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Globalization and women's and girls' health in 192 UN-member countries convention on the elimination of all forms of discrimination against women.
International Journal of Social Economics. 2016 Jul 11; 43(7):692-721.Purpose - The purpose of this paper is to explore the relationship between the ratification of the United Nations' (UN's) Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and women's and girls' health outcomes using a unique longitudinal data set of 192 UN-member countries that encompasses the years from 1980 to 2011. Design/methodology/approach - The authors focus on the impact of CEDAW ratification, number of reports submitted after ratification, years passed since ratification, and the dynamic impact of CEDAW ratification by utilizing ordinary least squares (OLS) and panel fixed effects methods. The study investigates the following women's and girls' health outcomes: Total fertility rate, adolescent fertility rate, infant mortality rate, maternal mortality ratio, neonatal mortality rate, female life expectancy at birth (FLEB), and female to male life expectancy at birth. Findings - The OLS and panel country and year fixed effects models provide evidence that the impact of CEDAW ratification on women's and girls' health outcomes varies by global regions. While the authors find no significant gains in health outcomes in European and North-American countries, the countries in the Northern Africa, sub-Saharan Africa, Southern Africa, Caribbean and Central America, South America, Middle-East, Eastern Asia, and Oceania regions experienced the biggest gains from CEDAW ratification, exhibiting reductions in total fertility, adolescent fertility, infant mortality, maternal mortality, and neonatal mortality while also showing improvements in FLEB. The results provide evidence that both early commitment to CEDAW as measured by the total number of years of engagement after the UN's 1980 ratification and the timely submission of mandatory CEDAW reports have positive impacts on women' and girls' health outcomes. Several sensitivity tests confirm the robustness of main findings. Originality/value - This study is the first comprehensive attempt to explore the multifaceted relationships between CEDAW ratification and female health outcomes. The study significantly expands on the methods of earlier research and presents novel methods and findings on the relationship between CEDAW ratification and women's health outcomes. The findings suggest that the impact of CEDAW ratification significantly depends on the country's region. Furthermore, stronger engagement with CEDAW (as indicated by the total number of years following country ratification) and the submission of the required CEDAW reports (as outlined in the Convention's guidelines) have positive impacts on women's and girls' health outcomes.
Ambulatory Pediatrics. 2008 Sep-Oct; 8(5):300-304.Background.-Ninety-nine percent of the 4 million neonatal deaths per year occur in developing countries. The World Health Organization (WHO) Essential Newborn Care (ENC) course sets the minimum accepted standard for training midwives on aspects of infant care (neonatal resuscitation, breastfeeding, kangaroo care, small baby care, and thermoregulation), many of which are provided by the mother. Objective.-The aim of this study was to determine the association of ENC with all-cause 7-day (early) neonatal mortality among infants of less educated mothers compared with those of mothers with more education. Methods.-Protocol- and ENC-certified research nurses trained all 123 college-educated midwives from 18 low-risk, first-level urban community health centers (Zambia) in data collection (1 week) and ENC (1 week) as part of a controlled study to test the clinical impact of ENC implementation. The mothers were categorized into 2 groups, those who had completed 7 years of school education (primary education) and those with 8 or more years of education. Results.-ENC training is associated with decreases in early neonatal mortality; rates decreased from 11.2 per 1000 live births pre- ENC to 6.2 per 1000 following ENC implementation (P <.001). Prenatal care, birth weight, race, and gender did not differ between the groups. Mortality for infants of mothers with 7 years of education decreased from 12.4 to 6.0 per 1000 (P < .0001) but did not change significantly for those with 8 or more years of education (8.7 to 6.3 per 1000, P ¼.14). Conclusions.-ENC training decreases early neonatal mortality, and the impact is larger in infants of mothers without secondary education. The impact of ENC may be optimized by training health care workers who treat women with less formal education.
Progress and challenges in modelling country-level HIV/AIDS epidemics: the UNAIDS Estimation and Projection Package 2007.
Sexually Transmitted Infections. 2008; 84(Suppl 1):i5-i10.The UNAIDS Estimation and Projection Package (EPP) was developed to aid in country-level estimation and shortterm projection of HIV/AIDS epidemics. This paper describes advances reflected in the most recent update of this tool (EPP 2007), and identifies key issues that remain to be addressed in future versions. The major change to EPP 2007 is the addition of uncertainty estimation for generalised epidemics using the technique of Bayesian melding, but many additional changes have been made to improve the user interface and efficiency of the package. This paper describes the interface for uncertainty analysis, changes to the user interface for calibration procedures and other user interface changes to improve EPP's utility in different settings. While formal uncertainty assessment remains an unresolved challenge in low-level and concentrated epidemics, the Bayesian melding approach has been applied to provide analysts in these settings with a visual depiction of the range of models that may be consistent with their data. In fitting the model to countries with longer-running epidemics in sub-Saharan Africa, a number of limitations have been identified in the current model with respect to accommodating behaviour change and accurately replicating certain observed epidemic patterns. This paper discusses these issues along with their implications for future changes to EPP and to the underlying UNAIDS Reference Group model.
Dar es Salaam, Tanzania, Research on Poverty Alleviation [REPOA], 2007. 26 p. (Special Paper 07.25)The intention of this paper is to highlight the key issues of children and vulnerability in Tanzania. The paper states that a national framework for social protection must be established to address these overwhelming facets of insecurity and vulnerability for children in Tanzania. The framework needs to reduce vulnerability, strengthen capabilities and must therefore put priority on improving the rural economy and rural conditions of life, and on improving health care and other services in rural areas to reduce the toll of ill-health on children and their caregivers. According to the paper pre-natal and obstetric care must be improved so that at birth babies and their mothers are provided health services which minimise their risk of death. Moreover, individuals who require special support may be identified through a combination of community and local government systems, with strengthened organised community groups to care for the most vulnerable. The paper further states that the level of support provided by several programmes to a relatively small number of children, for clothing, for example, is far in excess of the average expenditures by the majority of households on their children. The challenge is to provide support mechanisms which are not stigmatising, nor discriminatory, but which ensure that all children, no matter what their circumstances, benefit from and contribute to their own development and that of the nation to their fullest capacity. In conclusion the paper emphasises that the implications of this analysis suggest that investments are most critically needed to ensure that there is equitable access to quality health care, and that much more serious attention is needed towards the social attitudes towards children and young people and practices of caring for children, not only as infants, but also as older children.
New York, New York, United Nations, 2006.  p. (ST/ESA/STAT/SER.K/17)The World's Women 2005: Progress in Statistics focuses on the state of statistics for addressing gender concerns. It reviews the current availability of national data and assesses progress in data reporting from 1975 to 2003, based on the information that national statistical authorities report to the international statistical system. The statistics reviewed include those related to population, health, education and work. Also reviewed in the report is the current state of statistics in some of the relatively newer areas, namely violence against women; poverty; power and decision-making; and human rights. The focus on official national statistics, as differentiated from internationally prepared estimates, reveals the extent to which Governments are able to produce statistics to address various gender concerns. By so doing, the report provides Governments with the means to assess progress, identify gaps and design strategies to improve the national collection and dissemination of gender statistics needed for policy formulation and programme planning and evaluation. (excerpt)
African Population Studies/Etude de la Population Africaine. 2006; 21(1):19-36.Relatively scant knowledge is available on the situations of older persons in sub-Saharan Africa. Reliable and accessible demographic and health statistics are needed to inform policy making for the older population. The process and outcome of a project to create a minimum data set (MDS) on ageing and older persons to provide an evidence base to inform policy are described. The project was initiated by the World Health Organization and conducted in Ghana, South Africa, Tanzania and Zimbabwe. A set of indicators was established to constitute a sub-regional MDS, populated from data sources in the four countries; a national MDS was produced for each country. Major gaps and deficiencies were identified in the available data and difficulties were experienced in accessing data. Specific gaps, and constraints against the production and access of quality data in the subregion are examined. The project and outcome are evaluated and lessons are drawn. Tasks for future phases of the project to complete and maintain the MDS are outlined. (author's)
New York, New York, UNICEF, 2006 Sep. 33 p.Water is as fundamental to human life as the air we breathe. Yet, ironically, this essence of life can have an injurious impact if its source is not free from pollution and infection -- and the most likely pollutant is human faeces that have not been disposed of and have spread because of a lack of basic sanitation and hygiene. Young children are more vulnerable than any other age group to the ill effects of unsafe water, insufficient quantities of water, poor sanitation and lack of hygiene. Globally, 10.5 million children under the age of five die every year, with most of these deaths occurring in developing countries. Lack of safe water, sanitation and adequate hygiene contribute to the leading killers of children under five, including diarrhoeal diseases, pneumonia, neonatal disorders and undernutrition. This means that Millennium Development Goal 7 -- to ensure environmental sustainability -- and its associated 2015 targets of reducing by half the proportion of people without sustainable access to safe drinking water and basic sanitation are of vital relevance to children. MDG 7 is also crucial in relation to improving nutrition, education and women's status, and success in this field will thus play a major role in determining whether the world meets its MDG targets across the board. (excerpt)
Bulletin of the World Health Organization. 1956; 15:5-41.The author reviews that mortality statistics from cancer of the breast in females and from malignant neoplasms of the uterus and of the other female genital organs for nineteen countries over the years 1920-53, first considering the general trend of the mortality series for each group of diseases for all ages and then analysing for each sector of mortality the changes which have occurred in the age-specific death-rates in some pivotal years during the same period. Considerable differences in the levels of total mortality from each group of tumours for various countries are noted. The important variations among age-specific death-rates for cancer of the breast in females and for uterine neoplasms in various countries are examined and their significance is commented upon. (excerpt)
Bulletin of the World Health Organization. 1954; 11:201-228.The information contained in the table that follows was obtained from a questionnaire sent by WHO in June 1953 to all Member States in order to elicit information on the types of health statistics and related vital statistics that are available in different countries, how they are obtained, and to what extent they are made available to the international organizations. The questionnaire asked for information on causes of death, causes of foetal death, and notifiable diseases, in addition to the subjects listed in the table. It will be seen that only a certain number of countries answered fully that part of the questionnaire with which we are concerned here. The reason is fairly obvious: statistics pertaining to health in its various aspects are numerous, varied, and scattered among many government departments apart from the health administrations--for instance, among the ministries of social welfare (social insurance returns, hospital statistics), of defence (army, navy, and air force health statistics), and of education (school medical inspection, number of students and graduates in medicine and in allied professions). To compile a complete inventory of existing health statistics would require many months of patient search in publications and reports and correspondence with the many national administrations concerned. (excerpt)
Lancet. 2006 Jan 21; 367(9506):190-193.After decades of debate about the need to improve the quality of basic health statistics in developing countries, there is at last substantial progress on the horizon. The recently created Health Metrics Network and the Ellison Institute for World Health offer the potential for strengthened health information systems to inform better policy development. Both initiatives are backed by new funding. Both will lead to new secretariats and partnerships between academics, governments, and intergovernmental agencies. That is the promise. The magnitude of the need has been well documented. Many countries are still unable to count their dead, let alone produce accurate statistics for cause of death or disease. Most countries do not have the capacity to regularly assess the performance of their health systems and few use reliable information for decision-making. In recent years, some progress has been made in addressing the need for improved global and regional health data. For specific diseases, such as HIV, a solid empirical database has been established. (excerpt)
New York, New York, UNICEF, 2005 Feb.  p.This reference book, jointly produced by the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO), presents detailed statistics on the performance of national and local immunization systems for 193 countries and territories. It provides a quick overview of key aspects of immunization systems, including: Trends in national and territorial coverage rates for six antigens; The proportion of districts achieving target ranges of coverage for DTP3 and measles-containing vaccine; DTP drop-out rates; District-level performance indicators reflecting the prevalence of interruptions in vaccine supply and the adequacy of supplies of autodisable syringes for routine services. (excerpt)
New York, New York, UNICEF, 2005 Nov.  p.FGM/C is a fundamental violation of human rights. In the absence of any perceived medical necessity, it subjects girls and women to health risks and has life-threatening consequences. Among those rights violated are the right to the highest attainable standard of health and to bodily integrity. Furthermore, it could be argued that girls (under 18) cannot be said to give informed consent to such a potentially damaging practice as FGM/C. FGM/C is, further, an extreme example of discrimination based on sex. The Convention on the Elimination of All Forms of Discrimination against Women defines discrimination as "any distinction, exclusion or restriction made on the basis of sex which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise by women, irrespective of their marital status, on a basis of equality of men and women, of human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field." Used as a way to control women's sexuality, FGM/C is a main manifestation of gender inequality and discrimination "related to the historical suppression and subjugation of women," denying girls and women the full enjoyment of their rights and liberties. (excerpt)
New York, New York, UNICEF, 2005 Apr. 40 p.The objective of this study is to present available empirical evidence obtained through household surveys in order to estimate the prevalence of child marriage and to identify and understand the factors associated with child marriage and cohabitation. The presentation of the empirical evidence and analysis is structured around the indicators presented previously. The term 'child marriage' will be used to refer to both formal marriages and informal unions in which a girl lives with a partner as if married before the age of 18. The report presents a global assessment of child marriage levels, differentials in child marriage rates according to socio-economic and demographic variables, characteristics of the union, and knowledge and access to sexual and reproductive health information and materials. Statistical associations between indicators can reveal potential linkages in programming to promote the delay of marriage and point to opportunities to integrate advocacy and behaviour-change campaigns toward the prevention of child marriage and a multivariate analysis allows for the illumination of the net effect of each variable. Anomalies to general trends are often highlighted in the text in order to direct programmers and researchers towards case examples that may require further study or circumstances that may provide models for eradication efforts. (excerpt)
New York, New York, UNICEF, 2005 Feb. 32 p.The objective of this study is to present available empirical evidence obtained through household surveys in order to estimate levels of registration and to understand which factors are associated with children who obtain a birth certificate, and thus realize their right to a name and legal identity. The paper presents a global assessment of birth registration levels, differentials in birth registration rates according to socio-economic and demographic variables, proximate variables and caretaker knowledge, as well as a multivariate analysis. Statistical associations between indicators regarding health, education and poverty can reveal potential linkages in programming to promote the registration of children. By analysing levels of birth registration in the context of other health, education and poverty indicators, the study points to opportunities to integrate advocacy and behaviour change campaigns for birth registration with early childhood care and immunization. By linking birth registration to early childhood programmes, a legal hurdle can become a helpful referral to promote improved health, education and protection for disadvantaged children and their caretakers. (excerpt)
New York, New York, UNFPA, 2005.  p.Population dynamics and reproductive health are central to development and must be an integral part of development planning and poverty reduction strategies. Promoting the goals of the United Nations Conferences, including those of the International Conference on Population and Development (ICPD), is vital for laying the foundation to reduce poverty in many of the poorest countries. At the ICPD in 1994, the international community agreed that US $17 billion would be needed in 2000 and $18.5 billion in 2005 to finance programmes in the area of population dynamics, reproductive health, including family planning, maternal health and the prevention of sexually transmitted diseases, as well as programmes that address the collection, analysis and dissemination of population data. Two thirds of the required amount would be mobilized by developing countries themselves and one third, $6.1 billion in 2005, was to come from the international community. (excerpt)
Bangkok, Thailand, United Nations, Economic and Social Commission for Asia and the Pacific [ESCAP], .  pThe purpose of this paper was originally to assist the deliberation of the High-Level Intergovernmental Meeting, Beijing +10, (Bangkok 7-10 September, 2004) by presenting a summary of the current situation of women in relation to men in a number of key areas in the Asia-Pacific region. This revised version forms the first volume in a series of two papers, all aimed at addressing major developments in the situation of women in the Asia-Pacific region. The Asia- Pacific region as defined by ESCAP’s membership includes some 50 countries in the region and some 9 territories covering East and North-East Asia, North and Central Asia, South and South-West Asia, South-East Asia and the Pacific. It has repeatedly been demonstrated that data are key to catalyzing and monitoring progress, as well as supporting country-level planning and local accountability. Gender statistics has therefore been a priority area in ESCAP’s statistical capacity building work for many years. As a result, considerable statistical progress has been achieved in the region since the Beijing Declaration and Platform for Action in 1995 adopted the strategic objective “to generate and disseminate sex-disaggregated data and information for planning and evaluation”. (excerpt)
Promises to keep: achieving gender equality and the empowerment of women. Background paper of the Task Force on Education and Gender Equality.
[New York, New York], United Nations Development Programme [UNDP], Millennium Project, 2003 Apr 18.  p.The purpose of the paper is to review progress countries have made in reaching this goal and to suggest recommendations to hasten progress. The paper has four key messages: First, the current MDG gender equality target and indicators do not capture all the major components of gender equality. The paper proposes three domains of gender equality: capability (basic human abilities as measured by education, health and nutrition), opportunity (access to assets, income, and employment), and agency (the ability to make choices that can alter outcomes) and suggests new targets and indicators to augment the ones proposed by U.N. member states. Second, each of these domains is amenable to policy intervention: “capabilities” can be addressed in large part through existing initiatives in health, education, and other sectors; “opportunities” requires some fundamental changes in the economic order; and “agency” is possible through electoral quotas, legislation on violence against women, and other measures. Third, internationally-funded initiatives (such as Education for All), conventions (such as the Convention to Eliminate All Forms of Discrimination Against Women), and other mechanisms (the ILO Decent Work Agenda) that currently exist provide reasonable frameworks for achieving gender equality. These should be complemented by a new international campaign for zero tolerance for violence against women. Finally, the paper urges the international community to translate rhetoric to action by improving the availability and quality of sex-disaggregated data, increasing financial and technical resources for agencies dedicated to promoting the status of women, and enhancing political commitment at the highest levels to end gender inequality and empower women. (excerpt)
Lancet. 2004 Jan 3; 363:67-68.The UN Millennium Declaration has eight goals and 18 targets, including the reduction of maternal mortality by three-quarters by 2015. While this target helps to raise the profile of pregnancy-related deaths, it also has some drawbacks. One of these relates to the distinction between maternal health and maternal death; averting deaths will not alone reduce the burden of suffering caused by pregnancy-related complications, for women, their families, and their communities. Progress judged only in terms of maternal mortality will mask this fact and even distort programme priorities. But a further drawback to the target is that it assumes maternal mortality is indeed measured. Herein lies a problem for the Millennium Declaration and indeed for the many international charters linking human rights to health that presume the availability of outcome indicators for monitoring progress. Here we seek to argue the case of women who are not even statistics—for their right to count. 100 years ago, the case report in the panel might have come from the UK; today it is typical of the estimated half-a-million maternal deaths that occur every year in the developing world. But this figure—like many global indicators of public health—is really just a guess, and most national estimates are not much better. Under-reporting of maternal deaths ranges from 17% to 63% in the routine statistical systems of several developed countries. Similarly, the most recent enquiry into maternal deaths in the UK noted that 19% of direct deaths were initially missed. Addressing the difficulty of counting maternal deaths is, however, a very different prospect in these settings than in the world’s poorest countries. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], . 39 p.Reduction of maternal mortality has been endorsed as a key development goal by countries and is included in consensus documents emanating from international conferences such as the World Summit for Children in 1990, the International Conference on Population and Development in 1994 and, the Fourth World Conference on Women in 1995, and their respective five-year follow-up evaluations of progress in 1999 and 2000, the Millennium Declaration in 2000 and the United Nations General Assembly Special Session on Children in 2002. In order to monitor progress, efforts have to be made to address the lack of reliable data, particularly in settings where maternal mortality is thought to be most serious. The inclusion of maternal mortality reduction in the Millennium Development Goals (MDGs) stimulates increased attention to the issue and creates additional demands for information.1The first set of global and national estimates for 1990 was developed in order to strengthen the information base2. WHO, UNICEF and UNFPA undertook a second effort to produce global and national estimates for the year 1995.3 Given that a substantial amount of new data has become available since then, it was decided to repeat the exercise. This document presents estimates of maternal mortality by country and region for the year 2000. It describes the background, rationale and history of estimates of maternal mortality and the methodology used in 2000 compared with the approaches used in previous exercises in 1990 and 1995. The document opens by summarising the complexity involved in measuring maternal mortality and the reasons why such measurement is subject to uncertainty, particularly when it comes to monitoring progress. Subsequently, the rationale for the development of estimates of maternal mortality is presented along with a description of the process through which this was accomplished for the year 2000. This is followed by an analysis and interpretation of the results, pointing out some of the pitfalls that may be encountered in attempting to use the estimates to draw conclusions about trends.2,3 The final part of the document presents a summary of the kind of information needed to build a fuller understanding of both the levels and trends in maternal mortality and the interventions needed to achieve sustained reductions in the coming few years. (excerpt)
Indian Journal of Gender Studies. 2002 Jan-Jun; 9(1):61-79.The international community has largely felt the need for near-universal primary schooling as an essential aspect of basic human development (UN 1994; UNICEF 1990; USAID 1995). The Programme of Action chalked out at the International Conference on Population and Development (ICPD) held in Cairo in 1994 has underlined two major aspects of children's schooling. The first is universal primary education for both boys and girls, while the second is education for girls beyond the primary level. Principle 10 of the Programme states, 'Everyone has the right to education, which shall be directed to the full development of human resources and human dignity and potential, with particular attention to women and the girl child.' Highlighting the elimination of gender inequality in schooling along with higher educational attainment for the girl child, the Programme mentions: 'Beyond the achievement of the goal of universal primary education in all countries before the year 2015, all countries are urged to ensure the widest and earliest possible access by girls and women to secondary and higher levels of education' (para 4.8). That the main emphasis with respect to education beyond the primary level is to promote girls" schooling is evident in the summary of goals of the ICPD presented in the State of the World Population Report 1995 (UNFPA 1995: 10). The UN's analysis of the ICPD programme has also underlined the importance of women's education as an imperative issue in population development (UN 1994: 25). (excerpt)
New York, New York, UNFPA, 2001. xii, 98 p.Financial Resource Flows for Population Activities in 1999 is the thirteenth edition of a report previously published by UNFPA (United Nations Population Fund) under the title of Global Population Assistance Report. The United Nations Population Fund has regularly collected data and reported on flows of international financial assistance to population activities. The Fund's annual Reports focused on the flow of funds from donors through bilateral, multilateral and non-governmental channels for population assistance to developing countries I and countries with economies in transition. Also included were grants and loans from development banks for population activities in developing countries. In light of the 1994 International Conference on Population and Development and, at the request of the Commission on Population and Development, UNFPA updated its reporting system and began collecting data on domestic resource expenditures in developing countries in addition to data on international population assistance. This report contains information on international assistance from 1990 to 1999 and domestic resource flows to population activities from 1997 to 1999. (excerpt)
Washington, D.C., TvT Associates, Synergy Project, 2002. 36 p. (USAID Contract No. HRN-C-00-99-00005-00)Children on the Brink 2002 contains statistics on children orphaned by HIV/AIDS from 88 countries (Appendix I), analysis of the trends found in those statistics, and strategies and principles for helping the children. The third in a series (earlier editions were published in 1997 and 2000), this document covers 1990 to 2010 and provides the broadest and most comprehensive statistics yet on the historical, current, and projected number of children orphaned by HIV/AIDS. The report is a collaboration of the U.S. Agency for International Development (USAID), the United Nations Children’s Fund (UNICEF), and the Joint United Nations Programme on HIV/AIDS (UNAIDS). (author's)
Health Watch. 2003 Spring; 6(2):5-6.Overall, the first five years of Multilateral Initiative on Malaria (MIM) were characterized largely as an infancy, with the hope that its next five years will mark a coming of age. Four major recommendations emerged from the review which revolve around a central theme--the need for MIM to more strongly identify with its niche of increasing the research capacity of African nations to combat the problem of malaria on the home front. (excerpt)
Comparative performances, under laboratory conditions, of seven pyrethroid insecticides used for impregnation of mosquito nets. [Performances comparées, dans des conditions de laboratoire, de sept insecticides à base de pyréthroïde utilisés pour l'imprégnation des moustiquaires]
Bulletin of the World Health Organization. 2003 May; 81(5):324-333.Objective: To compare the efficacy of seven pyrethroid insecticides for impregnation of mosquito nets, six currently recommended by WHO and one candidate (bifenthrin), under laboratory conditions. Methods: Tests were conducted using pyrethroid-susceptible and pyrethroid-resistant strains of Anopheles gambiae and Culex quinquefasciatus. Knock-down effect, irritancy and mortality were measured using standard WHO cone tests. Mortality and bloodfeeding inhibition were also measured using a baited tunnel device. Findings: For susceptible A. gambiae, alpha-cypermethrin had the fastest knock-down effect. For resistant A. gambiae, the knockdown effect was slightly slower with alpha-cypermethrin and much reduced following exposure to the other insecticides, particularly bifenthrin and permethrin. For susceptible C. quinquefasciatus, the knock-down effect was significantly slower than in A. gambiae, particularly with bifenthrin, and no knock-down effect was observed with any of the pyrethroids against the resistant strain. Bifenthrin was significantly less irritant than the other pyrethroids to susceptible and resistant A. gambiaebut there was no clear ranking of pyrethroid irritancy against C. quinquefasciatus. In tunnels, all insecticides were less toxic against C. quinquefasciatusthan against A. gambiaefor susceptible strains. For resistant strains, mortality was significant with all the pyrethroids with A. gambiaebut not with C. quinquefasciatus. Inhibition of blood-feeding was also high for susceptible strains of both species and for resistant A. gambiaebut lower for resistant C. quinquefasciatus; bifenthrin had the greatest impact. Conclusions: Efficacy for impregnation of mosquito nets against A. gambiae was greatest with alpha-cypermethrin. Bifenthrin is likely to have a significant comparative advantage over other pyrethroids in areas with pyrethroid resistance because of its much stronger impact on the nuisance mosquito, C. quinquefasciatus, despite its slower knock-down effect and irritancy. Selection of pyrethroids for mosquito vector control and personal protection should take into account the different effects of these insecticides, the status of pyrethroid resistance in the target area, and the importance of nuisance mosquitoes, such as C. quinquefasciatus. (author's)
World Health Organization hemoglobin cut-off points for the detection of anemia are valid for an Indonesian population.
Journal of Nutrition. 1999; 129:1669-1674.The study was designed to determine whether population-specific hemoglobin cut-off values for detection of iron deficiency are needed for Indonesia by comparing the hemoglobin distribution of healthy young Indonesians with that of an American population. This was a cross-sectional study in 203 males and 170 females recruited through a convenience sampling procedure. Hemoglobin, iron biochemistry tests and key infection indicators that can influence iron metabolism were analyzed. The hemoglobin distributions, based on individuals without evidence of clear iron deficiency and infectious process, were compared with the National Health and Nutrition Survey (NHANES) II population of the United States. Twenty percent of the Indonesian females had iron deficiency, but no male subjects were iron deficient. The mean hemoglobin of Indonesian males was similar to the American reference population at 152 g/L with comparable hemoglobin distribution. The mean hemoglobin of the Indonesian females was 2 g/L lower than that of the American reference population, which may be the result of incomplete exclusion of subjects with milder form of iron deficiency. When the WHO cutoff (Hb < 120 g/L) was applied to female subjects, the sensitivity of 34.2% and specificity of 89.4% were more comparable to the test performance for white American women, in contrast to those of the lower cut-off. On the basis of the finding of hemoglobin distribution of men and the test performance of anemia (Hb < 120 g/L) for detecting iron deficiency for women, it is concluded that there is no need to develop different cut-off points for anemia as a tool for iron-deficiency screening in this population. (author's)