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  1. 1
    017669

    Bitter pills: medicines and the Third World poor.

    Melrose D

    Oxford, United Kingdom, OXFAM, 1982. 277 p.

    Third World countries face foreign domination of their drug markets, a glut of overpriced and unnecessary medicines, a short supply of essential drugs, technical obstacles to local production, unethical promotion techniques, and inadequate warnings about the side effects of certain drugs that may be banned in the developed world. However, a number of small-scale grass roots projects are attempting to redress this situation. For example, Gonoshasthaya Kendra (People's Health Center) in rural Bangladesh operates a pharmaceutical factory which manufactures inexpensive, essential generic drugs. Profit margins are set lowest on drugs considered most useful, and research and development are tailored to local needs. In addition, countries such as Sri Lanka and Mozambique have adopted comprehensive national drug policies that give priority to essential drugs for primary health care. To make the benefits of modern medicine more available to the poor, Third World governments must prioritize preventive and primary health care services and reallocate resources to the poor majority. National drug policies should include identification of essential drugs, compulsory use of generic names, balanced drug information sheets for prescribers and patients, establishment of an efficient public sector drug distribution system, controls on private distribution, and strict curbs on promotion. Medical training should be rooted in social and economic realities so health workers become oriented toward prevention. Also, the schools, mass media, and community organizations should be used to challenge people's dependence on drugs. The success of new drug policies requires the support of the major drug producing nations. These nations should increase their financial support to UN programs aimed at the needs of developing countries and should not obstruct the World Health Organization in its work on an international code of drug marketing practices. Nongovernmental agencies should publicize examples of constructive policy initiatives and continue to fund community health projects that avoid high technology options. The major transnational drug companies should be consistent in the standards they apply, regardless of loose controls in developing countries, and should demonstrate social responsibility by not creating a demand for nonessential preparations.
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  2. 2
    052222

    [Malaria chemoprophylaxis] Chimioprophylaxie du paludisme.

    Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1982 Dec 10; 57(49):381-4.

    In view of reports of resistance of the Malaria parasite Plasmodium falciparum in localities in East Africa to the prophylactic drug chloroquine, the WHO has made medium-term recommendations for drug suppression, pending a thorough review. There are 3 types of drugs available for malaria suppression: the dihydrofolate reductase inhibitors (DHFR), the 4-amino-quinolines (chloroquine and amodiaquine), and the dihydropteroate synthetase inhibitors (DHPS). The DHPS drugs, proguanil, pyrimethamine or others, are no longer considered adequate used alone. The DHPS drugs Fansidar and Maloprim are already being used in part of South America and East Asia where the M. falciparum has become chloroquine resistant. Recommendations for prophylaxis in Africa depend on the type of risk. Non-immune travellers should take chloroquine or amodiaquine 300 mg weekly and carry a treatment course of sulfadoxine-pyrimethamine in case of fever. The triple drug regimen is not advised because of chance of selection of resistant malaria parasites. Non-immune residents may take chloroquine as recommended for a total of 6.5 years. Those residing longer should take preventive measures against mosquito bites and use treatment if affected. Among semi-immune residents, only pregnant women past the 4th month should take chloroquine, and if infected use quinine or antibiotics (not tetracycline). Special at-risk groups such as army units should rely on preventive measures to reduce selection of resistant parasites.
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  3. 3
    017856

    Treponemal infections. Report of a WHO scientific group.

    World Health Organization [WHO]. Scientific Group on Treponemal Infections

    World Health Organization Technical Report Series. 1982; (674):1-75.

    The World Health Organization (WHO) Scientific Group on Treponemal Infections met in Geneva during October 1980 with the objective of reviewing all aspects of the treponematoses and of providing updated standards and guidelines for their diagnosis, treatment, and control. WHO has always attached great importance to the sexually transmitted diseases and to the nonvenereal endemic treponematoses, because of the heavy burden they impose on both the individual and the society. This report of the WHO Scientific Group on Treponemal Infections covers the following: epidemiological aspects (syphilis and nonvenereal treponematoses); clinical aspects; laboratory aspects (diagnosis, microcsopic tests used to identify treponemes, serological tests for the detection of antibodies in individuals with treponemal infections, and diagnosis of neurosyphilis by cerebrosponal fluid (CSF) examination); management aspects; control aspects; and research aspects. The diagnosis of a primary or secondary treponemal infection should be established by identification of the causative organisms using darkfield microscopy. A reliable nontreponemal serological test has confirmatory value in such circumstances. A combination of nontreponemal and treponemal serological tests is essential for the diagnosis of all other stages of syphilis. In clinical outposts where nonmedical health workers deliver health care, simple clinical algorithm may help to ensure that genital ulcers and other clinical manifestations of treponemal infections are treated immediately with adequate doses of suitable penicillin preparations. After nearly 40 years, penicillin remains the drug of choice in the treatment of all forms of syphilis. The following were among the recommendations made by the Scientific Group on Treponemal Infection: the following categories should be used in reporting cases of syphilis, i.e., primary and secondary infections, early latent infections, late latent infections, symptomatic late infections, congenital infections in patients under 2 years of age, and congenital infections in patients 2 years of age and older; improved teaching should have the highest priority, particular attention being directed to congenital syphilis; darkfield microscopy should be the preferred diagnostic test for infectious treponemal disease; physicians should be cautioned never to use less than the recommended dosages of penicillin; practical guidelines should be established on the efficient epidemiological analysis of the extent of syphilis, the logistics of syphilis control programs, and the indications for, and application of, various control strategies; and the highest priority should be given to the prevention of congenital syphilis.
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  4. 4
    018420

    Current treatments in the control of sexually transmitted diseases [draft]

    World Health Organization [WHO]. Consultative Group on Current Treatments in the Control of Sexually Transmitted Diseases

    [Unpublished] 1982. 79 p.

    The World Health Organization (WHO) Consultative Group on current treatments in the control of sexually transmitted diseases (STD) met in Geneva during November 1980 in an effort to develop recommendations for the treatment of STD applicable to areas in which resistance to antimicrobial agents is high and possibly poorly defined and in which diagnostic capabilities are limited. The therapeutic recommendations cover the following: specific infections (gonococcal infections, Chlamydia trachomatis, lymphogranuloma venereum, syphilis, chancroid, genital herpes simplex virus infections, venereal warts, donovanosis, Trichomonas vaginalis infections, genital candidiasis, Gardnerella vaginalis, scabies, pediculosis pubis); STD associated syndromes (urethritis, acute epididymo-orchitis, and acute pelvic inflammatory disease). Discussions underlying the recommendations focused on the choice of antimicrobial regimens, antimicrobial resistance in N. gonorrhoeae, gonococcal infections, chancroid, chlamydial infection, genital herpes simplex virus infection, syphilis, donovanosis, trichomoniasis, nonspecific vaginitis, STD associated syndromes, simultaneous infections, surveillance of antimicrobial sensitivity, STD health care delivery, and syndromic approach to management. The incidence of most STDs appears to have increased markedly during the last decade, and there has been increased recognition of disease caused by sexually transmitted agents such as chlamydia trachomatis and the appearance of new diseases, such as the acquired immune deficiency syndrome (AIDs) which are apparently related to sexual activity. The antimicrobial resistance of several sexually transmitted pathogens has increased. N. gonorrhoeae now exhibits high levels of chromosomal resistance to a variety of antimicrobial agents. Regimens required to treat these infections have reached the limits of human tolerance. Tetracycline is now administered in doses of 2 gm daily and increased doses are associated with high rates of gastrointestinal disturbances. Treatments of gonorrhea have included the intramuscular administration of 4.8 million units of aqueous procaine penicillin G, requiring multiple injections. When, in an effort to overcome intrinsic microbial resistance, the intramuscular dose was increased to 9.6 million units, requiring 4-8 separate injections, 25% of recipients developed acute procaine reactions.
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  5. 5
    273084

    Gambian Primary Health Care Resource Group (First meeting, Banjul, 7 - 9 June 1982).

    World Health Organization [WHO]. Health Resource Group for Primary Health Care

    [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.
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