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Validation of maternal and neonatal tetanus elimination in Equatorial Guinea, 2016. alidation de l'elimination du tetanos maternel et neonatal en Guinee equatoriale, 2016.
Releve Epidemiologique Hebdomadaire. 2017 Jun 16; 92(24):333-44.Add to my documents.
MEASURE Evaluation Bulletin. 2001; (2):1-27.This issue of the MEASURE Evaluation Bulletin includes articles in a number of areas of monitoring and evaluation of AIDS programs. The first four articles are based on a field test of indicators on knowledge, sexual behavior and stigma that was carried out as part of a large international effort to improve monitoring and evaluation of national programs. The field test resulted in revisions of standard indicators for AIDS programs, which were eventually published by UNAIDS, and revisions of the survey tools that are now used to collect AIDS information in many countries. Three subsequent articles deal with different aspects of monitoring and evaluation. The first of these explores estimation of the size of core groups, such as commercial sex workers or bar workers, which is essential but difficult. Capture-recapture techniques can be used to make such estimates, although there are multiple pitfalls. The next article focuses on monitoring trends in HIV prevalence among young antenatal women, which is the most feasible method of monitoring HIV incidence. Modelling shows that using prevalence trends to extrapolate incidence trends has to be done very carefully, but can be done if one takes measures to minimize the various biases. The last article of the Bulletin discusses the use of newspaper clippings as a source of indicators on political will and commitment and stigma. Although newspaper clippings have been cited as an easily accessible source for these indicators, the analysis suggests that an analysis of newspaper clippings may be more suitable for a cross-sectional situation analysis or in-depth qualitative research than for monitoring purposes. (excerpt)
Washington, D.C., World Bank, Latin America and the Caribbean Region, Human Development Department, 2007 Oct. 55 p. (Policy Research Working Paper No. 4377)A new literature on the nature of and policies for youth in Latin America is emerging, but there is still very little known about who are the most vulnerable young people. This paper aims to characterize the heterogeneity in the youth population and identify ex ante the youth that are at-risk and should be targeted with prevention programs. Using non-parametric methodologies and specialized youth surveys from Mexico and Chile, the authors quantify and characterize the different subgroups of youth, according to the amount of risk in their lives, and find that approximately 20 percent of 18 to 24 year old Chileans and 40 percent of the same age cohort in Mexico are suffering the consequences of a range of negative behaviors. Another 8 to 20 percent demonstrate factors in their lives that pre-dispose them to becoming at-risk youth - they are the candidates for prevention programs. The analysis finds two observable variables that can be used to identify which children have a higher probability of becoming troubled youth: poverty and residing in rural areas. The analysis also finds that risky behaviors increase with age and differ by gender, thereby highlighting the need for program and policy differentiation along these two demographic dimensions. (author's)
Cadernos de Saude Publica. 2005; 21 Suppl:S89-S99.This paper describes the sample design used in the Brazilian application of the World Health Survey. The sample was selected in three stages. First, the census tracts were allocated in six strata defined by their urban/rural situation and population groups of the municipalities (counties). The tracts were selected using probabilities proportional to the respective number of households. In the second stage, households were selected with equiprobability using an inverse sample design to ensure 20 households interviewed per tract. In the last stage, one adult (18 years or older) per household was selected with equiprobability to answer the majority of the questionnaire. Sample weights were based on the inverse of the inclusion probabilities in the sample. To reduce bias in regional estimates, a household weighting calibration procedure was used to reduce sample bias in relation to income, sex, and age group. (author's)
Over-the-counter access, changing WHO guidelines, and contraindicated oral contraceptive use in Mexico.
Studies in Family Planning. 2006 Sep; 37(3):197-204.This study examines the prevalence of contraindications to the use of oral contraceptives in Mexico by sociodemographic characteristics and by whether this family planning method was obtained with or without a doctor's prescription. Using data on smoking behavior and blood-pressure measurements from the 2000 Mexican National Health Survey, the authors found that, under the 1996 World Health Organization (WHO) medical eligibility guidelines, the prevalence of contraindications is low and that no significant differences in contraindications exist at any level between those who obtain oral contraceptives at clinics and those who obtain them at pharmacies. In 2000, however, WHO substantially revised its criteria regarding the level of hypertension that would constitute a contraindication for oral contraceptive use. Applying the new guidelines, the authors found that 10 percent of pill users younger than 35 and 33 percent aged 35 and older have health conditions that are either relative or absolute (Category 3 or 4) contraindications. The relevance of these findings to the larger debate concerning screening and over-the-counter access to oral contraceptives is discussed. (author's)
Bulletin of the World Health Organization. 1956; 15:5-41.The author reviews that mortality statistics from cancer of the breast in females and from malignant neoplasms of the uterus and of the other female genital organs for nineteen countries over the years 1920-53, first considering the general trend of the mortality series for each group of diseases for all ages and then analysing for each sector of mortality the changes which have occurred in the age-specific death-rates in some pivotal years during the same period. Considerable differences in the levels of total mortality from each group of tumours for various countries are noted. The important variations among age-specific death-rates for cancer of the breast in females and for uterine neoplasms in various countries are examined and their significance is commented upon. (excerpt)
Bulletin of the World Health Organization. 1954; 11:201-228.The information contained in the table that follows was obtained from a questionnaire sent by WHO in June 1953 to all Member States in order to elicit information on the types of health statistics and related vital statistics that are available in different countries, how they are obtained, and to what extent they are made available to the international organizations. The questionnaire asked for information on causes of death, causes of foetal death, and notifiable diseases, in addition to the subjects listed in the table. It will be seen that only a certain number of countries answered fully that part of the questionnaire with which we are concerned here. The reason is fairly obvious: statistics pertaining to health in its various aspects are numerous, varied, and scattered among many government departments apart from the health administrations--for instance, among the ministries of social welfare (social insurance returns, hospital statistics), of defence (army, navy, and air force health statistics), and of education (school medical inspection, number of students and graduates in medicine and in allied professions). To compile a complete inventory of existing health statistics would require many months of patient search in publications and reports and correspondence with the many national administrations concerned. (excerpt)
Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. [Tasas de cesáreas y resultados de embarazos: la encuesta mundial de la OMS del año 2005 sobre salud materna y perinatal en América Latina]
Lancet. 2006 Jun 3; 367(9525):1819-1829.Caesarean delivery rates continue to increase worldwide. Our aim was to assess the association between caesarean delivery and pregnancy outcome at the institutional level, adjusting for the pregnant population and institutional characteristics. For the 2005 WHO global survey on maternal and perinatal health, we assessed a multistage stratified sample, comprising 24 geographic regions in eight countries in Latin America. We obtained individual data for all women admitted for delivery over 3 months to 120 institutions randomly selected from of 410 identified institutions. We also obtained institutional-level data. We obtained data for 97 095 of 106 546 deliveries (91% coverage). The median rate of caesarean delivery was 33% (quartile range 24--43), with the highest rates of caesarean delivery noted in private hospitals (51%, 43--57). Institution-specific rates of caesarean delivery were affected by primiparity, previous caesarean delivery, and institutional complexity. Rate of caesarean delivery was positively associated with postpartum antibiotic treatment and severe maternal morbidity and mortality, even after adjustment for risk factors. Increase in the rate of caesarean delivery was associated with an increase in fetal mortality rates and higher numbers of babies admitted to intensive care for 7 days or longer even after adjustment for preterm delivery. Rates of preterm delivery and neonatal mortality both rose at rates of caesarean delivery of between 10% and 20%. High rates of caesarean delivery do not necessarily indicate better perinatal care and can be associated with harm. (author's)
UNICEF report indicates infant mortality rates much higher than official statistics in the Caucasus and Central Asia.
Connections. 2003 Sep;  p..Actual infant mortality rates in the Caucasus and Central Asia are up to four times higher than officially reported statistics indicate and five times greater than death rates in the rest of Central and Eastern Europe (CEE) and Eurasia, according to UNICEF's Social Monitor 2003, which was released July 22. "Our research shows that infant mortality is a far greater problem in these countries than suggested by the official data. We have looked beyond the official statistics and talked to mothers in their own homes. Their stories reveal a child survival crisis," UNICEF Executive Director Carol Bellamy said in a statement marking the release of the annual regional report, which examines the well-being of children in CEE and Eurasia. Noting that largely preventable factors such as poverty, poor maternal health and nutrition, infection, and sub-standard medical care all contribute the high rate of infant mortality, Bellamy stated, "We have two distinct problems: tens of thousands of infant deaths that should be prevented and a systemic failure to properly count the lives being lost. Misunderstanding the scope of what's happening prevents effective action to fix it, so getting the numbers right is a major issue. It is a crucial first step to saving young lives." (excerpt)
Chinese Primary Health Care. 2002; 16(4):33-34.The authors analyzed expenses of Poverty Medical Alleviation for Poor Maternal of Health VI Project Loaned by World Bank, which is based on some of the project counties in five years. The main results are: (1) The Poverty Medical Alleviation Project had improved the utilization equity of Maternal and Child Health in poor areas. (2) Project counties should strengthen the management and sustainability of Poverty Alleviation Fund. (3) Information system should be improved. (author's)
Indian Journal of Tuberculosis. 2005; 52:121-131.Drug resistant tuberculosis has been reported since the early days of the introduction of chemotherapy, but recently multi-drug resistant tuberculosis (MDR-TB) has been an area of growing concern and is posing a threat to control of tuberculosis. A review of 63 surveys conducted between 1985 and 1994 suggested that primary and acquired MDR-TB was between 0-10.8% and 0-48% respectively. However, the qualities of these studies were variable due to the lack of proper representativeness and size of population sampled, as well as lack of standardized laboratory methods in some of them. In 1994, WHO-IUATLD carried out a surveillance which concluded that the problem is global; the median prevalence of primary and acquired multi drug resistance was 1.4% (0-14.4%) and 13% (0-54.4%) respectively. A second WHO-IUATLD global project on drug surveillance carried out in 1996-1999 in 58 countries, found that the median prevalence of primary and acquired multi-drug resistance was 1% (0-14%) and 9% (0 - 48%) respectively. Current estimates report, the prevalence of primary and acquired multidrug resistance in India as 3.4% and 25% respectively. It must be emphasized that optimal treatment of MDR-TB alone will not curb the epidemic. Efforts must be focused on the effective use of first line drugs in every new patient so as to prevent the ultimate emergence of multidrug resistance. The use of reserve drugs to cure multi-drug resistant tuberculosis and to reduce further transmission should be considered, but only as part of well structured programmes of tuberculosis control. (author's)
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):100-102.For a long time, the sexual and reproductive health needs of men— beyond their roles as women’s partners— received little attention from the global reproductive health community. In fact, some people feared that involving men in women’s reproductive health would undermine attempts to empower women. This changed only with the onset of the AIDS epidemic in the 1980s. Early attempts to understand and contain the disease made it clear that public health experts required better knowledge of men’s (and women’s) sexual behaviour. But men’s health care needs and the significance of men’s roles go far beyond HIV/AIDS. Men play a key role in the occurrence and prevention of unplanned pregnancies and sexually transmitted infections (STIs) other than HIV/AIDS, as well as in healthy marital relationships and child rearing. In 1994, the ICPD recognised the importance of “male responsibilities and participation” in sexual and reproductive health. The conference’s 20- year Programme of Action called for leaders to “promote the full involvement of men in family life and the full integration of women in community life”, ensuring that men and women are equal partners in both spheres. In particular, it said, “efforts should be made to emphasise men’s shared responsibility and promote their active involvement in responsible parenthood, sexual and reproductive behaviour, including family planning; prenatal, maternal and child health; prevention of sexually transmitted diseases, including HIV; [and] prevention of unwanted and high-risk pregnancies”. (excerpt)
Population 2005. 2003 Dec; 5(4):9.A survey conducted by the United Nations Population Fund (UNFPA), in collaboration with the International Center for Migration and Health, has tracked startling statistics regarding the health system in Iraq. According to UNFPA, the number of women who die from pregnancy and childbirth in Iraq has close to tripled since 1990. Among the causes of the reported 310 deaths per 100,000 live births in 2002 are bleeding, ectopic pregnancies and prolonged labor. In addition, stress and exposure to chemical contaminants are also partly to blame for the rise in miscarriages among Iraqi women. Access to medical facilities is becoming more difficult for women due to breakdowns in security and weakened communication and transport systems. This has caused nearly 65 per cent of Iraqi women to give birth at home, the majority without skilled help. (excerpt)
Journal of Nutrition. 2004 May; 134(5):1175-1180.The WHO recently conducted, within its Global Burden of Disease 2000 Study, a Comparative Risk Assessment (CRA) to estimate the global health effect of low fruit and vegetable intake. This paper summarizes the methods used to obtain exposure data for the CRA and provides estimates of worldwide fruit and vegetable intakes. Intakes were derived from 26 national population-based surveys, complemented with food supply statistics. Estimates were stratified by 14 subregions, 8 age groups, and gender. Subregions were categorized on the bases of child mortality under age 5 y and 15- to 59-y-old male mortality (A: very low child and adult mortality; B: low child and adult mortality; C: low child, high adult mortality; D: high child and adult mortality; E: high child, very high adult mortality). Mean intakes were highest in Europe A [median = 449 g/(person • d)] and the Western Pacific Region A. They were lowest in America B [median = 192 g/(person • d)], and low in Europe C, the South East Asian Regions B and D, and Africa E. Children and elderly individuals generally had lower intakes than middle-aged adults. SDs varied considerably by region, gender, and age [overall median = 223 g/(person • d)]. Assessing exposure levels for the CRA had major methodological limitations, particularly due to the lack of nationally representative intake data. The results showed mean intakes generally lower than current recommendations, with large variations among subregions. If the burden of disease attributable to dietary factors is to be assessed more accurately, more countries will have to assess the dietary intake of their populations using comparable methods. (author's)
Indian Journal of Community Medicine. 2000 Jul-Sep;  p..Research question: What is the status of antenatal care among pregnant women in India? Objective: To assess the status of antenatal care for pregnant women in India. Sampling design: WHO 30 cluster survey methodology with certain modifications incorporating information on female literacy and distance of the village has been used. Setting: Survey covered about nineteen thousand pregnant mothers from 90 districts of the country. Statistical analysis: Simple proportions. Results: The characteristics of sample households for pregnant women were broadly in proportion to the characteristics of the all India population. About 89% of the pregnant women availed antenatal visits of which 62% had received three or more ANC visits. Those receiving the second dose of TT or booster dose were about 78%. About 73% of the pregnant women received IFA tablets during their pregnancy. About 53% of the pregnant women had full package of ANC i.e. availed 3 or more ANC visits, both the doses of TT/ boster and IFA tablets. The proportion of pregnant women who availed full ANC package was lower in rural as compared to urban areas, lowest for ST followed by SC; higher for literate women as compared to illiterate women. The proportion of Institutional deliveries managed by hospitals and health centres was about 41%, it being higher among literate women and in urban areas. Conclusion: The literacy of women is the key to improve antenatal care of pregnant women. Hence efforts should be made to have Information, Education and Communication (IEC) activities targeted to educate the mothers especially in rural areas. The tribal, small and inaccessible villages and the states of Bihar, Rajasthan, UP, MP and North Eastern states (combined) should be focused and targeted in the RCH programme. (author's)
Trends in antenatal human immunodeficiency virus prevalence in western Kenya and eastern Uganda: evidence of differences in health policies?
International Journal of Epidemiology. 2004 Jun; 33(3):542-548.The objective was to observe recent trends in human immunodeficiency virus (HIV) prevalence in antenatal clinic attendees to determine if previously noted falls in HIV prevalence are occurring on both sides of the Kenyan-Ugandan border. An ecologic study was conducted at the district level comparing HIV prevalence rates over time using data available through reports published by the Kenyan and Ugandan Ministries of Health and UNAIDS. Sentinel sites were compared with respect to population, ethnicity, language group, and the prevalence of circumcision practice. The prevalence of HIV found at each sentinel site was recorded for the years 1990–2000 and analysed visually and by conducting bivariate correlations. Ethnographic analysis revealed a wide mix of ethnic and language groups and circumcision rates on both sides of the border. All sentinel surveillance sites in Uganda showed trends towards decreasing HIV prevalence, with three of five sites showing statistically significant declines (r = -0.87, -0.85, -0.86, P <0.05). In contrast, all of the surveillance sites in Kenya showed trends toward increasing HIV prevalence, with two of the five sites showing statistically significant increases (r = 0.62, 0.84, P <0.05). The declines in HIV prevalence occurring in Uganda are not being seen in geographically proximal districts of Kenya. No obvious differences in ethnic groupings or their associated prevalence of circumcision appeared to explain these differences. This suggests that decreasing HIV prevalence in Uganda is not due to the natural course of the epidemic but reflects real success in terms of HIV control policies. (author's)
Public Health Reports. 2002 Nov-Dec; 117(6):592.A study, conducted from March to July 2002 by UNICEF and the CDC in conjunction with the Afghanistan Ministry of Health, determined that Afghan women suffer from one of the highest levels of maternal mortality in the world. Almost half of the deaths among women from the ages of 15 to 49 are a result of pregnancy and childbirth. This study, the largest of its kind ever conducted in Afghanistan, was conducted in four provinces in Afghanistan-Kabul, Laghman, Kandahar, and Badakshan-ranging from rural to urban settings. The surveys found that on average there were 1,600 maternal deaths per 100,000 live births in Afghan women. Linda Bartlett, MD-a medical officer with CDC's reproductive health program and the leader of the surveys-stated, "These women are dying needlessly. Most of these deaths could have been avoided, which suggests important opportunities for prevention." The study examined data from 13,000 households, which included an estimated 85,000 women. UNICEF and the CDC recommended the following as a result of the findings of this study: there is a need to establish properly equipped health care services in remote areas and to encourage women's use of such facilities; the need to train skilled female birth attendants; and to rebuild and repair roads to improve access to these facilities. (excerpt)
SCN News. 2002 Dec; (25):4-30.This paper addresses the most common nutrition and health problems in turn, assessing the extent of the problem; the impact of the condition on overall development, and what programmatic responses can be taken to remedy the problem through the school sys- tern. The paper also acknowledges that an estimated 113m children of school-age are not in school, the majority of these children living in Sub-Saharan Africa and South-East Asia. Poor health and nutrition that differentially affects this population is also discussed. (excerpt)
Tashkent, Uzbekistan, Analytical and Information Center, 2003 May. ix, 30 p.This preliminary report documents the changes that have occurred in the medical-demographic situation of Uzbekistan since the 1996 Demographic and Health Survey. Additional information is provided concerning issues of both male and female adult health: life style practices, knowledge and attitudes towards tuberculosis, HIV/AIDS, STDs, risk factors for cardiovascular diseases, and information about respiratory, digestive, and dental diseases. (excerpt)
Journal of Biosocial Science. 2003 July; 35(3):335-351.Improved child health and survival are considered universal humanitarian goals. In this respect, understanding the nutritional status of children has far-reaching implications for the better development of future generations. The present study assessed, first, the nutritional status of children below 5 years using the three anthropometric measures weight-forage, height-for-age and weight-for-height in two states of India, Kerala and Goa. Secondly, it examined the confounding factors that influence the nutritional status of children in these states. The NFHS-I data for Kerala and Goa were used. The results showed that the relative prevalence of underweight and wasting was high in Kerala, but the prevalence of stunting was medium. In Goa, on the other hand, the relative prevalence of wasting and underweight was very high, and that of stunting was high. Both socioeconomic and family planning variables were significantly associated with malnutrition in these states, but at varied levels. The study recommends more area-specific policies for the development of nutritional intervention programmes. (author's)
Lancet. 2003 Jul 19; 362(9379):233-241.Gaps in child mortality between rich and poor countries are unacceptably wide and in some areas are becoming wider, as are the gaps between wealthy and poor children within most countries. Poor children are more likely than their better-off peers to be exposed to health risks, and they have less resistance to disease because of undernutrition and other hazards typical in poor communities. These inequities are compounded by reduced access to preventive and curative interventions. Even public subsidies for health frequently benefit rich people more than poor people. Experience and evidence about how to reach poor populations are growing, albeit largely through small-scale case studies. Successful approaches include those that improve geographic access to health interventions in poor communities, subsidised health care and health inputs, and social marketing. Targeting of health interventions to poor people and ensuring universal coverage are promising approaches for improvement of equity, but both have limitations that necessitate planning for child survival and effective delivery at national level and below. Regular monitoring of inequities and use of the resulting information for education, advocacy, and increased accountability among the general public and decision makers is urgently needed, but will not be sufficient. Equity must be a priority in the design of child survival interventions and delivery strategies, and mechanisms to ensure accountability at national and international levels must be developed. (author's)
Washington, D.C., Population Reference Bureau [PRB], 2003 Apr.  p.This policy brief presents two rationales for investing in neonatal health services: investing in newborn health and survival helps achieve health and development goals, and honoring newborns' human rights.
JAMA. 1993 Feb 17; 269(7):846, 850.From February 1991 through July 1992, 67,000 Bhutanese of Nepalese ethnic origin entered southeastern Nepal because of ethnic persecution in Bhutan, and were established in 6 refugee camps. In July 1992, the Office of the UN High Commissioner for Refugees, the Save the Children Fund, and CDC established a surveillance system to monitor morbidity and mortality of these refugees. Mortality surveillance was established for diarrhea, acute respiratory infections (ARI), measles, malaria, injuries, maternal deaths, and other/unknown. Data were collected from March through July 1992 by a single designated health worker at each camp by interviewing the families. From March 25 through June 30, daily mortality rates for children under 5 years, of age (<5MR) averaged over each week were 2.3-8.8 deaths/10,000 persons/day, a rate 2-8 times greater than in Nepal. Daily crude mortality rates (CMRs) for the entire camp population were 1.5 deaths/10,000/day. Based on verbal autopsies of 89 deaths during July 3-19, 49 (55%) deaths were caused by ARI and 25 (28%) by diarrhea. The ARI-specific <5MR (1.6 deaths/10,000/day) was more than 5 times greater than the ARI-specific mortality rate for persons aged =or> 5 years (0.3 deaths/10,000/day). From March 1 through April 30, 549 cases of measles were recorded at camp health centers. Following this outbreak, <5MRs increased to 4.4-8.8 deaths/10,000/day during April 1-May 16. Nearly 12% of patients with diarrhea during July 3-19 had bloody diarrhea. Shigella flexneri types 1, 2, and 3 were cultured from 5 of 13 (38%) patients. All isolates were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole but sensitive to nalidixic acid. From June 15 through July 19, in one camp 38 (3.4%) of 1129 refugees with suspected malaria had blood smears slide-positive for Plasmodium falciparum and 37 (3.3%) had blood smears positive for P. vivax.
[Unpublished] 1991 Apr 24. , 28 p. (SEA/DD/43; Project: ICP CDD 001)Physicians collected data on 4319 households and 3766 0-5 year old children living in rural areas of Dhaka Division in Bangladesh to determine the prevalence of diarrhea among the children, the percentage of diarrhea cases treated with various forms of oral rehydration therapy and with drugs, and caretaker awareness of when to refer children with diarrhea to a health facility. 60.3% received no treatment at all. The 24-hour point prevalence of diarrhea stood at 5.2%. Blood accompanied the diarrhea of 22.3% of these children. Yet only 12% of bloody diarrhea cases received appropriate antibiotic therapy. 13.4% of the children had experienced a diarrheal episode during the 2 weeks before the interview. Mean duration was 7 days, but 22.4% of the children had diarrhea for at least 14 days. The adjusted annual diarrhea incidence rate was 2.3 episodes/child. 33.7% of caretakers asked others for help in treating diarrhea. The advisers tended to be village doctors or quacks (21%), government health workers (17%), and homeopaths (17%). 75% of advisors, except family and friends, suggested drugs. Only 27% and 16% recommended administering oral rehydration solution (ORS) and various home fluids, respectively. Only 22% and 17% suggested caretakers to continue feeding and breast feeding, respectively. The ORS use rate during the previous 24 hours was only 11.9% and just 3.6% of cases drank properly prepared ORS. Yet 93.8% knew about ORS. Most caretakers did not use enough water or all the contents of the ORS packet. Use rate for home fluids was 16.5%. 97.5% of lactating mothers continued to breast feed during the diarrhea episode. 36.1% of children received drugs compared with 25.8% for use of oral rehydration therapy. 70.7% of caretakers gave ill children at least the same amount of solid or semisolid foods during the episode. 70% of caretakers preferred ORS to drugs. The leading reasons for referring cases to a health facility included too many stools (79.7%), failure to improve (28.3%), and fever (26.7%). The researchers deemed only 23.5% to have adequate referral knowledge (=or> 3 reasons).
Expanded Programme on Immunization. Programme review. Bhutan. Programme Elargi de Vaccination. Examen du programme, Bhoutan.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1986 Jan 24; 61(4):21-3.The Expanded Programme on Immunization (EPI) in Bhutan began in 1979. A strong and effective management team expanded EPI to 17 of 18 districts by 1985. A team reviewed it and other primary health care activities such as the control of diarrheal disease program between in 1985. EPI and maternal and child health (MCH) activities were integrated fully. The EPI/MCH program had moved towards decentralization to improve program management and understanding of local needs. It used 1 chart to monitor growth monitoring and to record immunizations. Team members conducted a survey in Chirang District. EPI leaders had introduced a consistent system for reporting immunization doses. Despite the problems with the Himalayas and poor communications and transport systems, EPI established a well operated cold chain. Only 13% of children were fully immunized. Just 20% had been immunized with all 3 doses of diphtheria/pertussis/tetanus/polio vaccine. Further 53% had received no immunizations at all. Moreover drop out rates stood about 50%. Nevertheless measles coverage was 1 of the highest in the WHO Southwest Asia Region (24%). Most children received their immunizations at outreach clinics rather than basic health units or hospitals. 29% of mothers whose children were not fully immunized did not know about the need for immunization while 10% said the location for immunizations was too far to travel. The estimated annual diarrhea rate for <5 year old children was 4.1 episodes/child. 41% of children had a diarrheal episode 2 weeks before the survey. 20% of children with diarrhea received oral rehydration solution. 91% of mothers delivered at home with no assistance from a health worker or a traditional birth attendant. 97% of the children were breast fed for at least 1 year. In conclusion, the EPI/MCH program must increase immunization coverage and reduce drop out rates.