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Geneva, Switzerland, World Health Organization [WHO], 2010.  p.This report describes the status and trends with respect to the use of safe drinking-water and basic sanitation, and progress made towards the MDG drinking-water and sanitation target. As the world approaches 2015, it becomes increasingly important to identify who are being left behind and to focus on the challenges of addressing their needs. This report presents some striking disparities: the gap between progress in providing access to drinking-water versus sanitation; the divide between urban and rural populations in terms of the services provided; differences in the way different regions are performing, bearing in mind that they started from different baselines; and disparities between different socioeconomic strata in society. Each JMP report assesses the situation and trends anew and so this JMP report supersedes previous reports. The information presented in this report includes data from household surveys and censuses completed during the period 2007-2008. It also incorporates datasets from earlier surveys and censuses that have become available to JMP since the publication of the previous JMP report in 2008. In total, data from around 300 surveys and censuses covering the period 1985 - 2008, has been added to the JMP database. The updated estimates for 2008, 2000 and 1990 are given in the statistical table starting on page 38. This table for the first time shows the number of people who gained access to improved sanitation and drinking-water sources in the period 1990-2008. It is important to note that the data in this report do not yet reflect the efforts of the International Year of Sanitation 2008, which mobilized renewed support around the world to stop the practice of open defecation and to promote the use of latrines and toilets. (Excerpt)
Care of mother and baby at the health centre: a practical guide. Report of a technical working group.
Geneva, Switzerland, WHO, Division of Family Health, Maternal Health and Safe Motherhood Programme, 1994. , 55 p. (Safe Motherhood Practical Guide; WHO/FHE/MSM/94.2)This report is designed for health planners and program managers to improve access to health and to decentralize maternal and newborn health care. It covers secondary care services that traditional birth attendants (TBAs), midwives, and other nonphysician health workers in health centers can perform. Specifically, it defines the tasks and skills required to provide comprehensive care of mother and infant at the health center and in the community. It also looks at the role of the health center in training, supervision, and continuing logistic support for community based care. The first chapter examines the health center's role in maternal health and the 3 approaches to integrated care: vertical integration, integration across time, and horizontal integration. The next chapter reviews the essential elements of obstetric and neonatal care, including sexually transmitted diseases and HIV/AIDS. Topics discussed in the chapter on developing and maintaining a functional referral system include referral protocols, functional links with referral centers, obstetric first aid, maternity waiting homes, transport and communication, and reception of referred cases in referral centers. Institutional support mechanisms (chapter 4) are training; teamwork and supervision; logistics, maintenance, and essential drugs and supplies; management, communication, and interpersonal skills; and data collection and research. Topics included in the chapter on community support systems are TBA training and retraining, integrating the TBA into the health care system, IEC, and community support mechanisms for the health of mothers and newborns. The last chapter revolves around evaluation and monitoring, including estimating catchment area and coverage, monitoring quality of care for mothers and newborns, performance indicators, record keeping, and home-based maternal records.
SAFE MOTHERHOOD NEWSLETTER. 1994 Jul-Oct; (15):10.Use of the partograph during labor can prevent suffering and loss of life. The partograph records the progress of labor, especially the rate of cervical dilatation. WHO's partograph differentiates between the latent phase of labor (slow dilatation up to 2 cm) and the active phase, during which the cervix dilates by at least 1 cm/hour to full dilatation. The partograph can detect abnormal progression of labor. Then clinicians can either augment labor by administering oxytocin or, in extreme cases of prolonged or obstructed labor, perform a cesarean section. Use of the WHO partograph in 8 hospitals in Indonesia, Thailand, and Malaysia reduced postpartum infections (by 59%), the number of stillbirths, the amount of oxytocin augmentation, and unnecessary cesarean sections. Thus, the WHO partograph was able to differentiate labors requiring intervention from those not requiring intervention. WHO calls for health personnel to use its partograph and its management protocol, both in labor wards with the capabilities to manage labor complications and in health centers without these capabilities which can refer women with labor complications to a specialist facility.
Surveillance of acquired immunodeficiency syndrome in Africa: an analysis of evaluations of the World Health Organization and other clinical definitions.
EPIDEMIOLOGIC REVIEWS. 1994; 16(2):403-17.In order to improve public health efforts to combat the HIV pandemic, a system for surveillance of HIV and AIDS is needed. Definitions used for case reporting are at the heart of such a system. In many parts of Africa, however, facilities for diagnosing HIV infection and its subsequent complications are unavailable, and the definition developed by the US Centers for Diseases Control and Prevention (CDC) for use in developed countries is often impractical in Africa. The World Health Organization (WHO) in early 1985 therefore proposed using a provisional case definition of AIDS based principally upon clinical criteria. Developing a clinical definition of AIDS in Africa, however, is also complicated. The nonspecific nature of many of the signs and symptoms of HIV infection as well as the clinical redundancy between HIV and other epidemic health problems make definitive identification of any single disease problematic. Evaluation of the surveillance definition of AIDS in Africa is complicated by the lack of an accepted standard for comparison. Most studies in the field have used HIV serology as the standard, while others have employed the CDC definition for AIDS, giving the evaluations a certain relativity. This paper reviews available information on the WHO definition and other clinical definitions for AIDS in Africa in order to analyze their various field evaluations and explore the use of such definitions in the African context. Sections discuss surveillance clinical case definitions for African AIDS in adult and pediatric populations, clinical case definitions of African AIDS in adult and pediatric populations, sensitivity and specificity, the WHO clinical case definition for HIV epidemiologic survey, clinical definitions for AIDS in clinical practice, and working toward the improvement of the clinical definition of AIDS.
TUBERCLE AND LUNG DISEASE. 1994 Jun; 75(3):163-7.Poor management of tuberculosis (TB) control is responsible for resistance to antituberculosis drugs. It leads to treatment failure, relapse, transmission of resistant TB, and multi-drug resistant TB. In developing countries, where resources are already limited, an epidemic of multi-drug resistant TB would jeopardize TB control. The effect of HIV infection is likely to worsen drug resistance-related problems. Specifically, streptomycin injections pose a risk of HIV transmission. It appears that withdrawal of thiacetazone from HIV infected TB patients causes resistance to more powerful drugs. If these 2 antibiotics cannot be used to treat TB patients, the armamentarium available to control TB in high HIV prevalence countries is reduced, which could foster resistance to the fewer remaining antibiotics. Good management and supervision is needed to prevent resistance to antituberculosis drugs. Surveillance of drug resistance is also needed to monitor the current level and characteristics of the drug resistance problem and to identify effective solutions. Specifically, at the national level, a TB surveillance system can assess the TB control program's performance and assess the need to modify the current treatment policy. It can identify districts or health centers with high levels of drug resistance and determine the risk factors for resistance. WHO will assist developing countries in developing their own surveillance systems. WHO and the International Union Against Tuberculosis and Lung Disease plan on setting up a network of supranational reference laboratories to determine the quality control and standardization of susceptibility testing needed for international comparison. WHO also plans on supporting national reference laboratories in developing countries.
Laboratory diagnosis of measles infection and monitoring of measles immunization: memorandum from a WHO meeting.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1994; 72(2):207-11.Measles infection remains a major global health problem. Although it may be easily confused with other conditions, the disease is frequently diagnosed in many countries on clinical grounds alone. A World Health Organization Consultation on Laboratory Diagnosis of Measles Infection and Monitoring of Measles Immunization was held in Glasgow August 7-8, 1993, to discuss ways to improve the situation. This brief summarizes the discussions and recommendations made by the participants. It is recommended that since only limited efforts have been made in recent years to develop tools for the diagnosis and surveillance of measles virus infection, focus should be given to techniques for the rapid diagnosis of measles using inexpensive techniques and technologies currently employed in other immunological and molecular diagnostic methods, with priority given to assay systems which determine parameters associated with current and recent infection; an international network of laboratories involved in the diagnosis and surveillance of measles should be established; and to evaluate next-generation diagnostic tools and establish criteria for their use, panels of serum samples should be established from individuals with a well-defined history of vaccination and/or wild-type measles virus infection. A bank of clinical specimens from monkeys experimentally infected or vaccinated with different measles viruses should also be established. Ongoing efforts will require a sound financial base. The proposed laboratory network is described, followed by sections on the laboratory diagnosis of measles in clinical materials, the direct detection of measles virus antigens in clinical specimens, and the detection of specific nucleic acids.
Arlington, Virginia, Partnership for Child Health Care, 1995. , 10,  p. (BASICS Trip Report; BASICS Technical Directive: 000 HT 51 012; USAID Contract No. HRN-6006-C-00-3031-00)In March 1995, a BASICS (Basic Support for Institutionalizing Child Survival) Project technical officer participated in a World Health Organization (WHO) Global Programme on Vaccines and Immunization (GPV) meeting in Geneva, Switzerland, about introduction of vaccine vial monitors (VVMs). VVMs constitute color-coded labels that can be affixed to vials of vaccines which, when exposed to heat over time, change irreversibly. In 1994, WHO and UNICEF requested that, starting in January 1996, VVMs be affixed on all UNICEF-purchased vials of oral polio vaccine. Yet, UNICEF does not require vaccine manufacturers to include VVMs in their vaccine labels. USAID has supported much of the development and field testing of VVMs since 1987. Participants discussed status of interactions between UNICEF and vaccine manufacturers, issues and means related to introducing VVMs worldwide, and the prospect for conducting a study or studies on the initial effect of VVMs on vaccine-handling practices. They also heard an update on the pilot introduction of VVMs in some countries. BASICS could contribute to the development of a plan for global VVM introduction, since time constraints and heavy workloads face WHO/GPV leaders. UNICEF and GPV staff suggested that other VVM products from different manufacturers also be sold to avoid a monopoly. Participants considered issues of global introduction and resolution of issues with manufacturers of VVMs and vaccines to be high priority issues. WHO and UNICEF asked BASICS to draft general training materials for staff at the central, provincial, district, and periphery levels, focusing on actions that each level should take as a result of VVM use. They also asked BASICS to develop a quick-reference sheet for policy makers.
Manila, Philippines, WHO, Regional Office for the Western Pacific, 1994 Jun.  p.This document presents four configurations of tabulated socioeconomic and health data from the Regional Office for the Western Pacific of the World Health Organization. Part 1 considers each of the 35 countries in terms of the following indicators: area, population, annual population growth rate, age distribution, urban population, rate of annual natural increase of the population, crude birth rate, crude death rate, life expectancy at birth, infant mortality rate, total fertility rate, socioeconomic indicators for the year 2000, per capital gross national product (GNP) at market prices, rate of growth of per capita GNP, percentage gross domestic product derived from manufacturing industries at constant factor cost, economically active population in primary sector, daily per capita calorie supply, daily per capita protein supply, adult literacy rate, health budget/expenditure, health manpower, 10 leading causes of communicable diseases morbidity, 10 leading causes of death, cases and deaths from 18 selected diseases, proportion of infants fully immunized and pregnant women immunized against tetanus, percent of population served with safe water, percent of population with adequate sanitary facilities, percent of low birth weight infants, and maternal mortality rate. Part 2 presents these same data organized by country or area. Part 3 tabulates data on global and regional indicators used to monitor/evaluate the strategies for "health for all" by the year 2000. These indicators fall under the following headings: mortality trends, nutritional status of children, safe water and basic sanitation, maternal and child care (including family planning), immunization, treatment for common diseases, primary health care coverage, national health policies and strategies, community involvement, international support for health system development, financial resources, human resources for health, trends in education, and economic trends. Part 4 reorganizes these data according to country or area.
Planning meeting to discuss development of a health facility quality review, WHO / CDR and USAID / BASICS, Geneva, May 15-19, 1995.
Arlington, Virginia, Partnership for Child Health Care, 1995. , 9,  p. (BASICS Trip Report; BASICS Technical Directive: 000 HT 55 012; USAID Contract No. HRN-6006-C-00-3031-00)In May 1995, representatives of the World Health Organization Division of Diarrheal and Acute Respiratory Disease Control and of the US Agency for International Development's Basic Support for Institutionalizing Child Survival Project (BASICS) met in Geneva to discuss the first phase of the process of developing a methodology for collecting information on the quality of facility services in areas where integrated case management is being used. This monitoring and evaluation instrument is called Health Facility Quality Review: Case Management of Childhood Illness. The discussions revolved around the focus of activities, series of quality review activities, personnel, facilities, health workers observed and interviewed, indicators, pre-assessment for program planning, the process, materials, sampling, guidelines for developing forms, country adaptation, and format. A BASICS staff member has developed a pre-assessment tool for program planning scheduled to be used in Eritrea in June 1995. Content categories of the Health Facility Quality Review forms should include case observation, case examination, caretaker interview, health worker interview, review of records, review of facility space and furnishings, review of availability of facility equipment and supplies, review of drug supplies, review of vaccines available, review of other supplies, drug management, staffing, supervision, clinic organization, and interventions. BASICS will budget and make plans for the field test of the quality review during June-July 1995. It will oversee the pretest of forms probably in October 1995.
Arlington, Virginia, Partnership for Child Health Care, 1995.  p. (BASICS Trip Report; BASICS Technical Directive: 000 HT 51 012; USAID Contract No. HRN-6006-C-00-3031-00)A specialist of vaccine vial monitors (VVMs) assisted in developing the agenda for and participated in a meeting in Geneva designed to develop plans for introducing VVMs on oral polio vaccine (OPV). Representatives of the World Health Organization (WHO) Global Programme on Vaccines and Immunization (GPV), the US Agency for International Development (USAID), UNICEF, and Basic Support for Institutionalizing Child Support Project (BASICS)/ Program for Appropriate Technology in Health (PATH) participated in the discussions. The meeting served to update all agencies involved with OPV delivery about VVMs and to identify what actions are needed as well as the parties responsible for the global introduction of vaccines with VVMs. In the summer of 1995, Tanzania will be hosting a pilot project of introducing VVMs with OPVs. Other potential pilot sites include Swaziland and Vietnam. Discussion of pilot activities focused on their purpose, resources available for establishing and monitoring them, and the appropriate number of pilot countries. There were also discussions of a framework for global introduction of VVMs, potential costs associated with VVMs, the effect on vaccine forecasting, and training materials. There were sessions on the organization of the GPV, vaccine supply and quality, the view from Sudan and Indonesia, and human and financial resources. Meeting participants agreed on follow-up actions: continue to work with international OPV supplies, begin to approach national OPV producers to lay the groundwork for use beginning in 1996, limit pilot activities to 4-5 countries (1-2 countries only receiving a packet of information and no technical assistance), develop a package of introduction materials, and develop a briefing sheet on VVMs.
JOURNAL OF COMMUNICABLE DISEASES. 1994 Dec; 26(4):231-2.The World Health Organization (WHO) criteria for HIV clinical disease were tested among individuals with high-risk behavior in northern India. A questionnaire, based upon history and physical examination alone, standardized by the WHO to include both major and minor signs necessary for the clinical diagnosis of AIDS in adults was applied to 165 consecutive patients attending the STD clinic of Dr. R.M.L. Hospital, New Delhi. All patients were screened for the presence of STDs by the dermatologist in charge of the clinic, with patients fulfilling two major and at least two minor WHO criteria eventually classified as having clinical AIDS based upon the WHO case definition. Each of those patients was subjected to serological confirmation of the clinical suspicion using ELISA and Western blot commercial tests. Of the 165 patients screened, a definite diagnosis of STD was possible in 85. These patients were 20-45 years old (mean age, 30.59 years). All were male and chancroid was the most common STD in the cohort. Of the 85, only one satisfied the WHO clinical criteria for AIDS. Serological investigations, ELISA, and Western blot confirmed the subject's HIV-seropositive status. These results indicate that in northern India, clinical HIV disease remains rare even among individuals with high-risk behavior. The low prevalence of clinical HIV disease in that part of the country makes it difficult to assess the specificity and sensitivity of the WHO clinical criteria for AIDS.
Progress towards health for all: third monitoring report. Progres vers la sante pour tous: troisieme rapport de suivi.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1995; 48(3-4):174-249.In 1977, the World Health Assembly designated the year 2000 as the time by which it should be possible for all citizens of the world to obtain a level of health that would permit them to be socially and economically productive. This document, which assesses implementation of health-for-all strategies during 1991-93, is the third report to monitor progress toward this goal. The report opens with an introduction describing the monitoring process and the data upon which the assessment was based. The second section of the report describes population and socioeconomic trends and considers such issues as patterns in population growth, longterm trends in births and deaths, social change, age structure, migration, urbanization, refugees and displaced persons, and trends in education. The third section discusses trends in the provision of a healthy environment and promotion of healthy life styles. Section 4 summarizes health status data on life expectancy, mortality rates, causes of death, morbidity trends, disability trends, and the nutritional status of children. Implementation of primary health care (PHC)is covered in the next section, which looks at health education and promotion, food supply and proper nutrition, safe water and basic sanitation, maternal and child care, control of locally endemic diseases, immunization, treatment of common diseases, and PHC coverage. The sixth section assesses the development of health systems based on PHC and looks at national health policies, strategies, and legislation; organization and management of health systems based on PHC, intersectoral collaboration, community involvement, health systems research, technology for PHC delivery, international support for health system development, sustainable development initiatives, and emergency preparedness and relief. Section 7 is devoted to health resources in the areas of financial activities, human resources, the physical infrastructure, and logistics and supplies. The concluding section of the report summarizes the status of 1) the major determinants of health, 2) the implementation of PHC and the development of health systems, and 3) the distribution of health resources. The next in-depth analysis of progress toward health-for-all is scheduled to begin in 1997.
MEMORIAS DO INSTITUTO OSWALDO CRUZ. 1996 May-Jun; 91(3):335-8.The World Health Organization (WHO) Global Program on AIDS (GPA) organized the WHO Network for HIV-1 Isolation and Characterization to monitor HIV-1 variability. Brazil is one of the HIV vaccine trial sites selected by WHO-GPA. HIV-1 subtypes B, F, and C have thus far been found in the country. A study involving 235 Brazilian isolates found subtype B to prevail in 88.5% of cases, subtype F in 8.9%, and subtype C in 1.7%. 2 samples (0.9%) were variants resulting from a recombination between subtypes B and F. Further studies have found that Brazilian HIV-1 strains have genetic and antigenic differences compared to North American/European prototype strains, potentially affecting the success of immunoprophylactic programs based upon HIV-1 vaccine candidates currently proposed for testing in Brazil. A Brazilian Network for HIV-1 Isolation and Characterization (BNHIC) was thus established in March 1993, as part of the National Program of HIV/AIDS Vaccine Development and Evaluation. The BNHIC was organized upon a 3-tier basis including primary site, central reference laboratory, and secondary laboratories. The authors discuss efforts made to achieve network goals in Brazil.
Impact of the 1994 expanded World Health Organization AIDS case definition on AIDS surveillance in university hospitals and tuberculosis centers in Cote d'Ivoire.
AIDS. 1997 Dec; 11(15):1867-72.To assess the impact of the 1994 expanded World Health Organization (WHO) AIDS case definition upon AIDS surveillance in Cote d'Ivoire, passive AIDS case surveillance was conducted from March 1994 through December 1996 at the 3 university hospitals in Abidjan, while active AIDS case surveillance was conducted at the 8 large tuberculosis (TB) centers throughout Cote d'Ivoire. Standardized questionnaires were administered and blood samples for HIV testing were collected from patients evaluated. 3658 of the 8648 hospital patients met the clinical and/or expanded case definition: 744 HIV-seropositive individuals met only the expanded definition, 44 HIV-seropositive individuals met only the clinical definition, 2334 HIV-seropositive individuals met both definitions, and 536 HIV-seronegative persons met only the clinical definition. Of 18,661 TB center patients, 9664 met the clinical and/or expanded case definition: 5685 HIV-seropositive individuals met only the expanded definition, none of the HIV-seropositive individuals met only the clinical definition, 2625 HIV-seropositive individuals met both definitions, and 1354 HIV-seronegative persons met only the clinical definition. The use of the 1994 expanded definition for surveillance purposes should be encouraged in areas of the developing world where HIV serologic testing is available.
INTERNATIONAL DIGEST OF HEALTH LEGISLATION. 1998; 49(1):265-82.The significance of human rights for the advancement of women's health and self-determination has gained recognition and momentum through recent UN conferences, with the program of action adopted by member states at the 1994 International Conference on Population and Development recognizing the importance of human rights in protecting and promoting reproductive health. The author discusses the application of human rights to protect and promote women's health. She surveys some of the decisions of regional and international courts which advance women's health, and describes monitoring mechanisms to hold governments and their agents accountable for violating women's rights to health protection and promotion. The author also suggests actions the World Health Organization could take with regard to women's health and human rights over the next 50 years.
Meeting report on Fourth Regional Workshop on HIV / STD Surveillance, Cairo, Egypt, 7-10 October 1996.
Alexandria, Egypt, WHO, Regional Office for the Eastern Mediterranean, 1997. , 28 p. (WHO/EM/STD/2/E/L)The Eastern Mediterranean Regional Office of the World Health Organization is working to develop and strengthen surveillance for HIV, AIDS, and sexually transmitted diseases (STDs). Progress in the implementation of such strategies was discussed at the Fourth Regional Workshop on HIV/STD Surveillance held in Cairo, Egypt, in October 1996. The main objectives of HIV surveillance are 1) to monitor trends in HIV infection over time and place, and 2) provide information for program planning, advocacy, and program implementation. By the end of June 1996, a cumulative total of 3979 AIDS cases had been reported by 21 Member States in the region; however, the actual number is considered to be well over 12,000 and an estimated 220,000 persons are HIV-infected. HIV surveillance has focused primarily on STD patients. Obstacles to this approach include low attendance of STD patients (especially women) at public sector clinics, the unacceptability of unlinked anonymous testing in many countries, and insufficient coordination between sentinel sites and testing laboratories. Options for improving HIV surveillance include orientation of policy-makers on the importance of using unlinked anonymous testing to reduce participation bias, involvement of private doctors and nongovernmental organizations in surveillance of high-risk groups, introduction of tests for syphilis and hepatitis B in sentinel sites before surveillance begins, proper selection of sentinel sites to ensure adequate sample size, and preparation of an operations manual for staff at surveillance sites. The AIDS case definition needs to be reviewed and revised to suit the prevailing situation in the region. For STD surveillance, reports should be obtained from both private and public health facilities, with an etiology-based rather than syndromic approach to diagnosis.
Arlington, Virginia, Partnership for Child Health Care, Basic Support for Institutionalizing Child Survival [BASICS], 1998. , 6,  p. (Report; USAID Contract No. HRN-C-00-93-00031-00)This report pertains to a consultant visit to Douala, Cameroon, during October 1998, to fulfill World Health Organization objectives. The goals were to evaluate the implementation of recommendations made during a February conference in Chad, to examine the status of acute flaccid paralysis (AFP) surveillance in participating countries, to assess progress toward a vaccine independence initiative, and to set an agenda for 1999. The consultant participated in a workshop among representatives of Cameroon, Congo, Gabon, Equatorial Guinea, Central African Republic, Democratic Republic of Congo, and Chad. Representatives made presentations at the workshop on their current national situation on the state of preparedness for 1998 National Immunization Days (NIDs), implementation of the Chad conference recommendations on surveillance systems (SS), implementation of a sustainable integrated national SS, and reinforcement activities for routine immunization services. Plenary topics included certification criteria for eradication of polio, active surveillance of AFP, management tools for AFP surveillance, case investigation, sensitizing clinicians, reimbursing the cost of transporting samples, interagency collaboration, and vaccine independence. NIDs are planned for areas in the Congo where security risks are at the lowest, which would include coverage of about 54% of the country's population. Logistical evaluation needs to be performed before NIDs occur. A new budget needs to be drafted to meet the realities of the emerging situation. About 30 recommendations are listed for NIDs, routine EPI, and surveillance.
PAEDIATRIC AND PERINATAL EPIDEMIOLOGY.. 1998 Oct; 12 Suppl 2:156-64.The Data and Safety Monitoring Committee (DSMC) of the World Health Organization (WHO) Antenatal Care Randomized Controlled Trial is charged with reviewing logistics, protocol compliance, efficacy data, ethical concerns, and safety-related indications for stopping the trial. The committee is comprised of an obstetrician, an epidemiologist, and a biostatistician. The DSMC reviews monthly statistics from the 53 study sites in Argentina, Cuba, Thailand, and Saudi Arabia on maternal deaths, fetal deaths, and eclampsia as well as quarterly data on perinatal deaths. It was agreed that the DSMC should take action if an increase of more than 25% in the intervention group (a new prenatal care regimen) compared with the control group (standard prenatal care) occurred in either of the primary outcomes: low birth weight or maternal morbidity index. It was further decided that the DSMC should be independent from the steering committee, with free access to unblinded interim data on the two arms of the trial. The DSMC chose not to establish any definite stopping rules before study initiation. There was initial concern about an excess of maternal deaths in the experimental arm of the study. The first four maternal deaths occurred in the intervention group, but a review of case history details reassured the DSMC that adherence to the new prenatal care regimen was not to blame. Similarly, an initial preponderance of fetal deaths in one arm turned out, when investigated, to reflect differential timing of reporting early pregnancy events rather than real outcome differences.
Global medium-term programme. Programme 13.11: Sexually transmitted diseases (venereal diseases and treponematoses).
[Unpublished] 1991. Presented at the 1st International Course on Planning and Managing STD Control Activities in Developing Countries, Antwerp, Belgium, September 9-21, 1991. 12 p.This paper outlines the World Health Organization's global medium-term program to prevent and control sexually transmitted diseases (STDs) during 1990-95, in an effort to reduce the impact of their complications and sequelae, such as infertility, congenital and perinatal infections, and genital cancers. The program has progressed considerably during the 7th General Program of Work, with the control of STDs enjoying higher priority in many countries because of the HIV/AIDS pandemic. The program will be promoted in accordance with the general principles outlined in the 8th General Program of Work, with specific emphasis upon the implementation of intervention strategies within primary health care. Priorities during the current period will include support of the application of practical and simple technologies to assess the extent and impact of STD morbidity; support of planning and implementing practical and low-cost STD control technologies at the primary health care level; better understanding of the behavioral patterns associated with STD transmission; development and application of cost-effective standard treatment regimens; transfer of simple diagnostic and therapeutic techniques to the peripheral level; refinement of technical skills for STD control workers; and support for research, including the cost-effectiveness evaluation of STD control strategies in different settings.
MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT. 1999 Jun 25; 48(24):513-8.This report outlines progress toward polio eradication from 1998 through April 1999 in the African region (AFRO). WHO accelerated various strategies to annihilate poliomyelitis in the region of Africa. A highlight of supplementary vaccination activities [i.e., National Immunization Days (NIDs) and acute flaccid paralysis (AFP) surveillance] was conducted in the region, and plans for program acceleration--such as intensified NIDs and mopping-up vaccinations to meet the 2000 eradication project--were developed. However, intense wild poliovirus transmission continued to occur in Angola, DR Congo, and western and central Africa. Thus, high-quality house-to-house vaccination campaigns were launched to help eliminate wild poliovirus transmission quickly in these parts of AFRO. Although civil conflict, economic decline, and the high burden of HIV-related diseases have strained public health infrastructures leading to a decline in routine vaccination coverage and low health staff morale in Africa, an intensely focused effort to eliminate the virus, if it is adequately supported, will allow WHO to achieve its goal of polio eradication by 2000.
Adverse events monitoring as a routine component of vaccine clinical trials: evidence from the WHO Vaccine Trial Registry.
Bulletin of the World Health Organization. 2000; 78(9):1167.This article assesses whether and how investigators are monitoring adverse events following immunization (AEFI) in vaccine trials, using evidence from the WHO Vaccine Trial Registry. It is noted that the Registry includes all vaccine trials sponsored since 1987 by the WHO Expanded Programme on Immunization, Global Programme for Vaccines and Immunization, and Department of Vaccines and Biologicals. For each trial, records include internal documents, reports of visits to trial sites, and publications. Based on the records from 68 trials, completed or in progress, analysis indicates that only few investigators included detailed AEFI monitoring in their study reports and publications. However, an increasing trend to include AEFI monitoring in vaccine clinical trials was noted. Since many vaccine trials are conducted by independent investigators, and AEFI monitoring methods and results deserve to be included in any publication, along with vaccine efficacy methods and results, it should be the responsibility of the study investigators, rather than of the vaccine manufacturer and the national control authority, as suggested. Several practical points for monitoring AEFIs in vaccine clinical trials are cited.
Reproductive Health Matters. 2001 Nov; 9(18):191.In 1997 UN International Children's Fund, WHO, and UN Population Fund developed guidelines for monitoring obstetric services, offering relevant process indicators which used proxy measures for maternal mortality, because counting deaths had been highly inaccurate. The Malawi Safe Motherhood Project covers half the country's population of 5 million and was the first large project to adopt the use of the recommended indicators within routine monitoring procedures, albeit with significant adaptation. Development of the monitoring process required: a needs assessment, including identification of sources of data and definition of terms, such as for obstetric conditions; development of tools for data collection: and actual operations research. The research considered patient flow in obstetric clinics; recording of complications; and identification of maternal deaths, referral systems and the origin of patients, in order to determine the catchment populations for each service point. Subsequently, when the new monitoring system was deemed to be feasible and effective, training programs were conducted by trainers from each district, and information was disseminated. The intention is that the Safe Motherhood information system training modules will eventually be incorporated into all basic and in-services training for maternity staff. Introduction of the indicators in Malawi was characterized by wide consultation, systematic clarification of all definitions, rigorous testing and use of already established systems. All of these steps were required to gain support and motivate staff involved in data collection and analysis. (full text)
Geneva, Switzerland, World Health Organization [WHO], Department of Reproductive Health and Research, 2001. , 34 p. (Occasional Paper No. 6; WHO/RHR/01.22)This paper was commissioned by the Department of Reproductive Health and Research at the WHO to examine lessons learned from more than 2 decades of experience in applying information, education and communication (IEC) interventions in support of public health. It defines IEC, then offers lessons learned in planning, monitoring, and evaluating a strategy. It also discusses peer education, gender issues, youth, life skills, religious institutions, and building partnerships with other organizations.
New Delhi, India, WHO, SEARO, 1991 Dec. , 35 p. (Regional Health Paper, SEARO, No. 20)The Joint WHO/UNICEF Nutrition Support Programme (JNSP) began operations in Myanmar in 1984 and expanded nationwide in three phases. A detailed situation analysis of nutrition conditions and nutrition programs in primary health care (PHC) were conducted prior to JNSP activities. They served as the rationale for the decision to implement JNSP activities nationally. These activities are almost entirely administered through the Ministry of Health. JNSP redesigned nutrition training for village workers, their supervisors, and district health personnel. It has strengthened nutrition units at the central and regional levels. All JNSP-technical activities revolve around nutrition monitoring and counseling. JNSP participated in the establishment and operations of a food and nutrition surveillance system. It facilitated implementation of the nutrition and nutrition-related aspects of the People's Health Plan. The JNSP was evaluated in 1989. During the JNSP period, mortality among children less than 3 years old fell. 3-year-old children grew at a faster rate than prior to JNSP. Improvements were also noted in young child feeding practices, health seeking behavior of mothers, counseling by voluntary workers, and health staff performance. The evaluators concluded that JNSP directly benefitted the health and nutrition of children less than 3 years old. External costs of JNSP added up to US$5.63 million. The government put in another US$5.43 million. The communities contributed US$2.9 million. JNSP covers 30% of the total population. Per capita annual costs were US$1.67. These low per capita costs suggest that JNSP is sustainable and replicable. JNSP's further expansion depends on expansion of the health delivery system. All levels regularly provide support and supervision. Planned evaluation and feedback is the norm.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1995; (857):i-vi, 1-91.In 1993, the World Health Organization (WHO) Study Group on Vector Control for Malaria and other Mosquito-Borne Diseases convened in Geneva to develop well-defined guidelines for implementing the vector control component of the Global Malaria Control Strategy. Goals and objectives of the control strategy, vector control, and the study group as well as those concerning use of the insecticide DDT are addressed in the meeting's published report. A review of the global status and trends in malaria and other mosquito-borne diseases follows. Malaria status and experiences, priorities, and trends in vector control in the various WHO regions are examined. One section reviews objectives of vector control, considerations in planning and implementation, selectivity and sustainability, information systems management, stratification of malarious areas by eco-epidemiological criteria, and priority geographical areas and risk groups. Indoor residual spraying, personal protection measures, larviciding and biological control, and environmental management are also discussed. The next section examines the role of vector control in malaria epidemics and drug-resistant malaria. Another section examines indicators of operational and entomological impact and of impact on disease and integrated use of control methods under the context of monitoring and evaluation of vector control efforts. Entomological parameters and techniques discussed include detection and monitoring of insecticide resistance, bioassays, adult density, resting indices, mosquito age and survival rates, human-vector contact, mosquito infection rates, entomological inoculation rate, and measurement of malaria transmission as well as choice of parameters and design for evaluating interventions. Other topics include the role of entomological services in malaria control, managerial aspects of malaria vector control and entomological services, comprehensive vector-borne disease control, capacity building, role of communities and other sectors in vector control, cost-effectiveness in vector control, research in vector control, and policy issues related to vector control.