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  1. 1

    Istanbul Declaration.

    International Congress on Population Education and Development (1993: Istanbul)

    In: First International Congress on Population Education and Development, Istanbul, Turkey, 14-17 April, 1993. Action Framework for Population Education on the Eve of the Twenty-First Century. Istanbul declaration, [compiled by] United Nations Population Fund [UNFPA] [and] UNESCO. [New York, New York], UNFPA, 1993. 5-7.

    Participants at the International Congress on Population Education and Development, organized by the United Nations Educational, Scientific, and Cultural Organization (UNESCO) and the UN Populations Fund in Istanbul during April 14-17, 1993, adopted the Istanbul Declaration and approved an action framework for population education. Population is one of the world's most serious concerns, which education can help to solve. The world's population needs to be taught about important population issues. In particular, population education projects and programs need to reach to all levels of the educational system, to all types of educational institutions, and to all settings of non-formal education. Population education should be developed as an integrated component of educational curricula. Population education, environmental education, and international education all improve the quality of life and the relationships of humans with each other and nature. Congress participants call upon international and organizational support for new and ongoing population education.
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  2. 2

    [Female genital mutilation in France] Mutilations sexuelles feminines en France.

    Mouvement Francais pour le Planning Familial [MFPF]. Centre de Documentation

    Paris, France, MFPF, 1993 Jun. ii, 73 p. (Dossier Documentaire)

    The French Movement for Family Planning (MFPF) has compiled documents on female genital mutilation in France. The documents are presented with an introduction entitled Excision in Law and four sections addressing the last excision trials in France; action of the public powers; in the UK, family planning action and of IPPF; trials for excision in January and February 1993 (facts across the press); and family planning in Mali fighting against sexual mutilation. Interspersed in these sections are witness accounts, indictments, and counsel's speech. Some titles of newspaper and magazine articles in the MFPF collection include Five Years in Prison for Excision (Le Monde); For the First Time in France, an African is Condemned to a Year on a Prison Farm for Having Her Daughters Excised (Le Monde); Excision: The Pain of the Innocents (Nouvel Observateur); and Excision: The Word of Cut Women (Marie-Claire). The MFPF collection presents an IPPF report called Restoring to Women their Life Space which is about female genital mutilation. The collection ends with an interview in the Bulletin of the Malian Association for Family Planning (AMPPF) with an obstetrician-gynecologist serving on the AMPPF executive board who addresses excision and other traditional practices.
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  3. 3

    Vienna Declaration on Human Rights. [Selected passages].

    United Nations Conference on Human Rights (1993: Vienna)

    POPULATION AND DEVELOPMENT REVIEW. 1993 Dec; 19(4):877-82.

    This document contains reprints of selected passages in the "Vienna Declaration and Programme of Action" which was formulated during the UN Conference on Human Rights held in Vienna, Austria, on June 14-25, 1993. Part I focuses on the commitment of all states to fulfill their obligations in the promotion of human rights. It also emphasizes the right of each individual to self-determination and the role of the international community in the promotion and protection of all human rights. Furthermore, it recognizes the dignity and contribution of indigenous people to the development of society, and stresses the rights of children to a full and harmonious development in a family environment. It also expresses dismay over ethnic cleansing and systemic rape of women in war situations. Meanwhile, Part II of the declaration addresses the rights of women in terms of gender and educational equality as well as the accessibility and adequacy of health services.
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  4. 4

    Equal Remuneration Convention (ILO 100). [Status].

    International Labour Organisation [ILO]

    In: Multilateral treaties, index and current status, Tenth Cumulative Supplement, compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1993. 170.

    The following countries became parties to this Convention in 1992: a) Azerbaijan, 19 May 1992; b) Latvia, 27 June 1992; and c) Slovenia, 9 June 1992. This Convention requires that parties promote and ensure the application of the principle of equal remuneration for men and women workers for work of equal value.
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  5. 5

    [Convention on the] Political Rights of Women. [Status].

    United Nations

    In: Multilateral treaties, index and current status, Tenth Cumulative Supplement, compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1993. 174.

    The following countries became parties or succeeded to this Convention in 1991-92: a) Croatia, 8 October 1991 (suc.); b) Jordan, 1 July 1992; c) Latvia, 14 April 1992; and d) Slovenia, 25 June 1991 (suc.). This Convention affirms the right of women to vote and their eligibility for public office and publicly elected bodies.
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  6. 6

    Night Work (Women) Convention (ILO 4). Status.

    International Labour Organisation [ILO]

    In: Multilateral treaties, index and current status, Tenth Cumulative Supplement, compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1993. 137-8.

    On 9 June 1992, Slovenia became a party to this Convention. In 1992, Belgium, France, Greece, Italy, Portugal, Spain, and Switzerland registered their denunciations of this Convention. The Convention places restrictions on women working at night. On 3 March 1992, Argentina registered its denunciation of the Night Work (Women) Convention (ILO 4). This Convention also places restrictions on women working at night. See Multilateral Treaties, Index and Current Status, 10th Cumulative Suppl., 1993, pp. 137-8.
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  7. 7

    Status of Refugees Convention. Protocol Relating to the Status of Refugees. [Status].

    United Nations

    In: Multilateral treaties, index and current status, Tenth Cumulative Supplement, compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1993. 170, 211.

    The following countries became parties or succeeded to this Convention and Protocol in 1991-92: a) Albania, 18 August 1992; b) Cambodia, 15 October 1992; c) Croatia, 8 October 1991 (suc.); d) Honduras, 23 March 1992; e) Republic of Korea, 3 December 1992; and f) Slovenia, 25 June 1991 (suc.). The Convention and Protocol contain detailed provisions on the obligations of parties with respect to persons claiming to be refugees. Among these are provisions on legal status, employment, social welfare, housing, education, freedom of movement, social security, travel documents, deportation, and international cooperation.
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  8. 8

    [International] Covenant on Civil and Political Rights. [Status].

    United Nations

    In: Multilateral treaties, index and current status, Tenth Cumulative Supplement, compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1993. 210.

    The following countries became parties or succeeded to this Covenant in 1991-92: a) Angola, 10 January 1992; b) Azerbaijan, 13 August 1992; c) Benin, 12 March 1992; d) Brazil, 24 January 1992; e) Cambodia, 26 May 1992; f) Cote d'Ivoire, 26 March 1992; g) Croatia, 8 October 1991 (suc.); h) Guatemala, 5 May 1992; i) Latvia, 14 April 1992; j) Lesotho, 9 September 1992; k) Paraguay, 10 June 1992; l) Seychelles, 5 May 1992; m) Slovenia, 25 June 1991 (suc.); n) Switzerland, 18 June 1992; and o) United States, 8 June 1992. The Covenant contains human rights provisions relating to equality of the sexes, freedom of movement, freedom from arbitrary and unlawful interference with the home and family; protection of children and the family; the right to marry and found a family; and equality of spouses in marriage, among other things. In addition, the following of the above countries became parties or succeeded to the International Covenant on Economic, Social and Cultural Rights on the same dates in 1991-92: a) Angola, Azerbaijan, Benin, Brazil, Cambodia, Cote d'Ivoire, Croatia (suc.), Latvia, Lesotho, Paraguay, Seychelles, Slovenia (suc.), and Switzerland. Guinea-Bissau became a party to this Covenant on 2 July 1992. This Covenant contains human rights provisions relating to equality of sexes, equal pay for equal work, maternity benefits, housing, education, health care, and protection of the family, children, and mothers, among other things. See Multilateral Treaties, Index and Current Status, 10th Cumulative Suppl., pp. 209-210.
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  9. 9

    Convention on [the Elimination of All Forms of] Discrimination against Women. [Status].

    United Nations

    In: Multilateral treaties, index and current status, Tenth Cumulative Supplement, compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1993. 278.

    The following countries became parties or succeeded to the Convention on the Elimination of All Forms of Discrimination against Women in 1990-92: a) Benin, 12 March 1992; b) Burundi, 8 January 1992; c) Cambodia, 15 October 1992; d) Croatia, 8 October 1991 (suc.); e) Jordan, 1 July 1992; f) Latvia, 14 April 1992; g) Namibia, 23 November 1992; h) Samoa, 25 September 1992; i) Seychelles, 5 May 1992; and j) Slovenia, 25 June 1991 (suc.). Under this Convention, the parties agree to take steps to eliminate discrimination against women in the political, social, economic, and cultural areas of life and with respect to education, employment, health care, and the family, among other things. The Convention also creates a Committee to review reports that individual countries are required to prepare on their progress in implementing the Convention.
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  10. 10

    Workers, [with] Family Responsibilities Convention. [Status].

    International Labour Organisation [ILO]

    In: Multilateral treaties, index and current status, Tenth Cumulative Supplement, compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1993. 289.

    On 9 June 1992, Slovenia became a party to this Convention. The Convention requires that parties accept as their national policy that men and women with family responsibilities should be able to exercise their right to work without discrimination against them because of these responsibilities. The Convention applies to workers with dependent children and workers with other family responsibilities.
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  11. 11

    Convention on the Rights of the Child. [Status].

    United Nations

    In: Multilateral treaties, index and current status, Tenth Cumulative Supplement, compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1993. 86-7.

    The following countries became parties or succeeded to the Convention on the Rights of the Child in 1990-1992: a) Austria, 6 August 1992; b) Azerbaijan, 13 August 1992; c) Bahrain, 13 February 1992; d) Cambodia, 15 October 1992; e) Cape Verde, 4 June 1992; f) Central African Republic, 23 April 1992; g) China, 2 March 1992; h) Croatia, 8 October 1991 (suc.); i) Equatorial Guinea, 15 June 1992; k) Germany, 6 March 1992; j) Iceland, 28 October 1992; k) India, 11 December 1992; l) Ireland, 28 September 1992; m) Latvia, 14 April 1992; n) Lesotho, 10 March 1992; o) Slovenia, 25 June 1991 (suc.); p) Thailand, 27 March 1992; and q) Tunisia, 30 January 1992. This Convention obligates parties to protect the human rights of the child with respect to the provision of adequate food, shelter, and health care; freedom from abuse and exploitation; and the participation of children in social, economic, religious, and political life. The Convention creates a Committee to review periodic reports submitted by parties on the implementation of the Convention.
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  12. 12

    Convention on Consent to Marriage [Minimum Age for Marriage and Registration of Marriages]. Status.

    United Nations

    In: Multilateral treaties, index and current status, Tenth Cumulative Supplement, compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1993. 199.

    On 1 July 1992, Jordan became a party to this Convention. In addition, on 8 October 1991, Croatia succeeded to the Convention. The Convention reaffirms the consensual nature of marriages and requires the parties to establish a minimum age by law and to ensure the registration of marriages. The following countries became parties or succeeded to the Convention on the Nationality of Married Women in 1991-92: a) Croatia, 8 October 1991 (suc.); b) Jordan, 1 July 1992; c) Latvia, 14 April 1992; and d) Slovenia, 25 June 1991 (suc.). The Convention provides for the retention of nationality by women upon marriage or dissolution of marriage or when their husbands change their nationality. It also contains provisions on the naturalization of foreign wives. See Multilateral Treaties, Index and Current Status, 10th Cumulative Suppl., 1993, p. 181.
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  13. 13

    First International Congress on Population Education and Development.

    In: First International Congress on Population Education and Development, Istanbul, Turkey, 14-17 April, 1993. Action Framework for Population Education on the Eve of the Twenty-First Century. Istanbul declaration, [compiled by] United Nations Population Fund [UNFPA] [and] UNESCO. [New York, New York], UNFPA, 1993. 3-4.

    Resolution 5.3, adopted by the General Conference of UNESCO at its 26th session in 1991, authorized the Director-General to organize, jointly with the UN Population Fund (UNFPA), the first International Congress on Population Education and Development (ICPED). Congress aims were to review trends in population education worldwide over the past 2 decades, to adopt a declaration upon the role of population education in human development, and to devise an action framework in the field. The congress was also held to strengthen the integration of population education into formal and non-formal education systems. At the invitation of the Turkish government, the congress was held in Istanbul during April 14-17, 1993, during which 93 countries were represented and 245 participants attended, including 20 ministers of education and 5 deputy ministers. The 27th session of the General Conference of UNESCO in Paris during October-November 1993 welcomed the conclusions of the first ICPED and endorsed its declaration. Member states, nongovernmental organizations, and governmental agencies are encouraged to implement the principles and activities suggested in the declaration and action framework.
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  14. 14

    The theory and practice of mass information. A method to regularize unwarranted population movements, to promote voluntary repatriation.

    Casella A

    [Unpublished] 1993 Aug. [24] p.

    Once regionally confined population movements of migrants and refugees have become increasingly globalized and irregular. Increasingly directed from developing to developed countries, these movements result from the breakdown of traditional economic and social structures, protracted low-intensity conflicts, and deteriorating standards of living due to natural disasters, rapid population growth, economic mismanagement, the ease of transportation, and the massive development in mass communication. In particular, mass communication fuels audiences' perception that people in developing countries experience a lower standard of living than that found in more developed countries and that moving to a wealthier country will improve one's standard of living. Indeed, perception is the main factor driving irregular population movements of a non-refugee nature. The volume of such movements is becoming problematic. However, mass information conveyed directly from the source of an international organization to people contemplating migration can be applied to help stabilize irregular population movements of a non-refugee nature. Irregular departure and emigration, voluntary repatriation, and experiences in Vietnam, Albania, and Cambodia are discussed.
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  15. 15

    [Population questions from a German viewpoint, with reference to the 1994 International Conference on Population and Development (ICPD 1994): presentation of the government report for the ICPD 1994] Bevolkerungsfragen aus deutscher Sicht im Hinblick auf die Internationale Konferenz 1994 fur Bevolkerung und Entwicklung (ICPD 1994): Vorstellung des Regierungsberichts fur die ICPD 1994.

    Kroppenstedt F


    This article provides a summary of a report prepared by the German government in preparation for the 1994 International Conference on Population and Development. Topics reviewed include the demographic situation in Germany, population questions and policies, and international cooperation in the area of population policy. (ANNOTATION)
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  16. 16

    [It is time to act] E tempo de agir.

    PLANEAMENTO FAMILIAR. 1993 Jul-Dec; (61-62):18.

    Time to act was the topic of the World Health Organization (WHO) on World AIDS Day, December 1, 1993, marked by a number of initiatives in many countries including Portugal. In Lisbon, 16 nongovernmental organizations met in order to launch a campaign of solidarity to humanize the services in Santa Maria and Curry Cabral hospitals and the Hospital of Estefania, where patients with AIDS are treated. The campaign lasted until December 31 and it collected funds, books, and goods to improve the material conditions of services. There was a program of animations and a video projection of four case histories. The nongovernmental organizations set up four working groups in prevention, social aid, hospital conditions, and elaboration of the rights of the infected. Other activities were also organized. 500 bikers rolled through the streets of the capital distributing brochures about AIDS. An international marathon was promoted and kiosks were also set up in Loures and Sacavem. There were also a national information and sensitivity campaign and education sessions for students. On the eve of December 1, a satirical show was performed in the Sao Luis Theatre. Simultaneously, the National Commission of the Combat Against AIDS disclosed that 1503 AIDS cases had been reported by November 1993 in Portugal, which corresponds to approximately 15,000 HIV infections. 66% of infections are transmitted via the sexual route, a fact which reinforces the importance that the WHO attaches to sex education in schools to prevent its spread among young people. A report of the WHO indicated that sex education increases the adoption of safe sex practices. The same study indicated that 14 million people are infected with HIV, a figure which may increase to 40 million by the year 2000. Almost half of those infected are persons in the 15-24 age group.
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  17. 17

    Health in the central and eastern countries of the WHO European Region: an overview.

    Nanda A; Nossikov A; Prokhorskas R; Abou-Shabanah MH


    The socioeconomic conditions in eastern European countries are declining. Deterioration began during the mid-1960s. The mortality gap has continued to widen during the 1980s. The Central Asian Republics show mortality patterns similar to ones in developing countries; infant mortality is about 8 times higher than in western Europe. Infant mortality rates in eastern and central Europe are 2-3 times higher than in western Europe. Cardiovascular diseases are the leading cause of death. Another increasing mortality group is lung cancer, and the gap is widening in the West. The NIS (formerly republics of the Soviet Union) have high rates of communicable diseases preventable through immunization. The logistics of vaccine distribution and storage are inadequate. Abortion is the primary means of family planning. 70% of the population of the Russian Federation reported their health as less than good, and only 20% of Russian military personnel are fit based on international standards. Tobacco consumption and high alcohol consumption are the primary health risks. Poor nutrition, stress, and drug abuse add to the risks. The health gap is wide also due to poor housing conditions and environmental pollution. Health care systems, unhealthy lifestyles, and unhealthy environments all contribute to the widening gap in health. The rigid administrative health structures are not conducive to change. The quality of care is low. Decentralization and private sector involvement may produce needed changes in the quality of health services. CCEE countries spend 4.5-7.1% of gross national product on health, compared to 7.3% in the West. In the Czech Republic, Poland, Hungary, and Slovakia, health expenditures per person are 3-4 times less than in OECD countries. Prices are very high for drugs, food, and energy. Although the medical staff-patient ratio is high, there are shortages in particular specialties. Nurses are poorly trained and in low supply. Hospital equipment is very old and poorly maintained. There is overuse of secondary and tertiary hospitals and underuse of general hospitals.
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  18. 18

    Communicable diseases in the CCEE / NIS.

    Roure C; Oblapenko G


    Two main types of operational indicator were used to evaluate the regional Expanded Programme on Immunization (EPI): immunization coverage by different vaccines in children under 1 or 2 years old and morbidity trends. The European Region is passing through a period of rapid transition, with the most dramatic changes in the countries of central and eastern Europe (CCEE) and newly independent states (NIS). The provision of adequate vaccine supplies has become a priority for many member states in their efforts to sustain immunization activities. The World Health Organization's Regional Office has therefore launched a special program on vaccines for CCEE/NIS. New operational targets for EPI in Europe in the 1990s were established by the European Advisory Group on EPI in 1993. These operational targets emphasize the steps countries need to follow to achieve the European target 5, which calls for no indigenous cases of poliomyelitis, diphtheria, neonatal tetanus, measles, mumps, and congenital rubella by the year 2000. Immunization coverage generally remains high and stable in the region. During 1990-1992, pockets of nonimmunized individuals in different countries led to outbreaks of disease. Currently, the low coverage with diphtheria-pertussis-tetanus (DPT/DT) vaccines in many provinces of the Russian Federation is one of the reasons for the epidemic of diphtheria that has affected the country since 1990. Despite the difficulties experienced by many CCEE and NIS, progress has occurred. Morbidity from poliomyelitis declined during 1990-1993. There remain only a few areas with endemic transmission of wild poliovirus: the Balkans, trans-Caucasus, and central Asia. The diphtheria situation deteriorated in 1990, becoming increasingly dramatic in 1992 and 1993. Almost all cases have been reported from the Russian Federation and the Ukraine. Increasing diphtheria morbidity has been observed in Belarus, Kazakhstan and Uzbekistan.
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  19. 19
    Peer Reviewed

    Childhood blindness: a new form for recording causes of visual loss in children.

    Gilbert C; Foster A; Negrel AD; Thylefors B


    In London, the International Centre for Eye Health (ICEH), a WHO Collaborating Centre for Blindness Prevention, and WHO have developed a standardized protocol for reporting causes of blindness in children, primarily those in schools for the blind and those attending hospital clinics. There is a section for blind children identified during population-based prevalence surveys. A set of coding instructions and a database for analysis accompany the WHO/PBL Eye Examination Record for Children with Blindness and Low Vision. ICEH and WHO hope the new form will identify preventable and treatable causes of childhood blindness. It will also serve as a mechanism to monitor changing patterns of childhood blindness over time in response to changes in health care services, specific interventions, and socioeconomic development. Further, it will allow eye doctors to assess the requirements of individual children for medical and/or surgical treatment optical correction, and low vision services. Finally, it will give educators the opportunity to assess the educational needs of blind children. The contents of the form include census, personal details, visual assessment, general assessment, previous eye surgery, eye examination (site of abnormality leading to blindness and etiology of blindness), refraction/low vision aid assessment, action needed, prognosis for vision, education, full diagnosis, and names of the examiners. Both ICEH in London, and WHO in Geneva will maintain a centralized data blank. Local ophthalmologists with an interest in pediatric ophthalmology and those assigned to develop the form tested the form while examining about 1600 children in schools for the blind in 4 continents. Ophthalmologists can examine and complete the form on 5-8 children/hour in schools for the blind.
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  20. 20

    [Breast feeding and the infant food industry: mutual respect as a form of collaboration (letter)] Lactancia materna e industria dietetica infantil: el respeto mutuo como forma de colaboracion.

    Temboury Molina MC

    ANALES ESPANOLES DE PEDIATRIA. 1993 Jun; 38(6):560-1.

    A letter from a pediatrician responding to comments on an earlier publication about breast feeding and the infant formula industry acknowledges the importance of having adequate preparations available for infants who for any reason cannot be breast fed. But some continuing advertising and marketing practices of the infant formula industry, along with inappropriate maternity ward routines and sociocultural changes, are jeopardizing the practice of breast feeding in rich and poor countries alike. The World Health Organization and UNICEF estimate that nutritional, infectious, and diarrheal diseases are more prevalent today than 20 years ago, and that abandonment of breast feeding is a factor in at least 1 million infant deaths each year. The nutritional problems caused by abandonment of breast feeding are not as drastic in developed countries, but some protections against allergies and infections are lost, as are the emotional bonding between the mother and infant. Furthermore, in developed countries the least advantaged groups are the least likely to breast feed. The World Health Organization General Assembly in 1974 called attention to the decline of breast feeding and requested member nations to promulgate laws regulating advertising and marketing of infant formula. A global campaign by health organizations and citizens' groups led to adoption by the World Health Organization in 1981 of an international code for marketing of milk substitutes. Various countries have subsequently adopted its measures, at least in part. Despite the code, bottle feeding continues to become more prevalent. A Spanish decree of 1992 established regulations for the wording and illustrations on infant formula containers and in advertising. A statement indicating the relative superiority of mothers' milk is required, and advertising of infant formulas is restricted to scientific publications. The wording may not imply that bottle feeding is equivalent to breast feeding. Advertising at points of sale, distribution of samples, and similar activities directed toward the consumer are prohibited. Health administrators are given responsibility for assuring that information on infant feeding provided to pregnant women and families is objective and coherent, and for limiting use of artificial preparations to infants requiring them. The World Health Organization/UNICEF August 1990 meeting established as goals for 1995 the establishment of multisectorial national committees on breast feeding, the guarantee that all maternity wards would establish routines support of breast feeding, the promulgation of measures to put into practice all articles of the international code for marketing of milk substitutes, and the approval of laws to protect the practice of breast feeding by working women. Although Spain's new legislation is an important step, much remains to be done.
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  21. 21

    In Berlin, a forum for IPPF experiences with HIV.

    FORUM. 1993 Dec; 9(2):39.

    The International Planned Parenthood Federation (IPPF) has promoted the notion of sexual health for several years as a concept under which different elements contributing to the reproductive well-being of individuals and communities are integrated. This comprehensive approach combines attention to family planning, HIV prevention, promotion of safer sex, male involvement, attention to women's perspective, and community participation. This approach was shared with activists, HIV-positive people, community health workers, professionals, representatives from international organizations and donors who attended the 9th International Conference on AIDS in Berlin in June 1993. The IPPF approach has been well-received, with colleagues from other countries requesting theoretical and educational materials used in the program, and some expressing an interest in making field visits for personal observation.
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  22. 22

    Population programmes: assessment of needs.

    Allison CJ

    In: Population policies and programmes. Proceedings of the United Nations Expert Group Meeting on Population Policies and Programmes, Cairo, Egypt, 12-16 April 1992. New York, New York, United Nations, 1993. 114-20. (ST/ESA/SER.R/128)

    The paper addresses: 1) national population principles and objectives; 2) the population dimension of national development policy; 3) national population programs; 4) the rationale, opportunities and needs for external donor support; and 5) processes for population program needs assessment based on the work of one bilateral donor, the United Kingdom Overseas Development Administration. The population dimension to national development policy formulation is most important in relation to policies on: 1) provision of social services (health, education, family planning); 2) environment; 3) development planning and resource allocation; 4) poverty alleviation; 5) labor force and human resource development (youth employment, child labor); 6) social security for the elderly; and 7) the status of women. A population program establishes the strategies to implement the national population policy. Effective family planning programs recognize diverse needs for contraception (youth adults, couples wishing to space their children, those who have completed their families). Ready access to family planning can be achieved through: 1) integrating family planning into clinic-based maternal and child health services; 2) community-based activities; and 3) the retail sector using social marketing. Other population activities include effective dissemination of data including population education in schools. United Kingdom development donor assistance and wider development policies includes: 1) public expenditure rationalization for structural adjustment; 2) civil service reform; 3) health system restructuring; and 4) decentralization. External assistance would include: 1) technical assistance, using local and international expertise; 2) training, in-country and overseas; 3) supplies, including contraceptives; 4) renovation of the existing health infrastructures; and 5) local costs, such as salaries. For donors, one model is the UNFPA program review and strategy development process.
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  23. 23
    Peer Reviewed

    Evaluation of two staging systems for HIV infection for use in developing countries.

    Vandenbruaene M; Colebunders R; Goeman J; Alary M; Farber CM; Kestens L; Van Ham G; Van den Ende J; Van Gompel A; Van den Enden E

    AIDS. 1993 Dec; 7(12):1613-5.

    In 1990, Belgium, physicians enrolled 415 consecutive patients attending HIV reference centers in Antwerp, Brussels, and Ghent in a cross-sectional study designed to evaluate the clinical axis of the WHO staging system with and without the lymphocyte stratification proposed by Montaner el al. (that is, modified WHO staging system) (>1500, 1500- 1000, and <1000 cells x 1 million/l). They filled in a standardized questionnaire with all criteria of the WHO staging system. Laboratory personnel used standard hematology and flow cytometry techniques to determine absolute and CD4 lymphocyte counts. 80% of the patients were Caucasians. 46% of all patients were homosexual and 42% were heterosexual; 79.2% were men. Median CD4 lymphocyte counts fell in both staging systems as the stage of HIV infection increased. There were significant differences in median CD4 counts between stages of each staging system (p < .001). The modified WHO staging system's stage I was more sensitive at identifying patients with CD4 lymphocyte counts of more than 500 cells x 1 million/l than the WHO clinical stage 1 (83% sensitivity vs. 48% sensitivity). The positive predictive value of WHO clinical stage 4 and of the modified WHO staging system's stage IV for identifying people with CD4 lymphocyte counts of less than 200 cells x 1 million/l was quite high (79% and 80%, respectively). The researchers suggested that clinicians use stages 4 and IV as end-points is clinical trials in developing countries. Clinicians completing the questionnaire knew the patients' earlier CD4 lymphocyte count, which may have introduced a bias in the study. For example, they may have more thoroughly examined patients with low CD4 lymphocyte counts than those with normal counts. Nevertheless, the study's results indicated that either one of these systems may be a good alternative in developing countries to the technical equipment-dependent CD4 lymphocyte count-based HIV staging system used in developed countries. Cohort studies in developing countries would evaluate their prognostic value.
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  24. 24
    Peer Reviewed

    Boost for vaginal microbicides against HIV.

    Lange JM; Karam M; Piot P

    Lancet. 1993 Nov 27; 342(8883):1356.

    In November 1993, WHO and the UK Department of Health cosponsored a meeting at which the participants addressed the need for women-controlled methods of preventing HIV infection. They called for animal studies to develop vaginal microbicides active against HIV which, in an ideal situation, the women could use without their sexual partners' knowledge. Ideally, any new product would also prevent transmission of other sexually transmitted diseases (STDs). They did caution, however, that the use of such microbicides should not replace, but complement other methods to prevent sexual transmission of HIV. They recommended also that appropriate clinical trials testing the safety and efficacy of the product should also take place. Participants called for WHO to develop the prototype protocols for phase I-III trials of vaginal microbicides. Some spermicides (nonionic detergents or surfactants) provide protection against some STDs (gonorrhea and chlamydial infections) and, in vitro, destroy HIV. Yet, they tend to irritate vaginal mucosa, facilitating HIV transmission. The likelihood of vaginal irritation increases with frequency of use and with doses. Women may not have symptoms indicating that they have spermicide-induced mucosal lesions. A study in Nairobi suggests that use of a sponge impregnated with high dose nonoxynol-9 increased the probability of HIV seroconversion. Lower doses of nonoxynol-9 had a protective effect against HIV seroconversion in studies in Cameroon and Zambia. In all these studies, however, there were sizable methodological limitations. The risk/benefit ratio for individuals using low to moderate doses of spermicides is not clear. Another consideration in that prevention of STDs, significant risk factors for HIV transmission, would reduce the spread of HIV.
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  25. 25

    HIV testing: reduce costs by all means, but not at all costs [letter]

    Simon F; Brun-Vezinet F

    Lancet. 1993 Aug 7; 342(8867):379-80.

    Some HIV specialists propose alternative strategies of anti-HIV antibody screening to reduce costs. A western blot (WB) test confirming a positive anti-HIV antibody screening test is the time-honored strategy. WHO has guidelines on how to interpret WB results and how to handle indeterminate patterns. Tests for p24 antigen may identify HIV infection in those cases where the WB test fails to detect HIV infection during seroconversion. Alternative strategies proposed by authors of an earlier article to reduce HIV testing costs are flawed. For example, in 1 strategy, a positive result in the first test or ELISA and a negative result in a second test based on antigens or in another screening test based on a different principle leads to medical workers telling the person that he/she is HIV seronegative. Yet, the negative results of the second test may be due to seroconversion. Even though the first test should be as sensitive as possible, a subsequent negative test result should require another blood sample to test for p24 antigen. A second proposed strategy uses a competitive ELISA as the second test, but these assays cannot detect HIV-2 infection. The authors pooled the samples to illustrate cost saving, but pooling data loses sensitivity, especially for rapid tests. Virologists from Hospital Bichat-Claude Bernard in Paris, France, and earlier demonstrated the loss of sensitivity of rapid tests among sera from 9 patients in the early stage of HIV-1 seroconversion. They further believed that the manufacturer should determine reliability, sensitivity, and specificity. WHO did not take the above information into account when it addressed reducing the costs of HIV screening tests. Realistic diagnostic strategies are indeed needed in countries with few resources, but unreliable testing should not be the result of cost reductions.
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