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Towards the creation of strategic partnerships: improving access to drugs for HIV / AIDS. Report of a consultative meeting, 30 June - 2 July 1997, Salle C, WHO, Geneva.
Geneva, Switzerland, UNAIDS, 1998. 20 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/98.40)From January 1996, the UNAIDS Secretariat has been in consultation with key players in the pharmaceutical industry, NGOs, people living with HIV, UN, major bilateral donors, country representatives and National AIDS Programme Managers on issues relating to access to drugs for HIV/AIDS. This meeting, held on 30 June to 2 July 1997, was the climax of this consultative process. The meeting brought together people living with HIV/AIDS, NGO representatives, National AIDS Programme Managers and UN representatives. With a modified version of the Search Conference approach, the following questions were raised: What are the current and future issues on access to drugs for HIV/AIDS at country and global levels? What partnerships should be created at country level to address these issues? What should be the content of these partnerships at country level? What should the UN do at global and country level to support these partnerships? To foster regional exchange of experience as well as enhance regional specificity, participants were assigned groups on a regional basis. (excerpt)
Rational Pharmaceutical Management Plus. Technical Advisory Group (TAG) -- 2nd Meeting on Tuberculosis: trip report.
Arlington, Virginia, Management Sciences for Health [MSH], Center for Pharmaceutical Management, Rational Pharmaceutical Management Plus, 2005 Oct. 15 p. (USAID Cooperative Agreement No. HRN-A-00-00-00016-00)RPM Plus has been substantially involved in TB activities in the E&E region both at the country and regional level since 1998, providing technical leadership to StopTB partners and technical assistance to countries in streamlining TB drug management systems as part of overall WHO DOTS strategy. In recognition of the RPM Plus role as a leader in pharmaceutical management, RPM Plus Program Manager for TB Andrey Zagorskiy was elected a member of the WHO/Euro Technical Advisory Group (TAG), with the first meeting in 2004 in Sinaia, Romania. In 2005, RPM Plus continued to provide technical leadership in pharmaceutical management for TB to WHO/Euro TAG, and participated in the second meeting in September 2005, in Copenhagen, Denmark. (author's)
Will the circle be unbroken? - includes related article on population assistance to developing countries - child survival programs and fertility decline.
UN Chronicle. 1998 Winter; 35(4): p..The demographic transition which has been under way in the developing countries since the middle of the twentieth century has shown much difference, both in its course and in the factors behind it, from the transition which started two centuries ago in countries that are now developed. In the developed countries, the gradual improvement in living conditions accompanying industrialization and urbanization, coupled with broadening education and sanitation and a growing understanding of the principle of hygiene and nutrition, resulted in progressive gains in child survival and declines in mortality at all ages. These same forces of development were progressively changing attitudes towards reproduction, reducing the demand for children and lowering marital fertility. In the developing countries, there have been unprecedented declines in mortality over a few decades since midcentury. Only sub-Saharan Africa as a whole Ires not yet entered into this phase of demographic transition to a significant extent. A distinguishing feature of this transition has been that declines in mortality and fertility were not accompanying major gains in economic development. (excerpt)
[Unpublished] 1986. 6 p. (WHO/CDD/CMT/86.1)This article presents an overview of current therapeutic practice as recommended by the World Health Organization (WHO) Diarrheal Disease Control Program. The recommendations apply solely to acute diarrheal disease in infants and children. Therapy for such cases is primarily concerned with the prevention or correction of dehydration, the maintenance of nutrition, and the treatment of dysentery. The various approaches to treatment considered are: 1) oral rehydration, which is highly effective for combating dehydration and its serious consequences, but does not diminish the amount or duration of diarrhea; 2) antimotility drugs, none of which are recommended for use in infants and children because the benefits are modest and they may cause serious side effects, such as nausea and vomiting; 3) antisecretory drugs, only a few of which have been properly studied in clinical trials, virtually all of which have important side effects, a low therapeutic index, and/or only modest efficacy. Consequently, none can at present be recommended for the treatment of acute infectious diarrhea in infants and children. 4) aciduric bacteria, on which conclusive evidence is still lacking; 5) adsorbents: kaolin and charcoal have been proposed as antidiarrheal agents in view of their ability to bind and inactivate bacterial toxins, but the results of clinical studies have been disappointing. 6) improved Oral Rehydration Salts (ORS): this may turn out to be the most effective and safest antidiarrheal drug. 7) antibiotics and antiparasitic drugs for a few infectious diarrheas (e.g., cholera). Antibiotics can significantly diminish the severity and duration of diarrhea and shorten the duration of excretion of the pathogen. No antibiotic or chemotherapeutic agent has proven value fort the routine treatment of acute diarrhea; their use is inappropriate and possibly dangerous. It is concluded that oral that oral rehydration is the only cost-effective method of treating diarrhea among infants and children.The Inter-African Committee's (IAC) work against harmful traditional practices is mainly directed against female circumcision. Progress towards this aim is achieved mostly through the efforts of th non governmental organizations (NGO) Working Group on Traditional Practices Affecting the Health of Women and Children and the IAC. In 1984 the NGO Working Group organized a seminar in Dakar on such harmful traditional practices in Africa. The IAC was created to follow up the implementation of the recommendations of the Dakar seminar. The IAC has endeavored to strengthen local activities by creating national committees in Benin, Djibouti, Egypt, Ethiopia, Gambia, Ghana, Kenya, Liberia, Mali, Nigeria, Senegal, Sierra Leone, Somalia, Sudan and Togo. IAC activities in each country are briefly described In addition, the IAC has created an anatomical model, flannelgraphs, and slides to provide adequate educational material for the training of medical staff in teaching hospitals and to make village women aware of the harmful effects of female circumcision. The IAC held 2 African workshops at the Nairobi UN Decade for Women Conference. The African participants recognized the need for international solidarity to fight female circumcision and showed a far more definite and positive difference in their attitude towards the harmful practice than was demonstrated at the Copenhagen Conference/ Forum of 1980. At the United Nations level, female circumcision is receiving serious consideration. A special Working Group has been set up to examine the phenomenon. Finally, this article includes a statement by a sheikh from the Al Azhar University in Cairo about Islam's attitude to female circumcision.
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.
Policy statement on preventive therapy against tuberculosis in people living with HIV. Report of a meeting held in Geneva, 18-20 February 1998. World Health Organization. Global Tuberculosis Programme and UNAIDS.
[Geneva, Switzerland], World Health Organization [WHO], Global Tuberculosis Programme, 1998. 26 p. (WHO/TB/98.255; UNAIDS/98.34)During February 18-20, 1998, the Global Tuberculosis (TB) Programme of the WHO and the Joint UN Programme on HIV/AIDS convened a meeting in Geneva to review available data on TB and to make updated recommendations to governments concerning preventive therapy (PT). This document presents the policy statement arising from the meeting regarding PT against TB in people living with HIV. It also forms a technical annex to those guidelines and sets out the process by which the guidelines were developed, as well as the technical information on which they are based. The meeting brought together 50 people comprising technical experts, potential consumers, policy-makers, and donor agencies. The meeting was spent reviewing knowledge on the interactions between TB and HIV; strategies for TB control; approaches to HIV care; experience with voluntary HIV counseling and testing; efficacy, feasibility and cost-efficacy of PT.
Evaluation of certain veterinary drug residues in food. Fifty-fourth report of the Joint FAO / WHO Expert Committee on Food Additives.
Geneva, Switzerland, World Health Organization [WHO], 2001. vi, 96 p. (WHO Technical Report Series 900)During February 15-24, 2000, the Joint Food and Agriculture Organization (FAO)/WHO Expert Committee on Food Additives (JECFA) convened at the WHO Headquarters, Geneva, to evaluate the safety of residues of certain veterinary drugs in food and to recommend maximum levels for such residues in food. This report presents the conclusions of the Joint FAO/WHO Expert Committee's meeting. Inclusion of the report considers the interpretation of data on inhibition of cholinesterase activity and recommendations arising from an informal meeting on harmonization with the Joint FAO/WHO Meeting on Pesticide Residues. The Committee also evaluated toxicological and residue data on a variety of veterinary drugs: one anthelminthic agent (ivermectin); four antimicrobial agents (flumequine, lincomycin, oxytetracycline and tilmicosin); six insecticides (cyhalothrin, cypermethrin, alpha-cypermethrin, dicyclanil, permethrin, and metrifonate (trichlorfon)); and one production aid (melegestrol acetate). Annexed to the report are a summary of the Committee's recommendations on these drugs, including Acceptable Daily Intakes and Maximum Residue Limits and further information required.
AFRICA HEALTH. 2001 May; 23(4):37.Since AIDS has been considered the greatest public health challenge, the encouragement of the participation of drug companies and other "partners" in the fight against AIDS will be the personal priority of UN Secretary-General Kofi Annan. During a meeting in Amsterdam, where he met with top executives from the biggest drug companies--companies such as Boehringer Ingelheim, Bristol-Myers Squibb, Glaxo SmithKline, Hoffman-La Roche, Abbot Laboratories, and Pfizer--he was promised an improvement in the accessibility to AIDS treatments in developing countries. This commitment has achieved price reductions of HIV/AIDS treatment drugs, with Bristol-Myers Squibb having achieved the biggest price reductions. A guide on the use of antiretroviral treatments for HIV/AIDS patients lists methods of undertaking these treatments in resource-limited settings.
Zidovudine to prevent mother-to-infant HIV transmission in developing countries: any questions? [editorial]
Tropical Medicine and International Health. 1998 Sep; 3(9):689-90.The 12th World AIDS Conference in Geneva, Switzerland, held last June 28 to July 3, 1998, pursued the noble aim of bridging the HIV control/AIDS care gap between the developing and developed world. The collaboration of three organizations, namely, the Joint UN Program on AIDS/HIV, the UN Children's Fund, and the WHO, took an initiative to reduce mother-to-child perinatal HIV transmission in developing countries. It will seek support to provide a short zidovudine regimen to 30,000 HIV-infected pregnant women living in 30 project areas in 11 pilot countries. The cost of drugs under the proposed short regimen seems promising, some US$50 per treatment course. However, for the short zidovudine regimen to be effective, at least one antenatal visit is needed before 34-36 weeks of gestation. At that moment pregnant women should have access to voluntary and nonstigmatizing HIV testing. In less developed countries unjust distribution of global health services is prominent. Thus, several ethical problems concerning equity, sustainability, development, and women's and patients' rights remained to be considered in developing countries.
BMJ. British Medical Journal. 1992 May 30; 304(6839):1398.A disregard for public health, cry the consumers. "Everything's under control," says industry. "Let's sit down and talk it over," says the WHO. The problem--the ethics of drug promotion--was being debated in Geneva at the world health assembly, which ended its 45th, 2 week session last week. The 3 leading actors in this decade long imbroglio remained true to form, with the usual jostling for media attention. 10 days before the assembly Health Action International (HAI), a public interest group represented in 60 countries, held a meeting in Geneva at which it launched a 50 page booklet attacking "misleading, wasteful and dangerous drug marketing." The book gave examples of products promoted for unapproved indications and of hospitality, prizes, and other inducements offered by drug firms to doctors to influence their prescribing habits. It also described poor postmarketing surveillance by drug firms. The problem, says HAI, is not confined to a few "bad apples" but "is a global phenomenon." Undaunted, on the opening day of the assembly the International Federation of Pharmaceutical Manufacturers Associations (IFPMA) briefed journalists on the code of pharmaceutical marketing practices it had established in 1981. Since that year the IFPMA has dealt with 72 complaints citing 926 alleged breaches of the code--92% of them in developing countries. All were investigated, said the IFPMA, and 527--over half--confirmed. "All these violations were rectified or avoided in future promotional campaigns," said the IFPMA's spokesman Mr. Jean-Francois Gaulis, "The code works." HAI disagrees. The IFPMA's code, said Dr. Wilbert Bannenberg, a Dutch public health physician and trustee of the organization, was "far too weak." "Just waiting for complaints to come in is not enough : there must be an active monitoring system and a way of enforcing respect for the code. National authorities in developing countries often don't have the facilities to do this." HAI also criticized WHO for its failure to prevail on national governments to abide by its ethical code for drug promotion, drawn up in 1988. "That code is also too weak," said Dr. Bannenberg. The debate during the world health assembly was prompted by concern among WHO member states over a lack of evidence of "progress in controlling medicinal drug promotion," since WHO's code was established. In the end the assembly passed a resolution calling for a meeting to be held on neutral territory where "interested parties"--notably HAI and the IFPMA--can thrash out their differences. (full text)
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1990; (796):1-57.This report from the World Health Organization (WHO) Expert Committee meeting of November, 1989, reaffirms the concept of essential drugs as fundamental to WHO's revised drug strategy. WHO's Model List of Essential Drugs is deemed essential to WHO member states in ensuring the most rational approach to drug procurement and supply. An updated Model List of Essential Drugs is included in this report along with explanations of changes. Parts of the previous report requiring either no modification or modest updating are included as well. Following a brief introduction, guidelines for establishing a national program for essential drugs are presented, followed by discussion of selection criteria for the drugs. Following report sections include guidelines for the selection of pharmaceutical dosage forms, discussion of reserve antimicrobials and monitoring resistance, and applications of the essential drugs concept. Essential drugs and primary health care, quality assurance, drug surveys, research and development, and drug information and education are additional topics covered prior to reaching the Model List. An alphabetical list of essential drugs concludes the body of the report.
Lancet. 1992 May 23; 339(8804):1287.1200 delegates from 175 member countries attended the 45th World Health Assembly in Geneva. Everyone at the Assembly ratified measures to prevent and control AIDS. 12 countries intended to do long term planning for community based care for AIDS patients. Further the Assembly denounced instances where countries and individuals denied the gravity of the AIDS pandemic. In fact, it expressed the importance for urgent and intensive action against HIV/AIDS. The assembly backed proposals to prevent and control sexually transmitted diseases that affect AIDS patients, especially hepatitis B. For example, in countries with hepatitis B prevalence >8% (many countries in Sub-Sahara Africa, Asia, the Pacific region, and South America), health officials should introduce hepatitis B vaccine into their existing immunization programs by 1995. By 1997, this vaccine should be part of all immunization programs. The Assembly was aware of the obstacles of establishing reliable cold chains for nationwide distribution, however. Delegates in Committee A objected to the fact that >50% of the populations of developing countries continued to have limited access to essential drugs. They also expressed disapproval in implementation of WHO's 1988 ethical criteria for promotion of drugs which WHO entrusted to the Council for International Organisations of Medical Sciences (CIOMS). CIOMS lacked WHO's status and thus could not effectively monitor drug advertising. In fact, the pharmaceutical industry as well as WHO provided the funds for a meeting of 25 experts to discuss principles included in the ethical criteria. At least 4 countries insisted that WHO have the ultimate authority in monitoring drug advertising. Delegates did adopt a compromise resolution on this topic which required that industry promotion methods be reported to the 1994 Assembly via the Executive Board. The Assembly requested WHO to establish an international advisory committee on nursing and midwifery and to improve the network of WHO collaborating centers which help national nursing groups.
Editor's introduction [to the proceedings of the Second International Conference on Health Law and Ethics, London, July 16-21, 1989].
LAW, MEDICINE AND HEALTH CARE. 1990 Spring-Summer; 18(1-2):11-4.The editor introduces selected proceedings from the 2nd International Conference on Health Law and Ethics. Over 600 participants from more than 60 international cooperating organizations and the World Health Organization (WHO) were in attendance. Papers considered to be among the finest from the conference are included in the proceedings, and represent a widely-diverging range of cultures and approaches. While this introduction points repeatedly to the United States' health system for contrast and comparison with other systems, the conference paid special attention to global dimensions, wealth and poverty, and innovative ways of approaching health law and ethics in other nations and regions. The publication introduced by the editor considers 6 main topics, the 1st being AIDS medicine, law, and public health in industrialized and 3rd world countries. In light of the ethical challenges in international research, resource distribution, prevention, and blood supply protection, and drug and vaccine availability, steps by WHO's Global Program on AIDS and the Council for International Organizations of Medical Sciences to develop international ethical guidelines for research and development of therapeutic agents are discussed. Comparative treatments of euthanasia, medical malpractice, resource allocation and service inequity, abortion and family planning, and the state's role in medical coercion are explored.
Report from Consultation on Psychosocial Research Needs in HIV Infection and AIDS, Geneva, 25-28 May 1987.
[Unpublished] 1989. 18 p. (WHO/GPA/SBR/89.2)A meeting was held to review the state of research upon the behavioral aspects of HIV transmission, the social factors associated with it, and the effectiveness of control measures, and to consider priorities and future social and behavioral research directions. Despite advances in the virology and immunology of AIDS, much research is called for regarding behavioral aspects of HIV transmission and the impact of AIDS on individual and community life. Such knowledge may be applied in developing effective intervention strategies. The report discusses the nature of the problem, followed by specific topics in the social and behavioral aspects of HIV transmission. Sexual behavior, homosexuality, prostitution, substance abuse, and injections and other skin piercing practices are covered. Social perceptions and explanatory systems are explored, along with coping strategies broken into family children, psychosocial expression, counselling, and family, marriage and reproduction subtopics. Recommendations for research are set forth in the report, aimed at high risk behavior, explanatory models/systems, and coping responses. A variety of research methodologies are suggested, and include population-based surveys, psychometric, ethnographic, and other psychosocial approaches as well as focus group methods. Brief closing mention is made of translating research into action, technical working groups, collaborating centers, a research steering committee, and communications/information.
[The Collaborating Centers of the World Health Organization and AIDS: report of a meeting of the World Health Organization] Les Centres Collaborateurs de l'OMS et le SIDA: memorandum d'une reunion de l'OMS.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1986; 64(1):63-8.The World Health Organization (WHO) meeting on acquired immune deficiency syndrome (AIDS) held in Geneva in September 1985 stressed the importance of the WHO collaborating centers in the worldwide struggle against AIDS. The network of collaborating centers was established after and April 1985 WHO meeting to facilitate international cooperation in training of laboratory personnel, supplying reference reactives, evaluating diagnostic tests, and organizing activities to establish the natural history of the disease in different parts of the world. The AIDS virus is transmitted during sexual intercourse, by parenteral exposure to blood or contaminated blood products, or from the mother to the infant during the perinatal period. In the US and Western Europe, over 90% of victims are still homosexual and bisexual men, intravenous drug users, and their sexual partners, but in many developing countries heterosexuals with active sex lives are the main victims. There are no indications that the virus is spread by casual contact or by insect vectors. Health authorities of all countries should establish surveillance programs to measure the extent of AIDS infection. A precise case definition including only the most serious manifestations of the disease should be used. The US Centers for Disease Control definition has been approved for countries with appropriate diagnostic capabilities. Only immunological diagnostic methods are practical for large scale routine testing. Radioimmunological and immunoenzymatic titers are the most frequently used routine testing procedures. They are very sensitive, but because of the possibility of false positive results, confirmation using another test is needed for individuals belonging to low risk populations. The Western blot or other immunoblotting tests are most often used for confirmation. Progress in laboratory diagnosis would be furthered if international reference standards, simpler diagnostic tests, and other measures were made avaliable. Until drugs capable of preventing and treating AIDS become available, prevention will depend mainly on reduction of risks based on information and education. Cases of AIDS spread by blood transfusion can be eliminated by excluding donors belonging to high-risk groups and by testing the blood for antibodies before transfusion. Reuse of nonsterile needles and syringes should be absolutely avoided. Despite efforts to identify an effective agent for treatment of AIDS, no substance has been found as yet that supplies more than a transitory arrest of viral replication. Interferon has been shown to be effective against Kaposi's sarcoma. New antiviral agents should be careful studied in conformity with accepted protocols for drug evaluation. Numerous attempts to develop an anti-AIDS vaccine are underway. The heterogeneity of the virus poses a significant problem. Several specific recommendations for its 1986-87 program were made to further the role of the WHO as a centraL clearinghouse for AIDS information.
DEVELOPMENT DIALOGUE. 1985; (2):1-4.On November 25-29, 1985, the World Health Organization held a Conference in Nairobi of Experts on the Rational Use of Drugs. In the early 1980s, both the International Federation of Pharmaceutical Manufacturers Association (IFPMA) and Health Action International (HAI) had developed codes of pharmaceutical marketing practices in order to come to terms with the malpractices in this field. A more comprehensive approach was needed, however. Prime responsibility for rational drug use must rest with the member governments, operating through national regulatory authorities and assisted in their work by guidelines on minimum requirements for national drug regulation prepared by WHO. The Dag Hammarskjold Foundation organized a seminar on Another Development in Pharmaceuticals as an independent contribution to the international debate on this global issue. The seminar emphasized that development should be need-oriented, self-reliant, and based on structural transformations. Governments view the pharmaceutical crisis as 1 facet of the more general problem of spiralling health costs which put an intolerable burden on already overstretched welfare services. The pharmaceutical industry sees the crisis largely in terms of excessively restrictive regulations which stifle innovation of products. Some doctors and pharmacists feel that increased regulatory measures will erode their rights to prescribe and to control the supply and information to patients. On the other hand, some clinical pharmacologists and administrators express concern about excessive, irrational and uneconomic prescribing and its effects on public health. Consumer groups define the problem in terms of an overbearing and greedy business community. The general public fail to understand the effects of pharmaceuticals.
[Record of the second meeting of the WHO Collaborating Centers on AIDS] Deuxieme reunion des centres collaborateurs de l'OMS pour le SIDA: memorandum d'une reunion de l'OMS.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1986; 64(2):221-31.Participants at the 2nd meeting of World Health Organization (WHO) collaborating centers on AIDS (acquired immune deficiency syndrome) held in Geneva in December 1985 reported on progress since the 1st meeting in September 1985 and made a number of recommendations for future action in the areas of information, education, and prevention; reference reactants and tests of anti-HTLV-III antibodies; epidemiologic evaluation; and research on vaccines and antiviral agents. It was recommended that ministries of health, education, and social services provide the public with timely and accurate information on AIDS, that physicians, nurses, and similar personnel inform the ill and the public about AIDS and its prevention, and that school age children and young people be informed about AIDS and how to avoid infection. Systems of registration of AIDS cases should be implemented in order to provide the WHO and member states with data on the international level. Standardization and availability of serologic tests is also required. Instructions for avoiding infection should be provided for health personnel and others caring for AIDS patients, for individuals providing personal services to the public, and to ensure adequate methods of disinfection. Instructions for preventing AIDS should discuss sexual and parenteral transmission as well as perinatal transmission. Specific recommendations for education and family placement for children with AIDS have already been published. Instructions should be provided for prisons and similar estabilshments. Requiring international travellers to provide certificates attesting to their AIDS-free status is not justified as a preventive measure. The significant existing demand for reference reactants including human serums with anit-HTLV-III antibodies and controls is being addressed by several institutes in different countries, but it would be premature to furnish reference reactants other than serums. The WHO collaborating centers should furnish materials for purposes of training in diagnostic techniques. Existing tests for diagnosis and confirmation should be imporved and new tests should be developed, with particular attention to simple methods appropriate for use in developing countries. It will be necessary to establish international biological standards for the HTLV-III virus, but the required specifications are not yet known. Technical cooperation and epidemiological evaluation must be planned separately, based on the different prevalence of infections and technical expertise of different countries. A clinical definition of AIDS is needed for countries lacking resources needed to apply the Centers for Disease Control/WHO definition. Surveillance methods and laboratories can be installed with WHO assistance, to help evaluate the extent of AIDS infection in different countries. Later technical cooperation in the areas of continued surveillance and laboratory capacities will depend on results of the initial evaluation in each country. Research is currently underway in several countries of possible vaccines and drugs. Careful preclinical studies should be done to evaluate the toxicity of an agent before clinical studies are conducted. Convenient animal models should be sought for future research. 3 annexes to this report specify methods of disinfection; general principles of preventing transmission of the AIDS virus through parenteral exposure or following donation of organs, sperm, or other tissue; and a proposed definition of clinical cases of AIDS.
In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., AID, International Center for Diarrhoeal Disease Research, Bangladesh [ICDDR/B], United Nations Children's Fund [UNICEF], and the World Health Organization [WHO], 1983. 156-9. (International Conference on Oral Rehydration Therapy, 1983, proceedings)In 1969 the World Health Organization (WHO) arranged for trials of oral rehydration salts (ORS) production. The formula that was developed contained the following basic ingredients per liter of water: 20.0 grams of glucose anhydrous, 3.5 grams of sodium chloride, 2.5 grams of sodium bicarbonate and 1.5 grams of potassium chloride. As the product has become more widely used, a problem with its stability has been discovered, due to the interaction of glucose and sodium hydrogen carbonate. The stability problem was solved in some developing countries by packing glucose or bicarbonate separately, but the solution was not feasible in some countries due to a lack of necessary facilities or funds to maintain them. Based on WHO initiated testing, trisodium citrate offered the best prospects as a substitute for bicarbonate. It should be noted that the present ORS formulation is not discredited by the citrate alteration. If the bicarbonate formula is to be produced it should be packaged in a number of ways including aluminum foil, polyethylene bags, or 2 separate bags, depending upon where or when they will be distributed. The citrate formula should be packaged in aluminum foil, polyethylene bags, or paper/polyethylene laminations, depending upon use. Choice of formula and packing material depends also on the quantity to be produced. Small amounts of ORS can be prepared in hospital pharmacies for in and outpatients. Quantities of more than 2 million packets per year are easier to fill with semiautomatic equipment. Quantities of 4 million or more are more conveniently filled with an automatic machine. In most cases locally produced ORS is no less expensive than imported packets, but they offer advantages like the ability to respond immediately in an emergency and freedom to choose a dosage that is adapted to a standard size container for the country. Flexibility to produce ORS according to local needs and the principle of self reliance are also important advantages of locally produced ORS.
Role of the pharmaceutical industry of the developing countries in research on fertility regulation.
In: Diczfalusy E, Diczfalusy A, ed. Research on the regulation of human fertility: needs of developing countries and priorities for the future, Vol. 2. Background documents. Copenhagen, Denmark, Scriptor, 1983. 975-86.The pharmaceutical industry of the developing countries is at present not equipped for and unlikely to contribute much to the discovery and development of new fertility regulating agents, but could play an effective role in process development, and in the organization of clinical trials. In view of the crucial role of the pharmaceutical industry to bring the research effort on a new contraceptive to fruition, and because of the waning interest of the industries of the developed countries in this field, the pharmaceutical companies of the developing countries should be encouraged to get involved in research by special incentives from their national governments, such as tax exemption for investment made for inhouse research of for sponsored research. The subsidiaries of multinational corporations, which dominate the pharmaceutical industry in the developing world, must establish research centers in these countries with efforts focussed on local priority health problems, such as contraceptive development; such research conducted in some of the developing countries would be more cost effective. It would be necessary to establish government or public sector research institutes to supplement the research facilities of the private industries, particularly for animal toxicology studies; these institutions could even serve as regional centers, supported by international agencies, since some of the smaller countries may not be able to develop their own centers. The collaboration between industrial, academic and public secotr institutions should be encouraged and formalized to establish partnership in research on contraceptive development; the exact mode and form would depend upon the scientific and technical institutional structure and industrial development status of each country. (author's modified)
[Geneva, Switzerland], WHO, 1982. 17 p. (HRG/CRU.1/Rev.1/Mtg.1)In 1979, a WHO team collaborated with national personnel in The Gambia in developing a comprehensive primary health care (PHC) plan of action for the period 1980/81 - 1985/86. In his address to the legislature in August, 1980, the president declared that the plan involved the active participation of local communities and emphasized programs for health promotion and disease prevention. This monograph reports on a meeting of the Gambian Ministries of Economic Planning and Industrial Development and of Health, Labor and Social Welfare in June 1982. Improvements in rural health are a basic need. In order to provide PHC, it was fully realized that a strong supportive infrastructure was essential. The village sensitization program was considered as vital for success. Not 1 village has rejected PHC or its responsibilities. The training program for community health nurses, village health workers and traditional birth attendants was proceeding according to plan for the various levels. Recognizaing that an efficient drug supply was essential, concomitant action had been taken to reorganize the central store. Another essential element without which success could not be achieved related to provision of transport and facilities for their maintenance, so that communications could be assured with rural areas. The need for a radio network to link 6 staions and 26 sub-stations was stresses. The list of participants and the agenda are attached as are the requirements for external support for the planned provision of PHC which were considered by the participants of the meeting.