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[Implementation of the Integrated Management of Childhood Illnesses strategy in Northeastern Brazil] Implementacao da estrategia Atencao Integrada as Doencas Prevalentes na Infancia no Nordeste, Brasil.
Revista De Saude Publica. 2008 Aug; 42(4):598-606.OBJECTIVE: The majority of child deaths are avoidable. The Integrated Management of Childhood Illnesses strategy, developed by the World Health Organization and the United Nations Children's Fund, aims to reduce child mortality by means of actions to improve performance of health professionals, the health system organization, and family and community practices. The article aimed to describe factors associated with the implementation of this strategy in three states of Northeastern Brazil. METHODS: Ecological study conducted in 443 municipalities in the states of Northeastern Brazil Ceara, Paraiba and Pernambuco, in 2006. The distribution of economic, geographic, environmental, nutritional, health service organization, and child mortality independent variables were compared between municipalities with and without the strategy. These factors were assessed by means of a hierarchical model, where Poisson regression was used to calculate the prevalence ratios, after adjustment of confounding factors. RESULTS: A total of 54% of the municipalities studied had the strategy: in the state of Ceara, 65 had it and 43 did not have it; in the state of Paraiba, 27 had it and 21 did not have it; and in the state of Pernambuco, 147 had it and 140 did not have it. After controlling for confounding factors, the following variables were found to be significantly associated with the absence of the strategy: lower human development index, smaller population, and greater distance from the capital. CONCLUSIONS: There was inequality in the development of the strategy, as municipalities with a higher risk to child health showed lower rates of implementation of actions. Health policies are necessary to help this strategy to be consolidated in the municipalities that are at a higher risk of child mortality.
[Organizational change: the implementation of children-friendly hospitals] Mudanca organizacional: implantacao da Iniciativa Hospital Amigo da Crianca.
Ciencia and Saude Coletiva. 2010 Jun; 15 Suppl 1:1263-73.Empirical evidences have pointed out the relevant role of breastfeeding to diminish infantile mortality. Children-friendly Hospitals (IHAC) is a worldwide action developed by the United Nations Children's Fund - UNICEF and by the World Health Organization, aiming to promote, protect and support breastfeeding and also prevent precocious weaning. The aim of the present study is to identify the main organizational changes which occurred in two hospitals, located in the State of Minas Gerais, Brazil that implemented IHAC. The organizational analysis carried out was based upon six perspectives, according to Motta's analytical chart that includes: strategic, structural, cultural, human, technological and political perspectives. A qualitative research was carried out, by using as a data gathering method the semi-structured interview, applied in all hierarchical levels. In order to interpret data, it was adopted the content analysis. In both cases, it could be concluded that the implementation of IHAC resulted in changes and improvement in the management of the organizations, due to the establishment of procedural patterns and staff training. It was verified that the cultural and technological changes occurred in a more intense manner and that the least perceived were the political and strategic changes.
[Implementation of World Health Organization guidelines for management of severe malnutrition in a hospital in Northeast Brazil] Implementacao do protocolo da Organizacao Mundial da Saude para manejo da desnutricao grave em hospital no Nordeste do Brasil.
Cadernos de Saude Publica. 2006 Mar; 22(3):561-570.To assess the implementation of WHO guidelines for managing severely malnourished hospitalized children, a case-series study was performed with 117 children from 1 to 60 months of age. A checklist was prepared according to steps in the guidelines and applied to each patient at discharge, thus assessing the procedures adopted during hospitalization. Daily spreadsheets on food and liquid intake, clinical data, prescribed treatment, and laboratory results were also used. 36 steps were evaluated, 24 of which were followed correctly in more than 80% of cases; the proportion was 50 to 80% for seven steps and less than 50% for five steps. Monitoring that required frequent physician and nursing staff bedside presence was associated with difficulties. With some minor adjustments, the guidelines can be followed without great difficulty and without compromising the more important objective of reducing case-fatality. (author's)
[Diagnosis and treatment of tuberculosis in children -- an updated review of an old problem] Diagnostico e terapeutica da tuberculose infantil -- uma visao atualizada de um antigo problema.
Jornal de Pediatria. 2002 Nov-Dec; 78 Suppl 2:S205-S214.Tuberculosis is still one of the most severe chronic diseases, especially in the world's poorest regions. Developing countries still have to face serious problems related to this endemic disease, in spite of the control programs they have implemented. The present study aims at updating the diagnosis and treatment of tuberculosis in three South American countries: Brazil, Chile and Argentina. Sources: Medline and Lilacs databases, official guidelines and consensuses of the three countries involved. Brazil, Chile and Argentina have guidelines based on the World Health Organization documents and on international consensuses. The standardization is similar between these countries, allowing the unification of language and favoring control measures. Within the Brazilian context, the new guidelines on the treatment of tuberculosis set out by the Ministry of Health are presented. Since each country had to make adaptations in an attempt to solve the epidemiological differences between them, the treatments against tuberculosis still present some discrepancies, such as the use of three or four drugs in some cases. (author's)
[Immunization coverage survey: empirical assessment of the cluster sampling method proposed by the World Health Organization] Inquérito de cobertura vacinal: avaliação empírica da técnica de amostragem por conglomerados proposta pela Organização Mundial da Saúde.
Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 2005; 17(3):184-190.Objective: To analyze the representation of the sample and the precision of estimates obtained using the conglomerate methodology (30 of 7) proposed by the World Health Organization via their application to inquiries of vaccination coverage realized in Diadema and São Caetano do Sul, state of São Paulo, Brazil, in 2000. Methods: The representation of the samples was evaluated by comparing the tax-paying sector, sorted by their inquiries, to other sectors in two municipalities in terms of socio-demographic characteristrics (age structure of the population, schooling, proportion of families with women at the head, monthly income of the head of the family, and sanitation conditions). The precision of the estimates of coverage by the vaccines in the basic vaccination scheme (BCG; diphtheria, Pertussis and tetanus or DPT, poliomyelitis, hepatitis B; measles, mumps, and rubella or viral triplice) was analyzed through the measurements of the effect of the design and range of the confidence intervals. Precision was considered satisfactory when the effect of the design was less than 2.0 and the range of the confidence intervals was less than 10%. Results: In both municipalities, the comparison between the sorted and non-sorted sectors showed similar distributions for the socioeconomic and demographic variables. With regard to the precision of the estimates, the effect of the design was less than 2.0 for all the vaccines as much as in Diadema as in São Caetano do Sul. In Diadema, the confidence intervals were less than 10% for all vaccines, except viral triplice. In São Caetano do Sul, as the included children were a bit more than 10% for the vaccine against poliomyelitis (10.3%), for the vaccine against the hepatitis B virus (11.8%), for the vaccine against measles (10.4%), for the viral triplice (12.9%) and for the complete scheme (11.2%). Conclusion: The inquiry method of vaccination coverage proposed by the World Health Organization is capable of providing representative facts about the population since the methodological proceedings of selection are followed rigorously in the countryside. (author's)
[Sexual and reproductive health and reproductive rights. A question of human rights] Saúde sexual e reprodutiva e direitos reprodutivos. Uma questão de direitos humanos.
Sexualidade & Planeamento Familiar. 2001 Nov-Dec; (32):45-52.There is currently an international consensus that reproductive rights are human rights. In the work, it is defended that, although the governments have taken some steps to guide and broaden the services in order to better satisfy the sexual and reproductive health needs of the populations, to advance equality and parity between the sexes and to promote reproductive rights, it is necessary to do much more to make health and reproductive rights a reality for women and men in the entire world. The UN Conference and the agreement about reproductive health (RH) and reproductive rights (RR). Any of the global Conferences that the UN holds in this decade - each one focusing on an important, different and particular question - amplifies the same common message: that to have success, the development efforts should be centered on the people. Ensuring human rights and satisfying the basic necessities of the people are the first critical steps in the resolution of global problems. The right to development itself included key elements such as broadening the access of the population to basic social services and sustaining means of life, balancing the interaction between people, resources and the environment and equitably reconciling the needs of the present with those of future generations. (excerpt)
[A review of breastfeeding in Brazil and how the country has reached ten months' breastfeeding duration] Reflexôes sobre a amamentação no Brasil: de como passamos a 10 meses de duração.
Cadernos de Saude Publica. 2003; 19 Suppl 1:S37-S45.In 1975, one out of two Brazilian women only breastfed until the second or third month; in a survey from 1999, one out of two breastfed for 10 months. This increase over the course of 25 years can be viewed as a success, but it also shows that many activities could be better organized, coordinated, and corrected when errors occur. Various relevant decisions have been made by international health agencies during this period, in addition to studies on breastfeeding that have reoriented practice. We propose to review the history of the Brazilian national program to promote breastfeeding, focusing on an analysis of the influence of international policies and analyzing them in four periods: 1975-1981 (when little was done), 1981-1986 (media campaigns), 1986-1996 (breastfeeding-friendly policies), and 1996-2002 (planning and human resources training activities backed by policies to protect breastfeeding). The challenge for the future is to continue to promote exclusive breastfeeding until the sixth month, taking specific population groups into account. (author's)
[Brazilian policy for the distribution and production of antiretroviral drugs: a privilege or a right?] A política brasileira de distribuição e produção de medicamentos anti-retrovirais: privilégio ou um direito?
Cadernos de Saude Publica. 2002 Jan-Feb; 18(1):213-219.This article focuses on the Brazilian National AIDS Program and its policy of distributing and producing antiretroviral drugs, emphasizing links between local decisions and global HIV/AIDS policies. Emphasizing recent developments in the Brazilian and international scenario with regard to access to treatment for people with HIV/AIDS, the article highlights the participation by the pharmaceutical industry, governments, civil society, and UN agencies in establishing responses to the pandemic. The author concludes by identifying transnational activism as a key response to both the power of pharmaceutical corporations and the law of the market (including patent laws), thus fostering global solidarity for people with HIV/AIDS. (author's)
[A guide to providing reproductive health services] Guia para prestacao de services em saude reprodutiva.
Fortaleza, Brazil, Secretaria da Saude, 1998. xxvi, 432 p.The Viva Mulher [Healthy Woman] Program developed by the Secretariat of Health of the State of Ceará (SESA-CE), in partnership with several local, national and international institutions, was conceived after recognition of the unfavorable health situation of women throughout the State. Sensitized by the size of the problem and encouraged by other successful initiatives, such as the Community Health Agent program and the Healthy Child program, the results of which were translated into a reduction in infant mortality and an increase in the coverage of Basic Health Actions, the State Government resolved to promote a broad mobilization of institutions interested in the problems so as to develop intensive joint efforts involving society as a whole in an attempt to make a significant change in the health profile of women in Ceará. The first concrete act was the holding of the "Woman, Health, Life" seminar in Fortaleza in August 1992, which had more than 1,000 participants, to launch the Healthy Woman program on the basis of directives from the Ministry of Health (PAISM). The Healthy Woman program was associated from the beginning with the United Nations Population Fund (FNUAP), which proposed to offer technical assistance and financial resources through a four-year cooperation project with the State Government. The Pan American Health Organization (PAHO), collaborating agencies of the U.S. Agency for International Development (AID) and other international entities later joined in the process and have been cooperating in various complementary manners. (excerpt)
[The role and responsibility of volunteers in context of APFs] Papel e responsabilidade dos voluntarios no contexto das APFs.
Sexualidade e Planeamento Familiar. 2001 Jan-Jun; (29-30):37-9.The International Planned Parenthood Federation (IPPF) is considered the primary organization in the world in the area of sexual and reproductive health, however, potential donors have viewed it as too rigid. The IPPF organized a task force to confront this charge and come up with recommendations for improvement. Their proposal was that IPPF should be comprised of a diverse collection of volunteers in terms of age, sex, socioeconomic origin, occupation, performance, race, creed as well as linguistic and geographical representation in such a way that this can represent the communities in which they function.
[Maternal care in developing countries: recommendations of FIGO] Cuidados maternos nos paises em desenvolvimento --recomendacao da FIGO.
PLANEAMENTO FAMILIAR. 1992 Jul-Sep; (57):6.At the 13th General Assembly of the International Federation of Gynecology and Obstetrics (FIGO), which took place in September 1991, recommendations were formulated concerning the responsibility for maternal care in developing countries. The general recommendations included: to increase the access of women to maternal care by decentralization, and, in order to maximize the use of human resources, to ensure that the staff have the required minimum specialized training with continuous supervision for safe and effective delivery of service. Specific recommendations suggested that, when there is a lack of medical specialists, it is possible to train groups of medical personnel to carry out various functions, including emergency surgical procedures. These functions have to be clearly defined and competencies have to be maintained along with new competencies. FIGO must fund workshops on special techniques for midwives, general practitioners, technicians, and other health workers at the primary and secondary intervention levels. Taking into account the 5 major causes of maternal death, some fundamental practices could prevent and treat these women at the primary health care level: 1) for prolonged labor, its earliest possible diagnosis, its management, and practical guidance; 2) for postpartum hemorrhage, uterine massage, oxytocin, and manual removal of the retained placenta; for puerperal infection, early detection and practical utilization of antibiotics using a list of dosages; 3) for hypertensive cases during pregnancy, early identification and appropriate treatment; 4) for the prevention and management of complications of abortion, making available and acceptable contraceptives in order to prevent undesired pregnancies. The success of these measures depends on the support and participation of the community. Health workers must collect data for the evaluation of maternal care. The implementation of these recommendations requires the cooperation of national societies of gynecologists/obstetricians and associations of midwives and schools of nursing.
[Highlights, consensuses and afterwards. Regional Seminar on "The Human Rights of Women in the World Conferences"] Cumbres, consensos y despues. Seminario Regional "Los Derechos Humanos de las Mujeres en las Conferencias Mundiales". Reuniao de cupula, consensos e depois. Seminario Regional "Os Direitos Humanos de Mulheres nas Conferencias Mundiais".
Lima, Peru, Comite de America Latina y el Caribe para la Defensa de los Derechos de la Mujer [CLADEM], 1996 Nov. 218, 214 p.The Second Regional Seminar of the Latin American and Caribbean Committee for Defense of Women’s Rights (CLADEM) was held in Lima in April 1996 on the theme of the human rights of women in the five UN international conferences from the 1992 environmental conference in Rio de Janeiro to the 1995 Beijing conference on women. Evaluation of advances achieved in the conferences was organized around the six priority interests identified by CLADEM in 1992 as the basic themes for women in the region: citizenship, sexual and reproductive rights, violence and peace, development, ethno-racial perspectives, and the environment. The work opens with reflections on the five conferences, with examination of the place of women in the structure of each conference, whether gender inclusive language was used, conceptual advances in the human rights of women, limitations of the paradigm of equality, mechanisms and resources for implementation of the various Declarations, international achievements and national realities, north-south differences, universality and cultural relativity, and challenges for the next millennium. Six presentations follow on citizenship of women as a challenge for the democracies of the region, sexual and reproductive rights, the struggle against gender violence and advances in international instruments, ethno-racial perspectives, gender and the economic rights of women, and women and the environment. Each presentation assessed progress over the course of the five international conferences, and each includes commentaries from two representatives of organizations in the region whose activities were related to the theme. The final section identifies points that should be considered and possible strategies in each of the six areas.
REVISTA DE NUTRICAO DA PUCCAMP. 1997 Jan-Jun; 10(1):5-19.The study analyzed the critical contribution of the WHO, PAHO, and FAO to the literature on nutritional education, which provides the material for teachers of nutritional education courses. The differences between education and orientation were summarized. Various challenges were also listed for nutritionists pertaining to the teaching, research, and implementation of programs. The first publication of the WHO that dealt specifically with nutrition education was published in 1951. It addressed eating habits and their social significance as well as the organization of nutrition programs. The major contributors to nutrition education included the following authors: Jean Ritchie (1951; dealing with good nutritional habits); Jean Ritchie (1968; addressing agronomists, economists, physicians, health personnel, and biochemists); Burgess and Dean (1963; techniques for the implementation of programs); Jelliffe (1970; human suffering caused by living conditions and malnutrition); Bosley (1976; nutrition education and preventive medicine); Mushkin (1982; investment in nutrition and economic development); Jelliffe (1983; the planning process in nutrition education); and Williams (1991; food, environment, and health). Some other authors (Reboul, 1974; Freire, 1983; Alves, 1984; Morais, 1986; Freire, 1985; Amatuzzi, 1989; Garcia, 1992) dealt with the problem of how to change human thinking to ensure the successful implementation of programs. The challenges in the area of nutrition education are the construction of theories supporting research that reflect reality, the implementation of nutrition education activities in public health services, and investment in the training of specialists.
SEXUALIDADE E PLANEAMENTO FAMILIAR. 1995 Jul-Sep; (7):17-8.The Portuguese Association of Family Planning has learned about a study of the World Health Organization that associated certain types of combined oral contraceptives (OCs) with an increased risk of cardiovascular diseases, notably deep venous thrombosis. The position of the International Medical Advisory Panel (IMAP) of the IPPF, however, was that such conclusions were not definitive and new studies should be conducted to confirm or refute these conclusions. Furthermore, since the risk is rare, those using OCs should have regular medical examinations. For the majority of OC users the benefits outweigh the risks. The author of one of the two studies that hinted at the cardiovascular risks of third-generation progestagens stated that the British authorities incorrectly interpreted the data, which were preliminary. In fact, these data suggest that the new generation of OCs protects against cardiac attack and associated mortality. Even the WHO took the position that these results should be confirmed by independent studies. The polemic mounted when the British authorities issued an alert about the possible negative effects of seven types of OCs containing progestagens which putatively doubled the risk of venous thrombosis. This was based on the findings of three studies: two of them were incomplete, one was done at the initiative of the WHO, one was carried out in Europe, and the third one was done in the UK. At the meeting of the Committee of Pharmaceutical Specialties of the European Agency of Medicaments in October 1995 in London the position was taken that it is not appropriate to withdraw such OCs; investigators should analyze these data in depth and perform new studies; the three companies that manufacture such OCs should submit more information by the end of 1995; and physicians should take into account thromboembolic risk factors when prescribing such OCs.
Acta Medica Portuguesa. 1995 Nov; 8(11):655-9.From the end of the 1970s up to June 1994, a total of 985,119 cases of AIDS had been reported to the World Health Organization (WHO), of which figure 331,376 were from Africa (33.5%). WHO has also calculated that the real figure was around 4 million cases since the beginning of the epidemic, of which 67% had occurred in Africa. In addition there were an estimated 16 million cases of HIV infection including 1 million children in the whole world. Again, sub-Saharan Africa was the most affected and the transmission was predominantly heterosexual. In Africa the majority of individuals with HIV infection have chronic persistent lymphadenopathy. There are different classifications of AIDS based on clinical criteria: the Bangui Definition of 1986 used at locations without laboratories, the Centers for Disease Control and Prevention/WHO Definition of 1987, the Water Reed Institute Classification, the WHO Classification of 1970 of HIV-1 and HIV-2. Among opportunistic infections tuberculosis and Kaposi's sarcoma are the most frequent. Particular clinical aspects for children include malnutrition, fever, and diarrhea. Sickle cell anemia and blood transfusion patients are at increased risk of getting infected. Tests for the detection of antibodies against HIV include the enzyme-linked immunosorbent assay (ELISA) and the passive hemagglutination test. For confirmation of the positive results the Western Blot, indirect immunofluorescence, and radioimmunoprecipitation tests are used. The treatment of HIV-infected patients in Africa consists of the treatment of the HIV infection, that of opportunistic infections and tumors, and primary and secondary prophylaxis of opportunistic infections. Counseling and psychosocial support even utilizes traditional healers and the large African family. Prevention and control of AIDS must combat polygamy, the oppression of women, wars, natural catastrophes, and the shortage of physicians. In Angola 26% of AIDS cases could not be traced, the future depopulation of the country threatens, there is a growing trend of AIDS, and a significant underreporting of cases.
SERVIR. 1995 Sep-Oct; 43(5):270-2.A seminar of the International Labor Organization (ILO) was held to shed light on the role of AIDS in decimating qualified professionals in Anglophone Africa. The estimates of the World Health Organization indicate that the number of people infected with HIV in the whole world was 13-15 million persons at the end of 1994, of which 8 million lived in sub-Saharan Africa. In Uganda it is calculated that 1.5 million people are carriers of HIV, and by 1998 this figure could increase to 1.9 million. In both Zambia and Zimbabwe, in the 20-39 year age group, AIDS cases amount to 70% and 74%, respectively. Studies carried out in Rwanda, Zaire, Swaziland, and Zimbabwe revealed that AIDS is most frequent among members of the higher socioeconomic classes. The inability to find replacements for jobs requiring higher qualifications will result in dire consequences for these economies. During the 6-year period between 1988-89 and 1993-94 the Uganda Commercial Bank registered 229 deaths due to AIDS among its 1600 employees (14%). AIDS also requires the expenditure of scarce health resources on treatment: in 1992, hospital occupancy for diseases associated with AIDS reached 40-60% in Kinshasa, Zaire; 50% in Lusaka, Zambia; 60% in Kigali, Rwanda; and 70% in Bujumbura, Burundi. Various programs have been launched to fight HIV/AIDS in Zimbabwe, Zambia, and Uganda, to sensitize and educate people about the epidemic. The protection of human rights, the avoidance of discrimination, and the adoption of safe sex techniques are promoted by these programs. Companies have programs to combat AIDS. Ubombo Ranches Ltd. in Swaziland started an information program in 1991 and distributed free condoms. BAT Uganda Ltd. also started an information and training-of-trainers program in 1989, which by 1994 had benefitted about 90% of the employees. This has resulted in the reduction of AIDS cases and associated medical costs.
SEXUALIDADE E PLANEAMENTO FAMILIAR. 1994 Jul-Sep; (3):19-20.The national directorate of Portugal's Family Planning Association (FPA) introduced a novel motion for the biennial period of 1994-96. 27 years after its foundation the association recommended a woman to be the president of its national directorate. This choice was proposed by the president of the International Planned Parenthood Federation at the time of the expiration of his mandate stating that the next president of IPPF should be a woman, and the idea caught on in international circles. Within different associations male perspectives and problems were also addressed in addition to the sexual and reproductive rights of women. The dominant areas of the FPA are health and education, which are intimately linked to psychology and sociology, as well as social assistance to people in need. The diverse training and educational activities at the national directorate are carried out by a staff consisting of a teacher, a psychologist, a sociologist, a nurse, and three physicians. Nowadays family planning has to be approached from a multidisciplinary point of view. For the coming two years, 1994 and 1995, the program of FPA in the area of education comprises new courses for motivators; organizing two major projects by producing materials and doing social communication field work: one for educated and uneducated young people and the other one for socially underprivileged women in poor areas; holding the 7th national meeting of voluntary workers; new interregional projects; and the formation of an interregional FPA delegation for the Azores. International work comprises the active participation in the program of the IPPF, especially with the southern European group. The Advanced School of Education also prepares teachers and motivators for sex education programs teaching basic sex education.
BEMFAM NOTICIAS. 1994 Jan-Mar; 3(1):1.The International Conference on Population and Development was held in September, 1994. Recent events have reinforced the vital role of this conference, including the UN Conference on the Environment and Development in 1992. The 1994 conference continued the discussions of previous conferences in 1974 in Bucharest and in 1984 in Mexico City, which examined the close connection between population growth and sustainable economic development. Within this theme, 6 topics will unfold in the next decade: 1) the complex relationship between population, development, and the environment; 2) mobilization of national and international resources for appropriate plans and programs; 3) the connection between population dynamics and the social and economic conditions of women; 4) family planning, health, and welfare programs; 5) the relationship between demography and socioeconomic development; and 6) the socioeconomic aspects that influence national and international migrations and the consequences of urban and rural development. Preparatory activities started already in 1991. In Brazil a national committee was formed from ministries, parliamentary observers, and a representative of civil society. In order to elaborate the Brazilian position 3 seminars were organized: 1) on population growth, demographic structure, and spatial mobility; 2) on public policies, social agents, and development; and 3) on women in the context of population policy. The Economic and Social Council of the UN solicited the participation of nongovernmental organizations (NGOs). These NGOs, in particular family planning groups and women's groups, have been involved in activities related to population in cooperation with governments and will draw up plans for the implementation and evaluation of programs and policies in this area. In Brazil this line of work involves the NGOs in general and in particular BEMFAM, which has expanded its services not only to its clinics, but (in association with the state) to health posts in 1200 towns of the country.
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.
REVISTA PAULISTA DE MEDICINA. 1989 Jan-Feb; 107(1):47-52.In the fight against maternal mortality, the WHO recommended that developing countries adopt effective measures to reduce its high prevalence. One measure is the improvement of data about maternal deaths and major risk factors during pregnancy, delivery, and puerperium. Official figures are underreported by 50% or more, and the cause of death tends to be attributed to an immediate preceding complication. In the US, maternal mortality declined from 37/100,000 live births in 1960 to 8/100,000 in 1984; in Chile from 299 in 1960 to 45 in 1984; in Ecuador from 270 in 1960 to 189 in 1984; and in Paraguay from 327 in 1960 to 283 in 1984, a barely noticeable reduction. Strategies that improve knowledge include the keeping of statistics; epidemiological investigations (case control studies); and the formation of committees on maternal death, which are composed of highly regarded professionals (the UK, Chile, and Cuba obtained good results with them). The education of the populace by radio, television, and print media to utilize prenatal assistance is another measure. The human resources, location, and minimum instrumentation of these health centers are basic requirements. Most maternal deaths occur in hospitals of inadequate staff and material resources. The traditional birth assistant training program of Ceara state, Brazil, is a model for others. Caesareans save many lives in complicated deliveries, but in Sao Paulo state, more than 80% of some groups choose it without justification. Assistance Needs to be extended into the puerperium to monitor normal involution of the genital organs, to confirm normal lactation, and observe any pathology present during pregnancy. Cardiopathy, renal insufficiency, chronic hypertension, grand multiparity, and advanced maternal age are high risk factors for pregnancy. Postabortion deaths account for more than half of mortality in some Latin American countries. In the UK, mortality dropped from 35 in 1969, after the legalization of abortion in 1968 to 8 in 1975. The reverse was observed in Romania when abortion became outlawed. Nonetheless, abortion is a touchy issue and education about contraceptives should be stressed.
[Breastfeeding: a right of the mother and child] Aleitamento materno: um direito da mae e da crianca.
REVISTA PAULISTA DE MEDICINA. 1987 Mar-Apr; 105(2):103-7.The laws concerning the protection of working women who nurse and the outcome of the breast feeding program at the state university of Campinas (UNICAMP), Brazil, are discussed. The International Labor Organization (ILO) was founded in 1919 with the objective of improving the working conditions and lives of workers worldwide. At a 1952 convention, the right of women to interrupt work to nurse was accepted. In 1975, the declaration on the equal opportunity and treatment of working women was passed. ILO's recommendation was adopted in 30 countries which allowed working woman to nurse for 30 minutes or more. In Italy and Bulgaria, 60 minutes is assigned for nursing. A 1923 Brazilian law decreed that nurseries must be near the work place where mothers could nurse regularly. ILO's 1952 convention was ratified in 1966 in Brazil, and, in 1986, a paid nursery scheme was passed. UNICAMP has been dealing with nursing programs since 1975, focusing on education, breastfeeding techniques, presentations, and group discussions. The mothers were monitored until weaning or until the child reached 9 months of age. The program had a higher impact among women >25 and married, than among women >30 with less education. In a follow-up program, 100 women 7 months pregnant received prenatal assistance and were asked to fill out a questionnaire. 76 complied: 28 nursed their present child but not the previous one, and 22 nursed their first child (50% for less than 6 months). A 1977 survey in the city of Paulinia on breast feeding duration of children up to 2 years of age showed that 12.1% of 610 were never nursed. 57% were exclusively breast fed in the first month, but only 18% were nursed by the 6th month. In 1982, an infant center was inaugurated by UNICAMP where a child could nurse 5 times a day up to 6 months of age. In the first 4 years, 334 children attended and were nursed for 12 months, although 8.8 months was the expected duration, and the previous child had been nursed for only 6 months.
[Integrated family planning for small farmers: a handbook] Planeamento familiar integrado para pequenos agricultores: um manual.
Rome, Italy, Food and Agriculture Organization of the United Nations, 1985. iv, 57,  p.The objective of this training program manual was the elevation of the knowledge levels of Group Organizers and Action Research Fellows (GP/ARFs) of countries that participated in the Small Farmers Development Project (SFDP) launched by the Regional, Office for Asia and the Pacific of the UN Food and Agriculture Organization (FAO). The SFDP had the mission of increasing technical knowledge to small farmer to curtail the dichotomy of rapid population growth in Asian countries which started in the 1970s and the faltering agricultural output. A survey of agrarian reform (ASARRD) was also launched, and, after the implementation of SFDP in 1976 by Bangladesh, Nepal, and the Philippines, a family planning (FP) program (PopEd) was initiated in 1978 under SFDP in these countries. Income generating projects aimed at improving the quality of life of small farmers, Family Planning Education had the objective of disseminating FP information; however, after initial success, practical application bogged down. Thus, PopEd introduced a new strategy of training GO/ARFs, as group organizers and mobilizers, to enhance their knowledge about the relationship of poverty, development, and population growth, about its applicability to small farmers, and about the role of communication. The planning, management, and evaluation of the training program is detailed, with an overview of FAO programs for small farmers.
[Child health in the states of Ceara, Rio Grande do Norte and Sergipe, Brazil: description of a methodology for community diagnosis] A saude das criancas dos estados do Ceara, Rio Grande do Norte e Sergipe, Brasil: descricao de uma metodologia para diagnosticos comunitarios.
Revista de Saude Publica / Journal of Public Health. 1991 Jun; 25(3):218-25.From 1987 to 1989, UNICEF collaborated with state and municipal health organs of the Brazilian states of Ceara (C), Rio Grande do Norte (R), and Sergipe (S) in order to realize a community diagnosis of maternal-child health care. The estimation of mortality required investigating women aged 15-49 visiting 8000 households, examining 4513 children <3 years old. In R and S, a sample of 1000 children <5 was used to estimate most common health problems. In these states, 1920 households were visited, and a questionnaire served for collection of demographic and socioeconomic data. Children were weighed, and a modified AHRTAG anthropometer served for measuring body length. About 1/4 to 1/3 of children were first-born. In C, 19.3% of children were seventh-born or higher, almost double the rate of the other 2 states. Income, literacy rate of parents, living conditions, and availability of running water indicators were much worse in C. 34.8% of the women in C had not received prenatal care; this figure was 15.7% in S an R, respectively. In C, only 24.3% of the mothers had received 6 or more prenatal care checkups vs. about 1/2 in the other states. Hospital deliveries reached 64.8% in C vs. almost 90% in the other states. In C, breast feeding was more prevalent: 83% were breast feeding for 1 month and 27.1% for 12 months. Malnutrition indicated by height and age was 27.6% in C vs. 16.1% in S and 14/2% in R. There was a clear association between family income and nutritional deficits of height/age and weight/age indicators. In C, malnutrition was higher in all income groups. Diarrhea incidence was 12% in C vs. 7.3% in S and 6/4% in R. A lower percentage used rehydration in C. 9.9% of children in C had been hospitalized in the previous 12 months vs. 6.2% in S and 6.9% in R. Coughing, fever and respiratory difficulties ran to 8.6% in C. Only 42.4% had full vaccination in C vs. 61.7% in S and 71.3% in R. 30/5% had been weighed in C in the previous 3 months vs. 45.1% in S and 44.2% in R.
PLANEAMENTO FAMILIAR. 1991 Jul-Dec; (52-53):17.Between 9-10 million people are infected with the human immunodeficiency virus (HIV) according to the estimation of the WHO. This number is expected to double or treble within this decade resulting in the birth of 5-10 million infected children. By the end of the 20th century there would be 30-40 million infected people and 10-15 million orphans because of the death of 1 or both parents. The number of AIDS cases reported to the WHO up to October 1991 totaled 8,418,413 cases (3/4 infected via heterosexual contact). There were 676 cases in Portugal. In AFrica it is especially difficult to treat AIDS victims who also suffer discrimination in addition to mental anguish. UNICEF calculated that there would be 5 1/2 million orphans <15 years of age by 2000. Most sensitization campaigns are directed at the cities at the expense of rural areas where tradition and culture tend to hinder action. It is effective to have seropositives and AIDS victims participate in prevention programs to alert the people that the reality of AIDS cannot be denied.
[A new attempt to infringe on reproductive rights] Uma nova onda para atropelar os direitos reprodutivos.
Revista Brasileira de Estudos de Populacao. 1990 Jan-Jun; 7(1):87-94.The author criticizes the agenda of some international agencies that focus on the slowing of population growth in the Third World. She asserts that treating developing countries uniformly is not appropriate to the situation in Latin America. "In this region, while some inter and intra-country variability continues to exist, growth rates show a tendency for decline. In addition, women's reproductive intentions signal a desire for fewer children. There is, therefore, room for measures in the reproductive health area within general health programs, according to the principle of respect for the reproductive rights of individuals." (SUMMARY IN ENG) (EXCERPT)