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Geneva, Switzerland, WHO, 1990 Oct. ix, 72 p. (WHO/MCH/GPA/90.2)Guidelines for medical professionals in supervisory, managerial and administrative positions in Maternal-Child Health/Family Planning programs (MCH/FP) in developing countries have been developed by the Division of Family Health, Programme of Maternal and Child Health including Family Planning and the Global Programme on AIDS of the World Health Organization (WHO) with the UN Population Fund (UNFPA). MCH/FP programmes occupy a unique position to help stop the spread of AIDS because they comprise the largest pool of health personnel already experienced in counseling, education and training in sexuality, contraception and STD prevention. The booklet begins with a review of HIV facts, with a few additions specifically for developing areas, such as a discussion of the possible increased risk to those who have undergone female circumcision. HIV prevention during pregnancy is as usual, with additional recommendations of measures to prevent the need for blood transfusions, e.g., iron and folic acid supplements, and malaria treatment. Recommendations for HIV containment in labor and delivery wards are the usual universal cautions for health workers, with additional suggestions for sterilization and disposal of materials in areas without conventional western waste facilities. Diagnosis of HIV infected newborns is based on a special WHO clinical case definition for pediatric AIDS, since laboratory tests are not accurate on infants. Treatment and care should be supportive since many HIV infected children can have months of years of quality life. HIV prevention in women and adolescents in terms of men, condoms and family planning is reviewed: no unique information is available for MCH programs. A section covering logistics and supplies suggests solutions to maximize the efficient use of condoms, plastic aprons, and particularly sterile and nonsterile gloves, by strict management at the local level. Suggestions include provision of a set number of paris for each delivering woman, and providing heavy work gloves semi-annually for cleaning staff. The chapter on training MCH staff in use of guidelines has specific curricula, and that on how to evaluate the implementation of these guidelines has several detailed questionnaires. The traditional services of MCH/FP are vital and must be expanded to include information, education and counseling on safer sex related to STD and HIV prevention.
TROPICAL DOCTOR. 1988 Oct; 18(4):155-8.Based on suggestions made by Simmonds and Walker in 1982, The World Health Organization developed a standard Emergency Health Kit intended for use in refugee camps during the first 3 months of an emergency, by populations of 10,000. The complete kit had a weight of 858 kg and a volume of 2.6 cubic meters. Among its contents was a list of the drugs and equipment it contained. The list was divided into drugs that could be used by health workers with minimal training; drugs to be prescribed only by doctors and senior health workers; and simple laboratory and clinic equipment. The kit was used in many relief settings, some of which were quite different from those it was intended for. In 1986 WHO commissioned a survey of representatives of relief organizations, on their experiences with the kit. 153 questionnaires were sent to 128 organizations. Based on the 55 responses from 50 organizations (36% return), the advantages of the kit were its ease of transport, time savings, the use of drugs familiar to most volunteers, guaranteed quality, and usability in establishing a national basic health unit. Disadvantages included unfamiliarity of some national staff with drug names and doses, ethical dilemmas where refugees might receive better health care than native populations, long receipt times, high costs of transport, use and storage (sometimes = to cost of kit, c. US$4800), incompatibility with some national emergency drug lists, a size too large for small countries or scattered populations, and non-adaptability to varying local situations. Recommendations of kit revision cover decreasing kit size, provision for cold storage, purchase of most liquids locally and elimination of glass containers, more detailed labelling, and better customs and shipment procedures. The list of drugs proved to be the most valuable item for those surveyed. A WHO committee is currently implementing these suggestions and a draft document of a revised kit has been prepared.