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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.
Lancet. 1993 Jan 30; 341(8840):304-5.WHO provides health workers with guidelines for case management strategies for children with acute respiratory infections (ARI) to reduce child mortality. Its clinical case definitions for ARI do not assume that a child has only 1 disease, however. The guidelines also help health workers diagnose and treat other conditions in those children with fever who live in malaria endemic areas such as Africa where Plasmodium falciparum is transmitted. They also guide health workers on how to refer children with danger signs of severe malaria, meningitis, or severe malnutrition to the hospital. Based on studies in Malawi and the Gambia, WHO 1st recommended using co-trimoxazole and chloroquine to treat children with malaria who have a cough and fever and who are breathing quickly. Experts at a WHO meeting in April 1991 now recommend 5 days of co-trimoxazole alone to treat such children in areas where malaria is moderately to highly endemic, the leading parasite is P. falciparum, and it is sensitive to sulfadoxine/pyrimethamine. WHO has incorporated this change into its clinical guidelines and training materials. The guidelines emphasize that local health workers must adapt the guidelines for children with concomitant malaria as necessary to guarantee appropriate identification and referral of children with severe anemia. WHO and UNICEF are developing a fully integrated training package to address case management of children with pneumonia, diarrhea, malaria, measles, and/or malnutrition. This package also instructs health workers on how to manage middle ear inflammation, anemia, meningitis, and acute ocular problems from measles and vitamin A deficiency. WHO and UNICEF hope to have this integrated training package available in late 1993.
Journal of the Indian Medical Association. 1983 Apr; 80(7-8):108-11.In 1977 the World Health Assembly launched the movement for "Health for all by the year 2000." The 1st step was taken at the International Conference on Primary Health Care in Alma Alta, USSR, in 1978. The conference declared that primary health care (PHC) was the key to realizing the goal of health for all by 2000. It also emphasized the need for urgent and effective national and international action to develop and implement a PHC program throughout the world. A general review of the progress in terms of the indicators will facilitate tracing the progress and realizing the magnitude of the tasks ahead. In terms of the 1st 2 indicators, the target has been endorsed at the highest official level by parliaments or governments in most countries and the mechanism has been strengthened in most of the developing countries to involve people in the implementation of the health development programs. The trouble begins with the 3rd indicator which requires countries to spend at least 5% of the gross national product (GNP) on health. For most of the developing countries where health development is inextricably linked with socioeconomic development, investing 5% of the GNP on health is difficult. It is almost an impossibility for the least developed countries (LDCs). The position of the developing countries like India, though somewhat better than that of the LDCs, is not very encouraging either. In India's 6th Plan the allocation on health as percentage of total allocation in the budget was 2.40 in 1978-79 and 2.10 in 1979-80. India's position with regard to the 4th global indicator, requiring that a reasonable percentage of national health expenditure be devoted to the local health care, is not yet satisfactory though considerable efforts have been made in this area. In regard to the 5th indicator, namely, equitable distribution of resources on various population groups or geographical areas, the desired standard has not been achieved. A most important indicator, indicator 7, set by the WHO for monitoring the progress of the global strategy is that PHC should be available to the entire population. About 361 million of India's rural population do not have adequate drinking water facilities and sanitation facilities. In respect to the drug requirement of indicator 7, only a few of the essential drugs of the 20 required, are available. About 50% of the children live in conditions of poverty, deprivation, and malnutrition, and about 40% of all deaths in the country occur among children below age 5 and 10% of all children born do not live to celebrate their 1st birthday. Despite the conditions, child care continues to receive low priority from the government of India. Nutrition programs have been launched, but most of these programs have only touched on the problem.