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  1. 1

    Technical bases for the WHO recommendations on the management of pneumonia in children at first-level health facilities.

    World Health Organization [WHO]. Programme for the Control of Acute Respiratory Infections

    Geneva, Switzerland, WHO, Programme for the Control of Acute Respiratory Infections, 1991. [26] p. (WHO/ARI/91.20)

    About 13 million children under 5 years of age die every year in the world, 95% of them in developing countries. Pneumonia is one of the leading causes, accounting for about 4 million of these deaths. Despite this fact, for a combination of technical and operational reasons, pneumonia has been a neglected problem until very recently. Clinicians and epidemiologists thought that the control of respiratory infections did not deserve high priority because of the difficulties involved in preventing and managing these infections; it was said that antibiotics might not be an effective treatment against pneumonia because patients are often weakened by conditions such as chronic malnutrition and parasitic infections, and that a wide variety of viruses and bacteria are associated with pulmonary infections making it impossible to identify the specific etiological agent in each patient (1.) On the other hand, some public health experts felt that a programme aimed at preventing mortality from pneumonia could not succeed because it would be difficult to deliver the available technology (antibiotics) through peripheral health units and community-based health workers. At most, one quarter of the pneumonia cases in children can be prevented by the measles and pertussis vaccines included in the immunization schedule of the Expanded Programme on Immunization. There is a clear need for research to develop and test vaccines against the most frequent agents of pneumonia in children. Such research has been pursued by WHO, notably within the Programe for the Control of Acute Respiratory Infections (ARI) and the Vaccine Development Programme; however, WHO has simultaneously been utilizing current clinical knowledge to formulate a case management strategy to reduce the high mortality from pneumonia in children. The present document is not intended to provide detailed case management guidelines. These are to be found in the manual "Acute respiratory infections in children: Case management in small hospitals in developing countries. A manual for doctors and other senior health workers", document WHO/ARI/90.5 (1990). (excerpt)
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  2. 2

    Environmental health in urban development. Report of a WHO Expert Committee.

    World Health Organization [WHO]. Expert Committee on Environmental Health in Urban Development

    Geneva, Switzerland, WHO, 1991. vi, 65 p. (WHO Technical Report Series 807)

    This report by WHO's Expert Committee on Environmental Health in Urban Development explains that social and physical factors, including the destruction of the natural environment, place the health of urban dwellers at risk. The report discusses the urbanization phenomenon and its consequences, the problems and needs in environmental health, and provides recommendations. From 1950-80, the world's urban population nearly tripled, with most of the growth occurring in developing countries, where urban population quadrupled. Experts predict that many urban centers in developing countries will have an annual growth rate of more than 3% over the next 40 years. While developed countries have seen declines in the level of population growth, the health risks to its urban inhabitants have nonetheless increased. Technological changes, increased energy consumption, and increased levels of waste have placed great stress on the environment and have increased the health risks. But developing countries have seen even more problems associated with urban living. Rapid urbanization levels have led to overcrowding, congestion, and the destruction of previously unsettled ecosystems. Pollution levels have increased. Due to the lack of sanitation services, the threat of communicable diseases has increased. Social problem such as crime and violence also affect the well-being of urban dwellers. The group at greatest risk includes poor women and children. The report explains that tackling the health problems associated with urbanization will require a major conceptual change, considering that current efforts are ineffectual. Some of the recommendations include: strengthening the management of urban development; strengthening the management and technology for environmental health; and strengthening community action.
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  3. 3

    The situation analysis of mothers and children in Turkey.

    UNICEF; Turkey. Ministry of Health

    Ankara, Turkey, UNICEF, 1991 Apr. xxxv, 405 p. (Country Programme, 1991-1995 Series No. 2)

    This report is the synthesis and analysis of data from the interventions for the improvement of the health situation of mothers and children in Turkey. It also identifies areas where mother and child related problems are concentrated. The document is organized into six parts. Part I discusses the state of children and the development connection. Part II presents the country profile of Turkey. Part III is the core of the document and discusses relevant issues on maternal and child health and presents the analysis of the different sectors that affect children. Part III also establishes the correlation between literacy rates in the provinces, average life expectancy and per capita income. Part IV presents the analysis of the profile of development and disparities by regions. Part V briefly reviews the Government of Turkey-UN Children's Fund cooperation with nongovernmental organizations (NGOs) and summarizes priority subjects from the Situation Analysis Report. Reviewed under the chapters of NGOs are the functions and potential of the NGOs with respect to the women and the child. Part VI focuses on the major problems which underline all the other concrete problems related to the quality of the mother s and children's life.
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  4. 4

    [Resolution No.] 1991/23. Refugee and displaced women and children [30 May 1991].

    United Nations. Economic and Social Council


    This document contains the text of a 1991 UN resolution on refugee and displaced women and children. After reviewing previous UN action on this issue, the resolution recommends that: 1) member states cooperate with UN agencies and nongovernmental organizations to address the root cases of refugee migrations; 2) women and children be protected from violence and abuse; 3) the specific needs of refugee women and children be considered in planning; 4) refugee women be given sufficient information to make decisions on their own future; 5) women and, when possible, children, be given access to individual identification documents; 6) refugee women participate fully in the assessment of their needs and in the planning and implementation of programs; 7) the UN Secretary-General review the ability of its organizations to address the situation of refugee women and children; and 8) international organizations increase their capacity to respond to the needs of refugee women and children through greater coordination of efforts. The resolution commends member states which receive large numbers of refugees and asks the international community to share the resulting burden and further recommends that all pertinent organizations adopt an appropriate policy on refugee women and children, female field staff be recruited, staff be trained to increase awareness of the issues related to refugee of women and children and skills for planning appropriate actions, and the collection of refugee statistics be disaggregated by age and gender.
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  5. 5

    Environment issues are human rights issues.

    Davies T

    In: Environment: children first, [compiled by] UNICEF. New York, New York, UNICEF, [1991]. 2 p..

    The view is taken that human rights was not sufficiently addressed in preparatory committees to the 1992 UN Conference on the Environment and Development (UNCED). Only one afternoon session in the entire four weeks of meetings was devoted to the discussion of poverty, health, and education. The author believes that environmental issues are human rights and children's rights issues. The scientific issues were the dominant issues addressed at UNCED meetings, while the issues of debt alleviation of nations, environmentally-friendly development, and people-oriented development were left in question. The Conference's action plan, Agenda 21, is considered the appropriate vehicle for addressing financial and technical problems and implementation. Nongovernmental organizations are viewed as the appropriate groups to assure that changes involve benefits to people. The effort must involve a united human rights perspective among all nongovernmental groups. The Convention of the Rights of the Child was ratified by over 100 countries. This convention indicated that a development issue was the assurance of children's right to life, survival, health, education, and an adequate standard of living. The UNCED is viewed as the potential means of actually setting the course for sustainable development. Actualization of sustainable development is considered as requiring major changes in the use of human and material resources and the participation and imagination of millions of people.
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  6. 6

    Women and children on the environmental front line.


    In: Environment: children first, [compiled by] UNICEF. New York, New York, UNICEF, [1991]. 3 p..

    The focus of this article is on the impact of environmental degradation on women and children. The position is taken that the poor in developing countries, most of whom are women and children, are the most vulnerable to environmental disasters and depletion of natural resources. Children are the most susceptible to the effects of environmental degradation in terms of disease, malnourishment, and pollution and toxic chemicals. The task of collecting fuelwood contributes to wastage of time and energy and loss of schooling, health care visits, child care, and food quality. If animal dung or other agricultural products are used as replacement fuel sources, soil nutrient loss results. When land is sufficiently degraded, household food production becomes impossible. Migration as a solution to environmental depletion results in urban slums. One solution is identified as empowerment of communities and satisfaction of basic needs. Social mobilization campaigns are useful for promoting use of latrines and safe sanitation. Promotion of sanitation is facilitated by the inclusion of ideas about privacy and convenience. Oral rehydration therapy and immunization are useful in controlling and preventing disease. A shift to smoke-free, efficient stoves reduces deforestation. Food security problems can be alleviated with improved crop varieties, nitrogen-fixing plants, small-scale irrigation, and appropriate technologies. UNICEF is associated with a people-centered approach, which is considered the most hopeful prospect for preserving the global environment and achieving more equitable and sustainable development.
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  7. 7

    [The control of viral diseases in the developing countries with the use of existing vaccines] Borba s virusnymi bolezniami v razvivaiushchikhsia stranakh s pomoshchiu sushchestvuiushchikh vaktsin.

    Gendon I


    In developing countries, every year about 70 million measles cases occur with 1.5 million deaths, over 200,000 children contract paralytic poliomyelitis, 50 million people get infected with viral B hepatitis causing over 1 million deaths, and several thousand people perish because of yellow fever according to WHO data. At the present time, there are 12 vaccines against viruses: vaccines against German measles and mumps in addition to the above. The universal immunization program (UIP) of WHO targets measles and polio. In 1989, a WHO resolution envisioned a 90% immunization coverage by the year 2000. Measles vaccination is recommended for children aged 9-23 months, since most children have maternal antibodies during the first 3-13 months of age. The Edmonston-Zagreb vaccine provided seroconversion of 92, 96, and 98% for 18 months vs. the 66, 76, and 91% rate of the Schwarz vaccine. In the US, measles incidence increased from 1497 cases in 1983 to 6382 cases in 1988 to over 14,000 cases in 1989, prompting second vaccination in children of school age. The highest incidence of polio was registered in Southeast Asia, although it declined from 1 case/100,000 population in 1975 to .5/100,000 in 1988. Oral poliomyelitis vaccine (OPV) provides protection: there is only 1 case/2.5 million vaccinations. Hepatitis B has infected over 2 billion people. About 300 million are carriers, with a prevalence of 20% in African, Asian, and Pacific region populations. Plasmatic and bioengineered recombinant vaccine type have been used in 30 million people. The first dose is given postnatally, the second at 1-2 months of age, and the 3rd at 1 year of age. Yellow fever vaccine was 50 years old in 1988, yet during 1986-1988 there were 5395 cases with 3172 deaths in Africa and South America. Vaccination provides 90-95% seroconversion, and periodic follow-up vaccinations under UIP could eradicate these infections and their etiologic agents.
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  8. 8

    Covenant on Economic, Social, Cultural Rights. [Additional parties and location].

    United Nations

    In: Multilateral treaties, index and current status, 8th cumulative suppl., compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1991. 158.

    Since 1983, the International Covenant on Economic, Social, and Cultural Rights has been ratified by the following countries: Algeria, 12 September 1989; Argentina, 8 August 1986; Burundi, 9 May 1990; Cameroon, 27 June 1984; the Congo, 5 October 1983; Equatorial Guinea, 25 September 1987; Ireland, 8 December 1989; the Republic of Korea, 10 April 1990; Luxembourg, 18 August 1983; Niger, 7 March 1986; the Philippines, 23 October 1986; San Marino, 18 October 1985; Somalia, 24 January 1990; Sudan, 18 March 1986; Togo, 24 May 1984; Democratic Yemen, 9 February 1987; and Zambia, 10 April 1984. Provisions of the covenant guarantee equal rights for men and women, pay equity, maternity benefits, social protection for children and the family, and the rights to housing, education, and health care, among other things.
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  9. 9

    Convention on the Rights of the Child. [Summary].

    United Nations

    In: Multilateral treaties, index and current status, 8th cumulative suppl., compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1991. 81-2.

    The Convention on the Rights of the Child was ratified by Belize on 2 May 1990, Ecuador on 23 March 1990, Ghana on 5 February 1990, Guatemala on 6 June 1990, Sierra Leone on 18 June 1990, and Viet Nam on 28 February 1990. The text of the convention is reproduced in the Annual Review of Population Law, Vol. 16, 1989, Section 510.
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  10. 10

    Missed opportunities for immunization: the REACH experience.

    Grabowsky M

    Rosslyn, Virginia, John Snow [JSI], Resources for Child Health [REACH], 1991 Mar. [5], 16 p. (USAID Contract No. DPE-5927-C-00-5068-00)

    Children may fail to come into contact with the immunization system, may drop out before becoming fully immunized, or may stay in the system long enough to gain full immunity from given target diseases. As child immunization coverage nears 80% at the end of 1990, greater emphasis will be placed upon the quality of Expanded Program on Immunization (EPI) services. It is important to lower barriers to immunization and increase the certainty that every immunized child gains full protection. While EPI managers are able to measure coverage levels and assess and monitor immunization quality with the EPI 30-cluster survey, the analysis is complex and time-consuming. The Coverage Survey Analysis System (COSAS), however, employs computer technology to quickly and accurately analyze data. COSAS was developed by the World Health Organization with the input of assisting organizations and gives program managers access to information on the age distribution of immunizations, dose intervals, dropout rates, and other factors which influence program quality. Missed opportunities for immunization (MOI) occur when a child eligible for immunization leaves a health center without obtaining antigens needed for full protection. MOIs are therefore sensitive indicators of the quality of EPI services. Exit interviews have observed MOIs in certain developing countries in the range of 17-76% with a median of 49%. This decreased likelihood of a child being immunized infers eventual higher costs, delayed or missed protection, and loss of confidence in the EPI system. COSAS may help evaluate the quality of care, but it is unable to identify the determinants of quality care. Observation checklists and exit interviews are, however, able to determine the causes of poor service quality and find that they are frequently due to false contraindications, improper screening, lack of supplies, fear of giving multiple injections, and poor clinic organization.
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  11. 11

    Child's right to special care.

    Sharma A; Gupta S

    ICCW NEWS BULLETIN. 1991 Jul-Dec; 39(3-4):12-5.

    In 1924, the League of Nations adopted the 1st international law recognizing that children have inalienable rights and are not the property of their father. The UN Declaration on the Rights of the Child emerged in 1959. 1979 was the International Year of the Child. In 1990 there was the World Summit on Children and the UN General Assembly adopted the Global Convention on the Rights of the Child. The convention included civil, economic, social, cultural, and political rights of children all of which covered survival, development, protection, and participation. At the end of 1990, 60 countries had ratified the convention, thus including it into their national legislation. Even though India had not yet endorsed the Convention by the end of 1991, it expressed its support during the 1st workshop on the Rights of the Child which focused on girls. India has a history of supporting children as evidenced by 250 central and state laws on their welfare such as child labor and child marriage laws. In 1974, India adopted the National Policy for Children followed by the establishment of the National Children's Board in 1975. The Board's activities resulted in the Integrated Child Development Services Program which continues to include nutrition, immunization, health care, preschool education, maternal education, family planning, and referral services. Despite these laws and actions, however, the Indian government has not been able to improve the status of children. For example, between 1947-88, infant mortality fell only from 100/1000 to 93/1000 live births and child mortality remained high at 33.3 in 1988 compared with 51.9 in 1971. Population growth poses the biggest problem to improving their welfare. Poverty also exacerbates their already low status.
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  12. 12

    Maternal mortality and the right of the child to survival, protection and development. Perspectives on southern and eastern Africa in light of international law.

    Nurkse D

    In: The effects of maternal mortality on children in Africa: an exploratory report on Kenya, Namibia, Tanzania, Zambia, and Zimbabwe, [compiled by] Defense for Children International-USA. New York, New York, Defense for Children International-USA, 1991. 97-143.

    How international law documents such as the Convention on the Rights of the Child establish a legal framework within which to promote child survival in Southern and Eastern Africa, emphasizing the documents' significance for maternal mortality, the most important factor affecting child survival, is examined. In November 1989, the UN General Assembly unanimously adopted the Convention, a comprehensive treaty that establishes the rights of children and their families, outlining the responsibilities of governments and adults in securing those rights. By September 1990, most countries in Southern and Eastern Africa had ratified the treaty; the remaining countries had pledged to approve it. The Convention not only obligates governments to allocate greater resources to the most vulnerable members of society, but also requires a higher level of international cooperation, including greater commitment from industrialized countries and greater participation at the grassroots level. The economic, social, and cultural dimensions of maternal mortality and its impact on child survival are discussed, as well as the maternal and child survival issues addressed by the Convention: 1) maternal-child health services; 2) traditional practices harmful to the mother and child (in this case, female circumcision and child marriage); and 3) survival and development through international cooperation. The implications of the Convention on the primary health care model are also discussed. The impact of other international documents on maternal mortality and child health is examined.
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  13. 13

    Innocent victims of unjust economic order.

    Perez Esquivel A


    The author indicts World Bank, International Monetary Fund, and overall developed country policy as responsible for Latin America's large impoverished and disenfranchised child and adolescent population. As an example of the magnitude of the problem, he notes that 1/3 of Brazil's 150 million population is comprised of youth and children. 8 million live on the streets, of which only 1 million receive official aid. Forced to fend for themselves, these youths fall into drug addiction, prostitution, and crime, suffering poor health, malnutrition, and widespread illiteracy. Many are sold, imprisoned, kidnapped, and exploited. Street children in Rio de Janeiro even suffer the added threat of being killed by the Squadrons of Death who consider the murder of juveniles a solution to delinquency. The state of affairs has deteriorated to such an extent in Peru that abandoned children are considered the most significant social problem. Argentina, Bolivia, Haiti, Honduras, Guatemala, and Nicaragua all suffer similar problems of impoverished youths, and claim some of the highest infant mortality rates (IMR) in the world. Cuba is the only country in Latin America with an IMR comparable to and often lower than many developed countries. Chile and Costa Rica follow closely behind in their achievements. Where Latin America already holds the largest gap between wealthy and poor, meeting adjustment demands of Northern economies and countries has only made conditions and inequities worse. Recession and poverty have worsened at the expense of youths. Attempting to pay down debt over the 1980s, improvements in Latin America's trade balance have gone unnoticed as the South has grown to be a net exporter of capital. Latin American nations need more than token charitable donations in times of emergency and particular duress. Development programs sensitive to the more vulnerable segments of society, and backed by the political will of developed nations, are called for. Unless constructive, supportive policy is enacted by Northern nations to help those impoverished in the South, social rebellion and continued, enhanced resistance should be expected from Latin American youths in the years ahead.
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  14. 14

    The struggle to meet great needs. Interview: Mrs. Sadako Ogata.

    Hamand J

    PEOPLE. 1991; 18(4):10-2.

    The head of the United Nations High Commission for Refugees, Sadako Ogata, anticipates continued growth in the numbers of migrants and refugees in the 21st century, in part as a result of the collapse of the political and economic systems in developing countries and Eastern Europe. Development assistance that provides jobs, alleviates poverty, and seeks to maintain family structures in developing countries is necessary for both urban and rural areas, and nongovernmental organizations are being urged to prioritize education, training, and primary health care activities. Of particular concern are the special needs of refugees and migrants who are women and children. Children are most susceptible to the diseases, especially diarrhea and subsequent dehydration, that are prevalent in refugee camps. Needing further attention is the psychological trauma to refugee children created by dislocation and exposure to war. Maternal-child health care, including family planning, is another area in need of greater emphasis. Although women head most families in refugee camps, camp management tends to be male-dominated and the special needs of women and children are not receiving sufficient attention. Activities that go beyond basic sustainment of life will have beneficial effects in the longterm as well, as refugees are repatriated and reintegrated into the community.
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  15. 15

    Use and interpretation of pediatric anthropometry in epidemiologic studies.

    Sullivan K; Gorstein J; Trowbridge F; Yip R

    [Unpublished] 1991. Presented at the Society for Epidemiologic Research 24th Annual Meeting, Buffalo, New York, June 11-14, 1991. 12, [18] p.

    Health workers use anthropometry to determine the nutritional status of children. The accepted international growth reference curves provide the bases for the indices which include weight for height (W/H), height for age (H/A) and weight for age (W/A). Health workers must interpret these indices with caution, however. For example, W/H and H/A represent different physiological and biological processes while W/A combines the 2 processes. Further Z-scores, percentiles, or percent of median may be used as the scale for the indices and each scale has different statistical features. Specifically, Z-scores and percentiles acknowledge smoothed normalized distributions around the median, but the percent-of-median ignores the distribution around the median. Some researchers suggest using Z-scores rather than percentiles or percent-of-median since statisticians can interpret them more clearly and can calculate the proportion of children in the reference population who fall above or below a cut off point more easily. This cutoff should be only used to screen children who are likely to be malnourished since not all children below a cutoff are indeed malnourished. Some researchers have identified a leading limitation of the CDC/WHO based indices. A disjunction exists where the 2 smoothed based curves based on a population of <36 month old children from Ohio (longitudinal data) and another population of 2-18 year old children (cross sectional health surveys) meet. Further there is a reduction in age specific prevalences at 24 months. Thus some researchers recommend that anthropometry data be presented on an age specific basis, if age information is accurate. They further suggest that, if comparing data from different geographic areas, researchers should standardize age to have a summary measure. If age is not known the W/H summary measure should include 2 groups: <85 cm and =or+ 85 cm.
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  16. 16

    Children orphaned by AIDS: a call for action for NGOs and donors.

    Poonawala S; Cantor R

    Washington, D.C., National Council for International Health [NCIH], 1991 Mar 31. [3], 27 p.

    AIDs provides a unique and unprecedented opportunity to affect behavioral change, open up discussion on sexuality, and strengthen health and educational programs. This National Council for International Health policy report encourages collaborative multisectoral programs to deal with the issues of AIDs orphaned children. The contents include introductory chapters as well as chapters on the economic, public health, and social implications of AIDs in the Third World; supporting the child, family,and community; recommendations for the role of NGO's and the role of donor agencies; and conclusions. It is hoped that NGOs and donors will be mobilized to deal with a problem that will strain the already inadequate health, social and financial resources of developing countries, and thereby affecting the increasing demand for long term child care. WHO estimates of HIV infected children <5 years are 10% of 25-30 million by the year 2000. The current problem also includes children orphaned from the estimated 3 million women who will die in 1990. The economic implications are that economic productivity is reduced, low income families will be unable to provide for the additional orphaned children, and debt and low prices for exports have already reduced national budgets and reflect less social spending. The public health implication is the 1-10 US dollars/per person health spending cannot accommodate AIDs screening which alone cost 1 US dollar. AZT costs 20,000 US dollars a year/per child, or the combined annual income of 133 Mozambique farmers. A child's AIDs hospitalization in Zaire costs 4 months wages for the average workers. A funeral costs 11 months wages. In Rwanda, the doctor/patient ratio is 1:36,000. Child survival may be reversed because of reduced credibility in breastfeeding and immunization, confidence in common health remedies, and of confusion between AIDs symptoms with other treatable ailments. AIDs confronts Africans with a challenge to their cultural beliefs and marital, family, and sexual patterns. The alternatives for care are the extended family, alternative residential facilities, and adoption and foster placement. It is recommended that NGO's increase information exchange/program coordination; balance short term emergency assistance with long term sustainable solutions; give priority to maintaining a child's sense of identity and ties with family, clan, and community; involve communities in all phases of project planning, implementation, and evaluation; provide resources to empower women to make choices; and ensure the discrimination due to HIV infection does not occur. Donor agencies should encourage NGOs to pursue multisectoral solutions; increase funding and improve dispursement means for NGOs; facilitate information exchange, funding, conducting research, offering strategic guidance, and taking responsibility for program coordination; ensure the sustainability of AIDs orphan's projects; and realize the goal of improved status of women and children legally, socially, and economically.
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  17. 17

    Infection spreading faster than previously thought. World AIDS Day 1991 -- 1 December.

    POPULATION. 1991 Nov; 17(11):1.

    According to its latest predictions, the World Health Organization (WHO) anticipates that by the end of the century the number of people worldwide infected with HIV will be somewhere between 30-40 million -- sharply up from the previous projection of 25-30 million. As of April 1991, some 8-10 million adults and 1 million children worldwide were already infected with HIV. While the infection rate appears to be slowing in some industrialized countries, the number of new infections is increasing rapidly in the developing world -- particularly in sub-Saharan Africa. Asia, Latin America, and the Caribbean have also seen marked increases in the number of infections. WHO estimates that by the end of the century, 25-30 million children will have been born with the disease. Already, some 1.5 million people have developed AIDS since the beginning of the pandemic. Although heterosexual intercourse accounts for about 70% of all HIV transmissions, only 6% of contraceptive users choose condoms, the only effective barrier against the virus. Since no cure yet exists for AIDS, experts say that education is the first line of defense, but these prevention campaigns can only work if they receive full commitment from government leaders. UNFPA has already begun addressing the AIDS pandemic through public information activities and education. UNFPA has incorporated AIDS features to population education and teacher training curricula in many countries, and regularly provides large supplies of condoms.
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  18. 18

    Rational management of diarrhoea in children.

    World Health Organization [WHO]. Division of Diarrhoeal and Acute Respiratory Disease Control

    ESSENTIAL DRUGS MONITOR. 1991; (11):10-1.

    Most health professionals in developing and developed countries consider oral rehydration therapy (ORT) to be the most effective treatment for diarrhea. An estimated 1,500 million episodes of diarrhea occur annually and 3 million of these results in death of children <5 years old. Caretakers must give increased amounts of fluids (rice water, tea, and gruel) to children with diarrhea to prevent dehydration. If they become dehydrated, caretakers must take them to a health workers so he/she can assess and treat them with oral rehydration solution (ORS) or, in the case of severe dehydration, rehydrate them intravenously. Drugs should not be used to treat diarrhea cases. Nevertheless, surveys in 4 Asian nations indicated that drug use ranged from 22-68% of diarrhea episodes and ORS use ranged only from 9-21%. Drug use is very expensive. In fact, Peru spent >US$2 million on antidiarrheals in 1988- 1989. Further, drugs often make up >40% of health care costs in developing countries, so ORS use reduces these costs. Indeed drug us deflects from correct case management of diarrhea. In addition, drugs have no proven value for acute diarrhea. They do not decrease the fluid loss responsible for death and may even have serious side effects, such as central nerve depression and gastrointestinal toxicity. If health workers suspect cholera or dysentery, however, they can administer effective and relatively inexpensive antibiotics. Since the early 1980s, almost all developing countries had a national control of diarrheal disease program. In several countries, hospital admission rates for diarrhea fell 61% and the case fatality rate fell 71% after ORT introduction. Some hospitals have even saved as much as 60% in costs due to these declines. WHO has a book available which covers rational use of drugs in managing acute diarrhea in children.
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  19. 19

    International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations. Jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989.

    World Health Organization [WHO]. Global Programme on AIDS

    [Unpublished] 1991. [2], 64 p.

    The International Conference on the Implications of AIDS for Mothers and Children was organized by the World Health Organization (WHO) in cooperation with the French Government. Co-sponsors included the United Nations organizations UNDP, UNICEF, and UNESCO, along with the International Labor Organization (ILO), the World Bank, and the Council of Europe. Following assorted introductory addresses, statements by chairmen of the conference's technical working groups are presented in the paper. Working group discussion topics include virology; immunology; epidemiology; clinical management; HIV and pregnancy; diagnoses; implications for health, education, community, and social welfare systems; and economic and demographic impact. Chairman statements include an introduction, discussion of the state of current knowledge, research priorities, implications for policies and programs, and recommendations. The Paris Declaration on Women, Children and Acquired Immunodeficiency Syndrome concluded the conference.
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