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New York, United Nations Fund for Population Activities; London, England, Croom Helm, 1980. 215 p.The Arab population, consisting of 20 states and the people of Palestine, was almost 153 million in 1978 and is expected to reach 300 million by the year 2000. Most Arab countries have a high population growth rate of 3%, a young population structure with about 50% under age 15, a high rate of marriage, early age of marriage, large family size norm, and an agrarian rural community life, along with a high rate of urban expansion. Health patterns are also similar with epidemic diseases leading as causes of mortality and morbidity. But there is uneven distribution of wealth in the region with per capita annual income ranging from US$100 in Somalia to US$12,050 in Kuwait; health care is also more elaborate in the wealthier countries. Fertility rates are high in most countries, with crude birthrates about 45/1000 compared with 32/1000 in the world as a whole and 17/1000 in most developed countries. In many Arab countries up to 30-50% of total investment is involved in population-related activities compared to 15% in European countries. There is also increasing pressure in the educational and health systems with the same amount of professionals dealing with an increasing amount of people. Unplanned and excessive fertility also contributes to health problems for mothers and children with higher morbidity, mortality, and nutrition problems. Physical isolation of communities contributes to difficulties in spreading health care availability. Urban population is growing rapidly, 6%/year in most Arab cities, and at a rate of 10-15% in the cities of Kuwait and Qatar; this rate is not accompanied by sufficient urban planning policies or modernization. A unique population problem in this area is that of the over 2 million Palestinians living in and outside the Middle East who put demographic pressures on the Arab countries. 2 major constraints inhibit efforts to solve the Arab population problem: 1) the difficulty of actually reallocating the people to achieve more even distribution, and 2) cultural and political sensitivities. Since in the Arab countries fertility does not correlate well with social and economic indicators, it is possible that development alone will not reduce the fertility of the Arab countries unless rigorous and effective family planning policies are put into action.
In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 167-72. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)Research is the tool which can help accelerate control of filariasis including the most important, river blindness and elephantiasis. The principles for control include eliminating the vectors and changing the way of life of the people. However these methods do not take into account the different ecologies of the land, cultures of the people and technical and political differences of the endemic areas. The WHO Onchocerciasis Control Program in the Volta Basin has been highly successful, but reinvasion of vectors is possible and there is concern that unacceptable levels of pollution will occur. Several successful limited programs of control are cited, but the absence of suitable drugs to kill the parasites is evident. One of the areas of research is centering on the characterization of the parasites and their vectors. More studies of isoenzyme markers are needed to distinguish different species of filarial parasites. An important advance in the diagnosis of filariasis has been the application of membrane filtration techniques for detecting light infection. Some of the current vector research is noted. This is particularly important because the main vectors of filariasis in Africa are also the main vectors of malaria. WHO is encouraged to stimulate collaborative research in this area. Chemotherapy is currently the most encouraging aspect of research. WHO is supporting 4 major centers where old and new filaricides are being evaluated. Some experiments are indicating the possibility that resistance to the disease can be stimulated by using irradiated larvae as appear in a cat model. Testing is now underway in a bovine onchocerciasis model. The new laboratory developments must continue so they can be applied clinically.