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National Program on the Control of Diarrheal Diseases. Report of the Joint MOH / WHO / UNICEF / USAID Comprehensive Program Review, 28 January to 11 February, 1985.
Manila, Philippines, Ministry of Health, 1985. v, 36 p.In early 1985, representatives of the Philippines Ministry of Health, WHO, UNICEF, and USAID visited health facilities (barangay health stations to hospitals) and used data from 9106 households (11,131 children under 5 years old) in the provinces of La Union, Bohol, and Bukidnon in the Philippines, to evaluate implementation and effect of the National Program on the Control of Diarrheal Diseases (CDD). 10.8% of the children had had diarrhea within the last 2 weeks. Mean diarrhea episode/child/year stood at 2.8. Mean infant mortality was 62.3/1000 live births (35.8 in La Union to 94 in Bukidnon). Diarrhea-related mortality for all children studied ranged from 3 in La Union to 18.3 in Bukidnon (mean = 8.6). Between 1978 and 1982, the diarrhea-related mortality rate for all of the Philippines fell from 2.1 to 1, presumably due to the CDD Program. Diarrhea was the leading cause of death in Bukidnon (21.3%), but in La Union and Bohol, it was the 5th leading cause of death (6.6% and 10.3%, respectively). 33% of children with diarrhea received oral rehydration solution (ORS), 12% did not receive any treatment, and 72% received herbs, antibiotics, or antidiarrheals. Many of the children receiving ORS also received other treatments. 86% of mothers were familiar with ORS and 73% of them had used it. 92% would use it again. 84% would buy it from stores, if sold. Government health facilities tended to use ORS and to prescribe it for diarrhea cases. Most facilities had successfully promoted breast feeding. The supply of ORS packets in most facilities was good. Almost all health personnel had received ORT training. Some recommendations included promotion of non-ORT strategies (e.g., hand-washing and food safety), conducting research (e.g., to identify suitable fluids and foods for home-based oral rehydration therapy, and regular monitoring and evaluation of the CDD Program.
Causes of mortality change: observations based on the experience of selected countries in the ESCAP Region.
In: Mortality and health issues: review of current situation and study guidelines. Bangkok, Thailand, U.N. Economic and Social Commission for Asia and the Pacific, 1985. 93-97. (Asian Population Studies Series No. 63.)In the past 30 years or so, mortality has declined in all countries, and the member countries of Economic and Social Commission for Asia and the Pacific (ESCAP) are no exception to this general trend. Standardization is most often used in a limited fashion to account for the effect on demographic indices of a changing age and sex structure of the population; this chapter uses it to examine the fast decline in mortality. A decline in mortality may be due to any of the following processes: 1) reduction of exposure to risk, or an increased proportion of the population protected from the risk by immunization or other preventive measures; 2) introduction of effective treatment may result in the considerable reduction of case fatality, and hence of mortality from a given disease; and 3) intervention along both lines. Foremost among the studies of variation of mortality levels among the countries at various stages of socioeconomic development are those associating measures of national income and life expectancy at birth. Economic advance appears not to be a major factor in more recent mortality reductions; a large part of the decline has resulted from the application of broad-based public health programs of insect control, environmental sanitation, and immunization. Mother's educational level, family income, family size, and pattern of child spacing have demonstrable effects on the probability of child survival. Further advancement to understand the complex fabric of social and bioligical processes involved in health protection and health impairments that often lead to death requires joint formulation at the planning stage of methodologies and concepts combining suitable factors from different disciplines. The multidisciplinary approach to research in mortality would lend assurance to the results of studies and would provide a firmer basis for the development of relevant policies to reduce morbidity and mortality.
World Health. 1985 Nov; 13-15.In November 1980, Dr. Halfdan Mahler, Director-General of the World Health Organization (WHO), and James Grant, head of the UN Children's Fund (UNICEF), drafted a joint program to improve the nutritional status of children and women through developmental measures based on primary health care. The government of Italy agreed to fund in full the estimated cost of US$85.3 million. When a tripartite agreement was signed in Rome in April 1982, the WHO/UNICEF Joint Nutrition Support Program (JNSP) came into being. It was agreed that resources would be concentrated in a number of countries to develop both demonstrable and replicable ways to improve nutrition. Thus far, projects are underway or are just starting in 17 countries in Africa, Asia, Latin America, and the Caribbean. In most of these countries, infant and toddler mortality rates are considerably higher than the 3rd world averages. Program objectives include reducing infant and young child diseases and deaths and at the same time improving child health, growth, and development as well as maternal nutrition. These objectives require attention to be directed to the other causes of malnutrition as well as diet and food. JNSP includes nutrition and many other activities, such as control of diarrhea. The aim of all activities is better nutritional status leading to better health and growth and lower mortality. Feeding habits and family patterns differ from 1 country to another as do the JNSP country projects. Most JNSP projects adopt a multisectoral approach, incorporating varied activities that directly improve nutritional status. Activities involve agriculture and education as well as health but are only included if they can be expected to lead directly to improved nutrition. A multisectoral program calls for multisectoral management and involves coordination at all levels -- district, provincial, and national. This has been one of the most difficult things to get moving in many JNSP projects, yet it is one of the most important. Community participation is vital to all projects. Its success can only be judged as the projects unfold, but early experiences from several countries are encouraging.
The World Health Organization's Expanded Programme on Immunization: a global overview. Le Programme Elargi de Vaccination de L'Organization Mondiale de la Sante: apercu mondial.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(2):232-52.In recognition that immunization is an essential element of primary health care, the World Health Organization (WHO), with other agencies, is sponsoring the Global Program on Immunization whose goal is to reduce morbidity and mortality from vaccine-preventable diseases by providing immunization for all children of the world by 1990. A global advisory group of experts meets yearly to review the program. This paper summarizes the most salient features of the 1984 meeting. The major event for the Expanded Program on Immunization (EPI) in 1984 was the Bellagio Conference on protecting the world's children. Activities undertaken as a result of this conference are discussed. 1 outcome was the formation of the Task Force for Child Survival whose main objective is to promote the reduction of childhood morbidity and mortality through acceleration of key primary health care activities. Focus is on supporting Colombia, India and Senegal in accelerating the expansion of their immunization programs and strengthening other elements of primary health care, such as diarrheal diseases control, family planning and improved nutrition. The 5-point action program consists of the following components: promoting EPI within the context of primary health care; investing adequate human resources in EPI; ensuring that programs are continuously evaluated and adapted so as to achieve high immunization coverage and maximum reduction in target-disease deaths and cases; and pursuing research efforts as part of program operations. EPI has continued to collaborate with other programs to help assure that immunization services are provided to support delivery of other services. Integration of EPI in Africa, the Americas, the Eastern Mediterranean Region, Europe, the South-East Asia Region, and the Western Pacific Region is examined.
The potential of national household survey programmes for monitoring and evaluating primary health care in developing countries. L'apport potentiel des enquetes nationales sur les menages a la surveillance et a l'evaluation des soins de sante primaires dans les pays en developpement.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(1):38-64.National programs of household sample surveys, such as those being encouraged through the National Household Survey Capability Program (NHSCP), are a principal source of information on primary health care in developing countries. Being representative of the total population, the major population subgroups and geographic subdivisions, they permit calculation of health status and utilization of health services. Household surveys have an important role to play in monitoring and evaluating primary health care since they sample directly the intended beneficiaries, and so can be used to judge the extent to which programs are meeting expected goals. Caution is necessary, however, since methodological problems have been experienced for many evaluation surveys. National surveys are especially appropriate for measuring many indicators of progress towards national goals within a broad socioeconomic perspective. Future directions in making the optimum use of household surveys for health program purposes are indicated. The NHSCP is a major undertaking of the UN system including WHO to collaborate with developing countries to establish a continuing flow of integrated statistics on a recurrent basis to support the national development process and information priorities. It brings together the principal users and producers of data to plan and conduct surveys which respond to national needs and priorities. The NHSCP encourages countries to employ a permanent national field organization for data collection. Areas of discussion are: the potential for monitoring and evaluation, the household survey as a source of health indicators, the demand for household surveys of health, followed by a summary of the health and health-related topics covered by 6 national health and nutrition surveys conducted in several developing countries. The special themes of infant and child mortality, morbidity and nutritional surveillance are also considered. The experience of many developed countries has been very positive with the use of nonmedically organized health surveys. Although the sample survey can be used in many settings to obtain population-based data, it must be carefully designed and implemented according to scientific procedures in order for the results to be validly extrapolated to the population or subgroups of primary concern.