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  1. 1

    The ORT opportunity: putting children at the forefront of accelerated primary health care.

    Grant JP

    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. 8-13. (International Conference on Oral Rehydration Therapy, 1983, proceedings)

    The worst economic setbacks since the 1930s do not augur well for the 100s and millions of children already trapped in the day-to-day silent emergency resulting from the conjunction of extreme poverty and underdevelopment which contributes so greatly to the death and disability toll which afflict over 40,000 small children per day. In the absence of special measures to accelerate health progress significantly, millions more children and mothers in low income areas are likely to die in the decade ahead. This meeting on promoting oral rehydration therapy is a concrete reminder that the key to the effectiveness in improving children's conditions is a refusal to accept a limitation upon what can be done with the available resources. In September, 1982, UNICEF invited a group of experts drawn from international agencies and nongovernmental groups involved in improving the lives of children to meet and discuss the problem. They recognized that certain elements of the primary health care strategy, including oral rehydration therapy, could greatly contribute to the realization of the health for all goal. They focused on community-based services and primary health care and how to improve health services. The improved techniques and technologies, the increased acceptance of the primary health care approach, and a new capacity of social organization for reaching low-income families could save a high proportion of children's lives. Nutritional surveillance, oral rehydration, breastfeeding and better weaning practices, immunization, family spacing, food supplements, and health education will contribute to the health of millions of mothers and families. Everyone is urged to make a commitment to strive for the health for all goal. The media, private organizations and ministeries of health must all join in the effort.
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  2. 2

    Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C.

    Cash RA

    Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 210 p. (International Conference on Oral Rehydration Therapy, 1983, proceedings)

    With over 600 participants from more than 80 countries, the International Conference on Oral Rehydration Therapy (ICORT) was a testimony to the international health community's recognition of the seriousness of diarrheal disease, the value of oral rehydration therapy, and the commitment to primary health care. The conference, initiated by the Agency for International Development, was cosponsored by the International Center for Diarrheal Disease Research, Bangladesh, the United Nations Children's Fund, and the WHO. The conference focused on oral rehydration therapy, an important treatment of diarrhea. 1 out of 10 children born in developing countries dies from the effects of diarrhea before the age of 5. A 70% reduction in the mortality rate can result from ORT--a major breakthrough for primary health care. Excellent laboratory investigation, well-conducted clinical studies, and careful field observation have led to this effective therapy. Many papers presented at the conference demonstrated the effectiveness of ORT. Participants agreed on the best formula for ORT in terms of electrolyte content and on the need for an international commitment to expand implementation of ORT. Problems in implementing oral therapy programs are discussed. Possible areas of investigation include: 1) improving the solution through the addition of glycine, other amino acids, or cereal-based substrates; 2) developing methods for teaching ORT; and 3) investigating better methods of program evaluation. Innovative approaches to informing the public about the use and benefits of oral therapy were also discussed. Participants, recognizing that problems are shared among many different programs and nations, exchanged ideas and addresses, pledging to keep each other abreast of their ORT research and implementation efforts. The conference closed with a strong call for action to attain near universal availability of ORT in the next 10 years.
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  3. 3

    WHO Meeting on Maternal and Child Health Indicators for Health for All by 2000: Evaluation of Alternatives, Geneva, 8-12 November 1982.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, [1983]. 27 p. (WHO/HS/NAT.COM/83.383)

    The main objectives of the Maternal and Child Health (MCH) and Family Planning (FP) Indicators meeting, held in Geneva from November 8-12, 1982, were to: evaluate and critically review past data collection experiences; systematically review existing and new indicators for the evaluation and monitoring of MCH/FP programs; and to discuss the problems and alternative methods of obtaining the necessary data for indicators. The major part of the meeting was devoted to a review of indicators for assessing the progress of MCH/FP programs at the global, regional, and national levels and the consideration of possible sources of information for obtaining the data upon which to base these indicators. On the basis of this review, the meeting sought to arrive at a consensus on the types of information that might be collected for monitoring and evaluting MCH/FP programs under various health circumstances. Information is presented on the following: the experience of the World Health Organization (WHO) ad hoc surveys on infant and childhood mortality; other data collection experiences (World fertility Survey program, international MCH/FP Program of the Population Council, National Household Survey Capability Program, and a study of levels and trends of infant mortality in Mauritius); MCH/FP indicators (global and regional indicators, factors affecting national indicators, mortality and morbidity indicators, positive health indicators MCH and family planning, and sources of information); and future directions (health modules of household surveys and population censuses, innovative techniques, cluster sampling, record keeping systems, vital registration, training of all health workers, and MCH audit). With regard to the ad hoc surveys on infant and childhood mortality conducted in 5 countries in the early and mid 1970s and other data collection experience, the evaluation background paper found that the surveys were too ambitious. The goals were unclear, and the program was not well planned and managed. The shortcomings of these particular surveys were not intended to reflect on the ability of surveys to serve as important vehicles in development of databases for health planning purposes. The meeting heard from various national project directors who emphasized some of the more positive results of the survey for their country. The work of the WFS was particularly encouraging in showing how surveys can provide a whole set of complex data through household interviews. The meeting recognized the need to address the technical problem of data development, particularly the development of indicators for MCH/FP purposes and suggested several directions for the future. The approaches range from using health supplements and modules to national surveys and population censuses, to innovative approaches in the use of synthetic indirect estimation systems and expanded use of cluster sampling, to increased opportunities for training personnel in various aspects of data collection, use, and management.
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  4. 4

    Fresh thinking on fertility.

    United Nations. Department of International Economic and Social Affairs. Population Division

    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.
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  5. 5
    Peer Reviewed

    A case study in the administration of the Expanded Programme of Immunization in Nigeria.

    Jinadu MK

    Journal of Tropical Pediatrics. 1983 Aug; 29(4):217-9.

    The World Health Organization (WHO) launched the Expanded Program of Immunization (EPI) in 1974 based on the belief that most countries already had some elements of national immunization activities which could be successfully expanded if the program became a national priority with a commitment from the government to provide managerial manpower and funds. The federal government of Nigeria quickly adopted the policy of WHO on EPI and urged the state governments to set up administrative arrangements for planning and implementation of EPI. The program started off in Oyo State of Nigeria after a pilot study conducted at Ikire in Irewole Local Government area in 1975. The stated objectives of the programs were: to provide immunization service to at least 85% of the target population e.g. children under 4 years; and to integrate immunization programs into routine activities of all static primary health centers in the state. This study focuses on administration of the immunization program in the Oranmiyan Local Government area of Oyo State, within the structure of the local government health system and the field health administration of the state government. This study shows that the stated objectives of the EPI are not likely to be achieved in the near future because of low coverage of the eligible population, due to inadequate community involvement in the planning and implementation of the program; 2) poor communication between different government departments; and 3) inadequate publicity. The effect of improvement in health status because of immunization programs, has been very difficult to demonstrate in Nigeria because a lack of accurate data on birth, morbidity, and mortality patterns of the population. Other socioeconomic and health factors of significance in the battle against infectious diseases include environmental sanitation, adequate and safe water supply, housing and nutrition. Nevertheless, immunization programs constitute one of the most economical and effective approaches to the prevention of communicable diseases and can produce dramatic effects in the battle to lower infant and childhood mortaltiy rates in the developing countries if they are well implemented.
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  6. 6

    Birth spacing and childhood mortality.

    Sathar ZA

    Ippf Medical Bulletin. 1983 Aug; 17(4):2-3.

    Recent evidence from developing countries indicates that there is a relationship between the length of the interval between consecutive births and the survival of the younger sibling. This relationship has long been observed in the developed world. A study conducted by the World Health Organization in 9 largely metropolitan locations in developing countries found a reverse J-shaped pattern, with mortality rates initially falling with increased intervals but showing an upturn for the longest intervals of 5-6 and 6 or more years. The birth interval-mortality link tended to be stronger for postneonatal rather than neonatal and child mortality. A World Fertility Survey (WFS) cross-national analysis found a longer birth interval substantially improved the survival chance of the youngest child in all 29 countries studied. This advantage persisted to 5 years of age. The ratio of the infant mortality rate of children born within an interval of less than 2 years to that of those born after an interval of 4 years ranged from 1.26 in Venezuela to 3.91 in Syria. A 2nd WFS study found that the birth interval-mortality link persisted when maternal education was controlled. More detailed analysis of data gathered for this study from Pakistan revealed that the association between birth interval and mortality of the younger sibling was unaffected by the early death of the older sibling. Although it has been hypothesized that competition between children for food and attention is the major causal mechanism in the birth interval-mortality link, this finding suggests that maternal depletion (giving rise to low birth weights and inadequate breast milk) plays a role. However, the additional finding that survivorship of order 5 and more births was unaffected by average spacing patterns once the length of the immediately preceding birth interval was controlled suggests that maternal depletion may not be cumulative. The data from Pakistan further show interval length to have the same effect on mortality of the older sibling, even when length of breastfeeding was controlled, suggesting that involuntary weaning because of the next pregnancy is the critical explanatory factor. This research points to the need for a renewed emphasis on contraception for spacing purposes.
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  7. 7

    Family Planning in the Gambia.

    Follis P

    Novum. 1983 May; (23):10-1.

    To encourage family planning, a mobile health clinic will be sent to a village when child clinics are held in the Gambia, so that women may receive family planning advice. All methods are used; the Pill is the most popular. There are around 3000 family planning acceptors. The Gambia Family Planning Association (GFPA) supplies condomes and pessaries were needed. The Association sells contraceptives to private doctors at a discount. Supplies are also available in hospitals. The average family has 6 children. Seminars on family planning have been held. The GFPA trains extension workers in family planning. The infant mortality rate is 217/1000 live births; 40% of the children die before the age of 5. Breastfeeding has been a problem. Many children are malnourished. The GFPA is staffed by 1 doctor; a senior nursing sister, a nursing sister, clinical assistants, and rural fieldworkers. There are 5 main clinics. The GFPA's staff teach family life education to schoolchildren. Planned parenthood/women's development projects are also taking place. The GFPA is largely funded by the IPPF.
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  8. 8

    New plans to save children in hard times

    Cornia GA

    Populi. 1983; 10(3):54-62.

    The group of low-cost programs that have been developed by UNICEF to assist governments of developing countries in reducing infant and child mortality despite financial constraints is described. Such programs include growth monitoring, oral rehydration, breast-feeding, immunization, child-spacing services, food supplements, health education, water and sanitation, and female education. (ANNOTATION)
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  9. 9

    Health for all by the year 2000: the countdown has begun.

    Roy BN

    Journal of the Indian Medical Association. 1983 Apr; 80(7-8):108-11.

    In 1977 the World Health Assembly launched the movement for "Health for all by the year 2000." The 1st step was taken at the International Conference on Primary Health Care in Alma Alta, USSR, in 1978. The conference declared that primary health care (PHC) was the key to realizing the goal of health for all by 2000. It also emphasized the need for urgent and effective national and international action to develop and implement a PHC program throughout the world. A general review of the progress in terms of the indicators will facilitate tracing the progress and realizing the magnitude of the tasks ahead. In terms of the 1st 2 indicators, the target has been endorsed at the highest official level by parliaments or governments in most countries and the mechanism has been strengthened in most of the developing countries to involve people in the implementation of the health development programs. The trouble begins with the 3rd indicator which requires countries to spend at least 5% of the gross national product (GNP) on health. For most of the developing countries where health development is inextricably linked with socioeconomic development, investing 5% of the GNP on health is difficult. It is almost an impossibility for the least developed countries (LDCs). The position of the developing countries like India, though somewhat better than that of the LDCs, is not very encouraging either. In India's 6th Plan the allocation on health as percentage of total allocation in the budget was 2.40 in 1978-79 and 2.10 in 1979-80. India's position with regard to the 4th global indicator, requiring that a reasonable percentage of national health expenditure be devoted to the local health care, is not yet satisfactory though considerable efforts have been made in this area. In regard to the 5th indicator, namely, equitable distribution of resources on various population groups or geographical areas, the desired standard has not been achieved. A most important indicator, indicator 7, set by the WHO for monitoring the progress of the global strategy is that PHC should be available to the entire population. About 361 million of India's rural population do not have adequate drinking water facilities and sanitation facilities. In respect to the drug requirement of indicator 7, only a few of the essential drugs of the 20 required, are available. About 50% of the children live in conditions of poverty, deprivation, and malnutrition, and about 40% of all deaths in the country occur among children below age 5 and 10% of all children born do not live to celebrate their 1st birthday. Despite the conditions, child care continues to receive low priority from the government of India. Nutrition programs have been launched, but most of these programs have only touched on the problem.
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  10. 10

    Health, mortality and population, statement made at the National Council for International Health, Washington D.C., 26 September, 1983.

    Salas RM

    New York, N.Y., UNFPA, [1983]. 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.
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  11. 11

    Can youth save 40 thousand children who die everyday of malnutrition and infection.

    Abraham S

    In: World Assembly of Youth. International workshop on youth participation in population, environment, development at Colombo, 28th Nov. 83 to 2nd Dec. 83. Copenhagen, Denmark, WAY, [1983]. 62-8.

    Social welfare has undergone a revolution in the past century--from paternalism to participative development; from poor houses to self-help. A more holistic approach is being made with the growing realization that since development is for the people, it should be people-oriented. The new International Development Strategy recognizes that economic development alone in terms of GNP is not adequate indicator of improved quality of life in the 3rd world. Human development results from the totality of development efforts. In its 1980 World Development Report, the World Bank concluded that since primary education investments had better returns than industrial undertakings, development should combine both the economic and social dimensions. There is a direct importance of the well-being of the human resources of the country for production, productivity and profits. Infant and young children's mortality rates in several poor countries have been reduced more than those in countries 4 or 5 times richer. Maximum utilization of resources has stated and Sri Lanka is a prime example in the 3rd world, indicating the priority of the government in working for the well-being of the people, especially women and children. Malnutrition, the theme of Universal Children's Week, is a major but invisible problem. A study showed that 80% of mothers did not even know their childred were undermourished. UNICEF, the leading agency advocating the cause of children's well-being, was created by the General Assembly of the UN in 1946 to provide emergency relief to the young, destitute victims of the 2nd World War. Today UNICEF is involved both directly and indirectly in more long-term development strategies which benefit children, particularly the disadvantaged. The basic services for the poor include the provision of health, education, income, water and sanitation, food and nutrition. The primary health care approach emphasized prevention and provides a system for curative services. UNICEF's Executive Director suggested a Children's Revolution in his 1982/83 report on the state of the world's children. He made 4 proposals: nutrition education to mothers; treatment of diarrhea; immunization of all children; increasing food production and consumption; and wiser spacing of children. Educational programs can be particularly valuable.
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  12. 12


    Heckler MM

    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.
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  13. 13

    Measles: summary of worldwide impact.

    Assaad F

    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.
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