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  1. 1

    A guide to identifying and documenting best practices in family planning programmes.

    World Health Organization [WHO]. Regional Office for Africa

    Brazzaville, Republic of the Congo, WHO, Regional Office for Africa, 2017. 40 p.

    This guideline defines best practices, lists criteria for identifying best practices, gives examples of best practices, and provides guidance in the documentation and scaling up of best practices. It also explains how to use and disseminate this guideline.
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  2. 2

    Larval source management: a supplementary measure for malaria vector control. An operational manual.

    World Health Organization [WHO]. Global Malaria Programme

    Geneva, Switzerland, WHO, 2013. [128] p.

    Larval source management (LSM) refers to the targeted management of mosquito breeding sites, with the objective to reduce the number of mosquito larvae and pupae. When appropriately used, LSM can contribute to reducing the numbers of both indoor and out-door biting mosquitoes, and -- in malaria elimination phase -- it can be a useful addition to programme tools to reduce the mosquito population in remaining malaria ‘hotspots’. This operational manual has been designed primarily for National Malaria Control Programmes as well as field personnel. It will also be of practical use to specialists working on public health vector control, and malaria programme specialists working with bilateral donors, funders and implementation partners. It has been written by senior public health experts of the malaria vector control community under the guidance of the WHO Global Malaria Programme. The manual’s three main chapters provide guidance on: the selection of larval control interventions, the planning and management of larval control programmes, and detailed guidance on conducting these programmes. The manual also contains a list of WHOPES-recommended formulations, standard operating procedures for larviciding, as well as a number of country case studies.
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  3. 3

    Practical guidelines for supporting EDUCAIDS implementation.

    Greenall M

    Paris, France, United Nations Educational, Scientific and Cultural Organization [UNESCO], 2012. 158 p.

    The education sector has a significant role to play in the response to HIV and AIDS. The sector can help to prevent the spread of HIV through education, and, in countries that are highly affected by HIV, by taking steps to protect itself from the effects of the epidemic. It can also make a significant contribution by supporting health improvement more generally and by helping to improve the sexual and reproductive health of young people in particular.This framework is designed to help those working in the education sector at a national level to understand the need for a robust response to HIV and AIDS in order to achieve Education for All (EFA) and the education-related Millennium Development Goals (MDGs). The document also highlights the education sector’s role in contributing to universal access to HIV and AIDS prevention, treatment, care and support.
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  4. 4

    Monitoring equity in access to AIDS treatment programmes: a review of concepts, models, methods and indicators.

    World Health Organization [WHO]; Regional Network for Equity in Health in East and Southern Africa [EQUINET]; Training and Research Support Centre [TARSC]; REACH Trust

    Geneva, Switzerland, WHO, 2010. [98] p.

    The World Health Organization (WHO) and the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through REACH Trust Malawi and Training and Research Support Centre (TARSC) developed this review. It provides a practical resource for programme managers, health planning departments, evaluation experts and civil society organizations working on health systems and HIV / AIDS programmes at sub-national, national and regional levels in East and Southern Africa. Many of the orientations and tools in this document were developed through a wide consultation process, starting in 2003. We draw on the broader analysis of health equity advanced by EQUINET, as well as evidence from five background studies on equity and health systems impacts of ART programming in East and Southern Africa which were supported by EQUINET, TARSC and DFID (available at www. (Excerpt)
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  5. 5

    Repositioning family planning: Guidelines for advocacy action. Le repositionnement de la planification familiale: Directives pour actions de plaidoyer.

    World Health Organization [WHO]. Regional Office for Africa; Population Reference Bureau [PRB]. Bringing Information to Decisionmakers for Global Effectiveness [BRIDGE]; Academy for Educational Development [AED]. Africa's Health in 2010

    Washington, D.C., Academy for Educational Development [AED], 2008. 64 p.

    Countries throughout Africa are engaged in an important initiative to reposition family planning as a priority on their national and local agendas. Provision of family planning services in Africa is hindered by poverty, poor access to services and commodities, conflicts, poor coordination of the programmes, and dwindling donor funding. Although family planning enhances efforts to improve health and accelerate development, shifting international priorities, health sector reform, the HIV/AIDS crisis, and other factors have affected its importance in recent years. Traditional beliefs favouring high fertility, religious barriers, and lack of male involvement have weakened family planning interventions. The combination of these factors has led to low contraceptive use, high fertility rates in many countries, and high unmet needs for family planning throughout the region. Family planning advocates must take action to change this situation. Family planning, considered an essential component of primary health care and reproductive health, plays a major role in reducing maternal and newborn morbidity and mortality and transmission of HIV. It contributes to the achievement of the Millennium Development Goals and the targets of the Health-for-All Policy for the 21st century in the Africa Region: Agenda 2020. In recognition of its importance, the World Health Organisation Regional Office for Africa developed a framework (2005-014) for accelerated action to reposition family planning on national agendas and in reproductive health services, which was adopted by African ministers of health in 2004. The framework calls for increase in efforts to advocate for recognition of "the pivotal role of family planning" in achieving health and development objectives at all levels. This toolkit aims to help those working in family planning across Africa to effectively advocate for renewed emphasis on family planning to enhance the visibility, availability, and quality of family planning services for increased contraceptive use and healthy timing and spacing of births, and ultimately, improved quality of life across the region. It was developed in response to requests from several countries to assist them in accelerating their family planning advocacy efforts.
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  6. 6

    Engaging faith-based organizations in HIV prevention. A training manual for programme managers.

    Toure A; Melek M; Jato M; Kane M; Kajungu R

    New York, New York, United Nations Population Fund [UNFPA], 2007. [53] p.

    The influence behind faith-based organizations is not difficult to discern. In many developing countries, FBOs not only provide spiritual guidance to their followers; they are often the primary providers for a variety of local health and social services. Situated within communities and building on relationships of trust, these organizations have the ability to influence the attitudes and behaviours of their fellow community members. Moreover, they are in close and regular contact with all age groups in society and their word is respected. In fact, in some traditional communities, religious leaders are often more influential than local government officials or secular community leaders. Many of the case studies researched for the UNFPA publication Culture Matters showed that the involvement of faith-based organizations in UNFPA-supported projects enhanced negotiations with governments and civil society on culturally sensitive issues. Gradually, these experiences are being shared across countries andacross regions, which has facilitated interfaith dialogue on the most effective approaches to prevent the spread of HIV. Such dialogue has also helped convince various faith-based organizations that joining together as a united front is the most effective way to fight the spread of HIV and lessen the impact of AIDS. This manual is a capacity-building tool to help policy makers and programmers identify, design and follow up on HIV prevention programmes undertaken by FBOs. The manual can also be used by development practitioners partnering with FBOs to increase their understanding of the role of FBOs in HIV prevention, and to design plans for partnering with FBOs to halt the spread of the virus. (excerpt)
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  7. 7

    UNAIDS practical guidelines for intensifying HIV prevention: Towards universal access.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, 2007. [66] p. (UNAIDS/07.07E; JC1274E)

    These Practical Guidelines for Intensifying HIV Prevention: Towards Universal Access are designed to provide policy makers and planners with practical guidance to tailor their national HIV prevention response so that they respond to the epidemic dynamics and social context of the country and populations who remain most vulnerable to and at risk of HIV infection. They have been developed in consultation with the UNAIDS cosponsors, international collaborating partners, government, civil society leaders and other experts. They build on Intensifying HIV Prevention: UNAIDS Policy Position Paper and the UNAIDS Action Plan on Intensifying HIV Prevention. In 2006, governments committed themselves to scaling up HIV prevention and treatment responses to ensure universal access by 2010. While in the past five years treatment access has expanded rapidly, the number of new HIV infections has not decreased - estimated at 4.3 (3.6-6.6) million in 2006 - with many people unable to access prevention services to prevent HIV infection. These Guidelines recognize that to sustain the advances in antiretroviral treatment and to ensure true universal access requires that prevention services be scaled up simultaneously with treatment. (excerpt)
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  8. 8

    Assistance for the implementation of the ECOWAS Plan of Action against Trafficking in Persons. Training manual.

    United Nations. Office on Drugs and Crime

    New York, New York, United Nations, 2006. [164] p.

    Trafficking in Persons has become a major concern for all countries of Western Africa. The Meeting of ECOWAS Heads of States, in December 2001, adopted a Declaration and the ECOWAS Plan of Action against Trafficking in Persons (2002-2003). It directed the ECOWAS Executive Secretariat to prepare proposals for controlling trafficking in persons in the sub-region, with special consideration to the situation of trafficked children. The UNODC project FS/RAF/04/R60 on the "Assistance for the Implementation of the ECOWAS Plan of Action against Trafficking in Persons" will strengthen the capacity of the ECOWAS Secretariat and its Member States in implementing the ECOWAS Plan of Action, particularly as it relates to assessment of existing national legislation and the drafting of new legislation in response to the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women and Children. This Manual presents the definitions of trafficking in human beings and smuggling of migrants as well as general guidelines on investigation and prosecution of cases related to trafficking in human beings, with a focus on cooperation between ECOWAS Member States. This Manual is to be used as reference material and in training activities under the project. (excerpt)
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  9. 9

    Interim WHO clinical staging of HIV / AIDS and HIV / AIDS case definitions for surveillance. African region.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2005. [46] p. (WHO/HIV/2005.02)

    With a view to facilitating the scale-up of access to antiretroviral therapy (ART) in the African Region the present document outlines recent revisions made by WHO to the clinical staging of HIV/AIDS and to case definitions for HIV/AIDS disease surveillance. These interim guidelines are based on an international drafting meeting held in Saas Fee in June 2004 and on recommendations made by experts from African countries at a meeting held in Nairobi in December of the same year. The revisions to the clinical staging target professionals ranging from senior consultants in teaching and referral hospitals to surveillance officers and first-level health care providers, all of whom have important roles in caring for people living with HIV and AIDS (PLWHA), including children. It is proposed that countries review, adapt and repackage the guidelines as appropriate for specific tasks at different levels of health service delivery. It is hoped that national HIV/ AIDS programmes in African countries will thus be assisted to develop, revise or strengthen their ART guidelines, patient monitoring and surveillance efforts. The interim clinical staging and revised definitions for surveillance are currently being reviewed in the other WHO regions and will be finalized at a global meeting to be held in September 2005. (excerpt)
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  10. 10

    Guidelines for implementing collaborative TB and HIV programme activities.

    Hargreaves N; Scano F

    Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2003. [84] p. (WHO/CDS/TB/2003.319; WHO/HIV/2003.01)

    The main aim of the guidelines is to enable the central units of national TB and HIV/AIDS programmes to support districts to plan, coordinate and implement collaborative TB/HIV activities. The guidelines are intended for countries with either an overlapping TB and HIV epidemic or where there is an increasing HIV rate which may fuel the TB epidemic. The WHO “Strategic Framework to Reduce the Burden of TB/HIV" provides the evidence base for these guidelines. The guidelines are designed to implement the interventions as described in this framework. The guidelines reflect lessons learned from TB/HIV field sites including ProTEST with experience from comprehensive TB/HIV health services and interventions. The guidelines are structured in line with the main theme of putting these interventions into action: what to implement, how to implement it and by whom. The health situation is urgent and requires a move away from small scale, often costly and time-limited pilot projects to phased implementation of collaborative TB/HIV activities. Phased implementation will build on experience learned form ProTEST pilot sites. Human and financial constraints make phased implementation necessary. (excerpt)
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  11. 11

    Priorities in child health. Easily digestible information for health workers on managing the young child. Booklet 1: Introduction.

    Kibel M; Hendricks M; Hussey G; Swingler G; Zar H

    Pretoria, South Africa, Management Sciences for Health [MSH], EQUITY Project, [2000]. [35] p. (USAID Contract No. 674-0320-C-00-7010-00)

    This series of booklets is a course of self-based learning on the comprehensive management of the sick infant and young child. It is intended for use by first level health workers who, in South Africa, are generally nurses. The principles used are based on the World Health Organisation strategy “Integrated Management of Childhood Illness (IMCI)”. For those who have not yet benefitted from full IMCI training, the booklets provide specific information on important elements of child health care that each nurse should know and use. As her knowledge and experience expands, she will increasingly approach each child in the comprehensive manner promoted in this series. The booklets are not intended as a substitute for existing training programmes, but rather as an adjunct to such learning. Short case studies are employed to illustrate problems to be discussed in each section. (excerpt)
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  12. 12

    Education and HIV / AIDS: a sourcebook of HIV / AIDS prevention programs.

    World Bank

    Washington, D.C., World Bank, 2003. [395] p.

    This Sourcebook aims to support efforts by countries to strengthen the role of the education sector in the prevention of HIV/AIDS. It was developed in response to numerous requests for a simple forum to help countries share their practical experiences of designing and implementing programs that are targeted at school-age children. The Sourcebook seeks to fulfill this role by providing concise summaries of programs, using a standard format that highlights the main elements of the programs and makes it easier to compare the programs with each other. For many countries, HIV/AIDS is a newly recognized challenge to the education sector, and as a result, very few programs have been in place long enough to be formally evaluated. Rather than delaying access to program information until success was confirmed, the Sourcebook combines two approaches to offer some assurance of program quality. First, the programs were selected by national experts because they show promise where they have been implemented. Second, all the programs were benchmarked against criteria that the Joint United Nations Programme on HIV/AIDS (UNAIDS) Inter-Agency Task Team (IATT) for Education considers to be sound programming practice. This provides a framework for exploring the strengths and weaknesses of the program design, pending more conclusive evaluation. The Sourcebook has been developed rapidly to fill an important gap in information on programming within the education sector. It is a work in progress, and the content will be expanded and refined in use. (excerpt)
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  13. 13

    District guidelines for yellow fever surveillance.

    World Health Organization [WHO]. Division of Emerging and Other Communicable Diseases Surveillance and Control; World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    Geneva, Switzerland, WHO, Division of Emerging and Other Communicable Diseases Surveillance and Control, 1998. 59 p. (WHO/EPI/GEN/98.09)

    Yellow fever is a viral haemorrhagic fever transmitted by mosquitos infected with the yellow fever virus. The disease is untreatable, and case fatality rates in severe cases can exceed 50%. Yellow fever can be prevented through immunization with the 17D yellow fever vaccine. The vaccine is safe, inexpensive and reliable. A single dose provides protection against the disease for at least 10 years and possibly life-long. There is high risk for an explosive outbreak in an unimmunized population—and children are especially vulnerable—if even one laboratory-confirmed case of yellow fever occurs in the population. Effective activities for disease surveillance remain the best tool for prompt detection and response to an outbreak of yellow fever especially in populations where coverage rates for yellow fever vaccine are not high enough to provide protection against yellow fever. The guidelines in this manual describe how to detect and confirm suspected cases of yellow fever. They also describe how to respond to an outbreak of yellow fever and prevent additional cases from occurring. The guidelines are intended for use at the district level. (excerpt)
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  14. 14

    HIV prevention in maternal health services: training guide.

    Perchal P; Mielke E; Kaniauskene A; Verbel LB

    New York, New York, United Nations Population Fund [UNFPA], 2004. [126] p.

    The goal of this training is to build the capacity of programme managers and staff to address pregnant and postpartum clients’ HIV and STI needs by offering integrated HIV and STI services within their own particular service-delivery setting. The general objectives of this curriculum are to ensure that by the end of the training, the participants will have the knowledge, attitudes, and skills necessary to carry out the following key prevention tasks: 2 Help clients assess their own needs for a range of HIV and STI services, information, and emotional support. 2. Provide clear and correct information appropriate to clients’ identified concerns and needs. 3 Assist clients in making their own voluntary and informed decisions about HIV nad STI risk reduction. 4. Help clients develop the skills they will need to carry out those decisions. (excerpt)
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  15. 15

    HIV prevention in maternal health services: programming guide.

    Perchal P; Farrell B; Koumpounis A; Galvão L; Mielke E

    New York, New York, United Nations Population Fund [UNFPA], 2004. [148] p.

    While this guide primarily addresses HIV prevention, it also makes the link to other STI’s, since these can increase a pregnant woman’s succeptibility to HIV infection and since both HIV/AIDS and other STI’s can be transmitted to the foetus or newborn child. While preventing HIV infection in pregnant women is a critical element in preventing HIV transmission to the child (vertical transmission), this guide does not attempt to duplicate the many training aides and programme guides that already address prevention of vertical transmission. Prevention of mother-to-child transmission (PMTCT) is more than the provision of antiretroviral drugs to prevent transmission of HIV from an HIV-positive woman to her infant. A comprehensive programme to prevent HIV transmission to pregnant women, mothers, and their children, which has been endorsed by the UN system, includes four elements known as PMTCT, defined as: 1. Prevention of HIV, especially among young people and pregnant women. 2. Prevention of unintended pregnancies among HIV-infected women. 3. Prevention of HIV transmission from HIV-infected women to their infants. 4. Provision of treatment, care, and support to HIV-infected women and their families. This guide focuses primarily on the first of the four elements. (excerpt)
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  16. 16

    Building trust in immunization: partnering with religious leaders and groups.


    New York, New York, UNICEF, 2004 May. 36 p.

    Whether immunizing children house-to-house or providing services at fixed sites, the support of the community is essential in achieving broad coverage. One way of eliciting such support is to gain the trust and confidence of religious leaders, who often wield tremendous authority at the grass roots. Religious leaders not only have the power to shape public opinion, they can also mobilize their constituencies and improve the links between communities and health services. By approaching religious groups with an informed respect for their views, communication and health officers can often gain the trust needed to garner their support. However, even with strong alliances, vocal minorities have sometimes used religious arguments to dissuade parents from immunizing their children. Such resistance may be tied to a political agenda or based on a misunderstanding of the facts. Whatever the case, UNICEF, among other agencies, is often a key player in developing an appropriate response. Allies among religious organizations can be crucial collaborators in reacting in an appropriate and effective way. The guidelines presented in this workbook were created for communication and programme officers and their immunization partners seeking to develop and maintain strong working relationships with religious leaders and groups. They also suggest what actions might be taken when a religious leader or group organizes resistance to immunization. While the guidelines provide an overall framework, they do not offer specific health messages based on religious texts. Such messages should be generated at the local level by religious groups themselves, since interpretation of doctrine can be influenced by culture and social conditions and may vary among religious sects. In fact, the very process of debate and arriving at a common position on immunization is what can ensure long-term involvement on the part of religious groups. (excerpt)
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  17. 17

    Home, the best medicine, Zimbabwe.

    Matende F

    Paris, France, UNESCO, 2001 Oct. [14] p. (Literacy, Gender and HIV / AIDS Series)

    This booklet is one of an ever-growing series of easy-to-read materials produced at a succession of UNESCO workshops partially funded by the Danish Development Agency (DANIDA). The workshops are based on the appreciation that gender-sensitive literacy materials are powerful tools for communicating messages on HIV/AIDS to poor rural people, particularly illiterate women and out-of-school girls. Based on the belief that HIV/AIDS is simultaneously a health and a social cultural and economic issue, the workshops train a wide range of stakeholders in HIV/AIDS prevention including literacy, health and other development workers, HIV/AIDS specialists, law enforcement officers, material developers and media professionals. Before a workshop begins, the participants select their target communities and carry out needs assessments of their potential readers. At the workshops, participants go through exercises helping them to fine tune their sensitivity to gender issues and how these affect people's risks of HIV/AIDS. The analysis of these assessments at the workshops serves as the basis for identifying the priority issues to be addressed in the booklets. They are also exposed to principles of writing for people with limited reading skills. Each writer then works on his or her booklet with support from the group. The booklets address a wide-range of issues normally not included in materials for HIV/AIDS such as the secondary status of girls and women in the family, the "sugar daddy" phenomenon, wife inheritance, the hyena practice, traditional medicinal practices superstitions, home-based care and living positively with AIDS. They have one thing in common- they influence greatly a person's safety from contracting HIV/AIDS. We hope that these booklets will inspire readers to reflect on some of life's common situations, problems and issues that ordinary women and men face in their day-to-day relationships. In so doing, they might reach a conclusion that the responsibility is theirs to save their own lives and those of their loved ones from HIV/AIDS. (excerpt)
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  18. 18

    Me, you and AIDS. Kenya. A product of a UNESCO-DANIDA workshop for preparation of post-literacy materials and radio programmes for women and girls in Africa.

    Nyingi P

    Paris, France, UNESCO, 2000 Jan. [24] p.

    Though the booklets are intended for use with neo-literate women and out-of-school girls, the messages in the stories and the radio programme scripts that accompany them are also relevant for use as supplementary reading materials in formal schools for readers of both sexes. The subjects of the booklets, based on the needs assessments, reflect a wide range of needs and conditions of African women - from Senegal to Kenya, from Mali to South Africa, from Niger to Malawi. A list of common concerns has emerged. These include: HIV-AIDS, domestic violence, the exploitation of girls employed as domestic servants, the lack of positive role models for women and girls, the economic potential of women through small business development, the negative consequences of child marriage, and the need for a more equal division of labour between men and women in the home. Each booklet describes one way of treating a subject of high priority to African women. In the process, the authors have attempted to render the material gender-sensitive. They have tried to present African women and girls and their families in the African context and view the issues and problems from their perspective. We hope these booklets will inspire readers, as they did their authors, to reflect on some of life's common situations, problems and issues that ordinary women and men face every day. The questions accompanying each booklet will help readers ask questions and find answers to some of the issues which also touch their own lives. How the characters in these booklets cope with specific situations, their trials and tribulations, can serve as lessons for women and men living together in 21st Century Africa. (excerpt)
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  19. 19

    Infection control for viral haemorrhagic fevers in the African health care setting.

    Lloyd E; Perry H

    Atlanta, Georgia, United States Centers for Disease Control and Prevention [CDC], National Center for Infectious Diseases, Division of Viral and Rickettsial Diseases, Special Pathogens Branch, 1998 Dec. [10], 198 p.

    This manual describes a system for using VHF Isolation Precautions to reduce the risk of transmission of VHF in the health care setting. The VHF Isolation Precautions described in the manual make use of common low-cost supplies, such as household bleach, water, cotton cloth, and plastic sheeting. Although the information and recommendations are intended for health facilities in rural areas in the developing world, they are appropriate for any health facility with limited resources. The information in this manual will help health facility staff to: 1. Understand what VHF Isolation Precautions are and how to use them to prevent secondary transmission of VHF in the health facility. 2. Know when to begin using VHF Isolation Precautions in the health care setting. 3. Apply VHF Isolation Precautions in a large-scale outbreak. (When a VHF occurs, initially as many as 10 cases may appear at the same time in the health facility.) 4. Make advance preparations for implementing VHF Isolation Precautions. 5. Identify practical, low-cost solutions when recommended supplies for VHF Isolation Precautions are not available or are in limited supply. 6. Stimulate creative thinking about implementing VHF Isolation Precautions in an emergency situation. 7. Know how to mobilize community resources and conduct community education. (excerpt)
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  20. 20
    Peer Reviewed

    Can highly active antiretroviral therapy reduce the spread of HIV? A study in a township of South Africa.

    Auvert B; Males S; Puren A; Taljaard D; Caraël M

    Journal of Acquired Immune Deficiency Syndromes. 2004 Mar 1; 36(1):613-621.

    To estimate the proportion of people eligible for combination antiretroviral therapy and to evaluate the potential impact of providing HAART on the spread of HIV-1 under World Health Organization (WHO) guidelines in a South African township with a high prevalence of HIV-1. A community-based cross-sectional study in a township near Johannesburg, South Africa, of a random sample of approximately 1000 men and women aged 15 to 49 years. Background characteristics and sexual behavior were recorded by questionnaire. Participants were tested for HIV-1, and their CD4+ cell counts and plasma HIV-1 RNA loads were measured. The proportion of people whose CD4+ cell count was less than 200 cells/mm/3 and who would be eligible to receive HAART under WHO guidelines was estimated. The potential impact of antiretroviral drugs on the spread of HIV-1 in this setting was determined by estimating among the partnerships engaged in by HIV-1–positive individuals the proportion of spousal and nonspousal partnerships eligible to receive HAART and then by calculating the potential impact of HAART on the annual risk of HIV-1 transmission due to sexual contacts with HIV-1–infected persons. The results were compared with those obtained using United States Department of Health and Human Services (USDHHS) guidelines. The overall prevalence of HIV-1 infection was 21.8% (19.2%–24.6%), and of these people, 9.5% (6.1%–14.9%) or 2.1% (1.3%–3.3%) of all those aged 15 to 49 years would be eligible for HAART (ranges are 95% confidence limits). In each of the next years 6.3% (4.6%–8.4%) of those currently infected with HIV-1 need to start HAART. Among the partnerships in which individuals were HIV-1–positive, only a small proportion of spousal partnerships (7.6% [3.4%–15.6%]) and nonspousal partnerships (5.7%, [3.0% 10.2%]) involved a partner with a CD4+ cell count below 200 cells/mm3 and would have benefited from the reduction of transmission due to the decrease in plasma HIV-1 RNA load under HAART. Estimates of the impact of HAART on the annual risk of HIV-1 transmission show that this risk would be reduced by 11.9% (7.1% 17.0%). When using USDHHS guidelines, the proportion of HIV-1 positive individuals eligible for HAART reached 56.3% (49.1% 63.2%) and the impact of HAART on the annual risk of HIV- transmission reached 71.8% (64.5%–77.5%). The population impact of HAART on reducing sexual transmission of HIV-1 is likely to be small under WHO guidelines, and reducing the spread of HIV-1 will depend on further strengthening of conventional prevention efforts. A much higher impact of HAART is to be expected if USDHHS guidelines are used. (author's)
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  21. 21

    The World Health Organization guidelines for air quality. Part 2: Air-quality management and the role of the guidelines. [Recomendaciones sobre calidad del aire de la Organización Mundial de la Salud. Parte 2: Manejo de la calidad de aire y papel de las recomendaciones]

    Schwela D

    EM. The Urban Environment. 2000 Aug; 23-27.

    In Part 1 of this article (July 2000, pp 29-34), the revised and updated guidelines for air pollutants were presented. It was emphasized that the guideline values and exposure-response relationships should be considered in the framework of air-quality management. Air-quality management is important for several reasons, which become particularly clear if one is looking at the estimated global burden of disease caused by air pollution. Recent estimates of mortality and morbidity caused by indoor and ambient air pollutions are reproduced in Figures 1 and 2. Figure 1 illustrates the daily mortality for urban ambient air exposure, urban indoor air exposure, and rural indoor air exposure as potentially caused by particulate matter in eight regions: Established Market Economies (EME); Eastern Europe (EE); China; India; SoutheastAsia/Western Pacific (SEAWP); Eastern Mediterranean (EM); Latin America (LA); and SubSaharan Africa (SSA). On a global scale, air-pollution-related mortality accounts for 4% to 8% of the total death rate of 52.2 million annually. Figure 2 estimates the number of people with respiratory diseases potentially caused, or exacerbated by, exposure to suspended particulate matter (SPM). Accordingly, between 20% and 30% of 760 million cases of respiratory diseases recorded annually may be affected by suspended particulate matter. These estimates, when viewed along with the existing information on the health effects of air pollution, lead to the conclusion that controlling sources of ambient and indoor air pollution is necessary to avoid a significant increase in the burden of disease it can cause. This issue is addressed in the World Health Organization 19996 Guidelines for Air Quality (hereafter referred to as Guidelines). In Part 2 of this article, we describe the main statements in the Guidelines with respect to ambient and indoor air management. (excerpt)
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  22. 22

    Immunization and health reform: making reforms work for immunization. A reference guide.

    Feilden R; Nielsen OF

    Geneva, Switzerland, World Health Organization [WHO], Department of Vaccines and Biologicals, 2001. vi, 95 p. (WHO/V&B/01.44)

    Concerns have been raised over the effects of health reforms upon immunization. This document has been prepared to provide some insights into how quality immunization services can be sustained in a reformed and decentralized health system, especially if integration involves disbanding the vertical EPI programme. There is no single model that encapsulates “health reform”, which sometimes involves radical constitutional and structural changes not only to health services but also in other sectors. This document presents two case studies of countries, which have approached reforms in very different ways, and highlights the lessons learned presented in Chapter 6. For organizations supporting countries undergoing health reform, the following are prerequisites: Gain an understanding of the background leading to reform in a particular country, and of the ambitions and guiding principles behind the reforms. Identify which sectors are involved, what is the leading sector or institution, and who are the key players. Find out how far ownership extends beyond the core group, and the extent of consensus. Identify the changes in structures and functions. The organigrams developed for this document illustrate how radical the changes may be. It is likely that the old systems used for vertical programmes must be changed to fit the reformed structures and processes; appropriate solutions will be specific to a particular setting. The following general principles were identified: Use the set of essential functions in Chapter 3 to assess whether immunization seems to be adequately covered. It is important to distinguish between temporary problems arising from the transition to the new system, and structural flaws or weaknesses in the design of the new system. If necessary, propose further adjustments to ensure that essential functions can be covered. Reforms are likely to involve operational changes in the way that immunization services are to be managed. Integration of services is often perceived to provide a more cost-effective approach than the vertical programmes. Take the opportunity offered by reforms to extend the standards developed for immunization to other aspects of primary health care, thus reinforcing good management practices and building up capacity. Consider new approaches to funding arrangements for supporting immunization, especially for procurement of specialized equipment. Monitoring and reviews provide ways of assessing the execution of essential functions at national level and the management of immunization services through all levels of the system. Suggestions for indicators are given in Annex 2. Be aware of the time frame and agenda for reforms and the annual planning cycle, allow more time for reaching consensus with all key players, and be patient. (excerpt)
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  23. 23

    AIDS in Africa: a manual for physicians.

    Piot P; Kapita BM; Ngugi EN; Mann JM; Colebunders R; Wabitsch R

    Geneva, Switzerland, World Health Organization [WHO], 1992. viii, 125 p.

    The first reported AIDS cases in Africa occurred in central Africa in 1982. AIDS is rapidly spreading among the population living there as well as among populations in southern and western Africa. The AIDS pandemic is overtaxing an already burdened health system in sub-Saharan African countries. WHO has put together this manual so health workers in Africa could have a reliable source of current information in this new and rapidly expanding field. The manual's introduction discusses the public health and social significance of AIDS and provides some HIV seroprevalence rate (e.g., <1-20% of the general population, 27-88% of female prostitutes in some cities). The manual next covers the etiology and pathogenesis of AIDS, the human immunodeficiency virus (HIV) being the causative agent. Chapter 3 reviews the epidemiology of HIV infection and AIDS, including an historical review of AIDS in Africa and transmission. Clinical manifestations of acute retroviral illness and asymptomatic and symptomatic HIV infection are delineated in Chapter 4. Opportunistic infections (fungal, parasitic, bacterial, and viral infections), Kaposi's sarcoma, and lymphoma make up Chapter 5. Considerable information exists in Chapter 6 on HIV infection in children. Chapter 7 reviews clinical and laboratory diagnoses of HIV infection and AIDS. The most involved chapter in the manual is Chapter 8, which provides guidance on the management of HIV/AIDS patients. Counseling and psychosocial support is covered in Chapter 9. The manual concludes with a chapter on the prevention and control of HIV/AIDS. The annexes include the CDC 1987 revision of the case definition for AIDS for surveillance purposes and the CDC classification system for HIV infection.
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  24. 24

    International migration in North America, Europe, Central Asia, the Middle East and North Africa: research and research-related activities.

    Russell SS

    Geneva, Switzerland, United Nations, Economic Commission for Europe, 1993. v, 83 p.

    As a joint effort of the World Bank and the Economic Commission for Europe, the aim of this report was to identify international migration research and research-related activities in major political and institutional context, general overviews, and data sources, migration is discussed in terms of demography, international policies, economic and labor market aspects, highly skilled workers, development, integration, migration networks, ethnic relations, refugees and asylum seekers. East-west migration is also treated in a political and institutional context, with general overviews and data sources cited. The development and labor markets as well as ethnicity and return migration are considered. South-north migration is examined in a broad manner, with special emphasis on migration in the Mediterranean Basin and the Middle East. The review is meant to serve as a useful resource and as a stimulus for dialogue. Basic data are missing on east-west migration and labor, migration patterns within the Middle-East, and north-south movements other than from North Africa. Basic institutional sources for data and research on international migration are available from the Council of Europe; the Organization for Economic Cooperation and Development (OECD); the International Labor Organization; the International Organization for Migration; the Office of the UN High Commissioner for Refugees; the Intergovernmental Consultations on Asylum, Refugee, and Migration Policies in Europe, North America, and Australia; and the European Community. 13 major publications are primary sources of data, of which the most extensive is OECD's SOPEMI Report. 9 sources of data pertain to demographic aspects of migration. The 1986 SOPEMI report and updates document national policies and practices of entry control in OECD member countries; the UN Population Division also published a survey of population policies, including migration policies. The Commission of European Communities policies, including migration policies. The Commission of European Communities also publishes a document on noncommunity citizens. Researchers who have analyzed recent trends are identified, and research papers are cited for labor aspects of migration, highly skilled workers and migration, migration and development, integration and ethnic relations, migrant networks, refugees and asylum seekers, security, return migration, clandestine migration and ethical issues.
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  25. 25

    How to estimate incremental resource requirements and costs of alternative TT immunization strategies: a manual for health and program managers. Revised version.

    Brenzel L; Foulon G

    Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1989 Jun. [4], 22 p. (USAID Contract No. DPE-5927-C-00-5068-00)

    The REACH Project originally prepared this manual for health and program managers for WHO workshops in Africa on the control of neonatal tetanus. The manual provides rapid methods for determining incremental resource requirements and costs of tetanus toxoid (TT) immunization programs. Its design allows for flexibility. It categorizes costs into variable costs such as vaccines, syringes, and needles and fixed costs such as training, personnel, supervision, and transportation. The manual provides a worksheet for calculating the variable costs for programs which requires the managers to consider the target population (pregnant women or women of childbearing age) and coverage objective (TT2 or TT5). Further it presents a formula for determining costs of additional personnel (a variable cost): personnel costs=number of workers x proportion of time for TT vaccination for each worker x annual gross earnings of each workers. It also has guidelines for determining fixed costs such as cold chain equipment costs. Transportation costs consists mostly of fuel costs but also includes the costs of vehicles to move vaccines, supplies, and personnel. Training costs include production of training materials, travel, per diem, and proportion of annual salaries of trainers and trainees for training time. The manual also has worksheets for determining supervision and monitoring costs. Further it has a worksheet to calculate additional media costs for TT immunization including radio. TV, and posters. Once managers have determined the costs of various components of TT immunization programs, they can sum the costs up and determine the cost effectiveness of TT immunization strategies on another worksheet. The manual concludes with a formula to assist managers determine whether changing from 1 strategy to another would save them more money and be more cost effective.
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