Annals of Community Health

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https://imsear.searo.who.int/handle/123456789/150290

Editor: Dr Umesh Y Ramadurg , Dr Raghuram Venugopal
ISSN(Print): 2347-5455 Online:2347-5714

Frequency: Yearly

Language: English

Open Access Peer-reviewed journal

Web site: https://www.annalsofcommunityhealth.in/ojs/index.php/AoCH/index

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Now showing 1 - 20 of 74

Assessment of Body Mass Index and Waist Hip Ratio for development of Type II Diabetes in rural area of RRMCH, Bangalore.
(2013-12) Shyam, A C; Damayanthi, M N
Background: Diabetes is a syndrome characterized by chronic hyperglycaemia and relative deficiency of insulin. In urban population its figure are quoted to be high. Now in rural area incidence of diabetes is increasing. Methodology: Study setting: Rural field practice area, Ittamadu. Study population: All adults above 20 yrs of age. Study design: Cross Sectional study. Study duration: Two months. Sampling technique: Purposive sampling. Sample size: 165 subjects. Study variables: Socio‐demographic profile, measurement of height, weight, waist circumference, hip circumference. Results: Out of 165 subjects 33% of the participants are males 23.6% of them are pre‐obese and 11.5% are obese, which was more for females. 9.1% of the male participants have Waist to Hip ratio of >1 while 48.2% of female have Waist to Hip ratio of >0.8. Conclusion: Indian Diabetes Risk Score is an appropriate tool in the Community to identify the risk groups for the development of Type II Diabetes, which were used to identify the risk factors with respect to Body Mass Index and Waist To Hip ratio for the development of Type II Diabetes.
Association between Smoking and Body Mass Index among Males Aged 20 Years and Above - A Study in Rural Tamil Nadu, South India.
(2014-07) Mathew, Anil C; Kurian, Royce; Akshaya, K M; Karthikeyan, S; Chacko, Thomas V
Objective: To investigate the relationship between smoking status and Body Mass Index (BMI) in men aged 20 years and above. Methods: A cross sectional study was conducted in the rural field practice area of Department of Community Medicine, PSG Institute of Medical Science and Research, Coimbatore during June and July 2010. A total of 459 men aged 20 years and above were included in the study. Statistical analyses were done using General Linear Model procedure of SPSS. Results: Cigarette smokers weighed (Kg) less, p<0.01 (age adjusted mean ± standard error = 58.64 ± 0.44) and were leaner, p<0.001 [age adjusted mean BMI (kg/m2) ± standard error = 21.13 ± 0.13] than ex/non-smokers (61.11 ± 0.69 and 22.19 ± 0.2 respectively). Regarding the intensity of smoking and BMI, light smokers (1 to 20 cigarettes per day) were leaner than ex/non smokers (mean ± standard error were 21.13 ± 0.13, 22.19 ± 0.208 respectively, p< 0.001). Regarding the duration of smoking and BMI, a linear diminution in BMI is observed with increasing duration of cigarettes smoking compared to ex/non smokers (mean ± standard error of BMI) for ex/non smokers 22.19 ± 0.208, 1 to 10 years of smoking 21.56 ± 0.221(p<0.05); 11 to 20 years of smoking 21.23 ± 0.256 (p<0.01); 21 to 30 years of smoking 20.30 ± 0.333 (p<0.001); 30 and above years of smoking 20.07 ± 0.501(p<0.001). Conclusion: We found significant results confirming an association between cigarette smoking and lower BMI in men.
Challenges in the area of heath care waste management.
(2013-12) Pruthvish, S; Girish, N; Hemanth, T
Commentory on “Live, Orally given Poliovirus Vaccine - Effects of Rapid Mass Immunization In Population Under Conditions of Massive Enteric Infection with other Viruses".
(2015-01) Raghuram, V
The following is a commentary on the article “Sabin AB, Ramos-Alvarez M, Alvarez-Amezquita J, Pelon W, Michaels RH, Spigland I, et al. Live, orally given poliovirus vaccine: effects of rapid mass immuniza-tion on population under conditions of massive enteric infection with other viruses. Jama. 1960;173(14):1521-6.” Abstract (of the original article): The phenomenon of viral interference must be taken into account in planning the use of live poliovirus vac-cine in areas where conditions favor the extensive dissemination of naturally occurring polioviruses. Expe-rience with feeding a trivalent vaccine to 26,033 children in a tropical city of 100, 000 population led to the conclusion that interference was overcome by mass feeding of vaccine to 86% of all children under 11 years within a period of about four days, and that, because dissemination of the poliovirus was self-limited, a second feeding of trivalent vaccine was necessary to achieve immunization of almost all children. Recom-mendations are here formulated for the eradication of poliomyelitis, but they apply only to subtropical and tropical regions with extensive dissemination of various enteric viruses and not to temperate zones with good sanitation and hygiene during certain periods of the year and under conditions of low or absent dis-semination of enteric viruses.
Commentory on “LIVE, ORALLY GIVEN POLIOVIRUS VACCINE - EFFECTS OF RAPID MASS IMMUNIZATION IN POPULATION UNDER CONDITIONS OF MASSIVE ENTERIC INFECTION WITH OTHER VIRUSES.
(2015-01) Raghuram, V
The following is a commentary on the article “Sabin AB, Ramos-Alvarez M, Alvarez-Amezquita J, Pelon W, Michaels RH, Spigland I, et al. Live, orally given poliovirus vaccine: effects of rapid mass immunization on population under conditions of massive enteric infection with other viruses. Jama. 1960;173(14):1521-6.” Abstract (of the original article): The phenomenon of viral interference must be taken into account in planning the use of live poliovirus vaccine in areas where conditions favor the extensive dissemination of naturally occurring polioviruses. Experience with feeding a trivalent vaccine to 26,033 children in a tropical city of 100, 000 population led to the conclusion that interference was overcome by mass feeding of vaccine to 86% of all children under 11 years within a period of about four days, and that, because dissemination of the poliovirus was self-limited, a second feeding of trivalent vaccine was necessary to achieve immunization of almost all children. Recom-mendations are here formulated for the eradication of poliomyelitis, but they apply only to subtropical and tropical regions with extensive dissemination of various enteric viruses and not to temperate zones with good sanitation and hygiene during certain periods of the year and under conditions of low or absent dis-semination of enteric viruses.
A Comparative Study on Health Expenditure among Individuals with Diabetes and Hypertension in Rural Tamil Nadu
(Akash Institute of Medical Sciences and Research Centre, 2019 Apr) Deodatt, S; Elango, S; Charumathi, N; Dheekshana, S; Cynthia, S
Introduction: Recent data reveal the diabetic prevalence in adult population to be around 8.8% and prevalence of hypertension 25–29%. Out-of-pocket (OOP) expenditure on the treatment of chronic diseases continues to be the major impediment and a burden on the people. 78% of Indian population spend out of their pockets financing for health in India. Aim and Objectives: The aim of the study is to compare OOP expenditure of diabetes and hypertension. Materials and Methods: A descriptive cross-sectional study was carried out in the rural field practice area of tertiary medical college in Trichy district of India. Mean cumulative expenditures on diabetes hypertension in medications and investigations were compared. Results: Mean cumulative OOP expenditure was Indian rupee (INR) 1435/month (approximately INR 17,200 annually) for diabetes and INR 313 (approximately INR 3756 annually) for hypertension. Comparative cumulative OOP expenditure per month between the two groups was found to be highly significant (0.009). Conclusion and Recommendations: Out of Pocket Expenditure on diabetes treatment in the present setting was 4 times the treatment of hypertension. Policymakers should consider subsidizing the cost of diabetes expenditure.
A COMPARISON OF MENTAL HEALTH OF URBAN INDIAN ADOLESCENTS AMONG WORKING AND NON WORKING MOTHERS.
(2014-04) Seenivasan, P; Kumar, Caroline Priya
Aim: To estimate the prevalence of mental health problems among school-going adolescents aged 13-16 years in India and compare the mental health status of children whose both parents are employed with those who have stay at home mothers. Materials and Methods: This study was conducted at two schools of the Chennai Corporation. The mental health status of the students was assessed using the self-report version of the Strengths and Difficulties Questionnaire (SDQ). Results: Conduct problems were the highest (22.6%), fol-lowed by Peer problem (12.8%), Pro-social behaviour (12.4%) and Emotional problem (12.2%). 117(23.4%) of the students felt that these problems interfered with Homelife, Friendships, classroom life, leisure activities and difficulties upset or disturbed them There are 236 students (47.2%) whose mothers are not working and 264 students (52.8%) whose both parents are employed. Mental problems were significantly higher among those children whose both parents were employed, across all categories. Conclusion: With increasing control of acute-disease in childhood and adolescence the focus is shifting towards chronic and mental health prob-lems and these problems need to gain more priority in public health measures. Maternal employment influ-ences family processes that mediate child outcomes. Parental involvement is an important factor for positive child mental health for both boys and girls. Healthcare providers should encourage parents to be actively involved in their adolescent children’s lives.
Coverage and Compliance of Mass Drug Administration for Elimination of Lymphatic Filariasis in Bijapur District, Karnataka.
(2014-10) Waseem, A; Dorle, A S; Mannapur, B S; Vetri, S
Background: Lymphatic Filariasis (LF) is the world's second leading cause of long-term disability. The current estimate reveals that 120 million people in 83 countries of the world are infected with LF parasites and more than 20% of the world's population are at risk of acquiring infection. The present study was con-ducted to assess the program effectiveness of the 2-drug strategy in terms of actual coverage, compliance rates of MDA against filariasis in the district along with the reasons for non-compliance. Objectives: To eval-uate independently the MDA Programme against Filariasis with respect to its coverage and compliance among the community. To know the reasons for non-compliance. Materials and Methods: A Community based Cross-Sectional Study was conducted in Bijapur District. A total of four clusters, one urban and three rural clusters were selected randomly. All the sampled eligible population who belong to the MDA campaign area were included. The eligible population did not include pregnant and lactating women, children below two years of age and seriously ill persons. The data were collected in pretested Performa, tabulated using Microsoft Excel 2013 and analysed using OPENEpi software. Results: The demographic profile of the study sample is as follows, 67.6% of the population were in the age group of 14-60 years. Male to female ratio was equal. 66.48% of the study population were from rural area and 33.52% were from urban area. 81.63% of the population received the drugs. 79.21% of the population consumed the DEC and Albendazole tablets. 14.60% of the sample population did not consume. Major reasons for not taking tablets were fear of side effects (56.67%) and 22.50% forgotten to take the tablets. Conclusions: The effective coverage was below the target (85%). The overall coverage was better in rural areas compared with urban areas.
Creation of Public Health Cadre in Karnataka State, India.
(2014-04) Babu, Giridhara R; Sathyanarayana, T N; Shapeti, Suresh S; Srikanthi; Halagi, P N; Raveendra, H N
Background: Public Health is the science and art of promoting Health, preventing diseases and prolonging life through organized efforts of Society. The Government of Karnataka constituted a committee to revive the Public health system in state of Karnataka to provide recommendations for creation of Public health ca-dre. Objectives: To provide recommendations for creation of efficient public health system through creation of public health cadre. Methods: We reviewed several documents for studying the history and current struc-ture of the department regarding creation of public health cadre/department. We conducted 35 brainstorm-ing sessions involving in-depth discussions. We also conducted field visits and administered a pre-designed format for collecting the feedbacks from the officials of different levels. Results: The reviewed documents had a common finding of implementing public health cadre. Our analysis of current human resources in health department indicates that there is shortfall of qualified public health professionals in the department to opt and continue in public health cadre. Among the existing staff, 51% of the respondents wanted to up-date their skills through continued professional education. Our results from the study demonstrated to create a Public health directorate and public health cadre in Karnataka state. Conclusions: We recommend that there can be three levels in Public Health Cadre namely, Taluk level officers, District level officers and State level officers. We recommend time bound promotions of medical officers in accordance with published and updated common seniority list, which is the basis for all service matters.
Cross-sectional study of Sociodemographic Factors Affecting Persistent Sputum Positivity among Adult Pulmonary Tuberculosis Patients under Treatment in a Tuberculosis Unit, Bagalkot, Karnataka
(Akash Institute of Medical Sciences and Research Centre, 2018 Oct) Dorle, Ashok S.; Thippeswamy
Tuberculosis (TB) treatment not only cures the patient but also helps in prevention, as it stops transmission of infection by rendering the patient’s sputum non-infectious. Sputum conversion is an important milestone during treatment and is to be achieved as soon as possible. When there is non-conversion, patient sputum persists to be positive for tubercle bacilli and patient continues to be infective. There are multiple factors responsible for this persistence of sputum positivity which have explored by various studies. There are variations in the association of these predisposing factors with persistent sputum positivity. Objectives: The current study was conducted to know the prevalence and the sociodemographic factors responsible for persistent sputum positivity in Bagalkot Taluk TB unit. Materials and Methods: A total of 170 adult pulmonary TB (Category – I) patients of Bagalkot Taluk TB Unit were selected. A community-based survey with the pre-tested questionnaire was administered to collect relevant sociodemographic data regarding factors that influence persistent sputum positivity. Laboratory data were collected through concerned health facilities. Data were tabulated in MS-EXCEL 2013 and analyzed in Openepi version 3.01 and SPSS version 20. Results: Among 170 patients, pulmonary TB was seen more frequently among males (63.5%), middle-aged (31.7%), urban residents (55.3%), lower socioeconomic status (95.4%), and illiterates (28.8%). Prevalence of persistent sputum positivity was 10.59%. Among the persistent sputum positive patients, a higher prevalence was seen in males (66.67%) and lower socioeconomic class (88.33%). Age, literacy, and occupation were associated, whereas gender, place of residence, type of family, smoking, and alcoholism were not associated with persistent sputum positivity.
A Cross-sectional Study on Binge Drinking among Health Institutional Students in Bagalkot.
(2015-01) Vetri, Selvan T; Sumalatha, N; Dorle, Ashok S; Ghattargi, C H; Jambaiah, B
Background: Alcohol consumption is a major public health problem worldwide. In 2012, about 3.3million deaths were attributed to alcohol consumption. DALY attributed to alcohol consumption is 139 million. Adolescence is the critical period when the first initiation of alcohol intake takes place. Sixteen percent of drinkers of age more than 15yrs engage in heavy episodic drinking. Due to change in lifestyle a considerable num-ber of social drinking have shifted to binge drinking. Objectives: To know the prevalence of binge drinking among health institution students in Bagalkot. Material and Methods: A cross sectional study was conducted among 380 health institution students. Five different cadre of health institutions were taken, one medical, one dental, one Ayurveda, one nursing and one Pharmacy College. A pre designed, semi structured questionnaires were used. The results were analysed by chi square test. Results: Among total 380 participants, 68% were girls and 32% were boys. Majority of the respondents were staying away from home (83%). More than one fifth (20.53%) of respondents had tasted alcohol at least once, of which more than one third (37.18%) were female. Prevalence of binge drinking was 3.16%. Among binge drinkers, 58.33% had at least one of their family members who consumed alcohol. Conclusion: Existence of risk behaviour like binge drinking among students were seen and it demands integrated approach. Increased awareness among parents and also the respondents is needed to prevent adolescent behaviours from becoming a risk to their health and community.
A Cross-sectional Study on Binge Drinking among Health Institutional Students in Bagalkot.
(2015-01) Selvan, T Vetri; Sumalatha, N; Dorle, Ashok S; Ghattargi, C H; Jambaiah, B
Background: Alcohol consumption is a major public health problem worldwide. In 2012, about 3.3million deaths were attributed to alcohol consumption. DALY attributed to alcohol consumption is 139 million. Ad-olescence is the critical period when the first initiation of alcohol intake takes place. Sixteen percent of drink-ers of age more than 15yrs engage in heavy episodic drinking. Due to change in lifestyle a considerable num-ber of social drinking have shifted to binge drinking. Objectives: To know the prevalence of binge drinking among health institution students in Bagalkot. Material and Methods: A cross sectional study was conducted among 380 health institution students. Five different cadre of health institutions were taken, one medical, one dental, one Ayurveda, one nursing and one Pharmacy College. A pre designed, semi structured ques-tionnaires were used. The results were analysed by chi square test. Results: Among total 380 participants, 68% were girls and 32% were boys. Majority of the respondents were staying away from home (83%). More than one fifth (20.53%) of respondents had tasted alcohol at least once, of which more than one third (37.18%) were female. Prevalence of binge drinking was 3.16%. Among binge drinkers, 58.33% had at least one of their family members who consumed alcohol. Conclusion: Existence of risk behaviour like binge drinking among students were seen and it demands integrated approach. Increased awareness among parents and also the respondents is needed to prevent adolescent behaviours from becoming a risk to their health and community.
A Cross-sectional Study on Quality of Life among Diabetic Patients Attending Tertiary Care Hospital in Bagalkot City, Karnataka
(Akash Institute of Medical Sciences and Research Centre, 2018 Jan) Mhetri, Jayaraj R.; Dorle, A. S.
India has the large number of diabetic patients, and the number is expected to raise to 69.9 million by 2025. “Quality of life (QOL)” evaluation has emerged as an important outcome measure for chronic disease management. In diabetes, psychosocial factors have an important impact on self-care, acceptance of therapeutic regimens, treatment success, and QOL. Aims and Objectives: The aim of the study was to find out the QOL among the diabetic patients attending the outpatient department of tertiary care hospital in Bagalkot city. Methodology: It is a cross-sectional descriptive study, which was undertaken at a tertiary care hospital in Bagalkot city. The duration of the study was from August 10, 2016 to October 25, 2016. A sample size of 180 was obtained after considering the prevalence of diabetes in Karnataka as 10.22%. Patients attending the hospital for outpatient services were interviewed in their own language after obtaining the consent. QOL instrument for Indian Diabetes Patients questionnaire was used it is a reliable, valid, and sensitive tool for the assessment of diabetes-specific QOL in Indian subjects. Statistical analysis was done using Microsoft Excel 2010 and SPSS 20.1 trial version. Chi-square and Fisher’s exact test was used. Results: The mean age of study participants was 58.14 ± 13.46 years. 31.8% of the study participants were on insulin therapy. 52.3% of the males in the study had good QOL. The patients who were obese had poorer QOL than the patients with overweight and normal body mass index; this was statistically significant. Married participants had better QOL. In participants with comorbidities, QOL was poorer when compared to those without comorbidities; this difference was statistically significant.
Demographic and Behavioural Risk factors for Cervical Cancer among Urban Women in Coastal Karnataka.
(2014-04) Suma, R K; Keerthi, S Y; Prasanna, K S; Jayaram, S
Background: Cervical cancer is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in women worldwide. India accounts for 27% of the total cervical cancer deaths. Objectives: 1.To assess the risk factors associated with cancer cervix among the study population. 2. To study socio de-mographic profile of the study population. Materials and Methods: A community based, cross sectional study was conducted by the department of Community Medicine, A J Institute of Medical Sciences, in the urban field practice area, Kavoor among married women in the reproductive age group of 15-49years from April 2011 to September 2011. Socio demographic details and risk factors for cervical cancer were assessed. Results: A total of 357 women in the reproductive age group participated in the study. More than two third (87.2%) of the study population belonged to the age group of 30 – 49 years. 52.7% of the respondents be-longed to class IV socio economic status and 22.1% of the respondents were married before the age of 18 years. In this study 14% had their first child before the age of 18 years and43.2% respondents had 3 or more than 3 children. Cervical erosion was found in 38.4% of the respondents. Conclusion: Various risk factors like early age at marriage, low socioeconomic status, and multi parity are present in the study population. Screening and early detection efforts can be directed to the group at risk.
Depressive Disorders among People with Chronic Illness in an Urban Area of South India
(Akash Institute of Medical Sciences and Research Centre, 2018 Jul) Raghuram, V.; Murthy, N. S. Narasimha
Over the past decades, twin demographic and epidemiological transitions have been reflected an increase in the burden of chronic diseases. Although public health practitioners have recognized the increasing burden, the socioeconomic and overall health impact is to be adequately researched. Depressive disorders are considered an important correlate, for appropriate management of chronic disease but have been given relatively less importance. Hence, this study was taken up in an urban slum of Bengaluru city to explore the associations between depressive disorders and chronic diseases.Methodology: The cross-sectional community-based study was conducted in an urban slum of Bengaluru city using a modified cluster sampling technique. All persons who were ill or on long-term medication or were hospitalized for a period more than 3 weeks in the past 1 year were interviewed. A semi-structured pre-tested questionnaire incorporating Hamilton Depression Rating Scale was used. Results: He overall prevalence of chronic illness was 10% among the study population with 10.9% having mild depression, and 1.2% having mild-moderate depression, and none severe depression. None of them were taking any treatment for their depression. The mean age of those with mild depression was 53.9 years and was greater among females (males 5.0% and females 16.7%). The latter was highly statistically significant. Of the 91 persons with symptoms of mild depression, nearly two-thirds (58.2%) belonged to Class IV of Modified B G. Prasad’s classification. Factor analysis showed that HAM-D scores to have a significant relation with chronic illness. Discussion: Depressive disorders among those with chronic disorders are hitherto unrecognized in routine clinical practice. Middle ages, females and those lower down in the socioeconomic hierarchy are at greater risk. There is a need to establish a mechanism for appropriate management of these disorders.
Determinants of Nutritional Status of Under - Five Children - A Cross Sectional Study.
(2014-04) Nayak, Rakesh K; Walvekar, Padmaja R; Mallapur, M D
Introduction: Children between one and five years of age constitute 16.5% of the total population whereas mortality in this age group constitutes 40% of the total deaths in the country. Environmental factors like parental education, socio-economic status, sanitation, standard of living, parental attitudes and child rearing practices influence the growth and development of children. Objective: To find the determinants of malnu-trition in children aged 1-5 years. Methods: This study was conducted in a Primary Health Centre area. The study population consisted of children 1-5yrs of age. Sample size calculated was 933. Anthropometric meas-urements, i.e., height, weight of each subject, were taken according to the standard procedures. Children were considered with underweight, stunting and wasting if their weight-for age, height-for-age and weight-for-height z-scores were below -2.0 SD of the WHO standards. EPI INFO statistical package was used for analysis. Results: The present study included 933 (453 males and 480 females) under five children. The prev-alence of wasting, stunting and underweight (< -2 SD) by WHO standards was 23.7%, 38.2% and 37% respec-tively. Type of family, overcrowding, birth weight, duration of exclusive breast feeding and administration of pre-lacteal feeds were found to have an effect on the nutritional status. Literacy of mother also contributed to malnutrition in children. Conclusion: Besides poverty, there are other factors that directly or indirectly affect the nutritional status of children. The prevalence can be reduced using multiple interventional strate-gies.
Developing a Learning Need Assessment Tool (LNAT) to Teach Epidemiology for Medical Students.
(2014-04) Muhammad, G M; Amol, Dongre; Chacko, Thomas V
Background: The Department of Community Medicine of PSG Institute of Medical Sciences and Research has been training the medical students to become competent community physicians for improving Community Health. Epidemiology is the subject within community medicine which teaches them the principles of medical research. Objective: This study intends to develop a tool to identify the student learning needs in learning Epidemiology and thereby improves their learning by bridging the knowledge and competency gaps through reinforcing sessions and also to measure the learning outcome using the same tool after the reinforcing sessions. What was done?: LNAT was developed using a matrix which lists cognitive domains and practical skills in Epidemiology and the level of understanding and competency were measured using this matrix containing John P Reiling and G.E Millers Framework on assessment of learning. This Learning Need Assessment Tool was administered to 71 students in Final MBBS Part 1 phase over a period of 3 months. Pre and post self-assessment data were analyzed and proportions were calculated. Results: There was student per-ceived improvement in cognitive domains and computing skills in various measurements used in Epidemiology. Conclusion: This LNAT on Epidemiology identified the gaps and also the learning needs of UG medical students through pre test. The Post test enabled the teacher to measure the change in learning need after the completion of reinforcing epidemiology classes using the LNAT.
DYING IN SLOW MOTION.
(2014-04) Mahabalaraju, D K
Evidence based public health –the need of the hour.
(2013-12) Raghuram, V
Extermination of the Smallpox Virus – Light at the End of the Tunnel… or not – the Stalemate Continues.
(2014-04) Kiran, Pretesh Rohan; Gagan, S; Saldanha, Smitha C
The following is a commentary on the article “Arita I, Breman JG. Evaluation of smallpox vaccination policy. Bulletin of the World Health Organization. 1979;57(1):1-9.” Abstract (of the original article): During 1978 and 1979 the Global Commission for the Certification of Smallpox Eradication will proceed with verification of smallpox eradication in 31 countries. If current surveillance activities do not discover any further cases before the end of 1979, the world will be declared smallpox free. However, the recent occurrence of two laboratory associated smallpox cases in Birmingham, England, revealed that the stocks of variola virus held in at least 12 laboratories in the world pose a real danger to the achievement of smallpox eradication and efforts are being made to reduce the number of laboratories retaining the virus to not more than 4-all WHO collaborating centres-by 1980. Scientific data indicate the unlikelihood of smallpox recurring once it has been eradicated from the human population, although further confirmatory studies are continuing. If the Global Commission verifies the eradication of smallpox, continuation of smallpox vaccination will be unjus-tifiable in view of its severe complications, however infrequent, and the expected global savings that would result from the termination of vaccination programmes.

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