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Geneva, Switzerland, WHO, 2015. 124 p.The report delivers both promising and disappointing messages about the situation in low- and middle-income countries. Within-country inequalities have narrowed, with a tendency for national improvements driven by faster improvements in disadvantaged subgroups. However, inequalities still persist in most reproductive, maternal, newborn and child health indicators. The extent of within-country inequality differed by dimension of inequality and by country, country income group and geographical region. There is still much progress to be made in reducing inequalities in RMNCH.
In: Population policies and programmes. Proceedings of the United Nations Expert Group Meeting on Population Policies and Programmes, Cairo, Egypt, 12-16 April 1992. New York, New York, United Nations, 1993. 27-41. (ST/ESA/SER.R/128)The world population reached 5.4 billion in mid-1991, and it is growing by 1.7% per annum. The medium-variant United Nations population projection for the year 2025 is now 8.5 billion, 260 million more than the United Nations projection in 1982. This implies reducing the total fertility rate in the developing countries from 3.8 to 3.3 by the year 2000 and increasing contraceptive prevalence from 51 to 59%. This will involve extending family planning services to 2 billion people. For the first time, fertility is declining worldwide, as governments have adopted fertility reduction measures through primary health care education, employment, housing, and the enhanced status of women. Since the 1960s, contraceptive prevalence in developing countries has grown from less than 10% to slightly over 50%. However, 300 million men and women worldwide who desire to plan their families lack contraceptives. Life expectancy has been increasing: for the world, it is 65.5 years for 1990-1995. Infant mortality rates have been halved. Child mortality has plummeted, but in more than one-third of the developing countries it still exceeds 100 deaths/1000 live births. Globally, child immunization coverage increased from only 5% in 1974 to 80% in 1990. At the beginning of the 1980s, only about 100,000 persons worldwide were infected with HIV. During the 1980s, 5-10 million people became infected. WHO projects that the cumulative global total of HIV infections will be between 30 and 40 million by 2000. The European governments are concerned with growing international migration. Currently, 34.5% of governments have adopted policies to lower immigration. In the early 1970s, the number of refugees worldwide was about 3.5 million; by the late 1980s, they had increased to nearly 17 million. A Program of Action for the Least Developed Countries for the 1990s was adopted in September 1990 to strengthen the partnership with the international donor community.
WORLD HEALTH FORUM. 1993; 14(3):329-30.Measles kills about 1.4 million children each year. To bring about reductions in measles cases and deaths, WHO has made some recommendations. Public health officials at the community, district, and national levels need to achieve at least 90% measles vaccine coverage. This coverage level reduces cases and deaths, but may not stop transmission. The primary goal should be that health workers deliver at least 1 dose of measles vaccine to all children at the scheduled age. Several complementary strategies are needed within each country to achieve this high coverage. In situations where there is a high incidence of measles in a defined subgroup of older children, older children should receive extra doses of vaccine when they enter school. In-service training of hospital and clinic staff should reduce the number of missed opportunities (i.e., children who visit health facilities but who are not screened and administered needed immunizations). Public health workers need to identify reasons for high drop-out rates and take corrective action. Limited resources should be directed to high risk areas: areas with high population density, low measles immunization coverage, known vitamin A deficiency, or high reported measles incidence or death rate. Unimmunized urban poor children, underserved ethnic minorities, refugees, people in underserved border areas, children admitted to the hospital, and infants of HIV positive mothers comprise high risk groups. Measles outbreaks occur even in areas where measles immunization coverage is high. Control measures are not always effective, especially if taken late in an epidemic. At the very least, health officials should gather data on cases and death (e.g., date of onset and immunization status). They should determine why the outbreak took place. If possible, they should conduct a vaccine efficacy study. To reduce deaths from measles by 95%, immunization, treatment of measles and its complications at an early stage, and vitamin A supplementation are needed.
Lancet. 1993 Jan 30; 341(8840):304-5.WHO provides health workers with guidelines for case management strategies for children with acute respiratory infections (ARI) to reduce child mortality. Its clinical case definitions for ARI do not assume that a child has only 1 disease, however. The guidelines also help health workers diagnose and treat other conditions in those children with fever who live in malaria endemic areas such as Africa where Plasmodium falciparum is transmitted. They also guide health workers on how to refer children with danger signs of severe malaria, meningitis, or severe malnutrition to the hospital. Based on studies in Malawi and the Gambia, WHO 1st recommended using co-trimoxazole and chloroquine to treat children with malaria who have a cough and fever and who are breathing quickly. Experts at a WHO meeting in April 1991 now recommend 5 days of co-trimoxazole alone to treat such children in areas where malaria is moderately to highly endemic, the leading parasite is P. falciparum, and it is sensitive to sulfadoxine/pyrimethamine. WHO has incorporated this change into its clinical guidelines and training materials. The guidelines emphasize that local health workers must adapt the guidelines for children with concomitant malaria as necessary to guarantee appropriate identification and referral of children with severe anemia. WHO and UNICEF are developing a fully integrated training package to address case management of children with pneumonia, diarrhea, malaria, measles, and/or malnutrition. This package also instructs health workers on how to manage middle ear inflammation, anemia, meningitis, and acute ocular problems from measles and vitamin A deficiency. WHO and UNICEF hope to have this integrated training package available in late 1993.
In: Disease and mortality in Sub-Saharan Africa, edited by Richard G. Feachem, Dean T. Jamison. Oxford, England, Oxford University Press, 1991. 31-6.This article is an overview of 4 chapters of part I of the 1991 World Bank publication entitled Disease and Mortality in Sub-Saharan Africa. It discusses what the health community currently knows about the levels, trends, and patterns of mortality in Sub-Saharan Africa. In fact, it points out that only limited data are currently available. Demographic techniques have evolved to overcome data limitations, however. These chapters also identify important information gaps that must be filled to plan interventions. These chapters reveal that mortality levels are higher in Sub-Saharan Africa than in other developing regions. Mortality of children <5 years old has decreased since the 1940s in most Sub-Saharan African countries, except for countries who have experienced war and civil unrest. Further Sub-Saharan Africa exhibits a specific mortality pattern: higher levels of infant, young child, and adult mortality exist in western Africa than in eastern or southern Africa. Nevertheless adult mortality in western Africa fell considerably between the 1950s-late 1970s, but it did not fall much in eastern African countries (their levels were lower initially though). This article suggests that donors could greatly contribute to developing planning ability in Sub-Saharan Africa by supporting the establishment of a vital registration system. Health planners often have access to hospital record and community survey data, however, but these data are biased. Further these chapters show that interventions to reduce mortality do not necessarily result in a reduction in morbidity. Rapid population growth and high fertility pose further problems for health planners.
BMJ. British Medical Journal. 1992 Feb 22; 304(6825):455-6.Iraq is faced with large scale public health problems that have been caused by the destruction to their infrastructure during the Gulf war. Humanitarian aid is needed in order to avoid a large scale human disaster. In 1988 73% of Iraq's population lived in urban areas. The loss of electrical generating capacity has affected hospitals, water purification and sewage treatment. Iraq had made great strides int he health of their people with an infant mortality rate of 42/1000 in 1990 and 52./1000 for children under 5. The international study team's survey of over 9000 households revealed surprising evidence of widespread chronic malnutrition. Based on accepted mortality as a baseline, data suggests that mortality among Iraqi infants and children under 5 doubled in 1991. The current food ration provides only half of the energy requirement and with rapidly accelerating inflation, the cost of food while only make the situation worse. The UN Disaster Relief Office has received $1.059 billion from donor countries; but, only half of the requested $14 million has been funded through Unicef. This money is needed to meet basic requirements for water, sanitation, antibiotics, and vaccines. The UN Security Council approved resolutions 706 and 712 which would have allowed Iraq to sell $1.6 billion for foodstuffs, medicines, and materials and supplies necessary to civilian needs subject to monitoring and supervision to ensure equitable distribution. The Iraqi government has not met the requirements of 706 and 712 because of the monitoring conditions, so no money has been issued. More money is needed if humanitarian organizations are to do their work. Only $29 million of the $145 million needed for the 1st half of this year has been pledged.
Lancet. 1990 Jul 28; 336(8709):221-4.The World Health Organization (WHO) has developed an acquired immunodeficiency syndrome (AIDS) projection model based on available human immunodeficiency virus (HIV) serologic survey data and annual rates of progression from HIV infection to AIDS. The model assumes a progression rate to AIDS, for adults, of 75% within 15 years and 95% within 20 years, and, for children, of 25% in the 1st year, 45% by the end of the 2nd year, 60% by the end of the 3rd year, and 80% by the 4th year. Application of this model suggests that, by early 1990, over 3 million women, most of whom were of childbearing age and 80% of whom are in sub-Saharan Africa, were infected with HIV. The model further suggests that, by the end of 1989, there will be excess of 800,000 AIDS cases in African women and close to 300,000 pediatric AIDS cases; by the end of 1992, these figures are projected to be 600,000 cases in women and 600,000 cases in children. Since the majority of these African cases will go undiagnosed, and untreated, death can be expected to occur within a year after symptoms. AIDS will obviously have a major impact on child and adult mortality rates in regions such as sub-Saharan Africa. In countries where 10% or 20% of pregnant women are HIV- infected (a not uncommon phenomenon in Central African cities), the child mortality rate can be expected to be 118 or 136/1000 live births, respectively. In addition, a 5-10% prevalence of HIV infection among sexually active adults in these cities can be expected to double or triple the adult mortality rate by the early 1990s and lead to a 10% increase in the number of uninfected orphans in Africa. As growing numbers of women and children become infected with the HIV virus, African governments will be forced to address the need for greater social support to these families.
Bangkok, Thailand, World Health Organization, Global Epidemiological Surveillance and Health Assessment, and Mahidol University, Faculty of Public Health, Institute for Population and Social Research, 1986. 546 p. (UNFPA Project No. INT/80/P09)This book on new developments in mortality analysis is a product of a joint WHO/UN research program. Part 1 examines mortality transition in terms of the causes and mechanisms of mortality decline in Europe and North America, reflecting on the study of development processes in countries now undergoing development. Part 2 deals with the use of mortality data in health planning and the use of mortality and other epidemiologic information in the assessment of preventable deaths. Attention is paid to the development of an index of preventable deaths. Part 3, Methodological Developments, examines intersectoral aspects of mortality projections (in terms of health care inputs), the measurement of social inequality and mortality, and maternal death and its impact on the female population. Part 4 deals with cause of death analysis: estimation of global mortality patterns by cause of death, trends and differentials in Thailand, and maternal mortality and differentiation by cause of death. Part 5 discusses nutrition, including a Southern Asia-based study of the relationship between nutritional deficiencies and infant and child mortality, and a study on advances in child nutrition and health that have taken place despite slow economic development. Part 6 discusses mortality change: achievements and failures in South and East Asia, a study on changing health in Japan, mortality decline in Mexico, and socioeconomic correlates of mortality in Pakistan. The section concludes with articles on trends and differentials in mortality in Malaysia and Thailand, and a study of the effects of declining mortality and population aging in rapidly-developing Jamaica.
New York, New York, United Nations, 1984. ix, 476 p. (International Conference on Population, 1984; Statements)The Expert Group on Fertility and Family was one of 4 expert groups assigned the task of examining critical, high priority population issues and, on that basis, making recommendations for action that would enhance the effectiveness of and compliance with the World Population Plan of Action. The report of the Expert Group consisted of 6 topics: 1) fertility response to modernization; 2) family structure and fertility; 3) choice with respect to childbearing, 4) reproductive and economic activity of women, 5) goals, policies and technical cooperation, and 6) recommendations. Contained in this report are also selected background papers with discuss in detail fertility determinants such as modernization, fertility decision processes, socioeconomic determinants, infant and child mortality as a ddeterminant of achieved fertility in some developed countries, the World Fertility Survey's contribution to understanding of fertility levels and trends, fertility in relation to family structure, measurement of the impact of population policies and programs on fertility, and techinical cooperation in the field of fertility and the family.
Populi. 1983; 10(1):13-35.Levels and trends of fertility throughout the world during the 1970s are assessed in an effort to show how certain factors, modifications of which are directly or indirectly specified in the World Population Plan of Action as development goals, affected fertility and conditions of the family during the past decade. The demographic factors considered include age structure, marriage age, marital status, types of marital unions, and infant and early childhood mortality. The social, economic, and other factors include rural-urban residence, women's work, familial roles and family structure, social development, and health and contraceptive practice. Recent data indicate that the rate at which children are born into the world as a whole has continued its slow decline. During 1975-80 there were, on the average, 29 live births/1000 population at mid year. During the preceding 5-year period, there occurred annually about 32 live births/1000 population. This change represents a decline of 3 births/1000 population worldwide and approximately 14 million fewer births over a period of 5 years. This change in the global picture largely reflects the precipitous downward course that appears to have characterized China's crude birthrate. There are marked differences in fertility levels between developing and developed regions. In developing countries, births occurred on the average at the rate of 33/1000 population during 1975-80, compared with only about 16/1000 in the developed nations. Levels of the crude birthrate varied even more among individual countries. The changes in levels and trends of fertility may be attributed to many of the factors noted in the Plan of Action as requiring national and international efforts at improvement. The populations of the less developed and more developed regions as a whole aged somewhat during the decade of the 1970s. In both regions, the number of women in the reproductive ages increased relative to the size of the total population, but the change was more marked in the less developed regions. Recommendations in the Plan of Action as to establishment of an appropriate minimum age at 1st marriage subsume existence of too low an age at 1st marriage mainly in certain developing countries. The Plan of Action calls for the reduction of infant mortality as a goal in itself using a variety of means. Achievement of this goal might also affect fertility. Recent findings concerning the influence of social, economic, and other factors upon fertility levels and change are summarized, with focus on topics highlighted in the World Population Plan of Action.
Health, mortality and population, statement made at the National Council for International Health, Washington D.C., 26 September, 1983.
New York, N.Y., UNFPA, . 7 p. (Speech Series No. 99)There are well-eatablished links between patterns of health and population growth. In most of the countries for which there are reliable figures, a fall in birth rates follows a decline in rates of mortality. It is particularly important to reduce infant mortality, both as an end in itself and because, according to the evidence of the World Fertility Survey, the loss of a child shortens the interval between births. The result in many cases is a larger family. A considerable improvement in infant mortality can be made by spreading awareness of the causes of disease and helping to eliminate them. It has been shown that the children of uneducated mothers, or those least likely to know about the importance of nutrition and hygiene, are twice as likely to die in infancy as the children of literate mothers. The most important single element in bringing down mortality is access to health care. The steady building of an effective health service, although costly, is one of the most effective investments a country can make. Included in this report are selected recommendations to the International Conference on Population, in 1984.
In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 4-5. (International Conference on Oral Rehydration Therapy, 1983, proceedings)The Honorable Margaret Heckler, secretary of Health and Human Services, presents the goal of the conference--discussion of the remarkable potential of oral rehydration therapy and its importance to the health of infants and children throughout the world. The conference celebrates the scientific advances of recent years that give new hope for millions of children every year. Over 500 million episodes of diarrhea afflict infants in developing countries each year; each year, some 5 million children lose their lives to these diseases. In Europe, and in North America as well, diarrhea is the 6th most common cause of death among small children. At the turn of the century, mortality due to cholera was 60%. A scientist in Calcutta and 1 in Manila developed methods of intravenous therapy that reduced mortality dramatically to 20%. Treatment of the disease remained relatively unchanged until the middle of the century when work in Egypt and Asia resulted in a therapy method that reduced mortality for cholera to less than 1%. The crucial discovery of an effective cholera agent occurred in India in 1959. In 1962, scientists in Manila established the vital role of oral glucose in the absorption of sodium and water. The large-scale use of oral rehydration therapy was demonstrated in Dhaka and Calcutta in the 1960s, when 100s of cholera cases were managed under field conditions during a rural epidemic. A massive epidemic during a refugee crisis in 1971 was well-coped with by the Johns Hopkins group in Calcutta by treating 3700 patients over an 8-week period. This was one of the 1st large-scale uses of prepackaged materials for oral hydration, costing only US$750. In Dhaka and Calcutta in the early 1970s the critical discovery that noncholera diarrheal diseases could be treated with the oral rehydration therapy developed for cholera was made. The discovery of the role of glucose in accelerating the absorption of salt and water was underscored in the British journal "Lancet" as being potentially the most important medical advance of this century. A strong coalition of interest exists between governments and scientists of many nations as well as the international organizations to promote oral rehydration therapy. WHO, UNICEF, USAID and other agencies are playing an extremely important part in discovering how oral rehydration therapy can best be incorporated into broader health services, and how to prevent diarrheal diseases from occurring.