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Evidence behind the WHO guidelines: Hospital Care for Children: What are appropriate methods of urine collection in UTI?
Journal of Tropical Pediatrics. 2007 Aug; 53(4):221-224.Urinary tract infection (UTI) is a common cause of fever in children < 2 years of age. The prevalence of UTI is ~5% among febrile children in this age group, and may be as high as 9% in tropical regions. Invasive methods of urine collection are occasionally required to obtain urine samples from infants unable to void on command. Improper urine specimen collection can lead to contamination, and a clinical dilemma regarding which infants and children to treat, and how extensively to investigate them for suspected UTI. Under-resourced hospitals and clinics face the additional challenges related to limited means and expertise to adequately collect and process urine samples. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Division of Family Health, Maternal Health and Safe Motherhood Programme, 1992. 74 p. (Safe Motherhood; WHO/MSM/92.4)Women in Africa face a lifetime risk of maternal mortality 500 times greater than that of women in developed countries. This lifetime risk is also considerably higher for women in other developing regions compared to that for those in developed countries. Many health professionals believe that antenatal care in developing countries decreases the likelihood of women dying pregnancy and childbearing as well as significant maternal morbidity, yet no one has systematically assessed its potential to actually improve maternal health. The WHO Maternal Health and Safe Motherhood Programme plans to support research to examine antenatal care's potential. It has reviewed the effectiveness of antenatal interventions compared to poor maternal health in developing countries. The review reveals that good quality data are scarce and that health providers have not accurately tested many interventions. For example, the US, UK, and Sweden have all achieved low case fatality rates for eclampsia using a different anticonvulsant therapy for severe preeclampsia (magnesium sulfate; diazepam or other benzodiazepines; and hydralazine with at least chlorpromazine, pethidine, diazepam, and chlormethiazole, respectively), but few trails have compared the different treatments. This review begins with an overall look at antenatal care programs. It then examines interventions of the leading causes of maternal mortality and morbidity (hemorrhage and anemia, hypertensive disorders of pregnancy, obstructed labor, and puerperal sepsis and genitourinary). The most effective interventions are those that deal with chronic conditions rather than acute conditions which arise near delivery. The review concludes with a table of effective antenatal interventions and tables of research questions about potentially effective antenatal interventions against various maternal conditions.
[Main objectives of the WHO Special Program on Human Reproduction] Osnovnye napravleniia Spetsialnoi Programmy VOZ po Reproduktsii Cheloveka.
AKUSHERSTVO I GINEKOLOGIIA. 1984 Jul; (7):3-6.The WHO Special Program on Human reproduction was established in 1972 to coordinate international research on birth control, family planning, development of effective methods of contraception, and treatments for disorders of the human reproductive system. The Program's main objectives are: implementation of family planning programs at primary health care facilities, evaluation of the safety and effectiveness of existing birth control methods, development of new birth control methods, and development of new methods of sterility treatment. In order to attain these goals, the Program forth 3 major tasks for international research: 1) psychosociological aspects of family planning, 2) birth control methods, and 3) studies on sterility. Since most of the participating nations belong to the 3rd World, the Program is focused on human reproduction in developing countries. The USSR plays an important role in the WHO Special Program on Human reproduction. A WHO Paticipating Center has been established at the All-Union Center for Maternal and Child Care in Moscow. Soviet research concentrates on 3 major areas: diagnosis and treatment of female sterility, endocrinological aspects of contraception, and birth control prostaglandins.
PLANNED PARENTHOOD IN EUROPE: REGIONAL INFORMATION BULLETIN. 1986 Autumn; 15(2):3-13.This paper, prepared for European planned parenthood associations, reviews the range of political and ethical reactions to new reproductive technologies. Planned parenthood federations are committed to ensure that women and human living material are protected both from unethical scientific manipulation and exploitation for profit and that candidates for infertility treatment are given appropriate counseling. Within these limits, research into the causes and treatment of infertility has been encouraged. On the other hand, so-called pro-life forces challenge research in this area on the grounds that the sanctity of human life may be violated. A more recent development has been the emergence of feminist opposition to reproductive research on the grounds that it threatens to lead to the expropriation of women as childbearers. The potential removal of reproduction from people is viewed as a further devaluation of women's status and concern is voiced that pre-embryo screening may take the form of benign eugenics. Feminists further argue that in vitro fertilization services are disproportionately available to white, middle-class women. Finally, it is feared that the incorporation of sex preselection into the population programs of Third World countries will become possible as a logical extension of current importation to developing countries of chemical contraceptives (eg Depo-Provera) regarded as unsuitable for use in the US. In the face of such arguments, both from pro-life and feminist forces, planned parenthood federations are urged to be clear about potential uses and abuses of the new reproductive technologies.
Healthright. 1985 Aug; 4(4):9-12.The pattern of reproductive activity displayed by early hunter-gatherer ancestors, before the dawn of civilization, must have been vastly different from today's pattern. In the absence of contraception such women would have spent the greater part of their reproductive lives either pregnant or in lactational amenorrhea. In developing these ideas further it was estimated that a hunter-gatherer woman would have spent about 15 years in lactational amenorrhea, whereas just under 4 years would have been occupied by her 5 pregnancies, and she would only have had about 4 years of menstrual cycles. The total number of menstrual cycles she would experience in her entire life would be no more than about 50. This is in marked contrast to the situation today in a typical Western woman using contraceptives and experiencing menarche at 13 and the menopause at 50. Allowing her 2 years' respite from cycles during her 2 pregnancies, each followed by only a token period of breastfeeding, this leaves 35 years during which she would experience about 420 menstrual cycles. The conclusion is that an excessive number of menstrual cycles is an iatrogenic disorder of communities practicing any form of contraception. Thus, it is important to note that even the condom or vasectomy have important repercussions on the female's reproductive cycle. Since 99.9% of human existence has been spent living a nomadic hunter-gatherer life, this high frequency of menstrual cycles is a new experience, one that humans may be genetically ill-adapted to cope with. In fact, there are a number of "diseases of nulliparity" whose incidence is markedly increased in women with few or no children and who are therefore experiencing an increased number of menstrual cycles. These diseases include carcinoma of the breast, endometrium and ovaries, and endometriosis. As part of the effort to develop contraceptives that promote a healthy state of fertility, it is necessary to ask the question, "is a period really necessary?" To learn if women women accept a contraceptive method that reduced the frequency of menstruation, a clinical trial of an oral contraceptive was conducted. The OC was administered in such a way as to produce a withdrawal bleed only once every 3 months. This was termed the tricycle pill regimen. 196 women attending a family planning clinic in Edinburgh, Scotland, volunteered to participate, although 89 of them subsequently withdrew from the trial for a variety of reasons before it was completed at the end of a year. Overall, 82% of the women positvely welcomed the reduction in the number of periods; 91% of the women who completed the trial even refused to revert to a standard monthly OC regimen thereafter. The findings were in complete contrast to the results of a World Health Organization survey of patterns and perceptions of menstruation. But the WHO sample was highly biased in favor of women having regular menstrual cycles, and hence quite unrepresentative of the population as a whole. In sum, even the most pessimistic estimate of the WHO's menstruation survey shows that a proportion of women in every country investigated were prepared to accept amenorhea as a by-product of contraception. Reversible amenorrhea might become an increasingly popular form of contraception, and it might also confer significant health benefits.
Psychosocial aspects of involuntary infertility. Report of a Regional Seminar, Espoo, Finland, September 1984.
London, IPPF, Europe Region, 1984. 27 p.This report of a regional seminar conducted by the Planned Parenthood Federation of Finland focuses on the psychosocial aspects of involuntary infertility and their implications for counseling. The seminar was the culmination of a project launched by the Europe Regional Council with the aim of stimulating public awareness of the plight of infertile couples, emphasizing the role of psychosocial counseling in infertility problems, and supporting the role of planned parenthood associations as a resource. It was noted that infertility imposes profound emotional and social stress, in turn evoking feelings of denial, anger, grief, and guilt. However, in most cases the provision of psychosocial support is not given as much attention as the medical management of the problem. There is a need to combine the psychosocial and medical dimensions of infertility treatment through a division of labor between planned parenthood associations and hospitals. Counseling should be aimed initially at identifying the costs and benefits of infertility treatment from the client's perspective. Acceptance of childlessness, as well as becoming able to bear a child, are both valuable results of infertility treatment. Finally, the rapid development of technologic breakthroughs in infertility treatment (e.g., in vitro fertilization, embryo transfer, artificial insemination by donor) raises important legal and ethical considerations that must be addressed. The seminar articulated 5 general conclusions: 1) both the emotional and medical dimensions of infertility require attention, 2) personnel involved with infertility problems need special education and training, 3) there is a need for international guidelines regarding infertility clients and their offspring, 4) legislation to protect all partners involved should be considered, and 5) planned parenthood associations can make a major contribution in this area as a result of their expertise in human fertility, counseling, sex education, and information dissemination.
In: Intrauterine contraception: advances and future prospects, edited by Gerald I. Zatuchni, Alfredo Goldsmith, and John J. Sciarra. Philadelphia, Pennsylvania, Harper and Row, 1985. 354-64. (PARFR Series on Fertility Regulation)Little data is available from developing countries on the incidence of ectopic pregnancy and the associated risk factors: pelvic inflammatory disease (PID), sexually transmitted diseases (STDs), intrauterine devices (IUDs), and abortion. To address this problem, the World Health Organization conducted a multinational case-control study between 1978 and 1980 of factors associated with ectopic pregnancy in 12 centers, 8 in developing countries and 4 in developed countries. Results suggest that risk factors are similar in women from developing and developed countries. The only exceptions were increased risks of ectopic pregnancy associated with spontaneous abortion or smoking in developing but not developed country centers. This may reflect misreporting of illegal induced abortion or postabortion complications, and behavioral differences between smoking and nonsmoking women in developing countries. All methods of contraception prevent pregnancy and so provide protection against ectopic pregnancy. This protective effect is least with the IUD, however, and accidental conceptions during IUD use or after sterilization carry an increased risk of ectopic pregnancy. With the IUD, this probably reflects both differential protection against intrauterine and extrauterine pregnancy and an increased risk of IUD-related PID resulting in tubal damage. The risk of ectopic pregnancy is also increased in women with a previous history of PID or a prior pregnancy. However, cesarean section was found to reduce the risk of ectopic gestations in all comparison groups.
Geneva, WHO, 1984 Dec. ix, 152 p.88 recommendations were formulated by the International Conference on Population held in Mexico City in 1984. 4 of these dealt specifically with research requirements in the population field and are reproduced in this report in their entirety. As a result of the changing perspectives and requirements of the scientific fields in which the Special Program of Research, Development and Research Training in Human Reproduction operates and taking into account the various suggestions resulting from recent reviews of the Program, several new developments have occurred. First is the attempt to distinguish more clearly between activities related to research and development and those related to resources for research. These 2 distinct but closely connected activities will be reorganized to interact in a complementary fashion. In the research and development component, the most notable changes relate to the creation of new Task Forces on the Safety and Efficacy of Fertility Regulating Methods and on Behavioral and Social Determinants of Fertility Regulation. The Program has been actively promoting coordination with other programs which support and conduct research in human reproduction. The research and development section of this report provides a technical review of the activities and plans of the various task forces, covering the following: new and improved methods of fertility regulation (long-acting systemic methods, oral contraceptives, post-ovulatory methods, IUDs, vaccines, plants, male methods, female sterilization, and natural methods), safety and efficacy of fertility regulating methods, infertility, and service and psychosocial research. The section devoted to resources for research describes some features of the network of centers, reviews the Program's institution strengthening activities in the different regions, and also considers research training and the program of standardization and quality control of laboratory procedures. The section covering special issues in drug development focuses on relations with industry, patents, and the role of the Special Program in the drug regulatory process.
World Health Organization evaluates NORPLANT subdermal implants as effective, reversible, long-term contraceptive. News release.
New York, Population Council, 1985 Feb 22. 5 p.A World Health Organization (WHO) review of animal and human data on Norplant subdermal implants, convened at the request of the United Nations Fund for Population Activities, has determined that this contraceptive system is an "effective and reversible long term method of fertility regulation" and recommended that it be made available through family planning programs. George Zeidenstein, president of the Pouplation Council, which developed the Norplant system, has termed the WHO report "a giant step toward worldwide acceptance and availability." So far, extensive clinical trails have noted no adverse side effects of this contraceptive system, and animal studies on levonorgestrel suggest the drug is safe for use in humans. Clinical trial data on more than 4000 women have indicated continuation rates of 60-95% at the end of the 1st year and about 50% at the end of the 5th year. The annual pregnancy rate is 0.2-1.3/100 women over a 5 year period. Disturbance of the menstrual cycle, including increased frequency and number of bleeding days as well as irregular bleeding or spotting, occurs in the majority of women who use this method; however, bleeding problems tend to diminish with increased duration of use. The Norplant implant system is particularly suitable fo r women who seek extended contraceptive protection but either do not wish to undergo sterilization or who desire a child in the future. Norplant is currently a vailable in Finland and has just been granted registration in Sweden. Over the next 2 years, regulatory approval will be sought in 40 additional countries including the US, where the Norplant system is in clinical trials at 3 sites.
Outlook. 1985 Mar; 3(1):7-8.The World Health Organization (WHO) consultation convened in October 1984 the Special Programme of Reasarch in Human Rreproduction concluded that Norplant provides effective and reversible longterm contraception and should be available in family planning programs for women desiring longterm contraception. The Norplant implant systgem consists of 6 silastic capsules each containing 36 mg of levonorgestrel which is slowly released into the bloodstream. The implants can be left in place for up to 5 years or removed at any time. The consultation report considered the research data adequate to conclude that the method is safe for human use. Acceptability apperas to be high: 1st year continuation rates of 80-90% are roughly equivalent to those of the IUD, and continuation at the end of 5 years is about 50%. Bleeding irregularities are a common side effect, but heavy and prolonged menstrual bleeding is infrequent. The constant slow release of levonorgestrel minimizes the common side effects of contraceptive steroids, and the system exposes the body to less than 100 mg of levonorgestrel over 5 years. Since the method is new and not in widespread use, there have been few studies on longterm use or rare side effects, prompting the WHO consulatation to recommend "appropriate surveillance activities to evaluate its long-term safety." Additional research was also recommended on the effect of the implants on lactation and on the growth and development of children exposed to levonorgestrel in breastmilk. The consultation report pointed out the need for clinic facilities for insertion and removal and for adequate training of providers before introduction of the method into a program. An international pharmaceutical company based in Finland has been licensed by the Population Council, the developer of Norplant, to manufacture and distribute the implants. The Swedish National Board of Health and Welfare has also approved the Norplant system for contraceptive use in Sweden.
WHO Special Programme of Research, Development and Research Training in Human Reproduction (HRP): summary review of programme activities and recommendations on future policies and management. Report by the SAREC reference group for HRP, November 1982.
Stockholm, Sweden, SAREC, 1983 Apr.  p.This document, a summary view of the Reference Group for Human Reproduction (HRP) developments and achievements over the years, is based on the consideration of results from the 1981 assessment of the program by the Swedish Agency for Research Cooperation (SAREC). An attempt is made to outline broadly the responsibility of the World Health Organization (WHO) in the field of human reproduction research and family planning at large and to define the specific role and time perspective of HRP as a special program. Sweden played an active role in the creation of HRP and since the start has financed a substantial part of the project. HRP was established as a Special Program within WHO, implying the existence of a specific task and a time horizon. HRP was created in 1971, a time of rapidly increasing international efforts to encourage family planning activities in developing nations. Its objectives included contributing to the development of safe and effective contraceptive methods suitable for widespread use especially in the developing countries. Program objectives and activities have grown more complex. HRP activities now include the clinical testing of current contraceptive methods and methods in development, development of new contraceptive methods, health services research, a program of research on infertility, and the strengthening of national scientific resources. HRP has created a network of centers for clinical testing in a number of countries. This network has made possible the testing of methods in different social, cultural, and nutritional settings. To clinical tests of contraceptives should be added assessments of health services implications of the introduction of the methods, including the medical services needed for treatment of risk cases. While not in itself responsible for supporting basic research as a major activity, HRP could play an initiating and mediating role in the contraceptive research and development process. This role should focus on strengthening the links between research strategy and actual experience of family planning in developing countries. In terms of the HRP management structure, the program needs a new structure, one which clearly defines the responsibility for making decisions in different respects and provides for a direct and balanced influence of both developing countries and donors.