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Health Policy and Development. 2004 Aug; 2(2):96-99.The World Food Programme (WFP) is the United Nations (UN) agency responding to humanitarian emergencies by delivering food aid to vulnerable populations worldwide. The protracted insurgency in northern Uganda resulted in the displacement of up to 1,619,807 people, largely women and children. The humanitarian situation among displaced persons in northern and eastern Uganda led to diminished coping abilities and increased food aid needs. Access to food through productive means varies but, on average, households can only access about 0.5 - 0.75 acres of land. Recent nutrition and health assessments conducted in Pader District, in Feb 2004 and in Gulu District, in June 2004, highlight high mortality rates of more than 1 death/10,000 people/day. While Global Acute Malnutrition (GAM) rates appear to fall within the normal range expected within African populations (<5% GAM), high mortality rates consistently highlight the severity of the health situation in the camps. The WFP Uganda Country Office currently implements a Protracted Relief and Recovery Operation (PRRO) and a Country Programme (CP). The PRRO targets Internally Displaced Persons in Northern Uganda through General Food Distribution (GFD) activities, school children, HIV/AIDS infected and affected households and other vulnerable groups. In partnership with the Government of Uganda (GOU), sister UN agencies, international and national NGOs and Community Based Organisations, WFP currently assists the 1,619,807 Internally Displaced Persons, (IDPs), including 178,741 school children in the Gulu and Kitgum, 19,900 people infected with or affected by HIV/AIDS in Gulu and Kitgum and more than 750 food insecure persons involved in asset creation. Whilst WFP and other humanitarian actors continue to provide relief support to the displaced communities of northern Uganda, it is clear that without increased security the crisis will continue. (author's)
BMJ. British Medical Journal. 2006 Nov 11; 333(7576):986.Unclean water is an "immeasurably greater threat to human security than violent conflict" across the developing world, says the latest annual report from the United Nations Development Programme. The report says, "'Not having access to clean water' is a euphemism for profound deprivation. It means that people walk more than one kilometre to the nearest source of clean water for drinking, that they collect water from drains, ditches or streams that might be infected with pathogens and bacteria that can cause severe illness and death." Each year 1.8 million children die from diarrhoea that could be prevented; 443 million school days are lost to water related illnesses; and almost 50% of all people in poor countries have at any given time a health problem caused by a lack of water and sanitation. (excerpt)
SAfAIDS News. 2005 Sep; 11(3):2.Most people living with HIV and AIDS (PLWHA) are found in severely resource-constrained settings, where the pandemic continues to grow at an alarming rate, throwing into disarray the already enormous treatment challenge. High AIDS mortality rates are mainly experienced in sub-Saharan Africa, particularly in the southern Africa region. Yet recent events paint a gloomy picture regarding financial support for international remedial efforts against HIV and AIDS. There is uncertainty over continued funding of AIDS programmes in the future, forcing us to ask tough questions such as whether the aim of providing antiretroviral therapy (ART) to individuals clinically qualified to receive these medicines will be feasible and whether it will be possible to retain those already on treatment in the future. (excerpt)
[The United Nations revises its world population predictions upward] L'ONU revoit a la hausse ses previsions sur la population mondiale.
EQUILIBRES ET POPULATIONS. 2001 Mar; (66):5.Despite considerable excess mortality due to AIDS in countries and regions around the globe, high fertility in developing countries could add 500 million more people than projected to world population over the next 50 years. Medium-level UN projections anticipate a total world population of 9.3 billion individuals by 2050. Due to high fertility levels, the population of developing countries will grow from 4.9 billion people in 2000 to 8.2 billion in 2050. If the mean number of children per woman worldwide is 2.82, the 48 countries located in the world’s least developed regions have average total fertility rates greater than 5 children per woman. Most recent UN population projections for 2050 are higher than previous calculations due to a re-examination of fertility rates for 16 developing countries which will alone add 374 million people. The correction is particularly important in the cases of Bangladesh and Nigeria. At the same time, while the extent of AIDS mortality will increase over the next 5 years, to afflict 15.5 million people in the 45 worst-hit countries, those countries’ populations should continue to expand due to high fertility. Even in Botswana, where HIV prevalence is 36%, or in Swaziland and Zimbabwe, where HIV/AIDS infection rates are over 25%, the populations should continue to grow significantly over the next 50 years: by 37% in Botswana, 148% in Swaziland, and 86% in Zimbabwe. Only South Africa should see its population decline until 2025, then expand again. In this context, international migration and demographic aging are considered.
POPULATION AND DEVELOPMENT REVIEW. 1998 Sep; 24(3):655-8.The UN Program on HIV/AIDS and the World Health Organization jointly monitor the global HIV/AIDS epidemic. The agencies' most recent survey tracking the spread of the pandemic, published in June 1998, estimates that by the beginning of 1998, 30.6 million people were infected with HIV, including 12.1 million women and 1.1 million children under age 15 years, and that 11.7 million had already died from AIDS. An estimated 5.8 million people were newly infected with HIV in 1997, and 2.3 million people died during the year from AIDS. An estimated 8.2 million children under age 15 years since the beginning of the epidemic lost either their mother or both parents to AIDS. 21 million of the 30.6 million people living with HIV/AIDS reside in sub-Saharan Africa. Indeed, approximately 83% of the world's AIDS deaths have been in sub-Saharan Africa. Newly available sophisticated estimates of the impact of the epidemic upon adult mortality in some of the most severely affected sub-Saharan African countries are presented.
PUBLIC HEALTH REPORTS. 1998 Nov-Dec; 113:479-80.The World Health Organization (WHO) reported 31 million cases of measles causing almost 1 million deaths in 1997. Measles therefore accounted for a major portion of the disease burden in sub-Saharan Africa, India, much of Asia, and the Middle East. Indeed, measles caused a greater loss of disability-adjusted life years (DALYs) than did HIV and almost as great as the loss from malaria. Even so, the proposal for WHO's Health for All in the 21st Century program targets measles eradication for 2020, rather than sooner. A major initiative is needed to eradicate measles now. US public health leaders should endorse a 2-dose measles vaccine strategy, using catch-up campaigns to reduce circulation of the virus. Despite some limitations, the currently available measles vaccine has been used to eliminate the local circulation of the virus in North America, the UK, and the Caribbean, while developing areas such as the West Bank and Gaza have managed to eliminate measles. Simultaneous campaigns against measles and polio are not beyond the organizational and fiscal capabilities of all developing countries. Bold, urgent policy leadership and action are needed from the US and international organizations.
AIDS ILLUSTRATED. 1996 Oct; 2(1):9.War and AIDS-related mortality in Uganda have created an estimated 1.2 million orphans in the country. Child welfare advocates and nongovernmental organizations (NGOs) have therefore been working together for the past 4 years under an umbrella organization to coordinate efforts for vulnerable children. The Uganda Community-Based Association for Child Welfare (UCOBAC), links people and organizations involved in child advocacy, facilitates relations between the government and NGOs, and helps to strengthen the capacity of NGOs to identify and implement projects. UCOBAC emphasizes community-based initiatives which allow children to remain in their own communities instead of being institutionalized. One example of such an approach is a vocational skills training program in Rakai district established to help young orphans trying to make it on their own. More than 300 youths had benefitted from the program as of December 1994 and plans are underway to expand the program to 10 more districts. UCOBAC is also training communities and NGOs to identify and implement viable projects, and helps child welfare organizations by serving as a network for sharing information. UCOBAC came into existence in October 1990 with 93 members, including 57 local NGOs, 17 international NGOs, and 19 individual members. The organization has since established local offices in 35 of Uganda's 39 districts. UNICEF has thus far provided about US$130,000 for UCOBAC activities and will continue to fund local NGO initiatives through UCOBAC. UCOBAC, however, is giving priority to becoming financially independent of UNICEF within a couple of years. Future projects include an inventory of NGO child welfare projects, a child welfare resource library, and networking workshops with NGOs and government policymakers.
In: Good health at low cost. Proceedings of a Conference held at the Bellagio Conference Center, Bellagio, Italy, April 29 - May 3, 1985. Sponsored by the Rockefeller Foundation. Edited by Scott B. Halstead, Julia A. Walsh, Kenneth S. Warren. New York, New York, Rockefeller Foundation, 1985 Oct. 159-61.In its World Development Report, 1984, the World Bank gave the following 1982 figures for gross national product (GNP) per capita in 1982 dollars and average annual growth rate of GNP per capita (1960-82); China--$310 and 5.0%; Sri Lanka--$320 and 2.6%; Costa Rica--$1430 and 2.8%. World Bank tables supplied income data on Cuba in 1968: GNP per capita (in 1964 dollars) was $275, nearly identical to the figure of $283 for 1950. In 1950, Costa Rica had an income level equivalent to Cuba's ($264), but by 1968, Costa Rica's had grown to $403. Making the conversion from 1964 to 1982 dollars would put Cuba in 1968 at a GNP/capita of $821. In 1977, Costa Rica's revised real per capita gross domestic product was $1414 (in 1970 dollars) and Sri Lanka's was $553. With regard to the distribution of income, the World Development Report, 1984, presented figures for Sri Lanka, Costa Rica, and India. India and Sri Lanka had more evenly distributed incomes than typical, while Costa Rica's was less evenly distributed. Cuba had achieved one of the highest life expectancies in the developing world in the 1950s, at a time when its income was also relatively high. Mortality had continued to decline to the point where life expectancy was approximately 72 years in 1985. In 1960, life expectancy was about 64 years. The 1985 UN figure for Sri Lankan life expectancy in 1965-69 was 64.2 years, and in 1975-79 it had increased only to 65.0 years. In China, a major economic setback occurred during the Great Leap Forward period of 1958-61, when a shortfall in agricultural production was greatly exacerbated by policies that deemphasized the rural sector. The age distributions from the 1953 and 1964 censuses indicated that some 23-30 million excess deaths occurred during this period. Subsequently, the mortality decline was extremely rapid. Income growth probably facilitated this decline, but China's achievement in mortality far surpassed what could have been expected on the basis of its income level.
The United Nations, human rights and traditional practices affecting the health of women and children.
Development. 1993; (4):44-8.In 1991, the UN Commission of Human Rights presented a detailed report on 3 of the traditional practices which are harmful to the health of women and children: female genital mutilation, traditional delivery practices, and son preference. Female genital mutilation has received the most attention, and the World Health Organization (WHO) has supported a number of initiatives to eradicate it. In addition, the WHO Safe Motherhood Initiative was launched in the late 1980s to reduce the number of maternal deaths. WHO has resolved to gear its programs toward the elimination of harmful traditional practices. In 1984, nongovernmental organizations (NGOs) held a seminar in Senegal and established the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children which serves as a focal point of government and NGO activities. Meanwhile, a UN Working Group on genital mutilation, maternal practices, and son preference presented a report in 1986. Its tasks were then assumed by a Special Rapporteur who recommended that relevant UN agencies coordinate their work in this field more closely as they organize regional seminars, monitor the progress of work, and routinely include information on these practices in programs to improve the status of women. To date the UN's work has had few tangible results in preventing these practices and has failed to acknowledge the link between them and the more generalized problem of sexual discrimination. At one level, the problem is exacerbated by the difficulty of reconciling the competing concepts of universal human rights and cultural relativism. Also, human rights entitlements are sought from states and not in families. Despite these problems, the UN has given these matters international attention. The international community must affirm the universality of human rights norms and recognize the desirability of a culturally sensitive approach to the implementation of these norms. NGOs have also played a crucial role in bringing these issues to the consideration of the human rights community.
AUSTRALIAN NURSES JOURNAL. 1992 Aug; 22(2):16-9.The World Health Organization estimates that 40 million individuals will be infected with HIV by the turn of the century. The International AIDS Center at the Harvard School of Public Health, however, estimates that 24 million will have died from AIDS by that time and that more than 1000 million people will have been infected. The author worked with the HIV/AIDS and Development Program of the UN Development Program in New York and Africa over the past 16 months. Specifically, he has been designing and implementing an HIV risk reduction counsellors training of trainers program in Indonesia with the Academy for Educational development AIDSCOM Project. His work has allowed him to travel from Kenya to senegal where he visited hospitals and talked with health care professionals working in a variety of health care settings. He describes some observations of health and care conditions from Lusaka, Zambia; Harare; Nairobi; and an urban hospital in a country of West Africa in which HIV prevalence was 2-3%. In this latter situation, the author found 80% of 120 bed-occupying patients in the infectious disease unit to be HIV-seropositive. The majority were symptomatic for chronic diarrheal disease, for which many were receiving intravenous fluid replacement therapy. 4 antibiotics and 2 anti-diarrheals were available. These patients generally received all 4 antibiotics due to the lack of laboratory-based differential diagnoses. Overcrowding and understaffing were worse in the high-dependency unit. The author calls attention to the extreme inadequacy and squalor of health care facilities and supplies in this presumably low HIV-prevalence developing country. Conditions will only worsen as the epidemic spreads. He also points out the high potential for major HIV/AIDS epidemics in Southeast Asia and South America. Finally, policymakers are urged to realize that, in some countries, up to 25% of al health care professionals may be HIV-seropositive and that they should be prepared for the inevitable mortality of large numbers of health care providers.
WORLD HEALTH FORUM. 1993; 14(2):207-9.An analysis conducted by WHO in 1991 and 1992 indicated that death rates from diseases related to diet and life-style (heart conditions, cancer, and diabetes) have increased significantly in many countries during the past 30 years, largely owing to changes in diet and life-style. 40 high-income countries have diet-related disorders, and as many as 80 middle-income nations may have both undernutrition and overnutrition problems. Undernutrition is widespread in some 50 low-income countries and is associated with a high incidence of stunting and micronutrient deficiencies (especially iron, iodine, and vitamin A). Diet-related deficiencies affect 2000 million people. WHO scientists reviewed data from 26 developed and 16 developing countries from the period 1960-89: 20 countries showed increases ranging up to 160% in death rates from diet-related and life-style-related causes. The biggest decreases were in Australia, Canada, Japan, and the USA where education advised people to limit intakes of fat, saturated fat, and salt as well as to increase exercise and reduce smoking. Data on food availability for 1988-90 showed that an estimated 786 million people in developing countries were chronically undernourished. Hunger and malnutrition affect many of the 123 million people living in 11 countries where the food situation is critical. Some 192 million children <5 years of age suffer from protein-energy malnutrition characterized by retardation of physical growth and lowered resistance to infections. 55 million of these underweight children are in south Asian countries. In these countries, about half of all deaths occur before 5 years of age, and the majority of these deaths are caused by diarrheal disease. It is estimated that up to 70% of diarrhea cases are food-borne in origin. There are 1500 million episodes of diarrhea annually in children <5 years of age, killing 3 million of them.
Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean.
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 1992 Jul; 99(7):547-53.An epidemiologist analyzed community and hospital-based data obtained from the WHO data base on maternal mortality and morbidity to examine maternal mortality associated with hypertensive disorders of pregnancy (HDP) in Africa, Asia, the Caribbean, and Latin America. Overall estimates of mortality associated with HDP among countries in Africa, Latin America, and the Caribbean did not differ, even though overall maternal mortality was much higher in Africa than in Latin America and the Caribbean. In Asia, however, estimates of both maternal mortality and mortality associated with HDP were quite varied (maternal mortality range = 15-905 and percentage of deaths due to HDP range = 4 = 55%). Qatar had the lowest maternal mortality (15) and the highest percentage of deaths due to HDP (55%). Even though maternal mortality was lowest in southern Africa (90-115 vs. 80-1140), percentage of deaths due to HDP was basically high (10-27%). In West Africa, the same HDP levels ranged from 7% to 18%. Maternal mortality was relatively low in the Caribbean (30-80), but it had a very high percentage of deaths due to HDP (30-73%). In Argentina and Chile, maternal mortality was higher than that of the Caribbean (180 and 110. respectively), yet had a low percentage of deaths due to HDP (10%). These data indicated that overall 10-15% of all maternal deaths were associated with HDP. In those countries with detailed data, 60-100% of these deaths were due to eclampsia. Thus eclampsia caused 10% of all maternal deaths. These results suggested that infection and hemorrhage were responsible for the excess maternal mortality. They also implied that deaths associated with HDP may be the most difficult to prevent in developed and developing countries. Health practitioners do not agree on the optimal management of preeclampsia and eclampsia. Several clinical trials worldwide are now evaluating the various management options.
WORLD HEALTH. 1991 Mar-Apr; 14-5.Less developed countries are undergoing rapid, unplanned, and uncontrolled urbanization at the expense of their populations' health. Physical expansion of cities has outpaced the abilities of city planners and management and has contributed to the spread of tuberculosis, pneumonia, influenza, threadworm, cholera, dysentery, and other diarrheal diseases. Overcrowding, lack of access roads, dangerous roads, drinking water scarcity, frequently collapsing buildings, uncollected garbage, lack of sewers, inadequate air space, and houses littered with human feces are common conditions contributing to high mortality rates especially among children. In this context, the World Health Organization's Environmental Health in Rural and Urban Development Program, which is designed to promote awareness about the association between health and planning, is noted. Guidelines for change are also a component of the program, and are encouraged for adoption by planners of less developed countries, especially Africa. Urban rehabilitation and upgrading are recommended in the guidelines while maintaining central focus upon promoting the population's health. While examples of rampant urbanization are drawn primarily from Nigeria, ancient Greek and Roman societies as well as the UK are mentioned in the context of urban planning with a view to health.
New York, New York, UNFPA, . ix, 81 p.Rapid population growth is an obstacle to Vietnam's socioeconomic development. Accordingly, the Government of Vietnam has adopted a population policy aimed at reducing the population growth rate through family planning programs encouraging increased age at 1st birth, birthspacing of 3-5 years, and a family norm of 1-2 children. TFR presently holds at 4, despite declines over the past 2 decades. Current mortality rates are also high, yet expected to continue declining in the years ahead. A resettlement policy also exists, and is aimed at reconfiguring present spatial distribution imbalances. Again, the main thrust of the population program is family planning. The government hopes to lower the annual population growth rate to under 1.8% by the year 2000. Achieving this goal will demand comprehensive population and development efforts targeted to significantly increase the contraceptive prevalence rate. Issues, steps, and recommendations for action are presented and discussed for institutional development strategy; program management and coordination and external assistance; population data collection and analysis; population dynamics and policy formulation; maternal and child health/family planning; information, education and communication; and women, population, and development. Support from UNFPA's 1992-1995 program of assistance should continue and build upon the current program. The present focus upon women, children, grass-roots, and rural areas is encouraged, while more attention is suggested to motivating men and mobilizing communities. Finally, the program is relevant and applicable at both local and national levels.
Dhaka, Bangladesh, UNICEF, 1988. 36 p.In 1988, floods occurred in Bangladesh like in 1987, but they were worse in 1988. They affected nearly everyone in the inundated areas, especially 4.63 million infants and children. The social response was greater in 1988 than 1987, with individuals leading the effort. Health conditions were generally poor, but the floods worsened these conditions, especially impacting on diarrhea and acute respiratory infections (ARIs). The diarrhea case fatality rate during the 4 months following the 1987 floods doubled indicating that the rate in 1988 would probably result in >80% excess morality among children <5 years old. Since about 1 million homes were lost and 2 million damages, many families and children stayed in crude shelters and were exposed to cold nights in November-February. They therefore were at high risk of ARIs. This and malnutrition would threaten the lives of many children. Normally malnutrition increased during the postmonsoon period due to already existing poverty, disease, and inadequate food intake, but the 1988 floods would increase malnutrition, especially among the children of the poorest of the poor. At the peak of the 1988 floods, about 200,000 hand pumps in the affected area were flooded thereby making it possible for people to draw potable water. They then drew water from the polluted flood waters which had inundated most of the few latrines. Despite efforts to operate refugee centers in a sanitary manner, they most likely had an inadequate water supply and means of feces disposal. Further, due to crowded conditions, refugees used unhygienic practices. Such conditions continued in slums, but government and volunteer workers were able to reach them easier than the rural refugee centers. The floods hindered efforts to repair the primary schools damaged in 1987. In 1988, >50% of schools were damaged in 16 districts. All schools were damaged in 3 UNICEF responded to the 1988 floods by generating US$5 million for special assistance with most money going to food and nutrition.
In: Women's health and apartheid: the health of women and children and the future of progressive primary health care in Southern Africa, edited by Marcia Wright, Zena Stein and Jean Scandlyn. New York, New York, Columbia University, 1988. 84-9.There is a large discrepancy between maternal mortality rates in developed and developing countries, with maternal mortality as a leading cause of death of young women in poor countries. There has been renewed interest in maternal mortality among international agencies and major foundations quite recently. Women and children form up to 2/3 of the population of many developing countries, and over 1/2 of primary health care resources are devoted to maternal and child health programs. Nevertheless, little of this is directed at maternal mortality; most goes to immunization, oral rehydration for diarrhea, monitoring children's growth, and promoting breastfeeding. While some of the international health community attribute the long neglect of maternal mortality to not knowing the extent and severity of the problem before, prior data existed demonstrating the alarmingly high rates. Low maternal mortality in the West may have distracted attention from the international problem. Sexism may have been a major factor, as even today efforts to reduce maternal mortality need to be justified in terms of the implications for the family, children and society as a whole. The reasons for the current concern are not clear, but may relate to an interest in concrete issues after the United Nations Decade for Women, or real surprise in the international community once the problem was pointed out. As various agencies rush to establish maternal mortality programs, it is imperative to evaluate which approaches will be really effective. Critical evaluation of programs is necessary to capitalize on the current interest.