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PubMedDate not supplied

[Intervention priorities in the acute stage of complex emergencies drafted by nine humanitarian aid agencies].

BACKGROUND: Complex Emergencies are an international Public Health problem currently becoming increasingly more frequent and of growing proportions which lead to major death and disease rates, especially during the acute stage thereof. This study is aimed at identifying and analyzing the top-priority areas of intervention in the acute stage of a complex emergency drafted in the operating manuals of the main aid agencies, as well as the degree of development and structuring of the activities proposed in each area on which priority has been placed. METHODS: The intervention manuals drafted by nine major aid agencies were used as study material. A quantitative analysis was then made of the 16 intervention priorities set out, as well as of the degree to which each priority was defined based on the development of 73 variables of aspects of the proposals set out in the manuals. RESULTS: The ACNUR manual includes 90% of the 73 variables for further expansion upon the priorities, the UN Humanitarian Affaire Coordination Office manual including 35% of the 73 variables. ACNUR better expands upon the non-healthcare variables, followed by MSF and USAID. Doctors without borders shows a 97.3% degree of expansion of the healthcare variables) followed by ACNUR (94.7%), USAID (92.1%). CONCLUSIONS: ACNUR has been found to have the most integral proposal, the UN Humanitarian Affairs Coordination Office having the most discreet. There is a general trend towad further expanding upon and unifying the health indicators, whilst other aspects are not further expanded upon.

Emergency Medical Services↗
PubMed2001

Research to support household and community IMCI. Report of a meeting, 22-24 January 2001, Baltimore, Maryland, USA.

The Integrated Management of Childhood Illness (IMCI) strategy combines improved case management of childhood illness with aspects of nutrition, immunization, disease prevention, and promotion of growth and development. The household and community component of IMCI was formulated to reach the numerous sick children who are ill and often die at home without ever being treated by a trained healthcare practitioner. In January 2001, USAID (Child Health Research Project and BASICS II) and the CORE Group sponsored a meeting in Baltimore, Maryland, to determine the research needed to implement household and community IMCI effectively. This paper summarizes the presentations at that meeting and highlights the research and programme priorities expressed using the three-element approach devised by the CORE Group and USAID (BASICS II and Child Survival Technical Support Project). Research priorities to improve partnerships between health facilities and the communities they serve (Element 1) include finding ways to increase community involvement and management of health facilities, establishing accurate costs for community IMCI services, and formulating cost-recovery mechanisms tailored to local circumstances. Programme priorities in Element 1 include establishment of systems for maintenance of an adequate supply of essential equipment and medicines, while retaining access for the poor and ensuring adequate referral mechanisms for severely-ill patients that include monitoring and incentives for the performance of health workers. Research priorities to increase appropriate, accessible care and information from community-based care providers (Element 2) consist of activities to design simplified IMCI guidelines for use by community health workers (CHWs) and volunteers and evaluation of the impact of using these guidelines on morbidity and mortality. Also a priority item in this category is experimenting with ways to teach mothers and families to care for sick children at home and strategies to improve the practice of medicine in the private sector. More research is also needed to improve the quality of nutritional and preventive health counselling given by CHWs and to find ways to make community IMCI interventions sustainable. Programme priorities in Element 2 include efforts at the national level to establish policies to improve care by traditional and private care providers and to define the position of volunteer workers in the national health system. Research priorities to integrate promotion of key family practices critical for public health (Element 3) are focused on determining which interventions are the most effective in reducing child morbidity and mortality at the household and community levels, finding the best methods of delivering these interventions, and implementing these and scaling up in essential service packages. Particular issues in child health, needing urgent attention from the research and programme communities, are HIV/AIDS and neonatal morbidity and mortality.

Child↗
PubMed2001

Urban malaria treatment behaviour in the context of low levels of malaria transmission in Lagos, Nigeria.

Urban malaria in West Africa is not well documented. While rapid urbanisation may create environmental conditions that favour mosquito breeding, urban pollution may inhibit the growth of Anopheles species. In 1996, the Basic Support for Institutionalizing Child Survival (BASICS) Project of the U.S. Agency for International Development (USAID) started building urban community health coalitions in Lagos, Nigeria, to empower communities to provide prompt treatment and appropriate prevention for major causes of childhood morbidity and mortality, including malaria, diarrhoeal disease, acute respiratory infections and vaccine preventable diseases. Intervention against malaria was predicated on national policies that assumed Nigeria was holo-endemic for malaria and that prompt treatment of febrile illness with anti-malarial drugs was an appropriate action. At the suggestion and with the assistance of another USAID programme, the Environmental Health Project (EHP), BASICS embarked on a rapid assessment of the epidemiological, entomological and sociological situation of malaria transmission and case management in three Lagos communities. During April and May 1998, blood film investigation of 916 children between the ages of 6 months and 5 years yielded a parasite prevalence rate of 0.9%. Night knockdown collections of mosquitoes in rooms yielded only C. quinquefasciatus and A. aegypti. The same results were obtained for night landing collections on human bait. Very low densities of A. gambiae larvae were found in breeding sites in Lagos Island (0.7) and Ajegunle (0.3). In contrast, community members, during focus group discussion identified malaria, in it various culturally defined forms, as a major health problem. Among the children examined clinically, 186 (20.3%) reported an illness, which they called "malaria" in the previous two weeks, and 180 had sought treatment for this illness. Data obtained from 303 shops in the area documented that a minimum of US dollars 4,000 was spent on purchases of anti-malarial drugs in the previous week. The implications of these findings for both professional and community education are discussed.

Animals↗
PubMed1987

Withholding of population funds, 13 August 1987.

The United States Agency for International Development (USAID) withheld from the United Nations Population Fund (UNFPA) $25 million appropriated for the Fund by the United States Congress. This was the third year that funds had been withheld. As in earlier years, the Reagan administration objected to UNFPA support for China. It viewed China's family planning program, which emphasized the importance of limiting family size to one child, as sanctioning coercive abortions.

Abortion, Induced↗
PubMed2000

Vaccine procurement and self-sufficiency in developing countries.

This paper discusses the movement toward self-sufficiency in vaccine supply in developing countries (and countries in transition to new economic and political systems) and explains special supply concerns about vaccine as a product class. It traces some history of donor support and programmes aimed at self-financing, then continues with a discussion about self-sufficiency in terms of institutional capacity building. A number of deficiencies commonly found in vaccine procurement and supply in low- and middle-income countries are characterized, and institutional strengthening with procurement technical assistance is described. The paper also provides information about a vaccine procurement manual being developed by the United States Agency for International Development (USAID) and the World Health Organization (WHO) for use in this environment. Two brief case studies are included to illustrate the spectrum of existing capabilities and different approaches to technical assistance aimed at developing or improving vaccine procurement capability. In conclusion, the paper discusses the special nature of vaccine and issues surrounding potential integration and decentralization of vaccine supply systems as part of health sector reform.

Developing Countries↗
PubMed1989

Interactive radio instruction: developing instructional methods.

The USAID has, since 1972, funded the development of a new methodology for educational radio for young children through 3 projects: the Radio Mathematics PRoject of Nicaragua, the Radio Language Arts Project of Kenya, and the Radio Science PRoject of Papua New Guinea. These projects developed math programs for grades 1-4 and English as a second language for grades 1-3; programs to teach science in grades 4-6 are now being developed. Appropriate techniques were developed to engage young children actively in the learning process. Lessons are planned as a "conversation" between the children and the radio; scripts are written as 1/2 of a dialogue, with pauses carefully timed so that written as 12 of a dialogue, with pauses carefully timed so that students can contribute their 1/2. Teaching techniques used in all 3 projects include choral responses, simultaneous individual seatwork, and activities using simple materials such as pebbles and rulers. Certain techniques were specific to the subject being taught, or to the circumstances in which the lessons were to be used. Patterned oral drill was used frequently in the English lessons, including sound-cued drills. "Deferred" oral responses were used often in the math lessons. In this method, the children are instructed to solve a problem silently, not giving the answer aloud until requested, thus allowing time for even the slower children to participate. "One-child" questions were used in both English and science: the radio asks a question to be answered by a single child, who is selected on the spot by the classroom teacher. This allows for open-ended questions, but also requires constant supervision of the classroom teacher. Songs and games were used in all programs, and extensively for didactic purposes in the teaching of English. Instructions for science activities are often more complex than in other courses, particularly when the children are using science apparatus, especially when they work in pairs to share scarce equipment, a cost-saving device developed specifically for use in the science course.

Adolescent↗
PubMed1988

Withholding of funding for UNFPA, 1988.

In 1988, USAID decided for the fourth year in a row to withhold its contribution to the UN Population Fund (UNFPA). The contribution amounts $25 million. The stated reason for the withholding of funds was the same as in past years: the Agency's objection to UNFPA support for China. It viewed China's family planning program, which emphasized the importance of one child per family, as sanctioning coercive abortions.

Abortion, Induced↗
PubMed1994

Agency announces policy on use of U.S. dollars to fund abortions.

In an April 1994 statement, the USAID articulated its current policy on abortion. Reiterating the Clinton Administration's view that abortions should be "safe, legal, and rare," the policy remains surprisingly close to the positions of the Reagan and Bush Administrations. According to the Helms Amendment to the Foreign Assistance Act (FAA), AID monies cannot be used for the "performance of abortion as a method of family planning." Under the previous Administrations, AID ceased all abortion funding based on this restrictive language. The Clinton Administration policy notes that AID neither "advocate[s] the use of abortion as a method of family planning" nor "use[s] its policies or programs to restrict ... [the] right to choose" abortion. Yet it interprets the Helms Amendment to permit abortion funding only in cases of rape, incest, and life endangerment--the same conditions placed on federal Medicaid funds by the Hyde Amendment. Funds can also be used for the treatment of complications caused by unsafe, incomplete, or septic abortions. Because the US is a major contributor to population and family planning programs, a change in AID policy can have a widespread impact on the reproductive health of women worldwide, especially in developing countries. Up to 167,000 women are estimated to die each year as a result of unsafe abortion and its complications.

Abortion, Induced↗
PubMedDate not supplied

Qualitative research to make practical sense of sustainability in primary health care projects implemented by non-governmental organizations.

Sustainability continues to be a serious concern for Primary Health Care (PHC) interventions targeting the death of millions of children in developing countries each year. Our work with over 30 Non-Governmental Organizations (NGOs) implementing USAID's Child Survival and Health Grants Program (CSHGP)-funded projects revealed the need for a study to develop a framework for sustainability assessment in these projects. We surveyed NGO informants and project managers through semi-structured interviews and questionnaires. This paper summarizes our study findings. The NGOs share key values about sustainability, but are skeptical about approaches perceived as disconnected from field reality. In their experience, sustainable achievements occur through the interaction of capable local stakeholders and communities. This depends strongly on enabling conditions, which NGO projects should advance. Sustainability assessment is multidimensional, value-based and embeds health within a larger sustainable development perspective. It reduces, but does not eliminate, the unpredictability of long-term outcomes. It should start with the consideration of the 'local systems' which need to develop a common purpose. Our ability to address the complexity inherent to sustainability thinking rests with the validity of the models used to design interventions. A participant, qualitative research approach helped us make sense of sustainability in NGO field practice.

Child↗
PubMed1980

Malaria control and long-term periodicity of the disease in Pakistan.

The classic investigations of the malaria epidemics in the Punjab led to the conclusion that in this most populous and most malarious province of the present-day Pakistan, epidemics occurred regularly at intervals of approximately eight years. Against this background, the results of a Malaria Control Programme launched in 1975 are examined. The Programme, supported by USAID and WHO, represents in economic terms the greatest effort made against malaria in the country. Malathion, the main attack weapon of the Programme, was used on an unprecedented scale. This created logistic and--unexpectedly--toxicity problems among the spraying workers. Despite these difficulties, an over-all reduction of 76% in the slide positivity rate was observed in the first two years of operations of the Programme. The authors warn against measures which may curtail the activities of the Programme when, according to the cyclical periodicity of malaria in the Punjab, an epidemic wave can be expected in 1980-81, with inevitable repercussions all over the country.

Disease Outbreaks↗
PubMed1993

Children's nutritional status in female-headed households in the Dominican Republic.

A national representative household survey of food consumption, income, and expenditure was conducted in the Dominican Republic in 1986 by Tufts University School of Nutrition in cooperation with USAID Office of Nutrition [1: Rogers B. L. and Swindale A. Determinants of Food Consumption in the Dominican Republic. USAID/S & T/Nutrition, Washington, DC, 1988]. Out of 1440 families surveyed 706 had children under 6 years of age. Anthropometric indicators of height and weight were collected for all 1251 children in the sample in a follow-up study conducted from December 1986 to January 1987 by Tufts with USAID/Santo Domingo Mission funding. Anthropometric measurements were converted to standard deviation scores using NCHS standards; nutritional status was thus measured by height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ). Earnings in families with children having males as heads-of-household were roughly one-third greater than in those with females as household head; total income was also greater in these families, though not significantly. More calories and protein per adult equivalent were available in male-headed families as well. In spite of this superior economic and dietary situation, there was a trend throughout the entire sample for children of female-headed households to be taller and heavier for their age than those of two parent homes; all three anthropometric measures showed differences in the same direction. In the lowest expenditure quartile, WAZ and WHZ were significantly greater for children in female-headed households than their counterparts in male-headed households (WAZ: P = 0.01, WHZ: P = 0.00).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Sex in Geneva, sex in Lilongwe, and sex in Balaka.

This paper compares three interpretations of women and the transmission of HIV in rural Malawi. One is disseminated world-wide by institutions with a global reach such as the World Health Organization in Geneva and United States Agency for International Development (USAID); the second is provided by urban Malawians situated in the capital of Lilongwe, the seat of government and the site of the many international and national non-governmental agencies; the third is articulated by rural women and men in Balaka District, Malawi. We focus on women's motivations for extramarital sex, using qualitative interview data. We find that whereas in Geneva and Lilongwe women from rural Malawi are said to engage in sexual relationships outside of marriage because they need money for survival, in Balaka they are said to be motivated not only by money for survival but also for attractive consumer goods as well as by passion and by revenge for a husband's infidelity. We also find that data collection procedures influence explanations for women's affairs, as does the respondent's gender. An implication of this study is that AIDS-prevention policies based on the view from Geneva and Lilongwe need modification for Balaka, and by implication for rural Africa more generally.

Adolescent↗
PubMed2007

Tropical Whitefly IPM Project.

The Tropical Whitefly IPM Project (TWFP) is an initiative of the Systemwide IPM Programme of the Consultative Group on International Agricultural Research (CGIAR), financed by the Department for International Development (DFID) of the United Kingdom, the Danish International Development Agency (DANIDA), the United States Department of Agriculture (USDA) and Agency for International Development (USAID), the Australian Centre for International Agricultural Research (ACIAR), and the New Zealand Agency for International Development (NZAID), to manage whitefly pests and whitefly-transmitted viruses in the Tropics. Participating CGIAR and other international centers include the Centre for International Tropical Agriculture (CIAT); the International Institute of Tropical Agriculture (IITA); The International Potato Centre (CIP); the Asian Vegetable Research and Development Centre (AVRDC); and the International Centre of Insect Physiology and Ecology (ICIPE), in close collaboration with the National Resources Institute (NRI-UK); national agricultural research institutions; agricultural universities; and advanced agricultural research laboratories in Africa, Asia, Europe, the Pacific Region, and the Americas. The TWFP was launched in 1996 as five separate but closely linked subprojects targeting: (1) Bemisia tabaci as a vector of viruses affecting cassava and sweet potato in sub-Saharan Africa (IITA, NRI, CIP, CIAT); (2) B. tabaci as a vector of viruses in mixed cropping systems of Mexico, Central America, and the Caribbean (CIAT); (3) B. tabaci as a vector of viruses in mixed cropping systems of eastern and southern Africa (ICIPE, AVRDC); (4) B. tabaci as a vector of viruses in mixed cropping systems of Southeast Asia (AVRDC); (5) Trialeurodes vaporariorum as a pest in mixed cropping systems of the Andean highlands (CIAT); and (6) whiteflies as pests of cassava in South America (CIAT). Diagnostic surveys conducted in Phase I (1997-2000) clearly showed that the two main whitefly pests in the Tropics are B. tabaci and, in the highlands, T. vaporariorum. Other whitefly species investigated by the TWFP included B. afer and Aleurotrachelus socialis. B. tabaci is the main vector of plant viruses inducing African cassava mosaic disease, sweet potato virus disease, bean golden mosaic disease, and many other diseases of horticultural crops, mainly tomato, hot and sweet peppers, squash, melon, and several other cucurbits. Genetic resistance was identified as the most important component of an IPM programme, followed by phytosanitary, cultural and legal measures. The two most important factors contributing to whitefly/virus epidemics were shown to be pesticide abuse and the use of virus-infected planting materials. Biological control is only effective in cropping systems with minimal or rational use of insecticides, and should be considered only as a complementary IPM strategy. Farmer education and technical assistance are considered the most critical steps toward the implementation of sustainable and economically viable IPM strategies in tropical countries affected by whitefly pests and whitefly-transmitted viruses.

Animals↗
PubMed1997

Geographic information systems and the distribution of Schistosoma mansoni in the Nile delta.

New computer-based sensor technology and geographic methods have led to emerging interest in use of satellite environmental assessment tools for design of disease control programs, especially for those that are vector borne. The long-range goal of work reported here by John Malone and colleagues on behalf of this Egyptian Ministry of Health-USAID Schistosomiasis Research Project team (Box 1) is to utilize data from sensor systems on board earth-observing satellites to develop more-sensitive disease-prediction and -control models. If successful, methods developed may provide a potentially vital capability for use by disease control program managers, particularly in less-developed countries, where mapping resources are not well advanced. Longer term, broader basic questions on the interaction of environment and disease in anticipation of predicted global climate change may be addressed. These studies focused on the lower Nile river basin of Egypt. The specific objective was to link data on environmental requirements for propagation and transmission of schistosomiasis with parameters measurable from space.

Journal Article↗
PubMed2000

The impact of consuming iron from non-food sources on iron status in developing countries.

OBJECTIVE: : To determine the impact of contaminant iron and geophagy on iron intake and status of persons living in developing countries. DESIGN: : Literature for review was identified by searching Medline and Agricola, from appropriate other texts and from three reports from the Opportunities for Micronutrient Interventions (OMNI) Project of USAID. SETTING: : The dietary intake of iron by people living in developing countries is generally high but iron deficiency remains prevalent. This apparent paradox is because the iron being consumed is predominantly in the non-haem form, which is poorly absorbed. Some of this non-haem iron is from contamination of food with iron from soil, dust and water; iron leaching into food during storage and cooking; contamination during food processing such as milling; and the practice of geophagy. RESULTS: : Although the contribution of contaminant iron to overall iron intake is well documented, its absorption and thus its impact on iron status is not. To be available for absorption, contaminant iron must join the common non-haem pool, i.e. be exchangeable. The absorption of exchangeable contaminant iron is subject to the same interactions with other constituents in the diet as the non-haem iron that is intrinsic to food. The limited available evidence suggests wide variation in exchangeability. In situations where a significant fraction of the contaminating iron joins the pool, the impact on iron status could be substantial. Without a simple method for predicting exchangeability, the impact of contaminant iron on iron status in any particular situation is uncertain. CONCLUSIONS: : Interventions known to increase the absorption of iron intrinsic to foods will also increase absorption of any contaminant iron that has joined the common pool. Any positive effect of geophagy resulting from an increased intake of iron is highly unlikely, due to inhibiting constituents contained in soils and clays. The efficacy of approaches designed to increase the intake of contaminant iron remains encouraging but uncertain. An approach using multiple interventions will continue to be essential to reduce iron deficiency anaemia.

Biological Availability↗
PubMed2000

The potential of various foods to serve as a carrier for micronutrient fortification, data from remote areas in Indonesia.

OBJECTIVE: To estimate the potential of various industrially produced foods, to serve as a carrier for micronutrient fortification based on the frequency of their consumption in different socio-economic strata; to determine the role of fortified instant noodles as a source of micronutrients; to assess the contribution of plant foods, animal foods and fortified foods to vitamin A intake. SETTING: A survey was conducted in rural South Sulawesi and urban South Kalimantan between November 1996 and January 1997. SUBJECTS: Households (1500 in South Sulawesi; 2112 in South Kalimantan) were selected randomly by multi-stage cluster sampling. From each household, data were collected from the mother and her youngest child (0-5 y). DATA COLLECTION: Mothers were interviewed on various topics, including socio-economic status, food consumption, receipt of high-dose vitamin A capsules, health and nutritional status. RESULTS: Monosodium glutamate and salt were consumed daily in almost all households in both areas, and consumption was not associated with socio-economic status. Instant noodles were consumed in nearly all households in both areas, but consumption of fortified noodles was related to socio-economic status; it was highest among households of government employees and private investors, and lowest among farmers and share-croppers. Vegetables were the most important source of vitamin A in rural South Sulawesi, while foods of animal origin were the most important source in urban South Kalimantan. CONCLUSIONS: The results support double or triple fortification of salt and/or monosodium glutamate with iodine, vitamin A and/or iron. Efforts to overcome associated technical and logistical difficulties are urgently needed. SPONSORSHIP: Opportunities for Micronutrient Interventions (OMNI); United States Agency for International Development (USAID). European Journal of Clinical Nutrition (2000) 54, 822-827

Adult↗
PubMed2001

Socio-economic status and puberty are the main factors determining anaemia in adolescent girls and boys in East Java, Indonesia.

OBJECTIVE: To determine prevalence and contributing factors of anaemia in adolescents. DESIGN: Cross-sectional study of anaemia prevalence, socio-economic status and puberty. SETTING: Schools in East Java, Indonesia. SUBJECTS: Male and female adolescent pupils (age 12-15 y; n=6486). RESULTS: Anaemia prevalence was 25.8% among girls (n=3486), 24.5% among pre-pubertal boys (n=821), and 12.1% among pubertal boys (n=2179). Socio-economic status, indicated by type of school attended, was an important factor determining the risk of anaemia. Girls had a higher risk when they attended a poor school (OR poorest school, 1.00; other schools, 0.67-0.87), had reached puberty (OR, 1.25), had lower retinol intake (OR 1st-4th quartiles-1.00, 0.97, 0.89, 0.77) and higher vitamin A intake from plant sources (OR 1st-4th quartiles-1.00, 1.10, 1.31, 1.04). Boys had a higher risk of anaemia when they attended a poor school (OR poorest school 1.00, other schools 0.54-0.63), were younger (OR per year=0.79), had not yet reached puberty (OR not yet, 1.00; already, 0.78), were shorter (OR per cm 0.95), had smaller mid-upper-arm circumference (MUAC) (OR per mm 0.99) and lower retinol intake (OR 1st-4th quartile 1.00, 0.67, 0.74, 0.68). CONCLUSIONS: Anaemia in adolescents should be reported separately for pre-pubertal and pubertal subjects and for different ages, and the population's socio-economic status should be specified. The results of this survey call for treatment of anaemia in adolescents. Given Indonesia's current situation, micronutrient intake of adolescents should be increased using supplements for all girls and for pre-pubertal boys. SPONSORSHIP: This survey was funded by USAID through the OMNI project.

Adolescent↗
PubMed2000

Nutrition in the Republic of Korea.

Until the 1970s, the Korean economy was dominantly agriculture, but nowadays, less than 10 % of the population lives in a rural area, and it is expected that within a generation the proportion of the population engaged in agriculture will be less than 5 %. The living standard is rising as the national economy benefits from the increased sale of industrial products. The dietary patterns are being changed. The diet has changed from one based predominantly on starch based food such as cereals or roots and vegetables to one in which animal products take great prominence with consequent increases in animal fat and protein. The move from simple unrefined foods to more refined and complex manufactured foods has become commonplace. As a result, the general nutritional situation has been improved. Such improvement, however, has brought about an increase in overnutrition in more affluent sections of the population, whereas dietary inadequacy among the lower socio-economic groups and vulnerable classes still persists. Overall, Korea suffers from both undernutrition and overnutrition. The national school feeding program started in 1953 after the Korean War with the support of UNICEF, CARE, and USAID as a relief food program and is now expanding successfully to a self-supporting nationwide scale. The applied nutrition project in rural areas introduced in 1967 with the support of UNICEF, FAO, WHO, and the Korean government continues successfully to the present day. A national dietary survey has been carried out once a year since 1969, and once every 3 years from 1998. Korean recommended dietary allowances were established in 1962 and have been revised every 5 years. The government intends to establish national dietary guidelines for health promotion and prevention of chronic degenerative diseases. Nutrition education and research are also very important national undertakings.

Adolescent↗