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London, England, Child-to-Child Trust, 1993. 183 p.Published since 1989 by UNICEF, WHO, UNESCO, and UNFPA in partnership with more than 160 of the world's best-known children's agencies, Facts for Life presents in plain language what medical science knows about practical, low-cost ways of protecting children's lives and health. Children for Health includes the messages contained in the most recent edition of Facts for Life and is designed for those who work with children and believe that children, in schools and as family members, need to be considered as partners in spreading health messages as well as benefiting from them. Part one on children as partners looks at Children for Health, Facts for Life, helping children to help others, three levels of action, who benefits, ideas into action, and evaluation. Part two on health messages and children's action is presented in the following sections: twelve messages to save and improve lives, breastfeeding, child growth, child development, hygiene, diarrhea, immunization, coughs and colds, malaria, AIDS, safe motherhood, accidents, food for the family, and some useful resources.
Issues and trends in emergency preparedness for technological disasters: moving beyond the "natural" and "technological" labels.
In: Environmental management and urban vulnerability, edited by Alcira Kreimer, Mohan Munasinghe. Washington, D.C., World Bank, 1992. 237-59. (World Bank Discussion Papers 168)Major cities face a potentially serious threat to the environment and public safety with toxins released into the environment by households, small businesses, and the dangers posed by accidents at major industrial complexes. The Bhopal accident resulted in 3500 deaths, although 200,000 to 300,000 survivors also suffer long-term health problems. The Organization for Economic Cooperation and Development suggested, when drawing up an emergency preparedness plan, to involve elected administrative officials, emergency management or civil defense agencies, fire departments, police, industrial facilities, transportation departments, environmental agencies, emergency medical services, and the media among others. The World Bank suggested that an emergency plan should cover: 1) emergency treatment for the community, facility workers, and emergency responders; 2) medical education for preventing avoidable injury, trauma, and disease; and 3) periodic medical examinations for personnel exposed to hazardous materials. The computer program Computer-Aided Management of Emergency Operations contains decoded information for chemical synonyms, United Nations identification numbers, DOT Emergency Response Book identification numbers, information on over 3000 commonly transported chemicals, and models the dispersion of chemical clouds and estimates downwind spreads. The Hazardous Materials Information Exchange database provides emergency managers with information on training, resources and technical assistance, federal and state regulations, and on the emergency management of hazardous materials. The Disaster Management Center at the University of Wisconsin provides courses in disaster management. The Emergency Management Institute maintains a library with over 50,000 books and periodicals on emergency management. Environmental officials from developed countries have tried to provide technical advice to developing countries on technological hazards, with meager results. In developing countries the poor who occupy traditional housing suffer far less mortality following earthquakes and storms than the urban poor who live in substandard housing. A UNEP document provides a process that is universally applicable to developing countries.
In: Environmental management and urban vulnerability, edited by Alcira Kreimer, Mohan Munasinghe. Washington, D.C., World Bank, 1992. 187-236. (World Bank Discussion Papers 168)Since 1950, only 13 acute chemical disasters in developing countries have resulted in more than 100 facilities or 1000 injured. The Bhopal, Indian, chemical poisoning that killed at least 2000 people is atypical. Some other accidents were unnoticed: 1) 10,000 people in Morocco in 1959 suffered from cooking oil contaminated with degraded lubricating oil, 2) 50,000 people were affected in Iraq in 1971 from exposure to methyl mercury, and 3) 7500 people were made ill in Pakistan in 1976 from a misuse of the insecticide malathion. Multiple risks are associated with producing, transporting, storing, using and disposing of dangerous chemicals. Nuclear plants, the transport of nuclear wastes over long distances, and the increasing byproducts of the deactivation of nuclear plants also pose risks. In the United States, by the year 2000, there will be about 47,900 metric tons of spent fuel, compared with 12,900 tons in 1985. There were 435 commercial nuclear plants in existence at the start of the 1990s with nearly 100 more under construction. Several computer-linked disasters in the United States as well as Japan have had negative chain reactions. In the 1970s the world became aware of nuclear power threats, in the 1980s of the chemical hazards risks, and the 1990s could witness a biotechnological disaster on the scale of Chernobyl or Bhopal in some developing country that has imported this new technology without instituting the safeguards. 96% percent of population growth is in developing countries with the growth of hugh cities by massive migration from rural to urban areas. The general implication is that to import more and improved disaster technology into developing countries can only address technological problems, and social problems can only be dealt with socially.
Vulnerability and resiliency: environmental degradation in major metropolitan areas of developing countries.
In: Environmental management and urban vulnerability, edited by Alcira Kreimer, Mohan Munasinghe. Washington, D.C., World Bank, 1992. 107-52. (World Bank Discussion Papers 168)The main factors contributing to vulnerability to natural and man-made hazards and the implications of environmental degradation for large urban areas in the developing world are outlined. Many high-risk metropolitan areas in developing countries are projected to have populations of over 10 million by the year 2000; including Baghdad, Bangkok, Beijing, Bombay, Buenos Aires, Cairo, Calcutta, Dhaka, Delhi, Jakarta, Istanbul, Karachi, Manila, Mexico City, Rio de Janeiro, Sao Paulo, Shanghai, and Teheran. Water depletion and quality is a looming issue. In Thailand water demand for the area of Bangkok will increase from 2.8 million cubic meters per day in 1987 to 4.1 million by 1997, and to 5.2 million by 2007. Only 2% of the population of Bangkok is connected to the sewer system. In Calcutta there are 3 million people in settlements which have no systematic means of disposing human wastes. Fertilizers have had a severe negative impact on the environment. Among the cities which have polluted their coastlines are Alexandria, Dakar, Guayaquil, Karachi, Panama City, and Valparaiso. Montevideo and Rio de Janeiro have polluted beaches. The Torrey Canyon, the Exxon Valdez and the Gulf War each focused world attention on marine oil pollution that stems from tanker operations, refineries, and offshore oil wells; from the disposal of industrial and automotive oils; and from industrial and motor vehicle emissions. Because of inappropriate sitting, hundreds of people were killed by mudslides in Rio de Janeiro in 1988, in Medellin in Colombia in 1987, and in Caracas in 1989. In Guatemala, 65% of deaths in the capital following the 1976 earthquake occurred in the badly eroded ravines around the city. The production of greenhouse gases will lead to a rapid warming of the biosphere sometime in the next century, changed rainfall patterns, altered paths of ocean currents, and rising sea levels. A World Bank study recommends for country responses 1) to focus on particular environmental problems; 2) to concentrate on vulnerable populations using vulnerability analysis; and 3) to focus on government intervention strategy.
[The health-for-all strategy: are we reaching our targets to reduce mortality?] Helse for alle-strategien--nar vi malene for redusert dodelighet?
Tidsskrift for den Norske Laegeforening. 1992; 112(1):57-63.The author examines Norway's efforts toward attaining the WHO goal of health for all by the year 2000. "This article presents and discusses the sub-goals for expectation of life and mortality, and analyzes the possibilities of reaching them." Consideration is given to reductions in mortality from accidents, cardiovascular effects, and cancer; age-specific mortality rates; and deaths from suicide and homicide. (SUMMARY IN ENG) (EXCERPT)
Epidemiological experience in the mission of the United Nations Transition Assistance Group (UNTAG) in Namibia.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1992; 70(1):129-33.Medical reports modelled after the US Peace Corps surveillance form provided mortality and morbidity data of the United Nations Transition Assistance Group in Namibia in 1989-1990. Contingents included Australians, Canadians, Danes, Finns, Kenyans, Malays, Poles, Spaniards, and Britons. Traffic accidents, mostly those on long distance journeys caused 14 of 16 deaths. The fatality ratio was 0.21/million km driven which was considerably higher than that in Switzerland 0.02/million km driven. Even though heavy traffic was not a problem in Namibia, limited experience on unpaved roads; high speeds induced by long and tedious driving; and reduced visibility caused by climactic conditions, fatigue, and alcohol contributed to high fatality. The hospitalization rate of 5.2% (369 patients) was rather high for a young and healthy population. The leading reasons for hospitalization included fever of unknown origin, trauma, and respiratory tract infections. Swiss Medical Unit physicians transferred 25 patients to the State Hospital in Windhoek, most for orthopedic surgery. Injuries, psychiatric problems, and alcoholism resulted in repatriation for 66% of 46 repatriated patients. New consultations for treatment averaged 2.7/person and those for preventive measures averaged 0.8/person. Helicopter pilots was the largest group returning for 2nd visits (56% compared to 1% for logistics staff). The major reasons for attending outpatient clinics included immunizations (18.8%), dental problems (10.5%), and respiratory infections (10.5%). In addition to respiratory infections, other frequent communicable diseases included diarrhea or dysentery, dermatological infections, sexually transmitted diseases, and confirmed or suspected malaria. Preventive measures are needed to reduce mortality due to traffic accidents and the prevalence of psychological and dental problems.
MEDICINE AND WAR. 1989 Jul-Sep; 5(3):132-6.Health care in post war Nicaragua, specifically interventions directed at infant and child mortality, rehabilitation of war disabled and counseling of the aggrieved, was surveyed in a 2-week study tour by the Health Network of the (British) Nicaragua Solidarity Campaign in 1987. There has been a grassroots health program initiated by the Government to use a system of health "briagadistas" and "multipliers" whereby volunteers train others in immunization and oral rehydration. The workers who have only some primary education receive 2 weeks intensive training followed by 1 day per month. In the last 4 years 70 of these workers have been killed by Contras. The infant mortality rate was cut from 120/1000 live births in 1977 to 75 by 1983. Mass immunizations were held on special health weekends. Poliomyelitis has been eradicated; no cases of diphtheria have been reported since 1985; and the incidence of measles has fallen. Rehabilitation of persons disabled by loss of limbs is limited by facilities: only 1 42-bed rehabilitation hospital with 1 orthopedic surgeon donating a few hours per week is available for a population of 3.3 million. Outside donors have set up prosthetics and wheelchair workshops, using local materials as much as possible. There is also a center in Managua teaching manual trades to 75 disabled. About 65,000 people have died in the civil and Contra wars, about 3 times the death rate in Britain in World War II. Caregivers are being trained in grief counseling by teams from Mexico at Nicaragua's 2 medical schools.
World Development Forum. 1985 Jun 15; 3(11):2.The World Health Organization (WHO) calls attention to a growing hazard of life in the big cities of developing countries: accidents. In Venezuela, 45% of deaths among 10 to 24 year olds are due to accidents, for lack of proper care. Someone involved in an accident in Kenya is 9 times as likely to die as in the US, and an accident victim in India is up to 15 times as likely to die as one in the United Kingdom. "With fast growing cities and land increasingly crisscrossed with pavements," reports WHO, "accidents are beginning to rival infections and parasitic diseases in the toll they take of young lives." (full text)