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 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The challenge of reducing maternal mortality is increasingly being addressed by area-based efforts to improve access to care of obstetric emergencies. Improving coverage and quality of skilled attendance at birth is also being increasingly emphasized. Post-abortion care, better reproductive health services for adolescents, and improved family planning care are important ingredients in maternal mortality reduction. New developments in malaria, nutrition, violence and HIV/AIDS in relation to maternal health are highlighted, as well as measurement issues. Maternal mortality reduction is also being promoted today by using a human rights approach.
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PMID:Strategies to reduce maternal mortality worldwide. 1112 15

In August, 1999, three-quarters of East Timorese adults voted to end more than two decades of an Indonesian administration never recognised by the United Nations. The ensuing spree of violence and destruction by militia backed by the Indonesian military meant the birth of the fledgling nation became a complex humanitarian disaster. 1 year on, progress was heartening: a transitional government, a judiciary, and tax systems were in place, and East Timor was a proud competitor in the Sydney Olympic games. Rebuilding a country from ground level has brought a golden opportunity for fresh approaches. However, reconstruction is also a slow, complex, and sometimes controversial process at the mercy of multiple agendas. The health sector has seen basic care restored, establishment of a much-needed public-health service, and planning for the future health system. An innovative partnership between WHO/Roll Back Malaria and Merlin for post-conflict research has provided data to guide malaria control. The story of progress from humanitarian emergency to national health plan epitomises the triumphs and challenges of this newest nations' first 18 months.
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PMID:Growing pains of East Timor: health of an infant nation. 1151 12

The World Health Organization is the leading international agency in health. WHO's reputation reached a peak in the 1970s with the then director-general Halfdan Mahler's advocacy of Health for All by the Year 2000 and the successful worldwide eradication of smallpox. The 1980s and 1990s saw WHO lose much of its authority. Too easily, the blame was put on one man-Mahler's successor, Hiroshi Nakajima. In 1998, Gro Harlem Brundtland, Figure 1 a former Prime Minister of Norway, took office and WHO began a period of major strategic and structural reform. Almost 4 years into her first term as director-general, I visited WHO's headquarters in Geneva to learn about Dr Brundtland's successes and failures. Figure 2 The ground rules of my visit were that I could talk with anybody and attend almost any meeting (budget discussions were excluded). I interviewed Dr Brundtland, executive directors, members of the staff association, and directors and project managers of programmes such as StopTB, Roll Back Malaria, HIV-AIDS, violence prevention, polio eradication, essential drugs and medicines, and sustainable development. At senior levels, WHO is confident and clear about its purpose-in a way that matches Mahler's vision and goes beyond it in results. Brundtland told me that her most important achievements were to have "strengthened the credibility of WHO" and to have "raised the awareness of health on to the political and global development agendas". But there is a troubling schism between the aspirations of its leadership and the realities faced by the organisation on the ground. Rapid change during the past 4 years has reinvigorated WHO's mandate, but poor management has created new tensions that the organisation's leadership seems unwilling to address.
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PMID:WHO: the casualties and compromises of renewal. 1235 5

The Program of Information, Education, and Services for Basic Family Health Care in Magdalena Medio and Bajo was designed to increase knowledge and use of contraception and to improve basic health practices and nutrition in the region, which includes municipios belonging to 9 different departments and a total population of 1,720,000. Poverty levels in the area are high. During the 1st year of the project, which was underway from February 1988-May 1991, home visits were made to inform each family about basic family health, to weigh and measure children under 5 not receiving health care elsewhere, and to refer families to the nearest health services. Talks were presented to small groups on family planning, intestinal parasites, sexually transmitted diseases, nutrition, vaccination, cancer prevention, malaria, acute diarrhea, and acute respiratory infection. Community workshops were presented in the 2nd year. Community distribution posts were created for contraceptive and other health product distribution. Information and communication materials from PROFAMILIA were used, and other materials were specially designed for the project by the Foundation for Development of Health Education in Colombia. PROFAMILIA's system of service statistics was used for quantitative evaluation of the information and education activities and sales of contraceptives, antiparasitics, and oral rehydration packets of each instructor. In the 3 years of the program, 89.086 cycles of pills, 398,772 condoms, 29,080 vaginal tablets, 209.791 antiparasitics, and 49,305 oral rehydration packets were sold. 9295 talks were presented to 143,227 residents of the region. 22,000 children were enrolled in the growth monitoring program, and almost 40,000 women were referred for prenatal care and cytology. The instructors gave 900 talks to distributors of contraceptives, antiparasitics, and oral rehydration packets. Surveys of women aged 15-49 residing in the municipios covered by the project were conducted at the beginning and end of program activities in order to assess project impact. 1673 women were interviewed in the 1st survey in June-July 1988 and 1660 were interviewed in the 2nd survey in March-April 1991. In general terms, the region of Magdalena Medio and sand Bajo showed important changes in contraceptive prevalence, maternal-child health, knowledge of AIDS, and family violence over the 3 years of the project. Knowledge of contraception improved throughout the region, especially in rural areas. The proportion of women in union using a method increased from 56.7% to 58.0%. There were no overall changes in the proportions of children vaccinated.
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PMID:[Basic family health program in Magdalena Medio y Bajo]. 1228 83

The director general of the World Health Organization (WHO), Hiroshi Nakajima, in an interview following a two-day visit to Rwanda stressed the need to restore safe blood transfusion services to prevent the spread of AIDS as well as distribution of essential drugs and vaccines. According to WHO, health facilities were looted, while 75% of the more than 5000 health workers fled or were killed since ethnic violence broke out April 6, 1994. Fighting between the majority Hutu-led government and Tutsi-dominated Rwandan Patriotic Front claimed more than 500,000 lives and forced more than two million people to seek refuge in neighboring countries. The WHO will provide training, equipment, and laboratory supplies in order to strengthen epidemiological monitoring of preventable epidemic diseases like cholera, dysentery, acute respiratory infections, meningitis, tuberculosis, and malaria. Of particular concern, was the need to monitor systematically forms of cholera and bacillary dysentery which has the ability to change its resistance to different antibiotics A dysentery epidemic has already claimed thousands of lives in refugee camps in Tanzania, Zaire and Rwanda. War and massive population displacements have dramatically increased transmission of HIV, as HIV prevalence was about 30% in Kigali among women and up to 50% among soldiers. Before the war, HIV infection rates ranged from 20 to 30% among the urban population and less than 10% in rural areas. More than 200,000 persons were already infected with HIV in Rwanda in 1992. The WHO will provide blood transfusion kits to ensure collection, testing and transfusion of blood. It will also train 60 blood transfusion technicians. The WHO will help to supply the management system of the Central Rwandan Pharmaceutical Office and provide essential drugs and vaccines to supplement stocks supplied by international donors. Nakajima appealed to both the international community and Africa to help Rwanda.
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PMID:Prevention of disease the answer. 1228 13

"This paper examines the adult-mortality transition in Costa Rica and its determinants. The risk of dying declined by 80% for young adults and by 40% for old adults from 1920 to 1990. The fastest decline took place in the 1950s for young-adult ages and in the late 1980s for old-adult ages.... By 1990, about 40% of Costa Rican deaths are caused by accidents and violence at young-adult ages and by cardiovascular diseases at old ages. Infectious and nutritional-related conditions (especially respiratory tuberculosis and malaria) account for three-fourths of the adult-mortality decline between 1951 and 1971, but only for 30% since that year on." (SUMMARY IN ENG)
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PMID:[Adult mortality decline in Costa Rica]. 1229 Feb 24

The UK is donating US$800,000 to Uganda to reduce the death rate in the western region; the number of cases of malaria there has soared because of unusually severe rains. The health ministry is recommending self-medication with drugs purchased from licensed drug shops and pharmacies (there have been cases of fake or substandard chloroquine tablets and injectable solutions). Cholera is a problem in most of the country, but patients seem reluctant to go to the hospital, even though adequate supplies of drugs are available. Because of the Rift Valley Fever outbreak in Kenya, the health ministry is monitoring movements of people in the border area and conducting a mass screening for the disease. The Mulago National Referral Hospital is receiving US$35 million to improve wards and utilities and to build a new drug quality control laboratory. A training hospital which will provide palliative care for patients with AIDS has opened recently; it is a collaborative project with Mildmay Hospital in the UK. During its regional scientific conference in Masaka, members of the Association of Surgeons of East Africa and Central Africa offered free services to patients in Masaka and Rakai districts. According to the Minister of State for Gender and Community Development, fewer Ugandan women are being circumcised; the rate has dropped by 56% since 1990, due to the efforts of government and women's groups. However, other forms of violence against women remain a problem; the Family Protection Unit of the Ugandan police list 400 reported cases of wife beating, 150 cases of rape, and 250 cases of "defilement of school girls." Police intend to work with teachers to decrease the rising rate of sexual crimes in school. Police also say 90% of street children sniff solvents.
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PMID:Around Uganda. 1229 19

South Africa's apartheid policies have had direct and indirect effects on morbidity and death that will likely remain for decades. Since 1964, the economy has largely been deteriorating, while the population has grown at 2.8%/year, both of which have hampered economic development and health. South Africa needs to supply water, sanitation, and housing to 75% of the population. Rural development is needed to stem malnutrition, soil erosion, and overgrazing. Urban development design and planning must include health. Schooling needs to improve educators can emphasize school health education. Electricity and better lighting are needed to reduce chest diseases and paraffin poisoning and to improve literacy and learning. Labor migration has contributed to a high rate of sexually transmitted diseases and HIV/AIDS in rural areas. In some cases, industry and the public sector have become partners to improve health. The alcohol industry sponsors drive safe campaigns. South Africans need to address inequalities in health status by race, region, and gender, and to follow a holistic development approach. Infant mortality is just 6.4/1000 for Whites, while it is 66.7/1000 for Blacks. It is 1.5 times lower in the best region than it is in the worst region. 2 of every 25 children die before their first birthday among Africans living in the poorest third of South Africa. 42% of Black men who live to 15 years die before their 60th birthday, while just 17.5% of like White women do. Black children less than 5 years old have an almost 9-fold excess in deaths over White children. The tuberculosis rate is among the highest in the world and is likely to increase as HIV/AIDS spreads. Many other preventable diseases occur among South Africans. 5-8% of the population suffer a disability. South Africa has the highest per capita violence mortality rate worldwide (59.2/100,000 vs. 9.6/100,000 in the US). South Africa is likely to face increases in lung cancer, chronic lung disease, heart disease, and malaria.
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PMID:Health status and its determinants in South Africa. 1234 7

Access to an efficacious antimalarial drug is one of the cornerstones of the Roll Back Malaria initiative to decrease malaria morbidity and mortality. This is particularly important in emergency and post-emergency settings where access to treatment in the event of therapeutic failure may be restricted. In the aftermath of violence securing the independence of East Timor (1999), chloroquine continued to be used as first line therapy for the treatment of malaria. However, reliable data on the efficacy of chloroquine was not available. This paper represents the first attempt to document treatment failure with chloroquine in East Timor. The study was conducted using modified WHO guidelines in a rural hospital outpatient department in an area where there is seasonal transmission of both Plasmodium vivax and Plasmodium falciparum. 48 subjects presenting with fever and microscopically confirmed P. falciparum monoinfection were given supervised oral treatment with quality controlled chloroquine (25 mg/kg over 3 days) and followed clinically and parasitologically for 28 days. 32 of the 48 subjects had recurrent parasitaemia, and PCR confirmed that 28 of these were likely to be due to recrudescent parasites. The corrected treatment failure was, therefore, 58.3% (28/48), with all but one (2.1%) defined as late treatment failures (7-28 days after treatment). Further research into appropriate chemotherapy, including sulphadoxine-pyrimethamine and combination therapy for example with artemesinin or its derivatives, should be undertaken to select the most appropriate first line therapy for the management of uncomplicated malaria in East Timor.
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PMID:Efficacy of chloroquine in the treatment of uncomplicated Plasmodium falciparum infection in East Timor, 2000. 1294 82

Tanzania's health policy is to improve the health of all Tanzanians with a focus on those most at risk. One of the major objectives is to reduce infant and maternal morbidity and mortality and increase life expectancy. The life expectancy in Tanzania is 49 years for males and 53 years for females. Maternal mortality is recorded at 300-400 deaths per 100,000 women. The main causes are haemorrhage, sepsis, rupture of the uterus, anaemia, and others. The risk factors associated with the above causes include maternal height, age, child spacing, and number of births per woman; malaria and anaemia; imbalance of energy and food intake; HIV/AIDS; women's workload; and female genital mutilation (FGM). To address issues of women's health, the government has put in place many strategies, for example, a ministry to look after women's issues, the safe motherhood initiatives, improvement of the knowledge and skill of health care providers, as well as collaboration with nongovernmental organizations (NGOs) and private agencies. The health sector reform is important because it has negatively affected women's access to health care. To improve the health of women in Tanzania, health and health-related sectors should cooperate and collaborate in order to empower women in the areas of education, social status, and technology. Policies must also address poverty, nutrition, adolescent health, and violence and sexual abuse.
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PMID:Major factors that impact on women's health in Tanzania: the way forward. 1295 70


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