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  1. 26

    Prevention of micronutrient deficiencies: tools for policymakers and public health workers.

    Howson CP; Kennedy ET; Horwitz A

    Washington, D.C., National Academy Press, 1998. xii, 207 p.

    Globally, micronutrient malnutrition affects approximately 2 billion people and carries adverse sequelae of premature death, poor health, blindness, growth stunting, mental retardation, learning disabilities, and low work capacity. In late 1980s, the US Agency for International Development (USAID) funded a randomized trial of vitamin A supplementation in developing countries. In this regard, the Office of Health and Nutrition of USAID has requested the Institute of Medicine's Board on International Health to evaluate global micronutrient deficiency prevention programs conducted in developing countries. The project was conducted in two phases. The first phase featured a 2-day workshop evaluating approaches to the prevention of micronutrient malnutrition and identified the elements that led to the programs' success. This book presents the findings of the workshop, which will provide the basis of the Phase 2 study. Chapter 1 summarizes the findings and recommendations of the workshop. Chapter 2 discusses key elements in the design and implementation of micronutrient interventions. Chapters 3-5 present the three background papers on iron, vitamin A, and iodine. The appendix contains the workshop study.
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  2. 27

    [L'Oreal aids women in science in the countries of the South] L'Oreal aide la science au feminin dans les pays du Sud.

    de Sainte Lorette C

    EQUILIBRES ET POPULATIONS. 2001 Mar; (66):4.

    The L’Oreal Award for Women in Science rewards 5 scientists annually with UNESCO support. As such, L’Oreal, a cosmetics manufacturer, is making an effort to support women’s role in research in both developed and developing countries. Professor Adeyinda Gladys Falusi, a 2001 award recipient, describes the difficult conditions in which she has studied, for 25 years, the molecular genetics of often seen hereditary blood diseases in Nigeria, such as falci-form anemia. In Africa, and especially Nigeria, a lack of resources frustrates research. When resources are available, the equipment is old and poorly maintained. Energy and transport problems also exist, including frequent power outages. It is common for lights and computers to lose power in the middle of an experiment. Regarding information sources, research centers and universities lack funding to subscribe to scientific journals. Although many of her colleagues have gone to work in countries with better research conditions, Professor Falusi prefers to remain in Nigeria with hopes of having a more significant impact upon her society. She hopes her research will directly and significantly help populations. Professor Falusi visits schools to help prevent the diseases she researches, such as anemia, affecting 3 million people in Nigeria and associated with multiple complications. She also researches malaria. Falusi and her colleagues lack the resources and support they need to properly teach the population about its health and provide access to health services. They depend upon international aid, which should be more forthcoming.
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  3. 28
    Peer Reviewed

    Training health workers to assess anaemia with the WHO haemoglobin colour scale.

    Gosling R; Walraven G; Manneh F; Bailey R; Lewis SM

    Tropical Medicine and International Health. 2000 Mar; 5(3):214-21.

    The WHO recommends that all pregnant women be screened for anemia. In rural Africa this is often done by clinical examination which is known to have variable reliability. The recently developed WHO Haemoglobin Colour Scale may be the answer to this problem as it is simple and reliable. This study examines the training procedure recommended by WHO for the Haemoglobin Colour Scale when resources are very limited. The authors trained 7 laboratory technicians from the Medical Research Council Laboratories Hospitals, Fajara, The Gambia, and 13 Community Health Nurses (CHNs) from North Bank Division East, a rural area in The Gambia, to use the Haemoglobin Colour Scale. The CHNs used the Scale to estimate hemoglobins on all new bookings to antenatal clinics for a period of 1 month and recorded how they were managed. At the end of the study period they completed a qualitative questionnaire about the Scale. Both groups of trainees were successfully trained although the WHO protocol for training was impossible to follow due to resource limitations. 8 of the 13 trained CHNs used the Scale in practice and recorded 307 estimations with a mean hemoglobin of 9.1 g/dl. The results were normally distributed. 6 of the 9 patients with Hb readings of <4 g/dl were managed correctly. In response to the questionnaire the CHNs thought the Scale was cheap, easy and quick to use and as good as the hemoglobinometer they had used previously. The main criticism was that it was not robust enough. The development of a low-technology, cheap, simple, and reliable method for measuring hemoglobin is a welcome development. However, a simpler training procedure and a standard way of measuring observer performance are necessary. (author's)
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  4. 29
    Peer Reviewed

    Health-care camps for the poor provide mass sterilisation quota.

    Kumar S

    Lancet. 1999 Apr 10; 353(9160):1251.

    In Andhra Pradesh, India, women's groups have formed a Group Against Targeted Sterilization (GATS) to protest the creation of sterilization camps created by government officials in Hyderabad and Secunderabad, where 20,000 people, mostly women, were sterilized to meet a quota deadline. GATS charges that the women were offered incentives to undergo sterilization and that those who resisted were threatened with disconnection of their household utilities. GATS does not oppose family planning or female sterilization but opposes the dehumanizing use of incentives and threats. The impoverished women who are targeted for mass sterilization undergo the procedures in unhygienic settings. Many are anemic, which is a contraindication to any surgical procedure, and they receive no postoperative care. The targeted sterilizations were performed under the banner of the Indian Population Project (IPP), which is funded by the World Bank. GATS fears that the entire IPP will be diverted from the intention of its donor (the World Bank is committed to a target-free approach) and will become subservient to population control efforts.
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  5. 30

    Validation of outpatient IMCI guidelines.

    United States. Agency for International Development [USAID]. Child Health Research Project

    SYNOPSIS. 1998 Jan; (2):1-8.

    The World Health Organization (WHO)/UN Children's Fund (UNICEF) Integrated Management of Childhood Illness (IMCI) guidelines were designed to maximize detection and appropriate treatment of illnesses due to the most common causes of child mortality and morbidity in developing countries: pneumonia, diarrhea, malaria, measles, bacterial infections in young infants, malnutrition, anemia, and ear problems. The health worker first examines the child and checks immunization status, then classifies the child's illness and identifies the appropriate treatment based on a color-coded triage system. By May 1997, 17 countries had introduced IMCI and 16 others were in the process of introduction. This issue reports on field tests of the guidelines conducted in Kenya, the Gambia, Uganda, Bangladesh, and Tanzania. Health workers who used the guidelines performed well when compared to physicians who had access to laboratory and radiographic findings as well as health workers trained in full case management. Of concern, however, are research findings suggesting the potential for overdiagnosis in some disease classifications. Current IMCI research priorities include the following: 1) determining health workers' ability to learn to detect lower chest wall indrawing; 2) identifying clinical signs to increase the specificity of referral for severe pneumonia; 3) identifying other clinical signs to increase the specificity of hospital referrals, thereby reducing unnecessary referrals; 4) investigating how clinical care for severely ill children could be expanded in areas where referral is not feasible; 5) finding ways to increase the specificity of the diagnosis of malaria; and 6) recognizing clinical signs to increase the specificity of the diagnosis of severe anemia and the specificity of the diagnosis of moderate or mild anemia, with the possible goal of regional adaptation of the anemia guidelines.
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  6. 31
    Peer Reviewed

    Integrated management of childhood illness: conclusions. WHO Division of Child Health and Development.

    Gove S


    Studies have helped improve the guidelines for the integrated management of childhood illness (IMCI) as well as the WHO/UNICEF training course for teaching those guidelines to health workers in first-level health facilities. Those guidelines can lead to the appropriate management of sick children by health workers in first-level facilities. Field studies' results on the effectiveness of the guidelines are presented and important issues to address are identified. The paper also describes the process for adapting program guidelines to specific country situations and presents the broader IMCI strategy and the status of its implementation in several countries as of May 1997. The following issues in need of further attention are discussed: the performance of lower chest wall indrawing as a sign for referral, the specificity of the clinical signs of malaria in settings of low malaria prevalence, the performance of clinical signs in detecting anemia, and the performance of the guidelines in identifying children in need of referral. Program strategy objectives are to reduce the levels of child morbidity and mortality in developing countries, and to enhance child growth and development. IMCI activities are therefore organized to improve health workers' skills, health systems, and family and community practices.
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  7. 32
    Peer Reviewed

    Micronutrient malnutrition -- half of the world's population affected.

    INDIAN PEDIATRICS. 1997 Mar; 34(3):263-5.

    An estimated 6.6 million of the 12.2 million deaths that occur each year among children under 5 years of age in developing countries are associated with malnutrition. The World Health Organization, in collaboration with other United Nations agencies and nongovernmental organizations, has launched campaigns focused on protein-energy malnutrition, iodine deficiency disorders, vitamin A deficiency, and iron deficiency anemia. By January 1996, 96 countries had developed national plans of action for nutrition and an additional 41 had a plan under preparation. Various types of micronutrient malnutrition (especially iron deficiency) not only are important causes of disability in themselves, but also make the body less able to withstand infections and other sources of morbidity. Iron supplementation, salt iodization, and vitamin A supplementation--in addition to the production, distribution, and preparation of healthy foods--are essential to nutritional health.
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  8. 33

    Implementing the ICPD Plan of Action in Central Asian Republics and Kazakhstan (CARAK). Kyrgyzstan. Breast-feeding is best.

    Kushbakeeva A

    ENTRE NOUS. 1995 May; (28-29):11.

    The socioeconomic problems which began in Kyrgyzstan in 1990 have impacted on the health of the people living there. A major decline in income, living standards, and social security is reflected in the low fertility rate, high maternal and infant mortality, and shorter life expectancy. Tuberculosis, viral hepatitis, anemia, hypertrophy, and rachitis have become very common in young children. In order to remedy this situation, breast feeding has gained the importance of a national program. Other unresolved issues include the high neonatal mortality rate, and the increasing maternal mortality rate (from 76.4 per 100,000 live births in 1991 to 84.2 per 100,000 currently). There has been a functioning family planning service and a system of social patronage since 1989. In the latter system, a social worker takes charge of families at risk. One worker on average attends 30 families. The International Planned Parenthood Federation has financed 689 social patronage workers over the past year. International organizations have supported the supply of contraceptives through humanitarian aid. Because of this, the number of women accepting family planning is rising and the fertility rate is decreasing (from 28.2 per 1000 in 1991 to 26.9 in 1993).
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  9. 34

    Hookworm infection and anaemia: approaches to prevention and control.

    Pawlowski ZS; Schad GA; Stott GJ

    Geneva, Switzerland, World Health Organization [WHO], 1991. vi, 96 p.

    WHO published this manual on the prevention and control of hookworm infection and anemia primarily for community health workers. The manual addresses the epidemiology, diagnosis, and management of these conditions. Its annexes provide details of appropriate examination techniques for hookworm and hookworm anemia surveys and sample survey considerations. It emphasizes the importance of thorough population surveys. The worldwide prevalence of infection with Ancylostoma duodenale and Necator americanus is about 25%. It occurs predominantly in developing countries, where prevalence may be as high as 80% in some areas. It is a major cause of iron deficiency anemia. Its presence indicates deficiencies in sanitation and health education. Many persons, including public health officials, are not interested in national control of hookworm infection, probably because it induces low mortality and it is technically difficult to measure and quantify hookworm-related morbidity. Control of hookworm infection and hookworm-related anemia is uncomplicated and effective. It consists of health education, effective sanitation, and treatment with antihelminthics and iron supplements. The manual's seven chapters cover the following: hookworms infecting humans; clinical pathology of hookworm infection; hookworm infection as a cause of anemia; epidemiology of hookworm infection; principles of prevention and control; assessing the situation; and practical prevention and control.
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  10. 35

    Diagnosing and treating anaemia. Conclusion: what is recommended?

    MOTHERCARE MATTERS. 1993 Apr-May; 3(1-2):13-4.

    This paper presents some of the recommendations from a recent World Health Organization technical meeting examining issues involved in detecting and managing anemia at the community, health center, and hospital levels. A woman at the community level should be asked whether she feels tired or breathless after doing a normal day's work, whether she experienced more than a cup full of vaginal bleeding in the pregnancy, if she delivered a child in the preceding twelve months, whether the pregnant woman is a young primigravida, if she required a blood transfusion for her last pregnancy, and if she had problems delivering the placenta during the last pregnancy. Affirmative responses to one or more of these questions indicate that the woman may be anemic. The pallor of her conjunctiva, tongue, palms of hands, and nail beds should be examined. A woman with no high risk factor and who is not pale should receive a standard dose of iron and folate for one month, malaria chemoprophylaxis according to the local situation, and should be seen again in one month. If the woman's history shows risk factors or she looks pale, she should be given an higher dose of iron and folate for one month, malaria chemoprophylaxis according to the local situation, and antihelminth if hookworm is endemic to the area, and she should be referred to the health center for supervision. Advice should be given on diet. Iron rich foods should be eaten with some animal foods or fresh fruit or tuber staples. She should avoid tea or coffee with her meal. The standard and higher doses of iron and folate are presented, followed by recommendations for action at the health center and district hospital levels.
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