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  1. 1

    Effective prevention strategies in low HIV prevalence settings.

    Brown T; Franklin B; MacNeil J; Mills S

    Arlington, Virginia, Family Health International [FHI], HIV / AIDS Prevention and Care Department, 2001. [41] p. (UNAID Best Practice Key Materials; USAID Cooperative Agreement No. HRN-A-00-97-00017-00)

    Countries with low HIV prevalence share a set of concerns and challenges regarding their responses to a potential HIV epidemic. Many of these countries also present an opportunity to avert large numbers of future HIV infections if appropriate prevention strategies are chosen and implemented early, greatly reducing future HIV/AIDS-related costs to the country. The purpose of this publication is to identify those challenges and propose a prevention strategy that can maintain low HIV prevalence in the general population, while reducing existing or preventing potential HIV sub-epidemics in population subgroups with substantial levels of risk behavior. Decisions on the strategic placement and targeting of prevention interventions are important to both international agencies and countries planning their prevention response. Both need to make difficult choices regarding geographic and population subgroups to ensure that resources are allocated efficiently. (excerpt)
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  2. 2

    Estimation of the incidence and prevalence of sexually transmitted infections. Report of a WHO consultation, Treviso, Italy, 27 February - 1 March 2002.

    World Health Organization [WHO]. Department of HIV / AIDS

    Geneva, Switzerland, WHO, Department of HIV / AIDS, 2002. 26 p. (WHO/HIV/2002.14; WHO/CDS/CSR/NCS/2002.7)

    WHO in collaboration with the Office of International and Social Health at the Department of Health, Veneto Region, Italy organized a consultation on the estimation of STI prevalence and incidence on 27 February– 1 March 2002 in Treviso, Italy with the following objectives : to determine the strengths, weaknesses and appropriateness of the current WHO approach to estimating the prevalence and incidence of STIs; to identify the STIs or syndromes that are most appropriate for surveillance and the most appropriate methods for deriving estimates of their incidence and prevalence; to identify structural surveillance needs within countries; to determine the utility and feasibility of using specific STI data as indicators of HIV risk behaviour within the concept of second-generation HIV surveillance; and to make recommendations for how the data collected can best be used to prevent STIs and to improve the care of individuals with STIs or their outcomes. (excerpt)
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  3. 3

    FAO / WHO launch expert report on diet, nutrition and prevention of chronic diseases [editorial]

    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)
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  4. 4

    Who should receive hepatitis A vaccine?

    Arankalle VA; Chadha MS

    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)
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  5. 5

    [Health: old and new diseases] La sante: anciennes et nouvelles maladies.

    Khlat M

    In: La population du monde: enjeux et problemes, edited by Jean-Claude Chasteland and Jean-Claude Chesnais. Paris, France, Institut National d'Etudes Demographiques [INED], 1997. 435-60. (Travaux et Documents Cahier No. 139)

    The author clarifies the conceptual framework of the study of populations health in an attempt to understand the notions of demographic transition and epidemiological transition. World Health Organization (WHO) statistics are then noted, followed by the presentation of WHO data on the global health situation. Estimated numbers of all cases of morbidity and mortality worldwide by cause are presented for 1993. Where possible, the prevalence, incidence, and number of long-term handicaps caused by each ailment are presented in addition to the number of deaths caused. According to data collected by WHO, approximately 51 million people died worldwide in 1993, of which almost 24% were in developed countries and 76% were in developing countries. The most important groups of illnesses were infectious and parasitic diseases, and causes of maternal, perinatal, and neonatal mortality, responsible for about 40% of all mortality during the year. 99% of these latter deaths occurred in the developing world. Then, circulatory system diseases, chronic lower respiratory system illness, and cancer were together responsible for about the same number of deaths, with the numbers of such deaths divided almost equally between developed and developing countries. External causes, such as accidents, suicides, and homicides caused near to 4 million deaths, or 8% of the overall total. These causes of morbidity and mortality are discussed, followed by consideration of likely future trends for the world s predominant ailments.
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  6. 6

    Gap in HIV infection widens.

    Gottlieb S

    BMJ (CLINICAL RESEARCH ED.). 1998 Jul 4; 317(7150):11.

    While most industrialized nations and a handful of developing countries are seeing the spread of HIV infection level off or even decline, infection rates are reaching alarming new highs in much of the developing world, according to the first country by country analysis by the joint United Nations Programme on HIV/AIDS (UNAIDS). Along with the widening gap in infection rates, the report also reveals a looming divide between countries where rates of new AIDS cases and deaths from AIDS are falling and countries where they are rising as people infected with the disease succumb in greater numbers than before. The major reason is uneven access to newer antiretroviral drugs, which forestall the development of AIDS. Among the report's most striking findings was new information concerning 13 countries in sub-Saharan Africa, where at least 10% of all adults are infected with HIV, with the prevalence in many capital cities 35% or more. Botswana and Zimbabwe have each reached a prevalence of 25%, a new world high. (full text)
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  7. 7

    Tuberculosis control and research strategies for the 1990s: memorandum from a WHO meeting] Estrategias de control e investigacion de la tuberculosis en el decenio de 1990: memorandum de una reunion de la OMS.

    World Health Organization [WHO]


    Mycobacterium tuberculosis, the pathogenic agent causing tuberculosis, is carried by one third of the world's population. Some 8 million new clinical cases of tuberculosis are diagnosed annually. Pulmonary tuberculosis is the most infectious clinical manifestation, tubercular meningitis is the principal form causing infant death, and tuberculosis may affect various other organs. Untreated tuberculosis has a fatality rate of over 50%. Chemotherapy greatly reduces the rate, but some 2.9 million persons die of tuberculosis each year because of the inadequacy of many national treatment programs. Tuberculosis is the most important cause of death from a single infectious agent in the world. An estimated one fourth of avoidable deaths to adults aged 15-59 in the developing world are attributed to tuberculosis. Tuberculosis is especially prevalent in Africa south of the Sahara and in Southern Asia. Two new obstacles threaten to aggravate the problem: the HIV epidemic and drug resistance. HIV infection is the most serious risk factor yet identified because it converts latent tuberculosis infection into active disease. In Africa almost half of all persons seropositive for HIV are also infected with tuberculosis. Ineffective treatment programs favor the formation of pharmacoresistent strains, and drug resistance has become a major problem in various parts of the world. Effective measures exist to control tuberculosis. Although it does little to protect adults against infectious forms of tuberculosis, the BCG vaccine prevents the most lethal forms. Coverage of infants the BCG is over 80% in the developing world as a whole, but under 60% in sub-Saharan Africa. Chemotherapy can cure almost all cases and convert cases with positive sputum into noninfectious cases, reducing transmission. Normal treatment must be administered over at least 12 months, straining the resources of health services in developing areas. The introduction of a shorter therapy has revolutionized treatment in some national programs, which have achieved cure rates of 80% in new patients. Evaluation of some national programs has demonstrated that well managed short duration chemotherapy is cost effective even under difficult conditions. Progress in controlling tuberculosis has been slower than expected in developing countries because of excessive optimism about the prospects for quick declines as occurred in the industrialized countries, and because of lack of resources. A well organized and vigorous international effort under World Health Organization leadership is required to bring the tuberculosis problem to the world's attention, mobilize assistance on a wide scale, and provide information and direct support to national programs. Research will be needed to adapt proven control techniques to local cultures, develop new drugs, shorten treatment regimens, and encourage greater patient compliance.
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  8. 8
    Peer Reviewed

    Histologic types of breast carcinoma in relation to international variation and breast cancer risk factors. WHO Collaborative Study of Neoplasia and Steroid Contraceptives.

    Stalsberg H; Thomas DB; Noonan EA

    INTERNATIONAL JOURNAL OF CANCER. 1989 Sep 15; 44(3):399-409.

    Associations between breast cancer risk factors and histologic types of invasive breast carcinoma were studied in 2728 patients. Lobular and tubular carcinomas occurred with increased relative frequency in most high risk groups. The proportion of these types increased with age to a maximum at 45-49 years and decreased in the following decade. Significantly increased proportions of lobular and tubular carcinomas were also associated with high risk countries, prior benign breast biopsy, bilateral breast cancer, concurrent mammary dysplasia, high age at 1st livebirth, never-pregnant patients compared to those with a 1st livebirth before age 20, private pay status, and length of education. Nonsignificant increases were associated with family history of breast cancer, less than 5 livebirths, less than 25 months total breastfeeding, use of oral contraceptives or IUD, and high occupational class. As a general trend, the higher the overall relative risk, the higher the proportion of lobular and tubular carcinomas. The occurrence of other histologic types also increased breast cancer risk, but to a smaller degree than for lobular/tubular carcinomas. It is suggested that all hormonally related, socioeconomic, and geographic risk factors enter their effect by selectively increasing the number of lobular cells at risk. Family history of breast cancer and age over 49 years did not follow the general trend of parallel increases in the proportion of lobular/tubular carcinomas and breast cancer risk, and may operate through other mechanisms. (author's)
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  9. 9

    Levels and trends of contraceptive use as assessed in 1988.

    United Nations. Department of International Economic and Social Affairs

    New York, N.Y., United Nations, 1989. viii, 129 p. (Population Studies No. 110; ST/ESA/SER.A/110)

    This global review of contraceptive practice was conducted by the Population Division of the Department of International Economic and Social Affairs of the UN Secretariat as part of its regular program of studies of demographic trends. Increasing government interest in and support for family planning programs over the past several decades are reflected in the attention given to this topic in the World Population Plan of Action adopted in 1974 and the resolutions adopted at the International Conference on Population held in 1984. The report contains a comprehensive overview of survey-based data on the level of contraceptive use, types of methods employed, and recent trends in contraceptive practice. It discusses the availability of contraceptives to national populations, drawing on results of recent international studies. Updated global and regional estimates of average levels of contraceptive use and methods are included. 1 new feature is a discussion of the amount of growth in contraceptive use that will be needed if fertility is to decline in developing countries in accordance with UN population projections. A new reference table shows national survey measures of current contraceptive use, by method, for all available countries and dates. Data available through May 1988 are included in the review. Nationally representative sample survey data, which are considered to provide the most comprehensive available information about levels of contraceptive use and methods employed, were available for at least 1 date for 97 countries and areas containing over 80% of the world's population. The concentration of recent surveys in developing countries makes contraceptive practice 1 of the few demographic topics for which data are more timely and more comprehensive for developing regions as a whole than for the industrialized countries.
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  10. 10

    World contraceptive use in 1987 [news]

    ENTRE NOUS. 1989 Mar; (13):16-17.

    Worldwide contraceptive use prevalence, methods, and trends are depicted in a UN Population Division chart. In 1987, it is estimated that 51% of the world's couples used contraceptives. Developing country use increased from less than 10% before the mid-1960s to 45% and ranges from a low of 1% to a high of 75%. In developed countries, contraceptive use is estimated to be 70% and ranges from at least 50%-83%. Female sterilization has increased rapidly since the early 1970s. It is wide-spread today except in developed areas and performed 2-3 times more often than male sterilization. Other contraceptive methods and their prevalence are: IUDs--6% in developed and 10% in developing countries; birth control pills--13% in developed and 6% in developing countries; and withdrawal, the rhythm method, or other nonmedical service/supply methods--25% in developed and 5% in developing countries.
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  11. 11

    The prevalence of anaemia in the world. La prevalence de l'anemie dans le monde.

    DeMaeyer E; Adiels-Tegman M

    World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(3):302-16.

    Tables present data on the prevalence of anemia in the world. Anemia may be defined as a state in which the quantity or the quality of circulating red cells is reduced below the normal level. The most common way to diagnose anemia is by measuring the hemoglobin concentration in the blood which is controlled by a homeostatic mechanism. It varies slightly among normal subjects. In 1959, the World Health Organization (WHO) proposed levels of hemoglobin concentrations for different groups of individuals that could be considered as the lower limits of normality. Subjects with values below these levels were considered to be anemic. The causes of anemia, which are multiple, include a deficiency of hemopoietic factos, genetic disorders causing hemolytic anemias, infections including malaria, and increased losses of blood caused inter alia by infections such as ankylostomiasis or schistosomiasis. A survey of the prevalence of anemia in women in developing countries was published by WHO in 1982. It estimated the prevalence of nutritional anemia in developing countries (other than China) at 60% in pregnant women and 47% in non-pregnant women. The prevalence of anemia in all women of reproductive age was estimated at 49%. It appears that studies on the prevalence of anemia were conducted regularly during the 1960-84 period, with the exception of studies on elderly people most of which were conducted before 1970. Most studies included from 100 to 300 subjects. Studies on adolescents usually covered fewer than 100 subjects. The tables provide no data on the severity of anemia, i.e., the percentage of subjects with a hemoglobin concentration below a specific level. On the basis of the present review, the total prevalence of anemia in the world is most likely about 30%. Expressed in absolute numbers this means some 1300 million people of the estimated world population of 4440 million in 1980. For the developing regions of the world, the prevalence of anemia is probably about 36% or 1200 million people, and for the more developed regions about 8% or just under 100 million people. Young children and pregnant women are the most affected groups with an estimated global prevalence of 43% and 51%, respectively. The regions with the highest overall prevalence of anemia are South Asia and Africa. With the exception of pregnant women, the prospects for the prevention of iron deficiency anemia in a population are poor at the present time. Iron fortification and the daily administration of an iron supplement present great problems in developing countries, and they will not be resolved easily.
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  12. 12

    Informal Meeting on the Development of a Methodology for the Surveillance of Breastfeeding, Geneva, 2-4 February, 1981.

    World Health Organization [WHO]

    [Unpublished] 1981. 58 p.

    A fundamental part of the World Health Organization's (WHO's) task of biannually reporting on the steps taken by the organization to promote breastfeeding and to improve infant and young child feeding will necessitate the regular collection of statistical information on the prevalence and duration of breastfeeding in the different Member States. The purpose of this document is to outline the following: the rationale for the collection of breastfeeding data; a summary of the scientific methods by which these data can be collected; a module which can be attached to ongoing surveys; and a protocol which can be used by national field workers in conducting surveys specifically on the subject of breastfeeding. Information on trends in breastfeeding is important because it can be used to provide a valuable insight into a variety of maternal and child health issues and serve as a useful health and social indicator. Changes in the prevalence and duration of breastfeeding reflect the attitudes of mothers toward infant care, their knowledge on infant feeding, their concept of family life, time, and work, and their relative exposure to different sources of information concerning the advantages and disadvantages of breastfeeding. There are 2 major ways of collecting epidemiological information--a tool for assessment of breastfeeding practices--surveillance and surveys. Potential sources of information are vital statistics, hospital records, postnatal clinic records, market research, national health/nutrition surveys, and fertility surveys. The core breastfeeding module should contain the minimum number of questions required to assess the prevalence and duration of exclusive and partial breastfeeding along with key demographic questions designed to describe breastfeeding in terms of time, place, and person. Suggested items are listed. The development of a standardized protocol/study design which, with modification, can be adapted to national conditions and needs, will facilitate surveys and permit the comparability of data. The details of survey development are reviewed.
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