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[Crisis in human resources for health: millennium development goals for maternal and child health threatened] Tekort aan gezondheidswerkers in Afrika: millenniumdoelstellingen voor moeder- en kindzorg in gevaar.
Nederlands Tijdschrift Voor Geneeskunde. 2010; 154(5):A1159.International migration of health care workers from low-income countries to the West has increased considerably in recent years, thereby jeopardizing the achievements of The Millennium Development Goals, especially number 4 (reduction of child mortality) and 5 (improvement of maternal health).This migration, as well as the HIV/AIDS epidemic, lack of training of health care personnel and poverty, are mainly responsible for this health care personnel deficit. It is essential that awareness be raised amongst donors and local governments so that staffing increases, and that infection prevention measures be in place for their health care personnel. Western countries should conduct a more ethical recruitment of health care workers, otherwise a new millennium development goal will have to be created: to reduce the human resources for health crisis.
[The practice guideline 'Hormonal contraception' (second revision) from the Dutch College of General Practitioners; a response from the perspective of obstetrics and gynecology] De standaard 'Hormonale anticonceptie' (tweede herziening) van het Nederlands Huisartsen Genootschap; reactie vanuit de verloskunde-gynaecologie.
Nederlands Tijdschrift voor Geneeskunde. 2004 Jun 26; 148(26):1274-1275.The Dutch College of General Practitioners' (NHG) guideline on hormonal contraception does not follow the WHO criteria for the use of oral contraceptives in contrast to the guideline of the Dutch Society of Obstetrics and Gynaecology. Contrary to the WHO criteria, the NHG guideline considers a blood-pressure measurement before starting with an oral contraceptive to be unnecessary. It also considers no form of migraine to be contraindication for oral contraceptives. The NHG guideline further disclaims the (slightly) increased risk of developing breast cancer in women using oral contraceptives. It advises initiation of oral-contraceptive use two weeks postpartum in non-breast-feeding women and six weeks postpartum in breastfeeding women, instead of the three weeks and six months, respectively, indicated in the WHO guideline. Lastly, the NHG guideline is too optimistic as to the reliability of oral-contraceptive use, as no distinction is made between efficacy and effectiveness. Such discrepancies between two Dutch guidelines can be detrimental to women's health care. The WHO criteria for contraceptive use may be a valuable tool to overcome differences of opinion to as to achieve a badly needed full consensus. (author's)
[Lactation-induced amenorrhea as birth control method] Lactatieamenorroe als geboorteregelingsmethode.
NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE.. 1998 Jan 10; 142(2):60-2.In 1966 WHO published a document on improving access to quality care in family planning, which who pronounced to be a fundamental human right. According to this document, despite the assortment of reliable contraceptives worldwide 350 million people have unmet need for contraception because of lack of access or availability. Adequate reproductive health depends not only access to contraceptives, but also on adequate screening and treatment of anemia, sexually transmitted diseases, and cervical carcinoma. Among 8 groups of birth control methods studied, the lactational amenorrhea method (LAM) was dealt with in detail. The underlying mechanism lies in the stimulation that breastfeeding brings about and in breastfeeding's suppression of the release of gonadotropin- releasing hormone and of dopamine (the prolactin inhibiting factor). A 1974 investigation in Rwanda demonstrated that 50% of rural women who breast fed their children frequently got pregnant within 23 months of childbirth and that 50% of city women became pregnant 9 months postpartum. The Bellagio consensus has stated that LAM provides 98% protection against pregnancy in the first 6 months postpartum as long as breast feeding is the exclusive feeding method practiced. A 1992 analysis of 9 prospective studies reported that 6 months postpartum only 0.7% of the women using LAM became pregnant. LAM still plays a crucial role in Africa, where the average number of children per woman is 6. Without breastfeeding the estimated figure would be 10.
NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE.. 1998 Aug 1; 142(31):1781-5.South Sudan has 5 million inhabitants and has been fighting a war of independence with North Sudan since 1959. The hostilities have totally disrupted the society and its government. In this region, international nongovernmental organizations (NGOs) are cooperating in relief activities in Operation Life Line, providing assistance to semi-nomadic pastoral tribes such as the Nuers and the Dinkas. The NGO Doctors Without Borders assisted in fighting a major epidemic of kala azar in the late 1980s; it cost some 200,000 lives, half of the Nuers' total population. The report of these doctors flying to different spots in the South of the country recounted how medical consultations were carried out under trees where possible. Kala azar was treated with ampules of Pentostam, and brucellosis patients were picked from the waiting group. Tuberculosis, whose indications are heavy coughing and expectoration, was also rampant. The abscess of a woman caused by a human bite was treated under local anesthesia with ketamine. The team had examined 70 patients by midday. In Duar, a site where Doctors Without Borders has treated 20,000 kala azar patients, basic health care and vaccinations were performed. In a marshy region, the Dinkas allow their livestock to graze, and there is a small but acceptable clinic in this location to which 3 patients with cerebral malaria were admitted by noon. There were also many TB patients. The doctors prescribed routine medications before conducting further examinations.
NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE. 1998 Jan 10; 142(2):60-2.In 1996, a document was published by the World Health Organization (WHO) with a detailed analysis of various birth control methods and stressing the right to them. At least 350 million couples in the world do not have access to safe and reliable contraceptive methods meaning that they have an unmet need. The WHO strategy concerning the dissemination of contraception consists of recognition of the central position of women; the availability of contraceptive methods; and scientifically credible counseling. Reproductive health means not only access to contraceptives, but also the treatment of anemia and STDs, and the promotion of breast-feeding. Eight groups of contraceptive methods were analyzed and ranked on a scale to ascertain their suitability for women of differing ages, lifestyles, and socioeconomic status. The reliability of contraceptives also greatly depends on patient compliance. The lactational amenorrhea method (LAM) was recognized as a reliable method for the first time by WHO. The mechanism of action of breast feeding results in the suppression of gonadotropin-releasing hormone (GnRH) and of prolactin inhibiting factor (PIF) leading to the stimulation of prolactin. A 1974 Rwandan study confirmed that 50% of rural women who breast fed their children ad libitum, in comparison to urban women who fed them according to the Western model, became pregnant 23 months postpartum in contrast to 9 months postpartum for city women. The Bellagio consensus stated that LAM provides a 98% rate of protection against pregnancy in the first 6 months, if exclusive breast-feeding is practiced. In 1997, LAM played a crucial role in global family planning, as modern contraceptives are still not widely available. In Africa, the average number of children per woman would be 10 without LAM, not 6.
[International Conference on Population and Development in Cairo] De internationale conferentie over bevolking en ontwikkeling in Cairo.
NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE. 1994 Nov 5; 138(45):2259-61.The UN Conference on Population and Development was held in Cairo in September 1994, and dealt with a range of sensitive issues that were eventually recorded in an action program. In addition, a sort of shadow conference was also held by various organizations. The precedents of this conference were the conferences held in Bucharest in 1974, which stressed the world crisis and population explosion, and in Mexico in 1984, where the first signs of the slackening of population growth induced less emphasis on family planning programs and more on the status of women. At Cairo again a crisis atmosphere reigned because rapid population growth has not been followed by rapid development. Birth control discussions also focused on ethical and religious norms, human rights, and emancipation problems. Most of all, the sustainability of development programs was stressed. Global decline of mortality combined with a continuing high birth rate has resulted in a population growth of 3% or more. In the course of 40 years the growth was 46% in industrialized countries as compared to 161% in the poorest lands. The total world population has reached 5 billion, of which only 20% live industrial countries. The influence of the AIDS epidemic on the demographic figures is not likely to be as much as anticipated a few years ago. Other problems are demographic aging, population decline (a below replacement fertility rate in Japan, Spain, and Italy), and uncontrolled internal and international migration (refugees in developing countries and flight to major cities). In the next 30 years almost two-thirds of the population of developing countries will be living in shabby, sprawling megacities. In 1989, in preparation for the Cairo conference, an international forum was held in Amsterdam on population. It dealt with the reproductive rights of women, the negative impact of structural readjustment programs on family planning, and the priority of women's education.
[World population at a turning point? Results of the International Conference on Population, Mexico, August 14-16, 1984] De wereldbevolking op een keerpunt? Resultaten van de Internationale Bevolkingsconferentie, Mexico, 6-14 augustus 1984.
Brussels, Belgium, Centrum voor Bevolkings- en Gezinsstudien [CBGS], 1985. viii, 274 p. (CBGS Monografie No. 1985/3)The aim of this report is to summarize the results of the International Conference on Population, held in Mexico City in August 1984, and to review the findings of working groups and regional meetings held in preparation for the conference. Chapters are included on developments in the decade since the 1974 World Population Conference, world population trends, fertility and the family, population distribution and migration, mortality and morbidity, population and the environment, results of five regional U.N. conferences, the proceedings and results of the Mexico City conference, and activities involving Belgium.
Maandstatistiek Van de Bevolking. 1985 Feb; 33(2):41-80.An analysis of international migration to and from the Netherlands in 1983 is presented. The demographic characteristics of both immigrants and emigrants are described, with attention to marital status, family relationship, sex, age, region of origin, and urban or rural residence. An appendix is included on the new U.N. recommendations concerning the collection of international migration statistics and the extent to which the Dutch data conform to these recommendations. (summary in ENG) (ANNOTATION)