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[Unpublished] 1984. 27 p.The current status of the Control of Diarrhoeal Diseases (CDD) Program was reviewed, and activities related to the evaluation of country control programs, the assessment of potential diarrheal disease control interventions, and the program's operational research activities were examined. In the health services component, ciontinued efforts to promote the preparation of plans of operation for national CDD programs is recommended, as is continued use of the national CDD program managers training course. Concern was expressed that the level of use of oral rehydration therapy (ORT) appeared to be modest. Case management was endorsed as the major program strategy. The series of studies on interventions for reducing diarrhea's mortality and morbidity were welcomed. For evaluation purposes, it is recommended that the program develop additional criteria for monitoring increased access to and usage of oral rehydration salts (ORS) and the reduction of diarrheal mortality. Continued accumulaton and publication of information yielded by the program's survey of the impact of ORT in hospitals was recommended. In the research component, the growth of research activities is satisfying. While biomedical aspects have developed well, it might be necessary to relate them gradually to specific control interventions in the future. Further studies of improved ORS formulatons were recommended. High priority should also be given to the promotion of breast feeding, immunization, and water supply and sanitation. The underlying mechanisms that cause the intervention to reduce diarrheal morbidity or mortality should be clarified. Research is recommended on the promotion of personal and domestic hygiene, food hygiene, and improved weaning practices. Emphasis on the development and evaluation of vaccines against the causes of diarrhea is supported. Some changes in the balance of research activities should be made. Epidemiological weak.
WORLD HEALTH FORUM. 1993; 14(4):333-44.WHO evaluated the implementation of the health-for-all strategy using data from 151 countries. 110 countries still endorsed the strategy. 95 have either completely implemented or further developed community involvement. Just 33 countries had more equitable distribution of resources. The percentage of gross national product (GNP) that the government dedicated to health rose in the least developed countries. Developed countries spent a higher proportion of their GNP on health than did developing countries (3.3% vs. 0.9%, 1991). Maldistribution of health personnel continued to be a major problem. Between 1985 and 1990, the proportion of people in developing countries with access to safe water rose from 68 to 75%. Adequate sewage disposal coverage rose from 46 to 71% (1985-1991). Prenatal care coverage by trained personnel increased from 58 to 67%. Tetanus toxoid coverage of pregnant women only increased from 24 to 34%. Most maternal deaths were a result of inadequate prenatal care, inadequate care during childbirth, pregnancies spaced too closely, multiparity, and poor health and nutritional status before the first pregnancy. Immunization coverage rose considerably in every region (e.g., 47-83% for diphtheria). Nevertheless, substantial differences in coverage existed between countries. A substantial trend towards more integrated primary health care occurred. Child survival rates improved, but the gap in infant mortality rates between developed countries and the least developed countries widened. The gap in health status between the poor and the wealthy had become larger. Developing countries in the process of the epidemiological transition continued to be burdened with both infectious and degenerative diseases. GNP and adult literacy rose, but less so in the least developed countries. These findings suggested that governments must sustain the commitment to reduce inequities, realign health systems, improve health financing systems, improve coordination between health sectors, and improve linkage between health and development.