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Epidemiology of measles in the central region of Ghana: a five-year case review in three district hospitals.
East African Medical Journal. 2003 Jun; 80(6):312-317.Objective: As part of a national accelerated campaign to eliminate measles, we conducted a study, to define the epidemiology of measles in the Central Region. Design: A descriptive survey was carried out on retrospective cases of measles. Setting: Patients were drawn from the three district hospitals (Assin, Asikuma and Winneba Hospitals) with the highest number of reported cases in the region. Subjects: Records of outpatient and inpatient measles patients attending the selected health facilities between 1996 and 2000. Data on reported measles eases in all health facilities in the three study, districts were also analysed. Main outcome measures: The distribution of measles eases in person (age and sex), time (weekly, or monthly, trends) anti place (residence), the relative frequency, of eases, and the outcome of treatment. Results: There was an overall decline in reported eases of measles between 1996 and 2000 both in absolute terms and relative to other diseases. Females constituted 48%- 52% of the reported 1508 eases in the hospitals. The median age of patients was 36 months. Eleven percent of eases were aged under nine months; 66% under five years and 96% under 15 years. With some minor variations between districts, the highest and lowest transmission occurred in March and September respectively. Within hospitals, there were sporadic outbreaks with up to 34 weekly eases. Conclusion: In Ghana, children aged nine months to 14 years could be appropriately targeted for supplementary, measles immunization campaigns. The best period for the campaigns is during the low transmission months of August to October. Retrospective surveillance can expediently inform decisions about the timing and target age groups for such campaigns. (author's)
Chandigarh, India, Punjab Nutrition Development Project, 1974. 115 p.The primary goal of the Punjab Nutrition Development Project was to develop a plan of delivering supplementary foodstuffs to pregnant and nursing women, infants, and children up to age 11. The project was assisted by CARE and was led by an anthropologist, a pediatrician, a nutritionist, and a statistician who worked with a supportive staff from the government. Research was undertaken in 4 main areas: nutritional assessment and diet surveys; studies of community participation, sociocultural aspects of malnutrition and midday meals programs; development of local foods; and organizational and administrative aspects. The following specific studies were conducted: nutritional assessment of preschool children of Punjab; diet survey of preschool children, pregnant and lactating women; chandigarh study of privileged children; nutritional assessment of primary school children; sociocultural aspects of malnutrition in Punjab; nutrition knowledge level of village leaders and their opinions regarding the formation of local health/nutrition teams; a study of the midday meals program with special emphasis on the role of the teacher; comprehensive study of food processing and marketing; food formulations feasibility studies; bulk food consumption by preschool chidlren; feeding programming through community participation; prototype food preparation center; and, evaluation of the midday meals program.
Geneva, WHO, 1976. (WHO Technical Report Series No. 600) 98 p.Approximately 125 million infants were born in 1975 and approximately 10-12 million died before their first birthday. The WHO Expert Committee on Maternal and Child Health met in Geneva December 9-15, 1975 to consider new approaches and trends in delivering maternal and child care health services. The Committee decided to redefine health problems and adapt delivery of services in light of social and environmental changes. The effect of careful and informed mothering on the health of the entire family and the relation of family health to community health are important factors in individual, national, and community development. The roles of environmental and socioeconomic factors in mortality, morbidity, and growth and development have been further clarified during the last decade. In countries where data was not previously available, the mmultiple causation of the main health problems of mothers and children has been better documented. The priority health problems are related to the synergistic effects of malnutrition, infection, and unregulated fertility, together with poor socioeconomic conditions and scarcity of health services.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 144 p. (Syncrisis: the dynamics of health, XIX)This report uses available statistics to examine health conditions in Senegal and their interaction with socioeconomic development. Background data are presented, after which population, health status, nutrition, environmental health, health infrastructure, facilities, services and manpower, national health policy and planning, international organizations, and the Sahel are discussed. Diseases such as malaria, measles, tuberculosis, trachoma and venereal diseases are endemic in Senegal, and high levels of infant and childhood mortality exist throughout the country but especially in rural areas. Diarrhea, respiratory infections, and neonatal tetanus contribute to this mortality and are evidence of the poor health environment, and lack of basic services including nutrition assistance, health education, and potable water. Nutrition in Senegal appears to be good in general, but seasonal and local variations sometimes produce malnutrition. Lowered fertility rates would reduce infant and maternal mortality and morbidity and might slow the present decline in per capita food intake. At present the government of Senegal has no population policy and almost no provisions for family planning services. Health services are inadequate and inefficient, with shortages of all levels of health manpower, poor planning, and overemphasis on curative services.
[Unpublished] 1980. Presented at the Annual Meeting of the Population Association of America, Denver, Colorado, April 10-12, 1980. 34 p.The Calabar Rural Maternal and Child Health/Family (MCH/FP) Project ran from July 1975 to December 1980 funded by the Cross River State Government Ministry of Health with assistance from the Population Council (New York) and the UN Fund for Population Activities. Calabar met the following requirements: it is rural; population between 200,000-500,000; family planning and maternal and child health is integrated from the top level of administration to the delivery of services to the clients; the target population is all women who deliver within the area and their children up to 5 years; services are at levels that can be expanded to larger areas of the country; and attention is given to evaluation of both health benefits and results of family planning services. As a model of health care delivery services to be used throughout the developing world, maternal health services are most important because the level of preventable deaths is highest in preschool children and in women at childbirth and MCH is the most appropriate an effective vehicle for introducing family planning. At the end of the Calabar Rural MCH/FP Project, the office will be closed but the services will continue under the direction of the local governments in Cross River State. 6 health centers and 1 hospital served 275 villages. Knowledge of contraception was low but positively associated with education.
New York, UN, 1979. 279 p. (Population studies No. 62)This report was prepared by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat on the basis of inputs by the Division, the International Labour Organisation, the Food and Agriculture Organization of the UN, the UN Educational, Scientific and Cultural Organization, and the World Health Organization. Tables are presented for sex compositions of populations; demographic variables; percentage rates of change of unstandardized maternal mortality rates and ratios; population enumerated in the United States and born in Latin America; urban and rural population, annual rates of growth, and percentage of urban in total population, the world, the more developed and the less developed regions, 1950-75; crude death rates, by rural and urban residence, selected more developed countries; childhood mortality rates, age 1-4 years; and many others. The world population amounted to nearly 4 billion in 1975, a 60% increase over the 1950 population of 2.5 billion. The global increase is about 2%. The average death rate in developing areas has dropped from 25/1000 in 1950 to about 15/1000, a 40% decline. Estimates of birth rates in developing countries are 40-45 for 1950 and 35-40/1000 for 1975. Most of the shifts in vital trends in the less developed regions are still at an early stage or of limited geographical scope.
Washington, D.C., Family Health Care, Inc., May 31, 1977. 132 p.Current demographic characteristics for SAHEL countries are presented along with a health delivery strategy based on a distributive philosophy and linking health activities with other development efforts. Resource allocation is proposed within a village-based system, integrating the following components: 1) nutrition; 2) village water; 3) environmental sanitation; and 4) communicable disease control. Investment in a health services infrastructure is anticipated to be a factor in socioeconomic development. Improved health should stimulate labor productivity, enhance the role of women, and increase survival, hence population growth and development. Health services at the village level will be divided into 4 levels: arrondissement, cercle, regional, and national. Specific action recommendations proposed are: 1) organization of a permanent health group to investigate and disseminate information to member countries of SAHEL and to examine experiences in other countries; 2) sponsorship of a ministry-level conference to implement health strategy recommendations; 3) enhancement of health policy, planning, and resource allocation capabilities by development of policy and planning infrastructures by donor organizations, which would also provide training; and 4) incorporation in the next 3- or 5-year plan of SAHEL countries village-based health systems.
Studies in Family Planning. September 1978; 9(9):235-237.The National Family Planning Coordinating Board (BKKBN) of Indonesia began a program of expansion of services in mid-1977. On Java and Bali there are 25,000 contraceptive resupply posts. In the 10 outer-island provinces where program services began in 1973-74 village family planning volunteers work in 4000 communities. The BKKBN has been conducting intensive training programs for community leaders to manage local fertility programs since 1977. The major responsibility for maintaining family planning acceptors will be transferred from government agencies to local organizations. The total family planning budget for fiscal year 1975-76 was U.S. $25.5 million, 50% of which came from the Indonesian government and 50% from donor agencies, including USAID. USAID provided 34 million monthly cycles of oral contraceptives in 1976. Indonesia will be able to supply most of its own contraceptives by 1983-84. The number of family planning service points for all of Indonesia have increased to 1.8/1000 married women in 1976 to 3.8/1000 in 1978. These should increase to 5.4/1000 by 1982.
Bangkok, Thailand, Ministry of Public Health, 1957. 22 pThe Department of Public Health was instituted in 1918 under the Ministry of Interior to supervise the medical and public health services of Thailand. The Ministry of Public Health was established in 1942. Its main activities are: a sanitary campaign; health education of the public; population and vital statistics; control of communicble diseases and narcotic drugs; and medical registration. The department was upgraded in 1950 by international and foreign aid from organizations such as the UN and WHO. The projects which benefitted were malaria control, yaws control, tuberculosis control, maternal and child health, hospital improvement, nursing and midwifery education, nutrition survey, leprosy control, and scholarships for study abroad. The crude death rates declined from 14.5 in 1946 to 9.4 in 1955. 11,112 physicians, dental surgeons, pharmacists, nurses (male), nurse/midwives, and midwives were registered in 1957. There are 8 nursing schools and 3869 registered nurses. There are 2 midwifery schools graduating 300 midwives per year, who practise in rural areas.
A Framework for Evaluating Long-Term Strategies for the Development of the Sahel-Sudan Region. Annex 2. Health, Nutrition, and Population. A final report, September 1, 1973 through December 31, 1974
Cambridge, Massachusetts, Massachusetts Institute of Technology, Center for Policy Alternatives, December 31, 1974. Contract AID/afr-C-1040. 315 pThis report on the health-care system of the Sahel-Sudan characterizes it as fragmented and severely understaffed. There is inequitable distribution of health resources, with a strong tendency toward urbanization. The largest, inappropriately so, fraction of available resources goes to curative medicine; investment in preventive medicine is recommended as cost effective. Improvements in health require improvements in nutrition, water supply, waste disposal, public health programs, hygiene, education, and transportation; in addition, health-care delivery systems must be improved. A vaccination program for measles will reduce child mortality but will also expand the dependency ration and further strain available resources geared to younger aged persons. The principle recommendations for improving health care are: 1) integration of all components of the system; 2) improvements in monitoring disease; 3) reorientation of the system toward preventive medicine; 4) emphasis on mother-child care; 5) use of all communications media in health education; and 6) strengthening of health education to amplify health-care delivery. The low average population density in this region means that demographic issues have not been of overriding concern. The present stagnation of economic development, high rate of unemployment, prevalence of undernutrition, and dependence on foreign aid suggest that under current circumstances population is in excess of the optimal land-population ratio. The present average population growth rate of 2.2%/year, together with the fact that nearly half of the total population is below 15 years of age, means that the population will double in 32 years or less unless the growth rate falls. Some pronatalist laws have been changed.
Syncrisis: the dynamics of health. An analytic series on the interactions of health and socioeconomic development. VI. Haiti.
Washington, D. C., U.S. Government Printing Office. November 1972. (Syncrisis: The Dynamics of Health, No. 6) 42 pIn Haiti, both the small, literate, urban, elite and the isolated, illiterate, Vodoun-practicing rural peasantry have been adversely affected by the economic decline and stagnation of this once-rich French colony. For nearly a century and a half it has been virtually isolated. Vital statistics are extremely unreliable, but special surveys indicate that infant mortality is at least 150/1000 live births (180-200 according to 1 survey) and mortality among children aged 1-4 is 33/1000. Diarrheal diseases, tetanus, respiratory infections, intestinal parasites, and the common childhood diseases all play a part. 70% of children aged 5 show signs of malnutrition and 10% show 3rd degree malntrition. After age 5 chances of survival improve although intestinal and perhaps malarial parasites will permanently stunt physical development. A mass yaws program and a mass antimalarial program show public willingness to accept public health measures. Rough estimates place annual growth at 2-2.5%. Since virtually all the island is engaged in subsistence farming, this will soon put unbearable pressure on resources. As it is, Hati is the poorest country in the Americas and 1 of the poorest in the world. Since family patterns stress the desirability of a large number of children to work the land and prove masculinity, the situation promises to get worse. Large numbers of young people have tried to emigrate, but other countries in the area do not want large numbers of Haitians coming in to compete with their own unskilled work forces. High illiteracy, poor communications, rural isolation, and a formerly pronatalist government with only recent commitment to family planning all hamper efforts in this direction. 2 major projects are currently operating with foreign funds: a 2-year U.N. Special Population Fund pilot project in Port-au-Prince and a Unitarian Universalist Service Committee pilot project. In addition, a USAID-Funded, CARE-administered community help project in northwest Haiti includes family planning services. Popular acceptance has been encouraging.
In: Bannerman RH, Burton J, Ch'en Wen-Chieh. Traditional medicine and health care coverage: a reader for health administrators and practitioners. Geneva, Switzerland, World Health Organization, 1983. 281-9.It is now widely recognized that there is great potential in traditional medicine to contribute to primary health care, specially in developing countries. Such a potential is due not only to the wide acceptance of these systems at the community level but also to their simple, inexpensive, non-toxic, and time-tested remedies for the alleviation of disease and disability. In order to contribute usefully to primary health care, these systems must be functionally integrated into the country's health system. A thorough study should therefore be made of the prevailing traditional systems in their entirety--the type of system, the available manpower, the existing training programs, including any linkage to the official health services and the budgetary requirements. The identification of areas of health care to which these systems can contribute effectively and problems relating to their further development also require scrutiny. A list of recommendations given by WHO in 1979 for the development of traditional medicine are given. These include: manpower planning, the development of traditional medicine programs at the community level, and the identification of research priorities (drug research, the characteristics of traditional practitioners, integration programs, and cost effectiveness of traditional remedies and practices). An additional area of research suggested is the effectiveness of traditional remedies against chronic diseases for which there are no satisfactory treatments in modern medicine. WHO has been actively promoting traditional medicine as an integral part of primary health care through its technical cooperation programs with member states. In the last few years, a useful program to encourage visits of teams from different countries to China has been carried out in collaboration with the United Nations development program. The emphasis of WHO's programs are on coordinated and integated efforts to foster traditional systems and to maximize their usefulness towards the attainment of health for all.