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  1. 1

    The partograph -- use it!

    MCH News. 1996 May; (2):6-7.

    Prolonged and obstructed labour are important causes of both maternal and perinatal morbidity and mortality. In the early 1970s, Hugh Philpot designed and developed the partograph in Zimbabwe to help prevent such problems and adverse outcomes during the active management of labour. He showed that the partograph helped to reduce prolonged labour, caesarian sections, labour augmentation and perinatal deaths. Anecdotal reports also mentioned of how the partograph made the occurrence of ruptured uteri much rarer, and implied that it had contributed to a reduction in maternal mortality. Anyone with experience of working in deprived areas where maternal care is predominantly managed by poorly supported midwives, and where the expertise for doing an emergency hysterectomy is limited or non-existent, will testify to the great value of the partogram. And yet, more than twenty years since its development, the partogram is still infrequently and inconsistently used in this country (both in rural and urban areas). (excerpt)
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  2. 2

    Hepatitis B and breastfeeding.

    World Health Organization [WHO]. Global Programme for Vaccines and Immunization; World Health Organization [WHO]. Division of Child Health and Development; World Health Organization [WHO]. Division of Reproductive Health (Technical Support)

    Geneva, Switzerland, WHO, Division of Child Health and Development, 1996 Nov. [4] p. (Update No. 22)

    The question of whether breastfeeding plays a significant role in the transmission of hepatitis B has been asked for many years. It is important given the critical role of breastfeeding and the fact that about 5% of mothers worldwide are chronic hepatitis B virus (HBV) carriers. Examination of relevant studies indicates that there is no evidence that breastfeeding poses any additional risk to infants of HBV carrier mothers. The use of hepatitis B vaccine in infant immunization programmes, recommended by WHO and now implemented in 80 countries, is a further development that will eventually eliminate risk of transmission. This document discusses the issues relevant to breastfeeding and HBV transmission, and provides guidance from a WHO perspective. (excerpt)
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  3. 3

    AIDS deaths may exceed 100,000 per year in Uganda over the next 25 years.

    Hollander D

    International Family Planning Perspectives. 1996 Jun; 22(2):87-8.

    The World Bank began a study in 1990 to assess the demographic and economic impact of AIDS in Uganda. It determined that as of 1993, an estimated 15% of Uganda's adult population, 1.3 million people, was infected with HIV. The annual number of AIDS-related deaths has been climbing steadily and is not likely to peak until early in the next century. AIDS deaths may exceed 100,000 per year in Uganda over the next 25 years. The epidemic has also increased child mortality rates and decreased life expectancy at birth. These findings are based upon data from a variety of sources, including a 1987-88 serological survey, the 1991 census, the national AIDS control program, and numerous small-scale studies of HIV infection. The researchers based fertility and mortality estimates upon data from the 1988-89 Demographic and Health Survey. Current HIV and AIDS prevalence, projected prevalence, demographic implications, and recommendations are presented.
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  4. 4
    Peer Reviewed

    Regulatory actions to enhance appropriate drug use: the case of antidiarrhoeal drugs.

    Haak H; Claeson ME

    Social Science and Medicine. 1996 Apr; 42(7):1011-9.

    Inappropriate drug use is a major problem in the control of diarrheal diseases. Addressing the problem, the World Health Organization's (WHO) Program for the Control of Diarrheal Diseases reviewed the literature on the most commonly used antidiarrheal agents, and distributed the resulting document widely in 1990. Individual and group campaigns against the registration and use of antidiarrheal drugs also brought considerable attention to the issue in the popular media. This article evaluates the actions taken against antidiarrheal drugs by national drug regulators during and after these events, January 1989 through December 1993. Information on regulatory actions was requested from countries and extracted from published and unpublished sources. 16 countries reported regulatory actions on 21 occasions during the period of study, with the majority of actions taken against antimotility drugs. Few were against adsorbents, antidiarrheal drugs containing antimicrobials, or adult formulae. Six countries took action against large and heterogenous groups of antidiarrheal drugs, with most actions occurring within two years of the distribution of the WHO review and the attention in the media. Many more antidiarrheal drugs may lose their register in the future through a passive deregistration process. The deregistration of inappropriate drugs, however, will probably take quite a while, with widespread deregistrations unlikely. Moreover, regulatory actions alone are probably not enough to achieve a more appropriate use of drugs. Greater effect can be expected from simultaneous regulatory, managerial, and educational interventions directed at providers, combined with communication to the general public.
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  5. 5
    Peer Reviewed

    Efficacy of a single oral dose of 200,000 iu of oil-soluble vitamin A in measles-associated morbidity.

    Rosales FJ; Kjolhede C; Goodman S

    AMERICAN JOURNAL OF EPIDEMIOLOGY. 1996 Mar 1; 143(5):413-22.

    In 1991, in Ndola, Zambia, staff at urban health centers randomly allocated children with acute measles who did not require hospitalization to receive either a single oral dose of 200,000 IU of oil-soluble vitamin A (90 children) or a placebo (110 children). (A single oral administration of vitamin A at this dose is recommended by the World Health Organization [WHO]). This double-blind placebo-controlled clinical study aimed to determine whether or not a single oral dose of vitamin A would minimize measles-associated morbidity in children who do not require hospitalization. The cross-sectional analysis revealed that at week 4 the vitamin A group was more likely than the placebo group to have no symptoms of acute respiratory infection (ARI) (93% vs. 78%) and less likely to have pneumonia (0 vs. 12%) (p = 0.005). It did not find any significant association prior to week 4, however. None of the three longitudinal analyses found vitamin A to have a significant benefit on morbidity. These analyses considered the effect of treatment on the movement of individual patients between ARI health states. The odds ratio for pneumonia in children with measles-associated cough and for measles-associated cough or pneumonia in asymptomatic measles patients suggested that vitamin A minimized morbidity (0.73 and 0.52, respectively). Yet vitamin A failed to improve pneumonia (odds ratio = 1.23, in favor of placebo). These findings suggest that a single oral dose of 200,000 IU of oil-soluble vitamin A is not as effective at preventing measles complications as that indicated earlier for two 200,000 IU doses of water-miscible vitamin A. Thus, the WHO recommendations need to be reconsidered.
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  6. 6

    Malawi wakes up to harsh AIDS reality.

    AIDS ANALYSIS AFRICA. 1996 Feb; 6(1):1.

    Considerable data on AIDS in Malawi are available at the local level, but much of the information long languished instead of being formally collected and put together to provide an overall picture of the epidemic in the country. A World Health Organization (WHO) epidemiologist, however, has completed the first comprehensive, nationwide survey of HIV prevalence rates in Malawi. 1.6 million of Malawi's 11 million population are infected with HIV, making it one of countries in Africa worst affected by the epidemic. In 1995 alone, there were an estimated 265,000 new HIV cases and 74,900 deaths from AIDS. There are also fears about the safety of the blood supply. The WHO survey suggests that three of the country's 62 hospitals are not testing blood for HIV. Moreover, the effectiveness of the system is undermined by the widespread carelessness and dishonesty of overworked technicians who conduct the tests. While the reasons are many and complex for the spread of HIV, it seems that the policies of former President Hastings Kamuzu Banda were a contributory factor. President Banda's neglect of grassroots health care, especially in rural areas, and his refusal to allow public debate on the disease no doubt fueled the spread of HIV in Malawi. Traditional sex practices also probably play a role. For example, in some ethnic groups, young teenage girls are sexually initiated by men specially chosen for their physical prowess. Any one of these men who happens to be HIV-seropositive and has sex with many of these young girls may pass the virus on to many other people.
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