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  1. 1

    Report of the Expanded Programme on Immunization Global Advisory Group Meeting, 20-23 October 1980, Geneva.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]. Global Advisory Group

    [Unpublished] 1980. 39 p. (EPI/GEN/80/1)

    This report of the Expanded Program on Immunization (EPI) Global Advisory Group Meeting, held during October 1980 in Geneva, Switzerland, presents conclusions and recommendations, global and regional overviews, working group discussions, and outlines global advisory group activities for 1981. In terms of global strategies, the EPI confronts dual challenges: to reduce morbidity and mortality by providing immunizations for all children of the world by 1990; and to develop immunization services in consonance with other health services, particularly those directed towards mothers and children, so they can mutually strengthen the approach of primary health care. Increased resources are needed to support the expansion of immunization services and to establish them as permanent elements of the health care system. The Global Advisory Group affirms the importance of setting quantified targets as a basic principle of management and endorses the principle of setting targets for the reduction of the EPI diseases at national, regional, and global levels. The primary focus for the World Health Organization (WHO) in promoting the EPI continues to be the support to national program implementation in all its aspects. The Group reviewed current EPI immunization schedules and policies and concurs in the following: for measles, for most developing countries, the available data support the current recommendations of administering a single dose of vaccine to children as early as possible after the child reaches the age of 9 months; for DPT, children in the 1st year of life should receive a series of 3 DPT doses administered at intervals of at least 1 month; for tetanus toxoid, the control of neonatal and puerperal tetanus by immunizing women of childbearing age, particularly pregnant women, is endorsed; for poliomyelitis, the Group endorses the "Outline for WHO's Research on Poliomyelitis, Polioviruses and Poliomyelitis Vaccines" prepared by the WHO Working Group convened in October 1980, i.e., for oral (live) vaccines, a 3-dose schedule, administered simultaneously with DPT vaccine, is recommended again; and for BCG concurred with the Advisory Committee on Medical Research conclusion that the use of BCG as an anti-tuberculosis measure within the EPI should be continued as at present. The implementation of programs at the national level remains the foremost priority for the EPI. National commitment, evidenced in part by the designation of a national manager, the establishment of realistic targets, and the allocation of adequate resources, is essential if programs are to succeed.
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  2. 2

    WHO Expert Committee on Tuberculosis: ninth report.

    World Health Organization [WHO]. Expert Committee on Tuberculosis


    This document represents the work of a World Health Organization (WHO) Expert Committee on Tuberculosis, which met in Geneva in 1973. Chapters in this volume focus on epidemiology, Bacillus Calmette-Guerin (BCG) vaccination, case finding and treatment, national tuberculosis programs, research, WHO activities in this field, and the activities of the International Union against Tuberculosis and voluntary groups. The Committee emphasized that tuberculosis still ranks among the world's major health problems, particularly in developing countries. Even in many developed countries, tuberculosis and its sequelae are a more important cause of death than all the other notifiable infectious diseases combined. The previous WHO report, issued in 1964, set forth the concept of a comprehensive tuberculosis control program on a national scale. The implementation of this approach has encountered many problems, including deficiencies in the health infrastructure of many countries (shortages of financial, material, and physical resources and a lack of trained manpower) and resistance to change. However, many countries have instituted comprehensive programs and tuberculosis control has become a widely applied community health activity. A priority will be control of pulmonary tuberculosis. The Committee stressed that national programs must be countrywide, permanent, adapted to the expressed demands of the population, and integrated in the community health structure. Steps involved in setting up such programs include planning and programming, selection of technical policies, implementation, and evaluation. Research priority areas identified by the Committee include epidemiology, bacteriology and immunology, immunization, chemotherpy, the systems analysis approach to tuberculosis control, and training methods and instructional materials.
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  3. 3

    International Workshop on Youth Participation in Population, Environment, Development at Colombo, 28th Nov. 83 to 2nd Dec. 83.

    World Assembly of Youth

    Maribo, Denmark, WAY, [1984]. 120 p.

    The objectives of the International Youth Workshop on Population and Development were to provide a forum to the leaders of national youth councils and socio-political youth organizations. These leaders were brought together to review national and local youth activities and their plans and action programs for the future. The outlook for these discussions was local, regional, and global. In addition the Workshop aimed at providing interaction among the youth organizations of the developing and the developed countries. These proceedings include an inaugural address by Gemini Atukorata, Minister of Youth Affairs, Government of Sri Lanka and presentations focusing on the following: youth and development; the key role of youth in production and reproduction -- important factors of development; 60% of the aid goes back to the giving country in several ways; adolescent fertility as a major concern; social development for the poor with particular reference to the well-being of children and women; commitment for the cause is the key to attract funds; and observance of the International Youth Year under the themes of participation, development, and peace. The 11th workshop session dealt with follow-up and the future direction of the World Assembly of Youth (WAY). The following points emerged in this most important session: WAY should emphasize "Youth Participation in Development" as the major program; WAY's population programs should not be limited to just information, education, and communication, and youth groups should be encouraged to become service delivery agents for contraceptives wherever possible; environment awareness should become an integral part of population and development programs; youth in the service of children, health for all, and drug abuse should be the new areas of operation for WAY; and programs of youth working in the service of disabled, especially disabled young people, and youth and crime prevention programs also found favor with the participants. Recommendations and action programs are outlined. Proceedings include a summary of WAY activities and resolutions.
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  4. 4

    Validation of outpatient IMCI guidelines.

    United States. Agency for International Development [USAID]. Child Health Research Project

    SYNOPSIS. 1998 Jan; (2):1-8.

    The World Health Organization (WHO)/UN Children's Fund (UNICEF) Integrated Management of Childhood Illness (IMCI) guidelines were designed to maximize detection and appropriate treatment of illnesses due to the most common causes of child mortality and morbidity in developing countries: pneumonia, diarrhea, malaria, measles, bacterial infections in young infants, malnutrition, anemia, and ear problems. The health worker first examines the child and checks immunization status, then classifies the child's illness and identifies the appropriate treatment based on a color-coded triage system. By May 1997, 17 countries had introduced IMCI and 16 others were in the process of introduction. This issue reports on field tests of the guidelines conducted in Kenya, the Gambia, Uganda, Bangladesh, and Tanzania. Health workers who used the guidelines performed well when compared to physicians who had access to laboratory and radiographic findings as well as health workers trained in full case management. Of concern, however, are research findings suggesting the potential for overdiagnosis in some disease classifications. Current IMCI research priorities include the following: 1) determining health workers' ability to learn to detect lower chest wall indrawing; 2) identifying clinical signs to increase the specificity of referral for severe pneumonia; 3) identifying other clinical signs to increase the specificity of hospital referrals, thereby reducing unnecessary referrals; 4) investigating how clinical care for severely ill children could be expanded in areas where referral is not feasible; 5) finding ways to increase the specificity of the diagnosis of malaria; and 6) recognizing clinical signs to increase the specificity of the diagnosis of severe anemia and the specificity of the diagnosis of moderate or mild anemia, with the possible goal of regional adaptation of the anemia guidelines.
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  5. 5

    Food safety in primary health care.

    Abdussalam M; Kaferstein FK

    WORLD HEALTH FORUM. 1994; 15(4):393-7.

    The fact that food safety is given a low priority in the health care systems of many countries despite an increase in food-borne diseases may be due to a lack of reliable quantitative data on incidence of disease. The World Health Organization (WHO) has linked this increase to intensive methods of livestock production which foster the spread of salmonella and other pathogens. By relying on legislation, regulations, and standards to monitor food commerce, policy-makers have failed to emphasize health education for food handlers and consumers. WHO has proposed a collaborative, intersectoral approach between governments, food industries, and consumers which will emphasize consumer education. WHO has also prepared 10 rules for safe food preparation. Governments can insure the education of consumers and food handlers by using the primary health care (PHC) mechanism for health education. To date, the most intensive involvement of the PHC community has been in efforts to avoid diarrheal diseases through hand-washing, sanitation, and safe storage of water. Insufficient cooking, faulty food storage, and improper reuse of leftovers have all been neglected topics. Food safety efforts at the local level should 1) identify specific food-related practices and behavior relevant to risk factors, 2) change risky behavior and practices through health education, 3) involve the community in making improvements related to food safety, 4) mobilize and coordinate relevant activities of other sectors, 5) report incidences of food-borne illnesses, 6) generate a strong public demand for food safety, and 7) research diseases and cultural practices related to food handling and safety. To achieve these objectives, PHC workers should be trained in the epidemiology of food-borne diseases and the sociocultural characteristics of their area, in health education and community involvement, and in research methodology.
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  6. 6

    Vaccination strategies in developing countries.

    Poore P

    VACCINE. 1988 Oct; 6(5):393-8.

    In developing countries, where economic development is lacking and literacy rates are low, priority must be given to primary health care and to the establishmend of sustainable health care delivery systems. The World Health Organization's Expanded Program of Immunization was designed with the goal of immunizing all children against measles, pertussis, tetanus, poliomyelitis, tuberculosis, and diphtheria by 1990. A second function of the immunization program is to establish a health care delivery system. Today 50% of infants receive 3 doses of diptheria/pertussis/tetanus and polio vaccines, and 70% receive at least 1 dose. Measles kills 2 million children every year. The standard strain of attenuated vaccine is given at 9 months, and 1 dose protects 95% of children for life. Tetanus kills 800,000 infants every year. The vaccine must be refrigerated, and 2 doses are essential. Tuberculosis kills 2 million children under 5 every year. The attenuated BCG vaccine should be given at birth, and a single dose confers some protection. Diphtheria is most common among poor, urban children in termperate climates, and 3 doses of toxoid at monthly intervals are recommended. Poliomyelitis paralyzes 250,000 children a year. 4 doses of live attenuated Sabin vaccine are recommended. The vaccine is very sensitive to heat. Other vaccines in use or being developed include yellow fever, meningococcus, Japanese B encephalitis, rubella, hepatitis B, cholera, rotavirus, pneumonococcus, and Haemophilus influezae. 2 problems that confront the delivery of health services, including immunization, are lack of funds and lack of access to susceptible populations. Approaches to the lack of funds problem include fee for service, taxation, beter management of existing resources, reallocation of health resources, and increased funding from donor nations. Approaches to the problem of access include vaccination whenever children come into contact with a health facility for any reason, channeling by members of the community, involvement of traditional healers and birth attendants, outreach services, mass campaigns, pulse technics, and financial incentives.
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  7. 7

    Diarrheal diseases morbidity, mortality and treatment rates in Bahrain (1986).

    Al-Khateeb M

    [Unpublished] 1988. Presented at the 13th World Conference on Health Education, Houston, Texas, August 28 - September 2, 1988. 60 p.

    This study is the report of a 1986 baseline survey, guided by the World Health Organization's "Guidelines for a Sample Survey of Diarrheal Diseases Morbidity, Mortality, and Treatment Rate." The survey method was the Expanded Program on Immunization 30 cluster 2-stage method. Baseline data were also gathered on the status of immunization against diphtheria, tetanus, whooping cough, poliomyelitis, measles, and tuberculosis. Primary health care services in Bahrain are generally good. The archipelago of 670 sq km has a population of 417,210 including 55,000 children under 5. There are 18 health centers and 480 physicians or 1 physician for every 860 people. All inhabitants of a catchment area live within 5 km of a health center, and medical care is free. Diarrhea is due to a number of different organisms, including typhoid, paratyphoid, salmonellosis, Escherichia coli, rotaviruses, and giardiasis, but there has been no cholera in Bahrain since 1979. The national diarrheal diseases control program, drafted by the World Health Organization in 1985, emphasized the use of oral rehydration therapy, breast feeding, and feeding during diarrhea. No vaccinations are compulsory in Bahrain, but immunization coverage has been reported annually since 1981, and vaccinations are in line with the World Health Organization's criteria. Diphtheria-Typhoid-Paratyphoid vaccinations were 1st given in Bahrain in 1957; polio vaccination began in 1958 with Salk vaccine and in 1962 with the Sabin vaccine. Measles vaccination began in 1974. BCG vaccination has been given to children entering school since 1972. All health centers in the country offer vaccination services. Vaccines are stored under refrigeration, and the central supply is at the Public Health Directorate. Adverse effects of vaccinations are monitored. The 1986 diarrheal diseases survey, using the 30 cluster method, looked at a sample of 4114 children under 5 from 2515 households. 378 (9.2%) of the children suffered from diarrhea, and 200 (52.9%) were treated with oral rehydration salts. The under-5 diarrheal mortality rate was .97/1000. The estimated number of episodes of diarrhea per child per year is 2.4, with a high of 8.7 episodes in the Northern Region and a low of 1.2 episodes in the Muharraq Region. Vaccination coverage of children under 2 for other diseases was found to be 96.5% for diphtheria, paratyphoid, and typhoid; 95% for polio; 82.5% for measles; and 59.8% for the trivalent mumps, measles and rubella vaccine. 96.4% of all vaccinations were given in government hospitals. 98.7% of mothers have been examined during pregnancy, and 98.9% of all deliveries are in hospitals. It is recommended that a health education campaign be concentrated on diarrhea, breast feeding, feeding during diarrhea, and hygiene; that both medical staff and mothers be trained in the use of oral rehydration salts; that they should also be informed of the adverse effects of treating diarrhea with antibiotics; that a system for reporting cases of diarrhea be developed; that health education campaigns emphasize the importance of receiving booster doses of vaccines and of vaccination against measles; that staff at health centers adjust their schedules so as to be available for immunizations as needed; and that this survey be repeated every 2 years.
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  8. 8

    Global overview: the Expanded Programme on Immunization, Cartagena, Colombia, 14-16 October 1985.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1985. 15 p.

    This paper reviews the development of the global Expanded Program on Immunization (EPI) initiative, reports on program progress since the 1984 EPI conference, and identifies actions needed to meet the goal of providing immunization services to all children of the world by 1990. The central EPI strategy to date has been to deliver immunization in consonance with other health services, particularly those aimed at mothers and children. The long-term goal of such efforts is to strengthen the health infrastructure so as to ensure the continuous provision of immunization and other primary health care services. Simply by reinforcing existing health services, a coverage level of 60-70% will be achieved in developing countries by 1990. If universal coverage is to be achieved, external funds will have to be provided to meet operational costs and train national managers. Acceleration of existing efforts constitutes the main EPI priority at present. Specific areas suggested for immediate action include provision of information about immunization at every health contact; a reduction in the drop-out rates between 1st and last immunization; increased attention to the control of measles, poliomyelitis, and neonatal tetanus; improved immunization services to the disadvantaged in urban areas; and, where appropriate, acceleration of the EPI through approaches such as national immunization days. Ongoing actions that need to be pursued include strengthening disease surveillance and outbreak control, reinforcing training and supervision, and pursuing applied research and development. Overall, management capacity within national programs remains the most severe constraint for the EPI.
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