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Issue paper: Review and assessment of HIV / AIDS strategies that explicitly include attention to rights. Impact mitigation.
Geneva, Switzerland, UNAIDS, 2004. Prepared for the 4th Meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, August 23-25, 2004. 4 p.This issue paper examines human rights based approaches explicitly defined as such by organizations addressing impact mitigation policy and programmatic efforts. Given the diversity of definitions of rights based approaches, consideration is given to how rights are conceptualized, and the explicit attention to rights in these policy and program efforts. Commonalities and differences should be considered between the various approaches to determine the evidence that exists of the value of paying attention to rights in these strategies, as well as how rights based approaches to impact mitigation are articulated. While impact mitigation covers a broad range of areas, given the devastating consequences of the epidemic on the lives of children, most of the examples below will focus on children orphaned by AIDS as an example to illustrate how rights based approaches are applied at policy and programmatic levels. (excerpt)
Arlington, Virginia, Family Health International [FHI], HIV / AIDS Prevention and Care Department, 2001.  p. (UNAID Best Practice Key Materials; USAID Cooperative Agreement No. HRN-A-00-97-00017-00)Countries with low HIV prevalence share a set of concerns and challenges regarding their responses to a potential HIV epidemic. Many of these countries also present an opportunity to avert large numbers of future HIV infections if appropriate prevention strategies are chosen and implemented early, greatly reducing future HIV/AIDS-related costs to the country. The purpose of this publication is to identify those challenges and propose a prevention strategy that can maintain low HIV prevalence in the general population, while reducing existing or preventing potential HIV sub-epidemics in population subgroups with substantial levels of risk behavior. Decisions on the strategic placement and targeting of prevention interventions are important to both international agencies and countries planning their prevention response. Both need to make difficult choices regarding geographic and population subgroups to ensure that resources are allocated efficiently. (excerpt)
Application of the factor analysis of correspondence to a fertility survey in Algeria. [Application de l'analyse factorielle de correspondance à une étude de fertilité en Algérie]
[Unpublished] 1972. Presented at the Seminar on the Role of Social Sciences in Demographic Activities, UNESCO, Paris, France, June 19-23, 1972. 39 p. (SHC.72/Conf.13/6)The so-called factor method of correspondence shows that it is possible to analyse globally and simultaneously all the large number of variables that come into consideration in a survey where the sample is relatively small, as is most often the case in investigations into, for example, fertility factors or the motives for migration. This method brings to light the highly logical structure and inner coherence of the replies formulated by the respondent without however going beyond a simple description of the facts and a classification of the variables. It also shows the wealth of material available through the so-called C.A.P. fertility surveys, which furnish us with information not only on fertility but also on daily life in the Third World. Educational status and the development of mass communication media unquestionably stand out as the principal variables in Algeria, where considerable efforts have in fact been made in this domain over the past few years. However, the results of these efforts have yet to influence the fertility rate, still one of the highest in the Third World. It is indeed only to be expected that there should be a time-lag between the occurrence of changes in economic and social conditions and the moment when the fertility rate begins in turn to be affected. (excerpt)
Lancet. 2003 Sep 6; 362(9386):830-831.There are more than one billion adolescents (age 10–19 years) in the world today and their importance as a demographic group is increasing, especially in the developing world as the age distribution of populations changes over time. Despite their numbers, they have not traditionally been considered a health priority since they have lower morbidity and mortality than older and younger groups. Nonetheless, in some areas such as mental and sexual health, adolescents suffer disproportionately. The consequences of poor health at this age also stretch into the future, affecting their prospects and those of their children. In addition, health-related behaviours, such as smoking, eating habits, sexual behaviours, and help-seeking behaviours developed during adolescence often endure into later life. (excerpt)
East African Medical Journal. 2003 Jun; 80(6 Suppl):S1-S20.Health sector reform is 'a sustained process of fundamental changes in national health policy, institutional arrangements, etc. guided by government and designed to improve the functioning and performance of the health sector and, ultimately, the health status of the population'. All the forty six countries in the African Region of the World Health Organisation have embarked on one form of health sector reform or the other. The contexts and contents of their health reform programmes have varied from one country to another. Health reforms in the region have been influenced largely by the poor performance of the health systems, particularly with regard to the quality of health services. Most countries have taken due congnizance of the deficiencies on their health systems in the design of their health reform programmes and they have made some progress in the implementation of such programmes. Indeed, some countries have adopted sector-wide approaches (SWAps) in developing and implementing their health reform programmes. Since countries are at various stages of implementing their health reform programmes, there is a lot of potential for countries to learn from one another. This paper is a synthesis of the experiences of the countries of the Region in the development and implementation of their health sector reform programmes, it also highlights the future perspectives in this important area. (author's)
Journal of Biosocial Science. 2003 July; 35(3):335-351.Improved child health and survival are considered universal humanitarian goals. In this respect, understanding the nutritional status of children has far-reaching implications for the better development of future generations. The present study assessed, first, the nutritional status of children below 5 years using the three anthropometric measures weight-forage, height-for-age and weight-for-height in two states of India, Kerala and Goa. Secondly, it examined the confounding factors that influence the nutritional status of children in these states. The NFHS-I data for Kerala and Goa were used. The results showed that the relative prevalence of underweight and wasting was high in Kerala, but the prevalence of stunting was medium. In Goa, on the other hand, the relative prevalence of wasting and underweight was very high, and that of stunting was high. Both socioeconomic and family planning variables were significantly associated with malnutrition in these states, but at varied levels. The study recommends more area-specific policies for the development of nutritional intervention programmes. (author's)
Vitamin A deficiency and increased mortality among human immunodeficiency virus-infected adults in Uganda.
Nutrition Research. 2003 May; 23(5):595-605.The specific aims of the study were to determine the prevalence of vitamin A deficiency and to examine the relationship between vitamin A deficiency and mortality among human immunodeficiency virus (HIV)-infected adults in sub-Saharan Africa. A prospective cohort study was conducted at the outpatient clinic of Mulago Hospital, Kampala, Uganda, among HIV-infected adults enrolled in the placebo arms of a randomized clinical trial to prevent Mycobacterium tuberculosis infection. Of 519 subjects at enrollment, 186 (36%) had serum vitamin A concentrations consistent with deficiency (<1.05 µmol/L). During follow-up (median 17 months), the mortality among subjects with and without vitamin A deficiency at enrollment was 30% and 17%, respectively (P = 0.01). In a multivariate model adjusting for CD4+ lymphocyte count, age, sex, anergy status, body mass index, and diarrhea, vitamin A deficiency was associated with a significantly elevated risk of death [relative risk (RR) = 1.78, 95% confidence interval (CI) 1.2-2.6]. Vitamin A deficiency is common among HIV-infected adults in this sub-Saharan population and is associated with higher mortality. (author's)
Nutritional status of vegetarian and omnivorous adolescent girls. [Estado nutricional de adolescentes vegetarianas y omnívoras]
Nutrition Research. 2001 May; 21(5):689-702.This study compared the dietary and anthropometric profile of 24 ovo-lacto-vegetarian and 36 omnivorous female adolescents, between 15 and 18 years old. Weight, height and skinfolds were measured. Food frequency questionnaires and a three day food record were used for dietary assessment. Vegetarians presented subscapular, suprailiac and midaxillary skinfolds statistically higher than omnivores, but the percent body fat was not different. The vegetarian diet provided smaller amounts of energy than that of the omnivores ( p < 0.05) and only 17% of the vegetarians was able to reach the recommended allowance for protein. Regarding calcium, 83% of the vegetarians and 69% of the omnivores ate less than 2/3 of the recommended allowances and a significantly higher percentage of vegetarians presented low ingestion of iron, riboflavin, and niacin than omnivores ( p < 0.05). It was concluded that the intake of vegetarians was lower in fat and cholesterol, and less adequate in micronutrients than the omnivores ones. (author's)
Nutrition Research. 1999 Jun; 19(6):843-860.Child malnutrition measured by stunting, wasting, and under-weight is a serious problem in Botswana. There are conflicting reports from previous studies in developing countries on the effect of some of the known factors affecting child malnutrition. We used descriptive statistics, regression, and logistic regression methods to identify the determinants of malnutrition based on data from a national cross-sectional study. There is 29.6% stunting, 14.9% underweight, and 7.1% wasting among children. Ordered logistic regression analysis shows the significance of some of the factors not shown by association statistics, regression analysis, and ordinary logistic regression analysis. Hence it is a better tool in the search for determinants of child malnutrition. The determinants of malnutrition cover biological, social, cultural, economic, and morbidity factors: age, birth-weight, breast-feeding duration, gender of family head, residence, house type, toilet facility, education of mother and father, child caretaker; intake levels of milk and dairy products, staple foods and cereals, and beverages; and incidence of cough and diarrhea. The influence of these factors can be used in the development of strategies of intervention for reducing child malnutrition. (author's)
Public Health. 2003 Jul; 117(4):221-227.This study describes urban and rural trends of infant, child and under-five mortality in Mozambique (1973–1997) by mother’s place of residence. A direct method of estimation was applied to the 1997 Mozambican Demographic and Health Survey data. The levels of infant, child and under-five mortality were considerably higher in rural than in urban areas. The difference in mortality between urban and rural areas increased over time until 1988–1992 and thereafter diminished. Possible causes of the different trends (e.g. the impact of civil war, drought, migration, adjustment programme and HIV/AIDS) are discussed. The increase in mortality in urban areas during the last few years before the survey may have been related to the immigration to urban areas of mothers whose children had high levels of mortality. Higher levels of infant, child and under-five mortality still prevail, particularly in rural areas. Further studies are needed to investigate the differentials of infant and child mortality by mother’s place of residence. (author's)
ORS is never enough: physician rationales for altering standard treatment guidelines when managing childhood diarrhoea in Thailand.
Social Science and Medicine. 2003 Sep; 57(6):1031-1044.This study explores Thai physicians’ rationales about their prescribing practices for treating childhood diarrhoea within the public hospital system in central Thailand. Presented first are findings of a prospective clinical audit and observations of 424 cases treated by38 physicians used to estimate the prevalence of sub-optimal prescribing practices according to Thai government and WHO treatment guidelines. Second, qualitative interview data are used to identify individual, inter-personal, socio-cultural and organisational factors influencing physicians’ case management practices. Importantly, we illustrate how physicians negotiate between competing priorities, such as perceived pressure by caretakers to over-prescribe for their child and the requirement of health authorities that physicians in the public health system act as health resource gatekeepers. The rationales offered by Thai physicians for adhering or not adhering to standard treatment guidelines for childhood diarrhoea are contextualised in the light of current clinical, ethical and philosophical debates about evidence-based guidelines. We argue that differing views about clinical autonomy, definitions of optimal care and optimal efficiency, and tensions between patient-oriented and community-wide health objectives determine how standard practice guidelines for childhood diarrhoea in Thailand are implemented. (author's)
Our families, our friends: an action guide. Mobilize your community for HIV / AIDS prevention and care.
[Bangkok, Thailand], United Nations Development Programme [UNDP], South East Asia HIV and Development Project, 2000. vi, 30 p. (Best Practice Documentation on Community Mobilization for HIV / AIDS: Case of Thailand)Community actions on the prevention and control of AIDS are initiated based on the community’s needs. The community hospital may play an important role in promoting and supporting care for people with HIV/AIDS (PWHA) within their area. In turn, the sustainability of controlling HIV problems in the community is based on the strength of that community. Therefore, building resources within the community should be promoted, so that those concerned understand the problems, provide acceptance to PWHA, and work together to reduce the impact of HIV/AIDS. Religious leaders can play a major role in providing support and encouraging social change towards the acceptance of PWHA. Self-help groups are very important community units, they provide care, psychosocial support and generate income for PWHA. The work plan of activities needs to be flexible, based on the needs of PWHA and their community. This action guide can help people in your community to understand how to help one another and work together for their mutual benefit, now and in the future. (excerpt)
In: International Population Conference / Congres International de la Population, Montreal 1993, 24 August - 1st September. Volume 3, [compiled by] International Union for the Scientific Study of Population [IUSSP]. Liege, Belgium, IUSSP, 1993. 269-78.Modeling life table functions by statistical methods, begun at the Population Branch of the UN in the early 1950s, resulted in the publication of a set of model life tables. From 158 life tables for various countries and periods, the UN analysts noted that the probability of dying in a certain age interval provides excellent approximation when the parameters defining the polynomial are obtained by the method of least squares. Factor analysis of probabilities of dying from a set of 154 abridged life tables was found to produce 5 factors in an earlier study by Ledermann and Breas. In this study of 120 life tables each for males and females, a principal component analysis produced only 2 factors with eigenvalues greater than 1. Together these 2 factors explained 97 and 98%, respectively, of the male and the female variance. The 1st factor loadings were found to be inversely related to age, while the opposite was the case with the 2nd set. They could reproduce life expectancy with a high degree of accuracy, the squared multiple correlations being .98 for male and .97 for female life tables. In conjunction with suitable pairs of factor scores, model life tables can be constructed. The method is also suitable for the determination of factor scores of any life table which are indicators of the states of mortality at younger and older ages. Combinations of these factor scores can also generate sets of life tables with identical life expectancies. In replicating the analysis of Ledermann and Breas with these data, 4 factors with a 5th bordering on significance together explained only 91% of the variance compared with the 97% and 98% found by the current study. The 2 dimensions of life tables represented by the 2 factors provide an interesting comparison with their counterparts, namely region and life expectancy. A comparison of this model with the Brass relational logit model revealed it was similar to a special case of this model derived by retaining only the 1st factor. The 2-factor model should produce better results.
Coping with extra Poisson variability in the analysis of factors influencing vaginal ring expulsions.
STATISTICS IN MEDICINE. 1991 Feb; 10(2):241-54.Statistical modeling of variation in expulsion rates for levonorgestrel- releasing vaginal rings, employing 1st Poisson distribution, models for over-dispersion parameters, and then a truncated Poisson model to account for the variation. The data were a series of trials by WHO on 1005 women in 19 centers in 1 countries. The variables were number of involuntary expulsions, age, parity, ponderal index, number of days of ring use and health care center. In the WHO report, generalized linear models left a remaining variation greater than anticipated if the expulsion event were constantly distributed. The Poisson regression model initially tested here allowed for different number of days of use by women, and assumed that the mean number of expulsions directly proportional to the log of the duration of use. Analysis of deviance suggested that the data were over-dispersed, with a deviance exceeding the degrees of freedom. Possible explanations include: outlying points from women with high numbers of expulsions, variables not included in the data, an underestimated true variance, an incorrect functional form for "f", or an assumed variability between individuals that is not actually the same for all women. A model using an over-dispersion parameter was fitted into the Breslow model and was recomputed until the Pearson X squared statistic was close to the degrees of freedom. After fitting the resulting Poisson model, center and parity were significant. A truncated Poisson model, where centers reporting no expulsions were omitted, showed no over-dispersion. Women of parity 1, 2, or 3 has 1.7 times the rate of expulsion of women of 0 parity, and those with parity >4 has 2.80 times the expulsion rate, possible reflecting relaxation of the vaginal outlet. There was a trend toward higher expulsion during defecation for women from Asian countries, compared to those from Africa, Europe and Latin America.