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Earth Times. 2002 Nov 25;  p..Dr. Shaban Abou El-Fotoh is very proud of the gold stars he has been awarded by Egypt's Ministry of Health and displays them proudly on the wall of his office in the Hegazy Medical Center, a public clinic in the town of Caliobeya, just outside of Cairo. He was awarded these stars based on his management of the clinic, a clean but basic facility that receives more than 300 patients a day and serve four local neighborhoods that comprise of over 27,000 residents. El-Fotoh and many of the nurses, physicians and technicians in the center have received supplemental medical training from a program spearheaded by Egyptian anthropologist Dr. Hind Khattab in conjunction with the United Nations Population Fund's Cairo field office. Her program was established to improve the quality and sensitivity of reproductive health care services in rural Egypt. The Hegazy Medical Center is one of a handful of clinics near Cairo involved in Khattab's pilot program that has been so successful in its results that UNFPA decided to continue supporting it in its new program for 2002-2006. The idea for the program was born in 1988, when Khattab attended a conference on maternal mortality. She wanted to understand why women in Egypt, as well as many other developing nations, were not aware of their gynecological health and effectively suffer in silence. (excerpt)
[Unpublished] 1991 Apr 24. , 28 p. (SEA/DD/43; Project: ICP CDD 001)Physicians collected data on 4319 households and 3766 0-5 year old children living in rural areas of Dhaka Division in Bangladesh to determine the prevalence of diarrhea among the children, the percentage of diarrhea cases treated with various forms of oral rehydration therapy and with drugs, and caretaker awareness of when to refer children with diarrhea to a health facility. 60.3% received no treatment at all. The 24-hour point prevalence of diarrhea stood at 5.2%. Blood accompanied the diarrhea of 22.3% of these children. Yet only 12% of bloody diarrhea cases received appropriate antibiotic therapy. 13.4% of the children had experienced a diarrheal episode during the 2 weeks before the interview. Mean duration was 7 days, but 22.4% of the children had diarrhea for at least 14 days. The adjusted annual diarrhea incidence rate was 2.3 episodes/child. 33.7% of caretakers asked others for help in treating diarrhea. The advisers tended to be village doctors or quacks (21%), government health workers (17%), and homeopaths (17%). 75% of advisors, except family and friends, suggested drugs. Only 27% and 16% recommended administering oral rehydration solution (ORS) and various home fluids, respectively. Only 22% and 17% suggested caretakers to continue feeding and breast feeding, respectively. The ORS use rate during the previous 24 hours was only 11.9% and just 3.6% of cases drank properly prepared ORS. Yet 93.8% knew about ORS. Most caretakers did not use enough water or all the contents of the ORS packet. Use rate for home fluids was 16.5%. 97.5% of lactating mothers continued to breast feed during the diarrhea episode. 36.1% of children received drugs compared with 25.8% for use of oral rehydration therapy. 70.7% of caretakers gave ill children at least the same amount of solid or semisolid foods during the episode. 70% of caretakers preferred ORS to drugs. The leading reasons for referring cases to a health facility included too many stools (79.7%), failure to improve (28.3%), and fever (26.7%). The researchers deemed only 23.5% to have adequate referral knowledge (=or> 3 reasons).
Evaluating the progress of national CDD programmes: results of surveys of diarrhoeal case management.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1991 Sep 6; 66(36):265-70.National diarrhea disease control (CDD) programs need to evaluate their effect on diarrhea morbidity and mortality, but this is often difficult. So national CDD programs often follow the WHO Global CDD Programme model. It uses 13 indicators designed to measure the extent the CDD program is being effectively administered. These indicators are mainly concerned with diarrhea case management in the home and in health facilities, e.g., oral rehydration therapy (ORT) use rate. WHO is enlarging the list to include breast feeding. It suggests that national CDD programs use WHO developed household and health facility surveys to evaluate their programs. These surveys can also identify problems and demonstrate possible solutions to bring about effective implementation. Evaluation teams have used WHO's Morbidity, Mortality, and Treatment survey almost 400 times. China, Ethiopia, the Philippines, and Viet Nam habitually conduct 1-2 evaluation surveys/year. Ecuador and Kenya use them to train professionals in conducting WHO surveys. 1989-1990 surveys in 17 developing countries reveal positive findings: 89.8-100% of mothers in 16 of the countries (49% in Iran) still breast feed during a diarrhea episode and 60-70% of mothers offer ill children at least the same amount of food as they are offered when well. On the other hand, caregivers do not always use ORT (13.4 [India]-91.8% [Indonesia]) and increased fluid intake is low (15-30%). 13 surveys show that water was the most commonly given nonmilk fluid offered. This information helps programs to identify appropriate home fluids. A 1990 addendum to the WHO household survey allows program managers to assess antidiarrheal drug use. WHO's 1990 manual provides protocols for observing case management practices, interviews with caretakers and health workers, assessing health facilities and supplies, and reviewing records.
ENTRE NOUS. 1999 Spring; (42):14.The constant increase in the incidence of syphilis in Kyrgyzstan, particularly in the country's capital, Bishkek, in the last five years has prompted action by WHO. WHO started a project in January 1998 based on free confidential out-patient treatment of syphilis with benzathine benzylpenicillin by short regimen. Since the initiation of the innovative treatment procedure, there has been an increase in attendance at STD clinics by patients for check-ups and treatment. Exceptions to the outpatient rule are made for pregnant women, children, and other difficult diagnostic cases. The project resulted in a decrease in the incidence of syphilis for 1998 as compared to 1997. Another problem facing Bishkek is the widespread incidence of STDs among sex workers, as seen all over the city. In response to this problem, a project for the creation of a support center that would cater to the medical and psychosocial needs of sex workers was recommended.
ENTRE NOUS. 1999 Spring; (42):12.A survey on the sexually transmitted disease (STD) incidence in the rural region of Chatlon was conducted by the Republican Reproductive Health Center as part of the agreement between the Government of Tajikistan and WHO for the implementation of the United Nations Population Fund (UNFPA) project "Improving Reproductive Health Services and Access to Family Planning." Some 1034 women answered the questionnaire on all aspects of STDs; 400 women were physically examined, and 200 blood specimens were tested for syphilis, hepatitis B and C, and HIV. 75.7% of the examined cases revealed a variety of STDs: trichomoniasis (25.3%), candidosis (17.9%), chlamydia trachomatis (14.9%), syphilis (5.6%), gonorrhea (.2%), and hepatitis B virus (.2%). STDs were most commonly found in the 21-39 age group; the lowest rate (1.89% of the cases) was found among women with a high educational level. Investigations also showed a low awareness of STDs among the population: 72% of those questioned knew nothing about STDs, while 62.8% of all housewives in the survey group knew nothing to prevent STDs. Furthermore, STD screening of the 17-20 age group revealed that 30% had genital skin changes, while 77.7% of the 19-20 age group had vaginal discharges. The results confirmed that there was a high prevalence of STDs in Tajikistan, suggesting that there was a need to promote urgent social and medical remedies. Three main goals for combating STDs are outlined: 1) to improve quality of life, 2) to decrease the risk of infection through primary prevention, and 3) to diagnose and provide early treatment to people who are infected with curable forms of STDs.
WORLD HEALTH. 1992 Jul-Aug; 24-5.Most rural water sources are not protected adequately from contamination by human and animal feces. These sources are stored rainwater, surface water (streams and ponds), and groundwater from shallow holes, dug wells (often with no protective lining), and shallow hand-pumped and deeper mechanically pumped tubewells. In developing countries, after the International Drinking Water Supply and Sanitation Decade, only 59% of rural areas have improved, more accessible, safer water supplies. In rural China, just 10% of the population receive piped water. The WHO Collaborating Centre for the Protection of Drinking Water and Health has developed reliable, simple, and inexpensive methods for sanitarians to identify important sanitary hazards and to protect and improve rural water supplies. The sanitarian and community representatives should inspect the water source or area of sanitary concern and list all hazards observed. Each hazard receives a set number of points based on risk. Each district level should determine its own sanitary hazard weighting for each hazard. The sanitarian adds all the points for a sanitary inspection risk or hazard score. He/she discusses with the community representatives what needs to be done to improve sanitation, then provides a copy of the report to a representative, who signs it, to help him/her remember the discussion. Another copy is filed at the health center. Between 1989 and 1992, sanitarians in Indonesia, Nepal, Nicaragua, Peru, and Thailand have implemented this procedure in pilot projects to identify the most serious hazards resulting in high levels of fecal pollution. This can be eliminated gradually because it is expensive. In Thailand and Indonesia the most common problems were not related to high levels of fecal contamination. In Thailand, remedial action always improved water quality.
WORLD HEALTH FORUM. 1991; 12(4):449-50.Staff at the Shivajinagar Urban Health Centre in Deonar (population 250,000) near Bombay, India conducted a cluster survey in 30 sectors of the slum using the WHO methodology for evaluating immunization coverage to measure neonatal and perinatal mortality among births that occurred between November 1986-April 1988. They gathered information on 54 births for the case group and 9 controls from each cluster. 1610 live births and 19 stillbirths occurred in the study period. There were 27.6 perinatal deaths for every 1000 total births (standard error=1.108). Neonatal deaths equalled 28.6/1000 live births (standard error-1.126). Confidence intervals for perinatal mortality rate and neonatal mortality rate were 25.39-29.82 and 26.35-30.85 and significant (p<.05). 26.4% of births occurred at home. Untrained women attended 84.6% of these deliveries. The remaining births occurred at the municipal general hospital or at a municipal maternity home. 60% of the fetal deaths were females. 77% of the 26 early neonatal deaths were males, but the male female ratio of deaths after 7 days was the same. The leading causes of neonatal mortality were prematurity and low birth weight. Other causes included congenital malformations and neonatal tetanus. Obstructed labor resulted in fetal death in 40% of stillbirths. The researchers at the Shivajinagar Urban Health Centre in Deonar, India concluded that the 30-cluster survey technique was effective in measuring perinatal and neonatal mortality in a community with >50,000 people in a developing country.
New York, New York, International Planned Parenthood Federation, Western Hemisphere Region, 1985. xi, 102, 24 p. (IPPF/WHR Caribbean Contraceptive Prevalence Surveys)An analysis of Caribbean contraceptive prevalence surveys is the focus of this report by the IPPF, Western Hemisphere Region, through its Caribbean Population and Development project. This booklet reports on 1 aspect of the project--the analysis of contraceptive surveys conducted in St. Kitts-Nevis and Montserrat to determine levels of contraceptive use and assess the effectiveness of information, education, and delivery services. Chapter 1 outlines the background, economic, social, and family structures, and organization of family planning services in St. Kitts-Nevis. The methodology of the survey is explained. Chapter 2 provides a demographic analysis of fertility, parity, and unplanned pregnancy rates. The level of awareness of contraceptives and contraceptive outlets is presented in Chapter 3. Patterns of contraceptive use, with user and non-user profiles, preferred sources for contraceptive outlets, user satisfaction with methods and outlets, male involvement in family planning, and the timing of contraceptive use are the topics covered in Chapter 4. Chapter 5 provides an overview of contraceptive use, family planning programs, and sense of self-worth in St. Kitts-Nevis. Social sources of resistance to contraceptive use and the contraceptive intentions of non-acceptors are characterized in Chapter 6. Chapter 7 offers a summary and conclusions of the study findings, and the 1984 contraceptive prevalence survey used in St. Kitts-Nevis is supplied in the appendix.
Dacca, Bangladesh, Directorate of Population Control and Family Planning Research, Evaluation, Statistics and Planning Wing, April 1977. 30 p.Upon completion of a report on Research Inventory and Analysis of Family Planning Communication Research in Bangladesh, the convenor of Task Force II proposed a study on Family Planning Communication Audience, a top priority study, as documented by the Task Force II in its report submitted earlier to the government. The objectives of this study are to: 1) examine if 2 steps or a multi-step communication model is in operation in Bangladesh; 2) determine which of the media has the largest audience; 3) determine the contribution of each of the mass media in disseminating the family planning message; and 4) determine socioeconomic characteristics of various media audiences. The sample design included exposure to 5 mass media: newspapers, television, radio, audiovisual van, and village bard. The study shows that: 1) both groups of respondents (male and female) have been exposed to the mass media in varying degrees, but that the audiences, after receiving the message, did not keep it confined to themselves; 2) the 2 and 3 step model of communication is in operation in the sample population; 3) in terms of exposure, the data show that radio had larger audiences among both male and female respondents; 4) newspapers, radio, and television audiences differ from the audiences of the other 2 media--village bard, and audiovisual van--in the following areas: education, age, income, and parity. Recommendations are made for further development of family planning communication programs through the mass media: 1) More news, advertisements, pictures, and features printed in the daily newspapers "Ittefaq," and "Dainik Bangla," which are widely read by rural populations; 2) installation of radios and television sets at public sites will enable public service announcements on family planning to be viewed; 3) the musical drama, "Jatragan," by the village bard is highly effective in delivering the family planning message; 4) future studies should include control groups for each of the 5 media audiences; and 5) since women cannot join men in viewing the audiovisual van performances, special arrangement should be made for them.
In: Rodrigues W, ed. The Third American Conference on Integrated Programmes [Rio de Janeiro, Brazil, August 17-20, 1982] Capri III. [Unpublished] 1982. 111-8.Group 1 analyzed the question: "How to organize the community and elicit people's participation?" The following items were identified as priorities: 1) previous diagnosis of the community; 2) leadership identification; 3) identification of opposition to the programs; 4) formation of a planned and systematic voluntary action; and 5) selection of human resources. In spite of considering sources at the community, municipal, state, federal, and foreign levels, the group recognizes and advises priority and emphasis to the community as the agent of its own development and therefore all efforts should be made in order to make the maximum use of all available resources. In order to increase the available sources, it is important to reach the highest potentials from all community resources, and elicit the interentity integration besides promoting campaigns for collecting resources. Group 2 developed the Community Development Methodology Pattern in response to the question: "How to organize community and elicit people's participation?" The survey, diagnosis, planning, implementation, and evaluation of the community and program should be included. Funding can be obtained from international or national agencies, or derive from the community itself. However, the ultimate goal should be the self-financing of the program. In response to the question: "How to organize and elicit people's participation," Group 3 concluded that knowledge of the community, and frankness toward the community was of paramount importance. In order to motivate and educate the community, the strategies of dissemination and motivation must be set up, including the use of popular literature, and audiovisual materials. The development of human resources is a factor essential to any program. Training must cover the working team as well as the leaders and volunteers of the community. A part of the training process is the information and experience exchange meetings held by the participants of the different programs. Coordination with agencies concerned avoids duplication of efforts, program performance efficiency is improved, and each agency's role is clearly delineated.