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  1. 1
    Peer Reviewed

    Global support for new vaccine implementation in middle-income countries.

    Kaddar M; Schmitt S; Makinen M; Milstien J

    Vaccine. 2013 Apr 18; 31(Suppl 2):B81-B96.

    Middle-income countries (MICs) as a group are not only characterized by a wide range of gross national income (GNI) per capita (US $1026 to $12,475), but also by diversity in size, geography, governance, and infrastructure. They include the largest and smallest countries of the world-including 16 landlocked developing countries, 27 small island developing states, and 17 least developed countries-and have a significant diversity in burden of vaccine-preventable diseases. Given the growth in the number of MICs and their considerable domestic income disparities, they are now home to the greatest proportion of the world’s poor, having more inhabitants below the poverty line than low-income countries (LICs). However, they have little or no access to external funding for the implementation of new vaccines, nor are they benefiting from an enabling global environment. The MICs are thus not sustainably introducing new life-saving vaccines at the same rate as donor-funded LICs or wealthier countries. The global community, through World Health Assembly resolutions and the inclusion of MIC issues in several recent studies and important documents-including the Global Vaccine Action Plan (GVAP) for the Decade of Vaccines-has acknowledged the sub-optimal situations in some MICs and is actively seeking to enhance the situation by expanding support to these countries. This report documents some of the activities already going on in a subset of MICs, including strengthening of national regulatory authorities and national immunization technical advisory groups, and development of comprehensive multi-year plans. However, some additional tools developed for LICs could prove useful to MICs and thus should be adapted for use by them. In addition, new approaches need to be developed to support MIC-specific needs. It is clear that no one solution will address the needs of this diverse group. We suggest tailored interventions in the four categories of evidence and capacity-building, policy and advocacy, financing, and procurement and supply chain. For MICs to have comparable rates of introduction as other wealthier countries and to contribute to the global fight against vaccine-preventable diseases, global partners must implement a coordinated and pragmatic intervention strategy in accord with their competitive advantage. This will require political will, joint planning, and additional modest funding.
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  2. 2

    The progress of nations, 1998. The nations of the world ranked according to their achievements in fulfillment of child rights and progress for women.


    New York, New York, UNICEF, 1998. [41] p.

    The Progress of Nations is a clarion call for children. It asks every nation on earth to examine its progress towards the achievable goals set at the World Summit for Children in 1990 and to undertake an honest appraisal of where it has succeeded and where it is falling behind. This year’s report highlights successes attained and challenges remaining in efforts to register each child at birth, to immunize every child on earth and to help adolescents, particularly girls, as they set out on the path towards adulthood. With its clear league tables, The Progress of Nations is an objective scorecard on these issues. Commentaries by leading thinkers and doers stress the need for an approach to development based on child rights, calling on governments to fulfill the promises they made in ratifying the Convention on the Rights of the Child. The Progress of Nations reminds us annually that rhetoric about children must be backed up with action. I would commend it to anyone concerned about the status of our most vulnerable citizens. (excerpt)
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  3. 3

    Maternal mortality in 2000: estimates developed by WHO, UNICEF, and UNFPA.

    AbouZahr C; Wardlaw T

    Geneva, Switzerland, World Health Organization [WHO], [2003]. 39 p.

    Reduction of maternal mortality has been endorsed as a key development goal by countries and is included in consensus documents emanating from international conferences such as the World Summit for Children in 1990, the International Conference on Population and Development in 1994 and, the Fourth World Conference on Women in 1995, and their respective five-year follow-up evaluations of progress in 1999 and 2000, the Millennium Declaration in 2000 and the United Nations General Assembly Special Session on Children in 2002. In order to monitor progress, efforts have to be made to address the lack of reliable data, particularly in settings where maternal mortality is thought to be most serious. The inclusion of maternal mortality reduction in the Millennium Development Goals (MDGs) stimulates increased attention to the issue and creates additional demands for information.1The first set of global and national estimates for 1990 was developed in order to strengthen the information base2. WHO, UNICEF and UNFPA undertook a second effort to produce global and national estimates for the year 1995.3 Given that a substantial amount of new data has become available since then, it was decided to repeat the exercise. This document presents estimates of maternal mortality by country and region for the year 2000. It describes the background, rationale and history of estimates of maternal mortality and the methodology used in 2000 compared with the approaches used in previous exercises in 1990 and 1995. The document opens by summarising the complexity involved in measuring maternal mortality and the reasons why such measurement is subject to uncertainty, particularly when it comes to monitoring progress. Subsequently, the rationale for the development of estimates of maternal mortality is presented along with a description of the process through which this was accomplished for the year 2000. This is followed by an analysis and interpretation of the results, pointing out some of the pitfalls that may be encountered in attempting to use the estimates to draw conclusions about trends.2,3 The final part of the document presents a summary of the kind of information needed to build a fuller understanding of both the levels and trends in maternal mortality and the interventions needed to achieve sustained reductions in the coming few years. (excerpt)
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  4. 4

    Alma Ata revisited.

    Tejada de Rivero DA

    Perspectives in Health. 2003; 8(2):3-7.

    This year marks the 25th anniversary of the first International Conference on Primary Health Care in Alma- Ata, Kazakhstan, an event of major historical significance. Convened by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), Alma-Ata drew representatives from 134 countries, 67 international organizations and many non-governmental organizations. China, unfortunately, was notably absent. By the end of the three-day event, nearly all of the world's countries had signed on to an ambitious commitment. The meeting itself, the final Declaration of Alma-Ata and its Recommendations mobilized countries worldwide to embark on a process of slow but steady progress toward the social and political goal of "Health for All." Since then, Alma-Ata and primary health care have become inseparable terms. A quarter century later, it is useful to look back on the event and its historical context – particularly on the theme of "Health for All" in its original sense. For one who was a direct witness to these events, it is clear that the concept has been repeatedly misinterpreted and distorted. It has fallen victim to oversimplification and voguishly facile interpretations, as well as to our mental and behavioral conditioning to an obsolete world model that continues to confuse the concepts of health and integral care with curative medical treatment focused almost entirely on disease. (author's)
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  5. 5

    World Breastfeeding Week, August 1-7, 1992.

    World Alliance for Breastfeeding Action [WABA]

    HYGIE. 1992; 11(2):6-7.

    The World Alliance for Breastfeeding Action (WABA) based in Penang, Malaysia has selected August 1-7, 1992 to be World Breastfeeding Week worldwide. The US coordinator is in Flushing, New York. WABA is a group of organizations and individuals who communicate among themselves to identify ways to inform others that breast feeding is a right of all children and women. WABA aims to identify a week each year to promote breast feeding since many countries are experiencing a decrease in breast feeding. The 1992 theme for World Breastfeeding Week is the WHO/UNICEF Baby-Friendly Hospital Initiative. WABA, WHO, and UNICEF suggest various activities for community organizations, individuals, hospitals, and clinics to observe before and during the week. All groups could form a World Breastfeeding Week Committee. Hospitals could go a step further and form a Baby-Friendly Hospital Committee. They could evaluate their practices by completing the Self Appraisal Questionnaire. Hospitals could also implement all 10 steps to successful breast feeding so they can receive the Baby-Friendly Hospital designation during the celebration week. Health facility managers should tell staff about the International Code of the Marketing of Breast Milk Substitutes and invite them to look for code violations in the facility and the community. Community groups or individuals could arrange for various competitions such as posters, breast-feeding slogans, and essays. The could also try to gain the support of retail store operators by encouraging them to implement the Code and set up a Baby-Friendly work environment for employees. They could invite children to take part in the week by doing a puppet show or participating in a coloring contest. Community organizations and individuals could encourage the local newspaper to do either an article about breast feeding or print a photo with an eye-catching caption.
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  6. 6

    Divergence on teaching about sexual diseases.

    AIDS ANALYSIS ASIA. 1995 Jul-Aug; 1(4):2.

    The United Nations Children's Fund (UNICEF) has launched a study, "Progress of Nations," of standards of health, education, nutrition, and progress for women. It reveals that many rich nations have records on health, nutrition, and women's rights that are much worse than those of poorer countries. Economic growth does not necessarily result in a better standard of living for the majority of people. "Progress of Nations" uses specific indicators to gauge achievements, then ranks each country accordingly; it also states how much individual nations are contributing to the global aid budget, and where funds are being spent. A table lists countries chronologically in order of introduction of education about sexually transmitted diseases (STDs), including acquired immunodeficiency syndrome (AIDS). Singapore (1986), Sri Lanka (1986), Japan (1987), China (1989), Thailand (1989), Hong Kong (1990), Malaysia (1991), and Viet Nam (1991) have done so. As of early 1993, Bhutan, Cambodia, Indonesia, India, Lao Republic, Nepal, Pakistan, and the Philippines had not incorporated sex education into school curriculums. One section examines the fertility decline since 1963 in all countries and the unmet need for family planning. In Thailand and Indonesia, where population growth has been reduced dramatically over the last 30 years, 12% and 14% of married women aged 15-49 years want to stop having children or to postpone the next pregnancy for at least 2 years, but are not using contraception.
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  7. 7

    [UNICEF. Children's new world order] UNICEF. Bornenes ny verdensorden.

    Neertoft S

    SYGEPLEJERSKEN. 1992 Mar 18; 92(12):15-6.

    UNICEF's 1992 report about the situation of children called for increased efforts to overcome malnutrition, disease, and illiteracy in poor countries. Developing countries were criticized for devoting only 12% of their budgets to health care and education of the poorest. Rich countries were criticized for setting aside only about 10% of their development assistance for health care, education, and family planning. One billion people do not have access to adequate food, clean water, health care, and schooling. After half a century of wars and ideological conflict, it is time to solve conflicts in the world peacefully and concentrate on social needs to blaze the trail towards a new world order. According to James Grant, the executive director of UNICEF, every week 250,000 perish because of hunger and disease, and of those who survive, many millions subsist in malnutrition and disease. This is a crisis situation that requires priority attention. However, there are signs of change, as evidenced by the World Summit on Children in September 1990. This was the largest such gathering, with 71 state and government leaders and other representatives from 159 countries. Its results included a program to prevent 4 million child deaths a year, put an end to malnutrition, eradicate poliomyelitis, and provide clean water, family planning methods, and basic education for all. In 1990 a goal was set to vaccinate 80% of the children of developing countries within 10 years, but only 1 out of every 10 children has been vaccinated so far, which still amounts to 3 million lives saved every year. Hitherto 60 countries have drafted national plans, which should increase to over 100 by early 1992. Mexico decided to boost the budget of health care and education for the poorest fifth of the population. The need of developing countries for 12-13 billion dollars could be secured from reducing their military outlays by 10%, while the share of developed countries of 6-7 billion dollars to reach all the goal of the Summit could be obtained from reducing their military expenditures by only 1%. Only 1% of developing country assistance allocation is needed for establishing basic health care service that could prevent 80% of diseases and the consequences of malnutrition. Only about 1% is needed for family planning and even less for elementary schools.
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  8. 8

    Approaching STDs and AIDS on a global scale. Interview with Peter Piot, Associate Director, Sexually Transmitted Diseases, Global Programme on AIDS (GPA), World Health Organisation (WHO).

    AIDS BULLETIN. 1993 Jul; 2(2):4-5.

    Dr. Piot became involved with the World Health Organization (WHO) Global Program on AIDS (GPA) through his early involvement as Chairman of the WHO Steering Committee on the Epidemiology of AIDS. He responds to questions about the HIV pandemic. Although researchers realized early on that HIV could be transmitted sexually and suspected that condom use could confer protection against HIV infection as it does against other STDs such as gonorrhea and syphilis, only minimal light was shed to the public on the association of HIV with STDs. The delay in clearly pointing out the association stemmed from professionals' lack of desire to further stigmatize HIV/AIDS by designating it as a STD. Furthermore, many Western hematologists had little interest in STDs, and STD control in many countries tended to be coercive. Regarding the risk of HIV infection, Dr. Piot notes that the presence of a genital ulcer caused by syphilis, chancroid, or herpes increases one's risk 10-20-fold; risk increases 3- to 4-fold where gonorrhea or chlamydia are present. Acknowledging the association between STDs and the risk of contracting HIV and understanding the need to control STDs for the prevention of HIV/AIDS, the WHO's STD program was brought under the auspices of and integrated with the GPA. People, and especially women, who may present at STD clinics for treatment are prime candidates for much needed help in avoiding HIV infection; Dr. Piot notes that unlike men, many women do not realize they are infected with an STD until complications develop. Dr. Piot's recent appointment at GPA means the WHO will increase its focus upon the prevention and treatment of STDs. The WHO favors an integrated program approach. Additionally, the GPA plans to develop a short-list of recommended drugs for treating STDs and hopes to develop ways for developing countries to buy them affordably with help from UNICEF and the World Bank. Finally, Dr. Piot explains that, with some exceptions, the prevalence of STDs is lower in developed countries and, therefore, less of a prevention priority.
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  9. 9
    Peer Reviewed

    HIV and breast-feeding.

    World Health Organization [WHO]


    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.
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  10. 10

    The world's women 1970-1990: trends and statistics.

    United Nations. Department of International Economic and Social Affairs. Statistical Office; United Nations. Centre for Social Development and Humanitarian Affairs; UNICEF; United Nations Population Fund [UNFPA]; United Nations Development Fund for Women [UNIFEM]

    New York, New York, United Nations, 1991. xiv, 120 p. (Social Statistics and Indicators Series K No. 8; ST/ESA/STAT/SER.K/8)

    5 UN agencies worked together to develop this statistical source book to generate awareness of women's status, to guide policy, to stimulate action, and to monitor progress toward improvements. The data clearly show that obvious differences between the worlds of men and women are women's role as childbearer and their almost complete responsibility for family care and household management. Overall, women have gained more control over their reproduction, but their responsibility to their family's survival and their own increased. Women tend to be the providers of last resort for families and themselves, often in hostile conditions. Women have more access to economic opportunities and accept greater economic roles, yet their economic employment often consists of subsistence agriculture and services with low productivity, is separate from men's work, and unequal to men's work. Economists do not consider much of the work women do as having any economic value so they do not even measure it. The beginning of each chapter states the core messages in 4-5 sentences. Each chapter consists of text accompanied by charts, tables, and/or regional stories. The 1st chapter covers women, families, and households. The 2nd chapter addresses the public life and leadership of women. Education and training dominate chapter 3. Health and childbearing are the topics of chapter 4 while housing, settlements, and the environment comprise chapter 5. The book concludes with a chapter on women's employment and the economy. The annexes include strategies for the advancement of women decided upon in Nairobi, Kenya in 1985, the text of the Convention on the Elimination of All Forms of Discrimination against Women, and geographical groupings of countries and areas. During the 1990s, we must invest in women to realize equitable and sustainable development.
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  11. 11

    Street youth and the AIDS pandemic.

    Luna GC; Rotheram-Borus MJ

    AIDS Education and Prevention. 1992 Fall; Suppl:1-13.

    Homelessness among youth is universal, but is particularly great in developing countries. Children advocates have categorized youth with no fixed address in the US as runaways, throwaways, homeless youth, system youth, and street youth. About 50% of such youth are system youth who have lived in institutions or foster homes. Around 21% are children whose parents forced them out of the home. 60% have been sexually abused at home. Homeless youth are at higher risk of HIV than those who have a home. This risk comes primarily from unprotected, often homosexual, intercourse and iv drug use. Some subgroups of street youth in Brazil have an HIV prevalence rate of 35%. Street youth take on these risky behaviors to just survive. PAHO, WHO, and UNICEF have placed HIV prevention among teenagers as a top priority. VArious countries have hosted national and international conferences on this topic. In June 1990, the 1st International Conference on AIDS and Homeless Youth took place in San Francisco to gather international community specialists from 32 countries to respond to the AIDS crisis. Many recommendations came from this conference. 1st, all nations and international bodies must recognize and enforce the rights of children. Street youth must have access to comprehensive health care (mental health care, treatment for substance abuse, bereavement services, and HIV testing and counseling). Health workers must be prepared to provide street-based services. HIV prevention messages based in reality must reach these children. Research needs include epidemiologic data, cross-national and cross-cultural trends, ethnographic descriptions, and high risk behaviors. The next international conference is planned for September 1992 in Brazil and will include street youths as delegates.
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  12. 12

    Health education: historic windows of opportunity.

    Grant JP

    HYGIE. 1992; 11(2 Suppl):8-14.

    In 1991, the Executive Director of UNICEF addressed the World Conference on Health Education in Helsinki, Finland which centered on international cooperation in improving health. Health educators should convince world leaders to apply the money available after reductions in military spending due to the end of the Cold War toward revitalizing health and education systems and alleviating poverty. Another opportunity that they should not let slip away is that more countries are choosing democracy. The international consensus is now leaning toward human centered development. At least 71 national leaders and representatives from 88 other countries have supported the World Summit Plan of Action which emphasizes health education efforts leading toward child survival. This global, political endorsement also presents a plan for social mobilization. Health educators have already contributed greatly to the success of achieving universal child immunization (>80%) by the end of 1990. They communicated health education messages via the mass media and traditional channels to motivate individuals and society to immunize their children. UNICEF has 27 goals for the 1990s such as eradication of polio and guinea worm disease. In 1989, UNICEF, WHO, UNESCO, and about 100 other agencies began the Facts for Life initiative by 1st publishing a book. Lay and professional health educators have incorporated its messages into various media: street theater, radio, comics, soap operas, billboards, T-shirts, and bumper stickers. Medical research has shown that individual responsibility for one's own health adds years to life expectancy, e.g., individuals should not smoke. Health educators face the challenge of reaching adolescents, especially since most behavior patterns are established during adolescence. Other challenges include developing effective messages to curb the AIDS pandemic, to motivate hospitals to promote breast feeding, and to encourage world leaders to place children's needs at the top of society's priorities.
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  13. 13

    Update: the Baby-Friendly Hospital Initiative.

    Donovan P

    HYGIE. 1992; 11(2):5.

    WHO and UNICEF have joined to work toward reversing the trend toward infant formula use and strengthen all infants' chances of receiving the benefits of breast feeding. The WHO/UNICEF Baby-Friendly Hospital Initiative encourages health workers and facilities to promote, protect, and support breast feeding instead of hampering it. This initiative followed a decision by major manufacturers and distributors of infant formulas to comply with Article 6 of the International code of Marketing of Breast-Milk Substitutes by December 1992. This action, if carried out, would stop the distribution of free and low cost supplies to maternity facilities in developing countries. Indeed WHO and UNICEF plan to persuade all such facilities worldwide to promote and protect breast feeding within their facilities as well as in the community. They have prepared guidelines to successful breast feeding for health facilities. Entire communities need to recognize the benefits of breast feeding and not expect mothers to breast feed only in the home. In 1991, 12 developing countries tested the initiative. The goals included a stop in the distribution of free and low cost supplies of infant formulas in hospitals and maternity centers and to initiate transformation of hospitals into baby-friendly hospitals by February 1992. Each of the countries had witnessed an end to free and low cost supplies of infant formula to health facilities. The governments, nongovernmental organizations, and even the infant formula industry are monitoring the situation to assure compliance. The IFM has targeted 42 other developing countries where infant formula is still distributed to enforce the Code. The infant formula industry has not yet decided to do the same in developed countries, however. Yet 2 leading manufacturers said they would not do anything to compromise the goals of the initiative.
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  14. 14

    A strategy for reducing numbers? Response.

    Jolly R

    HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):28.

    UNICEF advocates the reduction of infant/child mortality because it feels that such an action will reduce both fertility and human suffering. It was feared in the beginning, and today as well, that increasing the survival rate for children would cause rapid population growth. However, there is a large body of evidence to the contrary. When such measures are combined with measures to promote and support family planning there are even greater reductions in fertility levels. This is why such organizations as UNFPA, WHO, and UNICEF have advocated this course of action. This strategy is also present in the Declaration of the World Summit for Children. Anyone advocating the reduction in support for programs designed to enhance child survival as a method of population control is confusing the issues, misdirecting environmental attention, and stirring up the debate about international mortality. The evidence clearly shows that family planning without family health, including child health, is much less successful. Further, child mortality, even at high levels does little to slow population growth while such death and suffering greatly burden women and families. While rapid population growth and high population densities in developing countries present serious problems, both are much less important than the high levels of consumption in developed nations. Each child in the industrialized world will, at present levels of consumption, be expected to consume 30 to 100 times more than a child born in the poorest nations. Such suggestions in a time of instant global communication only attempt to set back international morality and tempt those in the international intellectual community to embrace ideas similar to the eugenic principles that led to the holocaust.
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  15. 15

    Midwifery education -- international [editorial]

    Tickner V

    NURSE EDUCATION TODAY. 1991 Aug; 11(4):245-7.

    The international aspects of midwife education are discusses: the 5 most pressing questions concerning midwife education, steps taken by world health bodies to improve midwife educationists. The most challenging issues are international health studies in all programs; including the role of WHO, and other international agencies; instruction analyzing influence of Western on developing nations; content on demographic, economic and political factors affecting health of developing countries; and how health care educationists can achieve health for all. In the light of the WHO Safe Motherhood Initiative embodied in the slogan "Health For All," midwives all over the world are committed to reduce maternal mortality 50% by 2000. ICM/WHO/UNICEF made an action statement in 1987, the World Health Assembly published a Resolution on Material Health and Safe Motherhood, and a Resolution on Strengthening Nursing Midwifery. In 1990 the Governments of 70 countries committed to safe motherhood, i.e., 50% reduction of maternal mortality, as part of the World Declaration and Plan of Action on Survival, Development and Protection of Children, at a meeting at the UN. 1990 40 midwife educationists met in Kobe, Japan at a Pre-Congress Workshop before the International Confederation of Midwives (ICM), of the WHO/UNICEF. They discussed ways to approach the 5 major causes of maternal mortality: postpartum hemorrhage, obstructed labor, puerperal sepsis, eclampsia and abortion. Each participant assessed the status of midwife education in her own country. Some of the factors affecting maternal and child health are illiteracy, low status of women, population growth, and inadequate food production and distribution. There is a shortage of midwife teachers and teaching materials, and curricula are usually based on inappropriate Western models. In Europe, midwives still have much work to do to reduce maternal morbidity.
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  16. 16

    Public health and the ethics of sustainability. Swellengrebel Lecture.

    King M

    TROPICAL AND GEOGRAPHICAL MEDICINE. 1990 Jul; 42(3):197-206.

    An exposition of the ethical arguments for placing sustainability as a priority in implementation of public health programs is made, considering the definition of sustainability, theories of the demographic transition, the ecological transition, the relationship between sustainability of the ecosystem and the human birth rate, types of ethical conflicts over the issue of child survival interventions, a suggested way of resolving the dilemma and a possible paradigm shift constituting a scientific revolution in the field of international health. Sustainability means maintenance of the capacity to support life in quantity and variety. Although most demographers are familiar with Notestein's classic definition of the demographic transition, many are unaware of the likelihood that many countries will become entrapped in stage 2, to the extent that they destroy their ecosystem and thus their population, the "demographic trap." The 3 stages of the ecological transition are 1) expanding human demands with sustainable yield; 2) excess human demands with consumption of biological reserves; 3) ecosystem collapse and death or exit of the human population. An early sign of the 3rd phase is a rise in infant mortality. Sustainability can be increased by adjusting the environment or by lowering human birth rate, with Chinese rigor in need be, or by adding sustainable elements to the system that outweigh de-sustaining ones. Unfortunately there are too many unremovable constraints, and not enough time to wait for socioeconomic gains to lower birth rates. The current attempt by UNICEF to lower the child death rate to effect a demographic transition is attractive but unsound, since it has been proven that numbers of child deaths do not affect family fertility sufficiently. Reducing child deaths will only make population pressure worse. Ethical principles arguing for lowering child deaths have been articulated in Western culture, but now the challenge of sustainability may outweigh them all. It may be possible to apply sustaining measures to countries where possible, but for others, it is argued that child survival measures should not be instituted. These would only make the demographic transition impossible and prolong human misery for larger numbers. For these societies, only the kind of care Mother Teresa gives is appropriate. Finally, residents of developed countries must assume a "deep green" behavior code, a sustainable consumption level. WHO's definition of health should be updated to "Health is a sustainable state of complete...well-being."
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  17. 17

    IBFAN: on the cutting edge.

    Allain A

    DEVELOPMENT DIALOGUE. 1989; (2):5-38.

    The story of IBFAN, the International Baby Food Action Network, from its beginning with 6 members in 1979, to its status of 140 groups worldwide in 1989 is told by its founder, Annelies Allain. IBFAN celebrated its 10th anniversary in October 1989 with a week-long Forum of 350 organizers from 67 countries. IBFAN is a single-tissue grass-roots organization, almost entirely women: the issue is that bottle-feeding kills babies. It has mounted a successful campaign ending in passage of the WHO/UNICEF International Code of Marketing of Breast-milk Substitutes in 1981. With this success, the political power of the "third system," of people, as opposed to government and transnational corporations, was recognized. The most important fundamental activity of IBFAN is to amass information to make its point that million of babies, primarily in developing countries, have died from consuming powdered formula instead of breast milk. IBFAN also set out to show that milk companies have influenced medical school training, health care providers, UN and WHO policies, and governments of developing countries through advertising and tax income. IBFAN's methods are boycott, corporate marketing analysis, shareholder, resolutions, and numerous strategies invented by local activists. The baby food industry responded by forming the International Council of Infant Food Industries, headed by a former WHO Assistant Director General, and applied for registration as an official NGO with the WHO. Again in 1987 they formed the Infant Food Manufacturers Associations, headed by a former WHO staff member, and gained WHO NGO status, claiming to advance infant nutrition and adhere to the WHO Code. Ibfan's current emphasis is on combatting free infant formula given out at maternity hospitals, the most effective way to block successful lactation, is developed as well as developing countries. An effort to monitor this activity will mark the 10th anniversary of the Code in 1991.
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  18. 18

    Child health in the Third World.

    Gurry D

    MEDICAL JOURNAL OF AUSTRALIA. 1990 Dec 3-17; 153(11-12):635-7.

    While most infant-related health problems in the Third World can be attributed to commonplace diseases, the lack of resources necessary to implement Western styles of medicine suggests the need for new strategies -- those that rely less on technology and more on grass roots efforts. Most illnesses in the developing world are the result of the top 5-10 diseases. Of the 4 million deaths from pneumonia each year, 97% take place in the Third World. Measles causes the yearly deaths of 1.6 million. Many of these diseases have been eradicated in the West; the others can be easily treated. But in the 3rd World, health problems are compounded by the fact that attention is often sought late, as well as the lack of doctors and nurses. Most of those with Western-style medical training rarely practice in rural or urban slum areas. One strategy to meet these difficulties is to train personnel on how to diagnose and treat these 5-10 common diseases without them having to go through Western-style training -- reminiscent of the famous "barefoot doctors" of China. These local health workers can more easily meet the health needs of isolated areas, since they can be trained to carry out immunization, and teach nutrition and family planning. Furthermore, this strategy does not rely on high technology, following instead the scheme laid out by acronym GOBI -- Growth monitoring. Oral rehydration therapy, Breast feeding, and Immunization. Developed nations can help in this effort by supporting WHO, UNICEF and other international organizations, as well as sending personnel to work in 3rd World countries. While individual 3rd World nations must confront these problems, worldwide social, political, and economic changes will be necessary.
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  19. 19

    Breastfeeding and health care services.

    Jolly R

    In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 7 p.. (USAID Contract No. DPE-3040-A-00-5064-00)

    Breastfeeding is on the decline in most countries, despite the fact it can help prevent the 38,000 daily deaths of infants and young children through its nutritional, immunologic, and sanitary aspects. The World Health Organization (WHO) and the UN International Children's Emergency Fund (UNICEF) have combined to issue guidelines on the role of maternity services in promoting breastfeeding. In the most developed countries, breastfeeding has increased despite generally unsupportive hospital environments, the availability of clean water, and the fact that breastfeeding was virtually a lost practice in these countries 40 years ago. An increased awareness of the benefits, some of which are outlined, coupled with mother-to-mother support are most likely to have influenced this increase. The guidelines developed by WHO/UNICEF seek to put into practice specific recommendations agreed upon by pediatricians, obstetricians and gynecologists, nutritionists, nurses, midwives, and other health care providers in national and international forums. The main points of the guidelines are as follows: every facility providing maternity services should develop a policy on breastfeeding, communicate it to all staff, define specific practices to implement the policy, and ensure that all staff are adequately trained in the skills necessary to ensure implementation of the policy; facilities for 24-hour rooming-in, initiation of breastfeeding immediately after delivery, and demand-feeding are essential in every maternity ward; every pregnant mother should be informed fully about how breast milk is formed, the proper way to nurse a child, and the benefits of breastfeeding; and harmful practices, such as the use of bottles and teats for newborn infants, should be eliminated during this early period and exclusive breastfeeding maintained for at least 4-6 months from birth. These activities, when fully implemented, will ensure that every mother/infant couple reached prenatally, at birth, and postnatally gets off to a good start. Then, other support services will be more effective. These standards have been successful in the field and have had a positive impact on the rates of breastfeeding. A need exists for collaboration and an interdisciplinary approach to the promotion, protection, and support of breastfeeding, and, hopefully, this workshop is the first of a series of technical consultations.
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  20. 20

    Acute respiratory infections are the leading cause of death in children in developing countries.

    Denny FW; Loda FA


    A paper by Hazlett et al. is of particular importance because it addresses the question of the role of acute respiratory infections (ARI) as a cause of morbidity and especially mortality in 3rd world children. Diarrheal disease and malnutrition are generally thought to be the major killers of these children, and until recently little attention was paid to ARI. Recent data suggest that ARI are more important than realized previously and almost certainly are the leading cause of death in children in developing countries. It is estimated that each year more than 15 million children less than 5 years old die, obviously most in socially and economically deprived countries. Since death usually is due to a combination of social, economic, and medical factors, it is impossible to obtain precise data on the causes of death. It has been estimated that 5 million of the deaths are due to diarrhea, over 3 million due to pneumonia, 2 million to measles, 1.5 million to pertussis, 1 million to tetanus, and the other 2.5 million or less to other causes. Since pertussis is an acute respiratory infection and measles deaths frequently are due to infections of the respiratory tract, it is becoming clear that ARI are associated with more deaths than any other single cause. The significance of this is emphasized when the mortality rates from ARI in developed and underdeveloped nations are compared. Depending on the countries compared, age group, and other factors, increases of 5-10-fold have been reported. These factors raise the question of why respiratory infections are so lethal for 3rd world children. The severity of pneumonia, which is the cause of most ARI deaths, seems to be the big difference. Data are accumulating which show that bacterial infections are associated with the majority of severe infections and "Streptococcus pneumoniae" and "Haemophilus influenzae," infrequent causes of pneumonia in developed world children, are the microorganisms incriminated in a large proportion of cases. The increase in severity of ARI in 3rd world children has been associated, at least in port, with malnutrition, diarrheal diseases, an increased parasite load, and more recently with air pollution. Crowding and other factors associated with poverty doubtless also play a role. How these various factors contribute to increased severity and lethality is not well understood. The increasing recognition of the important role played by ARI as causes of mortality in 3rd world children is encouraging. The UN International Children's Emergency Fund (UNICEF) has joined the World Health Organization in the battle against ARI in developing countries, and the 2 organizations recently issued a joint statement on the subject in which they pledged to collaborate to integrate an ARI component into the primary health care program.
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  21. 21

    Vitamin A deficiency and xerophthalmia, recent findings and some programme implications.

    Eastman SJ

    ASSIGNMENT CHILDREN. 1987; (3):3-84.

    Recent findings from xerophthalmia studies in Indonesia have served as a catalytic force within the international health and nutrition community. These analyses conclude that, in Indonesia, there is a direct and significant relationship between vitamin A deficiency and child mortality. Further research is under way to determine the degree to which these findings are replicable in other countries and contexts. At the same time, representatives from international, bilateral, national and private organizations are critically examining their programs in vitamin A deficiency and xerophthalmia control for future planning. At UNICEF, there has been a special concern for vitamin A issues because of the possible implications in child survival. This is noted in the 1986 State of the World's Children Report. UNICEF recruited a consultant in January 1986 to examine its existing vitamin A programs, review scientific findings and meet with specialists to prepare policy options for consideration in future UNICEF involvement in the area of vitamin A. A brief background is given on the absorption, utilization, and metabolism of vitamin A, and its role in vision, growth, reproduction, maintenance of epithelial cells, immune properties, and daily recommended allowances. Topics cover xerophthalmia studies, treatment and prevention, prevalence, morbidity and mortality, program implications and directions, and procurement of vitamin A. Target regions include Asia, the Americas and the Carribean.
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  22. 22

    The national immunization campaign of El Salvador: against the odds.

    Argueta RH; Jaramillo H

    Assignment Children. 1985; 69/72:397-414.

    The recent immunization campaign in El Salvador has been a success despite the civil war. Both the government and the guerrillas agreed that the goal of immunizing children was an ideal transcending all differences, and that immunization should be taken to all parts of the country and all Salvadorian children. The campaign had the personal support of the head of state, the church, UNICEF, PAHO/WHO, ICRC and other organizations who worked with the parties to implement the campaign. The 3 national immunization days, held on February 3, March 3, and April 21, 1985 were transformed into days of tranquillity. This article describes how the campaign was organized and presents an assessment of its achievements. An executive committee was created and both UNICEF and PAHO/WHO took part in its meetings. Specific commissions handled channeling, training, supplies, the cold chain, information and evaluation, and promotion and education. The plan of action proposed that all branches of government and the private sector support the immunization campaign and a national support council was establish for this purpose. The original goal was to immunize 400,000 children under 3 years of age against diphtheria, pertussis, tetanus, polio, and measles. The goal was extended to cover children under 5 years of age. Funding was provided from both public and private organizations. Reasons the campaign was a success despite war conditions include: the campaign was backed by political commitment; the mechanisms created to implement the campaign functioned smoothly; mobilizing the media generated a change in opinion and attitude. The campaign rested on solid technical and political foundations. It reached 87% of children under 5 in the area.
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  23. 23

    The Joint WHO/UNICEF Nutrition Support Programme.

    Gurney M

    World Health. 1985 Nov; 13-15.

    In November 1980, Dr. Halfdan Mahler, Director-General of the World Health Organization (WHO), and James Grant, head of the UN Children's Fund (UNICEF), drafted a joint program to improve the nutritional status of children and women through developmental measures based on primary health care. The government of Italy agreed to fund in full the estimated cost of US$85.3 million. When a tripartite agreement was signed in Rome in April 1982, the WHO/UNICEF Joint Nutrition Support Program (JNSP) came into being. It was agreed that resources would be concentrated in a number of countries to develop both demonstrable and replicable ways to improve nutrition. Thus far, projects are underway or are just starting in 17 countries in Africa, Asia, Latin America, and the Caribbean. In most of these countries, infant and toddler mortality rates are considerably higher than the 3rd world averages. Program objectives include reducing infant and young child diseases and deaths and at the same time improving child health, growth, and development as well as maternal nutrition. These objectives require attention to be directed to the other causes of malnutrition as well as diet and food. JNSP includes nutrition and many other activities, such as control of diarrhea. The aim of all activities is better nutritional status leading to better health and growth and lower mortality. Feeding habits and family patterns differ from 1 country to another as do the JNSP country projects. Most JNSP projects adopt a multisectoral approach, incorporating varied activities that directly improve nutritional status. Activities involve agriculture and education as well as health but are only included if they can be expected to lead directly to improved nutrition. A multisectoral program calls for multisectoral management and involves coordination at all levels -- district, provincial, and national. This has been one of the most difficult things to get moving in many JNSP projects, yet it is one of the most important. Community participation is vital to all projects. Its success can only be judged as the projects unfold, but early experiences from several countries are encouraging.
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  24. 24

    Immunisation in Nicaragua [letter].

    Williams G

    Lancet. 1985 Oct 5; 2(8458):780.

    Despite the continuing war between government forces and the US backed-counter revolutionists, the Sandinista National Liberation Front, which came to power in Nicaragua in 1980, managed, with assistance from the World Health Organization and the UN Children's Fund, to greatly expand immunization coverage throughout the country. Between 1980-84, immunization coverage increased from 33%-97% for tuberculosis, 15%-33% for diptheria, pertussis, and tetanus, 20%-76% for polio, and 15%-60% for measles. Vaccinations are given as part of the routine care provided at health centers and health posts. In addition, measle and polio vaccinations are provided during mass community campaigns, which are held 3 times each year between January and June. During these campaigns about 20,000 volunteers, brigadistas, provide vaccinations for the children living in their own community. The volunteer force is made up of teachers, students, factory workers, housewives, farmers, and civil servants. 70% are women. A manual, using cartoon type pictures, is used to train the volunteers in vaccination procedures. The vaccination campaigns are extensively promoted in the mass media, and the results of each campaign are also publicized in the media. As a result of all of these efforts, no cases of polio were reported since 1982, only 3 cases of diptheria were reported in 1983, and the incidence of measles decreased markedly in recent years. Neonatal tetanus remains a serious problems, and a campaign to reduce the incidence of neonatal tetanus was instituted in 1983. By 1984, 27% of the female target group was vaccinated with 2 doses of tetanus toxoid. Due to expanded health care coverage, the infant mortality rate declined from 121/1000 live births to 80/1000 live births between 1978-83. The immunization effort is currently being curbed by increased contra activities and by the economic sanctions imposed by the US. Under these sanctions, it is difficult for Nicaragua to import items needed to conduct the vaccination program. In addition, many of the brigadistas now serve on medical teams which care for wounded military personnel or are helping to harvest the crops. This report was submitted by a physician who visited Nicaragua in 1984 and talked with health workers in Leon and in several nearby villages.
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  25. 25

    Guide to sources of international population assistance 1985 (Fourth Edition).

    United Nations Fund for Population Activities [UNFPA]

    New York, New York, United Nations Fund for Population Activities, [1985]. xi, 428 p. (Population Programmes and Projects, v. 1.)

    The fourth edition of the guide to international population assistance lists multilateral, regional, bilateral, nongovernmental, university, research, and training agencies and organizations that offer financial or technical assistance to population programs in developing countries. The guide is organized by type of agency. Each agency listing includes a description of the mandate of the agency, its population activities, fields of special interest, program areas in which assistance is offered, types of support provided, restrictions, channels and procedures, how to apply for assistances, how programs are evaluated, reports required, and the agency's address. Appendices include a bibliography of current newsletters and journals and index.
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