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Gender mainstreaming in emerging disease surveillance and response, Western Pacific Region. Draft background paper.
[Unpublished] 2011. Draft background paper commissioned by the World Health Organization for the World Conference on Social Determinants of Health, Rio de Janeiro, Brazil, 19-21 October 2011.  p. (WCSDH/BCKGRT/16/2011; Draft Background Paper 16)The primary lessons learned from this case study are that gender awareness training of staff and staff collective planning are useful avenues by which to begin the process of gender mainstreaming. Additionally, full support from all levels of leadership has been crucial to the success of gender mainstreaming within the Division. In particular, support for gender mainstreaming and pressure to implement gender mainstreaming by Division and Regional Office leadership have been crucial to the early success of these efforts. (Excerpt)
New York, New York, United Nations, Department of Economic and Social Affairs, 2007 Jun. 36 p.Since their adoption by all United Nations Member States in 2000, the Millennium Declaration and the Millennium Development Goals have become a universal framework for development and a means for developing countries and their development partners to work together in pursuit of a shared future for all. The Millennium Declaration set 2015 as the target date for achieving most of the Goals. As we approach the midway point of this 15-year period, data are now becoming available that provide an indication of progress during the first third of this 15-year period. This report presents the most comprehensive global assessment of progress to date, based on a set of data prepared by a large number of international organizations within and outside the United Nations system. The results are, predictably, uneven. The years since 2000, when world leaders endorsed the Millennium Declaration, have seen some visible and widespread gains. Encouragingly, the report suggests that some progress is being made even inthose regions where the challenges are greatest. These accomplishments testify to the unprecedented degree of commitment by developing countries and their development partners to the Millennium Declaration and to some success in building the global partnership embodied in the Declaration. The results achieved in the more successful cases demonstrate that success is possible in most countries, but that the MDGs will be attained only if concerted additional action is taken immediately and sustained until 2015. All stakeholders need to fulfil, in their entirety, the commitments they made in the Millennium Declaration and subsequent pronouncements. (excerpt)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.In 1991, the 44th World Health Assembly set two key targets for global tuberculosis (TB) control to be reached by 2000: 70% case detection of acid-fast bacilli smear-positive TB patients under the DOTS strategy recommended by WHO and 85% treatment success of those detected. This paper describes how TB control was scaled up to achieve these targets; it also considers the barriers encountered in reaching the targets, with a particular focus on how HIV infection affects TB control. Strong TB control will be facilitated by scaling-up WHO-recommended TB/HIV collaborative activities and by improving coordination between HIV and TB control programmes; in particular, to ensure control of drug-resistant TB. Required activities include more HIV counselling and testing of TB patients, greater use and acceptance of isoniazid as a preventive treatment in HIV-infected individuals, screening for active TB in HIV-care settings, and provision of universal access to antiretroviral treatment for all HIV-infected individuals eligible for such treatment. Integration of TB and HIV services in all facilities (i.e. in HIV-care settings and in TB clinics), especially at the periphery, is needed to effectively treat those infected with both diseases, to prolong their survival and to maximize limited human resources. Global TB targets can be met, particularly if there is renewed attention to TB/HIV collaborative activities combined with tremendous political commitment and will. (author's)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.The development and expansion of WHO's DOTS strategy was successful, with 83% of the world's population living in countries or parts of countries covered by this strategy by the end of 2004. Treatment success in the 2003 DOTS cohort of 1.7 million patients was 82% on average, close to the 85% target. Treatment success was below average in the African Region (72%), which can be partly attributed to occurrence of HIV co-infection, and in the European Region (75%), partly due to drug resistance. Drug resistance, specifically multidrug resistance and extensive drug resistance, is a serious threat to public health in all countries, especially in the Russian Federation, where the highest rates of multidrug resistance are presently accompanied by a rapid increase in HIV infection. Based on the experience of the first projects approved by the Green Light Committee, the treatment success of patients with multidrug-resistant tuberculosis (MDR-TB) is lower than that of drug-susceptible cases, but nevertheless reaches 70%. The collaborative effort of different organizations, professionals and communities is needed to address the development and spread of multidrug resistance and extensive drug resistance, which combined with the epidemic of HIV infection is one of the barriers to dealing effectively with TB. This effort should be directed towards facilitating the diagnosis and treatment of TB patients, in particular by improving access to drug susceptibility testing and strengthening treatment delivery by rigorous adherence to DOTS as outlined by the Stop TB Partnership. (author's)
Recent experiences in infectious diseases: strengthening public health infrastructure in disease surveillance.
Contact. 2005 Jan; (179):29-31.In the past century there have been remarkable achievements in the prevention and treatment of infectious diseases. Bacteria and viruses have been identified; laboratory techniques have greatly advanced; the pathogenesis and epidemiology have been defined for most diseases; and antibiotics and vaccines have been developed to treat and prevent a host of discusses. Examples are everywhere. We have eradicated smallpox and come close to doing the same for polio. Inexpensive treatments such as Oral Rehydration Therapy (ORT) for diarrhoea have greatly reduced mortality and morbidity among children. Improvements in water and sanitation helped to reduce expose to certain pathogens. Yet, despite these great successes in controlling and treating infectious diseases, they remain a serious medical burden in both developing and industrialized in countries. It is estimated that about 15 million of the 57 million annual deaths (about 26%) are directly related to infectious diseases. This estimate does not include deaths due to the consequences of past infections (for example, rheumatic heart disease) or from complications of chronic infections (for example, hepatocellular carcinoma from hepatitis B infection). (excerpt)
UN Chronicle. 2005 Jun-Aug; 42(2): p..We have the opportunity in the coming decade to cut world poverty by half. Billions more people could enjoy the fruits of the global economy, and tens of millions of lives could be saved. The practical solutions exist. The political framework is established. And for the first time, the cost is utterly affordable. Whatever one's motivation for combating extreme poverty--human rights, religious values, security, fiscal prudence, ideology--the solutions are the same. All that is needed is action. The United Nations Millennium Project is an independent advisory body commissioned by Secretary-General Kofi Annan to develop a global plan for achieving the Millennium Development Goals (MDGs) by 2015. If the world achieves these Goals, more than 500 million people will be lifted out of poverty and 250 million will no longer suffer from hunger, while 30 million children and 2 million mothers who might reasonably have been expected to die will be saved. (excerpt)
Poverty, infectious disease, and environmental degradation as threats to collective security: a UN Panel Report.
Population and Development Review. 2005 Sep; 31(3):595-600.Among the documents to be considered at the 2005 World Summit at the UN General Assembly in September is the report of the Secretary-General’s High-Level Panel on Threats, Challenges and Change. The Panel, chaired by Anand Panyarachun, former Prime Minister of Thailand, brought together 16 prominent individuals to assess current threats to peace and security and the institutional capacity, especially within the UN, to respond to them. Its report, A More Secure World: Our Shared Responsibility, was issued in December 2004. Most of the publicity surrounding the report focused on its recommendations for UN reform, especially its proposals for expansion of the Security Council. The first two-thirds of the document, however, is concerned with the substance of collective security issues and prevention strategies. Defining a threat to international security as “any event or process that leads to large-scale death or lessening of life chances and undermines States as the basic unit of the international system,” the Panel identified six clusters of existing or anticipated threats: Economic and social threats (in particular, poverty, infectious disease, and environmental degradation); inter-State conflict; internal conflict (civil war, genocide, other large-scale atrocities); nuclear, radiological, chemical, and biological weapons; terrorism; and transnational organized crime. The section of the report (paragraphs 44–73) treating economic and social threats, titled “Poverty, infectious disease and environmental degradation,” is reproduced below. Paragraph numbers have been omitted. (author's)
Lancet. 2005 Mar 26; 365:1147-1152.Child survival efforts can be effective only if they are based on accurate information about causes of deaths. Here, we report on a 4-year effort by WHO to improve the accuracy of this information. WHO established the external Child Health Epidemiology Reference Group (CHERG) in 2001 to develop estimates of the proportion of deaths in children younger than age 5 years attributable to pneumonia, diarrhoea, malaria, measles, and the major causes of death in the first 28 days of life. Various methods, including single-cause and multi-cause proportionate mortality models, were used. The role of undernutrition as an underlying cause of death was estimated in collaboration with CHERG. In 2000–03, six causes accounted for 73% of the 10.6 million yearly deaths in children younger than age 5 years: pneumonia (19%), diarrhoea (18%), malaria (8%), neonatal pneumonia or sepsis (10%), preterm delivery (10%), and asphyxia at birth (8%). The four communicable disease categories account for more than half (54%) of all child deaths. The greatest communicable disease killers are similar in all WHO regions with the exception of malaria; 94% of global deaths attributable to this disease occur in the Africa region. Undernutrition is an underlying cause of 53% of all deaths in children younger than age 5 years. Achievement of the millennium development goal of reducing child mortality by two-thirds from the 1990 rate will depend on renewed efforts to prevent and control pneumonia, diarrhoea, and undernutrition in all WHO regions, and malaria in the Africa region. In all regions, deaths in the neonatal period, primarily due to preterm delivery, sepsis or pneumonia, and birth asphyxia should also be addressed. These estimates of the causes of child deaths should be used to guide public-health policies and programmes. (author's)
Geneva, Switzerland, WHO, Initiative for Vaccine Research, 2003 Apr. 74 p. (WHO/IVR)The most effective way to reduce disease and death from infectious diseases is to vaccinate susceptible populations. Although highly effective vaccines are available against a number of pathogens, for other infectious diseases vaccines are either not completely protective or no vaccine is available. For these diseases, it is of crucial importance that vaccine R&D is considered as a priority. The present document represents an extensive analysis of the state of the art of vaccine R&D against infectious diseases of public health importance for which vaccines are either non-existent, or need substantive improvement. The first section is a critical review of the situation for each specific infectious disease in terms of epidemiological data, control strategies and vaccine R&D. The second section provides a table listing the main vaccine candidates for each disease, their state of development and the industrial or academic entities involved. (excerpt)
Report on infectious diseases 2002. Scaling up the response to infectious diseases. A way out of poverty.
Geneva, Switzerland, WHO, 2002. 101,  p.In December 2001, the Commission on Macroeconomics and Health presented the results of its two-year work to the World Health Organization in a publication titled Macroeconomics and Health: Investing in Health for Economic Development. The Commissioners present a new global blueprint for health that is both compassionate and cost-effective. Millions of deaths occur each year in the developing world due to conditions which can be prevented or treated. The Commissioner's outline a plan of action to save millions of these lives every year at a small cost relative to the vast improvements in health and increased prosperity. The Report shows that just a few conditions are responsible for a high proportion of the avoidable deaths in poor countries — and that well-targeted measures, using existing technologies, could save around 8 million lives per year and generate economic benefits of more than $360 billion per year, by 2015–2020. The aggregate cost of scaling up essential health interventions in low-income countries would be around $66 billion per year, with the costs roughly divided between high income donor countries and low-income countries. Thus, the economic benefits would vastly outstrip the cost. Scaling Up the Response to Infectious Diseases: A way Out of Poverty takes up the Commission's challenge. It outlines how increased investment in health can be well spent, stressing how interventions, health system strengthening and behaviour change together can help achieve the goals we are setting ourselves. This report takes forward the Commission's action agenda. It will help decision makers see how we can turn increased investment in health into concrete results. (excerpt)
Bulletin of the World Health Organization. 2005; 83:217-223.The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries), multiple admissions to hospital and lengthy hospitalization. The implementation, and expansion and sustainability of WHO-approved methods of tuberculosis control in Russian Federation are unlikely to be realized under the prevailing system of service delivery. This is because implementation does not take into account the wider context of the health system. In order for the control programme to be sustainable, the health system will need to be changed to enable services to be reconfigured so that incentives are created to reward improvements in efficiency and outcomes. (author's)
Emerging Infectious Diseases. 2004 Nov; 10(11):2022-2024.Women have an enhanced vulnerability to disease, especially if they are poor. Indeed, the health hazards of being female are widely underestimated. Economic and cultural factors can limit women’s access to clinics and health workers. The World Health Organization (WHO) reports that less is spent on health care for women and girls worldwide than for men and boys. As a result, women who become mothers and caretakers of children and husbands often do so at the expense of their own health. The numbers tell the story: the latest (2003) World Health Report showed that, globally, the leading causes of death among women are HIV/AIDS, malaria, complications of pregnancy and childbirth, and tuberculosis. One might have thought that by the year 2004, gender myopia would be far less of a factor. For we now know that only by opening up educational, economic, social, and political opportunities for women can the world ensure progress in stabilizing population growth, protecting the environment, and improving human health, starting with the well-being of young children. (excerpt)
Global HealthLink. 2000 Mar-Apr; 102: p..A shift has been occurring in the family planning field from a focus on demographic goals and contraceptive prevalence to a more client-centered focus and recognition of the broader sexual and reproductive health (SRH) needs of clients. The 1994 International Conference on Population and Development’s Programme of Action and the 1995 United Nations Fourth World Conference on Women in Beijing have fueled rapid shifts in programs and policies toward a broader SRH approach, with particular emphasis on prevention of HIV and other sexually transmitted infections (STIs). Integration of HIV/STI prevention in family planning programs has been seen as important because family planning programs reach large numbers of sexually active people, and are often the only contact that women have with the health-care system. Although family planning programs are in a unique position to provide HIV/STI prevention services, many still concentrate almost entirely on contraceptive acceptance. (excerpt)
New York, New York, UNFPA, .  p.This paper contains global estimates for family planning commodities, and condoms for STI/HIV prevention, for the years 2000 to 2015. It combines these two estimates and attempts to show the broad dimensions of commodity shortfalls potentially being experienced for these products in developing countries. It does not include commodities for other components of reproductive health such as maternal care and STI diagnosis and treatment; these estimates will be added to an updated and expanded version of this paper in due course. The estimates of family planning commodities, which do not include costs related to voluntary sterilization, are based on surveys reviewed in a work previously commissioned by UNFPA. The estimates of condoms for STI/HIV prevention were prepared by the Commodity Management Unit of the Inter-country Programmes and Field Support Branch of the Technical Support Division of UNFPA, in conjunction with staff from other Divisions, and in consultation with UNAIDS, the United Nations Population Division and others. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], 2003. 36 p.The rapid needs assessment tool has been developed through collaborative work with an expert group, and pre-tested in four countries— Bangladesh, Brazil, Ghana, and Kenya. The current report presents the results of these assessments along with issues for consideration in the possible improvement of the needs assessment tool and the recommended process for using the tool. The four reports conclude that while condoms are widely available, and condom use is generally increasing, there is much that could be done to improve their distribution, their promotion, and their utilization, especially among key target groups that are at a high risk for HIV. In all four countries, a significant bifurcation of condom programming was found between the distribution of condoms through family planning services and the promotion and distribution of condoms by HIV/AIDS prevention programs. Little coordination or joint planning of condom programming was found. Overall, the rapid needs assessment tool was found to be valuable and easily adjusted to local circumstances. However, the current forms and process of the assessment tool have incorporated suggestions from field implementers as well as UNFPA collaborators that will strengthen its future implementation. The process of consulting key condom programming managers and policy makers led to the identification of problems and the next steps for solving them (which was an important objective of the tool). In fact, the rapid needs assessment’s bringing together all of the stake holders involved in condom issues for mutual discussion of problems and potential solutions proved effective in all four countries. This process of engagement, discussion, argument, and ultimately, consensus, was probably the most valuable aspect of the exercise. Despite strong efforts to create a rapid needs assessment exercise, in none of the countries could it be implemented within the time frame of the 7-10 days that was desired. While data gathering activities did not necessarily take a long time, the process of scheduling meetings and interviews with high level government officials required a far greater time frame than anticipated – approximately two months — due to travel schedules, local administrative crises, and holidays. (excerpt)
New York, New York, UNFPA, 2001. 32 p. (Preventing HIV / Promoting Reproductive Health)UNFPA has worked in the field of population and development for more than three decades and has addressed the issue of HIV/AIDS for the last decade. However, no organization by itself has the capacity or the resources needed to address and halt the pandemic. An effective response requires careful collaboration and coordination among organizations, with each bringing to the partnership a distinct set of capabilities, strengths and comparative advantages. As one of the eight cosponsors of UNAIDS (the other cosponsors being UNICEF, UNDP, UNDCP, UNESCO, ILO, WHO and World Bank), UNFPA chairs Theme Groups in many countries and supports HIV-prevention interventions in almost all of its country programmes. To maximize its response and to strengthen coordinated activities with other partners, it is critical for staff at every level to have a common understanding of the Fund’s policies and strategic priorities. The aim of this document is to provide such guidance to staff, delineating the niche in which UNFPA as an organization has a definite comparative advantage in addressing the HIV/AIDS epidemic, especially at the country level. (excerpt)
New York, New York, UNFPA, 2004. iv, 17 p. (E/500/2004)This report is intended for use in planning contraceptive supply, and for advocacy and resource mobilization. It contains country-specific information provided by donors on the type, quantity and total cost of contraceptives they supplied to reproductive health programmes in developing countries during 2002. The United Nations Population Fund (UNFPA) collected information for this report in 2003; as in earlier years, the UNFPA database is especially useful to illustrate commodity shortfalls and changes in funding by donor and country. The report highlights trends since 1990 and the gap between estimated needs and actual donor support, comparing UNFPA estimates of condom requirements for STI/HIV prevention, and contraceptive requirements for family planning programmes, with actual donor support. It also indicates donor support by region and product, the top ten countries supported by donors and the quantity of male and female condoms supplied. UNFPA tried to collect information on donor support for antibiotics for prevention of STIs/RTIs. In many cases, however, either donors did not record this information or the countries receiving support did not disaggregate information by commodity. UNFPA’s Commodity Management Unit will continue to discuss how to collect this information. (excerpt)
Role of a sentinel surveillance system in the context of global surveillance of infectious diseases.
Lancet Infectious Diseases. 2004 Mar 1; 4(3):171-177.In some nation states, sustained integrated global epidemiological surveillance has been weakened as a result of political unrest, disinterest, and a poorly developed infrastructure due to rapidly increasing global inequality. The emergence of severe acute respiratory syndrome has shown vividly the importance of sensitive worldwide surveillance. The Agency for Cooperation in International Health, a Japanese non-governmental organisation, has developed on a voluntary basis a sentinel surveillance system for selected target infectious diseases, covering South America, Africa, and Asia. The system has uncovered unreported infectious diseases of international importance including cholera, plague, and influenza; current trends of acute flaccid paralysis surveillance in polio eradication; and prevalence of HIV, syphilis, hepatitis B, and hepatitis C in individual areas covered by the sentinels. Despite a limited geographical coverage, the system seems to supplement disease information being obtained by global surveillance. Further development of this sentinel surveillance system would be desirable to contribute to current global surveillance efforts, for which, needless to say, national surveillance and alert system takes principal responsibility. (excerpt)
Lancet. 2003 Sep 6; 362(9386):829-830.Undoubtedly, Tanzania must increase overall funding for its health service. Economic growth is needed, but to do so necessitates improvements in health and better infrastructure and planning of public services in all sectors. External organisations have driven most reforms in the health sector. Thus far they have succeeded in creating an essentially market driven system with few safeguards for the poor, and inadequate population coverage of high quality medical services. The expansion of the private sector is progressing at an exceptional pace; an issue of concern since there is very little capacity to monitor and regulate its effect, and it seems likely to result in further inequity. It remains to be seen how well the recent reforms will meet Tanzania’s needs, and it is doubtful whether the government has sufficient ownership to exert control. (excerpt)
SCN News. 2002 Dec; (25):61-63.The Report of the CMH (Commission on Macroeconomics and Health) is likely to be influential given the high profile of the Commissioners, the weighty composition of its Working Groups and its endorsement by WHO. Its description of the global health situation and of health systems in poor countries, as well as its key recommendations are strongly reminiscent of the central thrust of the World Bank's influential 1993 Report, "Investing in Health", which also emphasized the point that health is a major input to economic growth, but also studiously avoided any critical engagement with the global macroeconomic architecture that continues to generate economic growth accompanied by deepening inequalities. A decade has elapsed since that influential global health policy document was published and promoted. Yet in poor countries, particularly Africa, poverty has deepened and the health situation has further deteriorated, and health systems and their capacity have declined. It is difficult to avoid asking the question: "Why should things be different this time?" (excerpt)
In: War and public health, edited by Barry S. Levy, Victor W. Sidel. Washington, D.C., American Public Health Association [APHA], 2000. 254-278.War has always been disastrous for civilians, and the Persian Gulf War was no exception. Yet the image that has been perpetuated in the West is that the Gulf War was somehow "clean" and fought with "surgical precision" in a manner that minimized civilian casualties. However, massive wartime damage to Iraq's civilian infrastructure led to a breakdown in virtually all sectors of society. Economic sanctions further paralyzed Iraq's economy and made any meaningful post-war reconstruction all but impossible. Furthermore, the invasion of Kuwait and the subsequent Gulf War unleashed internal political events that have been responsible for further suffering and countless human fights violations. The human impact of these events is incalculable. In 1996, more than five years after the end of the war, the vast majority of Iraqi civilians still subsist in a state of extreme hardship, in which health care, nutrition, education, water, sanitation, and other basic services are minimal. As many as 500,000 children are believed to have died since the beginning of the Persian Gulf War, largely due to malnutrition and a resurgence of diarrheal and vaccine- preventable diseases. Health services are barely functioning due to shortages of supplies and equipment. Medicines, including insulin, antibiotics, and anesthetics, are in short supply. The psychological impact of the war has had a damaging and lasting effect on many of Iraq's estimated eight million children. (excerpt)
Geneva, Switzerland, WHO, 1991. vi, 65 p. (WHO Technical Report Series 807)This report by WHO's Expert Committee on Environmental Health in Urban Development explains that social and physical factors, including the destruction of the natural environment, place the health of urban dwellers at risk. The report discusses the urbanization phenomenon and its consequences, the problems and needs in environmental health, and provides recommendations. From 1950-80, the world's urban population nearly tripled, with most of the growth occurring in developing countries, where urban population quadrupled. Experts predict that many urban centers in developing countries will have an annual growth rate of more than 3% over the next 40 years. While developed countries have seen declines in the level of population growth, the health risks to its urban inhabitants have nonetheless increased. Technological changes, increased energy consumption, and increased levels of waste have placed great stress on the environment and have increased the health risks. But developing countries have seen even more problems associated with urban living. Rapid urbanization levels have led to overcrowding, congestion, and the destruction of previously unsettled ecosystems. Pollution levels have increased. Due to the lack of sanitation services, the threat of communicable diseases has increased. Social problem such as crime and violence also affect the well-being of urban dwellers. The group at greatest risk includes poor women and children. The report explains that tackling the health problems associated with urbanization will require a major conceptual change, considering that current efforts are ineffectual. Some of the recommendations include: strengthening the management of urban development; strengthening the management and technology for environmental health; and strengthening community action.
[People's perception of diseases: an exploratory study of popular beliefs, attitudes and practices regarding immunizable diseases]
Dhaka, Bangladesh, Worldview International Foundation, 1987 Nov.  p.Researchers interviewed 57 mothers and 27 heads of family in predominantly rural areas about 135km from the capital city of Dhaka, Bangladesh to learn about their perception of diseases. They also talked with 3 traditional healers and 8 influential people in the different locales, e.g., teachers and imams. They learned that each vaccine preventable disease has at least 1 local name rooted in popular beliefs, e.g., all local names for poliomyelitis are associated with an ominous wind. Generally, the local people believe that witches or evil spirits cause all the vaccine preventable diseases. These entities prefer attacking babies, but also are known to afflict women. A preventive measure practiced includes pregnant women never leaving the house in the evening, at noon, or at midnight since these are the times when they are most exposed to evil spirits. There exist 2 traditional healers--fakirs and kabiraj. Fakirs use mystic words with religious chants and perform various healing rituals. The kabiraj sometimes use healing rituals, but also prescribe indigenous medicines. This research provides some useful insights into WHO's Expanded Programme on Immunization in developing communication strategies which build on what people already know. For example, since the local people believe that evil spirits or witches attack the newborn immediately after birth may provide an incentive for early immunization. Since preventing illness and death in newborns is a goal of both modern and traditional medicine, it is likely that the local people are not so concerned with the real cause of illness and will accept any practice that keeps their infant healthy and that fits into their beliefs and perceptions.
Eradication of indigenous transmission of wild poliovirus in the Americas. Plan of action, July 1985.
[Washington, D.C.], PAHO, 1985 Jul. 26 p. (EPI-85-102; CD31/7 Annex II)The Pan American Health Organization (PAHO) appointed a Technical Advisory Group (TAG) which met in July 1985 to plan eradication of wild poliovirus in the Americas by 1990 by immunization and surveillance. The strategies to be adopted are mobilization of national resources; vaccine coverage of 80% or more of the target population; surveillance to detect all cases; laboratory diagnosis; information dissemination; identification and funding of research needs; development of a certification protocol; and evaluation of ongoing program activities. The expanded immunization program (EPI) will be organized at the country level by setting up National Work Plans, with inventories of resources and identification of participating agencies and donors, under the guidance of national EPI offices. The TAG will be composed of a core of 5 experts on immunization, with additional consultants as needed, meeting quarterly, semi-annually or annually to review progress and publish recommendations. Regional EPI offices will coordinate eradication activities between the Ministries of Health, the 10-11 epidemiologists/technical advisors in each country and all agencies affiliated with the PAHO. Support personnel will be available at the sub-regional and regional level, including support virologists to assist the laboratory network. Appendices are attached showing estimated costs for regional and regional personnel, vaccines, laboratories, and program activities, predicting that the effort will pay for itself 2.3 times over by 2000.
Report of the third meeting of the scientific working group on viral diarrhoeas: microbiology, epidemiology, immunology and vaccine development, [held in] Geneva, 1-3, February 1984.
Geneva, Switzerland, WHO, . 19p.The current status of the Scientific Working Group Program is reviewed, showing an expansion of activities in both its health services component (planning, implementation and evaluation of national diarrheal diseases control programs) and its research component (biomedical and operational). Submission of research proposals is encouraged by the Steering Committee (SC), namely those investigating the etiological role of viral agents in diarrheal disease and the epidemiology of these agents. Recently, the SC has made a particular effort to stimulate research in the area of immunology of viral enteric infections, which has been a generally neglected area. Other important areas of Program activity include site visits to review progress made by its projects, to participate in the initial design or the analysis of studies, or to stimulate general interest among research workers in the activities of the SWG. Workshops have also been initiated and conducted in WHO regions. The SWG notes with satisfaction the progress of the Program and commends the SC's efforts to stimulate and support research activities. SWG recommendations bear on the need for more data on the etiology and epidemiology of diarrhea in the community and the encouragement of further community-based studies. Particular attention should also be given to the preparation of reagents for the serotyping and subgrouping of rotaviruses. Moreover, the Group recommends that research strengthening workshops be continously held. In addition to the review of the meeting and recommendations, this paper includes a report on active and passive immunity to viral diarrheas. Special attention is given to rotavirus diarrhea as it tends to be common and quite severe. Its epidemiology is briefly presented, showing its incidence, seasonality (winter) in temperate climates, age-specific occurrence (most severe in infants and young children) and transmission (fecal-oral, person-to-person). Neonatal ans sequential postneonatal rotavirus infection are addressed ans issues for further investigation clarified; e.g., the relationship between low birth weight and the occurrence and severity of infection. Much remains to be elucidated regarding the serotyping-specific epidemiology of rotaviruses. The Group notes that further immunological studies of rotaviruses are essential to elucidate the role of passive protection. The other area of study in which research activities need to concentrate is vaccine development.