Your search found 164 Results
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.
Geneva, Switzerland, WHO, 2006. 15 p. (WHO/HIV/2006.05)In August 2006, the World Health Organization (WHO) launched a coordinated global effort to address a major and often overlooked barrier to preventing and treating HIV: the severe shortage of health workers, particularly in low- and middle-income countries. Called 'Treat, Train, Retain' (TTR), the plan is an important component of WHO's overall efforts to strengthen human resources for health and to promote comprehensive national strategies for human resource development across different disease programmes. It is also part of WHO's effort to promote universal access to HIV/AIDS services. TTR will strengthen and expand the health workforce by addressing both the causes and the effects of HIV and AIDS for health workers (Box). Meeting this global commitment will depend on strong and effective health-care systems that are capable of delivering services on a scale much larger than today's. (excerpt)
The World Health Organization multinational study of breast-feeding and lactational amenorrhea. II. Factors associated with the length of amenorrhea.
Fertility and Sterility. 1998 Sep; 70(3):461-471.The objective was to determine the relation between infant feeding practices (and other factors) and the duration of postpartum amenorrhea, and to establish whether there are real differences in the duration of postpartum amenorrhea for similar breast-feeding practices in different populations. Design: Prospective, nonexperimental, longitudinal follow-up study. Setting: Five developing and two developed countries. Patient(s): Four thousand one hundred eighteen breast-feeding mothers and their infants. Breast-feeding women collected ongoing information about infant feeding and family planning practices, plus the return of menses. Fortnightly follow-up occurred in the women's homes. A multivariate analysis explored the association between the risk of menses return and 16 infant feeding variables and 11 other characteristics. Ten factors (in addition to center effects) were significantly related to the duration of amenorrhea. Seven of these were infant feeding characteristics and the remaining three were high parity, low body mass index, and a higher frequency of infant illness. The breast-feeding stimulus is strongly linked to the duration of postpartum amenorrhea. Cross-cultural effects also are extremely important and may have caused the variations in feeding, the variation in amenorrhea, or both. (author's)
Bulletin of the World Health Organization. 1956; 15:5-41.The author reviews that mortality statistics from cancer of the breast in females and from malignant neoplasms of the uterus and of the other female genital organs for nineteen countries over the years 1920-53, first considering the general trend of the mortality series for each group of diseases for all ages and then analysing for each sector of mortality the changes which have occurred in the age-specific death-rates in some pivotal years during the same period. Considerable differences in the levels of total mortality from each group of tumours for various countries are noted. The important variations among age-specific death-rates for cancer of the breast in females and for uterine neoplasms in various countries are examined and their significance is commented upon. (excerpt)
Bulletin of the World Health Organization. 1955; 22:63-83.This paper presents the results of the tuberculin-testing of over 3,600 patients in tuberculosis hospitals and of nearly 34,000 schoolchildren in widely separated areas where arrangements could be made for specially trained personnel to work uniform materials and techniques. Both patients and children were tested with an intradermal dose of 5 TU, and the children were retested with 100 TU if the reactions were less than 5 mm. The results confirm those of earlier papers, that at least two different kinds of naturally acquired tuberculin sensitivity are found in many human populations: a high-grade sensitivity, designated as specific for virulent tuberculous infection, and a low-grade kind designated as non-specific, or not specific for tuberculous infection. Specific sensitivity is the kind found in tuberculous patients and in some schoolchildren everywhere. It follows a remarkably uniform pattern wherever it is found, apparently varying only in prevalence, not in degree, from place to place. In contrast, non- specific sensitivity varies both in prevalence and in degree. It ranges from nearly universal prevalence in some localities to almost complete absence in others, from a low degree to a relatively high degree approaching that of specific sensitivity. Non-specific sensitivity is not correlated with specific sensitivity and may have different causes in different places. (excerpt)
World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women.
American Journal of Obstetrics and Gynecology. 2006 Mar; 194(3):639-649.The purpose of this trial was to determine whether calcium supplementation of pregnant women with low calcium intake reduces preeclampsia and preterm delivery. Randomized placebo-controlled, double-blinded trial in nulliparous normotensive women from populations with dietary calcium !600 mg/d. Women who were recruited before gestational week 20 received supplements (1.5 g calcium/d or placebo) throughout pregnancy. Primary outcomes were preeclampsia and preterm delivery; secondary outcomes focused on severe morbidity and maternal and neonatal mortality rates. The groups comprised 8325 women who were assigned randomly. Both groups had similar gestational ages, demographic characteristics, and blood pressure levels at entry. Compliance were both 85% and follow-up losses (calcium, 3.4%; placebo, 3.7%). Calcium supplementation was associated with a non-statistically significant small reduction in preeclampsia (4.1% vs 4.5%) that was evident by 35 weeks of gestation (1.2% vs 2.8%; P = .04). Eclampsia (risk ratio, 0.68: 95% CI, 0.48-0.97) and severe gestational hypertension (risk ratio, 0.71; 95% CI, 0.61-0.82) were significantly lower in the calcium group. Overall, there was a reduction in the severe preeclamptic complications index (risk ratio, 0.76; 95% CI, 0.66-0.89; life-table analysis, log rank test; P = .04). The severe maternal morbidity and mortality index was also reduced in the supplementation group (risk ratio, 0.80; 95% CI, 0.70-0.91). Preterm delivery (the neonatal primary outcome) and early preterm delivery tended to be reduced among women who were %20 years of age (risk ratio, 0.82; 95% CI, 0.67-1.01; risk ratio, 0.64; 95% CI, 0.42-0.98, respectively). The neonatal mortality rate was lower (risk ratio, 0.70; 95% CI, 0.56-0.88) in the calcium group. A 1.5-g calcium/day supplement did not prevent preeclampsia but did reduce its severity, maternal morbidity, and neonatal mortality, albeit these were secondary outcomes. (author's)
Lancet. 2005 Jul 2; 366(9479):1.Last week, WHO distributed to all European ministries of health one of the most important documents on prison health ever published. The report, Status Paper on Prisons, Drugs and Harm Reduction, brings together the wealth of evidence that shows that infectious disease transmission in prisons can be prevented and even reversed by simple, safe, and cheap harm-reduction strategies. Perhaps most importantly, the paper affirms WHO’s commitment to harm reduction, despite opposition from many governments who view such approaches as a tacit endorsement of illegal behaviour. The public-health case for action is strong, but political commitment to this method of combating health problems in prisons remains elusive. Indeed, health problems in prisons are numerous. Prisoners are often from the poorest sectors of society and consequently already suffer from health inequalities. Being in prison commonly exacerbates existing health problems—incarcerating anyone, especially vulnerable groups such as drug users and those with mental illness, has serious health and social consequences. (excerpt)
Programming for male involvement in reproductive health. Report of the meeting of WHO Regional Advisors in Reproductive Health, WHO / PAHO, Washington DC, USA, 5-7 September 2001.
Geneva, Switzerland, WHO, 2002.  p. (WHO/FCH/RHR/02.3)Research has shed some light on the gaps in our knowledge of reproductive health issues as they relate to men, but we have little information about programmatic issues and how such research could improve programme operation and service delivery. WHO Country Offices are often consulted by programme managers and policy-makers for advice on strategies for including men in the delivery of reproductive health services. It was proposed that the meeting of WHO Regional Advisers and Directors of Reproductive Health for 2001 focus on the design, success stories, lessons learned and research recommendations for programmes that aim to include men in reproductive health. Regional experiences, case studies, systematic reviews, research highlights and model projects representing a variety of regions were presented at the meeting by a select group of experts working in the field, Regional Offices, collaborating agencies, programme managers, and researcher institutions. Among these were several experts and individuals who had participated in RHR-funded studies at the global or the regional level. (excerpt)
WHO / CONRAD Technical Consultation on Nonoxynol-9, World Health Organization, Geneva, 9–10 October 2001. Summary report.
Geneva, Switzerland, WHO, 2003.  p. (PN-ACQ-110)An effective, easy to use vaginal microbicide would provide women with a method under their own control with which to protect themselves against infection with the human immunodeficiency virus (HIV). While many novel compounds are currently being developed and tested, it will be many years before a new product can be fully evaluated and distributed to users. The spermicide Nonoxynol-9 (N-9) has been widely available as a contraceptive for many years and has been shown to be effective against HIV in laboratory studies. If it also provided effective protection against HIV in clinical studies, N-9 could be made rapidly available to women who require protection. The World Health Organization Global Programme on AIDS (GPA) and the Joint United Nations Program on HIV/AIDS (UNAIDS) sponsored a clinical trial of a gel containing N-9 to assess its effectiveness in protecting against HIV. Preliminary results from the study were presented in July 2000 at the 13th International AIDS Conference in Durban, South Africa, and showed, contrary to expectation, that the HIV incidence was higher in women using N-9 than in women using a comparison product. While a disappointment with regard to the rapid deployment of an effective microbicide, these results also raised questions about the safety of N-9 when used for its main indication, protection against unwanted pregnancy. After presentation of the preliminary results from the study in July 2000, the World Health Organization (WHO) was approached to provide an assessment of the scientific information regarding the safety and effectiveness of N-9 when used for family planning purposes. This summary should permit Member States to assess the risks and benefits of N-9 use among women in their country who may be at risk of HIV infection from inadequately protected sexual activity. Accordingly, the WHO Department of Reproductive Health and Research (RHR) convened a Technical Consultation in October 2001, in partnership with the CONRAD Program, Arlington, VA, USA, to review the available evidence and provide advice to member states on the use of N-9. The Consultation included experts from developed and developing countries with experience in product development, safety assessment, and public health and representatives from collaborating agencies (Annex). Reviews of key issues were commissioned prior to the meeting and are summarised in this report. The meeting also considered the submitted manuscripts from recently completed studies directly relevant to the safety and effectiveness of N-9. This report summarises the evidence presented to the meeting on the safety of N-9 and its effectiveness for protection against pregnancy, sexually transmitted infections (STIs) and HIV. The meeting concluded with recommendations on the use of N-9 and identified key areas of uncertainty where more research was urgently required. (excerpt)
Geneva, Switzerland, WHO, Department of Immunization, Vaccines and Biologicals, 2004.  p. (WHO/EPI/TRAM/93.5 (updated 2004); WHO/PBL/93.31)This teaching aid is about measles, and its potentially harmful effects on the eyes of children.1 Understanding the risks of damage to the eye from measles is the first step before learning what action to take to save sight. Measles causes a great amount of unnecessary death and blindness in children, especially in Africa and parts of Asia. Death and loss of sight due to measles are health care disasters that simply should not occur. Measles is a highly infectious disease preventable by immunization. Reducing deaths due to measles is a global health priority. Immunized children rarely get measles and the cost of immunization is low. The road to good health is also the road to good vision. Since the eye problems due to measles are especially dangerous in children who eat less well, this teaching aid also presents good feeding habits and how to improve the diet for the malnourished child. Protein-energy malnutrition is the most widespread form of malnutrition. It is not easily preventable in poor communities or where there is serious shortage of food as in famine situations and civil strife. (excerpt)
Geneva, Switzerland, WHO, Department of Communicable Disease Surveillance and Response, 1999 Apr. 66 p. (WHO/CDS/CSR/EDC/99.1)This document has been prepared to assist medical and public health leaders to better respond to future threats of pandemic influenza. It outlines the separate but complementary roles and responsibilities for the World Health Organization (WHO) and for national authorities when an influenza pandemic appears possible or actually occurs. Specific descriptions are given of the actions to be taken by WHO as it assesses the risk posed by reported new sub-types of influenza, in advance of any epidemic spread. The responsibility for management of the risk from pandemic influenza, should it actually occur, rests primarily with national authorities. WHO strongly recommends that all countries establish multidisciplinary National Pandemic Planning Committees (NPPCs), responsible for developing strategies appropriate for their countries in advance of the next pandemic. In recognition of the individuality of countries, as well as the unpredictability of influenza, this document emphasizes the processes and issues appropriate for WHO and NPPCs, but does not provide a “model plan”. Furthermore, it is anticipated that NPPCs will confront new issues, which will call for additional international dialogue. For example, more consideration is needed about how scarce supplies of vaccines can be shared, and what might be the benefit of cancelling public gatherings to slow the spread of a pandemic virus among unvaccinated populations. (excerpt)
Estimation of the incidence and prevalence of sexually transmitted infections. Report of a WHO consultation, Treviso, Italy, 27 February - 1 March 2002.
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)
Global crises -- global solutions: managing public health emergencies of international concern through the revised International Health Regulations.
Geneva, Switzerland, WHO, Communicable Disease Surveillance and Response, International Health Regulations Revision Project, 2002. iii, 19 p. (WHO/CDS/CSR/GAR/2002.4)One of the obvious consequences of globalization is the increased risk of international spread of infectious diseases. People and goods are crossing national borders in massive numbers unparalleled in human history. While some countries may still opt for extreme protectionism, importation of diseases is always difficult to prevent. The cross-border impact of infectious diseases is better addressed through multilateral efforts. In the past, the most concrete measures to stop importation of infectious diseases were thought to be quarantine and trade embargoes. The ultimate way to stop international spread of disease would be to stop all international trade, travel and tourism. Such drastic measures, though no longer viable in today’s globalizing world, nonetheless underline the close connection between disease control, trade and travel. The International Health Regulations (IHR) are a multilateral initiative by countries to develop an effective global surveillance tool for cross-border transmission of diseases. The IHR strive to harmonize the protection of public health with the need to avoid unnecessary disruption of trade and travel. They remain the only legally binding set of regulations, for WHO Member States, on global alert and response for infectious diseases. (excerpt)
Marvellous microbicides. Intravaginal gels could save millions of lives, but first someone has to prove that they work.
Lancet. 2004 Mar 27; 363(9414):1042-1043.Preventing AIDS is theoretically simple: encourage mutual monogamy or consistent condom use. But experts warn that if responsibility for protection stays with men, these interventions will produce only small gains in the fight against AIDS. The majority of women in some parts of sub-Sarahan Africa are in immediate danger of contracting HIV. But these women are powerless to protect themselves because most are dependent on men for economic security, and are often unable to negotiate safe sex. If a method of HIV prevention were available that women could administer themselves, the situation could rapidly become very different. Alan Stone, chairman of the International Working Group on Microbicides believes that microbicides —topical agents that stop the HIV virus being transmitted during intercourse— are the only realistic option. “There is absolutely nothing else on the horizon that could make a large-scale impact”, he says. (excerpt)
New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization / Nutrition for Health and Development Iodine Deficiency Study Group Report.
American Journal of Clinical Nutrition. 2004 Feb; 79(2):231-237.Goiter prevalence in school-age children is an indicator of the severity of iodine deficiency disorders (IDDs) in a population. In areas of mild-to-moderate IDDs, measurement of thyroid volume (Tvol) by ultrasound is preferable to palpation for grading goiter, but interpretation requires reference criteria from iodine-sufficient children. The study aim was to establish international reference values for Tvol by ultrasound in 6–12-y-old children that could be used to define goiter in the context of IDD monitoring. Tvol was measured by ultrasound in 6–12-y-old children living in areas of long-term iodine sufficiency in North and South America, central Europe, the eastern Mediterranean, Africa, and the western Pacific. Measurements were made by 2 experienced examiners using validated techniques. Data were log transformed, used to calculate percentiles on the basis of the Gaussian distribution, and then transformed back to the linear scale. Age- and body surface area (BSA)–specific 97th percentiles for Tvol were calculated for boys and girls. The sample included 3529 children evenly divided between boys and girls at each year (x ± SD age: 9.3 ± 1.9 y). The range of median urinary iodine concentrations for the 6 study sites was 118-288 µg/L. There were significant differences in age- and BSA-adjusted mean Tvols between sites, which suggests that population-specific references in countries with long-standing iodine sufficiency may be more accurate than is a single international reference. However, overall differences in age- and BSA-adjusted Tvols between sites were modest relative to the population and measurement variability, which supports the use of a single, site-independent set of references. These new international reference values for Tvol by ultrasound can be used for goiter screening in the context of IDD monitoring. (author's)
Health for the Millions. 2004 Jan; 30(4-5):28-29.Availability of essential drugs has been one of the major components of the Alma Ata Charter. Dr. Halfden Mahler, former Director General, WHO had called increasing pharmaceuticalisation of health care and the increasing power of the drug corporators and the drug exporting countries as neo colonialism. He set up the Drug Action Program in WHO that reported to him directly. The model essential drug list was brought out and the guidelines for National Drug Policy were drawn. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], . 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)
International Journal of Gynecology and Obstetrics. 2003 Sep; 82(3):357-367.The International Federation of Gynecology and Obstetrics – FIGO – has been striving hard to carefully attend to women’s well-being, and respect and implement their rights, the status and their health, which is well beyond the basic obstetric and gynecological requirement. FIGO is deeply involved in acting as a catalyst for the all-round activities of national obstetric and gynecologic societies to mobilise their members to participate in and contribute to, all of their endeavours. FIGO’s committees strengthen these objectives and FIGO’s alliance with WHO provides a springboard. The task is gigantic, but FIGO, through national obstetric and gynecological societies and with the strength of obstetricians and gynecologists as its battalion, can offer to combat and meet the demands. (author's)
Perspectives in Health. 2003; 8(2):26-29.More and more, nurses in the Caribbean have been packing their bags and heading for countries with less-than-perfect climates to get better pay and more respect. Now the region is looking for ways to keep them from leaving – and even to lure those abroad back home. (author's)
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)
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)
Human Resources for Health. 2003 Jul 22; 1: p..Background: Human resources are an essential element of a health system’s inputs, and yet there is a huge disparity among countries in how human resource policies and strategies are developed and implemented. The analysis of the impacts of services on population health and well-being attracts more interest than analysis of the situation of the workforce in this area. This article presents an international comparison of the health workforce in terms of skill mix, sociodemographics and other labour force characteristics, in order to establish an evidence base for monitoring and evaluation of human resources for health. Methods: Profiles of the health workforce are drawn for 18 countries with developed market and transitional economies, using data from labour force and income surveys compiled by the Luxembourg Income Study between 1989 and 1997. Further descriptive analyses of the health workforce are conducted for selected countries for which more detailed occupational information was available. Results: Considerable cross-national variations were observed in terms of the share of the health workforce in the total labour market, with little discernible pattern by geographical region or type of economy. Increases in the share were found among most countries for which time-trend data were available. Large gender imbalances were often seen in terms of occupational distribution and earnings. In some cases, health professionals, especially physicians, were overrepresented among the foreign-born compared to the total labour force. Conclusions: While differences across countries in the profile of the health workforce can be linked to the history and role of the health sector, at the same time some common patterns emerge, notably a growing trend of health occupations in the labour market. The evidence also suggests that gender inequity in the workforce remains an important shortcoming of many health systems. Certain unexpected patterns of occupational distribution and educational attainment were found that may be attributable to differences in health care delivery and education systems; however, definitional inconsistencies in the classification of health occupations across surveys were also apparent. (author's)
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)
Education for the prevention of AIDS. No. 1. Selection of extracts from teachers' guides. Revised ed. Education pour la prevention du SIDA. Selection d'extraits de guides pedagogiques a l'usage des enseignants. Educacion para la prevencion del SIDA. Seleccion de paginas de guias pedagogicas para el uso de personal docente.
[Paris, France], UNESCO, 1992 Oct. , 146 p.UNESCO's AIDS School Education Resource Center (ASERC), in collaboration with the World Health Organization (WHO), has compiled eight teachers' guides from Australia, Canada, Cameroon, Spain, the Pacific islands, Uganda, and the US (Hispanic curriculum). The teachers' ability to consider the myths, taboos, attitudes, habits, and knowledge of their students determines the effectiveness of AIDS preventive education. There are different approaches to effectively teach secondary school students. Essentially all the guides have a section on knowledge and information about HIV/AIDS (e.g., ways to prevent HIV transmission and clinical symptoms) and a section on appropriate attitudes and behavior towards HIV/AIDS (e.g., adopting preventive behavior). This last section contains participatory activities on decision making and on how students should behave towards and deal with persons with AIDS. Various teaching aids proposed by the guides include transparencies, fact sheets for teachers, pupils' guides, videocassettes, films, ideas for making puppets, and a glossary. Annex 1 has a pre-test that teachers can use to assess student knowledge, attitudes, and behavior towards AIDS. Annex 2 lists bibliographical references to other guides available at ASERC.
[Estimation of the rate of mother-to-child HIV transmission: methodological problems and current estimates. Report of 2 study workshops (Ghent, Belgium, 17-20 February 1992 and 3-5 September 1993)] Estimation du taux de transmission du VIH de la mere a l'enfant: problemes methodologiques et estimations actuelles. Rapport de deux ateliers de travail (Gand, Belgique, 17-20 fevrier 1992 et 3-5 septembre 1993).
SANTE. 1994 Mar-Apr; 4(2):73-86.Many cohort studies since 1985-1989 have estimated the rate of mother-to-child transmission of HIV. Data collection and analysis problems in many of these studies made it hard to compare transmission rates between studies. The AIDS Task Force/European Community and WHO/Global Program on AIDS held workshops on methodological problems and actual estimations of mother-to-child transmission of HIV in February 1992 and September 1993 in Belgium. Researchers who have conducted studies in Central and Eastern Africa, Europe, Haiti, and the US participated. They examined enrollment and follow-up methods, diagnostic criteria and case definitions, measurement and comparison of mother-to-child transmission rates, and determinants of transmission. The reported transmission ranges varied from 13% to 32% in developed countries and from 25% to 48% in developing countries. Since the estimation methods differed, the participants could not make direct comparisons, so they developed a common methodology at the 1992 workshop. They agreed on definitions of HIV-related signs and symptoms, AIDS in children, and HIV-related deaths. They developed a classification system of children born to HIV-1 infected women based on probable HIV infection status during the first 15 months of life. This system let them define a direct method of computation of the transmission rate and an indirect method for studies with a comparison group of children born to HIV negative women. At the 1993 workshop, participants applied some data sets to these standardized methods to revise earlier estimates and to compare mother-to-child HIV-1 transmission rates in 13 different locations. The transmission rates, determined by the direct and indirect methods, ranged from 12.7% to 42.1% and from 20.7% to 42.8%, respectively. Using the direct method, those in industrialized countries and developed countries ranged from 14% to 25% and from 13% to 42%, respectively. Both methods attain a reasonable estimate of the true rate. Application of these methods to all studies would help researchers design and implement trials assessing interventions trying to reduce or prevent mother-to-child transmission of HIV.