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  1. 1

    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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  2. 2

    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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  3. 3

    1991 ESCAP population data sheet.

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

    Bangkok, Thailand, ESCAP, Population Division, 1991. [1] p.

    The 1991 Population Data Sheet produced by the UN Economic and social Commission for Asia and the Pacific (ESCAP) provides a large chart by country and region for Asia and the Pacific for the following variables: mid-1991 population, average annual growth rate, crude birth rate, crude death rate, total fertility rate, infant mortality rate, male life expectancy at birth, female life expectancy at birth, % aged 0-14 years, % aged 65 and over, dependency ratios, density, % urban, and population projection at 2010. 3 charts also display urban and rural population trends between 1980 and 2025, the crude birth and death rates and rate of natural increase by region, and dependency ratios for 27 countries.
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  4. 4

    India Population Projects in Karnataka.

    Reddy PH; Badari VS

    POPULATION RESEARCH ABSTRACT. 1991 Dec; 2(2):3-11.

    An overview, objectives, implementation, and research and evaluation studies of 2 India Population Projects in Karnataka are presented. The India Population Project I (IPP-I) was conducted in Karnataka and Uttar Pradesh. India Population Project III (IPP-III) took place between 1984-92 in 6 districts of Karnataka: Belgaum, Bijapur, Dharwad, Bidar, Gulbarga, and Raichur, and 4 districts in Kerala. The 6 districts in Karnataka accounted for 36% (13.2 million) of the total national population. The project cost was Rs. 713.1 million which was shared by the World Bank, and the Indian national and regional government. Due to poor past performance, these projects were undertaken to improve health and family welfare status. Specific project objectives are outlined. IPP-I included an urban component, and optimal Government of India program, and an intensive rural initiative. The urban program aimed to improved pre- and postnatal services and facilities, and the family planning (FP) in Bangalore city. The rural program was primarily to provide auxiliary nurse-midwives and hospitals and clinics, and also supplemental feeding program for pregnant and nursing mothers and children up to 2 years. The government program provided FP staff and facilities. IPP-I had 3 units to oversee building construction, to recruit staff and provide supplies and equipment, and to establish a Population Center. IPP-III was concerned with service delivery; information, education, and communication efforts (IEC) and population education; research and evaluation; and project management. Both projects contributed significantly to improving the infrastructure. A brief account of the types and kinds of studies undertaken is given. Studies were grouped into longitudinal studies of fertility, mortality, and FP; management information and evaluation systems for health and family welfare programs; experimental strategies; and other studies. Research and evaluation studies in IPP-III encompassed studies in gaps in knowledge, skills, and practice of health and FP personnel; baseline and endline surveys; and operational evaluation of the management information and evaluation system; factors affecting primary health care in Gulbarga district; evaluation of radio health lessons and the impact of the Kalyana Matha Program; and studies of vaccination and child survival and maternal mortality. Training programs were also undertaken.
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  5. 5

    Using 30-cluster survey to assess neonatal and perinatal mortality [letter]

    Aras R; Velhal G; Pai N; Naik V

    WORLD HEALTH FORUM. 1991; 12(4):449-50.

    Staff at the Shivajinagar Urban Health Centre in Deonar (population 250,000) near Bombay, India conducted a cluster survey in 30 sectors of the slum using the WHO methodology for evaluating immunization coverage to measure neonatal and perinatal mortality among births that occurred between November 1986-April 1988. They gathered information on 54 births for the case group and 9 controls from each cluster. 1610 live births and 19 stillbirths occurred in the study period. There were 27.6 perinatal deaths for every 1000 total births (standard error=1.108). Neonatal deaths equalled 28.6/1000 live births (standard error-1.126). Confidence intervals for perinatal mortality rate and neonatal mortality rate were 25.39-29.82 and 26.35-30.85 and significant (p<.05). 26.4% of births occurred at home. Untrained women attended 84.6% of these deliveries. The remaining births occurred at the municipal general hospital or at a municipal maternity home. 60% of the fetal deaths were females. 77% of the 26 early neonatal deaths were males, but the male female ratio of deaths after 7 days was the same. The leading causes of neonatal mortality were prematurity and low birth weight. Other causes included congenital malformations and neonatal tetanus. Obstructed labor resulted in fetal death in 40% of stillbirths. The researchers at the Shivajinagar Urban Health Centre in Deonar, India concluded that the 30-cluster survey technique was effective in measuring perinatal and neonatal mortality in a community with >50,000 people in a developing country.
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  6. 6

    World urbanization prospects 1990. Estimates and projections of urban and rural populations and of urban agglomerations.

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

    New York, New York, United Nations, 1991. viii, 223 p. (ST/ESA/SER.A/121)

    This statistical compendium provides revised UN estimates and projections of urban and rural population and urban agglomerations (UAs) for countries, regions, and major areas in the world. Less developed and more developed regions have data on the size and diversity of the urban population, urban and rural growth rates, and the rate of urbanization. The 10 largest UAs (Mexico City, tokyo, Sao Paulo, New York, Shanghai, Los Angeles, Calcutta, Buenos Aires, Bombay, and Seoul in ranked order from high to low in 1990) are discussed in terms of population and rate of change with 8 million or more people as well as % population in UAs. Sources of data by country and data access information are identified. Tables include % of population living in urban areas and urban population, in less developed regions, and in urban areas in Asia for 1990, 2000, and 2025. Also included are data on the annual urban population increase in Latin America, between 1975-90, 1990-2000, and 2000-25; and countries with 75% or greater urban population. The 10 largest UAs are ranked by size decennially 1950-2000, and regional distribution of UAs with 5 million and 8 million or more people. UAs with 8 million or more people are ranked by size decennially 1950-2000 and include average annual rate of change. % of the urban population living in UAs is given by city and region decennially 1950-2000. Tables on the distribution of the population among urban and rural areas by major area, region, and country, every 5 years between 1950-2025, as well as the growth rates and the average annual rate of change urban or rural are also included. The world's 30 largest UAs are ranked by population size decennially 1950-2000. Population and average annual rate of change of UAs of >1 million by country, every 5 years 1950-2000, and the % of the total population residing in UAs, followed by population of capital cities for 1990 are given. Figures show various dimensions of growth rate and mega-city growth rates. The overview is that at mid-1990 45% (2.4 billion) lived in urban areas with 37% in less developed and 735 in more developed areas, with projected increases to 51% in 2000.
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  7. 7

    Tackling Africa's slums.

    Egunjobi L

    WORLD HEALTH. 1991 Mar-Apr; 14-5.

    Less developed countries are undergoing rapid, unplanned, and uncontrolled urbanization at the expense of their populations' health. Physical expansion of cities has outpaced the abilities of city planners and management and has contributed to the spread of tuberculosis, pneumonia, influenza, threadworm, cholera, dysentery, and other diarrheal diseases. Overcrowding, lack of access roads, dangerous roads, drinking water scarcity, frequently collapsing buildings, uncollected garbage, lack of sewers, inadequate air space, and houses littered with human feces are common conditions contributing to high mortality rates especially among children. In this context, the World Health Organization's Environmental Health in Rural and Urban Development Program, which is designed to promote awareness about the association between health and planning, is noted. Guidelines for change are also a component of the program, and are encouraged for adoption by planners of less developed countries, especially Africa. Urban rehabilitation and upgrading are recommended in the guidelines while maintaining central focus upon promoting the population's health. While examples of rampant urbanization are drawn primarily from Nigeria, ancient Greek and Roman societies as well as the UK are mentioned in the context of urban planning with a view to health.
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  8. 8

    The present is appalling, the future bleak.

    Maxwell RJ

    WORLD HEALTH. 1991 Mar-Apr; 11-3.

    The World Health Organization primary health care (PHC) strategy's longstanding emphasis upon improving rural health at the expense of urban health improvement is noted and international health experts' preoccupations with and skills in infectious diseases are considered as much of the underlying cause of neglect. While the health of both rural and urban populations are interdependent, greater attention needs to be focused upon PHC in urban areas. Urban areas are growing faster than rural areas, with urban growth rates 4 times greater than rural growth rates in the developing world. The poorest of the poor, dispersed, mobile, and invisible, are at great risk, and often do not appear in official health statistics. Urban health statistics typically describe averages instead of the extremes faced by these groups. Concentrated in cities, medical and other health care resources fail to reach and help the poor. The poor face both the urban problems of environmental pollution, violence, sexually transmitted diseases, and cardiovascular diseases as well as the rural problems of malnutrition and infectious disease. PHC initiatives should be supported and accepted by health institutions and authorities, incorporating strong community focus and involvement. Intersectoral participation and monitoring are also needed to properly effect low cost, effective technologies designed to help populations help themselves.
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  9. 9

    Different strategies for different situations.

    Trigg P

    WORLD HEALTH. 1991 Sep-Oct; 10-2.

    The number of malaria cases is rising very rapidly in undeveloped, politically, and economically unstable areas. The magnitude of malaria varies within these prone areas, however. There are several species of anopheles mosquito that transmit different malaria species to a variety of human populations in different climates and physical environments. So no single prevention and control strategy works for all situations. Different strategies include at least 1 of the following control measures: early diagnosis and early treatment, impregnated bednets, close surveillance, insecticide spraying, developing health services, and personal protection measures. Malaria specialists have recommended different control strategies depending on the malaria situation. They have identified 8 such situations: African savanna malaria, desert fringe and highland fringe malaria, malaria associated with traditional agriculture in plains and river valleys outside Africa, forest related malaria, malaria associated with extensive agricultural development, urban malaria and malaria in planned human settlements, coastal and marshlands malaria, and malaria in war zones and areas with sociopolitical disturbances. African savanna malaria represents the most serious situation since it occurs in Sub-Saharan Africa where 80% of malaria cases in the world and 90% of malaria mortality cases occur. It also has highly efficient mosquitoes which transmit malaria to almost everyone early in life. In terms of agricultural development, the crops most associated with malaria are rice, sugar cane, and bananas because of irrigation and cotton because of seasonal labor and massive use of insecticides. The health community does have the technical means to bring about a substantial fall in the effect of malaria, all that is needed is political will, well-managed resources, malaria specialists, health workers, and active community participation.
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  10. 10

    Fertility-related, husband wife communication in Zimbabwe: an indicative qualitative analysis.

    Makomva R; Falala S; Johnston T

    In: African research studies in population information, education and communication, compiled and edited by Tony Johnston, Aart de Zeeuw, and Waithira Gikonyo. Nairobi, Kenya, United Nations Population Fund [UNFPA], 1991. 1-12.

    40 couples participated in separate focus group discussions each with 10 single sex individuals either in the city of Harare, Zimbabwe or at a rural center. Researchers also conducted indepth interviews with 25 couples. The wanted to examine husband-wife communication concerning fertility management. Only younger married women, especially those in Harare, included family planning issues as topics of occasional communication. Urban young married women tended to be more educated than older and rural women. Older rural women tended to avoid discussions concerning marital interpersonal relationships. Men believed that women had much opportunity to talk and to make decisions about family welfare such as household management and child care. Yet women did not feel that they had the opportunity to discuss issues. In fact, they believed that the men made fertility decisions while the men believed these decisions were mainly up to the women. Some men did mention, like urban young married women, that ideally these decisions should be made jointly, however. Men were uncomfortable talking to the researchers about fertility management decisions. Both men and women were reluctant to discuss who initiates discussions on family planning. Basically women do not because they are afraid and men only initiate discussion when things go wrong. Women did have a tendency to use inference or indirect inference to initiate family planning discussions. For example, the neighbors' children have new school uniforms actually means they have a small family and can afford them. Women also used repetitional offhand reminders and bargaining or negotiating position. Men's fear that the male command structure within the family (the status quo) will not be maintained and women's fear that making fertility management decisions would threaten their marriage were barriers to husband-wife communication concerning family planning.
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  11. 11

    Economic and social aspects of population ageing in Argentina.

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

    New York, New York, United Nations, 1991. x, 58 p. (ST/ESA/SER.R/113)

    With approximately 12% of its 1980 population over age 60, Argentina's elderly constitute a higher-than-average proportion of the total population when compared to other developing countries. Governments are increasingly assuming greater responsibility for the care and support of the elderly. Accordingly, this paper describes the social and economic aspects of population ageing in Argentina, with the aim of providing planners with a better understanding of the social and economic implications of these demographic changes. Better understanding should result in the development of appropriate plans and policies targeted to the elderly. While the ageing process in Argentina is comparatively advanced when compared to other developing countries, ageing presently proceeds at a slower pace when compared to past trends. Slow ageing is also projected into the future. The elderly, themselves, have been ageing, and tend to live to a greater extent in urban areas. Elderly women when compared to men are more likely to live alone and in urban settings. Despite a stagnating economy, social gains and improvements in living conditions for the elderly have been largely sustained. The working-age population grew more slowly, however, over recent decades than the total population. The number of retirement system beneficiaries also grew over the period, with retirement benefits reported as the leading sources of income among the elderly. The health care system remains strained by the country's present economic situation, with care failing to reach all of the elderly. Wide societal agreement exists that the family should be a major care provider. With more than 1/2 of all persons aged 65 and over living in extended or mixed households, the family plans an important care and support function.
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  12. 12

    USAID steps up anti-AIDS program.

    USAID HIGHLIGHTS. 1991 Fall; 8(3):1-4.

    This article considers the epidemic proportion of AIDS in developing countries, and discusses the U.S. Agency for International Development's (USAID) reworked and intensified strategy for HIV infection and AIDS prevention and control over the next 5 years. Developing and launching over 650 HIV and AIDS activities in 74 developing countries since 1986, USAID is the world's largest supporter of anti-AIDS programs. Over $91 million in bilateral assistance for HIV and AIDS prevention and control have been committed. USAID has also been the largest supporter of the World Health Organization's Global Program on AIDS since 1986. Interventions have included training peer educators, working to change the norms of sex behavior, and condom promotion. Recognizing that the developing world will increasingly account for an ever larger share of the world's HIV-infected population, USAID announced an intensified program of estimated investment increasing to approximately $400 million over a 5-year period. Strategy include funding for long-term, intensive interventions in 10-15 priority countries, emphasizing the treatment of other sexually transmitted diseases which facilitate the spread of HIV, making AIDS-related policy dialogue an explicit component of the Agency's AIDS program, and augmenting funding to community-based programs aimed at reducing high-risk sexual behaviors. The effect of AIDS upon child survival, adult mortality, urban populations, and socioeconomic development in developing countries is discussed. Program examples are also presented.
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  13. 13

    AIDS in India: constructive chaos?

    Chatterjee A

    HEALTH FOR THE MILLIONS. 1991 Aug; 17(4):20-3.

    Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
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