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[Unpublished] 1980. 60 p. (Authorization: Ltr. AID/DS/POP: 3/2/81; Assgn. No. 582049)This evaluation of International Fertility Research Program activities focused on contract activities, grant activities, and the IFRP's organizational structure. The goals and objectives of the IFRP, its earlier and current program activities, and changes resulting from previous evaluations are described. Observations on the structure, focus, staff, projects, technology transfer and training, information dissemination, board of directors, technical advisory committee and financial considerations are followed by a number of recommendations in each area. A partial reorganization is recommended to resolve structural problems. More emphasis should be placed on the long term effects of contraceptive methods now used in the developing world, while some other programmatic activities should be deemphasized. Staff vacancies should be filled. Specific recommendations for individual projects, including the maternity care record, prevalence studies, reproductive age mortality surveys, and fertility regulation methods were made in accordance with current research needs and the particular mission of the IFRP.
[Unpublished] 1980 Sep 9. 16 p.In 1978 the Federal Drug Administration (FDA) banned use of Depo-Provera in the U.S., but the International Planned Parenthood Federation (IPPF) has distributed it in 53 countries since 1971. Although the drug is associated with some side effects, in 6 and a half million women-years of use and monitoring, it has not been associated with any deaths. IPPF supplies approximately half a million doses of Depo-Provera each year. Some of the benefits of Depo-Provera are as follows: reliability; safety for administration in remote or unhygienic locations; cultural acceptability in many parts of the world, e.g., Southeast Asia and Africa; not coitus related nor requiring daily activity by the user; not requiring privacy; and interfering less with lactation than the Pill. An estimated 1 and a half million women worldwide choose Depo-Provera. Compared to the 65 million using the oral pill and 15 million using the IUD, the number is small, but use of injectables is on the rise. Nonapproval of Depo-Provera in the U.S. sometimes restricts its use in other countries. The purchase of Depo-Provera is governed by the prevailing international prices. If the restrictions on the drug were removed and it was available on a large scale, the price would be lowered. There is no perfect contraception. The effects of unlimited pregnancy are well-documented. Women need the greatest possible choice so they can make the best decision in light of their own circumstances.
[Regulation of implantation as a contraceptive method] La regulacion de la implantacion como metodo anticonceptivo.
Gaceta Medica de Mexico. 1980 Jul; 116(7):318-28.Implantation of a fertilized ovum requires physiological and structural modifications in the endometrial tissue. Several mechanisms are currently being studied to modify or inhibit the implantation process: 1) a decrease in the secretion of luteinizing hormone; 2) action on endometrial progesterone receptors; 3) changes in prostaglandin secretion; 4) modifications of the surface of the ovum by utilizing antibodies against the pellucid zone; and 5) modification of the endometrial surface so to hinder the adhesion process. Most studies in this field are sponsored by the WHO, and they are all still at an experimental stage.
Science. 1980 Dec 19; 210(4476):1301.Overall, Simon's reassurances concerning world population and resources are at best unconvincing. His article begins nicely with an example of a UN demographer's report being misconstrued. In the rest of the article he inadvertently shows us why such reports are so easily misconstrued by the formats and arguments he uses in presenting his own data. The UN (FAO) Food and Agriculture Organization published data on per capita food production from individual countries. Simon evidently recognized that he could best serve his argument by tabulating the data on a worldwide basis. His table shows a 1969 index of 119 rising to 128 in 1976. However, FAO data show that Africa (the subject of Simon's 1st report) suffered a decline from index=100 in 1969 to 94 in 1976 and was at 90 in 1977 and 1978. In addition, FAO data show that the per capita food supply (often higher than food production in underdeveloped countries) has dropped for the countries considered most severely affected by food shortages, from 2040 calories in 1962 to 2030 in 1973. This tells a different tale from 1 that would be produced by Simon's technique, the worldwide food supply having increased during the same period from 2410 to 2550 calories. (Author's modified)
Washington, D.C., World Bank, Sept. 1980. 28 p. (Poverty and Basic Needs Series.)In 1978 the World Bank launched a program of studies to examine the implications for the Bank of undertaking the meeting of basic needs as part of the program for reducing absolute poverty. It is proposed that to reduce poverty the productivity of the poor must be raised, and in order to accomplish this the basic needs such as nutrition, water, sanitation, shelter, and access to public services such as health care and education must be met. The principal concern of these studies is the allocation of resources to most effectively improve the conditions of the poorer segments of a country's population. It was found that in many cases resources were not inadequate, but were used in a way that did not help the condition of the poor, e.g. in one instance a large part of the resources for education was spent on university training rather than on primary education or literacy programs. Another key factor in financing a program was the cost of continuing its operation after it had been instituted: it was recommended that operating costs be carefully reviewed with the consideration that the government will eventually be expected to finance the operation. A list of the published studies that were a part of the program, as well as data tables concerning population, income, and basic needs in 125 countries are appended.
New York, Foreign Policy Association, 1980 Oct. 80 p. (Headline Series 251)World population will be facing serious problems in the 1980s and 1990s as a result of 2 population trends which are presently dominating the demographic scene. The number of young people aged 15-30 in developing countries is increasing rapidly and they will be soon asserting themselves politically, economically, and socially. The 2nd trend which exists is the disparity between high population growth in the impoverished developing countries and the lower rates in the affluent industrial countries. This century's population growth has occurred primarily in the developing world and is the result of lower death rates rather than higher birthrates. The situation is attributable to demographic transition; however, the major demographic questions of how quickly birthrates will fall and how wide the gap will be before birthrates follow the classic transition remain unanswered. 3 approaches to help answer these and other demographic questions are: 1) demographic approach; 2) historical approach; and 3) observation of recent events. These various approaches are given attention in this monograph. The consequences of too rapid population growth can be seen in the low food supplies which exist leaving many in developing countries undernourished, in a decline in the quality of life, in the reduction of the potential capacity to produce what is necessary (diminished land resources, pollution of water and air), in the increases in the price of energy and natural resources, in the difficulties in acquiring employment opportunities, and in burgeoning urban growth (which puts a serious strain on housing, transportation, etc.). Family planning was adopted in various countries in the world despite government policies to counter this. While there is recognition of the need for measures to be taken to reduce fertility, the question of how to accomplish this still remains. A brief overview of developing country adoption of family policies is included. What become clear is that family planning programs do make a difference in birthrate reduction and in population growth control. An effective, extensive family planning/population program exists in the People's Republic of China; Indonesia, Colombia, Tunisia, and Mauritius are other countries with successful programs. Various socioeconomic factors influence fertility and they include: literacy and education, urbanization, improvement in the status of women, health, family or community structure, development (modernization), and even the lack of development. Population and development will be greatly affected in the future by the quality and depth of leadership. Government leadership and the private sector, donor agencies, as well as international leadership, especially that of the UNFPA, will be critical. Also included here are discussion questions and reading references for those who are interested.
In: United Nations. Dept. of International and Social Affairs. World population trends and policies: 1979 monitoring report. Vol. 1. Population trends. New York, U.N., 1980. 23-7. (Population Studies; No. 70)In 1978 the United Nations Population Division reassessed world population estimates and projections in light of data that became available after the previous assessment of 1973. In this report the 1973 figures and the 1978 figures are compared with respect to base population, growth rate, and projections for the latter half of the 20th century. According to the 1978 assessment the population growth rates projected in 1973 were too high for both developing and developed countries, and the world population growth rate has been declining since the 1960s rather than rising as previously thought. However, the revised estimate of 1975 world population is higher by 65 million than the previous estimate, so the projection for the year 2000 is only slightly lower than before in spite of lower growth rates. The 1973 and 1978 assessments for major areas in developed and developing regions are tabulated and discussed.
Progress of work, 1979-1980, of the Department of International Economic and Social Affairs in the field of population: report of the Secretary-General.
New York, UN, 1980 Nov 18. 20 p. (E/CN.9/349)A progress report of work performed during the 1979-1980 period by the Department of International Economic and Social Affairs in the field of population is presented. Covered in the report are activities of the Secretariat in the analysis of demographic trends and structure, demographic estimates and projections, fertility and family planning, population and development, population policy, monitoring and review and appraisal of the World Population Plan of Action. Also included are other continuing activities of the Secretariat. During the period covered by the report, efforts continued to carry out the program adopted by the Commission and the General Assembly. Mortality studies were reinstated along with urbanization studies, the scope of work in international migration was expanded, and new projections were prepared of total population, its sex-age structure, its urban-rural distribution, and the number of households and families. Additional work was carried out on analysis of World Fertility Survey data and of factors affecting acceptance of family planning programs. Also continued was the investigation of the relationships between social and economic factors and the components of demographic change. Under continuous study was the policy implications of the changing world population. Studies in population development and studies analyzing population policies were predominant in this 3rd round of monitoring of population trends and policies.
In: Burns AB, ed. Population/family planning resources: plugging into the 1980s. New York, APLIC-I, 1980. 45-51.Focus is on 1 aspect of the PIACT program -- the need to meet the informational needs of illiterates. PIACT activities concentrate on modifying or adapting contraceptives and their accompanying informational and instructional materials to the cultural and physical characteristics of the people who use them. At this time support is provided to affiliated programs in 8 countries -- Bangladesh, Colombia, Egypt, Indonesia, Mexico, the Philippines, Sri Lanka and Thailand. PIACT's 1st project to develop an informational pamphlet for illiterate and semi-literate oral contraceptive (OC) users was initiated in Mexico in 1977. The pamphlet was 8 pages in a comic book format. It used both illustrations and some words. When tested on 240 women in various regions of Mexico, project staff found that those who could read understood the booklet, but those who could not read did not. Since producing the initial OC booklet, the Mexican program has produced a series of instructional pamphlets on the IUD, the postpartum IUD, female sterilization, and the injectable. Several general lessons have emerged from the process of developing materials for illiterates which can be transferred to other countries to facilitate the development of similar materials in different cultural settings. These include the following: 1) the project to develop technical materials for nonreaders should be directed by an individual who has rapport and experience in working with the target population; 2) the target population needs to play an important role in the development of the material; and 3) content must be limited to the most important messages.
London, IPPF, 1980. 10 p.This catalog provides information on 22 family planning 16 mm films produced by the International Planned Parenthood Federation and currently available for purchase. The contents of each film is briefly described and information on the cost, length, and language of the film is provided. Topics dealt with in the films include 1) clinic management; 2) community-based distribution programs; 3) contraceptive methods; 4) population growth and the need for family planning; 5) fieldworker techniques; 6) human reproduction; and 7) the changing role of women. Other films depict family planning and health programs and population problems in specific cultural settings.
London, International Planned Parenthood Federation, 1980. 70 p.This document provided specific instructions to help family planning personnel produce their own low cost family planning visual aids. The manual provided instructions 1) for making simple drawings, such as stick figures; 2) for enlarging illustrated objects for use on posters and other materials; 3) for lettering; 4) for constructing flannel boards, magnetic boards, and plastigraphs; and 5) for designing and constructing posters and charts. Techniques for making effective use of chalkboards were described in detail. Also provided were instructions for making and using silk screening equipment, for making and using puppets, and for making handmade slides and filmstrips. All of the aids were produced with materials which are readily available in most settings. Many of the techniques were illustrated.
General information programme Fourth UNISIST Meeting on the Planning and Implementation of National Information Activities in Science and Technology.
Paris, UNESCO, 1980 NOv. 25 p. (PGI-80/WS/26)The rapporteur's summary of the main issues discussed by the participants at the 4th meeting arranged by UNESCO to promote the exchange of information between planners and developers of national information systems in science and technology was provided. The seminar agenda, a list of participants, and a personal assessment of the seminar by the rapporteur was also included. Individuals from both developed and developing countries were invited to participate in the seminar on the basis of their expertise in specific areas. Topics discussed in the sessions included 1) the types of information needed by development planners; 2) the role of information in development; 3) the types of persons who need information for development; 4) the sources of information for development including human sources, information systems, and documents; 5) problems of document availability in developing countries; 6) the economic and technical problems involved in making public and proprietary information accessible to potential users; 7) the degree to which potential users are aware of different kinds of information sources; 8) the legal aspects of processing and distributing information; and 9) the role of document centers, archives, and university and national libraries in providing information for development. The rapporteur noted that the seminar was unfocused and suggested that future seminars should seek to develop specific policy recommendations and participation in the seminars should be broadened to include sociologists, educators, bankers, agricultural experts, and others interested in the development process.
In: Zatuchni GI, Labbok MH, Sciarra JJ, eds. Research frontiers in fertility regulation. Hagerstown, Maryland, Harper and Row, 1980. 213-29. (PARFR Series on Fertility Regulation)The systems-engineering approach to delivery of long-term contraception can involve the use of matrix devices for contraceptive steroids from which the steroid is released at a controlled rate over a prolonged period of time after a single administration. The concept of system design principles in contraceptive delivery is explained. In 1973, WHO organized a task force on long-acting systemic agents for fertility regulation. This is the report on a WHO-sponsored project to incorporate the basic design principles of a long-acting system into the design of an injectable particulate contraceptive system. The initial requirements included: 1) provision by a single administration of continuous controlled release of NET (norethisterone) for at least 6 months; 2) injection-administered carrier; 3) biodegradable carrier; 4) no carrier-induced side effects at the site of the injections; 5) complete disappearance of all components from the injection site; 6) a flexible system as to dose and duration to accommodate individual needs; and 7) reversibility of treatment. Experimental data so far satisfy the 1st 6 requirements. The injectable particulate system cannot be made reversible. Aspects for future research in this area are mentioned.
In: Zatuchni GI, Labbok MH, Sciarra JJ, eds. Research frontiers in fertility regulation. Hagerstown, Maryland, Harper and Row, 1980. 58-63. (PARFR Series on Fertility Regulation)The important characteristics of a contraceptive are as follows: 1) sex of the user; 2) duration of effectiveness; 3) probability and ease of reversibility; 4) timing of use; 5) ability to be used after the suspicion or recognition of conception; 6) mode of applciation; 7) frequency of use; 8) safety and side-effects; 9) contraceptive effectiveness; 10) need for continuing volition or motivation to use the method; and, 11) peer approval. Scientists often underestimate the potential for misuse of even the simplest means of fertility control. One-time methods such as the IUD or sterilization have been found effective in developing countries unable to provide a continuous supply of contraceptives to their population. For the IUD, adequate follow-up care msut be available. Many methods require a sophisticated health care system. To expect physician-dependent delivery of anything but a 1-time only method as a practical approach to family planning is unrealistic. Community workers, auxiliary, and paramedical personnel have been able to reach many couples with Western style methods, e.g. pill distribution. Contraceptives like the condom can be distributed through commercial systems. By procuring contraceptive commodities competitively and in bulk, USAID has negotiated extremely low costs. From 1968-79, over $233 million was spent for these commodities.
Trends in Pharmacological Sciences. 1980 Aug; 1(12):319-21.The World Health Organization (WHO) Special Program of Research, Development and Research Training in Human Reproduction was established in 1972, supported in part by voluntary contributions from WHO's member states. Objectives are the promotion of research and the building up in developing countries of resources for research in this field. The 5 primary research areas are the following: safety and effectiveness of current birth control methods; improvement of these methods and the development of new techniques; psychosocial aspect of family planning; delivery of family planning care; and diagnosis and treatment of infertility. Some aspects of the Program's work of interest to pharmacologists are reviewed. Attention is directed to injectable contraceptives, entirely new methods, IUDs, and building up a capacity for clinical pharmacology. Only 2 injectable contraceptives are available for widespread use -- depotmedroxyprogesterone acetate (DMPA), which has been in use for several years, and norethisterone enanthate, which has been marketed only recently. Since 1973 the Program has been involved in an extensive research program on these 2 injectables. No toxicological reasons have been found for not continuing to use DMPA in family planning programs, but it has been concluded that extensive WHO studies should be pursued for norethisterone enanthate. The safety and use-effectiveness of IUDs have been little assessed in randomized comparative multicentered studies, particularly in developing countries. The Program is developing totally new modalities of birth control, and it has collaborated with industry in developing prostaglandin suppositories for pregnancy termination.
International Library Review. 1980; 12:259-67.Documentalists and librarians should promote the development of a collaborate network of libraries to increase the availability of family planning information and materials throughout the world. There has been a phenomenal increase in family planning information in recent years and it is becoming increasingly difficult for small libraries and libraries located in developing countries to make this information available to their users. The network should promote resource sharing between libraries within each country. A national documentation center should be established in each country and every region should have a regional documentation center. The regional centers would work to promote the world wide sharing of population information. Specific suggestions for facilitating information sharing at each network level were provided, and the functions performed by the WHO Regional Documentation Center on Human Reproduction, Family Planning, and Population Dynamics, established in 1973 in New Delhi, were also described.
World Health. 1980 Apr; 18-9.International collaborative research, conducted under the sponsorship of the WHO Special Programme of Research, Development and Research Training in Human Reproduction, led to the development of improved IUDs. Scientists from many disciplines and many countries were involved in these research activities. WHO centers in more than 20 countries conducted evaluation studies on different types of IUDs. The studies were designed so as to facilitate comparative analysis. The studies conducted at these centers indicated a need to develop IUDs which would be associated with less bleeding and IUDs which would be more effective. The mechanisms of IUD induced bleeding were examined and several drugs were identified which could be used to reduce the bleeding. The drugs were either given orally or used to impregnate the IUD. Efforts to produce more effective IUDs led to the development of a progesterone releasing IUD. Other WHO supported activities involved the development of new methods for delivering IUD services to the inhabitants of developing countries. Midwives were trained in IUD insertion techniques and their performance was evaluated. The performance level attained by the midwives was as high or higher than that attained by physicians.
Glimpse. 1980 Sep; 2(9):1-2.No effective prevention has yet been developed for diarrhea, the most important cause of death and disability in developing countries. Two steps may alleviate the suffering attributed to diarrhea. Through research, the 1st step, effective and inexpensive measures have been developed for application. One is oral rehydration therapy (ORT), a highly effective, inexpensive and technologically simple measure which can abolish death and most of the disability caused by watery diarrhea. The 2nd step is training people to use ORT. ICDDR, B has an important role to play in this process. An effective oral rehydration solution contains an appropriate concentration of salts, water and carrier substances which transport the salts and water into the body. Glucose has been the standard carrier sustance, but certain amino acids are also effective. As both glucose and amino acids are found in many food items, an active research program is needed to test the relative efficacy of food sources which contain glucose and amino acids and which when mixed with salts and water will provide an effective oral rehydration solution. Sucrose-based solutions have also been used to treat watery diarrhea. Fundamental to the ORT is the ability to measure correctly a certain volume of water and to mix a given amount of solutes with the measured amount of water. This is the objective of training and education. By encouraging and assisting research and development of any group with ideas of merit, the ICDDR, B hopes to serve as a catalyst in the rapid spread of effective ORT in the afflicted parts of the world.
Lancet. 1980 May 17; 1(8177):1082.This letter reports rehydration of 7 infants by an oral solution similar to the UNICEF formulation. This solution contained: sodium chloride (3.5 gm), sodium bicarbonate (2.5 gm), potassium chloride (1.5 gm), and glucose (20 gm) dissolved in 1 liter of potable water. When admitted, 2 patients were hypernatremic and 5 had normal sodium levels. All children were well-nourished. They were given the oral glucose-electrolyte solution at admission, and in all cases treatment had to be interrupted after a mean period of 41+ or -9 hours due to high levels of potassium in 6 cases and aggravation of preexisting hypernatremia in the other. Average oral volume was 140 ml/kg. It is recommended that well-nourished children be given the UNICEF oral therapy formulation for no more than 24 hours, since potassium loading seems probable.
The role of oral electrolyte-glucose solutions in hydration for children: international and domestic aspects. [Editorial]
Journal of Pediatrics. 1980 Jan; 96(1):51-4.Focus is currently on the use of the oral route for prevention and treatment of dehydration occurring secondary to diarrhea. Conflicts have arisen regarding how to carry out the oral regimen, and these conflicts have slowed progress. Attention in this discussion is directed to the roles of the clinician, psychologist and public health worker. Before delineating the existing conflict and proposed resolution, the historical development of the current state of knowledge of oral therapy is reviewed. The success with oral therapy for cholera led public health physicians to use the method for nonspecific enteritis in infants all over the developing world. The formulation recommended by World Health Organization (WHO) committees contained less sodium than originally proposed for adults in order to have the practical advantage of single formation and distribution. Such a solution may be and has been used successfully for patients of all ages who have cholera. This soon led to recommending the solution for all diarrheal disease of infants when dehydration had occurred or was threatened. Implementation of the WHO program for oral hydration therapy became stalled in part because the need for a single solution conflicted with the physiology of infancy, which calls for use of a lower solute content. In May 1979 a group was called together to see if an accommodation was possible. The compromise reached was to have 2 sets of instructions for a single formulation. The method proposes use of the WHO oral rehydration solution (ORS) formulation but administers the solution by giving 1 feeding of plain water for each 2 of ORS, all in equal volume. On the 2nd and subsequent days, breast milk and plain water are given in increasing amounts.
Strengthening rural health service delivery project. First progress review meeting on the Diarrheal Disease Control Study.
Mansura, Egypt, [Westinghouse Health Systems], 1980 Jun 2. 38 p.This is the report on a study into the availability, utilization, effectiveness, and cost of sucrose/salt rehydration mixtures and prepackaged rehydrant solutions of glucose, potassium, and bicarbonate. A WHO-sponsored program was established in Egypt in 1977 to distribute prepackaged electrolytes for use in cases of diarrhea. Results have been unsatisfactory because there is distrust and, consequently, underuse of the product. In addition, it is only available at clinics, which are also underutilized by the population. Therefore, since 1978, the Ministry of Health has been conducting a pilot project to distribute the oral rehydrants through rural health care delivery. This program involves teaching home preparation and administration of a salt/sugar solution to mothers, providing packets through medical personnel at clinics, and intravenous treatment in hospitals in severe cases. A comparative study will be undertaken in 2-3 districts of the pilot project to assess the relative benefits of the home-prepared salt/sugar solutions and the prepackaged oral rehydrants. The methodology of the study, plus specific research outputs expected, are outlined. The 2 preparations will be compared as to effectiveness, availability, safety, acceptability, cost, and principal advantages.
Recommendations of the Meeting on Socio-economic Determinants and Consequences of Mortality: report of the Secretary-General.
New York, UN, 1980 Dec 8. 12 p. (E/CN.9/352)This document contains the recommendations of the Meeting on Socioeconomic Determinants and Consequences of Mortality, organized by the Population Division and the World Health Organization. The meeting was held June 19-25, 1979 in Mexico City. The participants developed and adopted a set of recommendations for future research and action in the following areas: data collection and processing; methodological and substantive research activities, international coordination, training and data dissemination, and funding of future research and training activities. The recommendations are presented to the Population Commission for its consideration and appropriate action, within the context of the future work program in population. Dissemination of information on results of national studies on mortality and its differentials should be part of an international information-exchange system. Suitable mechanisms at the international and national levels should be set up to establish such a system. Governments should make mortality and social class data available to private research organizations whenever possible. Since mortality had received low priority in the allocation of funds for research and training, the Meeting called upon bilateral and multilateral funding agencies in population and public health to rectify that deficiency.
Technical cooperation activities in population of the Department of Technical Cooperation for Development, 1979-80: report of the Secretary-General.
New York, UN, 1980 Nov 25. 22 p. (E/CN.9/350)Presented in this document is an account of the activities carried out by the Population Programs and Project Branch Division of Development Administration of the Department of Technical Cooperation for Development in the field of technical cooperation in population during the July 1978 to June 30, 1980 period. Focus is on the 3 subprograms which make up the core of these activities: 1) support for training in demography and population; 2) support for basic population/demographic data evaluation and analysis; and 3) support for population policy and development planning. Attention is also directed to support to new dimension activities, such as projects on women's participation and role in population and development. These activities are carried out with the financial support of the United Nations Fund for Population Activities (UNFPA). This program required much substantive and technical support and monitoring by United Nations Headquarters staff of about 100 to 120 projects annually in nearly 80 countries. The Population Programs and Project Branch Division continued to exercise its primary responsibilities with respect to technical cooperation in population by assisting governments in determining needs, by appraising project proposals and providing technical guidance in the formulation of projects, and by monitoring the implementation of projects. During the 2-year period under review, the United Nations continued to support extensive training in population activities.
In: Campbell AA, ed. Social, economic, and health aspects of low fertility. [Bethesda, Maryland], U. S. Dept. of Health, Education, and Welfare, Public Health Service, 1980. xi-xii. (NIH 80-100)An explanation as to why WHO (World Health Organization) was co-sponsoring a conference on the social, economic, and health implications of low fertility was provided. WHO defines health broadly to include not just physical health but also mental and social health. WHO's interest in the health implications of population dynamics is a long-term concern. In 1965 the World Health Assembly, recognizing the impact of population dynamics on the health status of populations, mandated WHO to study the health implications of population dynamics, human reproduction, and family planning. Since that time this mandate was frequently reaffirmed and broadened. Given WHO's broad approach to health problems, WHO's interest in the health implications of declining fertility and low fertility is logical and understandable.
Some factors influencing the regulation of pharmaceuticals in developing countries, with particular reference to Africa.
International Digest of Health Legislation. 1980; 31(3):453-83.This long review discusses a few of the factors liable to influence attempts at drug regulation in developing countries, i.e., the existing situation with regard to pharmaceuticals and some of the manifold factors (psychosocial, geopolitical, etc.) that are likely to affect legislation, particularly in countries recently achieving independence, as well as all developing countries. Sections in the monograph include, an analysis of the present situation of pharmaceutical distribution and regulation in developing countries; problems in the regulation of pharmaceuticals in Africa; analysis of legislation already in force (including those countries which have communicated their legislation to WHO and those who have not and why); adequacy of pharmaceutical supplies and approriateness of legislation; priorities (e.g., pricing, regulation, importation, distribution, quality control, and substance control); and problems connected with enforcement of legal measures (e.g., unguarded frontiers, inadequacy of administration, regional uniformity of legislation, and shortage of qualified pharmacy and medical personnel). The monograph ends with published pharmaceutical legislation in developing countries, from Algeria to Zambia.