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Designing HIV testing algorithms based on 2015 WHO guidelines using data from six sites in sub-Saharan Africa.
Journal of Clinical Microbiology. 2017 Oct; 55(10):3006-3015.Our objective was to evaluate the performance of HIV testing algorithms based on WHO recommendations, using data from specimens collected at six HIV testing and counseling sites in sub-Saharan Africa (Conakry, Guinea; Kitgum and Arua, Uganda; Homa Bay, Kenya; Douala, Cameroon; Baraka, Democratic Republic of Congo). A total of 2,780 samples, including 1,306 HIV-positive samples, were included in the analysis. HIV testing algorithms were designed using Determine as a first test. Second and third rapid diagnostic tests (RDTs) were selected based on site-specific performance, adhering where possible to the WHO-recommended minimum requirements of 99% sensitivity and specificity. The threshold for specificity was reduced to 98% or 96% if necessary. We also simulated algorithms consisting of one RDT followed by a simple confirmatory assay. The positive predictive values (PPV) of the simulated algorithms ranged from 75.8% to 100% using strategies recommended for high-prevalence settings, 98.7% to 100% using strategies recommended for lowprevalence settings, and 98.1% to 100% using a rapid test followed by a simple confirmatory assay. Although we were able to design algorithms that met the recommended PPV of 99% in five of six sites using the applicable high-prevalence strategy, options were often very limited due to suboptimal performance of individual RDTs and to shared falsely reactive results. These results underscore the impact of the sequence of HIV tests and of shared false-reactivity data on algorithm performance. Where it is not possible to identify tests that meet WHO-recommended specifications, the low-prevalence strategy may be more suitable.
[Prevalence of HIV infection and associated factors in the Central African Republic in 2010] Prévalence de l’infection VIH et facteurs associés en République Centrafricaine en 2010.
Calverton, Maryland, ICF International, 2012 Apr.  p.Nearly 68 percent of all HIV-positive individuals worldwide live in Sub-Saharan Africa. The region remains the most severely affected in the world, even though only 12 percent of the world's population lives there. Central Africa, which is less afflicted than Southern and Eastern Africa, nevertheless has a high enough level of infection for it to be characterized as a generalized epidemic. This is the case in the Central African Republic. The Central African Republic has long lacked reliable data on the epidemic, which has slowed the national response that otherwise would have occurred with more factual data. In response to the perceived need, the United Nations Population Fund (UNFPA), World Bank, World Health Organization (WHO), and Joint United Nations Program on HIV/AIDS (UNAIDS) have financed HIV testing in two multiple indicator cluster surveys--the 2006 MICS and 2010 MICS. This partnership has led to collection of reliable data to monitor trends in HIV prevalence and distribution among the population age 15 to 49. Also monitored are distribution of the epidemic by geographic region and population group. Because the decrease in HIV prevalence between 2006 and 2010 will be interpreted as an encouraging sign of progress, it is important to remain vigilant. The disaggregated results show that the epidemic continues to grow in scope and provokes disastrous consequences in certain groups. For the first time since 2006, the Central African Republic has reliable data to inform decision-making and intervention planning. These data have permitted the pandemic areas in the Central African Republic to emerge from the shadows. For the future, we wish to put in place systematic HIV testing similar to that of the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS). The UNFPA office in the Central African Republic is committed to improving knowledge about HIV and reinforcing the availability of information for planning, implementation, and follow-up of the country's National Strategic Plan for the Fight against AIDS.
Journal of Human Lactation. 2010 Aug; 26(3):297-303.The objective of this study was to translate and psychometrically assess a Portuguese version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). The original English version of the BSES-SF was translated to Portuguese and tested among a sample of 89 mothers in southern Brazil from the 2nd to 12th postpartum week followed by face-to-face interviews. The mean total score of the Portuguese version of the BSES-SF was 63.6 +/- 6.22. The reliability analysis of each item in the scale attained significant Cronbach's alphas of 0.63 or superior. The Cronbach's alpha generated by the entire range of 14 questions was 0.71. A factor analysis identified one factor that contributed to 20% of the variance. This study demonstrates that the original English version of the BSES-SF was successfully adapted to Portuguese. The Portuguese version of the BSES-SF constitutes a reliable research instrument for evaluating breastfeeding self-efficacy in Brazil.
Research Triangle Park, North Carolina, FHI, 2008.  p.In order to help nonmenstruating clients safely initiate their method of choice, Family Health International (FHI) developed a simple checklist for use by family planning providers. Although originally the Pregnancy Checklist was developed for use by family planning providers, it can also be used by other health care providers who need to determine whether a client is not pregnant. For example, pharmacists may use this checklist when prescribing certain medications that should be avoided during pregnancy (e.g., certain antibiotics or anti-seizure drugs). The checklist is endorsed by the World Health Organization (WHO) and is based on criteria established by WHO for determining with reasonable certainty that a woman is not pregnant. Evaluation of the checklist in family planning clinics has demonstrated that the tool is very effective in correctly identifying women who are not pregnant. Furthermore, recent studies in Guatemala, Mali, and Senegal have shown that use of the checklist by family planning providers significantly reduced the proportion of clients being turned away due to menstrual status and improved women's access to contraceptive services.
Lancet. 2007 Dec 1; 370(9602):1802.Ahead of World AIDS Day on Dec 1, UNAIDS released their annual global HIV/AIDS estimates for 2007. The new revised data show that the global HIV prevalence has leveled off and that the number of new infections has fallen from 40 million estimated last year to 33.2 million, in 2007. However, with 6800 new infections and 2500 deaths every day, AIDS is still a leading killer globally and remains one of the primary causes of death in Africa, especially in sub-Saharan Africa. The downward revision is largely due to improved methodology, an increase in sentinel surveillance sites and population-based household surveys, and changes in key epidemiological assumptions used to calculate the estimates. Revised figures for India account for much of the decrease, followed by several sub-Saharan African countries, including Nigeria, Mozambique, Zimbabwe, Kenya, and Angola. For the first time the report also documents the progress being made by prevention and treatment programmes as seen by a decline in new infections in some countries and a reduction of mortality and improvement of life expectancy in others. (excerpt)
Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study.
BMJ. British Medical Journal. 2006 Jul 15; 333(7559):124.The objective was to assess the reliability of self reported form of female genital mutilation (FGM) and to compare the extent of cutting verified by clinical examination with the corresponding World Health Organization classification. Design: Cross sectional study. Settings: One paediatric hospital and one gynaecological outpatient clinic in Khartoum, Sudan, 2003-4. Participants: 255 girls aged 4-9 and 282 women aged 17-35. Main outcome measures: The women's reports of FGM the actual anatomical extent of the mutilation, and the corresponding types according to the WHO classification. All girls and women reported to have undergone FGM had this verified by genital inspection. None of those who said they had not undergone FGM were found to have it. Many said to have undergone "sunna circumcision" (excision of prepuce and part or all of clitoris, equivalent to WHO type I) had a form of FGM extending beyond the clitoris (10/23 (43%) girls and 20/35 (57%) women). Of those who said they had undergone this form, nine girls (39%) and 19 women (54%) actually had WHO type III (infibulation and excision of part or all of external genitalia). The anatomical extent of forms classified as WHO type III varies widely. In 12/32 girls (38%) and 27/245 women (11%) classified as having WHO type III, the labia majora were not involved. Thus there is a substantial overlap, in an anatomical sense, between WHO types II and III. The reliability of reported form of FGM is low. There is considerable under-reporting of the extent. The WHO classification fails to relate the defined forms to the severity of the operation. It is important to be aware of these aspects in the conduct and interpretation of epidemiological and clinical studies. WHO should revise its classification. (author's)
BMJ. British Medical Journal. 2005 Jan 22; 330: p..In their critique of procedures of the World Health Organization for analysing and presenting health statistics, Murray et al make a series of misleading statements about monitoring and evaluation of tuberculosis. Ironically, part of the reason that they can criticise WHO's tuberculosis statistics is that, by design, WHO is completely open about the process of gathering, analysing, and presenting data. We refer to just three issues among many more. Firstly, it is untrue that no affordable and feasible methods are currently available to assess tuberculosis in a community. China, India, and other countries have carried out a series of large scale population surveys of infection and disease that have shown, or have the potential to show, the impact of their tuberculosis control programmes. Secondly, after years of exposure to these statistics, Murray et al still do not seem to understand the meaning of basic indicators, such as case detection, and how they are used in planning and evaluation. These indicators are fully explained in our annual report. (excerpt)
[Lactation-induced amenorrhea as birth control method] Lactatieamenorroe als geboorteregelingsmethode.
NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE.. 1998 Jan 10; 142(2):60-2.In 1966 WHO published a document on improving access to quality care in family planning, which who pronounced to be a fundamental human right. According to this document, despite the assortment of reliable contraceptives worldwide 350 million people have unmet need for contraception because of lack of access or availability. Adequate reproductive health depends not only access to contraceptives, but also on adequate screening and treatment of anemia, sexually transmitted diseases, and cervical carcinoma. Among 8 groups of birth control methods studied, the lactational amenorrhea method (LAM) was dealt with in detail. The underlying mechanism lies in the stimulation that breastfeeding brings about and in breastfeeding's suppression of the release of gonadotropin- releasing hormone and of dopamine (the prolactin inhibiting factor). A 1974 investigation in Rwanda demonstrated that 50% of rural women who breast fed their children frequently got pregnant within 23 months of childbirth and that 50% of city women became pregnant 9 months postpartum. The Bellagio consensus has stated that LAM provides 98% protection against pregnancy in the first 6 months postpartum as long as breast feeding is the exclusive feeding method practiced. A 1992 analysis of 9 prospective studies reported that 6 months postpartum only 0.7% of the women using LAM became pregnant. LAM still plays a crucial role in Africa, where the average number of children per woman is 6. Without breastfeeding the estimated figure would be 10.
Madison, Wisconsin, Midwest Universities Consortium for International Activities, Environmental and Natural Resources Policy and Training Project [EPAT/MUCIA], 1994 Jun. , 15 p. (Working Paper No. 12)Population-related policy-makers should pay attention to the weaknesses in the data bases used to project population. Country variations, particularly in developing countries, are reflected in data deficiencies in birth and death registration and migration. Variations may be affected by higher rates of marriage, declines in sexually transmitted diseases, or reduced breast-feeding practices. The reliance on a single projection may appear easier, but alternative plans may be necessary as an appropriate response to the lack of certainty in projections. The medium estimate may be best used as a target for family planning or development, but plans must proceed for development of employment, services, infrastructure, and environmental quality due to population increases. Demographers should be wary of labels such as "most likely." Disseminating agencies should invest in data quality improvements, institutionalize surveys and alternate focuses, and develop more complex models. The UN's population projections show 31 countries that had constant fertility between 1960 and 1990, but reduced medium projections in population with reduced fertility of three to four children per woman over the next 30 years. How this is possible with no statistical evidence of decline makes the projection questionable. Declines in world population stagnated during the 1980s due to limited declines in fertility in India and China and the end to new fertility declines in other countries. Age structure has contributed to high birth rates, which offers the most hope for fertility change in the future. The medium UN projection for 2100 is rather optimistic if it assumes Chinese fertility will be below replacement level early in the century. Even the chief of the UN Population Division has considered that the high variant projections are more plausible than the medium variants. The US Census Bureau's projections may be considered high but are really reasonable middle projections. The UN and the World Bank revise projections every two years. Inherent in UN projections is the fallacious assumption that an orderly process will prevail without war, famine, or new epidemics.
The poor quality of official socio-economic statistics relating to the rural tropical world: with special reference to South India.
MODERN ASIAN STUDIES. 1984; 18(3):491-514.Statistics relating to the sizes of farm-holdings, the output and yield of crops, household income and expenditure, occupation, cattle ownership, and the sizes of villages were considered, and some features of the Karnataka population census were criticized. The main reason for the extremely poor quality of so many official socioeconomic statistics relating to the rural tropical world is the failure to realize that statistical procedures are based on conditions peculiar to advanced countries. The All-India National Sample Survey is a rare example of a wasted exercise which runs into several hundred separate reports. Because of the inevitable unreliability of most statistics it should be assumed that all statistics covering whole countries or large states, which relate to agricultural yields, crop values, and production, are bound to include a large element of estimation. Organizations like the UN Food and Agricultural Organization (FAO) should provide some information on the basis of estimates, and statistical tables without notes should not be published, such as the regular Statistical Bulletins of the FAO. Far fewer figures of far higher quality should be produced. Owing to the diversity of agrarian systems, very few economic generalizations (any presumed inverse relationship between crop yield and size of farm-holding) can be of universal application. Organizations like the FAO should advise tropical countries that it is wasteful to collect statistics that are considered conventional in advanced countries because of the nature of their agrarian systems and systems of land tenure. Instead of estimating the proportions of households below poverty levels, economic indicators of living standards, such as agricultural wage rates and determinants of the distribution of household farmland, should be identified.
AIDS WEEKLY. 1994 Oct 10; 12-3.The World Health Organization (WHO) estimates that more than half a million people in Africa had AIDS in 1993 alone. According to the WHO, another 10 million Africans now carry HIV, including more than half a million in Nigeria. But some Nigerian scientists charge that their counterparts in the industrialized world deliberately inflate the figures to create the impression that Africa is as poor in health as it is economically. On the other hand, some feel AIDS has been killing more people in Nigeria than official reports show. Professor Akande Abdulkarim, a biochemist of the University of Khartoum, Sudan, argued that AIDS is not as pandemic as the Western scientists maintain. Abdulkarim wondered how AIDS, first discovered among homosexual communities in the United States, had suddenly become an African scourge. He added that body slimness as one of the manifestations of AIDS could be deceitful since Africa has about 11 diseases which cause weight loss, including tuberculosis. Since the discovery of AIDS, Nigerian health officials have alerted the nation, quoting very high figures even though not many people go for AIDS screening in the country. The Health and Social Services Minister announced early in 1994 that AIDS prevalence had risen from 300 reported cases in 1992 to 962 in 1993. More than 600,000 Nigerians had tested HIV-positive since 1986, when the disease was first diagnosed in the country. As of December 1993, only 100 Nigerians were officially deemed to have died from AIDS. But another scientist cautioned Nigerians against being deluded by the low AIDS-mortality figure reported; the low death rate was misleading because some deaths have been wrongly attributed to some other ailments.
POPULATION AND DEVELOPMENT REVIEW. 1994 Jun; 20(2):413-21.A comparison was made between maternal mortality rates published by the World Bank in its World Development Report (WDR), 1993, with 1988 data and the UN's Human Development Report (HDR), 1993. Both data sources claimed the data was based on World Health Organization (WHO) data, but the two sets of figures were different. When rate differences of 50 points were taken to be exactly the same, HDR gave higher values for 26 countries, lower values for 12 countries, and the same values for 17 countries compared to WDR. Even the averages were different. HDR gave an average maternal mortality rate of 393/100,000 births for 55 countries, and WDR gave a figure of 346/100,000. When the data were weighted for the estimated number of married women in each country, the figures were 260 for HDR and 231 for WDR. The correlation coefficient between the two values was 0.70 or an R2 = 0.50. There was a less significant relationship between the two values for 23 countries with high maternal mortality rates (>450 in HDR); R2 = 0.18. The data in each volume were reported exactly the same or similarly as in the case of time period. WDR reported that data ranged from 1983 to 1991 by country, and HDR stated that data were of uncertain unreliability. A comparison of the WHO's Maternal Mortality: A Global Factbook, 1991, and WHO's definition according to the 9th and 10th Revisions of the International Classification of Diseases (ICD) indicated some variance with the WDR definition. The WHO definition was given in full with the notation that the ICD 10th revision included pregnancy-related death within 42 days of the end of pregnancy and regardless of the cause of death. WHO did not produce its own figures, but based its figures on prior studies and statistics. Reliability of maternal mortality rates is dependent on reliable maternal mortality and birth data. Reporting anomalies are footnoted, where extremely divergent from actual mortality. A comparison of WHO published figures and HDR and WDR figures indicated that, for Benin, WHO and WDR agreed on a rate of 161, while the HDR figure of 800 was close to an 809 figure based on a hospital study, which not representative. There were differences in the two data sets in the countries selected for inclusion, and the reasons were not apparent. The suggestions were to liberally use technical notes, to coordinate and agree on international publication of figures, and to provide the best estimate from a wide range of estimates and qualify with a footnote.
WHO international quality assessment scheme for HIV antibody testing: results from the second distribution of sera.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1992; 70(5):605-13.The WHO international quality assessment scheme for human immunodeficiency virus (HIV) antibody testing has been established to monitor the quality of laboratory performance in testing for antibodies to HIV. Following a small trial distribution of specimens early in 1989, the second distribution was made in February 1990. A total of 20 specimens of sera, 10 of which contained antibodies to HIV-1, were sent to 103 laboratories located in the 6 WHO Regions. Participants were asked to report to WHO their findings on each specimen for each diagnostic assay used and their interpretation of the HIV antibody status of each specimen. For the antibody-positive specimens; 98.2% of the results were interpreted as positive and 1.8% as indeterminate; no false-negative interpretations were reported. For their antibody-negative specimens, 90.3% of the results were interpreted as negative, 1.3% as positive, and 8.4% as indeterminate. Most of the indeterminate reports were associated with one particular specimen. A wide variety of diagnostic assays and combinations of assays were used. In terms of the technical results obtained rather than their interpretation, the assays appeared extremely reliable for the positive specimens, with 99.5% of assay results being recorded as positive, 0.17% as negative, and 0/34% as indeterminate. There were more errors associated with the negative specimens: 93.5% of assay results were recorded as negative, 3.5% as positive, and 3% as indeterminate. However, ;61% of the false-positive and indeterminate assay results obtained with the negative specimens were associated with only 2 specimens. There were considerable variations in the Western blot patterns reported and a variety of different interpretative criteria were applied to them. (author's)
AFRICA HEALTH. 1992 Jul; 14(5):10-1.An update on clinical aspects of HIV in africa highlights new proposed clinical definitions of adult AIDS and of tuberculosis in HIV+ adults, and staging of adult HIV infection. The 1986 WHO clinical definition of AIDS has been widely used in Africa, but now research suggests that this definition has several limitations: the definition will pick up several unrelated diseases such as diabetes mellitus and renal failure. It does not ascertain cases of AIDS marked by nonopportunistic infections. Most persons with pulmonary tuberculosis may be wrongly diagnosed with AIDS by this definition. The study showed that the WHO clinical definition has good specificity and positive predictive value for HIV+ people, but its positive predictive value fell to 30% in identifying people with AIDS in Africa. New definitions should take into account any serious morbidity, tuberculosis, neurological disease, both endemic localized Kaposi's, and aggressive typical Kaposi's sarcoma, and HIV serological testing. Tuberculosis is a problem because few HIV+ people suspected of having pulmonary TB (sputum-negative TB) actually have it based on bronchoscopy, while HIV+ persons with TB experience high mortality, often from pyogenic bacteremia. HIV+ persons with TB suffer high rates of relapse, possibly related to insufficient drug treatment or reinfection. 1 study showed that 6 months of isoniazid significantly improved incidence of TB over 30 months of follow-up. Staging of AIDS in Africa based on degree of immunosuppression was proposed as: 1) clinically inapparent HIV infection marked by pulmonary TB, soft tissue infections, and community acquired pneumonia; 2) lymphadenopathy, oral thrush, widespread pruritic maculopapular rash, herpes zoster, enteric illness, dysentery, and Kaposi's sarcoma; and 3) HIV wasting syndrome, chronic pulmonary disease, meningitis, and fever of unknown origin.
Estimates of long-term immigration to the United States: moving U.S. statistics toward United Nations concepts.
DEMOGRAPHY. 1992 Nov; 29(4):613-26.U.S. immigration data are revised to reflect the U.N. demographic concept of long-term immigration. Long-term immigration is measured by the number of new immigrants (permanent resident aliens) arriving in the year, temporary migrant arrivals (nonimmigrants) who subsequently adjust to permanent resident status, arrivals of asylees and refugees, and nonimmigrants who arrive during the year and stay for more than twelve months before departing. The estimates of long-term immigration for 1983 are compared to official INS statistics on alien immigration. Significant differences emerge according to country of origin, age, and state of intended residence. A method of producing current estimates of long-term immigration is illustrated. This is a revised version of a paper originally presented at the 1990 Annual Meeting of the Population Association of America. (EXCERPT)
CONTRACEPTION. 1992 Apr; 45(4):363-8.Researchers analyzed interview and physician records' data on 45 women with breast cancer (cases) admitted to the Central Institute of Cancer Research in Berlin, East Germany between November 1982-June 1986 and born in 1983 or later and 194 women (controls) admitted to the Klinikum Berlin-Buch also in East Germany for conditions other than breast cancer to compare recall accuracy in women who had ever used an IUD. These women were drawn from case control study of the relationship between breast cancer and oral contraceptive use was part of the WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Agreement between patient recall and physician records was exceptional for duration of IUD use (p<.001), number of IUD episodes (kappa=0.79), time since 1st IUD and time since last IUD use (p<.001). Agreement rates did not differ between cases and controls. 75% of the women could not name the IUD brand used so the researcher could not examine agreement of brand name. Thus, other than brand name, this study showed that validity of information on IUD use obtained from interviews is significant. In fact, it also pointed out that case control studies probably yield sound relative risk estimates.
[Unpublished] 1991. Presented at the Society for Epidemiologic Research 24th Annual Meeting, Buffalo, New York, June 11-14, 1991. 12,  p.Health workers use anthropometry to determine the nutritional status of children. The accepted international growth reference curves provide the bases for the indices which include weight for height (W/H), height for age (H/A) and weight for age (W/A). Health workers must interpret these indices with caution, however. For example, W/H and H/A represent different physiological and biological processes while W/A combines the 2 processes. Further Z-scores, percentiles, or percent of median may be used as the scale for the indices and each scale has different statistical features. Specifically, Z-scores and percentiles acknowledge smoothed normalized distributions around the median, but the percent-of-median ignores the distribution around the median. Some researchers suggest using Z-scores rather than percentiles or percent-of-median since statisticians can interpret them more clearly and can calculate the proportion of children in the reference population who fall above or below a cut off point more easily. This cutoff should be only used to screen children who are likely to be malnourished since not all children below a cutoff are indeed malnourished. Some researchers have identified a leading limitation of the CDC/WHO based indices. A disjunction exists where the 2 smoothed based curves based on a population of <36 month old children from Ohio (longitudinal data) and another population of 2-18 year old children (cross sectional health surveys) meet. Further there is a reduction in age specific prevalences at 24 months. Thus some researchers recommend that anthropometry data be presented on an age specific basis, if age information is accurate. They further suggest that, if comparing data from different geographic areas, researchers should standardize age to have a summary measure. If age is not known the W/H summary measure should include 2 groups: <85 cm and =or+ 85 cm.
The collection, analysis and transmission of population policy data at the United Nations Secretariat.
In: International transmission of population policy experience. Proceedings of the Expert Group Meeting on the International Transmission of Population Policy Experience, New York City, 27-30 June 1988, [compiled by] United Nations. Department of International Economic and Social Affairs. Population Division. New York, New York, United Nations, 1990. 21-39. (ST/ESA/SER.R/108)In order to illuminate the complex process of population policy research, this article describes how the UN Secretariat collects, analyzes, and transmits population policy data. The role of conducting population policy research falls under the UN's Population Commission and its substantiative secretariat, the Population Division of the Department of International Economic and Social Affairs. Providing a historical background, the article explains the gradual development of consensus as to the proper role of the UN with regards to population policy. While in 1948 the UN mandated the Population Commission to "arrange for studies and advise" on "policies designed to influence the size and structure of populations and changes therein," it was not until the late 1960s when population policy became a pressing issue. The paper goes on to detail the process of population policy research. Data collection depends on a combination of 2 factors: the number of countries or units of analysis and the specific issues under consideration. The paper explains that the Population Commission collects its data from 4 general sources: 1)government documents, intergovernmental documents, nongovernmental documents, and UN inquiries. Over the past 40 years, the Commission has developed 4 implicit principles concerning the analysis of data. The analysis should be neutral, comprehensive, global, and effective. In order to transmit population policy research, the Commission employs 3 major avenues: 1)UN published reports, documents, studies, etc.; 2: conferences, meetings, seminars, etc.; and 3)computer files. Following the description of the search process, the paper discusses key issues and concerns over this process. Examples of such concerns include the validity of results, issues of consistency and reliability, problems of definition, and the classification of government.
AFRICA HEALTH. 1990 Jul; 12(5):18-9.In comparison with the commercially available ELISA test for HIV, new more appropriate tests for use in African locales are being supported by USAID, PATH, the International Development Research Center of Canada and the Rockefeller Foundation. ELISA tests are suited for high volume, high technology, automation, data management, accuracy, and cost about US$1 per test. In contrast, tests for African laboratories must be inexpensive, suitable for small numbers of tests, possibly no refrigeration or electricity, and unsophisticated technicians. a series of 5 prototype tests designed for african laboratories been evaluated at the Mama Yemo Hospital, Kinshasa, Zaire, under the auspices of Diagnostic Technology for Community Health (USAID-funded) and managed by PATH. Results comparable to those with ELISA could be achieved with duplicate testing, but the cost remained about the same. to lower final costs, development and overhead for the supplier must be carried by donor funds. With there criteria in mind, PATH is working on a public sector HIV test taking <30 minutes, costingAdd to my documents.20049519
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1988; 66(2):143-54.Through a review of the work on the control of poliomyelitis carried out under the auspices of the World Health Organization (WHO) during the past 20 years, the importance of international collaboration is shown. Because of efforts in planning and coordinating, the production and control of the Sabin strains of the live oral vaccine provide safe, reliable, and potent vaccines. The cooperative efforts have included working not only with national control laboratories but with poliomyelitis vaccine producers in many countries. In the early 1970s, a Consultative Group of WHO became active. Their initial efforts included an extensive epidemiological study in 13 interested countries. Later, the group saw to studying the reliability of the marker tests used in the intratypic differentiation of poliovirus stains of different origins. Additionally, they saw to standardizing tests for the neurovirulence of vaccine lots, including analyzing and recording results, and to ensuring that adequate supplies of vaccine will be available for the next 200 years. After 15 years of continual surveillance of vaccine-associated cases by WHO epidemiologists and clinicians, the findings show the following: Type 1 live poliovirus vaccine is almost never implicated in postvaccination paralysis; type 2 strain occasionally causes of paralysis in contacts of the vaccine, and type 3 strain causes most of the few cases of postvaccine paralysis. The occurrences of the cases from type 2 and 3 strains remains an enigma. Current research of the group suggests an even more effective vaccine may become available in the future.21229128
POPULATION TODAY. 1989 Jan; 17(1):6-8.The quality of data collected by the U.S. Immigration and Naturalization Service (INS) is assessed, with a focus on differences between U.S. and U.N. definitions of immigrants, emigrants, and refugees. The author suggests that "gaps in migration data collected for the U.S. limit their usefulness for studying international migration and estimating national population change. For example, no information is collected on emigration of legal permanent residents or U.S. citizens, nor is there any direct information on the immigration of U.S. citizens. Data collected on legal immigrants are based on a legal and administrative definition that often conflicts with the demographic definition of an immigrant." (EXCERPT)22268486
Civil registration and vital statistics in the Africa region: lessons learned from the evaluation of UNFPA-assisted projects in Kenya and Sierra Leone.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Dec. viii, 25 p.To review the experience of vital statistics and civil registration in the Africa Region, projects in 2 countries were evaluated in-depth: the Civil Registration Demonstration in Kenya and the Strengthening of the Civil Registration and Vital Statistics System in Sierra Leone. Based on these project evaluations and on experience in the area of data collection and project implementation in other parts of the Africa Region, specific observations/conclusions and recommendations are made in 5 areas. 1) United Nations Fund for Population Activities (UNFPA) support for civil registration is justified if and when it can be expected to produce vital statistics which are not less reliable than estimates derived from censuses and surveys. 2) Regarding project strategy, a gradually expanding registration area is preferable in countries in the Africa Region which have extensive rural areas. 3) A thorough assessment of the registration hierarchy is required when establishing new methods and procedures for civil registration. In deciding upon the topics to be included in the region records, usefulness, collectability and neutrality of the inputs are important criteria. 4) Regarding project inputs, Governments may wish to choose an existing organization which has a large field staff and a bureaucratic hierarchy to undertake civil registration activities. In this way these activites could then be added on as new functions of existing posts. The careful selection of types of equipment and supplies greatly affects the implementation of civil registration activities and external resources are required in many projects for vehicles and paper for registration forms. 5) While the projects evaluated have followed the procedures for monitoring through the submission of Project Progress Reports and the holding of Tripartite Review Meetings, the monitoring system has not served as a triggering mechanism for actions. This is mainly due to the lack of follow-up by the governments, and executing and finding agencies of the monitoring reports, and at times, the absence of key technical and administrative persons at Tripartite Review Meetings. Recommendations made concerning these conclusions are addressed to the governments of the Region to improve their civil registration systems; some are addressed specifically to UNFPA and the United Nations Department of Technical Cooperation for Development to improve their assistance to governments.23031538
Washington, D.C., SOMARC, .  p.This document contains briefing materials for the participants of an upcoming meeting of the advisory council and working groups of Social Marketing for Change (SOMARC), an organizational network, funded by the US Agency for International Development (USAID) and composed of 5 firms which work together in helping agencies, organizations, and governments develop contraceptive social marketing programs. Social marketing is the use of commercial marketing techniques and management procedures to promote social change. The briefing materials include 3 background and 18 issue papers. The background papers provide brief summaries of USAID's population activities and of the history of social marketing programs, an overview of USAID sponsored contraceptive social marketing programs in 14 countries and of 3 major non-USAID programs, and a listing of the skills and resources needed to develop effective contraceptive social marketing programs. The issue papers provide a focus for the discussion sessions which are scheduled for SOMARC's working groups on marketing communication, management, and research. USAID's objective is to promote the development of family planning programs which are completely voluntary and which increase the reproductive freedom of couples. Contraceptive social marketing programs are consistent with this objective. USAID provides direct funding for family planning programs as well as commodity, technical, and training support. USAID's involvement in social marketing began in 1971, and USAID is currently sponsoring programs in Jamaica, Bangladesh, Nepal, El Salvador, Egypt, Honduras, Ecuador, the Caribbean Region, Costa Rica, Guatemala, and Peru. In the past, USAID provided support for programs in Mexico, Tunisia, and Ghana. The Mexican project is now functioning without USAID support, and the projects in Tunisia and Ghana are no longer operating. Major non-USAID contraceptive social marketing programs operate in India, Sri Lanka, and Colombia. These programs received only limited technical support from USAID. To ensure the success of social marketing programs, social marketers must have access to the knowledge and skills of commercial marketers in the areas of management, analysis and planning, communications, and research. Social marketers must also have expertise in social development and social research. In reference to the issue papers, the working groups and the advisory council were asked to develop suggestions for 1) overcoming social marketing program management problems, 2) motivating health professionals toward greater involvement in social marketing programs, 3) improving the media planning component of the programs, 4) improving management stability and training for management personnel, and 5) improving program evaluation. Areas addressed by the issue papers were 1) whether social marketing programs should be involved in creating a demand for contraceptives or only in meeting the existing demand, 2) the development of a methodology for assessing why some programs fail and others succeed, 3) the feasibility of using anthropological and questionnaire modules for conducting social marketing research, 4) techniques for overcoming the high level of nonsampling error characteristic of survey data collected in developing countries, 5) techniques for identifying contraceptive price elasticity, 6) the feasibility of using content analysis in social marketing communications, 7) the applicability of global marketing strategies for social marketing, and 8) how to select an an appropriate advertising agency to publicize social marketing programs.24039358
Methodological problems in evaluation of family planning impact of programmes that are integrated with other development sectors.
In: Studies to enhance the evaluation of family planning programmes by United Nations Department of International Economic and Social Affairs. Population Division [DIESA] New York, New York, United Nations, 1985. 108-110. (Population Studies No. 87 ST/ESA/SER.A/87)Governments of developing countries began to undertake family planning in the 1960s thanks to a sudden availability of funds for programs exaggerating an already existing cleavage between program and general demography professionals. Discussion at the World Population Conference (WPC) in Bucharest recognized social and economic factors as an important element in the use of family planning and attempted to encourage better cooperation between program evaluators and demographers. Separation of family planning effects from development effects has been difficult. The WPC's World Population Plan of Action (WPPA) reiterated that population and population policies were interrelated with and should not be considered substitutes for socioeconomic development policies. Increasingly, governments have been integrating family planning with education and health programs as recommended by the WPPA. Family planning being a relatively new venture, it is necessary to develop a theoretical framework to justify assumptions that family planning and development are productively integrable and synergistic, determining demographic effects and their causal mechanisms, whether social or program related. A careful record of program inputs must be kept. Important issues in education, which generally speaking has an inverse effect on fertility, are: in which sex and age group of the population is education most effective for fertility control allowing for lag time; and what are the intervening effects--age at marriage, better knowledge, or change of attitudes? Some of the simplest integrated programs combine family planning with educational programs in schools, health programs, and agricultural programs. Thus teachers are trained to educate pupils in population problems; health workers educate family health consumers a logical diversity of function that is however limited by the scope of the health program. The benefits of small family size may be incorporated into rural development ideology. Critical evaluation will necessitate demonstration of integration's beneficial effects.25029902
Surveys to measure programme coverage and impact: a review of the methodology used by the expanded programme on immunization. Enquetes sur la couverture et l'impact des programmes: methodes quantitative utilisees par le programme elargi de vaccination.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(1):65-75.To improve the health status of their populations, most countries are developing their ability to provide primary health care. This ultimately depends on information for planning, supervision and monitoring of health activities. Data are needed to define the need for health services, the efficiency of existing services, as well as their impact on morbidity and mortality. Such imformation can best be obtained from surveys. The WHO and other international agencies have been active in promoting the use of surveys and as an example, through its Expanded Program on Immunization (EPI), WHO aims to ensure the availability of immunization for all children in the world by the year 1990. This is a vital effort towards the goal of health for all by the year 2000. EPI developed an appropriate system for data collection which could be implemented in a relatively standardized manner from 1 country to another. The primary purpose of the methodology was to assess the level of immunization coverage, but becasue of its success, it was also adopted for other purposes and suggests limitations, modifications and alternatives to meet the needs of different health programs. The sampling strategy utilized was the probability proportionate to size (PPS) cluster sampling. The EPI survey, as it is currently carried out for determining immunization coverage, involves the detailed review of immunization status of about 210 children by trained reviewers. Field methodology involve identifying precisely what the population is and which age groups within the population are of particular interest and determining which individuals within the cluster to study. Random selection methods are explained. A distinct problem with the EPI methodology is the risk that surveys of adjacent households could either over or underestimate the true population coverage depending on where the starting households happen to be. Leaving selection of successive households to the interviewer creates another opportunity for bias. With some modifications, the EPI methodology has been applied to studies of the incidence of poliomyelitis, neonatal tetanus, diarrhea and studies of morality due to measles. Careful consideration of sample size is necessary. An evaluation of the EPI sampling strategy via computer simulation is presented. An alternative method is the Lot Quality Assurance Sampling (LQAS) technique.