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Adverse events after immunisation with aluminium-containing DTP vaccines: systematic review of the evidence.
Lancet Infectious Diseases. 2004 Feb 1; 4(2):84-90.We have reviewed evidence of adverse events after exposure to aluminium-containing vaccines against diphtheria, tetanus, and pertussis (DTP), alone or in combination, compared with identical vaccines, either without aluminium or containing aluminium in different concentrations. The study is a systematic review with metaanalysis. We searched the Cochrane Vaccines Field Register, the Cochrane Library, Medline, Embase, Biological Abstracts, Science Citation Index, and the Vaccine Adverse Event Reporting System website for relevant studies. Reference lists of retrieved articles were scanned for further studies. We included randomised and semi-randomised trials and comparative cohort studies if the report gave sufficient information for us to extract aluminium concentration, vaccine composition, and safety outcomes. Two reviewers extracted data in a standard way from all included studies and assessed the methodological quality of the studies. We identified 35 reports of studies and included three randomised trials, four semi-randomised trials, and one cohort study. We did a meta-analysis of data from five studies around two main comparisons (vaccines containing aluminium hydroxide vs no adjuvant in children aged up to 18 months and vaccines containing different types of aluminium vs no adjuvants in children aged 10–16 years). In young children, vaccines with aluminium hydroxide caused significantly more erythema and induration than plain vaccines (odds ratio 1·87 [95% CI 1·57–2·24]) and significantly fewer reactions of all types (0·21 [0·15–0·28]). The frequencies of local reactions of all types, collapse or convulsions, and persistent crying or screaming did not differ between the two cohorts of the trials. In older children, there was no association between exposure to aluminiumcontaining vaccines and onset of (local) induration, swelling, or a raised temperature, but there was an association with local pain lasting up to 14 days (2·05 [1·25–3·38]). We found no evidence that aluminium salts in vaccines cause any serious or long-lasting adverse events. Despite a lack of good-quality evidence we do not recommend that any further research on this topic is undertaken. (excerpt)
Arlington, Virginia, John Snow [JSI], Family Planning Logistics Management [FPLM], 2000. x, 67 p. (USAID Contract No. CCP-C-00-95-00028-00)This report documents the status of technical assistance provided by the USAID-funded Family Planning Logistics Management project to the Bangladesh Family Planning Program in developing a countrywide contraceptive logistics system. A study conducted in November 1999 to evaluate the impact of technical assistance on logistics management and contraceptive security is detailed. The report concludes with findings from the study, lessons learned, and recommendations to continue improvements in the system. (author's)
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1999; 77(2):176-80.In response to a World Health Organization's Global Advisory Committee on Health Research initiative, a "visual health information profile" was developed that provides a quantitative description of and an assessment of multidimensional aspects of health in a population. The profile uses a hierarchy of indicators, with first-level domains covering: 1) disease conditions and health impairments, 2) the health care system, 3) sociocultural characteristics, 4) environmental determinants, and 5) food and nutrition. Indicators at all levels can be disaggregated. A decile reference method can be used to display indicators by country and to rank performance for specific years, thus allowing country and time comparisons. The circular visual health information profile has radial sectors representing health domains (with sectors representing the indicators in each domain). Scaling is arranged so that situations needing urgent attention are displayed on the periphery. With fixed reference points, comparisons can be made over time. A prototype of this profile is available via the World Wide Web at http://faw.uni-ulm.de/planet/health-profile/circle.html. The profile was evaluated by superimposing indicators for Tunisia for 1994 over those for 1966. Because of the immediate impact of the visual display of information, the profile, which can be applied to indicators at various levels, can contribute to the improvement of public health.
AIDS. 1995 Apr; 9(4):375-82.During 1993, in a squatter community outside Kampala, Uganda, in-depth interviews and administration of WHO's Global Programme on AIDS (WHO/GPA) questionnaire and of a short, direct questionnaire about sexual behavior were conducted among 75 key informants and 246 respondents per questionnaire type, respectively. Observations were made during visits and at schools, youth centers, bars, nightclubs, and brothels. Researchers wanted to evaluate the quality of data on self-reported preventive sexual behavior. Prostitutes had a lower participation rate than the general population (60% vs. 91.3%), suggesting that high risk groups may be unwilling to take part in population surveys. The two strategies using questionnaires yielded similar numbers of reported sex partners and prevalence of condom use. In-depth interviews yielded different results. In-depth interviewing found a higher proportion of persons having non-regular sexual intercourse during the last 12 months than did the population surveys (e.g., men, 45.5% vs. 33.9-35.3%; female prostitutes, 87.1% vs. 50-59.4%). It found a higher proportion of men reporting condom use during last casual sexual intercourse than did the population surveys (70% vs. 51.4-54.3%). It also found a lower proportion of non-prostitutes using condoms during last sexual intercourse than the surveys (14.3% vs. 26.7-38.5%). These findings indicate that the WHO/GPA questionnaire may not be able to identify people at high risk of AIDS and sexually transmitted diseases. Yet it is the most realistic and cost-effective choice. Small qualitative studies (e.g., in-depth interviews and observations) should complement longer questionnaires (e.g., WHO/GPA) designed to evaluate HIV interventions in the general population to identify and iron out biases in interpreting results.
In: International Population Conference / Congres International de la Population, Montreal 1993, 24 August - 1st September. Volume 1, [compiled by] International Union for the Scientific Study of Population [IUSSP]. Liege, Belgium, IUSSP, 1993. 477-82.The definition of morbidity, its measurement, and the data collecting techniques commonly used are presented. Morbidity measures must be interpreted in a way that: 1) common definitions of good health and of morbidity must be used; 2) the measures of morbidity must be explained; and 3) the data collection technique employed in assessment of the morbidity state are also examined. WHO has defined health as not merely the absence of disease but includes social and mental well-being. The distinction between disease and illness derives from the contrast between biomedical definitions and culturally determined phenomena. The International Classification of Impairments, Disability and Handicaps (ICIDH) is the framework for classification of disease using 3 levels of disease consequences: impairment, disability, and handicap. The classification allows for assessment of functional activities at the personal level. These include behavior, communication, and personal care. Handicapping conditions deal with disadvantages that limit fulfillment of a normal role. The classification allows for a variety of rates to be calculated for specific age and sex groups. One paper dealt with morbidity causes and morbidity derived from signs, symptoms, laboratory test results, health examination, and medical records. Individual factors for selecting use of health service include accessibility, availability, and the socioeconomic status of the individual. Qualitative techniques employed include observational methods, focus group interviews, and in 2 depth interview. Cultural conceptions of illness in the measurement of morbidity and local ethnomedical classification of illness must be considered. The commonly employed quantitative method is the large-scale household survey. Comparison of the results of diarrhea prevalence by the Demographic Health Survey and CDD/WHO survey found that a close agreement between the 2 figures occurred in only 1 country. There is a marked contrast between medically defined morbidity and mortality reported by a person interviewed.
Report of the Meeting on Strategies for the Evaluation and Implementation of Laboratory Diagnosis of HIV Infection, Geneva, 31 August - 2 September 1988.
[Unpublished] 1989. 6 p. (WHO/GPA/BMR/89.2)A World Health Organization (WHO) meeting was held to review strategies for WHO activities in the laboratory diagnosis of HIV infection, and to propose feasible, practical ways of implementing recommendations from the Stockholm, 1987, meeting on "criteria for evaluation and standardization of diagnostic tests for detection of HIV antibody." The meeting commended efforts made over the previous 8 months by the WHO global program on AIDS in evaluating new test systems, training laboratory workers, and monitoring test performance. The paper reports recommendations regarding choice of test, training, quality control procedures, and research.
Incentives, disincentives, and family planning: selective bibliography for countries in the ESCAP region: annotated.
[Unpublished] 1987 Jan. 141 p.This is a first draft of an annotated bibliography on incentives and disincentives in family planning programs in the ESCAP region. Each entry contains fields for author, title, citation, type (type of study), country, sponsor, recipient, positive or negative, form (type of incentive), structure (graduated or fixed), timing, objective (use, space or limit), and effect measures (observed endpoint). The annotation consists of an abstract or condensed conclusion in most cases. Over 100 documents are reviewed.
Arlington, Virginia, International Science and Technology Insitute, Population Technical Assistance Project, 1987 Jul 15. ix, 66,  p. (Report No. 86-099-056)This evaluation of the village family planning program in Indonesia is prepared for USAID, which has supported the program for 15 years, and is to complete support in 1986. It is in general a positive evaluation, prepared by interviews, and visits to 7 out of 27 Provinces, 14 out of 246 Kabupatens (Districts), and 16 Villages. Village distribution centers have increased 38%, new acceptors by 38%, continuing user levels by 57%, and overall contraceptive prevalence by 38%. Access to varieties of contraceptives, especially longer acting methods, has improved, and costs per capita have decreased. Some problems were pointed out, generating several recommendations: physical conditions of the clinics need attention; motivation by consciousness raising has not been matched by better knowledge; the surgical program needs to be expanded; self-sufficiency in cost recovery should be fostered; operations research is needed on payment for field workers and volunteers; and social marketing should be expanded. USAID should continue support for the Outer Islands. In a final list of recommendations were the suggestions that USAID assist clinical programs further, support training of field workers, do more statistical review, continue to support the IEC program, operations research on community-based distribution, and program integration.
General lessons learned from evaluations of MCH/FP projects in Botswana, Malawi, Swaziland and Zambia.
New York, New York, UNFPA, 1984 Dec. iv, 41 p.4 maternal-child health/family planning (MCH/FP) projects were evaluated by the United Nations Fund for Population Activities (UNFPA) in the Southern Africa Region between 1981-1984. The projects were in Botswana, Malawi, Swaziland and Zambia. An overriding finding at the time of the Evaluation Missions was the acceptance of family planning (child spacing) by all 4 governments, when at the onset of the projects, family planning was either not included in the project documents or was included only as a minor contributant to the MCH programs. The intervention by UNFPA was very important for the acceptance and promotion of family planning activities by the governments. The Evaluation Missions concluded that there were 3 primary reasons for the successful intervention: UNFPA has a broad mandate to provide assistance in MCH and FP, a commitment to development projects in line with the governments' priorities, and the ability to fund projects very quickly, facilitating project implementation. Each of the 4 projects is assessed in terms of population policy changes, MCH/FP program strategy and serive delivery, organization of the MCH/Fp unit, health education, training, evaluation and research systems, and administration and management. Essential factors affecting the project are outlined and recommendations made. The last section discusses general lessons derived from the MCH/FP projects evaluated. 5 areas are identified where similar problems exist to varying degrees in all the projects evaluated. These are: training of medical personnel in FP (the main MCH/FP service provider in these projects was the nurse/midwife); supervision of personnel and the supply and distribution of contraceptives; research and evaluation, especially regarding the sociocultural setting of target populations and the inadequacy of existing service statistics and other sources of data; project monitoring (technical and financial) and finally project execution by the World Health Organization (WHO). Specifically in regard to the recruitment of experts, the provision of supplies and equipment, and the provision of funds for local costs, WHO execution has been deficient.
In: The Graduate Education of Foreign Physicians in Public Health and Preventive Medicine. The Role of United States Teaching Institutions, edited by Wendy W. Steele and Sally F. Oesterling. Philadelphia, Pennsylvania, Educational Commission for Foreign Medical Graduates, . 29-31.This presentation focuses on the changing role of US schools of public health over the past 60 years and covers predictions and trends of future changes. Foreign physician graduates of US schools of public health were not only responsible for founding the WHO, but have also served in positions such as director-general of WHO. Since World War II there has been an increase in foreign students trained in US schools of public health. Between 1965 and 1981 the number of foreign students increased from approximately 250 to about 700/year, and by 1983 the foreign student enrollment in US schools of public health had reached almost 1200. Most of the increase comes from heavily populated countries in Asia and in Africa. India was the country of origin for an average of 24 public health students in the US during 1967-68, but this number declined to 16 by 1977-78 and 1981. Nigeria significantly increased the number of trainees sent to the US from 5 students in 1967-68 to 54 in 1981. Although the total enrollment of foreign students has more than tripled since the 1960s, the % of foreign students in US schools of public health has dropped from over 20% in the early 1960s to about 13% in 1983. A review of all Johns Hopkins medical graduates shows that 75% of over 700 foreign medical graduate students live in their countries of origin, and only 14% live in the US. In general, the number of students from each country reflects that country's need. Assuming adequate levels of financing, US schools of public health should assist in the development of a sufficient number of schools of public health in their countries to meet those countries' needs for public health professionals.
Washington, D.C., USAID, 1979 Dec. 246 p. (A.I.D. Program Evaluation Report No. 1.)USAID sponsored a workshop in April 1979 to identify from research and experience the circumstances under which direct family planning services or developmental activities are most effective in reducing population growth in specific developing countries. Background papers prepared for the workshop on family planning efforts in Java, Colombia, and Thailand showed that family planning alone, without socioeconomic developmental additions, had lowered fertility levels significantly. However, these programs did not consider other factors which might have been responsible as well. Most of the crosscultural studies which have been done show that family planning and development activities taken together will have the greatest impact of fertility declines. Political commitment to these programs is necessary. Such commitment facilitates localized family planning activity, the most effective delivery system system. Administrative capability and socioeconomic/cultural acceptability of family planning are factors of major importance also. The workshop examined experience and made projections as to whether various countries, based on certain demographic and socioeconomic trends, will be able to achieve annual crude birth rates of 20/1000 by the year 2000. Countries were classified as certain, probably, possible, and unlikely. Flexibility of approach is urged.
[Unpublished] 1983. Presented at the 1983 Annual Meeting of the Population Association of America, Pittsburgh, April 14-16. 35 p.In 1950 fertility levels in the developing countries were high. The crude birthrates (CBRs) were about 47 in Africa, 42 in the Americas, and 41 in Asia and the Pacific. In Asia and the Pacific, several countries are thought to have had fertility rates between 35-40/1000. In Latin America, Argentina, Cuba, and Uruguay the birthrates were less than 30/1000 and between 30-35/1000 in Chile and Jamaica. No country in Africa was reported to have had a rate below 40 with the sole exception of Gabon which is reported to have had a crude birthrate between 30-35/1000, not only in 1950 but this remained unchanged up to 1980. By 1965 there had been a little change in several countries but virtually no change at all in Africa. During the next 15 years the situation changed markedly in Asia and the Pacific with the crude birthrate decreasing by almost 1/4, from a little more than 39 to 30. There was a similar but slightly smaller decrease in Latin America, a decrease from 40-32, or about 20%. In Africa there was virtually no change. Many scholars and laypersons concerned about the rapid rate of population growth have expressed the view that population policies have been slow to develop. By 1980, 39 countries with a population of 2.6 billion or 78% of the population of all developing countries had adopted official policies to reduce the population growth rate. Many of these policies are without substance but a fairly large number of the countries have developed substantial population programs, as well as policies to reduce rates of population growth. There were an additional 33 countries with a total population of 554 million that had no demographic policy to reduce rates of population growth but nonetheless gave officcial support to family planning activities. Prior to 1960 only India had a population policy to reduce rates of population growth but during the 1960-64 period 4 additional countries in Asia and the Pacific adopted such policies, namely China, Korea, Pakistan, and Fiji. It was not until 1965 and after that African and Latin American countries adopted such policies. The annual number of family planning acceptors in large scale programs increased from a few tens of thousands around 1960 to about 2 1/2 million in 1965 and to approximately 25 million in 1980, excluding China, for which quantitative data are less readily available. In some countries contraceptive prevalence rates remain low after many years of a national family planning program, e.g., Ghana, Kenya, Morocco, and Bangladesh. Various macroeconomic studies, using countries as units, have found that both socioeconomic and population programs have important effects on fertility decline. UN projections (medium variant) to 2000-2005 assume a continuation of fertility decline in less developed countries (LDCs), including the start of decline in black Africa and Arab countries. Even if the UN projections are consistent with the realities of the years ahead, there is enormous population growth ahead.
Report on the evaluation of UNFPA assistance to population education projects executed by the ILO in Nepal: NEP/74/PO1--population education in the organised sector and NEP/77/PO2--population education through panchayats, cooperatives and training institutions (November 1982).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1983 Dec. vi, 61,  p.2 projects financed by the the United Nations Fund for Population Activities (UNFPA) and implemented by the Nepalese Government with the International Labor Organization (ILO) as the executing agency are reviewed. The projects are assessed, conclusions drawn and recommendations made in terms of the achievement of the country level project objectives, training and educational activities undertaken, and information education and communication (IEC) materials produced for population education projects, the to which projects have been integrated into relevant country level programs and into Maternal-Child health/Family Planning (MCH/FP) programs, the strategies used and the impact on the various target populations. Part I deals in general with the immediate objectives of the projects; part II goes into more detail on project plans, implementation and achievements. The basis of the Population Education in the Organization Sector project was the development of worker motivators who would promote family planning. The overall plan was for seminars to arouse awareness, support and commitment at the national level, regional seminars for local managements, regional tripartite and plant bipartite committees to develop and sustain local awareness, to encourage practical management support at the local level. The project was carried out successfully in terms of the original plan and work schedules. However, there were deficiencies in the original project design (e.g., combining the industrial sector, the cooperative sector and women under 1 project); objectives were not well formulated and little attention was paid to them after the project started. Review and evaluation aspects of the management of the project were neglected and follow-up was thus deleteriously affected. Recommendations focus on attempts to consolidate and institutionalize the achievements of the project. The target groups of the 2nd project were the leaders and officers in the Department of Cooperatives and in the Ministry of Panchayat and Local Development, the members of cooperative societies and community leaders. The project was designed to contribute to the implementation of the national population program by institutionalizing the provision of population education on a continuing basis to rural families through the work-related training network of the named organizations. For the most part, the objectives for the cooperative sector have been met: a significant number of cooperative officers are more aware of population issues and population education is part of the staff's regular curriculum. Many quantitative targets were met. However, some of the qualitative aspects of activities could be improved and the commitment to the population education program by the Cooperative Department must be translated into manpower and budgetary allocations that will provide the necessary means for continued activity.