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Releve Epidemiologique Hebdomadaire. 2013 Apr 26; 88(17):173-80.Add to my documents.
Lancet. 2003 Nov; 362(9395):1557.In a follow up to demands by the 2001 Commission on Macroeconomics and Health (CMH) for a massive increase in health investment, ministers in charge of health, finance, and planning from 40 developing countries met on Oct 29–30 to discuss progress and priorities. Aside from lip service paid to recent achievements, the assessment from the WHO-convened conference was bleak. “Two years on, the world still has not shown determination to increase health investment enough to measurably impact major diseases that affect the world’s poor”, said WHO. (excerpt)
BERC BULLETIN. 1987 Mar; (15):12-5.UNICEF-supported work (GOBI/FFF) has proposed to early childhood mortality and disease which are free, relevant and available: 1) growth mortality, which can expose malnutrition before it's too late; 2) oral rehydration therapy for diarrhea which is a major killer and is remedied by rehydration salts; 3) breast feeding, which provides immunity, nutrition at low cost, and warmth, and security, and 4) immunization from measles, TB, diphtheria, tetanus, polio, and whooping cough. GOBI/FFF recommends strengthening female education, providing nutritious food, and providing family planning which involves child spacing. Most children in the east African regions are denied the rights outlined in the 1959 UN Declaration of the Rights of the Child, even though governments do provide some level of care. Kenya, with the highest birth rate, has all departments providing some input into the well-being of the child. Several national programs are supported by UNICEF in concert with the Kenya government. The 3 neediest rural districts receive concentrated resources, and the health department has been reorganized to focus on child survival. Integrated community rural development projects are underway. Basic urban services with be provided in Kisumu Municipality in a participatory process with civil servants which will focus on female headed households with lots of children. The emphasis will be on increasing family income. In order to relieve mothers of some of the work burden, technology in food production, and in water and fuel collection will be introduced. Educational materials for young and old people need to be developed. Greater coordination and utilization of resources need to be implemented to insure that all parents are informed of birth spacing, prenatal care, low cost ways of preventing and managing childhood illnesses, how to promote normal physical and mental growth, and birth control.
In: The epidemiological transition: policy planning and implications for developing countries, edited by James N. Gribble and Samuel H. Preston. Washington, D.C., National Academy Press, 1993. 170-96.The author examines goals set by the UN World Summit for Children held on September 29-30, 1990. "This paper is a brief assessment of the implications and consequences of pursuing and/or achieving the goals of the summit. In the first section of the paper, I consider whether the magnitude of the mortality reduction goals proposed seems feasible in light of past experience and whether achievement of these goals is likely to lead to substantial additional population growth. The second section of the paper is a discussion of the methods proposed in the summit document for implementing the goals, and the implications of governments and donors pursuing some goals but not others." (EXCERPT)
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1987. iii, 33,  p. (USAID Contract No.: DPE-5927-C-00-5068-00)Sudan is one of 8 USAID African child survival emphasis countries. This documents focuses upon linking the discrete areas of child survival to each other in efforts to achieve sustained reductions in national morbidity and mortality rates. The scope of the problem is briefly considered as background in the text, followed by a more in-depth presentation of government policy and programs. This section includes examination of the structure and organization of existing health services, child survival activities, and current progress and constraints. Child survival activities are listed as immunization, control of diarrheal diseases, nutrition, child spacing, malaria control, acute respiratory infections, and AIDS. The current strategy of USAID support for these activities is outlined, and includes mention of private volunteer organization and private sector participation. The role of UNICEF, WHO, and the World Bank in child survival in Sudan is also highlighted. Recommendations for child survival strategy in Sudan are presented and discussed at length in the text. Continued support to UNICEF, cost recovery and health care financing efforts through WHO, child spacing and population program support, and support to on-going USAID projects constitute USAID's priorities and emphasis in child survival strategy for Sudan. Detailed short- and long-term recommendations for immunization, control of diarrheal diseases, nutrition, child spacing, and child survival and health care financing are provided following the section on priorities. In closing, staffing and recommendations for malaria and other endemic disease, acute respiratory infections, AIDS, and management are considered. Appendices follow the main body of text.
INFECTION CONTROL. 1984 Nov; 5(11):538-41.In 1978 the Ministry of Health and Social Welfare (MHSW) of Liberia launched the Expanded Program on Immunization (EPI) with the 5-year objective of establishing an 80% reduction in child mortality and morbidity from measles, polio, diphtheria, neonatal tetanus, pertussis, and tuberculosis. The program at first adopted a strategy of using 15 mobile units in 11 operational zones to deliver vaccinations throughout the country. However, by 1980, despite support from the Baptist World Alliance, the UN International Children's Emergency Fund (UNICEF), and the World Health Organization (WHO), it became evident that the mobile strategy was neither economically feasible nor practical. Therefore, with support from the US Agency for International Development (USAID), the EPI shifted to a strategy of integrating immunization activities into the existing network of state health facilities. After 5 years, in 1982, the Program was evaluated by a team from the MHSW, WHO, USAID, and the Centers for Disease Control. The evaluating team felt that the EPI's strategy was good, but its goals were not being achieved due to deficiencies in funding, clinic supervision, and rural community outreach, as well as shortages of kerosene and spare parts needs to keep the essential refrigerators in operating condition. Measles remains endemic; in the capital, Monrovia, only 9% of the children have been vaccinated against it. Immunization coverage is particularly low in the capital the countries. Other reasons for low vaccination coverage in Liberia are lack of community awareness of existing facilities and the importance of vaccination and lack of coordination at the community level to use the existing facilities efficiently. International assistance is still needed, especially to develop heat-stable vaccines, so that maintenance of refrigerators will not be necessary.
[Vaccination, the right of each child, World Day of Health 1987] Vacunacion: derecho de cada nino, Dia Mundial de la Salud 1987.
BOLETIN DE LA OFICINA SANITARIA PANAMERICANA. 1987 Mar; 102(3):263-80.In the 10 years since the Panamerican Health Organization (PAHO) and the World Health Organization initiated the Extended Immunization Program in the Americas (PAI), coverage has increased from less than 1/3 to over 1/2 of children immunized in their first year against 6 major childhood diseases. Due mainly to the PAI, the incidence of measles, tetanus, and diptheria has been reduced by 1/2, that of whooping cough by 75%, and that of tuberculosis by about 5% annually. About 75% of children are immunized against polio, which has 1/10 as many victims today as 10 years ago. PAHO and several other organizations have targeted 1990 for eradication of polio from the South American continent. Since the PAI was established in 1977, more than 15,000 health workers have been trained, cold chains have been established to preserve vaccines, and more than 250 technicians have been trained to maintain and repair the needed equipment. The cost of the campaign to eradicate polio is estimated at US $ 24 million per year for the entire region--a low total compared to the costs of hospitalization and rehabilitation of the victims in the absence of such a program. The goal of immunizing all the world's children by 1990 proposed by the World Health Assembly in 1977 is achievable, but much remains to be done. The number of children immunized in the largest Third World countries ranges from 20-90% owing in part to national immunization days but also to assumption by local communities of the goal of universal immunization by 1990. All deaths produced by these 6 killer diseases are not registered, but the World Health Organization estimates that measles takes 2.1 million lives annually, neonatal tetanus 800,000, and whooping cough 600,000. Governmental and nongovernmental international organizations have made financial help available to countries needing it for their immunization programs. Most developing countries are expected to achieve the goal of universal immunization by 1990, but the 10 poorst countries of Africa and the Eastern Mediterranean may not be able to do so. At the worldwide level, 41% of the 118 million children who survive their first year have been vaccinated against measles and 46% against tuberculosis. 47% have received the full course of vaccine against diptheria, whooping cough, tetanus, and polio. The cost of these immunization is $5-15 per child and 80% is assumed by local countries. The World Health Organization recommends that all children, even the undernourished or slightly ill, be vaccinated, and that all health services vaccinate. Parents should be urged to return for the 2nd and 3rd doses of polio and DPT vaccines. Vaccination programs should pay more attention to impoverished urban populations. Several countries of the region have added innovations such as vaccination against other illnesses, house to house searches for unvaccinated children, or use of mass media to publicize national vaccination programs.
World Health. 1986 Apr; 23.Diarrheal diseases are the leading cause of sickness and death in Thailand. The problem is particularly severe in children under age 5 who account for about 40% of all cases and about 50% of all deaths due to diarrhea. In October 1980, Thailand began a program of national control of diarrheal disease. It had as its target a substantial reduction in mortality from acute diarrheal diseases through oral rehydration therapy (ORT) by way of the primary health care approach and reduced morbidity by promoting better nutritional and maternal and child health practices and safer water supply and sanitation. The government's Pharmaceutical Organization produces 750 milliliter packets of oral rehydration salts (ORS) according to the World Health Organization (WHO) formula specifications. These are purchased by the Department of Communicable Diseases and distributed to all health facilities and to village health volunteers through the provincial health offices. Some villages have their own drug cooperatives run by village committees or by volunteers, where people also can buy ORS and other essential drugs. WHO and the UN International Children's Emergency Fund (UNICEF) are helping to supply training materials in the Thai language for health staff at all levels to familiarize them with clinical and program management. The volunteers themselves receive training as providers of ORS and as disseminators of health information. Since 1983, more and more messages reach the public through the mass media, especially television and radio. Most hospitals are able to screen slide sets and video cassettes about ORT and diarrhea prevention while the mothers sit in the waiting rooms. Between 1981-84, the proportion of the population under 5 years of age with access to ORT has risen from 12% to about 60% in areas where the program is fully developed. In areas where the program is fully developed, the use rate of ORS in the same group has gone up from 12% to 30%. Throughout Thailand as a whole, the use rate in children under 5 suffering from diarrhea is about 18%. The mortality rate from diarrhea in these young children fell from 4.97/100,000 in 1981 to 2.35/100,000 in 1983, a reduction of 53%. In 1984, the mortality rate increased from the previous year while the morbidity rate decreased. One reason may be that the most non-severe cases can be self-managed by ORT, while more severe cases are detected and referred by the village health volunteers and other health workers. This results in a higher number of deaths reported.
In: UNICEF Bangladesh. Situation analysis report, prepared for UNICEF Bangladesh country programming. [DACCA] Bangladesh, UNICEF, 1977 Apr. 25-34.The lack of a vital registration system in Bangladesh and the absence of any nationwide health statistics make it impossible to form an accurate impression of the situation of maternal and child health in the country. However, the few statistics gathered from small scale research projects show that infant and child mortality rates in Bangladesh are unacceptably high. The most important children's health problems in the rural areas appear to be diarrheal diseases, dysentery and malnutrition. A number of factors contribute to this low level of health status including poverty, lack of health and nutrition education, lack of health services and poor sanitation. Children's health care needs are usually served by the same facilities as the general public; the existing health services do not address the major health problems of children which could be cured and prevented with rather unsophisticated interventions. Data on maternal health is also insufficient. Crude indicators reveal that women marry young, the mean age at 1st delivery is 18.5 and the average number of pregnancies in a woman's reproductive life is 8. Maternal mortality is high and the largest proportion of these deaths are directly related to obstetrical factors, with eclampsia being the commonest single cause of death. Family planning programs, antenatal and postpartum services could reduce a large proportion of these maternal deaths. Health services for mothers are of poor quality. No information is available on % of deliveries attended by the various providers (physicians, nurses, TBAs, relatives) and about the quality of such deliveries. Recent government health policy focuses on establishing a health infrastructure in the rural areas, which is prevention-oriented. Examination of the government's health budget, however, does not reveal that health is a high priority. An important recent addition to the government's health delivery system specifically for children is the initiation of Under-5 Clinics, held once a month and offering comprehensive services, e.g., immunization, physical exams, stool and blood exams, nutrition and hygiene training and milk supplement provision. In terms of policy, this is the 1st massive effort specially concerned with children; the initial response indicates an important commitment to children by the government. UNICEF's assistance in the past 5 years has consisted primarily of supplies of drugs, medical equipment and vehicles. Future UNICEF aid will be planned with a more Basic Services/Primary Health Care approach which is domiciliary and rural-based. Attached are tables illustrating trends in infant and child mortality and their causes.
Bangkok, Thailand, Population Council, Regional Office for South and East Asia, Aug. 1982. 152 p.Summarizes the Population Council's review of Indian population policy and programs, including their recommendations to USAID concerning future assistance over the next 5 years in this area. The review starts with the assumption that there are no simple or universally applicable approaches for achieving desired demographic objectives. Approaches suitable to local needs and social, economic, and political realities must be found and applied. The report analyzes both the family planning program and nonprogram elements in the Indian development process, assesses the past and present state of population policies and programs in India, examines program and nonprogram constraints, discusses direction for the future and makes recommendations regarding future USAID involvement including the role of other U.S.-based institutions. The population of India has nearly doubled in the past 34 years. The past performance in reducing the growth rate has been disappointing. However, there seems to be a renewed political commitment to reducing population growth rates. The need for continued and if possible, increased USAID support is stressed.
In: Grant JP. The state of the world's children, 1982-83. New York, Oxford Univ. Press, 1982. 3-42.40 thousand young children died each day from malnutrition and infection in developing countries during 1982. For each child that died, 6 live on in hunger and ill-health. A continuation of present trends would result in an increase in the nubers to some to 650 million seriously undernourished children by the year 2000. This report indicates that organized communities and trained paraprofessional development workers backed by government services and international assistance can bring basic education, primary health care, cleaner water, and safer sanitation to the majority of poor communities in the developing world. Specifically, oral rehydration therapy, universal child immunization, promotion of breast feeding, and the use of growth charts are touted as low-cost, low-risk people's health actions that do not depend on economic and political changes. 1/3 of the families whose children are malnourished are simply too poor to provide enough food for the children to eat. For these people, the long-term solution to eradicate malnutrition lies in having the land to grow food or the jobs and income with which to buy it. Employment and land reform are therefore areas that must eventually be addressed in the quest for reduced child mortality levels.
[Child health in Chile and the role of the international collaboration (author's transl)] Salud infantil en Chile y el rol de la colaboracion internacional.
Revista Chilena de Pediatria. 1982 Sep-Oct; 53(5):481-90.Assuring the rights sanctioned by the UN Declaration on the Rights of Children requires the participation of the family, community, and state as well as international collaboration. Health conditions in Chile have improved significantly and continuously over the past few decades, as indicated by life expectancy at birth of 65.7 years, general mortality of 9.2/1000 in 1972 and 6.2/1000 in 1981, infant mortality of 27.2/1000 in 1981. Although the country has experienced broad socioeconomic development, due to inequities of distribution 6% of households are indigent and 17% are in critical poverty. The literacy rate in 1980 was 94%, but further progress is needed in environmental sanitation, waste disposal, and related areas. Enteritis, diarrhea, respiratory ailments, and infections caused 60.4% of deaths in children under 1 in 1970 but only 37.8% in the same group by 1979. Measures to guarantee the social and biological protection of children in Chile, especially among the poor, date back to the turn of the century. Recent programs which have affected child health include the National Health Service, created in 1952, which eventually provided a wide array of health and hygiene services for 2/3 of the population, including family planning services starting in 1965; the National Complementary Feeding Program, which supervised the distribution in 1980 of 25,195 tons of milk and protein foods to pregnant women and small children; the National Board of School Assistance and Scholarships, which provides 300,000 lunches and 750,000 school breakfasts; and programs to promote breastfeeding and rehabilitate the undernourished. Health services are now extended to all children under 8 years in indigent families. Bilateral or multilateral aid to health services in Chile, particularly that offered by the UN specialized agencies and especially the World Health Organization, Pan American Health Organization, and UNICEF, have contributed greatly to the improvement of health care. The Rockefeller, Ford, and Kellogg Foundations have contributed primarily in the areas of teaching and basic and operational research. Aid from the US government assisted in the development of health units and in nutritional and family health programs. The International Childhood Center in Paris rendered educational aid in social pediatrics. (summary in ENG)