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.
