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MMWR. Morbidity and Mortality Weekly Report. 2017 May 05; 66(17):436-443.In 2011, the 46 World Health Organization (WHO) African Region (AFR) member states established a goal of measles elimination* by 2020, by achieving 1) >/=95% coverage of their target populations with the first dose of measles-containing vaccine (MCV1) at national and district levels; 2) >/=95% coverage with measles-containing vaccine (MCV) per district during supplemental immunization activities (SIAs); and 3) confirmed measles incidence of <1 case per 1 million population in all countries (1). Two key surveillance performance indicator targets include 1) investigating >/=2 cases of nonmeasles febrile rash illness per 100,000 population annually, and 2) obtaining a blood specimen from >/=1 suspected measles case in >/=80% of districts annually (2). This report updates the previous report (3) and describes progress toward measles elimination in AFR during 2013-2016. Estimated regional MCV1 coveragedagger increased from 71% in 2013 to 74% in 2015. section sign Seven (15%) countries achieved >/=95% MCV1 coverage in 2015. paragraph sign The number of countries providing a routine second MCV dose (MCV2) increased from 11 (24%) in 2013 to 23 (49%) in 2015. Forty-one (79%) of 52 SIAs** during 2013-2016 reported >/=95% coverage. Both surveillance targets were met in 19 (40%) countries in 2016. Confirmed measles incidence in AFR decreased from 76.3 per 1 million population to 27.9 during 2013-2016. To eliminate measles by 2020, AFR countries and partners need to 1) achieve >/=95% 2-dose MCV coverage through improved immunization services, including second dose (MCV2) introduction; 2) improve SIA quality by preparing 12-15 months in advance, and using readiness, intra-SIA, and post-SIA assessment tools; 3) fully implement elimination-standard surveillancedaggerdagger; 4) conduct annual district-level risk assessments; and 5) establish national committees and a regional commission for the verification of measles elimination.
BMJ. 2016; 352:i8.Add to my documents.
Vaccine. 2013 Apr 18; 31(Suppl 2):B81-B96.Middle-income countries (MICs) as a group are not only characterized by a wide range of gross national income (GNI) per capita (US $1026 to $12,475), but also by diversity in size, geography, governance, and infrastructure. They include the largest and smallest countries of the world-including 16 landlocked developing countries, 27 small island developing states, and 17 least developed countries-and have a significant diversity in burden of vaccine-preventable diseases. Given the growth in the number of MICs and their considerable domestic income disparities, they are now home to the greatest proportion of the world’s poor, having more inhabitants below the poverty line than low-income countries (LICs). However, they have little or no access to external funding for the implementation of new vaccines, nor are they benefiting from an enabling global environment. The MICs are thus not sustainably introducing new life-saving vaccines at the same rate as donor-funded LICs or wealthier countries. The global community, through World Health Assembly resolutions and the inclusion of MIC issues in several recent studies and important documents-including the Global Vaccine Action Plan (GVAP) for the Decade of Vaccines-has acknowledged the sub-optimal situations in some MICs and is actively seeking to enhance the situation by expanding support to these countries. This report documents some of the activities already going on in a subset of MICs, including strengthening of national regulatory authorities and national immunization technical advisory groups, and development of comprehensive multi-year plans. However, some additional tools developed for LICs could prove useful to MICs and thus should be adapted for use by them. In addition, new approaches need to be developed to support MIC-specific needs. It is clear that no one solution will address the needs of this diverse group. We suggest tailored interventions in the four categories of evidence and capacity-building, policy and advocacy, financing, and procurement and supply chain. For MICs to have comparable rates of introduction as other wealthier countries and to contribute to the global fight against vaccine-preventable diseases, global partners must implement a coordinated and pragmatic intervention strategy in accord with their competitive advantage. This will require political will, joint planning, and additional modest funding.
Contraception. 2011 Oct; 84(4):339-41.This editorial focuses on a strategy to expand contraceptive coverage through the development of a numerical International Statistical Classifications of Diseases (ICD) code for "unwanted fertility." It explains how this strategy would work, how to make the strategy happen through a revision process, and defining unwanted fertility as a medical problem. Copyright © 2011 Elsevier Inc. All rights reserved.
Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response.
Geneva, Switzerland, WHO, 2010.  p.This new report on anti-tuberculosis (TB) drug resistance by the World Health Organization (WHO) updates "Anti-tuberculosis drug resistance in the world: Report No. 4" published by WHO in 2008. It summarizes the latest data and provides latest estimates of the global epidemic of multidrug and extensively drug-resistant tuberculosis (M/XDR-TB). For the first time, this report includes an assessment of the progress countries are making to diagnose and treat MDR-TB cases. (Excerpt)
The Global Fund 2010: Innovation and impact. Global Fund-supported programs saved an estimated 4.9 million lives by the end of 2009.
Geneva, Switzerland, Global Fund to Fight AIDS, Tuberculosis and Malaria, 2010 Mar.  p.The substantial increase in resources dedicated to health through overseas development assistance and other sources during the past years has begun to change the trajectory of AIDS, tuberculosis (TB) and malaria, and more broadly, of the major health problems that low- and middle-income countries have been confronted with. The results and emerging signs of impact presented in this report paint a hopeful and encouraging picture. Ten years ago, virtually no one living with AIDS in low- and middle-income countries was receiving lifesaving antiretroviral therapy (ART), although it had been available since 1996 in high-income countries. At the end of 2008, over 4 million people had gained access to AIDS treatment, representing over 40 percent of those in need. AIDS mortality has since decreased in many high-burden countries. For example, in Ethiopia’s capital, Addis Ababa, the rollout of ART has led to a decline of about 50 percent in adult AIDS deaths over a period of five years.
Symptom-based screening of child tuberculosis contacts: improved feasibility in resource-limited settings.
Pediatrics. 2008 Jun; 121(6):e1646-52.OBJECTIVE: National tuberculosis programs in tuberculosis-endemic countries rarely implement active tracing and screening of child tuberculosis contacts, mainly because of resource constraints. We aimed to evaluate the safety and feasibility of applying a simple symptom-based approach to screen child tuberculosis contacts for active disease. METHODS: We conducted a prospective observational study from January through December 2004 at 3 clinics in Cape Town, South Africa. All of the children <5 years old in household contact with an adult tuberculosis source case were assessed by documenting current symptoms and tuberculin skin test and chest radiograph results. RESULTS: During the study period, 357 adult tuberculosis cases were identified; 195 cases (54.6%) had sputum smear and/or culture positive results and were in household contact with children aged <5 years. Complete information was available for 252 of 278 children; 176 (69.8%) were asymptomatic at the time of screening. Tuberculosis treatment was administered to 33 (13.1%) of 252; 27 were categorized as radiologically "certain tuberculosis," the majority (n = 22) of which had uncomplicated hilar adenopathy. The negative predictive value of symptom-based screening varied according to the case definition used, with 95.5% including all of the children treated for tuberculosis and 97.1% including only those with radiologically "certain tuberculosis." CONCLUSIONS: Our findings support current World Health Organization recommendations, demonstrating that symptom-based screening of child tuberculosis contacts should improve feasibility in resource-limited settings and seems to be safe.
Lancet. 2008 Sep 13; 372(9642):962-71.Primary health care was ratified as the health policy of WHO member states in 1978.(1) Participation in health care was a key principle in the Alma-Ata Declaration. In developing countries, antenatal, delivery, and postnatal experiences for women usually take place in communities rather than health facilities. Strategies to improve maternal and child health should therefore involve the community as a complement to any facility-based component. The fourth article of the Declaration stated that, "people have the right and duty to participate individually and collectively in the planning and implementation of their health care", and the seventh article stated that primary health care "requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care". But is community participation an essential prerequisite for better health outcomes or simply a useful but non-essential companion to the delivery of treatments and preventive health education? Might it be essential only as a transitional strategy: crucial for the poorest and most deprived populations but largely irrelevant once health care systems are established? Or is the failure to incorporate community participation into large-scale primary health care programmes a major reason for why we are failing to achieve Millennium Development Goals (MDGs) 4 and 5 for reduction of maternal and child mortality?
Towards universal access to prevention, treatment and care: experiences and challenges from the Mbeya region in Tanzania -- a case study.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2007 Mar. 49 p. (UNAIDS Best Practice Collection; UNAIDS/07.11E; JC1291E)This study takes stock of the situation in Mbeya in 2005, documenting the region's continuing efforts to build on the Regional Programme's strong comprehensive prevention approaches to further increase their coverage while strengthening the new district focus, expanding multisectoral work and making available antiretroviral treatment. In doing so, this study describes Mbeya's progress towards universal access and identifies ongoing challenges. Through its comprehensive, decentralized and multisectoral approaches and the continuing efforts of a variety of actors, the region appears to be in a better position to reach universal access than other parts of Tanzania and Africa in general. The experiences of the Mbeya region to date can serve as lessons learnt to other parts of the country and, more broadly, the continent. This publication is neither a scientific study nor an evaluation of the Regional Programme. It is an analytical description of HIV control activities in the region to date and their status to date. Its focus is mainly on access. The programmes presented here follow national and international recommendations. The quality of the individual programmes, however, has not been assessed for the purpose of this publication. (excerpt)
Lancet. 2006 Dec 23; 368(9554):2193-2195.The global incidence of dengue has increased exponentially over past decades. Fuelled by conditioning factors such as rapid urbanisation, demographic change, large-scale migration, and travel, the disease is now endemic in most countries of the tropics, and about 925 million people now live in urban areas that are at risk of dengue infection. The increasing incidence, intensity, and geographical expansion of dengue epidemics pose a growing threat to the health and economic well-being of populations living in endemic areas, where the introduction of new virus strains to regions affected by existing serotypes is a risk factor for outbreaks and severe disease. Dengue is a major international public-health concern, as expressed in World Health Assembly resolution WHA 55.17 and in the 2005 revision of the International Health Regulations (WHA 58.3). We do have strategies, methods, and guidelines with which we can greatly reduce dengue case-fatality rates and virus transmission, but weak implementation of these plans and an inability to respond effectively to conditioning factors (such as those mentioned above) outside the health sector is causing concern. (excerpt)
New York, New York, UNDP, . 16 p.The 22 country offices where the We Care programme has been rolled out are taking great strides in making their workplaces truly AIDS competent. We are beginning to understand that HIV/AIDS is not 'out there' but among us -- and that if we are to make a difference in the way the world responds to it, WE MUST BEGIN WITH OURSELVES. Today, the We Care initiative is a global programme aiming at creating HIV/AIDS competence in all country offices, regional offices and headquarters by end of 2005. We Care is promoted together with initiatives spearheaded by other UN agencies, including 'Caring for Us' by UNICEF, the joint Access to Treatment and Inter-Organisational Needs (ACTION) programme facilitated by the UN Secretariat and the 'HIV/AIDS in the Workplace' initiative by WFP and ILO. (excerpt)
New York, New York, UNDP, . 16 p.We often assume that as UN employees, especially at Headquarters, we are somehow immune. Immune to being infected or affected by HIV/AIDS, immune from stigma and discrimination, immune from needing care, counselling, testing or treatment. But the truth is, we are as vulnerable as everyone else in society, and just like everyone else, we need to make informed decisions when it comes to HIV and AIDS. We need to be educated, we need to know how we can protect ourselves and how we can have a better quality of life if we happen to be living with HIV. We need to know that we have access to care and treatment and the right to confidentiality and non-discrimination in the workplace. In addition, as UN employees we have a special role to play. Before we can share with the world how HIV/AIDS should be addressed, we need to look into ourselves. Are we really that well informed, that sensitive? Can we talk openly to our co-workers about HIV/AIDS? Are we really sure that we will not be stigmatized if we happen to be living with HIV? Are we afraid of working closely with someone living with HIV? Do we discuss our anxieties and concerns within our families, with our partners, friends and co-workers? The We Care initiative addresses these issues. It helps us recognize that HIV/AIDS is not only 'out there' but also among us. And that if we are to create an environment that is empowering and respectful of the rights and responsibilities of every individual, we must first begin with ourselves. (excerpt)
Manila, Philippines, WHO, Regional Office for the Western Pacific, . 71 p.The purpose of this publication is to outline ways of responding to the health needs of ageing populations in developing countries. It focuses on the Western Pacific Region of the World Health Organization (WHO). The aims of the paper are essentially practical in that it seeks to provide health workers with a framework for selecting appropriate ways of approaching the tasks of improving quality of life, disease prevention and health services delivery for older people. Populations in all countries of the Western Pacific Region are ageing – an increasing proportion of people are aged 65 and over. This, together with changing lifestyles, means that there has been a radical shift in the types of health problems facing health workers in developing countries. Increasingly, health policies and programmes will have to address the demands posed by the rapidly emerging epidemic in chronic, noncommunicable, lifestyle-based diseases and disabilities. While these diseases present a challenge for health policy for people at all stages of the life course, they are particularly evident among older people where their impact is more obvious. The growing proportion of elderly people among the population simply highlights the importance of addressing these health problems. (excerpt)
Geneva, Switzerland, WHO, Department of Nutrition for Health and Development, 2003.  p.Malnutrition contributes to an estimated 60% of deaths in under-five children. Typically, the median case fatality rate for severe malnutrition ranges from 30–50%. This has remained unchanged in most settings for the past five decades. However, it is possible to reduce mortality rates substantially by modifying treatment to take account of the physiological and metabolic changes that occur in cases of severe malnutrition. Case fatality rates have decreased to below 5% in treatment centres applying an appropriate management scheme recommended in WHO guidelines. (excerpt)
Emerging Infectious Diseases. 2004 Sep; 10(9):1523-1528.The World Health Organization’s goal for tuberculosis (TB) control is to detect 70% of new, smear-positive TB cases and cure 85% of these cases. The case detection rate is the number of reported cases per 100,000 persons per year divided by the estimated incidence rate per 100,000 per year. TB incidence is uncertain and not measured but estimated; therefore, the case detection rate is uncertain. This article proposes a new indicator to assess case detection: the patient diagnostic rate. The patient diagnostic rate is the rate at which prevalent cases are detected by control programs and can be measured as the number of reported cases per 100,000 persons per year divided by the prevalence per 100,000. Prevalence can be measured directly through national prevalence surveys. Conducting prevalence surveys at 5- to 10-year intervals would allow countries with high rates of disease to determine their case detection performance by using the patient diagnostic rate and determine the effect of control measures. (author's)
Lancet. 2003 Dec 31; 363(9402):71-72.The advent of modern obstetric care has led to the eradication of obstetric fistula in nearly every industrialized country. However, in the developing world obstetric fistula continues to cause untold pain and suffering in millions of women. The very existence of this condition is the result of gross societal and institutional neglect of women that is, by any standard, an issue of rights and equity. In the developing world, obstetric fistula is almost always the result of obstructed labour. During prolonged obstructed labour the soft tissues of the pelvis are compressed between the descending baby’s head and the mother’s pelvic bone. The lack of blood flow to these tissues leads to necrosis and ultimately a hole forming between the mother’s vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal), or both, that leaves her with urinary or faecal incontinence, or both. Early intervention to relieve obstructed labour will restore perfusion to these tissues and, in most cases, will prevent fistula. The results of fistula are devastating. In nearly every case the baby is stillborn. Women and girls with fistula are unable to stay dry. They smell of urine or faeces and are shunned by the community and, at times, even by their own husbands and families. They remain hidden, shamed, and forgotten. (excerpt)
Lancet. 2003 Nov 29; 362(9398):1850-1853.Each year, about 2 million babies are born to HIV-1- infected women. Despite widespread knowledge of proven methods to prevent mother-to-child transmission (MTCT) of the virus, most infants at risk of contracting the infection from their mothers receive no prophylactic intervention. This inaction leads to the infection and ultimate death of about 800 000 children per year. It has been known since 1994 that MTCT is largely preventable, and interventions appropriate for use in the developing world have been available since 1999. Singledose intrapartum and neonatal nevirapine—the simplest and perhaps most effective of the short-course antiretroviral regimens studied—has been available free of charge from the manufacturer since 2000. Nevertheless, few women have access to MTCT-prevention services. In the more than 3 years since its inception, the donation programme has shipped only 189 000 courses of the drug, a tiny fraction (<5%) of the estimate worldwide need. Why this feasible10 and cost-effective intervention has failed to reach so many of the women and infants who need it is a difficult question with no simple answers. Whatever the reasons, we believe that the continued low level of coverage of MTCT-prevention services is no longer acceptable from either a public health or a humanitarian perspective. We argue for a goal-directed approach to scaling-up of such services, in which we first acknowledge that the guiding objective should be to save babies from HIV-1 infection. To meet this objective, it will be necessary in many settings to dissociate the complex business of expanding HIV-1 testing services from the simpler matter of providing nevirapine prophylaxis. (author's)
The second meeting of the Working Group for the Prevention and Treatment of Obstetric Fistula, Addis Ababa, 30 October -1 November, 2002.
New York, New York, UNFPA, 2003. 38 p.Much of the meeting was devoted to presentation of needs assessments from 12 African countries. Nine countries were surveyed by Engender Health; the African Medical and Research Foundation surveyed Kenya; and the Women’s Dignity Project assessed the situation in Tanzania. Dr. Catherine Hamlin and Ruth Kennedy also presented information about the situation in Ethiopia. The assessments provide a clear and informed base—for the first time—on which to build a realistic plan of action to combat fistula in the region. This information should also help to bring the tragedy of fistula out from under its shroud of shame and secrecy. We expect this will result in increased support for many of the best programmes already in place in Africa and in the creation of a regional network for fistula prevention and treatment. (excerpt)
Public Health Reports. 2002 Nov-Dec; 117(6):592.A study, conducted from March to July 2002 by UNICEF and the CDC in conjunction with the Afghanistan Ministry of Health, determined that Afghan women suffer from one of the highest levels of maternal mortality in the world. Almost half of the deaths among women from the ages of 15 to 49 are a result of pregnancy and childbirth. This study, the largest of its kind ever conducted in Afghanistan, was conducted in four provinces in Afghanistan-Kabul, Laghman, Kandahar, and Badakshan-ranging from rural to urban settings. The surveys found that on average there were 1,600 maternal deaths per 100,000 live births in Afghan women. Linda Bartlett, MD-a medical officer with CDC's reproductive health program and the leader of the surveys-stated, "These women are dying needlessly. Most of these deaths could have been avoided, which suggests important opportunities for prevention." The study examined data from 13,000 households, which included an estimated 85,000 women. UNICEF and the CDC recommended the following as a result of the findings of this study: there is a need to establish properly equipped health care services in remote areas and to encourage women's use of such facilities; the need to train skilled female birth attendants; and to rebuild and repair roads to improve access to these facilities. (excerpt)
Perspectives in Health. 2003; 8(2):23-25.Today the Pedro Kourí Institute for Tropical Medicine comprises 52,000 square meters and 700 employees and is Cuba's leading research and training center in infectious diseases, as well as a major player in international efforts to control tropical diseases. Many of the national laboratories of Cuba are housed at the institute, along with the island's only tertiary AIDS clinic and research center. It continues to receive support from TDR as well as Canada, France, Spain, Belgium, the European Union and the Wellcome Trust, among others. (excerpt)
Lancet. 2003 Jul 26; 362(9380):333-334.Despite well documented and successful HIV-prevention programmes in a few countries, the HIV/AIDS epidemic continues to spread in Asia and the Pacific. Moreover, without wishing to detract from the achievements of Cambodia and Thailand, recent developments show that success might be relative. Despite well funded, comprehensive programmes, one in every 100 people in Thailand is infected with HIV, and AIDS has become the leading cause of death in that country. Now is hardly the time to divert much-needed political commitment for confronting the major microbial killers. The diluted sense of urgency about tackling these diseases in the UN report’s sections on policy discussion can be attributed to flawed assumptions underlying the progress analysis. HIV/AIDS and tuberculosis pose clear and present danger to development in the Asia-Pacific region. The UN’s high-profile report is making its way toward the desks of the policy makers in the region. The public-health community has the duty to set the record straight and protect public-health interests. (excerpt)
Unintended consequences: drug policies fuel the HIV epidemic in Russia and Ukraine. A policy report prepared for the UN Commission on Narcotic Drugs and national governments.
New York, New York, Open Society Institute, International Harm Reduction Development program, 2003. 16 p.Taking action now to reduce HIV transmission rates and treat those already infected is critical. With the goal of avoiding adverse effects on social welfare and public health, the Russian and Ukrainian governments should reconsider how they interpret international treaties. Policy changes should be made in the following areas: Harm reduction. The governments should play an active role in establishing and supporting a large, strategically located network of harm reduction programs that provide services for IDUs, including needle exchange, HIV transmission education, condom distribution, and access to viable treatment programs such as methadone substitution. Similar services should be available in all prisons. Education. Simple, direct, and dear information about HIV transmission should be made available to all citizens-especially those most at risk. Similarly, society at large should be educated about the realities of drug use and addiction as part of an effort to reduce stigma. Discrimination and law enforcement abuse. Public health and law enforcement authorities should take the lead in eliminating discrimination, official and de facto, toward people with HIV and marginalized risk groups such as drug users. Authorities must no longer condone or ignore harassing and abusive behavior, including physical attacks, arrest quotas, arbitrary searches, detainment without charges, and other violations of due process. HIV-positive people, including IDUs, should be included in all policy discussions related to them in the public health and legal spheres. Legislation. Laws that violate the human rights of people with HIV and at-risk groups should be repealed or restructured to better reflect public health concerns. Moving forward with the above strategies may make it appear that the governments are backing away from the goals and guidelines of the UN drug conventions. They may be criti- cized severely by those who are unable or unwilling to understand that meeting the goals of the conventions, some of which were promulgated more than 40 years ago, is far too great a price to bear for countries in the midst of drug use and HIV epidemics. Governments ultimately have no choice, though, if they hope to maintain any semblance of moral legitimacy among their own people. (excerpt)
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.
Geneva, Switzerland, World Health Organization, Maternal and Child Health and Family Planning, Division of Family Health, 1990. iv, 59 p. (WHO/MCH/90.11)In February, 1987, the Safe Motherhood Conference was held in Nairobi, Kenya. It was sponsored by WHO, the World Bank, the UN Fund for Population Activities (UNFPA) and joined by UNDP. The Safe Motherhood Initiative was then started. This is a worldwide attempt to reduce maternal morbidity and mortality. The goal is to reduce maternal deaths by at least 1/2 by the year 2000. Partners in the safe motherhood initiative are governments, agencies, nongovernmental organizations (NGOs) and other groups and individuals who want to take part in efforts which will reduce the number of women dying and suffering from childbearing and pregnancy. A combination of health and nonhealth schemes is being used to add to the quality and safety of women's lives. Focus is on the need for more and better maternal health services, the extension of family planning facilities, and instruments that will improve the nutritional, social, and health status of females. Activities of the Safe Motherhood Initiative are reflected in many of the World Health Assembly Resolutions. There has also been a series of WHO Regional Committee resolutions. The major approach to achieve the reduction of maternal mortality and morbidity is actions in 4 areas. The 1st area is addressing social inequities; the 2nd, ensuring family planning access; the 3rd, developing community-based maternity care; and the 4th, providing support and backup at the 1st referral level for women who need obstetric care. Epidemiologic studies have been done, as have operation research studies. Evaluations of the home-based maternal record were completed in 12 countries by the end of 1988. Information analysis and dissemination and advocacy activities are described, as are technical cooperation activities with countries. Also described are human resources development activities and other closely linked program activities. Coordination and cooperation are described in chapter 4. A description of program management and resources is given in chapter 5.
Geneva, Switzerland, WHO, 1988. ii, 119 p.The 6th report of the World Health Organization's (WHO) Control Program (CDD) describes the activities of the program during 1986 and 1987. The program consists of health services, a research component, and information services. Program review bodies are discussed, as are resources and obligations. New publications and documents are listed. 7 appendices are given: 1) diarrheal diseases control--resolution of the World Health Assembly, May 15, 1987; 2) WHO CDD estimates of oral rehydration salts (ORS) access and ORS/oral rehydration therapy (ORT) use rates by country and region, 1986; 3) new research projects supported by the program (from January 1, 1986 to December 31, 1987); 4) publications arising out of program-supported research; 5) collaborating centers; and 6) financial status. Health service program activities include planning and implementation, and training. Also important is increasing the availability of ORT. Health education and communication are important in the health services program. Program progress must be evaluated. The program's research component consists of biomedical and epidemiological, and operational (health) services research. Research projects include improved ORS formulations and ORT; feeding during and after acute disease; drugs in diarrhea therapy; persistent diarrhea; epidemiology of specific diseases; studies on risk factors for diarrhea and related interventions; development, evaluation, and improvement of diagnostic procedures for diarrhea; and development and testing of vaccines. Research also consists of collaborating with industry and other organizations.