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Tuberculosis control in resource-poor countries: have we reached the limits of the universal paradigm?
Tropical Medicine and International Health. 2004 Jul; 9(7):833-841.The aim of TB control is to break the cycle of transmission by treating TB cases as early and efficiently as possible. In its efforts to promote a model of worldwide TB control, WHO defined specific targets and launched the ‘Directly Observed Therapy, Short-course’ (DOTS) strategy as the main tool to reach them. However, the diversity of patients’ attitudes towards the disease and the extreme variability of access to care, especially in resource-poor countries, are amongst the many factors of social context that profoundly affect the ability of control programmes to implement this policy effectively. There are multiple reports of TB control programmes using various types of intervention to promote adherence and enhance case-holding, but most of these interventions depend on external funding, which bring into question their long-term sustainability. In this paper, we address the problems related to operational variabilities in the implementation of the DOTS strategy in resource-poor countries and question the appropriateness of a universal paradigm for global TB control. This analysis is of particular importance as programmers consider using this model in the delivery of anti-retroviral therapies for the treatment of HIV in resource-limited settings. (author's)
FAR EASTERN ECONOMIC REVIEW. 1992 Feb 20; 29-30.AIDS and HIV infection are in the early stages in Indonesia. 21 AIDS cases have been reported, and 30 persons have tested HIV-seropositive. Given the relatively low number of cases, and the presumed slow spread of HIV in the population, the government may yet be able to react in timely fashion to thwart epidemic spread. A rigorous education campaign and early detection of infected individuals are elements central to such intervention. The World Health Organization set a 1992 budget of US$500,000 for AIDS efforts in Indonesia. Research is young, awareness is minimal, and the campaign has barely commenced. AIDS cases have emerged in Jakarta, Surabaya, Bandung, and Denpasar. It is especially in cities that the government is concerned over checking the spread of AIDS. In these populations, many engage in extramarital sex, visible transvestite communities exist, and commercial sex districts thrive. Low condom use among sex workers, and relatively high rates of untreated STDs prevail in the general population. From March, blood donated in 15 cities, including these 4, will be compulsorily screened for HIV. Socially, moral and religious attitudes must be recognized and accommodated in mounting an effective AIDS prevention and education campaign in Indonesia. While religious sensibilities may be offended by the discussion of sex and sexual practices, such discussion is necessary and must be supported by the well-organized religious groups in this overwhelmingly Muslim country. Hopefully, Indonesia will bring to bear against AIDS the same cultural pragmatism exhibited to effect population control in the 1970s and 1980s.
INTEGRATION. 1991 Sep; (29):4-5.The work of the Soviet Family Health Association (SFHA) is described. Created in January, 1989, the organization boasts 25 state-paid workers, and as of June 1991, membership of 15,000 corporate and individual members. Individual annual membership fee is 5 rubles, and entitles members to counseling and family planning (FP) services. The SFHA works in cooperation with the Commission on Family Planning Problems of the USSR's Academy of Sciences, and has been a member of the International Planned Parenthood Federation (IPPF) since 1990. Association activities include lectures for students, newly-weds, adolescents, and working women on modern contraceptive methods; research on attitude regarding sex, sex behaviors, and the perceived need for effective contraception; clinical trials of contraceptive suitability for women; and the training of doctors in FP and contraceptives. Problems central to the SFHA's operations include insufficient service and examination equipment, a shortage of hard currency, and the small number of FP specialists in the country. Solutions to these obstacles are sought through collaboration with the government, non-governmental organizations in the Soviet Union, and international groups. The SFHA has a series of activities planned for 1991 designed to foster wider acceptance of FP. Increased FP services at industrial enterprises, establishing more FP centers throughout the Soviet Union, and studying FP programs in other countries are among Association targets for the year. Research on and promotion of contraceptives has been virtually stagnant since abortion was declared illegal in 1936. Catching up on these lost decades and remaining self-reliant are challenges to the SPHA.
HEALTH FOR THE MILLIONS. 1991 Aug; 17(4):20-3.Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1991 Jun.  p. (Occasional Operations Papers; USAID Contract No. DPE-5969-Z-00-7064-00)The paper presents results from diarrheal disease control (CDD) activities in Kenya. A World Health Organization Diarrheal Diseases Household Case Management Survey of 23,884 children under 5 years of age indicates a high use of recommended fluids before and during episodes of diarrheal illness. ORT use was high, while ORS use and volume were low, with better diarrheal management practiced in Western Kenya. Children with diarrhea in districts with CDD communication program are more likely to receive proper care. For home treatment of diarrhea, the Kenyan Food and Fluids Panel recommends mothers to use uji, a locally available porridge, liberal quantities of plain water, fresh fruit juices, fermented milk, and coconut water; exclusive breastfeeding for the 1st 4 months of life; continued feeding of at least 5 times/day during diarrhea; and improved, targeted communication for behavior change especially among mothers of at-risk children. Additional research on food, feeding, communications, and marketing ORS was also recommended. Principal research findings of the survey are discussed in detail. Messages most effective in improving the management of diarrhea include emphasizing feeding during diarrhea, stressing the use of nutritional fluids, continued hesitation of ORS promotion until 1.2- liter packets become generally available through the health system, and emphasizing the rare need for drug therapy of diarrhea. Recognizing signs suggesting the need for health facility treatment should be reinforced.
[Unpublished] July, 1979. 49 p.This study assesses the effectiveness of family planning education in the Republic of Korea over the past 2 decades. Target populations in various metropolitan areas were studied regarding attitudes toward family planning knowledge, contraceptive behavior, media and personal contacts on family planning, number and gender preferences, and spacing preferences. Socioeconomic and demographic factors were taken into account. Statistics were compiled by area and analyses are presented. Use of more mass media is suggested to get information on family planning across to more people. It is important to extend the range and quality of family planning services, most especially to provide the best information about contraceptive methods.