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Danish Medical Bulletin. 2007 May; 54:150-152.In general, children and adolescents in the WHO European Region today have better nutrition, health and development than ever before. There are striking inequalities in health status across the 52 countries in the Region, however, with over ten-fold differences in infant and child mortality rates. Inequalities are also growing within countries, and several health threats are emerging. Against this background, the WHO Regional Office for Europe has developed a European strategy for child and adolescent health and development. The purpose of the Strategy, together with a tool kit for implementation, is to assist member states in formulating their own policies and programmes. (author's)
Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2002. 28 p. (WHO/FCH/CAH/02.23)Although the past 15 years have seen a decline in child mortality due to pneumonia, it remains a very important cause of death in developing countries. In Africa in particular, pneumonia and malaria are by far the most important causes of death for children under 5. The overall aim of this meeting was to help to define practical community approaches which could deliver a rapid reduction in this preventable mortality. WHO has developed and supported the use of case management of pneumonia through the ARI Programme and later as a part of IMCI. The main focus for these initiatives has been the health facility, although much of the demonstration of the efficacy of the clinical interventions was carried out at community level, using community health workers. IMCI uses the same clinical methodology. Although IMCI stresses the promotion of care-seeking by families with sick children, in general, the clinical management of such children is offered at the first level health facility. The importance of providing care without delay for children with malaria has led to the development and introduction, so far on a small scale, of interventions based in the community, either through a community health worker or directly by families, who are provided with packs of antimalarials. These two diseases in childhood, pneumonia and malaria, have major overlaps in terms of clinical presentation, the requirements for their effective management and the feasibility of providing standardised care in the community. Technically sound and operationally manageable community interventions that tackled both conditions would offer a most valuable tool for use in the reduction in child mortality in developing countries. (excerpt)
Lancet. 2003 Dec 31; 363(9402):75-76.In July, 2003, maternal health specialists from around the world gathered in Bellagio, Italy, to develop a list of proven and promising technologies, appropriate for low resource settings, to reduce maternal mortality. We defined technologies as equipment, consumable supplies including medicines, and techniques. While technology, especially in health care, often provokes thoughts of complex, costly interventions, the technologies identified at the Bellagio meeting are mostly simple and inexpensive. What is lacking are resources, human and financial, to scale-up and put proven technologies into widespread use and to assess and document the effectiveness of promising new interventions. There is an urgent need to accelerate the appropriate use of technologies and to reduce the inequitable burden of pregnancy-related mortality borne by women in poor countries. The 2003 Lancet series on child survival highlighted the interventions needed to ensure the health of children worldwide. We would add that saving the life of the mother is one of the best ways to prevent the death of a child. The half million women who die from pregnancy-related and childbirth-related causes every year leave behind at least 1 million motherless children who are all at increased mortality risk. (excerpt)
Report. European Parliamentarians' Forum on Child Survival, Women and Population: Integrated Strategies, February 12-13, 1986, the Hague, Netherlands.
[The Hague, Netherlands, European Parliamentarians' Forum on Child Survival, Women and Population, 1986.] 109 p.This report summarizes the consensus of the European Parliamentarians' Forum on Child Survival, Women, and Population. They have had the opportunity to examine integrated approaches to several of the world's most crucial issues of social development. Their co-sponsors, the World Health Organization, UNICEF, and the UN Population FUND, have been active in promoting integrated strategies to provide health for all, survival and well-being of mothers and children, family planning, and full and equal participation of men and women in the development process. But a great deal more remains to be done. The parliamentarians subscribe to the view that the effectiveness of the UN system will increase considerably in pursuit of commonly defined goals and objectives and action programs as defined in various conferences and meetings. Common action plans are available; the challenge now is to engage in a combined and concerted effort to implement these plans. Their role as parliamentarians is to implement the recommendations of today and to build up support, both within the governmental and the private sectors. Public perception tends to overlook the significant contributions the UN and related bodies are making to improve conditions of life and well-being the world over. The main tasks all have agreed on are 1) encouraging UN agencies and organizations concerned with social development to work together closely and to and enhance the effectiveness of their programs; 2) focusing public attention on the interrelatedness of issues relating to health, mother and child survival and care, the role and status of women, and freedom of choice for both men and women in family matters; 3) seeking greater support for social development programs of the UN, which ultimately strengthens the UN as a whole, through increased governmental contributions and better public understanding; and 4) maintaining and strengthening their own commitment through dialogues among themselves as parliamentarians.
AIDS. 1992 Dec; 6(12):1505-13.HIV/AIDS specialists have developed and applied 3 different scenarios to a comprehensive decision analysis model to estimate mortality rates for children of mothers infected with HIV during pregnancy and for children of mothers who were not infected with HIV during delivery. Scenario I represents Central Africa where HIV prevalence and incidence are high. Some scenario I assumptions are HIV prevalence in pregnant women of 30% and proportion of initially uninfected women who become infected after delivery during lactation (d) of 6%. Scenario II is a population where HIV epidemic is rather recent (e.g., some parts of Asia). Its assumptions are HIV prevalence of 5%, and s is 2%. Scenario III symbolizes high-risk populations in North America and Western Europe (HIV prevalence and s = 1%). The scenarios also consider child mortality rates and relative risks (RRs) of mortality of breast fed children and those who were not breast fed. Universal breast feeding would effect equal or higher mortality than non-breast feeding, when the RR of mortality is no more than 1.5 and HIV prevalence/incidence is high (high prevalence = > 10% and high incidence = > 5%). In developing countries, where the RR of mortality is high if children are not breast fed (RR > 3), breast fed children have almost always lower child mortality than those who are not breast fed, regardless of HIV infection status. The decision to breast feed when the HIV status is known depends greatly on the degree of an additional mortality risk if an infant is not breast fed. The model substantiates WHO and CDC recommendations: HIV-positive women in the UK and the US should not breast feed, while those in developing countries with high RR of child mortality should breast feed. Additional research would define the range of HIV transmission rates from breast feeding and increase specific assessments of RRs for various parts of the world.
The World Health Organization's Expanded Programme on Immunization: a global overview. Le Programme Elargi de Vaccination de L'Organization Mondiale de la Sante: apercu mondial.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(2):232-52.In recognition that immunization is an essential element of primary health care, the World Health Organization (WHO), with other agencies, is sponsoring the Global Program on Immunization whose goal is to reduce morbidity and mortality from vaccine-preventable diseases by providing immunization for all children of the world by 1990. A global advisory group of experts meets yearly to review the program. This paper summarizes the most salient features of the 1984 meeting. The major event for the Expanded Program on Immunization (EPI) in 1984 was the Bellagio Conference on protecting the world's children. Activities undertaken as a result of this conference are discussed. 1 outcome was the formation of the Task Force for Child Survival whose main objective is to promote the reduction of childhood morbidity and mortality through acceleration of key primary health care activities. Focus is on supporting Colombia, India and Senegal in accelerating the expansion of their immunization programs and strengthening other elements of primary health care, such as diarrheal diseases control, family planning and improved nutrition. The 5-point action program consists of the following components: promoting EPI within the context of primary health care; investing adequate human resources in EPI; ensuring that programs are continuously evaluated and adapted so as to achieve high immunization coverage and maximum reduction in target-disease deaths and cases; and pursuing research efforts as part of program operations. EPI has continued to collaborate with other programs to help assure that immunization services are provided to support delivery of other services. Integration of EPI in Africa, the Americas, the Eastern Mediterranean Region, Europe, the South-East Asia Region, and the Western Pacific Region is examined.
In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 4-5. (International Conference on Oral Rehydration Therapy, 1983, proceedings)The Honorable Margaret Heckler, secretary of Health and Human Services, presents the goal of the conference--discussion of the remarkable potential of oral rehydration therapy and its importance to the health of infants and children throughout the world. The conference celebrates the scientific advances of recent years that give new hope for millions of children every year. Over 500 million episodes of diarrhea afflict infants in developing countries each year; each year, some 5 million children lose their lives to these diseases. In Europe, and in North America as well, diarrhea is the 6th most common cause of death among small children. At the turn of the century, mortality due to cholera was 60%. A scientist in Calcutta and 1 in Manila developed methods of intravenous therapy that reduced mortality dramatically to 20%. Treatment of the disease remained relatively unchanged until the middle of the century when work in Egypt and Asia resulted in a therapy method that reduced mortality for cholera to less than 1%. The crucial discovery of an effective cholera agent occurred in India in 1959. In 1962, scientists in Manila established the vital role of oral glucose in the absorption of sodium and water. The large-scale use of oral rehydration therapy was demonstrated in Dhaka and Calcutta in the 1960s, when 100s of cholera cases were managed under field conditions during a rural epidemic. A massive epidemic during a refugee crisis in 1971 was well-coped with by the Johns Hopkins group in Calcutta by treating 3700 patients over an 8-week period. This was one of the 1st large-scale uses of prepackaged materials for oral hydration, costing only US$750. In Dhaka and Calcutta in the early 1970s the critical discovery that noncholera diarrheal diseases could be treated with the oral rehydration therapy developed for cholera was made. The discovery of the role of glucose in accelerating the absorption of salt and water was underscored in the British journal "Lancet" as being potentially the most important medical advance of this century. A strong coalition of interest exists between governments and scientists of many nations as well as the international organizations to promote oral rehydration therapy. WHO, UNICEF, USAID and other agencies are playing an extremely important part in discovering how oral rehydration therapy can best be incorporated into broader health services, and how to prevent diarrheal diseases from occurring.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):452-9.This summary of the worldwide impact of measles discusses epidemiology, reported incidence, clinical severity, community attitudes toward measles, and the impact of immunization programs on measles. Measles, 1 of the most ubiquitous and persistent of human viruses, occurs regularly everywhere in the world except in very remote and isolated areas. Strains of measles virus from different counties are indistinguishable, and serum antibodies from diverse population have identical specificity. Yet, the epidemic pattern, average age at infection, and mortality vary considerably from 1 area to another and provide a contrasting picture between the developing and the developed countries. In the populous areas of the world, measles causes epidemics every 2-5 years, but in the rapidly expanding urban conglomerations in the developing world, the continuous immigration from the rural population provides a constant influx of susceptible individuals and, in turn, a sustained occurrence of measles and unclear epidemic curves. In the economically advanced nations, measles epidemics are closely tied to the school year, building up to a peak in the late spring and ceasing abruptly after the summer recess begins. Maternal antibody usually confers protection against measles to infants during the 1st few months of life. The total number of cases of measles reported to WHO for 1980 is 2.9 million. Considering that in the developing world alone almost 100 million infants are born yearly, that less than 20% of them are immunized against measles, and that various studies indicate that almost all nonimmunized children get measles, less than 3 million cases of measles in 1980 is a gross underestimate. There was adecrease in the global number of reported cases of measles during the 1979-80 period due primarily to the reduction in the number of cases in the African continent and, to a lesser extent, in Europe. It is premature to conclude that such a reported decline is real and that it reflects the beginning of a longterm trend. The contrast between the developed and the developing worlds is most marked in relation to the severity and outcome of measles. Case fatality rates of more than 20% have been reported from West Africa. It has been estimated that 900,000 deaths occur yearly in the developing world because of measles, but data available to WHO indicate that the global case fatality rate in the developing world approaches 2% (in contrast to 2/10,000 cases in the US), and the actal mortality may be greater than 1.5 million deaths per year. The advent of WHO's Expanded Program on Immunization has brought about an awareness of the measles problem. Whenever and wherever measles vaccine has been used effectively on a large scale, a marked reduction in the number of cases has been recorded.