the Medium Term Plan.
status of the National AIDS Programme The Project Laboratory on Operational Dr. Edgar H.London Diseases.

and monitoring \1anager, for Infectious aspects attended and Dr.Lloyd Godette, the Workshop in Barbados Director, Nati<lllal on 10 -14 May.l 992. for AIDS Medium Tenn. Plans in the Caribhean.

Drs.

Morris A.IDS in Amsterdam.

and Clement The Secretariat Edwards Mc Ewan attended the VlIIth InternationaJ confi:rence on has not received a wTitten report on that Conference.
The first draft of policy guidelines extracted members AIDS Committee.

from thoseopereat of the National ring in Canada was circulated to 47 Traininf.

;._ Senior Lrncne Hardv.

[\'Is wee�" !

'AHO Fellowship I Joyd Director.

at CD '· · .

Atlanta Georgia sTrVi fl\.

J:pidcm,ologv Godette.

Technician at the National Blood Transfusion Ser.ice went on a 6 attachment National to the New York Brood Bank to upgrade her skills.

Diseases Surveilli!Llce.

National attended Policies.


a 6 weeks course Legal Issues.

Laboratory Tests.

in Laboratory for lnfeclious Dr.

fina,w.

:I ;-,,atcmcnt PLBLIC l:\'FORl\JA TION ACTIVITIES $ 83 J.

689.24 REGIONAL AIDS \VORKSHOP AND SEMINARS 677.049.JO SURVEILLANCE 80.220.00 OFFICE FURNITURE AJ>,D EQUIPMENT 145.900.00 NATIONAL BLOOD TRANSFUSION SERVICE I J 4.

432.00 OFFICE MATERIALS 219.063.95 Crnrul Supplies Unit FIELD \1A TERIAL DlET .
.\RY 25,640.56 5,489.05 Objectives Assessmem1 Comments National Conference of H.C Not done Postponed to Staff 1993 (Surveillance sample collection and Testing).

Net-work to improve visits·in Guyana Quality visited.

Partial Suddie Achievement and Bartica not Request Automatic ELIS.Ai reader.

Done Preventative equipment.

maintenance to Done Improve imernal arrangements Done 48 In process Position much better support.

for lo:1istical Contribute ofMediu111 to preparation Term Plan.
Review terms of E.EC support.

Done Support continned.

of service to Continuation B.T.S.

G.U.M.

Clinic and hospitals.

Private Done Daily basis.

Research Activities included.

system ofQ.C for Laboratories Provide private engaged in HIV testing Not completed Performance 199 l figures in brackets Tests Done Confirmed Positives VDRL ·B.T.S 3355(3550) 195 (114) Others 17, 796 (15, 234) 3,074 (l, 545) HB A-B.TS 4, 094 (3.
726) 83 (104) Others 768 ( 139} 79 (37) HIV-BT.S 4.025 (4,044) 65 (48) Others 1,696 (784) 312(151) F:ngures are not available for tests done by the Quick -test method.

These kits are mainly used by the Blood Transfusion weekends.

in Georgetown, New Amsterdam and Suddie.

Service to facilitate emergency Blood collection at Oualit .

Comrol There is internal panel.


control Quality Control daily, using controls from kits and the laboratory External control basis, for HIV is one by CAREC on a semi-annual and for VDRL by C.D.C Atlanta on a four monthly basis.

Some of the test controls from C. D C have been held up in the mail delivery system during the year.

but this fault has been corrected.

49 The Director.

G. U M. clinic continues to exercise further random external control.

of both HIV and VDRL The Director.

N LI.D.


was awarded a six (6) weeks Feliowship to C.D.D Atlanta, by him on his return, to up­ PA H.0.1\\!

grade the capabilit1 H.O.

The main objective and quality of the Laboratory of the award, was to enable These cases were 5.92% less that those in 1991.

This decrease was amongst ,·ivax cases reported.


of P. the number The age group most affected by both P. Falciparum and P. Vivax was 15-29 represested (30%) of persons affected by falciparum and 20 9%) of those affected by P \.1ales ,wax MAIN PROBLEMS The lack of continus ative administr progress and financial.

can only be attributed to several factors including logistical, Accessibility slow.

costly transpon and fuel supplies.

to most endemic and often hazarous.


area have became increasingly difficult.

Riverain transport is Within malarious area there has been a paucity of reliable These problems have resulted in: a) Inadequate consequent logistical of motivation.

and supervisory support for trained personnel and thus their of active b) Concentration case detection activities in easily accessible localities, but.

often with negligible stations.


coverage in problem areas that are remote from the field PROBLEMS ENCOUNTERED DURING THE YEAR: Semi-nomadic beaviour ofindegenous Amerindians and miners.

a) Shelters b) Persons c) Broken radical with little who only seek medical or no walls to afford residual attenti on when very ill. treatment.

spraying.

P.Falciparum parasited resistant to chloroquine.

3.

Malaria is at present scattered and often inaccessible.

an interior problem where farms, houses.

miners etc.
miners etc.

are widely 50 Finances 4.

Continous (land/water 5.

Logistics 6 High tu mover rate of trained 7.

Acute shortage transportation} Personnel.

of field facilities eg.

accommodation.

There are other factors control.

the present resources are insufficient to achieve this.

which have to be taken into consideration Although the abjective in Priorities and transmission and stratified.

characteristics of the disease have to be identified While a better is required.
understanding of the epidemiology STRA Tl FICA TION From the ecologisal in an ecosystem a sample into several stratum is a homoenerou factors control of transmission measures.

point of view.

stratification is the separation in space and time.

Epidemiologically speaking present between the orginisms it is the result oflreaking down specified criteria.

(In malaria.

sub samplesin accrdance with previously s area both ecological and epidemiological with more or Ess similar throughout, for example: climate.
geography, vectors and :parasites.

were made at stratification Attempts Regions.

respective of insecticide minimum (DDT) would be greatest in focus areas with the following which were previously free of the disease benefit Residual results and in critical areas where the use House Spraying was ca.med out to a of the programme in order to give proiority !fl areas within commission A bilateral and promoting the exchange 1991. one meeting was held at Springland s, Guyana.
with Suriname holds periodic ofinformation on malaria.

n meeting to discuss ways of ro-operatio During and other health filariasis i1&0es.

FINANCES resourcess expenditure of the programme Control for Vector Financial national be sanctioned over the vears.

have diminished was approximately $7,000 in terms of allocation During this period the 000 00.
This amount had to by the finance department for Reduction of malaria to mortality and morbidity through the case of a) Activities to be carried out b) Supervis ory visits to be made.

c) Purchases to be made.

d) Renumeration to be made to personnel.

51 STAHiNG the vear there were several During the vear.

there were 97 vacancie resignations from various categories ro staff At the end of s of a total of 19� staff position�.
AREA: TO ACHIEVE CONTROL IN MALARIOUS Reduction of malaria mortality and morbidity through: applied to non-miners to all presumptive I \ Chemopropylaxis 2) Chemotherapy 3) Follow-up 4) Hospitalisation 5) Training diagnosis on medical of acute with treatment.

of health personnel associated treatment.

in Mafaria Microscopy and actual malarious area.

subjects going into malarious area.

of ensure quick and reliable (1 J \1ass blood and fover case survey.
asvmptomatic These surveys are undertaken and clinical cases, malarious the parasite reserve.

thus depleting routinely in all areas to detect both SPECIAL PROJECT From September US$50.000 and 8 -those area with the highest 00 This project 1992 a project provides commenced funded by S.LM.A.P.

of in Region l, 7, to the programme of malaria Funds were provided for: emergency incidence ;issistance for a total Drugs a) Anti-Malaria Reagents.

b) Laboratory c) Laboratory Supplies.

d) Stationery.
d) Stationery.

e) Repairs to infrastructure.

This project was invaluable will conclude at the end of February and enhance 1993.

He assistance in the above regions.

d die activities offered to the programme during this period , ne :-ea, one ( l) '.\1alaria lG for six (6) Officers of the vector Coune: was conducted (Malaria) Service.

Microscopy from with funding This course was held in the During PAHO/\\.
l Georgetown for laboratory 3 Regional 1 = Sub-Regional Supervisors Supervisors Field Assistant 52 All students capabilities were successful, but also the general and their training diagnostic did not only enhance throughout facilities the Interi their Supervisory or locations.

It must be noted however examination (parasitological examination) that death due to Malaria.

must be confirm ed by a post mortem IMPORTED CASES OF MALARIA a) Region No.
l = 89 cases (from: Venezuela/Guyana Border - Delta Amacuro­ area) b) Georgetown =4 cases (2 Suriname.

associated During the year l 992. deaths Regions.

following l French Guiana.

]Venezuela) with Malaria were reported from the Region 2 6 7 8 9 lO G/town 6 2 I Nil I Hospitalization Region of severe malaria patients was routine during this period.

Ca se s hospitalized by Region No.

2 6 7 8 9 lO G/town 93 persons 185 26 105 16 27 76 266 3.
OPERATIONAL RESEARCH AND CONTJllOL ACTIVITIES Malaria investigations, # 7 Mazaruni/C11yuni Region The \fazaruni/Cuyuni!Potaro were the chiief be placed continued of transmission Emphasis was available.

where transportation to show unprecedenteil malaria on malaria on the Bartica Triangle and infection.

culprits Miners endemicity.


control to continued This investigation was undertaken with the said objectives: A brief review To ascertain transmission To advise of malaria the vector's was actually on approprite situation in Region# 7 present taking action in the Bartica Triangle place.

as a result ofinvestigation at I and 2. and to advise whether 3.
TABLE l: DA TA ON MALARIA CASES IN REGION # 7 PF p \' PFV 1988 ----· 2916 1989 1990 1991 1992 1655 1357 2394 1059 I 173 924 !054 2570 577 20 --· --.. 4119 37 21 14 2 2616 2343 4978 1638 Si\lE.\RS ACTIVE 8694 6382 3183 1792 1012 TAKEN PASSIVE 1046:Z 11060 11020 12645 7283 19156 17442 14203 14437 8296 54 TABLE I I: DATA ON MAI.ARIA CASES IN RE('.JON # 3 & 7 No.

of smears taken Positivity Week Active Passive Active Passive P.F.

P.V.

P.F.V P.F.

P.V PF.V.


26 1012 7283 110 44 0 949 533 2 *Data excluded the cases found in Georgetown TABLE lll:DATA BITING /OUTDOOR) ON THE GENUS AND SPEQES OF MOSQUITOES FOUND Locality An.Triannulatus An.Aquasalis Cx.Davisi Ae.Aegypti Bartica (township) 4 Miles 2 Miles Winipem + + Skull Point Kartabo Represents +: found; • = not found BRIEFING CONCLUSIONS + + + + + + + + ... + + I.

No evidence of actual transmission was taking place within the bartica triangle was found.

2.
2.

Active case detection resources including within the bartica triangle was not necessary scarce fouds could be directed and utif!Sed for operations elsewhere.

and therefore 55 3 Everv effort must including increase financial allocmons from the Ministry and also with of the mining community to signmcantly increase active case detection in the cooperation the Region.

comributed Passive case detection accounted detection some 85% of the malarial for some 80"/o of the smearing effort and 4.
The high passive case detection acute and high.

Thegametocyte clearly demonstrated that presons which were seeking poll in this of the malaria reservoir case a nd achieved if active every 21 day.

The present with getted frequency burden attempted and contra!

i.e at least was indeed Rigion detecetion effort was can only be decreased was undertaken ill-directed.

5.
5.

As advised since 1983, we again recommend, "tha supperssive treatment (prophyl axis as vehile interior including treatment at present be immediately and from discussions with many fever.

Consequently, inerferes with the detectrion of postivity."

discontinued.

Miners do spend long periods in the of these persons.

anti-malaria time of illness it seem that the pn:sent system of so-'Called preventative BERBICE REYER 4 MALARIA INVESTIGATIONS, In Decemder.
1991, an outbreak of malaria v,1as repoted in the berbice Rever about and above to ltablu, Kwakwani of malana was also reported but especiallv bv Gigliolo of malaria transmission at ltabu.The ( 1948) The Gigilioli ( 1945), fifty (50) cases were recorded.
Prior to 1991, a miners of gold and diamond small outbreak in the said areas in 194 among itinerant only other date documented as regards malaria from Kwakwani latter reported oninadquate were as a factor house screening This inestigation was conducted with the said objectives: to ascertain the vector/s or potential vector/s , 3 4. to determine the soure of the malaria problem to advise on control method/s feasible to initiate a viable health education programme.

to initiate control measures.


I. Parasitological Surveys r,.,tass Kwakwani blood surveys towship and fever respectively.

case surveys were cooducted at camp sites,ltabu are ga\!lm TABLES 1,11,ll and l, and Iv.

The results , Surveys Entomological Vector/s undertaken or potentiol vector/s surveys as regards mafaria transmission were also at ltabu and Kwkwani, Berbice Rever.

The results are given in TABLE VI.

56 3.

Control Operations Three forms of control effort were employed as under: I.
Treatment cases found of all positive 2.

Mass treatment River.

of all other presons found at ltabu,B.

J. DDT residual spraying.

The result on residual spraying with DDT is gevin in table V. 4 Health Education A number on malaria and demonstrations parasites and vectors were given by the parasit ologist/ oflectures Entomologist as follows: wakwani Primary School School I .

K 2.Kwakwani 3.
K 2.Kwakwani 3.

K wakwani 4.Kwakwani 5.Miners -Itabu Secondary School Hospital staff Company Bauxite TABLE t : DAT A ON THE NUMBER OF MALARIA CASES Areas Total no.
Smears Posivitivity ------------------------�-�---�-----------------------�------- ltabru 42 Kwakwani 10 62.4 30 16 SPR PF p V. 0 6 3 TABLE 11:DATA ON THE EPIDEMIOLOGICAL CASES CLASSIFICATION OF MALAR[A Area Indigenous Impacted (Local) - --·M·�-�-�- - -------�------------"""'-----------------------------·---�----�- - ---------------------------------- ltabru Kwakwani 10 0 9 3 57 T.\[l_;,E 111: DA TA ON THE AGE DISTRIBUTION OF MALARIA CASES IY SEX --��-�--�-----�-- --------------�--------------------------------------� Area -�----�_..,---·----·--- Male 15 years ----------------�------------------------------------- - --�----- ----�------ ltabru 17 --- Female 15 yean ----�- --..... -----------�--- -- 2 Kwakwani ------- 3 -------------------���---- -··----- ------------------------------ -�-�-------�-..... --�------�-- 0 TABLE IV;DATA ON THE NUMBER OF MALARIA CAESE WITH GAMETOCYTES -----------------�--------------------�--------------�-��--------�-----�---��-�-��--------- Area Species , ---------------- ltabru ------------------------ ---�---�- --------------- ---�-�---- -- ----����-���----- 3 2 PF PV.
Kwakwani 0 I ·----··-------··----·---··--·-·----·--- TABLE V:DATA ON THE NUMBER OF HABITATIONS SPRAYED wrm ]!

)OT (75% ,vP\ ·-·------------��----��----·-··-�--��---�--�- ··--··· ------------ Area -------- --------- -------- --·------ ---------------...-��------�----���--------��--- --- No.
ofHabitations Existed Sprayed % --�------�--- - ------- - -·--- - ------ --- - ---------- -----��- - ------ --- ----------------- ---- ----�---� ------�- -� ltabru 25 25 JOO --------------- ----------- -- ---��-----------�--------�---- ---•--•--••---••------�----�------------•e- -�--- TABLE Vf:DATA O.\f THE GE.\fUS A.\fD SPECIES OF MOSQUITOES BITING PER MAN-HOUR OUTDOORS Genus and Species Density .\nophe!es Culex Mansonia Anopheles Area Culex Mansonia Itabru Kwakwani Represents: + = found; - = not found 58 CONCLUSlONS/RECOMMENDATION S That complete radical on in the circumst ances since: interventi cure with anti-malar ia drugs seem the cost effective method of a) the mining camps were make-shilf for residua!
and rudimentary darlingi against DDT spraying surface and offered or no little b) in the case of aquasalis DDT residual -this mosquito is largely exophilic spraying will not be technicallv and exopagy therefure prudent and That all persons infected wi th P.fa!icparum River m ust be given radical treatment according the primaquine should be given on day one rather immediately transmission.
inactivate the gametocytes in infected persons in all areas of Guyana including the Berbice 4 to avoid recrudesce to Schedule nce.

Further, than on the fourth.

day as recommen ded to of and thus assist in the breaking That the identification card system of all miners as advocated with the endorsed malaria certificate must be urgently implemented This method clearance must by urgently important implemented.
This method if carefully of malaria tool in preventing the spread and effectively ifcarefully can be an utilised and effectively both to new areas and within endemic areas.

That a Collaborating Microscopist be trained from a member of the staff, Kwakwani endemic areas.

That literature educatio health on the subject be made available n programme as regards to staff, Kwakwani be undertaken Hospital.

and maintained That a in the malaria viable areas.


c) EPIDEMIOLOGICAL MALARIA SURVEILLANCE ACTIVITIES AN ARIKAIRICKSTONE/BUT AKARl In the Annual Report for 199 !

, a This visit was a follow-up report investigation was made of an outbreak to ascertain the status as regards of malaria malaria in the above areas.

endemicity.

59 TABLE !

:DATA ON THE MAI ARIA CASES FOUND -------�------------- LOCALITY TOT AL No.
SPECIES ----------------------------------�---�---------�- -------- ----�--�-------� ------�- --------------------------------------------------��---� OF SMEARS PF P.V.

P.F.V.
P.F.V.

TOTAL -------------�-------�--...----- ---�--------------------------------------- :\narika 180 ------ Rock stone 98 ----------------------------- 15 IO Butakari 88 --�---------------------------- 19 --------------��- 25 ---------------------------------��� ----------�----- ---�-------- ---------------------- -----�----- ------------- -----�-.-- ------------ ---------- ------------ ------------- ..... --------- .
.---�--- ------�-- ------- 22 8 12 7 ---�-------�---------- 30 0 0 0 60 TABLE t 1:QATA ON THE EPIDEMIOLOGICAL CASES -------------- LOCALITY INDIGENOUS ----------- --------... -------.. --... --... -- LOCALLY IMPORTED CLASSIFICATION OfMAl,ARIA ---------- 28 ----------- Anarika ----�----------------- Rockstone 0 ·------------- Butakari __ ....,.

_______________ ----�����.

--------------------------------- ------------ 25 ------------------------------ ----------�--- 2 ---------- -------------- 19 .,..
____ �--------- -----------�------ ----------·--· ----- ------��-- ...... 0 TABLE t I !
;DATA ON AGE GROUP DISTRIBUTION OF MALARIA CASES BY SEX LOCALITY MONTH 12-14 15 6 7-Jl MF MF MF MF ...... ---------------------- 3-6 7-11 MF MF 1-2 MF YEARS TOTAL MF ---.......... _______ _ 25 5 ---�-----------------·---- Anarika ------..... -----� Rockstonc --------------- Butakari -----�-------- 22 5 ----------------·-----------------�------------------ -------- 17 2 17 2 --------------------- ----- --���------- IO 2 0 2 I 22 I I 14 2 20 5 ----·----- --- TABLES lV:DATA MAN-HOUR (OUTDOOR) ON THE GENUS AND SPECIES-OF MOSQUITOES mTING PER GENUS AND SPECIES ANOPHELES CULEX -�---------------·- ----�-------� Anarika------------- ----�--------�---�-- ---------- ---·--------------- ·--·------------ ------ ------.��-�· DENSITY ANOPHELLES CUL EX -----��-- ----------···--�- ------��� ------- --���----�---�- -�----------- Rockstone Butakari ·--�---------�--------------------- += found; - = not found -------�------------ -�----�----·--- -�-�---·--�--- -�--------·- -------�-- 61 BRIEF CONCLUSIONS Continuous surveillance activities in these areas are necessary.
Indigenious imported cases at Rockstone and Butakari.

transmission of malaria was again confinned at Anarika in contrast to The presence of An.darlingi at Anarika is of grave concern to this logging concession.

that with the rain, this dangerous species of Our experience over the years demonstrated Anopheles breeding nearby quikly establish itself Gametocyte the Cuyuni/Mazaruni/Potaro their journey the outbreaks at nights concession.

Self-tr serves as potential to Linden and Georgetown.

at Anarika.
at Anarika.

in the Essequibo eatment gametocyte rest facility in of infection for do fishing of the logging concession In addition, River where they may also become infecte d and return to the These uncured is also much carriers.

These persons provide as a very temporary stay-over carried from the mining areas of many of the residents u ses the concession at the concession.

the ready pool practised also subjects education Malaria health malaria drugs must be emphasied must continue year and discoutaged.
around, The indiscrirnate use of anti ACHIEVEMENTS OF TARGETS Targets were fairly well set There as compared with the figure certain problems contributed to a marked shortfall prevented the projects for 1991 (36).

was an increase from getting No pilot project in the number of new patients for 1992 ( 48) as for integration off the ground.

These constraints also was implemented in the targets set for contact examinations and school surveys.
CONCLUSION of intergration The objective other targets have been fairly to Hansen's good.

Disease has not been relaised and needs to be addressed well executed.

There is a general improved seriously All attitude of Guyanese Complaints has been and short term theraphy seems to be much prefered 62 • I