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Geneva, Switzerland, WHO, 1985. 29 p. (WHO/CDD/85.12)This paper reports the activities and proposed program budget for 1986-1987 reviewed by the Technical Advisory Group (TAG) at its 6 meeting. The Group also examined 2 reports on the use of oral rehydration therapy (ORT) and the incorporation of cost-effective control interventions other than case management in national CDD programs, and reviewed revised guidelines for the management of the research component of the global Program. With respect to the health services component, the following conclusions and reccomendations were made: the program should maintain a comprehensive approach to diarrheal disease control, while continuing to give major emphasis to and expanding further the case management strategy; continued efforts to promote plan preparation in all developing countries should be maintained; progress is to be regularly monitored; latent plans should be implemented; efforts to improve the global use rate of ORT should be effected; routine antidiarrheal remedies are to be discouraged; training curricula of health personnel must be promoted and improved; preparation of guidelines to facilitate mobilization of developmental support is urged. In the research component, the Group approved the proposed changes in the research management structure, particularly the termination of the Scientific Working Groups and Steering Committees; it endorsed the overall approach of the Program in diarrheal research development; it stressed the need for and suggested ways of achieving a flexible, rapid response to operational research; it welcomed the increase of biomedical projects; it emphasized the need for urgent research to determine which diarrhea cases required ORS treatment. Numerous other recommendations were made.
Who Chronicle. 1984; 38(5):212-6.This article highlights the conclusions and recommendations of the 5th meeting of the Technical Advisory Group of the World Health Organization (WHO) Diarrheal Diseases Control (CDD) Program held in March 1984. On the basis of clinical trials supported by the CDD Program, WHO has endorsed use of oral rehydration salts (ORS) containing trisodium citrate dihydrate in place of sodium bicarbonate. Although the bicarbonate formulation remains highly effective and may continue to be used, the citrate formula results in less stool output and is more stable under tropical climatic conditions. At its meeting, the Technical Advisory Group expressed satisfaction with progress in the health services and research components of the program's activities. By 1983, 72 countries or areas had formulated plans of operation for national CDD programs and 52 had actually implemented programs. Training courses directed at program managers, first-line supervisors, and middle-level health workers are held on a regular basis. 38 developing countries are now producing ORS. Another area of activity has involved development of a management information system to monitor progress toward the target of increased access to and use of oral rehydration therapy for diarrhea in children under 1 year of age. Data from 40 countries indicate that access to ORS was 6-10% in 1982 and usage was 1-4%. There have been reviews of 10 national CDD programs, 7 of which utilized a joint national-external team to collect and analyze information on the management and impact of the CDD program. During 1983, 71 new research projects were funded by the CDD program, bringing the total number of projects supported to 231 (59% in developing countries). Biomedical research has focused on development of more stable and effective ORS; the etiology and epidemiology of acute diarrhea: and development and evaluation of new diagnostic tests, vaccines, and antidiarrheal drugs. In 1982-83, the CDD program received US$1.4 million from WHO and about US$11 million from voluntary contributors. The 1984-85 budget has been set at US$19.7 million.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 13 p.. (USAID Contract No. DPE-3040-A-00-5064-00)The World Health Organization's (WHO's) Control of Diarrheal Diseases Program (CDD) is seeking ways to prevent diarrhea and has identified breastfeeding as an important factor. CDD has developed activities in both its research and services components. In the research component, results from recent studies, some of which received support from the program, have shown the strong protective effect of breastfeeding against diarrheal morbidity and mortality. Exclusively breastfed infants are at lower risk of experiencing diarrhea than infants who are partially breastfed, and those who are partially breastfed are at lower risk than those who are not breastfed. Breastfeeding, which also may reduce the severity of the diarrheal illness, has a powerful effect on the risk of diarrhea-associated death. CDD's priorities for research support in the area of infant feeding were reviewed at an April 1988 meeting. Further research that the program feels is needed falls into 2 broad categories: trials of hospital and community-based interventions that aim to promote exclusive breastfeeding in the 1st 4-6 months of life; and evaluation of approaches for implementing tested breastfeeding promotion interventions in the context of national diarrheal disease control programs. CDD's services component has as its basic responsibility collaboration with countries in developing national control programs. It applies the results of research and involves activities in planning, oral rehydration solution (ORS) supply, training, communication, monitoring, and evaluation. It is in the area of training that specific recommendations on breastfeeding have been made. These recommendations are outlined. The training courses are being used to train approximately 5000 supervisory and management staff a year. The program plans to monitor the effectiveness of the training and develop future activities based on that information.
Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C.
Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 210 p. (International Conference on Oral Rehydration Therapy, 1983, proceedings)With over 600 participants from more than 80 countries, the International Conference on Oral Rehydration Therapy (ICORT) was a testimony to the international health community's recognition of the seriousness of diarrheal disease, the value of oral rehydration therapy, and the commitment to primary health care. The conference, initiated by the Agency for International Development, was cosponsored by the International Center for Diarrheal Disease Research, Bangladesh, the United Nations Children's Fund, and the WHO. The conference focused on oral rehydration therapy, an important treatment of diarrhea. 1 out of 10 children born in developing countries dies from the effects of diarrhea before the age of 5. A 70% reduction in the mortality rate can result from ORT--a major breakthrough for primary health care. Excellent laboratory investigation, well-conducted clinical studies, and careful field observation have led to this effective therapy. Many papers presented at the conference demonstrated the effectiveness of ORT. Participants agreed on the best formula for ORT in terms of electrolyte content and on the need for an international commitment to expand implementation of ORT. Problems in implementing oral therapy programs are discussed. Possible areas of investigation include: 1) improving the solution through the addition of glycine, other amino acids, or cereal-based substrates; 2) developing methods for teaching ORT; and 3) investigating better methods of program evaluation. Innovative approaches to informing the public about the use and benefits of oral therapy were also discussed. Participants, recognizing that problems are shared among many different programs and nations, exchanged ideas and addresses, pledging to keep each other abreast of their ORT research and implementation efforts. The conference closed with a strong call for action to attain near universal availability of ORT in the next 10 years.