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Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: a WHO study.
ARCHIVES OF CLINICAL NEUROPSYCHOLOGY. 1993 Mar-Apr; 8(2):123-35.In preparation for a World Health Organizations (WHO) study of human immunodeficiency virus-1-associated neurological and psychiatric disorders in a variety of geographic and sociocultural settings, 2 new tests of neuropsychological performance were evaluated. The goal was to identify instruments that are not only able to tap the primary functional domains affected in symptomatic HIV-1 cases but also suitable for cross-cultural use. The WHO/UCLA Auditory Verbal Learning Test (AVLT) presents subjects with a list of words with universal familiarity drawn from 5 categories (body parts, animals, tools, household objects, and vehicles), while Color Trails 1 and 2 is based on the use of numbered colored circles and universal sign language symbols. These instruments represent modifications of the previously utilized Rey AVLT and Trail Making A and B tests. Both the new instruments and the reference tests were administered to healthy or HIV-infected volunteers in 2 developed country settings (Germany and Italy) and 2 developing country sites (Thailand and Zaire). There was a significant correlation between scores on each new test and those on the reference tests, indicating that the new instruments tap the same functional domains. The variance of the z-transformed scores from test site to site was reduced for the WHO/UCLA AVLT compared to the Rey AVLT and for the Color Trails 2 compared to the Trail Making B, suggesting that the new tests are more culture-fair than their predecessors. Finally, the percentage of impaired subjects identified through the new tests was significantly higher among seropositive than seronegative subjects, indicating that these instruments are indeed sensitive to HIV-21 associated cognitive damage across different cultures.
New York, New York, United Nations, 1992. vii, 46 p. (ST/ESA/SER.A/127)Methods pertaining to the preparation of migration data for subnational population projections as of 1992 are explained. A brief review of sources of data for migration projections (censuses, surveys, and registration data) reveals that the requirements are base period estimates of the level or rate of migration between regions, estimates of the age and sex distribution of migrants, and any indicators that show likely future trends. In a discussion of the measurement of the volume of migration from census date, data on residence at a fixed prior time, estimates based on previous place of residence and duration of residence, and estimates of net migration of census survival/ratio methods are relevant. Estimates of the distribution of migrants by age and sex are explained based on different age and sex data: on place of residence at a fixed prior date, on place of previous residence and duration of residence, on age distributions from surveys, and from registers. Also explained is the use of model migration schedules when there is little or no information about age. Baseline migration projections for future estimates which are reasonable and account for variable rates of migration by region are discussed. The objectives desired are sometimes contradictory in that using a long time frame in order to average out random or abnormal fluctuations conflicts with continuing recent nonrandom or unusual changes so that emergent trends will be projected; objectives are also to use the most recent data available which account for shifts in migration patterns and to ensure convergence of migration rates toward equilibrium at some future point. Alternative strategies are provided as well as adjustments to provide consistent results. Adjustments involve the projection of numbers of migrants rather than rates, the use of out-migrant data on destination to adjust in-migration, and the scaling of in-migration to equal out-migration. Recommendations for data collection are presented. Internal migration data are best served by census data which asks the question about place of residence at a fixed prior time preceding the census and with a time interval designation that is of interest for projections. Single year of age and prior year questions and 5 years before are desired due to the need for short-range projections and planning. The 5-year prior place of residence question must be available by current region of residence and age and sex. Specific examples of multiregional projections are included.
In: The impact of international migration on developing countries, edited by Reginald Appleyard. Paris, France, OECD Publications, 1989. 197-212. (Development Centre Seminars)During the last 20 years the brain drain issue has figured prominently in international negotiations on development questions. Because of its complexity and the implications of control on the freedom of individuals, international agreement regarding appropriate action to mitigate negative consequences for developing countries has been difficult to achieve. In particular, serious reservations have been expressed by some developed countries concerning redistribution schemes such as the International Labour Compensatory Facility. However, systematic consideration of the subject in different fora has permitted linkages between the brain drain and such related issues as population, employment, human rights, science and technology, and health. Complex technical, conceptual, and methodological aspects of the phenomenon, including the tools for its measurement, have also been explored. Intensive multilateral negotiations have led to better understanding and hence a more balanced and integrated approach to development aspects of brain drain. The great challenge is to find appropriate solutions for mitigating the negative effects of brain drain for developing countries which take into account the interests of all parties involved as well as the basic right of human beings to move freely.
WORLD HEALTH. 1988 Jan-Feb; 10-11.In 1979 WHO invited its member states to participate in a global strategy for health and to monitor and evaluate its effectiveness using a minimum of 12 indicators. Members' 1982 implementation reports and 1985 evaluation reports form the basis for evaluating each measure. Indicators 1-6 have strong political and economic components in both developed and developing countries and are not complete. Indicator 7, for which rates of reply are satisfactory, asks whether at least 5 elements of primary health care are available to the whole population. The 8th gauge seeks information on the nutritional status of children, considering birth weight (a possible indicator of risk) and weight for age (a monitor of growth). Infant mortality rate and life expectancy at birth, indicators 9 and 10, are difficult to estimate in developing countries, and health services are not always kept informed of current estimates. Indicator 11 asks whether the literacy rate exceeds 70%; it can provide information on level of development and should emphasize literacy for women, for whom health information is critical. The last global measure yields information about the gross national product, which is not always the most recent, despite the trend of countries to publish their gross domestic product. Failure to make use of the best national sources, such as this, is one of several problems encountered by WHO's member states in collecting accurate data. Other problems include lack of universally acceptable definitions, different national accounting systems, disinterest of health authorities in economic matters, lack of staff, lack of financial resources in developing countries, and inadequately structured health system management. Each country must choose the most appropriate methods for collection of data. If an indicator cannot be calculated, the country is encouraged to seek and devise a substitute. WHO must produce more precise and reliable indicators. It must respond to requests for ways of improving or strengthening national systems.
[Unpublished] 1986 Aug. 71,  p. (AID Contract No. DPE-3024-C-00-4063-00)The evaluation of the Resources for Awareness of Population in Development (RAPID II) Project was initiated on June 18, 1985, 25 months into the project operation, to determine if the results of actions undertaken thus far have been adequate to justify the time and money spent on them and to find ways to improve the efficiency and effectiveness of the program efforts. The objective of the 5-year RAPIDS II project is to assist those involved in development planning to better understand the relationship between population growth and socioeconomic development and thereby increase the less developed country (LDC) commitment to efforts designed to reduce rapid rates of population increase. This evaluation report discusses the development assistance context and then focuses on the following: RAPID II operations over the 1984-85 period; policy analyses and LDC subcontracting; the RAPID model and its presentation; visits by the evaluation team to the countries of the Dominican Republic, Ecuador, Cameroon, and Liberia; what works in terms of population policy development; some major problems and potential resolutions; and RAPID II activities over the 1985-88 period. US Agency for International Development (USAID) officials in Washington as well as in the field described RAPID II as being of continuing utility in helping to create a climate favorable to more effective population policies. The review of RAPID II activities was generally positive. The project was identified as useful in several countries of sub-Saharan Africa and Latin America. Due to the evidence of satisfactory performance in the field, the evaluation focused on differences between plan and midterm results with a view toward suggesting course corrections that can improve project performance. As population policy development is an inherently ambiguous field of activity, it has not been possible to draw clear lines between specific policy development activities and policy change in particular countries. Yet, there has been an improvement in the environment for population programs in LDCs. There were significant differences between planned and actual expenditures under the several subcategories of project expenditure. RAPID II total expenditures in the first 2 years of the project equalled budgeted expenditures when the contract was signed, but the distribution of expenditures by category was substantially different from what had been anticipated. It is recommended that emphasis in the project must shift predominantly to policy analyses (80% of remaining funds) and that that RAPID-style presentation resources (20%) be used carefully for only the highest priority requests. In regard to development of LDC subcontracts for policy analysis, efficiency has been low.
Population Today. 1986 Feb; 14(2):3, 8.The UN recently released its lastest population projection for 1985-2025. Although demographers remain uncertain about the future shape and rate of population growth, the UN figures are generally regarded as representing the state of the art in projection making. The UN makes medium, high, and low variant projections. According to the medium variant, the world population, in millions, will be 4,837 in 1985, 6,122 in 2000, 7,414 in 2015, and 8,206 in 2025. High and low variant projections, in millions, for 2025 are 9,088 and 7,358. The medium variant projection indicates that between 1985-2025 the population, in millions, will increase from 3,663-6,809 in the developing countries but only from 1,1754-1,396 in the developed countries. In other words, the proportion of the world's population residing in the developed countries will decrease from 24%-17% between 1985-2025. The world's growth rate will continue to decline as it has since it peaked at 2.1% in 1965-70. According to the medium variant, the projected growth rate for the world will be 1.63% between 1985-90, 1.58% between 1990-95, 1.38% between 2000-05, 1.18% between 2010-15, and 0.96 between 2020-25. The growth rate will decrease from 1.94%-1.10% for the developing countries and from 0.60%-0.29% for the developed countries between 1985-2025. The medium variant projections assume that the total fertility rate will decrease from 3.3 in 1985-90 to 2.8 in 2000-05 and to 2.4 in 2020-25. Respective figures are 3.7, 3.0, and 2.4 for the developing countries only and 2.0, 2.0, and 2.1 for the developed countries only. By 2025 the age structure of the developing countries is expected to be similar to the current age structure of the developed countries. In 2025, the 10 countries with the largest populations and their expected populations, in millions, will be China (1,475), India (1,229), USSR (368), Nigeria (338), US (312), Indonesia (273), Brazil (246), Bangladesh (219), Pakistan (210), and Mexico (154). The populations of some countries which are relatively small at the present time will be quite large in 2025. For example, the population, in millions, will be 111 for Ethiopia and 105 for Vietnam. The projections are summarized in 4 tables.
In: Methodological foundations for research on the determinants of health development, by World Health Organization [WHO]. [Geneva, Switzerland], WHO, Office of Research Promotion and Development, 1985. 1-7. (RPD/SOC/85)Health development planning is part of overall development planning and is influenced by the total development process. Those dealing with health planning may present the health sector's development as the most important aspect of development whereas there may be more urgent problems in other sectors. All socioeconomic plans aim at improving the quality of life. There is some correlation between spending on health programs and the health indices. The health indices are poor in countries which accord low priority to health. A table gives measure of health status by level of GNP/capita in selected countries. No direct correlation appears between income and mortality. This paper examines the functions of health development planning; health development plans; intersectoral collaboration; health information; strategy; financial aspects; implementation, evaluation and reprogramming; and manpower needs. A health development plan usually includes an analysis of the current situation; a review of the immediate past plan and previous plans; the objectives, strategy, targets and physical infrastructure of the plan; program philosophy with manpower requirements; financial implications; and the role of the private sector and nongovernment organizations and related constraints. The main health-related determinants include: education, increased school attendance, agriculture and water, food distribution and income, human resources programs and integrated rural development. The strategy of health sector development today is geared towards development of integrated health systems. Intercountry coordination may be improved with aid from the WHO. Health expenditures in countries including Bangladesh, India and Norway is presented.
The potential of national household survey programmes for monitoring and evaluating primary health care in developing countries. L'apport potentiel des enquetes nationales sur les menages a la surveillance et a l'evaluation des soins de sante primaires dans les pays en developpement.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(1):38-64.National programs of household sample surveys, such as those being encouraged through the National Household Survey Capability Program (NHSCP), are a principal source of information on primary health care in developing countries. Being representative of the total population, the major population subgroups and geographic subdivisions, they permit calculation of health status and utilization of health services. Household surveys have an important role to play in monitoring and evaluating primary health care since they sample directly the intended beneficiaries, and so can be used to judge the extent to which programs are meeting expected goals. Caution is necessary, however, since methodological problems have been experienced for many evaluation surveys. National surveys are especially appropriate for measuring many indicators of progress towards national goals within a broad socioeconomic perspective. Future directions in making the optimum use of household surveys for health program purposes are indicated. The NHSCP is a major undertaking of the UN system including WHO to collaborate with developing countries to establish a continuing flow of integrated statistics on a recurrent basis to support the national development process and information priorities. It brings together the principal users and producers of data to plan and conduct surveys which respond to national needs and priorities. The NHSCP encourages countries to employ a permanent national field organization for data collection. Areas of discussion are: the potential for monitoring and evaluation, the household survey as a source of health indicators, the demand for household surveys of health, followed by a summary of the health and health-related topics covered by 6 national health and nutrition surveys conducted in several developing countries. The special themes of infant and child mortality, morbidity and nutritional surveillance are also considered. The experience of many developed countries has been very positive with the use of nonmedically organized health surveys. Although the sample survey can be used in many settings to obtain population-based data, it must be carefully designed and implemented according to scientific procedures in order for the results to be validly extrapolated to the population or subgroups of primary concern.
Studies in Family Planning. 1984 Nov-Dec; 15(6/1):253-66.This paper critically analyzes claims for the effectiveness of the Billings method of natural family planning and raises questions about the wisdom of actively promoting this method. The Billings method, developed in Australia, is based on client interpretation of changing patterns of cervical mucus secretion. Evaluation of the method's use-effectiveness has been hindered by its supporters' insistence on distinguishing between method and user failures and by the unreliability of data on sexual activities. However, the findings in 5 large studies aimed at investigating the biological basis of the Billings method provide little support for the claims that most fertile women always experience mucus symptoms, that these symptoms precede ovulation by at least 5 days, and that a peak symptom coincides with the day of ovulation. Although many women do experience a changing pattern of mucus symptoms, these changes do not mark the fertile period with sufficient reliability to form the basis for a fully effective method of fertility control. In addition, the results of 5 major field trials indicate that the Billings method has a biological failure rate even higher than the symptothermal method. Pearl pregnancy rates ranged from 22.2-37.2/100 woman-years, and high discontinuation rates in both developed and developing countries were found. Demand for the method was low even in developing countries where calendar rhythm and withdrawal are relatively popular methods of fertility control, suggesting that women of low socioeconomic status may prefer a method that does not require demanding interaction with service providers and acknowledgment of sexual activity. The Billings method is labor-intensive, requiring repeated client contact over an extended time period and high administrative costs, even when teachers are volunteers. It is concluded that although natural family planning methods may make a useful contribution where more effective methods are unavailable or unacceptable, many of the claims made for the Billings method are unsubstantiated by scientific evidence.
New York, United Nations, 1984. 108 p. (Population Studies, No. 85; ST/ESA/SER.A/85)The 3 parts of this report on world, regional, and international developments in the field of population, present a summary of levels, trends, and prospects in mortality, fertility, nuptiality, international migration, population growth, age structure, and urbanization; consider some important issues in the interrelationships between economic, social, and demographic variables, with special emphasis on the problems of food supply and employment; and deal with the policies and perceptions of governments on population matters. The 1st part of the report is based primarily on data compiled by the UN Population Division. The 2nd part is based on information provided by the Food and Agriculture Organization of the UN (FAO) and the International Labor Organization (ILO), as well as that compiled by the Population Division. The final part is based on information in the policy data bank maintained by the Population Division, including responses to the UN Fourth Population Inquiry among Governments. In 1975-80 the expectation of life at birth for the world was estimated at 57.2 years for both sexes combined. The corresponding figure for the developed and developing regions was 71.9 and 54.7 years, respectively. In 1975-80 the birthrate of the world was estimated at 28.9/1000 population and the gross reproduction rate was 1.91. These figures reflect considerable decline from the levels attained 25 years earlier: a crude birthrate of 38/1000 population and a gross reproduction rate of 2.44. World population grew from 2504 million in 1950 to 4453 million in 1983. Of the additional 1949 million people, 1645 million, or 84%, accrued to the less developed countries. The impact of population growth on economic development and social progress is not well understood. The governments of some developing countries still officially welcome a rapid rate of population growth. Many other governments see cause for concern in the need for the large increases in social expenditure, particularly for health and education, that accompany a young and growing population. Planners are concerned that the rapidly growing supply of labor, compounded by a trend toward rapid urbanization, may exceed that which the job market is likely to absorb. In the developed regions the prospect of a declining, or an aging, population is also cause for apprehension. There is a dearth of knowledge as to the impact of policies for altering the consequences of these trends. Many policies have been tried, in both developed and developing countries, to influence population growth and distribution, but the consequences of such policies have been difficult to assess. Frequently this problem arises because their primary objectives are not demographic in character.
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.