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Report of the first meeting of the Scientific Working Group on Viral Diarrhoeas: microbiology, epidemiology, immunology, and vaccine development, Geneva, 1980.
Geneva, Switzerland, WHO, 1980. 11 p.The main function of the Scientific Working Group was to review existing knowledge, designate areas where research was needed, recommended approaches for such research; and prepare a research plan. The Group's five year work plan for research is described, consisting of 3 priority topics: investigations related to viral diarrheas in general, studies of rotavirus diarrhea (recognized by the Group as the most important public health problem among the viral diarrheas at present), and research to determine the possible role as a cause of diarrhea of other viral agents (Norwalk and Norwalk-like agents, adenoviruses, calcivirus, coronavirus, axtrovirus, and other small round viruses). Needed epidemiological studies, clinical studies, and studies of disease resistance and vaccine development are identified. Identification of institutions to undertake research was discussed; priority was given to locating institutions and individuals within the developing world, or those in developed countries which work closely with developing world groups. An application form was reviewed and approved, and some general principles established. A list of participants in the meeting, and the 1st report of the Rotavirus reagents subgroup are appended.
Geneva, Switzerland, WHO, 1980. 25 p.Basic guidelines are presented for treatment of acute diarrhea in patients of different age and nutritional status, with emphasis on oral rehydration therapy for infants. The manual is intended for physicians, senior health workers and treatment facility staff and is designed for easy adaptation to local needs and situations. Definitions of diarrhea and dehydration and principles of patient assessment including needed medical history and signs and symptoms of mild, moderate and severe dehydration are spelled out. Patient management including fluid therapy and maintenance of nutrition is discussed for infants, older children and adults with differing severity of illness. The amount and rate of oral rehydration salt administration, other medicines that should and should not be used for different types of diarrheas, and associated problems and complications including malnutrition, fever, and convulsions are also discussed, as a measures for diarrhea prevention. The composition of oral rehydration salts and different solutions for intravenous infusion are discussed.
Guidelines for the trainers of community health workers on the treatment and prevention of acute diarrhoea.
Geneva, Switzerland, WHO, 1980. 29 p.Guidelines to help trainers of community health workers in teaching simple methods and procedures for treatment of acute diarrheal disease are presented. The material is divided into 3 sections: a description of the problem of diarrhea including its causes and dangers; a discussion of treatment including patient assessment, treatment plans for infants and young children, methods of feeding children with diarrhea, treatment plans for older children and adults, medicines for diarrhea, and reporting of cases; and a discussion of prevention of diarrhea covering food and feeding practices, water, and hygiene. The important topics recommended for discussion during training and a list of essential information are included in each section. The information in the guidelines is general and requires adaptation to local cultures and to the particular role of the community health worker in the national health program.
Geneva, Switzerland, WHO, 1980. 58 p.Guidelines suitable for adaptation to local conditions in different countries are designed to assist national authorities in establishing facilities for the production of packets of oral rehydration salts (ORS) of pharmaceutical quality for use in prevention and treatment of clinical dehydration. The composition of oral rehydration salts, procedures for estimating production needs and possibilities, a 6-room facility recommended for ORS manufacture, costs and specification for raw materials including glucose, sodium chloride, sodium bicarbonate, potassium chloride, aerosil, and packaging material, and suggestions for labelling are set forth. Itemized costing and power requirements of necessary and optional production and quality control equipment are listed, and some general considerations concerning equipment are discussed. A series of appendices include a checklist for different aspects of manufacture, example specification for ordering and testing finished packets of ORS, a discussion of good practices in the manufacture and quality control of drugs, examples of order specifications for ORS components, and test procedures for quality control of components and finished ORS packets.
Geneva, Switzerland, WHO, 1980. 14 p.This manual was designed to help national health workers, particularly managers of diarrheal disease control programs, to implement cholera control activities within the context of national programs. Recent knowledge of the bacteriology and epidemiology of cholera is presented, followed by a discussion of necessary preparations for cholera control. Case fatality rates of as high as 50% have been reported in unprepared communities, but the rate diminishes to under 3% when proper treatment becomes available. Preparations for cholera control including formation of national epidemic control committee, surveillance activities, health education activities, training in clinical management of acute diarrhea, laboratory services, establishment of mobile control teams, and logistics are described. The epidemic phase of a cholera outbreak requires intensification of ongoing diarrheal disease control activities. Components of the epidemic phase program including early case finding, establishing treatment centers, treatment, epidemiological investigation, laboratory support, control and prevention are discussed. Basic supplies for a mobile control team are listed.
Report of the First Meeting of the Scientific Working Group on Bacterial Enteric Infections: Microbiology, Epidemiology, Immunology, and Vaccine Development, Geneva, April 1980.
Geneva, Switzerland, WHO, 1980. 17 p.The group developed a five year research plan (1980-84). Topics were given priority based on the following group-established criteria: 1) the extent of the problem to be studied; 2) the chance of its early success given the limited funds available; and 3) the availability of good research workers with an interest in the problem. The epidemiology and microbiology of Vibrio cholerae 01 and Enterotoxigenic Escherichia coli (ETEC) are given first priority for study, as are immunology and vaccine development against cholera and ETEC diarrhoea. The immunology study will involve: 1) identification of protective antigens, 2) tests for antibody measurement and 3) measurement of acquired immunity. Methods of stimulating mucosal immunity are given first priority, as is the testing of existing candidate cholera vaccines such as B-subunit cholera vaccine and living vaccines made from non-toxigenic V. cholerae. Other organisms which will be studied are Campylobaster jejuni (which can account for up to 15% of acute diarrhoea cases in some settings), Salmonella, (including S. typhi), Shigella and Yersinia enterocolitica. Once there is a better understanding of the modes of transmission of the bacterial enteric pathogens, a study of specific cost effective methods of interrupting their transmission through environmental intervention is suggested, with emphasis on modifications in water supply and water usage, defecation practices, and personal and domestic hygiene. Identification of institutions to undertake research, and funding distribution, were also considered.
[Geneva, WHO, 1980]. 15 p.This training module, the first in a series predicated upon demographic data presented in the next module in this series entitled "Fictitia" PIP/802686, a wholly fictitious developing nation, is designed to introduce the issue of diarrheal diseases as a global public health issue. In the developing world, diarrheal disease is one of the most important causes of morbidity and mortality among children under 5 years old. This course, presented in modules, is designed to help improve the skills and knowledge of health care delivery managers of national programs for diarrheal disease control. The introduction explains the course's organization and course operations. It also provides a glossary of terms used in these training materials and a list of abbreviations applicable to the subsequent teaching materials as well. This series of training modules was designed by WHO.
[Geneva, WHO, 1980]. 54 p.In this training module, 1 in a series of such modules published by WHO, the student is asked to practice the following selected tasks involved in evaluation of a national program for control of diarrheal diseases. 1) Review a data collection form for clarity, simplicity, and completeness. 2) Plan collection of data for evaluation of a specific subtarget. 3) Prepare a chart showing numbers of diarrhea cases, and identify disease trends. 4) Calculate and compare annual mortality rates in an area. 5) Explore reasons for failure to achieve an expected mortality reduction. 6) Estimate the amount of money saved by providing vs. hospital therapy. This workbook can be used in conjunction with another in this WHO series on the teaching of programs for control of diarrheal diseases in developing countries, where they are a major cause of morbidity and mortality among children under 5, "Fictitia PIP/802686 which provides fictitious data on a made up developing country to use in solving workbook problems during this course.
[Geneva, WHO, 1980]. 45 p.As part of a series of WHO-designed training modules on developing a national program (in a developing nation) for the control of diarrheal diseases, this volume teaches how to determine logistical problems of supply and distribution of therapeutic modules for control of diarrheal disease. In this module, the student is expected to learn how to determine the quantity of oral rehydration salts (ORS) necessary in Fictitia, a wholly made up country, data on which is published in another module in this series called "Fictitia" PIP/802686, to recommend a distribution system for Fictitia, to determine the number of ORS packets the program manager needs to stock for proper inventory in Fictitia, to specify a schedule for reordering ORS packets in Fictitia, to determine the cost of local production of ORS in Fictitia, and to recommend whether Fictitia should produce its own ORS by target date 1986 or import the ORS the country needs.
[Geneva, WHO, 1980]. 123 p.This course facilitator, or teacher, guide is part of a series of modules which comprise a training course for health care deliverers in developing countries designed to teach the skills necessary to implement a program for control of diarrheal diseases on a national scale. In this course, each participant is provided with a set of booklets called modules that serve as the primary subject matter resource. The materials are designed to assist the participant in developing specific skills. The participant in this course is encouraged to work at his or her own pace within the time constraints imposed by the course length. The participant is expected to discuss any problems or questions with the course facilitor as they arise, and this teacher's module is designed to help the course facilitor provide immediate feedback of completed course work. WHO designed this training program, and all of the modules which comprise the student material are in POPLINE.
[Geneva, WHO, 1980]. 20 p.As part of the WHO series of training modules on programs for the control of diarrheal disease in developing nations, this module teaches how to select the priority health problems in children under age 5 for the country of Fictitia, a wholly made up collection of data on demographics and population characteristics which is presented in another, separate cover, training module in this series, "Fictitia" PIP/802686. The skills of priority selection gleaned from using this workbook in conjunction with fictitious data on a theoretical developing country called Fictitia should help health care providers in real developing nations learn the skills to allow them to select the priority health problems in their own country. Theoretical problems are put forth for users of these modules, designed by WHO, to solve (e.g., assess the incidence of a given health problem based on the data in "Fictitia" for a given year, or assess mortality from a health problem based on data for the theoretical developing country of Fictitia).
[Geneva, WHO, 1980]. 65 p.This WHO publication, one in a series which comprise a complete course on how to set up a diarrheal disease control program in a developing nation, is designed to teach the skills to health care providers from developing countries required to isolate specific sub-targets during different phases of implementation of a theoretical national program. This and its companion volumes which stress various aspects of designing a national diarrheal disease control program may be used in conjunction with a volume that publishes fictitious data on demographic and population characteristics in a fictitious country, "Fictitia" PIP/802686. This module on subtargeting has the student consider the plan for phasing of a national program for control of diarrheal diseases in the theoretical developing country of Fictitia, write subtargets for a region of the initial phases of such a national program, determine whether or not achievement of regional or coverage subtargets throughout Fictitia is likely to lead to achievement of the medium-term mortality reduction, and specify the major activities necessary to achieve 1 of the regional subtargets.
[Geneva, WHO, 1980]. 19 p.As part of a series of training modules which form a course, the purpose of which is to train health care practitioners and deliverers how to effectively set up an in-country program for control of diarrheal disease, this module presents ficticious data (demographics and population characteristics) about a made-up developing nation, Fictitia. Further modules in this series train users how to order priorities in a diarrheal control program, how to focus on targets and sub-targets in the population and delivery system, how to design an effectively administered diarrheal disease control program, and how to evaluate any such program once implemented in an actual developing nation. Since diarrheal disease is 1 of the largest causes of morbidity and mortality among children under 5 in developing nations of this world, WHO created these training manuals as exercises, which would provide skills, upon course completion, applicable to an actual developing nation on earth.
In: American University of Beirut. Faculty of Health Sciences. Human resources for primary health care in the Middle East. Beirut, Lebanon, American Univeristy of Beirut, 1980. 13-21.During 1979, the International Year of the Child, the World Health Organization (WHO) encouraged efforts to improve the collection of information on health and health related problems faced by underprivileged populations. To focus attention on health care for children, the theme of this year's World Health Day on April 7 was the well being of the child. The slogan, "a healthy child, a sure future," was chosen to promote breastfeeding, oral rehydration, nutrition, education, and immunization against the 6 major childhood diseases included in WHO's expanded immunization program. Currently, less than 10% of children in developing countries receive immunization. WHO and its member countries have committed themselves to providing immunization services for every child in the world by 1990, as part of the goal of "health for all by 2000." WHO recommends that each country appoint a program manager and supporting staff to provide detailed plans of operation for immunization. Emphasis in the planning stage should be on the integration of immunization services within the primary health care network for each country. Diarrheal diseases rank among the 1st 3 leading causes of death in children, taking an estimated 5-18 million lives a year, particularly among children under age 5. Dr. Halfdan Mahler, Director General of WHO, has said that the task of safeguarding the health of children cannot be realized through conventional means. What is required is a "radical new approach" which emphasizes the mobilization of national and international resources, the imaginative use of traditional medicine, and the development of health technologies relevant to local needs. A WHO study in 8 developing countries found that 90% of all child deaths could be avoided by safe water and sanitation. This can be regarded as the core of the problem, which indirectly relates to population dynamics and community attitudes. There also appears to be a link between child deaths and births. Maternal and child health care services are not well established in developing nations. Guidelines, quoted from David Werner's book "The Village Health Worker" are quoted to help bridge the gap in reaching the masses. Community health programs will have to be organized on the basis of local needs and priorities. Local health workers from within the community will have to be selected and trained in the delivery of simple basic health care and be responsible to the community.
Glimpse. 1980 Sep; 2(9):1-2.No effective prevention has yet been developed for diarrhea, the most important cause of death and disability in developing countries. Two steps may alleviate the suffering attributed to diarrhea. Through research, the 1st step, effective and inexpensive measures have been developed for application. One is oral rehydration therapy (ORT), a highly effective, inexpensive and technologically simple measure which can abolish death and most of the disability caused by watery diarrhea. The 2nd step is training people to use ORT. ICDDR, B has an important role to play in this process. An effective oral rehydration solution contains an appropriate concentration of salts, water and carrier substances which transport the salts and water into the body. Glucose has been the standard carrier sustance, but certain amino acids are also effective. As both glucose and amino acids are found in many food items, an active research program is needed to test the relative efficacy of food sources which contain glucose and amino acids and which when mixed with salts and water will provide an effective oral rehydration solution. Sucrose-based solutions have also been used to treat watery diarrhea. Fundamental to the ORT is the ability to measure correctly a certain volume of water and to mix a given amount of solutes with the measured amount of water. This is the objective of training and education. By encouraging and assisting research and development of any group with ideas of merit, the ICDDR, B hopes to serve as a catalyst in the rapid spread of effective ORT in the afflicted parts of the world.
[Unpublished] 1980. 26 p.During the meeting of the Technical Advisory Group, the following objectives and strategies of the WHO diarrhoeal Diseases Control Programme were endorsed: 1) reduction of diarrheal diseases mortality by means of widespread implementation of oral rehydration therapy, along with guidance on appropriate feeding practices and the strengthening or establishment of adequate epidemiological surveillance mechanisms to evaluate mortality changes, and 2) promotion of maternal and child care and environmental health practices to reduce diarrheal morbidity. By 1983, the Programme hopes to make oral rehydration salts (ORS) accessible to 25% of children under 5 years of age in developing countries. About 70 developing countries were reported to be either planning to develop or were formulating plans of operation for national CDD (Diarrheal Diseases Control) as a primary health care activity. Proposed Programme activities in the areas of country program planning and evaluation, management and technical training, logistic support and information dissemination were endorsed by the Group. The research component of the Programme was also reviewed, and priority areas were recommended for operational and basic research designed to improve strategies for program delivery and develop new tools for prevention and treatment. The Group also strongly endorsed the formation and convening of global and regional Scientific Working Groups or analogous bodies to coordinate and execute the research programme. The current budgetary status of the Programme was also discussed.
New York, UNICEF, 1980 May 28. 3 p.The activity of UNICEF in connection with oral rehydration therapy in developing countries is outlined. UNICEF was instrumental in developing an oral rehydration formulation based on research conducted in Bangladesh and India. The formula and packaging for this commodity is discussed. Oral rehydration salts are used for all age groups stricken with diarrhea in order to replace fluids and salts. UNICEF has been active in distributing oral rehydration packets, distributing over 10 million in 1978 alone. Its large-scale production has reduced the cost from an original 30 cents/packet to approximately 7 cents/packet. UNICEF is trying to aid in and supervise local production of the salts in several countries.
Oral rehydration therapy for treatment of rotavirus diarrhoea in a rural treatment centre in Bangladesh.
Archives of Disease in Childhood. 1980 May; 55(5):376-9.The outcome of a rehydration treatment used during a 40-day period at a WHO Center in Bangladesh on 216 children under age 5 is reported. In addition, an enzyme-linked immunosorbentassay (ELISA) designed to detect rotavirus in stool specimens is described and its application explained. The ELISA assay was adaptable to use in a rural treatment center. In a 40-day period, using the new virus-detecting assay, rotavirus without other pathogens was found in stools of 216 (45%) of 480 children who attended the center with gastrointestinal illness. Of these 216 children with only rotavirus pathogen, 188 were treated with oral rehydration alone (oral glucose solution prepared according to WHO procedures); 28 required additional intravenous rehydration therapy. No deaths occurred. 95% of the cases were judged successful on oral rehydration alone for gastrointestinal effects of rotavirus infection. No serious side effects were reported. This oral glucose solution is now indcated in E. coli (enter otoxin)-mediated diarrhea as well as in rotavirus-induced diarrhea.