Your search found 18 Results

  1. 1
    389490
    Peer Reviewed

    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.

    Mramba L; Ngari M; Mwangome M; Muchai L; Bauni E; Walker AS; Gibb DM; Fegan G; Berkley JA

    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.
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  2. 2
    369330
    Peer Reviewed

    Influences on participant reporting in the World Health Organisation drugs exposure pregnancy registry; a qualitative study.

    Allen EN; Gomes M; Yevoo L; Egesah O; Clerk C; Byamugisha J; Mbonye A; Were E; Mehta U; Atuyambe LM

    BMC Health Services Research. 2014; 14:525.

    BACKGROUND: The World Health Organisation has designed a pregnancy registry to investigate the effect of maternal drug use on pregnancy outcomes in resource-limited settings. In this sentinel surveillance system, detailed health and drug use data are prospectively collected from the first antenatal clinic visit until delivery. Over and above other clinical records, the registry relies on accurate participant reports about the drugs they use. Qualitative methods were incorporated into a pilot registry study during 2010 and 2011 to examine barriers to women reporting these drugs and other exposures at antenatal clinics, and how they might be overcome. METHODS: Twenty-seven focus group discussions were conducted in Ghana, Kenya and Uganda with a total of 208 women either enrolled in the registry or from its source communities. A question guide was designed to uncover the types of exposure data under- or inaccurately reported at antenatal clinics, the underlying reasons, and how women prefer to be asked questions. Transcripts were analysed thematically. RESULTS: Women said it was important for them to report everything they had used during pregnancy. However, they expressed reservations about revealing their consumption of traditional, over-the-counter medicines and alcohol to antenatal staff because of anticipated negative reactions. Some enrolled participants' improved relationship with registry staff facilitated information sharing and the registry tools helped overcome problems with recall and naming of medicines. Decisions about where women sought care, which influenced medicines used and antenatal clinic attendance, were influenced by pressure within and outside of the formal healthcare system to conform to conflicting behaviours. Conversations also reflected women's responsibilities for producing a healthy baby. CONCLUSIONS: Women in this study commonly take traditional medicines in pregnancy, and to a lesser extent over-the-counter medicines and alcohol. The World Health Organisation pregnancy registry shows potential to enhance their reporting of these substances at the antenatal clinic. However, more work is needed to find optimal techniques for eliciting accurate reports, especially where the detail of constituents may never be known. It will also be important to find ways of sustaining such drug exposure surveillance systems in busy antenatal clinics.
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  3. 3
    385625
    Peer Reviewed

    Feasibility and validity of using WHO adolescent job aid algorithms by health workers for reproductive morbidities among adolescent girls in rural North India.

    Archana S; Nongkrynh B; Anand K; Pandav CS

    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.
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  4. 4
    335772
    Peer Reviewed

    UNAIDS ‘multiple sexual partners’ core indicator: Promoting sexual networks to reduce potential biases.

    Dimbuene ZT; Emina JB; Sankoh O

    Global Health Action. 2014; 7:23103.

    UNAIDS proposed a set of core indicators for monitoring changes in the worldwide AIDS epidemic. This paper explores the validity and effectiveness of the ‘multiple sexual partners’ core indicator, which is only partially captured with current available data. The paper also suggests an innovative approach for collecting more informative data that can be used to provide an accurate measure of the UNAIDS’s ‘multiple sexual partners’ core indicator. Specifically, the paper addresses three major limitations associated with the indicator when it is measured with respondents’ sexual behaviors. First, the indicator assumes that a person’s risk of contracting HIV / AIDS / STIs is merely a function of his / her own sexual behavior. Second, the indicator does not account for a partner’s sexual history, which is very important in assessing an individual’s risk level. Finally, the 12-month period used to define a person’s risks can be misleading, especially because HIV / AIDS theoretically has a period of latency longer than a year. The paper concludes that, programmatically, improvements in data collection are a top priority for reducing the observed bias in the ‘multiple sexual partners’ core indicator.
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  5. 5
    333097

    Impact evaluation in practice.

    Gertler PJ; Martinez S; Premand P; Rawlings LB; Vermeersch CM

    Washington, D.C., World Bank, 2011. [266] p.

    This book offers an accessible introduction to the topic of impact evaluation and its practice in development. Although the book is geared principally toward development practitioners and policy makers, we trust that it will be a valuable resource for students and others interested in impact evaluation. Prospective impact evaluations assess whether or not a program has achieved its intended results or test alternative strategies for achieving those results. We consider that more and better impact evaluations will help strengthen the evidence base for development policies and programs around the world. Our hope is that if governments and development practitioners can make policy decisions based on evidence -- including evidence generated through impact evaluation -- development resources will be spent more effectively to reduce poverty and improve people's lives. The three parts in this handbook provide a nontechnical introduction to impact evaluations, discussing what to evaluate and why in part 1; how to evaluate in part 2; and how to implement an evaluation in part 3. These elements are the basic tools needed to successfully carry out an impact evaluation. The approach to impact evaluation in this book is largely intuitive, and we attempt to minimize technical notation. We provide the reader with a core set of impact evaluation tools -- the concepts and methods that underpin any impact evaluation -- and discuss their application to real-world development operations. The methods are drawn directly from applied research in the social sciences and share many commonalities with research methods used in the natural sciences. In this sense, impact evaluation brings the empirical research tools widely used in economics and other social sciences together with the operational and political-economy realities of policy implementation and development practice. (Excerpt)
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  6. 6
    341557
    Peer Reviewed

    CD4 validation for the World Health Organization classification and clinical staging of HIV/AIDS in a developing country.

    Edathodu J; Ali B; Alrajhi AA

    International Journal of Infectious Diseases. 2009 Mar; 13(2):243-6.

    OBJECTIVES: To validate the World Health Organization (WHO) clinical staging and classification of HIV/AIDS using CD4+ T-lymphocyte counts in the setting of a developing country. METHODS: This was a retrospective chart review of HIV-infected adults at the national HIV referral clinic in the Kingdom of Saudi Arabia. Four hundred HIV-infected individuals were reviewed. All individuals under the age of 15 years and those who had received antiretroviral therapy were excluded. WHO clinical stage at presentation was determined by a single reviewer. The first CD4+ T-lymphocyte count within 6 months of diagnosis of HIV infection was then abstracted by a different reviewer. The main outcome measure was the comparison of the WHO clinical stages of HIV/AIDS at the time of diagnosis and the CD4+ T-lymphocyte counts. RESULTS: Data were available for 191 individuals, of whom 123 were men and 68 were women. The mean CD4+ T-lymphocyte count was 281/mm(3) in the men and 425/mm(3) in the women. The distribution of individuals at the WHO clinical stages was 110 at stage I, 10 at stage II, 36 at stage III, and 35 at stage IV. Mean CD4+ T-lymphocyte counts were 457, 337, 188, and 86/mm(3) at the respective stages. The difference between the mean CD4+ T-lymphocyte count in patients at stage IV and at each of the other stages was significant; p<0.0001. The correlation between the stages and the mean CD4+ T-lymphocyte counts was -0.65. CONCLUSION: The WHO clinical staging and classification of HIV/AIDS correlates well with CD4+ T-lymphocyte counts.
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  7. 7
    319516

    A minimum data set on ageing and older persons in sub-Saharan Africa: Process and outcome.

    Ferreira M; Kowal P

    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)
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  8. 8
    311837
    Peer Reviewed

    Managing data for a multicountry longitudinal study: Experience from the WHO Multicentre Growth Reference Study.

    Onyango AW; Pinol AJ; de Onis M

    Food and Nutrition Bulletin. 2004; 25 Suppl 1:S46-S52.

    The World Health Organization (WHO) Multicentre Growth Reference (MGRS) data management protocol was designed to create and manage a large data bank of information collected from multiple sites over a period of several years. Data collection and processing instruments were prepared centrally and used in a standardized fashion across sites. The data management system contained internal validation features for timely detection of data errors, and its standard operating procedures stipulated a method of master file updating and correction that maintained a clear trail for data auditing purposes. Each site was responsible for collecting, entering, verifying, and validating data, and for creating site-level master files. Data from the sites were sent to the MGRS Coordinating Centre every month for master file consolidation and more extensive quality control checking. All errors identified at the Coordinating Centre were communicated to the site for correction at source. The protocol imposed transparency on the sites' data management activities but also ensured access to technical help with operation and maintenance of the system. Through the rigorous implementation of what has been a highly demanding protocol, the MGRS has accumulated a large body of very high-quality data. (author's)
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  9. 9
    310566

    WHO grade "a" sperm motility and zona pellucida-binding test predict IVF outcome [letter] [reply]

    Sifer C; Poncelet C; Porcher R; Wolf JP

    Human Reproduction. 2007 Jan; 22(1):311-312.

    We thank Professor Evers for his interest in our preliminary work. We agree that a positive likelihood ratio (LR+) of 1.67 will change the likelihood of disease in a clinically not very relevant way. Indeed, we have moderated our purpose saying that an LR+ of 1.67 indicated a small impact on the post-test probability of successful IVF. However, this change was statistically significant as our study showed. Thus, we believe that in the lack of other predictive tests that could be performed routinely, this new combined test is helpful to decrease the risk of fertilization failure during IVF therapy in the case of unexplained infertility. Concerning male factor, we have found an LR+ of 6.0, which indicated a better, though moderate, post-test impact, as we have said in our study and accordingly to Professor Evers' letter. However, we effectively did not include the 95% confidence interval (CI) of this LR in our study, and we agree that this could lead to misinterpretation. We thought that this CI is calculated using an approximate formula, which could not be considered as valid on such a small sample. (excerpt)
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  10. 10
    310565

    WHO grade "a" sperm motility and zona pellucida-binding test predict IVF outcome [letter]

    Evers JL

    Human Reproduction. 2007 Jan; 22(1):311.

    I have read with great interest the article by Sifer et al. (2005) on the combination of a newly developed sperm-zona pellucida-binding assay and WHO grade 'a' sperm motility to predict sperm fertilizing ability in IVF. The authors have to be commended for developing a--theoretically very appealing--new sperm function test, and it is easy to understand how they could get carried away by their enthusiasm about the clinical applicability of this new test. In fact, the authors are so positive about the results of their combination test that they consider it 'an excellent predictor of sperm fertilizing potential in cases of mild male-factor infertility', and they recommend that it 'should be incorporated as a functional test to direct patients to IVF or ICSI at their first attempt'. They continue by stating that 'the positive LR of 1.67 (95% CI 1.07-2.59) allowed us to use this test in these cases' (i.e. in patients with unexplained infertility). (excerpt)
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  11. 11
    296409

    Addressing HIV: do conferences and papers help? - human immunodeficiency virus. [Faire face au VIH : les conférences et les articles sur ce sujet sont-ils d'une grande aide ? - le virus de l'immunodéficience humaine]

    Weil B

    UN Chronicle. 1998 Fall; 35(3):[4] p..

    My initial reaction to the proposed title of the following article, "Addressing HIV: Do Conferences and Papers Help?," was strong and immediate. I also found myself sitting squarely on both sides of the fence: yes, of course, they help to expand people's minds and abilities to respond effectively to the epidemic, but there is so much wasted time and money involved in organizing most conferences. With the intention of exploring these reactions and putting them in an appropriate context, I decided to poll several colleagues, whom I have worked with, in defining and mobilizing the response to the worldwide human immunodeficiency virus (HIV) epidemic. The feedback I received on my mini-survey, which simply asked respondents to give me their immediate thoughts and feelings about the proposed title, filtered in from Canada, France, Senegal, South Africa and the United States. I have synthesized the general reactions and supplemented them with my own analysis of the question. (excerpt)
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  12. 12
    105040
    Peer Reviewed

    An evaluation of infant growth: the use and interpretation of anthropometry in infants.

    World Health Organization [WHO]. Working Group on Infant Growth

    BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1995; 73(2):165-74.

    In 1993 a World Health Organization (WHO) Working Group was established to evaluate infant growth with regard to the appropriate use and interpretation of anthropometry in infants, the identification of reference data for anthropometric indicators, and other crucial gaps in knowledge. Exclusive breast feeding is recommended by WHO from birth to 4-6 months of age, after which the child should continue breast feeding while receiving adequate complementary foods for up to 2 years of age. The Working Group focused mainly on the assessment of growth patterns of infants following WHO feeding recommendations, and the relevance of such patterns to developing growth references for infants. Seven data sets on the growth of breast-fed infants were surveyed from April to June 1992: 1 each from Canada, Denmark, Finland, Sweden and the United Kingdom, and 2 from the United States. 226 of the 453 infants followed in the 7 studies were breast-fed for at least 12 months, not receiving formula and solids until after the age of 4 months. 141 of these 226 infants were not given other milk or formulas regularly in the 1st year of life. More than half of them were not given solid foods until the age of 6 months. In the 12-month breast-fed pooled data set, the mean weight-for-age declined continuously from 2 to 12 months to a low of almost -0.6 standard deviation at 12 months. The decline in length-for-age was not so great, and the mean z-score tended to stabilize or increase after 8 months; the mean value at 12 months was approximately -0.3 standard deviation. The mean weight-for-length at 12 months was also below the current National Center for Health Statistics-World Health Organization (NCHS-WHO) growth reference mean. Comparison of growth between the 12-month breast-fed pooled data set and selected test populations in India, Peru, Egypt, Hungary, Kenya, Thailand, and Chile yielded substantial variance in growth interpretation, thus the NCHS-WHO reference needs to be revised.
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  13. 13
    140138
    Peer Reviewed

    Evaluation of the World Health Organization staging system for HIV infection and disease in Ethiopia: association between clinical stages and laboratory markers.

    Kassa E; Rinke de Wit TF; Hailu E; Girma M; Messele T; Mariam HG; Yohannes S; Jurriaans S; Yeneneh H; Coutinho RA

    AIDS. 1999; 13(3):381-9.

    Since the time from initial HIV infection to AIDS varies considerably between individuals, the identification of clinical and biological markers of progression to AIDS helps to facilitate the clinical management and proper counseling of HIV-infected patients. In 1990, a World Health Organization (WHO) staging system for HIV infection and disease meant for global use was proposed based upon a combination of clinical and biological parameters. The system includes a clinical axis comprised of 32 conditions divided into 4 stages, and a laboratory axis with 3 categories of CD4+ T-cell counts. Findings are presented from a study of the association between the clinical axis of the WHO staging system and laboratory markers in HIV-infected Ethiopians. The clinical manifestations and stage of HIV-positive individuals participating in a cohort study of HIV infection progression, and of HIV-positive patients hospitalized with suspicion of AIDS were compared to CD4+ T-cell count and viral load. Of the 86 HIV-positive participants in the cohort study, 53 (62%), 16 (19%), 16 (19%), and 1 (1.2%) were in stage 1, 2, 3, and 4, respectively. Minor weight loss in 15 and pulmonary tuberculosis (TB) in 9 were the most commonly diagnosed conditions among the 38 (44%) symptomatic HIV-positive individuals. A good correlation was found between WHO clinical stages and biological markers. CD4+ T-cell counts were low in Ethiopians, especially during the early stages of HIV-1 infection, and preliminary reference values at different stages of HIV-1 infection were determined. In HIV-infected Ethiopians, lymphocyte counts less than 1000 x 10(6)/l in nonhospitalized individuals, and less than 2000 x 10(6)/l in hospitalized patients, had high positive predictive value, but low sensitivity, in identifying subjects with low CD4+ T-cell counts who would benefit from the chemoprophylaxis of opportunistic infections.
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  14. 14
    134460
    Peer Reviewed

    The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties.

    World Health Organization [WHO]. Quality of Life Assessment Group

    Social Science and Medicine. 1998 Jun; 46(12):1569-85.

    The World Health Organization (WHO) Quality of Life Assessment (WHOQOL) instrument was developed through a process of extensive international collaboration to assess individuals' physical health, psychological state, level of independence, social relationships, and relationship to their environment. The initial version of the instrument emerged from an iterative process that included an agreed definition of Quality of Life, agreed definitions of its facets, generation of a large pool of items reflecting these definitions, and, finally, an agreed set of items for the pilot WHOQOL. This paper describes is subsequent psychometric evaluation. The pilot WHOQOL-100, comprised of 236 questions, was administered to a minimum of 300 respondents in each of the 15 participating field centers. Analyses of these data confirmed it is possible to develop a multicultural WHOQOL rather than to use different item, facet, and domain structures for each center. Although preliminary confirmatory factor analysis suggests the feasibility of a four domain solution (physical, psychological, social relationships, and environment), further field trials at new centers are necessary. Moreover, although a cross-culturally applicable model has been developed, add-on modules can be designed for specific populations (e.g., those with communication dysfunctions) or culture-specific diseases. Overall, the instrument is a reliable, valid, and responsive measure of the quality of life. Future tasks include investigation of the test-retest reliability of the WHOQOL-100 in populations who have not experienced significant life change, collection of longitudinal data from populations who have experienced life changes in order to assess the instrument's responsiveness to change, and further analyses of the discriminant validity of the WHOQOL-100.
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  15. 15
    076538

    WHO appropriate technology for birth revisited.

    Chalmers B

    BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 1992 Sep; 99(9):709-10.

    The validity of WHO recommendations for childbirth care are examined. WHO recommendations were published in 2 places: the August 1985 Lancet article on "The Appropriate Technology for Birth" and in the WHO book, "Having a Baby in Europe." Questions have arisen since publication about how the information was derived, the representativeness of the information, the relation to research findings,. and the potential bias. The issue of appropriate birth practices and use of technology had been debated since the 1979 UN International Year of the Child. WHO established a 15-member multidisciplinary perinatal study group to review the literature and an academic and lay publication in 1985 were the result. Birth Conferences were also held nationally in countries applying the WHO birth recommendations. there have been 43 conferences conducted in 23 member states in addition to the US, Canada, Australia, and China; issues were debated and consensus reached. the recent publication by Chalmers et al. (1989) answered many questions. In the publication appendix perinatal technology is distinguished as that technology with 1) reduces the negative outcome of pregnancy and childbirth, 2) is promising but unproven, 3) has unknown effects and requires evaluation, and 4) is unnecessary based on available evidence. An example from the appendix on WHO recommendations for specific birth technology is given in table form for 13 practices recommended and a statement of research support. For example, the recommendations is that women participate in decisions about their birth experiences. Research states that failing to involve women in decisions about their care should be abandoned. Another recommendation is that the healthy newborn must remain with the mother whenever possible, and the research states that separating mothers and babies routinely should be abandoned. No assessment in the Chalmers et al. publication is concerned with perinatal health care policy or setting of policy. The recommendations were developed from survey research, discussion, debate, and carefully controlled and critically evaluated randomized control trials.
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  16. 16
    070614

    Monitoring TT coverage through routine reporting: present and proposed methods.

    Steinglass R

    Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1988 Jun. 22 p. (USAID Contract No. DPE-5927-C-00-5068-00)

    Reported tetanus toxoid (TT) coverage is lower than that of other childhood vaccines in almost all developing countries. Further WHO and UNICEP TT coverage rates differ. For example, UNICEF estimates are 203 times higher than WHO's. Professionals are working on a standardized and shared computerized reporting system to help alleviate these discrepancies. In addition, TT indicators used by WHO globally and within the national Expanded Programme on Immunization (EPI) are not valid: WHO and EPI do not consider TT2 immunizations administered during the recent past even though they provide protection for 3 years. In fact, the number of immunizations administered in a year is incorrectly used to determine actual TT coverage levels. Besides this system fosters inappropriate delivery strategies and targets. REACH proposes applying the present routine reporting system to a simple alternative management tool. For example, the numerator consists of the number of TT2 immunizations given during the past 3 full years. This number is then divided by the population of eligible females to derive TT2 coverage. This method also allows for monitoring of TT3 immunization. Further it gives a point prevalence of maternal protection versus a period prevalence in any particular year. Instead of using a mother's health card, a child's immunization card, or a child's growth chart for recording TT immunization, REACH suggests TT protection cards covered in inexpensive transparent plastic. They should allow for the recording of 5 doses of TT and have important cultural symbols, such as religious symbols, printed on them. To ensure valid TT monitoring, clinic reporting forms should list TT immunization by does (TT1, TT2, TT3, TT4, and TT5) and target group (e.g., pregnant women).
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  17. 17
    070923
    Peer Reviewed

    Appropriate technology in maternal and child health.

    World Health Organization [WHO]; International Federation of Gynecology and Obstetrics [FIGO]

    International Journal of Gynecology and Obstetrics. 1992 Mar; 37(3):229.

    This article discusses the components involved in "appropriate technology" as it applies to maternal and child health. The World Health Organization (WHO) defines appropriate technology as methods, procedures, techniques, and equipment that are scientifically valid, can be adapted to local needs, acceptable to those for whom they are used, and can be afforded and maintained by the community or country. "Scientifically valid" refers to the technology's effectiveness in achieving its objective. As the article notes, obstetric and pediatric procedures have a history of being introduced into clinical practice without undergoing careful evaluation through clinical trials. If a technology is to "adapt to local needs," it must address the public health's rather than rare diseases of academic interest. The "acceptability" criterion, a basic health care principle, often requires health care professionals to carefully explain procedures or techniques to consumers, as well as the use of consent forms. The issue of "maintenance and cost" arises because medical equipment developed and tested in industrialized countries if often unsuitable for developing countries, and the purchase of such technologies can waste the resources of developing countries. The concept of appropriate technology has several implications for maternal and child health, including: antenatal, delivery, and postnatal practices should be justified in terms of quantitative outcome measures before general acceptance; and properly conduced epidemiological studies which take into account cultural and economic factors should provide the basis for appropriate maternal-child health care practices. Health care professionals should encourage adherence to the principle of appropriate technology.
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  18. 18
    068526

    The collection, analysis and transmission of population policy data at the United Nations Secretariat.

    United Nations. Department of International Economic and Social Affairs. Population Division

    In: International transmission of population policy experience. Proceedings of the Expert Group Meeting on the International Transmission of Population Policy Experience, New York City, 27-30 June 1988, [compiled by] United Nations. Department of International Economic and Social Affairs. Population Division. New York, New York, United Nations, 1990. 21-39. (ST/ESA/SER.R/108)

    In order to illuminate the complex process of population policy research, this article describes how the UN Secretariat collects, analyzes, and transmits population policy data. The role of conducting population policy research falls under the UN's Population Commission and its substantiative secretariat, the Population Division of the Department of International Economic and Social Affairs. Providing a historical background, the article explains the gradual development of consensus as to the proper role of the UN with regards to population policy. While in 1948 the UN mandated the Population Commission to "arrange for studies and advise" on "policies designed to influence the size and structure of populations and changes therein," it was not until the late 1960s when population policy became a pressing issue. The paper goes on to detail the process of population policy research. Data collection depends on a combination of 2 factors: the number of countries or units of analysis and the specific issues under consideration. The paper explains that the Population Commission collects its data from 4 general sources: 1)government documents, intergovernmental documents, nongovernmental documents, and UN inquiries. Over the past 40 years, the Commission has developed 4 implicit principles concerning the analysis of data. The analysis should be neutral, comprehensive, global, and effective. In order to transmit population policy research, the Commission employs 3 major avenues: 1)UN published reports, documents, studies, etc.; 2: conferences, meetings, seminars, etc.; and 3)computer files. Following the description of the search process, the paper discusses key issues and concerns over this process. Examples of such concerns include the validity of results, issues of consistency and reliability, problems of definition, and the classification of government.
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