CHANGES IN USE OF HEALTH-SERVICES IN A RURAL HEALTH ZONE IN ZAIRE

As part of the Combatting Childhood Communicable Diseases (CCCD) proje ct funded by the US Agency for International Development (USAID), the Zairian CCCD programme conducted surveys in the rural health zones of Kingandu and Pai-Kongila, Zaire, in 1984-1985 and 1988-1989 to determi ne whether a strategy of selective primary health care would affect ch ildhood mortality. This paper describes the changes in the medical car e infrastructure and the increasing coverage of selected services. The strategies evaluated were vaccination, oral rehydration therapy, and treatment of febrile episodes with antimalarial drugs for children; an d tetanus vaccination and malaria prophylaxis for pregnant women. The health infrastructure in the Kingandu and Pai-Kongila Health Zones exp anded considerably from 1984 to 1989, with health centres increasing f rom 7 to 18. During this period, economic conditions deteriorated mode rately, with the nation experiencing nearly 700% inflation. Medical ca re costs remained stable because of external subsidies. Use of health services was assessed in 1984, 1988, and 1989. Between 1984 and 1989, the proportion of children aged 12-23 months vaccinated against measle s increased from 22% to 71%. Coverage with other vaccine antigens incr eased similarly. Women's knowledge of the correct recipe for the prepa ration of sugar-salt solution increased from 0% to 61%. Reported treat ment at home with sugar-salt or oral rehydration solution increased fr om 6% to 53%. The proportion of children with febrile episodes who wer e treated presumptively for malaria with chloroquine remained unchange d (47% in 1984; 44% in 1988). We conclude that, despite a moderate det erioration in economic conditions, Kingandu and Pai-Kongila Health Zon es achieved remarkable increases in use of selected health services be tween 1984 and 1989, especially in vaccination coverage.