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[Experience with the expanded WHO program on immunization against tetanus] Opyt rasshirennoi programmy VOZ po immunizatsii protiv stolbniaka.
ZHURNAL MIKROBIOLOGII, EPIDEMIOLOGII I IMMUNOBIOLOGII. 1985 Nov; (11):97-103.According to (WHO) statistics, over 1 million infants in the developing countries die each year from tetanus. The estimated annual occurrence of tetanus in the 3rd World exceeds 2.5 million cases, including approximately 1.3 million newborn infants. In 1974, WHO began an expanded program for the systematic immunization of infants against tetanus and certain other diseases. The program uses 2 approaches for preventing tetanus: 1) immunization of infants under 1 year of age with the AKDS vaccine; and 2) immunization of pregnant women or, if possible, all women, with tetanus anatoxin. The 2nd approach is more effective, especially when 2 doses of tetanus anatoxin are administered within a minimum interval of 4 weeks. The anatoxin has no harmful effects on the fetus and can be used during any stage of pregnancy. The program strives to reduce infant mortality caused by tetanus to less than 1 case in 1000 by 1990, and to 0 by 2000. To attain these goals, systematic immunization should be combined with drastic improvements in delivery techniques and hygiene in developing countries. Specialized surveys indicate that initial steps toward implementation of the program resulted in a significant reduction of infant mortality caused by tetanus. Experience with the expanded WHO program shows that elimination of tetanus in infants is a realistic and attainable goal.
[Unpublished] 1984 May 3. Presented at the 1984 Annual Meeting of the Population Association of America, Minneapolis, Minnesota, May 3-5, 1984. 26 p.The paper summarizes the health strategy of the US Agency for International Development (AID). The goal of the strategy is to assist developing countries to 1) reduce mortality among infants and young children, and 2) to reduce disease and disability among selected population groups. The main strategy elements include: 1) improved and expanded use of available technologies; 2) development of new and improved technologies; and 3) strengthening human resource and institutional capability. A more in-depth look is taken at how AID implements its strategy in Asia emphasizing the primary goal of infant mortality reduction. The paper provides a demographic overview of the 9 AID-assisted Asian countries. A summary of AID's program support in Asia showing levels and trends by subcategory is provided. Particular attention is paid to projects supporting selective primary care. Finally, the paper discusses the difficulties of implementing the strategy in Asia and speculates on the chances for success. (author's)
[Unpublished] 1983. Presented at the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C. 11 p.3 aspects of oral rehydration therapy (ORT) have to be considered in evaluating its potential importance as a priority primary health care intervention. First, studies have proven that ORT is safe and effective. Second, the World Health Organization (WHO) and UNICEF have established a recommended approach to ORT delivery. This includes early therapy in the home with appropriate household solutions, use of OR salts (ORS) for treatment of dehydration at health centers and hospitals and by village health workers, and the provision of backup support with intravenous therapy at larger health centers and hospitals. A universal rehydration solution has been adopted as well, consisting of sodium chloride 3.5 gm, sodium bicarbonate 2.5 gm, potassium chloride 1.5 gm, dissolved in 1 liter of water; this solution is also appropriate for maintenance although its sodium concentration may be too high for use in infants. Studies have shown that dehydrated infants receiving a solution lacking potassium had prolonged hypokalemia compared with those receiving ORS solution. It is now known from experience in many countries that ORT using ORS solution can be readily implemented in health facilities and has also been shown to lead to a signicant decline in the use of intravenous fluids and case-fatality rates in hospitals and health centers. In Calcutta the efficacy of a solution made from cooked rice powder was compared in dehydrated infants with the standard ORS solution and one to which glycine was added. Both the rice-based ORS and that containing glycine resulted in a 40% decrease in stool output compared with the standard ORS solution; thus it might be possible to achieve a good result by using a rehydration solution that enhances fluid absorption in the intestine. Almost all typical home remedies for diarrhea lack the needed potassium chloride and sodium bicarbonate and are therefore not ideal but can be used in situations where ORS is not available. The 3rd aspect of ORT is its relationship to other factors in clinical management, namely the replacement of calories lost during the diarrhea episode. A recent WHO study estimated that in 1980 there were up to 1 billion diarrheal illnesses resulting in 4.6 million deaths in Africa, Asia, and Latin America, and that the highest incidence and mortality rates were in the 1st 2 years of life. The WHO diarrheal disease control program has 2 components, health services and research. In the health services area, the maternal and child health and environmental health strategies promote exclusive breastfeeding for the 1st 4-6 months of life, and continued breastfeeding up to at least 2 years of age, and the addition of locally available semisolid foods from age 4-6 months, as well as the use of clean water and hygienic food practices. Health education and information materials are also being produced.