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Geneva, Switzerland, WHO, 2015.  p.This document provides estimates of the prevalence of anaemia for the year 2011 in preschool-age children (6-59 months) and women of reproductive age (15-49 years), by pregnancy status, and by regions of the United Nations and World Health Organization (WHO), as well as by country. This document may serve as a resource for estimating the baseline prevalence of anaemia in women of reproductive age, in working towards achieving the second global nutrition target 2025, a 50% reduction of anaemia in women of reproductive age, as outlined in the Comprehensive implementation plan on maternal, infant and young child nutrition and endorsed by the Sixty-fifth World Health Assembly, in resolution WHA65.6.
Low sensitivity of total lymphocyte count as a surrogate marker to identify antepartum and postpartum Indian women who require antiretroviral therapy.
Journal of Acquired Immune Deficiency Syndromes. 2007 Nov; 46(3):338-342.Some studies support the use of total lymphocyte count (TLC) as a surrogate marker for CD4 cell count to guide antiretroviral therapy (ART) initiation. However, most of these studies have focused on nonpregnant adults. In light of expanding ART access through prevention of mother-to-child transmission (PMTCT)-plus programs in resource-limited settings, we assessed the sensitivity, specificity, and positive predictive value (PPV) of TLC for predicting low CD4 counts in antepartum and postpartum women in Pune, India. CD4, TLC, and hemoglobin were measured at third trimester, delivery, and 6, 9, and 12 months postpartum (PP) in a cohort of 779 HIV-infected women. Optimal TLC cutoff for predicting CD4 < 200 cells/mm3 was determined via logistic regression where sensitivity, specificity, PPV, and an area under the receiver operating characteristic (ROC) curve were calculated. Among the 779 women enrolled, 16% had WHO clinical stage 2 or higher and 7.9% had CD4 < 200 cells/mm3. Using 2689 TLC-CD4 pairs,the sensitivity, specificity, and PPV of TLC < 1200 cells/mm3 for predicting CD4 < 200 cells/mm3 was 59%, 94%, and 47%, respectively. The sensitivity of TLC < 1200 cells/mm3 cutoff ranged between 57% and 62% for time points evaluated. Addition of hemoglobin < 12 g/dL or < 11 g/dL increased the sensitivity of TLC to 74% to 92% for predicting CD4 < 200 cells/mm3 but decreased the specificity to 33% to 69% compared to TLC alone. A combination of TLC, hemoglobin, and WHO clinical staging had the highest sensitivity but lowest specificity compared to other possible combinations or use of TLC alone. The sensitivity and specificity of TLC < 1200 cells/mm3 to predict a CD4 < 350 cells/mm3 was 31% and 99%, respectively. Our data suggest that antepartum and PP women with TLC < 1200 cells/mm3 are likely to have CD4 < 200 cells/mm3. However, the sensitivity of this TLC cutoff was low. Between 45% and 64% of antepartum and PP women requiring initiation of ART may not be identified by using TLC alone as a surrogate markerfor CD4 < 200 cells/mm3. The WHO-recommended TLC cutoff of < 1200 cells/mm3 is not optimal for identifying antepartum and PP Indian women who require ART. (author's)
Diagnostic accuracy comparison between clinical signs and hemoglobin color scale as screening methods in the diagnosis of anemia in children.
Revista Brasileira de Saude Materno Infantil. 2006 Apr-Jun; 6(2):183-189.The objectives were to compare the validity and reproducibility of clinical signs with the World Health Organization hemoglobin color scale. Two hundred six children in the age range of 6-23 months, at the Instituto Materno Infantil Prof. Fernando Figueira, IMIP, were assessed. Two examiners evaluated the clinical signs and the hemoglobin color scale of each child at the different times. The hemoglobin value was used as a standard for validation. In more than 90% of cases the agreement between the values of the color scale and the laboratorial hemoglobin was <2 g/dL. Between the clinical signs the highest sensitivity level for diagnosing Hb<11 g/dL was presented by the hemoglobin color scale (75.7%). For moderate/severe anemia Hb<9g/dL the highest sensitivity was shown by combined palmar or conjunctival pallor (74.3%) and by the color scale (52.5%), according to the first and second observer, respectively. The highest specificity level for Hb<11 g/dL was presented by palmar pallor in comparison with the mother's palm and conjunctival pallor (100%). For Hb<9 g/dL the highest specificity was presented by the hemoglobin color scale (91.9%). This study suggests that moderate/ severe anemia can be diagnosed either by clinical signs or by the color scale, while, in cases of mild anemia, the better diagnosis tool appears to be the color scale. (author's)
Geneva, Switzerland, WHO, 1992. 100 p.The discussion of the prevalence of anemia in women focused on definitions of nutritional anemia, cause of nutritional anemia, and the sources of data and estimation methods. Tables are provided by country and region for hemoglobin levels (mean and percentage below the mean for lactating women, for pregnant women, for nonpregnant women, and all women) and for serum iron, serum folate, and serum vitamin B12 (mean and percentage below the norm). WHO's Maternal Health and Safe Motherhood Program is the repository for data. Nutritional anemia is caused by malnutrition such that the hemoglobin content of the blood is lower than normal as a result of deficiency in 1 or more essential nutrients. Iron is usually stored in the bone where it can be used to increase the rate of formation of hemoglobin to satisfy increased needs, such as during pregnancy. Causes of anemia are low nutrient intake, poor absorption or utilization, or increased nutrient losses or demands. Iron is absorbed more readily in the presence of animal foods or vitamin C and inhibited by meals of tea or high levels of bran. Other causes are malaria, sickle cell disease, bacterial infections, blood loss from obstetric causes, or intestinal parasites, such as hookworms. Underlying factors are poverty and hardships from poor nutrition, water shortages, food taboos, inadequacies in food production and storage and the absence of effect systems of social security. Anemia can be a direct cause of death or contribute to hemorrhage, which can lead to death, e.g., an anemic mother during childbirth cannot afford to lose less than 150 ml of blood, compared with a healthy mother's 1 liter blood loss. Anemic mothers have a lower resistance to infection, and surgery poses a risk. WHO anemia levels are determined as < 120 g/L of hemoglobin for nonpregnant adult women and < 110 g.L for pregnant adult women, < .50mg/L serum iron, < 3 ng/ml serum folate concentration, and < 100 pg/ml serum vitamin B12. 2,170 million persons were found to be anemic according to WHO definitions. The most affected groups were pregnant women, preschool age children, low birth weight infants, other women, the elderly, school age children, and adult men. In developing countries, prevalence rates are 40-60% among pregnant women. In developed countries, 18% if pregnant women and 12% of nonpregnant women are anemic. Over 33% of women in the world were anemic; the problem is particularly acute in Asia.
Strengthening maternal and child health programmes through primary health care. Guidelines for countries of the Eastern Mediterranean Region. Based on the deliberations of the Intercountry Meeting on the Integration of MCH into Primary Health Care, Amman, Jordan, 11-15 December 1988.
Alexandria, Egypt, WHO, EMRO, 1991. 75 p. (WHO EMRO Technical Publication No. 18)All countries in the WHO Eastern Mediterranean Region (EMRO) have had maternal and child health (MCH) programs for many years, yet maternal mortality and morbidity and infant mortality remain high. The EMRO office in Jordan, recognizing this dilemma, convened a meeting of national managers from the 22 EMRO member states to discuss how to integrate MCH programs with primary health care (PHC). The meeting resulted in the publication of guidelines and goals to help each country integrate MCH into PHC which would strengthen MCH services and improve MCH status. The managers noted the need to switch from a pregnancy-oriented approach to a holistic approach in which MCH/PHC programs and society consider women as more than childbearers. MCH/PHC programs and society need to be concerned about the well-being of females beginning with infancy and should place considerable health promotion for girls during the pubertal spurt and adolescence. They should also promote prevention of iron deficiency anemia in women. Since maternal mortality is especially high is EMRO, the national managers clearly laid out approaches for health services to reduce maternal mortality caused by obstetrical complications. They also recognized the need for a practical alternative to obstetric care provided by health workers--training traditional birth attendants in each village. They also provided guidance on improving prenatal care to reduce perinatal and neonatal mortality such as vaccination of every pregnant woman with the tetanus toxoid. Since the causes of death in the postneonatal period, MCH/PHC programs need to take action to reduce malnutrition and infection. For example, they must promote breast feeding for at least the first 6 months of life. The managers suggested the implementation of the Child Survival and Development Strategy which includes growth monitoring.
Tropical Medicine and International Health. 2000 Mar; 5(3):214-21.The WHO recommends that all pregnant women be screened for anemia. In rural Africa this is often done by clinical examination which is known to have variable reliability. The recently developed WHO Haemoglobin Colour Scale may be the answer to this problem as it is simple and reliable. This study examines the training procedure recommended by WHO for the Haemoglobin Colour Scale when resources are very limited. The authors trained 7 laboratory technicians from the Medical Research Council Laboratories Hospitals, Fajara, The Gambia, and 13 Community Health Nurses (CHNs) from North Bank Division East, a rural area in The Gambia, to use the Haemoglobin Colour Scale. The CHNs used the Scale to estimate hemoglobins on all new bookings to antenatal clinics for a period of 1 month and recorded how they were managed. At the end of the study period they completed a qualitative questionnaire about the Scale. Both groups of trainees were successfully trained although the WHO protocol for training was impossible to follow due to resource limitations. 8 of the 13 trained CHNs used the Scale in practice and recorded 307 estimations with a mean hemoglobin of 9.1 g/dl. The results were normally distributed. 6 of the 9 patients with Hb readings of <4 g/dl were managed correctly. In response to the questionnaire the CHNs thought the Scale was cheap, easy and quick to use and as good as the hemoglobinometer they had used previously. The main criticism was that it was not robust enough. The development of a low-technology, cheap, simple, and reliable method for measuring hemoglobin is a welcome development. However, a simpler training procedure and a standard way of measuring observer performance are necessary. (author's)
Geneva, Switzerland, World Health Organization [WHO], Division of Family Health, Maternal Health and Safe Motherhood Programme, 1992. 74 p. (Safe Motherhood; WHO/MSM/92.4)Women in Africa face a lifetime risk of maternal mortality 500 times greater than that of women in developed countries. This lifetime risk is also considerably higher for women in other developing regions compared to that for those in developed countries. Many health professionals believe that antenatal care in developing countries decreases the likelihood of women dying pregnancy and childbearing as well as significant maternal morbidity, yet no one has systematically assessed its potential to actually improve maternal health. The WHO Maternal Health and Safe Motherhood Programme plans to support research to examine antenatal care's potential. It has reviewed the effectiveness of antenatal interventions compared to poor maternal health in developing countries. The review reveals that good quality data are scarce and that health providers have not accurately tested many interventions. For example, the US, UK, and Sweden have all achieved low case fatality rates for eclampsia using a different anticonvulsant therapy for severe preeclampsia (magnesium sulfate; diazepam or other benzodiazepines; and hydralazine with at least chlorpromazine, pethidine, diazepam, and chlormethiazole, respectively), but few trails have compared the different treatments. This review begins with an overall look at antenatal care programs. It then examines interventions of the leading causes of maternal mortality and morbidity (hemorrhage and anemia, hypertensive disorders of pregnancy, obstructed labor, and puerperal sepsis and genitourinary). The most effective interventions are those that deal with chronic conditions rather than acute conditions which arise near delivery. The review concludes with a table of effective antenatal interventions and tables of research questions about potentially effective antenatal interventions against various maternal conditions.
AIDS ANALYSIS AFRICA. 1992 Nov-Dec; 2(6):4, 6.Developing countries face considerable obstacles to ensuring a safe blood supply and safe blood transfusions. There is a tendency for developing countries to not have enough available blood so they depend on family blood donors. Blood donors receive money for their donation. Testing is unreliable as is recording of results. Many clinicians do not have the experience to adequately determine when a transfusion is needed, e.g., physicians ordered a blood transfusion for a 5-year old African girl with pneumonia who had anemia (hemoglobin level of 52 m) after the 1st HIV test was negative. Yet this anemia case did not require a blood transfusion. A repeat of the test revealed the donated blood was indeed HIV positive. 2 other children also received that blood. The basic principles of blood safety are enough safe blood donors, a responsible blood transfusion service which can ensure appropriate and safe processing and testing of blood, and appropriate use of blood. A safe blood donor is healthy and has no risk factors for HIV and other infections. 40-60% of donated blood in developing countries goes to pregnant women often during delivery and children. The leading source of blood in the least developed and developing countries is replacement donors (88% and 81% respectively) who tend to be family members or friends. Yet often relatives of the patient pay someone they do not know to donate their blood. Blood banks also pay for donations and more than 56% of them are uncoordinated banks in hospitals. So organized blood donation services which can safely test and process blood would reduce the risk of transmitting HIV and other infections. WHO has set up a blood safety policy that encourages member countries to establish their own national blood transfusion policy. It supports countries along these lines via its global Programme on AIDS an the Global Blood Safety Initiative. Any blood safety activities can only succeeded with political commitment.
SOUTH AFRICAN MEDICAL JOURNAL. 1992 May 2; 81(9):444-5.The advantages and side effects of the injectable contraceptive, Depo-Provera, are highlighted. It has been available to women in South Africa and in about 90 developing and developed countries for 20 years. It is an effective and convenient contraceptive with no serious side effects. Its failure rate is 0.2-0.6/100 woman years. Nevertheless there is still concern that it may cause breast cancer because original tests of Depo-Provera using beagles indicated that it may increase breast cancer risk. WHO and the UK Committee on Safety of Medicines have since dropped the requirement of testing of beagles since they cannot predict the effects of steroids on women. A 12-year WHO multinational, hospital-based case-control study on neoplasia and hormonal contraceptives reassures Depo-Provera's safety. For example, the risk of breast cancer did not increase with duration or in women who had used it for >5 years. The risk was higher, however, among women who had used it for <4 years, particularly <35-year old women. The same holds true for oral contraceptive (OC) users. It has been suggested that this slight increase is because Depo-Provera and OCs may accelerate growth of some existing, previously undetected breast tumors. The WHO study verifies that the benefits of Depo-Provera surpass the side effects which include disturbed bleeding patterns, weight gain, and headaches. For example, it decreases the risk of ovarian and endometrial cancer. It is even more beneficial in developing countries where women often suffer from anemia because it increases hemoglobin levels. Further since women in developing countries cannot always comply and take their OCs, Depo-Provera can grant them the protection they need against pregnancy thus saving many lives. Depo-Provera should be available in developed as well as in developing countries.
[Unpublished] 1989 Mar.  p.The 1973 and 1980 censuses, and the Sudan Territory Fertility Survey of 1979, Sudan Emergency and Recovery Information and Surveillance System of 1986 and 1987 provide population data. Infant mortality is caused by diarrhea, acute respiratory diseases, malnutrition, high risk fertility practice, and 6 immunizable diseases, especially tetanus and measles, malaria, meningitis, onchocerciasis, leishmaniasis, and viral hepatitis. In 1986 there were 2674 physicians in the country, and 200 new medical school graduates are added annually. There are 190 hospitals with 18,594 beds and 4016 primary health care units. In 1982 diarrhea accounted for 13.5% of outpatient visits of children aged 0-4 and for 23.5% of all admissions. 1982=83 surveys in Khartoum and other towns showed diarrheal mortality 11=21.6/1000 children and morbidity of 3.1 and 3.3 episodes per child among children under 5. The control of diarrheal diseases (CDD) program plans to cover 76% of Sudan's children under 5 in 7 of the 9 regions. The National CDD Department was established in September 1985. Oral rehydration salt (ORS) is widely available, knowledge and acceptance of use is increasing dramatically. About 1,200,000 cases of 6 immunizable diseases occur in infants every year with an estimated 50,000 deaths. The Sudan expanded program on immunization (EPI) started in 1976. In 1980 a national plan was launched to immunize 80% of children aged 3-36 months in 45 urban areas. The national coverage was estimated to be 3% in 1976, 6% in 1985, 11% in 1986, 30% in 1987, and 51% in 1988. EPI is operational in 75 of 96 districts. 85% of vaccinations are delivered by mobile teams. The National Nutrition Department was formed in 1968 to provide nutrition education and growth monitoring. The regional project aims to protect against endemic goiter by single doses of oral or in ionized oil. Nutritional anemia is widespread. In 1988 the birth rate was 50/1000 population, maternal mortality was 655/100,000 live births, and 11,000 women died because of pregnancy-related causes, and with infant mortality of 121/1000 live births 380.160 infants died. Under maternal and child health services 4600 health assistants help 25 million people, less than 50% women in rural areas receive help from a trained midwife, and in rural areas 90% are attended by untrained birth assistants. Donor support and private is needed in all areas of maternal and child health care.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1991; 69(6):779-89.5-15% of all 3-15 year old children in the world are mentally impaired. In fact, 0.4-1.5% (10-30 million) are severely mentally retarded and an additional 60-80 million children are mildly or moderately mentally retarded. Birth asphyxia and birth trauma account for most cases of mental retardation in developing countries. >1.2 million newborns survive with severe brain damage and an equal number die from moderate or severe birth asphyxia. Other causes of mental retardation can also be prevented or treated such as meningitis or encephalitis associated with measles and pertussis; grave malnutrition during the 1st months of life, especially for infants of low birth weight; hyperbilirubinemia in neonates which occurs frequently in Africa and countries in the Pacific; and iodine deficiency. In addition, iron deficiency may even slow development in infants and young children. Current socioeconomic and demographic changes and a rise in the number of employed mothers may withhold the necessary stimulation for normal development from infants and young children. Primary health care (PHC) interventions can prevent many mental handicaps. For example, PHC involves families and communities who take control of their own care. Besides traditional birth attendants, community health workers, nurse midwives, physicians, and other parents must also participate in prevention efforts. For example, they should be trained in appropriate technologies including the risk approach, home risk card, partograph, mouth to mask or bag and mask resuscitation of the newborn, kick count, and ictometer. WHO has field tested all these techniques. These techniques not only prevent mental handicaps but can also be applied at home, health centers, and day-care centers.
Nutritional anemia: its understanding and control with special reference to the work of the World Health Organization.
American Journal of Clinical Nutrition. 1979 Feb; 32(2):368-417.Since 1949, the World Health Organization, recognizing the public health importance of nutritional anemia, has sponsored efforts directed towards its understanding and control. During this period, often as a result of the work of the Organization, advances have been made in many areas. Basic understanding of iron, folate, and vitamin B12 nutrition, and the various factors which may influence the availability and requirements of these factors, has greatly increased. Surveys in a number of countries have highlighted the widespread prevalence of nutritional anemia, particularly in developing countries. The major factor responsible is a deficiency of iron, with folate deficiency also playing a role in some population groups, especially in pregnant women. There is increasing evidence that anemia adversely affects the health of individuals and may have profound socioeconomic consequences. Control of nutritonal anemia is possible by providing the deficient nutrient(s) either as therapeutic supplements or by fortification of commonly used foodstuffs. Some control programs are reviewed and suggestions for further action are outlined. The Organization still has an important role to play in this field, encouraging the development of control programs and providing advice and technical assistance to member countries. (author's)