- Email: [email protected]
A priority health issue
140
Midwifery
been reduced to 35 departments. The ongoing work is that of streamlining the working relations of the WHO headquarters in Geneva with its regions and countries. There is a new dialogue with staff and it is intended, in time, to reduce the number of senior positions and reduce the overall costs of administration. In the second part of the address the Director General spoke of WHO working for, in and with countries as a first strategic theme. The second strategic theme is to be more focussed in helping to deliver better health outcomes whilst taking a realistic approach. Some areas scheduled to receive particular attention were highlighted. These included reducing the burden of sickness and suffering resulting from communicable diseases; increasing the ability to deal with noncommunicable diseases; paying more attention to the delivery of high quality care for children, adolescents and women; putting the spotlight back on immunisation and reducing the burden of malnutrition. The third strategy related to the WHO's ability to support more effective health sectors. In working with countries and with all others involved in governments, the private sector, and civil society to ensure that people get a better deal from their health system. To transform the way that the WHO works with countries a project 'Partnerships for Health Sector Development' has been launched. Statement by the Director General to the Executive Board at its 103rd session (January 1999)
First national wifery
meeting
on mid-
The Pakistan National Forum organised the first national meeting on midwifery in September 1998. Midwives, nurses, doctors and obstetricians numbering more than 150 attended the meeting to discuss various aspects of midwifery and its relationship with maternal care and maternal death. Speakers recognised that midwives are the backbone of maternal health delivery systems in developed countries and these countries have minimal death rates. The chief guest speaker, Mr Tasneem Siddiqui, advocated collaboration by all to achieve a revolutionary midwifery programme. Leading gynaecologist Professor Sadequa Jaffery stated that midwives could improve the present situation of
maternal deaths in Pakistan and proposed the working together of midwives and gynaecologists to begin this process. The outcome of the meeting was to agree a request for the government to introduce a strategy to gradually replace traditional birth attendants (Dai's) with competent, trained and licensed midwives. Subject to governmental approval, the National Forum on Women's Health has stated its willingness to prepare a national plan of action for the mobilisation of midwifery personnel for the achievement of the goal of Safe Motherhood in Pakistan. Letter from President o f Materni O, and Child Welfare Association and press cuttings from Daily News and Dawn
World Health Day celebrated in Pakistan by Safe Motherhood activities A film, entitled Mamta Ki Hifazat (protection of motherhood), was produced and shown widely at many health care settings. One version of this now has English subtitles. Other activities included a health camp where as well as distributing medicines and administering tetanus vaccination, talks were given to around 180 women on antenatal care, anaemia, miscarriage, pre-eclampsia and antepartum haemorrhage. A radio broadcast, seminars on Safe Motherhood and reproductive health, displays of posters, antenatal checks for women and extensive media coverage across Pakistan ensured the success of the events. Letter from the Secretary, National Committee on Maternal Health
Celebrations Day
of World
Health
The theme of Safe Motherhood for World Health Day, April 7, 1998, was captured by many countries by special events. In each region of the world countries marked the special day. There were many conferences and round table discussions which attracted health workers from many disciplines. Marches and open air theatre took the message into communities in some countries whilst others held media sessions and promoted the day through sales or gifts of promotional items. The making of videos, either of events or specifically on
the theme of Safe Motherhood means that the message will continue to be spread through countries over a period of time. Brief reports from Algeria, Belgium, Bosnia and Herzegovina, Cambodia, Ghana, India, Namibia, Nepal, Pakistan, Tanzania and Tunisia are all within a supplement to Issue 26 of the Safe Motherhood Newsletter. WHO Safe Motherhood, 1998. Issue 26(2)
A priority health issue WHO is focusing on building a knowledge base for policy and action and defining the role of the health sector in preventing violence against women and providing care for those who suffer it. This activity recognises that violence against women has serious consequences for their mental and physical well-being, and as a general rule is inflicted by men known to the women. WHO, in collaboration with other agencies, aims, in the long term, to determine effective strategies for preventing violence and decreasing morbidity and mortality among women who have been abused. Specific action is to increase knowledge about violence against women and share this knowledge with policy-makers and health providers; identify prevention and intervention strategies that can reduce violence against women and mitigate its consequences; improve the capacity of health workers to identify and respond to women suffering mental and physical abuse; support the formulation of anti-violence policies by national governments and serve as an advocate for greater recognition of the problem of violence against women. To effect this WHO is conducting a multicountry study on Women's Health and Domestic Violence. A database, which contains both statistical, and bibliographical information on violence against women and health has been set up. A poster and an exhibit have been produced together with an information pack entitled 'Violence against women: a priority health issue'. This is available in English, French, Spanish and Russian. Also available is a report of a workshop organised by WHO and the International Federation of Gynaecology and Obstetrics (FIGO) entitled 'Elimination of violence against women: in search of solutions'. Further information can be obtained from: the Violence and Injury, Team of Prevention of Social Change and Mental Health, World
International news
Health Organization. 1211 Geneva 27, Switzerland.
World Health No 5 September-October 1998
ECO states seek actions on men's role in reproductive h e a l t h At a conference in September 1998, held in the context of the 1994 Cario International Conference on Population and Development (ICPD), members of the Economic Co-operation Organization (ECO) have proposed concrete actions to foster men's rights and responsibilities in Azerbaijan, lran, Kazakhstan, Pakistan, Tajikistan, Turkey, Turkmenistan and Uzbekistan. Actions included a campaign on gender equality in Azerbaijan, the creation of hotline and confidential services, the establishment of reproductive health centres for men in Uzbekistan and the re-designation of maternal and child health/family planning units as family health centres in Turkey, expanding the legislative framework in Kazakhstan to regulate reproductive health issues for men and women, and the development of a social support system for men's concerns in Pakistan. Four major themes emerged from the discussions on women's perspectives on the male role in the family. The first, and common thread, was the need for partnerships between men and women. The second, that men have feelings but to show them can be considered unmanly. Third, that media should be used to reach men, and finally, that urgent changes are required to school curricula to better educate men on their roles in reproductive health. Services for men should be made accessible but not at the expense of those already provided for women.
Populi Vol 25, No 4, December 1998/ Janua O, 1999
Report deems male participation crucial A report from the John Hopkins School of Public Health shows that there are an estimated 75 million unintended pregnancies each year. The authors suggest that it is crucial for men to participate in family planning. One hundred million married women are reported to have an unmet need for family planning. These
141
are defined as women who are fecund. sexually active and do not want to become pregnant, but are using neither modern nor traditional contraceptive methods. An average of 9% of married women who have an unmet need cite their husband's disapproval as the principal reason for not using contraception, according to demographic and health surveys taken in India, Guatemala and the Philippines. Attention needs to be given to planning policies for men under the same criteria as other public health programmes. The provision of reproductive health care to men engaging men's participation in family planning can be scaled to suit resources and priorities the authors maintain.
Poplhw Vol 20 November-December 1998
Hepatitis B Hepatitis B, although one of the major diseases of mankind, is now preventable with safe and effective vaccines. The effects of this most serious type of viral hepatitis can be to cause a chronic carrier state which, in turn leads to cirrhosis of the liver or liver cancer. The incidence of infection in developing countries is high, with around 8-15% becoming chronic carriers. Transmission is by blood and close contact and is 100 times more infectious than the AIDS virus. Newborn babies may be infected if their mother is a chronic carrier. Transmission in Western Europe and North America is minimal as all pregnant women are screened and babies are treated at birth with vaccine and other medication. The transmission is these countries is most likely during young adulthood owing to sexual activity, needle sharing and occupational exposure, or travel. The severity of the outcome of infection is inversely related to the age at which a person becomes infected. HbeAg-positive mothers have a 7090% probability of infecting their newborn babies perinatally. Of these, around 90% will become chronic carriers and they then have a 30-50% probability of developing chronic hepatitis. A literature search determined that vaccine, administered with or without immune globulin (HBIg), is effective in preventing vertical transmission and chronic disease. It appeared that timing was the most important factor, with high levels of protection being afforded with high doses of vaccine without the c o n -
comitant use of HBIg, provided the first dose of vaccine was given at birth and the second at one month of age. Where the second dose was not given until two months of age the levels of protection were reduced. The vaccine has been available since 1982 and has an outstanding record for safety and effectiveness. In 1991 the WHO called for all countries to include Hepatitis B vaccine into their national immunisation programmes and, to date, 100 countries have complied with this request. The poorest countries are unable to afford the cost of the vaccine, (between £0.5 and £1.25 sterling). In November 1998 the WHO benefited by a large donation, proceeds from a concert and charity auction, from rock star Sir Elton John. The monies are to be used to purchase vaccine for developing countries and raise awareness.
Press Release WHO~81 6 November 1998; Fact Sheet WHO/204 November 1998 and Viral Hepatitis Volume 7 Number 1, October 1998
Human testing on A I D S vaccine begun The first ever large-scale human test of an AIDS vaccine began in the middle of 1998 in the USA. The three year trial, approved by the Food and Drug Administration, involves 5000 volunteers in more than 30 cities across the USA and has been extended to include 2500 volunteers in Thailand. The new vaccine, AIDSVAXTM, developed by VaxGen, a pharmaceutical company based in San Francisco, contains snippets of two strains of HIV. It is designed, in one formulation, to protect against the strains of HIV found in the Americas, Western Europe and Australia, and, in a separate formulation, to protect against the typical strains of the AIDS-causing virus found in Thailand, Japan, Korea, Taiwan and Indonesia. It is made from a protein from the surface of the virus, which has been copied through genetic engineering. There is no risk of the vaccine causing HIVq infection because it is a subunit vaccine and it is pure. The primary objective of the trial, which is randomised, double blind and placebo controlled, is to determine whether immunization with AIDSVAXTM vaccine protects at-risk persons from acquiring HIV-1 infection. The North American trial enrolled male
Midwifery
been reduced to 35 departments. The ongoing work is that of streamlining the working relations of the WHO headquarters in Geneva with its regions and countries. There is a new dialogue with staff and it is intended, in time, to reduce the number of senior positions and reduce the overall costs of administration. In the second part of the address the Director General spoke of WHO working for, in and with countries as a first strategic theme. The second strategic theme is to be more focussed in helping to deliver better health outcomes whilst taking a realistic approach. Some areas scheduled to receive particular attention were highlighted. These included reducing the burden of sickness and suffering resulting from communicable diseases; increasing the ability to deal with noncommunicable diseases; paying more attention to the delivery of high quality care for children, adolescents and women; putting the spotlight back on immunisation and reducing the burden of malnutrition. The third strategy related to the WHO's ability to support more effective health sectors. In working with countries and with all others involved in governments, the private sector, and civil society to ensure that people get a better deal from their health system. To transform the way that the WHO works with countries a project 'Partnerships for Health Sector Development' has been launched. Statement by the Director General to the Executive Board at its 103rd session (January 1999)
First national wifery
meeting
on mid-
The Pakistan National Forum organised the first national meeting on midwifery in September 1998. Midwives, nurses, doctors and obstetricians numbering more than 150 attended the meeting to discuss various aspects of midwifery and its relationship with maternal care and maternal death. Speakers recognised that midwives are the backbone of maternal health delivery systems in developed countries and these countries have minimal death rates. The chief guest speaker, Mr Tasneem Siddiqui, advocated collaboration by all to achieve a revolutionary midwifery programme. Leading gynaecologist Professor Sadequa Jaffery stated that midwives could improve the present situation of
maternal deaths in Pakistan and proposed the working together of midwives and gynaecologists to begin this process. The outcome of the meeting was to agree a request for the government to introduce a strategy to gradually replace traditional birth attendants (Dai's) with competent, trained and licensed midwives. Subject to governmental approval, the National Forum on Women's Health has stated its willingness to prepare a national plan of action for the mobilisation of midwifery personnel for the achievement of the goal of Safe Motherhood in Pakistan. Letter from President o f Materni O, and Child Welfare Association and press cuttings from Daily News and Dawn
World Health Day celebrated in Pakistan by Safe Motherhood activities A film, entitled Mamta Ki Hifazat (protection of motherhood), was produced and shown widely at many health care settings. One version of this now has English subtitles. Other activities included a health camp where as well as distributing medicines and administering tetanus vaccination, talks were given to around 180 women on antenatal care, anaemia, miscarriage, pre-eclampsia and antepartum haemorrhage. A radio broadcast, seminars on Safe Motherhood and reproductive health, displays of posters, antenatal checks for women and extensive media coverage across Pakistan ensured the success of the events. Letter from the Secretary, National Committee on Maternal Health
Celebrations Day
of World
Health
The theme of Safe Motherhood for World Health Day, April 7, 1998, was captured by many countries by special events. In each region of the world countries marked the special day. There were many conferences and round table discussions which attracted health workers from many disciplines. Marches and open air theatre took the message into communities in some countries whilst others held media sessions and promoted the day through sales or gifts of promotional items. The making of videos, either of events or specifically on
the theme of Safe Motherhood means that the message will continue to be spread through countries over a period of time. Brief reports from Algeria, Belgium, Bosnia and Herzegovina, Cambodia, Ghana, India, Namibia, Nepal, Pakistan, Tanzania and Tunisia are all within a supplement to Issue 26 of the Safe Motherhood Newsletter. WHO Safe Motherhood, 1998. Issue 26(2)
A priority health issue WHO is focusing on building a knowledge base for policy and action and defining the role of the health sector in preventing violence against women and providing care for those who suffer it. This activity recognises that violence against women has serious consequences for their mental and physical well-being, and as a general rule is inflicted by men known to the women. WHO, in collaboration with other agencies, aims, in the long term, to determine effective strategies for preventing violence and decreasing morbidity and mortality among women who have been abused. Specific action is to increase knowledge about violence against women and share this knowledge with policy-makers and health providers; identify prevention and intervention strategies that can reduce violence against women and mitigate its consequences; improve the capacity of health workers to identify and respond to women suffering mental and physical abuse; support the formulation of anti-violence policies by national governments and serve as an advocate for greater recognition of the problem of violence against women. To effect this WHO is conducting a multicountry study on Women's Health and Domestic Violence. A database, which contains both statistical, and bibliographical information on violence against women and health has been set up. A poster and an exhibit have been produced together with an information pack entitled 'Violence against women: a priority health issue'. This is available in English, French, Spanish and Russian. Also available is a report of a workshop organised by WHO and the International Federation of Gynaecology and Obstetrics (FIGO) entitled 'Elimination of violence against women: in search of solutions'. Further information can be obtained from: the Violence and Injury, Team of Prevention of Social Change and Mental Health, World
International news
Health Organization. 1211 Geneva 27, Switzerland.
World Health No 5 September-October 1998
ECO states seek actions on men's role in reproductive h e a l t h At a conference in September 1998, held in the context of the 1994 Cario International Conference on Population and Development (ICPD), members of the Economic Co-operation Organization (ECO) have proposed concrete actions to foster men's rights and responsibilities in Azerbaijan, lran, Kazakhstan, Pakistan, Tajikistan, Turkey, Turkmenistan and Uzbekistan. Actions included a campaign on gender equality in Azerbaijan, the creation of hotline and confidential services, the establishment of reproductive health centres for men in Uzbekistan and the re-designation of maternal and child health/family planning units as family health centres in Turkey, expanding the legislative framework in Kazakhstan to regulate reproductive health issues for men and women, and the development of a social support system for men's concerns in Pakistan. Four major themes emerged from the discussions on women's perspectives on the male role in the family. The first, and common thread, was the need for partnerships between men and women. The second, that men have feelings but to show them can be considered unmanly. Third, that media should be used to reach men, and finally, that urgent changes are required to school curricula to better educate men on their roles in reproductive health. Services for men should be made accessible but not at the expense of those already provided for women.
Populi Vol 25, No 4, December 1998/ Janua O, 1999
Report deems male participation crucial A report from the John Hopkins School of Public Health shows that there are an estimated 75 million unintended pregnancies each year. The authors suggest that it is crucial for men to participate in family planning. One hundred million married women are reported to have an unmet need for family planning. These
141
are defined as women who are fecund. sexually active and do not want to become pregnant, but are using neither modern nor traditional contraceptive methods. An average of 9% of married women who have an unmet need cite their husband's disapproval as the principal reason for not using contraception, according to demographic and health surveys taken in India, Guatemala and the Philippines. Attention needs to be given to planning policies for men under the same criteria as other public health programmes. The provision of reproductive health care to men engaging men's participation in family planning can be scaled to suit resources and priorities the authors maintain.
Poplhw Vol 20 November-December 1998
Hepatitis B Hepatitis B, although one of the major diseases of mankind, is now preventable with safe and effective vaccines. The effects of this most serious type of viral hepatitis can be to cause a chronic carrier state which, in turn leads to cirrhosis of the liver or liver cancer. The incidence of infection in developing countries is high, with around 8-15% becoming chronic carriers. Transmission is by blood and close contact and is 100 times more infectious than the AIDS virus. Newborn babies may be infected if their mother is a chronic carrier. Transmission in Western Europe and North America is minimal as all pregnant women are screened and babies are treated at birth with vaccine and other medication. The transmission is these countries is most likely during young adulthood owing to sexual activity, needle sharing and occupational exposure, or travel. The severity of the outcome of infection is inversely related to the age at which a person becomes infected. HbeAg-positive mothers have a 7090% probability of infecting their newborn babies perinatally. Of these, around 90% will become chronic carriers and they then have a 30-50% probability of developing chronic hepatitis. A literature search determined that vaccine, administered with or without immune globulin (HBIg), is effective in preventing vertical transmission and chronic disease. It appeared that timing was the most important factor, with high levels of protection being afforded with high doses of vaccine without the c o n -
comitant use of HBIg, provided the first dose of vaccine was given at birth and the second at one month of age. Where the second dose was not given until two months of age the levels of protection were reduced. The vaccine has been available since 1982 and has an outstanding record for safety and effectiveness. In 1991 the WHO called for all countries to include Hepatitis B vaccine into their national immunisation programmes and, to date, 100 countries have complied with this request. The poorest countries are unable to afford the cost of the vaccine, (between £0.5 and £1.25 sterling). In November 1998 the WHO benefited by a large donation, proceeds from a concert and charity auction, from rock star Sir Elton John. The monies are to be used to purchase vaccine for developing countries and raise awareness.
Press Release WHO~81 6 November 1998; Fact Sheet WHO/204 November 1998 and Viral Hepatitis Volume 7 Number 1, October 1998
Human testing on A I D S vaccine begun The first ever large-scale human test of an AIDS vaccine began in the middle of 1998 in the USA. The three year trial, approved by the Food and Drug Administration, involves 5000 volunteers in more than 30 cities across the USA and has been extended to include 2500 volunteers in Thailand. The new vaccine, AIDSVAXTM, developed by VaxGen, a pharmaceutical company based in San Francisco, contains snippets of two strains of HIV. It is designed, in one formulation, to protect against the strains of HIV found in the Americas, Western Europe and Australia, and, in a separate formulation, to protect against the typical strains of the AIDS-causing virus found in Thailand, Japan, Korea, Taiwan and Indonesia. It is made from a protein from the surface of the virus, which has been copied through genetic engineering. There is no risk of the vaccine causing HIVq infection because it is a subunit vaccine and it is pure. The primary objective of the trial, which is randomised, double blind and placebo controlled, is to determine whether immunization with AIDSVAXTM vaccine protects at-risk persons from acquiring HIV-1 infection. The North American trial enrolled male