Nurses have been urged to monitor the antenatal attendance of pregnant women for special attention to be given to those at risk. Dr Nii Adjei Adjetey, Assin North District Director of the Ghana Health Service who made the call expressed regret that some nurses took the handling of pregnant women at antenatal clinics as "routine business". He said this accounted for the high rate of maternal deaths in health facilities. Dr Adjei Adjetey stated that the district recorded 13 maternal deaths in 2006 as against nine in 2005 and said, "We need to change the way we approach the pregnant woman and have at the back of our mind that one pregnant woman or a mother lost is an economic and social disaster to the family and community". Addressing the District Health Performance Review meeting for 2006 at Assin Foso, Dr Adjetey noted that all the efforts to provide quality health care would not yield results if the people failed to manage the environment and maintained proper sanitation. "The poor sanitation within our communities accounts for the many diseases, which worry us", he noted and said, "I believe we have come to a stage where stringent sanctions must be applied for sanitary offences." Hr urged metropolitan, municipal and district assemblies to prove equal to the task. Dr Adjei Adjetey stated that even though the District did not record any cholera between 2003 and 2005 the epidemic resurfaced in 2006 when 219 cases resulting in two deaths were recorded. He commended the St. Francis Xavier Hospital at Assin Foso for its effective case management and other measures to contain the disease. The District Director of Health noted that malaria cases had declined steadily from 36,000 cases in 2004 to 22,300 in 2006. He attributed the decline to the effective case management with the Artesunate-amodiaquine combination, the use of insecticide treated nets and prophylaxis for pregnant women. Dr Adjetey mentioned delay in the re-imbursement of funds to health facilities for services provided and the issue of price differentials, which was casing some misunderstandings between some service providers and the District Mutual Health Insurance Scheme. Mr Benjamin Adjei, District Disease Control Officer, said five cases of Buruli Ulcer had been identified at Assin Dansame with one confirmed by health authorities. He said 38 snake; 46 dog, one monkey and seven human bites were recorded with one death from rabbis. Ms. Elizabeth Tinkorang, Presiding Member of the District Assembly, expressed concern about the rise in the reported cases of HIV/AIDS in the district and cautioned the people against promiscuity. Mr J. B. Abaidoo-Abbam, Health Administrator, cautioned workers against using dubious means to derail the health insurance scheme, saying, "anyone caught would be dismissed". Pastor John Apenkwa Brown, Assin District Pastor of the Assemblies of God Church and Chairman of the Board of Trustees of the Assinman Health Insurance Scheme, underscored the importance of health workers and commended them for working under difficult conditions. 11 Feb. GNA