World Health Organization

About: World Health Organization is a government organization based out in Islamabad, Pakistan. It is known for research contribution in the topics: Population & Public health. The organization has 13330 authors who have published 22232 publications receiving 1322023 citations. The organization is also known as: World Health Organisation & WHO.

Associations between wife-beating and fetal and infant death: impressions from a survey in rural India.

Abstract: Data from a 1993-94 survey of 1842 women 15-39 years old to compare women's autonomy in Uttar Pradesh and Tamil Nadu were analyzed to provide an exploratory, preliminary look at the effect of domestic violence on pregnancy outcomes. The sample included 894 women who had 1 or more pregnancies and were married 10 or fewer years. A socioeconomic profile reveals regional differences in women's decision-making authority and mobility but fewer differences in their ability to make purchases for themselves. Domestic violence affected 40-46% of the sample in Uttar Pradesh and 33-35% in Tamil Nadu and was widely accepted by women and by husbands. At least 27% of the sample reported pregnancy loss (including induced abortion), and 13% of the women who had a live birth experienced an infant death (16% from Uttar Pradesh and 10% from Tamil Nadu). Victims of domestic abuse were significantly more likely to experience fetal wastage or infant death regardless of religion or region of residence. This association survives logistic regression for other factors, such as education, age, number of children ever born, having worked for cash in the past year, number of consumer goods owned, religion, and autonomy. Strategies to combat domestic violence must deal with the root cause, which is women's powerlessness, as well as women's immediate needs. Community education programs must stress women's rights, the likely consequences of domestic violence, and the need to reverse social norms about male supremacy. Additional research is also needed on the sequelae of domestic violence and the attitudes of violent men. Language: en

Sampling Hard-to-Reach Populations with Respondent Driven Sampling

Abstract: Cost effective and targeted prevention, intervention and treatment programs for hard-to-reach populations at risk for HIV and other infections rely on the collection of quality data through biological and behavioral surveillance surveys (BBSS). Over the past decade, there has been a global expansion of BBSS to measure the prevalence of HIV and other infections, and related risk behaviors among injecting drug users, males who have sex with males, and female sex workers. However, a major challenge to sampling these hard-to-reach populations is that they are usually stigmatised and/or practice illegal behaviors which, in turn, make them difficult to access and unwilling to participate in research efforts. Over the past decade, respondent driven sampling (RDS) has become recognised as a viable option for rigorous sampling of hard-to-reach populations. This paper introduces RDS methods and describes some of the advantages and challenges to implementing and analysing surveys that use RDS.

After 2015: infectious diseases in a new era of health and development.

Abstract: Running over timescales that span decades or centuries, the epidemiological transition provides the central narrative of global health. In this transition, a reduction in mortality is followed by a reduction in fertility, creating larger, older populations in which the main causes of illness and death are no longer acute infections of children but chronic diseases of adults. Since the year 2000, the Millennium Development Goals (MDGs) have provided a framework for accelerating the decline of infectious diseases, backed by a massive injection of foreign investment to low-income countries. Despite the successes of the MDGs era, the inhabitants of low-income countries still suffer an enormous burden of disease owing to diarrhoea, pneumonia, HIV/AIDS, tuberculosis, malaria and other pathogens. Adding to the predictable burden of endemic disease, the threat of pandemics is ever-present and global. With a view to the future, this review spotlights five aspects of the fight against infection beyond 2015, when the MDGs will be replaced by a new set of goals for poverty reduction and sustainable development. These aspects are: exploiting the biological links between infectious and non-infectious diseases; controlling infections among the new urban majority; enhancing the response to international health threats; expanding childhood immunization programmes to prevent acute and chronic diseases in adults; and working towards universal health coverage. By scanning the wider horizon now, infectious disease specialists have the chance to shape the post-2015 era of health and development.

To retain or remove user fees?: reflections on the current debate in low- and middle-income countries.

Abstract: Many low- and middle-income countries continue to search for better ways of financing their health systems. Common to many of these systems are problems of inadequate resource mobilisation, as well as inefficient and inequitable use of existing resources. The poor and other vulnerable groups who need healthcare the most are also the most affected by these shortcomings. In particular, these groups have a high reliance on user fees and other out-of-pocket expenditures on health which are both impoverishing and provide a financial barrier to care. It is within this context, and in light of recent policy initiatives on user fee removal, that a debate on the role of user fees in health financing systems has recently returned. This paper provides some reflections on the recent user fees debate, drawing from the evidence presented and subsequent discussions at a recent UNICEF consultation on user fees in the health sector, and relates the debate to the wider issue of access to adequate healthcare. It is argued that, from the wealth of evidence on user fees and other health system reforms, a broad consensus is emerging. First, user fees are an important barrier to accessing health services, especially for poor people. They also negatively impact on adherence to long-term expensive treatments. However, this is offset to some extent by potentially positive impacts on quality. Secondly, user fees are not the only barrier that the poor face. As well as other cost barriers, a number of quality, information and cultural barriers must also be overcome before the poor can access adequate health services. Thirdly, initial evidence on fee abolition in Uganda suggests that this policy has improved access to outpatient services for the poor. For this to be sustainable and effective in reaching the poor, fee removal needs to be part of a broader package of reforms that includes increased budgets to offset lost fee revenue (as was the case in Uganda). Fourthly, implementation matters: if fees are to be abolished, this needs clear communication with a broad stakeholder buy-in, careful monitoring to ensure that official fees are not replaced by informal fees, and appropriate management of the alternative financing mechanisms that are replacing user fees. Fifthly, context is crucial. For instance, immediate fee removal in Cambodia would be inappropriate, given that fees replaced irregular and often high informal fees. In this context, equity funds and eventual expansion of health insurance are perhaps more viable policy options. Conversely, in countries where user fees have had significant adverse effects on access and generated only limited benefits, fee abolition is probably a more attractive policy option. Removing user fees has the potential to improve access to health services, especially for the poor, but it is not appropriate in all contexts. Analysis should move on from broad evaluations of user fees towards exploring how best to dismantle the multiple barriers to access in specific contexts.

Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy.

Abstract: Background Intake of supplements containing iron or a combination of iron and folic acid by pregnant women may improve maternal health and pregnancy outcomes. Recently, intermittent supplementation regimens have been proposed as alternatives to daily regimens. Objectives To assess the effectiveness and safety of daily and intermittent use of iron or iron+folic acid supplements by pregnant women. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2009) and contacted relevant organisations for the identification of ongoing and unpublished studies. Selection criteria All randomised or quasi-randomised trials evaluating the effect of supplementation with iron or iron+folic acid during pregnancy. Data collection and analysis We assessed the methodological quality of trials using the standard Cochrane criteria. Two authors independently assessed which trials to include in the review and one author extracted data. Main results We included 49 trials, involving 23,200 pregnant women. Overall, the results showed significant heterogeneity across most prespecified outcomes and were analysed assuming random-effects. The trials provided limited information related to clinical maternal and infant outcomes. Overall, daily iron supplementation was associated with increased haemoglobin levels in maternal blood both before and after birth and reduced risk of anaemia at term. These effects did not differ significantly between women receiving intermittent or daily iron or iron+folic acid supplementation. Women who received daily prenatal iron supplementation with or without folic acid were less likely to have iron deficiency at term as defined by current cut-off values than those who received no treatment or placebo. Side effects and haemoconcentration (a haemoglobin level greater than 130 g/L) were more common among women who received daily iron or iron+folic acid supplementation than among those who received no treatment or placebo. The risk of haemoconcentration during the second and third trimester was higher among those on a daily regimen of iron supplementation. The clinical significance of haemoconcentration remains uncertain. Authors' conclusions Universal prenatal supplementation with iron or iron+folic acid provided either daily or weekly is effective to prevent anaemia and iron deficiency at term. We found no evidence, however, of the significant reduction in substantive maternal and neonatal adverse clinical outcomes (low birthweight, delayed development, preterm birth, infection, postpartum haemorrhage). Associated side effects and particularly haemoconcentration during pregnancy may suggest the need for revising iron doses and schemes of supplementation during pregnancy and adjust preventive iron supplementation recommendations.