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Report of the third meeting of the scientific working group on viral diarrhoeas: microbiology, epidemiology, immunology and vaccine development, [held in] Geneva, 1-3, February 1984.
Geneva, Switzerland, WHO, . 19p.The current status of the Scientific Working Group Program is reviewed, showing an expansion of activities in both its health services component (planning, implementation and evaluation of national diarrheal diseases control programs) and its research component (biomedical and operational). Submission of research proposals is encouraged by the Steering Committee (SC), namely those investigating the etiological role of viral agents in diarrheal disease and the epidemiology of these agents. Recently, the SC has made a particular effort to stimulate research in the area of immunology of viral enteric infections, which has been a generally neglected area. Other important areas of Program activity include site visits to review progress made by its projects, to participate in the initial design or the analysis of studies, or to stimulate general interest among research workers in the activities of the SWG. Workshops have also been initiated and conducted in WHO regions. The SWG notes with satisfaction the progress of the Program and commends the SC's efforts to stimulate and support research activities. SWG recommendations bear on the need for more data on the etiology and epidemiology of diarrhea in the community and the encouragement of further community-based studies. Particular attention should also be given to the preparation of reagents for the serotyping and subgrouping of rotaviruses. Moreover, the Group recommends that research strengthening workshops be continously held. In addition to the review of the meeting and recommendations, this paper includes a report on active and passive immunity to viral diarrheas. Special attention is given to rotavirus diarrhea as it tends to be common and quite severe. Its epidemiology is briefly presented, showing its incidence, seasonality (winter) in temperate climates, age-specific occurrence (most severe in infants and young children) and transmission (fecal-oral, person-to-person). Neonatal ans sequential postneonatal rotavirus infection are addressed ans issues for further investigation clarified; e.g., the relationship between low birth weight and the occurrence and severity of infection. Much remains to be elucidated regarding the serotyping-specific epidemiology of rotaviruses. The Group notes that further immunological studies of rotaviruses are essential to elucidate the role of passive protection. The other area of study in which research activities need to concentrate is vaccine development.
[Geneva, Switzerland], WHO, . 2 p. (WHO/CDD/SER/84.7)In 1982-1983 the Who Diarrhoeal Diseases Control (CDD) Programme supported laboratory studies to identify a more stable ORS composition, particularly for use in tropical countries, where ORS has to be packed and stored under climatic conditions of high humidity and temperature. The results of these studies demostrate that ORS containing 2.9 grams of trisodium citrate dihydrate in place of 2.5 grams of sodium bicarbonate was the best of the formulations evaluated. 7 clinical trials were undertaken in which the efficacy of ORS-citrate and ORS-bicarbonate was compared. All but 1 of these trials had a double-blind study design. 4 of these studies were undertaken in children below 2 years of age with moderate to severe noncholera diarrhea. The ORS-citrate was received by 128 children and found to be uniformly as effective as ORS-bicarbonate in correcting acidosis. In 3 of the 4 studies from which preliminary data are available, there was a trend towards a reduction (8-14%) of diarrheal stool output in children receiving the ORS-citrate. Countries should have no hesitation in continuning to use ORS-bicarbonate, which is highly effective. However, because of its better stability and apparently greater efficacy, WHO and UNICEF now recommend that countries use and produce ORS-citrate where feasible.
Patterns of infertility in the developing world: preliminary observations from the WHO clinical study, Task Force on the Diagnosis and Treatment of Infertility, WHO Special Programme of Research, Development and Research Training in Human Reproduction.
[Unpublished] 1984 Feb. 11 p.This paper presents preliminary observations on infertility derived from a World Health Organization (WHO) clinical study conducted in 33 medical centers in 25 developed and developing countries. A major purpose of the investigation was to provide a standardized approach, including standardized diagnostic procedures and identical definitions, for the study of infertile couples. As of January 1984, 7600 couples had been enrolled in the study and over 5400 had completed the protocol. Infertility of at least 1 year's duration was required for admission to the study. The study results so far suggest certain patterns. Couples in developed countries were more likely to have primary than secondary infertility and to have been infertile for a shorter period of time than those in developing countries. However, Africa was the only area in which the majority of couples requesting medical consultation had secondary infertility. Over 70% of couples in developing countries had infertility for over 2.5 years before seeking consultation, whereas half of those in developed countries waited less than 2 years. On the other hand, similar proportions of couples (13-16%) in all regions became pregnant. Reasons for infertility were identified in both partners in 1/3 of African couples and 40% of those in the East Mediterranean region. The rate of infertility of unexplained etiology was 9-20% in developed countries, Latin America, and Asia, but 0% in Africa and 5% in the East Mediterranean. Over half of African women had infection-attributable diagnoses (including 43% bilateral tubal occlusion, 15% pelvic adhesions, and 4% acquired tubal abnormalities), a rate that was 60% higher than in other areas. Similarly, varicocele was diagnosed in 25% of African males investigated compared with 6-19% in other areas. Abnormal sperm morphology and low sperm motility were also more common among African males. Higher risks of tubal occlusion were consistently associated with number of previous pregnancies, a history of sexually transmitted infections, and a previous episode of postpartum or postabortal complications.
Studies in Family Planning. 1984 Nov-Dec; 15(6/1):253-66.This paper critically analyzes claims for the effectiveness of the Billings method of natural family planning and raises questions about the wisdom of actively promoting this method. The Billings method, developed in Australia, is based on client interpretation of changing patterns of cervical mucus secretion. Evaluation of the method's use-effectiveness has been hindered by its supporters' insistence on distinguishing between method and user failures and by the unreliability of data on sexual activities. However, the findings in 5 large studies aimed at investigating the biological basis of the Billings method provide little support for the claims that most fertile women always experience mucus symptoms, that these symptoms precede ovulation by at least 5 days, and that a peak symptom coincides with the day of ovulation. Although many women do experience a changing pattern of mucus symptoms, these changes do not mark the fertile period with sufficient reliability to form the basis for a fully effective method of fertility control. In addition, the results of 5 major field trials indicate that the Billings method has a biological failure rate even higher than the symptothermal method. Pearl pregnancy rates ranged from 22.2-37.2/100 woman-years, and high discontinuation rates in both developed and developing countries were found. Demand for the method was low even in developing countries where calendar rhythm and withdrawal are relatively popular methods of fertility control, suggesting that women of low socioeconomic status may prefer a method that does not require demanding interaction with service providers and acknowledgment of sexual activity. The Billings method is labor-intensive, requiring repeated client contact over an extended time period and high administrative costs, even when teachers are volunteers. It is concluded that although natural family planning methods may make a useful contribution where more effective methods are unavailable or unacceptable, many of the claims made for the Billings method are unsubstantiated by scientific evidence.
Breast cancer, cervical cancer, and depot medroxyprogesterone acetate. [WHO Collaborative Study of Neoplasia and Steroid Contraceptives] [letter].
Lancet. 1984 Nov 24; 2(8413):1207-8.This letter presents the preliminary findings of a collaborative, multinational, hospital-based, case-control study being conducted under the auspices of the World Health Organization to assess the influence of depot medroxyprogesterone acetate (DMPA) on risks of mammary, gynecological, and hepatobiliary malignancies. The frequency of ever-use of DMPA was greater in breast cancer cases (15/246, or 6,0%) than in controls (381/4162, or 9.2%). When adjusted for age, center, age of birth of 1st child, and nulliparity, the relative risk in women who had ever used DMPA was 0.7. The lowest risk was noted in women who had used DMPA for 3 or more years, but no decreasing trend in risk with duration of use was evident. The reducton in risk of breast cancer in DMPA users was largely confined to women with 1st exposure after age 30 years. In terms of cervical cancer, a history of DMPA use was reported by slightly more cases (67/469, or 14.3%) than controls (269/2704, or 9.9%). Use of oral contraceptives, number of cervical smears, and number of pregnancies were the variables most strongly related to cervical or having the greatest influence on relative risk estimates for users of DMPA. When controlled for these 4 factors and age and center, the relative risk in DMPA was 1.13. The highest relative risk was found in longterm users, although there was no clear trend of increasing risk with duration of DMPA use. These preliminary findings provide no evidence that DMPA increases the risk of breast cancer. The relative risk for cervical cancer for DMPA users obtained in this study could be due to chance or to incomplete control for the confounding effect of sexual variables. Although the absence of a trend of increasing risk with duration of use tends to rule out a causal connection between DMPA use and cervical cancer, the doubling of risk in women who used DMPA for 5 years or more is of potential concern.