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Michael Elmore-Meegan, BPh, MSc
International Community for the Relief of Starvation and Suffering Mbagathi, Kenya

JAMA. 1994;271(10):744-745.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.

—Walker et al make some very helpful points. There are complex differences between evolving African countries. South Africa's mortality rate for children under 5 years of age is 72 per 1000 live births compared with 180 in least-developed countries and a mean of 101 in developing countries.¹ Forty-nine percent of South Africa's population is urbanized compared with a mean of 28% in sub-Saharan Africa,¹ while the maternal mortality rate stands at 83% in South Africa and 600 for sub-Saharan Africa. In most of Africa, 80% of the population remains rural. It is a tribute to the great advances in South Africa that it is so nonrepresentative of most of the continent.

Walker et al are, of course, correct that there must be a strengthening of health facilities and infrastructure; nor must we forget referral mechanisms and secondary care. A great failing of many donors and funding . . . [Full Text PDF of this Article]

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