Despite a number of initiatives and campaigns over the years, immunization coverage in most parts of Nigeria remains low. That low coverage contributes to high morbidity and mortality levels among children. Poor transport, an ineffective cold chain, shortages of trained manpower, and inadequate community support and involvement are some of the factors which explain the underutilization of the immunization service. Aba is a city of approximately 500,000 people in eastern Nigeria in which the majority of inhabitants are traders. Aba's primary health care committee decided that immunization centers should be established in or near main trading areas to accommodate traders who did not want to leave their goods in order to take their children to primary care facilities for immunization. Traders' representatives helped to identify 8 suitable locations for vaccination sites in 3 shopping centers, the local authority provided financial and political support, and the state government gave technical and logistical assistance. The project began in September 1990 and was publicized through the traders' networks, which also helped to mobilize the relevant resources. Since many trading families were reached for the first time at the special centers, immunization coverage improved significantly for the 6 vaccine-preventable childhood diseases. Moreover, the project gave health workers the opportunity to deliver other services and counseling on matters of public health importance.
The effectiveness of a manual on breast self-examination was assessed in 190 female 11th- and 12th-grade students at a rural school in India's Haryana State. The students (average age, 16.6 years) completed a questionnaire on breast self-examination and related issues before they received copies of the manual and again 3 weeks after manual distribution. The pretested manual was culturally acceptable to both parents and teachers. At baseline, approximately 80% of the students had heard of breast cancer and over half believed it to be curable. Their principal sources of knowledge about breast cancer were television (38%), doctors (10%), friends and relatives (9%), and magazines (8%). On the baseline assessment, 8% of students achieved high scores, 83% obtained medium scores, and 9% had low scores. At retest 3 weeks after manual distribution, 79% achieved high scores and the remaining 21% had medium scores. Although knowledge of breast self-examination improved significantly, awareness of the structure of the breast and the increased risk of breast cancer in unmarried, childless women did not improve. A manual such as this can be used to educate young women about breast cancer prevention wherever there is a shortage of personnel trained to provide health education.
International approaches are indispensable in the management of foodborne risks to health. The contributions made by WHO and the World Trade Organization to achieving food safety are discussed below, and particular reference is made to the Agreement on the Application of Sanitary and Phytosanitary Measures and to the work of the Codex Alimentarius Commission.
Systematic immunization on a worldwide scale was not officially recognized as a practical possibility until 1974, when WHO launched its Expanded Programme on Immunization. Today, 80% of the world's children receive this form of protection against childhood diseases during their first year of life. Coverage can reach 90% by the year 2000, the effectiveness of the vaccines used is improving, and vaccines against additional diseases are being added to the programme.
Artistic activities are widely used in menial health care for both diagnostic and therapeutic purposes. The art produced in this process is often recognized as a valuable commodity in its own right, and this raises questions of ownership, self-determination, privacy, respect and psychic integrity.
The cultural and psychological dimensions of organ transplantation are often overlooked in the process of meeting its exacting technical requirements. This new branch of medicine has brought with it new ways of understanding death, human rights, commerce, gift giving, and ethics. It produces strong emotions in recipients, donors and transplanters alike. These factors need to be taken fully into consideration if organ transplantation is to evolve in ways that are felt to be beneficial for all concerned.
The Sri Sathya Sai Institute of Higher Medical Sciences in Andhra Pradesh can claim to have achieved the impossible--namely, the provision of high-tech medical services completely free of charge. Adherence to the five human values (truth, righteousness, peace, love and non-violence) and complete dedication to serve people without self-interest are the key elements for this success. This example may serve as a model for creating similar hospitals in the service of mankind.
The ideal of universal access to the best possible health is being replaced by questions of how best to distribute limited health resources. Epidemiology can help to answer these questions by combining its functions of investigation and target-setting. Thus studies on health differences should be aimed at reducing unjust inequalities.
In this second article to mark the fiftieth anniversary of the World Health Organization in 1998. World Health Forum briefly reviews the work of the Organization, highlighting some of the wide range of activities carried out or promoted by WHO from 1961 to 1973. This period covers the remaining years of Dr M. G. Candau's tenure as Director-General and the appointment of Dr Halfdan T. Mahler who succeeded him on 21 July 1973.
Although its importance is widely recognized, the health centre has been neglected. Some of the reasons for this are reviewed, as well as some of the possibilities for correcting it.
The authors discuss how to conduct information sessions on AIDS prevention for adolescents on the basis of experience gained in Marseilles secondary schools. Precautionary messages have to be conveyed without encouraging irrational fear and intolerance.
In ifs first issue in 1980 Would Health Forum carried a Round Table on malaria for which Dr M.A. Farid wrote the lead article, reviewing malaria "eradication" between the 1950s and the 1970s. He now gives his personal impressions of those early days of working with WHO to Dr Eilif Liisberg and Dr Socrates Litsios.
This fourth and final article marking the fiftieth anniversary of the World Health Organization briefly describes some of WHO's activities during the past ten years. Major historical events during this period include the end of the Soviet regime, genocidal wars in central Europe and Africa, the Gulf War, and the end of apartheid in South Africa. WHO's participation in global summit meetings on such issues as nutrition, population, the environment and social development reflects the wider implications of health and the Organization's closer involvement with other United Nations specialized agencies and nongovernmental organizations. This period covers Dr Hiroshi Nakajima's two terms as Director-General of WHO.
The author reflects upon her work in Bangladesh, Vietnam, and Cambodia in the early years of the World Health Organization's (WHO) existence, inventing and building the modes in which the organization was to put its mandate into practice. The author was in Bangladesh in 1953-58, in Vietnam in 1958-61, and in Cambodia in 1961-66. In Bangladesh, then East Pakistan, the men cut sugar cane or planted rice seedlings, while the women stayed closer to home, fetching water, tending vegetable gardens, and caring for their many children. The women were often worn out from frequent pregnancies and childbirth. WHO's Maternal and Child Health Project met a need and eventually became an ongoing, integrated national program in the country. The project in Vietnam was similar to the one in Bangladesh, but broader in scope. With maternal and child health were included pediatrics, hospital obstetric care, regional programs to develop community maternal and child health services, and the education and training of midwives, assistant midwives, and pediatric nurses to staff a large, new hospital. In Cambodia, WHO-assisted projects sometimes worked closely together, although the sad subsequent history of Cambodia likely eroded most of the activities in which the author was involved.
intertwined as new food safety challenges have emerged and as trade has expanded and changed to meet global demand. Growth in trade means that U.S. consumers are more dependent on the food safety measures used in other countries and that there are greater opportunities for U.S. food exports. ERS examined the conceptual relationships between food safety and international trade and analyzed empirical examples from the meat and poultry, produce, food crop, and seafood sectors. This packet of briefs presents some of the highlights of the ERS report, “International Trade and Food Safety: Economic Theory and Case Studies.”
