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Lancet. 1996 Sep 28; 348(9031):883.UNICEF and other international agencies are taking action to iodize salt in 118 countries where 1.5 billion people are at risk of iodine-deficiency disorders (IDD), the greatest preventable cause of mental retardation worldwide. Most of these target countries are developing countries. Only 46 of the 118 countries had a national salt-iodization program in 1990. That number has since increased to 83 (mid-1996). Salt iodization efforts focus on women of reproductive age, since IDD adversely affects fetal brain and nervous system development. Children with IDD also have fewer defenses against infections and other nutritional problems. UNICEF estimates that IDD is responsible for about 5.7 million cases of cretinism, 43 million cases of people with some degree of intellectual handicap, and 655 million cases of goiter. West Africa is endemic for IDD. In 1993, in central Guinea, 70% of adults had goiter and 2% of goiter cases were affected by cretinism. 55% of school children had thyroid swelling. 69% of all people had an iodine excretion level below the threshold of 20 mcg/l. The president of Guinea issued a decree in November 1995 for the iodization of salt. In Mamadou, Guinea, the health director is organizing religious and business leaders, teachers, and parents to educate them to the need for iodized salt. Knowledge about the importance of iodine and about the fact that cassava and fonio facilitate goiter growth is low. Soon after the 1993 survey, UNICEF distributed iodine capsules for the most severely affected people. It takes time to pass laws requiring the iodization of all salt. In Ghana, red tape has delayed passage of such a bill for many months. As a consequence, salt producers in Ghana are exporting 70% of their iodized salt to Mali and Burkina Faso, where salt iodization is required by law. Potassium iodate is more stable under different climatic conditions than potassium iodide. Thyrotoxicosis is a concern, but it usually stops 1-2 years after implementation of salt iodization. Salt iodization is the norm in Algeria, Cameroon, Eritrea, Kenya, Namibia, Nigeria, South Africa, Zambia, and Zimbabwe.
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.
Copenhagen, Denmark, World Health Organization, Regional Office for Europe, 1986. 62 p.A Consultation on Sexuality was convened by the Regional Office for Europe of the World Health Organization (WHO) in Copenhagen in November 1983 to examine the sexual dimensions of health problems. Sexuality influences thoughts, feelings, actions, and interactions and thus physical and mental health. Since health is a fundamental human right, so must sexual health also be a basic human right. 3 basic elements of sexual health were identified: 1) a capacity to enjoy and control sexual and reproductive behavior in accordance with social and personal ethics; 2) freedom from fear, shame, guilt, false beliefs, and other psychological factors inhibiting sexual response and impairing sexual relationships; and 3) freedom from organic disorders, diseases, and deficiencies that interfere with sexual and reproductive functions. The purpose of sexual health care should be the enhancement of life and personal relationships, not only counseling or care related to procreation and sexually transmitted diseases. Barriers to sexual health include myths and taboos, sexual stereotypes, and changing social conditions. In addition, sexuality is repressed among groups such as the mentally handicapped, the physically disabled, the elderly, and those in institutions whose sexual needs are not acknowledged. Homosexuals are often stigmatized because their sexual expression is at variance with dominant cultural values. Sex education programs and health workers must broaden their traditional approach to sexual health so they can help people to plan and achieve their own goals. Family planning programs must expand from their traditional goal of avoiding unwanted births and help people balance the need for rational planning on the one hand and the satisfaction of irrational sexual desires on the other hand. Promoting sexual health is an integral part of the promotion of health for all.
[Unpublished] 1981. 9 p.Recognizing a need to provide help to mentally handicapped women with fertility related problems, the Family Planning Association of Hong Kong established a clinic for the mentally handicapped in May 1979. The basic rationale for the service was the United Nations 1971 proclamation of a Declaration on the Rights of Mentally Retarded Persons and its call for the protection of these rights. Articles of particular interest in the declaration are listed. After studying the situation, the Association began by introducing a series of educational activities and establishing the special clinic. Several pilot programs were conducted with the cooperation of the Pine Hill Village schools following the workshop organized for professionals working with mentally handicapped youths. Experience from those projects indicated that special skills and materials would be required in order to teach sex education to the mild to moderate grade mentally handicapped youths. 9 welfare agencies cooperated in a project to develop sex education. A monthly sex education course for parents of mentally handicapped children was initiated in September 1980 to help them understand aspects of the child's sexual behavior and how to cope with it. Since May 1979 the Association has been operating a pilot special clinic with a team made up of a gynecologist, psychiatrist, clinical psychologist, counselor, and nurse. Services include self-management skills in menstrual hygiene and preliminary assessment for determining appropriate birth control methods. The clinic has handled 92 cases thus far, and 4 case histories are presented to illustrate the nature and scope of the services.