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MotherNewBorNews. 2006 Aug-Dec; 2(1): p.In 2006, USAID and several of its partners agreed to the implementation of a minimum set of evidence-based interventions in maternal and newborn programs. These included a number of community-based and facility-based interventions that could be phased in to improve the survival and well being of mothers and newborns. These interventions have been tested in various operations research studies and have also been provided as an integrated package of services as described in subsequent sections of this newsletter. Below is a summary of evidence for each of the interventions. In the interest of brevity and simplicity, we have limited the evidence to just a few key studies. To keep the document consistent with the MAMAN framework described in the previous article, the evidence for MAMAN interventions has been described under three broad categories: I) Minimum maternal and newborn care, II) Other essential interventions, and III) Context specific interventions. (excerpt)
Household survey of diarrhoea case management. Enquete dan les menages sur la prise en charge des cas de diarrhee.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1991 Sep 13; 66(37):273-6.The Diarrheal Disease Control (CDD) Program in Nepal conducted surveys in the Midhills and Terai regions of Nepal (9033 <5-year-old children) to determine the extent of diarrhea and knowledge and practices related to diarrhea case management and to evaluate the effectiveness of its activities. 11.7% of the children in Midhills and 7.4% of those in Terai had had diarrhea within 24 hours before the survey. Incidence rates stood at 3.5 and 3.1 episodes/child/year, respectively. 99% of all mothers who were breastfeeding continued to breast feed during the episode. 75% of mothers in Terai an 61% in Midhills also gave at least the same amount of food during the episode as they did before the episode. But only 28% in Terai and 9% in Midhills increased fluid amounts during diarrhea. Even though almost 66% of the mothers knew about oral rehydration solution (ORS), only 8% of cases in Terai who had had diarrhea in the preceding 24 hours and 10% of those in Midhills received ORS or sugar salt solution (SSS). Moreover, only 1.5% received properly prepared ORS. 6.3% of cases in Terai and 4.2% of cases in Midhills received SSS, but only 7 mothers prepared it correctly. The leading reason for improper mixing was addition of too little water. The mean amount of ORs and SSS given during the preceding 24 hours was 362 and 253 ml in Terai and 453 an 424 ml in Midhills, respectively. >51% of all mothers received ORS packets from a government physician or health worker. 21.8% of cases were treated with antidiarrheals some of which were provided by physicians and health workers. Only 19.6% of mothers in Terai and 25% in Midlands knew at least 3 correct reasons to take their child to a health worker. The CDD program should increase access to ORS, train mothers in its correct use, and promote an appropriate homemade SSS. It should also step up training of health workers concerning diarrhea case management.
Evaluating the progress of national CDD programmes: results of surveys of diarrhoeal case management.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1991 Sep 6; 66(36):265-70.National diarrhea disease control (CDD) programs need to evaluate their effect on diarrhea morbidity and mortality, but this is often difficult. So national CDD programs often follow the WHO Global CDD Programme model. It uses 13 indicators designed to measure the extent the CDD program is being effectively administered. These indicators are mainly concerned with diarrhea case management in the home and in health facilities, e.g., oral rehydration therapy (ORT) use rate. WHO is enlarging the list to include breast feeding. It suggests that national CDD programs use WHO developed household and health facility surveys to evaluate their programs. These surveys can also identify problems and demonstrate possible solutions to bring about effective implementation. Evaluation teams have used WHO's Morbidity, Mortality, and Treatment survey almost 400 times. China, Ethiopia, the Philippines, and Viet Nam habitually conduct 1-2 evaluation surveys/year. Ecuador and Kenya use them to train professionals in conducting WHO surveys. 1989-1990 surveys in 17 developing countries reveal positive findings: 89.8-100% of mothers in 16 of the countries (49% in Iran) still breast feed during a diarrhea episode and 60-70% of mothers offer ill children at least the same amount of food as they are offered when well. On the other hand, caregivers do not always use ORT (13.4 [India]-91.8% [Indonesia]) and increased fluid intake is low (15-30%). 13 surveys show that water was the most commonly given nonmilk fluid offered. This information helps programs to identify appropriate home fluids. A 1990 addendum to the WHO household survey allows program managers to assess antidiarrheal drug use. WHO's 1990 manual provides protocols for observing case management practices, interviews with caretakers and health workers, assessing health facilities and supplies, and reviewing records.
IN POINT OF FACT 1991 Jun; (76):1-3.This paper describes the serious effect of diarrheal and acute respiratory (ARI) disease upon children under 5 years old, and international efforts undertaken by the World Health Organization (WHO) to reduce such mortality. Combined, these diseases account for more then 1/2 of all deaths in this age group, and constitute the most serious threat to their health. WHO estimates for 1990 that diarrheal illnesses caused 3.2 million childhood deaths and that ARI caused 4.3 million. While some child deaths are due to measles and pertussis, the majority is caused by pneumonia and the consequences of diarrheal illnesses. These deaths could be readily averted through the timely, effective treatment of trained health workers with essential drugs. Immunization as well as improved nutrition, particularly through the practice of exclusive breast feeding of the child's 1st 4-6 months of life, are addition weapons potentially employed against child mortality. WHO programs for diarrhea and ARI control focus upon simplified treatment guidelines, training, communication messages, drug supplies, and evaluation methodology. Despite obstacles such as the marketing of useless and/or potentially dangerous anti-diarrheal drugs and cough and cold remedies, and inappropriate breastmilk substitutes and unnecessary foods, widespread progress in program development and implementation has been made over the past decade. Increased amounts of oral rehydration therapy and solutions are available and used, while many health workers have benefited from training programs.
Global issues on the agenda at the World Health Assembly. Discussion of HIV / AIDS, leprosy, access to drugs.
JAMA. 2001 Jul 4; 286(1):29-30.During the World Health Assembly in May 2001, some of the high-priority issues are discussed including HIV/AIDS, the WHO policy on medicines, leprosy, and recommendations for infant and young child feeding. In particular, the worldwide HIV/AIDS pandemic and the Global Fund to fight specific diseases in developing countries were subjects of particular interest. In terms of policy on drugs, the main point under discussion was to ensure that public health issues are taken into account as countries develop patent legislation. The secondary issue was the revised drug strategy. A special briefing was also conducted, pointing to great progress in controlling leprosy. Moreover, the main issue in infant and young feeding tackled during the meeting is the promotion and support of breast-feeding.
British Journal of Family Planning. 1984 Jul; 10(37):37.This editorial takes a broad, international look at the worldwide implications of decisions taken in the United Kingdom (U.K.) and the US with regard to family planning. National authorities, like the U.K. Committee for Safety of Medicines (CSM) of the US Food and Drug Administration, address issues concerning the safety of pharmaceutical products in terms of risk/benefit ratios applicable in their countries. International repercussions of US and U.K. decision making must be considered, especially in the area of pharmaceutical products, where they have an important world leadership role. Much of the adverse publicity of the use of Depo-Provera has focused on the fact that it was not approved for longterm use in the U.K. and the US. It is not equally known that the CSM, IPPF and WHO recommeded approval, but were overruled by the licensing agencies. The controversy caused by the Lancet articles of Professors with family planning doctors. At present several family planning issues in the U.K., such as contraception for minors, have implications for other countries. A campaign is being undertaken to enforce 'Squeal' laws in the U.K. and the US requiring parental consent for their teenagers under 16 to use contraceptives. In some developing countries, urbanization heightens the problem of adolescent sexuality. Carefully designed adolescent programs, stressing the need for adequate counseling, are needed. Many issues of international interest go unnoticed in the U.K. International agencies, like the WHO and UNiCEF, have embarked on a global program to promote lactation both for its benficial effects on an infant's growth and development and for birth spacing effects. It may be of benefit to family planning professionals in the U.K. to pay attention to international activity in such issues.