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  1. 1
    072591
    Peer Reviewed

    Global review on ORT (oral rehydration therapy) programme with special reference to Indian scene.

    Sarkar K; Sircar BK; Roy S; Deb BC; Biswas AB; Biswas R

    INDIAN JOURNAL OF PUBLIC HEALTH. 1990 Jan-Mar; 34(1):48-52.

    The WHO Global Diarrhoeal Disease Control (CDD) Programme has been implemented in at least 110 member countries. It encourages oral rehydration therapy (ORT) as the chief means to reduce child mortality caused by diarrhea. Despite relatively high ORT access rates ORT (20%->70% in Africa and South East Asia respectively, 1989), oral rehydration solution (ORS) use is inadequate (12.1-26.7% Africa and Eastern Mediterranean respectively, 1988) as well as ORT use (19.2-39.8% Africa and Eastern Mediterranean respectively, 1988). These poor results could be a factor of diminished knowledge and inadequate numbers of trained staff. Yet 58 countries now produce ORS and worldwide production increased from 100-350 million 1 between 1983-1987. In India, however, at least 75% of ORS brands do not meet WHO standards. Further 0.5-1 million <5 year olds succumb annually due to diarrhea (25% of all deaths among <5 year olds). In addition, about 500 million episodes of diarrhea occur each year. ORT is required in 50-100 million of these episodes and hospitalization is needed for 5 million. The Indian CDD program has reduced child mortality from diarrhea by 50% between 1981-1990. It operates under a 3 tier strategy including home management with ORS, and hospital management with ORS and/or IV fluids. This strategy faces several obstacles. For example, mothers in some villages do not know the village health guides who teach mothers how to make ORS. Besides few are motivated at the village level to teach this to mothers. According to government studies, ORT use varies in India from 36-96.3%, but according to operational research by the National Institute of Cholera and Enteric Diseases, ORT use in the best health facilitate is only 11-12%.
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  2. 2
    037426
    Peer Reviewed

    A case study in the administration of the Expanded Programme of Immunization in Nigeria.

    Jinadu MK

    Journal of Tropical Pediatrics. 1983 Aug; 29(4):217-9.

    The World Health Organization (WHO) launched the Expanded Program of Immunization (EPI) in 1974 based on the belief that most countries already had some elements of national immunization activities which could be successfully expanded if the program became a national priority with a commitment from the government to provide managerial manpower and funds. The federal government of Nigeria quickly adopted the policy of WHO on EPI and urged the state governments to set up administrative arrangements for planning and implementation of EPI. The program started off in Oyo State of Nigeria after a pilot study conducted at Ikire in Irewole Local Government area in 1975. The stated objectives of the programs were: to provide immunization service to at least 85% of the target population e.g. children under 4 years; and to integrate immunization programs into routine activities of all static primary health centers in the state. This study focuses on administration of the immunization program in the Oranmiyan Local Government area of Oyo State, within the structure of the local government health system and the field health administration of the state government. This study shows that the stated objectives of the EPI are not likely to be achieved in the near future because of low coverage of the eligible population, due to inadequate community involvement in the planning and implementation of the program; 2) poor communication between different government departments; and 3) inadequate publicity. The effect of improvement in health status because of immunization programs, has been very difficult to demonstrate in Nigeria because a lack of accurate data on birth, morbidity, and mortality patterns of the population. Other socioeconomic and health factors of significance in the battle against infectious diseases include environmental sanitation, adequate and safe water supply, housing and nutrition. Nevertheless, immunization programs constitute one of the most economical and effective approaches to the prevention of communicable diseases and can produce dramatic effects in the battle to lower infant and childhood mortaltiy rates in the developing countries if they are well implemented.
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