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Human Reproduction Update. 2003 Jan-Feb; 9(1):49-59.Progestogen-only implantable contraceptives are used by increasing numbers of women worldwide. This review outlines the evidence accumulated on these methods to date. Reviews of toxicological evaluations, clinical trials, endocrinological, epidemiological and social science studies, as well as operations research and economic evaluation were undertaken in preparation for an Expert Consultation convened by the World Health Organization in 2001. At the meeting, these reviews were further evaluated and the research results summarized in this consensus paper. A large body of evidence demonstrates the high contraceptive effectiveness and safety of the 5-year levonorgestrel-releasing implants Norplant and Jadelle. Information on the 3-year etonogestrel-releasing implant Implanon is more limited, but suggests that this implant has a high contraceptive effectiveness and a satisfactory safety pro®le. Information available on levonorgestrel-releasing implants manufactured and approved in China suggests that their clinical performance is satisfactory, but was insufficient to allow their full safety assessment. For all implants, there is insufficient information on their use by women with medical conditions. Provision of contraceptive implants requires good quality family planning services and specific provider training.
Lancet. 2007 Sep 22; 370(9592):1032-1033.Cost-effectiveness analysis, as referenced by Davide Mauri and Nikolaos Polyzos, constitutes one of several sources of information considered by policymakers in developing and developed worlds in making decisions about the optimum efficient use of health-care resources. The WHO Commission on Macroeconomics and Health has suggested that interventions costing less than three times a country's per capita gross domestic product per disability-adjusted life year gained can be regarded as good value, and analysts have equivalently applied this threshold to analyses that use quality-adjusted life years (QALYs). Preliminary results from a cost-effectiveness analysis of vaccination with quadrivalent HPV 6/11/16/18 vaccine in Mexico suggest a cost/QALY ratio well below this threshold in that country. Previous analyses in developed world settings have consistently shown that vaccination of girls and young women has a cost-effectiveness ratio within the range typically regarded as cost-effective. In countrieswith the fewest resources, direct assistance and public-private partnerships can help deliver needed medicines to the population at or below development costs-eg, the ivermectin donation for river blindness. Marc Arbyn states that if the cases of vaccine-type-related disease are subtracted from disease due to all types, there are a larger number of cases in women who received vaccine than in those who received placebo. This subtraction assumes that the subset of disease cases due to vaccine HPV types and the subset of cases due to non-vaccine HPV types are mutually exclusive, which is not the case. Coinfections with vaccine and non-vaccine types are common. In the presence of coinfection, the effect of such a subtraction is to ignore the presence of non-vaccine HPV types in disease where a vaccine-type HPV has also been detected. The effect of the subtraction is to preferentially attribute co-infected disease cases only to the vaccine HPV types. Individuals in the placebo group are more likely to have their non-vaccine type-related disease discounted in this way. Owing to the high efficacy of the vaccine, individuals in the vaccine group have less vaccine-type-related disease, and so those in the vaccine group have fewer such coinfection cases. To illustrate this point, an analysis of the numbers of individuals with disease due to vaccine and non-vaccine HPV types in the intention-to-treat population of protocols 013 and 015 is presented in the figure. The parts shaded blue would be the result of subtraction, similar to Arbyn's subtraction. However, the total numbers of cases of disease related to non-vaccine HPV types are 226+56=282 cases in the vaccine group and 193+106=299 cases in the placebo group. There is not an excess of cases caused by non-vaccine HPV types in the vaccine group. (full text)
In: An agenda for people: the UNFPA through three decades, edited by Nafis Sadik. New York, New York, New York University Press, 2002. 24-46.The solemn commitment that was made in Cairo in 1994 to make reproductive health care universally available was a culmination of efforts made by the United Nations Population Fund (UNFPA) and all those concerned about a people-centred and human rights approach to population issues. The commitment posed important challenges to national governments and the international community, to policy makers, programme planners and service providers, and to the civil society at large. The role of UNFPA in building up the consensus for the reproductive health approach before Cairo had to continue after Cairo if the goals of the International Conference on Population and Development (ICPD) were to be achieved. UNFPA continues to be needed to strengthen the commitment, maintain the momentum, mobilize the required resources, and help national governments and the international community move from word to action, and from rhetoric to reality. Reproductive health, including family planning and sexual health, is now one of three major programme areas for UNFPA. During 1997, reproductive health accounted for over 60 per cent of total programme allocations by the Fund. (excerpt)
Geneva, Switzerland, WHO, Division of Family Health, Programme of Maternal and Child Health and Family Planning, 1991 Dec. , 122 p. (WHO/MCH/91.10)This WHO consultation on maternal and perinatal infections reviews the epidemiology of these infections, examines the effectiveness of known intervention strategies to prevent and treat these infections, notes gaps in current knowledge, and develops recommendations for implementation of appropriate control strategies. The report is geared toward maternal and child health professionals in developing countries where maternal and perinatal infections cause considerable morbidity and death. These countries have limited resources for health care (e.g., US $5-10/person), largely due to the worsening economic situation. The report centers on the feasibility, effectiveness, and cost of interventions to prevent, treat, and control the infections. It has summary cost-effective analyses of maternal and perinatal infections and proposed interventions using 3 different hypothetical country situations to help policymakers decide on priorities and policies on prevention, treatment, and control of these infections. The report dedicates a chapter to each infection (syphilis, neonatal tetanus, malaria, hepatitis, HIV infections, chlamydial infections, herpes simplex infection, Group B Streptococcal infections, and maternal genital infection causing premature birth and low birth weight). Each chapter addresses their clinical and public health significance; prevalence in pregnant women and transmission from mother to fetus/infant; clinical effects; prevention, treatment, and control; and cost effectiveness and feasibility of various interventions. Based on public health importance, feasibility, and affordability, the consultants agreed that national and international programs should place the highest priority on these perinatal infections: gonococcal ophthalmia neonatorum, maternal and congenital syphilis, neonatal tetanus, hepatitis B, and maternal puerperal infections.
New York, FPIA, (1976). 7 pFamily Planning International Assistance (FPIA) is a division of Planned Parenthood Federation of America and was established in 1971 to promote family planning in developing countries. Since inception, FPIA has been guided by the principle that the most effective way to operate is through the existing network of established institutions, especially private voluntary groups. The FPIA provides information, communication channels, training programs, supplies, technical assistance, and financial support for the devleopment, continuation, and expansion of family planning programs. Almost 100 projects in 26 countries have been funded by FPIA in its first 5 years of operation. FPIA programs are diverse and cost effective since working through established groups reduces program costs. FPIA has supported innovative endeavors such as the introduction of voluntary sterilization in the Philippines and the development of new approaches in family planning communications. Current guidelines stress 1) supporting projects which can ultimately become self-sustaining; 2) developing model programs for broader application; 3) attempting to tap local resources for program assistance; and 4) continuing the practice of working through voluntary indigneous groups, especially women's organizations.