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Geneva, Switzerland, World Health Organization [WHO], 2007.  p. (WHO Discussion Papers on Adolescence; Issues in Adolescent Health and Development)The World Health Organization (WHO) has been contributing to meeting the Millennium Development Goals (MDGs) by according priority attention to issues pertaining to the management of adolescent pregnancy. Three of the aims of the MDGs - empowerment of women, promotion of maternal health, and reduction of child mortality - embody WHO's key priorities and its policy framework for poverty reduction. The UN Special Session on Children has focused on some of the key issues affecting adolescents' rights, including early marriage, access to sexual and reproductive health services, and care for pregnant adolescents. This review of the literature was conducted to identify (1) the major factors affecting the pregnancy outcome among adolescents, related to their physical immaturity and inappropriate or inadequate healthcare-seeking behaviour, and (2) the socioeconomic and political barriers that influence their access to health-care services and information. The review also presents programmatic evidence of feasible measures that can be taken at the household, community and national levels to improve pregnancy outcomes among adolescents. (excerpt)
[Unpublished] 1990. 12 p. (WHO/CDD/90.33)Findings from the 11th meeting of the Technical Advisory Group (TAG) of the Diarrheal Diseases Control Program are reviewed. Progress made in health services during 1988-1989 include training in supervisory skills for an estimated 17% of the staff and in case management for 11% of the staff, endorsal of breast feeding and rational drug use, 61 countries producing oral rehydration salts (ORS), a 60% access rate to ORS and 34% rate of use of oral rehydration therapy, increased communication activities, and improved assessment for diarrheal management. Major research progress includes determining the effectiveness of rice-based ORS, continued feeding, and breast feeding in diarrheal management. Revisions in research management include the utilization of multi- disciplinary research teams and the replacement of Scientific Working Groups (SWG) with experts to review research priorities, determine study methods, review proposals, and confer with investigators on research design. Research priorities are vaccine development and childhood diarrhea which involves case management research by employing clinical trials, epidemiology and disease prevention, and determining cost effectiveness and optimal delivery of intervention methods. 1995 goals are increased production of ORS, improved supervisory skills training, and improved case management of oral rehydration therapy. During 1988- 1989, the program had access to US$ 20.9 million. US$ 4.7 million carried over at the end of 1989 into 1990. The 1990-1991 overall budget was reduced by 26% because increased contributions were not acquired. Recommendations for the health services component of the program include program implementation which utilizes effective diarrheal assessment tools, focuses on lowering childhood mortality due to diarrhea in 24 countries, and correcting the misuse of antibiotics and antidiarrheal drugs; training for the medical profession in diarrheal management, improved training materials and additional training units; increased accessibility to ORS; improved communication which involves promoting diarrheal treatment in the educational system; and preventing diarrhea by encouraging breast feeding. Recommendations for research includes revised research management guidelines and close collaboration between TAG and investigators.
The global eradication of smallpox. Final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979.
Geneva, Switzerland, WHO, 1980. 122 p. (History of International Public Health No. 4)The Global Commission for the Certification of Smallpox Eradication met in December 1978 to review the program in detail and to advise on subsequent activities and met again in December 1979 to assess progress and to make the final recommendations that are presented in this report. Additionally, the report contains a summary account of the history of smallpox, the clinical, epidemiological, and virological features of the disease, the efforts to control and eradicate smallpox prior to 1966, and an account of the intensified program during the 1967-79 period. The report describes the procedures used for the certification of eradication along with the findings of 21 different international commissions that visited and reviewed programs in 61 countries. These findings provide the basis for the Commission's conclusion that the global eradication of smallpox has been achieved. The Commission also concluded that there is no evidence that smallpox will return as an endemic disease. The overall development and coordination of the intensified program were carried out by a smallpox unit established at the World Health Organization (WHO) headquarters in Geneva, which worked closely with WHO staff at regional offices and, through them, with national staff and WHO advisers at the country level. Earlier programs had been based on a mass vaccination strategy. The intensified campaign called for programs designed to vaccinate at least 80% of the population within a 2-3 year period. During this time, reporting systems and surveillance activities were to be developed that would permit detection and elimination of the remaining foci of the disease. Support was sought and obtained from many different governments and agencies. The progression of the eradication program can be divided into 3 phases: the period between 1967-72 when eradication was achieved in most African countries, Indonesia, and South America; the 1973-75 period when major efforts focused on the countries of the Indian subcontinent; and the 1975-77 period when the goal of eradication was realized in the Horn of Africa. Global Commission recommendations for WHO policy in the post-eradication era include: the discontinuation of smallpox vaccination; continuing surveillance of monkey pox in West and Central Africa; supervision of the stocks and use of variola virus in laboratories; a policy of insurance against the return of the disease that includes thorough investigation of reports of suspected smallpox; the maintenance of an international reserve of freeze-dried vaccine under WHO control; and measures designed to ensure that laboratory and epidemiological expertise in human poxvirus infections should not be dissipated.
Geneva, Switzerland, World Health Organization [WHO], . 40 p. (WHO/CDD/87.26)The Diarrheal Diseases Control Program which became operational in 1980 is collaborating with over 110 countries in the implementation of national diarrheal diseases control programs and related research. This report is an interim summary of activities during 1986. Activities in the health services component included support for training courses, organization of diarrhea training units and clinical managment courses, adoption of policies for household approaches to oral rehydration therapy (ORT), assistance for production of ORT, undertaking of diarrheal disease morbidity, mortality, and treatment surveys, and conducting of program reviews. The program continued to support biomedical, epidemiological, and operational research on priority topics such as improved treatment methods, vaccine development, evaluation and implementation of interventions for prevention of diarrheal diseases. The summary includes meetings of the Program's management and review bodies which took place in 1986 and the financial status of the program.
Health systems research in maternal and child health including family planning: issues and priorities. Report of the meeting of the Steering Committee of the Task Force on Health Systems Research in Maternal and Child Health including Family Planning, New Delhi, 12-15 March 1984.
[Unpublished] 1985. 23 p. (MCH/85.8)In a series of general discussions aimed at establishing health systems research priorities, the Steering Committee of the Task Force on the Risk Approach and Program Research in Maternal-Child Health/Family Planning Care identified 9 major issues: 1) health services and health systems, 2) research and service to the community, 3) involving the community, 4) evaluation, 5) information systems, 6) interdisciplinary nature of health systems research, 7) appropriateness in technology and research, 8) funding and collaboration between agencies, and 9) implications for research program strategies. Background considerations regarding subject priorities for health systems research include the policies, goals, and programs of WHO, especially the goal of health for all by the year 2000. Of particular importance is the joining of training in health systems research with the research itself given the shortage of workers in this area. The sequence of events in the management of research proposals includes approach by an applicant, the WHO response, information to the appropriate WHO regional office, the beginning of technical dialogue, development of protocol, submission of grant application, contractual agreement, initial payments, regular monitoring of progress, proposed training strategy, annual reports, final report, and assistance in disseminating results. 3 subject areas were identified by the Steering Committee for additional scrutiny: 1) the dissemination of results of health systems research in maternal-child health/family planning, 2) the implementation of health services research and the studies to be funded, and 3) the coordination and "broker" functions of the Steering Committee.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1974; (552):1-40.This document represents the work of a World Health Organization (WHO) Expert Committee on Tuberculosis, which met in Geneva in 1973. Chapters in this volume focus on epidemiology, Bacillus Calmette-Guerin (BCG) vaccination, case finding and treatment, national tuberculosis programs, research, WHO activities in this field, and the activities of the International Union against Tuberculosis and voluntary groups. The Committee emphasized that tuberculosis still ranks among the world's major health problems, particularly in developing countries. Even in many developed countries, tuberculosis and its sequelae are a more important cause of death than all the other notifiable infectious diseases combined. The previous WHO report, issued in 1964, set forth the concept of a comprehensive tuberculosis control program on a national scale. The implementation of this approach has encountered many problems, including deficiencies in the health infrastructure of many countries (shortages of financial, material, and physical resources and a lack of trained manpower) and resistance to change. However, many countries have instituted comprehensive programs and tuberculosis control has become a widely applied community health activity. A priority will be control of pulmonary tuberculosis. The Committee stressed that national programs must be countrywide, permanent, adapted to the expressed demands of the population, and integrated in the community health structure. Steps involved in setting up such programs include planning and programming, selection of technical policies, implementation, and evaluation. Research priority areas identified by the Committee include epidemiology, bacteriology and immunology, immunization, chemotherpy, the systems analysis approach to tuberculosis control, and training methods and instructional materials.
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.
Geneva, Switzerland, WHO, 1985. 101 p. (WHO/CDD/85.13)The Diarrheal Diseases Control (CDD) Program, initiated in 1978, is a priority program of WHO for attainment of the goal of Health for All by the Year 2000. Its primary objectives are to reduce diarrheal disease mortality and morbidity, particularly in infants and young children. This report describes the activities undertaken by the Program in the 1983-1984 biennium. During this period, the Program collaborated with more than 100 countries in the implementation of national diarrheal disease control and research activities. The biennium has witnessed a growing interest of other international, bilateral, and nongovernmental agencies in diarrheal disease control; their financial support and commitment have contributed in a large measure to furthering the development of CDD programs and related research in many countries. During the biennium, the services component continued to expand both the quantity and scope of its activities at global, regional, and national levels. This is readily seen from the increase in global acess to Oral Rehydration Salts (ORS) packets from less than 5% in 1981 to 21% in 1983. Other significant developments were a substantial increase in the number of countries planning and implementing programs and the initiation of a new management course in supervisory skills. Successful implementation of national primary health care systems was recognized as necessary for the achievement of the Program's objectives. Efforts of both developing and industrialized countries must continue in a joint endeavor to reduce the problem of diarrheal diseases, especially cholera, the most severe diarrheal disease. The following areas are discussed: the health services component; the research component; information services; program review bodies; program resources and obligations; and program publications and documents for 1983-1984.
[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.
Geneva, Switzerland, WHO,  27 p.This is the 1st interim report issued by the Diarrhoeal Diseases Control (CDD) Programme, summarizing progress in its main areas of activity during the previous calendar year. Most of the information is presented in the form of tables, graphs and lists. Other important developments are mentioned briefly in each section. The information is presented according to major program areas; health services; research; and program management. Within the health services component, national program planning, training, the production of Oral Rehydration Salts (ORS), health education and promotion are areas of priority activity. Progress in the rate of development of national programs, participants in the various levelsof training programs, and the countries producing their own ORS packets and developing promotional and educational materials are presented. An evaluation of the health services component, based on a questionnaire survey to determine the impact of Oral Rehydration Therapy (ORT), indicates significant decreases in diarrheal admission rates and in overall diarrheal case-fatality rates. Data collected from a total of 45 morbidity and and mortality surveys are shown. Biomedical and operational research projects supported by the program are given. Thhe research areas in which there was the greatest % increase in the number of projects funded were parasite-related diarrheas, drug development and management of diarrheal disease. Research is also in progress on community attitudes and practices in relation to diarrheal disease and on the development of local educational materials. The program's organizational structure is briefly described and its financial status summarized. The report ends with a list of new publications and documents concerning health services, research and management of diarrheal diseases.
World Health Organization Technical Report Series. 1978; (616):1-142.The World Health Organization (WHO) Scientific Group on Neisseria gonorrhoeae and Gonococcal Infections, which met in Geneva November 2-8, 1976, set 3 goals: 1) to evaluate current knowledge regarding N. gonorrhoeae, gonococcal infections, and complications of these infections; 2) to determine research directions in light of public health priorities; and 3) to propose a control policy adapted to existing health structures and epidemiologic sitations. In addition to specific recommendations pertaining to individual facets of the problem of gonococcal infections, such as their pathogenesis, epidemiology, clinical manifestations, identification, and antimicrobial susceptibility, the Group made 5 principal recommendations. 1st, the gonococcal antigens that have been defined immunochemically should be intensively investigated with the aim of establishing a sensitive, selective serologic test for gonorrhea and assessing the potential value of these components in vaccines against gonorrhea. Research should also be directed toward the effects of gonorrhea on male and femlae fertility, child development, and perinatal morbidity and mortality. 2nd, health education and stricter control over the availability of microbials are needed to counteract the development of drug resistance on the part of gonococcal strains of bacteria. A system for the continuous surveillance of the antimicrobial susceptibility pattern should be set up in each epidemiologic area. 3rd, governments should set up the best possible services for the diagnosis and treatment of gonococcal infections. These services should involve a well-balanced range of techniques, continuously monitored to evaluate their relevance and cost-effectiveness. In areas where diagnostic laboratory support is unavailable, a simplified control program based on clinical diagnosis and contact treatment may be considered a temporary measure to reduce the spread of infection. 4th, health authorities must determine the prevalence of beta-lactamase-producing strains and attempt to limit their spread. The recent appearance of these strains is regarded as a serious public health threat which may produce a major increase in morbidity and mortality. 5th, governments are urged to facilitate research on the practical value of new findings and to cooperate with WHO in training programs to improve the effectiveness of gonorrhea control. A network of national and regional centers for research and training would be a positive development.
Steering committee meeting of the Task Force on Reproductive Health in Adolescence, Geneva, 21-23 October 1986: report.
Geneva, Switzerland, World Health Organization, 1986. 24 p. (INT/83/P51)This report summarizes a meeting of the Task Force and Steering Committee held in Geneva to discuss adolescent reproductive health. The achievements of current and recently concluded projects were reviewed. Obstacles associated with obtaining progress and final reports of projects were contributed to governments' finding some research issues sensitive, inadequate timely technical advice, and misjudgment of time and effort necessary to complete some activities. The committee was concerned with the utilization of research findings by governments, health workers, and non-governmental organizations in developing policies and programs concerning this topic. Other committee activities include endorsement of projects originated since 1985, approval of a 1985 resolution by the World Health Assembly regarding maturity before childbearing and the promotion of responsible parenthood, discussion of duty travel and consultant activities, and examination of future proposed studies including a project employing drama to focus on population growth effects in Kenya, employing workshops in Africa and the caribbean for counseling skills training, and provision of sex education for male national service recruits in Tunisia. Future directions for the Steering Committee and the Task Force include developing fund-raising plans, attracting donor agencies through pamphlets reviewing the Task Force's accomplishments in promoting adolescent health, and increased involvement of regional offices through informal meetings, workshops, collaborating centers, and information materials on research methodology and service development and evaluation. Furthermore, it was determined that research's role in Task Force projects should be more clearly specified.
Stony Brook, New York, State University of New York at Stony Brook, 1989 Sep. xiv, 65 p. (Health Care Financing in Latin America and the Caribbean [HOFLAC] Research Report No. 10)Recently a 4 year research project was conducted in Latin America and the Caribbean on health care financing, sponsored by the US Agency for International Development. The work focused on 3 areas: health care costs, household demand for health care, and alternatives to the financing of health care from general tax funds. The work focuses on 10 countries of lower to middle income with small populations (except Peru), making them comparable. In most of these countries unfavorable economic conditions have prevented the governments from expanding primary health care, and have caused the deterioration of many health services. These conditions have stimulated private health care spending which has expanded in proportion of total health financing. Cost studies have indicated a wide variation of annual costs of primary care in the public, social security, and private sectors. In hospitals the larger facilities take a bigger share than standard accounts show. Research suggests that if user fees were charged for outpatient care in public hospitals, the overall use would stay the same, but some users would switch to private providers. Since private hospitals charge considerable more, inpatient care is more suited to public facilities. Findings here show the importance of social security in the financing of medical care, especially in these countries where 20-30% is paid from it. Recommendations from these studies include limiting personnel expenditures and cost containment in hospitals.
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.
New York, New York, United Nations Fund for Population Activities, 1984. viii, 60 p. (Report No. 79)This report presents the findings of a mission from the UN Fund for Population Activities to ascertain the needs for population assistance for the Republic of Botswana. Botswana's population is growing at a rate of 3.46% (1980-1985), a consequence of continuing high fertility and decreasing death rates. While there is an awareness of the implications of he high growth rate for development, the government appears to have relaxed its emphasis on controlling population growth, limiting its role to maternal and child health, and concentrating on the family welfare aspects of fertility control. The Mission expressed concern about the absence of a clearly articulated policy on population. However, it is hoped that the creation of the Botswana Population Council will result in the inclusion of such a policy in future national development plans. Migration is a major problem facing planners. The high rate of rural to urban migration and the reduction of migration to the Republic of South Africa for employment, have resulted in high unemployment rates within Botswana, particularly among unskilled workers. Critical gaps have been identified in the collection, analysis, and dissemination of population data, which are essential for the formulation of appropriate development strategies in this area. The Mission recommends that support in the form of training and technical assistance be provided to both the Central Statistics Office and the Registry of Births and Deaths, in the case of the latter to promote the establishment of a nation-wide civil registration system. Present health policy focuses on the concept of primary health care, with an emphasis on preventive health and community participation. Due to the shortage of health manpower and heavy dependence on expatriate personnel, the Mission's recommendations in this area stress support for the training of health workers at all levels and the inclusion of population components in this training. A high proportion of households, particularly in rural areas, are headed by women, and many of these households are poor. The Mission's recommendations seek to enhance women's economic status and improve their access to resources such as vocational training and agricultural extension services.
[Unpublished] 1988. Presented at the 116th Annual Meeting of the American Public Health Association [APHA], Boston, Massachusetts, November 13-17, 1988. 7 p.In most developing countries, particularly those in Africa and the Caribbean, equal numbers of women as men are affected by the acquired immunodeficiency syndrome (AIDS) and have the potential to infect their fetuses. Thus, any consideration of the AIDS problem in developing countries must give serious attention to women and children. Current research suggests a perinatal transmission rate of 30-40% and there is concern that AIDS-related pediatric deaths will undermine child survival efforts in countries that have begun to reduce infant and child mortality rates. A number of clinical issues that are now poorly understood require immediate research so that findings can be incorporated into AIDS prevention strategies. Among these issues are: the impact of pregnancy on progression of human immunodeficiency virus (HIV) infection to AIDS; factors that affect an HIV-infected mother's chance of infecting her fetus; the safety of breastfeeding; immunization; the relationships between HIV infection and various contraceptives; and the potential impact of HIV infection on fertility. The extent and nature of the social and financial impact of AIDS at the family and community levels must also be better understood. In the interim, UNICEF has proposed 6 programmatic approaches to prevent women from becoming infected, to prevent perinatal transmission, and to address the AIDS-related needs of women and children. 1st, traditional birth attendants should be trained in AIDS prevention measures and provided with supplies to ensure infection control. 2nd, women must be able to receive consistent, appropriate advice from both maternal-child health workers and family planning staff about contraception and their future health. 3rd, the issue of counseling for women should be broadened beyond that associated with routine prenatal HIV screening. 4th, AIDS education efforts for school-age children must be expanded. 5th, more attention should be given to the social service needs of AIDS-infected women and children. And 6th, there is an urgent need to improve protocols and treatment facilities for those affected with HIV and AIDS.
In: Women's health and apartheid: the health of women and children and the future of progressive primary health care in Southern Africa, edited by Marcia Wright, Zena Stein and Jean Scandlyn. New York, New York, Columbia University, 1988. 84-9.There is a large discrepancy between maternal mortality rates in developed and developing countries, with maternal mortality as a leading cause of death of young women in poor countries. There has been renewed interest in maternal mortality among international agencies and major foundations quite recently. Women and children form up to 2/3 of the population of many developing countries, and over 1/2 of primary health care resources are devoted to maternal and child health programs. Nevertheless, little of this is directed at maternal mortality; most goes to immunization, oral rehydration for diarrhea, monitoring children's growth, and promoting breastfeeding. While some of the international health community attribute the long neglect of maternal mortality to not knowing the extent and severity of the problem before, prior data existed demonstrating the alarmingly high rates. Low maternal mortality in the West may have distracted attention from the international problem. Sexism may have been a major factor, as even today efforts to reduce maternal mortality need to be justified in terms of the implications for the family, children and society as a whole. The reasons for the current concern are not clear, but may relate to an interest in concrete issues after the United Nations Decade for Women, or real surprise in the international community once the problem was pointed out. As various agencies rush to establish maternal mortality programs, it is imperative to evaluate which approaches will be really effective. Critical evaluation of programs is necessary to capitalize on the current interest.
Washington, D.C., International Science and Technology Institute, Population Technical Assistance Project, 1985 Aug 8. v, 7,  p. (Report No. 85-48-018; Contract No. DPE-3024-C-00-4063-00)The objectives of the consultation in Madagascar were to review existing policies and programs in population and family health, to assess government and nongovernment plans and capabilities to program implementation, to review other donor activities, to identify constraints impeding population and family planning activities, and to prepare recommendations for the US Agency for International Development (USAID) assistance to Madagascar. Although the government has no officially proclaimed population policy, there is increasing direct support of family planning. The private family planning association, Fianakaviana Sambatra (FISA) was officially recognized in 1967 and is permitted to import and distribute contraceptives. Sale of contraceptives in private pharmacies also is permitted. The major organization providing family planning services is FISA. The Ministry of Health (MOH) system does not include contraceptive services as part of its health care services, but at the request of MOH physicians, FISA provides services in 40 MOH facilities. Private pharmacies account for most of the contraceptive distribution, with oral contraceptives (OCs) being sold by prescriptions written by private physicians or, on occasion, by public health physicians. Contraceptive services also are provided in the medical centers of at least 3 organizations: JIRAMA, the water and electricity parastatal; SOLIMA, the petroleum parastatal; and OSTIE, a group of private enterprises that has its own health care system. A Catholic organization, FTK (Natural Family Planning Association) provides education and training in natural family planning. Demographic research has not been accorded a high priority in Madagascar. Consequently, the country's capabilities in the area are relatively limited. At this time, demographic research is carried out within several institutional structures. The major donor in the area of population/family planning is UN Fund for Population Activities (UNFPA). Activities of the UN International Children's Emergency Fund (UNICEF) in the area of health are relevant to the planned USAID assistance. For several years, USAID has provided population assistance to Madagascar through its centrally funded projects. Recommendations are presented in order of descending importance according to priorities determined by the consultation team: population policy; training/sensitization of the medical community; support to existing private voluntary organizations; demographic statistics and research; information, education, and communication; and collection and reinforcement of health statistics. In regard to population policy, assistance should be directed to 2 general objectives: providing guidance to the government in deciding which stance it ultimately wishes to adopt officially with regard to population; and encouraging the systematic incorporation of demographic factors into sectoral development planning.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1985; 63(2):241-8.The WHO memorandum outlines the present situation regarding pertussis vaccines, discusses ways to evaluate candidate vaccines, and identifies future research needs. Most existing whooping cough vaccines are whole-cell vaccines, combined with diphtheria and tetanus toxoid adsorbed on an aluminum or calcium carrier. As whole bacterial cells, they contain a complex array of at least 7 toxins and antigens, and display a narrow margin between potency and toxicity. The Japanese introduced an acellular vaccine, admittedly sometimes less potent, called the Precipitated Purified Pertussis Vaccine, in 1981. This material contains far less bacterial mass, notably less endotoxin, and consequently produces less fever, erythema and induration. WHO has not yet established minimum requirements for standardization; even the mouse potency assay may not be suitable. There are techniques, however, which will measure amounts of component antigens and toxicity. Conflicting results on assays of potency and immunogenicity will have to be resolved. Besides the obvious need for large clinical trials of defined vaccines, a whole range of research needs were suggested, from genetic studies of the organism to specific details of the host response. It is generally agreed that a less reactogenic and more effective pertussis vaccine is needed and feasible.
Expanded Programme of Immunization Eastern Mediterranean Region. A report for the EPI Global Advisory Group Meeting, Alexandria, 21-25 October 1984.
[Unpublished] 1984. 10,  p. (EPI/GAG/84/WP.7.a)The strategy adopted by the Members States of the Eastern Mediterranean Region (EMR) to achieve the objective of the promotion of the Expanded Program of Immunization (EPI) through primary health care (PHC) concentrates on strengthening synergistic integration of EPI with other services. Activities have been planned and implemented or are being implemented at the Regional Office and at the country level. 21 countries of the Region now have either a full-time or part-time manager or an EPI focal point. This is a considerable development, for in 1982 there were EPI managers in 9 countries. Except for 3 countries, all national EPI managers/focal points have received senior level training in EPI. At delivery points, vaccination is performed to a large extent by multipurpose health workers, but full-time vaccinators are available in about 6 countries. All field workers have received training at their respective regional levels. Limited financial resources continue to be 1 of the primary constraints of the program in the Region. Plans to resolve this problem include: counteracting wastage factors; close collaboration with the UN International Children's Emergency Fund (UNICEF) and other international agencies at the country level to standardize approaches and avoid overlap; tapping regional and international voluntary agencies to increase their contributions; and increased use of associate experts, UN volunteers, and national technical staff. The overall information system is to some extent weak and suffers from irregularity and a lack of continuity. Regular reports are received from 9 countries which have World Health Organization staff. Repeated requests from other countries yield incomplete and at times contradicting data. Research efforts are directed towards operational areas, and research in strategies, integration, community, and surveillance areas is being encouraged.
ASIA-PACIFIC POPULATION JOURNAL. 1987 Mar; 2(1):65-7.The Economic and Social Commission for Asia and the Pacific (ESCAP) recently organized a workshop to develop an analytical framework for population research and development planning. The workshop goal was to enable study directors to review and discuss research methodology and guidelines for a series of country studies to be undertaken as part of a large project devoted to integrating population and development. The overall project objective is to provide individual national entities with current and scientifically sound descriptions, analyses, and interpretations of significant population and development trends and their interrelationships along with assessments of the implications of such trends and relationships for the formulation and improvement of public policy. 1 reason for the limited progress in the integration of population and development planning is the lack of useful and applicable scientific information for responsible planners as well as a lack of analytical frameworks. If the results of the research are to be made useful for decisionmaking purposes, processing of the information is required. The need exists for current critical analysis and synthesis of available information at the country level on significant population and development trends and their interrelationships and an assessment of their implications for the formulation and improvement of public policy and programs. In regard to an analytical framework, much work has been done in the areas of population development interrelationships and their modelling. Bangladesh, Nepal, the Philippines, and Thailand are the countries which have been selected for investigation for the ESCAP project. The comparative analysis that is to be conducted will facilitate understanding of current population development research activities and the future needs of these countries.
Evaluation of the USAID grant to the International Center for Diarrheal Disease Research, Bangladesh: Maternal and Child Health/Family Planning Extension Project.
Arlington, Virginia, International Science and Technology Institute, Population Technical Assistance Project, 1986 Sep 18. xi, 23,  p. (Report No. 85-68-039)This report evaluates a US Agency for International Development (AID) grant to the International Center for Diarrheal Disease Research, Bangladesh (ICDDR, B), which supports the Maternal and Child Health/Family Planning Extension Project (EP). The EP operations research effort was initially designed to replicate the Matlab model in 2 upazilas, but shifted to an effort to initiate new approaches. Of the 13 major experiment undertaken during the project's 4-year history, over half have adopted by the Ministry of Health and Population Control, including a plan to add 10,000 female welfare assistants to the existing cadres. Considering the accomplishments of the EP to date, there is strong justification for continued funding of the project, at least until 1990 when the government's 5-year Plan concludes. It is recommended that the project's emphasis should continue to be to test various alternative strategies for improved implementation of family planning/maternal-child health programs within the overall framework of a limited number of clearly defined project objectives. The task of analyzing incremental costs should be given higher priority in the next 5 years and project documentation should be refined. The decision as to whether the project should be funded after 1990 or phased out should be deferred until a later date. Also presented in this report are specific recommendations regarding the selection of research topics, research procedures, dissemination of research results, addition of new staff, filling of staff vacancies, and Population Council involvement.
[Unpublished] 1985 Nov 19. Presented to the Executive Board, Seventy-seventh Session, Provisional Agenda Item 18. 20 p. (EB77/27)The Expanded Program on Immunization (EPI) has made major public health gains in the past decade. The central EPI strategy has been to deliver immunization in consonance with other health services, particularly those directed toward mothers and children. However, in the least developed countries and many other developing countries, it does not appear likely that national budgets will be sufficient by 1990 to support full immunization coverage on a sustained basis or that an adequate number of national managers can be assembled to staff effective programs. At the November 1985 meeting of the EPI Global Advisory Group, recommendations were made to accelerate global progress. These recommendations reflect optimism that the 1990 goal of reducing morbidity and mortality by immunizing all children of the world can be achieved, but also acknowledge that many fundamental problems of national program management remain to be resolved. 3 general actions needed are: 1) promote the achievement of the 1990 immunization goal at national and international levels through collaboration among ministries, organizations, and individuals in both the public and private sectors; 2) adopt a mix of complementary strategies for program acceleration; and 3) ensure that rapid increases in coverage can be sustained through mechanisms which strengthen the delivery of other primary health care interventions. The 4 specific actions needed are: 1) provide immunization at every contact point, 2) reduce drop-out rates between first and last immunizations, 3) improve immunization services to the disadvantaged in urban areas, and 4) increase priority for the control of measles, poliomyelitis, and neonatal tetanus. Continued efforts are also required to strengthen disease surveillance and outbreak control, reinforce training and supervision, ensure quality of vaccine production and administration, and pursue research and development.
[Expanded Programme on Immunization: Global Advisory Group] Programme Elargi de Vaccination: Groupe consultatif mondial.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1984 Mar 23; 59(12):85-9.In addition to the conclusions and recommendations reached at the 6th meeting of the Expanded Program on Immunization (EPI) Global Advisory Group and summarized in this report, the Group reviewed at length the status of the program in the Western Pacific Region and made a series of recommendations specifically directed to activities in the Region. Of particular significance for the operational progress of the global program are the recommendations concerning "Administration of EPI Vaccines," which were subsequently endorsed by the Precongress workshop on Immunization held before the XVIIth International Congress of Pediatrics in Manila in November 1983. These recommendations are not listed here. In his report to the World Health Assembly in 1982, the Director-General summarized the major problems which threaten the success of efforts to achieve the World Health Organization (WHO) goal of reducing morbidity and mortality by providing immunization for all children of the world by 1990. The 5-Point Action Program adopted at that time remains a relevant guide for countries and for WHO as they work to resolve those problems. The EPI is concerned about the prevention of the target diseases, not merely with the administration of vaccine. In addition to working toward increases in immunization coverage, the EPI must assure the strenghtening of surveillance systems so that the magnitude of the health problem represented by the target diseases is known at the community, district, regional, and national levels; immunization strategies are continuously adapted in order to reach groups at highest risk; and the target diseases are reduced to a minimum. The development of surveillance systems is one of the priorities in the development of effective primary health care services. Disease surveillance in its various forms should be used at all management levels for monitoring immunization programs performance and for measuring program impact. Specific recommendations regarding disease surveillance to be undertaken at global and regional levels and at the national level are listed. The results of more than 100 lameness surveys conducted in 25 developing countries confirm that paralytic poliomyelitis constitutes an important public health problem in any area in which the disease is endemic. In most programs, initial emphasis should be placed on the develpment of sentinel surveillance sites to monitor disease incidence trends. Some progress has been made in acting on the recommendations made at the meeting on the prevention of neonatal tetanus held in Lahore in 1982, but intensification of activities is required. In many developing countries, the surveillance and control of diphtheria must be improved. All aspects of progress and problems in the global program are reflected at least somewhere in the Western Pacific Region, and most of the findings and recommendations generally are valid beyond the regional boundaries.
World Health Organization, [WHO], Geneva, Switzerland, 1986. 89 p. (WHO/RPD/ACHR(HRS)/86)This report is the outcome of a study undertaken to outline for the WHO an approach to health research strategy, which sees health development in a historical and evolutionary perspective. There are 2 approaches to disease problems, 1 through control of disease origins, the other through intervention in disease mechanisms. The research strategy of the WHO should be devised primarily in the light of commitment to substantial progress in health by the year 2000, particularly in countries where the need is greatest. Steps that are likely to lead to rapid advance in health care include: control of diseases associated with poverty, control of communicable and noncommunicable diseases specific to the tropics, control of diseases associated with affluence, treatment and care of the sick, and delivery of health services. Goals must be determined in light of the circumstances and priorities of each country; each country should establish targets related to accomplishments in the following areas: national commitments to policies and programs supportive of health for all; improvements in mortality and morbidity rates; improvements in life-style and related health measures; improvements in coverage and various aspects of the quality of care; and improvements in health status and coverage of disadvantaged and marginal subgroups in the population.