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[Unpublished] 1985. 78 p.A Population/Family Health Assessment was conducted in the Democratic Republic of Madagascar (GDRN) to review population and family planning activities and to make general recommendations for improvement, including the type of US Agency for International Development (USAID) population assistance that should be provided. Despite the fact that Madagascar's population of approximately 9 million is growing at a rate of 2.8% annually, meaning the population will double in less than 25 years, there is no official population policy. Yet, it is significant that the reduction of maternal and infant mortality and morbidity has been identified as an explicit goal in the health sector, and the country's actions long have reflected an attitude of acceptance and support of family planning. The private family planning association is recognized as a nongovernmental organization, which provides clinical and contraceptive services throughout Madagascar. The public health system offers no family planning services. Although the French law of 1920 forbidding the sale and use of contraceptives has not been rescinded, it is not enforced. The private family planning association now provides contraceptive services in 40 Ministry of Health facilities at the request of public health physicians, and the government has approved the participation of 35 medical and paramedical personnel in training courses as well as the installation of laparoscopic equipment in 8 medical facilities. Several other organizations provide child spacing services. Despite the efforts being made, the availability of contraceptive services remains limited, and contraceptive prevalence was estimated at 1% of women aged 15-49 in 1982. Several obstacles impede accessibility to contraceptive services and expansion of family planning programs, including a culture which favors large families, the strong influence of the Catholic Church, and a limited number of medical centers providing family planning services. Further, communication between the Office of Population and the Ministry of Health has not been the most favorable for the development of effective programs either area, but the recent naming of a physician to the position of Director of Population may facilitate closer collaboration. The recommendations made outline a general strategy for the initiation of population activities in the shortterm.
[Experience with the expanded WHO program on immunization against tetanus] Opyt rasshirennoi programmy VOZ po immunizatsii protiv stolbniaka.
ZHURNAL MIKROBIOLOGII, EPIDEMIOLOGII I IMMUNOBIOLOGII. 1985 Nov; (11):97-103.According to (WHO) statistics, over 1 million infants in the developing countries die each year from tetanus. The estimated annual occurrence of tetanus in the 3rd World exceeds 2.5 million cases, including approximately 1.3 million newborn infants. In 1974, WHO began an expanded program for the systematic immunization of infants against tetanus and certain other diseases. The program uses 2 approaches for preventing tetanus: 1) immunization of infants under 1 year of age with the AKDS vaccine; and 2) immunization of pregnant women or, if possible, all women, with tetanus anatoxin. The 2nd approach is more effective, especially when 2 doses of tetanus anatoxin are administered within a minimum interval of 4 weeks. The anatoxin has no harmful effects on the fetus and can be used during any stage of pregnancy. The program strives to reduce infant mortality caused by tetanus to less than 1 case in 1000 by 1990, and to 0 by 2000. To attain these goals, systematic immunization should be combined with drastic improvements in delivery techniques and hygiene in developing countries. Specialized surveys indicate that initial steps toward implementation of the program resulted in a significant reduction of infant mortality caused by tetanus. Experience with the expanded WHO program shows that elimination of tetanus in infants is a realistic and attainable goal.
Voorburg, Netherlands, Netherlands Interuniversity Demographic Institute, 1985 Sep. ix, 56 p. (Working Paper of the N.I.D.I. No. 63)The objective of this report is to introduce the available techniques of life history analysis to study the data collected by the national migration surveys and to demonstrate the relevance of such techniques to provide more insight into to the problems addressed by the ESCAP migration and urbanization project. The 2nd section of the report introduces the basic concepts, with special reference to migration, and contains a simple example. Section 3 deals with 3 further issues which may arise while modeling migration histories: the alternative definitions of the state-space; the definition of the time dependence; and heterogeneity considerations and ways of dealing with heterogeneity for discrete state stochastic models of migration. The 4th section focuses on some major problems which may arise while estimating stochastic models of migration histories with ESCAP migration his. 2 issues are emphasized in this section: problems with the measurement of the timing of the events and issues related to using the information on the covariates of migration. Continous time stochastic models provide a powerful means of modeling event sequences. Migration histories consist of information on the times and the characteristics of migration experienced by individuals. More conventional ways of modeling such data are the dummy variables regression, the logit regression, or aggregation of the data are to form contingency tables and application of the log-linear models. Continous time event history models easily be generalized to incorporate complex designs of the state space, which express the moves between residences, and to provide detailed and cross nationally comparable information on the patterns of time dependence. Additionally, they are based on the estimation techniques which do not require unrealistic assumptions. These models aim at identifying a dynamic process that underlies the observed data. Estimated parameters of these models provide a description of the time dependence and also provide quantitative information about the effects of exogenous variables on the phenomenon of interest. The dependent variable of the continous time event history models is usually the instantaneous transition rate which is not directly observable. The estimated coefficients of the exogenous variables may be interpreted the same as the coefficients of a regression model, except that they usually have a multiplicative relation with the dependent variable. Once models of fundamental parameters of the underlying process are designed and estimated, many implications of such a process may be derived.
China: long-term development issues and options. The report of a mission sent to China by the World Bank.
Baltimore, Maryland, Johns Hopkins University Press, 1985. xiii, 183 p. (World Bank Country Economic Report)This report summarizes the conclusions of a World Bank study undertaken in 1984 to identify the key development issues China is expected to face in the next 20 years. Among the areas addressed by chapters in this monograph are agricultural prospects, energy development, spatial issues, international economic strategy, managing industrial technology, human development, mobilizing financial resources, and development management. China's economic prospects are viewed as dependinding upon success in mobilizing and effectively using all available resources, especially people. This in turn will depend on sucess in reforming the system of economic management, including progress in 3 areas: 1) greater use of market regulation to stimulate innovation and efficiency; 2) stronger planning, combining indirect with direct economic control; and 3) modification and extension of social institutions and policies to maintain the fairness in distribution that is basic to socialism in the face of the greater inequality and instability that may result from market regulation and indirect controls. Over the next 2 decades, China can be expected to become a middle-income country. The government has set the goal of quadrupling the gross value of industrial and agricultural output between 1980 and 2000 and increasing per capita income from US$300 to $800. China's size and past emphasis on local self-sufficiency offer opportunities for enormous economic gains through increased specialization and trade among localities. Increased rural-urban migration seems probable and desirable, although an increase in urban services and infrastructure will be required. The expected slow rate of population increase is an important foundation for China's favorable economic growth prospects. On the other hand, it may not be desirable to hold fertility below the replacement level for very long, given the effects this would have on the population's age structure. The increase in the proportion of elderly people will be a serious social issue in the next century, and reforms of the social security system need to be considered.
Liege, Belgium, International Union for the Scientific Study of Population, 1985. 45 p.The International Union for the Scientific Study of Population Problems (IUSSP) celebrated its 50th anniversary in Mexico City in 1977. 2 objectives for the organization were set: 1) to reassemble the documents and archives relating to the IUSSP, and 2) to organize a Florence Conference of an exhibition on the history of the IUSSP. Because of the historical evolution of demographic science, the IUSSP began its acitivities in developed countries, in which the majority of the national committes that were affiliated to it in 1947 were situated. The 1st World Population Conference was held in Geneva in 1927; different aspects of population problems (biological, social, medical, statistical, and political) were discussed. The Constituent Assembly of the IUSSP was held in Paris in 1928. 3 research committees were set up: 1) Population and Food, 2) Differential Fertility, Fecundity, and Sterility, and 3) Statistics of Primitive Races. During 1928-1947 several national committees were set up. Since 1947 research committees studying specific issues have grown considerably. Among the IUSSP's main achievements is the work of teh Multilingual Demographic Dictionary Committee, which resulted in the publication of the dictionary in 15 differnet language sections. The most impressive aspect of the work of the IUSSP is the extension of its program to less developed countries. The IUSSP is a multinational corporation whose profits are distributed in all parts of the world.
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.
In: Population prospects in developing countries: structure and dynamics, edited by Atsushi Otomo, Haruo Sagaza, and Yasuko Hayase. Tokyo, Japan, Institute of Developing Economies, 1985. 39-57, 326-7. (I.D.E. Statistical Data Series No. 46)A comparative study on mortality trends of developing countries was conducted by making use of UN projections of mortality measures. These mortality measures projected by the UN were used to observe future prospects of general mortality trends in selected countries. Under several research projects of the Institute of Developing Economies (IDE), some attempts were made to analyze recent trends of cause-specific mortality covering several selected countries. Estimates of future changes in cause-specific mortality may be considered useful to supply basic information needed for social and economic development planning of a country. Trends of mortality changes in the 1950s and 1960s were characterized in many countries by a rapid decline. Such a declining trend of mortality was brought about initially by a successful control of infectious and parasitic diseases accompanied by improvements in living conditions of the people in general. Thus the mortality of less developed countries that had been affected to a greater extent directly by infectious and parasitic diseases could be improved more drastically at such a stage. After the 1970s the pace of decline in mortality slowed down gradually to a considerable extent all over the world but was more prominent among more developed countries. In most countries mentioned in this discussion, regardless of whether they are more or less developed, the crude death rate is expected to reach the lowest level within a few decades. In many instances of developing countries, the crude death rate is assumed to reach such a minimum level in and around 2000. After reaching the lowest level, the crude death rate will turn to increase in varying degrees. Such a rise in crude death rate does not imply deterioration of mortality conditions. The crude death rate is often affected by the sex-age composition of the population. In contrast to the crude death rate, in most countries selected here, the expectation of life at birth is expected to expand steadily towards the future during the whole duration of this projection. An analytical observation was made on the cause-specific mortality for 10 selected countries covering the period from 1970 to the latest year for which basic data were available on the 8th (1965) revision of International Statistical Classification. Future prospects of cause structure of deaths will be very much influenced by proccesses effected by policy making and planning, and projections of cause-specific mortality should be made with an aim toward providing useful information for policy making and planning for national development.
Asian and Pacific Population Programme News. 1985 Mar; 14(1):2-5.In 1983, the ESCAP region added 44 million people, bringing its total population to 2600 million, which is 56% of the world population. The annual rate of population growth was 1.7% in 1983 compared to 2.4% in 1970-75. The urban population rose from 23.4% in 1970 to 26.4% in 1983, indicative of the drift from rural areas to large cities. In 1980, 12 of the world's 25 largest cities were in the ESCAP region, and there is concern about the deterioration of living conditions in these metropoles. In general, however, increasing urbanization in the developing countries of the ESCAP region has not been directly linked to increasing industrialization, possibly because of the success of rural development programs. With the exception of a few low fertility countries, a large proportion of the region's population is concentrated in the younger age groups; 50% of the population was under 22 years of age in 1983 and over 1/3 was under 15 years. In 1983, there were 69 dependents for every 100 persons of working age, although declines in the dependency ratio are projected. The region's labor force grew from 1100 million in 1970 to 1600 million in 1983; this growth has exceeded the capacity of country economies to generate adequate employment. The region is characterized by large variations in life expectancy at birth, largely reflecting differences in infant mortality rates. Whereas there are less than 10 infant deaths/1000 live births in Japan, the corresponding rates in Afghanistan and India are 203 and 121, respectively. Maternal-child health care programs are expected to reduce infant mortality in the years ahead. Finally, fertility declines have been noted in almost every country in the ESCAP region and have been most dramatic in East Asia, where 1983's total fertility rate was 40% lower than that in 1970-75. Key factors behind this decline include more aggressive government policies aimed at limiting population growth, developments in the fields of education and primary health care, and greater availability of contraception through family planning programs.
Lancet. 1985 Jul 13; 326(8446):83-5.Despite increasing attention to maternal and child health programs, most do little to reduce maternal mortality. In developing countries, maternal death rates of 100-300/100,000 births are common; rates are even higher in rural areas. Only 1 of the components of most maternal-child health programs (oral rehydration, growth monitoring, breastfeeding, family planning, and immunization) can reduce maternal mortality--family planning. Women who have many births or give birth at either extreme of the reproductive cycle are more likely to die of complications than other women. If all women who want to limit their families had access to efficient contraception, matenal mortality would be substantially reduced. Also needed is a major investment in a system of comprehensive maternity care. 75% of obstetric deaths are due to hemorrhage, infection, toxemia, and obstructed labor. Many of these complications occur among women with recognizable risk factors. It is recommended that the World Bank make maternity care 1 of its priorities. The Bank could initiate a program based on the construction of maternity centers in rural areas, the recruitment and training of staff for these centers, and the provision of supplies and drugs. Because women receiving maternity care can be offered family planning services as well, this proposal provides the World Bank with an opportunity to work toward its goal of reduced population growth rates.
New York, UNFPA, 1985 Mar. viii, 68 p. (Report No. 70)The UN Fund for Population Activities (UNFPA) is in the process of an extensive programming exercise intended to respond to the needs for population assistance in a priority group of developing countries. This report presents the findings of the Mission that visited Burma from May 9-25, 1984. The report includes dat a highlights; a summary and recommendations for population assistance; the national setting; population policies and population and development planning; data collection, analysis, and demographic training and research;maternal and child health, including child spacing; population education in the in-school and out-of school sectors; women, population, and development; and external assistance -- multilateral assistance, bilateral assistance, and assistance from nongovernmental organizations. In Burma overpopulation is not a concern. Population activities are directed, rather, toward the improvement of health standards. The main thrust of government efforts is to reduce infant mortality and morbidity, promote child spacing, improve medical services in rural areas, and generally raise standards of public health. In drafting its recommendations, whether referring to current programs and activities or to new areas of concern, the Mission was guided by the government's policies and objectives in the field of population. Recommendations include: senior planning officials should visit population and development planning offices in other countries to observe program organization and implementation; continued support should be given to ensure the successful completion of the tabulation and analysis of the 1983 Population Census; the People's Health Plan II (1982-86) should be strengthened through the training of health personnel at all levels, in in-school, in-service, and out-of-country programs; and the need exists to establish a program of orientation to train administrators, trainers/educators, and key field staff of the Department of Health and the Department of Cooperatives in various aspects of population communication work.