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POPULATION AND DEVELOPMENT REVIEW. 1998 Sep; 24(3):659-64.Choosing the topic of birth registration as one of the main themes addressed in its recent report "Progress of Nations 1998," UNICEF presents a well-reasoned argument about why such registration is important, offers a critical description of the deficiencies of birth registration in developing countries, and calls for improvement. Although the quantitative assessment of the degree of completeness of birth statistics is difficult to accomplish when a large percentage of births remain unregistered, UNICEF's report concludes that approximately 40 million births per year are not registered. This means that about one-third of all births go unregistered. Excerpts of the report are presented. The first section of the paper discusses the deficiencies of birth registration and presents UNICEF's rough regional and country estimates of the incompleteness of birth registration. The second section consists of an excerpt from an incisive commentary on the topic by Unity Dow, a High Court judge in Botswana.
BMJ. British Medical Journal. 1996 Feb 17; 312(7028):398.New data produced by the WHO and Unicef demonstrated that maternal mortality has been underestimated by a third, with nearly 80,000 more pregnancy-related deaths than previously reported. About 585,000 maternal deaths occur every year, 99% of them in developing countries. 55% of the deaths occur in Asia, which is responsible for 61% of the world's births, while Africa accounts for 40% of deaths and 20% of the world's births. Developed countries account for only 1% of maternal deaths and 11% of all births. Specific statistical models were used to assess the amount of underreporting that is common in developing countries, but can also occur in developed countries. When a pregnant woman is moved from the obstetrics department because of complications and subsequently dies, the original cause of the complication often is missing from the death certificate. A representative of WHO's maternal health and safe motherhood program remarked that these estimates are a great improvement over previous data. They also should encourage action to expand access to quality care for all women during pregnancy and childbirth. In North Africa, southern Africa, eastern Asia, Central America, and South America the estimates of maternal mortality were slightly lower than those available from earlier studies. The situation was particularly worrisome in eastern, middle, and western Africa, where the earlier estimates had been underestimated by almost one-third.
Mission report, Regional Office, Manila. Subject: Sexually transmitted diseases surveillance system.
[Unpublished] 1992 Mar 3. , 29 p. (ICP/GPA/012; RS/91/0545)The objectives of this mission of the World Health Organization (WHO) were to establish a region-wide sexually transmitted diseases (STDs) surveillance system by integrating it into the AIDS/HIV infection surveillance system, to evaluate the regional STD program, and to provide STD consultation to other WHO disease prevention and control programs. The annual number of cases of gonorrhea, syphilis, and yaws were reported by 35 countries of the region from 1979 to 1990. China reported STDs only in 1990. In another 6 countries with populations between 10 and 150 millions only 2 countries filed adequate reports. In 6 countries with populations between 1 and 9 million also only 2 countries reported data regularly. 7 countries with adequate reporting were among 22 countries with less than 1 million of population. Vietnam had a major increase in reported gonorrhea and syphilis cases in 1990. In the Philippines the ratio of gonorrhea versus syphilis implied problems with the reporting of syphilis. The ratio of Guam was 4 times higher than expected. The short- and medium-term plan for AIDS contained detailed information on STDs. Findings indicated that: 1) Only gonorrhea and syphilis were reported regularly. Two-thirds of the countries did not report gonorrhea or syphilis with sufficient regularity to allow analysis of trends. 2) Underreporting was the major problem in several countries. 3) There were reporting errors. More systematic collection and feedback by the Regional Office on the Member States should ensure better reporting. Errors should be reduced by validating the information received and improving underreporting (sentinel surveillance and prevalence studies). The control and reporting of genital ulcer disease and syphilis should be strengthened because of evidence that they are risk factors for HIV-1 transmission. The evaluation of primary prevention of AIDS/HIV/STDs by the use of condoms and other measures should be improved. Information on the sex worker system and behavior is needed in most countries.
GLOBAL AIDSNEWS. 1995; (1):5.Around 2.5 million people were newly infected in 1994 with the human immunodeficiency virus (HIV), according to the Global Programme on AIDS (GPA) estimates published in January 1995. This raised the total number of people infected with HIV to 19.5 million, including 1.5 million children, since the start of the pandemic. Sub-Saharan Africa, where the cumulative number of infections among adults rose to an estimated 11 million, remained hardest hit by the pandemic. But proportionately the greatest increase by region was in south and south-east Asia, where the total of HIV infections among adults rose to 3 million in 1994 from 2 million at the end of 1993. The number of people estimated to have developed AIDS since the start of the pandemic rose to around 4.5 million at the end of 1994. This is more than four times the figure actually reported to GPA. The difference between the estimated and reported figures is attributed to underdiagnosis, underreporting, and statistical delays. Dr. Rand Stoneburner of GPA's surveillance, evaluation, and forecasting unit said recent surveillance data from south-east Asia illustrated the geographic expansion of the epidemic. A trend of rising HIV prevalence among blood donors in Chiang Mai, Thailand, was now being repeated, with a delay of 3 or 4 years in Phnom Penh, Cambodia. And there was already evidence that a similar curve could be traced further along the graph for Viet Nam.
The current global situation of the HIV / AIDS pandemic. La situation actuelle de la pandemie de VIH / SIDA dans le monde.
WEEKLY EPIDEMIOLOGICAL RECORD. 1994 Jul 1; 69(26):191-2.Between mid-1993 and mid-1994, the number of AIDS cases reported to WHO increased 37%. The cumulative number of reported global AIDS cases is 985,119 (as of mid-1994). Of all reported AIDS cases, 42% are in the US, 33.5% in Africa, 11.5% in the Americas (excluding the US), 11.5% in Europe, 1% in Asia, and 0.5% in Oceania. Based on available data on global HIV infections, WHO considered incomplete reporting, underdiagnosis, and reporting delay to estimate the number of AIDS cases to be about 4 million and the global distribution of AIDS cases to be greater than 67% in the US, 12% in the Americas, 10% in the US, 6% in Asia, more than 4% in Europe, and less than 1% in Oceania. This adjusted number is a 60% increase over the estimated 2.5 million cases as of July 1993. The rise in AIDS cases in Asia reflects the rapid spread of the AIDS epidemic there. More than an estimated 16 million adults and 1 million children have been infected with HIV since the beginning of the HIV/AIDS pandemic (as of July 1994). Most of the HIV infected adults have been in sub-Saharan Africa (>10 million). South and Southeast Asia had the next highest number of all adults ever infected with HIV (2.5 million) followed by Latin America and the Caribbean (2 million) and North America (>1 million). Australia has the lowest number of cumulative adult HIV infected cases (>25,000). An estimated 80-90% of all children ever infected with HIV have lived in sub-Saharan Africa. The number of HIV infected adults and adult AIDS cases alive as of mid-1994 in sub-Saharan Africa was 8 million. The number for South and Southeast Asia, Latin America and the Caribbean, and North America was 2.5 million, 1.5 million, and more than 800,000, respectively. The number of HIV infected persons alive as of mid 1994 in developed countries was not much different than that of mid 1993, suggesting that the number of AIDS deaths was about the same as the number of new HIV infections.
REVISTA PAULISTA DE MEDICINA. 1989 Jan-Feb; 107(1):47-52.In the fight against maternal mortality, the WHO recommended that developing countries adopt effective measures to reduce its high prevalence. One measure is the improvement of data about maternal deaths and major risk factors during pregnancy, delivery, and puerperium. Official figures are underreported by 50% or more, and the cause of death tends to be attributed to an immediate preceding complication. In the US, maternal mortality declined from 37/100,000 live births in 1960 to 8/100,000 in 1984; in Chile from 299 in 1960 to 45 in 1984; in Ecuador from 270 in 1960 to 189 in 1984; and in Paraguay from 327 in 1960 to 283 in 1984, a barely noticeable reduction. Strategies that improve knowledge include the keeping of statistics; epidemiological investigations (case control studies); and the formation of committees on maternal death, which are composed of highly regarded professionals (the UK, Chile, and Cuba obtained good results with them). The education of the populace by radio, television, and print media to utilize prenatal assistance is another measure. The human resources, location, and minimum instrumentation of these health centers are basic requirements. Most maternal deaths occur in hospitals of inadequate staff and material resources. The traditional birth assistant training program of Ceara state, Brazil, is a model for others. Caesareans save many lives in complicated deliveries, but in Sao Paulo state, more than 80% of some groups choose it without justification. Assistance Needs to be extended into the puerperium to monitor normal involution of the genital organs, to confirm normal lactation, and observe any pathology present during pregnancy. Cardiopathy, renal insufficiency, chronic hypertension, grand multiparity, and advanced maternal age are high risk factors for pregnancy. Postabortion deaths account for more than half of mortality in some Latin American countries. In the UK, mortality dropped from 35 in 1969, after the legalization of abortion in 1968 to 8 in 1975. The reverse was observed in Romania when abortion became outlawed. Nonetheless, abortion is a touchy issue and education about contraceptives should be stressed.
WESTERN JOURNAL OF MEDICINE. 1987 Dec; 147(6):694-701.This article describes AIDS case definitions and reporting and the problems with serologic studies of HIV antibody detection. These problems include technical limitations of HIV antibody testing, false positive results due to the presence of malaria antibodies, and cross reactions between HIV 1 and HIV 2. There is a summary of the three basic modes of transmission: sexual, perenteral, and perinatal. Geographic patterns of transmission differ with the frequency of the three modes of transmission and the ways in which HIV infection occurs in different cultures. Three patterns are identified. Pattern I involves homosexual and bisexual transmission with some heterosexual transmission and significant perenteral transmission through intravenous (IV) drug use. Population seroprevalence is 1%. Countries with this pattern are North America, Europe, some areas of South America, Australia, and New Zealand. Pattern II involves larger risk groups and heterosexual transmission. There is high seroprevalence among women, and, as a result, perinatal transmission is evident. Seroprevalence is >1%. Examples of this pattern are central, eastern and southern Africa and Haiti. In Pattern III, the phenomena is recent and transmission is homosexual and heterosexual, particularly among prostitutes or persons from known HIV endemic areas. Imported blood and blood products have contributed to parenteral transmission. Middle Eastern and Asian countries exemplify this pattern. The global epidemiology is discussed by region: the Americas, Europe, Africa, and Oceania. Case reports from 127 countries to WHO have totaled 62,811 in 1987. 70% of the cases reported are from the United States. The estimated number of AIDS cases worldwide is 100,000-150,000, and HIV infected people are thought by WHO to number 5-10 million. In the United States, reported AIDS cases continue to double every year. There is some evidence for stabilization in at least one homosexual population. Between 1985-86, there was a 130% increase in heterosexual the number of heterosexuals (mostly women) who acquired AIDS from contact with IV drug users or bisexual men. Brazil has the second largest number of cases and follows Pattern I. Europe reported 5687 cases by 1987 compared to 44,000 for the US. The highest rate of AIDS cases in Europe is from Switzerland at 34.9/million (which compares to 140.2/million in the US). 50% of the reported cases in Europe are in people from Africa or the Caribbean. African AIDS is distinguished by 50% of cases being in women. AIDS cases from transfusion are still a problem. Perinatal transmission occurs. Nonmedical parenteral transmission (ritual scarification, circumcision, and so on) and medical injections play a role in transmission of HIV infection among children. Surveillance has improved. Oceania reported 569 cases by 1987. Australia has the highest rate in Oceania at 23.8/million and a male to female sex ratio of 26:1; pattern I predominates. Other countries which have reported cases are Thailand, Japan, the Philippines, Israel, and 2 cases from China.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1992; 70(6):801-7.In 99 countries or areas of the world, more than 40% of the population is at risk of acquiring malaria. Falciparum malaria does not exist or is not a problem in just 13 countries or areas. 9% of the population live in areas, chiefly in sub-Saharan Africa, where no national malaria program operates and malaria incidence is still high. Global incidence is about 120 million cases (>80% in sub-Saharan Africa) and almost 300 million people (>90% in sub-Saharan Africa) have the parasite. Reporting of malaria cases of WHO is improving, but is still variable. In north Africa, Libya and Tunisia appear to be free from malaria transmission. Number of cases in Egypt is falling and tend to be in El Faiyum Governorate. 53% of all cases in the Americas are in Brazil (almost 99% in Amazonia), 25% from Andean countries (especially Columbia and Ecuador), and 14% from Central America. Malaria transmission in the Caribbean is limited to Hispaniola. Even though most malaria cases are in Brazil, French Guiana and Guyana have the highest incidence (52 and 40 cases per 1000 people, respectively). Bahrain, Cyprus, Israel, Jordan, Kuwait, Qatar, and Lebanon are free of endemic malaria. Yet malaria transmission did occur in the Kerak Lowlands of Jordan in 1990, but remedial measures quickly eliminated the focus. Malaria cases still occur in Afghanistan, Pakistan, Iran, Oman, Saudi Arabia, Yemen, the United Arab Emirates, and Syria. India has more than 33% of the malaria cases outside of Africa. Except for the Maldives, the other south Asian countries continue to have malaria transmission. In east Asia and Oceania, the countries which continue to have malaria transmission are Thailand, Indonesia, Viet Nam, some areas of China, Cambodia, Laos, Myanmar, Papua New Guinea, Vanuatu, Solomon Islands, Malaysia, and Philippines. In Turkey, endemic malaria occurs in the southeast (Adana and southeast Anatolia) and at limited other foci. There are also small foci of endemic malaria in Azerbaijan and Tajikistan.
REVUE DE L INFIRMIERE. 1991 May 21; 41(10):27-32.The coordinator and nurse of the anti-AIDS program of the Red Cross in Tanzania relates that families affected by the disease are helped with food, clothes, and moral support. The new illness appeared in 1983 in a zone at the Tanzanian-Ugandan frontier. The first victim of AIDS was a Ugandan merchant, and the infection spread to the large cities of the country mostly by heterosexual transmission facilitated by the prevalent practice of having multiple sexual partners. According to January 1991 WHO figures there were 7128 cases reported in the country among 24 million inhabitants, but this figure ought to be multiplied by 2 or more. 30% of women were found seropositive at Kigali in the north and 20% in Dar-es-Salaam. Certain informal sources project 64,000 AIDS cases for 1992. If the WHO estimation that 50-100 seropositive persons hide behind 1 patient with AIDS is correct, one could calculate 3.2-6.4 million of seropositive people for 1992. Officially, this is not admitted because of the hesitation to tarnish the image of the country trying to attract tourists. The Muhimbili Hospital in Dar-es-Salaam has 45 beds, but it can accommodate 60 patients on mattresses. Hospitalization is mostly for opportunistic infections, and often for tuberculosis. AZT is very expensive, even in countries where it is available. The association WAMATA, in existence since 1989, offers help to seropositive people or AIDS victims trying to stress prevention and educate people about the use of the condom, although the modification of people's behavior in a culture where sexuality and fertility are closely linked is difficult. The government budget is not sufficient for buying condoms for protecting the whole population. The National AIDS Control Program has the objective of sensitization of young people by sex education and by belatedly discouraging traditional wedding ceremonies where guests get drunk and engage in love-making.
Environmental and project displacement of population in India. Part I: Development and deracination.
UFSI FIELD STAFF REPORTS. 1991; (14):1-16.Official development projects in India have displaced at least 20 million persons since Indian independence in 1947, and the majority have not been relocated in planned resettlement. India is in a race to implement development projects needed to support the growth of its population, which increased from 361 million in 1951 to 840 million in 1990. Through the 1960s and 1970s about 1/4 of these oustees were minimally resettled and the rest had to find their own way to get reestablished. There is no international consensus on the rights of internally displaced persons, but most countries compensate people. Agricultural labor and construction labor are the most common types of work of the landless oustees. 1,589 large dams built since independence ousted the largest number of people. Dams, reservoirs, and canals displaced 11,000,000 people; 2,750,000 were rehabilitated and 8,250,000 found their own way. Mines displaced 1,700,000; 450,000 were rehabilitated and 1,250,000 found their own way. Industries displaced 1,000,000; 300,000 were rehabilitated and 700,000 found their own way. Parks and sanctuaries displaced 600,000; 150,000 were rehabilitated and 450,000 relocated on their own. Other projects displacing people are forest preserves, wildlife sanctuaries, military installations, weapons testing grounds, nuclear installations, and railroads and roads. The World Bank requires compensation for people displaced by 12 dam projects it is funding in India: the underestimated count is 610,500 persons. The Pong Dam, a 130 m high gravel dam, under the western Himalayas ousted 30,330 families, about 167,000 people, but only 16,001 families were found eligible for compensation. The Subarnarekha Project in southern Bihar is displacing 10,000 families, about 55,000 people. The state government estimates that 35% of these will not settle in suggested relocation sites because land is not available.
INTEGRATION. 1989 Oct; (21):48.At the end of 1988, Asia was the continent with the least number of reported AIDS cases, yet its doubling time for AIDS cases stood at 1 year. In the beginning of 1983, there were 11 reported AIDS cases in Asia and, by 1984, there were 18. This number later shot up to 52 (1985), 96 (1986), 209 (1987), and then 360 (1988). The Americas have consistently had the highest number of reported AIDS cases from 1982-1985. For example, it stood at 1449 at the end of 1982 and at 23,207 the end of 1985. The Americas numbers grew to 43,109 in 1986, 72,850 in 1987, and 105,773 in 1988. Beginning in 1986, Sub-Sahara Africa had the highest number of AIDS cases based on WHO estimates. These numbers climbed from 79,900 in 1986 to 151,000 in 1987 and to 260,000 in 1988. Indeed WHO stated that for every reported AIDS case in Africa in 1988 there were almost 19 unreported cases. The number of cases for the entire African continent soared from 16 in 1983 to 27,149 in 1988. Europe followed the Sub-Sahara, the Americas, and Africa with the number of reported AIDS cases climbing from 133 in 1982 to 20,622 in 1988. Oceania was the 2nd least infected region with only 7 cases reported in early 1983 to 1314 in 1988. Using horizontal interpolation, Europe was almost 3 years behind the Americas; Oceania >3 years behind Europe; and Asia nearly 2 years behind Oceania.
INTEGRATION. 1989 Jul; (20):60.As of May 1, 1989, the SEARO region experienced the highest 4 month increase (+119%) in the cumulative reported number of AIDS cases. However, the only countries reporting cases in that region, India and Thailand ranked 1st and 3rd as the world's lowest (.019/100,000 and .004 respectively). Europe including Israel had the next highest 4 month increase (25.2%). The incidence rates for Switzerland and France ranked as the highest in the region (12.24 and 11.52 respectively). The incidence for Israel was 1.78 with imported blood responsible for transmitting HIV to most of the cases. Turkey and Romania had the lowest incidence rates in the region (.038 and .044 respectively) which also were the 4th and 6th lowest rates in the world. 5 predominantly Moslem nations (Qatar, Tunisia, Lebanon, Sudan, and Morocco) ranked behind Europe in terms of 4 month increase (22.5%). Qatar had the highest incidence (5.07) and like Israel these cases had AIDS due to transfusions of imported HIV contaminated blood. Morocco's incidence rate was the lowest at .095. The region that included Australia, New Zealand, Singapore, Papua New Guinea, Hong Kong, Japan, and the Philippines experienced a 19.3% 4 month increase. Incidence varied from 7.85 for Australia to .038 for the Philippines. In fact, the Philippines had the 5th lowest rate in the world. Even though the Americas had the 2nd lowest 4 month increase, the world's highest incidence rates were here. For example, the 3 largest included Bermuda 173.01, French Guiana 147.52, and the Bahamas 109.8. Bolivia had the lowest incidence rate in the Americas (.235). Africa had the distinction of being the region with the lowest 4 month increase (11.2%). The Congo had the largest incidence rate in the region and the 4th in the world (57.34) followed by Uganda (38.66). On the other hand, Nigeria had the world's 2nd lowest rate (.015) while many of its neighbors had much higher rates. For example, Benin's rate stood at .836, Cameroon .576, and Niger .619.
[Unpublished] 1990 Sep. , 14 p. (WHO/GPA/SFI/90.2 Rev. 1)On the basis of data available as of September 1990, the World Health Organization's Global Program on Acquired Immunodeficiency Syndrome (AIDS) estimates that over 8 million adults worldwide are infection with the human immunodeficiency virus (HIV), including more than 5 million in Africa, 1 million in North America, 1 million in South America, 500,000 in Asia, 500,000 in Europe, and 30,000 in Oceania. Although 283,010 cases of AIDS have been reported officially, the actual number is believed to exceed 800,000. In addition, over 400,000 pediatric AIDS cases (90% in sub-Saharan Africa) are estimated to exist. By the year 2000, there may be a cumulative total of 15-20 million HIV-infected individuals and 5-6 million AIDS cases. About 60% of present HIV infections were acquired through vaginal intercourse. During the 1990s, over 3 million AIDS cases will emerge in persons infected before 1990, another 1-2 million cases will develop as a result of HIV infections acquired in that decade, and another 1 million AIDS cases can be prevented through public health interventions. In general, the epidemiologic pattern of HIV/AIDS depends on both the year or time period when HIV was introduced or began to spread widely in a specified population and the predominant mode of transmission. In the industrialized Western countries, homosexuals and intravenous drug users will continue to be the population groups most affected by HIV infection in the 1990s, while bisexual men and female prostitutes are major carriers in the Caribbean and Latin America. In sub-Saharan Africa, AIDS is expected to increase child mortality rates by 50% and destroy gains in child survival. The costs to the health care system, and the socioeconomic impact of a disease that largely affects young Africans in their prime productive years, will be immense.