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Joicfp Review. 1983 Spring; (6):25-31.During 1980, the Integrated Family Planning and Parasite Control Project initiated the construction of 5 low-cost toilets in the rural Panchkhal Project area of Nepal for demonstration purposes on a subsidy basis. On recommendation from the members of the cooperation committee, these toilets were constructed within school premises located in different Village Panchayats. The overall strategy adopted during the parasite control program was to generate community participation in latrine construction. In the fiscal year 1981, 30 more subsidized sanitary toilets were built in the pilot area. With a view to determine how many families would be interested in constructing sanitary toilets on a subsidy basis towards the later part of 1981, the Project invited applications from the people of the pilot area. This was done to check people's attitudes towards the program. The response was encouraging. By the end of 1981, there were 300 applications; interest would have increased if the Project could aid all of the potential applicants. UNICEF has been involved in latrine construction by granting money and aiding in latrine design. The Panchkhal experience shows that community people are prepared to spend as much as 75% of the building costs for constructing sanitary toilets, when they are convinced that their health will improve as a result. Those who can afford the toilets will pay Nepal Rs25 (about US$1.90); those who cannot pay cash will provide labor to make the cement slabs. The very poor sector of the community, upon recommendation of members of the cooperation committees, may be given squatting slabs free of charge, if they are interested in constructing latrines. Constraints to the program include: difficult geography for constructing latrines; deforestation and dried-up wells; high illiteracy; lack of higher education facilities; and lack of appropriate technology. Recommendations call for distribution of materials at a nominal charge; casting the slabs over the household pits in difficult terrains; health education to motivate the community to adopt preventive measures against malnutrition and infection; and community organization for community participation. A field questionnairre and survey results obtained in 1982 are appended to the summary.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):452-9.This summary of the worldwide impact of measles discusses epidemiology, reported incidence, clinical severity, community attitudes toward measles, and the impact of immunization programs on measles. Measles, 1 of the most ubiquitous and persistent of human viruses, occurs regularly everywhere in the world except in very remote and isolated areas. Strains of measles virus from different counties are indistinguishable, and serum antibodies from diverse population have identical specificity. Yet, the epidemic pattern, average age at infection, and mortality vary considerably from 1 area to another and provide a contrasting picture between the developing and the developed countries. In the populous areas of the world, measles causes epidemics every 2-5 years, but in the rapidly expanding urban conglomerations in the developing world, the continuous immigration from the rural population provides a constant influx of susceptible individuals and, in turn, a sustained occurrence of measles and unclear epidemic curves. In the economically advanced nations, measles epidemics are closely tied to the school year, building up to a peak in the late spring and ceasing abruptly after the summer recess begins. Maternal antibody usually confers protection against measles to infants during the 1st few months of life. The total number of cases of measles reported to WHO for 1980 is 2.9 million. Considering that in the developing world alone almost 100 million infants are born yearly, that less than 20% of them are immunized against measles, and that various studies indicate that almost all nonimmunized children get measles, less than 3 million cases of measles in 1980 is a gross underestimate. There was adecrease in the global number of reported cases of measles during the 1979-80 period due primarily to the reduction in the number of cases in the African continent and, to a lesser extent, in Europe. It is premature to conclude that such a reported decline is real and that it reflects the beginning of a longterm trend. The contrast between the developed and the developing worlds is most marked in relation to the severity and outcome of measles. Case fatality rates of more than 20% have been reported from West Africa. It has been estimated that 900,000 deaths occur yearly in the developing world because of measles, but data available to WHO indicate that the global case fatality rate in the developing world approaches 2% (in contrast to 2/10,000 cases in the US), and the actal mortality may be greater than 1.5 million deaths per year. The advent of WHO's Expanded Program on Immunization has brought about an awareness of the measles problem. Whenever and wherever measles vaccine has been used effectively on a large scale, a marked reduction in the number of cases has been recorded.