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  1. 1

    Refugee women are focus of International Women's Day.

    UN Chronicle. 1991 Jun; 28(2):[1] p..

    The world's estimated 8 million female refugees--over half of the total refugee population--were the focus of International Women's Day on 8 March. "None have more fully demonstrated the capacity of women to cope and prevail than those women", Secretary-General Javier Perez de Cuellar said in his traditional message for the Day. Visions of women's potential for leadership were explored at "Making Women Count in the 1990s", a panel discussion held at UN Headquarters. Refugees, women and development issues, and women and work were other topics discussed by panelists Catherine O'Neill, Winn Newman and Dr. Nafis Sadik. Ms. O'Neill works with the Women's Commission for Refugee Women and Children; Mr. Newman, a lawyer, has successfully argued landmark legal cases in the United States on equal pay for work of comparable value; and Dr. Sadik is the Executive Director of the UN Population Fund. Author Erskine Childers, formerly with the UN Development Programme, was the moderator. The keynote speaker was former United States Congress member and Vice-Presidential candidate Geraldine Ferraro. (excerpt)
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  2. 2

    ICASO: a model for an NGO unified response against AIDS.

    Arauz R; Hernandez-Chavez JJ

    AIDS and Society. 1991 Oct-Nov; 3(1):12.

    The International Council of AIDS Service Organizations (ICASO) was founded in 1989 with the support of the World Health Organization's Global Programme on AIDS. The most recent meeting of ICASO's Council of Representatives took place this past June during the VII International Conference on AIDS in Florence, Italy. As an international consortium of AIDS service organizations (ASOs), ICASO's intent is to deal with AIDS from a broader perspective which includes advocacy for the contribu-ion of voluntary community organizations in prevention, access to care, support services, education and human rights advocacy. (excerpt)
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  3. 3

    Facts about female circumcision.

    Cairo Family Planning Association

    Cairo, Egypt, Cairo Family Planning Association, 1991 Mar. 18 p.

    In October 1979, the Cairo Family Planning Association (FPA) convened a seminar on the "Bodily Mutilation of Young Females." This seminar examined the issue of female genital mutilation from a religious, health, and social standpoint. Recommendations arising from the seminar included 1) generating interest in the topic in the mass media, 2) inviting women's organizations to participate in efforts to educate people about the harmful nature of the practice, and 3) encouraging schools and universities to include facts about female genital mutilation in their curricula. In addition, the FPA published this booklet containing data collected for the seminar as well as expert opinions on the subject. After the introduction, the booklet describes the motives cited for perpetrating female genital mutilation and the historical and geographical background. The booklet then reviews tenets of Islam and Christianity and notes that Islam holds that male circumcision is commendable because it offers a benefit that exceeds the pain of the procedure but that this is not the case with female circumcision, which is also not required of Christians. A description is then given of the three degrees of severity of mutilation that are common in Egypt as well as the physical, psychological, and social hazards associated with the mutilation. The next sections offer a legal opinion that female genital mutilation can be considered an intentional crime that can lead to criminal and civil liability, the conclusions of a 1959 Egyptian Ministry of Health committee on female circumcision, and the position of the World Health Organization.
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  4. 4

    Analysis of a development programme.

    Mehta M

    In: Changing perceptions: writings on gender and development, edited by Tina Wallace with Candida March. Oxford, England, Oxfam, 1991. 141-8.

    In this essay in a book of writings on gender and development, the author relates her experience as the first Woman Project Officer hired by the Oxfam West India office in 1984. The previously all-male staff decided to hire a woman with development experience to tackle gender issues and to attempt to involve women in development programs, especially in decision-making processes. The strategy used was to create structures which would enable women to form groups and, eventually, to define their own development activity priorities and needs. This strategy failed, largely because it was not relevant to the position of the women in their society. It became apparent, however, that women's development must be integrated in all aspects of Oxfam's work at the organizational, office, and program levels. In 1985, therefore, a group of women project officers formed a group called Action for Gender Relations Asia (AGRA) to work toward this goal. AGRA first concentrated on the organization of Oxfam and its staff but found its abilities limited by the fact that it was comprised solely of Oxfam staff. Studies of the impacts of various projects on women have been undertaken to develop awareness of appropriate strategies. The shift in strategy required that, instead of forming separate women's groups, women be incorporated in development efforts. These attempts were blocked by patriarchal male leaders. Thus, women were appointed as organizers of women's development. Since many of these women were inexperienced, the patriarchal set-up was reinforced. Also, whereas most of the development programs had economic goals, the work with the women emphasized conscientization and organization, which was difficult for some group leaders and staff members to accept. These attempts are part of a process of change that is constantly evolving. It is hoped that what was learned from them will contribute to an understanding of gender issues.
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  5. 5

    Improving primary education in developing countries.

    Lockheed ME; Verspoor AM; Bloch D; Englebert P; Fuller B; King E; Middleton J; Paqueo V; Rodd A; Romain R

    Oxford, England, Oxford University Press, 1991. xix, 429 p.

    The Education and Employment Division of the World Bank's Population and Human Resources Department conducted a four-year study on the effectiveness and efficiency of primary education in developing countries. The resulting book includes extensive reviews of the research and evaluation literature; consultations with policymakers in developing countries, representatives of donor agencies, and primary education specialists; and results of commissioned studies and of original research conducted in the division. Learning is the central theme of the book; it reminds people that learning occurs in schools and classrooms among teachers and children, not in government ministries of education or finance. It also tells readers that learning is foremost and that teacher training and instructional materials are important only if the children learn. Policymakers must consider the impact of the cost and financing of education on learning when making decisions. The goals of primary education include teaching children basic cognitive skills, developing attitudes and skills in children so they can function effectively in society, and promotion of nation-building. This publication examines five areas for improvement of primary education: inputs necessary for children to learn; methods for improving teachers and teaching; management requirements for promoting learning; ways to extend effective education to traditionally disadvantaged groups; and the means to afford enhanced education. The study reveals that there is limited research on children's learning and no research at all on change in learning. The chapters cover the following: primary education and development; a brief history of primary education in developing countries; improving learning achievement; improving the preparation and motivation of teachers; strengthening institutional capabilities; improving equitable access; strengthening the resource base for education; international aid to education; and educational reform: policies and priorities for educational development in the 1990s.
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  6. 6

    Safe motherhood: priorities and next steps. Forward-looking assessment on the reduction of maternal mortality and morbidity within the framework of the Safe Motherhood Initiative: (SMI).

    Law M; Maine D; Feuerstein MT

    [New York, New York], United Nations Development Programme [UNDP], 1991 Apr. [3], viii, 40, [31] p.

    Women in Development is one of six key policy areas for the UN Development Program's (UNDP) next programming cycle. UNDP acknowledges the hazards of pregnancy and childbirth that rob society of women society at the height of their productivity. It has supported the Safe Motherhood Initiative (SMI) from its inception to reduce maternal mortality and morbidity in developing countries. UNDP reviewed its contributions at the global, regional, and national levels within the framework of SMI to determine its contributions during the 1990s. A three-person, multidisciplinary team conducted a forward-looking assessment which included interviews with 200 persons in UN and bilateral donor agencies and nongovernmental organizations, a survey of UNDP staff in developing countries, and visits to Senegal and Indonesia. The team assessed progress that has been made in policies, programs, resources, coordination, research, technical cooperation, and information. UNDP support helped initiate SMI. Its support of SMI conferences has increased awareness and political commitment. UNDP contributes funds to WHO's Safe Motherhood Operations Research Programme. Some of its SMI projects will likely achieve significant improvements in maternal health. UNDP support in Senegal and Indonesia allowed the first national needs assessments and action plans in the SMI. The team found that funding of needs assessments and action plans is constructive. It agreed with UNDP's policy of pooling its support with that of other donors. It found the present organization and structure through which UNDP funds are implemented to be appropriate. It recommended that UNDP continue to contribute to SMI. It suggested that UNDP take the lead role in establishing the International Partnership to Prevent Maternal Deaths and Disability as a mechanism to take the SMI into its next phase of translating the increased concern and technical know-how into increased safe motherhood activity at the country level.
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  7. 7

    Janet Brown: on global environmental issues, the people are leading and the leaders are following.

    Lerner SD

    In: Earth summit. Conversations with architects of an ecologically sustainable future, by Steve Lerner. Bolinas, California, Commonweal, 1991. 229-36.

    A senior associate with the World Resources Institute believes that it is more worthwhile to strengthen the UN Environment Program than to create a new international environmental organization. Another possibility would be to convert the UN Trusteeship Council's purpose from administering UN territories to dealing with environmental issues. The Council has an equal number of developing countries and developed countries and no country has veto power. She also favors ad hoc groups dealing with very specific issues, e.g., International Panel on Climate Change. We need an international debt management authority which purchases outstanding debt at real market prices to finance policies and programs that alleviate poverty and protect the environmental issues should lie with 1 organization. She dismisses suggestions that the Group of Seven industrialized nations serve as a group to propose international initiatives because developing countries would not accept the G-7 process plus the G-7 countries do not even agree on environmental issues. Citizens push US politicians to address environmental issues rather than the politicians leading on environmental issues. Some members of the US Congress have taken the initiative, however, including Senators Gore and Mikulski from Tennessee and Maryland, respectively. The President must have a vision for a transition to sustainable development, which he does not. In the 1973-74 oil crisis, industry took it upon itself to become more energy efficient and still had real growth in the gross national product, illustrating that the costs required to become more sustainable are not as great as many people claim. Sustainable agriculture would reduce the demand for fossil fuels, on which fertilizers and pesticides are based. It would require making institutional changes. USAID should change dramatically the system it uses to distribute foreign aid money and to dedicate considerably more money to the environment and development.
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  8. 8

    Frances Spivy-Weber: the art of lobbying international environmental negotiations.

    Lerner SD

    In: Earth summit. Conversations with architects of an ecologically sustainable future, by Steve Lerner. Bolinas, California, Commonweal, 1991. 189-204.

    Frances Spivy-Weber is director of the International Program of the National Audubon Society. She is also chairperson of the executive committee of the US Citizens Network on the United Nations Conference on Environment and Development (UNCED). She responds to questions on the following: the origins of UNCED; the role nongovernmental organizations (NGO) play in UNCED negotiations; the position of the State Department on including NGOs in UNCED negotiations; the US Citizens Network and why it was created; activities of the Citizens Network; national energy policy; intended international functions of the Network; developing country NGOs; the US National Report to be submitted to UNCED; the Citizens Report; the Network's role in promoting UNCED; UNCED success in stimulating the initiation and passage of legislation in the US related to environment and development issues; the Network's role in shaping the resolution on forestry; the US Network's potential for pressuring Congress and the President to promote sustainable development; the most effective way to lobby the UNCED preparatory committee negotiations; the US position for UNCED and its evolution; and whether UNCED negotiations will culminate with any significant international agreements.
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  9. 9

    Brent Blackwelder: the campaign to reform the multilateral development banks.

    Lerner SD

    In: Earth summit. Conversations with architects of an ecologically sustainable future, by Steve Lerner. Bolinas, California, Commonweal, 1991. 157-73.

    Brent Blackwelder is acting president of Friends of the Earth, an international network of nongovernmental organizations working on environmental and development issues in 42 countries. He responds to questions on the following: the role of the World Bank in international environmental issues; the World Bank's bid for the Green Fund; the World Resources Institute's role in shaping the Tropical forestry Action Plan; his view on who should administer the Green Fund; whether the president of the World Bank is empowered to change its lending practices; US say in World Bank decisions; the difficulties encountered in getting international organizations to do the right thing on tropical deforestation and other international environmental issues; the loan policies of global banks; the IMF and the role of other agencies in the UN; the potential for and nature of a global economy; the potential for the creation of a global environmental protection agency; North-South relations and comparative negotiating power among countries; the scale of the environmental effort; grassroots organizations; poverty in developing countries; the continuance of regime-building around single issues or the evolution of some form of World Government; sustainable development and the general public; sustainable development and the US Democrats; US policy and leadership; and US President George Bush's mixed stance and policy record on the environment.
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  10. 10

    Bruce Rich: putting pressure on the World Bank to make its loans promote sustainable development.

    Lerner SD

    In: Earth summit. Conversations with architects of an ecologically sustainable future, by Steve Lerner. Bolinas, California, Commonweal, 1991. 131-56.

    Bruce M. Rich is Senior Attorney at the Environmental Defense Fund and Director of its International Program. He has focused over the past 8 years upon reforming the lending practices of the multilateral development banks and the International Monetary Fund. His book, Battle for the Biosphere, on international development and the global green movement is under development. He responds to questions on the following: the potential for entering a new era of environmental diplomacy; the Multilateral Development Bank campaign to reform the lending practices of these banks; World Bank criticism and the US Congress; sustainable development and institutional reform; the need to limit the rate of economic growth; regime building for negotiating solutions to global environmental problems; the potential for becoming a state-controlled economy in the interest of protecting the environment; environmental taxes on resources and incentives for sustainable development; implications of adopting a steady-state economic model; reducing population growth; the role of the United Nations; and North-South relations.
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  11. 11

    [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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  12. 12
    Peer Reviewed

    [Reproductive health in a global perspective] Reproduktiv helse i globalt perspektiv.

    Bergsjo P

    TIDSSKRIFT FOR DEN NORSKE LAEGEFORENING. 1991 May 30; 111(14):1729-33.

    The 4 cornerstones of reproductive health according to the WHO are family maternal care neonatal and infant care, and the control of sexually transmitted diseases. In recent years, the AIDS epidemic has caused concern in the world. The world's population doubled to 4 billion from 1927 to 1974, and it will reach 6 billion by the year 2000. The rate of growth is 1.4% in China and 2% in India vs. .3% in Europe. Contraceptive prevalence is 15-20% in Africa, 30% in South Asia, and 75% in East Asia. Shortage of contraceptives leads to abortion in eastern Europe. In 1985 in the USSR, there were 115.7 abortions/1000 women (mostly married) aged 15-44; and 6.4 million abortions for 5.5 million births in 1989. RU-486 or mifepristone combined with prostaglandin has produced abortion in 90% of first trimester pregnancies. After approval in France in 1987, it was used in 40,000 abortions in the following year. 90% of the estimated annual 500,000 maternal deaths occur in developing countries. In Norway, the rate is fewer than 10/100,000 births vs. 100/100,000 in Jamaica. In the mid-1980s, 26% of rural women in Thailand, 49% in Brazil, 54% in Senegal, and 87% in Morocco went without maternal care. In Norway, infant mortality is 6-8/1000 live births vs. 75-150/1000 in developing countries. A WHO investigation on causes of infertility in 25 countries found a 31% rate of tubal pathology in 5800 couples. In Africa, over 85% f infertility in women was infection related. Venereal diseases and infertility are associated with premarital sexual activity in young people. Various donor agencies and the WHO Special Program of Research, Development, and Research Training in Human Reproduction are providing help and resources including AIDS research.
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  13. 13

    U.N. sees global fertility drop, birth control gains.

    Booth W

    WASHINGTON POST. 1991 May 14; A1, A10.

    The Annual Report of the UN Population Fund (UNFPA) shows an increase in contraceptive usage among married couples to 51% in 1991 from 45% in the 1980s. This provides strong evidence that family planning does work. The current world population is 5.4 billion, and increases of 85 million/year and 850 million/10 years are expected. Desired family size has also declined as reported in numerous household surveys. In Latin America and Asia, birth rates have declined from an average of 6 to 3- 4/woman. Thailand, Indonesia, and South Korea have birth rates that have dropped precipitously. In Africa, which has the highest fertility rate and the lowest rate of contraceptive usage, there was only a modest decline from 6.6 in the 1960s to 6.2 currently. The declines in family size and birth rate are viewed by a demographer at UNFPA as the result of families seeing the advantages of smaller size. In spite of declines, the rate of growth is still higher than the replacement rate and is a root cause of environmental degradation and mass poverty. Rapid growth (even with fertility reduced from 6 to 4 children/women) in the presence of increased life expectancy and lower mortality means the population will not stabilize until it reaches 10.2 billion in 1085. Stabilization requires contraceptive usage of 75% worldwide. Over the next 100 years, demographers project that the ceiling will be 12.5 billion, with increases primarily in the developing world. Slow growth means widespread use of birth control (59%) in developing countries by the 2000. Contraceptive usage is unevenly distributed. China's usage is 72%, while west Africa's is 4%. The US figures are approximately 70%. There has been greater acceptance of family planning worldwide. Only Saudi Arabia, Iraq, Cambodia, and Laos actively restrict access to family planning services. UNFPA needs to increase spending on family planning to 9 billion US dollars by the year 2000 in order to increase birth control use. The US cut off support for UNFPA, but there is hope that the funding will be restored.
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  14. 14

    Budget priorities, national security, and Third World development.

    Moore SW

    In: Urban and rural development in Third World countries: problems of population in developing nations, edited by Valentine James. Jefferson, North Carolina, McFarland, 1991. 297-314.

    National security must be broadened to include national cultural survival in tandem with resource availability or scarcity, and tensions between developed and developing countries must be reduced. Budget priorities must accommodate a sense of fairness, humanness, and justice. Politics reflect priorities and values for scarce resources for US society and for the world. The needs of the Third World are described, followed by a presentation of a developmentalist alternative and a case study of Brazil and Central America. Attempts have been made to secure stability and harmony through unilateral armament, bilateral and multilateral treaty arrangements, and a European balance of power strategy. None of these strategies has been particularly successful. The UN Charter also provides for collective security arrangements and unilateral and regional defense systems. 9 objective and subjective criteria for a viable collective security system are listed. The US has never agreed on a definition of aggression or that it is totally undesirable. 157 nations are part of the UN, while others are still denied membership on ideological grounds. Confidence in the system and its members is lacking and nations have been unwilling to subordinate national behavior to UN standards. Collective security in the political world has not been realized. Nuclear deterrence has been used by the US since the 1950 for national security. Aristotle recognized that economic well-being is related to peace, and gross inequalities are related to conflict. The needs of developing countries are the reduction of poverty and of the gap between rich and poor nations. Poor nations are susceptible to corruption, capital flight, and increasing military expenditures. The US strategy has been to support corruptible repressive regimes. Budget priorities need to be reevaluated. An alternative developmentalist strategy would improve conditions to halt the spread of hostile ideologies and socioeconomic instability.
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  15. 15

    Process and outcome evaluation: experience with systems analysis in the PRICOR project.

    Heiby J

    In: Operations research: helping family planning programs work better. Proceedings of an International Conference and Workshop on Using Operations Research to Help Family Planning Programs Work Better, held in Columbia, Maryland, June 11-14, 1990, edited by Myrna Seidman, Marjorie C. Horn. New York, New York, Wiley-Liss, 1991. 395-410. (Progress in Clinical and Biological Research Vol. 371)

    Systems analysis was adopted by the AID Office of Health, Primary Health Care Operations Research (OR) Project (PRICOR) for evaluating the process of delivery of child survival services. Actual performance is compared with an accepted standard. The rationale for examining the process of service delivery is provided along with an outline of the process evaluation methodology and an overall framework for examining the different systems. Illustrative examples of findings are given. Applications of this approach for routine management evaluation are discussed with particular reference to small, rapid, cheap and relatively simple OR studies. Outcome analysis screens for unsatisfactory performance, and process analysis specifies certain activities which require management action or improvements in a supervisor's performance. The PRICOR project objective was the development of practical methodologies for gathering information on service delivery and quality of care. The first task was the detailed identification of concrete activities necessary in providing effective services, which were drawn from the public health literature and a panel of outside experts. This thesaurus was used to examine staff performance in 12 countries: Thailand, Zaire, Haiti, Costa Rica, Colombia, Indonesia, Philippines, Peru, Niger, Pakistan, Senegal, and Togo. Although not a statistically representative sample, it was the first large scale, systematic effort. The following areas were evaluated by observation or review: service delivery, clinical and support facilities, home visits, records, informant interviews, role- playing, training courses, supervisory contacts, and population-based surveys. 6000 interviews and observations were addressed to immunizations, maternal health, child spacing, and growth monitoring and promotion. The systems analysis focused on 7 major systems (quality of care, outreach, primary supervision, secondary and higher levels of supervision, training, logistics, and management of information which were subdivided into approximately 40 issues areas which broke down into approximately 200 distinct and observable staff activities. The findings were that there are extensive and serious deficiencies in quality of care, that program mechanisms are poorly developed to detect and correct deficiencies, and that it is feasible to examine the process of service delivery and determine practical solutions.
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  16. 16
    Peer Reviewed

    India: HIV banks.

    Kandela P

    Lancet. 1991 Aug 17; 338(8764):436-7.

    The professional blood donor organizations in Bombay, India, face difficulties, since many donors have become infected with the human immunodeficiency virus (HIV). Professional donors meet more than half of the demand from hospitals for blood. More than 5 million liters of blood are bought every year at an annual cost of more than 29 million pounds. The government suspended the manufacture of blood products, and a blood screening program was launched, yet up to 95% of donated blood is unsafe. In a WHo study, it was disclosed that 80% of Bombay's blood sellers are infected with HIV, and 1/3 of them show signs of AIDS or AIDS-related complex. India is expected to have 250,000 HIV carriers and at least 60,000 cases of AIDS by 1995. Medical organizations like the Indian Health Organization (IHO) and the WHO are educating blood donors and prostitutes about AIDs and are promoting safe sex. An IHO team consisting of a doctor, social worker, and health educator regularly visits the district of Bombay where 200,000 prostitutes ply their trade. Team members distribute literature, organize slide shows, and hand out free condoms to prostitutes and their clients.
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  17. 17

    Thirsty cities.

    Anton D


    Rapid population growth strains existing water resources, especially in major urban areas of many developing countries where urbanization between 1950 and 1980 ranged from 3.5% to 4.5%. 45 cities in developing countries already have at least 3 million people and 8 cities already exceed 10 million people. These include Mexico City, Sao Paulo, Buenos Aires, Calcutta, Bombay, Cairo, Shanghai, and Seoul. Water resources serving urban populations are susceptible to contamination from human and industrial wastes, e.g., human activity in Managua has damaged it Xolotlan lake. Thus cities face 2 water problems: availability and quality. In addition, few developing countries have antipollution laws and people can sidestep them in those countries that do have such laws. Yet most developing countries are trapped in a downward economic and environmental spiral. They stress production of inexpensive export goods to pay back foreign debt. This production tends to be done by multinational companies which pollutes the environment, e.g., coffee production wastes contaminate freshwater resources in Colombia, Brazil, Kenya, and Tanzania. Some cities such as Mexico City and Bangkok which have drawn heavily from groundwater reserves are actually sinking. This overpumping of groundwater reserves by coastal cities including Dakar, Jakarta, Lima, and Manila draws in saline sea water. As a result of environmental degradation of drinking water supplies, cities in many developing countries have resorted to lowering their drinking water standards which has already resulted in increased waterborne illnesses such as cholera. Another measure is rationing water, yet the poor suffer the first cuts in water service. The increasing foreign debt crisis is resulting in fewer international loans for infrastructure projects. A positive sign is that the World Bank and the Inter-American Development Bank have added environmental sustainability in their project development policies.
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  18. 18

    The dangers of "follow-up" feeds.

    Greiner T

    DIALOGUE ON DIARRHOEA. 1991 Sep; (46):4.

    Artificial feeds constituted with contaminated water and unclean bottles are the leading cause of diarrhea in infants. Companies market artificial feeds globally as infant formula (a substitute for breast milk) and follow-up formula (a complement to breast milk). Breast milk is best for all 0-12 month old infants. Breast-fed infants do not need any formula even follow-up formula. Indeed >6-month old infants require solid healthful foods and breast milk. Like infant formulas, follow-up formula made with contaminated water or bottles can cause the infant to become ill with an infection, and offering follow-up formulas to infants impedes weaning and is costly. Follow-up formulas do not complement breast milk, but instead tend to replace it. The 1986 WHO World Health Assembly has even declared that, in some countries, provision of follow-up formula is not necessary. WHO fears mothers could use follow-up formula instead of infant formula because it has a higher protein and mineral content thus increasing the risk of dehydration during diarrhea. Follow-up formula can result in an unbalanced diet. Since the International Code of Marketing of Breastmilk Substitutes does not address formulas marketed as a complement to breast milk, formula companies market follow-up formulas in both developed and developing countries. Most mothers do not know the risks of using follow-up formulas, however. Governments have several alternatives to stop the marketing of these formulas. They can design and implement a code that defines breast-milk substitutes as any formula perceived and used as a breast milk option even if promoted as a breast-milk complement. They can also amend an existing code. WHO offers technical assistance to any member government who wishes to design, implement, and monitor such a code.
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  19. 19

    Diabetes in the Third World.

    Johnson TO

    WORLD HEALTH. 1991 May-Jun; 8-10.

    Developing countries now feel the effects of chronic diseases such as diabetes mellitus. Its incidence is growing in these countries. Today >50 million people suffer from diabetes, almost 50% of whom live in developing countries. Public health specialists believe that for every person known to have diabetes in a developing country there is probably at least 1 other person with it that has not been counted. For every known diabetic, health workers have not yet diagnosed it in perhaps 4 other people. The proportion of diabetics in developing countries is increasing due to higher life expectancy, rural-urban migration, shifts from traditional to modern life styles, changes in diet and physical inactivity, and obesity. Every other Micronesian living on Nauru has diabetes--the highest recorded rates for diabetes. The severest form of diabetes (insulin dependent diabetes) seems to be somewhat rare in most developing countries, but it may be that many children with this form of diabetes die without ever being diagnosed. The noninsulin dependent diabetes predominates and its effects contribute greatly to premature deaths. In some developing countries, a rare form of diabetes has emerged called malnutrition related diabetes. Low literacy levels hinder diabetes education efforts. In developing countries, diabetics face discrimination. Competition with other health conditions often results in diabetic care and management being considered a low priority. The leading cause of death from diabetes is nonavailability of insulin. Developing countries should adopt a primary health care approach to prevention and management of diabetes similar to what they do for acute diseases. Health education for the individual, family, community, and policymakers; intersectoral cooperation; and nongovernmental organization participation are needed to affect change in diabetes prevention and control.
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  20. 20

    Rapid anthropologic assessment: applications to the measurement of maternal and child mortality, morbidity and health care.

    Scrimshaw SC

    [Unpublished] 1991. Presented at the International Union for the Scientific Study of Population [IUSSP] Committee on Population and Health and Cairo University Institute of Statistical Studies and Research, Center for Applied Demography Seminar on Measurement of Maternal and Child Mortality, Morbidity and Health Care: Interdisciplinary Approaches, Cairo, Egypt, November 4-7, 1991. 14 p.

    University Nations University (UNU) leaders requested rapid anthropological assessment procedures (RAP) guidelines in the early 1980s to examine health-seeking behavior in 16 developing countries. They were not content with the expense, time, and poor accuracy of standard survey techniques to study health care. UNU project researchers studies 42 communities in these countries. They used triangulation to assess the validity of their data and found the data to be accurate. RAP involves applied medical anthropologists and other social scientists with appropriate training to pass about 6 weeks in a community where a supposed effective primary health care (PHC) programs operates to learn the household and community perspective on PHC services. 6 weeks constitute a long time for health planners and policymakers, but for anthropologists this time period tends to be too. Yet the required time hinges on the amount and complexity of data needed. It is important that the anthropologists and/or other social scientists already know the language and the culture because they interview biomedical and indigenous health providers. RAP depends on limited objectives and on existing data and prior research. Research designers should modify the limited objectives or data collection guidelines to fit each culture and each project. RAP data collection techniques include formal and informal interviews, conversations, observation, participant observation, focus groups, and data collection from secondary sources. Indeed researchers should be able to adapt these various techniques during the project. Obstacles which RAP research designers must consider are: some anthropologists do not feel at ease with RAP; not all cultures are comfortable with an outsider coming into their community asking questions, thus highlighting the importance of using an anthropologist already known and trusted in the community; and the topic may not be appropriate for discussion in a community.
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  21. 21

    Comments on "International Development Perspectives for the 90s".

    Klein LR

    PAKISTAN DEVELOPMENT REVIEW. 1991 Winter; 30(4 Pt 1):493-6.

    Comments on the UN paper on the Development Decade of the 1980s and the next decade of the 1990s by Gamani Corea are presented. Corea's statements about the future are considered fair, but negative and lacking in quantitative input. As an econometrician and a quantitative economist, the author feels that the shortterm and mediumterm economic prospects are that 1988 was a good year, 1989 all right, and 1990 was recessionary for some countries. Recovery is anticipated by 1992. The Gulf crisis of 1990-91 caused fluctuations in energy prices and uncertainty or fear in people, which is hoped to be transitory and without major impact on economic matters. Positive expansion in the world economy after 1992 is anticipated, in spite of the recessions in the UK and some Nordic countries. Western Europe slowed, but the advent of the Single Market is favorable to an upswing. The Asia/Pacific arena is strong, and achievements in South Korea are considerable. Mexico, Venezuela, Colombia, and Chile are promising. Other economic problems in Latin America are only temporary. South Asia has done well. The Middle East and North Africa may have more lasting consequences of the Gulf war. Sub-Saharan Africa is in trouble with the race between population growth and food supplies, and negative or near zero growth rates/capita. Developing countries are experiencing severe recessionary adjustment periods in world economic malaise. With the collapse of socialism, there is no viable "Second World," and there are industrialized and developing countries. Eastern Europe and the USSR have a skilled population with the potential for producing world class goods and services. Primary commodity markets are expected to rise again which will strengthen export earnings in the developing world. Macroeconomic visions of hope are based on contingencies: financial fragility, issues related to the Gulf crisis, poor financial conditions in the US and to a certain extent in Japan and other financial centers. Trade negotiations in the Uruguay Round are in difficulty, which restricts free trade, and dilutes strong and vigorous activity which helps development. The economic restructuring of Europe is moving more slowly, but the Arms race is still extant in Third World countries such as Iraq. Price stabilization efforts may be futile attempts when underlying behavior patterns of production and consumption take over. Europe is the primary growth area. The Peace Dividend has been reduced because of Iraq's postures. South/South trade may be an option for developing countries. There is potential for expansion in e.g., and electronics, medical care, telecommunications, bioengineering, metallurgy, software construction. Technology and economics and international cooperation and coordination are hopeful prospects for the future.
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  22. 22

    Comments on "International Development Perspectives for the 90s".

    Papanek GF

    PAKISTAN DEVELOPMENT REVIEW. 1991 Winter; 30(4 Pt 1):497-501.

    Papanek's responses to the Gamani Corea paper on UN strategy for the 1990s in international development are presented. Corea's paper is considered as an evolution of thinking about development economies. Over 40 years, some issues have faded and others have taken prominence, and some issues have been ignored even though of considerable importance to development. 4 areas are identified for discussion: 1) the changing role of planning, and the market, poverty, and the environment; 2) north/south issues; 3) major changes in the world economic system; and 4) the world economic environment and the role of domestic policies. The greatest change has occurred in the emphasis on environmental consequences of development in contrast to past concerns with achieving a high rate of growth with some attention to land tenure issues. There is also an emphasis on the private sector and foreign private investment. Planning has taken a recessive role. Income distribution and poverty alleviation is also of concern. Although government intervention is no longer fashionable, it is not clear what provisions there are in the market for assuring that the poor have a reasonable share of the growth. The north/south issues are discussed in terms of the limited bargaining power of developing countries. Contributing factors are the multiplicity of objectives desired simultaneously. The UN resolutions on development strategy do not always reflect developing country's objectives. Suggestions are made to bargain 1) on objectives crucial to many developing countries, 2) on objectives that generate the least resistance among the industrialized countries, and 3) on those objectives where there is reasonable consensus on what needs to be done. Major changes in the world economic system that are not included in UN strategy but will affect policy are: 1) US leadership has declined as the principal supplier of capital; 2) US absorption of world exports is shrinking; 3) the peace dividend will insure stability if not an increase in transfers; 4) increased competition for markets and private investment will come from Eastern Europe and the Soviet Union; and 5) a response needs to be made to technology changes in the US, Japan, an Europe in order to stay competitive. There is recognition that countries shape their own destiny and can be successful with the appropriate policy mix.
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  23. 23

    News about AIDS.

    WORLD HEALTH FORUM. 1991; 12(4):496-7.

    WHO estimates that the number of AIDS cases worldwide will grow from about 1.5 million to 12-18 million by 2000--a 10 fold increase. Further it expects the cumulative number of HIV infected individuals to increase from 9-11 million to 30-40 million by 2000--a 3-4 fold increase. Dr. Hiroshi Nakajima, the Director-General of WHO, points out that despite the rise in AIDS, there is something for which to be thankful--neither air, nor water, nor insects disseminate HIV and causal social contact does not transmit it. Further since AIDS is basically a sexually transmitted disease, health education can inform people of the need to make life style changes which in turn prevents its spread. In addition, Dr. Nakajima illustrates how frank health education and information campaigns in the homosexual community in developed countries have resulted in reduced infection rates. In fact, many of the people disseminating the safer sex message in the homosexual community were people living with HIV and AIDS. HIV has infected >7 million adults and children in Sub-Saharan Africa since the AIDS pandemic began. It is now spreading quickly in south and southeast Asia where at least 1 million people carry HIV. In fact, WHO believes that by the mid to late 1990s HIV will infect more Asians than Africans. Further Latin America is not HIV free and it can be easily spread there too. Heterosexual intercourse has replaced homosexual intercourse and needle sharing by intravenous drug users as the leading route of HIV transmission.
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  24. 24

    Renewed mobilization against malaria.

    WORLD HEALTH FORUM. 1991; 12(4):495.

    >1 million people die in the world from malaria annually, 800,000 of whom are <5 year old children in Sub-Sahara Africa. Further it affects 270 million people. In fact, >110 million develop malaria, 90 million of whom are from Sub-Saharan Africa. Thus WHO has introduced a new world initiative for malaria control to reverse the worsening trend that began in the mid 1970s. In October 1991, 150 officials from 50 African, Asian, and Latin American countries and participants from UN cooperation and development agencies and bilateral agencies attended an interregional conference at the WHO Regional office for Africa in Brazzaville, Congo. It strove to evaluate malaria situations specific to Africa, to update the malaria control plan in Africa, and to contribute to the development of an implementable world strategy. This world strategy needs to consider the local situation and encourage participation of the government and people of affected countries. Further individuals, communities, and various sectors of the national economy including those involved in health, education, development, and agriculture need to participate in malaria control. In addition, for this strategy to work, most countries must strengthen the management and financing of health services to meet their needs. For example, local populations must share local operating costs such as those for essential drugs and mosquito control operations. Community participation must also include personal protection such as impregnated bed nets and environmental measures. Besides malaria control must be integrated into the existing health system at country, provincial, and peripheral levels. In sum, improved case management, control of malaria transmission, and prevention and control of epidemics form the basis for the new strategy.
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  25. 25

    A strategy for reducing numbers? Response.

    Rohde JE

    HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):24-5.

    While there may be no documented evidence that mortality decline is a causative factor in demographic transition, there is a close association between reductions in mortality and fertility. The Indian experience of more than 40 years shows that consistent efforts in the promotion of family planning will be rewarded with demographic transition. In the Indian state of Kerala, population 30 million, improving child survival, female literacy, strict child labor laws, and effective high coverage primary health care reduced mortality and fertility. Its infant mortality rate is 22/100 births, which is 25% of the national average. Its birth rate is 20/1000 and is continuing to fall. In the past decade population growth was only 14% compared to 25% nationally and 28% in the northern states. If Kerala's figures were applied to all of India, there would be 2 million less infant deaths and 8 million less births. The impact of reducing infant mortality on population growth in raw numbers in insignificant. With a mortality rate of 150/1000 there are 850 survivors. If the mortality rate is cut in half there will be only a .18% increase in population, but with a 50% reduction in infant suffering and death. Historically such mortality declines are associated with a 25% or more decline in fertility. This is the reason that UNICEF has been a long-time advocate of child survival programs as an integral part of population control measures. Euthanasia is surely not the solution to the population problem. The daily loss of 40,000 childhood lives is a tragic part of the human experience. However, helping these children to become and stay healthy is the best method of reducing population.
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