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The challenge of Trypanosoma brucei gambiense sleeping sickness diagnosis outside Africa. [Le défi que pose le diagnostic de la maladie du sommeil à Trypanosoma brucei gambiense en dehors de l'Afrique]
Lancet Infectious Diseases. 2003 Dec 1; 3(12):804-808.Sleeping sickness is a lethal African disease caused by parasites of the Trypanosoma brucei subspecies, which is transmitted by tsetse flies. Occasionally, patients are reported outside Africa. Diagnosis of such imported cases can be problematic when the infection is due to Trypanosoma brucei gambiense, the chronic form of sleeping sickness found in west and central Africa. The low number of trypanosomes in the blood and the non-specific, variable symptoms make the diagnosis difficult, particularly when the index of suspicion is low. When the trypanosomes have penetrated into the central nervous system, neuropathological signs become apparent but even at this stage, misdiagnosis is frequent. Rapid and correct diagnosis of sleeping sickness can avoid inappropriate or delayed treatment and even death of the patient. In this article, an overview on diagnosis of imported cases of T b gambiense sleeping sickness is given, and possible pitfalls in the diagnostic process are highlighted. Bioclinical parameters that should raise the suspicion of sleeping sickness in a patient who has been in west or central Africa are discussed. Techniques for diagnosis are reviewed. A clinician suspecting sleeping sickness should contact a national reference centre for tropical medicine in his or her country, or the WHO, Geneva, Switzerland, or the Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA, for clinical consultation and provision of specific diagnostic tests. Appropriate drugs for sleeping sickness treatment are also provided by WHO and the CDC. (excerpt)
Human development report 2003. Millennium Development Goals: a compact among nations to end human poverty.
New York, New York, Oxford University Press, 2003. xv, 367 p.The central part of this Report is devoted to assessing where the greatest problems are, analysing what needs to be done to reverse these setbacks and offering concrete proposals on how to accelerate progress everywhere towards achieving all the Goals. In doing so, it provides a persuasive argument for why, even in the poorest countries, there is still hope that the Goals can be met. But though the Goals provide a new framework for development that demands results and increases accountability, they are not a programmatic instrument. The political will and good policy ideas underpinning any attempt to meet the Goals can work only if they are translated into nationally owned, nationally driven development strategies guided by sound science, good economics and transparent, accountable governance. That is why this Report also sets out a Millennium Development Compact. Building on the commitment that world leaders made at the 2002 Monterrey Conference on Financing for Development to forge a “new partnership between developed and developing countries”—a partnership aimed squarely at implementing the Millennium Declaration—the Compact provides a broad framework for how national development strategies and international support from donors, international agencies and others can be both better aligned and commensurate with the scale of the challenge of the Goals. And the Compact puts responsibilities squarely on both sides: requiring bold reforms from poor countries and obliging donor countries to step forward and support those efforts. (excerpt)
New York, New York, UNFPA, . v, 36 p. (Report)The former government of Romania sought to maintain existing population and accelerate population growth by restricting migration, increasing fertility, and reducing mortality. The provision and use of family planning (FP) were subject to restrictions and penalties beginning in 1986, the legal marriage age for females was lowered to 15 years, and incentives were provided to bolster fertility. These and other government policies have contributed to existing environmental pollution, poor housing, insufficient food, and major health problems in the country. To progress against population-related problems, Romania most urgently needs to gather reliable population and socioeconomic data for planning purposes, establish the ability to formulate population policy and undertake related activities, rehabilitate the health system and introduce modern FP methods, education health personnel and the public about FP methods, promote awareness of the need for population education, and establish that women's interests are served in government policy and action. These topics, recommendations, and the role of foreign assistance are discussed in turn.
[Unpublished] . 27 p. (USAID Contract No. DPE-5927-C-00-5068-00)Health personnel in Niger report that malaria is the leading diagnosis in health facilities (1980-1984), about 380,000 cases/year), but just 19% of the population live within a 5 km radius of a health facility. A 1985 household survey reveals that 31.4% of children had a febrile illness (presumptive malaria) within the last 2 weeks and 22.1% of all child deaths were presumptive malaria related. The Government of Niger began developing a national malaria program in 1985 to reduce malaria-related deaths rather than morbidity reduction, because available data indicated that morbidity reduction was not feasible. There is no standard treatment regimen for presumptive malaria, however. Some studies indicate that an effective dose regimen is 10 mg chloroquine/kg body weight in a single dose. Some health workers use other antimalarial arbitrarily. Lack of uniformity can increase the risk of chloroquine and Fansidar resistant falciparum. Government officials are thinking about having only chloroquine available at first level facilities. It plans to set up national surveillance for chloroquine resistance. Niger has just 1 trained malariologist, indicating a need for training of more staff. To keep government costs to a minimum, it wants to set chloroquine at all points in the distribution network. The program's plan of action also includes chemoprophylaxis for pregnant women, limited vector control in Niamey, and health education stressing reducing breeding sites. A REACH consultant believes that it is possible for the program to reach its coverage targets within 5 years. Obstacles include limited access to health care, unavailable chloroquine in warehouses, and lack of untrained personnel (the main obstacle). The consultant suggests various interventions to help Niger meet its targets, e.g., periodic coverage surveys. The World Bank, WHO, the Belgian Cooperation, and USAID are either providing or planning to provide support to the malaria control programs.
[Unpublished] 1985. 47 p. (MCH/85.4)Despite improvements during the last decade in the health of women and children in developing countries, a great deal remains to be done. Barriers to continued progress take a number of forms, including financial and institutional. A study of existing data on international funding for maternal/child health and family planning (MCH/FP) shows the following: in 1983 the total official development assistance funding from developed countries totalled US$39.6 billion; 72% of these funds were dispersed through bilateral agencies, the rest through multilateral agencies (in 1983); nearly 6% of bilateral funds were allocated to the health sector (which includes population); analysis of 77 UNDP country reports indicates that about 1/10th of development funding is devoted to health and population; this proportion varies considerably by geographical region, being highest in Latin America and lowest in Africa; funding for MCH/FP programs constitutes about 1/15th of health and population funds reported by the UNDP; again, this proportion is lower in Africa than in Asia or Latin America, although this may be changing; in terms of women and children to be served, it appears that, on average, international funding for MCH/FP programs provides less than US$1 each; a survey of donor agencies indicates that most donors are willing to increase their funding of MCH/FP programs; when the donors were asked to name factors that would induce them to increase MCH/FP funds, the 2 most common answers were: more requests for funding, and , better evidence of unmet needs. Institutional barriers to optimal utilization of MCH/FP resources are discussed, including those often encountered in nongovernmental, bilateral and multilateral agencies, as well as in host countries and industry. Finally, a number of models for effective utilization of development funds are drawn from experience and developed. They include models of global, national, institutional and health services efforts. (author's)
International Conference on Population, 1984. Population distribution, migration and development. Proceedings of the Expert Group on Population Distribution, Migration and Development, Hammamet (Tunisia), 21-25 March 1983
New York, N.Y, United Nations. Department of International Economic and Social Affairs, 1984. vi, 505 p. (no. ST/ESA/SER.A/89)These are the proceedings of one of the four expert groups convened in preparation for the International Conference on Population, held in Mexico City in August 1984. The aim of the expert groups was to examine critical, high-priority population issues and to make recommendations for revisions to the World Population Plan of Action. The present publication concerns the relationships among population distribution, migration, and development. It contains a report of the discussions and a list of recommendations concerning population distribution and internal migration, international migration, and the promotion of knowledge and policies. The report also includes a selection of background papers. These papers include a review of population distribution, migration, and development in relation to the World Population Plan of Action; a review of technical cooperation in this area; and a description of United Nations Fund for Population Activities (UNFPA) assistance in the field of migration and population distribution.
[Unpublished] 1981. 126 p.This evaluation of UNFPA assistance to the Economic Commission for Western Asia (ECWA) Regional Population Program consists of 8 chapters which describe the terms of reference and methodology of the evaluation; provide general information on the ECWA region and its population situation and activities; describe the institutional context of the regional population program; assess the objectives and inputs of the program; discuss substantive areas including data collection, demographic analysis, population and development, population policies, and dissemination of work; assess operational activities including conferences and workshops, technical assistance, special studies, and publications and clearinghouse; review managerial aspects including staffing, coordination mechanisms, monitoring, and administrative matters; and comment on the program proposed for 1980-83 and the future of the program. The evaluation mission concluded that the program of work, strategy, specification, phasing, and budgeting of the program components have been well designed and executed and are in accord with the mandate given to ECWA, the available resources, and the perceptions of the countries of the region. The major strengths of the program were considered to be the ability to organize high quality meetings in the region, backstopping and promotional activities in data collection, and publication. Activities related to demographic analysis are still in a process of development and are expected to receive greater emphasis. The areas of population and development and population policy are still weak. The major difficulties encountered were mostly of an administrative and procedural nature, such as recruitment problems and poor monitoring. The mission recommended that ECWA and UNFPA support continue and that gradual expansion of the program be undertaken.
Report prepared for UNFPA/UN Interregional Consultative Group of Experts on the World Population Plan of Action, Geneva, 1975. 25 pAdd to my documents.
Joicfp Review. 1983 Spring; (6):25-31.During 1980, the Integrated Family Planning and Parasite Control Project initiated the construction of 5 low-cost toilets in the rural Panchkhal Project area of Nepal for demonstration purposes on a subsidy basis. On recommendation from the members of the cooperation committee, these toilets were constructed within school premises located in different Village Panchayats. The overall strategy adopted during the parasite control program was to generate community participation in latrine construction. In the fiscal year 1981, 30 more subsidized sanitary toilets were built in the pilot area. With a view to determine how many families would be interested in constructing sanitary toilets on a subsidy basis towards the later part of 1981, the Project invited applications from the people of the pilot area. This was done to check people's attitudes towards the program. The response was encouraging. By the end of 1981, there were 300 applications; interest would have increased if the Project could aid all of the potential applicants. UNICEF has been involved in latrine construction by granting money and aiding in latrine design. The Panchkhal experience shows that community people are prepared to spend as much as 75% of the building costs for constructing sanitary toilets, when they are convinced that their health will improve as a result. Those who can afford the toilets will pay Nepal Rs25 (about US$1.90); those who cannot pay cash will provide labor to make the cement slabs. The very poor sector of the community, upon recommendation of members of the cooperation committees, may be given squatting slabs free of charge, if they are interested in constructing latrines. Constraints to the program include: difficult geography for constructing latrines; deforestation and dried-up wells; high illiteracy; lack of higher education facilities; and lack of appropriate technology. Recommendations call for distribution of materials at a nominal charge; casting the slabs over the household pits in difficult terrains; health education to motivate the community to adopt preventive measures against malnutrition and infection; and community organization for community participation. A field questionnairre and survey results obtained in 1982 are appended to the summary.