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  1. 101

    Materials development in Zambia: concept versus reality.

    Tafira LM

    In: Natural family planning: current knowledge and new strategies for the 1990s. Proceedings of a conference, Part II, Georgetown University, Washington, DC, December 10-14, 1990, edited by John T. Queenan, Victoria H. Jennings, Jeffrey M. Spieler, Helena von Hertzen. [Washington, D.C.], Georgetown University, Institute for International Studies in Natural Family Planning, [1991]. 52.

    The Family Life Movement of Zambia's (FLMZ) five-year demonstration program to provide natural family planning services was the first of its kind and scope in Africa. In the absence of available textbooks and picturesque volumes, FLMZ developed its own training materials over time as the practical needs of the trainers, trainees, and users became evident. The World Health Organization (WHO) Family Fertility Learning Resource Package was later introduced and adapted to meet local needs, with instructor training objectives based on the WHO package objectives and taught effectively with chalk and blackboard. Teachers in the field use very simple materials and do not need much in addition to anatomy charts and cardboard thermometers for instruction purposes. In the Zambian experience, however, imported, elaborate colored charts and teaching aids were considered inappropriate. Teacher involvement in evaluating the teaching aids lead to the creation of more acceptable and appropriate materials.
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  2. 102

    The development of the International Federation for Family Life Promotion training guide.

    Martin MC

    In: Natural family planning: current knowledge and new strategies for the 1990s. Proceedings of a conference, Part II, Georgetown University, Washington, DC, December 10-14, 1990, edited by John T. Queenan, Victoria H. Jennings, Jeffrey M. Spieler, Helena von Hertzen. [Washington, D.C.], Georgetown University, Institute for International Studies in Natural Family Planning, [1991]. 53-4.

    The Human Life Foundation and the US Department of Health and Human Services in collaboration with the International Federation for Family Life Promotion (IFFLP) in 1974 began developing a training guide in natural family planning (NFP). A task analysis of NFP programs and teachers in the US and Canada found that teachers need to have sufficient and accurate knowledge and skills in fertility awareness to effectively teach ovulation and symptothermal methods to couples. Teachers also need to provide follow-up services until couples reach autonomy. Training materials were therefore developed for NFP teachers including four modules of instructional guides with specific knowledge, attitude, and performance training objectives stated; eight objective, multiple-choice tests, with two versions for each module; and a rating scale to measure the required initial skill level for teaching NFP to client couples under supervision. Training objectives were revised after review by national and international NFP experts. Reliability of the multiple-choice tests proved to be 0.93-0.95 for all versions of each of the eight tests. Field testing of the modules with more than 200 NFP teachers in the US and Canada found the average score for each of the four modules to be 85%; a postinstructional mastery level of 90% was subsequently established as the passing score to become an NFP teacher in the US. Attitude scales were also developed and used primarily as an attitude/surfacing tool. In 1976, the US affiliate of the IFFLP formally revised and validated the objectives, and developed tests to measure their achievement. At the same time, the World Health Organization (WHO) used the same task-based, original objectives as a basis for developing the Family Fertility Learning Resource Package. The final version of the WHO package was field tested in five countries, published, and distributed by 1981. USAID-funded NFP demonstration programs were conducted in Zambia and Liberia over the period 1983-90 to study the use, methodology, and cost-effectiveness of establishing a national NFP service delivery system. The author points out that a number of the lessons learned by the IFFLP over the past 17 years can be applied universally: teacher evaluation is improved with valid, reliable, and objective testing tools; testing instruments must reflect the realities of the situation in which NFP is to be taught; evaluation must be integrated into the total training approach; and translation of technical evaluation tools requires precision and accuracy to maintain the discriminant functions of each item and overall test efficiency.
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  3. 103

    TTCS AIDS prevention project. Togolese Transporters against AIDS.

    Ott B

    [Unpublished] 1991 Apr 18. [2], 21, [3] p. (Concept Paper, CARE Togo)

    There were 2 AIDS cases in Togo in 1987, 39 in 1989, and 83 in 1990. Thus, the Togolese government created a National Committee for the Control of AIDS to devise strategies to control AIDS, control prices for materials and products used to fight AIDS, inform and educate the public, and implement all aspects of a national AIDS prevention plan. CARE Togo has proposed working with this Committee and with the truck and taxi drivers union to develop an AIDS IEC (information, education, and communication) program which will reduce the transmission of the disease by providing information on the severity of the disease, the means of transmission, and preventive measures. The 11,000 taxi and truck drivers in Togo and their 500,000 clientele as well as their families and friends comprise the target population. Specific activities of this program will be 1) to train selected taxi and truck drivers in the communication of AIDS prevention messages; 2) to assure a mechanism of social marketing of condoms in small bars, truck stops, gas stations, and taxi depots; and 3) to launch a media campaign against AIDS using messages painted on taxis and large trucks, billboards, stickers, and posters as well as television and newspaper advertisements. The time frame for this project is 18 months, and the estimated budget is US $113,950.
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  4. 104

    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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  5. 105

    Regional Resource Group on Safe Motherhood for Francophone African Countries. Safe Motherhood in Francophone Africa: a Review of Progress to Date, Abidjan, Cote d'Ivoire, September 10-12, 1991.

    Azefor M; Daly P; Leke R

    Washington, D.C., World Bank, 1991. 36 p. (Partnership for Safe Motherhood)

    The Regional Resource Group on Safe Motherhood for Francophone African Countries met in Abidjan, Cote d'Ivoire, in September 1991 to review the progress of safe motherhood programs in French speaking African countries. The World Bank continues to support the integration of safe motherhood efforts within existing health, population, nutrition, and other social sector programs. Participants reviewed the findings of the World Bank Survey on Safe Motherhood which included limited data on maternal morbidity, leading causes of maternal death, interconnectedness of women's health and status, and major obstacles to safe motherhood. These obstacles include lack of political commitment, limited national and local interest in reducing maternal deaths, inadequate maternal health services, and shortage of trained health personnel. The participants reached a consensus that safe motherhood interventions should meet four objectives: preventing unplanned pregnancy, managing unwanted pregnancy, reducing the likelihood of complications during pregnancy and labor, and improving the outcome of women developing such complications. Priority services should include family planning and management of abortions, essential services for safe pregnancies (prenatal, intrapartum, and postpartum care), and services for the management of obstetrical emergencies. The Resource Group agreed that each country needs to determine its own priorities and unique approach to achieving safe motherhood. The first step is a strong national political commitment for safe motherhood through the adoption of a national policy and strategy. The Group classified the countries into six different groups, the most advanced group being countries where a political commitment exists and the basic components of a maternal health care program are implemented through an integrated health service delivery system. The next meeting of the Group will be in Kigali, Rwanda, in 1992. The meeting's report has a case study of safe motherhood in Senegal.
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  6. 106

    Review of further developments in fields with which the Sub-Commission has been concerned. Study on traditional practices affecting the health of women and children. Final report.

    Warzazi HE

    [Unpublished] 1991 Jul 5. [2], 39 p. (E/CN.4/Sub.2/1991/6)

    In late 1990, representatives of the Sub-Commission on Prevention of Discrimination and Protection of Minorities of the UN Economic and Social Council's Commission on Human Rights went to Djibouti and the Sudan to explore steps the governments and women's groups are taking to eliminate traditional practices adversely affecting women and children, especially female circumcision. The missions allowed the consultants to examine the problem with women and groups directly affected by the practices and within their cultural contexts. In 1991, the Centre for Human Rights and the Government of Burkina Faso organized the first regional Seminar on Traditional Practices Affecting the Health of Women and Children which considered the effects of female genital mutilation, son preferences, and traditional delivery practices, and facilitated the exchange of information on these practices to fight and eliminate them. The UN reviewed reports from governments, nongovernmental organizations, and UN agencies on these traditional practices. All these activities led the UN to make various observations and recommendations. The degree of public awareness about the harmful effects of female circumcision, nutritional taboos, and delivery practices have improved significantly. Governments and organizations have neither studied nor dealt with son preference and its effects adequately. More African governments were willing to address the problems of traditional practices, e.g., legislation against these practices. The Centre for Human Rights, WHO, UNICEF, and UNESCO should work together more closely to effectively take action on traditional practices. The Centre needs a full time professional staff to gather information, write reports, organize seminars, distribute documents, and network with appropriate organizations. The Sub-Commission should continue to have traditional practices on the agenda to keep it in the fore. No less than two more regional seminars on the issue should take place in Africa to discuss it and increase public awareness.
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  7. 107

    Women's savings groups and contraceptive use under Save Program: final report.

    Barkat-e-Khuda; Hadi A; Barkat A

    Bethesda, Maryland, University Research Corporation, 1991 Apr. ix, 77, [20] p. (BAN-14; USAID Contract No. DPE-3030-C-00-5043-00; TvT No. BAN-SAS-04-10)

    Save the Children has a women's savings program (SAVE), which is an integral part of its comprehensive integrated rural development program. Women's savings groups were introduced in Bangladesh on an experimental basis in 1982. Over the years, these indigenous small groups have evolved from simple "savings" groups to dynamic forums to improve women's economic and social horizons and enable them to gain greater control over their lives and those of their children. An operations research study was undertaken, at a cost of US $35,874, to examine and document the impact of womens' savings groups on contraceptive use. The study was undertaken in 8 villages in Nasirnagar Upazila where SAVE programs were in operation: 5 villages where programs were initiated in 1982 (old villages) and 3 villages (new villages) where programs were begun in 1989. 2 comparison villages (without SAVE programs) were also selected at random from among the villages in the same geographic area. The experimental and comparison villages were similar in terms of household size, age, parity, and total fertility of the married women of reproductive age. The study employed a quasi-experimental design. Data were collected using a baseline survey and a mini-contraceptive prevalence survey conducted in both experimental and comparison villages as well as 2 rounds of individual and group interviews with selected savings group members and nonmembers in the experimental villages. Relevant cost data were obtained from SAVE/Dhaka. Selected variables from the SAVE project management information systems (PMIS) were also used for comparison with similar variables obtained in the baseline survey. Womens' savings groups, combined with family planning (FP) motivation, supplies, and services can be an effective strategy of raising contraceptive prevalence in rural Bangladesh. Contraceptive use, both ever and current, was higher in the experimental than in comparison villages and was higher in the old than in the new villages. Contraceptive use was higher among savings group members than among nonmembers, and contraceptive use was higher among the latter group than in the comparison villages, suggesting that the SAVE program helped raise contraceptive use among both members and nonmembers in the project villages. Current use at the baseline among members was 30.9 and 16.9% among members in old and new villages, respectively, and 7.3% in the comparison villages. Among nonmembers, current use was 17.9% in the old villages and 12.9% in the new villages. Current contraceptive use declined from 30.9 to 25.4% in the old villages over the life of the project. One of the main reasons reported for discontinuation was nonavailability of FP methods.
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  8. 108

    Guidelines for prevention of adverse outcomes of pregnancy due to syphilis.

    Hira SK

    [Unpublished] 1991. 13 p. (WHO/VDT/91.455)

    The epidemiology, determining factors, prevention, detection, treatment, and programmatic aspects of maternal and congenital syphilis are discussed. Syphilis can be an acute or chronic infection, but is entirely curable; yet, it is one of the most damaging of all STDs to the fetus. Prevalence in maternal serum ranges from about 0.03% in the UK to 13-16% in some African urban areas. The adverse effects of untreated maternal syphilis to the fetus include abortion, intrauterine death, prematurity, congenital syphilis, and tardive infection. The infant is at greater risk if his mother's syphilis infection is acute; he may escape infection if her syphilis is chronic. Common barriers to effective control of syphilis in developing countries are late prenatal care, lack of screening or treatment, and, especially, failure to find a new infection after earlier prenatal screening. To prevent syphilis in pregnancy, the most important program approaches are health education and promotion of prenatal screening, adequate treatment, partner tracing, and treatment. Both in developing and Westernized settings, it is highly cost-effective to screen and treat maternal syphilis. In developing countries, the VDRL or rapid plasma reagin (RPR) card tests are adequate for screening. Programs should include the management techniques of training, evaluation, regular reporting, quality control of testing, and surveillance of maternal syphilis rates. All these systems can be linked to HIV testing and surveillance programs.
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  9. 109

    Warren H. Lindner: the history of the Brundtland Commission and the origins of UNCED.

    Lerner SD

    In: Earth summit. Conversations with architects of an ecologically sustainable future, by Steve Lerner. Bolinas, California, Commonweal, 1991. 237-48.

    The former secretary of the Brundtland Commission, now the executive director of the Center for Our Common Future, presents a historical overview of the international environment efforts since the formation of the independent Brundtland Commission. The 21-member commission held public hearings in Brazil, Canada, China, Europe, Indonesia, Kenya, and the USSR to get the common people's perspective. In fact, the commission used their quotes in the report, Our Common Future. The members organized regional presentations of the report to nongovernmental organizations and to governments. The UN Conference on Environment and Development (UNCED) emerged from the debate, which occurred on the day of the 1987 stock market crash, so it did not get much media coverage. The Center for Our Common Future was created to promote the messages of the commission's report and to increase the dialogue on sustainable development. The Center has set up a global network of 160 working partners in 70 countries. A key message of the report is forging a path from confrontation to cooperation. We all must accept part of the responsibility of working toward sustainable development. Participants in a 1990 meeting in Vancouver agreed that the UNCED process needs broad participation. 26 issues are on the UNCED agenda, including water, toxics, biodiversity, biotechnology, land management, ocean management, and acid rain, which are too numerous to manage at the UNCED. A North/South issue is no longer relevant because we are a global community and we must cooperate. The only way the North is going to advance is if it considers its economic self-interest. Much of the world is waiting for the US to lead, but it is not budging. Many suggest that Europe take the lead, e.g., Norway's climate fund. Grass roots groups need to organize and empower themselves to effect change.
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  10. 110

    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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  11. 111

    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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  12. 112

    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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  13. 113

    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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  14. 114

    Jessica Tuchman Mathews: the case for reinventing technology to promote sustainable development.

    Lerner SD

    In: Earth summit. Conversations with architects of an ecologically sustainable future, by Steve Lerner. Bolinas, California, Commonweal, 1991. 25-38.

    The public debate on the environment leading to the 1992 Earth Summit in Brazil has been restricted to global climate change instead of global change. The Summit should be part of an ongoing process and not a framework convention followed by protocols. Separate conventions for biodiversity and deforestation are likely to emerge, even though one convention integrating both biodiversity and deforestation is needed. Many environmental and development issues overlap, suggesting a need for an international group to coordinate these issues. Negotiating separate conventions for the various issues is costly for developing countries. Rapid population growth contributes to environmental degradation, but no coordinated effort exists to reduce it. The US continues to not support the UN Population Fund which, along with threats of US boycotts and disapproval, curbs initiatives to reduce population. At present population and economic growth rates, an environmental disaster will likely happen in the early 2000s. Developing countries, which also contribute greatly to global warming, will not take actions if industrialized nations do not initiate reductions of greenhouse gases. Developed countries emit the most greenhouse gases, have been responsible for most past emissions, and have the means to initiate reductions. Of industrialized nations, the US stands alone in setting targets to reduce carbon dioxide. Unlike some European nations, the US does not have an energy policy. The US abandoned public transportation for the automobile while Europe has a strong public transportation system. The World Bank has improved greatly in addressing global environmental issues, but only 1% of its energy lending is for energy efficiency. The Bank knows that projects implemented by nongovernmental organizations are more successful than those implemented by governments, yet it continues to lend money to governments. Humans need to redesign existing linear systems to be like nature's circular systems in which by-products are starting products for another reaction.
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  15. 115

    [Child health in the states of Ceara, Rio Grande do Norte and Sergipe, Brazil: description of a methodology for community diagnosis] A saude das criancas dos estados do Ceara, Rio Grande do Norte e Sergipe, Brasil: descricao de uma metodologia para diagnosticos comunitarios.

    Victora CG; Barros FC; Tomasi E; Ferreira FS; MacAuliffe J; Silva AC; Andrade FM; Wilhelm L; Barca DV; Santana S

    Revista de Saude Publica / Journal of Public Health. 1991 Jun; 25(3):218-25.

    From 1987 to 1989, UNICEF collaborated with state and municipal health organs of the Brazilian states of Ceara (C), Rio Grande do Norte (R), and Sergipe (S) in order to realize a community diagnosis of maternal-child health care. The estimation of mortality required investigating women aged 15-49 visiting 8000 households, examining 4513 children <3 years old. In R and S, a sample of 1000 children <5 was used to estimate most common health problems. In these states, 1920 households were visited, and a questionnaire served for collection of demographic and socioeconomic data. Children were weighed, and a modified AHRTAG anthropometer served for measuring body length. About 1/4 to 1/3 of children were first-born. In C, 19.3% of children were seventh-born or higher, almost double the rate of the other 2 states. Income, literacy rate of parents, living conditions, and availability of running water indicators were much worse in C. 34.8% of the women in C had not received prenatal care; this figure was 15.7% in S an R, respectively. In C, only 24.3% of the mothers had received 6 or more prenatal care checkups vs. about 1/2 in the other states. Hospital deliveries reached 64.8% in C vs. almost 90% in the other states. In C, breast feeding was more prevalent: 83% were breast feeding for 1 month and 27.1% for 12 months. Malnutrition indicated by height and age was 27.6% in C vs. 16.1% in S and 14/2% in R. There was a clear association between family income and nutritional deficits of height/age and weight/age indicators. In C, malnutrition was higher in all income groups. Diarrhea incidence was 12% in C vs. 7.3% in S and 6/4% in R. A lower percentage used rehydration in C. 9.9% of children in C had been hospitalized in the previous 12 months vs. 6.2% in S and 6.9% in R. Coughing, fever and respiratory difficulties ran to 8.6% in C. Only 42.4% had full vaccination in C vs. 61.7% in S and 71.3% in R. 30/5% had been weighed in C in the previous 3 months vs. 45.1% in S and 44.2% in R.
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  16. 116

    [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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  17. 117
    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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  18. 118

    [WHO Special Programme of Research, Development and Research Training in Human Reproduction (HRP). A summary] WHO Special Programme of Research, Development and Research Training in Human Reproduction (HRP). Eine zusammenfassende Darstellung.

    Janisch CP; Schubert A


    The WHO's Special Program of Research, Development, and Research Training in Human Reproduction (HRP) has been involved in a global research and development program since 1972 in the are of human reproduction with special regard to the needs of developing countries. HRP set up a worldwide network of cooperating institutes and organized task forces for carrying out priority research objectives/assignments. The goals of HRP include reducing population growth in developing countries by improving health care and by increasing the availability of contraceptives. HRP training and research activities have encompassed workshops, seminars, and training courses. Research and development have been concerned with contraceptive prevalence and use; risks of contraceptives (carcinogenicity, cardiovascular effects, and subdermal implants' side effects); the development of new and safe methods (1-2 month depot preparations; and the levonorgestrel-releasing vaginal ring); and efficacy of contraceptive methods (lactation for birth spacing and natural family planning). A multicentric study in 25 countries has examined infertility caused by infections and sexually transmitted diseases. The extension of research capacity in developing countries was enabled by long-term institutional development grants, capital grants, labor cost financing, training of scientists, and improvement of management. The social and individual determinants of family planning aims at increasing contraceptive prevalence from 11% in Africa, 24% in Southeast Asia, and 43% in Latin America to the level of industrial countries 68%. The structure and management, goal setting and priorities, international cooperation, and finances of HRP are further detailed.
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  19. 119


    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, [1991]. v, 36 p. (Report)

    The former government of Romania sought to maintain existing population and accelerate population growth by restricting migration, increasing fertility, and reducing mortality. The provision and use of family planning (FP) were subject to restrictions and penalties beginning in 1986, the legal marriage age for females was lowered to 15 years, and incentives were provided to bolster fertility. These and other government policies have contributed to existing environmental pollution, poor housing, insufficient food, and major health problems in the country. To progress against population-related problems, Romania most urgently needs to gather reliable population and socioeconomic data for planning purposes, establish the ability to formulate population policy and undertake related activities, rehabilitate the health system and introduce modern FP methods, education health personnel and the public about FP methods, promote awareness of the need for population education, and establish that women's interests are served in government policy and action. These topics, recommendations, and the role of foreign assistance are discussed in turn.
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  20. 120

    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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  21. 121

    Dietary management of young children with acute diarrhoea: a manual for managers of health programmes. 2nd ed.

    Jelliffe DB; Jelliffe EF

    Geneva, Switzerland, World Health Organization, 1991. iii, 29 p.

    This WHO manual is appropriate for use by managers of health programs in controlling the dietary intake of young children with acute diarrhea. diarrhea is a major cause of malnutrition because of the low food intake during the illness, reduced nutrient absorption, and increased nutrient needs from the infection. Those most at risk are young infants 4-6 months old, who are not breastfed, and older infants and children (4-6 months to 2 years old). The introduction presents the causes of diarrhea, causes of malnutrition, and recent findings on nutrition in young children and mothers and on the digestion and absorption of nutrients during diarrhea. The selection of foods to be given during and after diarrhea is discussed in terms of the following variables which affect the choice of foods: age of the child, availability of foods, resources needed for food preparation, nutritional value of food, stage of illness, consistency of food, and frequency of feeding. The role that traditional beliefs and practices play in treatment is also mentioned as is the nature of the beliefs. Foods are classified as food and nonfood, appropriate and inappropriate foods, cultural superfood, special occasion foods, and foods related to ideas concerning physiology. Common treatments for diarrhea are starving the child for a short time; partial food restriction; continuation or restriction of breastfeeding; the feeding of certain foods, at certain times, and in specified amounts; the administration of herbal drinks and plant infusions; and the use of purgatives, emetics, or magical potions. It is important to collect information from several sources in communities and to gather data from discussions, written records, and observation. Methods to prevent diarrhea include following good feeding practices, washing hands after defecation, and keeping the children clean. Monitoring children on a growth chart to diagnose specific nutrient deficiencies, particularly of vitamin A and iron, helps in determining malnutrition. The multimix principle in introducing weaning foods is given, and a table provides a list of important nutrients as well as a list of foods rich in these nutrients. It is of particular importance during diarrhea to consume potassium-rich foods, carotene-rich foods, and milk and to avoid sweetened drinks.
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  22. 122

    Interview: Mr. Tevia Abrams, UNFPA Country Director for India.

    ASIA-PACIFIC POPIN BULLETIN. 1991 Dec; 3(4):10-2.

    The government of India set up a population program 25 years ago, yet the population is expected to surpass that of China in the near future. The current UN Population Fund (UNFPA) program for India covers the period 1991-95 with coordination, implementation, and evaluation. Improved services focus on states with high fertility and mortality, high infant mortality, self-reliance in contraceptive production, models for maternal health care and traditional health care, national communication strategy, public awareness enhancement, and raising women's status by female literacy expansion and employment generation. UNFPA trains, provides equipment and contraceptives, and nongovernmental organization participation. The bulk of the $90 million cost of the program will come from UNFPA: maternal-child health, family planning (FP), and information, education, and communication (IEC) will receive the most funding. Ethnic and tribal areas will get attention under a decentralized scheme in accordance with the concept of a multicultural society where early age at marriage and high economic value of children are realities. The Ministry is responsible for IEC and FP targets and allocation of funds. Government institutes and universities carry out population research. The creation of India POPIN patterned after the Asia-Pacific Population Information Network is under development under IEC activities. The status of women is varied throughout India, in the state of Kerala literacy reaches 100%, and the birth rate of 19.8%/1000 women is below the national average of 30.5. In contrast, the states of Bihar and Rajasthan with female literacy of 23% and 21%, respectively, have birth rates of 34.4% and 33.9%.
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  23. 123

    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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  24. 124

    Universal child immunization: goal attained.

    WORLD HEALTH FORUM. 1991; 12(4):493.

    The achievement of immunizing 80% of the world's children against 6 diseases was officially reported to the UN in New York on 8 October 1991 by WHO's Director-General, Dr. Hiroshi Nakajima, and UNICEF's Executive Director, Mr. James P. Grant. The lives of more than 3 million children are now saved each year through immunization against 6 preventable childhood diseases (poliomyelitis, measles, diphtheria, pertussis, tetanus, and tuberculosis). This celebration is proof of how much good can be done for children--for humankind--when the twin engines of political will and popular participation work together with advances in medicine and technology, said the UN Secretary-General, Mr. Javier Perez de Cuellar. Both Dr. Nakajima and Mr. Grant spoke of the massive mobilization at all levels of society that had gone into achieving the global target of 80% child immunization by the end of 1990, which was established by the World Health Assembly. "This tremendous achievement--resulting from the most massive international peacetime collaboration in history--is now preventing the deaths of some 3 million young children each year, and enabling many millions more to grow in better health and without disabilities, they said in their official certification statement. Dr. Nakajima noted the need to harness biotechnology to improve existing vaccines, so that they can be given earlier in life, with fewer doses, and without the need for a complex cold chain to preserve their potency. And above all, the new, improved vaccines should be made affordable. Mr. Grant described the achievement as "a world war worth fighting," using vaccines instead of bullets, where children had quietly emerged victorious. He stressed the need to press ahead with new goals--90% immunization coverage, the elimination of neonatal tetanus, the dramatic reduction of measles, and the eradication of poliomyelitis within this decade. (full text)
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  25. 125

    The United Nations on the social situation in Africa.

    United Nations. Secretary-General

    POPULATION AND DEVELOPMENT REVIEW. 1991 Dec; 17(4):749-51.

    The report of the Secretary General of the UN on the social and economic conditions in Africa notes the worsening of conditions during 1986-90. Declines were apparent in education, health, nutrition, employment, and income. Government spending on health declined from 6% in 1985 to 5% in 1990 and on education from 15% to 11%. School enrollment declined from 77% in 1980 to 72% in 1987 and 70% in 1990. Primary school enrollments were also affected; i.e., only 65% of those enrolled in 1986 were still in school in 1990. Illiteracy rates dropped from 59.1% in 1985 to 52.7% in 1990, but the absolute numbers rose from 133.6 million to 138.8 million. Female illiteracy is very high at 66% compared to 46% for males. Government funding cuts have also had an impact on nutrition. There were 70 million more severely undernourished Africans in 1989 than in the mid 1970s (80 million), and 40% of preschool children suffered from acute protein energy deficiency, which is an increase of 25% from 1985. There was evidence of large numbers of underweight (26.6%), wasting (10.2%), and stunted children )53.3%). Diseases such as malaria, trypanosomiasis, and schistosomiasis, which had been under control or eradicated reappeared. The <5 years mortality rate remained stable and high at 182/1000. Improvements have been made in expansion of immunization, 22 countries achieved 75% immunization in 1990. There were fewer deaths from measles and diarrheal diseases. Maternal mortality remains high at 1120/1000. AIDS is a serious social problems. By 1991, 6 million people had been infected with HIV including 3 million women an increases are expected. 900,000 HIV-infected babies were born as of 1990. The number of AIDS orphans is increasing. Real wages declined by 30% during the 1980s, and unemployment grew an average of 10%/year between 1986-90. Formal sector employment stagnated, and informal sector employment showed tremendous increases. Substance farming became a survival strategy. Poverty has affected as much as 50% of the African population. Brain drain emigration has resulted in the loss of an estimated 50-60,000 people. For Africa, the future emphasis will be on efficacy, tough minded realism, self-reliance, and grassroots initiatives.
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