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Poverty in Focus. 2007 Oct; (12):6-7.Two years ago at Gleneagles, the G8 countries promised to double their aid to Africa. Since then, they have written off a substantial part of the external debt to the largest and oil-richest country, Nigeria. But new aid to the continent has stayed flat. In 2006, while Europe increased its aid, the two largest G8 economies, USA and Japan, reduced theirs. Africa, quite rightly, commands the growing attention of donors. But aid amount targets, both for Africa and globally, are often missed. Does that matter? This article makes four propositions: (i) traditional aid amount targeting is following a false scent in development terms; (ii) supply-driven aid has questionable value; (iii) aid should be more concerned with genuine country-based development goals; and (iv) rich countries should use aid as a means of facilitation, not as patronage. Targeting aid amounts is nothing new. In 1970, the UN set the target of 0.7 per cent of rich countries' Gross National Product (GNP) for Official Development Assistance (ODA). Since then a growing number of donor countries have stated their intention to reach it. The main purpose for setting such targets for aid is to create and sustain a momentum for ODA. While most donors haven't met the target, many have agreed that they should increase assistance to the poor countries. For the politicians of the rich countries and their constituents, therefore, aid volume targeting plays a useful role in reminding governments of their obligations. The two largest donors, however-USA and Japan-are exceptions. (excerpt)
Bulletin of the World Health Organization. 2007 Mar; 85(3):192-199.International health policy-makers now have a variety of institutional instruments with which to pursue their global and national health goals. These instruments range from the established formal multilateral organizations of the United Nations to the newer restricted-membership institutions of the Group of Eight (G8). To decide where best to deploy scarce resources, we must systematically examine the G8's contributions to global health governance. This assessment explores the contributions made by multilateral institutions such as the World Health Organization, and whether Member States comply with their commitments. We assessed whether G8 health governance assists its member governments in managing domestic politics and policy, in defining dominant normative directions, in developing and complying with collective commitments and in developing new G8-centred institutions. We found that the G8's performance improved substantially during the past decade. The G8 Member States function equally well, and each is able to combat diseases. Compliance varied among G8 Member States with respect to their health commitments, and there is scope for improvement. G8 leaders should better define their health commitments and set a one-year deadline for their delivery. In addition, Member States must seek WHO's support and set up an institution for G8 health ministers. (author's)
World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women.
American Journal of Obstetrics and Gynecology. 2006 Mar; 194(3):639-649.The purpose of this trial was to determine whether calcium supplementation of pregnant women with low calcium intake reduces preeclampsia and preterm delivery. Randomized placebo-controlled, double-blinded trial in nulliparous normotensive women from populations with dietary calcium !600 mg/d. Women who were recruited before gestational week 20 received supplements (1.5 g calcium/d or placebo) throughout pregnancy. Primary outcomes were preeclampsia and preterm delivery; secondary outcomes focused on severe morbidity and maternal and neonatal mortality rates. The groups comprised 8325 women who were assigned randomly. Both groups had similar gestational ages, demographic characteristics, and blood pressure levels at entry. Compliance were both 85% and follow-up losses (calcium, 3.4%; placebo, 3.7%). Calcium supplementation was associated with a non-statistically significant small reduction in preeclampsia (4.1% vs 4.5%) that was evident by 35 weeks of gestation (1.2% vs 2.8%; P = .04). Eclampsia (risk ratio, 0.68: 95% CI, 0.48-0.97) and severe gestational hypertension (risk ratio, 0.71; 95% CI, 0.61-0.82) were significantly lower in the calcium group. Overall, there was a reduction in the severe preeclamptic complications index (risk ratio, 0.76; 95% CI, 0.66-0.89; life-table analysis, log rank test; P = .04). The severe maternal morbidity and mortality index was also reduced in the supplementation group (risk ratio, 0.80; 95% CI, 0.70-0.91). Preterm delivery (the neonatal primary outcome) and early preterm delivery tended to be reduced among women who were %20 years of age (risk ratio, 0.82; 95% CI, 0.67-1.01; risk ratio, 0.64; 95% CI, 0.42-0.98, respectively). The neonatal mortality rate was lower (risk ratio, 0.70; 95% CI, 0.56-0.88) in the calcium group. A 1.5-g calcium/day supplement did not prevent preeclampsia but did reduce its severity, maternal morbidity, and neonatal mortality, albeit these were secondary outcomes. (author's)
Lancet. 2005 Aug 13; 366(9485):603-605.In September, 2005, a summit of world leaders in New York, USA, will review progress towards the Millennium Development Goals. Three of the eight goals are explicitly health-related: to reduce child mortality by two-thirds between 1990 and 2015, to reduce maternal mortality by three-quarters, and to control HIV, tuberculosis, and malaria. A lack of progress by April, 2001, led Kofi Annan, the United Nations Secretary General, to establish a Global Fund to increase health investment, especially in Africa and Asia. The fund’s focus was control of HIV, tuberculosis, and malaria, which are diseases that kill more than 6 million people every year. To date, the Global Fund for AIDS, tuberculosis, and malaria has committed US$3 billion in 128 countries to support aggressive interventions against the three diseases. Nearly 11 million children and more than 0.5 million mothers die every year, yet progress towards mortality reduction targets has been poor despite the availability of cost-effective and scalable interventions. Investment in maternal and child health programmes has lagged far behind those for AIDS, tuberculosis, and malaria. The investment gap between what is needed and what is spent is large. Mothers and children, not for the first time, have lost out. Here, we put the case for a new Global Fund to reduce maternal, neonatal, and child mortality. (excerpt)
Lancet. 2005 Aug 13; 366:522.The Global Fund to fight AIDS, Tuberculosis and Malaria is in the middle of a public relations offensive. Since June this year, the Fund has been championing a campaign of public awareness to help build confidence in its activities by showing people around the world that “their country’s aid money saves lives”. It already seems to be working. Last week, the UK Department for International Development announced that it was doubling its yearly contribution to the Fund to £100 million for 2005 and 2006. And several donor governments, including the UK, answered the Fund’s plea to hastily fulfill all 2005 commitments by the end of July this year to trigger a full payment of US$435 million from the USA, which, by law, cannot pledge more than 33% of the total held in the Fund’s trustee account on July 31 each year. Despite the recent financial boost, the Fund is still anticipating a funding shortfall of US$700 million. Why is the Fund struggling to gain the credibility that will ensure financial security? (excerpt)
Programming for male involvement in reproductive health. Report of the meeting of WHO Regional Advisors in Reproductive Health, WHO / PAHO, Washington DC, USA, 5-7 September 2001.
Geneva, Switzerland, WHO, 2002.  p. (WHO/FCH/RHR/02.3)Research has shed some light on the gaps in our knowledge of reproductive health issues as they relate to men, but we have little information about programmatic issues and how such research could improve programme operation and service delivery. WHO Country Offices are often consulted by programme managers and policy-makers for advice on strategies for including men in the delivery of reproductive health services. It was proposed that the meeting of WHO Regional Advisers and Directors of Reproductive Health for 2001 focus on the design, success stories, lessons learned and research recommendations for programmes that aim to include men in reproductive health. Regional experiences, case studies, systematic reviews, research highlights and model projects representing a variety of regions were presented at the meeting by a select group of experts working in the field, Regional Offices, collaborating agencies, programme managers, and researcher institutions. Among these were several experts and individuals who had participated in RHR-funded studies at the global or the regional 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)
International Journal of Gynecology and Obstetrics. 2003 Sep; 82(3):357-367.The International Federation of Gynecology and Obstetrics – FIGO – has been striving hard to carefully attend to women’s well-being, and respect and implement their rights, the status and their health, which is well beyond the basic obstetric and gynecological requirement. FIGO is deeply involved in acting as a catalyst for the all-round activities of national obstetric and gynecologic societies to mobilise their members to participate in and contribute to, all of their endeavours. FIGO’s committees strengthen these objectives and FIGO’s alliance with WHO provides a springboard. The task is gigantic, but FIGO, through national obstetric and gynecological societies and with the strength of obstetricians and gynecologists as its battalion, can offer to combat and meet the demands. (author's)
Geneva, Switzerland, UNAIDS, 1998 May. 8 p. (UNAIDS Best Practice Collection)Military personnel are a population group at special risk of exposure to sexually transmitted diseases (STDs), including HIV. In peace time, STD infection rates among armed forces are generally 2 to 5 times higher than in civilian populations; in time of conflict the difference can be 50 times higher or more. Paradoxically -- and fortunately -- strong traditions of organization and discipline give the military significant advantages if they move decisively against HIV/AIDS. (excerpt)
Public Health Nutrition. 2003 Jun; 6(4):323-325.This report and the subsequent commitment to a global strategy are extremely important for those of us working in Public Health Nutrition. They provide an important opportunity to promote the benefits of an evidence-based approach to solving major public health problems and raise the profile of nutrition. I have asked Este Vorster and Tim Lang to start off a discussion about the expert report. I look forward to other comments from readers. (excerpt)
POPLINE. 2003 May-Jun; 25:1, 2.If we are serious about a more equitable balance between population, environment and resources, Fornos said, " the industrialized world must commit itself to the provision of the necessary population assistance to the developing world." He stressed that solving the problem of rapid population growth is "a burden sharing exercise, with all of us - governments, multilateral agencies, the private sector, non-governmental organizations - working together for the common goal of improving the human condition." Fornos pointed out that throughout the world forests are declining, topsoil is eroding, deserts are expanding, temperatures are rising, and there remains the constant threat of unprecedented food and water shortages. (excerpt)
Human development report 2003. Millennium Development Goals: a compact among nations to end human poverty.
New York, New York, Oxford University Press, 2003. xv, 367 p.The central part of this Report is devoted to assessing where the greatest problems are, analysing what needs to be done to reverse these setbacks and offering concrete proposals on how to accelerate progress everywhere towards achieving all the Goals. In doing so, it provides a persuasive argument for why, even in the poorest countries, there is still hope that the Goals can be met. But though the Goals provide a new framework for development that demands results and increases accountability, they are not a programmatic instrument. The political will and good policy ideas underpinning any attempt to meet the Goals can work only if they are translated into nationally owned, nationally driven development strategies guided by sound science, good economics and transparent, accountable governance. That is why this Report also sets out a Millennium Development Compact. Building on the commitment that world leaders made at the 2002 Monterrey Conference on Financing for Development to forge a “new partnership between developed and developing countries”—a partnership aimed squarely at implementing the Millennium Declaration—the Compact provides a broad framework for how national development strategies and international support from donors, international agencies and others can be both better aligned and commensurate with the scale of the challenge of the Goals. And the Compact puts responsibilities squarely on both sides: requiring bold reforms from poor countries and obliging donor countries to step forward and support those efforts. (excerpt)
Journal of Viral Hepatitis. 2003 May; 10(3):157-158.Though a potent vaccine represents a powerful preventive tool, the policy of its use is governed by epidemiological and economical factors. Hepatitis A, an enterically trasmitted disease shows distinct association with socio-economic status, populations with improvement experiencing lower exposure to the virus. With the availability of vaccine, it is pertinent to consider its use in the effective control of the disease. However, with the varied epidemiological patterns and economical constraints in different countries it does not seem to be possible to evolve universal policy for immunization. Though, universal immunization may be the most effective way of control, the same is not practical for many countries. It is proposed that irrespective of endemicity of hepatitis A, high-risk groups such as travelers to endemic areas, patients suffering from chronic liver diseases, HBV and HCV carriers, tribal communities with high HBV carrier rates, food handlers, sewage workers, recipients of blood products, troops, and children from day-care centers should be immunized with hepatitis A vaccine. In addition, for populations with intermediate prevalence, infants, children from affordable families may be immunized. As coupling the vaccine with EPI schedule would be beneficial, use of combined A & B or A, B & E vaccine may be an attractive alternative. (author's)
Geneva, Switzerland, WHO, 1985. 101 p. (WHO/CDD/85.13)The Diarrheal Diseases Control (CDD) Program, initiated in 1978, is a priority program of WHO for attainment of the goal of Health for All by the Year 2000. Its primary objectives are to reduce diarrheal disease mortality and morbidity, particularly in infants and young children. This report describes the activities undertaken by the Program in the 1983-1984 biennium. During this period, the Program collaborated with more than 100 countries in the implementation of national diarrheal disease control and research activities. The biennium has witnessed a growing interest of other international, bilateral, and nongovernmental agencies in diarrheal disease control; their financial support and commitment have contributed in a large measure to furthering the development of CDD programs and related research in many countries. During the biennium, the services component continued to expand both the quantity and scope of its activities at global, regional, and national levels. This is readily seen from the increase in global acess to Oral Rehydration Salts (ORS) packets from less than 5% in 1981 to 21% in 1983. Other significant developments were a substantial increase in the number of countries planning and implementing programs and the initiation of a new management course in supervisory skills. Successful implementation of national primary health care systems was recognized as necessary for the achievement of the Program's objectives. Efforts of both developing and industrialized countries must continue in a joint endeavor to reduce the problem of diarrheal diseases, especially cholera, the most severe diarrheal disease. The following areas are discussed: the health services component; the research component; information services; program review bodies; program resources and obligations; and program publications and documents for 1983-1984.
Equilibres et Populations. 2001 May; (68):3.Poverty facilitates the development of disease, but at the same time, by attacking developing countries’ active populations, disease frustrates countries’ capacity to organize and produce. AIDS’ devastating effects upon poor countries threatens the development process. On the heels of the UN Conference on Underdeveloped Countries, UNFPA and IPPF dedicated a day to explore the links between AIDS and poverty. Following the notion that AIDS should lie at the core of all development aid policies, a new global fund against AIDS and infectious diseases has been developed. It will be administered by an independent council comprised of representatives from donor and recipient countries, the UN, nongovernmental organizations, and the private sector. The fund’s resources will be used to implement recipient country strategies, based upon needs in the field and already existing capacities. The private sector and the pharmaceutical industry have very important, yet still undefined roles. Efforts must certainly be made to enable developing countries to develop or build, together with their healthcare system infrastructure, pharmaceutical supply policies together with the World Health Organization, major industry groups, and international partners. Prior to mobilizing fund resources, agreements will have to be worked out with the pharmaceutical industry, while diversifying product demand concerns and implementing a differential pricing system.
GHANA OFFICIAL NEWS BULLETIN. 1997 May 1-31; 2(8):6.In a message attached to the World Health Organization's (WHO) 1997 report, WHO Director-General Dr. Hiroshi Nakajima argued that developing countries must stop trying to handle infectious diseases and chronic diseases sequentially. Rather, they must address them simultaneously with help from the international community. At the same time, developed countries cannot focus solely upon chronic diseases and ignore the dangers of infectious diseases, for the latter will return to developed countries should they be ignored. The world should expect a global increase in the level of premature morbidity from chronic diseases due to prevailing socioeconomic circumstances, including unhealthy lifestyles, labor-saving technologies, unsatisfactory diets, and misleading information about consumer products. While most infectious diseases are preventable, they are not yet curable.
VOX SANGUINIS. 1994; 67(4):377-81.As part of an effort to monitor the safety of global blood transfusion services, the World Health Organization circulates a questionnaire for use in a database on blood safety. In 1992, 67% of countries responding to the survey (100% of developed, 66% of developing, and 46% of less developed countries) were screening all blood donations for HIV antibodies and 87% of these countries (100% of developed, 92% of developing, and 63% of less developed countries) carried out supplementary testing to confirm positive results. All developed countries, 72% of developing, and 35% of less developed countries screen blood for hepatitis B surface antigen and 94%, 71%, and 48%, respectively, screen for syphilis. The primary reasons for inadequate blood testing are the cost of test kits and reagents and the unreliability of supplies. The proportion of safe donors is highest in systems where all donors are voluntary and nonremunerated--conditions that exist in 85% of developed countries but only 15% of developing and 7% of less developed countries. Blood safety would also be improved by more appropriate use of transfusions and the provision of alternatives such as saline and colloids. Other problems include insufficient blood supply (e.g., none of the less developed and only 9% of developing countries collect 30 units or more per 1000 population per year) and inadequate quality assurance in all aspects of preparatory testing.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1993; 71(5):633-9.Public health programs and activities are based on surveillance. The WHO Expanded Programme on Immunization (EPI) has designed and used different surveillance methods to improve disease control. It uses various methods of data collection. Routine reporting includes immunization coverage and cases of EPI target diseases (measles, neonatal tetanus, and poliomyelitis). Surveillance through sentinel sites and community-based reporting are other methods of data collection. Immunization programs should like their ongoing surveillance data with data supervision of immunization practices, health facility assessments, population surveys, and outbreak investigations. Program managers and other public health decision makers should use surveillance data to determine public health priorities, to decide on appropriate immunization schedules and strategies, to target populations at high risk, to implement immunization programs, and to evaluate program effectiveness. The US Centers for Disease Control have developed guidelines for evaluating surveillance systems. Surveillance system evaluations should examine the degree to which public health officials use data for policy-making and program improvement. They should also consider the timeliness, completeness, simplicity, accuracy, and cost of surveillance data. Public health decision makers should strengthen existing routine systems for surveillance of infectious diseases instead of instituting parallel systems for EPI target diseases. The district level should manage these systems. Countries with immunization coverage of infants greater than 80% should concentrate on areas and population groups with increased risk of disease. This high-risk approach is needed to eradicate the wild poliovirus. EPI's goals of reducing measles cases by 90%, eliminating neonatal tetanus, and eradicating poliomyelitis offer countries an opportunity to allocate resources to improve disease surveillance so as to achieve an effective disease surveillance system.
WORLD HEALTH. 1993 Jul-Aug; 46(4):3.The Director-General of WHO informs us that tuberculosis (TB) is responsible for 3 million deaths annually. TB is the major cause of death from 1 pathogen, making up about 25% of preventable adult deaths. Immediate action will save 30 million lives in the coming decade. In many areas of the world, TB is out of control. Most TB cases and more than 95% of TB deaths take place in developing countries. The number of TB cases in Europe and North America has increased considerably since the late 1980s. These countries cannot control TB unless developing countries greatly reduce TB as a health threat. TB takes on 8 million new victims each year. It is associated with AIDS. Persons infected with both HIV and TB are at a 25-fold increased risk of progressing to potentially fatal disease. Even though there are cost-effective tools to prevent and treat TB, they are not being used to their full potential. 6-8 months of consistent, uninterrupted heavy drug therapy is required for success. Some bacteria are becoming resistant to TB drugs because resources are not dedicated to making sure patients complete treatment. Curing infections as soon as possible stops TB transmission. TB control programs should include a health education component to increase the awareness of the need to complete TB drug therapy. It should also administer BCG vaccination to infants to prevent serious childhood TB. Political leaders need to restart weak or now defunct national TB control programs. WHO is working with governments in developing countries to implement effective TB treatment and prevention programs. Governments, public health officials, communities and the private sector need to unite to begin an immediate and extensive response to the global emergency of TB.
WORLD HEALTH. 1993 Mar-Apr; 46(2):17-9.The live, oral polio vaccine, introduced in the 196-s, has essentially eliminated poliomyelitis from the US, Canada, Europe, and the industrialized countries of the Pacific. WHO's Expanded Programme on Immunization (EPI) aims to eradicate poliomyelitis. Many people believe that polio is no longer a problem, however, paralytic polio is quite common in Africa. In 1991 and 1992, outbreaks occurred in polio free countries: Bulgaria, the Netherlands, and Jordan, reminding us that polio continues to be risk to all countries. EPI's universal childhood immunization initiative achieved a poliomyelitis vaccination coverage if 84% of children born in 1990. Thus, in 1991, there were just 127,000 paralytic poliomyelitis cases. Nevertheless, 1 case of poliomyelitis is undesirable. Eradication requires disease surveillance to rapidly detect every case and then immunization of people in the highest risk areas to stop transmission of the virus. Eradication of poliomyelitis will save more than US $100 million each year in the US for elimination of the need for vaccine purchases and for medical care. The last case of wild poliovirus-induced poliomyelitis in the Western Hemisphere was in August 1991, thanks to the eradication initiative strategies developed by the WHO Region of the Americas. UNICEF, USAID, and Rotary International are leaders of this Americas initiative for eradication of poliomyelitis. Between 1989 and 1991, eradication strategies have reduced reported polio cases by 58% in China. Polio-free zones exist in North Africa, southern and eastern Africa, the Middle East, Europe, and the Pacific Rim. India, Pakistan, and Bangladesh are a significant polio reservoir (they account for 66% of global cases). Major obstacles to the global eradication initiative in Europe, Asia, and Africa are war and political instability. Most of the funding for logistical support of the initiative comes from in-country resources, yet, lack of political will remains the major obstacle for the initiative.
WORLD HEALTH. 1993 Mar-Apr; 46(2):4-6.A 1990 meeting of vaccine research and application specialists ended in the Declaration of New York stating that current science can be used to develop vaccines which can be administered earlier in life, requiring 1-2 doses instead of many doses, and in the form of cocktails of several vaccines; maintain their potency in warm temperatures; and are affordable. In 1991, WHO, UN Development Programme, UNICEF, the World Bank, and the Rockefeller Foundation established the Children's Vaccine Initiative (CVI). Its main goal is 1 oral immunization to be administered shortly after delivery to protect all babies against all major childhood diseases. CVI also aims to streamline the provision of an adequate supply of affordable, safe, and effective vaccines; to expedite the development and production of new and improved vaccines; and to simplify the complex logistics of vaccine delivery. As of spring 1993, CVI partners have created an organizational structure to guide and manage CVI activities, begun a strategic planning process, and developed a heat-stable poliomyelitis vaccine and a single-dose tetanus toxoid vaccine. CVI consists of a Secretariat, a Consultative Group, a Management Advisory Committee, a Standing Committee, and Product Development Groups. Many specialists are currently working to advance strategic planning, biotechnology, immunology, epidemiology, vaccine supply, quality control, regulatory matters, licensing, patents, and financial and legal issues. The high cost of research and development through more and more sophisticated technologies (e.g., genetic engineering), high insurance premiums to obtain liability coverage, and limited companies doing research and development, possibly resulting in price-setting, contribute to the rising costs of vaccine development and production, posing a considerable obstacle for CVI. International vaccine producers have proposed a 2-tier price structure: a market price for developed countries and an affordable price for developing countries. The private sector awaits means to match corporate profits with public health goals before participating fully in CVI.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1993; 71(3-4):421-8.Worldwide coverage of measles vaccine is about 80%, but many communities and countries have considerably lower coverage rates. WHO is concerned about measles occurring in infants between 6 and 12 months old, especially in densely populated African cities. Measles rarely occurs in infants under 6 months old, but the measles case fatality rate is greatest in the 1st year of life. WHO aims for an effective measles vaccine to be administered at 6 months old. A high titer vaccine appears to reduce survival among children receiving it. Some countries have reduced measles incidence by as much as 90% by achieving coverage levels greater than 90% with a single dose measles vaccine. Another method to prevent early measles cases and later vaccine failures is administration of the 1st dose around 6 months and a 2nd dose no earlier than 12 months. Measles vaccine policy in the US and some countries in Europe is routine 2-dose measles schedules: 1st dose between 12-19 months and 2nd dose at school entry. This schedule is appropriate in developed countries with good immunization coverage. Other countries schedule the 1st dose anywhere between 6-9 months and the 2nd dose between 12 months and 7 years. All mathematical models of the effects of 2-dose schedules indicate that 2-dose schedule are a great benefit. The literature shows that developing countries with high immunization coverage and well-managed immunization programs can effectively execute and sustain 2-dose measles schedules. Measles vaccination early in life sometimes results in a blunted antibody response. The 2-dose schedules are probably more expensive than 1-dose schedules and require more cold storage space. No field trials have looked at clinical efficacy of 2-dose measles schedules in developing countries. Ideal field trials would be randomized controlled trials. Demonstration projects can evaluate operational issues, e.g., dropout rates, cost, and vaccine usage. Case control studies can address technical and epidemiological issues.
CENTRAL AFRICAN JOURNAL OF MEDICINE. 1992 Jul; 38(7):314-5.Participants at a 1992 WHO/UNICEF consultation meeting on HIV transmission and breast feeding weigh the risk of death from AIDS with the risk of death from other causes. Breast feeding reduces the risk of death from diarrhea, pneumonia, and other infections. Artificial or inappropriate feeding contributes the most to the more than 3 million annual childhood deaths from diarrhea. The rising prevalence of HIV infection among women worldwide results in more and more cases of HIV-infected newborns. About 33% of infants born to HIV-infected. Some HIV transmission occurs through breast feeding, but breast feeding does not transmit HIV to most infants HIV-infected mothers. Participants recommend that, in areas where infectious diseases and malnutrition are the leading causes of death and infant mortality is high, health workers should advise all pregnant women, regardless of their HIV status, to breast feed. The infant's risk of HIV infection via breast milk tends to be lower than its risk of death from other causes and from not being breast fed. HIV-infected women who do have access to alternative feeding should talk to their health care providers to learn how to feed their infants safely. In areas where the leading cause of death is not infectious disease and infant mortality is low, participants recommend that health workers advise HIV-infected pregnant women to use a safe feeding alternative, e.g., bottle feeding. Yet, the women and their providers should not be influenced by commercial pressures to choose an alternative feeding method. Health care services in these areas should provide voluntary and confidential HIV testing and counseling. Participants stress the need to prevent women from becoming HIV-infected by providing them information about AIDS and how to protect themselves, increasing their participation in decision-making in sexual relationships, and improving their status in society.
AMERICAN REVIEW OF RESPIRATORY DISEASE. 1992 Oct; 146(4):818-22.In May 1990 in Boston, Massachusetts, in the US, American Thoracic Society, the American Lung Association, and the International Union Against Tuberculosis and Lung Disease hosted the World Conference on Lung Health. At the end of the conference, participants adopted several resolutions calling on WHO and governmental and nongovernmental organizations to take specific actions to prevent and control lung diseases. The Conference adopted 7 resolutions pertaining to tuberculosis (TB) and AIDS, such as governments must ensure high quality care for TB and AIDS patients and strengthen TB and AIDS prevention programs. Since acute respiratory infections (ATIs), the leading cause of death in children, cause considerable suffering and death in children, the Conference asked WHO and government and nongovernment organizations to increase funding for provision, cold storage, and distribution of vaccines in developing countries, and for training care workers, and for programs to help parents recognize the signs and symptoms requiring medical attention. Other ARI-related resolutions included education about the risk and prevention of indoor air pollution and increased funding for research to develop heat-stable vaccines. Resolutions related to air pollution and health embraced tighter controls of emission of air pollutants, development of policies to protect indoor air, and more research into the hazards of indoor and outdoor air pollution. More research and gathering of accurate data on deaths and illness due to asthma were among resolutions related to asthma. Resolutions on smoking included a call for the end of all governmental support for the tobacco industry, including the import and export of tobacco products, and of all advertisements and promotions of tobacco products; for nonsmoking policies in all public places, especially health care facilities and schools; and for health workers to be societal role models by not smoking.
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.
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 email@example.com.