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[WHO updates medical eligibility criteria for contraceptives] OMS reactualizeaza criteriile medicale de eligibilitate pentru utilizarea contraceptivelor.
Targu-Mures, Romania, Institutul Est European de Sanatate a Reproducerii, 2006. 15 p. (Actualitati in planificarea familiala No. 1)The World Health Organization (WHO) has issued new family planning guidance, including the following: Most women with HIV infection generally can use IUDs. Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs. Women with clinical depression usually can take hormonal contraceptives. More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the 2000 Medical Eligibility Criteria (MEC) for Contraceptive Use. (excerpt)
Contraception. 2006 Feb; 73(2):154-165.Previous research has suggested that hormonal contraceptive users, compared with nonusers, may be at increased risk for acquiring sexually transmitted infections (STIs). We searched the MEDLINE and EMBASE databases for all articles from January 1966 through February 2005 for evidence relevant to all hormonal contraceptives and STIs (including cervical chlamydial and gonococcal infection, human papillomavirus, trichomoniasis, herpes and syphilis). We used standard abstract forms and grading systems to summarize and assess the quality of 83 identified studies. Studies of combined oral contraceptive and depot medroxyprogesterone use generally reported positive associations with cervical chlamydial infection, although not all associations were statistically significant. For other STIs, the findings suggested no association between hormonal contraceptive use and STI acquisition, or the results were too limited to draw any conclusions. Evidence was generally limited in both amount and quality, including inadequate adjustment for confounding, lack of appropriate control groups and small sample sizes. The observed positive associations may be due to a true association or to bias, such as differential exposure to STIs by contraceptive use or increased likelihood of STI detection among hormonal contraceptive users. (author's)
Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review.
Contraception. 2006 Feb; 73(2):145-153.Concerns exist as to whether the insertion of copper and levonorgestrel-releasing intrauterine devices (IUDs) increases the risk of pelvic inflammatory disease (PID) among women with sexually transmitted infection (STI). We searched the MEDLINE database for all articles published between January 1966 and March 2005 that included evidence relevant to IUDs and STIs and PID. None of the studies that examined women with STIs compared the risk of PID between those with insertion or use of an IUD and those who had not received an IUD. We reviewed indirect evidence from six prospective studies that examined women with insertion of a copper IUD and compared risk of PID between those with STIs at the time of insertion with those with no STIs. These studies suggested that women with chlamydial infection or gonorrhea at the time of IUD insertion were at an increased risk of PID relative to women without infection. The absolute risk of PID was low for both groups (0-5% for those with STIs and 0-2% for those without). (author's)
New York, New York, International Women's Health Coalition [IWHC], . 2 p.Today, about 1 billion people are between 10 and 19 years of age, 85% of them in developing countries. The Programme of Action of the International Conference on Population and Development recognized that adolescents have a special need for sexual and reproductive health information, education and services, and that these services must respect the right of adolescents to privacy. Many women around the world marry as adolescents. Across Sub-Saharan Africa, at least half of young women enter their first marriage or union by age 18 (e.g. Mali, Niger - more than 75% of young women; Cameroon, Malawi, Uganda, Nigeria - more than 50%). In Egypt and the Sudan, the proportion is 27%, but in Yemen, it is 49%. In Latin America and the Caribbean, between 20 and 40% of adolescent women in countries such as Brazil, the Dominican Republic, Mexico, El Salvador, Guatemala, and Trinidad and Tobago are married before age 18. Across Asia, the likelihood of early marriage is quite variable: 73% of women in Bangladesh enter a union by age 18, compared with 14% in the Philippines and Sri Lanka, and 5% in China. (excerpt)
Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 8 p. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The World Health Organization (WHO) has issued new family planning guidance, including the following: Most women with HIV infection generally can use IUDs. Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs. Women with clinical depression usually can take hormonal contraceptives. More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the 2000 Medical Eligibility Criteria (MEC) for Contraceptive Use. (excerpt)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 2-4. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The 2003 Expert Working Group made several changes to the MEC to indicate that women often can safely use IUDs in conditions related to HIV and other sexually transmitted infections (STIs). Taken together, these changes should help reduce some providers’ concerns about offering IUDs in areas where HIV infection and other STIs are common. At the meeting the WHO Expert Working Group concluded that a woman generally can start using an IUD, if she wishes, even if she has AIDS—provided she is receiving ARV therapy and is clinically well—or if she has HIV infection or she is at high risk of HIV infection. The Expert Working Group changed these conditions from category 3 to category 2 for starting IUD use. According to the bulk of research considered at the WHO meeting, IUD use does not increase a woman’s chances of acquiring HIV infection. Women generally can keep their IUDs if they become infected with HIV or develop AIDS while using IUDs (category 2), although IUD users with AIDS should be carefully monitored for pelvic infection. Limited evidence shows that complications of IUD use are no more common among IUD users infected with HIV than among IUD users who are not infected with HIV. Also, IUD use does not increase HIV transmission to sexual partners. (excerpt)
[New Delhi], India, UNFPA, 1999.  p.The prevalence of RTI/STDs in India, as known from community and institution-based studies, is reviewed in the study. The study also puts RTI prevalence into a wider context by reviewing regional and international sources. The multifaceted relationship between RTI/STDs and HIV/AIDS is explored in terms of demographic synergy, biological plausibility, commonality in risk as well as treatment-seeking behaviour and prevention aspects. A brief review of country experiences in RTI/STD management has also been included in the study. Because of the close linkage between RTI/STD and HIV/AIDS, the report advocates for integrating RTI/STD prevention in primary health care in the country. The silent epidemic - silent because the low status of women in many parts of India makes women suffer in silence or even feel too ashamed to seek treatment - needs to be acknowledged and a campaign mounted to confront it squarely. (excerpt)
Journal of Health and Population in Developing Countries. 2003 Jul 2;  p..The trend and predictors of infertility are not well known in sub-Saharan Africa. A nationally representative Demographic and Health Survey (TDHS) was conducted in Tanzania in 1991/92, 1996 and 1999, enabling a trend study of infertility. Logistic regression was used to determine the predictors of infertility. The prevalence of primary infertility was about 2.5%, and secondary infertility was about 18%. There was no change between the 1991/92, 1996 and 1999 TDHS. The risk of primary infertility was higher in the Dar es Salaam and Coast regions than in other regions and secondary infertility was higher in the Dar es Salaam region. The Dar es Salaam and Coast regions are known for also having elevated levels of HIV/AIDS. Because sexual practices and sexually transmitted diseases are strong predictors of pathological infertility and HIV infection in Africa, we recommend that concerted efforts be made to integrate the prevention of new incidences of infertility with the HIV/AIDS campaigns. (author's)
In: Population studies (lectures on population education), [compiled by] Sri Venkateswara University. Population Studies Centre. Tirupati, India, Sri Venkateswara University, Population Studies Centre, 1979. 41-50.This paper highlights the importance of health education in population education. Definition of health, as well as, the objectives of health education in the prospects of the WHO is presented in this paper. Furthermore, it focuses on the different aspects of health education, namely: personal hygiene and environmental sanitation; maternal and child health; nutrition education; applied nutrition program; school health education; transmission of diseases and cultural practices; national health programs; age at marriage of women and health; and population explosion and health hazards.
[New York, New York], Population Council, 2000. viii, 28 p.In 1993 UNICEF/Myanmar launched an innovative project aimed at preventing the further spread of HIV/AIDS in Myanmar through the promotion of reproductive health. One of the activities undertaken was life-skills training for women and youth, conducted in collaboration with the Myanmar Red Cross Society (MRCS) and the Myanmar Maternal and Child Welfare Association (MMCWA). The objective of the life-skills training activities was to encourage and promote informed decision making and care-seeking behavior among youth and women. The training aims to provide detailed and accurate information concerning sexuality, birth spacing, sexually transmitted diseases (STDs), and HIV/AIDS, and to provide skills for youth and women to enable them to cope with their daily lives and become proponents of community mobilization. This report presents findings of a participatory evaluation of the life-skills training activities implemented in late 1997 and early 1998. At the time of the evaluation, life-skills training had been conducted in 27 project townships. MRCS activities targeted youth aged 15-25 years, and MMCWA worked primarily with married women aged 20-40 years. Eight project townships were identified as project evaluation areas and one township was selected as a comparison township for each of the implementing organizations. In each of the selected project townships in-depth interviews and focus-group discussions were conducted with trained and non-trained individuals in urban and rural areas. The evaluation used a highly participatory approach in order to encourage self-reflection among the local implementing agencies. This report summarizes the findings and recommendations resulting from the participatory evaluation. (excerpt)
Arlington, Virginia, FHI, AIDS Control and Prevention Project, .  p.An estimated 250 million cases of sexually transmitted diseases (STDs) occur each year. In addition to the acute illnesses, chronic illnesses, and pregnancy-associated conditions they cause, studies suggest that STDs enhance transmission of HIV. Women and children bear the greatest burden of STDs. STDs are hard to manage because of the inadequate health-seeking behavior of the sufferers, poor STD care in medical facilities, and the asymptomatic nature of gonococcal or chlamydial infections in many women. The World Health Organization (WHO) has developed diagnostic algorithms based on clinical signs and symptoms for use at primary health care facilities and clinics. These algorithms are simple enough to be used by providers at all levels. Family Health International is working to validate the WHO algorithms in several countries. 500 symptomatic women in Jamaica were diagnosed on the basis of risk assessment and the results of a physical examination. The accuracy of the diagnoses was checked through laboratory tests. The WHO algorithm had sensitivity of 84%, specificity of 39%, and positive predictive value of 42%. The Comprehensive Health Clinic in Jamaica has, consequently, adopted the WHO guidelines and is disseminating this information throughout the country. Symptomatic women are being treated for both gonorrhea and chlamydia; and routine gonorrhea culture has been discontinued except for 25 cases a month to monitor antibiotic sensitivity. Instead, laboratory personnel are screening a large urban antenatal population for syphilis. Family planning clinics can treat STD symptoms effectively without laboratory tests. Risk assessment can be used for asymptomatic women but results in lower sensitivity and specificity. There is an urgent need for simple, inexpensive diagnostic tests for STDs in women.
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.
In: Body, mind, and spirit in sexual health: national conference report, Islamabad, Pakistan, February 13th to 15th, 2001. Organized by Aahung, edited by Shireen S. Issa. Karachi, Pakistan, Aahung, 2001. 81-8.In response to the high fertility rate in Pakistan, the Movement of Sustainable Social Autonomy and Gender Equity (MESSAGE) undertook a UN Children's Fund project that aimed to raise awareness regarding sexual health and initiate a positive change among those involved in high-risk sexual behaviors. The project, which is a nongovernmental organization focusing on human resource development in sexual health, targeted sex workers in the at risk areas of Multan. The project aimed to provide information on health and nutrition related facts especially sexually transmitted disease (STD)/HIV/AIDS; and increase awareness of about 5000 persons involved in risky behavior such as unprotected sex, drug use, and commercial blood donation. It also aimed to prepare and organize a group of about 50 community members by imparting knowledge rendering them capable of working toward the goals of promoting prevention of STDs and HIV/AIDS. Program activities include service delivery component; strengthening the capacity; advocacy and social mobilization; and creation of STDs and HIV/AIDS awareness. The author notes that despite the fact that MESSAGEs project experienced failure in the first 6 months of its implementation, several lessons were learned with regards to community involvement; long-term program development; inducting behavioral changes; limitation of pilot project; peer educators; and stigmatization.
[Study of the prevalence of STDs among pregnant Tunisian women, and a validation of the clinical algorithm proposed by the World Health Organization (WHO) for managing STDs] Etude de la prevalence des MST chez les femmes tunisiennes enceintes et validation de l'algorithme clinique propose par l'OMS pour la prise en charge des MST.
Contraception, Fertilite, Sexualite. 1999 Nov; 27(11):785-90.Sexually transmitted diseases (STDs) are public health problems in most of the world s countries because of their growing prevalence and their role as cofactors in HIV transmission. Results are presented from a study conducted on a sample of 409 pregnant Tunisian women during April-July 1996. These women underwent clinical and bacteriological exams as part of an assessment of the most frequently encountered STDs in the country. 1.7% of the women were under 20 years old and 6.6% were over age 40 years, although 30.1% of the women were 30-34 years old. 91% of the women were married, while 6.3% were divorced or unmarried. 65.7% were consulting health services to request an abortion. 42.3% of blood samples drawn were seropositive for the presence of STDs. The most often seen sexually transmitted agents were Trichomonas vaginalis with a prevalence of 5.6%, and Chlamydia trachomatis with a prevalence of 1.7%. No case of gonococcal infection was observed. Since this sample of women was comprised of pregnant women without any particular risk factors, these study results can be extrapolated to the general population. The WHO syndromic approach to STD management was also validated as a less than ideal tool, but one which is nonetheless highly useful when laboratory facilities are unavailable. The WHO approach also allows the diagnosis and treatment of the patient from the initial consultation.
ENTRE NOUS. 1999 Spring; (42):12.A survey on the sexually transmitted disease (STD) incidence in the rural region of Chatlon was conducted by the Republican Reproductive Health Center as part of the agreement between the Government of Tajikistan and WHO for the implementation of the United Nations Population Fund (UNFPA) project "Improving Reproductive Health Services and Access to Family Planning." Some 1034 women answered the questionnaire on all aspects of STDs; 400 women were physically examined, and 200 blood specimens were tested for syphilis, hepatitis B and C, and HIV. 75.7% of the examined cases revealed a variety of STDs: trichomoniasis (25.3%), candidosis (17.9%), chlamydia trachomatis (14.9%), syphilis (5.6%), gonorrhea (.2%), and hepatitis B virus (.2%). STDs were most commonly found in the 21-39 age group; the lowest rate (1.89% of the cases) was found among women with a high educational level. Investigations also showed a low awareness of STDs among the population: 72% of those questioned knew nothing about STDs, while 62.8% of all housewives in the survey group knew nothing to prevent STDs. Furthermore, STD screening of the 17-20 age group revealed that 30% had genital skin changes, while 77.7% of the 19-20 age group had vaginal discharges. The results confirmed that there was a high prevalence of STDs in Tajikistan, suggesting that there was a need to promote urgent social and medical remedies. Three main goals for combating STDs are outlined: 1) to improve quality of life, 2) to decrease the risk of infection through primary prevention, and 3) to diagnose and provide early treatment to people who are infected with curable forms of STDs.
Ann Arbor, Michigan, UMI Dissertation Services, 1995. , vi, 460 p. (UMI No. 9608121)This project examines the global politics of "technical assistance" as they shape and are reflected in struggles over solutions to the AIDS crisis in Kenya. Drawing on and refining feminist Nancy Fraser's analysis of the role of welfare experts in securing state control of women's bodies through the elaboration of "needs talk" and contextualizing the process in class-centered theories of African underdevelopment, the dissertation focuses on the implications of debates among international health experts at the World Health Organization (WHO) and struggles over donor money among Kenyan bureaucrats, researchers, and consultants for local efforts to help low-income Kenyan women avoid HIV infection. The author argues that in Kenya the relationship of scientific knowledge to the making of policies guiding how the national government defines its needy population, decides what is needed, and delivers public services is determined by the actions of groups of ideological and financial brokers within the network linking international, national, and local sites of interventions in crisis. The author examines the emergence in Kenya of a post-colonial discourse identifying low-income women as the culprits in the transmission of sexual disease prior to the appearance of AIDS. The depoliticization of AIDS from a problem of sexual inequality into a problem of inequality of technical know-how is their analyzed. At the local level, these historical processes have translated into hegemonic control of problem definition by Canadian, American, and European doctors enforcing a notion of masculine sexuality as promiscuous and fixed and feminine sexuality as subject to control and containment. The author concludes by arguing that such a deployment of a supposedly gender and nationality neutral science results in policies for the control of AIDS that are ineffective at best and potentially dangerous for women and men alike. (author's)
Risk assessment a screening tool for the diagnosis of sexually transmitted diseases (STDs) in antenatal clinic attenders in NW Tanzania.
[Unpublished], 1993. Background paper for Informal Technical Working Group Meeting on STD Activities in GPA, Geneva, Switzerland, February 15-17, 1993.  p.Asymptomatic carriers of STDs present a major public health problem. Although both men and women may have asymptomatic STD, the condition is far more likely to prevail in women. An effective way to screen for STDs in women has yet to be identified. In a pilot study among urban antenatal clinic (ANC) attenders and other rural ANC attenders, approximately half of the women with a proven cervical infection with Neisseria gonorrhoea or Chlamydia trachomatis were asymptomatic. Classical symptoms and signs are rather poor predictors of these STDs. However, in the urban population studied, being younger than age 20 years, subfertility, recent partner change, and reported condom use were associated with these infections. Based upon these findings, a combined score-driven diagnostic approach comprised of risk assessment, reported symptoms, and signs found on examination was developed. The method had a higher sensitivity and specificity than the classical diagnostic approach among the urban population. It could also contribute to a significant decrease in treatment costs per actual STD case treated. The score-driven approach tested upon the data set from the ongoing rural study delivered an unacceptably low sensitivity, but one nonetheless better than that obtained using the classical approach. The score-driven approach can be optimized for the rural population once the data set is complete.
[And after Cairo? It is now that the difficulties begin] Le Caire, et apres? C'est maintenant que les difficultes commencent.
EQUILIBRES ET POPULATIONS. 1994 Oct; (4):8.The international community and the UN should be congratulated for adopting a strategy and a very clear action plan at the International Conference on Population and Development in Cairo. The process leading up to and during the conference allowed all member nations, even the most conservative members, to communicate their interest in problems associated with population and development and their approaches to solving the problems. The members reached consensus and adopted the program of action. Conference delegates finalized the program of action by concentrating on a global vision of population policy. They recognized the need for unrestricted access to high quality family planning services and the right of women. The document calls for improved reproductive health in developing countries. Specifically, it pronounces the need for improved sanitary conditions during childbirth, access to safe abortion where it is legal, and successive steps to reduce sexually transmitted diseases, including AIDS. Implementation of the program of action poses some difficulties, however. Will the most developed countries provide the necessary financial resources to meet the needs of family planning and reproductive health? Many such countries have promised to contribute US$ 17 billion to meet these needs in developing countries. The US plans to contribute US$ 600 million in 1995. Japan will contribute US$ 3 billion over the next 7 years, 33% of which will go to family planning. Germany plans to give US$ 2 billion over the same period. The European Union plans to give US$ 400 million each year. Other countries also plan to contribute (UK and Belgium). We must make sure that the words adopted in Cairo become reality for the men and women of the planet.
In: International Population Conference / Congres International de la Population, Montreal 1993, 24 August - 1st September. Volume 1, [compiled by] International Union for the Scientific Study of Population [IUSSP]. Liege, Belgium, IUSSP, 1993. 593-603.Using data collected in cooperation with the World Fertility Surveys (WFS) and the Demographic and Health Surveys (DHS) the aim was to determine the levels, age patterns, and trends of sterility in benin, Burundi, Cameroon, Ghana, Ivory Coast, Kenya, Lesotho, Liberia, Mali, Mauritania, Nigeria, Senegal, Sudan, Togo, and Uganda. In sub-Saharan Africa, 10 countries completed a WFS survey from 1977 to 1982. From 1986 to 1991 a DHS survey was carried out in 13 countries. In Sudan, Lesotho and Mauritania only ever married women were eligible for interview. All women (generally age 15-49) were eligible in the rest of the sub-Saharan countries. The selected samples included women who had been sexually active at least 5 years. Subsequently the levels and range patterns of sterility were estimated for each country and by produce within each country. The inhibiting effect of sterility on fertility was also assessed. Age-specific rates of sterility were estimated by the subsequently infertile estimator. At age 34, the proportions sterile reached .41 in Cameroon, .11 in Burundi, and intermediate levels in the rest of the countries. Burundi had the lowest prevalence of sterility at all ages, Cameroon had the highest up to about age 42, and at older ages Sudan and Lesotho ranked highest. In general, sterility rose moderately up to age 35 and then more rapidly after age 40. Sterility was particularly prevalent along major rivers, lakes, and coastal areas. Sterility was relatively high around Lake Victoria as well as in the Coast region of Kenya in 1977-78. Primary sterility was less than 3% in Burundi, Ghana, Kenya, Togo, and in Ondo state, Nigeria; 3-5% in Lesotho, Liberia, Mali, and Nigeria (1990), Senegal, Sudan (1989-90) and Uganda; and 5% or more in Cameroon, Nigeria (1981-82), and Sudan (1978-79). Differential disease patterns caused the most variation in age-specific rates of sterility. Under the hypothesis of Burundi levels of age specific sterility and unchanged fertility, and African woman in the age range from 20 to 44 would have an additional .5 to 2 children.
Approaching STDs and AIDS on a global scale. Interview with Peter Piot, Associate Director, Sexually Transmitted Diseases, Global Programme on AIDS (GPA), World Health Organisation (WHO).
AIDS BULLETIN. 1993 Jul; 2(2):4-5.Dr. Piot became involved with the World Health Organization (WHO) Global Program on AIDS (GPA) through his early involvement as Chairman of the WHO Steering Committee on the Epidemiology of AIDS. He responds to questions about the HIV pandemic. Although researchers realized early on that HIV could be transmitted sexually and suspected that condom use could confer protection against HIV infection as it does against other STDs such as gonorrhea and syphilis, only minimal light was shed to the public on the association of HIV with STDs. The delay in clearly pointing out the association stemmed from professionals' lack of desire to further stigmatize HIV/AIDS by designating it as a STD. Furthermore, many Western hematologists had little interest in STDs, and STD control in many countries tended to be coercive. Regarding the risk of HIV infection, Dr. Piot notes that the presence of a genital ulcer caused by syphilis, chancroid, or herpes increases one's risk 10-20-fold; risk increases 3- to 4-fold where gonorrhea or chlamydia are present. Acknowledging the association between STDs and the risk of contracting HIV and understanding the need to control STDs for the prevention of HIV/AIDS, the WHO's STD program was brought under the auspices of and integrated with the GPA. People, and especially women, who may present at STD clinics for treatment are prime candidates for much needed help in avoiding HIV infection; Dr. Piot notes that unlike men, many women do not realize they are infected with an STD until complications develop. Dr. Piot's recent appointment at GPA means the WHO will increase its focus upon the prevention and treatment of STDs. The WHO favors an integrated program approach. Additionally, the GPA plans to develop a short-list of recommended drugs for treating STDs and hopes to develop ways for developing countries to buy them affordably with help from UNICEF and the World Bank. Finally, Dr. Piot explains that, with some exceptions, the prevalence of STDs is lower in developed countries and, therefore, less of a prevention priority.
TIDSSKRIFT FOR DEN NORSKE LAEGEFORENING. 1991 May 30; 111(14):1729-33.The 4 cornerstones of reproductive health according to the WHO are family maternal care neonatal and infant care, and the control of sexually transmitted diseases. In recent years, the AIDS epidemic has caused concern in the world. The world's population doubled to 4 billion from 1927 to 1974, and it will reach 6 billion by the year 2000. The rate of growth is 1.4% in China and 2% in India vs. .3% in Europe. Contraceptive prevalence is 15-20% in Africa, 30% in South Asia, and 75% in East Asia. Shortage of contraceptives leads to abortion in eastern Europe. In 1985 in the USSR, there were 115.7 abortions/1000 women (mostly married) aged 15-44; and 6.4 million abortions for 5.5 million births in 1989. RU-486 or mifepristone combined with prostaglandin has produced abortion in 90% of first trimester pregnancies. After approval in France in 1987, it was used in 40,000 abortions in the following year. 90% of the estimated annual 500,000 maternal deaths occur in developing countries. In Norway, the rate is fewer than 10/100,000 births vs. 100/100,000 in Jamaica. In the mid-1980s, 26% of rural women in Thailand, 49% in Brazil, 54% in Senegal, and 87% in Morocco went without maternal care. In Norway, infant mortality is 6-8/1000 live births vs. 75-150/1000 in developing countries. A WHO investigation on causes of infertility in 25 countries found a 31% rate of tubal pathology in 5800 couples. In Africa, over 85% f infertility in women was infection related. Venereal diseases and infertility are associated with premarital sexual activity in young people. Various donor agencies and the WHO Special Program of Research, Development, and Research Training in Human Reproduction are providing help and resources including AIDS research.
AFRICA HEALTH. 1993 Mar; 15(3):15-7.The real prevalence of pelvic inflammatory disease (PID) is unknown since many women are either asymptomatic or have atypical symptoms. It is often difficult to detect, manage, and prevent PID. Since PID has obstetric, gynecologic, and contraceptive-related causes, its prevalence is quite high. About 70% of PID hospital admissions in sub-Saharan Africa are a result of reproductive tract infections (RTIs) while this figure is 34% in Asia and 31% in developed countries. Only 10-20% of lower RTIs ascend into the upper genital tract and an even smaller percentage of women with PID develop chronic sequelae. Still, just 1 episode carries an increased risk of a tubal infertility, ectopic pregnancy, chronic pelvic pain, considerable pain during coitus, a new episode, and menstrual irregularities. Neisseria gonorrhoea and Chlamydia trachomatis are the most common causative organisms of PID. In Africa, the risk factors for PID are the same as they are for sexually transmitted diseases (STDs): multiple sex partners, young age at first intercourse, high frequency of coitus, and a high rate of acquiring new partners. The largest percentage of women with RTIs are monogamous women who are infected and constantly reinfected by their promiscuous husbands. The primary means to prevent PID are promotion of safer sexual behavior and condom usage. Secondary measures include accessible, acceptable, and effective STD services and education and counseling during case management. WHO suggests that STD treatment become part of the primary health care system. It has developed flow charts on syndromic diagnosis for urethral discharge in men and genital ulcer disease in women. Health workers should assume increased PID risk if the partner has had a history of urethral discharge and/or treatment for gonorrhea or nongonococcal urethritis. Partner notification is also needed for case management, but stigmatization in some countries poses a problem. WHO also recommends use of drugs which have a 95% STD cure rate.
Geneva, Switzerland, WHO, 1992. vii, 107 p.WHO has compiled tables and graphs in a book reflecting various components of the health of women worldwide. These tables and graphs demonstrate that women continue to be denied their right to health--the most basic of human rights. Gender-related factors account, for the most part, for women's vulnerability, resulting in poorer health for females than males. They reveal the social discrimination women who experience. The book covers women's lifespan to illustrate not only inequity and discrimination throughout the years, but also the intergenerational effects, importance of adolescence, the broader context of women's reproduction, and the importance of elderly women. It first examines socioeconomic determinants of women's health, such as women's status, female literacy, income level, labor force participation, mother's education, and female-headed household. Next, it looks at infancy and childhood, specifically sex preference, breast feeding and weaning, child nutrition, sex-specific mortality, and sex-specific incidence rates for respiratory infections. It then moves on to explore adolescence. It covers the adult years prior to age 65 by focusing on women at work, pregnancy and childbirth, infections and chronic diseases (e.g., HIV/AIDS, sexually transmitted diseases, malaria, cancer, and smoking-related diseases), and violence and mental disorders (e.g., domestic violence, homicide, rape, depression, and drug and alcohol abuse). It concludes with tables and graphs on elderly women. They show life expectancy, disability-free life expectancy, widowhood, distribution of the elderly, elderly living in rural and urban areas, cardiovascular disease death rates, osteoarthritis, and a definite rheumatoid arthritis.
[Unpublished] 1991. Presented at the 119th Annual Meeting of the American Public Health Association [APHA], Atlanta, Georgia, November 11-14, 1991. 7,  p.Maternal health affects child survival in many ways. For example, and infant in Bangladesh whose mother has died during childbirth has a 95% chance of dying in the 1st year. Further children <10 years old in Bangladesh, especially girls, who have lost their mother are 4 times as likely to also die. In addition, there is a relationship between protein energy malnutrition in mothers and low prepregnancy weight and meager wait gain during pregnancy which retards fetal growth resulting in a low birth weight (LBW) infant, LBW infants die at a rate 30 times that of adequate weight infants. In fact, child survival depends on maternal health even before the mother is able to conceive. Daughter as well as mothers in developing countries often eat last and smaller amounts of food than male family members. Females who remain poorly nourished often experience obstructed labor which causes several complications for the infant such as respiratory failure. Maternal infections such as malaria and sexually transmitted diseases are also closely linked to LBW. Some can also bring about preterm birth and congenital infections. Pregnancy and labor complications are responsible for about 500,000 maternal deaths annually. Hemorrhage, sepsis, eclampsia, and obstructed labor cause most of these deaths. A woman's fertility pattern also contributes to child survival. The high risk birth categories include too young, too old, too many children, and too closely spaced. In fact, the median mortality rate for infants born <2 years after the older sibling is 71% greater than that for those born 2-3 years apart. The World Bank recommends improved community based health care, improved referral facilities, and an alarm and transport system to improve maternal health. The World Bank, UNDP, UNFPA, UNICEF, WHO, IPPF, and the Population Council support the Safe Motherhood Initiative which aims to reduce maternal morbidity and death by 50% by 2000.