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  1. 1

    Measles: summary of worldwide impact.

    Assaad F

    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.
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  2. 2

    Report on international financial resources for maternal/child health and family planning.

    Maine D; Wray JD; Wallace M; Belsey MA; Foo-Gregory CL

    [Unpublished] 1985. 47 p. (MCH/85.4)

    Despite improvements during the last decade in the health of women and children in developing countries, a great deal remains to be done. Barriers to continued progress take a number of forms, including financial and institutional. A study of existing data on international funding for maternal/child health and family planning (MCH/FP) shows the following: in 1983 the total official development assistance funding from developed countries totalled US$39.6 billion; 72% of these funds were dispersed through bilateral agencies, the rest through multilateral agencies (in 1983); nearly 6% of bilateral funds were allocated to the health sector (which includes population); analysis of 77 UNDP country reports indicates that about 1/10th of development funding is devoted to health and population; this proportion varies considerably by geographical region, being highest in Latin America and lowest in Africa; funding for MCH/FP programs constitutes about 1/15th of health and population funds reported by the UNDP; again, this proportion is lower in Africa than in Asia or Latin America, although this may be changing; in terms of women and children to be served, it appears that, on average, international funding for MCH/FP programs provides less than US$1 each; a survey of donor agencies indicates that most donors are willing to increase their funding of MCH/FP programs; when the donors were asked to name factors that would induce them to increase MCH/FP funds, the 2 most common answers were: more requests for funding, and , better evidence of unmet needs. Institutional barriers to optimal utilization of MCH/FP resources are discussed, including those often encountered in nongovernmental, bilateral and multilateral agencies, as well as in host countries and industry. Finally, a number of models for effective utilization of development funds are drawn from experience and developed. They include models of global, national, institutional and health services efforts. (author's)
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