Dateline Health Nigeria. Supplement No. 4, 2001

Breaking Information: South Africa's Presidential AIDS Advisory Panel Report

1. Official spin on the report

By:

Dr Manto Tshabalala-Msimang
Minister of Health
4 April 2001

Source: http://www.gov.za/events/aidspanel.htm

MEDIA RELEASE
Interim Report of the Presidential AIDS Advisory Panel
4 April 2001

Early last year Cabinet endorsed a decision to invite
a panel of experts to South Africa to pursue debate on
questions relating to HIV/AIDS. The panel met on two
occasions in Pretoria, in May and in July, and the
propositions put at these two meetings were further
explored through exchanges on the internet.
The brief of the panel was to address the following
questions:
- Evidence of the viral aetiology of AIDS,
including:
- What causes the immune deficiency that leads to
death from AIDS?
- What is the most efficacious response to the
cause(s)?
- Why is AIDS heterosexually transmitted in
sub-Saharan Africa, while it is largely homosexually
transmitted in the Western world?
- The role of therapeutic interventions in the
context of developing countries, in relation to:
- Patients with AIDS; HIV-positive individuals;
preventing mother-to-child transmission; preventing
infection following occupational injury; preventing
transmission arising from rape.
- Prevention of HIV/AIDS, particularly in the
light of poverty, the prevalence of co-existing
diseases and infrastructural realities in developing
countries.

The panel, as you are aware, incorporated experts from
diverse backgrounds and included individuals who hold
diametrically opposing views on several key questions
pertaining to the link between HIV and AIDS. Some
adhere to the dominant position that there is a
clearly established causal link and others are
proponents of the dissident view that rejects the
causal relationship. This basic difference was
reflected in all debates, especially those relating to
treatment, surveillance and diagnostic methods.

However, it was not assumed at the start of the
exercise that the objective was to achieve consensus.
The idea was to pursue debate on scientific and public
policy issues in a dispassionate manner to provide the
best possible advice to the South African government.
The fruits of the panels interaction are to be found
largely in the formulation of proposals for further
empirical exploration. Such research would be original
in the sense that it would not simply replicate in a
local setting issues explored elsewhere, but would
break new ground and contribute globally to a richer
understanding of HIV/AIDS.

Some of this research is already underway -- but a
number of potential research projects outlined in the
list of recommendations have still to be assessed and
potential researchers identified.
Pending the outcome of further research, the debates
of the panel have not provided grounds for Government
to depart from its current approach to the HIV/AIDS
problem, which is rooted in the premise that HIV
causes AIDS. The five-year strategic plan for 2000
2005 remains the foundation of our programme. If
anything, the debate of the panel has shown a need to
intensify activities in a number of areas contained in
the plan.

While the division among panellists on the cause of
AIDS was fundamental, certain commonly held views did
emerge on the importance of various programmatic
interventions. In particular, the significant impact
of developmental issues issues such as poverty,
literacy, gender relations, nutrition, sanitation
was taken into account and acknowledged in a much more
far-reaching way than hitherto.

Key areas of discussion
Impact of other factors on the progression of the
disease.
Panel members concurred that factors like malnutrition
and the presence of other infectious diseases (like
TB, other STDs, malaria and parasitic infections)
impacted on the progression of HIV/AIDS. They also
concurred on the need to intervene vigorously to
manage these factors although they differed on
whether such intervention was a sufficient response to
HIV/AIDS.

Quality of testing for HIV.
There was much debate on the quality of testing to
detect HIV antibodies. This gave rise at an early
stage to the establishment of a team to investigate
this issue.

Surveillance.
Panellists generally agreed that a robust system for
collecting data was essential to understand and manage
the epidemic. The lack of accurate data on
AIDS-related mortality in South Africa was highlighted
as a gap. The need to understand the impact of factors
like malnutrition and other infectious diseases makes
it imperative to capture full data on each of these.

Peculiarities of South African HIV pattern.
Important debates related to the fact that the South
African HIV/AIDS pattern differs from that in most
other countries: We have a complex mixture of various
strains of the virus while most countries experience a
single viral strain. This has implications for the
vaccine development initiative in this country.

Prevention strategies.
Members of the panel construed prevention initiatives
in different ways, but there was a surface agreement
on useful interventions. These included: information,
education and life skills programmes; the promotion of
condom use; effective treatment of STDs; good
management of TB and communicable diseases; and
interventions to relieve poverty and improve quality
of life.

Use of anti-retrovirals
Views on this issue were obviously sharply divergent.
Panellists who deny a causal link between HIV and AIDS
regard the use of anti-retrovirals as totally
unjustifiable. Other panellists who believe
anti-retrovirals have positive effects still cautioned
against their use in the absence of effective
monitoring systems, including laboratory systems, and
other supportive services. The latter panelists made a
presentation on what they consider the benefits to be
of using anti-retrovirals to prevent mother-to-child
transmission of HIV.

Recommendations and future research
Panel members made a variety of recommendations for
future research. They identified a critical need for
social and behavioural research in relation to HIV and
AIDS, including investigation of risk-taking and
health-seeking behaviours. Some recommendations made
by panel members are already being implemented, either
by the Department of Health or through research
institutions.
In relation to surveillance:
- The Department of Health is collaborating
with US Centre for Disease Control (CDC) to establish
a system to determine the incidence of HIV (that is,
the rate at which new cases occur. Presently we only
measure prevalence or the total proportion of people
with HIV in the population).
- Second generation surveillance is being
instituted including behavioural surveillance among
vulnerable groups to understand the relationship
between HIV and personal behaviour.
- A task team has been set up by the Medical
Research Council, the Department of Home Affairs and
Stats SA to gain a better understanding of mortality
trends over the last 18 months and the degree to which
AIDS impacts on them.
- The impact of other infections is also being
monitored, including the close relationship between
HIV and TB.
Research currently in progress under the guidance of
panel members includes a three-phase investigation
into HIV testing.
Phase 1 aimed to establish the quality, reliability
and validity of HIV testing in South Africa. It
involved a comparison of results obtained in relation
to South African blood samples when tested locally and
in the United States
Phase 2 of this project will seek to establish the
"robustness" of HIV tests their ability to yield
consistent results in the presence of interfering
factors.
Phase 3 will focus on building capacity in South
Africa to synthesize, purify and use molecular
beacons. This technology will then be applied to the
blood samples collected in phase 1 to further define
what HIV testing actually establishes.
Some additional avenues of future investigation were
suggested by the panel debate. For instance, the stark
contrast between the patterns of HIV/AIDS in the West
and in Africa suggests that the possible role of
genetic factors needs to be interrogated.
And constraints in relation to ARV therapy have
pointed to the need to conduct research on alternative
therapeutic strategies, focusing particularly on
interventions to strengthen the immune systems
response to infection.

Appreciation of panel members
The South African Government wishes to express its
profound appreciation to the panellists many of them
eminent scientists who gave of their time to assist
us in this inquiry on matters, quite literally, of
life and death.
The fact that, despite their differences, they were
prepared to meet and engage each other speaks of their
commitment to join the African continent in the
crusade against AIDS. We are proud as South Africans
that distinguished scholars saw in our humble request
an opportunity to make a contribution.
The global search for answers to the many complex
questions will continue and, we believe, it has been
enriched and promoted by the research projects defined
through the process of debate in this particular
panel.

Dr Manto Tshabalala-Msimang
Minister of Health
4 April 2001

2. One unofficial spin on the report

AIDS panel's report reveals divergent views
-------------------------------------------
by Lynne Altenroxel

Source:
http://www.healthnet.org/afronets/afronets-hma/afro-nets.200104/msg00026.html

Two-and-a-half million rands later, the Presidential
AIDS Panel has come up with a report that shows little
more than the chasm between dissidents and orthodox
scientists. The final report, presented to the cabinet
in Cape Town on Wednesday (April 4, 2001), concludes
that the rift was so great that the delegates were
unable to find common ground on policy matters. "The
depth of the cleft on the aetiology of AIDS was such
that the commonalities of views on health policy and
public policy was by and large swallowed up," the
report concluded.

The panel could not even provide a single set of
recommendations. Its 13 pages of recommendations were
split up into two sections according to dissident and
orthodox views. Summaries range from statistical proof
that HIV-positive babies are dying from AIDS to a
recommendation by dissident Dr David Rasnick and
Medunsa Professor Sam Mhlongo that donated blood not
be screened for HIV because screening is a futile
exercise. Rasnick argues that "AIDS would disappear
instantaneously if all HIV testing were outlawed".
Under the heading South African epidemic - fact or
fiction, the report writes: "Those from the school of
thought that argues that HIV does not cause AIDS also
argued the futility of discussing an HIV epidemic, as
they do not believe that HIV causes AIDS."

The report deals with the deliberations and evidence
brought by both groups. Stark statistics presented by
the orthodox scientists included the results of two
studies. One, from King Edward VIII Hospital in
Durban, shows that the two-year fatality for children
infected with HIV is almost 60 percent. Case fatality
rates went up from 4,5 percent in 1995 to 22,6 percent
in 1999. Another, from Chris Hani Baragwanath Hospital
in Soweto, shows the infant mortality rate is more
than double in HIV-positive children versus
HIV-negative children. HIV incidence at the hospital
increased from 26 percent in 1997 to 30 percent in
1999.

Health Minister Dr Manto Tshabalala-Msimang said the
cabinet meeting, at which the report was one of the
main points on the agenda, focused more on preparing
for the release of the report than on its contents.
She justified the report by saying "the debate of the
panel has not provided ground for the government to
depart from its current ap- proach to the HIV and AIDS
problem, which is rooted in the premise that HIV
causes AIDS". "It was not assumed at the start of the
exercise that the objective was to achieve consensus,"
she said. Ironically, the R2,5-million spent on the
AIDS panel could have bought 5 million condoms, which
the government obtains at 50 cents each. Source: The
Star, 5 April 2001

3. Download the full report in various formats at:
http://www.gov.za/reports/

------

DATELINE HEALTH NIGERIA is a health communication
initiative of the Centre for Health Policy and
Strategic Studies (CHPSS), Lagos, Nigeria. Critical
comments on format, quality and content are welcome.

Please inform a friend about this e-bulletin

DISCLAIMER: CHPSS accepts no responsibility for the
accuracy of any information abstracted in this
Bulletin from identified sources.

Address all comments, enquiries, responses and request
for full report of any abstract by fax or e-mail to:
Titi Odulate
Editorial Assistant
Centre for Health Policy & Strategic Studies
34 Town Planning Way, Ilupeju
P.O. Box 7597, Ikeja, Lagos, Nigeria.
Tel. +234-1-470 1255
Fax. +234-1-263 5285
Email: [email][email protected]
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Dateline Health Nigeria No. 13, April 7, 2001

- Lagos to privatize drug distribution in
hospitals
- Group wants drug firms to drop suit against
government
- AIDS cure: Subject your discoveries to
international evaluation - Nwosu urges claimants
- NAFDAC, Always and media hysteria a media
critique
- Fresh hope for AIDS sufferers
-Overcoming the burden of hypertension

1. LAGOS TO PRIVATIZE DRUG DISTRIBUTION IN HOSPITALS

In a move to stem the inadequate drug supply in
hospitals, Lagos State government has planned to
privatize the services of pharmaceutical departments
in all the state hospitals, just as pharmacists have
urged the Federal Government to ensure sanitation of
the drug distribution network in the country. However,
the State chapter of the Pharmaceutical Society of
Nigeria (PSN) does not want to swallow this. They
maintain that inadequacy of drugs in the hospitals was
a result of poor funding and delays in payment of
contractors by the State Hospitals Management Boards
(SHMB). The pharmacists rather suggested that the
SHMBs should be strengthened through the involvement
of health consultants. Chairman of PSN, Mr. Funso
Fakolujo, in a memorandum to the Commissioner of
Health, Dr. Leke Pitan stated: If the government
wants to strengthen the health programme via drug
delivery, it may be imperative to constantly monitor
the drug supply system. This can only be done, if the
services of health consultants are engaged to
undertake the monitoring and evaluation of the supply
system. The consultants, according to the
association, should be able to establish a well
articulate protocol using reliable and sensitive
indicators for the exercise. The objectives of the
protocol, according to the memorandum, is to ensure
the supply of drugs to all the health institutions
under the control of the state government and to
improve the operational efficiency in healthcare
services through the provision of drugs and other
medicaments. The policy would also ensure cost
effectiveness without compromising quality and also
achieve equitable and affordable access to genuine
drugs in the state. These objectives would be
realizable if the consultants are able to put in place
drug selection and quantification process that ensures
the optimization of the therapeutic and economic
efforts and the establishment of a fraud-proof
protocol. The Guardian gathered that the state
government decided to embark on the initiative
following poor returns from its drug revolving fund
system occasioned by illegal sales and poor remittance
of fees to the state hospital management board.

Source: The Guardian, Monday, March 12, 2001 p.3. By
Ben Ukwuoma Keywords: Nigeria. Drug procurement and
distribution. Privatization of government
pharmaceutical services. Pharmaceutical Society of
Nigeria

2. GROUP WANTS DRUG FIRMS TO DROP SUIT AGAINST
GOVERNMENT

Doctors without borders, or Medicine Sans Frontiers
(MSE) has launched an international petition drive
calling on the 39 pharmaceutical companies suing the
South African government over the importation of
cheaper AIDS generic drugs to drop their case to
prevent more people from dying of the disease. This
case has struck a chord with people around the world
because it exposes the length that the industry will
go to protect its patents and profits, despite the
human costs, says MSF. Ellen Hofen, of the MSF, in a
statement urged individuals around the world to add
their voices to the growing chorus of outrage by
signing a petition by April 15, this year. There have
been demonstrations across the world demanding access
to life-saving drugs for South African HIV/AIDS
patients of about four million of its 40 million
population. Everyday people with HIV/AIDS who cannot
afford essential medicines visit our clinic. I think
that it is appalling that the pharmaceutical industry
insists on placing profits before people, and continue
to oppose the South African governments attempt to
improve access to medicines, said Dr. Eric Goemaere
of MSF South Africa. Former President Nelson Mandela
in 1997 signed a law aimed at improving access to
medicines, but the pharmaceutical industry immediately
filed a suit to block it. In the three years in which
the 39 companies have tied up this legislation in the
courts, more that 400,000 South Africans have died of
HIV/AIDS for lack of access to affordable treatments,
reports the Southern African correspondent of the News
Agency of Nigeria (NAN). The case opened in a Pretoria
High Court last Monday amidst protest to drop the case
as the companies sought a postponement of four months
but the judge granted three weeks.

Source: The Guardian, Monday, March 12, 2001 p.13. By
Anonymous. Keywords: Nigeria. HIV/AIDS. Access to
HIV/AIDS drugs. Patent protection and HIV/AIDS drugs.
Drug advocacy. Charitable organization. Medicine Sans
Frontiers.

3. AIDS CURE: SUBJECT YOUR DISCOVERY TO INTERNATIONAL
EVALUATION-NWOSU URGES CLAIMANTS

Claimants alleging to have discovered curative and
preventive vaccines/drugs against HIV/AIDS, have been
tasked to subject such discoveries to international
standard of vetting and verification. Minister of
Health, Prof. Alphonsus Nwosu, gave the challenge in
Abuja recently in his first public statement on claims
by Nigerians to have discovered the elusive cure to
the dreaded disease. Nwosu, denying bias to research
efforts of claimants, said: There are basic rules in
science. That is why we say truth exists, only
falsehood has to be investigated. I would expect
everybody whether he is within the institute for
pharmaceutical research or working independently, to
subject himself to these known standards of vetting
and verification. Continuing, he stated, As a
scientist, I have no bias, I have no prejudice. We can
get independent evaluations from the Nigerian
scientific class or from among Africans or developing
world or from the World Health Organization. So when
everybody (claimant) is ready, this ministry at least
with me, has no bias, but you cannot expect me to
evaluate an anti-AIDS vaccine for example when I am a
parasitologist and epidemiologist. With plans to set
up a youth army against AIDS towards curtailing the
spread of the dreaded disease, Nwosu added that in
April, Nigeria would host all African Heads of State
for an AIDS summit that would take a collective
resolution to stamp out HIV/AIDS from the continent.

Source: Vanguard, Tuesday, March 13, 2001, p.21, By
Sam Ogbeifun Keywords: Nigeria. HIV/AIDS cure claim
verification. Drug testing procedures. HIV/AIDS. Anti
AIDS vaccines.

4. NAFDAC, ALWAYS AND MEDIA HYSTERIA A MEDIA
CRITIQUE

The Nigerian media is the freest in Africa; but
occasionally, that liberty has tended to become
freedom to malign with impurity other entities in
society. A recent case in point was the media hysteria
surrounding the alleged implication of Always feminine
pads in the spread of HIV/AIDS and the purported
failure of NAFDAC to do something about it. Without
mincing words, it was media irresponsibility at its
worst which is not in any way remedied by the fact
that the ugly rumour was helped along by Chief (Mrs.)
Titilayo Ajanaku, Special Adviser to the President on
Women Affairs. Mrs. Ajanaku is not a medical doctor;
neither is she an expert epidemiologist. Her views on
such matters can at best be regarded as the opinions
of an ill-informed person despite her high station in
government. The media still owes it as duty to itself
and its own credibility, and being conscious of its
duty to society, to ensure that it establishes facts
where vital issues are concerned before going to
press. HIV/AIDS is a life and death matter and any
product or company implicated in spreading the
epidemic willingly or inadvertently stands condemned.
And for a global brand like Always marketed by a
multinational, the risk of contagion of the companys
other products are considerable. So it is not an issue
to be treated without utmost care. Similarly, the
attack on NAFDAC officials who, for those deeply
knowledgeable about the agency, are amongst the most
dedicated public servants in Nigeria, is not only
unfair to NAFDAC staff but also a disgrace to media
practitioners who have critised NAFDAC in editorials
and personal opinion columns without ascertaining the
truth of the matter. Now, what are the facts that need
to be established before anybody can indict Always and
NAFDAC? And were those facts proved beyond reasonable
doubt? First, media organizations should have
established that there were indeed cases of women or
young ladies presenting with HIV/AIDS whose infection
had been traced irrefutably to the use of fresh
(emphasis mine) Always. That is the minimum
requirement of journalism which had not degenerated to
pure sensationalism. What do we know? Till today, no
hospital or clinic has reported a single case of
HIV/AIDS infection linked to the use of Always. So
what started as a rumor perhaps hatched by mischievous
individuals or people with wild imagination remains
just that; a rumor. Secondly, the media should have
educated itself a little more about AIDS and the
processes by which the infection is passed on to
determine if the use of Always or any other sanitary
pad could possibly cause the infection. Here again,
the facts are that the virus cannot survive outside
its host cell for more that 48 hours and to survive it
must find itself in a liquid or moist environment rich
in amino acids, the building blocks of proteins. Even
a science illiterate knows that a dry cotton pad held
in place by plastic cover which travels for several
months from the manufacturer to the users does not
even begin to meet those conditions for AIDS virus
survival. This is a dry medium! Thirdly, the media, in
order to be fair to all concerned should have found
out about the production process of Always to
determine if anything in that process could promote
the growth and spread of HIV. This obviously was not
done before ill-informed commentators went to press.
Always starts from cotton buds from dry farms where
AIDS can never find habitat; it proceeds to the
manufacturing plant where it is totally sanitized as
to make it 100 percent germ free; it is sent to
sterile production areas where sterilized cotton wool,
cotton linen and plastic covering are assembled and
packaged for shipment after undergoing rigorous
quality control tests for micro-organisms. There is no
single link in the chain from the farm gate to the
final user where any amino acid rich moisture comes
in contact with raw materials or the final product.
Consequently, it is virtually impossible for AIDS
virus to contaminate the product at any point.
Fourthly, it would have been vital to consider the
reputation of the brand marketer. After all, the whole
purpose of establishing a great reputation, either by
an individuals or by a corporate citizen, is to ensure
that one is given the benefit of doubt when damaging
rumors are being peddled. Procter and Gamble, the
marketers of Always is the worlds leading consumer
goods producer with a reputation for excellent and
safe products second to none. That alone should have
cautioned commentators against careless reporting and
commentaries. Furthermore, the product has been in the
market for more than 20 years without blemish; and no
similar report of HIV infection from anywhere else in
the world or indeed Nigeria exists. Those facts put
together should again have sounded notes of warning to
everybody but the most careless media practitioners.
Always is the worlds leader in its product category
and that well-deserved position was achieved through
the type of painstaking attention to safety and
quality, which have become the hallmark of P & G.
Fifthly, it was essential to determine what NAFDAC was
doing about the matter before going to press to
malign this under-funded, under-staffed,
under-equipped yet overworked agency.

Source: Vanguard. Tuesday, March 13, 2001 pg. 22 By
Dele Sobowale Keywords: Nigeria. HIV/AIDS. Always
sanitary pads. Allegation about HIV/AIDS contamination
of sanitary pads. Media critique.

5. FRESH HOPE FOR AIDS SUFFERERS

There is hope in the horizon for AIDS sufferers, with
plans by the Federal Government to provide them with
cheap anti-retroviral drugs. This action is being
undertaken in conjunction with the pharmaceutical
industry and the Joint United Programme on HIV/AIDS
(UNAIDS). Already, the government, according to the
Special Assistant to the President on HIV/AIDS, Prof.
Ibironke Akinsete, has begun negotiating with five
pharmaceutical companies who are willing to provide
the drugs. Akinsete, stated this while addressing
participants at a one-day seminar on the
Communication Framework for HIV/AIDS jointly
organized by the World Banks, UNAIDS and Journalists
Against AIDS (JAAIDS). This took place in Lagos
recently. She further added that a national advisory
committee comprising of pharmacists, nurses and
doctors has been formed, which would look into areas
such as capacity building of trained personnel who
would monitor the usage of such drugs. She, however,
explained that, the necessary facilities for the
measurement of viral loads as well as CD4 count have
to be in place in major health institutions in the
country before anti-retroviral drugs are made
available. Ant-retrovirals are not as easy to manage
as people think because they expose the user to other
side effects such as bone marrow infections".
Akinsete, who explained that there are many
intricacies involved in the administration of
anti-retroviral drugs, stressed the need for People
Living with HIV/AIDS (PLWAs) to protect themselves
from common opportunistic infections particularly,
tuberculosis. I would rather that PLWAs focus on
improving their nutrition. Non-governmental
organizations (NGOs) and state governments should also
improve the quality of care being given to these
individuals. Akinsete, while restating that there is
currently no cure for AIDS, appealed to state
governments and NGOs to involve PLWAs in their various
HIV/AIDS programmes. The event also featured a
presentation by Mr. Bunmi Makinwa, Team leader, UNAIDS
Intercountry team for Eastern and Southern Africa who
stressed the need for the adoption of communication
strategies that would incorporate the relationship
between HIV/AIDs and issues such as culture,
socio-economic status as well as spirituality into
enlightenment campaigns aimed at reducing the rising
epidemic.

Source: The Punch, Wednesday March 14, 2001, p.29.
By:Olayide Akanni Keywords: Nigeria. HIV/AIDS.
Communication strategies. People living with AIDS.
Anti-retroviral drugs. Non-governmental organization.
UNAIDS. World Bank. Journalists Against Aids.

6. OVERCOMING THE BURDEN OF HYPERTENSION

There is a growing concern among medical experts over
the increased prevalence of non-communicable diseases
in the country particularly, cardiovascular diseases.
This development, medical expert believe, is
worrisome. Statistics have revealed that not less than
20 per cent of Nigerians over the age of 15 suffer
from hypertension. The bitter truth, however, is that
though hypertension is a major killer disease
world-wide, only a third of affected Nigerians are
aware of their condition. Experts have warned that the
key to the successful management of hypertension is an
alteration in lifestyle and habits. In support of this
view, Prof. Oladipo Akinkugbe, a renowned Nigerian
nephrologists, has attributed the increase in the
incidence of non-communicable diseases such as
diabetes, hypertension, stroke and heart attack to
changes in lifestyle patterns attending the trend of
rural-urban drift. He explained that, moving from
rural to urban setting increases the risk factor of
the individual by over 100 per cent. In addition,
studies have shown that those at both extremes of the
socio-economic ladder, run a high risk of being
hypertensive. Akinkugbe canvassed lifestyle changes,
which include a reduction of stress, regular exercise,
and a low intake of foods high in fat content, to
improve the quality of care given to those suffering
from hypertension. This, he explained can be achieved
through the provision of cheap and affordable
anti-hypertensive drugs. Once an individual is
diagnosed as hypertensive, treatment is for life.
Thus, it is important that quality drugs be made
available at affordable prices. Pharmaceutical
companies need to go into liaison with the government
to ensure that cheaper drugs within the reach of most
individuals are manufactured in the country.

Source: The Punch. Wednesday, March 14, 2001 pg. 29 By
Olayide Akanni Keywords: Nigeria. Hypertension.
Non-communicable disease. Control of hypertension in
Africa. Drug management of hypertension. Life-style
changes and hypertension. Causes of hypertension.
Epidemiology of hypertension. Health advocacy.

-------------------

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Please inform a friend about this e-bulletin.

DISCLAIMER: CHPSS accepts no responsibility for the
accuracy of any information abstracted in this
Bulletin from identified sources.

Address all comments, enquiries, responses and request
for full report of any abstract by fax or e-mail to:
Titi Odulate
Editorial Assistant
Centre for Health Policy & Strategic Studies
34 Town Planning Way, Ilupeju
P.O. Box 7597, Ikeja, Lagos, Nigeria.
Tel. +234-1-470 1255
Fax. +234-1-263 5285
Email: [email][email protected]
Web site: http://www.expage.com/chpsshomepage