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PubMed2002

Height, weight and haemoglobin status of 6 to 59-month-old Kazakh children living in Kzyl-Orda region, Kazakhstan.

OBJECTIVE: To estimate the prevalence of stunting, wasting and anaemia among children aged 6-59 months in the Kzyl-Orda region of Kazakhstan, and to determine the association between childhood height and haemoglobin concentration and a range of environmental and biological factors. DESIGN: A cross-sectional study using a randomly selected sample. The mothers of children were interviewed, and finger-prick blood samples and anthropometric measurements were collected on both mothers and their children. Associations between haemoglobin (Hb) concentration, anthropometric measurements and questionnaire data were evaluated by multivariate analysis. SETTING: Health centres in Kazalinsk, Djalagash and Zhanakorgan districts of Kzyl-Orda region, Kazakhstan. SUBJECTS: Two-thousand and twenty-four children aged between 6 and 59 months born to 1501 mothers who were randomly selected from health centre records. RESULTS: The overall prevalence of stunting (<-2.0 Z-scores height for age), wasting (<-2.0 Z-scores weight for height) and anaemia (Hb<11.0 g/dl) in the study children was found to be 15.8, 0.8 and 50.1%, respectively. However, analysis demonstrated considerable variation by age, with the second year of life showing the highest prevalence of both stunting and anaemia. Both childhood height and haemoglobin concentration were found to be significantly associated with a range of environmental and maternal variables. CONCLUSIONS: This study demonstrates that the prevalence of both stunting and anaemia among Kazakh children in the Kzyl-Orda region is considerable, and similar to that of other Central Asian children. These findings highlight Central Asia as a region with levels of childhood nutritional status that are of concern. SPONSORSHIP: Funding was provided by the United States Agency for International Development, Office of Nutrition, the United Kingdom Department for International Development, and the Polden-Puckham Trust.

Age Factors↗
PubMed2005

Economic access to effective drugs for falciparum malaria.

The increasing death toll from drug-resistant falciparum malaria is cause for international concern. In 2002, the US Agency for International Development commissioned the Institute of Medicine (IOM) to recommend global actions to ensure the broadest possible access to new, effective antimalarial treatments. In a report issued in 2004, the IOM Committee on Economics of Antimalarial Drugs recommended a global subsidy of 300 million dollars to 500 million dollars per year to replace increasingly ineffective drugs with coformulated artemisinin combination treatments to be distributed through public and private channels in affected areas. This approach allows the existing market to support the switch to new drugs and keeps treatment costs for consumers at levels similar to the current price of chloroquine. The leverage of an international subsidy of combination therapy can also discourage the distribution of monotherapies (such as solo artemisinins), the use of which might foster increasing resistance to antimalarial drugs in the future.

Antimalarials↗
PubMed2000

Improving the monitoring of immunization services in Kyrgyzstan.

Following the disbanding of the Soviet Union in 1991, the government of Kyrgyzstan was unable to maintain the previous level of health services. To revitalize the health services, the Ministry of Health (MOH) first focused on improving their immunization services, including the immunization component of the Health Management Information System (HMIS). Secondly, to increase immunization coverage, the MOH set as a priority the elimination of prescribing false contraindications to immunization. To accomplish both goals, the MOH updated the national immunization policies and established a more effective structure for managing immunization services. To support the MOH, the US Agency for International Development (USAID) Resources for Child Health (REACH) and Basic Support for Institutionalizing Child Survival (BASICS) projects provided technical assistance through a resident coordinator and consultants, and by organizing an international seminar. The improvements extended beyond systems and forms, but, instead, emphasized monitoring by the frontline health worker and supervising the quality of health information. To accomplish their objectives, the MOH appointed a Working Group to define the problems, revise record-keeping procedures, and develop monitoring tools. This group, representing both national and local levels, was composed of MOH epidemiologists, paediatricians and a management information specialist. To reduce the burden of excessive record-keeping and reporting requirements, the Working Group identified four key indicators for the service delivery level: (1) DPT3 immunization coverage rates for children less than 1 year of age; (2) contraindication rates for DPT; (3) usage of DPT vaccine; and (4) daily refrigerator temperatures. Additional indicators were included at district and provincial levels. After a successful 1-year trial, the MOH implemented the revised HMIS nationally. Not only did the quality of the information system improve, but the new approach provided visible evidence, from facility to national levels, that the MOH was approaching their objective of reducing contraindication rates for DPT immunizations to 5% or less, and that vaccine wastage could be substantially reduced. The project demonstrated that giving health workers the basic epidemiologic skills to monitor their own work measurably improved the quality of the data, and by acquiring the new skills, the workers developed a sense of pride in their work.

Child↗
PubMed2005

Building capacity for health promotion--a case study from China.

During the period 1997-2000 a technical assistance project to build capacity for community-based health promotion was implemented in seven cities and one province in China. The technical assistance project formed part of a much larger World Bank supported program to improve disease prevention capabilities in China, commonly known as Health VII. The technical assistance project was funded by the Australian Agency for International Development. It was designed to develop capacity within the Ministry of Health (MOH) and the cities and province in the management of community-based health promotion projects, as well as supporting institutional development and public health policy reform. There are some relatively unique features of this technical assistance which helped shape its implementation and impact. It sought to provide the Chinese MOH and the cities and province with an introduction to comprehensive health promotion strategies, in contrast to the more limited information, education and communication strategies. The project was provided on a continuing basis over 3 years through a single institution, rather than as a series of ad hoc consultancies by individuals. Teaching and learning processes were developmental, leading progressively to a greater degree of local Chinese input and management to ensure sustainability and maintenance of technical support for the project. Based on this experience, this paper presents a model for capacity building projects of this type. It describes the education, training and planning activities that were the key inputs to the project, as well as the limited available evidence on the impact of the project. It describes how the project evolved over time to meet the changing needs of the participants, specifically how the content of the project shifted from a risk-factor orientation to a settings-based focus, and the delivery of the project moved from an expert-led approach to a more participatory, problem based learning approach. In terms of impact, marked differences before and after the implementation of the training activities were identified in key areas for reform, in addition to the self reported positive change in knowledge, and a high level of participant satisfaction. Key lessons are summarized. Technical assistance projects of this kind benefit from continuity and a high level of coordination, the provision of culturally and linguistically appropriate teaching, and a clear understanding of the need to match workforce development with organizational/institutional development.

China↗
PubMed1993

Changes in use of health services in a rural health zone in Zaire.

As part of the Combatting Childhood Communicable Diseases (CCCD) project funded by the US Agency for International Development (USAID), the Zairian CCCD programme conducted surveys in the rural health zones of Kingandu and Pai-Kongila, Zaire, in 1984-1985 and 1988-1989 to determine whether a strategy of selective primary health care would affect childhood mortality. This paper describes the changes in the medical care infrastructure and the increasing coverage of selected services. The strategies evaluated were vaccination, oral rehydration therapy, and treatment of febrile episodes with antimalarial drugs for children; and tetanus vaccination and malaria prophylaxis for pregnant women. The health infrastructure in the Kingandu and Pai-Kongila Health Zones expanded considerably from 1984 to 1989, with health centres increasing from 7 to 18. During this period, economic conditions deteriorated moderately, with the nation experiencing nearly 700% inflation. Medical care costs remained stable because of external subsidies. Use of health services was assessed in 1984, 1988, and 1989. Between 1984 and 1989, the proportion of children aged 12-23 months vaccinated against measles increased from 22% to 71%. Coverage with other vaccine antigens increased similarly. Women's knowledge of the correct recipe for the preparation of sugar-salt solution increased from 0% to 61%. Reported treatment at home with sugar-salt or oral rehydration solution increased from 6% to 53%. The proportion of children with febrile episodes who were treated presumptively for malaria with chloroquine remained unchanged (47% in 1984; 44% in 1988). We conclude that, despite a moderate deterioration in economic conditions, Kingandu and Pai-Kongila Health Zones achieved remarkable increases in use of selected health services between 1984 and 1989, especially in vaccination coverage.

Adolescent↗
PubMed1993

Infant and child mortality estimates in two counties of Liberia: 1984.

To estimate baseline infant and child mortality in Liberia, a survey was carried out in 1984 as part of the Combatting Childhood Communicable Diseases (CCCD) project. The project, a collaborative effort of the Liberian Ministry of Health, the US Agency for International Development, and the US Centers for Disease Control, is aimed at reducing childhood morbidity and mortality through oral rehydration therapy, vaccination and treatment for malaria. As a measure of programme impact, mortality estimates from this survey will be compared with those from a second survey after 4-5 years. A sample of 40 clusters (50-70 households per cluster) was used. The size is sufficient to detect a 25% reduction in mortality of children under 5 years of age. Mortality was estimated from a pregnancy history questionnaire asked of women aged 15-49 residing in cluster households. A reliability survey was conducted and pregnancies were matched to determine the level of omission of births and deaths. Results show a very high level of mortality with a risk of death in infancy above 20% and a risk of dying before the fifth birthday of one-third. Since the extent of omission of deaths in the first survey proved substantial, the reinterview survey was essential.

Adolescent↗
PubMed1993

Time limitation and the role of research in the worldwide attempt to eradicate malaria.

The U.S. Congress established an intense, time-limited, worldwide malaria eradication program in 1958 and assigned operational responsibility to the U.S. Agency for International Development (and its predecessors). When the program was terminated on schedule in 1963, approximately $400 million had been consumed and malaria prevalence had greatly been reduced. Transmission began to increase thereafter. The open-ended WHO global eradication effort began in 1955 ended in 1969 and consumed approximately $15 million during the 1958-1963 period of progress, mainly provided by the United States. Intensified anti-malaria interventions continued after Congress discontinued direct support. Although malariological research was discouraged during the period of time limitation, it was embraced as the conceptual basis for the open-ended period of intervention that followed. This effort saved many lives but expended our ability to intervene against future epidemics and reduced human herd immunity. To avoid the "great gamble" inherent in any ambitious intervention against this disease, future programs should be designed to seek incremental, local antimalaria gains.

Animals↗
PubMedDate not supplied

Global gladiators: a model for international nursing education.

Vietnam is a beautiful country with many needs related to the achievement of optimal healthcare and the role of nurses in the country. The authors describe a U.S. Agency for International Development funded project sponsored by Health Volunteers Overseas. Nursing educators involved in the project share their experiences to help readers gain insight into the coordination necessary to make an international nursing education project successful.

Education, Nursing↗
PubMedDate not supplied

Expanding the role of nurses in Armenia.

The dissolution of the Soviet Union and the declaration of Independence by the Republic of Armenia created the need for significant changes in the healthcare delivery system in Armenia. The desire to raise the level of health care presented challenges and opportunities for nurses within the Republic. Members of the departments of nursing at Boston City Hospital/Boston Medical Center in Boston, Massachusetts, University of Massachusetts Medical Center, Worcester, Massachusetts, and the Emergency Scientific Medical Center of Yerevan, Armenia, joined forces through a grant written by Boston University School of Medicine and sponsored by the American International Health Alliance under a cooperative agreement with the United States Agency for International Development to expand the role of nursing. This article describes the assessment, planning, implementation, and evaluation of changes to the role of nursing and the development of new roles for nurses within a hospital in the capital city of Yerevan.

Armenia↗
PubMed2005

Methods to estimate the number of orphans as a result of AIDS and other causes in Sub-Saharan Africa.

OBJECTIVE: To derive methods to estimate and project the fraction of children orphaned by AIDS and other causes. METHODS: HIV/AIDS affects orphan numbers through increased adult and child mortality and reduced fertility of HIV-positive women. We extend an epidemiologic and demographic model used previously to estimate maternal orphans to paternal orphans. We account for the impact of HIV/AIDS on child survival by modeling the HIV status of the partners of men who die of AIDS or other causes based on data on the concordance of heterosexual partners. Subsequently, the proportion of orphans whose parents have both died is predicted by a regression model fitted to orphanhood data from 34 national demographic and health surveys (DHSs). The approach is illustrated with an application to Tanzania and compared with DHS estimates for the years 1992 and 1999. RESULTS: Projections of the number and age distribution of orphans using these methods agree with survey data for Tanzania. They show the rise in orphanhood over the last decade that has resulted from the HIV epidemic. CONCLUSIONS: The methods allow estimation of the numbers of children whose mother, father, or both parents have died for countries with generalized heterosexual HIV epidemics. These methods have been used to produce orphan estimates for high-prevalence countries published by Joint United Nations Program on HIV/AIDS, World Health Organization, United Nations Children's Fund, and US Agency for International Development in 2002 and 2004.

Acquired Immunodeficiency Syndrome↗
PubMed1995

ENSO and disaster: droughts, floods and El Niño/Southern Oscillation warm events.

The connection between El Niño/Southern Oscillation (ENSO) events and precipitation and temperature variability worldwide is increasingly well understood. ENSO has been linked to droughts and flooding in some regions. This paper uses the disaster history database of the U.S. Agency for International Development's Office of U.S. Foreign Disaster Assistance to examine the link between ENSO events and droughts or floods of sufficient magnitude to trigger international disasters. Worldwide, disasters triggered by droughts are twice as frequent during year two of ENSO warm events than during other years. No such relationship is apparent in the case of flood disasters. Drought disasters occur during year two of ENSO warm events significantly more frequently than in other years in Southern Africa and Southeast Asia. No regional pattern emerges from a comparable analysis of flood disasters. Those places likely to be affected by ENSO-triggered droughts can take proactive measures to mitigate the impacts.

Atmosphere↗
PubMed2002

The impact of an integrated family planning program in Russia.

In 1995, the U.S. Agency for International Development implemented an integrated program of family planning education and services in six Russian cities to increase physicians' and women's contraceptive knowledge and change current contraceptive use. Large population-based surveys of women ages 15-44 were carried out at the beginning of project implementation (in 1996) and 3 years later in two project sites and a comparison site. Results from these surveys indicate that project activities affected women's knowledge of family planning methods, and caused women to have more favorable attitudes toward modern contraception. In addition, abortion rates decreased in project sites while remaining virtually unchanged in the comparison site. Because of uneven implementation of project interventions in the demonstration sites, however, the intervention's actual impact on abortion rates remains unclear.

Abortion, Legal↗
PubMed2001

Are condoms effective in reducing the risk of sexually transmitted disease?

A panel of more than two dozen experts reviewed the scientific evidence on condom effectiveness for sexually transmitted disease (STD) prevention, and a final report was released July 20, 2001, by the Department of Health and Human Services. This panel was cosponsored and convened for a two-day workshop by four government agencies (Agency for International Development, Food and Drug Administration, Centers for Disease Control and Prevention [CDC], and the National Institutes of Health [NIH]).

Condoms↗
PubMed1993

Trypanosomes and microfilariae in feral owl and squirrel monkeys maintained in research colonies.

A group of 358 owl and squirrel monkeys imported from Colombia, Peru, and Bolivia for the U.S. Agency for International Development Malaria Vaccine Development Program was examined for trypanosomes and microfilariae. Trypanosoma rangeli, isolated by hemoculture from Aotus nancymai, Saimiri b. boliviensis, and S. b. peruviensis, accounted for 76.6% of all trypanosome infections. Trypanosoma cruzi was isolated from 25 of 194 S. b. boliviensis, including two mixed infections with T. rangeli. Identifications of trypanosomes were confirmed by blinded tests with a panel of five rRNA probes on a subsample of cultures identified morphologically. Although no trypanosomes were isolated from Aotus vociferans or A. lemurinus griseimembra, positive serologic responses to T. cruzi were observed by indirect immunofluorescence assay in all species of monkeys examined and ranged from 42.1% among S. b. peruviensis to 92.3% among A. vociferans. Among T. rangeli-infected monkeys, 43.7% were seronegative for T. cruzi. No microfilariae were found in S. b. boliviensis or A. l. griseimembra. Mansonella barbascalensis and Dipetalonema caudispina were observed in A. vociferans, M. panamensis in A. nancymai, and M. saimiri and D. caudispina in S. b. peruviensis. Such naturally occurring infections in imported animal models are potential sources of accidental transmission to animal handlers and uninfected laboratory animals and can introduce confounding variables into otherwise well-planned and well-executed studies.

Animals↗
PubMed2000

[Reproductive health in women in the Czech Republic 1993-1997. I. Study methodology and characteristics of the sample groups].

AIM OF THE STUDY: To identify changes in reproductive health status as a consequence of changes in the system of health care and social affairs. THE AIM OF THIS PART OF STUDY: To prepare the methodology of data collection and to identify changes of demographic characteristics. TYPE OF THE STUDY: Retrospective comparative epidemiological study. INSTITUTION: Institute for the Care of Mother and Child, Praha 4-Podolí. METHODS: Two nation-wide surveys on reproductive health of representative three-stage cluster samples in 1993 and 1997. After selection of residential sites from all districts the households were selected for interview. One hundred and fifty trained interviewers asked selected women of reproductive age (4,497 in 1993 and 1,735 in 1997) questions according to a special questionnaire. The basic demographic characteristics of the two samples were compared with the 1991 Census data. The 1993 Czech Republic Reproductive Health Survey was funded by the United States Agency for international Development via a WHO agreement; the 1997 Survey was funded by the Czech Statistical Office and Ministry of Health. RESULTS: The age structure is very similar in the 1993 sample and in the 1991 Census data, however, there is a remarkably lower proportion of women 15-19 years of age in the 1997 sample. According to the marital status, the 1997 sample has a higher proportion of women living in partner-strip and divorced women. The 1997 sample has a higher proportion of women with only one child and there were fewer women with 4 and more children. Also the proportion of women with secondary education with higher school certificate was higher in the later sample. CONCLUSION: This part of the study evaluate a changes in four demographic characteristics of women of reproductive age, because these changes could influence the reproductive health indicators (contraception, induced abortions), which are the subject of further analysis.

Adolescent↗
PubMed2001

Mortality during a famine--Gode district, Ethiopia, July 2000.

Recurrent famine has been a major cause of mortality in the Horn of Africa. In Ethiopia, three consecutive years of drought led to widespread loss of livestock, population displacement, and malnutrition, placing an estimated 10 million persons at risk for starvation in 2000. A large proportion of the population of the Gode district in Somali region was displaced in a search for food and food aid (CDC, unpublished data, 2000). From April through July 2000, nongovernmental organizations (NGOs) opened feeding centers in the Gode district. Because no vital statistics or public health surveillance system existed in the district, and no representative mortality or morbidity data were available, during July 2000, CDC, in collaboration with Save the Children U.S., the Office of Foreign Disaster Assistance of the U.S. Agency for International Development, and the United Nations Children's Fund (UNICEF), conducted a mortality survey. This report summarizes the results of this survey, which found persistently high levels of mortality, with measles representing an important cause of mortality in children aged <5 years and 5-14 years. Mass measles vaccination with vitamin A distribution is an important intervention during the acute phase of famines in sub-Saharan Africa.

Adult↗
PubMed1995

Prerana: a success story.

Prerana-Associate CEDPA, a women- and youth-focused community organization headquartered in New Delhi, has expanded its program activities with recent grants from two leading donors, the John D. and Catherine T. MacArthur Foundation and the Rockefeller Foundation. CEDPA provides important support through grants from The Xerox Foundation, The Turner Foundation, World Bank, and the US Agency for International Development. Founded in 1976, Prerana--whose name means "Inspiration" in Hindi--has grown steadily as knowledge of its comprehensive community-based program has spread. The organization conducts the CEDPA Better Life Options health, education, and vocational skills programs for girls and young women, maternal and child health services, and integrated community-based family planning. A parallel Better Life Options program for boys and young men was recently started. With almost 20 years of experience in the private sector, Prerana provides training and assistance to other private organizations. Prerana's Better Life Options program received international recognition in UNFPA's "The State of World Population 1994." The publication featured an article by a young Indian woman who participated in the program and as a result was able to develop life skills, improve her self-esteem, and, with her husband, decide to delay parenthood. "This success story," said Prerana Executive Director Dr. Uma Agarwal (WIM 29), "is being repeated by many other girls who find support at Prerana."

Asia↗