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POPULATION. 1991 Dec; 17(12):3.This article describes the recent activities of the Centre for Adolescent Reproductive Medicine at the University of Chile, which receives UNFPA support under a project aimed at establishing a center for training in adolescent reproductive health. The project, a collaboration of the government and UNFPA, focuses on biological and social issues related to adolescents' reproductive problems, as well as on family relationships. The project is also designed to train health personnel in adolescent reproductive health and support university research into adolescent health and fertility. The Centre used UNFPA funds to improve its facilities, provide training, and increase research and education on teen health. A university bulletin reports that last year, the Centre provided 6936 consultations for teens and increased its outreach activities through the use of educational courses and mass media. The Center also recruited 17 professional trainers in adolescent reproductive medicine, built an annex to its main building, and established a library that specializes on adolescence. Furthermore, UNFPA provided the Centre with medical equipment such as a fetal heartbeat monitor, the necessary paraphernalia to perform vaginal endoscopy for adolescents, and other specialized diagnostic instruments for child and adolescent gynecology. The article explains that teenage pregnancy is common problem in Latin America. According to a 1988 study, 1/3 of all women aged 15-17 living in Santiago (which contains about a 1/3 of Chile's population) had been pregnant at least once.
[Unpublished] 1984. 13 p. (EPI/CCIS/84.3)This document summarizes the work performed during 1983 and the 1st half of 1984 to improve the vaccine cold chain for the Expanded Program on Immunization (EPI). It provides a broad outline of the work being carried out by the World Health Organization (WHO) and summarizes major equipment developments. The state of the cold chain is described under 3 headings: cold chain management, training, and equipment. In recent years, the EPI has focused much effort on strengthening the weakest spots in the cold chain. The section of the report devoted to cold chain management describes progress in the development of management aids, such as indicators to monitor the cold chain, and an equipment maintenance and spare parts project. Additionally, it summarizes the current situation with the cold chain support services and projects in the countries and draws attention to the results of recent cold chain studies. There are 5 types of chemical indicators in use in the cold chain, and in 1983 a document was issued giving an update on the current status of field trials and feedback on routine use. These indicators are outlined. Cold chain training has been provided on a continuing basis to health workers and technicians. Over the past 5 years several audiovisual aids for cold chain training have been prepared: 3 films, 7 posters, 2 slide sets, and 3 stickers. 3 courses of cold chain training are being used at this time: a revised version of "Manage the Cold Chain" from the mid-level managers course; logistics and cold chain course for primary health care; and refrigerator repair technicians course. Development of equipment for the cold chain has fallen into 3 main areas: finding and testing existing equipment, modifying existing equipment so that it will work better in tropical conditions, and developing new equipment for the cold chain that cannot be found on the open market.
EPI in the Americas. Report to the Global Advisory Group Meeting, Alexandria, Egypt, 22-26 October 1984.
[Unpublished] 1984. 15 p.This discussion of the Expanded Program on Immunization (EPI) in the Americas covers training, the cold chain, the Pan American Health Organization's (PAHO) Revolving Fund for the purchase of vaccines and related supplies, evaluation, subregional meetings and setting of 1985 targets, progress to date and 1984-85 activities, and information dissemination. All countries in the Region of the Americas are committed to the implementation of the EPI as an essential strategy to achieve health for all by 2000. During 1983, over 2000 health workers were trained in program formulation, implementation, and evaluation through workshops held in Argentina, Brazil, Cuba, El Salvador, and Uruguay. From the time EPI training activities were launched in early 1979 through 3rd quarter 1984, it is estimated that at least 15,000 health workers have attended these workshops. Over 12,000 EPI modules have been distributed in the Region, either directly by the EPI or through the PAHO Textbooks Program. The Regional Focal Point for the EPI cold chain in Cali, Colombia, continues to provide testing services for the identification of suitable equipment for the storage and transport of vaccines. The evaluation of solar refrigeration equipment is being emphasized increasingly. PAHO's Revolving Fund for the purchase of vaccines and related supplies received strong support from the UN International Children's Emergency Fund (UNICEF), which contributed US $500,000, and the government of the US, which contributed $1,686,000 to the fund's capitalization. These contributions raise the capitalization level to US $4,531,112. Most countries are gearing their activities toward the increase of immunization coverage, particularly to the high-risk groups of children under 1 year of age and pregnant women. To evaluate these programs, PAHO has developed and tested a comprehensive multidisciplinary methodology for this purpose. Since November 1980, 18 countries have conducted comprehensive EPI evaluations. 6 countries also have had followup evaluations to assess the extent to which the recommendations from the 1st evaluation were implemented. At each subregional meeting, participants met in small discussion groups to review each other's work plans and discuss appropriate targets for the next 2 years. Immunization coverage has improved considerably in the Americas over the last several years. Figure 2 plots the incidence rates of polio, tetanus, diphtheria, whooping cough, and measles from 1970-83 in the 20 countries which make up the Latin American subregion. If all countries meet their 1985 targets, immunization coverages for DPT and polio will range from 60-100%, with most countries attaining coverages of over 80%. For measles, 1985 targets range from 50-95%, and from 70-99% for BCG. The main vehicle for dissemination of information is the "EPI Newsletter," which publishes information on program development and epidemiology of the EPI diseases.
Geneva, Switzerland, World Federation of Public Health Associations [WFPHA], 1984 Aug. vii, 78 p. (Information for Action)This bibliograph contains 4 parts. Part 1 is anannotated bibiography covering the following topics: an overview of health care in developing countries; planning and management of primary health care (PHC): manpower training and utilization; community participation and health education; delivery of health services, including nutrition, maternal and child health, family planning, medical and dental care; disease control, water and sanitation, and pharmaceutical; and auxiliary services, Part 2 is a reference directory covering periodicals directories, handbooks and catalogs, in PHC, as well as computerized information services, educational aids and training programs, (including audiovisual and other teaching aids), and procurement of supplies and pharmaceuticals. Also given are lists of international and private donor agencies, including development cooperation agencies, and directories of foundations and proposal writing. Parts 3 and 4 are the August 1984 updates of the original May 1982 edition of the bibliography.
WORLD HEALTH FORUM. 1982; 3(4):436-40.In this discussion of strengthening the vaccine cold chain, attention is directed to the following: preventing breakdowns (ensuring good performace, delivery and installation, and training users in maintenance) and repairing equipment (planning a maintenace system and suppliers of spare parts). Keeping vaccines continuously cold as they travel from the factory to the place where they are used calls for a "cold chain" of referigerators and cold boxes. In tropical countries with unreliable electricity supplies and without vehicles to carry the vaccines, this cold chain is highly vulnerable to interruption, with consequent loss of vaccine potency. Although the UN International Chilren's Emergency Fund, the World Health Organization, and many other agencies have spent hundreds of thousands of dollars in the past few years on equipment and training, vaccines continue to be damaged. Refrigeration engineers have produced many new ideas for keeping vaccines cold, including: refrigerators that regquire only 8 hours of electricity per day; an almost unbreakale lamp glass for use in kerosene refrigerator; freezers that can produce 40 kgof ice per day for cold boxes; and freezers that use bottled gas as fuel and are specially designed for making ice packs for cold boxes. Yet, the cold chain still fails. In a typical vaccine cold chain, between 30-50% of refrigerators and freezers are not working, due in part to refrigerators have a very short working life in tropical climates. The following recommendations should be followed whien buying and installing refrigerators or freezers for cold chain: mmake sure their performace is good enough; make sure the equipment is delivered and installed in good condition; and train users to look after the equipment properly. Even a perfectly maintained refrigerator or freezer eventually wiull break down. In a properly orgaized cold chain, the individual resonaible should then contact a repair workshop. Refrigerator and freezer repairs can be done in developing countries. The guidelines for ensuring prompt repairs consider both planning a maintenance system and storing the spare parts where they will be used. There are 2 options for ministries of health who want to improve their cold chain repair work: they can award a contract for the work to a private compan; they can do the work themselves. All the work that has been done on training, tool kit design, and spare parts is based on the assumption that countries have a national policy on maintenace and repair of cold chain rquipment. This is the responsibility of the ministry of health, and there must be a commiTMENT TO THIS POLICY IN THE HIGHEST LEVELS OF THE MINISTRY.