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  1. 1
    069430

    Evaluation of the Expanded Program on Immunization (EPI) of Belize, 26 March to 13 April 1984.

    Belize. Ministry of Health; Pan American Health Organization [PAHO]

    Belize City, Belize, Ministry of Health, 1984. [3], 54 p. (EPI/84/003)

    An evaluation of the Expanded Program on Immunization (EPI) in Belize was conducted by the Pan American Health Organization/World Health Organization at the request of the country's Ministry of Health. The evaluation was undertaken to identify obstacles to program implementation, and subsequently provide national managers and decision makers with viable potential solutions. General background information is provided on Belize, with specific mention made of demographic, ethnic, and linguistic characteristics, the health system, and the EPI program in the country. EPI evaluation methodology and vaccination coverage are presented, followed by detailed examination of study findings and recommendations. Achievements, problems, and recommendations are listed for the areas of planning and organizations, management and administration, training, supervision, resources, logistics and the cold chain, delivery strategies, the information and surveillance system, and promotion and community participation. A 23-page chronogram of recommended activities follows, with the report concluding in acknowledgements and annexes.
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  2. 2
    049191

    Report of the European Region on Immunization Activities. (Global Advisory Group EPI, Alexandria, October 1984). WHO/Expanded Immunization Programme and the European Immunization Targets in the Framework of HFA 2000.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]. European Region on Immunization Activities

    [Unpublished] 1984. Presented at the EPI Global Advisory Group Meeting, Alexandria, Egypt, 21-25 October 1984. 3 p. (EPI/GAG/84/WP.4)

    Current reported levels of morbidity and mortality from measles, poliomyelitis, diphtheria, tetanus, and tuberculosis in most countries in the European Region are at or near record low levels. However, several factors threaten successful achievement of the Expanded Program on Immunization (EPI) goal of making immunization services available to all the world's children by the year 2000, including changes in public attitudes as diseases pose less of a visible threat, declining acceptance rates for certain immunizations, variations in vaccines included in the EPI, and incomplete information on the incidence of diseases preventable by immunization and on vaccination coverage rates. To launch a more coordinated approach to the EPI goals, a 2nd Conference on Immunization Policies in Europe is scheduled to be held in Czechoslovakia. Its objectives are: 1) to review and analyze the current situation, including achievements and gaps, in immunization programs in individual countries and the European Region as a whole; 2) to determine the necessary actions to eliminate indigenous measles, poliomyelitis, neonatal tetanus, congenital rubella, and diphtheria; 3) to consider appropriate policies regarding the control by immunization of other diseases of public health importance; 4) to strengthen existing or establish additional systems for effective monitoring and surveillance; 5) to formulate actions necessary to improve national vaccine programs in order to achieve national and regional targets; 6) to reinforce the commitment of Member Countries to the goals and activities of the EPI; and 7) to define appropriate activities for the Regional Office for Europe of the World Health Organization to achieve coordinated action.
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  3. 3
    034367

    Alcohol related problems and their prevention with particular reference to adolescence. Report of the Task Force meeting Geneva, 31 August - 4 September 1984.

    World Health Organization [WHO]. Division of Mental Health

    [Unpublished] 1984. 46 p. (MNH/NAT/84.1.)

    Cultural, socioeconomic, and biological factors all influence alcohol use by adolescents and their experience of alcohol-related problems. Although the assessment of these problems presents methodological difficulties, strategies for prevention based on educational and legislative approaches both promise some measure of success. Further research is required to establish adequate data bases and to test the effectiveness of interventions. A number of specific research proposals were developed. These included epidemiological studies, with particular emphasis on longitudinal surveys, biomedical investigations and comparative evaluations of preventive interventions. In view of the increasing concern about alcohol-related problems in many developing countries, it was recommended that priority be given to the development of approaches applicable in such settings. It was also recommended that research projects should be facilitated which rely upon a strong multicentric approach. (author's)
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  4. 4
    273073

    Report of the third meeting of the Scientific Working Group on Bacterial Enteric Infections: Microbiology, Epidemiology, Immunology, and Vaccine Development.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Unpublished] 1984. 17 p. (WHO/CDD/BEI/84.5)

    The scientific topic discussed in detail by the Scientific Working Group (SWG) was recent research advances in the field of cholera. The SWG reviewed new knowlenge in areas such as epidemiology and ecology, phage-typing, pathogenesis, immunization, and related pathogens, and made recommendations for future research. The Diarrhoeal Disease Control Pragramme was continuing to emphasize the implementation of oral rehydration therapy as a means of reducing diarrheal mortality, and research aimed at an improved case-management strategy. The Steering Committee granted support to a number of projects aimed at clarifying the epidemiology of diarrhea and the pathogenesis of bacterial agents of acute diarrhea. Support was provided by the Steering Committee to projects aimed at, or closely related to the development of new vaccines against typhoid fever, cholera, and Shigella dysentery.
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  5. 5
    031138

    WHO Programme in Maternal and Child Health and Family Planning. Report of the second meeting of the WHO Programme Advisory Committee in Maternal and Child Health, Geneva, 21-25 November 1983.

    World Health Organization [WHO]. Division of Family Health. Maternal and Child Health Unit

    [Unpublished] 1984. 95 p. (MCH/84.5)

    The objectives of the 2nd meeting of the Program Advisory Committee (PAC) for the World Health Organization's (WHO's) Program in Maternal and Child Health, including Family Planning (MCH/FP) were to 1) assess the MCH/FP program's achievements since the 1st PAC meeting in June, 1982, 2) determine the level of scientific and financial resources available for the program, and 3) to examine the role of traditional birth attendants (TBAs) in the delivery of MCH/FP services. The committee reviewed the activities and targets of the program's 4 major areas (pregnancy and perinatal care, child health, growth, and development, adolescent health, and family planning and infertility), and developed a series of recommendations for each of these areas. Specific recommendations were also made for each of the major program areas in reference to the analysis and dessimination of information and to the development and use of appropriate health technologies. Upon reviewing the role of TBAs in the delivery of MCH/FP services, PAC recommended that all barriers to TBA utilization be removed and that training for TBAs should be improved and expanded. PAC's examination of financial support for MCH/FP activities revealed that for a sample of 26 countries, the average annual amount allocated to MCH activities was less than US$3/child or woman. This low level of funding must be taken into account when setting program targets. International funding agencies did indicate their willingness to increase funding levels for MCH programs. The appendices included 1) a list of participants, 2) an annotated agenda, 3) detailed information on the proposed activities of the program's headquarters for 1986-87, and 4) a description of the the function, organizational structure, and technical management of the MCH/FP program. Also included in the appendices was an overview of the current status of MCH and a series of tables providing information on infant, child, and maternal health indicators. Specifically, the tables provided information by region and by country on maternal, child, and infant mortality; causes of child deaths; maternal health care coverage; contraceptive prevalence; infant and child malnutrition; the number of low weight births; adolescent health; teenage births; breast feeding prevalence and duration; and the proportion of women and children in the population.
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  6. 6
    028826

    News from WHO's Diarrhoeal Diseases Control Programme.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases. Technical Advisory Group

    Who Chronicle. 1984; 38(5):212-6.

    This article highlights the conclusions and recommendations of the 5th meeting of the Technical Advisory Group of the World Health Organization (WHO) Diarrheal Diseases Control (CDD) Program held in March 1984. On the basis of clinical trials supported by the CDD Program, WHO has endorsed use of oral rehydration salts (ORS) containing trisodium citrate dihydrate in place of sodium bicarbonate. Although the bicarbonate formulation remains highly effective and may continue to be used, the citrate formula results in less stool output and is more stable under tropical climatic conditions. At its meeting, the Technical Advisory Group expressed satisfaction with progress in the health services and research components of the program's activities. By 1983, 72 countries or areas had formulated plans of operation for national CDD programs and 52 had actually implemented programs. Training courses directed at program managers, first-line supervisors, and middle-level health workers are held on a regular basis. 38 developing countries are now producing ORS. Another area of activity has involved development of a management information system to monitor progress toward the target of increased access to and use of oral rehydration therapy for diarrhea in children under 1 year of age. Data from 40 countries indicate that access to ORS was 6-10% in 1982 and usage was 1-4%. There have been reviews of 10 national CDD programs, 7 of which utilized a joint national-external team to collect and analyze information on the management and impact of the CDD program. During 1983, 71 new research projects were funded by the CDD program, bringing the total number of projects supported to 231 (59% in developing countries). Biomedical research has focused on development of more stable and effective ORS; the etiology and epidemiology of acute diarrhea: and development and evaluation of new diagnostic tests, vaccines, and antidiarrheal drugs. In 1982-83, the CDD program received US$1.4 million from WHO and about US$11 million from voluntary contributors. The 1984-85 budget has been set at US$19.7 million.
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  7. 7
    028741
    Peer Reviewed

    Effects of hormonal contraceptives on milk volume and infant growth.

    World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on Oral Contraceptives

    Contraception. 1984 Dec; 30(6):505-22.

    The World Health Organization (WHO) conducted a randomized comparative trail of th effects of hormonal contrception on milk volume and infant growth. The 341 study participants, drawn from 3 obstetric centers in Hungary and Thailand, were 20-35 years of age with 2-4 live births and previous successful experience with breastfeeding. Subjects who chose oral contraception (OC) were randomly allocated to a combined preparation containing 150 mcg levonorgestrel and 30 mcg ethinyl estradiol (N=86) or to a progestin-only minipill containing 75 mcg dl-norgestrel (N=8). 59 Thai women receiving 150 mg depot medroxyprogesterone (DPMA) intramuscularly every 3 months were also studied. An additional 111 women who were using nonhormonal methods of contraception or no contraception served as controls. Milk volume was determined by breast pump expression. No significant differences in average milk volume were noted between treatment groups at the 6 week baseline visit. However, between the 6th and 24th weeks, average milk volume in the combined OC group declined by 41.9%, which was significantly greater than the declines of 12.0% noted in the progestin-only group, 6.1% among DMPA users, and 16.7% among controls. The lower expressed milk volume among combined OC users did not impair infant growth. No significant differences were observed between treatment groups in terms of average infant body weight or rate or weight gain. Users of combined OCs may have compensated for their decreased milk volume by providing more extensive supplementary feeding or more prolonged suckling episodes. These results suggest that the estrogen content of combined OCs adversely affects the capacity of the breast to produce milk; thus, family planning programs should make nonestrogen-containing methods available to breastfeeding mothers. Although no effects on infant growth were noted in this study, the possibility of such efects cannot be excluded in populations where infant growth largely depends on the adequacy of unsupplemente d lactation.
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  8. 8
    273053

    List of research projects funded since 1980, by Scientific Working Group and broad priority area.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Unpublished] 1984. 51 p.

    This listing of research projects funded since 1980 by WHO's Diarrhoeal Diseases Control Programme, is arranged by project title, investigator and annual budget allocations. Project titles are listed by Scientific Working Grouping (SWG) and include research on bacterial enteric infections; parasitic diarrheas; viral diarrheas; drug development and management of acute diarrheas; global and regional groups and research strengthening activities. SWG projects are furthermore divided by geographical region: African, American, Eastern Medierranean, European, Southeast Asian and Western Pacific. The priority area for research within each SWG is specified.
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  9. 9
    027022

    Oral rehydration salts (ORS) formulation containing trisodium citrate.

    World Health Organization [WHO]. Diarrhoeal Diseases Control Programme; UNICEF

    [Geneva, Switzerland], WHO, [1984]. 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.
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  10. 10
    039223

    Report of the fifth meeting of the technical advisory group (Geneva, 12-16 March 1984).

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Unpublished] 1984. 27 p.

    The current status of the Control of Diarrhoeal Diseases (CDD) Program was reviewed, and activities related to the evaluation of country control programs, the assessment of potential diarrheal disease control interventions, and the program's operational research activities were examined. In the health services component, ciontinued efforts to promote the preparation of plans of operation for national CDD programs is recommended, as is continued use of the national CDD program managers training course. Concern was expressed that the level of use of oral rehydration therapy (ORT) appeared to be modest. Case management was endorsed as the major program strategy. The series of studies on interventions for reducing diarrhea's mortality and morbidity were welcomed. For evaluation purposes, it is recommended that the program develop additional criteria for monitoring increased access to and usage of oral rehydration salts (ORS) and the reduction of diarrheal mortality. Continued accumulaton and publication of information yielded by the program's survey of the impact of ORT in hospitals was recommended. In the research component, the growth of research activities is satisfying. While biomedical aspects have developed well, it might be necessary to relate them gradually to specific control interventions in the future. Further studies of improved ORS formulatons were recommended. High priority should also be given to the promotion of breast feeding, immunization, and water supply and sanitation. The underlying mechanisms that cause the intervention to reduce diarrheal morbidity or mortality should be clarified. Research is recommended on the promotion of personal and domestic hygiene, food hygiene, and improved weaning practices. Emphasis on the development and evaluation of vaccines against the causes of diarrhea is supported. Some changes in the balance of research activities should be made. Epidemiological weak.
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  11. 11
    041443

    Interim programme report, 1983.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    Geneva, Switzerland, WHO, [1984] 27 p.

    This is the 1st interim report issued by the Diarrhoeal Diseases Control (CDD) Programme, summarizing progress in its main areas of activity during the previous calendar year. Most of the information is presented in the form of tables, graphs and lists. Other important developments are mentioned briefly in each section. The information is presented according to major program areas; health services; research; and program management. Within the health services component, national program planning, training, the production of Oral Rehydration Salts (ORS), health education and promotion are areas of priority activity. Progress in the rate of development of national programs, participants in the various levelsof training programs, and the countries producing their own ORS packets and developing promotional and educational materials are presented. An evaluation of the health services component, based on a questionnaire survey to determine the impact of Oral Rehydration Therapy (ORT), indicates significant decreases in diarrheal admission rates and in overall diarrheal case-fatality rates. Data collected from a total of 45 morbidity and and mortality surveys are shown. Biomedical and operational research projects supported by the program are given. Thhe research areas in which there was the greatest % increase in the number of projects funded were parasite-related diarrheas, drug development and management of diarrheal disease. Research is also in progress on community attitudes and practices in relation to diarrheal disease and on the development of local educational materials. The program's organizational structure is briefly described and its financial status summarized. The report ends with a list of new publications and documents concerning health services, research and management of diarrheal diseases.
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  12. 12
    028006

    The role of food safety in health and development. Report of a Joint FAO-WHO Expert Committee on Food Safety.

    Joint Food and Agriculture Organization-World Health Organization Expert Committee on Food Safety

    World Health Organization Technical Report Series. 1984; (705):1-79.

    This document presents the recommendations of a Joint Food and Agriculture Organization (FAO)-World Health Organization (WHO) Expert Committe on Food Safety. Illness due to contaminated food is perhaps the most widespread health problem in the world and a major cause of reduced economic productivity. The safety of food is affected by food systems, sociocultural factors, food chain technology, ecologic factors, nturitional aspects, and epidemiology. It was the assumption of the Committee that, if food safety is given sufficient priority within national planning, countries can prevent and control foodborne disease, especially pathogen-induced diarrheal syndromes, and interrupt the vicious cycle of diarrhea-malnutrition-disease. Attainment of this objective requires a national commitment and the collaboration of all ministries and agencies concerned with health, agriculture, finance, planning, and commerce as well as the food industry, the biamedical and agricultural scientific community, and the consuming public. Prevention and control interventions should aim to avoid or minimize contamination, to destroy or denature the contaminant, and to prevent the further spread or multiplication of the contaminant. The Committee outlined a series of recommendations for achieving a worldwide reduction in the morbidity and mortality caused by foodborne hazards. Food safety should be considered an integral part of the primary health care delivery system. Food safety should also be regarded as an integral part of the total food system. National food control infrastructures should be strengthened, and regional, national, multinational, and international surveillance of foodborne diseases should be carried out. Each country should aim to develop at least 1 laboratory capable of identifying the etiologic agents of diarrhea and other foodborne diseases. Health workers should be trained to play a role in identifying and monitoring critical control points in food production and preparation. Health education, within the context of the cultural and social values of the community, should inform the public about food safety hazards and preventive measures. Finally, the hazard analysis critical control point approach to prevention is recommended.
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  13. 13
    026751

    World malaria situation, 1982. Situation du paludisme dans le monde, 1982.

    World Health Organization [WHO]. Malaria Action Programme

    World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1984; 37(2):130-61.

    This paper sets forth the number of malaria cases reported in 1973-82 to the World Health Organization (WHO) by region. Excluding Africa, the total number of cases rose from 3.9 million in 1973 to a high of 10.7 million in 1977 and declined to 6.5 million in 1982. It is noted, however, that reporting during this period was often deficient and uneven. The prevalence of malaria has remained relatively unchanged in Africa south of the Sahara, with the exception of urban centers where transmission has been considerably reduced. In the Americas, the number of cases reported has risen steadily since 1973. South East Asia experienced a dramatic increase in malaria cases in 1976, but intensive efforts haveresulted in a decline almost back to the 1973 level. About 28% of the world's population lives in areas where malaria never existed or disappered without specific antimalaria efforts. Another 18% lines in areas where the disease has been eliminated by improvements in health facilities, environmental changes, and specific antimalaria measures. 46%, or 2117 million people, live areas where the incidence of malaria has been reduced to varying degrees, ranging from a slight reduction of the original endemicity to the near elimination of the disease. A final 8%, or 365 million people, live in areas where no specific antimalaria measures are undertaken and the original levels of endemicity remain largely unchanged outside of certain urban centers. In addition to presenting data on malaria cases by world region, tables accompanying this article summarize malaria eradication registration, the importation of malaria cases into malaria-free countries, and the development of resistance to chloroquine.
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  14. 14
    049219

    Yellow fever vaccination in the Americas.

    BULLETIN OF THE PAN AMERICAN HEALTH ORGANIZATION. 1984; 18(2):188-92.

    Outbreaks of yellow fever in recent years in the Americas have prompted concern about the possible urbanization of jungle fever. Vaccination, using the 17D strain of yellow fever virus, provides an effective, practical method of large scale protection against the disease. Because yellow fever can reappear in certain areas after a 2-year dormancy period, some countries maintain routine vaccination programs in areas where jungle yellow fever is endemic. The size of the endemic area (approximately half of South America), transportation and communication difficulties, and the inability to ensure a reliable cold chain are problems facing these programs. In addition, the problem of reaching dispersed and isolated populations has been addressed by the use of mobile teams, radio monitoring, and educational methods. During yellow fever outbreaks, many countries institute massive vaccination campaigns, targeted at temporary workers and migrants. Because epidemics in South America may involve extensive areas, these campaigns may not effectively address the problem. The ped-o-jet injector method, used in Brazil and Colombia, should be used in outbreak situations, as it is effective for large-scale vaccination. Vaccine by needle, suggested for maintenance programs, should be administered to those above 1 year of age. An efficient monitoring method to avoid revaccination, and to assess immunity, should be developed. The 17D strain produces seroconversion in 95% of recipients, and most is prepared in Brazil and Colombia. But, problems with storage methods, instability in seed lots, and difficulties in large-scale production were identified in 1981 by the Pan American Health Organization and WHO. The group recommended modernization of current production techniques and further research to develop a vaccine that could be produced in cell cultures. Brazil and Colombia have acted on these recommendations, modernizing vaccine production and researching thermostabilizing media for yellow fever vaccine.
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  15. 15
    046689

    A perspective on controlling vaccine-preventable diseases among children in Liberia.

    Weeks RM

    INFECTION CONTROL. 1984 Nov; 5(11):538-41.

    In 1978 the Ministry of Health and Social Welfare (MHSW) of Liberia launched the Expanded Program on Immunization (EPI) with the 5-year objective of establishing an 80% reduction in child mortality and morbidity from measles, polio, diphtheria, neonatal tetanus, pertussis, and tuberculosis. The program at first adopted a strategy of using 15 mobile units in 11 operational zones to deliver vaccinations throughout the country. However, by 1980, despite support from the Baptist World Alliance, the UN International Children's Emergency Fund (UNICEF), and the World Health Organization (WHO), it became evident that the mobile strategy was neither economically feasible nor practical. Therefore, with support from the US Agency for International Development (USAID), the EPI shifted to a strategy of integrating immunization activities into the existing network of state health facilities. After 5 years, in 1982, the Program was evaluated by a team from the MHSW, WHO, USAID, and the Centers for Disease Control. The evaluating team felt that the EPI's strategy was good, but its goals were not being achieved due to deficiencies in funding, clinic supervision, and rural community outreach, as well as shortages of kerosene and spare parts needs to keep the essential refrigerators in operating condition. Measles remains endemic; in the capital, Monrovia, only 9% of the children have been vaccinated against it. Immunization coverage is particularly low in the capital the countries. Other reasons for low vaccination coverage in Liberia are lack of community awareness of existing facilities and the importance of vaccination and lack of coordination at the community level to use the existing facilities efficiently. International assistance is still needed, especially to develop heat-stable vaccines, so that maintenance of refrigerators will not be necessary.
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  16. 16
    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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  17. 17
    041357

    The cold chain status: June 1984.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1984. 13 p. (EPI/CCIS/84.3)

    This document summarizes the work performed during 1983 and the 1st half of 1984 to improve the vaccine cold chain for the Expanded Program on Immunization (EPI). It provides a broad outline of the work being carried out by the World Health Organization (WHO) and summarizes major equipment developments. The state of the cold chain is described under 3 headings: cold chain management, training, and equipment. In recent years, the EPI has focused much effort on strengthening the weakest spots in the cold chain. The section of the report devoted to cold chain management describes progress in the development of management aids, such as indicators to monitor the cold chain, and an equipment maintenance and spare parts project. Additionally, it summarizes the current situation with the cold chain support services and projects in the countries and draws attention to the results of recent cold chain studies. There are 5 types of chemical indicators in use in the cold chain, and in 1983 a document was issued giving an update on the current status of field trials and feedback on routine use. These indicators are outlined. Cold chain training has been provided on a continuing basis to health workers and technicians. Over the past 5 years several audiovisual aids for cold chain training have been prepared: 3 films, 7 posters, 2 slide sets, and 3 stickers. 3 courses of cold chain training are being used at this time: a revised version of "Manage the Cold Chain" from the mid-level managers course; logistics and cold chain course for primary health care; and refrigerator repair technicians course. Development of equipment for the cold chain has fallen into 3 main areas: finding and testing existing equipment, modifying existing equipment so that it will work better in tropical conditions, and developing new equipment for the cold chain that cannot be found on the open market.
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  18. 18
    040872

    Expanded Programme of Immunization Eastern Mediterranean Region. A report for the EPI Global Advisory Group Meeting, Alexandria, 21-25 October 1984.

    Sulieman O

    [Unpublished] 1984. 10, [8] p. (EPI/GAG/84/WP.7.a)

    The strategy adopted by the Members States of the Eastern Mediterranean Region (EMR) to achieve the objective of the promotion of the Expanded Program of Immunization (EPI) through primary health care (PHC) concentrates on strengthening synergistic integration of EPI with other services. Activities have been planned and implemented or are being implemented at the Regional Office and at the country level. 21 countries of the Region now have either a full-time or part-time manager or an EPI focal point. This is a considerable development, for in 1982 there were EPI managers in 9 countries. Except for 3 countries, all national EPI managers/focal points have received senior level training in EPI. At delivery points, vaccination is performed to a large extent by multipurpose health workers, but full-time vaccinators are available in about 6 countries. All field workers have received training at their respective regional levels. Limited financial resources continue to be 1 of the primary constraints of the program in the Region. Plans to resolve this problem include: counteracting wastage factors; close collaboration with the UN International Children's Emergency Fund (UNICEF) and other international agencies at the country level to standardize approaches and avoid overlap; tapping regional and international voluntary agencies to increase their contributions; and increased use of associate experts, UN volunteers, and national technical staff. The overall information system is to some extent weak and suffers from irregularity and a lack of continuity. Regular reports are received from 9 countries which have World Health Organization staff. Repeated requests from other countries yield incomplete and at times contradicting data. Research efforts are directed towards operational areas, and research in strategies, integration, community, and surveillance areas is being encouraged.
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  19. 19
    046113

    Subregional Workshop on Planning, Formulating and Evaluating of MCH-FP/PHC Projects, Nairobi, 15-19 October 1984. Final report.

    World Health Organization [WHO]. Regional Office for Africa

    Brazzaville, Congo, WHO, Regional Office for Africa, 1984. 27 p. (AFR/MCH/81)

    The objective of the Subregional Workshop on Planning, Formulating and Evaluating Maternal and Child Health-Family Planning/Primary Health Care (MCH-FP/PHC) Projects, held in Nairobi, Kenya, during October 1984, was to train national personnel so that they would be prepared to formulate, implement, monitor, and evaluate MCH-FP/PHC projects in the context of primary health care. These proceedings cover the 5 workshop sessions: mandates, roles and activities of the UN Fund for Population Activities (UNFPA) and the World Health Organization (WHO); planning and program development of both the UNFPA and WHO; project formulation and appraisal; practical information and procedures important for both the formulation and implementation of MCH/FP projects by the executing agency; and a project appraisal exercise. Also included is a project formulation exercise and a project monitoring and evaluation exercise. An evaluation of the workshop by participants also is included. Appendixes contain a list of participants, the opening address, the program of work, and reference documents.
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  20. 20
    041366

    [New cold chain monitor to be introduced on 1 January 1985] Introduction d'une nouvelle fiche de controle de la chaine du froid le 1er Janvier 1985.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1984. [2] p. (EPI/CCIS/84.6)

    As of January 1, 1985, a new and simpler vaccine cold chain monitor will be distributed with vaccines supplied by the UN International Children's Emergency Fund (UNICEF) and the World Health Organization (WHO). This new monitor (available in Arabic, English, French, and Portuguese) has the same function as the previous monitor, but it has 3 new features. These are: temperatures above 10 degrees Centigrade are monitored by a strip indicator that has only 3 windows, marked A, B, and C, and temperatures above 34 degrees Centigrade are monitored by a disk indicator; a simplified interpretation guide has been added to the bottom of the card; and the back of the card has some instructions on the use of the indicator. As previously, the new cold chain monitor will be activated by the vaccine manufacturer and sent with the vaccine to the central store. The storekeeper should complete the top part of the card. The monitor then is sent with the vaccine down the cold chain. The top part of the card should be completed at each level of the cold chain -- when the vaccine arrives in the store and again when the vaccine is dispatched. In the cold chain, the vaccine cold chain monitor has 2 functions: to monitor any temperatures above 10 degrees Centigrade so that the cold chain can be improved; and to give the person responsible for caring for the vaccine some guidance on whether to use the vaccine or not.
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  21. 21
    041360

    Status of cold box testing and buyers' guide: update, December 1984.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1984. 24 p. (EPI/CCIS/84.4)

    Since 1979, vaccine hand carriers, cold boxes, and vaccine packaging have been submitted by the World Health Organization (WHO) for laboratory testing at the Consumers Association Laboratories, Harpenden Rise, UK, and UNIVALLE, Cali, Colombia. The tests results have been summarized in this document in order to inform users and buyers of the equipment available as to its performance capacities and to serve as a guide to the selection of equipment most suited to specific conditions. Detailed tables list all equipment which has been tested. The equipment is divided into categories on the basis of vaccine storage capacity, and the following major features are listed: external dimensions (in centimeters); vaccine in storage capacity (in litres); number of icepacks necessary (as used during the tests); cold life at an ambient temperature of +43 degrees Centigrade; weight fully loaded (in kilograms); and durability (under rough handling conditions). Equipment has been subjected to 2 main types of routine test: performance or temperatur rise test; and durability or drop test. In the course of testing, a number of interesting observations were made, including: using more icepacks than specified will lengthen the cold life of a container without harming the vaccine but also will increase weight load and decrease the vaccine storage capacity; icepacks are more quickly frozen in "icepack freezers" as opposed to chest type domestic freezers; some boxes had problems with lid fastenings, which came undone on impact; and 5 factors should be taken into consideration in the purchase of any box, that is, vaccine storage capacity, cold life, weight fully loaded, durability, and price.
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  22. 22
    029874

    [Main objectives of the WHO Special Program on Human Reproduction] Osnovnye napravleniia Spetsialnoi Programmy VOZ po Reproduktsii Cheloveka.

    Vikhliaeva EM; Eristavi GV; Kurbatov MB

    AKUSHERSTVO I GINEKOLOGIIA. 1984 Jul; (7):3-6.

    The WHO Special Program on Human reproduction was established in 1972 to coordinate international research on birth control, family planning, development of effective methods of contraception, and treatments for disorders of the human reproductive system. The Program's main objectives are: implementation of family planning programs at primary health care facilities, evaluation of the safety and effectiveness of existing birth control methods, development of new birth control methods, and development of new methods of sterility treatment. In order to attain these goals, the Program forth 3 major tasks for international research: 1) psychosociological aspects of family planning, 2) birth control methods, and 3) studies on sterility. Since most of the participating nations belong to the 3rd World, the Program is focused on human reproduction in developing countries. The USSR plays an important role in the WHO Special Program on Human reproduction. A WHO Paticipating Center has been established at the All-Union Center for Maternal and Child Care in Moscow. Soviet research concentrates on 3 major areas: diagnosis and treatment of female sterility, endocrinological aspects of contraception, and birth control prostaglandins.
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  23. 23
    039060

    [Expanded Programme on Immunization: Global Advisory Group] Programme Elargi de Vaccination: Groupe consultatif mondial.

    World Health Organization [WHO]

    Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1984 Mar 23; 59(12):85-9.

    In addition to the conclusions and recommendations reached at the 6th meeting of the Expanded Program on Immunization (EPI) Global Advisory Group and summarized in this report, the Group reviewed at length the status of the program in the Western Pacific Region and made a series of recommendations specifically directed to activities in the Region. Of particular significance for the operational progress of the global program are the recommendations concerning "Administration of EPI Vaccines," which were subsequently endorsed by the Precongress workshop on Immunization held before the XVIIth International Congress of Pediatrics in Manila in November 1983. These recommendations are not listed here. In his report to the World Health Assembly in 1982, the Director-General summarized the major problems which threaten the success of efforts to achieve the World Health Organization (WHO) goal of reducing morbidity and mortality by providing immunization for all children of the world by 1990. The 5-Point Action Program adopted at that time remains a relevant guide for countries and for WHO as they work to resolve those problems. The EPI is concerned about the prevention of the target diseases, not merely with the administration of vaccine. In addition to working toward increases in immunization coverage, the EPI must assure the strenghtening of surveillance systems so that the magnitude of the health problem represented by the target diseases is known at the community, district, regional, and national levels; immunization strategies are continuously adapted in order to reach groups at highest risk; and the target diseases are reduced to a minimum. The development of surveillance systems is one of the priorities in the development of effective primary health care services. Disease surveillance in its various forms should be used at all management levels for monitoring immunization programs performance and for measuring program impact. Specific recommendations regarding disease surveillance to be undertaken at global and regional levels and at the national level are listed. The results of more than 100 lameness surveys conducted in 25 developing countries confirm that paralytic poliomyelitis constitutes an important public health problem in any area in which the disease is endemic. In most programs, initial emphasis should be placed on the develpment of sentinel surveillance sites to monitor disease incidence trends. Some progress has been made in acting on the recommendations made at the meeting on the prevention of neonatal tetanus held in Lahore in 1982, but intensification of activities is required. In many developing countries, the surveillance and control of diphtheria must be improved. All aspects of progress and problems in the global program are reflected at least somewhere in the Western Pacific Region, and most of the findings and recommendations generally are valid beyond the regional boundaries.
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  24. 24
    039860

    Yellow fever outbreak in Ghana and Upper Volta: news from Africa.

    WHO CHRONICLE. 1984; 38(38):34-5.

    Early in November 1983, WHO, UNICEF, and other agencies dispatched yellow fever vaccine, cold chain equipment, and motorcycles, fuel, and camping materials for mobile vaccination teams to help the governments of Ghana and Upper Volta (Burkina Faso) fight an outbreak of yellow fever. By December 1, 1983, the outbreak had claimed over 450 lives in the 2 countries combined. The 1st report of yellow fever cases in Ghana was received in mid-October. Retrospective inquires suggest that the outbreak actually began in July 1983. In Upper Volta, the first clinically suspect cases were reported to the authorities on October 4, 1983. Retrospective inquires suggest that the earliest cases occurred on September 18, 1983. In Upper Volta, a high level national committee was formed to coordinate activities against yellow fever. Immunization was carried out in the affected localities and, on a large scale in Ouagadougou. Health controls were established at the borders with Niger, Togo, and Ghana. Vaccination was carried out in Ghana and Togo. Ground spraying against domestic mosquitos in Ouagadougou began on November 11. In all, over 1 million people were immunized over a 3-week period with vaccine supplied by WHO, UNICEF, and other agencies. By early December a WHO team was in West Africa visiting the countries at risk from the epidemic evaluating the epidemiological situation and the measures already taken, proposing additional measures if necessary, reviewing yellow fever surveillance, and evaluating entomological activities.
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  25. 25
    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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