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  1. 1
    039142

    Basis for the definition of the organization's action policy with respect to population matters.

    Pan American Health Organization [PAHO]

    [Unpublished] 1984 May 8. 31 p. (CE 92/12)

    This report shows how demographic information can be analyzed and used to identify and characterize the groups assigned priority in the Regional Plan of Action and that it is necessary for the improvement of the planning and allocation of health resources so that national health plans can be adapted to encompass the entire population. In discussing the connections between health and population characteristics in the countries of the region, the report covers mortality, fertility and health, and fertility and population increase; spatial distribution and migration; and the structure of the population. Focus then moves on to health, development, and population policies and family planning. The final section of the report considers the response of the health sector to population trends and characteristics and to development-related factors. The operations of the health sector must be revised in keeping with the observed demographic situation and the projections thereof so that the goal of health for all by the year 2000 may be realized. In several countries of the region mortality remains high. In 1/3 of them, infant mortality during the period 1980-85 exceeds 60/1000 live births. If measures are not taken to reduce mortality 55% of the population of Latin America in the year 2000 will still be living in countries with life expectancies at birth of under 70 years. According to the projections, in the year 2000 the birthrate will stand at around 29/1000, with wide differences between the countries of the region, within each of them, and between socioeconomic strata. High fertility will remain a factor hostile to the health of women and children and a determinant of rapid population growth. Some governments view the present or predicted growth rates as excessive; others want to increase them; and some take no explicit position on the matter. The countries would be well advised to assign values to their birthrate, natural increase, and periods for doubling their populations in relation to their development plans and to the prospects for improving the standard of living and health of their populations. An important factor in urban growth is internal migration. These migrants, like some of those who move to other countries, may have health problems requiring special care. Regardless of a country's demographic situation, the health sector has certain responsibilities, including: the need to promote the framing and adoption of population and development policies, in whose implementation the importance of health measures is not open to question; and the need to favor the intersector coordination and articulation required to ensure that population aspects are considered in national development planning.
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  2. 2
    040875

    EPI in the Americas. Report to the Global Advisory Group Meeting, Alexandria, Egypt, 22-26 October 1984.

    Pan American Health Organization [PAHO]

    [Unpublished] 1984. 15 p.

    This discussion of the Expanded Program on Immunization (EPI) in the Americas covers training, the cold chain, the Pan American Health Organization's (PAHO) Revolving Fund for the purchase of vaccines and related supplies, evaluation, subregional meetings and setting of 1985 targets, progress to date and 1984-85 activities, and information dissemination. All countries in the Region of the Americas are committed to the implementation of the EPI as an essential strategy to achieve health for all by 2000. During 1983, over 2000 health workers were trained in program formulation, implementation, and evaluation through workshops held in Argentina, Brazil, Cuba, El Salvador, and Uruguay. From the time EPI training activities were launched in early 1979 through 3rd quarter 1984, it is estimated that at least 15,000 health workers have attended these workshops. Over 12,000 EPI modules have been distributed in the Region, either directly by the EPI or through the PAHO Textbooks Program. The Regional Focal Point for the EPI cold chain in Cali, Colombia, continues to provide testing services for the identification of suitable equipment for the storage and transport of vaccines. The evaluation of solar refrigeration equipment is being emphasized increasingly. PAHO's Revolving Fund for the purchase of vaccines and related supplies received strong support from the UN International Children's Emergency Fund (UNICEF), which contributed US $500,000, and the government of the US, which contributed $1,686,000 to the fund's capitalization. These contributions raise the capitalization level to US $4,531,112. Most countries are gearing their activities toward the increase of immunization coverage, particularly to the high-risk groups of children under 1 year of age and pregnant women. To evaluate these programs, PAHO has developed and tested a comprehensive multidisciplinary methodology for this purpose. Since November 1980, 18 countries have conducted comprehensive EPI evaluations. 6 countries also have had followup evaluations to assess the extent to which the recommendations from the 1st evaluation were implemented. At each subregional meeting, participants met in small discussion groups to review each other's work plans and discuss appropriate targets for the next 2 years. Immunization coverage has improved considerably in the Americas over the last several years. Figure 2 plots the incidence rates of polio, tetanus, diphtheria, whooping cough, and measles from 1970-83 in the 20 countries which make up the Latin American subregion. If all countries meet their 1985 targets, immunization coverages for DPT and polio will range from 60-100%, with most countries attaining coverages of over 80%. For measles, 1985 targets range from 50-95%, and from 70-99% for BCG. The main vehicle for dissemination of information is the "EPI Newsletter," which publishes information on program development and epidemiology of the EPI diseases.
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  3. 3
    039579

    Neonatal tetanus mortality: the magnitude of the problem and prospects for its control.

    Hadjian A

    In: Medical education in the field of primary maternal child health care [edited by] M.M. Fayad, M.I. Abdalla, Ibrahim I. Ibrahim, Mohamed A. Bayad. [Cairo, Egypt, Cairo University, Faculty of Medicine, Dept. of Obstetrics and Gynecology, 1984]. 421-34.

    This paper begins by stating that the mortality from neonatal tetanus has been peculiarly underestimated until recently, and discusses why this has been the case. The availability of a methodology for retrospective surveys and undertaking of such surveys in recent years has thrown much light on the subject. The results of these surveys from 15 countries are presented in tabular form. It is apparent that at present between 500,000 and 1 million newborn infants a year succumb to tetanus. The prospects for control, using the combined approach of improved maternity care and maternal immunization, are discussed, and an appropriate schedule of immunization suggested. The prospects for control are good wherever there is realization of the magnitude of the problem plus reasonable access to even quite basic primary health care. Some activities of WHO in this field are briefly described. (author's)
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  4. 4
    268486

    Civil registration and vital statistics in the Africa region: lessons learned from the evaluation of UNFPA-assisted projects in Kenya and Sierra Leone.

    Kannisto V; Makannah TJ; Mehta DC; McWilliam J

    New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Dec. viii, 25 p.

    To review the experience of vital statistics and civil registration in the Africa Region, projects in 2 countries were evaluated in-depth: the Civil Registration Demonstration in Kenya and the Strengthening of the Civil Registration and Vital Statistics System in Sierra Leone. Based on these project evaluations and on experience in the area of data collection and project implementation in other parts of the Africa Region, specific observations/conclusions and recommendations are made in 5 areas. 1) United Nations Fund for Population Activities (UNFPA) support for civil registration is justified if and when it can be expected to produce vital statistics which are not less reliable than estimates derived from censuses and surveys. 2) Regarding project strategy, a gradually expanding registration area is preferable in countries in the Africa Region which have extensive rural areas. 3) A thorough assessment of the registration hierarchy is required when establishing new methods and procedures for civil registration. In deciding upon the topics to be included in the region records, usefulness, collectability and neutrality of the inputs are important criteria. 4) Regarding project inputs, Governments may wish to choose an existing organization which has a large field staff and a bureaucratic hierarchy to undertake civil registration activities. In this way these activites could then be added on as new functions of existing posts. The careful selection of types of equipment and supplies greatly affects the implementation of civil registration activities and external resources are required in many projects for vehicles and paper for registration forms. 5) While the projects evaluated have followed the procedures for monitoring through the submission of Project Progress Reports and the holding of Tripartite Review Meetings, the monitoring system has not served as a triggering mechanism for actions. This is mainly due to the lack of follow-up by the governments, and executing and finding agencies of the monitoring reports, and at times, the absence of key technical and administrative persons at Tripartite Review Meetings. Recommendations made concerning these conclusions are addressed to the governments of the Region to improve their civil registration systems; some are addressed specifically to UNFPA and the United Nations Department of Technical Cooperation for Development to improve their assistance to governments.
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  5. 5
    035345

    A fresh look at the threshold hypothesis of fertility change in ESCAP region

    Pathak KB; Murthy PK

    Demography India. 1984 Jan-Dec; 13(1-2):153-67.

    The threshold hypothesis shares with transition theory the basic assumption that a decline in fertility is interrelated with a decline in mortality and change in the social, economic, and cultural conditions of the population. However, threshold theory fails to formulate a causal chain between fertility and the other variables and its application at the aggregate country level is limited by intracountry heterogeneity in cultural and social variables. Problematic is the fixing of the timing for a country of a decline in fertility to be inferred from the fact that some indicators of development have reached the threshold zone while others have not. This paper attempts to develope a combined index for socioeconomic development on the basis of data from 12 countries of the ESCAP region of South East Asia. Variables included were life expectancy at birth, infant mortality rate, adult female literacy, percentages of females economically active, GNP per capita, and percentage urban population. In 1970, 3 of the countries analyzed had a crude birth rate below 25, 6 countries had a rate between 25-40, and 3 had a rate above 40. The lowest value of the index recorded for countries of low fertility (crude birth rate below 25) and the highest value recorded for countries of high fertility (above 40) are taken as the threshold zones for the overall index. The number of countries in the threshold range increased from 5 in 1970 to 8 in 1975. With the increase in the index value, a reduction in the fertility level was noted. In contrast, where socioeconomic development was slow, fertility showed little change. Policy makers could use this system to assess which indicator could be pushed through to raise the overall index of development so as to effect a decline in fertility.
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  6. 6
    033687

    Demographic trends and their development implications.

    United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]

    In: Third Asian and Pacific Population Conference (Colombo, September 1982). Selected papers. Bangkok, Thailand, Economic and Social Commission for Asia and the Pacific, 1984. 9-40. (Asian Population Studies Series No. 58)

    This report summarizes the recent demographic situation and considers prospective trends and their development implications among the 39 members and associate members of the Economic and Social Commission for Asia and the Pacific (ESCAP). It presents data on the following: size, growth, and distribution of the population; age and sex structure; fertility and marriage; mortality; international migration; growth and poverty; food and nutrition; households and housing; primary health care; education; the working-age population; family planning; the elderly; and population distribution. Despite improvements in the frequency and quality of demographic data collected in recent years, big gaps continue to exist in knowledge of the demographic situation in the ESCAP region. Available evidence suggests that the population growth rate of the ESCAP region declined between 1970 and 1980, as compared with the preceding decade, but that its rate of decline was slow. Within this overall picture, there is wide variation, with the most developed countries having annual growth rates around 1% and some of the least developed countries having a figure near 3%. The main factors associated with the high growth rates are the past high levels of fertility resulting in young age structures and continuing high fertility in some countries, notably in middle south Asia. The population of countries in the ESCAP region is expected to grow from 2.5 billion in 1980, to 2.9 billion in 1990, and to 3.4 billion persons by the year 2000. This massive growth in numbers, which will be most pronounced in Middle South Asia, will occur despite projected continuing moderation in annual population growth rates. Fertility is expected to continue its downward trend, assuming a more widespread and equitable distribution of health, education, and family planning services. Mortality is expected to decline further from its current levels, where life expectancy is often at or around 50 years. In several countries, more than 10 in every 100 babies born die before their 1st birthday. The extension of primary health care services is seen as the key to reducing this figure. Rapid population growth and poverty tend to reinforce each other. Low income, lack of education, and high infant and child mortality contribute to high fertility, which in turn is associated with high rates of natural increase. High rates of natural increase feed back to depress socioeconomic development. High population growth rates and their correlates of young age structures and heavy concentrations of persons in the nonproductive ages tend to depress production and burden government expenditure with high costs for social overhead needs. Rapid population growth emerges as an important factor in the persistence of chronic undernutrition and malnutrition. It increases the magnitude of the task of improving the educational system and exacerbates the problem of substandard housing that is widely prevalent throughout Asia.
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  7. 7
    032627

    The measurement of family planning program effort: who wears the rose-colored glasses?

    Lapham RJ; Mauldin WP

    [Unpublished] 1984. Presented at the Annual Meeting of the American Public Health Association [APHA], Anaheim, California, November 11-15, 1984. 43 p.

    This study analyzes infromation from 3 types of population specialists on how much effort is being applied in family planning programs in developing nations. In short, what and how well are these programs doing? As part of a study of the conditions of fertility decline in 1965-80, new data on family planning program efforts were collected in 1983 and early 1984 from some 425 population specialists around the world. They include 3 types: (1) country officials and senior staff working in public or private family planning programs; (2) staff in donor agencies such as the World Bank, AID, and UNFPA; (3) other observers, including researchers. The study analyzes the extent to which these 3 types differ on total program effort scores, and on 4 broad components of program effort: (a) policies; (b) services and service-related activities; (c) record-keeping and evaluation; (d) availability and accessibility of fertility-control supplies and services. Score differences on selected program items such as training programs and supervision are also examined. The analysis shows that country officials and public program staff believe that services and service-related activities are in better shape than do observers in the other 2 categories. The policy implications of this and other findings are discussed. (author's)
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  8. 8
    030872

    [Reconciling censal and inter-censal data and determination of the population base] Conciliacion censal y determinacion de la poblacion base.

    Rincon MJ

    In: Metodos para proyecciones demograficas [compiled by] United Nations. Centro Latinoamericano de Demografia [CELADE]. San Jose, Costa Rica, Centro Latinoamericano de Demografia, 1984 Nov. 13-42. (Centro Latinoamericano de Demografia [CELADE] Series E, No. 1003)

    This work describes procedures used by the Latin American Demographic Center (CELADE) for establishing a base population for projection in quinquennial age groups by means of evaluation of population censuses and reconciliation of demographic data for 2 or more intercensal periods. Demographic reconciliation refers to the array of procedures through which the degree of coverage of successive censuses is evaluated; age and sex distributions resulting from incomplete coverage, differential omission, and poor age reporting are corrected; the demographic dynamics of intercensal periods are made coherent with estimates of mortality, fertility, and migration from all available sources; and a base population for population projection is established. There are no fixed rules for evaluation and reconciliation of census data, because the history and quality of data collection in each country are unique. The compensatory equation, in which 2 or more population censuses are reconciled in regard to fertility, mortality, and international migration in intermediate years usually in terms of age cohorts, is an indispensable tool for demographers in developing countries. The need to add children born in the years between censuses and the different types of errors typifying different age groups means that the process of census reconciliation should be carried out separately for at least 3 age groups: children under 5, the 5-9 year cohort, and those over 10 years of age. The age group 0-4 is often the most seriously underestimated. Because the age group 5-9 years is often the best enumerated in Latin American population censuses, it can serve as the basis for correction of the population aged 0-4. The data required include the population aged 5-9 in single years in the last census, the deaths in children under 10 by year of birth and age at death in single years, and the annual number of births in the 10 years preceding the last census. Data from Panama illustrate that the results of this technique are not always acceptable, in which case correction of the 0-4 cohort may be accomplished by means of correction of births and deaths using indirect methods. Corrections for the 5-9 cohort, if required, can be made in a similar manner to that for the youngest group. Evaluation and correction of errors of omission and misreporting of age of the population over 10 is the most difficult because data sources are most often inadequate, these age groups have the greatest age and sex differentials and poorest age reporting, and are most likely to be effected by emigration. All available data should be utilized to produce a group of alternative estimates for each cohort based on diverse basic data and assumptions about such variables as the sex ratios for age agroups. The most likely values must then be selected or calculated. The process by which census results from 1950-80 were used to estimate the base population for a projection by components in Panama illustrates the procedure used by CELADE.
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  9. 9
    028322

    The Billings method of family planning: an assessment.

    Betts K

    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.
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  10. 10
    027804

    Country statement: Ethiopia.

    [Unpublished] 1984. Presented at the Second African Population Conference, Arusha, Tanzania, January 9-13, 1984. 21 p.

    This discussion of Ethiopia focuses on: sources of demographic data; population size and age-sex distribution; urbanization; fertility; marital status of the population; mortality and health; rate of natural increase; economic activity and labor force activity rates; food production; education; population policies and programs; and population in development planning. As of 1983, Ethiopia's population was estimated at 33.7 million. Agriculture is the mainstay of the economy. Ethiopia has not yet conducted a population census, however, the 1st population and housing census is planned for 1984. The population is young with children under 15 years of age constituting 45.4% of the total population; 3.5% of the population are aged 65 years and older. The degree of urbanization is very low while the urban growth rate is very high. Most of the country is rural with only 15% of the population living in localities of 2000 or more inhabitants. In 1980-81 the crude birthrate was 46.9/1000. The total fertility rate was 6.9. Of those aged 15 years and older, 69.2% of males and 71.3% of females are married. According to the 1980-81 Demographic Survey the estimates of the levels of mortality were a crude death rate of 18.4/1000 and an infant mortality rate of 144/1000. At this time 45% of the population have access to health services. It is anticipated that 80% of the population will be covered by health care services in 10 years time. Ethiopia is increasing at a very rapid rate of natural increase; the 1980 estimation was 2.9% per annum. Despite the rich endowments in agricultural potential, Ethiopia is not self-sufficient in food production and reamins a net importer of grain. Enrollment at various levels of education is expanding rapidly. There is no official population policy. Financial assistance received from the UN Fund for Population Activities and the UN International Children's Emergency Fund for population programs is shown.
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  11. 11
    026268

    Concise report on the world population situation in 1983: conditions, trends, prospects, policies.

    United Nations. Department of International Economic and Social Affairs. Population Division

    New York, United Nations, 1984. 108 p. (Population Studies, No. 85; ST/ESA/SER.A/85)

    The 3 parts of this report on world, regional, and international developments in the field of population, present a summary of levels, trends, and prospects in mortality, fertility, nuptiality, international migration, population growth, age structure, and urbanization; consider some important issues in the interrelationships between economic, social, and demographic variables, with special emphasis on the problems of food supply and employment; and deal with the policies and perceptions of governments on population matters. The 1st part of the report is based primarily on data compiled by the UN Population Division. The 2nd part is based on information provided by the Food and Agriculture Organization of the UN (FAO) and the International Labor Organization (ILO), as well as that compiled by the Population Division. The final part is based on information in the policy data bank maintained by the Population Division, including responses to the UN Fourth Population Inquiry among Governments. In 1975-80 the expectation of life at birth for the world was estimated at 57.2 years for both sexes combined. The corresponding figure for the developed and developing regions was 71.9 and 54.7 years, respectively. In 1975-80 the birthrate of the world was estimated at 28.9/1000 population and the gross reproduction rate was 1.91. These figures reflect considerable decline from the levels attained 25 years earlier: a crude birthrate of 38/1000 population and a gross reproduction rate of 2.44. World population grew from 2504 million in 1950 to 4453 million in 1983. Of the additional 1949 million people, 1645 million, or 84%, accrued to the less developed countries. The impact of population growth on economic development and social progress is not well understood. The governments of some developing countries still officially welcome a rapid rate of population growth. Many other governments see cause for concern in the need for the large increases in social expenditure, particularly for health and education, that accompany a young and growing population. Planners are concerned that the rapidly growing supply of labor, compounded by a trend toward rapid urbanization, may exceed that which the job market is likely to absorb. In the developed regions the prospect of a declining, or an aging, population is also cause for apprehension. There is a dearth of knowledge as to the impact of policies for altering the consequences of these trends. Many policies have been tried, in both developed and developing countries, to influence population growth and distribution, but the consequences of such policies have been difficult to assess. Frequently this problem arises because their primary objectives are not demographic in character.
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