The Health Ministry reported progress in combating many other diseases. Syphilis, once prevalent, was eliminated. A broad program of serologic examinations involving over 2.3 million persons between 1947 and 1968 was utilized to detect venereal disease and was instrumental in reducing the rate of syphilis infection from 3.14 percent in 1949 to 0.02 percent in 1968. Incidence rates per 1,000 population of other illnesses decreased from 1955 to 1968 as follows: abdominal typhoid, from 5.2 to 2.4; dysentery, from 87.7 to 14.5; diphtheria, from 2.3 to 0.5; poliomyelitis, from 0.4 to 0.1; brucellosis, from 2.4 to 0.8; and arthritis, from 2.2 to 0.8. Trachoma was eliminated, and no cases of rabies were reported in the 1967-69 period. Deaths per 100,000 population from contagious diseases, including influenza, decreased from 220 in 1950 to 43 in 1968. Data on the number of deaths from heart ailments, cancer, and other causes were not published.

Although progress was made in reducing mortality among children up to one year of age—from 121.2 per 1,000 live births in 1950 to 75.2 in 1968—the rate remained unusually high. Failure to obtain timely medical assistance was given as the primary cause of death by health authorities. Malnutrition, shortages of professional medical personnel, and insufficient health facilities were also contributing factors. The rate for cities in 1968 was 65.4 as compared with 78.0 in rural areas. Some areas in the mountains of the north ran as high as 136.9 during the 1963-67 period. About three-fourths of all infant deaths occurred during the first six months after birth. In 1960 only 34 percent of infant deaths were diagnosed; by 1967 the percentage had increased to 65. Medical aid by a physician or midwife was provided for about 99 percent of births in cities; in rural areas approximately 61 percent of births were with medical assistance.

There were indications that some segments of the population, those in remote and most poverty-stricken areas, were in poor health. A 1968-69 study of 1,580 children up to three years of age in thirteen northern localities, reported by the Ministry of Health, showed that 60 percent suffered from neuromuscular disorders in various degrees and that 47 percent suffered from rickets. The principal causes for these abnormalities, according to the official study, were malnutrition and unsatisfactory hygienic-sanitary conditions.

Health and medical organizations from national to local levels were under the Ministry of Health. In the 1960s the departments of the ministry were: epidemiology, pharmaceuticals, sanitary inspectorate, medical prophylactic institutions, personnel, administration, finance, and planning. Data for 1968 reported by the minister of health listed facilities countrywide as: 196 hospitals and other facilities with beds; 11,922 beds for medical use; 1,108 first aid stations and polyclinics; and 36 dispensaries and tuberculosis centers. The average annual increase in hospital beds from 1950 to 1968 was 323; in 1968 there was 1 bed for every 169 inhabitants.

The total number of persons employed in health and medicine increased from 9,881 in 1960 to 14,370 in 1967. The numbers of professional and semiskilled workers in 1969 were: physicians, 1,396; stomatologists (mouth specialists), 183; pharmacists, 262; medical aides, 725; dental assistants, 139; pharmacist assistants, 334; midwives, 1,091; nurses, 4,100; and laboratory technicians, 737. Dentists were not listed as a separate category. The average number of inhabitants per doctor in the districts was approximately 2,000; however, in two districts the average was over 3,000, and in one, less than 1,000. All medical personnel were in government employ, and no private medical practice existed.

The expansion of medical services after World War II was made possible to a large extent by accelerated training programs. A school for training medical assistants was begun in 1948 and, starting in the early 1950s, the Red Cross conducted courses for semiskilled medical workers. A medical college for training professional personnel was established in 1952; in 1957 it became the Faculty of Medicine of the State University of Tirana, and the first doctors were graduated that year. During the 1950s most physicians were trained in the Soviet Union. In the late 1960s the number of persons undergoing training as midwives was increased, and the goal was to have at least one midwife in every village by June 1971.

The use of mobile medical teams and equipment played a major role in expanding and improving medical care in rural areas. Laboratory, X-ray, and other services once available only in the largest cities were established in the district and sometimes at lower levels. The regime, in its effort to build up agriculture in the mid-1960s, set as an objective the improvement of living conditions in the countryside and the elimination of the differential between city and country. Medical assistance to rural areas continued to increase in the late 1960s, but in late 1969 the minister of health stated that the differences between the center and the districts and between the cities and the villages were very pronounced. He directed that action be taken to lessen the gap but added that differences would continue to exist.

Nutrition

Food supply—perennially a problem because of poor soil, primitive methods of cultivation, and lack of readily accessible resources—did not keep pace with population growth. For the late 1960s calorie intake per capita per day probably did not exceed 2,100 to 2,200, while the estimate for the mid-1950s was 2,200 to 2,300. The diet lacked protein and other protective elements. An estimated 80 percent or more of food intake was carbohydrates. Fruits and green vegetables were in short supply, and meats were a real scarcity. Little progress had been made in increasing livestock herds during the period of Communist rule, and credits to procure adequate supplies of protective foods from sources outside the country were not available ([see ch. 8], Economic System).

The diet generally depicted scarcity and, in the mountain and rural areas, was simple and routine. Dishes, high in starch content, made from corn, wheat, rice, and potatoes were basic. Yogurt, cheese, and prepared dry beans were among the most commonly found other foods. Green vegetables and fruits appeared seasonally in limited quantities.