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PubMed1991

The national mental health programme in the United Republic of Tanzania. A report from WHO and DANIDA.

This is the terminal report on the pilot implementation phase of the national mental health programme in the United Republic of Tanzania which was carried out as a cooperative venture between the Government of Tanzania, the Danish International Development Agency (DANIDA), and the World Health Organization (WHO). Although Tanzania had already achieved wide coverage of its population through a decentralized and easily accessible system of primary health care facilities providing the most essential services, its mental health services were poorly staffed and concentrated in a few custodial-type institutions and out-patient departments hardly capable of ensuring even one contact per year to about one-fifth of the estimated 100,000 severely mentally ill adults and 37,000 children in need of care at any given point in time. The programme design, developed jointly by the three parties involved, aimed to take full advantage of Tanzania's existing primary health care infrastructure by integrating mental health into the general health services of the country, including the 'grassroot' level of the services in the village and the district. The objectives guiding the new programme were: (i) to create an infrastructure for mental health care provision which should meet the requirements of both adequate population coverage and quality of service; (ii) to raise the community's awareness of mental health issues (including informing the community on the availability of effective means to deal with specific problems) and thus enlist its support and participation. The essential features of the adopted strategy were as follows. 1. Mental health care provision was conceived as a sub-system within the health care system, extending from rural health posts and dispensaries through rural health centres to district and regional hospitals. While full integration of mental health care within the general functions of the health workers was sought at the village and dispensary level (first echelon of care), relative differentiation and identity of mental health services were considered necessary at the district and regional levels (the second echelon). Tasks appropriate to each level of care were defined in operational terms and referral pathways were designated to enable the unobstructed access of the patient to more specialized diagnostic or therapeutic services if the problem was not within the competence of the more peripheral level. These pathways were also used in reverse when, following assessment or treatment, a patient was discharged back to the rural service with appropriate instructions about maintenance treatment and aftercare.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1991

Establishment of smoke-free offices worldwide--U.S. Peace Corps.

The Peace Corps (PC) of the United States is a government-sponsored international development agency with more than 6000 volunteers in approximately 70 developing countries. Since July 1988, PC headquarters in the District of Columbia has been a smoke-free workplace. From February through March 1991, all overseas PC full-time staff members were surveyed regarding cigarette smoking and attitudes toward a proposed smoke-free policy (complete ban) for PC offices worldwide. In addition, the directors of all overseas offices were surveyed regarding existing restrictions on smoking in the workplace. This report summarizes results of the survey.

Developing Countries↗
PubMed1989

Impact of multidrug therapy on leprosy in Baroda district (Gujarat).

Though much information is available on MDT organising, it poses a challenge to the field staff due to limited field trials conducted and varied field conditions. The MDT project was begun on 11th June, 1984 in Baroda by the Govt. of India, with active assistance of State Government, the World Health Organisation and the Swedish International Development Agency. The Drug combinations for MB cases were Rifampicin 600 mg, Clofazamine 300 mg and dapsone 100 mg daily for 14 days intensive supervised therapy followed by once a month (Pulse) supervised dose of Rifampicin 100 mg, Clof. 300 mg and dapsone 100 mg for minimum period of 2 years or more if indicated and Clof 50 mg daily with dapsone 100 mg daily unsupervised for minimum period of 2 years or more if indicated, for PB cases, dapsone 100 mg daily for 6 months along with Rifampicin 600 mg supervised (Pulse) once a month for minimum period of 6 months or more if indicated. Total number of active cases at commencement of MDT was 10706, out of these 10348 (96.37%) brought under MDT till Dec. 1987. Amongst 10348, old active cases 9112 (88.05%) are cured with MDT, (3110 MB + 6002 PB) 180 old MB cases BI is still positive inspite of completed 24 pulse. The rest 1056 (10.23%) stopped the treatment for various reasons. 790 (74.81%) cases have left the villages to earn their livelihood, 30 (2.86%) were being treated by skin specialist, 86 (7.19%) refuse to continue the treatment inspite of best efforts of field staff. New cases detected since June 1984 till Dec. 1987 are 7628, out of which 7549 (96.28%) brought under treatment. Now cases cured till Dec. 1987 are 4640 (1120 MB + 3520 PB) 17 cases relapsed after MDT (15 PB + 2 MB). 280 (1.56%) cases got complications, 250 developed reactions, 3 cases Jaundice, 15 cases Gastritis and rest 12 got moderate to severe anaemia. The prevalence rate came down from 5.81 to 1.01% per thousand population till Dec., 1987. The deformity rate came down amongst new cases from 6.15 to 1.50% till Dec. 1987. regularity of treatment among PB cases is 90.84% as compared to 90.48% for MB cases. The study showed that MDT can be implemented in tribal, rural and urban populations with high rate of compliance.

Clofazimine↗
PubMed1994

Improving trauma care in Trinidad and Tobago.

Identification of trauma as a major cause of morbidity and mortality in Trinidad and Tobago prompted the establishment of a training programme aimed at improving trauma care in this developing country. An Advanced Trauma Life Support (ATLS) programme for physicians, funded through the Canadian International Development Agency resulted in a statistically significant improvement of in-hospital trauma patient outcome at the Port-of-Spain General Hospital (observed to expected mortality ratio of 3.16 pre-ATLS compared to 1.94 post-ATLS). A recent analysis of all motor vehicle injuries for a shorter period did not confirm this positive impact of the ATLS programme, primarily because a large number of these patients died in the pre-hospital period. Pre-hospital trauma care therefore required urgent attention to complement the positive in-hospital impact of the ATLS programme. A second training programme (the Pre-Hospital Trauma Life Support or PHTLS) for paramedical personnel was thus instituted in 1990. Over 250 physicians have been trained in the ATLS programme and to date over 100 paramedical personnel have been trained in the PHTLS programme. Attempts have also been made to equip the ambulances with more appropriate resuscitative devices in order to improve pre-hospital care. The combination of the PHTLS and the ATLS programme should result in further improvement in the care of patients sustaining major injuries in Trinidad and Tobago.

Emergency Medical Services↗
PubMed1994

Priorities for pharmaceutical policies in developing countries: results of a Delphi survey.

The use of the Delphi method as a systematic and logical approach to establishing consensus among international experts on the priorities for interventions in national drug policies in developing countries is described. The Delphi survey showed a high degree of reliability, as evidenced by the high response rate, the quality of respondents, and the high standard for consensus. In addition to creating consensus on key issues and key components for priority intervention, the study identified six components that could constitute a basic framework for designing drug policy in developing countries. The study's conclusions have important implications for decision-makers within international development agencies and national governments.

Delphi Technique↗
PubMed1998

Priorities for medium-term development in the health sector of Bosnia and Herzegovina.

In the medium term, the World Bank will work with the Government of Bosnia and Herzegovina, non-government organizations, and international development agencies to complete the reconstruction work already begun. There will be an increased emphasis on developing sustainable health finance regime and establishing a basic health system.

Bosnia and Herzegovina↗
PubMed1990

Dracunculiasis eradication: target 1995.

Substantial progress has been achieved over the past 3 years by the campaign to eradicate dracunculiasis. The target of eradication by 1995 has been set by the African Regional Office of the World Health Organization and accepted by the United Nations Children's Fund (UNICEF) and the United Nations Development Program. India and Pakistan continue to reduce their cases of the disease dramatically. In Africa, Ghana and Nigeria conducted national village-by-village searches in 1988-1990 and, between them, found greater than 800,000 cases of the disease. Most African countries have now prepared national plans of action, appointed national coordinators, and intend to use UNICEF's assistance to conduct national searches by the end of 1990. An international donors' conference held in 1989 facilitated major new assistance for the initiative by UNICEF, the United Nations Development Program, the United States Agency for International Development, the Japanese International Cooperation Agency, the Peace Corps, the American Cyanamid Company, and DuPont. The World Health Organization held a meeting early in 1990 to draft criteria and recommend the process for certifying achievement of elimination of dracunculiasis in formerly endemic countries. The major remaining obstacles to eradication of dracunculiasis by 1995 are civil wars in northeastern Africa and the apathy of some national and international officials.

Africa↗
PubMed2000

Towards a global alcohol policy: alcohol, public health and the role of WHO.

In 1983 the World Health Assembly declared alcohol-related problems to be among the world's major health concerns. Since then, alcohol consumption has risen in developing countries, where it takes a heavy toll. Alcohol-related problems are at epidemic levels in the successor states of the Soviet Union and are responsible for 3.5% of disability-adjusted life years (DALYs) lost globally. Substantial evidence exists of the relationship between the levels and patterns of alcohol consumption on the one hand and the incidence of alcohol-related problems on the other. Over the past 20 years, research has demonstrated the effectiveness of public policies involving, for example, taxation and restrictions on alcohol availability, in reducing alcohol-related problems. In the wake of rapid economic globalization, many of these policies at national and subnational levels have been eroded, often with the support of international financial and development organizations. Development agencies and international trade agreements have treated alcohol as a normal commodity, overlooking the adverse consequences of its consumption on productivity and health. WHO is in a strong position to take the lead in developing a global alcohol policy aimed at reducing alcohol-related problems, providing scientific and statistical support, capacity-building, disseminating effective strategies and collaborating with other international organizations. Such leadership can play a significant part in diminishing the health and social problems associated with alcohol use.

Alcohol Drinking↗
PubMedDate not supplied

Introducing quality in healthcare: an international perspective.

Several models for implementing quality improvement have been developed, but they have been applied primarily in the United States. One model developed by the U.S. Agency for International Development Quality Assurance Project has been applied in several other countries. This article discusses the steps to introduce the continuous quality improvement process, issues related to successful implementation of the process, and the methods by which Jordan and Saudi Arabia have introduced quality improvement into their healthcare systems.

Accreditation↗
PubMed1994

Women's studies project begins.

Family Health International has begun a 5-year program of research to determine the impact of family planning on women's lives in developing countries. The US Agency for International Development awarded FHI an $8.6 million agreement to manage the project, which began in October. Research has examined the impact of family planning services on infant health, demographic trends, health care costs and many other related subjects, says Dr. Theodore M. King, FHI's president and chief operating officer. "With this project, we hope to examine the benefits of family planning on numerous aspects of women's lives, including self-esteem, education and autonomy," Dr. King says. An ultimate goal of the project is to provide leaders in developing countries with research to help shape their national health policies and programs.

Americas↗
PubMed2002

Estimation of carotenoid accessibility from carrots determined by an in vitro digestion method.

OBJECTIVE: To develop an in vitro digestion method to assess the impact of heat treatment, particle size and presence of oil on the accessibility (available for absorption) of alpha- and beta-carotene in carrots. DESIGN: Raw and cooked carrots were either homogenized or cut into pieces similar to chewed items in size. The carrot samples, with or without added cooking oil, were exposed to an in vitro digestion procedure. Adding a pepsin-HCl solution at pH 2.0 simulated the gastric phase. In the subsequent intestinal phase, pH was adjusted to 7.5 and a pancreatin-bile extract mixture was added. Carotenoids released from the carrot matrix during the digestion were extracted and quantified on high-performance liquid chromatography (HPLC). RESULTS: Three percent of the total beta-carotene content was released from raw carrots in pieces. When homogenized (pulped) 21% was released. Cooking the pulp increased the accessibility to 27%. Addition of cooking oil to the cooked pulp further increased the released amount to 39%. The trends for alpha-carotene were similar to those for beta-carotene. CONCLUSION: The described in vitro digestion method allows a rapid estimation of carotene accessibility in processed carrots, which may reliably predict in vivo behavior. SPONSORSHIP: This study was supported by the Swedish International Development Cooperation Agency (SIDA) and the International Program in the Chemical Sciences (IPICS), Uppsala University, Sweden.

Antioxidants↗
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↗
PubMed2005

Many worlds, one ethic: design and development of a global research ethics training curriculum.

The demand for basic research ethics training has grown considerably in the past few years. Research and education organizations face the challenge of providing this training with limited resources and training tools available. To meet this need, Family Health International (FHI), a U.S.-based international research organization, recently developed a Research Ethics Training Curriculum (RETC). It was designed as a practical, user-friendly tool that provides basic, up-to-date, standardized training on the ethics of human research. The curriculum can easily be adapted to different audiences and training requirements. The RETC was reviewed by a group of international experts and field tested in five countries. It is available in English, French, and Spanish as a three-ring binder and CD-ROM, as well as on the Web. It may be used as either an interactive self-study program or for group training.

Clinical Trials as Topic↗
PubMed2001

Epidemiology as discourse: the politics of development institutions in the Epidemiological Profile of El Salvador.

STUDY OBJECTIVE: To determine the ways in which institutions devoted to international development influence epidemiological studies. DESIGN: This article takes a descriptive epidemiological study of El Salvador, Epidemiological Profile, conducted in 1994 by the US Agency for International Development, as a case study. The methods include discourse analysis in order to uncover the ideological basis of the report and its characteristics as a discourse of development. SETTING: El Salvador. RESULTS: The Epidemiological Profile theoretical basis, the epidemiological transition theory, embodies the ethnocentrism of a "colonizer's model of the world." This report follows the logic of a discourse of development by depoliticising development, creating abnormalities, and relying on the development consulting industry. The epidemiological transition theory serves as an ideology that legitimises and dissimulates the international order. CONCLUSIONS: Even descriptive epidemiological assessments or epidemiological profiles are imbued with theoretical assumptions shaped by the institutional setting under which epidemiological investigations are conducted.

Confounding Factors, Epidemiologic↗
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↗
PubMed1993

Reduced resources applied to antimalarial drug development.

This statement was made in 1984 (Ref. I): 'The Agency for International Development (AID) announced a major breakthrough in the development of a vaccine against the most deadly form of malaria in human beings. The vaccine should be ready for use around the world, especially in developing countries, within five years.' Since then, the spending on development of drugs against malaria has been on the decline. Brian Schuster and Wilbur Milhous wonder. did we declare victory too soon? Wouldn't the prudent approach have been to look at vaccines and drugs as complementary techniques rather than alternative approaches?

Journal Article↗