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  1. 176

    Bilateral population assistance.

    Harrington J

    In: Population policies and programmes. Proceedings of the United Nations Expert Group Meeting on Population Policies and Programmes, Cairo, Egypt, 12-16 April 1992. New York, New York, United Nations, 1993. 165-80. (ST/ESA/SER.R/128)

    The International Forum on Population held at Amsterdam in 1989 called for a doubling of support to the population sector by the year 2000, which was endorsed by a United National General Assembly resolution in 1989 and by a meeting of the Development Assistance Committee of OECD in June 1990. In 1992 the United States provided 56.4% of all population funding and 78.3% of all bilateral funds. By 1990, the percentage had dropped to 42.1%. Donors other than the United States have delivered their bilateral assistance through 1) multilateral-bilateral arrangements channeling bilateral funds through United Nations bodies; 2) international nongovernmental organizations, such as the International Statistical Institute (ISI); 3) regional institutions such as CELADE in the Economic Commission for Latin America and the Caribbean (ECLAC), the International Centre for Diarrhoeal Disease Research, Bangladesh, and the University of the West Indies; 4) local nongovernmental organizations; 5) national nongovernmental organizations, such as the Danish Red Cross or the World University Service (Canada), the World Bank, or the Asian Development Bank. As of 1989/90 only a few countries had many bilateral donors: Bangladesh, 10; Kenya, 9; Tanzania and Zimbabwe, 5 each; while 4 others had 4 donors and 8 had 3 donors. A total of 59 countries are receiving bilateral assistance. The recently proposed Priority Country Strategy of the United States would focus bilateral population funding on 17 countries, while phasing down the others. To maintain current levels of contraceptive prevalence, donor funding will have to double by the year 2000. So far, Germany, the Netherlands, and the United Kingdom have committed themselves publicly. There will be further pressure to reduce population growth rates in developing countries, as they are the root causes of international migration. In the past 25 years most countries have established population policies which they are implementing. All developed countries have a responsibility to assist with population programs.
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  2. 177

    Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: a WHO study.

    Maj M; D'Elia L; Satz P; Janssen R; Zaudig M; Uchiyama C; Starace F; Galderisi S; Chervinsky A


    In preparation for a World Health Organizations (WHO) study of human immunodeficiency virus-1-associated neurological and psychiatric disorders in a variety of geographic and sociocultural settings, 2 new tests of neuropsychological performance were evaluated. The goal was to identify instruments that are not only able to tap the primary functional domains affected in symptomatic HIV-1 cases but also suitable for cross-cultural use. The WHO/UCLA Auditory Verbal Learning Test (AVLT) presents subjects with a list of words with universal familiarity drawn from 5 categories (body parts, animals, tools, household objects, and vehicles), while Color Trails 1 and 2 is based on the use of numbered colored circles and universal sign language symbols. These instruments represent modifications of the previously utilized Rey AVLT and Trail Making A and B tests. Both the new instruments and the reference tests were administered to healthy or HIV-infected volunteers in 2 developed country settings (Germany and Italy) and 2 developing country sites (Thailand and Zaire). There was a significant correlation between scores on each new test and those on the reference tests, indicating that the new instruments tap the same functional domains. The variance of the z-transformed scores from test site to site was reduced for the WHO/UCLA AVLT compared to the Rey AVLT and for the Color Trails 2 compared to the Trail Making B, suggesting that the new tests are more culture-fair than their predecessors. Finally, the percentage of impaired subjects identified through the new tests was significantly higher among seropositive than seronegative subjects, indicating that these instruments are indeed sensitive to HIV-21 associated cognitive damage across different cultures.
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  3. 178

    Tuberculosis: a global emergency [editorial]

    Nakajima H

    WORLD HEALTH. 1993 Jul-Aug; 46(4):3.

    The Director-General of WHO informs us that tuberculosis (TB) is responsible for 3 million deaths annually. TB is the major cause of death from 1 pathogen, making up about 25% of preventable adult deaths. Immediate action will save 30 million lives in the coming decade. In many areas of the world, TB is out of control. Most TB cases and more than 95% of TB deaths take place in developing countries. The number of TB cases in Europe and North America has increased considerably since the late 1980s. These countries cannot control TB unless developing countries greatly reduce TB as a health threat. TB takes on 8 million new victims each year. It is associated with AIDS. Persons infected with both HIV and TB are at a 25-fold increased risk of progressing to potentially fatal disease. Even though there are cost-effective tools to prevent and treat TB, they are not being used to their full potential. 6-8 months of consistent, uninterrupted heavy drug therapy is required for success. Some bacteria are becoming resistant to TB drugs because resources are not dedicated to making sure patients complete treatment. Curing infections as soon as possible stops TB transmission. TB control programs should include a health education component to increase the awareness of the need to complete TB drug therapy. It should also administer BCG vaccination to infants to prevent serious childhood TB. Political leaders need to restart weak or now defunct national TB control programs. WHO is working with governments in developing countries to implement effective TB treatment and prevention programs. Governments, public health officials, communities and the private sector need to unite to begin an immediate and extensive response to the global emergency of TB.
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  4. 179

    Keep taking the initiatives.

    ECONOMIST. 1993 Nov 13; 99-100.

    The World Health Organization (WHO) eradicated smallpox in 1977. This was the first time that an effective vaccine disseminated through a systematically organized inoculation program had been so successful. In the aftermath, WHO launched the Expanded Program on Immunization (EPI) with the objective of eradicating measles, diphtheria, whooping cough, tetanus, tuberculosis, and polio. These diseases were chosen because all caused major child mortality and effective vaccines existed against each. After 16 years, 80% of the world's children have been immunized and many lives have been saved, but only patchy geographical coverage of immunizations has been achieved and each targeted disease in still with us. In light of this situation, program critics saw the need to take an alternative approach and launched the Children's Vaccine Initiative (CVI) in 1990. EPI concentrated on increasing the effectiveness of bureaucracy to delivery vaccines, but 5 clinic visits in the first 15 months of the baby's life were nonetheless needed for a complete regimen of inoculations against all 6 target diseases. The WHO bureaucracy had trouble incorporating improved vaccines as they were developed and in maintaining the cold chain. The CVI, however, has only minority participation by WHO and the different strategy of focusing upon the development of simpler, more robust vaccines. The CVI is striving to develop a combined vaccine against all 6 diseases which would be affordable, unaffected by changing temperatures, and administered orally in 1 dose shortly after birth. The WHO chief, Nakajima, conceded to the flaws of EPI and agreed to merge the program and its resources with CVI in January, 1994. This move will bring a great deal of program money to CVI. Regarding specific technologies, Virogenetics of Troy, New York, is testing canary-pox-based vaccines on people with the goal of securing a vaccine capable of effectively carrying 7 different antigens. Timed-release capsules are being tested as a means of dealing with the need for repeated doses and it appears that using heavy water to make polio vaccine increases the latter's resistance to heat; researchers are trying to find out why.
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  5. 180

    IMAP statement on voluntary surgical contraception (sterilization).

    International Planned Parenthood Federation [IPPF]. International Medical Advisory Panel [IMAP]

    IPPF MEDICAL BULLETIN. 1993 Jun; 27(3):1-2.

    Sterilization consists of occlusion of the vas deferentia or the Fallopian tubes to prevent the sperm and ovum from joining. Counseling is important since voluntary surgical and contraception is a permanent contraceptive method. Trained counselors should know about and discuss other contraceptive methods, the types of anesthesia available, and the different sterilization procedures and stress the permanent nature of sterilization and the minimal risk of failure. Counseling must maintain voluntary, informed consent and not coerce anyone to undergo sterilization. It is best to counsel both partners. Vasectomy should be encouraged because it is simpler and safer than female sterilization. Most sterilization techniques are simple and safe, allowing physicians to conduct them on an outpatient basis. Local anesthesia and light sedation are the preferable means to reduce pain and anxiety. In cases where general anesthesia is required, the patient should fast for at least 6 hours beforehand and the health facility must have emergency resuscitation equipment and people trained in its use available. Aseptic conditions should b maintained at all times. Vasectomy is not effective until azoospermia has been achieved, usually after at least 15 ejaculations. The no-scalpel technique causes less surgical trauma, which should increase the acceptability of vasectomy. Vasectomy complications may be hematoma, local infection, orchitis, spermatic granuloma, and antisperm antibodies. Spontaneous recanalization of the vasa is extremely rare. Postpartum sterilization is simpler and more cost-effective than interval sterilization. Procedures through which physicians occlude the Fallopian tubes include minilaparotomy, laparoscopy, and vaginal sterilization via colpotomy or culdoscopy. They either ligate the Fallopian tubes or apply silastic rings or clip to them. Vaginal sterilization is the riskiest procedure. Reversal is more likely with clips. So complications from female sterilization are anesthetic accidents, wound infection, pelvic infection, and intraperitoneal hemorrhage. About 1% of all sterilization clients request reversal. Pregnancy rates are low with reversal.
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  6. 181

    Technology: impact on human development.

    Basma Bint Talal

    In: Change: threat or opportunity for human progress? Volume IV. Changes in the human dimension of development, ethics and values, edited by Uner Kirdar. New York, New York, United Nations, 1992. 60-3.

    Since the early 1980s, 2 major events have occurred globally: the beginning of the information revolution and the dominance of the services economy. Based on the utilization of computers and modern telecommunications, the information age is transforming societies, improving the quality of life and fostering the global exchange of culture and knowledge, goods and services. New equipment, techniques, and materials have greatly improved efficiency and productivity in agriculture and industry, but simultaneously they are demanding more educated and qualified labor. The question is how women in developing societies are going to fare in this new information age. The UN Development Programme's (UNDP) 1990 Human Development Report reveals that in developing countries the literacy rate is still only 50% among women, but primary school enrollment is more than 80%. More than one-third go on to secondary education and more than 5% into higher education. Services now account for 28% of the labor force, compared with 61% in the industrialized countries. Women in developing countries now constitute one-third of the labor force. Illiteracy is gradually being eradicated; education levels among the young generation are improving. The services economy offers a prime opportunity for women because it does not require the fixed working regimes of the past which greatly hindered women's participation. Computers and modern communications have brought flexible working hours and conditions. Women, particularly in developing countries, must seize the opportunities. This requires a better educated population, a core of scientists and technocrats, and a home base for production. While in the industrialized countries of Europe, North America, and Japan, there are more than 14 scientists and technicians/every 100 people, in the developing countries there is only 1 scientist or technician/every 100 people. UNDP and other multilateral development agencies can help make the opportunities available to the women of the developing world.
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  7. 182

    Industrial restructuring for sustainable development: three points of departure.

    Simonis UE

    In: Change: threat or opportunity for human progress? Volume V. Ecological change: environment, development and poverty linkages, edited by Uner Kirdar. New York, New York, United Nations, 1992. 168-88.

    Man's envisaged economic conversion is integration of ecology and economy through reduction in resource input of production which results in a reduction of emissions and wastes that adversely affect the natural environment. Some industrial nations, the UN Environment Programme, and the Organization for Economic Cooperation and Development already use environmental indicators of adverse effects of production (e.g., emission data). We know less about the environmental significance of input factors in industrial production and which indicators contribute environmentally significant information about the structure of the economy, however. Using data from 31 countries, not including the US, an economist demonstrates that delinking of energy, steel, and cement consumption and weight of freight transport from the growth of the gross domestic product (GDP) results in environmental gratis effects (rate of usage of input factors having a negative impact on the environment stays lower than the growth rate of GDP). It appears that the trend in developed countries is industrial restructuring. The conventional environmental policy is react-and-cure strategies on air and water pollution, noise, and waste. This costly policy needs to be improved by comparing environmental expenditures with data on environmental damage, identifying problems before ecosystems are destroyed, and incorporating cost-effective preventive measures. Environmental impact assessments are a means to accelerate technical knowledge and public awareness. Environmental standard setting should be a continuous process. Economy as it now exists indicates disharmony with nature (i.e., natural raw materials are swapped for produced waste materials polluting the environment). We should incorporate the external effects of production within our conscious or subconscious guiding principles, return the costs to the economic units that cause the environmental problem, and include the ecological viewpoint into all investment and economic decision making. We have yet to adapt a throughput economy (systematic reduction of depletable resources and generation of pollution emissions and wastes through recycling and clean technology).
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  8. 183

    The Munich Summit on the Environment and on Population.


    At the end of the G-7 Summit in Munich, Germany, on July 8, 1992, an Economic Communique was issued. One section of the communique is concerned with the environment and refers to the Rio Earth Summit, another section deals with the economic situation in developing countries. As a result of the Earth Summit, all countries are urged to move toward sustainable development to safeguard the interests of present and future generations by reducing climate change, protecting forests and oceans, preserving marine resources, and maintaining diversity. The G-7 countries urge other countries to ratify the Climate Change Convention and to draw up and publish national action plans by the end of 1993, to work to protect species and habitats, to give additional financial and technical support to developing countries for sustainable development, to establish a Sustainable Development Commission at the 1992 UN General Assembly, to establish an international review process for the forest principles, to improve monitoring of the global environment, to promote development and diffusion of energy and environment technologies, and to convene the international conference on straddling and highly migratory ocean fish stocks as soon as possible. Among developing countries, although many have made economic and political progress, sub-Saharan Africa remains a cause for concern. The G-7 countries are committed to meeting global challenges such as population growth and the environment through worldwide cooperative efforts. Progress will only be assured if countries mobilize their own potential, involve all segments of the population, and respect human rights; progress can be enhanced by regional cooperation. Special attention must be paid to poverty, population policy, education, health, the role of women, and the well-being of children. Industrial countries are responsible for developing a sound global economy through trade, direct foreign investment, and activities of the private sector, all of which are important to developing countries. Countries that help themselves in credible ways will be supported in particular, and technical assistance should be offered to establish a diversified export base, especially in manufacturing.
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  9. 184

    Approaching STDs and AIDS on a global scale. Interview with Peter Piot, Associate Director, Sexually Transmitted Diseases, Global Programme on AIDS (GPA), World Health Organisation (WHO).

    AIDS BULLETIN. 1993 Jul; 2(2):4-5.

    Dr. Piot became involved with the World Health Organization (WHO) Global Program on AIDS (GPA) through his early involvement as Chairman of the WHO Steering Committee on the Epidemiology of AIDS. He responds to questions about the HIV pandemic. Although researchers realized early on that HIV could be transmitted sexually and suspected that condom use could confer protection against HIV infection as it does against other STDs such as gonorrhea and syphilis, only minimal light was shed to the public on the association of HIV with STDs. The delay in clearly pointing out the association stemmed from professionals' lack of desire to further stigmatize HIV/AIDS by designating it as a STD. Furthermore, many Western hematologists had little interest in STDs, and STD control in many countries tended to be coercive. Regarding the risk of HIV infection, Dr. Piot notes that the presence of a genital ulcer caused by syphilis, chancroid, or herpes increases one's risk 10-20-fold; risk increases 3- to 4-fold where gonorrhea or chlamydia are present. Acknowledging the association between STDs and the risk of contracting HIV and understanding the need to control STDs for the prevention of HIV/AIDS, the WHO's STD program was brought under the auspices of and integrated with the GPA. People, and especially women, who may present at STD clinics for treatment are prime candidates for much needed help in avoiding HIV infection; Dr. Piot notes that unlike men, many women do not realize they are infected with an STD until complications develop. Dr. Piot's recent appointment at GPA means the WHO will increase its focus upon the prevention and treatment of STDs. The WHO favors an integrated program approach. Additionally, the GPA plans to develop a short-list of recommended drugs for treating STDs and hopes to develop ways for developing countries to buy them affordably with help from UNICEF and the World Bank. Finally, Dr. Piot explains that, with some exceptions, the prevalence of STDs is lower in developed countries and, therefore, less of a prevention priority.
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  10. 185

    Technology and ecology.

    de Souza HG

    In: Change: threat or opportunity for human progress? Volume V. Ecological change: environment, development and poverty linkages, edited by Uner Kirdar. New York, New York, United Nations, 1992. 154-60.

    The most common global concerns are the threat to the earth's ecological balance, challenges originating from new technologies, and the ability of developing countries to respond to these changes in a way conducive to sustainable development. Creative learning means that political systems assimilate new information when making policy decisions. pathological learning implies that political systems prevent new information from influencing policies, eventually leading to the system's failure. Policymakers cannot ignore the new technologies and the changing environment. The UN University had identified the most important research gaps with regard to technological development. recommendations from this study are more research on the relationship between the effects of existing trends in the technological revolution and the formation of development strategies and the significance of identifying alternatives of technological development better suited to the actual needs and conditions of developing countries. For example, biotechnology may produce new medications to combat some tropical diseases, but a lack of commercial interest in industrialized countries prevents the needed research. Research in the Himalayas shows the importance of focusing on the linkages between mountains and plains, instead of just the mountains, to resolve environmental degradation. This finding was not expected. The researchers promote a broader, more holistic, critical approach to environmental problem-solving. Humans must realize that we have certain rights and obligations to the earth and to future generations. We must translate these into enforceable standards at the local, national, and international levels to attain intergenerational equity. Policy-makers must do longterm planning and incorporate environmentally sound technologies and the conservation of the ecological balance into development policy. sustainable development must include social, economic, ecologic, geographic, and cultural aspects.
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  11. 186

    Sustainable development through global interdependence.

    Attiga AA

    In: Change: threat or opportunity for human progress? Volume V. Ecological change: environment, development and poverty linkages, edited by Uner Kirdar. New York, New York, United Nations, 1992. 88-107.

    A new global geopolitical structure is taking shape, a multipolar system strengthened by various regional economic powers (e.g., the European Economic Community). These powers will inevitably vie for global status. This system will be based on a succession of bridges and linkages of global interdependence on human rights and freedom, energy and environmental management, international trade and finance, technological and science development, and modern communications. These bridges and linkages should effect a more balanced global structure. The best prospect for a system of cooperation and interdependence among nations is the UN. Proper engineering of these bridges and linkages within a global and regional framework can bring about sustainable development. If competition between various economic power blocs is the guiding principle of these bridges and linkages, the world will experience a new era of regional and global conflict. For example, developed countries and their transnational companies once controlled the oil industry. They exploited huge oil reserves in developing countries and did not provide them appropriate compensation for depletion of their most important natural resource. Host countries reacted to this unfair treatment and took over and nationalized the companies, leading to a sizable increase in oil prices in the 1970s. This then caused global economic instability and general mistrust between exporting and importing countries. Demand for oil fell, and the producing countries could not decide how to distribute the oil sales reduction among themselves, so the buyers took control and still have control of the oil market. The demand for oil is rising and preserves are shrinking which will result in a rapid increase in oil prices. Thus, all nations must invest in development of new sources of energy. Oil should be just a short bridge towards sustainable development. Developed countries should place peaceful resolution of regional conflicts and bilateral disputes at the top of their agenda. Internationalism should replace nationalism and multilateralism should replace bilateralism.
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  12. 187

    The 1990s: from worlds apart to a different world.

    Pronk J

    In: Change: threat or opportunity for human progress? Volume II. Economic change, edited by Uner Kirdar. New York, New York, United Nations, 1992. 21-31.

    The world may no longer be seen as divided along North-South and East-West lines of economic development and political institutions. Characteristics of the South are developing in pockets of the North, and parts of the South are assuming characteristics of the North. The former East-West political dichotomy has collapsed and the outmoded concept of national markets has been replaced by the themes of internationalization and globalization. It is hoped that this new perspective will lead to less absolute poverty and fewer developing countries by the turn of the century. A global development agenda for the 1990s may include the integration of environment and development; the integration of Eastern European countries into the international community in such a way that the position of developing countries will be strengthened; the discussion of trade and investment policies beyond the Uruguay Round; the coordination of international policies and programs for alternative, renewable, and safe energy; the development of international policies on migration which target the root causes; demilitarization; democratization; putting the domestic policies of industrialized countries on the agenda so that they pursue frugal and sustainable economic growth while restructuring industry and agriculture to increase the market access of developing countries; human development; the development of new approaches to increase the transfer of resource and reverse the current South-North net flow; and the reform of the United Nations.
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  13. 188

    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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  14. 189

    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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  15. 190

    Polio eradication is in sight.

    Hull H

    WORLD HEALTH. 1993 Mar-Apr; 46(2):17-9.

    The live, oral polio vaccine, introduced in the 196-s, has essentially eliminated poliomyelitis from the US, Canada, Europe, and the industrialized countries of the Pacific. WHO's Expanded Programme on Immunization (EPI) aims to eradicate poliomyelitis. Many people believe that polio is no longer a problem, however, paralytic polio is quite common in Africa. In 1991 and 1992, outbreaks occurred in polio free countries: Bulgaria, the Netherlands, and Jordan, reminding us that polio continues to be risk to all countries. EPI's universal childhood immunization initiative achieved a poliomyelitis vaccination coverage if 84% of children born in 1990. Thus, in 1991, there were just 127,000 paralytic poliomyelitis cases. Nevertheless, 1 case of poliomyelitis is undesirable. Eradication requires disease surveillance to rapidly detect every case and then immunization of people in the highest risk areas to stop transmission of the virus. Eradication of poliomyelitis will save more than US $100 million each year in the US for elimination of the need for vaccine purchases and for medical care. The last case of wild poliovirus-induced poliomyelitis in the Western Hemisphere was in August 1991, thanks to the eradication initiative strategies developed by the WHO Region of the Americas. UNICEF, USAID, and Rotary International are leaders of this Americas initiative for eradication of poliomyelitis. Between 1989 and 1991, eradication strategies have reduced reported polio cases by 58% in China. Polio-free zones exist in North Africa, southern and eastern Africa, the Middle East, Europe, and the Pacific Rim. India, Pakistan, and Bangladesh are a significant polio reservoir (they account for 66% of global cases). Major obstacles to the global eradication initiative in Europe, Asia, and Africa are war and political instability. Most of the funding for logistical support of the initiative comes from in-country resources, yet, lack of political will remains the major obstacle for the initiative.
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  16. 191

    The children's vaccine initiative.

    Hartvelt F

    WORLD HEALTH. 1993 Mar-Apr; 46(2):4-6.

    A 1990 meeting of vaccine research and application specialists ended in the Declaration of New York stating that current science can be used to develop vaccines which can be administered earlier in life, requiring 1-2 doses instead of many doses, and in the form of cocktails of several vaccines; maintain their potency in warm temperatures; and are affordable. In 1991, WHO, UN Development Programme, UNICEF, the World Bank, and the Rockefeller Foundation established the Children's Vaccine Initiative (CVI). Its main goal is 1 oral immunization to be administered shortly after delivery to protect all babies against all major childhood diseases. CVI also aims to streamline the provision of an adequate supply of affordable, safe, and effective vaccines; to expedite the development and production of new and improved vaccines; and to simplify the complex logistics of vaccine delivery. As of spring 1993, CVI partners have created an organizational structure to guide and manage CVI activities, begun a strategic planning process, and developed a heat-stable poliomyelitis vaccine and a single-dose tetanus toxoid vaccine. CVI consists of a Secretariat, a Consultative Group, a Management Advisory Committee, a Standing Committee, and Product Development Groups. Many specialists are currently working to advance strategic planning, biotechnology, immunology, epidemiology, vaccine supply, quality control, regulatory matters, licensing, patents, and financial and legal issues. The high cost of research and development through more and more sophisticated technologies (e.g., genetic engineering), high insurance premiums to obtain liability coverage, and limited companies doing research and development, possibly resulting in price-setting, contribute to the rising costs of vaccine development and production, posing a considerable obstacle for CVI. International vaccine producers have proposed a 2-tier price structure: a market price for developed countries and an affordable price for developing countries. The private sector awaits means to match corporate profits with public health goals before participating fully in CVI.
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  17. 192

    Natural family planning: effective birth control supported by the Catholic Church.

    Ryder RE

    BMJ. British Medical Journal. 1993 Sep 18; 307(6906):723-6.

    The Catholic Church approves the use of natural family planning (NFP) methods. Many people think only of the rhythm method when they hear NFP so they perceive NFP methods to be unreliable, unacceptable, and ineffective. They interpret the Catholic Church's approval of these methods as its opposition to birth control. The Billings or cervical mucus method is quite reliable and effective. Rising estrogen levels coincide with increased secretion of cervical mucus, which during ovulation is relatively thin and contains glycoprotein fibrils in a micelle like structure aiding sperm migration. Ultrasonography confirms that the day of most abundant secretion of fertile-type eggs white mucus is the day of ovulation. Once progesterone begins to be secreted, cervical mucus becomes thick and rubbery and acts like a plug in the cervix. Other symptoms associated with ovulation include periovulatory pain and postovulatory rise in basal body temperature. A WHO study of 869 fertile women from Australia, India, Ireland, the Philippines, and El Salvador found 93% could accurately interpret the ovulatory mucus pattern, regardless of education and culture. The probability of pregnancy among women using the cervical mucus method and having intercourse outside the fertile period was .004. The probability of conception increased the closer couples were to the fertile period when they had intercourse (.546 on -3 to -1 peak day and .667 on peak day 0), regardless of education and culture. The failure rate of NFP among mainly poor women in Calcutta, India, equal that of the combined oral contraceptive (0.2/100 women users yearly). Poverty was the motivating factor. NFP costs nothing, is effective (particularly in poverty stricken areas), has no side effects, and grants couples considerable power to control their fertility, indicating the NFP may be the preferred family planning method in developing countries. Prejudices about NFP should be dropped and worldwide dissemination of NFP information should occur.
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  18. 193
    Peer Reviewed

    Two-dose measles vaccination schedules.

    Rosenthal SR; Clements CJ


    Worldwide coverage of measles vaccine is about 80%, but many communities and countries have considerably lower coverage rates. WHO is concerned about measles occurring in infants between 6 and 12 months old, especially in densely populated African cities. Measles rarely occurs in infants under 6 months old, but the measles case fatality rate is greatest in the 1st year of life. WHO aims for an effective measles vaccine to be administered at 6 months old. A high titer vaccine appears to reduce survival among children receiving it. Some countries have reduced measles incidence by as much as 90% by achieving coverage levels greater than 90% with a single dose measles vaccine. Another method to prevent early measles cases and later vaccine failures is administration of the 1st dose around 6 months and a 2nd dose no earlier than 12 months. Measles vaccine policy in the US and some countries in Europe is routine 2-dose measles schedules: 1st dose between 12-19 months and 2nd dose at school entry. This schedule is appropriate in developed countries with good immunization coverage. Other countries schedule the 1st dose anywhere between 6-9 months and the 2nd dose between 12 months and 7 years. All mathematical models of the effects of 2-dose schedules indicate that 2-dose schedule are a great benefit. The literature shows that developing countries with high immunization coverage and well-managed immunization programs can effectively execute and sustain 2-dose measles schedules. Measles vaccination early in life sometimes results in a blunted antibody response. The 2-dose schedules are probably more expensive than 1-dose schedules and require more cold storage space. No field trials have looked at clinical efficacy of 2-dose measles schedules in developing countries. Ideal field trials would be randomized controlled trials. Demonstration projects can evaluate operational issues, e.g., dropout rates, cost, and vaccine usage. Case control studies can address technical and epidemiological issues.
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  19. 194

    Researchers report much grimmer AIDS outlook.

    Altman LK

    NEW YORK TIMES. 1992 Jun 4; A1, B10.

    The international AIDS Center at the Harvard School of Public Health led a coalition of AIDS research from around the world in an analysis of more than 100 AIDS programs and discovered that the HIV/AIDS pandemic is more serious than WHO claims. Its findings are in the book called AIDS in the World 1992. AIDS programs do not implement efforts that are known to prevent the spread of HIV. For example, clinicians in developing countries continue to transfuse unscreened blood to many patients, even though HIV serodiagnostic test have existed since 1985. Further, programs do not evaluate what works in other programs. As long as people debate whether or not to distribute condoms, exchange needles, or offer sex education and whether people with AIDS deserve care, the fight against HIV/AIDS is hindered. The report recommends that leader come up with a new strategy to address the AIDS pandemic. WHO claims to have done just that at its May 1992 meeting. An obstacle for WHO is political pressure from member nations. On the other hand, the private Swiss foundation, Association Francois-Xavier Bagnoud, finances the Harvard-based AIDS program, allowing members more freedom to speak out. The head of the Harvard program believes the major impact of AIDS has not yet arrived. Contributing to the continual spread of HIV is the considerable difference of funding for AIDS prevention and control activities between developed and developing countries (e.g., $2.70 per person in the US and $1.18 in Europe vs. $.07 in sub-Saharan Africa and $.03 in Latin America). Even though developed countries provide about $780 million for AIDS prevention and care in developing countries, they do not enter in bilateral agreements with developing countries. 57 countries limit travel and immigration of people with HIV/AIDS. Further, efforts to drop these laws have stopped. Densely populated nations impose travel constraints to prevent an explosive spread of HIV.
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  20. 195

    World development report 1993. Investing in health.

    World Bank

    New York, New York, Oxford University Press, 1993. xii, 329 p.

    The World Bank's 16th annual World Development Report focuses on the interrelationship between human health, health policy, and economic development. WHO provided much of the data on health and helped the World Bank on the assessment of the global burden of disease found in appendix B. Following an overview, the report has 7 chapters covering health in developing countries: successes and challenges; households and health; the roles of the government and the market in health; public health; clinical services; health inputs; and an agenda for action. Appendix a lists and discusses population and health data. The report concludes with the World Development Indicators for 127 low, lower middle, upper middle, and high income countries in tabular form. All developed and developing countries have experienced considerable improvements in health. But developing countries, particularly their poor, still experience many diseases, many of which can be prevented or cured. They are starting to encounter the problems of increasing health system costs already experienced by developed countries. The World Bank proposes a 3-part approach to government policies for improving health in developing countries. Governments must promote an economic growth that empowers households to improve their own health. Growth policies must secure increased income for the poor and expand investment in education, particularly for girls. Government spending on health must address cost effective programs that help the poor, such as control and treatment of infectious diseases and of malnutrition. Governments must encourage greater diversity and competition in the financing and delivery of health services. Donors can finance transitional costs of change in low income countries.
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  21. 196
    Peer Reviewed

    HIV and breast-feeding.

    World Health Organization [WHO]


    Participants at a 1992 WHO/UNICEF consultation meeting on HIV transmission and breast feeding weigh the risk of death from AIDS with the risk of death from other causes. Breast feeding reduces the risk of death from diarrhea, pneumonia, and other infections. Artificial or inappropriate feeding contributes the most to the more than 3 million annual childhood deaths from diarrhea. The rising prevalence of HIV infection among women worldwide results in more and more cases of HIV-infected newborns. About 33% of infants born to HIV-infected. Some HIV transmission occurs through breast feeding, but breast feeding does not transmit HIV to most infants HIV-infected mothers. Participants recommend that, in areas where infectious diseases and malnutrition are the leading causes of death and infant mortality is high, health workers should advise all pregnant women, regardless of their HIV status, to breast feed. The infant's risk of HIV infection via breast milk tends to be lower than its risk of death from other causes and from not being breast fed. HIV-infected women who do have access to alternative feeding should talk to their health care providers to learn how to feed their infants safely. In areas where the leading cause of death is not infectious disease and infant mortality is low, participants recommend that health workers advise HIV-infected pregnant women to use a safe feeding alternative, e.g., bottle feeding. Yet, the women and their providers should not be influenced by commercial pressures to choose an alternative feeding method. Health care services in these areas should provide voluntary and confidential HIV testing and counseling. Participants stress the need to prevent women from becoming HIV-infected by providing them information about AIDS and how to protect themselves, increasing their participation in decision-making in sexual relationships, and improving their status in society.
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  22. 197

    Highlights of interventions at meeting for 1994 International Conference on Population and Development.

    POPULATION HEADLINERS. 1993 Jun; (219):4-5.

    The Preparatory Committee for the International Conference on Population and Development in Cairo, Egypt (September 5-14, 1994), has received recommendations for the conference's final document from various population and development organizations. UNFPA's Executive Director, who serves as Secretary-General of this Conference, recommends that the document should list goals for all countries to achieve over 20 years, particularly a goal of dedicating 20% of public sector expenditures to social programs. She also calls for developing countries to reach levels of developed countries in maternal and infant mortality, life expectancy, education, gender equality, and access to the entire spectrum of family planning services. The Conference should affirm reproductive rights. Population activities of official development assistance should increase from 1.5% to 4%. Representatives from other groups and/or countries echo her concerns, but some want to accord more emphasis to other issues as well, including development, demographic aging, employment, the disabled, and poverty. The Japanese representative informs the Committee that the Government of Japan, UNFPA, and the United Nations University are sponsoring an international conference on global population issues in Tokyo during the summer of 1994. The Nepalese representative hopes the Conference recommendations will be practical, affordable, and appropriate to the objectives of developing countries. The Pakistani representative wants the Cairo Conference to build on the Bucharest and Mexico City Conferences and on the UN Conference on Environment and Development rather than renegotiating them.
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  23. 198

    Problems of AIDS in developing countries [editorial]

    Dutta GP


    The Chair of the Subject Committee on Health and Family Welfare of the Government of West Bengal and a Member of the West Bengal Legislative Assembly questions WHO's reasoning for testing an AIDS vaccine on Asians or any people in developing countries when most AIDS cases are in the US and Europe. Plus Asia is the least affected continent. WHO has skipped time-consuming laboratory trials to test the AIDS vaccine in humans in Brazil, Rwanda, Thailand, and Uganda. No case reports of full-blown AIDS cases have been published in Indian medical journals, and few people in India have seen an AIDS patient. WHO officials at the South-East Asian headquarters do not directly answer questions. Developed countries tend to dictate what actions developing countries should take to prevent and control the spread of AIDS. Since they are the source of AIDS in developing countries, they should help developing countries improve the health of their people, but let developing countries plan their own AIDS programs. The Indian legislator considers posters claiming AIDS is spread through breast milk, salvia, and urine and reports on estimated AIDS cases and HIV-infected cases to be propaganda. He contends that their purpose is to instill fear. Other questions include the vagueness of AIDS' clinical symptoms, not all AIDS cases are infected with HIV, and cofactors are responsible for the destruction of immune system cells. The legislator disapproves developed countries' unifactorial approach to combat AIDS (i.e., AIDS vaccine), which provide them commercial benefits and allows them to politically dominate developing countries. First and foremost, India needs to identify its priorities and combat AIDS accordingly. It should train clinicians to identify suspected AIDS cases and high risk groups, promote risk reduction behavior, and provide laboratories to do HIV serodiagnostic tests.
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  24. 199

    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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  25. 200

    World lung health: a concept that should become a reality [editorial]

    Murray JF; Enarson DA


    In May 1990 in Boston, Massachusetts, in the US, American Thoracic Society, the American Lung Association, and the International Union Against Tuberculosis and Lung Disease hosted the World Conference on Lung Health. At the end of the conference, participants adopted several resolutions calling on WHO and governmental and nongovernmental organizations to take specific actions to prevent and control lung diseases. The Conference adopted 7 resolutions pertaining to tuberculosis (TB) and AIDS, such as governments must ensure high quality care for TB and AIDS patients and strengthen TB and AIDS prevention programs. Since acute respiratory infections (ATIs), the leading cause of death in children, cause considerable suffering and death in children, the Conference asked WHO and government and nongovernment organizations to increase funding for provision, cold storage, and distribution of vaccines in developing countries, and for training care workers, and for programs to help parents recognize the signs and symptoms requiring medical attention. Other ARI-related resolutions included education about the risk and prevention of indoor air pollution and increased funding for research to develop heat-stable vaccines. Resolutions related to air pollution and health embraced tighter controls of emission of air pollutants, development of policies to protect indoor air, and more research into the hazards of indoor and outdoor air pollution. More research and gathering of accurate data on deaths and illness due to asthma were among resolutions related to asthma. Resolutions on smoking included a call for the end of all governmental support for the tobacco industry, including the import and export of tobacco products, and of all advertisements and promotions of tobacco products; for nonsmoking policies in all public places, especially health care facilities and schools; and for health workers to be societal role models by not smoking.
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