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Geneva, Switzerland, World Health Organization [WHO], 2007.  p. (WHO Discussion Papers on Adolescence; Issues in Adolescent Health and Development)The World Health Organization (WHO) has been contributing to meeting the Millennium Development Goals (MDGs) by according priority attention to issues pertaining to the management of adolescent pregnancy. Three of the aims of the MDGs - empowerment of women, promotion of maternal health, and reduction of child mortality - embody WHO's key priorities and its policy framework for poverty reduction. The UN Special Session on Children has focused on some of the key issues affecting adolescents' rights, including early marriage, access to sexual and reproductive health services, and care for pregnant adolescents. This review of the literature was conducted to identify (1) the major factors affecting the pregnancy outcome among adolescents, related to their physical immaturity and inappropriate or inadequate healthcare-seeking behaviour, and (2) the socioeconomic and political barriers that influence their access to health-care services and information. The review also presents programmatic evidence of feasible measures that can be taken at the household, community and national levels to improve pregnancy outcomes among adolescents. (excerpt)
MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT. 1997 Sep 26; 46(38):893-7.The World Health Assembly in 1989 resolved to reduce the levels of measles morbidity and mortality by 90% and 95%, respectively, by 1995. By 1996, the estimated incidence and death rates for measles worldwide had been reduced by 78% and 88%, respectively. In 1990, the World Summit for Children adopted the goal to vaccinate 90% of children against measles by 2000, but routine measles vaccination coverage has remained relatively stable since that year. Disease surveillance and vaccination coverage data received by the World Health Organization (WHO) headquarters as of August 29, 1997, indicate that in some regions, substantial progress has been made to control and interrupt measles transmission, while in others, measles continues to cause high morbidity and mortality because of failure to implement control strategies. The stages of measles control and progress toward implementing strategies are discussed. During 1980-96, the number of reported measles cases worldwide declined from 4.4 million to approximately 0.8 million. However, since measles reporting is incomplete, the actual burden from measles is estimated at 36.5 million cases and 1 million deaths. In 1996, 62% (445,949) of the measles cases worldwide were reported from the Africa Region. Of the 6 WHO regions, disease burden in 1996 was lowest in the Americas with only 2109 cases, of which 488 were reported from the US.
In: Health and disease in developing countries, edited by Kari S. Lankinen, Staffan Bergstrom, P. Helena Makela, Miikka Peltomaa. London, England, Macmillan Press, 1994. 135-46.In the early 1980s approximately 4.6 million children under 5 years old died from diarrheal diseases each year in developing countries, and the annual number of diarrheal episodes in this age group was above 1 billion. Rotavirus is the single most important causal agent of acute and profuse watery diarrhea characterized by vomiting and fever. The typical age for rotavirus diarrhea is between 6 and 11 months of age. Enterotoxigenic Escherichia coli (ETEC) are found in 10-50% of cases of acute diarrhea in developing countries. Enteropathogenic E. coli (EPEC) also cause diarrhea in developing countries, but only in the first months of life. Shigellosis commonly refers to dysentery, the clinical picture of which includes fever, abdominal cramps, and bloody diarrhea with frequent, small and mucoid stools. Both S. flexneri and S. dysenteriae 1 are important causes of dysentery in developing countries. Shigellosis is one of the few diarrheal infections in which antibiotics are indicated. The clinical symptoms of Salmonella sp. include fever, abdominal pains, headache, and cough, and clinical signs include coated tongue, splenomegaly, rales in lungs, and relative bradycardia. Typhoid fever is endemic in large parts of the world with an estimated death toll of 500,000-600,000 per year. An estimated 120,000 deaths are caused annually by Vibrio cholerae. Today most cases of cholera are manageable with oral rehydration therapy (ORT). In addition, antimicrobials are routinely given. Case management of acute diarrhea includes treatment of dehydration by oral rehydration solution (ORS). The physiological principles of ORT were established in the 1960s. The World Health Organization formula for ORT is suitable for the management of all types of dehydration. Antimicrobials should be discouraged in uncomplicated acute diarrhea. Several causes of persistent diarrhea have been proposed including: infection with enteroadherent E. coli, enteropathogenic E. coli and Cryptosporidium; and intolerance to foods.
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.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):452-9.This summary of the worldwide impact of measles discusses epidemiology, reported incidence, clinical severity, community attitudes toward measles, and the impact of immunization programs on measles. Measles, 1 of the most ubiquitous and persistent of human viruses, occurs regularly everywhere in the world except in very remote and isolated areas. Strains of measles virus from different counties are indistinguishable, and serum antibodies from diverse population have identical specificity. Yet, the epidemic pattern, average age at infection, and mortality vary considerably from 1 area to another and provide a contrasting picture between the developing and the developed countries. In the populous areas of the world, measles causes epidemics every 2-5 years, but in the rapidly expanding urban conglomerations in the developing world, the continuous immigration from the rural population provides a constant influx of susceptible individuals and, in turn, a sustained occurrence of measles and unclear epidemic curves. In the economically advanced nations, measles epidemics are closely tied to the school year, building up to a peak in the late spring and ceasing abruptly after the summer recess begins. Maternal antibody usually confers protection against measles to infants during the 1st few months of life. The total number of cases of measles reported to WHO for 1980 is 2.9 million. Considering that in the developing world alone almost 100 million infants are born yearly, that less than 20% of them are immunized against measles, and that various studies indicate that almost all nonimmunized children get measles, less than 3 million cases of measles in 1980 is a gross underestimate. There was adecrease in the global number of reported cases of measles during the 1979-80 period due primarily to the reduction in the number of cases in the African continent and, to a lesser extent, in Europe. It is premature to conclude that such a reported decline is real and that it reflects the beginning of a longterm trend. The contrast between the developed and the developing worlds is most marked in relation to the severity and outcome of measles. Case fatality rates of more than 20% have been reported from West Africa. It has been estimated that 900,000 deaths occur yearly in the developing world because of measles, but data available to WHO indicate that the global case fatality rate in the developing world approaches 2% (in contrast to 2/10,000 cases in the US), and the actal mortality may be greater than 1.5 million deaths per year. The advent of WHO's Expanded Program on Immunization has brought about an awareness of the measles problem. Whenever and wherever measles vaccine has been used effectively on a large scale, a marked reduction in the number of cases has been recorded.