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PubMed1993

Nepal launches new projects.

The CEDPA Nepal Country Office (NCO), directed by Mana Rana (WIM 5 and S&E 13), has launched an expanded leadership training program for women's NGOs and new service delivery projects under a 5-year grant extension from USAID. With additional support from the UNFPA, the NCO will undertake a new project with the Mothers' Club, a national women's NGO. The project will mobilize women and women's organizations to address grassroots needs. The CEDPA ACCESS Project recently funded the Nepal Red Cross and Family Planning Association of Nepal to begin community-based family planning projects. Trained volunteers will distribute nonclinical contraceptives from their homes, provide services through home visits, and refer clients to clinics. Nancy Russell, a nonprofit manager with 20 years of experience, has been appointed CEDPA resident coordinator for Nepal.

Asia↗
PubMedDate not supplied

Communicable disease control during major emergencies.

In December 2004 a major disaster occurred in the Indian Ocean killing over 150,000 people (USAID, 2005). This article will look at interventions required to control communicable diseases in an emergency. It is an introduction to emergency public health interventions for UK nurses who are responding to an international disaster.

Communicable Disease Control↗
PubMed2005

[The unfinished agenda for child survival: what role for the integrated management of childhood illness?].

The endorsement by the United Nations General Assembly of the Millennium Development Goals (MDG) and the growing acknowledgment by the international community that child survival is an unfinished agenda created a new momentum for rapid scaling up of effective child health interventions. In this review, the authors discuss the environment in which child health programs are being implemented and the potential role of the integrated management of childhood illness (IMCI) strategy in country efforts to achieve the MDGs. The discussion is based on the conclusions of a multi-country analytic review of the IMCI strategy conducted jointly by DFID, UNICEF, USAID, and WHO as well as the results of another multi-country evaluation coordinated by the WHO on IMCI costs, effectiveness, and impact. The article concludes on the need to increase child health investments and on the potential importance of IMCI in improving child survival. However, the MDGs may not be reached if IMCI is not implemented in conjunction with other strategies to reduce mortality during the first days of life and to strengthen the health system. The authors also stress the need to increase research on mechanisms to scale up delivery of existing public health interventions.

Child↗
PubMed2005

Screening HIV-infected persons for tuberculosis--Cambodia, January 2004-February 2005.

Worldwide, tuberculosis (TB) is one of the most common causes of death among persons infected with human immunodeficiency virus (HIV). The World Health Organization recommends screening HIV-infected persons for TB disease after HIV diagnosis, before initiation of highly active antiretroviral therapy (HAART), and during routine follow-up care. In 2003, health officials in Banteay Meanchey Province, Cambodia, in conjunction with CDC and the U.S. Agency for International Development (USAID), began a pilot project to increase TB screening among persons with HIV infection. Subsequently, CDC analyzed and evaluated data from the first 14 months of the project. This report summarizes the results of that analysis, which determined that, during January 2004--February 2005, among persons with HIV infection at voluntary counseling and confidential testing (VCCT) clinics, 37% were screened for TB disease, and 24% of those screened had TB disease diagnosed. On the basis of these findings, the Provincial Health Department (PHD) took action to increase awareness of the risk for TB among HIV-infected persons. During the 3 months after these measures were implemented, the TB screening rate among persons with HIV infection increased to 61%. Evaluation of projects like the one conducted in Banteay Meanchey Province can help develop an evidence-based approach for removing barriers to screening HIV-infected persons for TB.

Adolescent↗
PubMed1991

Current status of malaria in Taiwan from 1966 to 1990.

Malaria was highly or moderately endemic in about 200 townships among the 360 municipalities in Taiwan before the World War II. During and after the War, annual incidence of malaria was estimated as 1.2 million cases out of 6 million population at that period. In 1952, malaria mortality was reported as 27.5 per 100,000 persons. Malaria Eradication Program in Taiwan was successfully carried out during 1947-1965 through a combined effort made by the Government, WHO, UNICEF and USAID, and by the participation of the community. Since 1966, avoidance of malaria transmission in population centers has been well maintained through the network of malaria surveillance system, both parasitological and entomological, at the ports (sea and air) of entry and by the 383 public health services all over the island. Through this surveillance network, a total of 936 malaria cases and distribution of the vector mosquito Anopheles minimus have been well documented during 1966- June 1990. Of the 936 malaria cases detected, 819 cases were classified as imported from outside the country, 14 cases as relapsing, 17 cases as induced infection through blood transfusion, and 86 cases as the secondary infection originating from the imported cases. These 86 cases were exclusively P. vivax infections which were found concealed in the mountainous area of the northern most of Taiwan during 1968-1973. This small transmission focus was swiftly eliminated without further dissemination to the other parts of the island. Of the 819 imported cases; 250 cases were P. falciparum infection, 516 cases were P. vivax, 19 cases were P. malariae, 18 cases were P. ovale and 16 cases were mixed infection of P. falciparum with other parasite species. among the imported malaria cases with P. falciparum (in total 266), six were reported fatal cases before proper diagnose and treatment. Of the 14 relapsing cases; 13 cases were P. malariae infection, and the remaining one case was P. vivax malaria. All the 17 induced malaria cases were caused by the blood transfusion, exclusively with P. malariae infection. It was quite difficult to prove the positive parasitemia directly under microscopy from the blood donors due to very low parasite density of their blood.

Humans↗
PubMed1995

Administration of 25,000 IU vitamin A doses at routine immunisation in young infants.

OBJECTIVE: To investigate whether monthly administration of vitamin A at routine immunisation produces any side-effects, and to examine the effect of this supplementation on the vitamin A nutrition status of infants. DESIGN: A double-blind randomised placebo-controlled clinical trial. SETTING: Immunisation clinic of a large diarrhoea treatment centre. SUBJECTS: Infants aged 6-17 weeks who will receive their first diphtheria-pertussis-tetanus/oral polio vaccine (DPT/OPV) dose. METHODS: Infants were randomly assigned to receive either 25,000 IU vitamin A or placebo. Three such doses were given with each immunisation dose at monthly intervals. Infants were examined by a physician before and during 24 h after the doses and any signs of toxicity were recorded. Venous blood was drawn at entry and 1 month after the 3rd dose for retinol assay. RESULTS: One hundred and one infants received vitamin A and 98 received placebo. Decreased feeding, irritability, diarrhoea, and vomiting were comparable between the two groups. In the vitamin A group five infants developed bulging fontanelle; three of them developed it once (after 1st, 2nd and 3rd dose respectively), one developed it twice (after both the 2nd and 3rd dose), and the other infant after all three doses. In the placebo group a single child developed bulging fontanelle after the 3rd dose. In all the cases the bulging disappeared within 48 h of onset except in one infant, in whom it subsided at 60 h. The total bulging episodes in the vitamin A and placebo groups were 8 and 1 respectively (RR = 7.7; P < 0.04). However, none of these infants had irritability. At entry fasting retinol level was < 10 micrograms/dl in 35% infants and in 87% infants it was < 20 micrograms/dl. After the third dose fasting retinol level was marginally better in the vitamin A group (mean +/- s.d.: 21.9 +/- 8.2 vs 19.2 +/- 7.8; P = 0.05). However, 47% infants receiving supplementation still had serum retinol level <20 micrograms/dl. CONCLUSION: The results suggest that administration of 25,000 IU of vitamin A in young infants along with routine immunisations, though associated with increased incidence of transient bulging fontanelle without any associated adverse signs or symptoms, may still be inadequate to prevent deficiency in this population. SPONSORSHIP: This study was funded by the United States Agency for International Development (USAID) under grant no. DPE-5986-A-1009-00 with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). The ICDDR,B is supported by countries and agencies which share its concern for the health problems of developing countries.

Double-Blind Method↗
PubMed1995

Variations in estimates of Guatemalan infant mortality, vaccination coverage, and ORS use reported by different sources.

All available estimates of rates of infant mortality, vaccination coverage (for BCG, DPT 3, polio 3, measles, and tetanus toxoid), and ORS use in Guatemala in the 1980s were identified and investigated. A large number of sources and estimates were found. Large discrepancies were also found between the estimates for a given indicator, even when the estimates were reported for the same year by the same source. For instance, reports for 1985 yielded 10 different infant mortality estimates ranging from 56.0 to 79.8 deaths per 1,000 live births; vaccination coverage estimates ranging from 30% to 60.5% for BCG, 3.5% to 34.2% for DPT 3, 3.5% to 33.5% for polio 3, 11% to 58.2% for measles, and 1% to 8.2% for tetanus toxoid; and estimated use rates of oral rehydration solution ranging from 3.5% to 7.2%. In this same vein, three Guatemalan Ministry of Health estimates of infant deaths per 1,000 live births in 1984 ranged from 52.4 to 79.8; four UNICEF estimates for 1985 ranged from 65 to 79.8; and three USAID estimates for 1987 ranged from 59 to 72. The many reasons found for this diversity point to significant problems influencing the reliability of current data.

Child, Preschool↗
PubMed1993

Trends in malaria morbidity and mortality in Sri Lanka.

Trends since 1930 in malaria morbidity and mortality in Sri Lanka were analysed. The Malaria Control Programme, which began in 1945 with DDT spraying, was associated with a 100-fold reduction in morbidity and mortality over the following ten years, and gave way to the Malaria Eradication Programme in 1958. DDT spraying ceased in 1964 and a vivax malaria epidemic in 1968 returned to the island to 1952 morbidity levels, though with little mortality. After the discovery of DDT resistance in 1969, malathion spraying took over in 1973, and USAID-assisted control programme, involving case-detection and treatment, started in 1977. However, morbidity levels comparable to 1952 levels were observed in 1975 and 1986 when falciparum malaria morbidity levels were especially high. Mortality rates since 1960 have however remained lower than at any other previous time.

History, 20th Century↗
PubMed1993

Emergency public health surveillance in response to food and energy shortages--Armenia, 1992.

Living conditions in Armenia have deteriorated since 1988 as a result of an economic blockade related to a territorial conflict between Armenia and a neighboring country. The effects of this blockade--a drastic reduction in available food, heating fuel, gasoline, electricity, health services, drugs, and vaccines--have placed residents of Armenia at increased risk for morbidity and mortality from nutritional deficiencies, infectious diseases, and hypothermia. To assess and monitor the current health and nutritional status of residents of Armenia, the Armenian National Institute of Health, the U.S. Agency for International Development (USAID), and CDC have developed the Emergency Public Health Information Surveillance System (EPHISS). This report summarizes preliminary results for 1992.

Armenia↗
PubMed1995

Risk factors of nutritional blindness and determinants of a successful vitamin A prophylaxis programme.

Data on 7668 children (0-72 months) and their 4621 mothers and 81 Anganwadi Workers (AWWs) collected for the USAID Assisted ICDS Evaluation Surveys were analysed. The results indicated that the major risk factors of nutritional blindness were lack of nutrition and health knowledge among mothers; presence of iron deficiency anemia in the children; and history of the child having had measles in the past one year. Mother's health and nutrition, knowledge and maternal literacy status were the determinants of the success of a vitamin A prophylaxis programme. Factors that determined AWW's performance in vitamin A supplementation were her nutrition and health knowledge, her literacy status and the amount of supervisory assistance she received from Auxillary Nurse Midwife (ANM).

Adult↗
PubMed1997

HIV counseling for behavior change.

The purpose of this paper was to provide a framework for discussion in the working group on HIV Counseling for Behavior Change at the Third USAID HIV/AIDS Prevention Conference. The paper begins with a section defining HIV counseling and describing different types of HIV counseling. Next, points of consensus and controversy regarding the conduct and evaluation of HIV counseling are discussed. This is followed by a section outlining findings to date on the effectiveness of HIV counseling, and a discussion of methodological issues in evaluating counseling outcomes. Finally, the paper includes a list of key issues for further research.

Acquired Immunodeficiency Syndrome↗
PubMed1976

Research and development of unconventional systems for immunization.

The problems raised by the ever expanding world population justify the work of USAID (U.S. Agency for International Development). Continual efforts must be made to develop and efficiently operate methods of control of the microbial and parasitic infections which menace our sources of protein. This programme includes immunization, technical methods in bacterial and viral genetics to obtain attenuated strains, and improvements in production, preservation and distribution of preparations. An example of an unconventional but promising system of application is the pilot study recently begun in the Missouri-Mississippi River region.

Animals↗
PubMedDate not supplied

A cost analysis of family planning in Bangladesh.

This article presents a step-down cost analysis using secondary data sources from 26 Bangladesh non-government organizations (NGOs) providing family planning services under a US Agency for International Development-funded umbrella organization. The unit costs of the NGOs' Maternal-Child Health (MCH) clinics and community-based distribution (CBD) systems were calculated and found to be minimally different. Several simulations were conducted to investigate the impact of alternative cost-reduction measures. The more general financial analysis proved more insightful than the unit cost analysis in terms of identifying means by which to improve the efficiency of the family planning operations of these NGOs. The analysis revealed that 56 per cent of total expenditures in the two-tiered umbrella's organizational structure are incurred in management operations and overheads. Of the remaining 44 per cent of project expenditures, 39 per cent is spent on the CBD program and 5 per cent on the MCH clinics. Within the CBD program, most resources are spent providing 4 million contacts (two-thirds of the annual total) which do not involve contraceptive re-supply. The clinics devote more resources to providing MCH services than to providing family planning services. The findings suggest that significant savings could be generated by containing administrative costs, improving operational efficiency, and reducing unnecessary or redundant fieldworker contacts. The magnitude of the potential savings raises a fundamental question about the continued viability and sustainability of this supply-driven CBD strategy.

Adult↗
PubMedDate not supplied

Organizational development and privatization: a Bolivian success story.

This article presents a case study of a US Agency for International Development-sponsored privatization effort in Bolivia. This privatization effort differs from AID's more common approach in that rather than merely helping already existing organizations to expand, this project has created a new organization. More ambitious and encompassing, this approach is also preferable because it directly addresses one of the most serious bottlenecks to economic development, viz., organizational development. The article describes the evolution of PROSALUD, a private, non-profit network of 17 community-sponsored health centers. The article describes factors and characteristics which have either conditioned or have directly contributed to PROSALUD's success. First, PROSALUD's health care environment is analysed, starting with a broad brush profile of select characteristics and trends which exist throughout the health sector of Bolivia, then narrows the focus to the local health sector. The structure and operations of PROSALUD are then analysed, focusing on the organization's managerial practices and financing and the series of tradeoffs it has been forced to strike: in its pricing strategy, between striving for financial viability and maintaining access to care; between, on the one hand, responding to community needs and demands and improving coverage by opening more facilities, and, on the other hand, focusing managerial efforts and outreach on a more limited number of clinics and neighborhoods; between providing a socially desirable mix of services--in particular, continuing to provide a great deal of free preventive care--and focusing care on more lucrative curative services; between maintaining commitments to neighborhoods and communities and eliminating the less economically viable (especially rural) clinics.

Bolivia↗
PubMed1986

A review of ten years' experience with surgical equipment in international health programs.

The Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) began in June of 1973 with financial assistance from the Agency for International Development (AID). The purpose of the organization was to provide training and medical equipment to physicians in developing countries to update their education in reproductive health. JHPIEGO began by offering courses in the United States and shortly thereafter began training at centers in the developing countries themselves. Because of its important contributions to gynecological diagnosis in addition to its use in fertility management, laparoscopic equipment has been a major item in JHPIEGO reproductive health training. This paper details the development and role of laparoscopic training in JHPIEGO's program. Laparoscopic training begins with selection of trainees from appropriate institutions. Training itself begins with a didactic session at Baltimore or an in-country center. Trainees then receive clinical training and perform a minimum number of procedures, after which the practitioner, if he or she has successfully completed the clinical practice, can be named eligible to receive medical equipment to be donated to his or her institution. When equipment is installed, a field visit is made by a JHPIEGO consultant to insure the proper use and upkeep of equipment, and the understanding and implementation of standards and procedures. JHPIEGO has trained almost 3000 physicians in laparoscopy techniques between 1973 and 1984.

Developing Countries↗