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Bulletin of the World Health Organization. 1956; 15:5-41.The author reviews that mortality statistics from cancer of the breast in females and from malignant neoplasms of the uterus and of the other female genital organs for nineteen countries over the years 1920-53, first considering the general trend of the mortality series for each group of diseases for all ages and then analysing for each sector of mortality the changes which have occurred in the age-specific death-rates in some pivotal years during the same period. Considerable differences in the levels of total mortality from each group of tumours for various countries are noted. The important variations among age-specific death-rates for cancer of the breast in females and for uterine neoplasms in various countries are examined and their significance is commented upon. (excerpt)
Geneva, Switzerland, World Health Organization [WHO]. Department of Reproductive Health and Research, 2001. 178 p. (Occasional Paper No. 5)This report considers how human rights laws can be applied to relieve the estimated 1,400 deaths world-wide that occur every day, an annual mortality rate of 515,000, that women suffer because they are pregnant. Human rights principles have long been established in national constitutional and other laws and in regional and international human rights treaties to which nations voluntarily commit themselves. The intention of the report is to facilitate initiatives by governmental agencies, nongovernmental groups and, for instance, international organizations to foster compliance with human rights in order to protect, respect and fulfill women’s rights to safe motherhood. The report outlines how the dimensions of unsafe motherhood can be measured and comprehended, and how causes can be identified by reference to medical, health system and socio-legal factors. It introduces human rights laws by identifying their sources and governmental obligations to implement them, and explains a range of specific human rights that can be applied to advance safe motherhood. The rights are shown to interact with each other, and for purposes of discussion, they are clustered in the following ways: rights to life, survival and security; rights relating to maternity and health; rights to nondiscrimination and due respect for difference; and rights to information and education relevant to women’s health protection during pregnancy and childbirth. The setting of performance standards for monitoring compliance with rights relevant to reproductive health, and availability and use of obstetric services are addressed. In conclusion, the report considers several strategies to encourage professional, institutional and governmental implementation of the various human rights in national and international laws relevant to reduction of unsafe motherhood, and to enable women to go through pregnancy and childbirth safely. (excerpt)
Geneva, Switzerland, WHO, 2004.  p.Every year some eight million women suffer pregnancy-related complications and over half a million die. In developing countries, one woman in 16 may die of pregnancy-related complications compared to one in 2800 in developed countries. Most of these deaths can be averted even where resources are limited but, in order to do so, the right kind of information is needed upon which to base actions. Knowing the statistics on levels of maternal mortality is not enough—we need information that helps us identify what can be done to prevent such unnecessary deaths. Beyond the numbers presents ways of generating this kind of information. The approaches described go beyond just counting deaths to developing an understanding of why they happened and how they can be averted. For example, are women dying because: they are unaware of the need for care, or unaware of the warning signs of problems in pregnancy?; or the services do not exist, or are inaccessible for other reasons, such as distance, cost or sociocultural barriers?; or the care they receive is inadequate or actually harmful? (excerpt)
Measuring reproductive morbidity. Report of a Technical Working Group, Geneva, 30 August - 1 September 1989.
[Unpublished] 1990. 41 p. (WHO/MCH/90.4; Safe Motherhood; UNFPA Project No. INT/88/P14)Reproduction morbidity is defined as any morbidity or dysfunction of the reproductive tract. Obstetric morbidity is related to pregnancy. Direct obstetric morbidity results from obstetric complications of pregnancy, such as ante- or postpartum hemorrhage, eclampsia, or sepsis. Indirect obstetric morbidity results from preexisting diseases, such as malaria, hepatitis, and tuberculosis. Psychological obstetric morbidity includes puerperal psychoses, or fear of pregnancy and childbirth. Direct gynecological morbidity includes reproductive cancers and bacterial or viral sexually transmitted diseases (STDs). Indirect gynecological morbidity includes traditional practices, such as circumcision. Psychological morbidity is associated with STDs, infertility, and dyspareunia. Contraceptive morbidity involves efforts that limit fertility. Some aspects of reproductive morbidity have been covered extensively (e.g., STDs), while studies of uterine prolapse, fistulas, urinary/fecal incontinence, and secondary infertility are few. In a study in India 92% of women had a gynecological problem upon examination, but only 55% reported it. Language is a major impediment to communication because of euphemisms used to describe an ailment. Morbidities tend to be underreported. In a sample of Egyptian women asked about specific problems, backache (47%), abdominal pain (42%), discharge (41%), prolapse (30%), and urinary tract infections (24%) were most common. Hospital studies are used most often to research maternal morbidity followed by community studies, cross-sectional surveys, and case-control studies with proper sample size. The validity of self-reported data greatly depend on the interviewer, but recall bias also has to be considered. It is recommended that WHO sponsor research into reproductive morbidity, develop standardized questionnaires, study a community-based health project, develop a series of "case histories," and plan a meeting during 1990-91.
Amsterdam, Netherlands, WGNRR, 1991. 48 p.This report summarizes the activities of the Women's Global Network for Reproductive Rights (WGNRR), an organization that campaigns to reduce maternal mortality and morbidity, during 1991. In addition to its summary of activities, the report provides examples of local, national, and regional activities which illustrate the efforts of WGNRR's campaign. The report explains that the organization has succeeded in establishing May 28 as the Day of Action for Women's Health. For 1992, WGNRR hopes to make the issue of adolescent mothers the focus of the Day of Action. Having presented excerpts of Martha Rosenberg's paper entitled "Rethinking maternity: a women's task" (presented at the University of Salamanca, Spain on September 1990), the report goes on the describe the work done by WGNRR groups. As an example of a local initiative, the publication discusses the efforts conducted in Tanzania to end sexual harassment. This topic became the focus of the Day of Action. The Tanzania Media Women's Association held a seminar do discuss issues such as rape, media images of women, violence, and harassment in the workplace. The report goes on to describe a national campaign conducted in Chile, a campaign entitled "I am a woman. . . I want to be healthy," which focused on women's demands to humanize health care. For its regional experience, the report discusses accomplishments of the First Regional Workshop on Maternal Mortality, held in Managua in April 1991. The workshop attracted participants from Belize, Costa Rica, the Dominican Republic, Guatemala, Mexico, and Nicaragua. The report also includes an evaluation of the campaign conducted in Lima, Peru. Finally, the report presents excerpts of letters and reports of activities conducted by member groups around the world.
Progress in Reproductive Health Research. 2001; (56):1.Due to the poor implementation of antenatal care programs, women in developing countries are more than 400 times as likely to die from complications during pregnancy as women in southern Europe. To make matters worse, many components of these programs have not been subjected to rigorous scientific evaluation to determine their effectiveness. This lack of "hard" evidence has impeded the optimal allocation of scarce resources in developing countries. Thus, this issue of a bulletin called Progress in Reproductive Health Research provides a comprehensive review of antenatal care research in developing countries conducted by the Special Programme of Research, Development and Research Training in Human Reproduction, a global program of technical cooperation among several UN agencies, WHO and the World Bank. This introductory article explains that the first article in the bulletin is based on a systematic review of what is known about antenatal care and shows why this area has been difficult to study. Then, the major causes of maternal mortality and morbidity are described in the proceeding article. Finally, the next two articles describe the randomized controlled trial for the evaluation of the existing WHO antenatal model and discuss the findings.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1996; 49(2):74-6.This article is the introduction to a special journal issue devoted to themes concerning women's health security. A great deal of information about women's health and about ways to solve health problems is now available, and women's overall health and well-being have improved. Health must be considered in a holistic fashion that embraces a lifespan perspective. More needs to be done to reduce violence against women, improve maternal morbidity and mortality, and protect women from increasing HIV transmission. 20-50% of women worldwide have been beaten by a male partner. Women and children make up the majority of civilian victims of violent conflict and refugee situations. Pregnancy complications kill 1 woman in 50 in developing countries, compared to 1 woman in 8,000 in developed countries. Approximately one-third of all women in developing countries suffer at some time in their lives from maternal morbidity or disability, including uterine prolapse, reproductive tract infections, chronic anemia, and obstetric fistula. In 1995, almost half of new cases of HIV infection worldwide were women. The World Health Organization and the Global Commission on Women's Health are organizations committed to improving women's health security. Health care throughout the entire lifespan is a universal human right. Guaranteeing women the right to be free from violence, to education, to safe motherhood, to protection from HIV/AIDS, and to gender-sensitive interventions is a responsibility that can be met by advocacy as well as by concrete actions.
MODERN MIDWIFE. 1996 Sep; 6(9):10-3.Maternal mortality rates in developing countries are higher than previously estimated and exceed 1000/100,000 live births in approximately 21 developing countries. While conditions of war increase maternal deaths, the leading direct causes are hemorrhage, sepsis, obstructed labor, eclampsia, and abortion. The World Health Organization (WHO) has prepared a video on the topic that states that nobody knows the extent of the problem of maternal mortality, nobody cares enough to ensure that women's needs are met, and nobody prepares, because not enough people understand the need to prepare for a healthy pregnancy and birth or how to respond to an obstetric emergency. The WHO has identified "gatekeepers" at every level to family planning, prenatal care, clean and safe delivery, and essential obstetric care, and it has created a series of midwifery education modules to promote safe motherhood. Conditions of poverty and low status for women are the prime indirect causes of maternal mortality and maternal morbidity (which is compounded in developing countries by inaccessible or unaffordable health care). Activities to improve this situation include the provision of obstetric supply packs to families, birth spacing programs, discouragement of female genital mutilation and early marriage, use of a picture card or drama and song to illustrate maternal complications, improved postabortion care, international study for midwife teachers, establishment of maternity waiting homes near hospitals, and use of the radio for health education.
CONTRACEPTION. 1996 Jan; 53(1):1-7.In the year 2000, world population will exceed 6200 million and life expectancy will be over 68 years. The UN population projections for the coming 20 years after 1996 range from a low of 7100 million to a high of 7800 million. Between 1950 and 1992, in developing countries, life expectancy at birth increased by 29 years in China, by 24 years in India and Indonesia, by 21 years in Bangladesh, and by 16 years in Brazil. The gender difference in life expectancy is only 1 year in India, but 6 years in a number of developed countries. Corresponding increases in Australia were from 12.2 to 14.7 years for men and from 14.9 to 18.8 years for women. By the year 2025, the UN projects that the elderly (65 years and older) will constitute 10% of the population in Asia and more than 20% in North America and Europe, whereas 1.8% of the population of Asia, 4.6% of North America, and 6.4% of Europe will be very old (80 years and older). By the year 2030, there may be 1200 million postmenopausal women around the world, 76% of them in the developing countries. During the period 1990-2025 the elderly population of Sweden will increase by 33%, whereas that of Indonesia will increase by 414%. Between 2000 and 2100, the global population aged 15 years or younger will gradually decrease from 31.4% to 18.3%, while the population aged 65 and over will increase from 6.8% to 21.6%. The persistence of poverty in developing countries combined with aging poses a formidable challenge because the majority of old people receive little special support. The epidemiological dimension of aging embraces mortality and morbidity. Each year 39 million people die in the developing world mainly from infectious and parasitic diseases, noncommunicable and communicable diseases, and injuries. In the developed countries 11 million die primarily from cardiovascular diseases and malignant neoplasms. In the developing countries noncommunicable diseases represent 87% of the disease burden resulting in increased isolation of the elderly. The ethical dilemma facing health care is poverty among the elderly.
[Unpublished] 1990 Aug 30. Issued by World Health Organization [WHO]. Division of Family Health. , 77 p.This set of guidelines was developed to help researchers determine the extent and nature of reproductive morbidity in developing countries. After presenting definitions for obstetric morbidity (direct, indirect, and psychological), gynecological morbidity (direct, indirect, and psychological), and contraceptive morbidity, possible sources of existing information are considered (health providers, health care service records, previous studies, and other sources). Guidelines are given for generating morbidity data from community-based studies, and the following types of community-based prevalence studies are detailed: 1) those involving the clinical examination of eligible women, 2) those involving the clinical examination of symptomatic women only, 3) whose involving women who use local health services, and 4) those which consider perceived reproductive morbidity. The next section discusses the use of a pregnancy follow-up approach to study reproductive morbidity, and the final section considers the use of a combination of methods and the necessity to include a means of validating results. Appended information provides 1) suggestions for developing and pretesting data collection instruments, 2) information on interviewer selection and training, 3) an example of an interview for a community prevalence study, 4) notes on the interview schedule, 5) an example of a clinical examination record, 6) an example of a laboratory results record, and 7) operational definitions of some reproductive morbidities.
Safe motherhood: priorities and next steps. Forward-looking assessment on the reduction of maternal mortality and morbidity within the framework of the Safe Motherhood Initiative: (SMI).
[New York, New York], United Nations Development Programme [UNDP], 1991 Apr. , viii, 40,  p.Women in Development is one of six key policy areas for the UN Development Program's (UNDP) next programming cycle. UNDP acknowledges the hazards of pregnancy and childbirth that rob society of women society at the height of their productivity. It has supported the Safe Motherhood Initiative (SMI) from its inception to reduce maternal mortality and morbidity in developing countries. UNDP reviewed its contributions at the global, regional, and national levels within the framework of SMI to determine its contributions during the 1990s. A three-person, multidisciplinary team conducted a forward-looking assessment which included interviews with 200 persons in UN and bilateral donor agencies and nongovernmental organizations, a survey of UNDP staff in developing countries, and visits to Senegal and Indonesia. The team assessed progress that has been made in policies, programs, resources, coordination, research, technical cooperation, and information. UNDP support helped initiate SMI. Its support of SMI conferences has increased awareness and political commitment. UNDP contributes funds to WHO's Safe Motherhood Operations Research Programme. Some of its SMI projects will likely achieve significant improvements in maternal health. UNDP support in Senegal and Indonesia allowed the first national needs assessments and action plans in the SMI. The team found that funding of needs assessments and action plans is constructive. It agreed with UNDP's policy of pooling its support with that of other donors. It found the present organization and structure through which UNDP funds are implemented to be appropriate. It recommended that UNDP continue to contribute to SMI. It suggested that UNDP take the lead role in establishing the International Partnership to Prevent Maternal Deaths and Disability as a mechanism to take the SMI into its next phase of translating the increased concern and technical know-how into increased safe motherhood activity at the country level.
Health policies and programmes: accomplishments and future directions of the Safe Motherhood Initiative.
In: Population policies and programmes. Proceedings of the United Nations Expert Group Meeting on Population Policies and Programmes, Cairo, Egypt, 12-16 April 1992. New York, New York, United Nations, 1993. 236-9. (ST/ESA/SER.R/128)99% of the 500,000 annual maternal deaths worldwide occur in developing countries; women in developing countries are 100 times more likely to die from pregnancy than women in more developed countries. Inadequate health services as well as the social, cultural, and economic environment in which these women live are contributing factors to their excess mortality. A global effort to reduce maternal mortality and morbidity by 50% by the year 2000, the Safe Motherhood Initiative was initiated in 1987 in response to this ongoing trend. It will attempt to realize its objective by improving the socioeconomic and political status of women, providing family planning services, ensuring the availability and accessibility of high-quality, community-based prenatal and delivery care for all women, and ensuring the provision of skilled obstetric care for high-risk and emergency cases. This paper discusses the Initiative's accomplishments in the areas of advocacy, research, human resources development, and program development and considers future directions.
Washington, D.C., World Bank, 1993. xv, 143 p. (World Bank Discussion Papers No. 202)Women in developing countries face up to a 200 times higher risk of death from pregnancy, childbirth, and unsafe abortions than women in developed countries. The failure to take clear, scientifically informed action in the 1990s will likely result in more pregnant women dying than in any other decade. About 7 million newborns die each year due to maternal health problems. Maternal death also adversely affects the health and socioeconomic prospects for surviving children, families, and communities. In 1987, the World Bank, WHO, UNFPA, and many other organizations began the Safe Motherhood Initiative to reduce maternal mortality and morbidity (cost of a substantial reduction = about US $2/capita/year). Its short-term goals include improving the quality of, increasing access to, and educating the public about family planning services and maternal health care. Longterm goals encompass improving women's socioeconomic status. The Initiative helps countries develop safe motherhood programs, including a workable health infrastructure and targeting behavior. Research in Bangladesh, Ethiopia, and Guatemala shows that community-based approaches, such as family planning and training and use of midwives, reduce maternal mortality in high mortality areas. Appropriate referral and treatment of emergency obstetric complications are needed for considerable and sustained reduction of maternal death. Safe motherhood depends on interlinked steps: adolescent's nutritional status, woman's knowledge about contraception, danger signs during pregnancy, sexually transmitted diseases, access to trained health providers, and access to health care facilities or emergency transport to these facilities. National and political support of a safe motherhood program is needed. This report provides various approaches to tailoring a program to its setting, ranging from one with a limited health infrastructure to one with extensive services.
IPPF OPEN FILE. 1992 Jun; 1.On may 8, 1992, IPPF's Western Hemisphere Regional Office exhibited, at UN headquarters in New York City, 500,000 flowers representing the same number of women who die each year from pregnancy complications. Indeed 99% of these maternal deaths occurred in developing countries, especially Africa. 50 UN ambassadors and representatives attended this event which was endorsed by 40 health and development organizations. Film celebrity Lauren Hutton also attended to show her support. IPPF hoped this event would bring attention to the ongoing need to reduce unwanted pregnancy by providing family planning information and services. The Regional Director of IPPF noted that family planning is the most cost effective means to do so. The Regional Office's Programme Support Director also emphasized the need for trained birth attendants, emergency obstetric care, and proper nutrition. In 1990, the number of unwanted births was about 30 million. For each maternal death, 10-15 women are disabled during childbirth and 25 million pregnant women face serious childbirth complications. A World Bank study showed that if governments would invest just US$1.50/person/year to include prenatal care and family planning into primary health care programs, maternal deaths would fall considerably within 10 years. This amount had been invested during the last 15 years, IPPF would have only needed to display 167,000 flowers. If governments do not take action soon, IPPF will need to display 650,000 flowers in 2000. The Western Hemisphere Regional Office of IPPF has therefore established the Planned Motherhood Fund to expand and strengthen family planning and appropriate health services for women at highest risk of pregnancy-related death, especially teenagers and women in rural areas and urban slums.
BULLETIN OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE. 1990 Dec; 65(4):75.WHO estimates of pediatric AIDS cases are 400,000 by September 1990, not including 300,000 who have already died. WHO projects that 10 million or more infants and children will have HIV infections by 2000, in addition to 25-30 million adults. The primary mode of transmission in most countries is heterosexual contact, resulting in a rapidly increasing prevalence in women of childbearing age. WHO predicts that pediatric AIDS will be a major, and in some countries the predominant, cause of death in children in the 1990s. Even though child survival programs have made progress recently, by immunization and diarrhea control, the fruits of these efforts are expected to be reversed. The world's cumulative total of HIV infected women is about 3 million. In the U.S., 20,000 infants have been born to infected mothers. In contrast, in Eastern Europe, about 1000 children are infected, mostly from unscreened blood transfusions and unsterilized needles and syringes. The impact of childhood AIDS is expected to be an increase in child mortality by 50% in many developing countries. Serious social repercussions for children also stem from projected 10 million uninfected children orphaned by AIDS, mostly in sub-Saharan Africa. The only way to lessen this tragedy is for people to protect themselves by practicing safe sex and having sexually transmitted diseases treated.
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 1991 Apr; 98(4):345-8.Discusses dual concerns of the Royal College of Obstetricians and Gynaecologists (RCOG): that a widening gap between obstetric standards in Britain and those in the developing world exists and that the RCOG is unable to meet the needs of Third World doctors who come to the RCOG for postgraduate study. A meeting sponsored by Birthright and held at the Royal College of Obstetricians and Gynaecologists (RCOG) in June 1989 which explored aspects of Third World obstetric care reflects these concerns. The proceedings of the meeting have been published and verbatim recordings of the discussions are available on tape from the RCOG. Reports on maternal mortality/morbidity in the Third World indicate persistence of poor obstetrical practices and of common obstetrical complications. Suggestions for improvement include the redeployment of and the replanning of services within countries and an increase in health education for women. Access to care at the first referral institution level is seen as the key to the improvement of care. Problems of transport and communication create serious obstacles to the link between community care and the first referral institution. The goal of the World Health Organization (WHO) is to cut the Third World maternal mortality in half by the year 2000. To reach this goal WHO plans to field obstetric teams in Latin America, Africa and South Asia; to train nurse-midwives to perform life saving measures on their own initiative; and to employ community resources by training indigenous midwives to function as extensions of the health team. The RCOG will sponsor training designed for doctors who will work in developing countries.
In: Issues in contemporary international health, edited by Thomas A. Lambo and Stacey B. Day. New York, New York, Plenum Medical Book Company, 1990. 113-33.The causes of mortality and disability in the world are reviewed, and the 4 most important mechanisms for promoting maternal and child health are proposed: female literacy, family planning, community-based efforts and global strategies for international cooperation. The health needs of women, children and adolescents, who make up the majority and the most vulnerable segment of the population, must be met. Malnutrition is the single most important cause of health problems through adult life, and affects 20 million children in Africa alone. Statistics are cited for infant mortality, vaccine-preventable diseases, diarrheal diseases and respiratory infections, infant mortality and maternal mortality. The key determinant of infant survival is female literacy. Existing scientific cooperation is the closet thing we have to a global international community. An example of applied scientific solutions to health care is the risk approach in maternal health care. 2 strategies of scientific cooperation have emerged: the international center model in a country or region to address a specific problem, and the task force model, as used effectively by WHO, UNICEF, and the Task Force for Child Survival. Research topics on health in developing countries are listed that could be tackled by universities and scientific networks, e.g. scientific research is lacking on how to make household hygiene effective in poor countries. A concerted global research effort and surveillance effort is needed for AIDS.
[Unpublished] 1989. 6 p.Although there has been a lot of attention in researching maternal mortality world wide, there is little information on reproductive morbidity. A study in India in 1980 estimated that there were 16 cases of morbidity for every case of mortality. Assuming these estimates are accurate, the total number of cases of maternal morbidity would be 8,000,000 in the world every year. It is much harder to identify morbidity cases than as it is to identify mortality cases. To prevent and control reproductive morbidity, more must be known about its nature, type and incidence. There are indirect morbidities such as anemia, malnutrition, fatigue, and decreased resistance toward disease which can cause serious illnesses when pregnancy occurs. There are 3 types of reproductive morbidity, obstetric, gynecological, and psychological. The 1st is short term illness resulting from pregnancy and labor within 42 days of the end of pregnancy. This includes hemorrhage, sepsis, high blood pressure, ectopic pregnancy, and convulsions. The 2nd are more long term, such as reproductive infections, sexual diseases, fistulae and prolapse. The 3rd is caused by pressures on young girls by early marriage, early child bearing and repeated child bearing. In measuring morbidity bias in hospital or community studies must be considered. Hospitals will over-estimate acute diseases while underestimating other diseases and conditions. Interviews may be used but should be followed by clinical exams to identify specific infections. Various areas of a country and all age groups should be represented.
Lancet. 1989 Sep 30; 2(8666):795.In late August, the World Health Organization convened a technical working group in Geneva to consult on the measurement of reproductive morbidity in women. In many places ill health and injuries associated with childbearing are so common that people tend to accept them as normal and unavoidable, no matter how severe. Therefore the true extent of such illnesses is not known; according to some estimates, for every maternal death (of which there are some 500,000 a year) 10-15 women are injured or disabled by pregnancy or labor. The working group were seeking practical ways to measure reproductive morbidity. The need for community-based studies was recognized, and the working group thought that priority should be given to conditions such as vesicovaginal fistula, obstetric palsies, secondary infertility, sepsis, dyspareunia, prolapse and psychoses. One of the difficulties in measuring such morbidities will be getting access to the women and letting them know they can be helped. But the 1st step is to devise methods for measurement of reproductive morbidity. During the United Nations Decade for Women (1976-1985) the sheer suffering associated with maternity gradually became apparent. But much more than a decade is needed to recognize, measure, and correct the abuse and neglect of centuries. Could it be that we should be talking of WCH rather than just MCH? [full text]
Population dynamics of rural Cameroon and its public health repercussions. A socio-demographic investigation of infertility in Mbandjock and Jakiri districts.
Yaounde, Cameroon, Public Health Unit, Univ. Centre for Health Sciences, Univ. of Yaounde, 1979 Oct. 314 p.The preliminary findings of the Vital Statistics Survey Project, conducted under the auspices of the University of Yaounde in 2 rural districts of Cameroon in 1975-78, are reported. Vital statistics surveys were conducted in 20 villages in the Jakiri district and 3 villages in the Mbandjock district in 1976. Longitudinal surveys were conducted in 1976-77 and again in 1977-78 in Jakiri and in 1976-77 in Mbandjock. Jakiri's population is characterized by high fertility and high mortality. In contrast, Mbandjock shows low fertility and a stagnant or decreasing population trend. Data on factors related to fertility were collected from 3592 women in Jakiri and 251 women in Mbandjock. The crude birth rate in Jakiri was 37.5 livebirths/1000 population in 1976-77 and 27.5/1000 in 1977-78. In Mbandjock, the 1976-77 rates were 20.1, 31, and 12/1000 in the 3 villages surveyed. The average number of living children per woman was 2.67 in Jakiri and 1.55 in Mbandjock. 68.9% of Jakiro women and 79% of Mbandjock women ages 15-50 were currently married; however, the latter district is characterized by widespread marital instability. The average number of pregnancies per women was 3.1 in Jakiri and 2.67 in Mbandjock, with average child wastage ratios of 0.43 and 1.12, respectively. The infant mortality rate in Jakiri was 147/1000 livebirths in 1976-77 and 137/1000 in 1977-78. The rate in Mbandjock declined from 417/1000 livebirths in 1976 to 0 in 1977, a decrease attributed both to an effective measles campaign and the small sample size. The average desired family size was 9 in Jakiri and 6 in Mbandjock. Jakiri demonstrated a total infertility rate of 17%. The corresponding rates in the 3 Mbandjock villages were 48, 46, and 52%. The proportion of infertile women ages 20-29 was 18% in Jakiri and 22, 16, and 24% in the Mbandjock villages. According to the World Health Organization, a 15% infertility rate in this age group is the limit for declaring a serious public health problem. However, since Careroon authorities seem satisfied with the fertility situation in Jakiri, it is suggested that the limit be raised to 18%. Mbandjock, on the other hand, is considered to have a serious infertility problem. 4 recommendations are made to improve the health profile for this part of rural Cameroon: 1) family planning programs should be introduced in areas of population explosion; 2) health education campaigns should be directed against the high rates of communicable diseases and childhood immunization campaigns should be introduced; 3) nutrition education should be integrated into community development programs; and 4) vital statistics collection should be centrally supervised.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 144 p. (Syncrisis: the dynamics of health, XIX)This report uses available statistics to examine health conditions in Senegal and their interaction with socioeconomic development. Background data are presented, after which population, health status, nutrition, environmental health, health infrastructure, facilities, services and manpower, national health policy and planning, international organizations, and the Sahel are discussed. Diseases such as malaria, measles, tuberculosis, trachoma and venereal diseases are endemic in Senegal, and high levels of infant and childhood mortality exist throughout the country but especially in rural areas. Diarrhea, respiratory infections, and neonatal tetanus contribute to this mortality and are evidence of the poor health environment, and lack of basic services including nutrition assistance, health education, and potable water. Nutrition in Senegal appears to be good in general, but seasonal and local variations sometimes produce malnutrition. Lowered fertility rates would reduce infant and maternal mortality and morbidity and might slow the present decline in per capita food intake. At present the government of Senegal has no population policy and almost no provisions for family planning services. Health services are inadequate and inefficient, with shortages of all levels of health manpower, poor planning, and overemphasis on curative services.