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[Children in poor countries also have a right to good health care. A new health care program will reduce child mortality] Aven barn v fattiga lander har ratt till god vard. Nytt omvardnadsprogram skall minska barnadodligheten.
LAKARTIDNINGEN. 1997 Oct 8; 94(41):3637-41.This article discusses the integrated management of childhood illness (IMCI) approach, developed by WHO and UNICEF based on international experience, which allows the care and treatment of sick children in countries with limited resources. It is estimated that every year 12 million children die in low-income countries before age 5. 70% of these deaths are related to common diseases: respiratory infections, diarrhea, measles, malaria, and malnutrition. The guidelines were developed for local health workers. Two flowcharts were designed for presenting the guidelines: one for children aged 1 week to 2 months and one for children aged 2 months to 5 years. For infants, the treatment of bacterial infections, diarrhea and feeding, and low weight are paramount. Fever and breathing difficulty may be the expression of severe general infection. The care of children aged 2 months to 5 years should consider four general warning symptoms: cramps, loss of consciousness, inability to drink or suckle, and constant vomiting. The presence of one of these symptoms indicates serious illness and the need for immediate care. Coughing and breathing difficulties are signs of severe pneumonia or serious respiratory illness, which requires transfer to a hospital after administering a dose of antibiotics. The use of trimethoprim-cotrimoxazole is recommended for treatment of pneumonia, while trimethoprim-sulfamethoxazole is indicated for malaria. The diagnosis, classification, and treatment of diarrhea is performed according to earlier WHO guidelines. General erythema and either coughing, a cold, or red eyes are the signs of measles.
[The year of the World AIDS Day: children in a world of AIDS] Arets varldsaidsdag: barn v en varld med aids.
LAKARTIDNINGEN. 1997 Nov 26; 94(48):4501-2.Children living in a world with AIDS was the theme of a UNAIDS campaign launched because 1 million children are infected with HIV and 9 million children have become orphans due to AIDS (90% in sub-Saharan Africa). During 1996 alone, 400,000 children were infected: 90% were infected during pregnancy, delivery, or while breast feeding; the remaining 10% were infected sexually or via blood or blood products. In Africa, only one-third of HIV-infected children survive their 3rd birthday, and 8% of all children in Zimbabwe have lost their mothers to AIDS. A similar situation is rapidly evolving in Asia and South America. In Spain and Italy, more than 600 children have AIDS; most of them were infected through drug-abusing mothers. In France the figure is comparable, but here a large segment is represented by children of mothers from African countries. The total number of children with AIDS in the European Community is 2800: 86% were infected through their mothers. Romania has 4000 children with AIDS, who were predominantly infected via nonsterile syringes and blood transfusion. The European Commission has a specific AIDS prevention program, which addresses the measurement of disease spread, counteracting the disease, information and education, support for persons with HIV/AIDS, and countering discrimination. The risk of mother-to-child HIV transmission can be reduced from 25% to 8% by zidovudine (AZT) treatment during pregnancy and delivery.
[The hidden starving. Nutrition in underdeveloped countries] Den dolda svalten: Nutrition v utvecklingslanderna -- ett angelaget arbete.
NORDISK MEDICIN. 1997 Jun; 112(6):204-5.Undernutrition and malnutrition among children and women have diminished in most low-income countries in recent decades except for large parts of Africa. The Swedish International Agency for Development Cooperation (Sida), UNICEF, and the World Bank have financed nutrition projects. The right type of intervention can achieve much for children, especially when breast feeding is promoted. Although the importance of iodine has been known for a long time, the intensive iodination of salt worldwide has been propagated only in recent years. Research has shown that even slight deficiency of iodine leads to reduced ability to learn among children. 23-45% of child mortality could be reduced if the vitamin A needs of children could be assured. A combined strategy of large doses of vitamin A in capsule form as well as vitamin A-rich meals prepared from vegetables is recommended. Iron deficiency affects about half of the women and small children in many countries. Children's learning ability also worsens if iron deficiency is present. In the poorest countries nutritional assistance often falters because of the lack of local capacity to distribute and utilize aid. Sida has been singularly responsible for building up capacity to absorb aid in many African countries. In Ethiopia and Zambia mixed results have ensued, but in Zimbabwe and Tanzania the outcome has been splendid after many years of exertion. In these countries the nutritional status of children has improved in the 1990s despite their stagnating economies. The Tanzania Food and Nutrition Centre is technically the best developed on the continent, while Zimbabwe's Ministry of Health has succeeded in carrying out a nationwide nutrition program, and for most children (nearly 1 million) it provided a feeding program amidst recurring droughts. The promotion of the importance of breast feeding is borne out by the fact that exclusive breast feeding protects children against disease and stunting.
[Prevention of female genital mutilation in Sweden] Forebyggande av kvinnlig konsstympning v Sverige.
NORDISK MEDICIN. 1996 Dec; 111(10):358-60.In Goteborg, Sweden, a 3-year project was carried out among immigrant women about female genital mutilation, which involved discussion, information, and training to improve the situation of the women afflicted. It is estimated that there are around 115 million such women in Africa alone. In Europe there an estimated 50,000 young women who come from areas where female genital mutilation is practiced. In Sweden there are 16,000 such women and in the Goteborg area there are 2000-3000 who are at risk of being subjected to this practice. There are no exact figures about the number of those who have undergone this operation. The procedure includes Sunna mutilation and Pharaonic mutilation. The consequences are hemorrhage, shock, damage to the urethra, sepsis, the risk of HIV infection because of scarification, urinary retention, psychological trauma, development of fistula, dyspareunia, and infertility. In recent years there has been more open discussion about this practice, which is rooted in the male domination of women in Arab and African countries. International organizations have also addressed the issue in order to prevent it: the Inter Africa Committee on Traditional Practices Affecting the Health of Mothers and Children, the World Health Organization, UNICEF, and UNESCO. The first European conference on the subject was held in 1992 in London, and preventive strategies were developed. In 1982 Sweden had already adopted a law banning the practice. In 1993 the Goteborg immigration authority initiated a 3-year project about the practice, stressing collaboration with the immigrant women and their families as well as the personnel in health facilities, social agencies, schools, and immigrant processing centers. Two working groups were formed: one for health personnel including some Somali women and one for social agency personnel. In February, 1995, the guidelines for information transferral for health personnel were presented, which are now used locally.
["You are in bed with the Vatican]" On family planning during 20 years of work in developing countries] You are in bed with the Vatican] Om barnbegransning i bistandsarbetet under tjugo ar.
LAKARTIDNINGEN. 1994 Nov 23; 91(47):4382, 4385.The book entitled More People was published in Sweden before the first population conference was held in Bucharest in 1974. It outlined a critical, health-oriented perspective for fertility control and argued for more fundamental, poverty-related social initiatives to control the birth rate. The book was criticized as having a negative attitude to family planning (FP) and dismissed by many as an expression of an unholy alliance with reactionary Catholic circles. Right after the Bucharest conference, a high-ranking official of the Indian FP service was interviewed and stated that sex determination could be the solution to India's population problem. The book received a new appraisal some years later, when mass forced sterilizations took place in India, but instead of a breakthrough in population control, the government collapsed. Another book published in 1994 before the Cairo conference dealt with population policies in light of health, empowerment, and rights, drawing on demography, medicine, economics, ethics, anthropology, and sociology. It reviewed the 20 years that elapsed since the Bucharest conference, including the 1984 Mexico City conference when the US chose to give low priority to FP. The Nairobi Safe Motherhood Conference and the UN Decade of Women also featured as memorable events. In the early 1990s the alarm over the impending environmental catastrophe focused attention on population, environment, and development. The World Bank's structural readjustment programs have worsened the status of women's education and health, and the international feminist movement emphasized these issues right before the Cairo conference. Another book published in 1975 referred to the negative effect on women's health of development policies favoring macroeconomic stabilization, while in most northern countries massive overconsumption occurred. Population stabilization would require poverty alleviation, universal access to health care and education, and equality of the sexes.
[Adequate care in abortion. Compromise requirements in a UN document] Anstandig vard vid abort. Kompromisskrav i FN-dokument.
LAKARTIDNINGEN. 1994 Nov 2; 91(44):4020-1.The issue of abortion received a great deal of attention at the 1994 population conference in Cairo, indicating that there is a change in the attitude towards women's rights, education, and health in the last 10 years. A final United Nations document signed by 180 participants exhorted them to give decent care to women undergoing abortion. The decriminalization of abortion is needed for the protection of women's lives and health, according to the Norwegian prime minister Gro Harlem Brundtland, who talked frankly about this issue in contrast to the earlier timid approaches. The solution of the population problem lies in raising women's status and improving their economic and social conditions, education, and health. Reproductive health care does not mean the expansion of abortion, on the contrary it will eliminate or reduce abortion, unwanted pregnancies, and illegal abortions. Benazir Bhutto, Pakistan's prime minister, talked about the necessity of raising women's status. She accepted family planning (FP), but she rejected abortion as a means of population control, citing the Koran that one shall not kill a child because of poverty. The Vatican categorically condemned both abortion and artificial contraception, while most Islamic participants accepted FP, but were reluctant about sex education and women's equality. The UN document dealt with population development, FP, women's status and education, reproductive rights, maternal mortality, and reproductive health. Controversial issues were put in parentheses: abortion, sexuality, reproductive health, sex education, and safe motherhood programs. The final text stated that abortion should never be used as a means of FP.
[The WHO statement on strategies of HIV vaccinations: field trials in developing countries should await studies of the effects] WHO-uttalande om HIV-vaccinstrategier: faltprovningar i u-land bor avvakta effektstudier.
LAKARTIDNINGEN. 1993 Mar 31; 90(13):1245-6.The WHO steering committee for vaccine development reiterated its earlier position that the testing of HIV postinfectious vaccine candidates in developing countries must wait until there is initial proof that such a vaccine has some kind of effect in tests carried out in industrial countries. The often-used term about the latency of HIV infections is essentially faulty, as the infection means an ongoing destruction of the immune system for many years before symptoms appear. Therefore, it would be significant to have a therapeutic vaccine before the process has advanced too far. This is a practical problem, because the majority of the world's many millions of HIV-infected do not know that they are infected until there is an actual diagnosis of AIDS. Laboratory diagnosis to determine the number of CD4-T cells is expensive in developing countries where simple routines must be developed based on clinical observations. The study of vaccines would also provide important insights concerning the prevention of transmission of HIV infection to the child during pregnancy and childbirth. The WHO priority of developing and field testing an AIDS vaccine involves 4 field stations in Uganda, Rwanda, Thailand, and Brazil where the vaccine product could be tested, it is hoped, within 2-3 years. At the present time WHO is collecting and cataloging virus strains from various countries for the purposes of antigen selection. The vaccine candidate so far developed and tested in phase 2 trials is based on proteins from the coating of the virus. Ronald Desroisiers at the Harvard Medical School has made the virus apathogenic by removing several genes that accord it its virulence which also guarantees that it will not recur. All means have to be tried in view of the inexorable spreading of AIDS in Africa, Asia, and Latin America where in the worst affected areas 30-40% of pregnant women are HIV-infected.
[A description of a Swedish midwifery work environment in an assistance project in West Africa] En beskrivning av en svensk barnmorskas arbetsmiljo inom ett bistandsprojekt i Vastafrika.
JORDEMODERN. 1992 Jan-Feb; 105(1-2):20-3.The routine daily consultation in the health post of 1 of 10 project villages for pregnant women and children under age 5 is interrupted by a call to an emergency delivery which ends up with the birth of a baby girl weighing 2100 g who is named after the author. Under the project funded by SIDA, Stockholm, a local village committee was elected to open a dispensary which became well-attended. Due to visits to another nearby village, the number of children checked increased to 263 instead of the previous number of 147 per month. The weight status of children was worsening despite vaccination and nutritional advice, because women worked in the fields without taking a meal break for their children. After advising that several meals a day were needed, the children gained weight in the following months. A lecture by the project doctor to representatives of surrounding villages about the safety of delivery in the dispensary or the hospital elicited a positive response to send pregnant women there for delivery. The number of institutional deliveries had already increased from 249 in 1986 to 433 in 1989. Working in a developing country required preliminary preparations, French and English language study, a 4-week cultural orientation course organized by the International Child Health Unit, and reading professional books on obstetrics and gynecology in such countries.
LAKARTIDNINGEN. 1988 Oct 19; 85(42):3488.The Save the Children Foundation has proposed to support health education in Ethiopia to the amount of 750,000 Swedish kronor ($122,000). The education will be in the form of regional and national seminars for healthcare personnel and for training of officials of mass organizations. This support is part of the fight against AIDS which has been started in Ethiopia in collaboration with the World Health Organization (WHO) in the form of a 5-year plan through 1992. It includes epidemiological studies, support for hospital laboratories, improved sterilization, measures for minimizing transmission from mother to child and improved health education. To carry out the entire plan of action would require 20 million kronor ($3.25 million), which funds are not available. Many organizations, including Sida (Swedish International Development Authority) have declared their interest in supporting the work. According to WHO statistics, 37 AIDS cases had been registered through the spring of 1988, but the number is expected to increase sharply.
LAKARTIDNINGEN. 1988 Jun 15; 85(24):2152.In different countries opinions differ as to which chemotherapeutic methods should be used for malaria prophylaxis. It has long been the opinion of the Nordic countries, that WHO should give an official recommendation and the result is reflected now in the publication "Vaccination certificate requirements and health advice for internation travel." The malaria-endemic regions of the world are divided into 3 categories: regions without risk and no need for prophylaxis, low risk regions (A) with predominantly vivax inflections, risk regions (B) with predominantly chloroquine sensitive P. falciparum, and high risk regions (C) with often both chloroquine as well as sulfa/pyrimethamine resistance. Chloroquine is a sufficient prophylaxis for A-regions. For B-regions proguanil should be added and for C-regions only mefloquine is given. Proguanil was reintroduced basically because of Swedish research results in Liberia. An American initiative recommends for all regions, A-C, chemorprophylaxis as an alternative. However, a precondition is an observant traveller and clear instructions for self-treatment. Travellers who fall ill in a B-region should choose between Fansidar, mefloquine and quinine for self-treatment. Mefloquine has the least serious side effects, whereas quinine is therapeutically more safe. Fansidar very seldom gives any side effects. For C-regions only mefloquine is recommended for self-treatment. Nordic colleagues have recommended to double prophylaxis (chloroquine + Paludrine) treatment for the entire African tropical region. For short-time travellers to Kenya, Tanzania and Uganda, 6 tablets Lariam should be added. Only chloroquine is recommended for India and the Amazon region of South America. No chemoprophylaxis can guarantee full protection. Insect protection is therefore more important than ever. Malaria decreases the unspecific immune defense system. Surprisingly, repeated tests have shown that the AIDS frequency is not higher in patients with chronic malaria than for persons without plasmodia in the blood. In WHO's new little yellow booklet, a page concerning prophylaxis against AIDS appears. Equipment that is not new should be steamed or cooked for a least 20 minutes or treated with chemical disinfectants for at least 30 minutes. These measures should be enough to prevent HIV-infection.
JORDEMODERN. 1987 Jun; 100(6):172-3.As long as breast-feeding in the developing and developed countries is threatened by bottle-feeding and too early introduction of supplementary diets, the discussion about how breast-feeding is best protected must be kept alive within the organizations and the mass media. Representatives of the Swedish private organizations' foreign assistance programs participated in a seminar on April 3, 1987 in Stockholm, arranged by the Nordic Work Group for International Breast-Feeding Questions in cooperation with International Child Health (ICH). Breast-feeding increased strongly in Sweden during the 1970s, but bottle-feeding is still the norm in large parts of Europe and continues to increase in the developing countries. 6 years have passed since the international code for marketing of breast milk substitutes (even called the child food code) was approved by WHO, in 1981. It contains rules that limit companies' marketing efforts and establish responsibilities and duties that apply to health personnel. The application of these rules is slow and differences between company policies and practice exist. In a larger perspective, we are dealing with the position and significance of woman and children within the family and society. During a WHO meeting in 1986, a resolution was adopted that reinforces the content of the code, e.g., it stops the distribution of free breast milk substitutes to the hospital, where free samples are often given to leaving mothers. The WHO countries also expressed negative feeling toward marketing child food during a period where breast-feeding may be affected negatively. How the resolution is going to be implemented in Sweden is not yet known. There are signs that even in Sweden the existence of the code is being forgotten. The seminar participants recommended that the Social Board issue a simplified and easily read reminder about the code for wider distribution in Sweden.
LAKARTIDNINGEN. 1979 Apr 25; 76(17):1625-7.An overview of the risk of developing cancer related to oral contraceptive (o.c.) use is presented. A committee of experts affiliated with WHO studied the problem of developing cancer related to o.c. use. O.c. use for more than 2 years prevents the formation of benign breast tumors, even after discontinuing o.c. use. The effect is due to the progestin component. There is no clear indication that o.c. use increases the risk of breast cancer. A higher risk of endometrial cancer is associated with sequential preparation use, but not with the use of combination preparations. Cervical neoplasms and pituitary adenoma may be more frequent among predisposed women who use o.c.s. Studies show a reduced risk of ovarian cancer with o.c. use, but more studies are necessary. There is a marked increase in the relative risk of developing hepatocellular adenoma among women who use o.c.s for longer than 3 years. The risk increases with the hormone dosage, the duration of treatment, and the age of the patient. There is no reliable data to indicate that the risk of malignant melanoma increases with o.c. use. More study is needed to determine the possible cancer risks of injection preparations. Combination preparations can cause an increased risk of vaginal epithelial metaplasia. Diethylstilbestrol taken during early pregnancy can cause vaginal neoplasms in the offspring. More epidemiological studies and clinical and laboratory studies on the carcinogenic effects of o.c.s and the endocrinological effects of o.c.s on younger women should be undertaken. It is recommended that o.c.s with the lowest possible hormone dosages be used. O.c.s should not be prescribed to women with vaginal adenosis. (Summary in ENG)
[Swedish aid: Confidence instead of control. We are not guardians] Svenkst bistand: Fortroende i stallet for kontroll. Vi ar inga formyndare.
Lakartidningen 71(50): 5165-5170. December 11, 1974.The aid that the Swedish International Development Authority (SIDA) affords to developing countries is discussed. 10 ''program countries'' are given direct aid through this agency: Bangladesh, Botswana, Cuba, Democratic Republic of Vietnam, Ethiopia, India, Kenya, Tanzania, Tunisia, and Zambia. The receiving country decides what it will do with the money. SIDA grants aid to other international organizations, as well as Swedish organizations. Family planning aid is provided separately from other medical service aid. Many native personnel are trained to do the jobs performed by Swedish personnel, which saves money and helps the country to approach the goal set for it by SIDA: national self-sufficiency. Health and nutrition specialists try to educate the population about sanitation and nutrition, and in the process learn much themselves, since many specialists are ''overspecialized.'' The family planning aid that has been received comprises about 5-6% of total aid given and has been received with varying shades of enthusiasm. Research in the areas of demography, economy, and social development as well as population and family planning instruction are under the auspices of the family planning branch. Sweden is the 2nd largest world donor of population planning aid.