Some 67 journal articles that described and evaluated health education programmes in developing countries were read by two independent reviewers who examined the methodology used in the studies. Of the articles 47% provided a sufficiently detailed description of the educational intervention to allow replication and 40% described the educational level of the intended audience. Only 21% were controlled studies employing sample sizes greater than 60 individuals or two clusters, although six studies used randomized or quasi-randomized designs. Of the studies 33% looked at changes in health status while another 33% used observable changes in health behaviour as an endpoint. There was good agreement between the reviewers on whether these characteristics were present. Only three of the articles contained all four methodological attributes described above. The results of these articles suggests that successful health education depends on using a few messages, of proven benefit, repeatedly, and in many forums. It is important to improve the methodological quality of health education research. This can be done by using controlled, preferably randomized, designs, ensuring adequate sample sizes, examining only objective changes in behaviour or, better yet, changes in morbidity or mortality. Research reports should describe in detail the educational intervention employed and the target audience.
The results of 2 large field studies on the impact of the polio eradication initiative on health systems and 3 supplementary reports were presented at a December 1999 meeting convened by the World Health Organization. All of these studies concluded that positive synergies exist between polio eradication and health systems but that these synergies have not been vigorously exploited. The eradication of polio has probably improved health systems worldwide by broadening distribution of vitamin A supplements, improving cooperation among enterovirus laboratories, and facilitating linkages between health workers and their communities. The results of these studies also show that eliminating polio did not cause a diminution of funding for immunization against other illnesses. Relatively little is known about the opportunity costs of polio eradication. Improved planning in disease eradication initiatives can minimize disruptions in the delivery of other services. Future initiatives should include indicators and baseline data for monitoring effects on health systems development.
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