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Population 2005. 2003 Dec; 5(4):9.A survey conducted by the United Nations Population Fund (UNFPA), in collaboration with the International Center for Migration and Health, has tracked startling statistics regarding the health system in Iraq. According to UNFPA, the number of women who die from pregnancy and childbirth in Iraq has close to tripled since 1990. Among the causes of the reported 310 deaths per 100,000 live births in 2002 are bleeding, ectopic pregnancies and prolonged labor. In addition, stress and exposure to chemical contaminants are also partly to blame for the rise in miscarriages among Iraqi women. Access to medical facilities is becoming more difficult for women due to breakdowns in security and weakened communication and transport systems. This has caused nearly 65 per cent of Iraqi women to give birth at home, the majority without skilled help. (excerpt)
[Unpublished] 1991 Apr 24. , 28 p. (SEA/DD/43; Project: ICP CDD 001)Physicians collected data on 4319 households and 3766 0-5 year old children living in rural areas of Dhaka Division in Bangladesh to determine the prevalence of diarrhea among the children, the percentage of diarrhea cases treated with various forms of oral rehydration therapy and with drugs, and caretaker awareness of when to refer children with diarrhea to a health facility. 60.3% received no treatment at all. The 24-hour point prevalence of diarrhea stood at 5.2%. Blood accompanied the diarrhea of 22.3% of these children. Yet only 12% of bloody diarrhea cases received appropriate antibiotic therapy. 13.4% of the children had experienced a diarrheal episode during the 2 weeks before the interview. Mean duration was 7 days, but 22.4% of the children had diarrhea for at least 14 days. The adjusted annual diarrhea incidence rate was 2.3 episodes/child. 33.7% of caretakers asked others for help in treating diarrhea. The advisers tended to be village doctors or quacks (21%), government health workers (17%), and homeopaths (17%). 75% of advisors, except family and friends, suggested drugs. Only 27% and 16% recommended administering oral rehydration solution (ORS) and various home fluids, respectively. Only 22% and 17% suggested caretakers to continue feeding and breast feeding, respectively. The ORS use rate during the previous 24 hours was only 11.9% and just 3.6% of cases drank properly prepared ORS. Yet 93.8% knew about ORS. Most caretakers did not use enough water or all the contents of the ORS packet. Use rate for home fluids was 16.5%. 97.5% of lactating mothers continued to breast feed during the diarrhea episode. 36.1% of children received drugs compared with 25.8% for use of oral rehydration therapy. 70.7% of caretakers gave ill children at least the same amount of solid or semisolid foods during the episode. 70% of caretakers preferred ORS to drugs. The leading reasons for referring cases to a health facility included too many stools (79.7%), failure to improve (28.3%), and fever (26.7%). The researchers deemed only 23.5% to have adequate referral knowledge (=or> 3 reasons).
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.
New England Journal of Medicine. 2001 Apr 26; 344(17):1294-303.The authors expanded the survey conducted by the WHO and the International Union against Tuberculosis and Lung Disease to assess trends in resistance to antituberculosis drugs in countries on six continents. The authors obtained data using standard protocols from ongoing surveillance or from surveys of representative samples of all patients with tuberculosis. The standard sampling techniques distinguished between new and previously treated patients, and laboratory performance was checked by means of an international program of quality assurance. Between 1996 and 1999, patients in 58 geographic sites were surveyed; 28 sites provided data for at least 2 years. For patients with newly diagnosed tuberculosis, the frequency of resistance to at least one antituberculosis drug ranged from 1.7% in Uruguay to 36.9% in Estonia (median, 10.7%). The prevalence increased in Estonia, from 28.2% in 1994 to 36.9% 1998 (P = 0.01), and in Denmark, from 9.9% in 1995 to 13.1% in 1998 (P = 0.04). The median prevalence of multidrug resistance among new cases of tuberculosis was only 1.0%, but the prevalence was much higher in Estonia (14.1%), Henan Province in China (10.8%), Latvia (9.0%), the Russian oblasts of Ivanovo (9.0%) and Tomsk (6.5%), Iran (5.0%), and Zhejiang Province in China (4.5%). There were significant decreases in multidrug resistance in France and the US. In Estonia, the prevalence in all cases increased from 11.7% in 1994 to 18.1% in 1998 (P < 0.001). Multidrug-resistant tuberculosis continues to be a serious problem, particularly among some countries of eastern Europe. The authors' survey also identified areas with a high prevalence of multidrug-resistant tuberculosis in such countries as China and Iran. (author's)