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A Simplified Regimen Compared with WHO Guidelines Decreases Antenatal Calcium Supplement Intake for Prevention of Preeclampsia in a Cluster-Randomized Noninferiority Trial in Rural Kenya.
Journal of Nutrition. 2017 Oct; 147(10):1986-1991.Background: To prevent preeclampsia, the WHO recommends antenatal calcium supplementation in populations with inadequate habitual intake. The WHO recommends 1500-2000 mg Ca/d with iron-folic acid (IFA) taken separately, a complex pill-taking regimen. Objective: The objective of this study was to test the hypothesis that simpler regimens with lower daily dosages would lead to higher adherence and similar supplement intake.Methods: In the Micronutrient Initiative Calcium Supplementation study, we compared the mean daily supplement intake associated with 2 dosing regimens with the use of a parallel, cluster-randomized noninferiority trial implemented in 16 primary health care facilities in rural Kenya. The standard regimen was 3 x 500 mg Ca/d in 3 pill-taking events, and the low-dose regimen was 2 x 500 mg Ca/d in 2 pill-taking events; both regimens included a 200 IU cholecalciferol and calcium pill and a separate IFA pill. We enrolled 990 pregnant women between 16 and 30 wk of gestation. The primary outcome was supplemental calcium intake measured by pill counts 4 and 8 wk after recruitment. We carried out intention-to-treat analyses with the use of mixed-effect models, with regimen as the fixed effect and health care facilities as a random effect, by using a noninferiority margin of 125 mg Ca/d.Results: Women in facilities assigned to the standard regimen consumed a mean of 1198 mg Ca/d, whereas those assigned to the low-dose regimen consumed 810 mg Ca/d. The difference in intake was 388 mg Ca/d (95% CI = 341, 434 mg Ca/d), exceeding the prespecified margin of 125 mg Ca/d. The overall adherence rate was 80% and did not differ between study arms.Conclusions: Contrary to our expectation, a simpler, lower-dose regimen led to significantly lower supplement intake than the regimen recommended by the WHO. Further studies are needed to precisely characterize the dose-response relation of calcium supplementation and preeclampsia risk and to examine cost effectiveness of lower and simpler regimens in program settings. This trial was registered at clinicaltrials.gov as NCT02238704. (c) 2017 American Society for Nutrition.
A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study.
BMJ. 2017 Aug 03; 358:j3423.Objectives To construct growth curves for mid-upper-arm circumference (MUAC)-for-age z score for 5-19 year olds that accord with the World Health Organization growth standards, and to evaluate their discriminatory performance for subsequent mortality.Design Growth curve construction and longitudinal cohort study.Setting United States and international growth data, and cohorts in Kenya, Uganda, and Zimbabwe.Participants The Health Examination Survey (HES)/National Health and Nutrition Examination Survey (NHANES) US population datasets (age 5-25 years), which were used to construct the 2007 WHO growth reference for body mass index in this age group, were merged with an imputed dataset matching the distribution of the WHO 2006 growth standards age 2-6 years. Validation data were from 685 HIV infected children aged 5-17 years participating in the Antiretroviral Research for Watoto (ARROW) trial in Uganda and Zimbabwe; and 1741 children aged 5-13 years discharged from a rural Kenyan hospital (3.8% HIV infected). Both cohorts were followed-up for survival during one year.Main outcome measures Concordance with WHO 2006 growth standards at age 60 months and survival during one year according to MUAC-for-age and body mass index-for-age z scores.Results The new growth curves transitioned smoothly with WHO growth standards at age 5 years. MUAC-for-age z scores of -2 to -3 and less than-3, compared with -2 or more, was associated with hazard ratios for death within one year of 3.63 (95% confidence interval 0.90 to 14.7; P=0.07) and 11.1 (3.40 to 36.0; P<0.001), respectively, among ARROW trial participants; and 2.22 (1.01 to 4.9; P=0.04) and 5.15 (2.49 to 10.7; P<0.001), respectively, among Kenyan children after discharge from hospital. The AUCs for MUAC-for-age and body mass index-for-age z scores for discriminating subsequent mortality were 0.81 (95% confidence interval 0.70 to 0.92) and 0.75 (0.63 to 0.86) in the ARROW trial (absolute difference 0.06, 95% confidence interval -0.032 to 0.16; P=0.2) and 0.73 (0.65 to 0.80) and 0.58 (0.49 to 0.67), respectively, in Kenya (absolute difference in AUC 0.15, 0.07 to 0.23; P=0.0002).Conclusions The MUAC-for-age z score is at least as effective as the body mass index-for-age z score for assessing mortality risks associated with undernutrition among African school aged children and adolescents. MUAC can provide simplified screening and diagnosis within nutrition and HIV programmes, and in research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Pakistan: increasing access to SRH services in fragile contexts for rural women in hard-to-reach areas.
London, United Kingdom, IPPF, 2015 Sep. 2 p.In some areas of Pakistan, girls and women are vulnerable to harmful traditional practices, like swara (now illegal, a form of reconciliation where a girl or woman is given in marriage to settle a dispute) and early marriage, and many of them face tremendous obstacles to basic services, including sexual and reproductive health (SRH) services.
Following the World Health Organization's Recommendation of Exclusive Breastfeeding to 6 Months of Age Does Not Impact the Growth of Rural Gambian Infants.
Journal of Nutrition. 2017 Feb; 147(2):248-255.BACKGROUND: The WHO recommends exclusive breastfeeding (EBF) for the first 6 mo of life. OBJECTIVE: The objective of this study was to assess the benefit of EBF to age 6 mo on growth in a large sample of rural Gambian infants at high risk of undernutrition. METHODS: Infants with growth monitoring from birth to 2 y of age (n = 756) from the ENID (Early Nutrition and Immune Development) trial were categorized as exclusively breastfed if only breast milk and no other liquids or foods were given. EBF status was entered into confounder-adjusted multilevel models to test associations with growth trajectories by using >11,000 weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) z score observations. RESULTS: Thirty-two percent of infants were exclusively breastfed to age 6 mo. The mean age of discontinuation of EBF was 5.2 mo, and growth faltering started at approximately 3.5 mo of age. Some evidence for a difference in WAZ and WHZ was found between infants who were exclusively breastfed to age 6 mo (EBF-6) and those who were not (nEBF-6), at 6 and 12 mo of age, with EBF-6 children having a higher mean z score. The differences in z scores between the 2 groups were small in magnitude (at 6 mo of age: 0.147 WAZ; 95% CI: -0.001, 0.293 WAZ; 0.189 WHZ; 95% CI: 0.038, 0.341 WHZ). No evidence for a difference between EBF-6 and nEBF-6 infants was observed for LAZ at any time point (6, 12, and 24 mo of age). Furthermore, a higher mean WLZ at 3 mo of age was associated with a subsequent higher mean age at discontinuation of EBF, which implied reverse causality in this setting (coefficient: 0.060; 95% CI: 0.008, 0.120). CONCLUSION: This study suggests that EBF to age 6 mo has limited benefit to the growth of rural Gambian infants. This trial was registered at http://www.isrctn.com as ISRCTN49285450.
Performance of Risk Charts to Guide Targeted HIV Viral Load Monitoring of ART: Applying the Method on the Data From a Multicenter Study in Rural Lesotho.
Journal of Acquired Immune Deficiency Syndromes. 2016 May 1; 72(1):e22-5.Add to my documents.
How well do WHO complementary feeding indicators relate to nutritional status of children aged 6-23 months in rural northern Ghana?
BMC Public Health. 2015 Nov 23; 15(1157):1-12.Background Though the World Health Organization (WHO) recommended Infant and Young Child Feeding (IYCF) indicators have been in use, little is known about their association with child nutritional status. The objective of this study was to explore the relationship between IYCF indicators (timing of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet) and child growth indicators. Methods A community-based cross-sectional survey was carried out in November 2013. The study population comprised mothers/primary caregivers and their children selected using a two-stage cluster sampling procedure. Results Of the 1984 children aged 6-23 months; 58.2 % met the minimum meal frequency, 34.8 % received minimum dietary diversity (=4 food groups), 27.8 % had received minimum acceptable diet and only 15.7 % received appropriate complementary feeding. With respect to nutritional status, 20.5 %, 11.5 % and 21.1 % of the study population were stunted, wasted and underweight respectively. Multiple logistic regression analysis revealed that compared to children who were introduced to complementary feeding either late or early, children who started complementary feeding at six months of age were 25 % protected from chronic malnutrition (AOR=0.75, CI=0.50 - 0.95, P=0.02). It was found that children whose mothers attended antenatal care (ANC) at least 4 times were 34 % protected [AOR 0.66; 95 % CI (0.50 - 0.88)] against stunted growth compared to children born to mothers who attended ANC less than 4 times. Children from households with high household wealth index were 51 % protected [AOR 0.49; 95 % CI (0.26 - 0.94)] against chronic malnutrition compared to children from households with low household wealth index. After adjusting for potential confounders, there was a significant positive association between appropriate complementary feeding index and mean WLZ (ß=0.10, p=0.005) but was not associated with mean LAZ. Conclusions The WHO IYCF indicators better explain weight-for-length Z-scores than length-for-age Z-scores of young children in rural Northern Ghana. Furthermore, a composite indicator comprising timely introduction of solid, semi-solid or soft foods at 6 months, minimum meal frequency, and minimum dietary diversity better explains weight-for-length Z-scores than each of the single indicators.
Feasibility and validity of using WHO adolescent job aid algorithms by health workers for reproductive morbidities among adolescent girls in rural North India.
BMC Health Services Research. 2015 Sep 21; 15(1):400.Background: High prevalence of reproductive morbidities is seen among adolescents in India. Health workers play an important role in providing health services in the community, including the adolescent reproductive health services. A study was done to assess the feasibility of training female health workers (FHWs) in the classification and management of selected adolescent girls' reproductive health problems according to modified WHO algorithms. Methods: The study was conducted between Jan-Sept 2011 in Northern India. Thirteen FHWs were trained regarding adolescent girls' reproductive health as per WHO Adolescent Job-Aid booklet. A pre and post-test assessment of the knowledge of the FHWs was carried out. All FHWs were given five modified WHO algorithms to classify and manage common reproductive morbidities among adolescent girls. All the FHWs applied the algorithms on at least ten adolescent girls at their respective sub-centres. Simultaneously, a medical doctor independently applied the same algorithms in all girls. Classification of the condition was followed by relevant management and advice provided in the algorithm. Focus group discussion with the FHWs was carried out to receive their feedback. Results: After training the median score of the FHWs increased from 19.2 to 25.2 (p - 0.0071). Out of 144 girls examined by the FHWs 108 were classified as true positives and 30 as true negatives and agreement as measured by kappa was 0.7 (0.5-0.9). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 94.3 % (88.2-97.4), 78.9 % (63.6-88.9), 92.5 % (86.0-96.2), and 83.3 % (68.1-92.1) respectively. Discussion: A consistent and significant difference between pre and post training knowledge scores of the FHWs were observed and hence it was possible to use the modified Job Aid algorithms with ease. Limitation of this study was the munber of FHWs trained was small. Issues such as time management during routine work, timing of training, overhead cost of training etc were not taken into account. Conclusions: Training was successful in increasing the knowledge of the FHWs about adolescent girls' reproductive health issues. The FHWs were able to satisfactorily classify the common adolescent girls' problems using the modified WHO algorithms.
Maternal near miss and mortality in a rural referral hospital in northern Tanzania: a cross-sectional study.
BMC Pregnancy and Childbirth. 2013; 13:141.BACKGROUND: Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. In order to lower maternal morbidity and mortality in the immediate term, reduction of delay in the provision of quality obstetric care is of prime importance. The aim of this study is to assess the occurrence of severe maternal morbidity and mortality in a rural referral hospital in Tanzania as proposed by the WHO near miss approach and to assess implementation levels of key evidence-based interventions in women experiencing severe maternal morbidity and mortality. METHODS: A prospective cross-sectional study was performed from November 2009 until November 2011 in a rural referral hospital in Tanzania. All maternal near misses and maternal deaths were included. As not all WHO near miss criteria were applicable, a modification was used to identify cases. Data were collected from medical records using a structured data abstraction form. Descriptive frequencies were calculated for demographic and clinical variables, outcome indicators, underlying causes, and process indicators. RESULTS: In the two-year period there were 216 maternal near misses and 32 maternal deaths. The hospital-based maternal mortality ratio was 350 maternal deaths per 100,000 live births (95% CI 243-488). The maternal near miss incidence ratio was 23.6 per 1,000 live births, with an overall case fatality rate of 12.9%. Oxytocin for prevention of postpartum haemorrhage was used in 96 of 201 women and oxytocin for treatment of postpartum haemorrhage was used in 38 of 66 women. Furthermore, eclampsia was treated with magnesium sulphate in 87% of all cases. Seventy-four women underwent caesarean section, of which 25 women did not receive prophylactic antibiotics. Twenty-eight of 30 women who were admitted with sepsis received parenteral antibiotics. The majority of the cases with uterine rupture (62%) occurred in the hospital. CONCLUSION: Maternal morbidity and mortality remain challenging problems in a rural referral hospital in Tanzania. Key evidence-based interventions are not implemented in women with severe maternal morbidity and mortality. Progress can be made through up scaling the use of evidence-based interventions, such as the use of oxytocin for prevention and treatment of postpartum haemorrhage.
African Journal of Primary Health Care and Family Medicine. 2009 May 7; 1(1):4 p.Background: Breastfeeding is nearly universal in Kenya. However, supplementation of breast milk starts too early, thereby exposing the infants to diarrhoea and other infections. Despite the recommendation of the World Health Organization (WHO) of exclusive breastfeeding (EB) from birth to six months, EB is rare and poorly timed and complementary feeding (CF) practices are still common. The study describes feeding practices of children aged 0 to 24 months in the Mumias Division of the Kakamega district in Kenya. Method: Using a cross-sectional study, 180 mothers of infants/children were interviewed using a structured questionnaire. Data on socio-demographic characteristics, feeding practices and sources of information on the same were obtained from the mothers. Results: Whereas 92.1% of the children were breastfed, only 12.2% of the mothers practiced EB up to 4 to 6 months. Mothers introduced liquids and complementary foods at a mean age of 2.7 months and by the fourth month, more than one-third (34.5%) of the mothers had initiated CF. Apart from water, fresh milk, tea, commercial juices, maize-meal/millet porridge, mashed potatoes, bananas and fruits were also introduced. The perceived reasons for introducing these foods included the child being old enough (33.8%), another pregnancy (25%), insufficient milk (20.3%), sickness of the mother or child (10.5%) and in order for the child to eat other foods (11.4%). Over half (53.3%) of the mothers obtained information on BF and CF from friends, neighbours, media advertisements and health workers. Conclusion: Breastfeeding is common; however, mothers do not seem to practice the WHO recommendations. Mothers in this study area and other rural communities need to be empowered with information on the correct BF and CF practices through existing government health services, nongovernmental organisations and other community-based networks, especially in the light of the HIV/AIDS pandemic.
The state of food and agriculture, 2010-11. Women in agriculture: Closing the gender gap for development.
Rome, Italy, FAO, 2011.  p.This edition of The State of Food and Agriculture addresses Women in agriculture: closing the gender gap for development. The agriculture sector is underperforming in many developing countries, and one of the key reasons is that women do not have equal access to the resources and opportunities they need to be more productive. This report clearly confirms that the Millennium Development Goals on gender equality (MDG 3) and poverty and food security (MDG 1) are mutually reinforcing. We must promote gender equality and empower women in agriculture to win, sustainably, the fight against hunger and extreme poverty. I firmly believe that achieving MDG 3 can help us achieve MDG 1. (Excerpt)
Utility of the WHO ten questions screen for disability detection in a rural community -- the north Indian experience.
Journal of Tropical Pediatrics. 2007 Dec; 53(6):383-387.The utility of the WHO Ten Questions Screen (TQS) was studied in a rural community of North India. The study was done in three villages, in two phases. In phase 1, the TQS was administered to parents of children aged between 2 and 9 years, during a house-to-house survey. In phase 2, all children screened positive and a random sample of 110 screened negative were clinically evaluated in detail. The total population of the three villages was 5830 with 1763 children aged between 2 and 9 years. Seventy-six children were positive on the TQS, of these, 38 were found to have significant disability, 18 had protein energy malnutrition and 19 were found normal on clinical evaluation. All the 110 screen-negative children were normal. Significantly larger numbers of boys were positive on TQS as compared to girls [Odd Ratio (OR) 1.5]. The sensitivity of the TQS for significant disability was 100%; the positive predictive value was 50% and was higher for boys than for girls. Of the 50% children classified as false positive 23% had mild delays due to malnutrition. The estimated prevalence of disability was 16/1000. The TQS was found to be a sensitive tool for detection of significant disabilities among children 2-9 years of age. The low-positive predictive value would lead to over referrals but a large number of these children would benefit from medical attention. (author's)
European Journal of Public Health. 2007 Oct; 17(5):409.In public health teaching, tuberculosis (TB) has been a traditional example of how disease occurrence is determined by the triad agent, environment, host. And it has since long been standard textbook knowledge that there are strong socioeconomic determinants behind all three components: The agent is more prevalent and is spread more easily in conditions of crowding and poor hygienic conditions, and under these conditions several host factors are also more prevalent, such as malnutrition and alcoholism. In recent years another dimension has been added to the socioeconomic patterning of TB: An already very solid mass of research has highlighted the social and economic aspects of care and follow-up of patients with TB. A recent example of this research is the paper by Wang et al. in this issue of the journal, on differences in both patient's delay and doctor's delay in the diagnosis of TB, when comparing residents and non-residents (rural immigrants) in Shanghai. (excerpt)
Indian Journal of Community Medicine. 2006 Jun; 31(2):65.WHO and other international agencies has recommended that mother should breast feed the children exclusively for 4-6 month from birth and continue breast feeding along with appropriate supplemental food up to second year. Breast feeding should be initiated within an hour of birth instead of waiting several hours as is often customary. Although there is little milk at that time, it helps to establish feeding and a close mother-child relationship, known as "bonding". A community based study was conducted in the area of Experimental Teaching Health Sub Centres, Mati and Banthra under the Rural Health Training Centre, Sarojini Nagar, Department of community Medicine, K, G. Medical University, Lucknow. 200 lactating mothers were interviewed using a pre tested proforma to collect information regarding sociodemographic characteristics, current feeding practices, time of initiation of breast feeding and colostrum given to the new borns. (excerpt)
UN Chronicle. 1985 May; 22: p..Safe drinking water was provided for an estimated 345 million people in developing countries from 1980 to 1983, surpassing the record set during the entire period of the 1970s, according to a United Nations report on "Progress in the attainment of the goals of International Drinking Water Supply and Sanitation Decade." The report, a mid-Decade evaluation of progress achieved since the Decade was launched in 1980, will be considered later this year by the General Assembly. It notes almost 140 million rural and urban dwellers benefited from newly installed sanitation facilities, a prerequisite to improved health in most developing countries. An estimated 530 million additional people will receive reasonable access to safe drinking water and some 86 million people will receive adequate sanitation services by the end of 1985. Despite these advances, some 1,200 million people remain without safe water and some 1,900 million without adequate sanitation in the developing world. National, international and grassroots action on many fronts is needed to plan, design, construct, operate and maintain the services they require. (excerpt)
Indian Journal of Pediatrics. 2005; 72(9):735-739.The objective was to assess the practice of skills learnt by basic health workers for 4 – 8 weeks and one year after IMCI training, and to identify the gaps in practices due to various constraints. The anganwadi workers (AWWS) and the supervisory staff were given 5 days IMCI training using WHO package. The supervisors gave follow up visits to AWWs using standardized follow up forms adapted from WHO material. The supervisors gave follow up visit to the 1st batch of AWWs 1 year after training in IMCI and a second visit was given 4-8 weeks after the 1st visit. The 2nd batch of AWWs was followed up 4-8 weeks after training in IMCI. The performance on correct treatment of cases by AWWs weeks were trained 4 - 6 weeks prior to follow up was better than group followed up one year after the completion of training (81.8% and 47.9% respectively). At the same time, the performance on correct treatment showed significant improvement during the second follow up (47.9% and 83.8% respectively). Performance on counseling improved from 15.6% during 1st follow up to 52.1% during 2nd follow up visit. The average number of cases seen by AWWs increased from 6.6 in 1st follow up to 9.3 during second follow up of the same AWWs. The basic health workers (AWWs) are capable of correct case management of sick children using the IMCI guidelines. The first follow up visit should not be delayed as delay leads to loss of skills. The health workers benefit from frequent and regular follow up by supervisors. Provision of requisite supplies is essential for practice of skills after training in IMCI by basic health worker. (author's)
Indian Journal of Community Medicine. 2003 Apr-Jun; 28(2): p..Research question: What is the sensitivity and specificity of WHO s syndromic approach in diagnosing Reproductive Tract Infections (RTIs)? Objective: To test the validity of WHO diagnostic algorithm in diagnosing RTIs among married women. Study design: Cross-sectional study. Setting: Primary Health Centre, Palam, New Delhi. Participants: Married women attending antenatal and gynae clinics. Sample size: 300 married women. Statistical analysis: Proportions. Results: The prevalence of RTIs in married women was 37.0% by syndromic approach based on symptoms, 51.7% by clinical examination and 36.7% by microbiological laboratory investigations. The sensitivity and specificity of syndromic approach to diagnose any RTI was 53.6% and 72.6% respectively while clinical examination had 68.2% sensitivity and 60.5% specificity. Overall clinical examination had relatively high sensitivity but low specificity. For trichomoniasis and bacterial vaginosis the clinical examination had low sensitivity but a high specificity. Conclusions: WHO syndromic approach based on symptoms had a low sensitivity in diagnosing RTIs among women. Sensitivity increased when clinical examination was used for the diagnosis of these infections. In the absence of microbiological laboratory facilities, syndromic approach should be supplemented with clinical examination for diagnosing RTIs in women to avoid over-treatment of women. (author's)
Indian Journal of Community Medicine. 2002 Jul-Sep; 27(3): p..Health systems have undergone overlapping generations of reforms in the past 100 years, including the founding of national health care systems and extension of social insurance schemes. Subsequently to realize the goal of "Health for all" the system of primary health care was adopted the world over. The system of primary health care paid too little attention to the people's demand for health care and it concentrated exclusively on the perceived needs. In the past decade or so there has been gradual shift of vision towards what WHO calls the "New Universalism" high quality delivery of essential care, defined mostly by criterion of cost-effectiveness, for everyone, rather than all possible care for the whole population or only the simplest and most basic care for the poor. (excerpt)
Cambridge, Massachusetts, Massachusetts Institute of Technology [MIT], Poverty Action Lab, 2003 Sep. 25,  p. (Poverty Action Lab Paper No. 4)This paper presents the results of a two-year randomized evaluation of a large scale remedial education program, conducted in Mumbai and Vadodara, India. The remedial education program hires young women from the community to teach basic literacy and numeracy skills to children who reach standard three or four without having mastered these competencies. The program, implemented by a NGO in collaboration with the government, is extremely cheap (it cost 5 dollars per child per year), and is easily replicable: It has been implemented in 20 Indian cities, and reached tens of thousands of children. We find the program to be very effective: On average, it increased learning by 0.15 standard deviations in the first year, and 0.25 in the second year. The gains are the largest for children at the bottom of the distribution: Children in the bottom third gain 0.2 standard deviations in the first year, and 0.32 in the second year. In math, they gain 0.51 standard deviation in the second year. The results are similar in the two grade levels, and in the two cities. At the margin, extending this program would be up to 12-16 times more cost effective than hiring new teachers. (author's)
Towards putting farmers in control: a second case study of the rural communication system for development in Mexico's tropical wetlands. [Agricultores a las riendas: un segundo estudio de casos del sistema de comunicación rural para el desarrollo en los pantanos tropicales mexicanos]
Rome, Italy, FAO, 1990. v, 58 p. (Development Communication Case Study No. 9)This is the second Case Study of the Rural Communication System for Development in Mexico's Tropical Wetlands. The first was written in late 1985 and published by the Food and Agriculture Organization of the United Nations (FAO) in early 1987. The important changes that have taken place in Mexico since 1985, in particular as they relate to development in the tropical wetlands and the communication system working in that context, now warrant a second Case Study. To set the present Case Study in its proper context, it should, ideally, be read in conjunction with the earlier one, but since this may not be possible for all readers, the salient information provided in the earlier study will be given in the Background section, below. The first part of this Study will set the scene and describe the approach and the work being carried out, while the last section will attempt to examine the situation from various perspectives and offer some views regarding its future prospects. It should be noted, however, that this Study is not an evaluation. (excerpt)
Agrobiodiversity strategies to combat food insecurity and HIV / AIDS impact in rural Africa. Advancing grassroots responses for nutrition, health and sustainable livelihoods. Preliminary edition.
Rome, Italy, Food and Agriculture Organization of the United Nations [FAO], 2003.  p.This strategy paper has been developed in the framework of the FAO Population and Development Service (SDWP), under the support and lead of Marcela Villarreal (SDWP Chief). The paper aims at stimulating grassroots action for household food, nutrition and livelihood security in rural Africa, placing special emphasis on the evolving needs owing to the HIV/AIDS crisis. For the elaboration of the proposed strategies, the author carried out a specific FAO field mission to Uganda and Tanzania, as well as supplementary fieldwork in Ethiopia and Mali, in September-December 2001. (author's)
Micro-finance in rural communities in Southern Africa. Country and pilot site case studies, policy issues and recommendations.
Pretoria, South Africa, Human Sciences Research Council, 2002. , 170 p.While micro-finance in its various forms has helped to make loan capital more accessible to low-income rural communities, much remains to be done to increase its outreach, impact and sustainability. The essential objective of this study is to make well-researched recommendations for IRDP policy and strategy to enable the micro-finance agents that it will shortly be appointing to maximize improvements in these key indicators in the three pilot sites. Chapter 1 outlines the institutional context and terms of reference of the report and briefly discusses its timeframe, methodology, value and limitations. Chapters 2 and 3 depict, on the one hand, the demand for financial services in the three pilot sites and, on the other, access to micro-finance in the respective communities. In Chapter 4 an account is given of the essential nature and capabilities of microfinance, of recent developments in this regard, of fundamental lessons from international experience and of best practices in a rural context. Chapter 5 identifies the key sets of policy issues facing, in the first instance, public policy makers seeking to promote micro-finance development and, in the second, donors/investors/wholesalers seeking to support individual micro-finance retailers. It then applies the findings of Chapter 4 to the three on-the-ground pictures sketched out in Chapters 2 and 3 to arrive at some initial and very tentative recommendations for policy for the IRDP in the respective pilot sites. (excerpt)
Spotlight. 2003 May 30-Jun 5; 22(46): p..J. Bill Musoke, Country Representatives of the United Nations Population Fund (UNFPA), has been in Nepal for more than couple of years. Musoke, who has been involved in the implementation and execution of the UNFPA's major programs, spoke to Keshab Poudel on various population-related issues. (excerpt)
WHO indicators for evaluation of maternal health care services, applicability in least developed countries : a case study from Eritrea. [Indicateurs de l'OMS pour l'évaluation des services de santé maternelle, applicabilité dans les pays les moins développés : étude cas de l'Ethiopie]
African Journal of Reproductive Health. 2002 Aug; 6(2):13-22.The World Health Organization has recommended a number of process indicators to monitor the effect of health care programmes on maternal mortality. This study was therefore conducted to know if the recommended process indicators are useful also in the least developed countries. In 1994, all 17 health facilities offering maternal health care in a rural province in Eritrea were visited. An assessment was made of the obstetric services provided, obstetric complications, and accessibility of health facilities. The study revealed that necessary data were available for most indicators. The indicators were helpful to follow the coverage of obstetric care and to identify problems within the health care system. However, in countries where the coverage of assisted deliveries is low with few obstetric complications seen within the health care system, the indicators cannot be used as a tool to monitor the effect of maternal health care programmes on maternal mortality. (author's)