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  1. 1

    World population projections, 1989-90 edition: short-and long-term estimates.

    Bulatao RA; Bos E; Stephens PW; Vu MT

    Baltimore, Maryland, Johns Hopkins University Press, 1990. lxxiii, 421 p.

    The World Bank's Population and Human Resources Department regularly publishes a set of world population projections based on its data files. This 1989-90 report has projections for the world and for regions, income groups of countries, and 187 countries. World Bank staff made projections to the point where populations reach stability. In almost all cases, they made only 1 projection. Projection tables for 1985-2030 exist for each country's population. Each country also has tables on birth rate, death rate, net migration, natural increase, population growth, total fertility rate, life expectancy, infant mortality rate, and dependency ratio. The report shows that from 1985-90 population growth was 1.74%, and projected 1990 world population size was 5.3 billion. By 2025, 84.1% of the world's population will be living in developing countries. 58% of the population now lives in Asia. The population of Africa is growing faster than that of Asia, however, (3 vs. 1.9%). By 2000, the population of Africa will be second only to that of Asia, yet in 1989-1990, it is behind that of Asia, Europe and the USSR, and the Americas. The current dependency ratio (67) is expected to decline to 53 by 2025. The highest current dependency ratio belongs to Kenya (120). In developed countries with aging populations, the dependency ratio will rise from 50-58. China will most likely to continue to be the most populous country for about 200 years. India will continue to contribute more to population growth than any other country in the world. Yet the Federal Republic of Germany loses 100,000 people yearly. Total fertility rates are the greatest in Rwanda, the Yemen Arab Republic, Kenya, Malawi, and the Ivory Coast (all >7.2). Afghanistan and 3 western African countries have the shortest life expectancies (about 40 years). These trends illustrate the need to alter population growth.
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  2. 2

    A reassessment of the concept of reproductive risk in maternity care and family planning services. Proceedings of a seminar presented under the Population Council's Robert H. Ebert Program on Critical Issues in Reproductive Health and Population, February 12-13, 1990, the Population Council, New York, New York.

    Rooks J; Winikoff B

    New York, New York, Population Council, 1990. x, 185 p.

    Conference proceedings on reassessing the concept of reproductive risk in maternity care and family planning (FP) services cover the following topics: assessment of the history of the concept of reproductive risk, the epidemiology of screening, the implementation of the risk approach in maternity care in Western countries and in poorer countries and in FP, the possible effects on the health care system, costs, and risk benefit calculations. Other risk approaches and ethical considerations are discussed. The conclusions pertain to costs and allocation of resources, information and outreach, objectives, predictive ability, and risk assessment in FP. Recommendations are made. Appendixes include a discussion of issues involved in developing a reproductive risk assessment instrument and scoring system, and the WHO risk approach in maternal and child health and FP. The results show that the application of risk assessment warrants caution and usefulness in service delivery is questionable. The weaknesses and negative effects need further investigation. Risk-based systems tend toward skewed resource allocation. Equal access to care, freedom of choice, and personal autonomy are jeopardized. Risk assessment can accurately predict for a group, but not for individuals. Risk assessment cannot be refined as it is an instrument directed toward probabilities. The risk approach must be evaluated within a functioning health care system. Screening has been important in developed countries, but integration into developing country health care systems may be appropriate only when basic health care is in place and in urban and periurban communities. Recommendations are 1) to prevent problems and detect rather than predict actual complications when no effective maternity care is available; to provide effective care to all women, not just those at high risk; and to provide transportation to adequate facilities for women with complications. 2) All persons attending births should be trained to handle emergencies. 3) Risk assessment has no value unless basic reproductive health services are in place. Cost benefit analysis precludes implementation. Alternative strategies are available to increase contact of women with the health care system, to improve public education strategies, to improve the quality of traditional birth attendants, and to improve the quality of existing services. Women's ideas about what is "risk" and the cost and benefits of a risk-based system to women needs to be solicited. All bad outcomes are not preventable. Copies of this document can be obtained from The Population Council, One Dag Hammarskjold Plaza, NY, NY 10017. Tel: (212) 339-0625, e-mail
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  3. 3

    Maternal mortality ratios and rates: a tabulation of available information. 3d ed.

    World Health Organization [WHO]. Division of Family Health. Maternal Health and Safe Motherhood Programme

    [Unpublished] [1991]. 100 p. (WHO/MCH/MSM/91.6)

    The Maternal Health and Safe Motherhood Programme under WHO's Division of Family Health has compiled maternal mortality data in its 3rd edition of Maternal Mortality Ratios and Rates. The report contains data up to 1991. These data come from almost all WHO member countries. 1988 estimates reveal that 509,000 women die each year from causes related to pregnancy and childbirth. Most die from preventable causes such as aseptic abortions and lack of adequate health care. 4000 of these maternal deaths occur in developed countries. Thus developing countries, where 87% of the world's births occur, experience 99% of maternal deaths. In fact, the lifetime risk of death from causes related to pregnancy and childbirth in developing countries is 1:57 compared to 1:1825 in developed countries. Women in countries of western Africa have the greatest risk (1:18) and those in North America the smallest risk (1:4006). Even though the maternal mortality ratio for developing countries fell from 450-520 per 100,000 live births between 1983-1988, it increased in western African countries (700-760). This report consists mainly of tables of maternal mortality estimates for each country and in some cases certain areas of each country, for the world and various regions and subregions, and changes in maternal mortality since 1983 for the world and various regions and subregions. The world comparison table includes live births, maternal deaths, maternal mortality ratios and rates, lifetime risk, and total fertility. Country tables list year, data sources, maternal mortality ratio, indication if abortion deaths were included or not, and reference.
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  4. 4

    Statement at International Population Conference: Mexico City: August 1984.

    New Zealand

    [Unpublished] 1984. 4 p.

    In addressing the International Population Conference in Mexico City the New Zealand Delegation identified its role concerning the issues of world population and family planning. As a national member of the global community, New Zealand recognizes the importance of a worldwide balance of material goods and resources and population. Between the years 1974 and 1984, following the Population Conference in Bucharest, mortality trends have shown progress. The world population is gradually decreasing in developing and industrialized nations. however, during the same decade, the population showed an increase of 770 million. Many of the countries who experienced the greatest population increase were the least equipped to serve the population influx with proper food, shelter and health and education services. The Population Conferences have allowed for the global community to come together and review past accomplishments and to look at future needs. New Zealand's position on the role of women through family planning is to support women's exploration into positions beyond traditional roles and that women be fully incorporated in the process of development.
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  5. 5

    Population structure.

    Kono S


    This paper reviews recent new trends in population structure in the world and its major regions in order to access the determinants of those trends and explore issues regarding the recent and projected changes in the age structure of population and the relationships of those changes to social and economic development. In particular, the paper compares the change in age structure projected by the Population Division of the UN Secretariat in its most recent 3 series--namely, those completed in 1984, 1986, and 1988. By and large, the most recent UN assessment projects that a larger proportion of the world population will be aged 60 and over in 2000 and 2025 than was previously estimated. Those changes in projections can be observed for the world and for the more developed countries as a whole, and for the regions of Africa, Latin America, Northern America, East Asia, Europe, and Oceania. While the recommendations of the International Conference on Population called attention to the importance of changes in population structure, this paper recommends urgent government action in planning social programs for the aged because of the greater eminence of population aging in many settings. The case of Japan is used to illustrate the growing importance of increases in life expectancy as a determinant of age structure changes (in relation to fertility decline), a point that is reinforced through a cruder decomposition of UN estimates and projections for several European countries. (author's)
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  6. 6

    Annual report: 1985.

    Planned Parenthood Federation of America [PPFA]. Family Planning International Assistance [FPIA]

    New York, New York, FPIA, 1985. 206 p.

    Summarizing the work of the Family Planning International Assistance (FPIA) for the past 14 months, with emphasis on 1985, this document contains both regional and country reports for Africa, Asia and the Pacific, and Latin America. FPIA's strategy in Africa during 1985 was to focus on small, high-risk projects which call for extensive technical assistance. Project Assistance accounted for 48.8% of the total value of FPIA assistance to the region; Commodity Assistance accounted for 47.5% of the total value of FPIA assistance to the region. Special Grants accounted for slightly over 2.1% of the total assistance to Africa. In the Asia and Pacific Region, components of the FPIA strategy include: consolidate support and provide technical assistance to those agencies whose family planning services can be institutionalized and serve to complement and influence the goals, objectives, and program procedures of their governments' national family planning programs; problem solve with grantee agencies approaches to innovative delivery of temporary method services; provide training opportunities and technical assistance to project management and staff as well as to influential nonproject persons; and establish how FPIA commodities can complement supplies available to nongovernmental organizations through their government warehouses and bilateral supported community retail sales program. Project Assistance accounted for 47.1% of the total value of FPIA assistance in the region; Commodity Assistance accounted for 50.8% and Special Grants slightly over 1% of total assistance to the region. In Latin America, FPIA's program goals respond to agency goals of promoting family planning services in areas of unmet need, upgrading existing family planning service models, and encouraging service continuation following the phase-out of FPIA support. Project Assistance accounted for 46.8%, Commodity Assistance 52.2%, and Special Grants less than 1% of total FPIA assistance to the region. The combined value of all types of assistance provided worldwide during 1985 totaled over $18 million: $7.2 million in direct support to 128 funded projects in 39 countries; and $10.1 million in commodities shipped to 218 institutions in 66 countries. Oral contraceptive and condom shipments alone were sufficient to supply 2.4 million contraceptors for 1 year.
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  7. 7

    Development co-operation, 1986 review: efforts and policies of the members of the Development Assistance Committee.

    Wheeler JC

    Paris, France, Organisation for Economic Co-Operation and Development, 1986. 292 p.

    The 1986 annual report details the efforts and policies of the Development Assistance Committee members of the Organisation for Economic Co-operation and Development (DECD). Part 1 provides an overview of development assistance by region and ways it might be improved as well as a chapter on Africa's long-term prospects. Part 2 covers current trends and policy issues in official development assistance, including volume trends and prospects, basic priorities, shifts in geographic and functional aid distribution, financial terms of aid, environmental concerns, and the role of women in development. Individual countries' assistance is covered as well as multilateral agencies. Part 3 deals with improving aid effectiveness through strengthened aid co-ordination and better policies. Separate sections cover improved development policies and coordination, technical assistance in support of improved economic management capacity, cooperation in agricultural development, and cooperation for improved energy sector management. Part 4 reviews trends in external resource flows to Sub-Saharan Africa. Annexes detail good procurement practices for official development assistance and the recommendations of the Council of the DECD on the environment and development assistance.
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  8. 8

    Development co-operation with women: the experience and future directions of the fund.

    United Nations. Department of International Economic and Social Affairs

    New York, New York, United Nations, Department of International Economic and Social Affairs [DIESA], Development Fund for Women, 1985. 195 p. (United Nations Publication ST/ESA/159)

    This report covers the activities of the Voluntary Fund for the United Nations Decade for Women--currently called the United Nations Development Fund for Women--during the period 1978-1983. The objectives of the projects included regional and national strategies for the promotion of development in developing countries. They dealt with poverty, illiteracy, unemployment, self-reliance, health and nutrition; they promoted employment and self-sufficiency and created import-substitution products; they included agricultural production, human resource development through education and training, and institution-building. The assessment affirmed that women do participate in the development process but that they participate under unequal conditions. The findings of the assessment were also in agreement with the view of the General Assembly that changes in the family division of labor are needed in order to secure the participation of women on more equitable terms. Another lesson drawn from the projects that provides guidance for future activities is that projects should preferably be multi-faceted, encompassing human development needs as well as technical subjects. The cultural and political environments in which projects were implemented and the traditions of societies, when properly taken into account, contributed to the positive impact of projects. An obstacle faced in project implementation in several countries was the outdated and thus inadequate preparation of extension workers to cope with the multi-faceted work of women. Institutions were critical elements of project viability. The existence of local and national women's organizations and agencies proved to be a necessary condition for project effectiveness. The Fund reached policy levels from several directions. Although the effectiveness of these approaches varies both by country and by region, an interim judgment is that effective field projects may be the best approach.
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  9. 9

    Family planning program funds: sources, levels, and trends.

    Nortman DL

    New York, New York, Population Council, Center for Poplicy Studies, 1985 Aug. 42 p. (Center for Policy Studies Working Papers No. 113)

    This analysis of family planning program funding suggests that current funding levels may be inadequate to meet projected contraceptive and demographic goals. Expenditures on organized family planning in less developed countries (excluding China) totaled about US$1 billion in 1982--about $2/year/married woman of reproductive age. Cross-sectional analysis indicates that foreign support as a proportion of total expenditures decreases with program duration. Donor support to family planning in less developed countries has generally declined from levels in the late 1970s. This is attributable both to positive factors such as program success and increased domestic government support as well as requirements for better management of funds and the worldwide economic recession. Foreign assistance seems to have a catalytic effect on contraceptive use only when the absorptive capacity of family planning programs--their ability to make productive use of resources--is favorable. The lower the stage of economic development, the less visible is the impact of contraceptive use or fertility per investment dollar. On the other hand, resources that do not immediately yield returns in contraceptive use may be laying the foundation for later gains, making increased funding of family planning programs an economically justifiable investment. The World Bank has estimated that an additional US$1 billion in public spending would be required to fulfill the unmet need for contraception. To increase the contraceptive prevalence rate in developing countries to 58% (to achieve a total fertility rate of 3.3 children) in the year 2000 would require a public expenditure on population programs of US$5.6 billion, or an increase in real terms of 5%/year. Improved donor-host relations and coordination are important requirements for enhancing absorptive capacity and program performance. A growing willingness on the part of donors to allow countries to specify and run population projects has been noted.
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  10. 10

    Breastfeeding: growth of exclusively breastfed infants.

    Huffman SL

    Mothers and Children. 1985 Nov-Dec; 5(1):5, 7.

    Currently standards from industrialized countries are used to assess the growth patterns of breastfed infants in developing countries. Infant growth faltering is interpreted as an indicator of insufficient lactational capacity on the mother's part. 2 recent articles suggest the need for a critical reappraisal of current growth standards and their use for evaluating the adequacy of infant feeding practices. The most commonly used standards to evaluate infant growth are derived from the US National Center for Health Statistics based on anthropometric data collected in the US population 3-month intervals up to the age of 3. During this period, infant feeding practices varied greatly. Many babies were bottle-fed and given supplemental feedings early in life. No large sample of exclusively breastfed infants has been studied from birth on, and thus a standard for breastfed infants is not available. A study of fully breastfed infants was done in England and suggests that there are differences in growth rates. Among a population of 48 exclusively breastfed boys and girls, for the 1st 3 to 4 months of life, growth of breastfed infants was greater than National Center for Health Statistics Standards, while after 4 months growth velocity decelerated more quickly than the standard. The growth of infants studied in Kenya, New Guinea and the Gambia appears to falter at 2-3 months of age using the NCHS standard. Findings suggest that current FAO/WHO recommended energy intakes may be excessive. Recent studies in the US support this assertion. The adequacy of the milk production for the infants in this US study done in Texas was illustrated by their growth rates. Length for age percentiles were higher than the NCHS standards throughout the study though at birth they did not differ significantly. 1 reason these breastfed infants were able to maintain growth despite less than recommended energy intakes is that the ratio of weight gain/100 calories of milk consumed was 10-30% higher among the breastfed infants compared to formula fed infants, suggesting a more efficient use of breastmilk than formula. There is a need for studies of exclusively breastfed infants with larger samples to determine what growth pattern should be considered the norm.
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  11. 11

    Report on developments and activities related to population information during the decade since the convening of the World Population Conference, Bucharest, 1974.

    Hankinson R

    New York, United Nations, 1984 Jun. vi, 52 p. (POPIN Bulletin No. 5 ISEA/POPIN/5)

    A summary of developments in the population information field during the decade 1974-84 is presented. Progress has been made in improving population services that are available to world users. "Population Index" and direct access to computerized on-line services and POPLINE printouts are available in the US and 13 other countries through a cooperating network of institutions. POPLINE services are also available free of charge to requestors from developing countries. Regional Bibliographic efforts are DOCPAL for Latin America. PIDSA for Africa, ADOPT and EBIS/PROFILE. Much of the funding and support for population information activities comes from 4 major sources: 1) UN Fund for Population Activities (UNFPA): 2) US Agency for International Development (USAID); 3) International Development Research Centre (IRDC): and 4) the Government of Australia. There are important philosophical distinctions in the support provided by these sources. Duplication of effort is to be avoided. Many agencies need to develop an institutional memory. They are creating computerized data bases on funded projects. The creation of these data bases is a major priority for regional population information services that serve developing countries. Costs of developing these information services are prohibitive; however, it is important to see them in their proper perspective. Many governments are reluctant to commit funds for these activites. Common standards should be adopted for population information. Knowledge and use of available services should be increased. The importance os back-up services is apparent. Hard-copy reproductions of items in data bases should be included. This report is primarily descriptive rather than evaluative. However, given the increase in population distribution and changes in government attitudes over the importance of population matters, the main tasks for the next decade should be to build on these foundations; to insure effective and efficient use of services; to share experience and knowledge through POPIN and other networks; and to demonstrate to governments the valuable role of information programs in developing national population programs.
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  12. 12

    Estimates and projections of infant mortality rates.

    Bucht B; Chamie J

    [Unpublished] 1982. Presented at the 51st Annual Meeting of the Population Association of America, San Diego, California, April 29-May l, 1982. 35 p.

    The purpose of this paper was to consider the estimates and projections produced by the UN Population Division about infant mortality (IM) worldwide between 1950-2025. 46 countries were selected and estimates of IM were based on registered data on births and infant death. The data in developed countries posed few problems and thus IM estimates are considered to be accurate. In developing countries where vital registration is complete and where no independent sources of information are available to check completeness, registered data were used. Where adequate registration statistics were lacking, other sources of data had to be used to estimate IM. For other countries data relevant to IM were nonexistent. Direct and indirect methods have been used to estimate these rates. The direct method is characterized by measures of births and infant deaths during a given period of time; the primary indirect method transforms the proportions of children dead by age of mother into probabilities of dying before a given age. Projections of IM in the UN Infant Mortality Project (UNIMR) were based on the overall methods of mortality projections prepared at the UN Population Division. To prepare mortality projections, an estimate of life expectancy at birth is established for a given date and then assumptions are made concerning future trends. IM rates have declined dramatically; for the less developed regions it declined from 164 to 100/1000. The most rapid mortality decline was seen in East Asia. The Soviet Union had the most rapid decline among the developed nations. Projections presuppose that the 1980 ranking of countries will be maintained in the future; the likelihood, however, is that the regions will be markedly different by 2000. 5 examples are presented relevant to the substantive and methodological issues encountered in the UNIMR Project. These included: Sweden, Turkey, Tunisia, Bahrain, and Swaziland, Togo, and Kenya. Results clearly indicate that impressive declines have occurred since 1950 and these are likely to continue into the future. However, IM will remain high in certain less developed countries unless greater effort is expended in these areas to bring the rate down to 50/1000 by 2000. From a methodological perspective, the results of this project emphasize base data. Good data clearly result in more accurate estimates. Future research should examine these results and more attention should be paid to past declines in overall mortality. Also, analyses for some past trends in IM are necessary.
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  13. 13

    Estimates and projections of the number of households by country, 1975-2000 based on the 1973 assessment of population estimates and projections.

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

    New York, UN, 1981 May 15. 76 p. (ESA/P/WP.73)

    The household estimates and projections presented in this report cover the period 1975-2000 and use the population estimates as assessed in 1978. The purpose of these household estimates is to respond to the need for demographic projections in terms of individual traits such as sex, age, labor force status, occupation, and urban-rural residential status and in terms of group characteristics such as the family and household composition. Families and households form the primary unit where individuals are socialized and interact with each other, and, consequently, can be considered as the molecular units of a population. The objectives of this report are to apply existing projections methods to available data, discuss the major problems encountered in their application, especially with regard to the estimation and projection of headship rates, and present the results. The detailed results are presented in tables and provide the total number of households, their annual rates of growth, and average household size by area, region, and country for each 5-year period between 1975 and 2000 according to medium, high, low, and constant variants. During the next 2 decades, it is expected that the number of households in the world will increase at a faster rate than the world's population. The total number of households of the world, which is estimated to have been about 909 million in 1975, is projected to increase by another 775 million (85%), reaching 1684 million by the turn of the century (medium variant). The range of the low and high variants is 1622 and 1754 million, respectively. The average household size for the world population is projected to decline from 4.4 persons in 1975 to 3.7 persons in the year 2000, reflecting the expected future fertility declines and the assumed increases in headship rates. The relatively rapid increases of households projected for the less developed regions is largely due to their high rates of population growth and to expected changes in headship rates. Among the 8 major areas of the world, the rate of increase in the number of households will be the highest in Africa and Latin America. The lowest average annual growth is expected in Europe.
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  14. 14

    Population policy briefs: current situation in developed countries, 1980.

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

    New York, UN, 1981 Jan 26. 41 p. (ESA/P/WP.72)

    The attempt is made to present on a systematic basis a brief summary of governments' current perceptions and policies in relation to population growth, fertility, international migration, and spatial distribution. The assessment, which covers 35 Member States and Non-Member States of the United Nations considered to be developed, is of September 1980. The information included in this document is based on the replies to the 3rd and 4th Population Inquiry Among Governments, material contained in the Population Policy Data Bank of the Population Division, and national development plans and publications of various organizations. The 35 countries assesed are the following: Albania; Australia; Austria; Belgium; Bulgaria; Byelorussian Soviet Socialist Republic; Canada; Czechoslovakia; Denmark; Finland; France; German Democratic Republic; Federal Republic of Germany; Greece; Hungary; Iceland; Ireland; Italy; Japan; Luxembourg; Malta; Netherlands; New Zealand; Norway; Poland; Portugal; Romania; Spain; Sweden; Switzerland; Ukrainian Soviet Socialist Republic; Union of Soviet Socialist Republics; United Kingdom; United States of America; and Yugoslavia.
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  15. 15

    Report on monitoring of population policies: addendum. [Tables]

    United Nations. Economic and Social Council. Population Commission

    New York, UN, 1979 Mar 16. 167 p. (E/CN.9/XX/CRP.2/Add.1)

    A series of descriptive tables, prepared by the United Nation's Population Commission, on the population policies of member states as of July 1978 was provided. The tables provided information on government perceptions and policies in regard to their country's population growth, average life expectancy, fertility rate, population distribution, and emigration and immigration rates. The information was collected in accordance with the recommendation of the 1974 World Population Conference that the United Nations should periodically monitor the population policies of member states. Data was provided for individual nations but the data was also aggregated by development status and by geographical regions. In regard to population growth information was provided on 1) the degree to which governments perceived their country's rate of natural increase as having a positive or negative impact on development; 2) the degree to which governments believed it was appropriate to intervene to alter the rate of natural increase; 3) specific policies selected by the governments to alter the rate of natural increase; and 4) changes in governments' perceptions of the acceptability of their rate of natural increase between 1976 and 1978. Other tables provided information on 1) governments perceptions of the acceptability of their country's current average life expectancy, fertility rate, population distribution, and immigration and emigration rates; 2) governments' policies in regard to providing effective contraception and making contraceptives available; 3) the relationship between fertility and population growth policies; and 4) government policies with respect to immigration and emigration.
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  16. 16

    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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