The United Nations development programme initiative for sustainable energy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hurry, S.

1997-12-01

Energy is central to current concerns about sustainable human development, affecting economic and social development; economic growth, the local, national, regional, and global environment; the global climate; a host of social concerns, including poverty, population, and health, the balance of payments, and the prospects for peace. Energy is not an end in itself, but rather the means to achieve the goals of sustainable human development. The energy systems of most developing countries are in serious crisis involving insufficient levels of energy services, environmental degradation, inequity, poor technical and financial performance, and capital scarcity. Approximately 2.5 billion people in the developingmore » countries have little access to commercial energy supplies. Yet the global demand for energy continues to grow: total primary energy is projected to grow from 378 exajoules (EJ) per year in 1990 to 571 EJ in 2020, and 832 EJ in 2050. If this increase occurs using conventional approaches and energy sources, already serious local (e.g., indoor and urban air pollution), regional (eg., acidification and land degradation), and global (e.g., climate change) environmental problems will be critically aggravated. There is likely to be inadequate capital available for the needed investments in conventional energy sources. Current approaches to energy are thus not sustainable and will, in fact, make energy a barrier to socio-economic development. What is needed now is a new approach in which energy becomes an instrument for sustainable development. The two major components of a sustainable energy strategy are (1) more efficient energy use, especially at the point of end-use, and (2) increased use of renewable sources of energy. The UNDP Initiative for Sustainable Energy (UNISE) is designed to harness opportunities in these areas to build upon UNDP`s existing energy activities to help move the world toward a more sustainable energy strategy by helping program countries.« less

Multilateral Agencies in the Construction of the Global Agenda on Education

ERIC Educational Resources Information Center

King, Kenneth

2007-01-01

This article traces the construction of the educational dimension of the global development agenda over the period 1990 to 2006. It argues that the multilateral agencies, and notably the World Bank, UNICEF, UNESCO and UNDP, played vital roles in designing the architecture of this world agenda, supported at a key stage by the Development Assistance…

The Long March. Building an Afghan National Army

DTIC Science & Technology

2009-01-01

UNDP, 2007). Illiteracy and gender discrimination remain widespread. Additionally, 2006 witnessed a significant rise in terror- ist attacks and a 59...TERRORISM AND HOMELAND SECURITY TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit research organization...ANA) is seen as a sine qua non for security in Afghanistan. The recent resurgence of the Taliban, operating out of bases in Pakistan and parts of

Romani Peoples' Resistance to Mainstream Schooling: A Focus on Romani Woman and Girls' Education and the Educational Policies, Barriers, and Practices in Greece

ERIC Educational Resources Information Center

Macris, Vicki

2015-01-01

The Romani (or Roma) people are, perhaps, the oldest and most discriminated against ethnic minority group in Eastern Europe. In particular, Romani women and girls have been described by the UN Women, United Nations Development Program (UNDP), and Office of High Commission of Human Rights (OHCHR) as "one of the most disempowered groups in…

Towards the Third Cycle of APEID. Final Report. Regional Consultation Meeting on the Asian Programme of Educational Innovation for Development (7th, Bangkok, Thailand, June 1-10, 1981).

ERIC Educational Resources Information Center

United Nations Educational, Scientific, and Cultural Organization, Bangkok (Thailand). Regional Office for Education in Asia and the Pacific.

The Seventh Regional Consultation Meeting on the Asian Programme of Educational Innovation for Development (APEID) was devoted to a tripartite review of the United Nations Development Programme (UNDP) component of APEID. APEID had undertaken four development themes in its second cycle: universalization of education at early school levels and…

Building Capacity in the Public Utility Sectors of Basra, Iraq

DTIC Science & Technology

2007-10-01

has a broad range of academic and personal interests in fields that use the creative application of quantitative analysis and systems thinking to solve ... comprehensive study by Tokyo Engineering Consultants Co., Ltd. [5] references a joint United Nations Development Program (UNDP) Iraqi Central Organization...creative solutions to solve this problem. We then develop a means to evaluate and rank these potential solutions using the stakeholder values as the

The Earth Sciences, Human Well-Being, and the Reduction of Global Poverty

NASA Astrophysics Data System (ADS)

Mutter, John C.

2005-04-01

Poverty is not solely a social or political matter, nor is it caused simply by population pressures as Thomas Malthus postulated in 1798. A new understanding of poverty is emerging in which natural and environmental drivers, together with social, political, and demographic causes, underpin livelihoods. The Earth sciences, therefore, play a critical role in identifying the deep causes of human suffering and in identifying solutions. The State of the Planet: Why Are So Many So Poor? For far too many, the state of human well-being is bleak. Around one in six human beings-1 billion people-live in extreme poverty, struggling to survive on less than $1 a day; another one sixth of humanity ekes out existence on $2 per day (U.N. Development Programme (UNDP) Human Development Report, 2004; http://hdr.undp.org/2004/). The extreme poor lack all normal attributes of a decent, dignified life: adequate food, housing, sanitation, health care, education, and employment. Some 800 million people lack sufficient nourishment almost every day. It stunts their mental and physical development and shortens their lives, making them susceptible to common illnesses that attack their hunger-weakened bodies. Poor nutrition in mothers and infants is the leading cause of reduced disability-adjusted life years in poor countries [ Economist, 2004].

Worldwide Emerging Environmental Issues Affecting the U.S. Military

DTIC Science & Technology

2010-08-01

Brazil protecting non-Amazonian tropical forests . A summary of the consultations across the region are presented in the UNDP LAC Regional...North-American Environmental Integration……..13 6.6 World’s Humid Tropical Forests to Suffer Considerable Biodiversity Change by 2100….…13 6.7 Latin...35456&Cr=sanitation&Cr1 Item 2. Food Security Concerns Increase Around the World The Food Security Risk Index 2010 reveals that the countries most

The Employment Challenge: An Agenda for Global Action. A Policy Paper Commissioned by UNDP for the World Summit for Social Development (Copenhagen, Denmark, March 1995).

ERIC Educational Resources Information Center

United Nations Development Programme, New York, NY.

In May 1994, 26 experts from 10 countries attended a technical meeting on economic policies and employment. After hearing and discussing eight papers on the nature of the employment problem and its macroeconomic solution, the group formulated an outline for global action that called on nations to act together to increase their chances of providing…

El Salvador: Political, Economic, and Social Conditions and U.S. Relations

DTIC Science & Technology

2008-11-18

Ever,” Latin American Weekly Report, February 7, 2008; United Nations Development Program (UNDP), “Maras y Pandillas: Comunidad y Policia en ...to 60% of homicides, but CRS-4 6 “2,576 Homicidios en el 2004 en El Salvador,” Agence France Presse, January 5, 2004; United Nations Office on Drugs...El Salvador, along with Ecuador , Aruba, and the Netherlands Antilles, serves as a Forward Operating Location (FOL) for U.S. anti- drug forces. In 2007

Do reimbursement recommendation processes used by government drug plans in Canada adhere to good governance principles?

PubMed

Rawson, Nigel Sb; Adams, John

2017-01-01

In democratic societies, good governance is the key to assuring the confidence of stakeholders and other citizens in how governments and organizations interact with and relate to them and how decisions are taken. Although defining good governance can be debatable, the United Nations Development Program (UNDP) set of principles is commonly used. The reimbursement recommendation processes of the Canadian Agency for Drugs and Technologies in Health (CADTH), which carries out assessments for all public drug plans outside Quebec, are examined in the light of the UNDP governance principles and compared with the National Institute for Health and Care Excellence system in England. The adherence of CADTH's processes to the principles of accountability, transparency, participatory, equity, responsiveness and consensus is poor, especially when compared with the English system, due in part to CADTH's lack of genuine independence. CADTH's overriding responsibility is toward the governments that "own," fund and manage it, while the agency's status as a not-for-profit corporation under federal law protects it from standard government forms of accountability. The recent integration of CADTH's reimbursement recommendation processes with the provincial public drug plans' collective system for price negotiation with pharmaceutical companies reinforces CADTH's role as a nonindependent partner in the pursuit of governments' cost-containment objectives, which should not be part of its function. Canadians need a national organization for evaluating drugs for reimbursement in the public interest that fully embraces the principles of good governance - one that is publicly accountable, transparent and fair and includes all stakeholders throughout its processes.

Family planning: a basic development need.

PubMed

1994-06-01

The 1994 Human Development Report from the United Nations Development Program (UNDP) proposes a 20-20 Human Development Compact based on shared responsibilities between poor and rich nations, whereby poor and rich nations would help unmet basic human development needs such as primary education, primary health care, safe drinking water, and family planning over the next 10 years. This would require an additional US $30 to US $40 billion annually. Developing countries would commit 20% of their budgets to human priority concerns instead of the current 10% by reducing military expenditure, selling off unprofitable public enterprises and abandoning wasteful prestige projects. Donor countries would increase foreign aid from the current average of 7% to 20%. The report will propose a new concept of human security at the World Summit for Social Development to be held in March 1995, calling widespread human insecurity a universal problem. On average, poor nations have 19 soldiers for every one doctor. Global military spending has been declining since 1987 at the rate of 3.6% a year, resulting in a cumulative peace dividend of US $935 billion from 1987 to 1994. But this money has not been expended on unmet human needs. India ordered fighter planes at a cost that could have provided basic education to the 15 million Indian girls now out of school. Nigeria bought tanks from the UK at a cost that could have immunized all 2 million unimmunized children while also providing family planning to nearly 17 million couples. UNDP proposes a phasing out of all military assistance, military bases, and subsidies to arms exporters over a 3-year period. It also recommends the major restructuring of existing aid funds, and proposes a serious study on new institutions for global governance in the next century.

The Association between Peace and Life Expectancy: An Empirical Study of the World Countries.

PubMed

Yazdi Feyzabadi, Vahid; Haghdoost, Aliakbar; Mehrolhassani, Mohammad Hossein; Aminian, Zahra

2015-03-01

Although theoretically peace affects health, few published evidence for such an association was empirically available. This study aimed to explore the association between peace and life expectancy (LE) among the world countries. In an ecological study and using random effects regression model, we examined the association between peace and LE among world countries between 2007 and 2012. The LE at birth and global peace index (GPI: a score between 1 and 5, higher score means lower peace) were selected as outcome and main predictor variables, respectively. We adjusted their association for the gross national income (GNI) per capita and education index (EI). Data were obtained from the Institute for Economics and Peace (IEP) and UNDP (United Nations Development Programme (UNDP). Numbers of included countries were 158 based on the available data. GPI had a negative, considerable, and statistically significant effect on LE (standardized coefficient -0.039; 95% CI: -0.058, -0.019). This association was also significant even after the adjustment for EI (-0.019; 95% CI: -0.035, -0.003), GNI (-0.035; 95% CI: -0.055, -0.015), and both EI and GNI (-0.017; 95% CI: -0.033, -0.001). The full model showed that around 0.61 of the variation of LE among countries may be explained by the GPI, EI and GNI per capita. The contribution of peace as a global determinant of LE was empirically considerable even after the adjustment for the economic and education levels of countries. This implies that governments should make efforts to settle peace through implementing good governance based on interactions with both public and other countries.

The Association between Peace and Life Expectancy: An Empirical Study of the World Countries

PubMed Central

YAZDI FEYZABADI, Vahid; HAGHDOOST, Aliakbar; MEHROLHASSANI, Mohammad Hossein; AMINIAN, Zahra

2015-01-01

Background: Although theoretically peace affects health, few published evidence for such an association was empirically available. This study aimed to explore the association between peace and life expectancy (LE) among the world countries. Methods: In an ecological study and using random effects regression model, we examined the association between peace and LE among world countries between 2007 and 2012. The LE at birth and global peace index (GPI: a score between 1 and 5, higher score means lower peace) were selected as outcome and main predictor variables, respectively. We adjusted their association for the gross national income (GNI) per capita and education index (EI). Data were obtained from the Institute for Economics and Peace (IEP) and UNDP (United Nations Development Programme (UNDP). Numbers of included countries were 158 based on the available data. Results: GPI had a negative, considerable, and statistically significant effect on LE (standardized coefficient −0.039; 95% CI: −0.058, −0.019). This association was also significant even after the adjustment for EI (−0.019; 95% CI: −0.035, −0.003), GNI (−0.035; 95% CI: −0.055, −0.015), and both EI and GNI (−0.017; 95% CI: −0.033, −0.001). The full model showed that around 0.61 of the variation of LE among countries may be explained by the GPI, EI and GNI per capita. Conclusion: The contribution of peace as a global determinant of LE was empirically considerable even after the adjustment for the economic and education levels of countries. This implies that governments should make efforts to settle peace through implementing good governance based on interactions with both public and other countries. PMID:25905077

Using stable isotopes and multi-spatial variable parameters in characterising the karstic aquifer of the Ajloun area, NW-Jordan - A case study of the Tanour and Rasoun springs

NASA Astrophysics Data System (ADS)

Hamdan, Ibraheem; Wiegand, Bettina; Ptak, Thomas; Licha, Tobias; Toll, Mathias; Margane, Armin; Sauter, Martin

2015-04-01

Key words: Karst systems, Groundwater vulnerability, Stable isotopes, Jordan. Water resources are extremely scarce in Jordan, which is considered as one of the poorest countries in the world with respect to water resources availability (UNDP 2014), with more than 90% of the country receiving less than 200 mm/year of rainfall (Al Kharadsheh et al. 2012). The most important aquifer for drinking-water purposes in Jordan is the upper Cretaceous limestone aquifer. The karstic springs of Tanour and Rasoun, located in the Ajloun governorate around 75 kilometres northwest of the capital of Amman, have been selected for this study. These springs are the main source for the local domestic water supply, with an average discharge between the years 2000 and 2012 of 200 m3/h and 60 m3/h, respectively (MWI, 2013). During the past few years, the water supply from these two springs had to be discontinued due to high contamination of the groundwater either by microbiological contaminants or by wastewater from local olive oil presses. This wastewater is locally called 'Zeebar'. Understanding of the karst aquifer system, the pathways and movement within the epikarst, and estimation of the travel and residence time within the aquifer is important for managing and evaluating the pollution risk, which affects the usability of groundwater for drinking purposes. For a better understanding of the karstic system and its behaviour, different methods are applied: 1. Analysis of the stable isotope composition of δ2H and δ18O during the winter season for both (a) Tanour and Rasoun groundwater, and (b) rainfall samples collected from several locations at different elevations within the catchment. 2. Analysis of major ion concentrations in groundwater of the Tanour and Rasoun springs. 3. Long-term measurements of different physico-chemical parameters from the Tanour and Rasoun springs (temperature, conductivity, turbidity, TOC, etc.) using multiparameter probes with telemetric data transfer. 4. Application of a travel time-based groundwater vulnerability method, and other different groundwater vulnerability methods for karst systems. The resulting data will be processed and used as spatially variable parameters for determining the karst aquifer characteristics within the study area. The springs show a rapid response to rainfall events which reflects a fast travel time and short residence time in the karst aquifer. References - Al Kharadsheh E, Akroush S and Mazahreh S (2012) Land Degradation in Jordan - Review of Knowledge Resources, International Center for Agricultural Research in the Dry Areas (ICARDA), OASIS Country Report 1. - MWI - Ministry of Water and Irrigation (2013) Discharge Data for Tanour and Rasoun Springs, Water Information System, National Master Plan Directorate, Amman, Jordan. - UNDP (United Nations Development Programme) (2014, September) About Jordan, http://www.jo.undp.org/content/jordan/en/home/countryinfo/

Strategic emphases for tropical diseases research: a TDR perspective.

PubMed

Remme, Jan H F; Blas, Erik; Chitsulo, Lester; Desjeux, Philippe M P; Engers, Howard D; Kanyok, Thomas P; Kengeya Kayondo, Jane F; Kioy, Deborah W; Kumaraswami, Vasanthapuram; Lazdins, Janis K; Nunn, Paul P; Oduola, Ayoade; Ridley, Robert G; Toure, Yeya T; Zicker, Fabio; Morel, Carlos M

2002-10-01

Setting priorities for health research is a difficult task, especially for the neglected diseases of the poor. A new approach to priority setting for tropical diseases research has been adopted by the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (known as the TDR). Priorities are defined on the basis of a comprehensive analysis of research needs and research opportunities for each of the ten major tropical diseases in the TDR portfolio. The resulting strategic emphases matrix reflects the priorities for tropical diseases research from the perspective of the TDR. Its purpose is not to impose global research priorities, but we believe the results could be useful to other organizations.

Association between gender inequality index and child mortality rates: a cross-national study of 138 countries.

PubMed

Brinda, Ethel Mary; Rajkumar, Anto P; Enemark, Ulrika

2015-03-09

Gender inequality weakens maternal health and harms children through many direct and indirect pathways. Allied biological disadvantage and psychosocial adversities challenge the survival of children of both genders. United Nations Development Programme (UNDP) has recently developed a Gender Inequality Index to measure the multidimensional nature of gender inequality. The global impact of Gender Inequality Index on the child mortality rates remains uncertain. We employed an ecological study to investigate the association between child mortality rates and Gender Inequality Indices of 138 countries for which UNDP has published the Gender Inequality Index. Data on child mortality rates and on potential confounders, such as, per capita gross domestic product and immunization coverage, were obtained from the official World Health Organization and World Bank sources. We employed multivariate non-parametric robust regression models to study the relationship between these variables. Women in low and middle income countries (LMICs) suffer significantly more gender inequality (p < 0.001). Gender Inequality Index (GII) was positively associated with neonatal (β = 53.85; 95% CI 41.61-64.09), infant (β = 70.28; 95% CI 51.93-88.64) and under five mortality rates (β = 68.14; 95% CI 49.71-86.58), after adjusting for the effects of potential confounders (p < 0.001). We have documented statistically significant positive associations between GII and child mortality rates. Our results suggest that the initiatives to curtail child mortality rates should extend beyond medical interventions and should prioritize women's rights and autonomy. We discuss major pathways connecting gender inequality and child mortality. We present the socio-economic problems, which sustain higher gender inequality and child mortality in LMICs. We further discuss the potential solutions pertinent to LMICs. Dissipating gender barriers and focusing on social well-being of women may augment the survival of children of both genders.

Indigenous well-being in four countries: an application of the UNDP'S human development index to indigenous peoples in Australia, Canada, New Zealand, and the United States.

PubMed

Cooke, Martin; Mitrou, Francis; Lawrence, David; Guimond, Eric; Beavon, Dan

2007-12-20

Canada, the United States, Australia, and New Zealand consistently place near the top of the United Nations Development Programme's Human Development Index (HDI) rankings, yet all have minority Indigenous populations with much poorer health and social conditions than non-Indigenous peoples. It is unclear just how the socioeconomic and health status of Indigenous peoples in these countries has changed in recent decades, and it remains generally unknown whether the overall conditions of Indigenous peoples are improving and whether the gaps between Indigenous peoples and other citizens have indeed narrowed. There is unsettling evidence that they may not have. It was the purpose of this study to determine how these gaps have narrowed or widened during the decade 1990 to 2000. Census data and life expectancy estimates from government sources were used to adapt the Human Development Index (HDI) to examine how the broad social, economic, and health status of Indigenous populations in these countries have changed since 1990. Three indices - life expectancy, educational attainment, and income - were combined into a single HDI measure. Between 1990 and 2000, the HDI scores of Indigenous peoples in North America and New Zealand improved at a faster rate than the general populations, closing the gap in human development. In Australia, the HDI scores of Indigenous peoples decreased while the general populations improved, widening the gap in human development. While these countries are considered to have high human development according to the UNDP, the Indigenous populations that reside within them have only medium levels of human development. The inconsistent progress in the health and well-being of Indigenous populations over time, and relative to non-Indigenous populations, points to the need for further efforts to improve the social, economic, and physical health of Indigenous peoples.

Synthesis of national reports for Rio+20

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

2013-01-15

In the lead up to the United Nations Conference on Sustainable Development (Rio+20), which took place in Brazil in June 2012, there were numerous efforts in countries around the world to help governments, civil society organizations and individuals prepare for the event. One of the more significant efforts led by UNDP in collaboration with the United Nations Department of Economic and Social Affairs (UN DESA) was a support programme to 72 countries across all regions to build a consensus on national views around the themes and objectives of the Rio+20 Conference. This report highlights significant advances in sustainable development frommore » almost 60 country reports and underscores the challenges and bottlenecks to moving beyond the economic-led growth strategies of the past 20 years.« less

New U.N. program promotes multisectoral approach to AIDS prevention. Q and A [with Peter Piot].

PubMed

1996-05-01

The new joint United Nations (UN) Program on HIV/AIDS (UNAIDS) coordinates the HIV/AIDS activities of its six co-sponsors: the UN Children's Fund (UNICEF), the UN Development Program (UNDP), the UN Population Fund (UNFPA), the UN Educational, Scientific, and Cultural Organization (UNESCO), the World Health Organization (WHO), and the World Bank. In this interview, UNAIDS Executive Director Peter Piot discusses the program's goals and challenges. The UNAIDS program will be more multisectoral in scope than other efforts, involving all sectors of society that can affect the course of the epidemic or are affected by it. This includes the health and education sectors; ministries of trade, finance, planning, and development; nongovernmental and community organizations; people living with HIV and AIDS; research institutions; and the business sector. In each country, the UN agencies will form a "Theme Group on HIV/AIDS" to formulate intersectoral strategies.

Review on Rapid Seismic Vulnerability Assessment for Bulk of Buildings

NASA Astrophysics Data System (ADS)

Nanda, R. P.; Majhi, D. R.

2013-09-01

This paper provides a brief overview of rapid visual screening (RVS) procedures available in different countries with a comparison among all the methods. Seismic evaluation guidelines from, USA, Canada, Japan, New Zealand, India, Europe, Italy, UNDP, with other methods are reviewed from the perspective of their applicability to developing countries. The review shows clearly that some of the RVS procedures are unsuited for potential use in developing countries. It is expected that this comparative assessment of various evaluation schemes will help to identify the most essential components of such a procedure for use in India and other developing countries, which is not only robust, reliable but also easy to use with available resources. It appears that Federal Emergency Management Agency (FEMA) 154 and New Zealand Draft Code approaches can be suitably combined to develop a transparent, reasonably rigorous and generalized procedure for seismic evaluation of buildings in developing countries.

A misuse of public funds: U.N. support for geomagnetic forecasting of earthquakes and meteorological disasters

NASA Astrophysics Data System (ADS)

Campbell, Wallace H.

The legitimate scientific community needs to be alerted to the expenditure of considerable public funds forpseudoscientific projects that build false hopes of protection from geophysical hazards. One example of such a project is a recently published, 147- page United Nations (U.N.) document titled “Manual on the Forecasting of Natural Disasters: Geomagnetic Methods.” Although the document has been distributed internationally, it seems not to have been subjected to pre-publication, international peer review.The manual was prepared for a U.N. international workshop recently held in Beijing, China, from February 12 to 18,1998. The meeting was sponsored by the Chinese Academy of Sciences, the State Seismological Bureau of China, the U.N. Global Programme for the Integration of Public Administration and Science of Disasters in the Department for Economic and Social Affairs (DESA), and the U.N. Development Programme (UNDP) in Beijing.

Education on Risk Management with Gender Equity: Experiences in United Nations Development Programme (UNDP) courses using on-site education and synchronous technologies for distance education

NASA Astrophysics Data System (ADS)

Cepeda, J.; Marroquín, W.; Villar, Y.

2009-04-01

The experiences in two Risk Management courses organised by the Universidad Centroamericana "José Simeón Cañas" (UCA) and the "América Latina Genera" project of the BCPR-UNDP (Bureau for Crisis Prevention and Recovery of the United Nations Development Programme) are presented focusing on the design of teaching material and the selection and use of information-communication technologies (ICT) during the learning process. The organisation of these courses has posed three main challenges: the integration of a gender-equity approach in a subject that has traditionally lacked of it, the preparation of specialised teaching material for an audience with varied backgrounds and experience, and a widespread distribution of students and lecturers in different countries and with significant differences in ICT resources. These courses have combined tutorials, video-conferences, forums, chats, a media centre with video and podcast, and other resources to allow a close follow-up of the students' progress and strengthen the learning process. A specialised database of information within the "América Latina Genera" project has also been used intensively. Even though the building of capacity has been important, the emphasis of the courses has been on the practical application of projects in the students' work environment and in other real situations. The first course took place between June and December 2008 and consisted of a combination of on-site and distance education. The 15 students that registered the course included officials of local and central government institutions, private consultants, university staff and members of non-governmental organisations. Lecturers from the United States Geological Survey and the International Centre for Geohazards broadcasted videoconferences from the United States and Norway, respectively. The second course started in November 2008 and is scheduled to finish in February 2009. This course has been fully developed using distance education. The synchronous technology that has been used is web conferencing. The total registration for this course was 35 students who have participated in lectures from their locations in Argentina, Cuba, Dominican Republic, El Salvador, Guatemala, Panama, Peru and Uruguay. The lectures for this course have been broadcasted from locations in El Salvador and Norway.

(Coordinated research of chemotherapeutic agents and radiopharmaceuticals)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Srivastava, P.C.

1991-01-14

The traveler received a United Nations Development Program (UNDP) Award for Distinguished Scientists to visit Indian Research Institutions including Central Drug Research Institute (CDRI), Lucknow, the host institution, in cooperation with the Council of Scientific and Industrial Research (CSIR) of India. At CDRI, the traveler had meetings to discuss progress and future directions of on-going collaborative research work on nucleosides and had the opportunity to initiate new projects with the divisions of pharmacology, biopolymers, and membrane biology. As a part of this program, the traveler also visited Sanjay Gandhi Post Graduate Institute (SGPI) of Medical Sciences, Lucknow; Board of Radiationmore » and Isotope Technology (BRIT) and Bhabha Atomic Research Center (BARC), Bombay; Variable Energy Cyclotron Center (VECC) and Indian Institute of Chemical Biology, Calcutta. He also attended the Indo-American Society of Nuclear Medicine Meeting held in Calcutta. The traveler delivered five seminars describing various aspects of radiopharmaceutical development at the Oak Ridge National Laboratory (ORNL) and discussed the opportunities for exchange visits to ORNL by Indian scientists.« less

Water governance: learning by developing adaptive capacity to incorporate climate variability and change.

PubMed

Kashyap, A

2004-01-01

There is increasing evidence that global climate variability and change is affecting the quality and availability of water supplies. Integrated water resources development, use, and management strategies, represent an effective approach to achieve sustainable development of water resources in a changing environment with competing demands. It is also a key to achieving the Millennium Development Goals. It is critical that integrated water management strategies must incorporate the impacts of climate variability and change to reduce vulnerability of the poor, strengthen sustainable livelihoods and support national sustainable development. UNDP's strategy focuses on developing adaptation in the water governance sector as an entry point within the framework of poverty reduction and national sustainable development. This strategy aims to strengthen the capacity of governments and civil society organizations to have access to early warning systems, ability to assess the impact of climate variability and change on integrated water resources management, and developing adaptation intervention through hands-on learning by undertaking pilot activities.

The strategic approach to contraceptive introduction.

PubMed

Simmons, R; Hall, P; Díaz, J; Díaz, M; Fajans, P; Satia, J

1997-06-01

The introduction of new contraceptive technologies has great potential for expanding contraceptive choice, but in practice, benefits have not always materialized as new methods have been added to public-sector programs. In response to lessons from the past, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP) has taken major steps to develop a new approach and to support governments interested in its implementation. After reviewing previous experience with contraceptive introduction, the article outlines the strategic approach and discusses lessons from eight countries. This new approach shifts attention from promotion of a particular technology to an emphasis on the method mix, the capacity to provide services with quality of care, reproductive choice, and users' perspectives and needs. It also suggests that technology choice should be undertaken through a participatory process that begins with an assessment of the need for contraceptive introduction and is followed by research and policy and program development. Initial results from Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Vietnam, and Zambia confirm the value of the new approach.

Health Systems' Responsiveness and Its Characteristics: A Cross-Country Comparative Analysis

PubMed Central

Robone, Silvana; Rice, Nigel; Smith, Peter C

2011-01-01

Objectives Responsiveness has been identified as one of the intrinsic goals of health care systems. Little is known, however, about its determinants. Our objective is to investigate the potential country-level drivers of health system responsiveness. Data Source Data on responsiveness are taken from the World Health Survey. Information on country-level characteristics is obtained from a variety of sources including the United Nations Development Program (UNDP). Study Design A two-step procedure. First, using survey data we derive a country-level measure of system responsiveness purged of differences in individual reporting behavior. Secondly, we run cross-sectional country-level regressions of responsiveness on potential drivers. Principal Findings Health care expenditures per capita are positively associated with responsiveness, after controlling for the influence of potential confounding factors. Aspects of responsiveness are also associated with public sector spending (negatively) and educational development (positively). Conclusions From a policy perspective, improvements in responsiveness may require higher spending levels. The expansion of nonpublic sector provision, perhaps in the form of increased patient choice, may also serve to improve responsiveness. However, these inferences are tentative and require further study. PMID:21762144

Dataset on the prevalence of tobacco smoking in men and women of selected countries whit difference human development.

PubMed

Riahi, Mina; Mohammadi, Ali Akbar; Rohani, Hosein; Bidkhori, Mohammad

2018-06-01

This study was conducted to investigate the effect of human development index (HDI) on tobacco smoking prevalence in men and women of countries which their data about tobacco smoking were available for 2015. Pearson's correlation coefficient and linear regression were used to investigate the association between HDI and all types of smoking, particularly cigarette. Daily smoking and current smoking were used as tobacco smoking indices. The information about prevalence of tobacco smoking and HDI was obtained from the World Health Organization (WHO) website and United Nations Development Programme (UNDP), respectively. The results showed that there is no statistically significant relationship between HDI and current tobacco smoking in men (B = -0.45_CI 95%: -29.97, 29.06). However, the same association was significant for women (B = 43.87, CI 95%: 24.97-62.78). The results indicated that women in developed countries are more at risk of health effects attributed to tobacco smoking. Countries should focus on socioeconomic factors to prevent the spread of risk factors for non-communicable diseases.

The role of international organizations in aid: A case study of a teacher education programme in Sierra Leone

NASA Astrophysics Data System (ADS)

Banya, Kingsley

1988-12-01

By the early 1970s, the Sierra Leone government realized that the educational system was not meeting the developmental needs of the country. In an attempt to reverse the increasing trend of migration to urban areas, to improve rural productivity and the quality of rural life, and to counteract other deleterious effects of this system, in 1974 the government collaborated with Unesco, UNDP and the African Development Bank in launching the Bunumbu project to train primary school teachers for rural areas. This linked a training college with 20 pilot schools and the local community. This paper critically examines the role played by each of the international organizations in executing the project. It gives examples of resources wasted in supplying inappropriate equipment and expensive building materials, and argues strongly for more consideration of local conditions, and for the involvement of local training agencies and local labour, in any similar future plans. The paper concludes with a discussion of who really benefits from international aid and resolves that both recipients and donors should abandon grandiose schemes.

Behavioural aspects of the control of parasitic diseases*

PubMed Central

Dunn, Frederick L.

1979-01-01

Human behaviour has been largely neglected in research on the parasitic diseases, in part because of the long-standing separation of the behavioural disciplines from the physical and biomedical sciences. Some of the reasons for the persistence of this ”intellectual discontinuity” are discussed. The paper is principally concerned with the prospects for greater use of the methods and orientations of the behavioural sciences in parasitic disease research and control programmes. Behavioural research tends to fall into two categories employing, on the one hand, survey research and epidemiological methods and, on the other, participant observation and interviewing in depth. These approaches are shown to be complementary—equally useful and necessary. Various categories of health-related behaviour and kinds of research objective are reviewed in the following sections. Special attention is given to psychosocial cost—benefit studies, to analyses of control sectors, and to the formulation of a control philosophy. Finally, some specific behavioural research needs are discussed for some of the parasitic diseases of priority in the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases—schistosomiasis, filariasis, American and African trypanosomiases, and malaria. PMID:316733

Applied gamma ray spectrometry and remote sensing in delineation of nepheline syenites in rift tectonic settings

NASA Astrophysics Data System (ADS)

Chiwona, Annock Gabriel; Manning, David A. C.; Gaulton, Rachel; Cortes, Joaquin A.

2017-04-01

The United Nations (2016) observes that 'Neglected Development Minerals' including industrial minerals such as nepheline syenites have great potential for sustainable development, yet their exploitation has not been equally promoted like high value minerals. Nepheline syenites have great potential as alternative potassium (K) silicate fertiliser, as well as a source of Rare Earths. Demand for K fertiliser keeps rising by 3-3.5% annually (Jena et al., 2014) due to increased need to replace K removal from the soil (Sheldrick et al., 2002). The situation is most critical in Sub-Sahara Africa where nutrient loss due to intensive farming accounts to 22kg N, 2.5 kg P and 15 kg of K per hectare annually (Keeble, 2012). Ironically, Africa with 15% of global population, which is also expected to double by 2040 (Manning, 2015), uses only 1.5% of global K fertiliser. In this study, we use recently acquired countrywide airborne geophysical gamma ray data of Malawi (Bates & Mechennef, 2013) and satellite remote sensing data to identify nepheline syenites, suitable as sources of K silicate fertilizer, in rift tectonic settings. Initial focus was on the East African Rift System (EARS) starting with Malawi. Results from these two techniques are compared with X-ray fluorescence (XRF) geochemical analyses of sample collected from fieldwork in some potential areas of Malawi. With lessons from the Rochagem movement (Theodoro & Leonardos, 2006), identification of novel alternative potash sources in Africa will greatly benefit millions of farmers in developing countries, especially in Sub Sahara Africa where fertiliser costs are very high. Considering that high-resolution airborne geophysical data is not available in many African countries due to high costs associated with data acquisition campaigns, alternative and effective remote sensing approaches for delineating nepheline syenite rocks are necessary. References: [1] Bates M & Mechennef, F (2013) Data Acquisition Report, Sander Geophysics Limited 1:1-294. [2]Jena SK, Dhawan N, Rao DS, et al. (2014) International Journal of Mineral Processing 133: 13-22. [3] Keeble F. (2012) Nature 483 (7391): 510. [4] Manning DAC. (2015) Proceedings of Geologists' Association 126: 14-17. [5] Sheldrick W and Lingard J. (2004) Food Policy 29: 61-98. [6] Sheldrick, W., et al. (2002) Nutrient Cycling in Agroecosystems 62 (1):.61-72. [7] Theodoro, S., & Leonardos, O. (2006) Anais Da Academia Brasileira De Ciencias 78, (4):721-730. [8] ACP-EU Development Minerals Programme In partnership with UNDP, (accessed on 29/11/ 2016: http://www.undp.org/content/dam/brussels/docs/Other/Request%20for%20Applications_Neglected%20Development%20Minerals%20Workshop_Georgetown_2016.pdf)

Factors Influencing Farmers' Willingness to Participate in the Conversion of Cultivated Land to Wetland Program in Sanjiang National Nature Reserve, China

NASA Astrophysics Data System (ADS)

Zhang, Chunli; Robinson, Daniel; Wang, Jing; Liu, Jibin; Liu, Xiaohui; Tong, Lianjun

2011-01-01

Sanjiang National Nature Reserve (NNR) is a state-owned natural wetland in China that has suffered severe degradation due to cultivation and wetland reclamation by farmers. As a consequence, the conversion of cultivated land to wetlands (CCW) was proposed by the government of Heilongjiang province and the United Nations Development Programme/Global Environment Facility (UNDP/GEF) project team in 2007. We suggest that voluntary participation in the CCW could be an important tool for accomplishing the integrated objectives of wetland conservation and local development. The purpose of this study was to examine the main factors that influence farmers' willingness to participate in the CCW through a field investigation and a questionnaire. Based on the data from our questionnaire, which provided an effective sample of 310 households in 11 villages, the influencing factors of farmers' willingness to participate were analyzed through binary logistic regression analyses. It was concluded that age, education, the amount of cultivated land, geographical location, and the perceived benefits and risks were important factors for participation. Furthermore, suggestions for improving the wetland compensation system and providing alternative livelihoods are proposed to strengthen participation.

[Population mobility and HIV/AIDS in Central America and Mexico].

PubMed

Leyva-Flores, René; Aracena-Genao, Belkis; Serván-Mori, Edson

2014-09-01

Estimate the magnitude of the association between population mobility, measured by net migration rate (NMR), and HIV prevalence in Central America and Mexico. Using time series models, based on public information from UNAIDS, UNDP, ECLAC, and the World Bank for the period 1990-2009, this association was studied in individuals aged 15-49 years, and adjusted for socioeconomic factors (education, unemployment, life expectancy, and income). NMR was negative in all countries except Costa Rica and Panama. Unadjusted results of the model show a positive association and that NMR can explain 6% of recorded HIV prevalence. When socioeconomic cofactors are included by country (education, health, and income), the magnitude increases to 9% (P<0.05). NMR, even when adjusted for socioeconomic factors, explains some of recorded HIV prevalence. All socioeconomic indicators show improvements in Central America and Mexico, although large gaps persist among countries. The modest association observed between population mobility and HIV prevalence is conditioned by the socioeconomic status of the countries studied. Information availability limited the study's ability to establish the existence of this association with greater certainty. Accordingly, based on available information, it is not possible to affirm that migration plays a key role in the spread of HIV.

The "AIDS and MDGs" approach: what is it, why does it matter, and how do we take it forward?

PubMed

Kim, Julia; Lutz, Brian; Dhaliwal, Mandeep; O'Malley, Jeffrey

2011-01-01

Progress towards the Millennium Development Goals (MDGs) has been mixed, and many observers have noted the tendency for development actors to address individual MDGs largely in isolation from one another. This in turn has resulted in missed opportunities to catalyse greater interdisciplinary collaboration and innovation towards MDG achievement. The term 'AIDS and MDGs' is gaining currency as an approach that aims to explore, strengthen and leverage the links between AIDS and other health and development issues. Drawing from academic literature and from MDG country reports, this article sets out three important pillars to an AIDS and MDGs approach: 1) understanding how AIDS and the other MDGs affect one another; 2) documenting and exchanging lessons learned across MDGs; and 3) creating cross- MDG synergy. We propose broader policy level implications for this approach and how UNDP and other partners can take this agenda forward. Because the MDGs explicitly locate HIV within a broader international commitment to human development targets, they provide a critical platform for development partners to galvanise resources, political will and momentum behind a broader, systematic and structural approach to HIV, health and development.

Health systems' responsiveness and its characteristics: a cross-country comparative analysis.

PubMed

Robone, Silvana; Rice, Nigel; Smith, Peter C

2011-12-01

OBJECTIVES. Responsiveness has been identified as one of the intrinsic goals of health care systems. Little is known, however, about its determinants. Our objective is to investigate the potential country-level drivers of health system responsiveness. DATA SOURCE. Data on responsiveness are taken from the World Health Survey. Information on country-level characteristics is obtained from a variety of sources including the United Nations Development Program (UNDP). STUDY DESIGN. A two-step procedure. First, using survey data we derive a country-level measure of system responsiveness purged of differences in individual reporting behavior. Secondly, we run cross-sectional country-level regressions of responsiveness on potential drivers. PRINCIPAL FINDINGS. Health care expenditures per capita are positively associated with responsiveness, after controlling for the influence of potential confounding factors. Aspects of responsiveness are also associated with public sector spending (negatively) and educational development (positively). CONCLUSIONS. From a policy perspective, improvements in responsiveness may require higher spending levels. The expansion of nonpublic sector provision, perhaps in the form of increased patient choice, may also serve to improve responsiveness. However, these inferences are tentative and require further study. © Health Research and Educational Trust.

U.S. backs "well-being" programs for women. An interview with Julia Taft, Assistant Secretary of State for Population, Refugees and Migration.

PubMed

Scherr, E F

1998-09-01

This interview with Julia Taft, Assistant Secretary of State for Population, Refugees and Migration concerns a wide range of well-being programs for women in the US. The ICPD Program of Action considers family planning and reproductive health in the broader contexts of women's empowerment, girls¿ and boys' education, child health, and social elements (among them economic and environmental elements), that affect the lives of girls and women. US programs and policies encompass the promotion of the whole range of well-being of women and girls, of which family planning and reproductive health are key elements. Congress has passed a law ensuring complete access to reproductive health care services by making it a crime to use force or to interfere with reproductive health providers or their patients. There was also a recent decision to require federal employees' health insurance plans to cover contraceptives. The US supports several international organizations working on population issues such as UNFPA, UNICEF, UNAIDS, WHO, and UNDP. The UN will continually have to evaluate its progress so that in 15 years human rights, civil rights, and proper health care will have been extended to the entire world.

An Explanatory Model of Poverty from the Perspective of Social Psychology and Human Rights.

PubMed

Pérez-Muñoz, Alfonso; Chacón, Fernando; Martínez Arias, Rosario

2015-12-09

Poverty is a social problem, entailing not only an economical perspective but above all a human and social issue. Poverty is promoted, justified and maintained by unique individuals and groups by means of our own attitudes, interests and behavior, as well as with our social structures and social relationships. From this interactive, psychosocial and sociostructural perspective, and also considering poverty as a denial of basic human rights (UNDP, 1998), we carried out a study with the primary objective to design and verify an Explanatory Model of Poverty. This research may helps to increase the validity of diagnostics and the effectiveness of interventions. Most of the hypotheses were accepted during the analysis and verification of the Model (p < .001), with data fitting the Model (CFI: 1 RMSEA: .025: LO90: 0 - HI90: .061. RMR: .008). These results, if replicated in new investigations, could have the following implications: (a) the need for a broad and comprehensive definition of poverty including its effects, processes and causes; (b) the need for everybody to accept the social responsibility in the prevention and solution to poverty; and (c) the need to conduct longitudinal interventions with scientific methodology and social participation.

Human Development Inequality Index and Cancer Pattern: a Global Distributive Study.

PubMed

Rezaeian, Shahab; Khazaei, Salman; Khazaei, Somayeh; Mansori, Kamyar; Sanjari Moghaddam, Ali; Ayubi, Erfan

2016-01-01

This study aimed to quantify associations of the human development inequality (HDI) index with incidence, mortality, and mortality to incidence ratios for eight common cancers among different countries. In this ecological study, data about incidence and mortality rates of cancers was obtained from the Global Cancer Project for 169 countries. HDI indices for the same countries was obtained from the United Nations Development Program (UNDP) database. The concentration index was defined as the covariance between cumulative percentage of cancer indicators (incidence, mortality and mortality to incidence ratio) and the cumulative percentage of economic indicators (country economic rank). Results indicated that incidences of cancers of liver, cervix and esophagus were mainly concentrated in countries with a low HDI index while cancers of lung, breast, colorectum, prostate and stomach were concentrated mainly in countries with a high HDI index. The same pattern was observed for mortality from cancer except for prostate cancer that was more concentrated in countries with a low HDI index. Higher MIRs for all cancers were more concentrated in countries with a low HDI index. It was concluded that patterns of cancer occurrence correlate with care disparities at the country level.

The start-up phase of the national satellite forest monitoring systems for DRC and PNG: a joint venture between FAO and INPE

NASA Astrophysics Data System (ADS)

Jonckheere, I. G.; FAO UN-REDD Team Forestry Department

2011-12-01

Reducing Emissions from Deforestation and Forest Degradation (REDD) is an effort to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. "REDD+" goes beyond deforestation and forest degradation, and includes the role of conservation, sustainable management of forests and enhancement of forest carbon stocks. In the framework of getting countries ready for REDD+, the UN-REDD Programme, a partnership between UNEP, FAO and UNDP, assists developing countries to prepare and implement national REDD+ strategies. Designed collaboratively by a broad range of stakeholders, national UN-REDD Programmes are informed by the technical expertise of FAO, UNDP and UNEP. For the monitoring, reporting and verification, FAO supports the countries to develop satellite forest monitoring systems that allow for credible measurement, reporting and verification (MRV)of REDD+ activities. These are among the most critical elements for the successful implementation of any REDD+ mechanism, also following the COP 16 decisions in Cancun last year. The UN-REDD Programme through a joint effort of FAO and Brazil's National Space Agency, INPE, is supporting countries to develop cost-effective, robust and compatible national monitoring and MRV systems, providing tools, methodologies, training and knowledge sharing that help countries to strengthen their technical and institutional capacity for effective MRV systems. To develop strong nationally-owned forest monitoring systems, technical and institutional capacity building is key. The UN-REDD Programme, through FAO, has taken on intensive training together with INPE, and has provided technical help and assistance for in-country training and implementation for national satellite forest monitoring. The goal of the start-up phase for DRC and Papua New Guinea (PNG) in this capacity building effort is the training of technical forest people and IT persons from these two interested REDD+ countries, and to set-up the national satellite forest monitoring systems. The Brazilian forest monitoring system, TerraAmazon, which is used as a basis for this initiative, allows countries to adapt it to country needs and the training on the TerraAmazon system is a tool to enhance existing capacity on carbon monitoring systems. The start-up phase of the National Forest Monitoring System for DRC and PNG will allow these countries to follow all actions related to the implementation of its national REDD+ policies and measures. The monitoring system will work as a platform to obtain information on their REDD+ results and actions, related directly or indirectly to national REDD+ strategies and may also include actions unrelated to carbon assessment, such as forest law enforcement. With the technical assistance of FAO, INPE and other stakeholders, the countries will set up an autonomous operational forest monitoring system. An initial version and the methodologies of these syste,s will be launched in Durban, South Africa during COP 17 and is presented here.

Zoonoses and marginalised infectious diseases of poverty: where do we stand?

PubMed

Molyneux, David; Hallaj, Zuhair; Keusch, Gerald T; McManus, Donald P; Ngowi, Helena; Cleaveland, Sarah; Ramos-Jimenez, Pilar; Gotuzzo, Eduardo; Kar, Kamal; Sanchez, Ana; Garba, Amadou; Carabin, Helene; Bassili, Amal; Chaignat, Claire L; Meslin, Francois-Xavier; Abushama, Hind M; Willingham, Arve L; Kioy, Deborah

2011-06-14

Despite growing awareness of the importance of controlling neglected tropical diseases as a contribution to poverty alleviation and achieving the Millennium Development Goals, there is a need to up-scale programmes to achieve wider public health benefits. This implementation deficit is attributable to several factors but one often overlooked is the specific difficulty in tackling diseases that involve both people and animals - the zoonoses. A Disease Reference Group on Zoonoses and Marginalised Infectious Diseases (DRG6) was convened by the Special Programme for Research and Training in Tropical Diseases (TDR), a programme executed by the World Health Organization and co-sponsored by UNICEF, UNDP, the World Bank and WHO. The key considerations included: (a) the general lack of reliable quantitative data on their public health burden; (b) the need to evaluate livestock production losses and their additional impacts on health and poverty; (c) the relevance of cross-sectoral issues essential to designing and implementing public health interventions for zoonotic diseases; and (d) identifying priority areas for research and interventions to harness resources most effectively. Beyond disease specific research issues, a set of common macro-priorities and interventions were identified which, if implemented through a more integrated approach by countries, would have a significant impact on human health of the most marginalised populations characteristically dependent on livestock.

Poverty assessment using DMSP/OLS night-time light satellite imagery at a provincial scale in China

NASA Astrophysics Data System (ADS)

Wang, Wen; Cheng, Hui; Zhang, Li

2012-04-01

All countries around the world and many international bodies, including the United Nations Development Program (UNDP), United Nations Food and Agricultural Organization (FAO), the International Fund for Agricultural Development (IFAD) and the International Labor Organization (ILO), have to eliminate rural poverty. Estimation of regional poverty level is a key issue for making strategies to eradicate poverty. Most of previous studies on regional poverty evaluations are based on statistics collected typically in administrative units. This paper has discussed the deficiencies of traditional studies, and attempted to research regional poverty evaluation issues using 3-year DMSP/OLS night-time light satellite imagery. In this study, we adopted 17 socio-economic indexes to establish an integrated poverty index (IPI) using principal component analysis (PCA), which was proven to provide a good descriptor of poverty levels in 31 regions at a provincial scale in China. We also explored the relationship between DMSP/OLS night-time average light index and the poverty index using regression analysis in SPSS and a good positive linear correlation was modelled, with R2 equal to 0.854. We then looked at provincial poverty problems in China based on this correlation. The research results indicated that the DMSP/OLS night-time light data can assist analysing provincial poverty evaluation issues.

Zoonoses and marginalised infectious diseases of poverty: Where do we stand?

PubMed Central

2011-01-01

Despite growing awareness of the importance of controlling neglected tropical diseases as a contribution to poverty alleviation and achieving the Millennium Development Goals, there is a need to up-scale programmes to achieve wider public health benefits. This implementation deficit is attributable to several factors but one often overlooked is the specific difficulty in tackling diseases that involve both people and animals - the zoonoses. A Disease Reference Group on Zoonoses and Marginalised Infectious Diseases (DRG6) was convened by the Special Programme for Research and Training in Tropical Diseases (TDR), a programme executed by the World Health Organization and co-sponsored by UNICEF, UNDP, the World Bank and WHO. The key considerations included: (a) the general lack of reliable quantitative data on their public health burden; (b) the need to evaluate livestock production losses and their additional impacts on health and poverty; (c) the relevance of cross-sectoral issues essential to designing and implementing public health interventions for zoonotic diseases; and (d) identifying priority areas for research and interventions to harness resources most effectively. Beyond disease specific research issues, a set of common macro-priorities and interventions were identified which, if implemented through a more integrated approach by countries, would have a significant impact on human health of the most marginalised populations characteristically dependent on livestock. PMID:21672216

["Me? I'm just here, part of the world". A field experience on endemic disease control in Cansanção, Minas Gerais, Brazil].

PubMed

Dias, R B

1998-01-01

This free-style article reports an experience with Chagas' disease control involving community participation in the Jequitinhonha Valley (Minas Gerais, Brazil) implemented during the 1980s and recently reevaluated. As an action-based participant research project, it was supported by the Socioeconomic TDR Committee (WHO/WB/UNDP) in the area of Popular Education. The main objective was to investigate the meaning of Chagas' disease from the community's perspective, seeking alternative control measures with their participation. Despite the extremely high prevalence of the disease, it was no perceived as a priority by the population, who were living in destitution and simply fighting for their very survival. Given this situation, Chagas' disease control was performed in an integrated manner, taking other community needs into account. The article suggests some forms of participation in the control of endemic diseases, taking into account the people's knowledge, focused on the "here and now" in an integrated vision of both their problems and their ability to mobilize behind concrete interests. Changes are also needed in the relationship between outside agents and the community, reciprocity in the involvement with community, a permanent attitude of listening and solidarity, a "self-diagnosis", and organization of population.

Rehabitilation and extension of a khettara for a sustainable use of underground water resources

NASA Astrophysics Data System (ADS)

Pilia, A.; Spanu, V.; Concollato, C.; Calzolai, E.; Valenilla, A. M.

2009-04-01

As one of the major effects of soil degradation resulting from antropogenic factors and influenced by climate variations, desertification represents a significant environmental issue in arid and semi-arid areas. Owing to a lack of resources to tackle the problem, the consequences of desertification drastically affect the population of developing countries. One of the areas affected by this problem is the desert area of Hassi Labiad, near to Merzouga, in the South- East of Morocco, close to the border with Algeria, where the Erg Chebbi desert begins. From a geological point of view the studied zone extends across coarse sand dunes from Quaternary (Erg Chebbi Desert), which lies on a basement constituted by clay schist with sandstone intercalations and mauve- grayish sandstone from Lower Viséen (Carboniferous). Basement outcrops are identified in the area. In this area, the hydrological supply has been guaranteed for thousands of years by an ancient irrigation system, used in these area since about 1000 BC, the so called khettara. This system, from its creation by the Persians, has been diffused across the whole arabic culture; it's based on the picking up of water through underground draining channels from shallow acquifers with an altitude above sea level, which are higher than the irrigation areas to which water is brought. This system worked until a few years ago when, due to touristic development in the area, many groundwater pumping wells were created; the overpumping caused the decrease of groundwater level. Therefore, there was no more intersection between the khettara channel and the aquifer; and it became necessary to find a new intersection point by prolongating the ketthara principal channel. This project has been promoted and directed by the UNDP, the local ONG AHT Hassi Labiad in collaboration with Bambini nel Deserto NGO, and Osservatorio Mediterraneo Onlus. Basically, it consisted of a hydrogeological study in order to check the feasibility of the extension and the optimal peculiarities for the new channelling, for a sustainable use of underground water resources. The methodology consisted principally of topographic and water level measurements through wells and piezometers. Most of these measurements were made in water wells that already exist, due to the existence of the old khettara, while in the areas where enough density of measurement points is not found, new piezometres have been realised. Moreover, an analysis of rain gauge data and a valuation of the quantity of the underground water taken from the system have been carried out, in order to make a first hydrogeological balance. From the achieved results with the hydrogeological study an extension of the khettara of 230 m with a E-W direction has been made, that allowed to reintercept the alluvial ground water and to create a drainage system able to pick up the underground water in a sustainable way, also during the driest period of the year. Work carried out with a Bambini nel Deserto project, with the financial support of UNDP, the local ONG AHT Hassi Labiad in collaboration with Osservatorio Mediterraneo Onlus.

Terrestrial biodiversity analyses in Dalmatia (Croatia): a complementary approach using diversity and rarity.

PubMed

Jelaska, Sven D; Nikolić, Toni; Serić Jelaska, Lucija; Kusan, Vladimir; Peternel, Hrvoje; Guzvica, Goran; Major, Zoran

2010-03-01

Here we present the methodology used for terrestrial biodiversity analysis and site selection in Phase B of the UNDP/GEF COAST project. The analysis was focused on the problem of biodiversity evaluation in four Croatian counties stretching from sea level to the highest mountain in Croatia. Data on habitats, vascular flora, and fauna (mammals, birds, reptiles, amphibians, butterflies, ground beetles, and underground invertebrates) were collected and analyzed for each of the four counties. Emphasis was given to the richness of endangered species and the rarity of endemic species. Based on the spatial analyses of habitat, fauna, and flora data, four to six areas were selected from each county and ranked according to their biodiversity importance. Overlap between areas important for richness and those important for rarity was highest for data on flora (65.5%) and lowest for data on fauna (16.7%). When different data sets were compared, the lowest overlap was between flora and fauna (17.1%) and largest between fauna and habitats (23.9%). Simultaneous overlap among all three data sets was found in just 6.5% of the overall selected areas. These results suggest that less specific data, with respect to taxa threat status, could better serve as surrogate data in estimating overall biodiversity. In summary, this analysis has demonstrated that Dalmatia is a region with a high overall biodiversity that is important in a broader European context.

Terrestrial Biodiversity Analyses in Dalmatia (Croatia): A Complementary Approach Using Diversity and Rarity

NASA Astrophysics Data System (ADS)

Jelaska, Sven D.; Nikolić, Toni; Šerić Jelaska, Lucija; Kušan, Vladimir; Peternel, Hrvoje; Gužvica, Goran; Major, Zoran

2010-03-01

Here we present the methodology used for terrestrial biodiversity analysis and site selection in Phase B of the UNDP/GEF COAST project. The analysis was focused on the problem of biodiversity evaluation in four Croatian counties stretching from sea level to the highest mountain in Croatia. Data on habitats, vascular flora, and fauna (mammals, birds, reptiles, amphibians, butterflies, ground beetles, and underground invertebrates) were collected and analyzed for each of the four counties. Emphasis was given to the richness of endangered species and the rarity of endemic species. Based on the spatial analyses of habitat, fauna, and flora data, four to six areas were selected from each county and ranked according to their biodiversity importance. Overlap between areas important for richness and those important for rarity was highest for data on flora (65.5%) and lowest for data on fauna (16.7%). When different data sets were compared, the lowest overlap was between flora and fauna (17.1%) and largest between fauna and habitats (23.9%). Simultaneous overlap among all three data sets was found in just 6.5% of the overall selected areas. These results suggest that less specific data, with respect to taxa threat status, could better serve as surrogate data in estimating overall biodiversity. In summary, this analysis has demonstrated that Dalmatia is a region with a high overall biodiversity that is important in a broader European context.

The Directorate-General for Health and Consumers 1999-2014: An assessment of its functional capacities.

PubMed

Clemens, Timo; Sørensen, Kristine; Rosenkötter, Nicole; Michelsen, Kai; Brand, Helmut

2017-06-01

Capacity assessment has become a popular measure in the health sector to assess the ability of various stakeholders to pursue agreed activities. The European Commission (EC) is increasingly dealing with a variety of health issues to coordinate and complement national health policies. This study analyses the functional capacity of the Directorate-General for Health and Consumers (DG SANCO) between 1999 and 2004. It applies the UNDP Capacity Assessment Framework and uses a literature review, a document review of EU policy documents and expert interviews to assess the capacity of DG SANCO to fulfill its mandate for public health and health systems. Our results suggest that DG SANCO has established capacities to engage with stakeholders; to assess various health issues, to define issue-specific health policies and to collect information for evaluative purposes. In contrast, capacities tend to be less established for defining a clear strategy for the overall sector, for setting priorities and for budgeting, managing and implementing policies. We conclude that improvements to the effectiveness of DG SANTE's (the successor of DG SANCO) policies can be made within the existing mandate. A priority setting exercise may be conducted to limit the number of pursued actions to those with the greatest European added value within DG SANTE's responsibilities. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Forest resources of nations in relation to human well-being.

PubMed

Kauppi, Pekka E; Sandström, Vilma; Lipponen, Antti

2018-01-01

A universal turnaround has been detected in many countries of the World from shrinking to expanding forests. The forest area of western Europe expanded already in the 19th century. Such early trends of forest resources cannot be associated with the rapid rise of atmospheric carbon dioxide nor with the anthropogenic climate change, which have taken place since the mid 20th century. Modern, most recent spatial patterns of forest expansions and contractions do not correlate with the geography of climate trends nor with dry versus moist areas. Instead, the forest resources trends of nations correlate positively with UNDP Human Development Index. This indicates that forest resources of nations have improved along with progress in human well-being. Highly developed countries apply modern agricultural methods on good farmlands and abandon marginal lands, which become available for forest expansion. Developed countries invest in sustainable programs of forest management and nature protection. Our findings are significant for predicting the future of the terrestrial carbon sink. They suggest that the large sink of carbon recently observed in forests of the World will persist, if the well-being of people continues to improve. However, despite the positive trends in domestic forests, developed nations increasingly outsource their biomass needs abroad through international trade, and all nations rely on unsustainable energy use and wasteful patterns of material consumption.

"Young blood" to head new UN AIDS body.

PubMed

1995-01-01

Dr. Peter Piot has been appointed to run the UN Joint and Co-sponsored Programme on HIV/AIDS, which replaces the Global Programme on AIDS (GPA). Dr. Piot's reputation as an excellent scientist with awareness of social issues makes him acceptable to both the medical and development communities. He became an Associate Director of the GPA in 1992; served as President of the International AIDS Society from 1991-1994; and, as Director of Research and Development, was responsible for the GPA's initiative on sexually transmitted disease (STD) control and for promotion of the development of vaginal microbicides. Before joining the GPA, he worked at the Institute of Tropical Medicine in Belgium, where he launched a series of African projects concerned with acquired immunodeficiency syndrome (AIDS). These included Zaire's SIDA, the first international project on AIDS in a developing country. The new program will unite the AIDS activities of 6 UN agencies: the World Health Organization (WHO), the UN Children's Fund (UNICEF), the UN Development Programme (UNDP), the UN Educational, Scientific, and Cultural Organization (UNESCO), the UN Family Population Fund (UNFPA), and the World Bank. Dr. Piot will report directly to the UN Secretary-General, Dr. Boutros Boutros-Ghali. The program should be fully operational by 1996 and will be run from Geneva. Its budget is expected to be the largest in the international AIDS arena, and its political clout should be greater than its predecessor. There will be fewer posts in the new program.

An Integrated Strategy for Promoting Geoscience Education and Research in Developing Countries through International Cooperation

NASA Astrophysics Data System (ADS)

Aswathanarayana, U.

2007-12-01

Geoscience education and research in Developing countries should aim at achieving food, water and environmental security, and disaster preparedness, based on the synergetic application of earth (including atmospheric and oceanic realms), space and information sciences through economically-viable, ecologically- sustainable and people-participatory management of natural resources. The proposed strategy involves the integration of the following three principal elements: (i) What needs to be taught: Geoscience needs to be taught as earth system science incorporating geophysical, geochemical and geobiological approaches, with focus (say, 80 % of time) on surficial processes (e.g. dynamics of water, wind and waves, surface and groundwater, soil moisture, geomorphology, landuse, crops), and surficial materials (e.g. soils, water, industrial minerals, sediments, biota). Subjects such as the origin, structure and evolution of the earth, and deep-seated processes (e.g. dynamics of the crust-mantle interaction, plate tectonics) could be taught by way of background knowledge (say, 20 % of the time), (ii) How jobs are to be created: Jobs are to be created by merging geoscience knowledge with economic instruments (say, micro enterprises), and management structures at different levels (Policy level, Technology Transfer level and Implementation level), customized to the local biophysical and socioeconomic situations, and (iii) International cooperation: Web-based instruction (e.g. education portals, virtual laboratories) through South - South and North - South cooperation, customized to the local biophysical and socioeconomic situations, with the help of (say) UNDP, UNESCO, World Bank, etc.

Interview: Health technology assessment in Asia: an emerging trend.

PubMed

Yang, Bong-min

2012-05-01

Bong-min Yang, PhD (in economics), is Professor and former Dean of the School of Public Health at the Seoul National University, South Korea. Professor Yang has led research and written many papers in health economics and healthcare systems in Korea and Asia. His recent research and publications focus on the field of economic evaluation and outcomes research. He played a key role in the introduction of a formal health technology assessment system within Korean healthcare. He is currently serving as Executive Director, Institute of Health and Environment, Seoul National University. In addition to his research and publications, Professor Yang is Associate Editor for Journal of Comparative Effectiveness Research, is co-editor-in-chief for Value in Health Regional Issues, and is currently chair of the Management Advisory Board of Value in Health and a member of the editorial board of the Journal of Medical Economics. He has been a policy consultant to China, Japan, Indonesia, Hong Kong, Malaysia, Taiwan, Thailand and India. He has also worked as a short-term consultant at the WHO, ADB, UNDP and the World Bank. For the Korean government, he served as Chairperson of the Health Insurance Reform Committee, and Chairperson of the Drug Pricing and Reimbursement Committee. He is currently serving as Chair of the International Society of Pharmacoeconomics and Outcomes Research-Asia Consortium, and a member of the Board of Directors of the International Society of Pharmacoeconomics and Outcomes Research.

Impact of disaster-related mortality on gross domestic product in the WHO African Region

PubMed Central

Kirigia, Joses M; Sambo, Luis G; Aldis, William; Mwabu, Germano M

2004-01-01

Background Disaster-related mortality is a growing public health concern in the African Region. These deaths are hypothesized to have a significantly negative effect on per capita gross domestic product (GDP). The objective of this study was to estimate the loss in GDP attributable to natural and technological disaster-related mortality in the WHO African Region. Methods The impact of disaster-related mortality on GDP was estimated using double-log econometric model and cross-sectional data on various Member States in the WHO African Region. The analysis was based on 45 of the 46 countries in the Region. The data was obtained from various UNDP and World Bank publications. Results The coefficients for capital (K), educational enrolment (EN), life expectancy (LE) and exports (X) had a positive sign; while imports (M) and disaster mortality (DS) were found to impact negatively on GDP. The above-mentioned explanatory variables were found to have a statistically significant effect on GDP at 5% level in a t-distribution test. Disaster mortality of a single person was found to reduce GDP by US$0.01828. Conclusions We have demonstrated that disaster-related mortality has a significant negative effect on GDP. Thus, as policy-makers strive to increase GDP through capital investment, export promotion and increased educational enrolment, they should always keep in mind that investments made in the strengthening of national capacity to mitigate the effects of national disasters expeditiously and effectively will yield significant economic returns. PMID:15113453

Renewed UN drive against AIDS.

PubMed

McGregor, A

1994-12-17

After a 1-day meeting of agency directors on December 12 in New York, UN Secretary-General Boutros Boutros-Ghali announced the appointment of Dr. Peter Piot as director of a renewed UN program against human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), provisionally entitled "UN Joint and Co-sponsored Programme on AIDS." The 6 UN agencies already involved (UNICEF, UNDP, UNESCO, UN Population Fund, the World Bank, and WHO) will be more tightly coordinated; the World Health Organization (WHO) will remain in charge. Dr. Piot, a 45-year-old Belgian physician and co-discoverer of the Ebola virus (1976), assisted and effectively succeeds Dr. Michael Merson, the director of the World Health Organizations's global program on AIDS. While professor of microbiology at the Institute of Tropical Medicine in Antwerp, Dr. Piot launched a series of collaborative projects in Africa, including "Project SIDA" in Kinshasa in 1984. The new program will not be fully operational until 1996. The World Bank is expected to provide additional money. Dr. Merson's predecessor, Dr. Jonathan Mann (now director of the International Center at the Harvard School Of Public Health) expressed hopefulness about the new leadership and concern that what has been learned about AIDS in the last decade will be applied in the new program. A transition team has been working on a provisional program blueprint that provides for a resident coordinator and the full integration of local staff in each country. Additional emphasis will be given to education. An estimated 17 million people are infected with HIV, 3 million more since June of last year. 20-40 million are expected to be infected by 1999.

Factors associated to infant mortality in Sub-Saharan Africa

PubMed Central

Ester, Pablo Viguera; Torres, Alberto; Freire, José M.; Hernández, Valentín; Gil, Ángel

2011-01-01

Half of the 10 million children who die annually in the world are from Sub-Saharan Africa (SSA). The reasons are known, but lack of will and resources avoid the development of sustainable policies. Associated factors to the high infant mortality rate (IMR) in SSA have been investigated in this research. An ecological multi-group study was designed comparing rates within SSA. The dependent variable is the IMR and health services, economic and development indicators are the independent variables. Information and data sources were WHO, World Bank, UNICEF and UNDP (1997–2007). IMR mean value is 92.2 (per 1000 live births) and a relationship with several of the factors could be observed. In the bi-variate analysis direct relationship was observed with maternal mortality rate and an inverse relationship was observed with prenatal care coverage, births assisted by skilled health personnel, gross national income per capita, per capita government expenditure on health, social security expenditure, adult literacy rate, net primary school enrolment rate, population with access to safe drinking water (in urban and rural areas) and with population with access to basic sanitation in rural areas. In the multi-variate analysis IMR had an inverse relationship with children under 5 years with diarrhoea who receive oral re-hydration, with social security expenditure as percentage of general government expenditure on health and with per capita government expenditure on health. The situation in SSA would change if their inhabitants received education and information to demand more equitable polices and better investments from their governments. PMID:28299068

Global Framework for Climate Services (GFCS): status of implementation

NASA Astrophysics Data System (ADS)

Lucio, Filipe

2014-05-01

The GFCS is a global partnership of governments and UN and international agencies that produce and use climate information and services. WMO, which is leading the initiative in collaboration with UN ISDR, WHO, WFP, FAO, UNESCO, UNDP and other UN and international partners are pooling their expertise and resources in order to co-design and co-produce knowledge, information and services to support effective decision making in response to climate variability and change in four priority areas (agriculture and fod security, water, health and disaster risk reduction). To address the entire value chain for the effective production and application of climate services the GFCS main components or pillars are being implemented, namely: • User Interface Platform — to provide ways for climate service users and providers to interact to identify needs and capacities and improve the effectiveness of the Framework and its climate services; • Climate Services Information System — to produce and distribute climate data, products and information according to the needs of users and to agreed standards; • Observations and Monitoring - to generate the necessary data for climate services according to agreed standards; • Research, Modelling and Prediction — to harness science capabilities and results and develop appropriate tools to meet the needs of climate services; • Capacity Building — to support the systematic development of the institutions, infrastructure and human resources needed for effective climate services. Activities are being implemented in various countries in Africa, the Caribbean and South pacific Islands. This paper will provide details on the status of implementation of the GFCS worldwider.

General health in Timor-Leste: self-assessed health in a large household survey.

PubMed

Earnest, Jaya; Finger, Robert P

2009-08-01

Timor-Leste is one of the world's newest nations and became a democracy in 2002. Ranked 150 out of 177 in the 2007 UNDP Human Development Index, the country has the worst health indicators in the Asia-Pacific region. The objective of this study was to collect and analyse data on subjectively assessed general health, health service use, migration and mobility patterns. The data collection involved recording self-reported status of general health using a structured questionnaire. The survey was administered to 1,213 Timorese households in six districts using a multi-stage random cluster sampling procedure. Basic descriptive statistical analyses were performed on all variables with SPSS version 13. More than a quarter (27%) of respondents reported a health problem at the time of the survey. Only approximately half of respondents assessed their health to be good (53%) or average (38%). Barriers reported in the uptake of healthcare services were no felt needed; difficulty in accessing services and unavailability of service. Results reveal that Timor-Leste needs a more decentralised provision of healthcare through primary healthcare centres or integrated health services. Trained traditional healers, who are familiar with the difficult terrain and understand cultural contexts and barriers, can be used to improve uptake of public health services. An adult literacy and community health education program is needed to further improve the extremely poor health indicators in the country. Key lessons that emerged were the importance of understanding cultural mechanisms in areas of protracted conflict and the need for integrated health services in communities.

Multidisciplinary study on anthropogenic landslides in Nepal

NASA Astrophysics Data System (ADS)

Puglia, Christopher; Derron, Marc-Henri; Nicolet, Pierrick; Sudmeier-Rieux, Karen; Jaboyedoff, Michel; Devkota, Sanjay

2013-04-01

Nepal is a country in which shallow landslide is a frequent phenomenon. Monsoon is the main triggering factor but anthropogenic influence is often significant too. Indeed, many infrastructures, such as roads or water pipes, are not built in a rigorous way because of a lack of funds and knowledge. In the present study we examine the technical, social and economic issues of landslide management for two sites in Nepal. The first site is located in Sanusiruwari VDC (Sindhupalchock district, central Nepal) and the second one in Namadi VDC (Ramecchap district, central Nepal). Both sites are affected by landslides induced by the construction of hydropower plants. These landslides may threaten the viability of the hydropower plants. At both sites the problems are quite similar, but the first site project is a private one and the second one is a public one implemented by the United Nations Development Programme (UNDP). For both sites, bioengineering methods using Vetiver (Vetyveria zizanioides) plantations is the main stabilization measure. To follow the progression of both landslides, fieldwork observations were conducted before and after the 2012 rainy season, including photogrammetric and distancemeter acquisitions. Main issues were discussed with communities and stakeholders of the hydropower projects through interviews and participatory risk mapping. Main issues include: lack of communication between the project managers and communities leading to conflict and the lack of maintenance of the bio-engineering sites, leading to less effective Vetiver growth and slope stabilization. Comparing the landslide management (technical, social and economic) of the two projects allows to point out some specific issues within an integrated risk perspective.

Gender inequality, health expenditure and maternal mortality in sub-Saharan Africa: A secondary data analysis

PubMed Central

Atwood, Stephen; Van der Putten, Marc

2013-01-01

Abstract Background This article provided an analysis of gender inequality, health expenditure and its relationship to maternal mortality. Objective The objective of this article was to explore gender inequality and its relationship with health expenditure and maternal mortality in sub-Saharan Africa (SSA). A unique analysis was used to correlate the Gender Inequality Index (GII), Health Expenditure and Maternal Mortality Ratio (MMR). The GII captured inequalities across three dimensions – Reproductive health, Women empowerment and Labour force participation between men and women. The GII is a composite index introduced by the UNDP in 2010 and corrects for the disadavanatges of the other gender indices. Although the GII incorporates MMR in its calculation, it should not be taken as a substitute for, but rather as complementary to, the MMR. Method An exploratory and descriptive design to a secondary documentary review using quantitative data and qualitative information was used. The article referred to sub-Saharan Africa, but seven countries were purposively selected for an in-depth analysis based on the availability of data. The countries selected were Angola, Botswana, Malawi, Mozambique, South Africa, Zambia and Zimbabwe. Results Countries with high gender inequality captured by the gender inequality index were associated with high maternal mortality ratios as compared with countries with lower gender inequality, whilst countries that spend less on health were associated with higher maternal deaths than countries that spend more. Conclusion A potential relationship exists between gender inequality, health expenditure, and maternal mortality. Gender inequalities are systematic and occur at the macro, societal and household levels.

Feasibility and outcomes of paid undergraduate student nurse positions.

PubMed

Gamroth, Lucia; Budgen, Claire; Lougheed, Mary

2006-09-01

An Undergraduate Nurse Employment Demonstration Project (UNDP) was implemented in four Health Service Areas in British Columbia with a concurrent evaluation study. This demonstration project comprised the development and implementation of a new position in the BC healthcare system. The position enabled third- and fourth-year nursing students to be employed at their level of education. The purposes of the evaluation were to explore the feasibility and outcomes of this type of paid undergraduate student nurse employment. The three-year project and evaluation included both implementation and outcome analysis. The implementation evaluation design was descriptive and prospective, involving multiple data sources. The outcome evaluation design was quasi-experimental, with intervention and comparison groups. Learning outcomes for undergraduate nurses were increased confidence, organizational ability, competency and ability to work with a team. Workplace outcomes were increased unit morale, help with workload and improved patient care. New graduates with undergraduate nurse experience reported less time required for orientation and transition than other graduates who did not have this experience, and workplace nurses viewed these new graduates as more job-ready than other new graduates. After 21 months, new graduates with undergraduate nurse experience were less likely to move to other employment than other new graduates. Results from the four Health Service Areas indicated that the paid undergraduate nurse position was feasible and that outcomes benefited students, new graduates and workplaces. The undergraduate nurse position is now being implemented throughout all Health Service Areas in British Columbia.By 2000, concerns in British Columbia about the nursing workforce, workplace and patient safety had escalated to the point where diverse stakeholder groups were prepared to work together in new ways to prepare nursing graduates to be more job-ready, to recruit and retain new graduates and to retain existing nurses. Stakeholder groups were administrators, labour organizations, professional associations, educators and government. One idea to support job readiness and retention focussed on the feasibility of implementing cooperative education for nursing students. The effort was unsuccessful owing to lack of funding, but resulted in a review of the literature on cooperative education and other work-study programs. Cooperative education connects classroom learning with paid work experience for the purpose of enhancing students' education (Fitt and Heverly 1990; Heinemann and De Falco 1992; Ryder 1987). Reported benefits for students were improved job preparation and graduate retention (Ishida et al. 1998), additional staffing and reduction in orientation time (Cusack 1990; Ishida et al. 1998), increased practice judgment (Cusack 1990; Siedenberg 1989) and better workload management (Ross and Marriner 1985). A work-study model reported in the literature offered benefits similar to those of cooperative education, with greater flexibility in design. An example was the University of Texas Health Science Center at Houston's collaborative work-study scholarship program with local hospitals (Kee and Ryser 2001). Students in second clinical semesters were employed as unlicensed personnel by hospitals. The students, as unlicensed personnel, worked to the level of their nursing preparation. Reported benefits for students were academic credit, financial assistance, interaction with multidisciplinary teams, opportunity to refine clinical skills, understanding of nurses' roles and guaranteed interview for positions on graduation (Kee and Ryser 2001). Benefits for practice organizations were skilled help, the opportunity to recruit new nurses and increased interaction with a university nursing program. While nurse education stakeholders in British Columbia were exploring options, the concept of undergraduate student nurse employment was initiated by a group of fourth-year students at the University of Victoria who were completing the course "Nurses Influencing Change." The students were concerned about having enough practice experience to meet increasing nursing competency requirements and their survival as new graduates given workplace realities. Debt load also was a concern because extensive student practicum time limited opportunities for paid employment during the nursing education program. Students found that the idea of paid undergraduate nurse positions, based on the student employment model in Alberta, was supported by nurse leaders, many practising nurses and nursing faculty who also were concerned about meeting patient care standards and adequately preparing nursing students. In 2000, the BC Ministry of Health Services funded an Undergraduate Nurse Demonstration Project (UNDP) - one type of paid employment for undergraduate student nurses - in four Health Service Areas linked with four schools of nursing. A concurrent three-year evaluation study examined the feasibility and outcomes of the UNDP (Gamroth et al. 2004). This paper summarizes the findings of the evaluation. Evaluation Research An Undergraduate Nurse Employment Demonstration Project (UNDP) was implemented in four Health Service Areas in British Columbia with a concurrent evaluation study. This demonstration project comprised the development and implementation of a new position in the BC healthcare system. The position enabled third- and fourth-year nursing students to be employed at their level of education. The purposes of the evaluation were to explore the feasibility and outcomes of this type of paid undergraduate student nurse employment. The three-year project and evaluation included both implementation and outcome analysis. The implementation evaluation design was descriptive and prospective, involving multiple data sources. The outcome evaluation design was quasi-experimental, with intervention and comparison groups. Learning outcomes for undergraduate nurses were increased confidence, organizational ability, competency and ability to work with a team. Workplace outcomes were increased unit morale, help with workload and improved patient care. New graduates with undergraduate nurse experience reported less time required for orientation and transition than other graduates who did not have this experience, and workplace nurses viewed these new graduates as more job-ready than other new graduates. After 21 months, new graduates with undergraduate nurse experience were less likely to move to other employment than other new graduates. Results from the four Health Service Areas indicated that the paid undergraduate nurse position was feasible and that outcomes benefited students, new graduates and workplaces. The undergraduate nurse position is now being implemented throughout all Health Service Areas in British Columbia. By 2000, concerns in British Columbia about the nursing workforce, workplace and patient safety had escalated to the point where diverse stakeholder groups were prepared to work together in new ways to prepare nursing graduates to be more job-ready, to recruit and retain new graduates and to retain existing nurses. Stakeholder groups were administrators, labour organizations, professional associations, educators and government. One idea to support job readiness and retention focussed on the feasibility of implementing cooperative education for nursing students. The effort was unsuccessful owing to lack of funding, but resulted in a review of the literature on cooperative education and other work-study programs. Cooperative education connects classroom learning with paid work experience for the purpose of enhancing students' education (Fitt and Heverly 1990; Heinemann and De Falco 1992; Ryder 1987). Reported benefits for students were improved job preparation and graduate retention (Ishida et al. 1998), additional staffing and reduction in orientation time (Cusack 1990; Ishida et al. 1998), increased practice judgment (Cusack 1990; Siedenberg 1989) and better workload management (Ross and Marriner 1985). A work-study model reported in the literature offered benefits similar to those of cooperative education, with greater flexibility in design. An example was the University of Texas Health Science Center at Houston's collaborative work-study scholarship program with local hospitals (Kee and Ryser 2001). Students in second clinical semesters were employed as unlicensed personnel by hospitals. The students, as unlicensed personnel, worked to the level of their nursing preparation. Reported benefits for students were academic credit, financial assistance, interaction with multidisciplinary teams, opportunity to refine clinical skills, understanding of nurses' roles and guaranteed interview for positions on graduation (Kee and Ryser 2001). Benefits for practice organizations were skilled help, the opportunity to recruit new nurses and increased interaction with a university nursing program. While nurse education stakeholders in British Columbia were exploring options, the concept of undergraduate student nurse employment was initiated by a group of fourth-year students at the University of Victoria who were completing the course "Nurses Influencing Change." The students were concerned about having enough practice experience to meet increasing nursing competency requirements and their survival as new graduates given workplace realities. Debt load also was a concern because extensive student practicum time limited opportunities for paid employment during the nursing education program. Students found that the idea of paid undergraduate nurse positions, based on the student employment model in Alberta, was supported by nurse leaders, many practising nurses and nursing faculty who also were concerned about meeting patient care standards and adequately preparing nursing students.

The CEOS Recovery Observatory Pilot

NASA Astrophysics Data System (ADS)

Hosford, S.; Proy, C.; Giros, A.; Eddy, A.; Petiteville, I.; Ishida, C.; Gaetani, F.; Frye, S.; Zoffoli, S.; Danzeglocke, J.

2015-04-01

Over the course of the last decade, large populations living in vulnerable areas have led to record damages and substantial loss of life in mega-disasters ranging from the deadly Indian Ocean tsunami of 2004 and Haiti earthquake of 2010; the catastrophic flood damages of Hurricane Katrina in 2005 and the Tohoku tsunami of 2011, and the astonishing extent of the environmental impact of the Deepwater Horizon explosion in 2009. These major catastrophes have widespread and long-lasting impacts with subsequent recovery and reconstruction costing billions of euros and lasting years. While satellite imagery is used on an ad hoc basis after many disasters to support damage assessment, there is currently no standard practice or system to coordinate acquisition of data and facilitate access for early recovery planning and recovery tracking and monitoring. CEOS led the creation of a Recovery Observatory Oversight Team, which brings together major recovery stakeholders such as the UNDP and the World Bank/Global Facility for Disaster Reduction and Recovery, value-adding providers and leading space agencies. The principal aims of the Observatory are to: 1. Demonstrate the utility of a wide range of earth observation data to facilitate the recovery and reconstruction phase following a major catastrophic event; 2. Provide a concrete case to focus efforts in identifying and resolving technical and organizational obstacles to facilitating the visibility and access to a relevant set of EO data; and 3. Develop dialogue and establish institutional relationships with the Recovery phase user community to best target data and information requirements; The paper presented here will describe the work conducted in preparing for the triggering of a Recovery Observatory including support to rapid assessments and Post Disaster Needs Assessments by the EO community.

GIPA in Mongolia

NASA Astrophysics Data System (ADS)

Dashpuntsag, Nasanbat

2008-04-01

I'm writing from ``Positive Life Center'' NGO from Mongolia. I'm working as project manager for ``Positive Life Center'' NGO and Volunteer for UNDP. 2002-2004 i was worked in project at National AIDS foundation. This project goal was to distribute accurate information of HIV/AIDS for youngs and students. Then I was participated related to HIV/AIDS many workshop, training and local conference. in 2007, I was successfully participated training and meeting organized from Korea HIV/AIDS Network OF Solidarity organization in Republic of Korea. Since 2006, the PLWHA highly increasing in Mongolia. But we are having some problem that's we are non-experience to contact with PLWHA including care, treatment, finance support and another serves. So we must will contact with NGOs in abroad and will be able to participate workshop, training ng experience. Positive Life is a Mongolian non-governmental organisation at the forefront of the fight against HIV/AIDS and serve for PLwha in Mongolia. We aspire to a Mongolia for PLWHA , particularly those who are vulnerable, have equal access to effective, non- discriminatory HIV prevention and care and support services to improve the quality of their life. To bring this about, we collaborate with international supporters, the Mongolian government and a host of grass-roots organisations in towns and villages all over the country to develop and foster the most effective response to this devastating epidemic. This response includes prevention work, the provision of care and support, advocacy, awareness-raising and a wide variety of other initiatives and activities. Through a steadily increasing volume of work, ever higher levels of donor funding, and our growing maturity, we are now proud to be recognised locally and nationally as the voice of the Mongolian PLWHA sector in HIV/AIDS work.

Transgender social inclusion and equality: a pivotal path to development

PubMed Central

Divan, Vivek; Cortez, Clifton; Smelyanskaya, Marina; Keatley, JoAnne

2016-01-01

Introduction The rights of trans people are protected by a range of international and regional mechanisms. Yet, punitive national laws, policies and practices targeting transgender people, including complex procedures for changing identification documents, strip transgender people of their rights and limit access to justice. This results in gross violations of human rights on the part of state perpetrators and society at large. Transgender people's experience globally is that of extreme social exclusion that translates into increased vulnerability to HIV, other diseases, including mental health conditions, limited access to education and employment, and loss of opportunities for economic and social advancement. In addition, hatred and aggression towards a group of individuals who do not conform to social norms around gender manifest in frequent episodes of extreme violence towards transgender people. This violence often goes unpunished. Discussion The United Nations Development Programme (UNDP) views its work in the area of HIV through the lens of human rights and advances a range of development solutions such as poverty reduction, improved governance, active citizenship, and access to justice. This work directly relates to advancing the rights of transgender people. This manuscript lays out the various aspects of health, human rights, and development that frame transgender people's issues and outlines best practice solutions from transgender communities and governments around the globe on how to address these complex concerns. The examples provided in the manuscript can help guide UN agencies, governments, and transgender activists in achieving better standards of health, access to justice, and social inclusion for transgender communities everywhere. Conclusions The manuscript provides a call to action for countries to urgently address the violations of human rights of transgender people in order to honour international obligations, stem HIV epidemics, promote gender equality, strengthen social and economic development, and put a stop to untrammelled violence. PMID:27431473

GCMs and MDGs: can climate science reduce poverty?

NASA Astrophysics Data System (ADS)

Thomson, M. C.; Connor, S. J.

2004-12-01

Sub-Saharan Africa, the birthplace of humankind, is seen by many, both as the least developed region of the world, and the region where the processes of globalization and sustainable development are most difficult to set in motion. Sub-Saharan African countries invariably appear en masse at the bottom of the annual UNDP Human Development Report rankings with development indicators such as life expectancy and basic nutrition levels in decline. The poorer communities are most vulnerable to adverse impacts of climate fluctuations and seen as the least able to cope with current climate variability. Sub-Saharan Africa has a population of approximately 625 million, with more than two thirds of the people dependant on rain-fed agriculture. The vast majority of the population lack access to clean water and sanitation and sub-Saharan Africa currently bears the highest burden of infectious diseases such as HIV-AIDS, TB and Malaria to be found anywhere in the world. With almost half of the region's population living on less than US$1 per day, sub-Saharan Africa accounts for one quarter of the world's poor. The rural poor are often considered to have no voice and therefore form a very weak political constituency. International development targets such as the recently articulated UN Millennium Development Goals are seen as one means of giving voice to this large but disenfranchised population. Improved management of climate sensitive sectors is essential to achieving a number of the MDgs: Poverty-Hunger, Disease, Water and sanitation. Climate information is also essential to measuring that achievement, as climate often acts as a confounder in any analysis of interventions. Here we present work on how climate science, including state of the art - multi-model ensemble seasonal climate forecasting models, are being used in support of achieving the MDGs in Africa.

Transgender social inclusion and equality: a pivotal path to development.

PubMed

Divan, Vivek; Cortez, Clifton; Smelyanskaya, Marina; Keatley, JoAnne

2016-01-01

The rights of trans people are protected by a range of international and regional mechanisms. Yet, punitive national laws, policies and practices targeting transgender people, including complex procedures for changing identification documents, strip transgender people of their rights and limit access to justice. This results in gross violations of human rights on the part of state perpetrators and society at large. Transgender people's experience globally is that of extreme social exclusion that translates into increased vulnerability to HIV, other diseases, including mental health conditions, limited access to education and employment, and loss of opportunities for economic and social advancement. In addition, hatred and aggression towards a group of individuals who do not conform to social norms around gender manifest in frequent episodes of extreme violence towards transgender people. This violence often goes unpunished. The United Nations Development Programme (UNDP) views its work in the area of HIV through the lens of human rights and advances a range of development solutions such as poverty reduction, improved governance, active citizenship, and access to justice. This work directly relates to advancing the rights of transgender people. This manuscript lays out the various aspects of health, human rights, and development that frame transgender people's issues and outlines best practice solutions from transgender communities and governments around the globe on how to address these complex concerns. The examples provided in the manuscript can help guide UN agencies, governments, and transgender activists in achieving better standards of health, access to justice, and social inclusion for transgender communities everywhere. The manuscript provides a call to action for countries to urgently address the violations of human rights of transgender people in order to honour international obligations, stem HIV epidemics, promote gender equality, strengthen social and economic development, and put a stop to untrammelled violence.

(Re)politicising and (re)positioning prevention: community mobilisations and AIDS prevention in the new AIDS era.

PubMed

Rolston, Imara Ajani

2016-07-01

An increasing focus on the relationship between AIDS prevalence and socio-economic inequality signals the need for a revaluation of the role of "politics" and "power" in AIDS prevention. This revaluation bears great significance when considering the future trajectories of the AIDS prevention efforts that target highly marginalised populations with high prevalence rates. An emphasis on intersecting forms of inequality has direct implications for the future of AIDS prevention practice. This study explores the experiences of participants, facilitators and local stakeholders applying the United Nations Development Programme (UNDP) Community Capacity Enhancement-Community Conversations (CCE-CC) approach to AIDS prevention in the Eastern Cape province of South Africa. It uses the political narrative analysis of life histories and semi-structured interviews as a means to interrogate the lived experiences of local actors participating in or influenced by this popularised form of community mobilisation used throughout sub-Saharan Africa. Findings suggest the need for a more explicit and intentional valuation for the intersection between the social and political determinants of health in programmes that use community mobilisation as prevention. They also signal a need to critically re-evaluate "community mobilisation" as an AIDS prevention tradition. Intersecting social and political power dynamics play a significant role in both opening up and constraining community mobilisation efforts. This paper proposes the need for a pedagogical turn to "deep organising" and "participatory forms of democracy", as a necessary frontier for programmes working with highly marginalised populations with high prevalence rates. Programmes need to more explicitly support, protect, and advocate for the ability of affected communities to engage in political processes, discourse and long-term organising.

The role of satellite remote sensing in REDD/MRV

NASA Astrophysics Data System (ADS)

Jonckheere, Inge; Sandoval, Alberto

2010-05-01

REDD, which stands for 'Reducing Emissions from Deforestation and Forest Degradation in Developing Countries' - is an effort to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. The UN-REDD Programme, a collaborative partnership between FAO, UNDP and UNEP launched in September 2008, supports countries to develop capacity to REDD and to implement a future REDD mechanism in a post- 2012 climate regime. The programme works at both the national and global scale, through support mechanisms for country-driven REDD strategies and international consensus-building on REDD processes. The UN-REDD Programme gathers technical teams from around the world to develop common approaches, analyses and guidelines on issues such as measurement, reporting and verification (MRV) of carbon emissions and flows, remote sensing, and greenhouse gas inventories. Within the partnership, FAO supports countries on technical issues related to forestry and the development of cost effective and credible MRV processes for emission reductions. While at the international level, it fosters improved guidance on MRV approaches, including consensus on principles and guidelines for MRV and training programmes.It provides guidance on how best to design and implement REDD, to ensure that forests continue to provide multiple benefits for livelihoods and biodiversity to societies while storing carbon at the same time. Other areas of work include national forest assessments and monitoring of in-country policy and institutional change. The outcomes about the role of satellite remote sensing technologies as a tool for monitoring, assessment, reporting and verification of carbon credits and co-benefits under the REDD mechanism are here presented.

Structure and needs of global loss databases about natural disaster

NASA Astrophysics Data System (ADS)

Steuer, Markus

2010-05-01

Global loss databases are used for trend analyses and statistics in scientific projects, studies for governmental and nongovernmental organizations and for the insurance and finance industry as well. At the moment three global data sets are established: EM-DAT (CRED), Sigma (Swiss Re) and NatCatSERVICE (Munich Re). Together with the Asian Disaster Reduction Center (ADRC) and United Nations Development Program (UNDP) started a collaborative initiative in 2007 with the aim to agreed on and implemented a common "Disaster Category Classification and Peril Terminology for Operational Databases". This common classification has been established through several technical meetings and working groups and represents a first and important step in the development of a standardized international classification of disasters and terminology of perils. This means concrete to set up a common hierarchy and terminology for all global and regional databases on natural disasters and establish a common and agreed definition of disaster groups, main types and sub-types of events. Also the theme of georeferencing, temporal aspects, methodology and sourcing were other issues that have been identified and will be discussed. The implementation of the new and defined structure for global loss databases is already set up for Munich Re NatCatSERVICE. In the following oral session we will show the structure of the global databases as defined and in addition to give more transparency of the data sets behind published statistics and analyses. The special focus will be on the catastrophe classification from a moderate loss event up to a great natural catastrophe, also to show the quality of sources and give inside information about the assessment of overall and insured losses. Keywords: disaster category classification, peril terminology, overall and insured losses, definition

The Heritage of the Operational Usda/nasa Global Reservoir and Lake Monitor

NASA Astrophysics Data System (ADS)

Birkett, C. M.; Beckley, B. D.; Reynolds, C. A.

2012-12-01

Satellite radar altimetry has the ability to monitor variations in surface water height for large lakes and reservoirs. A clear advantage is the provision of data where in situ data are lacking or where there is restricted access to ground-based measurements. A USDA/NASA funded program is performing altimetric monitoring of the largest lakes and reservoirs around the world. The near-real time height measurements are currently derived from NASA/CNES Jason-2/OSTM mission data. Archived data are also utilized from the NASA/CNES Topex/Poseidon and Jason-1 missions, the NRL GFO mission, and the ESA ENVISAT mission. Lake level products are output within 1-2 weeks after satellite overpass, a time delay which will improve to a few days as the project moves into its next phase. The USDA/FAS utilize the products for assessing irrigation potential (and thus crop production estimates), and for general observation of high-water status and short-term drought. Other end-users explore the products to study climate trends, observe anthropogenic effects, and to consider water management and regional security issues. This presentation explores the heritage of the Global Reservoir and Lake Monitor (GRLM) which has its origins in the field of ocean surface topography and the exploration of radar altimetry techniques over non-ocean surfaces. The current system closely follows the software design of the historical NASA Ocean Pathfinder Project and utilizes a global lakes catalogue that was created for climate change/aridity studies. The output of lake level products, imagery and information also echoes an earlier trial (UNDP-funded) lakes database which first offered altimetric products via the world wide web and which enabled world-wide interest to be both assessed and highlighted.;

Can AIDS prevention move to sufficient scale?

PubMed

Slutkin, G

1993-05-01

Much has been learned about which AIDS prevention interventions are effective and what an AIDS prevention program should look like. It is also clear that important program issues must be worked out at the country level if effective interventions are to be had. Programs with successful interventions and approaches in most countries, however, have yet to be implemented on a sufficiently large scale. While some national programs are beginning to use proven interventions and are moving toward implementing full-scale national AIDS programs, most AIDS prevention programs do not incorporate condom marketing, are not using mass media and advertising in a well-programmed way, do not have peer projects to reach most at-risk populations, and do not have systems in place to diagnose and treat persons with sexually transmitted diseases (STD). Far more planning and resources for AIDS prevention are needed from national and international public and private sectors. International efforts by the World Health Organization (WHO), UNICEF, UNDP, UNESCO, UNFPA, and the World Bank have increased markedly over the past few years. Bilaterally, the US, Sweden, United Kingdom, Canada, Netherlands, Norway, Denmark, Japan, Germany, France, and other countries are contributing to WHO/GPA and to direct bilateral AIDS prevention activities. USAID happens to be the largest single contributor to WHO/GPA and is also the largest bilateral program with its $168 millions AIDSCAP funded over 5 years. AIDSCAP integrates condom distribution and marketing, STD prevention and control, behavioral change and communication strategies through person-to-person and mass media approaches, and strong evaluation components. AIDSCAP can help fulfill the need to demonstrate that programs can be developed on a country-wide level by showing how behavior can be changed in a broad geographical area.

Assessing changes in HIV-related legal and policy environments: Lessons learned from a multi-country evaluation.

PubMed

Ferguson, Laura; Nicholson, Alexandra; Henry, Ian; Saha, Amitrajit; Sellers, Tilly; Gruskin, Sofia

2018-01-01

There is growing recognition in the health community that the legal environment-including laws, policies, and related procedures-impacts vulnerability to HIV and access to HIV-related services both positively and negatively. Assessing changes in the legal environment and how these affect HIV-related outcomes, however, is challenging, and understanding of appropriate methodologies nascent. We conducted an evaluation of a UNDP project designed to strengthen legal environments to support the human rights of key populations, in particular LGBT populations, women and girls, affected by HIV in sub-Saharan Africa. We analyzed data on activities designed to improve legal environments through a systematic document review and 53 qualitative interviews. The project made substantial strides towards legal change in many places, and examples provide broader lessons for work in this area. Two core pillars appear fundamental: a government-led participatory assessment of the legal environment, and building the capacity of those impacted by and engaged in this work. Systematic attention to human rights is vital: it can help open new spaces for dialogue among diverse stakeholders, foster new collaborations, and ensure local ownership, nuanced understanding of the political landscape, attention to marginalized populations, and accountability for (in)action. Entry points for effecting legal change go beyond "HIV laws" to also include other laws, national policies and strategies. Conducting legal environment assessments, multi-stakeholder dialogues, action planning and related activities, alongside capacity building, can contribute to changes in knowledge and attitudes directly relevant to reforming laws that are found to be harmful. Shorter-term goals along the causal pathway to legal change (e.g. changes in policy) can constitute interim markers of success, and recognition of these can maintain momentum. Increasing understanding of progress towards changes in the legal environment that can positively affect HIV-related outcomes is important in working to improve the health and lives of people living with HIV.

Promoting good health research practice in low- and middle-income countries

PubMed Central

Mahendradhata, Yodi; Nabieva, Jamila; Ahmad, Riris Andono; Henley, Patricia; Launois, Pascal; Merle, Corinne; Maure, Christine; Horstick, Olaf; Elango, Varalakshmi

2016-01-01

Background Good clinical practice (GCP) guidelines have been the source of improvement in the quality of clinical trials; however, there are limitations to the application of GCP in the conduct of health research beyond industry-sponsored clinical trials. The UNICEF/UNDP/World Bank/WHO Special Program for Research and Training in Tropical Disease is promoting good practice in all health research involving human through the Good Health Research Practice (GHRP) training program initiative. Objective To report the results of piloting the GHRP training program and formulate further steps to harness GHRP for promoting good practices in all health research involving human, particularly in low- and middle-income countries (LMICs). Design The objective of this training is to impart knowledge and skills for the application of ethical and quality principles to the design, conduct, recording, and reporting of health research involving human participants based on the level of risk, to ensure a fit-for-purpose quality system. This has been formulated into five sequential modules to be delivered in a 4-day course. Four courses have been organized in the pilot phase (2014–2015). The courses have been evaluated and assessed based on course feedback (quantitative and qualitative data) collected during course implementation and qualitative email-based pre- and post-course evaluation. Results Participants were highly satisfied with the course content and its organization. The relevance and applicability of the course content resulted in positive feedback and an articulated willingness to adapt and disseminate the course. Action points to strengthen the training program have been identified, and showed the imminent need to develop a consensus with a broader range of key stakeholders on the final set of GHRP standards and means for implementation. Conclusions There is an urgent need to harness the momentum to promote high-quality and ethical health research in LMICs through scaling up GHRP training and further development of GHRP principles into international standards. PMID:27498965

Monitoring of ovarian activity by measurement of urinary excretion rates of estrone glucuronide and pregnanediol glucuronide using the Ovarian Monitor, Part II: reliability of home testing.

PubMed

Blackwell, Leonard F; Vigil, Pilar; Gross, Barbara; d'Arcangues, Catherine; Cooke, Delwyn G; Brown, James B

2012-02-01

The UNDP/WHO/World Bank/Special Programme of Research, Development and Research Training in Human Reproduction (Geneva) set up a study to determine whether it is feasible for women to monitor their ovarian activity reliably by home testing. Daily self-monitoring of urinary hormone metabolites for menstrual cycle assessment was evaluated by comparison of results obtained with the Home Ovarian Monitor by untrained users both at home and in study centres. Women collected daily data for urinary estrone glucuronide (E1G) and pregnanediol glucuronide (PdG) for two cycles, then the procedure was repeated in the women's local centre (in Chile, Australia or New Zealand) giving a total of 113 duplicate cycles. The tests were performed without the benefit of replicates or quality controls. The home and centre cycles were normalized and compared to identify assay errors, and the resulting home and centre menstrual cycle profiles were averaged. Reliable mean cycle profiles were obtained with the home and centre excretion rates agreeing to within 36 ± 21 nmol/24 h for E1G and 0.77 ± 0.28 µmol/24 h for baseline PdG values (1-5 µmol/24 h). The cycles had a mean length of 28.1 ± 3.1 days (n = 112; 5th and 95th percentiles: 24 and 35 days, respectively), a mean follicular phase of 14.8 ± 3.1 days (n = 107; 5th and 95th percentiles: 11 and 21 days) and a mean luteal phase length of 13.3 ± 1.5 days (n = 106; 5th and 95th percentiles: 11 and 17 days), calculated from the day of the LH peak. The study confirmed that the Ovarian Monitor pre-coated assay tubes worked well even in the hands of lay users, without standard curves, quality controls or replicates. Point-of-care monitoring to give reliable fertility data is feasible.

Impact of health research capacity strengthening in low- and middle-income countries: the case of WHO/TDR programmes.

PubMed

Minja, Happiness; Nsanzabana, Christian; Maure, Christine; Hoffmann, Axel; Rumisha, Susan; Ogundahunsi, Olumide; Zicker, Fabio; Tanner, Marcel; Launois, Pascal

2011-10-01

Measuring the impact of capacity strengthening support is a priority for the international development community. Several frameworks exist for monitoring and evaluating funding results and modalities. Based on its long history of support, we report on the impact of individual and institutional capacity strengthening programmes conducted by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and on the factors that influenced the outcome of its Research Capacity Strengthening (RCS) activities. A mix of qualitative and quantitative methods (questionnaires and in-depth interviews) was applied to a selected group of 128 individual and 20 institutional capacity development grant recipients that completed their training/projects between 2000 and 2008. A semi-structured interview was also conducted on site with scientists from four institutions. Most of the grantees, both individual and institutional, reported beneficial results from the grant. However, glaring inequities stemming from gender imbalances and a language bias towards English were identified. The study showed that skills improvement through training contributed to better formulation of research proposals, but not necessarily to improved project implementation or communication of results. Appreciation of the institutional grants' impact varied among recipient countries. The least developed countries saw the programmes as essential for supporting basic infrastructure and activities. Advanced developing countries perceived the research grants as complementary to available resources, and particularly suitable for junior researchers who were not yet able to compete for major international grants. The study highlights the need for a more equitable process to improve the effectiveness of health research capacity strengthening activities. Support should be tailored to the existing research capacity in disease endemic countries and should focus on strengthening national health research systems, particularly in the least developing countries. The engagement of stakeholders at country level would facilitate the design of more specific and comprehensive strategies based on local needs.

Impact of Health Research Capacity Strengthening in Low- and Middle-Income Countries: The Case of WHO/TDR Programmes

PubMed Central

Minja, Happiness; Nsanzabana, Christian; Maure, Christine; Hoffmann, Axel; Rumisha, Susan; Ogundahunsi, Olumide; Zicker, Fabio; Tanner, Marcel; Launois, Pascal

2011-01-01

Background Measuring the impact of capacity strengthening support is a priority for the international development community. Several frameworks exist for monitoring and evaluating funding results and modalities. Based on its long history of support, we report on the impact of individual and institutional capacity strengthening programmes conducted by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and on the factors that influenced the outcome of its Research Capacity Strengthening (RCS) activities. Methodology and Principal Findings A mix of qualitative and quantitative methods (questionnaires and in-depth interviews) was applied to a selected group of 128 individual and 20 institutional capacity development grant recipients that completed their training/projects between 2000 and 2008. A semi-structured interview was also conducted on site with scientists from four institutions. Most of the grantees, both individual and institutional, reported beneficial results from the grant. However, glaring inequities stemming from gender imbalances and a language bias towards English were identified. The study showed that skills improvement through training contributed to better formulation of research proposals, but not necessarily to improved project implementation or communication of results. Appreciation of the institutional grants' impact varied among recipient countries. The least developed countries saw the programmes as essential for supporting basic infrastructure and activities. Advanced developing countries perceived the research grants as complementary to available resources, and particularly suitable for junior researchers who were not yet able to compete for major international grants. Conclusion The study highlights the need for a more equitable process to improve the effectiveness of health research capacity strengthening activities. Support should be tailored to the existing research capacity in disease endemic countries and should focus on strengthening national health research systems, particularly in the least developing countries. The engagement of stakeholders at country level would facilitate the design of more specific and comprehensive strategies based on local needs. PMID:22022630

The impact of HIV/AIDS on human development in African countries.

PubMed

Boutayeb, Abdesslam

2009-11-18

In the present paper, we consider the impact of HIV/AIDS on human development in African countries, showing that, beyond health issues, this disease should and must be seen as a global development concern, affecting all components of human development. Consequently, we stress the necessity of multidisciplinary approaches that model, estimate and predict the real impact of HIV/AIDS on human development of African countries in order to optimise the strategies proposed by national countries, international institutions and their partners. In our search strategy, we relied on secondary information, mainly through National Human Development Reports of some African countries and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organization (WHO) and the World Bank. We restricted ourselves to reports dealing explicitly with the impact of HIV/AIDS on human development in African countries. HIV/AIDS is affecting the global human development of African countries through its devastating impact on health and demographic indicators such as life expectancy at birth, healthcare assistance, age and sex distribution, economic indicators like income, work force, and economic growth, education and knowledge acquisition and other indicators like governance, gender inequality and human rights. On the basis of the national reports reviewed, it appears clearly that HIV/AIDS is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors. Consequently, HIV/AIDS is a development question and should be viewed as such. The disease is impeding development by imposing a steady decline in the key indicators of human development and hence reversing the social and economic gains that African countries are striving to attain. Being at the same time a cause and consequence of poverty and underdevelopment, it constitutes a challenge to human security and human development by diminishing the chances of alleviating poverty and hunger, achieving universal primary education, promoting gender equality, reducing child and maternal mortality, and ensuring environmental sustainability.

A Multidisciplinary Approach to Decommissioning Offshore Wells Using Stakeholder Engagement, Risk Identification, and the United Nations Sustainable Development Goals

NASA Astrophysics Data System (ADS)

Battalora, L.; Prasad, M.

2017-12-01

Context/PurposeThe typical oil and gas project lifecycle includes acquisition, exploration, drilling, production, and decommissioning phases. The oil and gas industry (Industry) has become proactive in identifying and mitigating health, safety, security, environment, and social responsibility risks during these phases as well as designing for sustainable development. With many fields reaching the end stages of the lifecycle, Industry is faced with the challenge of identifying and evaluating risks in the decommissioning phase. The level of challenge is increased when planning for the decommissioning of offshore wells. This paper describes tools that can be applied in the multidisciplinary design of the decommissioning program including use of the United Nations Sustainable Development Goals (SDGs). MethodsStakeholder engagement is key to a successful project. Typical stakeholders in an oil and gas project include the community, regulatory agencies, federal, state, and local governments, private investors, academia, and non-governmental organizations. Before engagement begins, stakeholders must be identified as well as their level of influence in the project. Relationships between stakeholders are "mapped" providing a better understanding of priorities and areas of concentration. Project risks are identified and ranked according to likelihood and impact. Mitigations are matched to risks. Sustainable development is implemented through acknowledgement of societal, economic, and environmental impacts in engineering design. InterpretationRecently, the United Nations Development Programme (UNDP), the International Finance Corporation (IFC) and IPIECA, the global oil and gas industry association for environmental and social issues, partnered to develop the publication, Mapping the oil and gas industry to the Sustainable Development Goals: An Atlas. SDGs have been linked to Industry operations and can serve as a guide for the offshore decommissioning phase ConclusionA multidisciplinary approach using stakeholder engagement and risk identification tools and the United Nations Sustainable Development Goals is recommended for designing the decommissioning program of offshore wells. This recommendation also applies to onshore decommissioning programs.

Scaling up nutrition in fragile and conflict-affected states: the pivotal role of governance.

PubMed

Taylor, Sebastian A J; Perez-Ferrer, Carolina; Griffiths, Andrew; Brunner, Eric

2015-02-01

Acute and chronic undernutrition undermine conditions for health, stability and socioeconomic development across the developing world. Although fragile and conflict-affected states have some of the highest rates of undernutrition globally, their response to the multilateral 'Scaling Up Nutrition' (SUN) initiative in its first two-year period was ambivalent. The purpose of this research was to investigate factors affecting fragile and conflict-affected states' engagement with SUN, and to examine what differentiated those fragile states that joined SUN in its first phase from those that did not. Drawing on global databases (Unicef, World Bank, UNDP), and qualitative country case studies (Afghanistan, the Democratic Republic of Congo, Sierra Leone, Pakistan and Yemen) we used bivariate logistic regressions and principal component analysis to assess social, economic and political factors across 41 fragile states looking for systematic differences between those that had signed up to SUN before March 2013 (n = 16), and those that had not (n = 25). While prevalence of malnutrition, health system functioning and level of citizen empowerment had little or no impact on a fragile state's likelihood of joining SUN, the quality of governance (QOG) strongly predicted accession. SUN-signatory fragile states scored systematically better on the World Bank's Country Policy and Institutional Assessment (CPIA) and the Worldwide Governance Indicators 'effectiveness of government' indices. We conclude that strengthening governance in fragile states may enhance their engagement with initiatives such as SUN, but also (recognising the potential for endogeneity), that the way aid is structured and delivered in fragile states may be an underlying determinant of whether and how governance in such contexts improves. The research demonstrates that more nuanced analysis of conditions within and among countries classed as 'fragile and conflict-affected' is both possible and necessary if aid policies are to be shaped in ways that support rather than undermine growth in governance capacity. Copyright © 2014 Elsevier Ltd. All rights reserved.

Assessing changes in HIV-related legal and policy environments: Lessons learned from a multi-country evaluation

PubMed Central

Nicholson, Alexandra; Henry, Ian; Saha, Amitrajit; Sellers, Tilly; Gruskin, Sofia

2018-01-01

Introduction There is growing recognition in the health community that the legal environment—including laws, policies, and related procedures—impacts vulnerability to HIV and access to HIV-related services both positively and negatively. Assessing changes in the legal environment and how these affect HIV-related outcomes, however, is challenging, and understanding of appropriate methodologies nascent. Methods We conducted an evaluation of a UNDP project designed to strengthen legal environments to support the human rights of key populations, in particular LGBT populations, women and girls, affected by HIV in sub-Saharan Africa. We analyzed data on activities designed to improve legal environments through a systematic document review and 53 qualitative interviews. Results The project made substantial strides towards legal change in many places, and examples provide broader lessons for work in this area. Two core pillars appear fundamental: a government-led participatory assessment of the legal environment, and building the capacity of those impacted by and engaged in this work. Systematic attention to human rights is vital: it can help open new spaces for dialogue among diverse stakeholders, foster new collaborations, and ensure local ownership, nuanced understanding of the political landscape, attention to marginalized populations, and accountability for (in)action. Entry points for effecting legal change go beyond “HIV laws” to also include other laws, national policies and strategies. Conclusion Conducting legal environment assessments, multi-stakeholder dialogues, action planning and related activities, alongside capacity building, can contribute to changes in knowledge and attitudes directly relevant to reforming laws that are found to be harmful. Shorter-term goals along the causal pathway to legal change (e.g. changes in policy) can constitute interim markers of success, and recognition of these can maintain momentum. Increasing understanding of progress towards changes in the legal environment that can positively affect HIV-related outcomes is important in working to improve the health and lives of people living with HIV. PMID:29474486

Building climate adaptation capabilities through technology and community

NASA Astrophysics Data System (ADS)

Murray, D.; McWhirter, J.; Intsiful, J. D.; Cozzini, S.

2011-12-01

To effectively plan for adaptation to changes in climate, decision makers require infrastructure and tools that will provide them with timely access to current and future climate information. For example, climate scientists and operational forecasters need to access global and regional model projections and current climate information that they can use to prepare monitoring products and reports and then publish these for the decision makers. Through the UNDP African Adaption Programme, an infrastructure is being built across Africa that will provide multi-tiered access to such information. Web accessible servers running RAMADDA, an open source content management system for geoscience information, will provide access to the information at many levels: from the raw and processed climate model output to real-time climate conditions and predictions to documents and presentation for government officials. Output from regional climate models (e.g. RegCM4) and downscaled global climate models will be accessible through RAMADDA. The Integrated Data Viewer (IDV) is being used by scientists to create visualizations that assist the understanding of climate processes and projections, using the data on these as well as external servers. Since RAMADDA is more than a data server, it is also being used as a publishing platform for the generated material that will be available and searchable by the decision makers. Users can wade through the enormous volumes of information and extract subsets for their region or project of interest. Participants from 20 countries attended workshops at ICTP during 2011. They received training on setting up and installing the servers and necessary software and are now working on deploying the systems in their respective countries. This is the first time an integrated and comprehensive approach to climate change adaptation has been widely applied in Africa. It is expected that this infrastructure will enhance North-South collaboration and improve the delivery of technical support and services. This improved infrastructure will enhance the capacity of countries to provide a wide range of robust products and services in a timely manner.

Evaluation of Commercially Available Diagnostic Tests for the Detection of Dengue Virus NS1 Antigen and Anti-Dengue Virus IgM Antibody

PubMed Central

Hunsperger, Elizabeth A.; Yoksan, Sutee; Buchy, Philippe; Nguyen, Vinh Chau; Sekaran, Shamala Devi; Enria, Delia A.; Vazquez, Susana; Cartozian, Elizabeth; Pelegrino, Jose L.; Artsob, Harvey; Guzman, Maria G.; Olliaro, Piero; Zwang, Julien; Guillerm, Martine; Kliks, Susie; Halstead, Scott; Peeling, Rosanna W.; Margolis, Harold S.

2014-01-01

Commercially available diagnostic test kits for detection of dengue virus (DENV) non-structural protein 1 (NS1) and anti-DENV IgM were evaluated for their sensitivity and specificity and other performance characteristics by a diagnostic laboratory network developed by World Health Organization (WHO), the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and the Pediatric Dengue Vaccine Initiative (PDVI). Each network laboratory contributed characterized serum specimens for the panels used in the evaluation. Microplate enzyme-linked immunosorbent assay (ELISA) and rapid diagnostic test (RDT formats) were represented by the kits. Each ELISA was evaluated by 2 laboratories and RDTs were evaluated by at least 3 laboratories. The reference tests for IgM anti-DENV were laboratory developed assays produced by the Armed Forces Research Institute for Medical Science (AFRIMS) and the Centers for Disease Control and Prevention (CDC), and the NS1 reference test was reverse transcriptase polymerase chain reaction (RT-PCR). Results were analyzed to determine sensitivity, specificity, inter-laboratory and inter-reader agreement, lot-to-lot variation and ease-of-use. NS1 ELISA sensitivity was 60–75% and specificity 71–80%; NS1 RDT sensitivity was 38–71% and specificity 76–80%; the IgM anti-DENV RDTs sensitivity was 30–96%, with a specificity of 86–92%, and IgM anti-DENV ELISA sensitivity was 96–98% and specificity 78–91%. NS1 tests were generally more sensitive in specimens from the acute phase of dengue and in primary DENV infection, whereas IgM anti-DENV tests were less sensitive in secondary DENV infections. The reproducibility of the NS1 RDTs ranged from 92-99% and the IgM anti-DENV RDTs from 88–94%. PMID:25330157

Assessment of impacts of climate change on gender in the context of Nepal

NASA Astrophysics Data System (ADS)

Paudel, R.; Acharya, A.

2016-12-01

Climate change and its impact on gender in the context of Nepal has not been clearly understood due to lack of proper scientific research in terms of gender and climate change. Climate induced disasters such as droughts, floods, GLOFs, and landslides affect men and women differently. This study is conducted to analyze the scenario of gender equality, and impacts of climate change on gender in Nepal. This study also identifies gender based adaptation approaches through the use of observed climate data, and projected and modeled demographic data such as Adolescent Fertility Rate, Labor Force Participation Rate, and Maternal Mortality Ratio. The major tasks of this project include the calculation of Gender Inequality Index (GII), trend analysis and correlation between GII and temperature, that helps to evaluate the women vulnerability and identify the gender based adaptation interventions in Nepal. The required data on gender and temperature are obtained from World Bank and Department of Hydrology and Meteorology, Nepal. GII is calculated for almost 26 years starting from the year 1990 by utilizing a tool "Calculating the Indices using Excel" provided through the UNDP. The Reproductive Health Index (RHI), Empowerment Index (EI), and Labor Market Index (LMI) that are required to determine GII are also calculated through the use of same tool. The trend analysis shows that GII follows a decreasing trend indicating higher gender equality. The correlation analysis shows the temperature positively correlated with RHI (r=0.64), EI Female (r=0.61), and EI Male (r=0.73). In case of LMI, temperature is positively correlated with female (r=0.14) and negatively correlated with male (r=-0.57). The analysis depicts negative correlation (r=-0.68) between climate change and GII. This research will provide some valuable insights in the research relating to gender and climate change that could help gender advocates and policymakers in developing further plans for women empowerment.

Recommendations of the International Symposium on Contraceptive Research and Development for the Year 2000 and Beyond.

PubMed

1993-01-01

The government of Mexico and the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction organized an international symposium on "Contraceptive Research and Development for the Year 2000 and Beyond" that was held March 8-10, 1993 in Mexico City. 11 recommendations were established: 1) reproductive and sexual health should be given priority in both governmental and nongovernmental health research agendas, with coordination and collaboration between public and private sectors, nationally and internationally; 2) more funds should be provided by international donors for such research in developing countries; 3) women's health advocates and potential users should be represented on advisory bodies and in the decision making processes; 4) the existing health infrastructure and family planning services available, method potential, and safeguards concerning safety, effectiveness, and consent should be considered before adopting a new procedure; 5) "basic biomedical, technological, clinical, epidemiological, and social science research" leading to new or improved methods that are safe, effective, affordable, suitable for different age groups and designed in response to user's needs should receive increased support; 6) support should also be increased for "introductory, sociocultural, programmatic, operational, epidemiological, and qualitative research" that improves information, method, or service delivery; 7) research is needed on sexuality, gender roles, and gender relationships in different cultures; in particular, on discrimination and violence against women, sexual behavior, risk taking attitudes toward disease transmission and pregnancy, men's perceived needs, and the reasons for refusal of or inability to use services available; 8) industry, especially in developing countries, should collaborate with national regulatory agencies in order to expedite the process of development; 9) research should be undertaken that ensures quality abortion services that are safe, affordable, and accessible; 10) special attention should be given to the needs of adolescents; and 11) research findings should be disseminated to policy and opinion makers, providers and users of methods, and the general public and applied to problem solving.

More than 5000 patients with metastatic melanoma in Europe per year do not have access to recommended first-line innovative treatments.

PubMed

Kandolf Sekulovic, L; Peris, K; Hauschild, A; Stratigos, A; Grob, J-J; Nathan, P; Dummer, R; Forsea, A-M; Hoeller, C; Gogas, H; Demidov, L; Lebbe, C; Blank, C; Olah, J; Bastholt, L; Herceg, D; Neyns, B; Vieira, R; Hansson, J; Rutkowski, P; Krajsova, I; Bylaite-Bucinskiene, M; Zalaudek, I; Maric-Brozic, J; Babovic, N; Banjin, M; Putnik, K; Weinlich, G; Todorovic, V; Kirov, K; Ocvirk, J; Zhukavets, A; Kukushkina, M; De La Cruz Merino, L; Ymeri, A; Risteski, M; Garbe, C

2017-04-01

Despite the efficacy of innovative treatments for metastatic melanoma, their high costs has led to disparities in cancer care among different European countries. We analysed the availability of these innovative therapies in Europe and estimated the number of patients without access to first-line recommended treatment per current guidelines of professional entities such as the European Society for Medical Oncology (ESMO), the European Organisation for Research and Treatment of Cancer (EORTC), the European Association of Dermato-Oncology (EADO), and European Dermatology Forum (EDF). Web-based online survey was conducted in 30 European countries with questions about the treatment schedules from 1st May 2015 to 1st May 2016: number of metastatic melanoma patients, registration and reimbursement of innovative medicines (updated data, as of 1st October 2016), percentage of patients treated and availability of clinical studies and compassionate-use programmes. The recommended BRAF inhibitor (BRAFi) + MEK inhibitor (MEKi) combination was both registered and fully reimbursed in 9/30 (30%) countries, and in 13/30 (43%) (all from Eastern Europe) not reimbursed. First-line immunotherapy with anti-PD1 antibodies was registered and fully reimbursed in 14/30 (47%) countries, while in 13/30 (43%) (all from Eastern Europe) not reimbursed. It was estimated that in Europe 19,600 patients with metastatic melanoma are treated, and 5238 (27%) do not have access to recommended first-line therapy. Significant correlation was found between human development index (HDI, UNDP report 2015), (r = 0.662; p < 0.001), health expenditure per capita (r = 0.695; p < 0.001) and the Mackenbach score of health policy performance (r = 0.765; p < 0.001) with the percentage of patients treated with innovative medicines and a number of reimbursed medicines. Great discrepancy exists in metastatic melanoma treatment across Europe. It is crucial to increase the awareness of national and European policymakers, oncological societies, melanoma patients' associations and pharma industry. Copyright © 2017 Elsevier Ltd. All rights reserved.

Social inequalities, regional disparities and health inequity in North African countries.

PubMed

Boutayeb, Abdesslam; Helmert, Uwe

2011-05-31

During the last decades, North African countries have substantially improved economic, social and health conditions of their populations in average. In all countries, human development in general and life expectancy, literacy and per capita income in particular have increased. However, improvement was not equally shared between groups of different milieu, regions or level of income. Social inequalities and health inequity have persisted or even worsened. Data are generally scarce and few studies were devoted to this topic in North Africa as a region. In this paper, we carry out a comparative study on the achievements of these countries, not only in terms of human development and its components but also in terms of inequalities' reduction and health equity. This study is based on data available for comparison between North African countries. The main data sources are provided by reports released by the World Health Organisation (WHO), United Nations Development Programme (UNDP), United Nations Children's Fund (UNICEF), the World Bank, surveys such as Demographic Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) and finally recent papers published on equity in different countries of the region. There is no doubt that education, health and human development in general have improved in North Africa during the last decades. Improvement was, however, uneven and unequally enjoyed by different socioeconomic groups. Indeed, each country included in this study shows large urban-rural disparities, discrepancies between advantaged and disadvantaged regions and cities; and unacceptable differences between rich and poor. Health inequity is particularly seen through access to health services and infant mortality. During the last decades, North African decision makers have endeavoured to improve social and economic conditions of their populations. Globally, health, education and living standard in general have substantially improved in average. However, North African countries have still a long way to go to reduce social inequalities and health inequity at different levels: rural-urban, advantaged-marginalised regions and cities, between groups of different level of income and wealth. The challenge for the next decade is not only to improve economic, social and health conditions in average but also and mainly to reduce avoidable inequalities in parallel.

Water for Two Worlds: Designing Terrestrial Applications for Exploration-class Sanitation Systems

NASA Technical Reports Server (NTRS)

Adams, Constance; Andersson, Ingvar; Feighery, John

2004-01-01

At the United Nations Millennium Summit in September of 2000, the world leaders agreed on an ambitious agenda for reducing poverty and improving lives: the Millennium Development Goals (MDGs), a list of issues they consider highly pernicious, threatening to human welfare and, thereby, to global security and prosperity. Among the eight goals are included fundamental human needs such as the eradication of extreme poverty and hunger, the promotion of gender equality, the reduction of child mortality and improvement of maternal health, and ensuring the sustainability of our shared environment. In order to help focus the efforts to meet these goals, the United Nations (UN) has established a set of eighteen concrete targets, each with an associated schedule. Among these is Target 10: "By 2015, reduce by half the proportion of people without access to safe drinking water." A closely related target of equal dignity was agreed at the World Summit on Sustainable Development (Johannesburg, September 2002): "By 2015, reduce by half the proportion of people without access to basic sanitation." One of the greatest successes in the development of Exploration-class technologies for closed-loop, sustainable support of long-duration human space missions has been the work both ESA and NASA have done in bioregenerative water reclamation (WRS), and secondarily, in solid-waste management. Solid-waste and WRS systems tend to be combined in the commercial world into the field of sanitation, although as we will see, the most essential principles of sustainable terrestrial sanitation actually insist upon the separation of solid and liquid excreta. Seeing the potential synergy between the space program ALS technologies developed for Mars and the urgent needs of hundreds of millions of people for secure access to clean water here on Earth, we set out to organize the adaptation of these technologies to help the United Nations Development Programme (UNDP) meet Target 10. In this paper, we will summarize the issues and results of the first "Water for Two Worlds" summit held in January of this year, describe,the status of the sustainable sanitation systems that are on the table for adaptation to widespread terrestrial use, and present fundamental strategies for forward work.

Geographical disparities in HIV prevalence and care among men who have sex with men in Malawi: results from a multisite cross-sectional survey.

PubMed

Wirtz, Andrea L; Trapence, Gift; Kamba, Dunker; Gama, Victor; Chalera, Rodney; Jumbe, Vincent; Kumwenda, Rosemary; Mangochi, Marriam; Helleringer, Stephane; Beyrer, Chris; Baral, Stefan

2017-06-01

Epidemiological assessment of geographical heterogeneity of HIV among men who have sex with men (MSM) is necessary to inform HIV prevention and care strategies in the more generalised HIV epidemics across sub-Saharan Africa, including Malawi. We aimed to measure the HIV prevalence, risks, and access to HIV care among MSM across multiple localities to better inform HIV programming for MSM in Malawi. Between Aug 1, 2011, and Sept 13, 2014, we recruited MSM into cross-sectional research via respondent-driven sampling (RDS) in seven districts of Malawi. RDS and site weights were used to estimate national HIV prevalence and engagement in care and in multilevel regression models to identify correlates of prevalent HIV infection. The comparative prevalence ratio of HIV among MSM relative to adult men was calculated by use of direct age-stratification. 2453 MSM were enrolled with a population HIV prevalence of 18·2% (95% CI 15·5-21·2), as low as 4·1% (2·2-7·6) in Mzuzu and as high as 24·5% (19·5-30·3) in Mulanje. The comparative HIV prevalence ratio was 2·52 when comparing MSM with the adult male population. Age-stratified HIV prevalence showed early onset of infection with 11·8% (95% CI 7·3-18·4) of MSM aged 18-19 years HIV infected. Factors positively associated with HIV infection included being aged 21-30 years and reporting female or transgender identity. Among HIV infected MSM, less than 1% reported ever being diagnosed with HIV infection (0·9%, 95% CI 0·4-2·5) and initiated antiretroviral treatment (0·2%, 0·2-0·3). HIV disproportionately affects MSM in Malawi with disparities sustained across the HIV care continuum. These issues are geographically heterogeneous and begin among young MSM, supporting geographically focused and age-specific approaches to confidential HIV testing with linkage to HIV services. Malawi Department of Nutrition, HIV and AIDS (DNHA), UNDP, UNFPA, UNAIDS, and UNICEF. Copyright © 2017 Elsevier Ltd. All rights reserved.

The essence of governance in health development.

PubMed

Kirigia, Joses Muthuri; Kirigia, Doris Gatwiri

2011-03-28

Governance and leadership in health development are critically important for the achievement of the health Millennium Development Goals (MDGs) and other national health goals. Those two factors might explain why many countries in Africa are not on track to attain the health MDGs by 2015. This paper debates the meaning of 'governance in health development', reviews briefly existing governance frameworks, proposes a modified framework on health development governance (HDG), and develops a HDG index. We argue that unlike 'leadership in health development', 'governance in health development' is the sole prerogative of the Government through the Ministry of Health, which can choose to delegate (but not abrogate) some of the governance tasks. The general governance domains of the UNDP and the World Bank are very pertinent but not sufficient for assessment of health development governance. The WHO six domains of governance do not include effective external partnerships for health, equity in health development, efficiency in resource allocation and use, ethical practises in health research and service provision, and macroeconomic and political stability. The framework for assessing health systems governance developed by Siddiqi et al also does not include macroeconomic and political stability as a separate principle. The Siddiqi et al framework does not propose a way of scoring the various governance domains to facilitate aggregation, inter-country comparisons and health development governance tracking over time.This paper argues for a broader health development governance framework because other sectors that assure human rights to education, employment, food, housing, political participation, and security combined have greater impact on health development than the health systems. It also suggests some amendments to Siddigi et al's framework to make it more relevant to the broader concept of 'governance in health development' and to the WHO African Region context. A strong case for broader health development governance framework has been made. A health development governance index with 10 functions and 42 sub-functions has been proposed to facilitate inter-country comparisons. Potential sources of data for estimating HDGI have been suggested. The Governance indices for individual sub-functions can aid policy-makers to establish the sources of weak health governance and subsequently develop appropriate interventions for ameliorating the situation.

National Satellite Land Monitoring Systems for REDD+ : the UN-REDD support to countries

NASA Astrophysics Data System (ADS)

Jonckheere, I. G. C.

2015-12-01

REDD+, which stands for 'Reducing Emissions from Deforestation and Forest Degradation in Developing Countries' - is a climate mitigation effort and aims to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. The UN-REDD Programme, a collaborative partnership between FAO, UNDP and UNEP launched in September 2008, supports nationally-led REDD+ processes and promotes the imeaningful involvement of all stakeholders, including Indigenous Peoples and other forest-dependent communities, in national and international REDD+ implementation.The Programme supports national REDD+ readiness efforts in partner countries spanning Africa, Asia-Pacific and Latin America, in two ways: (i) direct support to the design and implementation of UN-REDD National Programmes; and (ii) complementary support to national REDD+ action through common approaches, analyses, methodologies, tools, data and best practices. The UN-REDD Programme currently supports 62 partner countries. The UN-REDD Programme gathers technical teams from around the world to develop common approaches, analyses and guidelines on issues such as measurement, reporting and verification (MRV) of carbon emissions and flows, remote sensing, and greenhouse gas inventories. Within the partnership, FAO supports countries on technical issues related to forestry and the development of cost effective and credible MRV processes for emission reductions. While at the international level, it fosters improved guidance on MRV approaches, including consensus on principles and guidelines for MRV and training programmes. It provides guidance on how best to design and implement REDD, to ensure that forests continue to provide multiple benefits for livelihoods and biodiversity to societies while storing carbon at the same time. Other areas of work include national forest assessments and monitoring of in-country policy and institutional change. The outcomes about the role of satellite remote sensing technologies as a tool for national monitoring under the REDD+ mechanism are here presented. Some specific country examples will be shown and the current use(fulness) of radar and high resolution data is discussed.

Building policy-making capacity in the Ministry of Health: the Kazakhstan experience.

PubMed

Chanturidze, Tata; Adams, Orvill; Tokezhanov, Bolat; Naylor, Mike; Richardson, Erica

2015-01-20

Recent economic growth in Kazakhstan has been accompanied by slower improvements in population health and this has renewed impetus for health system reform. Strengthening strategic planning and policy-making capacity in the Ministry of Health has been identified as an important priority, particularly as the Ministry of Health is leading the health system reform process. The intervention was informed by the United Nations Development Programme (UNDP) framework for capacity building which views capacity building as an ongoing process embedded in local institutions and practices. In response to local needs extra elements were included in the framework to tailor the capacity building programme according to the existing policy and budget cycles and respective competence requirements, and link it with transparent career development structures of the Ministry of Health. This aspect of the programme was informed by the institutional capability assessment model used by the United Kingdom National Health Service (NHS) which was adapted to examine the specific organizational and individual competences of the Ministry of Health in Kazakhstan. There were clear successes in building capacity for policy making and strategic planning within the Ministry of Health in Kazakhstan, including better planned, more timely and in-depth responses to policy assignments. Embedding career development as a part of this process was more challenging. This case study highlights the importance of strong political will and high level support for capacity building in ensuring the sustainability of programmes. It also shows that capacity-building programmes need to ensure full engagement with all local stakeholders, or where this is not possible, programmes need to be targeted narrowly to those stakeholders who will benefit most, for the greatest impact to be achieved. In sum, high quality tailor-made capacity development programmes should be based on thorough needs assessment of individual and organizational competences in a specific institutional setting. The experience showed that complementary approaches to human resource development worked effectively in the context of organizations and systems, where an enabling environment was present, and country ownership and political will was complemented by strong technical assistance to design and deliver high quality tailor-made capacity building initiatives.

FAO UN-REDD- INPE Joint Programme on Forest Monitoring Systems based on RS and GIS techniques

NASA Astrophysics Data System (ADS)

Jonckheere, I. G.; FAO UN-REDD MRV Team

2010-12-01

Capacity Development and Training for National Forest Monitoring Systems for Reducing Emissions from Deforestation and Forest Degradation in Developing Countries (REDD+) REDD+, which stands for ’Reducing Emissions from Deforestation and Forest Degradation in Developing Countries’ - is an effort to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. The UN-REDD Programme, a collaborative partnership between FAO, UNDP and UNEP launched in September 2008, supports countries to develop capacity to REDD+ and to implement a future REDD+ mechanism in a post-2012 climate regime. The programme works at both the national and global scale, through support mechanisms for country-driven REDD strategies and international consensus-building on REDD+ processes. The UN-REDD Programme gathers technical teams from around the world to develop common approaches, analyses and guidelines on issues such as measurement, reporting and verification (MRV) of carbon emissions and flows, remote sensing, and greenhouse gas inventories. Within the partnership, FAO supports countries on technical issues related to forestry and the development of cost effective and credible MRV processes for emission reductions. While at the international level, it fosters improved guidance on MRV approaches, including consensus on principles and guidelines for MRV and training programmes. It provides guidance on how best to design and implement REDD+, to ensure that forests continue to provide multiple benefits for livelihoods and biodiversity to societies while storing carbon at the same time. Other areas of work include national forest assessments and monitoring of in-country policy and institutional change. FAO and INPE (Brazilian Space Agency) have joint forces through a MoU signed last year in Copenhagen. A major joint programme has been agreed upon to set up national forest satellite monitoring systems in the developing countries and to train them in order to get them ready for REDD+. The outcomes about the role of satellite remote sensing technologies as a tool for monitoring, assessment, reporting and verification of carbon credits and co-benefits under the REDD+ mechanism are here presented.

Significance of ground-water chemistry in performance of North Sahara Tube wells in Algeria and Tunisia

USGS Publications Warehouse

Clarke, Frank Eldridge; Jones, Blair F.

1972-01-01

Nine ground-water samples from the principal shallow and deep North Sahara aquifers of Algeria and Tunisia were examined to determine the relation of their chemical composition to corrosion and mineral encrustation thought to be contributing to observed decline in well capacities within a UNESCO/UNDP Special Fund Project area. Although the shallow and deep waters differ significantly in certain quality factors, all are sulfochloride types with corrosion potentials ranging from moderate to extreme. None appear to be sufficiently supersaturated with troublesome mineral species to cause rapid or severe encrustation of filter pipes or other well parts. However, calcium carbonate encrustation of deep-well cooling towers and related irrigation pipes can be expected because of loss of carbon dioxide and water during evaporative cooling. Corrosion products, particularly iron sulfide, can be expected to deposit in wells producing waters from the deep aquifers. This could reduce filterpipe openings and increase casing roughness sufficiently to cause significant reduction in well capacity. It seems likely, however, that normal pressure reduction due to exploitation of the artesian systems is a more important control of well performance. If troublesome corrosion and related encrustation are confirmed by downhole inspection, use of corrosion-resisting materials, such as fiber-glass casing and saw-slotted filter pipe (shallow wells only), or stainless-steel screen, will minimize the effects of the waters represented by these samples. A combination of corrosion-resisting stainless steel filter pipe electrically insulated from the casing with a nonconductive spacer and cathodic protection will minimize external corrosion of steel casing, if this is found to be a problem. However, such installations are difficult to make in very deep wells and difficult to control in remote areas. Both the shallow waters and the deep waters examined in this study will tend to cause soil salinization because their salt contents are relatively high, and both have sodium absorption ratios which are unfavorable to sodium-sensitive soils and vegetation. Proper drainage and soil treatment are the only means of overcoming these problems during irrigation.

The essence of governance in health development

PubMed Central

2011-01-01

Background Governance and leadership in health development are critically important for the achievement of the health Millennium Development Goals (MDGs) and other national health goals. Those two factors might explain why many countries in Africa are not on track to attain the health MDGs by 2015. This paper debates the meaning of 'governance in health development', reviews briefly existing governance frameworks, proposes a modified framework on health development governance (HDG), and develops a HDG index. Discussion We argue that unlike 'leadership in health development', 'governance in health development' is the sole prerogative of the Government through the Ministry of Health, which can choose to delegate (but not abrogate) some of the governance tasks. The general governance domains of the UNDP and the World Bank are very pertinent but not sufficient for assessment of health development governance. The WHO six domains of governance do not include effective external partnerships for health, equity in health development, efficiency in resource allocation and use, ethical practises in health research and service provision, and macroeconomic and political stability. The framework for assessing health systems governance developed by Siddiqi et al also does not include macroeconomic and political stability as a separate principle. The Siddiqi et al framework does not propose a way of scoring the various governance domains to facilitate aggregation, inter-country comparisons and health development governance tracking over time. This paper argues for a broader health development governance framework because other sectors that assure human rights to education, employment, food, housing, political participation, and security combined have greater impact on health development than the health systems. It also suggests some amendments to Siddigi et al's framework to make it more relevant to the broader concept of 'governance in health development' and to the WHO African Region context. Summary A strong case for broader health development governance framework has been made. A health development governance index with 10 functions and 42 sub-functions has been proposed to facilitate inter-country comparisons. Potential sources of data for estimating HDGI have been suggested. The Governance indices for individual sub-functions can aid policy-makers to establish the sources of weak health governance and subsequently develop appropriate interventions for ameliorating the situation. PMID:21443766

The special programme of research in human reproduction: forty years of activities to achieve reproductive health for all.

PubMed

Benagiano, Giuseppe; d'Arcangues, Catherine; Harris Requejo, Jennifer; Schafer, Alessandra; Say, Lale; Merialdi, Mario

2012-01-01

The Special Programme of Research in Human Reproduction (HRP), co-sponsored by the UNDP, UNFPA, WHO, and the World Bank, is celebrating 40 years of activities with an expansion of its mandate and new co-sponsors. When it began, in 1972, the main focus was on evaluating the acceptability, effectiveness, and safety of existing fertility-regulating methods, as well as developing new, improved modalities for family planning. In 1994, HRP not only made major contributions to the Plan of Action of the International Conference on Population and Development (ICPD); it also broadened its scope of work to include other aspects of health dealing with sexuality and reproduction, adding a specific perspective on gender issues and human rights. In 2002, HRP's mandate was once again broadened to include sexually transmitted infections and HIV/AIDS and in 2003 it was further expanded to research activities on preventing violence against women and its many dire health consequences. Today, the work of the Programme includes research on: the sexual and reproductive health of adolescents, women, and men; maternal and perinatal health; reproductive tract and sexually transmitted infections (including HIV/AIDS); family planning; infertility; unsafe abortion; sexual health; screening for cancer of the cervix in developing countries, and gender and reproductive rights. Additional activities by the Programme have included: fostering international cooperation in the field of human reproduction; the elaboration of WHO's first Global Reproductive Health Strategy; work leading to the inclusion of ICPD's goal 'reproductive health for all by 2015' into the Millennium Development Goal framework; the promotion of critical interagency statements on the public health, legal, and human rights implications of female genital mutilation and gender-biased sex selection. Finally, HRP has been involved in the creation of guidelines and tools, such as the 'Medical eligibility criteria for contraceptive use', the 'Global handbook for family planning providers', the 'Definition of core competencies in primary health care', and designing tools for operationalizing a human rights approach to sexual and reproductive health programmes. Copyright © 2012 S. Karger AG, Basel.

Tracking the career development of scientists in low- and middle-income countries trained through TDR's research capacity strengthening programmes: Learning from monitoring and impact evaluation.

PubMed

Halpaap, Béatrice; Vahedi, Mahnaz; Certain, Edith; Alvarado, Tini; Saint Martin, Caroline; Merle, Corinne; Mihut, Michael; Launois, Pascal

2017-12-01

The Special Programme for Research and Training in Tropical Diseases (TDR) co-sponsored by UNICEF, UNDP, World Bank and WHO has been supporting research capacity strengthening in low- and middle-income countries for over 40 years. In order to assess and continuously optimize its capacity strengthening approaches, an evaluation of the influence of TDR training grants on research career development was undertaken. The assessment was part of a larger evaluation conducted by the European Science Foundation. A comprehensive survey questionnaire was developed and sent to a group of 117 trainees supported by TDR who had completed their degree (masters or PhD) between 2000 and 2012; of these, seventy seven (77) responded. Most of the respondents (80%) rated TDR support as a very important factor that influenced their professional career achievements. The "brain drain" phenomenon towards high-income countries was particularly low amongst TDR grantees: the rate of return to their region of origin upon completion of their degree was 96%. A vast majority of respondents are still working in research (89%), with 81% of respondents having participated in multidisciplinary research activities; women engaged in multidisciplinary collaboration to a higher extent than men. However, only a minority of all have engaged in intersectoral collaboration, an aspect that would require further study. The post-degree career choices made by the respondents were strongly influenced by academic considerations. At the time of the survey, 92% of all respondents hold full-time positions, mainly in the public sector. Almost 25% of the respondents reported that they had influenced policy and practice changes. Some of the challenges and opportunities faced by trainees at various stages of their research career have been identified. Modalities to overcome these will require further investigation. The survey evidenced how TDR's research capacity grant programmes made a difference on researchers' career development and on south-south collaborations, by strengthening and localizing research capacity in lower income regions, and also showed there is more that needs to be done. The factors involved, challenges and lessons learnt may help donors and policy makers improve their future interventions with regard to designing capacity strengthening programmes and setting funding priorities.

The impact of delays on maternal and neonatal outcomes in Ugandan public health facilities: the role of absenteeism.

PubMed

Ackers, Louise; Ioannou, Elena; Ackers-Johnson, James

2016-11-01

Maternal mortality in low- and middle-income countries continues to remain high. The Ugandan Ministry of Health's Strategic Plan suggests that little, if any, progress has been made in Uganda in terms of improvements in Maternal Health [Millennium Development Goal (MDG) 5] and, more specifically, in reducing maternal mortality. Furthermore, the UNDP report on the MDGs describes Uganda's progress as 'stagnant'. The importance of understanding the impact of delays on maternal and neonatal outcomes in low resource settings has been established for some time. Indeed, the '3-delays' model has exposed the need for holistic multi-disciplinary approaches focused on systems change as much as clinical input. The model exposes the contribution of social factors shaping individual agency and care-seeking behaviour. It also identifies complex access issues which, when combined with the lack of timely and adequate care at referral facilities, contributes to extensive and damaging delays. It would be hard to find a piece of research on this topic that does not reference human resource factors or 'staff shortages' as a key component of this 'puzzle'. Having said that, it is rare indeed to see these human resource factors explored in any detail. In the absence of detailed critique (implicit) 'common sense' presumptions prevail: namely that the economic conditions at national level lead to inadequacies in the supply of suitably qualified health professionals exacerbated by losses to international emigration. Eight years' experience of action-research interventions in Uganda combining a range of methods has lead us to a rather stark conclusion: the single most important factor contributing to delays and associated adverse outcomes for mothers and babies in Uganda is the failure of doctors to be present at work during contracted hours. Failure to acknowledge and respond to this sensitive problem will ultimately undermine all other interventions including professional voluntarism which relies on local 'co-presence' to be effective. Important steps forward could be achieved within the current resource framework, if the political will existed. International NGOs have exacerbated this problem encouraging forms of internal 'brain drain' particularly among doctors. Arguably the system as it is rewards doctors for non-compliance resulting in massive resource inefficiencies. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

The impact of delays on maternal and neonatal outcomes in Ugandan public health facilities: the role of absenteeism

PubMed Central

Ackers, Louise; Ioannou, Elena; Ackers-Johnson, James

2016-01-01

Maternal mortality in low- and middle-income countries continues to remain high. The Ugandan Ministry of Health’s Strategic Plan suggests that little, if any, progress has been made in Uganda in terms of improvements in Maternal Health [Millennium Development Goal (MDG) 5] and, more specifically, in reducing maternal mortality. Furthermore, the UNDP report on the MDGs describes Uganda’s progress as ‘stagnant’. The importance of understanding the impact of delays on maternal and neonatal outcomes in low resource settings has been established for some time. Indeed, the ‘3-delays’ model has exposed the need for holistic multi-disciplinary approaches focused on systems change as much as clinical input. The model exposes the contribution of social factors shaping individual agency and care-seeking behaviour. It also identifies complex access issues which, when combined with the lack of timely and adequate care at referral facilities, contributes to extensive and damaging delays. It would be hard to find a piece of research on this topic that does not reference human resource factors or ‘staff shortages’ as a key component of this ‘puzzle’. Having said that, it is rare indeed to see these human resource factors explored in any detail. In the absence of detailed critique (implicit) ‘common sense’ presumptions prevail: namely that the economic conditions at national level lead to inadequacies in the supply of suitably qualified health professionals exacerbated by losses to international emigration. Eight years’ experience of action-research interventions in Uganda combining a range of methods has lead us to a rather stark conclusion: the single most important factor contributing to delays and associated adverse outcomes for mothers and babies in Uganda is the failure of doctors to be present at work during contracted hours. Failure to acknowledge and respond to this sensitive problem will ultimately undermine all other interventions including professional voluntarism which relies on local ‘co-presence’ to be effective. Important steps forward could be achieved within the current resource framework, if the political will existed. International NGOs have exacerbated this problem encouraging forms of internal ‘brain drain’ particularly among doctors. Arguably the system as it is rewards doctors for non-compliance resulting in massive resource inefficiencies. PMID:27142803

Tracking the career development of scientists in low- and middle-income countries trained through TDR’s research capacity strengthening programmes: Learning from monitoring and impact evaluation

PubMed Central

Halpaap, Béatrice; Vahedi, Mahnaz; Certain, Edith; Alvarado, Tini; Saint Martin, Caroline; Merle, Corinne; Mihut, Michael

2017-01-01

The Special Programme for Research and Training in Tropical Diseases (TDR) co-sponsored by UNICEF, UNDP, World Bank and WHO has been supporting research capacity strengthening in low- and middle-income countries for over 40 years. In order to assess and continuously optimize its capacity strengthening approaches, an evaluation of the influence of TDR training grants on research career development was undertaken. The assessment was part of a larger evaluation conducted by the European Science Foundation. A comprehensive survey questionnaire was developed and sent to a group of 117 trainees supported by TDR who had completed their degree (masters or PhD) between 2000 and 2012; of these, seventy seven (77) responded. Most of the respondents (80%) rated TDR support as a very important factor that influenced their professional career achievements. The “brain drain” phenomenon towards high-income countries was particularly low amongst TDR grantees: the rate of return to their region of origin upon completion of their degree was 96%. A vast majority of respondents are still working in research (89%), with 81% of respondents having participated in multidisciplinary research activities; women engaged in multidisciplinary collaboration to a higher extent than men. However, only a minority of all have engaged in intersectoral collaboration, an aspect that would require further study. The post-degree career choices made by the respondents were strongly influenced by academic considerations. At the time of the survey, 92% of all respondents hold full-time positions, mainly in the public sector. Almost 25% of the respondents reported that they had influenced policy and practice changes. Some of the challenges and opportunities faced by trainees at various stages of their research career have been identified. Modalities to overcome these will require further investigation. The survey evidenced how TDR’s research capacity grant programmes made a difference on researchers’ career development and on south-south collaborations, by strengthening and localizing research capacity in lower income regions, and also showed there is more that needs to be done. The factors involved, challenges and lessons learnt may help donors and policy makers improve their future interventions with regard to designing capacity strengthening programmes and setting funding priorities. PMID:29216192

Poverty and inequality - but of what - as social determinants of health in Africa?

PubMed

Worku, Eshetu B; Woldesenbet, Selamawit A

2015-12-01

Many African economies have achieved substantial economic growth over the past recent years, yet several of the Millennium Development Goals (MDGs) including those concerned with health, remain considerably behind target. This paper examines whether progress towards these goals is being hampered by existing levels of poverty and income inequality. It also considers whether the inequality hypothesis of Wilkinson and Pickett1 applies to population health outcomes in African states. Correlation analysis and scatter plots were used to assess graphically the link between variations in health outcomes, level of poverty and income inequality in different countries. Health status outcomes were measured by using four indicators: infant and under-five (child) mortality rates; maternal mortality ratios; and life expectancy at birth. In each of the 52 African nations, the proportion of the population living below the poverty line is used as an indicator of the level of poverty and Gini coefficient as a measure of income inequality. The study used a comprehensive review of secondary and relevant literature that are pertinent in the subject area. The data datasets obtained online from UNICEF2 and UNDP3 (2009) used to test the research questions. World Health Organization the three broad dimensions to consider when moving towards better population health outcome through Universal Health Coverage and the Social Determinants of Health framework reviewed to establish the poverty and income inequality link in African countries population health outcomes. The study shows that poverty is strongly associated with all health outcome differences in Africa (IMR, cc = 0.63; U5MR, cc = 0.64; MMR, cc = 0.49; life expectancy at birth, cc = -0.67); income inequality with only one of the four indicators (IMR, cc = 0.14; U5MR, cc = 0.07; MMR, cc = 0.22; life expectancy at birth, cc = -0.49), whereas income inequality is associated with one of the four indicators. The study shows that tackling poverty should be the immediate concern in Africaas a means of promoting better health for all. There is a question mark over whether the findings of Wilkinson and Pickett1 on the relationship between income inequality and health apply to Africa. The reasons for this question mark are discussed. More research is needed to investigate whether the inequality results found in this study are replicated in other studies of African health.

An average/deprivation/inequality (ADI) analysis of chronic disease outcomes and risk factors in Argentina

PubMed Central

De Maio, Fernando G; Linetzky, Bruno; Virgolini, Mario

2009-01-01

Background Recognition of the global economic and epidemiological burden of chronic non-communicable diseases has increased in recent years. However, much of the research on this issue remains focused on individual-level risk factors and neglects the underlying social patterning of risk factors and disease outcomes. Methods Secondary analysis of Argentina's 2005 Encuesta Nacional de Factores de Riesgo (National Risk Factor Survey, N = 41,392) using a novel analytical strategy first proposed by the United Nations Development Programme (UNDP), which we here refer to as the Average/Deprivation/Inequality (ADI) framework. The analysis focuses on two risk factors (unhealthy diet and obesity) and one related disease outcome (diabetes), a notable health concern in Latin America. Logistic regression is used to examine the interplay between socioeconomic and demographic factors. The ADI analysis then uses the results from the logistic regression to identify the most deprived, the best-off, and the difference between the two ideal types. Results Overall, 19.9% of the sample reported being in poor/fair health, 35.3% reported not eating any fruits or vegetables in five days of the week preceding the interview, 14.7% had a BMI of 30 or greater, and 8.5% indicated that a health professional had told them that they have diabetes or high blood pressure. However, significant variation is hidden by these summary measures. Educational attainment displayed the strongest explanatory power throughout the models, followed by household income, with both factors highlighting the social patterning of risk factors and disease outcomes. As educational attainment and household income increase, the probability of poor health, unhealthy diet, obesity, and diabetes decrease. The analyses also point toward important provincial effects and reinforce the notion that both compositional factors (i.e., characteristics of individuals) and contextual factors (i.e., characteristics of places) are important in understanding the social patterning of chronic diseases. Conclusion The application of the ADI framework enables identification of the regions or groups worst-off for each outcome measure under study. This can be used to highlight the variation embedded within national averages; as such, it encourages a social perspective on population health indicators that is particularly attuned to issues of inequity. The ADI framework is an important tool in the evaluation of policies aiming to prevent or control chronic non-communicable diseases. PMID:19505309

Projected impacts of climate change on hydrology, water resource use and adaptation needs for the Chu and Talas cross-border rivers basin, Central Asia

NASA Astrophysics Data System (ADS)

Shamil Iliasov, Shamil; Dolgikh, Svetlana; Lipponen, Annukka; Novikov, Viktor

2014-05-01

The observed long-term trends, variability and projections of future climate and hydrology of the Chu and Talas transboundary rivers basin were analysed using a common approach for Kazakhstan and Kyrgyzstan parts of the basin. Historical, current and forecasted demands and main uses of water in the basin were elaborated by the joint effort of both countries. Such cooperative approach combining scientific data, water practitioners' outlook with decision making needs allowed the first time to produce a comprehensive assessment of climate change impacts on water resources in the Chu-Talas transboundary rivers basin, identify future needs and develop the initial set of adaptation measures and recommendations. This work was carried out under the project "Promoting Cooperation to Adapt to Climate Change in the Chu and Talas Transboundary Basin", supported by the United Nations Economic Commission for Europe (UNECE) and the United Nations Development Programme (UNDP). Climate change projections, including air temperatures and rainfall in the 21st century were determined with a spatial resolution 0.5 degrees based on the integration of 15 climate change model outputs (derived from IPCC's 4th Assessment Report, and partially 5th Assessment Report) combined with locally-designed hydrology and glacier models. A significant increase in surface air temperatures by 3-6°C may be expected in the basin area, especially in summer and autumn. This change is likely to be accompanied by rainfall increase during the cold season and a decrease in the warm half of the year. As a result, a deterioration of moisture conditions during the summer-autumn period is possible. Furthermore, milder winters and hotter summers can be expected. Mountains will likely receive more liquid precipitation, than snow, while the area and volume of glaciers may significantly reduce. Projected changes in climate and glaciers have implications for river hydrology and different sectors of the economy dependent on water use. Assessment of agricultural sector vulnerability, which is the key water user in the basin, led to identification of the potential adaptation measures and discussion with relevant national and river basin authorities and the major stakeholders. Proposed adaptation measures range from technical - such as rehabilitation of irrigation systems to reduce water losses, modernize water reservoirs and adjust river regulation to environmental flow needs, changing land use and crop diversification - to policy and finance measures, including revision of subsidies, economic consideration of ecosystem services, etc. Next steps include a more detailed assessment of economics, effectiveness and feasibility of the initially proposed adaptation measures and additional research.

Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modelling study.

PubMed

Wijesooriya, N Saman; Rochat, Roger W; Kamb, Mary L; Turlapati, Prasad; Temmerman, Marleen; Broutet, Nathalie; Newman, Lori M

2016-08-01

In 2007, WHO launched a global initiative for the elimination of mother-to-child transmission of syphilis (congenital syphilis). An important aspect of the initiative is strengthening surveillance to monitor progress towards elimination. In 2008, using a health systems model with country data inputs, WHO estimated that 1·4 million maternal syphilis infections caused 520 000 adverse pregnancy outcomes. To assess progress, we updated the 2008 estimates and estimated the 2012 global prevalence and cases of maternal and congenital syphilis. We used a health systems model approved by the Child Health Epidemiology Reference Group. WHO and UN databases provided inputs on livebirths, antenatal care coverage, and syphilis testing, seropositivity, and treatment in antenatal care. For 2012 estimates, we used data collected between 2009 and 2012. We updated the 2008 estimates using data collected between 2000 and 2008, compared these with 2012 estimates using data collected between 2009 and 2012, and performed subanalyses to validate results. In 2012, an estimated 930 000 maternal syphilis infections caused 350 000 adverse pregnancy outcomes including 143 000 early fetal deaths and stillbirths, 62 000 neonatal deaths, 44 000 preterm or low weight births, and 102 000 infected infants worldwide. Nearly 80% of adverse outcomes (274 000) occurred in women who received antenatal care at least once. Comparing the updated 2008 estimates with the 2012 estimates, maternal syphilis decreased by 38% (from 1 488 394 cases in 2008 to 927 936 cases in 2012) and congenital syphilis decreased by 39% (from 576 784 to 350 915). India represented 65% of the decrease. Analysis excluding India still showed an 18% decrease in maternal and congenital cases of syphilis worldwide. Maternal and congenital syphilis decreased worldwide from 2008 to 2012, which suggests progress towards the elimination of mother-to-child transmission of syphilis. Nonetheless, maternal syphilis caused substantial adverse pregnancy outcomes, even in women receiving antenatal care. Improved access to quality antenatal care, including syphilis testing and treatment, and robust data are all important for achieving the elimination of mother-to-child transmission of syphilis. The UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction in WHO, and the US Centers for Disease Control and Prevention. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND license. Published by Elsevier Ltd.. All rights reserved.

Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Health.

PubMed

Vogel, Joshua P; Souza, João Paulo; Gülmezoglu, A Metin; Mori, Rintaro; Lumbiganon, Pisake; Qureshi, Zahida; Carroli, Guillermo; Laopaiboon, Malinee; Fawole, Bukola; Ganchimeg, Togoobaatar; Zhang, Jun; Torloni, Maria Regina; Bohren, Meghan; Temmerman, Marleen

2014-11-22

Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries. WHOMCS is a facility-based, cross-sectional survey database of birth outcomes in 359 facilities in 29 countries, with data collected prospectively from May 1, 2010, to Dec 31, 2011. For this analysis, we included deliveries after 22 weeks' gestation and we excluded births that occurred outside a facility or quicker than 3 h after arrival. We calculated use of antenatal corticosteroids in women who gave birth between 26 and 34 weeks' gestation, when antenatal corticosteroids are known to be most beneficial. We also calculated use in women at 22-25 weeks' and 34-36 weeks' gestation. We assessed tocolytic drug use, with and without antenatal corticosteroids, in spontaneous, uncomplicated preterm deliveries at 26-34 weeks' gestation. Of 303,842 recorded deliveries after 22 weeks' gestation, 17,705 (6%) were preterm. 3900 (52%) of 7547 women who gave birth at 26-34 weeks' gestation, 94 (19%) of 497 women who gave birth at 22-25 weeks' gestation, and 2276 (24%) of 9661 women who gave birth at 35-36 weeks' gestation received antenatal corticosteroids. Rates of antenatal corticosteroid use varied between countries (median 54%, range 16-91%; IQR 30-68%). Of 4677 women who were potentially eligible for tocolysis drugs, 1276 (27%) were treated with bed rest or hydration and 2248 (48%) received no treatment. β-agonists alone (n=346, 7%) were the most frequently used tocolytic drug. Only 848 (18%) of potentially eligible women received both a tocolytic drug and antenatal corticosteroids. Use of interventions was generally poor, despite evidence for their benefit for newborn babies. A substantial proportion of antenatal corticosteroid use occurred at gestational ages at which benefit is controversial, and use of less effective or potentially harmful tocolytic drugs was common. Implementation research and contextualised health policies are needed to improve drug availability and increase compliance with best obstetric practice. UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); WHO; USAID; Ministry of Health, Labour and Welfare of Japan; Gynuity Health Projects. Copyright © 2014 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd. All rights reserved.

Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08.

PubMed

Lumbiganon, Pisake; Laopaiboon, Malinee; Gülmezoglu, A Metin; Souza, João Paulo; Taneepanichskul, Surasak; Ruyan, Pang; Attygalle, Deepika Eranjanie; Shrestha, Naveen; Mori, Rintaro; Nguyen, Duc Hinh; Hoang, Thi Bang; Rathavy, Tung; Chuyun, Kang; Cheang, Kannitha; Festin, Mario; Udomprasertgul, Venus; Germar, Maria Julieta V; Yanqiu, Gao; Roy, Malabika; Carroli, Guillermo; Ba-Thike, Katherine; Filatova, Ekaterina; Villar, José

2010-02-06

There has been concern about rising rates of caesarean section worldwide. This Article reports the third phase of the WHO global survey, which aimed to estimate the rate of different methods of delivery and to examine the relation between method of delivery and maternal and perinatal outcomes in selected facilities in Africa and Latin America in 2004-05, and in Asia in 2007-08. Nine countries participated in the Asia global survey: Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. In each country, the capital city and two other regions or provinces were randomly selected. We studied all women admitted for delivery during 3 months in institutions with 6000 or fewer expected deliveries per year and during 2 months in those with more than 6000 deliveries. We gathered data for institutions to obtain a detailed description of the health facility and its resources for obstetric care. We obtained data from women's medical records to summarise obstetric and perinatal events. We obtained data for 109 101 of 112 152 deliveries reported in 122 recruited facilities (97% coverage), and analysed 107 950 deliveries. The overall rate of caesarean section was 27.3% (n=29 428) and of operative vaginal delivery was 3.2% (n=3465). Risk of maternal mortality and morbidity index (at least one of: maternal mortality, admission to intensive care unit [ICU], blood transfusion, hysterectomy, or internal iliac artery ligation) was increased for operative vaginal delivery (adjusted odds ratio 2.1, 95% CI 1.7-2.6) and all types of caesarean section (antepartum without indication 2.7, 1.4-5.5; antepartum with indication 10.6, 9.3-12.0; intrapartum without indication 14.2, 9.8-20.7; intrapartum with indication 14.5, 13.2-16.0). For breech presentation, caesarean section, either antepartum (0.2, 0.1-0.3) or intrapartum (0.3, 0.2-0.4), was associated with improved perinatal outcomes, but also with increased risk of stay in neonatal ICU (2.0, 1.1-3.6; and 2.1, 1.2-3.7, respectively). To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication. US Agency for International Development (USAID); UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Switzerland; Ministry of Health, Labour and Welfare of Japan; Ministry of Public Health, China; and Indian Council of Medical Research. Copyright 2010 Elsevier Ltd. All rights reserved.

Comparative analysis of Multiple risks in the Western part of Georgia

NASA Astrophysics Data System (ADS)

Tsereteli, N.; Chelidze, T.; Varazanashvili, O.; Amiranashvili, A.

2009-04-01

Georgia is prone to catastrophes. In the last two decades, there have occurred the following natural disasters: (a) Avalanches in Svaneti and Khevsureti, (b) landslides in the mountainous Achara, floods, (c) hurricane and drought in West and East Georgia, (d) Racha earthquake of 1991 and (e) the Tbilisi Earthquake of 2002. These phenomena are very special both from ecological and from social-economical points of view. By the disaster risk index obtained by the UNDP, Georgia is similar to countries with medium and high level risk. Therefore, natural disasters in Georgia are considered as a negative factor in the development process of the country. This implies the necessity of more active actions by all possible means to reduce the risk of natural disasters at each level and maintain the sustainable economic development of the country, including good education at the universities and schools for real understanding of natural hazards. The main goal of the work here is the assessment of 12 widespread natural disasters and multiple risks for political districts in West Georgia. These natural disasters include earthquakes, landslides, avalanches, floods, mudflows, droughts, hurricanes, lightning, hail, glaze, freezes, mists. The research was based on the following steps: (a) Creation of electronic detailed databases of natural disasters that occurred in Georgia. These databases consist of the parameters of such hazardous phenomena class that caused natural disasters. (b) Quantitative investigation of energetic and spatial-time regularities of 12 natural disasters for the territory of Georgia. Estimation of people and environment (technosphere) vulnerability. (c) Elaboration of mathematical models and algorithms of disasters multiple risks taking into account the concrete conditions: (i) Sharing and generalization of gathered experience in the world. This allows more proper and wide comparison of the multiple risks of Caucasus countries; (ii) Taking into account the general formula of risk = hazard x damage, transfer from analyze of separate risk to its complex one; (iii) Taking into account the reality of Georgia and complex scheme of revealed risk in separate district of the country during the construction of multiple risk models. Investigation of each step reveals problem according to essential parts in the multiple risks assessments, such as communication between scientists, engineers, civil protection and other agencies. A big gap in such kind of relationship leads to lack of important information, such as economic loss according to each hazard. Low level in education according in natural hazards cause bad management and sometimes increase economic and mortality loss.

E-health: determinants, opportunities, challenges and the way forward for countries in the WHO African Region.

PubMed

Kirigia, Joses M; Seddoh, Anthony; Gatwiri, Doris; Muthuri, Lenity H K; Seddoh, Janet

2005-12-20

The implementation of the 58th World Health Assembly resolution on e-health will pose a major challenge for the Member States of the World Health Organization (WHO) African Region due to lack of information and communications technology (ICT) and mass Internet connectivity, compounded by a paucity of ICT-related knowledge and skills. The key objectives of this article are to: (i) explore the key determinants of personal computers (PCs), telephone mainline and cellular and Internet penetration/connectivity in the African Region; and (ii) to propose actions needed to create an enabling environment for e-health services growth and utilization in the Region. The effects of school enrolment, per capita income and governance variables on the number of PCs, telephone mainlines, cellular phone subscribers and Internet users were estimated using a double-log regression model and cross-sectional data on various Member States in the African Region. The analysis was based on 45 of the 46 countries that comprise the Region. The data were obtained from the United Nations Development Programme (UNDP), the World Bank and the International Telecommunications Union (ITU) sources. There were a number of main findings: (i) the adult literacy and total number of Internet users had a statistically significant (at 5% level in a t-distribution test) positive effect on the number of PCs in a country; (ii) the combined school enrolment rate and per capita income had a statistically significant direct effect on the number of telephone mainlines and cellular telephone subscribers; (iii) the regulatory quality had statistically significant negative effect on the number of telephone mainlines; (iv) similarly, the combined school enrolment ratio and the number of telephone mainlines had a statistically significant positive relationship with Internet usage; and (v) there were major inequalities in ICT connectivity between upper-middle, lower-middle and low income countries in the Region. By focusing on the adoption of specific technologies we attempted to interpret correlates in terms of relationships instead of absolute "causals". In order to improve access to health care, especially for the majority of Africans living in remote rural areas, there is need to boost the availability and utilization of e-health services. Thus, universal access to e-health ought to be a vision for all countries in the African Region. Each country ought to develop a road map in a strategic e-health plan that will, over time, enable its citizens to realize that vision.

E-health: Determinants, opportunities, challenges and the way forward for countries in the WHO African Region

PubMed Central

Kirigia, Joses M; Seddoh, Anthony; Gatwiri, Doris; Muthuri, Lenity HK; Seddoh, Janet

2005-01-01

Background The implementation of the 58th World Health Assembly resolution on e-health will pose a major challenge for the Member States of the World Health Organization (WHO) African Region due to lack of information and communications technology (ICT) and mass Internet connectivity, compounded by a paucity of ICT-related knowledge and skills. The key objectives of this article are to: (i) explore the key determinants of personal computers (PCs), telephone mainline and cellular and Internet penetration/connectivity in the African Region; and (ii) to propose actions needed to create an enabling environment for e-health services growth and utilization in the Region. Methods The effects of school enrolment, per capita income and governance variables on the number of PCs, telephone mainlines, cellular phone subscribers and Internet users were estimated using a double-log regression model and cross-sectional data on various Member States in the African Region. The analysis was based on 45 of the 46 countries that comprise the Region. The data were obtained from the United Nations Development Programme (UNDP), the World Bank and the International Telecommunications Union (ITU) sources. Results There were a number of main findings: (i) the adult literacy and total number of Internet users had a statistically significant (at 5% level in a t-distribution test) positive effect on the number of PCs in a country; (ii) the combined school enrolment rate and per capita income had a statistically significant direct effect on the number of telephone mainlines and cellular telephone subscribers; (iii) the regulatory quality had statistically significant negative effect on the number of telephone mainlines; (iv) similarly, the combined school enrolment ratio and the number of telephone mainlines had a statistically significant positive relationship with Internet usage; and (v) there were major inequalities in ICT connectivity between upper-middle, lower-middle and low income countries in the Region. By focusing on the adoption of specific technologies we attempted to interpret correlates in terms of relationships instead of absolute "causals". Conclusion In order to improve access to health care, especially for the majority of Africans living in remote rural areas, there is need to boost the availability and utilization of e-health services. Thus, universal access to e-health ought to be a vision for all countries in the African Region. Each country ought to develop a road map in a strategic e-health plan that will, over time, enable its citizens to realize that vision. PMID:16364186

Renewable Energy Resources in Lebanon

NASA Astrophysics Data System (ADS)

Hamdy, R.

2010-12-01

The energy sector in Lebanon plays an important role in the overall development of the country, especially that it suffers from many serious problems. The fact that Lebanon is among the few countries that are not endowed with fossil fuels in the Middle East made this sector cause one third of the national debt in Lebanon. Despite the large government investments in the power sector, demand still exceeds supply and Lebanon frequently goes through black out in peak demand times or has to resort to importing electricity from Syria. The Energy production sector has dramatic environmental and economical impacts in the form of emitted gasses and environment sabotage, accordingly, it is imperative that renewable energy (RE) be looked at as an alternative energy source. Officials at the Ministry of Energy and Water (MEW) and Lebanese Electricity (EDL) have repeatedly expressed their support to renewable energy utilization. So far, only very few renewable energy applications can be observed over the country. Major efforts are still needed to overcome this situation and promote the use of renewable energy. These efforts are the shared responsibility of the government, EDL, NGO's and educational and research centers. Additionally, some efforts are being made by some international organizations such as UNDP, ESCWA, EC and other donor agencies operating in Lebanon. This work reviews the status of Energy in Lebanon, the installed RE projects, and the potential projects. It also reviews the stakeholders in the field of RE in Lebanon Conclusion In considering the best R.E. alternative, it is important to consider all potential R.E. sources, their costs, market availability, suitability for the selected location, significance of the energy produced and return on investment. Several RE resources in Lebanon have been investigated; Tides and waves energy is limited and not suitable two tentative sites for geothermal energy are available but not used. Biomass resources badly affect the environment with the current technology and it is preferred to go for recycling. Limited hydropower plants are already installed and there are plans for new projects. Small wind turbines found their way in the market for individuals living in the rural areas that suffer from blackouts the most to replace the fuel stand alone generators. Solar PV is still immature however projects like street lighting in the south were successfully achieved. Solar thermal power is the most suitable for water heating in and outside the residential areas. Projects to increase the efficiency like replacing lights with power saving lights and thermal insulation of buildings are funded by several organizations.

Adaptation to heavy rainfall events: watershed-community planning of soil and water conservation technologies in Syria

NASA Astrophysics Data System (ADS)

Ziadat, Feras; Al-Wadaey, Ahmed; Masri, Zuhair; Sakai, Hirokazu

2010-05-01

The Fourth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC) and other research, predict a significant future increase in the frequency and intensity of heavy rainfall events in many regions. This increase runoff and soil erosion, and reduce agricultural productivity, as well as increasing risks of flood damage to crops and infrastructure. Implementing adaptation measures and improved land management through erosion control and soil protection are among those that protect water and agriculture and limit their vulnerability. Soil erosion control practices are often based on long-term climatic averages. Special attention is needed to provide protection against average high-return frequency storms as well as severe storms with low-return frequency. Suitable and affordable soil conservation plans, coupled with an appropriate enabling environment, are needed. A watershed and community were selected in the mountainous area of North West Syria. The fields represent the non-tropical highland dry areas and dominated by olive orchards on steep slopes. Farmers were aware of resource degradation and productivity reduction, but lacked financial capital to implement the needed adaptation measures. A micro-credit system was established with the help of the UNDP Global Environment Facility - Small Grants Program (GEF-SGP) with small grants available for each farmer. Haphazard implementation on scattered fields proved inefficient in demonstrating obvious impact. Therefore, each watershed was classified into three erosion risk categories (high, moderate and low), derived from maps of flow accumulation, slope steepness, slope shape and land use. Using field survey of land ownership, the boundaries of 168 farms in the watersheds were mapped. Farmers' fields were classified using the erosion-risk map and considering the on-farm erosion hazard and the off-farm effect on other farmers' fields following the hillslope sequence. More than 60% of the farms were classified into high erosion risk areas. Accordingly, a community-watershed plan was established and revised with the community committee. Loans to implement soil and water conservation measures were distributed to 52 farmers based on the priorities of their farms. Results from four runoff events in 2009 showed that one erosive runoff event can deliver more than 50% of the total soil loss. Implementing semi-circular bunds reduced rill erosion by 40% and captured 3.4 tons of sediments per hectare. The effect of this approach in limiting the negative impact of extreme rainfall events, at watershed and field levels, are now being quantified and modeled. Keywords: climate change, land use, soil erosion, GIS, flow accumulation, land tenure.

Water Sciences - Connecting the dots to achieve the 2030 Agenda for Sustainable Development

NASA Astrophysics Data System (ADS)

Uhlenbrook, Stefan; Ortigara, Angela; Minelli, Lucilla

2017-04-01

Land use change, urbanisation, climate change, demographic development and migration, conflicts and peace, change of diets, industry 4.0, globalisation etc. are among the challenges that water sciences need to address to serve societal needs. Water availability per capita is decreasing, water quality is deteriorating at many places, but water demand is continuously escalating. Business as usual in water science is not up to the related challenges. In fact, business as usual cannot be the answer in all aspects, i.e. also current policy making processes will need to improve and take stock of evidences provided by science in order to better address societal challenges. However, exciting developments have been taking place. The global community agreed on a new and ambitious agenda for development, which aims to be comprehensive and include the participation of all stakeholders in one integrated framework. The 2030 Agenda for Sustainable Development provides a stimulating new era, with unique opportunities to reconcile science, society and policy making. Hydrology and water management - in all its facets including wastewater - play a central role in the Agenda 2030, as it is not only central in Sustainable Development Goal (SDG) 6, but it is fundamental for the realization of other SDGs related to, for instance, poverty reduction, sustainable growth, health, food security, climate change, ecosystems (land and sea), gender equality, etc. Despite the recognition of the critical importance of water in this agenda, the implementation of related policies and use of scientific developments represent a difficult task. Two main challenges remain: (i) the utilization of the knowledge and developments already available, and (ii) the need to overcome current and future knowledge gaps ensuring that scientific results support sustainable development effectively. The UN system will produce a Synthesis Report for SDG 6, which is currently being prepared by a UN-Water Task Force that includes several international organizations (i.e., CEO Water Mandate, FAO, ILO, UNDP, UNECE, UNEP, UNESCO, UNICEF, UN-Water TAU, WHO and WMO) and is coordinated by the UN World Water Assessment Programme of UNESCO. The Synthesis Report will provide an integrated analysis and synthesis of data, information and policy linkages between different SDG targets and indicators, providing Member Stater with 'the big picture' on progress made in achieving SDG 6, and recommendations for policy and decision makers and stakeholders in the water and development sectors. The role of (water) science is more critical than ever. In this era of rapid developments we are in dire need for action: further insights are needed to fully understand and quantify the systematic links between the different SDGs in order to explore future possible development pathways. Sound scientific basis has to support the development of effective policy implementation strategies.

Global Natural Disaster Risk Hotspots: Transition to a Regional Approach

NASA Astrophysics Data System (ADS)

Lerner-Lam, A.; Chen, R.; Dilley, M.

2005-12-01

The "Hotspots Project" is a collaborative study of the global distribution and occurrence of multiple natural hazards and the associated exposures of populations and their economic output. In this study we assess the global risks of two disaster-related outcomes: mortality and economic losses. We estimate risk levels by combining hazard exposure with historical vulnerability for two indicators of elements at risk-gridded population and Gross Domestic Product (GDP) per unit area - for six major natural hazards: earthquakes, volcanoes, landslides, floods, drought, and cyclones. By calculating relative risks for each grid cell rather than for countries as a whole, we are able to estimate risk levels at sub-national scales. These can then be used to estimate aggregate relative multiple hazard risk at regional and national scales. Mortality-related risks are assessed on a 2.5' x 2.5' latitude-longitude grid of global population (GPW Version 3). Economic risks are assessed at the same resolution for gridded GDP per unit area, using World Bank estimates of GDP based on purchasing power parity. Global hazard data were compiled from multiple sources. The project collaborated directly with UNDP and UNEP, the International Research Institute for Climate Prediction (IRI) at Columbia, and the Norwegian Geotechnical Institute (NGI) in the creation of data sets for several hazards for which global data sets did not previously exist. Drought, flood and volcano hazards are characterized in terms of event frequency, storms by frequency and severity, earthquakes by frequency and ground acceleration exceedance probability, and landslides by an index derived from probability of occurrence. The global analysis undertaken in this project is clearly limited by issues of scale as well as by the availability and quality of data. For some hazards, there exist only 15- to 25-year global records with relatively crude spatial information. Data on historical disaster losses, and particularly on economic losses, are also limited. On one hand the data are adequate for general identification of areas of the globe that are at relatively higher single- or multiple-hazard risk than other areas. On the other hand they are inadequate for understanding the absolute levels of risk posed by any specific hazard or combination of hazards. Nevertheless it is possible to assess in general terms the exposure and potential magnitude of losses to people and their assets in these areas. Such information, although not ideal, can still be very useful for informing a range of disaster prevention and preparedness measures, including prioritization of resources, targeting of more localized and detailed risk assessments, implementation of risk-based disaster management and emergency response strategies, and development of long-term plans for poverty reduction and economic development. In addition to summarizing the results of the Hotspots Project, we discuss data collection issues and suggest methodological approaches for making the transition to more detailed regional and national studies. Preliminary results for several regional case studies will be presented.

Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends

PubMed Central

Sedgh, Gilda; Bearak, Jonathan; Singh, Susheela; Bankole, Akinrinola; Popinchalk, Anna; Ganatra, Bela; Rossier, Clémentine; Gerdts, Caitlin; Tunçalp, Özge; Johnson, Brooke Ronald; Johnston, Heidi Bart; Alkema, Leontine

2017-01-01

Summary Background Information about the incidence of induced abortion is needed to motivate and inform efforts to help women avoid unintended pregnancies and to monitor progress toward that end. We estimate subregional, regional, and global levels and trends in abortion incidence for 1990 to 2014, and abortion rates in subgroups of women. We use the results to estimate the proportion of pregnancies that end in abortion and examine whether abortion rates vary in countries grouped by the legal status of abortion. Methods We requested abortion data from government agencies and compiled data from international sources and nationally representative studies. With data for 1069 country-years, we estimated incidence using a Bayesian hierarchical time series model whereby the overall abortion rate is a function of the modelled rates in subgroups of women of reproductive age defined by their marital status and contraceptive need and use, and the sizes of these subgroups. Findings We estimated that 35 abortions (90% uncertainty interval [UI] 33 to 44) occurred annually per 1000 women aged 15–44 years worldwide in 2010–14, which was 5 points less than 40 (39–48) in 1990–94 (90% UI for decline −11 to 0). Because of population growth, the annual number of abortions worldwide increased by 5·9 million (90% UI −1·3 to 15·4), from 50·4 million in 1990–94 (48·6 to 59·9) to 56·3 million (52·4 to 70·0) in 2010–14. In the developed world, the abortion rate declined 19 points (–26 to −14), from 46 (41 to 59) to 27 (24 to 37). In the developing world, we found a non-significant 2 point decline (90% UI −9 to 4) in the rate from 39 (37 to 47) to 37 (34 to 46). Some 25% (90% UI 23 to 29) of pregnancies ended in abortion in 2010–14. Globally, 73% (90% UI 59 to 82) of abortions were obtained by married women in 2010–14 compared with 27% (18 to 41) obtained by unmarried women. We did not observe an association between the abortion rates for 2010–14 and the grounds under which abortion is legally allowed. Interpretation Abortion rates have declined significantly since 1990 in the developed world but not in the developing world. Ensuring access to sexual and reproductive health care could help millions of women avoid unintended pregnancies and ensure access to safe abortion. Funding UK Government, Dutch Ministry of Foreign Affairs, Norwegian Agency for Development Cooperation, The David and Lucile Packard Foundation, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. PMID:27179755

Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group.

PubMed

Alkema, Leontine; Chou, Doris; Hogan, Daniel; Zhang, Sanqian; Moller, Ann-Beth; Gemmill, Alison; Fat, Doris Ma; Boerma, Ties; Temmerman, Marleen; Mathers, Colin; Say, Lale

2016-01-30

Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030. We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources. We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43·9% (34·0-48·7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0-3·1) in the Caribbean to 5·0% (4·0-6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%. Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths. National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. Copyright © 2016 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd.. All rights reserved.

Pre-referral rectal artesunate to prevent death and disability in severe malaria: a placebo-controlled trial

PubMed Central

Gomes, MF; Faiz, MA; Gyapong, JO; Warsame, M; Agbenyega, T; Babiker, A; Baiden, F; Yunus, EB; Binka, F; Clerk, C; Folb, P; Hassan, R; Hossain, MA; Kimbute, O; Kitua, A; Krishna, S; Makasi, C; Mensah, N; Mrango, Z; Olliaro, P; Peto, R; Peto, TJ; Rahman, MR; Ribeiro, I; Samad, R; White, NJ

2009-01-01

Summary Background Most malaria deaths occur in rural areas. Rapid progression from illness to death can be interrupted by prompt, effective medication. Antimalarial treatment cannot rescue terminally ill patients but could be effective if given earlier. If patients who cannot be treated orally are several hours from facilities for injections, rectal artesunate can be given before referral and acts rapidly on parasites. We investigated whether this intervention reduced mortality and permanent disability. Methods In Bangladesh, Ghana, and Tanzania, patients with suspected severe malaria who could not be treated orally were allocated randomly to a single artesunate (n=8954) or placebo (n=8872) suppository by taking the next numbered box, then referred to clinics at which injections could be given. Those with antimalarial injections or negative blood smears before randomisation were excluded, leaving 12 068 patients (6072 artesunate, 5996 placebo) for analysis. Primary endpoints were mortality, assessed 7–30 days later, and permanent disability, reassessed periodically. All investigators were masked to group assignment. Analysis was by intention to treat. This study is registered in all three countries, numbers ISRCTN83979018, 46343627, and 76987662. Results Mortality was 154 of 6072 artesunate versus 177 of 5996 placebo (2·5% vs 3·0%, p=0·1). Two versus 13 (0·03% vs 0·22%, p=0·0020) were permanently disabled; total dead or disabled: 156 versus 190 (2·6% vs 3·2%, p=0·0484). There was no reduction in early mortality (56 vs 51 deaths within 6 h; median 2 h). In patients reaching clinic within 6 h (median 3 h), pre-referral artesunate had no significant effect on death after 6 h or permanent disability (71/4450 [1·6%] vs 82/4426 [1·9%], risk ratio 0·86 [95% CI 0·63–1·18], p=0·35). In patients still not in clinic after more than 6 h, however, half were still not there after more than 15 h, and pre-referral rectal artesunate significantly reduced death or permanent disability (29/1566 [1·9%] vs 57/1519 [3·8%], risk ratio 0·49 [95% CI 0·32–0·77], p=0·0013). Interpretation If patients with severe malaria cannot be treated orally and access to injections will take several hours, a single inexpensive artesunate suppository at the time of referral substantially reduces the risk of death or permanent disability. Funding UNICEF/UNDP/World Bank Special Programme for Research and Training in Tropical Diseases (WHO/TDR); WHO Global Malaria Programme (WHO/GMP); Sall Family Foundation; the European Union (QLRT-2000-01430); the UK Medical Research Council; USAID; Irish Aid; the Karolinska Institute; and the University of Oxford Clinical Trial Service Unit (CTSU). PMID:19059639

A Sub-category Disaggregated Greenhouse Gas Emission Inventory for the Bogota Region, Colombia

NASA Astrophysics Data System (ADS)

Pulido-Guio, A. D.; Rojas, A. M.; Ossma, L. J.; Jimenez-Pizarro, R.

2012-12-01

Several international organizations, such as UNDP and UNEP, have recently recognized the importance of empowering sub-national decision levels on climatic governance according to the subsidiarity principle. Regional and municipal authorities are directly responsible for land use management and for regulating economic sectors that emit greenhouse gases (GHG) and are vulnerable to climate change. Sub-national authorities are also closer to the population, which make them better suited for educating the public and for achieving commitment among stakeholders. This investigation was developed within the frame of the Regional Integrated Program on Climate Change for the Cundinamarca-Bogota Region (PRICC), an initiative aimed at incorporating the climate dimension into the regional and local decision making. The region composed by Bogota and its nearest, semi-rural area of influence (Province of Cundinamarca) is the most important population and economic center of Colombia. Our investigation serves two purposes: a) to establish methodologies for estimating regional GHG emissions appropriate to the Colombian context, and b) to disaggregate GHG emissions by economic sector as a mitigation decision-making tool. GHG emissions were calculated using IPCC 1996 - Tier 1 methodologies, as there are no regional- or country-specific emission factors available for Colombia. Top-Down (TD) methodologies, based on national and regional energy use intensity, per capita consumption and fertilizer use, were developed and applied to estimate activities for following categories: fuel use in industrial, commercial and residential sectors (excepting NG and LPG), use of ozone depleting substances (ODS) and substitutes, and fertilizer use (for total emissions of agricultural soils). The emissions from the remaining 22 categories were calculated using Bottom-Up (BU) methodologies given the availability of regional information. The total GHG emissions in the Cundinamarca-Bogota Region on 2008 are estimated at 22.96±1.25 (1-sigma) Tg of CO2 equivalent (10.46±0.93 Tg CO2-e from Cundinamarca and 12.51±0.83 Tg CO2-eq from Bogota). 63% of Cundinamarca's GHG emissions are due to road transportation, agricultural soil management, enteric fermentation and fuel use in the cement industry. The road transportation and waste disposal sectors share 62% of emissions in Bogota. These activity sectors are considered to be the main GHG mitigation assessment targets. The calculated per capita emissions, 1.7 ton CO2-eq/hab-year for Bogota and 4.4 ton CO2-eq/hab-year for Cundinamarca (excluding emissions due to land-use change), do not reflect the fact that Cundinamarca provides goods and services to the city of Bogota. A deeper analysis is thus required to quantitatively account for Bogota's urban metabolism, including GHG emissions associated with consumption patterns. It is expected that the developed and applied methodologies, and the systematic compilation of the gathered information, will facilitate the development of GHG inventories for other regions of Colombia.

Installation and operation of a large scale RAPS system in Peru

NASA Astrophysics Data System (ADS)

Cole, J. F.

In 1997, International Lead Zinc Research Organization Inc. (ILZRO), Solar Energy Industries Association (SEIA), and the Ministry of Energy and Mines (MEM) of Peru signed a Memorandum of Understanding to facilitate the installation of hybrid remote area power supply (RAPS) systems in the Amazon region of Peru. Many remote villages in this vast region have either no or limited electricity supplied by diesel generators running a few hours per day. Subsequently, ILZRO sponsored the engineering design of the hybrid RAPS system and SEIA supported a socio-economic study to determine the sustainability of such systems and the locations for pilot installations. In mid-1998, the Peruvian government approved the design of the system. ILZRO then began efforts to obtain governmental and inter-governmental funding to supplement its own funds to underwrite the cost of manufacture and installation of the systems in two villages in the Amazon region. Additional major funding has been received from the Global Environmental Facility (GEF) administered by the United Nations Development Program (UNDP) and from the Common Fund for Commodities (CFC). Funds have also been received from the US Department of Energy, the International Greenhouse Partnership (Australia) and the Peruvian government. The RAPS system consists of modules designed to provide 150 kW h per day of utility grade ac electricity over a 24 h period. Each module contains a diesel generator, battery bank using heavy-duty 2 V VRLA GEL batteries, a battery charger, a photovoltaic array and an ac/dc inverter. The batteries and electrical components are housed in modified shipping containers. The modules can be installed with a new generator or retrofitted to an existing generator. The charging and discharging regime of the batteries has been recommended by a study carried out by CSIRO, which has simulated the RAPS operation. The system will employ a partial-state-of-charge (PSOC) regime in order to optimize the life of the batteries, which have a projected life of 8-10 years. A remote monitoring system will consist of a satellite link between each of the remote area power systems and one or more central hosts. The system operator will be able to obtain actual operational status of the system and will be able to change set points and to force operation of certain functions in order to test the system. Preliminary cost analyses indicate that such RAPS systems are more economically attractive to provide electricity to remote villages than other alternatives, including 24 h diesel generation and grid extension. The past 5 years have provided a number of lessons learned, particularly related to dealing with government agencies in a developing country, overcoming logistical problems such as shipping long distances and dealing with difficult climate and terrain. Despite difficulties encountered, the promise of RAPS systems as a rapidly growing market for lead-acid batteries appears to be bright given the demand for sustainable remote electrification.

Quantifying the risk of deforestation in Latin America and the Caribbean.

NASA Astrophysics Data System (ADS)

Manners, Rhys; Varela-Ortega, Consuelo

2015-04-01

Latin American and Caribbean countries have seen considerable deforestation due to a complex web of interconnected and interdependent causes, which include agricultural expansion, infrastructure development, social demographics and governmental policies and activity. It is necessary for successful and efficient policy development to understand how variability in these causes can potentially result in increased or decreased deforestation. The purpose of this study is to develop a tool that can quantify the risk, as in the threat or pressure, of potential deforestation, whilst identifying the key indicators that contribute to this risk. This tool will take the form of a composite index that will provide spatial and temporal trends of deforestation risk across Latin America and the Caribbean. The development of the Deforestation Risk Index (DRI) was based upon work performed in the EU project ROBIN1. Indicators of deforestation included in the index were identified based upon the multi-scalar approach adopted in ROBIN- nationally from principal component analysis and econometric modelling, provincially from extensive interviews with experts and farmers (subsistence and commercial) in Amazonian regions of Bolivia and Brazil, and locally from stakeholder workshops in Bolivia, Brazil and Mexico. The identification process was supported by an extensive literature review. In total, 11 indicators were identified and grouped into four components (biophysical, economic, governance and social) capable of explaining the risk of deforestation in Latin America and Caribbean countries. The DRI was calculated for 24 Latin American and Caribbean countries in the years 2000, 2005 and 2010 using national-level data collected from open access databases (FAOStat, WorldBank and UNDP). The DRI was subjected to two weighting schemes; the first based upon the opinions of experts from ROBIN (weighted biophysical and governance components heavily), and the second developed from the results of the ROBIN stakeholder workshops (heavily weighted the governance component). The results from the DRI were categorised as; low risk, moderate risk, at risk, elevated risk, high risk and extreme risk. The DRI demonstrated that in over 60% of countries, the risk of deforestation reduced between 2000-2010 with Belize, Costa Rica, Guyana and Venezuela being notable exceptions. Countries that saw reductions in their risk did so through economic growth (per capita GDP), institutional development (governmental effectiveness and regulatory quality), as well reductions in the scale of agricultural expansion. Despite the general trend towards lower risk, Amazonian countries were still found to be subject to potential deforestation. Bolivia, Ecuador, Guyana and Suriname were estimated to have an elevated risk of deforestation, with Brazil, Colombia and Peru considered to be at risk in 2010. The DRI provides an innovative, potentially multi-scalar tool, that can be used by national policy makers to identify where policies should be developed and directed, where specific measures in international programs such as REDD/+ could be most effectively pursued, and for international policy makers to identify and to tailor development or aid packages that reduce rather than contribute to deforestation.

[Intensive care in Africa: a report of the first two years of activity of the intensive care unit of Ouagadougou national hospital (Burkina Faso)].

PubMed

Ouédraogo, Nazinigouba; Niakara, Ali; Simpore, André; Barro, Svetlana; Ouédraogo, Hamadé; Sanou, Joachim

2002-01-01

Intensive care units (ICUs) are very expensive and their role and effectiveness in developing countries are discussed; yet, their performance in these countries was infrequently reported. We report the experience over the first two years of activity of the multidisciplinary intensive care unit of the Ouagadougou national hospital. The analysis of such experience raises the issues related to intensive care in a developing country in terms of technical and social efficiency. Retrospective study of medical records. Multidisciplinary ICUs of a national teaching hospital. The eleven million inhabitants of Burkina Faso are one the poorest nations in the world (3rd in UNDP classification). The Yalgado Ouedraogo national hospital is the largest in the country and the only one in the capital city, Ouagadougou; this national referral and teaching hospital has 724 beds. The ICU was created in December 1996; it has 8 beds, equipped with ventilators, monitors and various instruments. The staff consists of two full-time anesthesiologists and three others who contribute to the duty system, one senior nurse, two nurses specialized in anesthesia and fourteen other nurses. The unit is open to medical students and student nurses for hospital-based training. All patients admitted in 1997 and 1998. Data was collected from medical records and related to length of stay (LOS), morbidity, mortality, therapy and patients' socio-demographic background. No severity score was given. Three hundred and thirty-eight patients, mainly males (73%), were admitted; the average bed occupancy rate was 25%. The average age of patients was 39.05 +/- 1.21; there was no sex-specific age difference. Distribution as per socio-professional category showed a high proportion of civil servants (38.0%); farmers (23.7%) and housewives (17.6%) were relatively few. Admission diagnoses included 146 traumas (43.2%) of which 105 cranial traumas, 121 post operative (35.8%) and 71 medical pathologies (21.0%). Forty-nine patients (14.5%) were mechanically ventilated. The average LOS was 4.69 0.42 days; half of the patients stayed under 48 hours. The overall mortality rate was 63.6%. The rate was 79% for medical pathologies, 70.5% for traumas and 48.5% for post operative patients. The LOS was significantly longer in survivors (7.24 +/- 1.02) than in deceased (3.54 +/- 0.38). The cumulative survival curve showed a high death probability density which decreased in time: 0.74 on the first day, 0.58 on the second, 0.36 on the sixth. The mortality rate was higher in ventilated patients than in non-ventilated ones. The highest mortality rate was observed among senior civil servants and farmers, and the lowest among craftsmen. The analysis of the first two years of operation of the ICUs of Ouagadougou national hospital reveals a low bed occupancy and a high mortality rate, particularly in the first days and for farmers. These results provide an opportunity to suggest the need for reorganization, with special emphasis on personnel availability and training, and for improved affordability of intensive care services.

National, regional, and global levels and trends in maternal mortality between 1990 and 2015 with scenario-based projections to 2030: a systematic analysis by the United Nations Maternal Mortality Estimation Inter-Agency Group

PubMed Central

Alkema, Leontine; Chou, Doris; Hogan, Daniel; Zhang, Sanqian; Moller, Ann-Beth; Gemmill, Alison; Fat, Doris Ma; Boerma, Ties; Temmerman, Marleen; Mathers, Colin; Say, Lale; Ahmed, Saifuddin; Ali, Mohamed; Amouzou, Agbessi; Braunholtz, David; Byass, Peter; Carvajal-Velez, Liliana; Gaigbe-Togbe, Victor; Gerland, Patrick; Loaiza, Edilberto; Mills, Samuel; Mutombo, Namuunda; Newby, Holly; Pullum, Thomas W.; Suzuki, Emi

2017-01-01

Summary Background Millennium Development Goal (MDG) 5 calls for a reduction of 75% in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed scenario-based projections to highlight the accelerations needed to accomplish the Sustainable Development Goal (SDG) global target of less than 70 maternal deaths per 100,000 live births globally by 2030. Methods We updated the open access UN Maternal Mortality Estimation Inter-agency Group (MMEIG) database. Based upon nationally-representative data for 171 countries, we generated estimates of maternal mortality and related indicators with uncertainty intervals using a Bayesian model, which extends and refines the previous UN MMEIG estimation approach. The model combines the rate of change implied by a multilevel regression model with a time series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources. Results The global MMR declined from 385 deaths per 100,000 live births (80% uncertainty interval ranges from 359 to 427) in 1990 to 216 (207 to 249) in 2015, corresponding to a relative decline of 43.9% (34.0 to 48.7) during the 25-year period, with 303,000 (291,000 to 349,000) maternal deaths globally in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1.8% (0 to 3.1) in the Caribbean to 5.0% (4.0 to 6.0) for Eastern Asia. Regional MMRs for 2015 range from 12 (11 to 14) for developed regions to 546 (511 to 652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7.5%. Interpretation Despite global progress in reducing maternal mortality, immediate action is required to begin making progress towards the ambitious SDG 2030 target, and ultimately eliminating preventable maternal mortality. While the rates of reduction that are required to achieve country-specific SDG targets are ambitious for the great majority of high mortality countries, the experience and rates of change between 2000 and 2010 in selected countries–those with concerted efforts to reduce the MMR- provide inspiration as well as guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths. Funding Funding from grant R-155-000-146-112 from the National University of Singapore supported the research by LA and SZ. AG is the recipient of a National Institute of Child Health and Human Development, grant # T32-HD007275. Funding also provided by USAID and HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction). PMID:26584737

Sustainable harvest, people and pandas: assessing a decade of managed wild harvest and trade in Schisandra sphenanthera.

PubMed

Brinckmann, J A; Luo, W; Xu, Q; He, X; Wu, J; Cunningham, A B

2018-06-05

Endemic to China, the distribution of Schisandra sphenanthera Rehder & E.H.Wilson includes giant panda (Ailuropoda melanoleuca David, 1869) habitats in forests of the Minshan and Qinling Mountains, both inside and outside conservation areas. The fruit is used in indigenous medicines of the Qiang, Tibetan and Yi ethnic minorities of Sichuan. Also used in traditional Chinese medicine (TCM), indications for use are prescribed in the Chinese Pharmacopoeia. For continued access and medical use, survival of healthy populations depends on forests. Biodiversity conservation programmes implemented in forests within the panda landscapes that also benefit rural and indigenous communities, link future access to wild medicinal plants with survival of the panda and resilient rural economies. This study aimed at assessing the project activities, institutional-level outcomes and achievements, 10 years on, of the 5-year (2007-2011) UNDP- and WWF- supported EU-China Biodiversity Programme for sustainable, "panda-friendly" schisandra. Our study combined analysis of quantitative data such as purchase records coupled with qualitative data obtained from field work, project documents, site-visit reports, certification documents and published articles about the project. At start of project, interested companies were identified to support economic viability of the sustainable wild harvesting and a "panda friendly" pro-conservation model that provided an incentive to maintain habitat outside formal protected areas. Criteria of relevant sustainability standards, the Organic Wild-crop Harvesting Practice Standard and FairWild Standard, were applied while a new standard was drafted, the Giant Panda Friendly Products Standard. The initial pilot project involving 1 village determined feasibility leading to formation of the Pingwu Shuijing TCM Cooperative which, by 2016, scaled out to membership of 22 villages. From the cooperative's first commercial sale of S. sphenanthera Rehder & E.H.Wilson fruits of 0.5 MT in 2009, annual quantities steadily increased up to 30 MT sold in 2017. The cooperative achieved organic certification in 2012. In 2016, governmental authorisation for the certification of Chinese operations implementing the FairWild Standard was granted. In 2017, the Giant Panda Friendly Products Standard became an official Chinese standard with the cooperative becoming the first panda-friendly certified operation in 2018. A decade after the project first started, there is strong evidence for the pro-conservation micro- and small enterprise model. For example, through the establishment of a TCM cooperative with members in 22 villages engaged in sustainable resource management, harvesting and equitable trade of TCM ingredients with organic and panda-friendly branding. The project benefited from multi-disciplinary collaboration of experts in ethnoecology, TCM, panda biology and habitat, nature conservation, sustainability standards and international trade. Inviting interested companies at the start enabled a transition from a funded-project to annual contracts for sustainably harvested TCM herbal drugs. At end of project (2011), the companies and NGOs remained engaged and motivating for completion of activities started during the project. Major eventual outcomes rooted in the initial project included Chinese government authorisation of the FairWild Standard (2016) and Giant Panda Friendly Products Standard (2017). Copyright © 2018. Published by Elsevier B.V.

Monitoring and evaluating recovery from natural disasters using remote sensing - towards creating guidelines on the use of satellite images in the context of disaster recovery

NASA Astrophysics Data System (ADS)

Saito, K.; Brown, D.; Spence, R.; Chenvidyakarn, T.; Adams, B.; Bevington, J.; Platt, S.; Chuenpagdee, R.; Juntarashote, K.; Khan, A.

2009-04-01

The use of high-resolution optical satellite images is being investigated for evaluating and monitoring recovery after natural disasters. Funded by EPSRC, UK, the aim of the RECOVERY project is to develop indicators of recovery that can exploit the wealth of data now available, including those from satellite imagery, internet-based statistics and advanced field survey techniques. The final output will be a set of guidelines that suggests how remote sensing can be used to help monitor and evaluate the recovery process after natural disasters. The final guideline that will be produced at the end of the two year project, which started in February 2008, will be freely available to aid agencies and anyone that is interested. Currently there is no agreed standard approach for evaluating the effectiveness of recovery aid, although international frameworks such as PDNA (Post-Disaster Needs Assessment, United Nations Development Program, European Commission and World Bank) is currently being developed, and TRIAMS (Tsunami Recovery and Impact Assessment and Monitoring System, by UNDP and WHO) is being implemented to monitor the recovery from the Indian Ocean Tsunami. The RECOVERY project consists of three phases. Phase 1 was completed by September 2008 and focused on user needs survey, developing the recovery indicators and satellite image data identification/acquisition. The user needs survey was conducted to identify whether there were any indicators that the aid community would like to see prioritised. The survey result suggested that most indicators are equally important. Based on this result and also referring to the TRIAMS framework, a comprehensive list of indicators were developed which belong to six large categories, i.e. housing, infrastructure, services, livelihood, environment, social/security, risk reduction. For the RECOVERY project, two case study sites have been identified, i.e. the village of Baan Nam Khem on the west coast of Thailand, which was heavily damaged by the 2004 Indian Ocean Tsunami, and the city of Muzaffarabad, Pakistan, which was hit by the October 2005 Kashmir earthquake. For both sites, high-resolution optical satellite images from the following time periods have been acquired: for Baan Nam Khem, pre-event (-30 months), 1 week after, 4 months after, 7 months after, 13 months after, 23 months after and 38 months after; for Muzaffarabad, pre-event (-14 months), 14 days after, 8 months after and . The potential indicators cover all aspects of recovery. However not all of them can be monitored and evaluated using remote sensing. A set of indicators that can be monitored using remote sensing has been identified, and the images are currently being analysed for these indicators. In early February 2009, a field trip to Baan Nam Khem will take place to verify the findings of the image analysis. A narrative of the change that is observed in the images will be presented to the local community, and feedback will be sought to see how accurate the narrative produced by the image analysis is, and also to identify the issues that cannot be monitored using images. Interviews will be carried out with aid agencies that have been working in Baan Nam Khem, as well as household surveys to capture the recovery process. Preliminary results from the field trip to Thailand will be presented.

Provision of medical supply kits to improve quality of antenatal care in Mozambique: a stepped-wedge cluster randomised trial.

PubMed

Betrán, Ana Pilar; Bergel, Eduardo; Griffin, Sally; Melo, Armando; Nguyen, My Huong; Carbonell, Alicia; Mondlane, Santos; Merialdi, Mario; Temmerman, Marleen; Gülmezoglu, A Metin

2018-01-01

High levels of maternal and newborn mortality and morbidity remain a daunting reality in many low-income countries. Several interventions delivered during antenatal care have been shown to improve maternal and newborn outcomes, but stockouts of medical supplies at point of care can prevent implementation of these services. We aimed to evaluate whether a supply chain strategy based on the provision of kits could improve quality of care. We did a pragmatic, stepped-wedge, cluster-randomised controlled trial at ten antenatal care clinics in Mozambique. Clinics were eligible if they were not already implementing the proposed antenatal care package; they served at least 200 new pregnant women per year; they had Maternal and Child Health (MCH) nurses; and they were willing to participate. All women attending antenatal care visits at the participating clinics were included in the trial. Participating clinics were randomly assigned to shift from control to intervention on prespecified start dates. The intervention involved four components (kits with medical supplies, a cupboard to store these supplies, a tracking sheet to monitor stocks, and a one-day training session). The primary outcomes were the proportion of women screened for anaemia and proteinuria, and the proportion of women who received mebendazole in the first antenatal care visit. The intervention was delivered under routine care conditions, and analyses were done according to the intention-to-treat principle. This trial is registered with the Pan African Clinical Trial Registry, number PACTR201306000550192. Between March, 2014, and January, 2016, 218 277 antenatal care visits were registered, with 68 598 first and 149 679 follow-up visits. We found significant improvements in all three primary outcomes. In first visits, 5519 (14·6%) of 37 826 women were screened for anaemia in the control period, compared with 30 057 (97·7%) of 30 772 in the intervention period (adjusted odds ratio 832·40; 99% CI 666·81-1039·11; p<0·0001); 3739 (9·9%) of 37 826 women were screened for proteinuria in the control period, compared with 29 874 (97·1%) of 30 772 in the intervention period (1875·18; 1447·56-2429·11; p<0·0001); and 17 926 (51·4%) of 34 842 received mebendazole in the control period, compared with 24 960 (88·2%) of 28 294 in the intervention period (1·88; 1·70-2·09; p<0·0001). The effect was immediate and sustained over time, with negligible heterogeneity between sites. A supply chain strategy that resolves stockouts at point of care can result in a vast improvement in quality during antenatal care visits, when compared with the routine national process for procurement and distribution of supplies. Government of Flanders and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. © 2017 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this Article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the Article's original URL.

PubMed Central

Delpeuch, F.; Martin-Prével, Y.; Fouéré, T.; Traissac, P.; Mbemba, F.; Ly, C.; Sy, A.; Trèche, S.; Maire, B.

1996-01-01

Developing countries frequently see their currency depreciated to varying degrees. The consequences of such monetary disturbances on the nutrition of young children are not well known, though children are the most vulnerable in nutritional terms. One year after the 50% devaluation of the CFA Franc (communauté financière africaine, "African Financial Community"), which took place on 12 January 1994 simultaneously in fourteen countries, nine of which are on the UNDP list of least developed countries, we wanted to find out the long-term effects of the devaluation, and the strategies that families had adopted to cope with it. In Brazzaville, Congo, in December 1994, an epidemiological survey was conducted on a representative sample of 893 children between the ages of 4 and 12 months in two districts, and indicators of child nutrition were established. A comparable survey had been conducted in December 1993, before the devaluation. In Senegal, in the absence of a previous survey which could be used in comparison, a qualitative survey using RAP methodology, was conducted in January 1995 in two towns near the capital. In three districts in each of these towns, a cluster of ten plots was chosen at random and surveyed, with a combination of semi-structured individual interviews with mothers (n = 60) and group interviews with all the women together (n = 6). The information was put together with interviews of 25 local traders selling food. In the Congo, comparison of the two surveys shows that the practice of breast-feeding had hardly changed, nor had the age at which baby food was introduced (90% of children of 4-5 months take semi-solid and solid foods); on the other hand, more children are being given the ordinary family meal earlier, at 6-9 months. The proportion of baby foods based on commercially imported flour has fallen (from 32% in 1993 to 18% in 1994), and has been replaced with local products based on maize; this change is more marked among poorer families. The low nutritional value of such preparations is in part compensated by the addition of sugar, though less milk is added (28% in 1994 as opposed to 43% in 1993). In Senegal, mothers do not seem to have changed their breast-feeding practices either, the age at which baby foods are introduced, or the number of times they are provided daily. The most important change is the drop in quality of food given to children, and the poorer family food for the older children. The partial switch from imported products to local produce was an expected consequence of devaluation; it is clearly confirmed here for nutrition of young children, with the consequent loss of nutritional quality (a reduction in energy density and in nutrients). The first thing needed is, therefore, an improvement in local manufacture of food supplements of good nutritional quality, for young children. Mothers also complain of the increased difficulty in managing a family diet so as to take account of economic needs, cultural values and nutrition. They therefore criticize a number of nutritional education messages that are clearly no longer appropriate to the new economic context. Finally the fact that young children are getting poorer quality nutrition is worrying for the future: if it lasts, the nutritional status of children will deteriorate; whenever possible, monitoring must be established so that measures can be taken when necessary to forestall any dramatic deterioration that would endanger the health of the children. PMID:8653818

Multidimensional Space-Time Methodology for Development of Planetary and Space Sciences, S-T Data Management and S-T Computational Tomography

NASA Astrophysics Data System (ADS)

Andonov, Zdravko

This R&D represent innovative multidimensional 6D-N(6n)D Space-Time (S-T) Methodology, 6D-6nD Coordinate Systems, 6D Equations, new 6D strategy and technology for development of Planetary Space Sciences, S-T Data Management and S-T Computational To-mography. . . The Methodology is actual for brain new RS Microwaves' Satellites and Compu-tational Tomography Systems development, aimed to defense sustainable Earth, Moon, & Sun System evolution. Especially, extremely important are innovations for monitoring and protec-tion of strategic threelateral system H-OH-H2O Hydrogen, Hydroxyl and Water), correspond-ing to RS VHRS (Very High Resolution Systems) of 1.420-1.657-22.089GHz microwaves. . . One of the Greatest Paradox and Challenge of World Science is the "transformation" of J. L. Lagrange 4D Space-Time (S-T) System to H. Minkovski 4D S-T System (O-X,Y,Z,icT) for Einstein's "Theory of Relativity". As a global result: -In contemporary Advanced Space Sciences there is not real adequate 4D-6D Space-Time Coordinate System and 6D Advanced Cosmos Strategy & Methodology for Multidimensional and Multitemporal Space-Time Data Management and Tomography. . . That's one of the top actual S-T Problems. Simple and optimal nD S-T Methodology discovery is extremely important for all Universities' Space Sci-ences' Education Programs, for advances in space research and especially -for all young Space Scientists R&D!... The top ten 21-Century Challenges ahead of Planetary and Space Sciences, Space Data Management and Computational Space Tomography, important for successfully de-velopment of Young Scientist Generations, are following: 1. R&D of W. R. Hamilton General Idea for transformation all Space Sciences to Time Sciences, beginning with 6D Eukonal for 6D anisotropic mediums & velocities. Development of IERS Earth & Space Systems (VLBI; LLR; GPS; SLR; DORIS Etc.) for Planetary-Space Data Management & Computational Planetary & Space Tomography. 2. R&D of S. W. Hawking Paradigm for 2D Complex Time and Quan-tum Wave Cosmology Paradigm for Decision of the Main Problem of Contemporary Physics. 3. R&D of Einstein-Minkowski Geodesies' Paradigm in the 4D-Space-Time Continuum to 6D-6nD Space-Time Continuum Paradigms and 6D S-T Equations. . . 4. R&D of Erwin Schrüdinger 4D S-T Universe' Evolutional Equation; It's David Bohm 4D generalization for anisotropic mediums and innovative 6D -for instantaneously quantum measurement -Bohm-Schrüdinger 6D S-T Universe' Evolutional Equation. 5. R&D of brain new 6D Planning of S-T Experi-ments, brain new 6D Space Technicks and Space Technology Generalizations, especially for 6D RS VHRS Research, Monitoring and 6D Computational Tomography. 6. R&D of "6D Euler-Poisson Equations" and "6D Kolmogorov Turbulence Theory" for GeoDynamics and for Space Dynamics as evolution of Gauss-Riemann Paradigms. 7. R&D of N. Boneff NASA RD for Asteroid "Eros" & Space Science' Laws Evolution. 8. R&D of H. Poincare Paradigm for Nature and Cosmos as 6D Group of Transferences. 9. R&D of K. Popoff N-Body General Problem & General Thermodynamic S-T Theory as Einstein-Prigogine-Landau' Paradigms Development. ü 10. R&D of 1st GUT since 1958 by N. S. Kalitzin (Kalitzin N. S., 1958: Uber eine einheitliche Feldtheorie. ZAHeidelberg-ARI, WZHUmnR-B., 7 (2), 207-215) and "Multitemporal Theory of Relativity" -With special applications to Photon Rockets and all Space-Time R&D. GENERAL CONCLUSION: Multidimensional Space-Time Methodology is advance in space research, corresponding to the IAF-IAA-COSPAR Innovative Strategy and R&D Programs -UNEP, UNDP, GEOSS, GMES, Etc.

Glacial hazards: communicating the science and managing the risk

NASA Astrophysics Data System (ADS)

Reynolds, J. M.

2009-04-01

The recession of glaciers worldwide has received huge media coverage over the last few years in association with the issue of climate change. Young people at schools and colleges are increasingly aware of the environmental pressures due to ‘global warming'. Yet simultaneously, there appears to be an increasing move away from studying science both at pre-university and undergraduate levels. One of the oft cited reasons is that students cannot see the application of the subjects being taught them. Glacial hazards are one of the most obvious adverse effects of climate change, with many, often poor, communities in remote mountain areas being the most affected by frequently devastating Glacial Lake Outburst Floods (GLOFs). When students are exposed to examples of these hazards and the science behind them, many become enthused by the subject and want to study it further. There has been a huge increase in the number of students selecting projects on glacial hazards as well as a large increase in the number of institutions offering to teach modules on this subject. In an effort to provide a basic visualisation, Peter Kennett has taken the principle of GLOFs and developed a cheap but highly visual demonstration of the potentially devastating effect of melting ice within a moraine leading to subsidence and subsequent dam failure. This is available on www.earthlearningidea.com as ‘Dam burst danger - modelling the collapse of a natural dam in the mountains - and the disaster that might follow'. Furthermore, the methods by which glacial hazards are assessed provide excellent applications of geophysics, geology, geography (physical and Human), engineering, mathematics, and glaciology. By exploring the potential vulnerability of communities downstream, the applications can be extended to include sociology, economics, geopolitics and even psychology. Glacial hazards have been the subject of presentations to the Earth Science Teachers Association (ESTA) in the UK to demonstrate these scientific applications. Communicating the science to students and trying to excite them to the fun of applying these scientific disciplines in the field are important as part of science outreach. It is also important to communicate the science to those in government (local and national) within those countries affected by such hazards and to international funding agencies. There are two issues here: (a) using the media to a positive effect without alarming vulnerable and sensitive communities, and (b) providing the appropriate authorities with the necessary technical information about the hazards, their potential effects if catastrophe strikes, and how to manage the risk in an effective and timely fashion. For (a) where this is not handled correctly, the media are still ever too keen to headline potential catastrophes and unwittingly cause alarm among local communities. The so-called Palcacocha fiasco in the Cordillera Blanca, Peru, in April 2003 and the Imja Tsho media flurry of May 2008 in Nepal are but two recent examples. For (b) there needs to be a programme of interaction through workshops between the scientific community and key stakeholders in affected countries. Where these have been undertaken, such as in Bhutan, Nepal and Peru, the outcomes have been extremely productive and beneficial. However, much remains to be done in ensuring that authorities and funding agencies, for example, are aware of existing international guidelines on the assessment of glacial hazards that use objective methodologies, such as those funded by the British Government and published in 2003 (see www.geologyuk.com/mountain_ hazards_group/dfid.htm from which the guidelines can be downloaded in PDF format). Similar workshops, for example, are also being developed separately in Austria by the Glacier and Permafrost Hazard (GAPHAZ) Working Group and in Bhutan by the UNDP.

A prospective, open-label, single arm, multicentre study to evaluate efficacy, safety and acceptability of pericoital oral contraception using levonorgestrel 1.5 mg

PubMed Central

Festin, Mario P.R.; Bahamondes, Luis; Nguyen, Thi My Huong; Habib, Ndema; Thamkhantho, Manopchai; Singh, Kuldip; Gosavi, Arundhati; Bartfai, Gyorgy; Bito, Tamas; Bahamondes, M. Valeria; Kapp, Nathalie

2016-01-01

STUDY QUESTION Will the use of levonorgestrel (LNG) 1.5 mg taken at each day of coitus by women who have relatively infrequent sex be an efficacious, safe and acceptable contraceptive method? SUMMARY ANSWER Typical use of LNG 1.5 mg taken pericoitally, before or within 24 h of sexual intercourse, provides contraceptive efficacy of up to 11.0 pregnancies per 100 women-years (W-Y) in the primary evaluable population and 7.1 pregnancies per 100 W-Y in the evaluable population. WHAT IS KNOWN ALREADY LNG 1.5 mg is an effective emergency contraception following unprotected intercourse. Some users take it repeatedly, as their means of regular contraception. STUDY DESIGN, SIZE, DURATION This was a prospective, open-label, single-arm, multicentre Phase III trial study with women who have infrequent coitus (on up to 6 days a month). Each woman had a follow-up visit at 2.5, 4.5 and 6.5 months after admission or until pregnancy occurs if sooner, or she decided to interrupt participation. The study was conducted between 10 January 2012 and 15 November 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 330 healthy fertile women aged 18–45 years at risk of pregnancy who reported sexual intercourse on up to 6 days a month, were recruited from four university centres located in Bangkok, Thailand; Campinas, Brazil; Singapore and Szeged, Hungary to use LNG 1.5 mg pericoitally (24 h before or after coitus) as their primary method of contraception. The participants were instructed to take one tablet every day she had sex, without taking more than one tablet in any 24-h period, and to maintain a paper diary for recording date and time for every coital act and ingestion of the study tablet, use of other contraceptive methods and vaginal bleeding patterns. Anaemia was assessed by haemoglobin evaluation. Pregnancy tests were performed monthly and pregnancies occurring during product use were assessed by ultrasound. At the 2.5-month and final visit at 6.5 months, acceptability questions were administered. MAIN RESULTS AND THE ROLE OF CHANCE There were 321 women included in the evaluable population (which includes all eligible women enrolled), with 141.9 woman-years (W-Y) of observation and with a rate (95% confidence interval [CI]) of 7.1 (3.8; 13.1) pregnancies per 100 W-Y of typical use (which reflects use of the study drug as main contraceptive method, but also includes possible use of other contraceptives from admission to end of study) and 7.5 (4.0; 13.9) pregnancies per 100 W-Y of sole use. In the primary evaluable population (which includes only eligible enrolled women <35 years old), the rate was 10.3 (5.4; 19.9) pregnancies per 100 W-Y of typical use, and 11.0 (5.7; 13.1) pregnancies per 100 W-Y of sole use. There were three reported severe adverse events and 102 other mild adverse events (most common were headache, nausea, abdominal and pelvic pain), with high recovery rate. The vaginal bleeding patterns showed a slight decrease in volume of bleeding and the number of bleeding-free days increased over time. There was only one case of severe anaemia, found at the final visit (0.4%). The method was considered acceptable, as over 90% of participants would choose to use it in the future or would recommend it to others. LIMITATIONS, REASONS FOR CAUTION This was a single-arm study with small sample size, without a control group, designed as a proof of concept study to explore the feasibility of this type of contraception. WIDER IMPLICATIONS OF THE FINDINGS A larger clinical study evaluating pericoital contraception with LNG is feasible and our data show that this method would be acceptable to many women. STUDY FUNDING/COMPETING INTEREST(S) This study received partial financial support from the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR) and the World Health Organization. Gynuity and the Bill and Melinda Gates Foundation (BMGF) provided financial support for project monitoring. HRA Pharma donated the LNG product. N.K. was the initial project manager when she was with WHO/HRP and was employed by HRA Pharma, which distributes LNG for emergency contraception. The other authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER This study was registered on ANZCTR, Trial ID ACTRN12611001037998. TRIAL REGISTRATION DATE 4 October 2011. DATE OF FIRST PATIENT'S ENROLMENT 10 January 2012. PMID:26830816

A prospective, open-label, single arm, multicentre study to evaluate efficacy, safety and acceptability of pericoital oral contraception using levonorgestrel 1.5 mg.

PubMed

Festin, Mario P R; Bahamondes, Luis; Nguyen, Thi My Huong; Habib, Ndema; Thamkhantho, Manopchai; Singh, Kuldip; Gosavi, Arundhati; Bartfai, Gyorgy; Bito, Tamas; Bahamondes, M Valeria; Kapp, Nathalie

2016-03-01

Will the use of levonorgestrel (LNG) 1.5 mg taken at each day of coitus by women who have relatively infrequent sex be an efficacious, safe and acceptable contraceptive method? Typical use of LNG 1.5 mg taken pericoitally, before or within 24 h of sexual intercourse, provides contraceptive efficacy of up to 11.0 pregnancies per 100 women-years (W-Y) in the primary evaluable population and 7.1 pregnancies per 100 W-Y in the evaluable population. LNG 1.5 mg is an effective emergency contraception following unprotected intercourse. Some users take it repeatedly, as their means of regular contraception. This was a prospective, open-label, single-arm, multicentre Phase III trial study with women who have infrequent coitus (on up to 6 days a month). Each woman had a follow-up visit at 2.5, 4.5 and 6.5 months after admission or until pregnancy occurs if sooner, or she decided to interrupt participation. The study was conducted between 10 January 2012 and 15 November 2014. A total of 330 healthy fertile women aged 18-45 years at risk of pregnancy who reported sexual intercourse on up to 6 days a month, were recruited from four university centres located in Bangkok, Thailand; Campinas, Brazil; Singapore and Szeged, Hungary to use LNG 1.5 mg pericoitally (24 h before or after coitus) as their primary method of contraception. The participants were instructed to take one tablet every day she had sex, without taking more than one tablet in any 24-h period, and to maintain a paper diary for recording date and time for every coital act and ingestion of the study tablet, use of other contraceptive methods and vaginal bleeding patterns. Anaemia was assessed by haemoglobin evaluation. Pregnancy tests were performed monthly and pregnancies occurring during product use were assessed by ultrasound. At the 2.5-month and final visit at 6.5 months, acceptability questions were administered. There were 321 women included in the evaluable population (which includes all eligible women enrolled), with 141.9 woman-years (W-Y) of observation and with a rate (95% confidence interval [CI]) of 7.1 (3.8; 13.1) pregnancies per 100 W-Y of typical use (which reflects use of the study drug as main contraceptive method, but also includes possible use of other contraceptives from admission to end of study) and 7.5 (4.0; 13.9) pregnancies per 100 W-Y of sole use. In the primary evaluable population (which includes only eligible enrolled women <35 years old), the rate was 10.3 (5.4; 19.9) pregnancies per 100 W-Y of typical use, and 11.0 (5.7; 13.1) pregnancies per 100 W-Y of sole use. There were three reported severe adverse events and 102 other mild adverse events (most common were headache, nausea, abdominal and pelvic pain), with high recovery rate. The vaginal bleeding patterns showed a slight decrease in volume of bleeding and the number of bleeding-free days increased over time. There was only one case of severe anaemia, found at the final visit (0.4%). The method was considered acceptable, as over 90% of participants would choose to use it in the future or would recommend it to others. This was a single-arm study with small sample size, without a control group, designed as a proof of concept study to explore the feasibility of this type of contraception. A larger clinical study evaluating pericoital contraception with LNG is feasible and our data show that this method would be acceptable to many women. This study received partial financial support from the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR) and the World Health Organization. Gynuity and the Bill and Melinda Gates Foundation (BMGF) provided financial support for project monitoring. HRA Pharma donated the LNG product. N.K. was the initial project manager when she was with WHO/HRP and was employed by HRA Pharma, which distributes LNG for emergency contraception. The other authors declare no conflicts of interest. This study was registered on ANZCTR, Trial ID ACTRN12611001037998. 4 October 2011. 10 January 2012. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.

ROLE OF GRASSROOTS ENVIRONMENTAL LITERACY: The case of water security at Bwaila Secondary School in Malawi

NASA Astrophysics Data System (ADS)

Chasukwa Mwalwenje, Yvonne; Chasukwa, Steria

2015-04-01

Malawi is popularly known as the Warm Heart of Africa. Malawi has a total land area of 45,747 sq. miles. Of the total area, 80 % is covered by fresh water from Lake Malawi and other rivers. The country boasts that it holds large amounts of fresh water and has the third largest lake in Africa. Ironically, the number of households with reliable water access is low (Water Aid, 2014, UNDP, Human Development Report 2008). Regardless of signs of economic development, water security still remains a challenge in the Warm Heart of Africa. The problem with access to water prompted the Government of Malawi to introduce a National Water Policy in 1994 with the vision of 'Water and Sanitation for All'. Since then, other water access interventions have impacted on the ability to manage water sustainably. Over the past few years, more inclusive and diversified interventions have been put in place to reverse the situation. For instance, the government of Malawi has taken action to increase the number of water tanks in schools (UNICEF 2005). Several stakeholders' support the government in their role provides policy direction and coordinate management of the water sector. The outlined National Water and Sanitation Policy strategies includes promoting water conservation and catchment protection; incorporating local governments and communities in planning, development and management of water supplies and sanitation services; rehabilitating the existing infrastructure; creating an enabling environment for public-private partnerships in water supply and sanitation activities; undertaking rehabilitation and reduction of unaccounted-for-water of existing urban, peri-urban, as a priority; promoting economic incentives and opportunities to encourage the participation of small-scale water and sanitation service providers; and promoting water recycling and re-use. Despite of all these interventions, Malawi still continues to face significant challenges with issues of access and quality of water. The main challenge is the degradation of water resources which result into siltation that blocks the water sources due to rain while in the dry season the water level in reservoirs goes down. Other challenges include inadequate service coverage, insufficient literacy on climate change, inadequate mitigation measures for water related disasters and inadequate promotion of hygiene and sanitation. Bwaila Secondary School in Malawi is no exception in experiencing inadequate water service coverage amidst opportunities such as availability of relatively abundant water resources, political will, active women and youth. The formal education curriculum in secondary schools has enriched students' knowledge of environmental management in subjects such as Geography, Agriculture and Biology to improve their understanding of natural resource management. However, the primary gap is that students do not use the skills in environmental management acquired from the formal school setting in their day to day life henceforth rendering it to be a mere academic exercise confined within classroom walls. It is against such background that Grassroots Environmental Literacy (GEL), an environmental management social marketing franchise in non-formal education was established to fill in the gap. GEL's mission is to inspire students to become change agents in environmental management in their own lives in both formal and non-formal settings in Malawi. GEL believes that the cultivation of broad-based private and public support is the key to bringing about positive and lasting environmental change hence contributing to water security. The education sector in general and school attendance in particular is largely affected by water security. Furthermore, technological limitations have also affected the accessibility of water resources. UNICEF (2008) asserts that water resources may be scarce as it is capital intensive to sink a bore hole in Malawi. Bwaila secondary school is one of the examples to illuminate the water challenges. The school has low attendance when water supply is low. Girls are more affected as water shortage affects them hygienically. Consequently, girls cannot attend classes when there is no water in schools. This has affected the academic performance of girls. Sometimes, the school is prematurely closed as a preventive measure because lack of water access may result in the spread of water borne diseases. In conclusion, water security at Bwaila Secondary School is a concern because of its impact on the attendance of students and the potential to spread of water borne pathogens. This paper seeks to explore ways of mitigating water problems at Bwaila Secondary School through GEL. GEL proposes that sustainable solution to improve students' attendance at school would be to better equip students in core competencies of water management in non-formal settings in Malawi. Additionally, the GEL will initiate the construction of a water reservoir and promote sanitation and hygiene practice. GEL's believe cultivation of broad-based private and public support to these education initiatives is the key to bringing about positive and lasting way solutions to access to water access issues in Malawi.

A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls.

PubMed

Bahamondes, Luis; Brache, Vivian; Meirik, Olav; Ali, Moazzam; Habib, Ndema; Landoulsi, Sihem

2015-11-01

Is there any difference in the clinical performance of the 3-year one-rod etonogestrel (ENG)- and the 5-year two-rod levonorgestrel (LNG)-releasing contraceptive implants during 3 years of insertion, and between implant and intrauterine device (IUD) contraception, in particular complaints possibly related to hormonal contraceptives? The cumulative contraceptive effectiveness after 3 years and method continuation through 2.5 years were not significantly different between ENG and LNG implants, but both outcomes were significantly worse in the non-randomized age-matched group of IUD users than in the combined implant group. ENG- and LNG-releasing implants are safe and highly efficacious contraceptives with pregnancy rates reported to be 0.0-0.5 per 100 women-years (W-Y). No head-to-head comparative study of the two implants has been undertaken, and little information is available on comparisons of complaints of side effects of implant and copper IUD users. This was an open parallel group RCT with 1:1 allocation ratio of the ENG and the LNG implants with non-randomized control group of women choosing TCu380A IUD to address lack of reliable data on common side effects typically attributed to the use of progestogen-only contraceptives. After device(s) placement, follow-ups were at 2 weeks, 3 and 6 months, and semi-annually thereafter for 3 years or until pregnancy, removal or expulsion of the implant/IUD occurred. The study took place in family planning clinics in Brazil, Chile, Dominican Republic, Hungary, Thailand, Turkey and Zimbabwe. Women seeking long-term contraception were enlisted after an eligibility check and informed consent, and 2982 women were enrolled: 1003, 1005 and 974 in the ENG-implant, LNG-implant and IUD groups, respectively; 995, 997 and 971, respectively, were included in the per protocol analysis reported here. ENG and LNG implants each had the same 3-year cumulative pregnancy rate of 0.4 per 100 W-Y [95% confidence interval (CI) 0.1-1.4]. A weight of ≥70 kg at admission was unrelated to pregnancy. Method continuation rates for ENG and LNG implants at 2.5 years were 69.8 (95% CI 66.8-72.6) and 71.8 per 100 W-Y (68.8-74.5), and at 3 years 12.1 (95% CI 5.2-22.0) and 52.0 per 100 W-Y (95% CI 41.8-61.2), respectively. Bleeding disturbances, the most frequent reason for method discontinuation, were significantly more common in the ENG group [16.7 (95% CI 14.4-19.3)] than in the LNG group [12.5 (95% CI 10.5-14.9)] (P 0.019). The 3-year cumulative loss to follow-up was lower in the ENG- than in the LNG-implant group, 8.1 (95% CI 6.4-10.2) and 14.4 per 100 W-Y (95% CI 12.1-17.1), respectively. The median duration of implant removal was 50 s shorter among women with ENG than among women with LNG implant (P < 0.0001). In the observational comparison between IUD and implant users, the 3-year relative risk for pregnancy in IUD group compared with the combined implant group was 5.7 per 100 W-Y (95% CI 4.4-7.3) (P = 0.0003). The 3-year expulsion rate of the IUD was 17.8 per 100 W-Y (95% CI 14.5-21.9), while the discontinuation rate for bleeding disturbances was 8.5 (95% CI 6.7-10.9). Frequency of complaints of headache and dizziness was not significantly different between implant and IUD users (P = 0.16 and 0.77, respectively), acne and bleeding irregularities were more frequent among implant users (P < 0.0001), while heavy bleeding and lower abdominal pain occurred more often among IUD than implant users (P < 0.0001). Few women were ≤19 years old or nulligravida, the proportion of implant users ≥70 kg was <20% and <8% were obese. Findings of the study can inform policy makers and clinicians about choice of implant, but also about TCu380A IUD in relation to implants. UNDP/UNFPA/WHO/UNICEF/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization (WHO). This report contains the views of an international expert group and does not necessarily represent the decisions or the stated policy of the WHO. ISRCTN33378571 registered on 22 March 2004. The first participant was enrolled on 12 May 2003. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Developing a Science-based River Basin Management Plan for the Kharaa River Basin, Mongolia

NASA Astrophysics Data System (ADS)

Karthe, Daniel

2013-04-01

The Kharaa River Basin (KRB), which is located north of Mongolia's capital Ulaanbaatar and south of Lake Baikal, was chosen as a model region for the development and implementation of an integrated water resources management consisting of a monitoring concept, technical measures and a capacity development program (Karthe et al. 2012a). The basin of the Kharaa River covers an area of 14534 km² that is partly mountaineous and largely covered by taiga and steppe. At its outlet, the 362 km Kharaa River has a mean long-term annual discharge of 12.1 m³/s (MoMo Consortium 2009). A highly continental climate results in limited water resources, and rising water consumption coupled with the effects of climate and land use change may in the future exacerbate this water scarcity (Malsy et al. 2012; Karthe et al. 2013). Whereas the environment in the upper part of the catchment is in a relatively pristine state, the mid- and downstream sections of the river are characterized by nearby industry, mining activities and intensive agriculture (Menzel et al. 2011), resulting in declining water quality and ultimately a degradation of aquatic ecosystems (Hofmann et al. 2010; Hartwig et al. 2012). Moreover, it is a problem for the supply of major cities like Darkhan which largely rely on alluvial aquifers containing shallow-depth groundwater (Mun et al. 2008). Currently, there are alarming signs of water quality deterioration. With regard to water provision, a major problem is the poor state of distribution infrastructures which were often built in the 1960s and 70s (Scharaw & Westerhoff 2011). Rather little is currently known about the water quality supplied to end users; the latter is even more dubious in the city's informal ger districts (Karthe et al. 2012b). One important goal of the research and development project "Integrated Water Resources Management in Central Asia: Model Region Mongolia" lies in the implementation of a holistic concept for water resources monitoring and management. In the past, shared and unclear responsibilities, a spatial mismatch between administrative and river basin boundaries, the lack of relevant information, financial resources and implementation capacity resulted in an uncoordinated and partially uncontrolled exploitation of water resources (Livingstone et al. 2009; Horlemann et al. 2012). The recent decision of the Mongolian government to develop river basin management plans and to provide for their implementation through river basin councils and administrations, and the comparatively good data availability resulting from the R&D project, resulted in the decision to jointly develop a science-based river basin management plan for the KRB as a model region for other river basins of the country. References: Hartwig, M.; Theuring, P.; Rode, M. & Borchardt, D. (2012): Suspended sediments in the Kharaa River catchment (Mongolia) and its impact on hyporheic zone functions. Environmental Earth Sciences 65(5):1535-1546. Hofmann, J.; Venohr, M.; Behrendt, H. & Opitz, D. (2010): Integrated Water Resources Management in Central Asia: Nutrient and heavy metal emissions and their relevance for the Kharaa River Basin, Mongolia. Water Science and Technology 62(2):353-363. Horlemann, L. & Dombrowsky, I. (2012): Institutionalising IWRM in developing and transition countries: the case of Mongolia. Environmental Earth Sciences 65(5):1547-1559. Karthe, D.; Borchardt, D. & Hufert, F. (2012a): Implementing IWRM: Experiences from a Central Asian Model Region. In: Pandya, A.B. (Ed.) (2012): India Water Week 2012. Water, Energy and Food Security: Call for Solutions, Part A3, pp. 1-15. Delhi: Ministry of Water Resources, Government of India. Karthe, D.; Sigel, K.; Scharaw, B. et al. (2012b): Towards an integrated concept for monitoring and improvements in water supply, sanitation and hygiene (WASH) in urban Mongolia. Water & Risk 20:1-5. Karthe, D.; Malsy, M.; Kopp, B. & Minderlein, S. (2013): Assessing Water Availibility and its Drivers in the Context of an Integrated Water Resources Management (IWRM): A Case Study from the Kharaa River Basin, Mongolia. GeoÖko (submitted). Livingstone, A.J.; Erdenechimeg, C. & Oyunsuvd, A. (2009): Needs assessment on institutional capacity for water governance in Mongolia. Ulaan Baatar: Government of Mongolia & UNDP Mongolia. Malsy, M.; aus der Beek, T.; Eisner, S. & Flörke, M. (2012): Climate Change impacts on Central Asian water resources. Advances in Geosciences 32:77-83. Menzel, L.; Hofmann, J. & Ibisch, R. (2011): Untersuchung von Wasser- und Stoffflüssen als Grundlage für ein Integriertes Wasserressourcen - Management im Kharaa-Einzugsgebiet (Mongolei). Hydrologie und Wasserbewirtschaftung 55(2):88-103. MoMo Consortium (2009): Integrated Water Resources Management for Central Asia: Model Region Mongolia (MoMo). Case Study in the Kharaa River Basin. Final Project Report. Mun, Y.; Ko, I.H.; Janchivdorj, L. et al. (2008): Integrated Water Management Model on the Selenge River Basin: Status Survey and Investigation (Phase I). Seoul: KEI Publications. Scharaw, B. & T. Westerhoff (2011): A Leak Detection in Drinking Water Distribution Network of Darkhan in Framework of the Project Integrated Water Resources Management in Central Asia, Model Region Mongolia. Proceedings of the IWA 1st Central Asian Regional Young and Senior Water Professionals Conference, Almaty/Kazakhstan, pp. 275-282.

Interventions for emergency contraception.

PubMed

Shen, Jie; Che, Yan; Showell, Emily; Chen, Ke; Cheng, Linan

2017-08-02

Emergency contraception (EC) is using a drug or copper intrauterine device (Cu-IUD) to prevent pregnancy shortly after unprotected intercourse. Several interventions are available for EC. Information on the comparative effectiveness, safety and convenience of these methods is crucial for reproductive healthcare providers and the women they serve. This is an update of a review previously published in 2009 and 2012. To determine which EC method following unprotected intercourse is the most effective, safe and convenient to prevent pregnancy. In February 2017 we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Popline and PubMed, The Chinese biomedical databases and UNDP/UNFPA/WHO/World Bank Special Programme on Human Reproduction (HRP) emergency contraception database. We also searched ICTRP and ClinicalTrials.gov as well as contacting content experts and pharmaceutical companies, and searching reference lists of appropriate papers. Randomised controlled trials including women attending services for EC following a single act of unprotected intercourse were eligible. We used standard methodological procedures recommended by Cochrane. The primary review outcome was observed number of pregnancies. Side effects and changes of menses were secondary outcomes. We included 115 trials with 60,479 women in this review. The quality of the evidence for the primary outcome ranged from moderate to high, and for other outcomes ranged from very low to high. The main limitations were risk of bias (associated with poor reporting of methods), imprecision and inconsistency. Comparative effectiveness of different emergency contraceptive pills (ECP)Levonorgestrel was associated with fewer pregnancies than Yuzpe (estradiol-levonorgestrel combination) (RR 0.57, 95% CI 0.39 to 0.84, 6 RCTs, n = 4750, I 2 = 23%, high-quality evidence). This suggests that if the chance of pregnancy using Yuzpe is assumed to be 29 women per 1000, the chance of pregnancy using levonorgestrel would be between 11 and 24 women per 1000.Mifepristone (all doses) was associated with fewer pregnancies than Yuzpe (RR 0.14, 95% CI 0.05 to 0.41, 3 RCTs, n = 2144, I 2 = 0%, high-quality evidence). This suggests that if the chance of pregnancy following Yuzpe is assumed to be 25 women per 1000 women, the chance following mifepristone would be between 1 and 10 women per 1000.Both low-dose mifepristone (less than 25 mg) and mid-dose mifepristone (25 mg to 50 mg) were probably associated with fewer pregnancies than levonorgestrel (RR 0.72, 95% CI 0.52 to 0.99, 14 RCTs, n = 8752, I 2 = 0%, high-quality evidence; RR 0.61, 95% CI 0.45 to 0.83, 27 RCTs, n = 6052, I 2 = 0%, moderate-quality evidence; respectively). This suggests that if the chance of pregnancy following levonorgestrel is assumed to be 20 women per 1000, the chance of pregnancy following low-dose mifepristone would be between 10 and 20 women per 1000; and that if the chance of pregnancy following levonorgestrel is assumed to be 35 women per 1000, the chance of pregnancy following mid-dose mifepristone would be between 16 and 29 women per 1000.Ulipristal acetate (UPA) was associated with fewer pregnancies than levonorgestrel (RR 0.59; 95% CI 0.35 to 0.99, 2 RCTs, n = 3448, I 2 = 0%, high-quality evidence). Comparative effectiveness of different ECP dosesIt was unclear whether there was any difference in pregnancy rate between single-dose levonorgestrel (1.5 mg) and the standard two-dose regimen (0.75 mg 12 hours apart) (RR 0.84, 95% CI 0.53 to 1.33, 3 RCTs, n = 6653, I 2 = 0%, moderate-quality evidence).Mid-dose mifepristone was associated with fewer pregnancies than low-dose mifepristone (RR 0.73; 95% CI 0.55 to 0.97, 25 RCTs, n = 11,914, I 2 = 0%, high-quality evidence). Comparative effectiveness of Cu-IUD versus mifepristoneThere was no conclusive evidence of a difference in the risk of pregnancy between the Cu-IUD and mifepristone (RR 0.33, 95% CI 0.04 to 2.74, 2 RCTs, n = 395, low-quality evidence). Adverse effectsNausea and vomiting were the main adverse effects associated with emergency contraception. There is probably a lower risk of nausea (RR 0.63, 95% CI 0.53 to 0.76, 3 RCTs, n = 2186 , I 2 = 59%, moderate-quality evidence) or vomiting (RR 0.12, 95% CI 0.07 to 0.20, 3 RCTs, n = 2186, I 2 = 0%, high-quality evidence) associated with mifepristone than with Yuzpe. levonorgestrel is probably associated with a lower risk of nausea (RR 0.40, 95% CI 0.36 to 0.44, 6 RCTs, n = 4750, I 2 = 82%, moderate-quality evidence), or vomiting (RR 0.29, 95% CI 0.24 to 0.35, 5 RCTs, n = 3640, I 2 = 78%, moderate-quality evidence) than Yuzpe. Levonorgestrel users were less likely to have any side effects than Yuzpe users (RR 0.80, 95% CI 0.75 to 0.86; 1 RCT, n = 1955, high-quality evidence). UPA users were more likely than levonorgestrel users to have resumption of menstruation after the expected date (RR 1.65, 95% CI 1.42 to 1.92, 2 RCTs, n = 3593, I 2 = 0%, high-quality evidence). Menstrual delay was more common with mifepristone than with any other intervention and appeared to be dose-related. Cu-IUD may be associated with higher risks of abdominal pain than mifepristone (18 events in 95 women using Cu-IUD versus no events in 190 women using mifepristone, low-quality evidence). Levonorgestrel and mid-dose mifepristone (25 mg to 50 mg) were more effective than Yuzpe regimen. Both mid-dose (25 mg to 50 mg) and low-dose mifepristone(less than 25 mg) were probably more effective than levonorgestrel (1.5 mg). Mifepristone low dose (less than 25 mg) was less effective than mid-dose mifepristone. UPA was more effective than levonorgestrel.Levonorgestrel users had fewer side effects than Yuzpe users, and appeared to be more likely to have a menstrual return before the expected date. UPA users were probably more likely to have a menstrual return after the expected date. Menstrual delay was probably the main adverse effect of mifepristone and seemed to be dose-related. Cu-IUD may be associated with higher risks of abdominal pain than ECPs.

Past and present Aral Sea

NASA Astrophysics Data System (ADS)

Dukhovniy, Viktor; Stulina, Galina; Eshchanov, Odylbek

2013-04-01

The tragedy of disappearing of Aral Sea is well known to the World. Before and after collapse of Soviet Union, a huge quantity of scientific and popular editions described with grief the situation around the Aral Sea. After the NIS states became independent, World Bank, UNDP, UNEP in proper competition with each other had provided some assessment of the situation through presentation of some small and medium grants, but after 2000, the local population remained alone with own problems. Although on the eyes of the present generation a unique transformation of great water body into deserts took place, the global scientific community did not find forces and financing for real and detail investigation of the processes accompanying the Sea shrinking and land formation. We should acknowledge and give big respect to NATO, later to German Government that through GTZ (now GIZ) - German International Collaboration Agency - and GFZ (Potzdam) paid attention to this area of environment crisis and organized scientific and protective design in the so-called Priaralie - the territory around the drying Sea and delta of the two rivers - Amudarya and Syrdarya. Thank to this assistance, the local specialists in collaboration with limited a number of foreign scientists (N.Aladin, P.Zavialov, Joop de Schutter, Hans Wilps, Hedi Oberhansli) organized significant works for detail socioeconomic, ecological and hydrological assessment situation in Priaralie and on the Aral sea coast. On this base, Ministry of Agriculture and Water resources of Uzbekistan and State Committee of Water resources of Kazakhstan developed a plan of rehabilitation of Amudarya and Syrdarya deltas and started implementation of these projects. If Kazakh water authority moved ahead in wetland restoration faster, a forestation of delta and drying bed of Aral Sea got big success in Uzbek territory. 244 thousands hectares of saxsaul and tamarix were planted for protection of the Priaralie. By request of GTZ SIC, ICWC organized in 2005-2009 sixth expeditions for complex remote sensing and ground investigations Aral Sea former bottom that were complemented in 2010 -2011 by two expeditions with GFZ. As a result, the landscape, soils and environment mapping was done with determination of ecologically unstable zones and assessment total change of lands situation compared with the pre-independence time. Moreover - methodic of monitoring water, environment and hydro geological indicators on the all deltas area was elaborated, organized its testing and combined with remote sensing data on Amudarya delta for 2009-2012. It permits to SIC ICWC to organize systematic permanent (decadal) monitoring and recording of size, volume and level of water in Aral Sea. Since the beginning of regular observations over the Aral Sea level, 2 periods can be emphasized: 1. Conditionally natural period - 1911-1960 - characterized by a relatively stable hydrological regime, with fluctuations in the level around 53 m and the range of inter-annual fluctuations at no more than 1 m., when the sea received annually about a half of the run-off in the Syrdarya and Amudarya Rivers, i.e. 50-60 km3/yr. 2. Intensive anthropogenic impact period - since the 1960s, a vast extension of irrigable land was carried out in Central Asia that resulted in intensive diversion of river run-off. Since then, the sea level has been falling steadily, causing a dramatic reduction in the water surface area, a decrease in water volume and depths, great changes in shoreline configuration and an expansion of the desert areas adjacent to the Aral Sea. From 1960-1985, when the sea was an integral water body, slight lowering in the sea level took place until the 1970s, when the sea-level decreased with the mean level lowering 1 m. The desiccation process accelerated visibly from the mid 1970s. In 1975-1980, the level decreased by 0.65 m a year on average. Moreover, the level dropped greatly, when the run-off of the Amudarya did not reach the Aral Sea any more (1980-1990). Kokaral was the first of the large islands becoming a peninsula, separating the Small Aral Sea in the north-east by joining the shoreline in the west. By 1986, the peninsula practically detached the small Aral Sea from the large Aral Sea, leaving only a narrow flow passage in the east. Since that time, the hydrological regimes of the Small and Large Seas have become separated. The construction of Kokaral dam in Kazakhstan, 12 km long and 8 m high, then completely separated the small Aral Sea from the large Aral Sea and changed the hydrological regimes of the water bodies. Level of this part of Sea became from this moment permanently higher than in the large Aral Sea on 42 m a.s.l. The eastern part of the sea, where the bed is much shallower and the slope is gentler is more subjected to shrinking then the western part. 2005 year became threshold, from which Eastern Aral Sea began new story - deviation from almost empty water body to almost 4 meters depth. Present assessment of water balance of Aral Sea and delta at whole dependent from delivery water river and drainage flow through control section of Samanbay on the Amudarya and some cross sections on the enter main collectors to the delta boundary. These hydrological characteristics accepted on the base of information from BWO Amudarya and our monitoring of allocation of different waters on the delta. Water volume and water surface area of Eastern and Western Aral Sea bowls were definite on the result RS data from Landsat. Bathymetric curves gave ability to assess dynamic levels of Seas. After series of enough water years 2002 - 2005 with average water income to south Priaralie 12.5 km3 period of water scarce years lead to sharp decrease of surface water area of the Eastern bowl from 1010,5 th.ha on average on two time with failure of level from 31,1 m up to average 28,5 m. But phase of permanent reducing all indicators water body changed in 2008 on deviation in range from 26.3 m to 29.5 m. Some time sharp changes in the level of water in 2.0 m take place in time one year. These changes same as degree of deltas' watering depends fully from inflow water to boundary of deltas. At the same time, the Western bowl remained more or less stable and without direct flow of surface water supported own water stability based on balance between evaporation and precipitation plus presumably the inflow of deep ground water.

Public Health and International Drug Policy

PubMed Central

Csete, Joanne; Kamarulzaman, Adeeba; Kazatchkine, Michel; Altice, Frederick; Balicki, Marek; Buxton, Julia; Cepeda, Javier; Comfort, Megan; Goosby, Eric; Goulão, João; Hart, Carl; Horton, Richard; Kerr, Thomas; Lajous, Alejandro Madrazo; Lewis, Stephen; Martin, Natasha; Mejía, Daniel; Mathiesson, David; Obot, Isidore; Ogunrombi, Adeolu; Sherman, Susan; Stone, Jack; Vallath, Nandini; Vickerman, Peter; Zábranský, Tomáš; Beyrer, Chris

2016-01-01

Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military or paramilitary forces that pursue them contribute to violence and insecurity in communities affected by drug transit and sales. In Mexico, the dramatic increase in homicides since the government decided to use military forces against drug traffickers in 2006 has been so great that it reduced life expectancy in the country. Injection of drugs with contaminated equipment is a well-known route of HIV exposure and viral hepatitis transmission. People who inject drugs (PWID) are also at high risk of tuberculosis. The continued spread of unsafe injection-linked HIV contrasts the progress that has been seen in reducing sexual and vertical transmission of HIV in the last three decades. The Commission found that that repressive drug policing greatly contributes to the risk of HIV linked to injection. Policing may be a direct barrier to services such as needle and syringe programmes (NSP) and use of non-injected opioids to treat dependence among those who inject opioids, known as opioid substitution therapy (OST). Police seeking to boost arrest totals have been found to target facilities that provide these services to find, harass, and detain large numbers of people who use drugs. Drug paraphernalia laws that prohibit possession of injecting equipment lead PWID to fear carrying syringes and force them to share equipment or dispose of it unsafely. Policing practices undertaken in the name of the public good have demonstrably worsened public health outcomes. Amongst the most significant impacts of pursuit of drug prohibition identified by the Commission with respect to infectious disease is the excessive use of incarceration as a drug-control measure. Many national laws impose lengthy custodial sentences for minor, non-violent drug offenses; people who use drugs (PWUD) are over-represented in prison and pretrial detention. Drug use and drug injection occur in prisons, though their occurrence is often denied by officials. HIV and hepatitis C virus (HCV) transmission occurs among prisoners and detainees, often complicated by co-infection with TB and in many places multidrug-resistant TB, and too few states offer prevention or treatment services in spite of international guidelines that urge comprehensive measures, including provision of injection equipment, for people in state custody. Mathematical modelling undertaken by the Commission illustrates that incarceration and high HCV risk in the post-incarceration period can contribute importantly to national HCV incidence amongst PWID in a range of countries with varying levels of incarceration, different average prison sentences, durations of injection, and OST coverage levels in prison and following release. For example, in Thailand where PWID may spend nearly half their injection careers in prison, an estimated 63% of incident HCV infection could occur in prison. In Scotland, where prison sentences are shorter for PWUD and OST coverage is relatively high in prison, an estimated 54% of incident HCV infection occurs in prison, but as much as 21% may occur in the high-risk post-release period. These results underscore the importance of alternatives to prison for minor drug offences, ensuring access to OST in prison, and a seamless link from prison services to OST in the community. The evidence also clearly demonstrates that drug law enforcement has been applied in a discriminatory way against racial and ethnic minorities in a number of countries. The US is perhaps the best documented but not the only case of racial biases in policing, arrest, and sentencing. In 2014, African American men were more than five times more likely than whites to be incarcerated in their lifetime, though there is no significant difference in rates of drug use among these populations. The impact of this bias on communities of people of color is inter-generational and socially and economically devastating. The Commission also found significant gender biases in current drug policies. Of women in prison and pretrial detention around the world, a higher percentage are detained because of drug infractions than is the case for men. Women involved in drug markets are often on the bottom rungs – as couriers or drivers – and may not have information about major traffickers to trade as leverage with prosecutors. Gender and racial biases have marked overlap, making this an intersectional threat to women of color, their children, families, and communities. In both prison and the community, HIV, HCV and TB programmes for PWUD – including testing, prevention and treatment – are gravely underfunded at the cost of preventable death and disease. In a number of middle-income countries where large numbers of PWUD live, HIV and TB programmes for PWUD that were expanded with support from the Global Fund to Fight AIDS, TB and Malaria have lost funding due to changes in the Fund’s eligibility criteria. There is an unfortunate failure to emulate the example of Western European countries that have eliminated unsafe injection-linked HIV as a public health problem by sustainably scaling up prevention and care and enabling minor offenders to avert prison. Political resistance to harm reduction measures dismisses strong evidence of their effectiveness and cost-effectiveness. Mathematical modeling shows that if OST, NSP and antiretroviral therapy for HIV are all available, even if the coverage of each of them is not over 50%, their synergy can lead to effective prevention in a foreseeable future. PWUD are often not seen to be worthy of costly treatments, or they are thought not to be able to adhere to treatment regimens in spite of evidence to the contrary. Lethal drug overdose is an important public health problem, particularly in light of rising consumption of heroin and prescription opioids in some parts of the world. Yet the Commission found that the pursuit of drug prohibition can contribute to overdose risks in numerous ways. It creates unregulated illegal markets in which it is impossible to control adulterants of street drugs that add to overdose risk. Several studies also link aggressive policing to rushed injection and overdose risk. People with a history of drug use, over-represented in prison because of prohibitionist policies, are at extremely high risk of overdose when released from state custody. Lack of ready access to OST also contributes to injection of opioids, and bans on supervised injection sites cut off an intervention that has proven very effective in reducing overdose deaths. Restrictive drug policies also contribute to unnecessary controls on naloxone, a medicine that can reverse overdose very effectively. Though a small percentage of PWUD will ever need treatment for drug dependence, that minority faces enormous barriers to humane and affordable treatment in many countries. There are often no national standards for quality of drug dependence treatment and no regular monitoring of practices. In too many countries, beatings, forced labor, and denial of health care and adequate sanitation are offered in the name of treatment, including in compulsory detention centres that are more like prisons than treatment facilities. Where there are humane treatment options, it is often the case that those most in need of it cannot afford it. In many countries, there is no treatment designed particularly for women, though it is known that women’s motivations for and physiological reactions to drug use differ from those of men. The pursuit of the elimination of drugs has led to aggressive and harmful practices targeting people who grow crops used in the manufacture of drugs, especially coca leaf, opium poppy, and cannabis. Aerial spraying of coca fields in the Andes with the defoliant glyphosate (N-(phosphonomethyl glycine) has been associated with respiratory and dermatological disorders and with miscarriages. Forced displacement of poor rural families who have no secure land tenure exacerbates their poverty and food insecurity and in some cases forces them to move their cultivation to more marginal land. Geographic isolation makes it difficult for state authorities to reach drug crop cultivators in public health and education campaigns and it cuts cultivators off from basic health services. Alternative development programmes meant to offer other livelihood opportunities have poor records and have rarely been conceived, implemented, or evaluated with respect to their impact on people’s health. Research on drugs and drug policy has suffered from the lack of a diversified funding base and assumptions about drug use and drug pathologies on the part of the dominant funder, the US government. At a time when drug policy discussions are opening up around the world, there is an urgent to bring the best of non-ideologically-driven health science, social science and policy analysis to the study of drugs and the potential for policy reform. Policy alternatives in real life Concrete experiences from many countries that have modified or rejected prohibitionist approaches in their response to drugs can inform discussions of drug policy reform. A number of countries, such as Portugal and the Czech Republic, decriminalised minor drug offenses years ago, with significant savings of money, less incarceration, significant public health benefits, and no significant increase in drug use. Decriminalisation of minor offenses along with scaling up low-threshold HIV prevention services enabled Portugal to control an explosive unsafe injection-linked HIV epidemic and likely enabled the Czech Republic to prevent one from happening. Where formal decriminalisation may not be an immediate possibility, scaling up health services for PWUD can demonstrate the value to society of responding with support rather than punishment to people who commit minor drug infractions. A pioneering OST program in Tanzania is encouraging communities and officials to consider non-criminal responses to heroin injection. In Switzerland and the city of Vancouver, Canada, dramatic improvements in access to comprehensive harm reduction services, including supervised injection sites and heroin-assisted treatment, transformed the health picture for PWUD. Vancouver’s experience also illustrates the importance of meaningful participation of PWUD in decision-making on policies and programmes affecting their communities. Conclusions and recommendations Policies meant to prohibit or greatly suppress drugs present a paradox. They are portrayed and defended vigorously by many policy-makers as necessary to preserve public health and safety, and yet the evidence suggests they have contributed directly and indirectly to lethal violence, communicable disease transmission, discrimination, forced displacement, unnecessary physical pain, and the undermining of people’s right to health. Some would argue that the threat of drugs to society may justify some level of abrogation of human rights for protection of collective security, as is also foreseen by human rights law in case of emergencies. International human rights standards dictate that in such cases, societies still must choose the least harmful way to address the emergency and that emergency measures must be proportionate and designed specifically to meet transparently defined and realistic goals. The pursuit of drug prohibition meets none of these criteria. Standard public health and scientific approaches that should be part of policy-making on drugs have been rejected in the pursuit of prohibition. The idea of reducing the harm of many kinds of human behavior is central to public policy in the areas of traffic safety, tobacco and alcohol regulation, food safety, safety in sports and recreation, and many other areas of human life where the behavior in question is not prohibited. But explicitly seeking to reduce drug-related harms through policy and programmes and to balance prohibition with harm reduction is regularly resisted in drug control. The persistence of unsafe injection-linked HIV and HCV transmission that could be stopped with proven, cost-effective measures remains one of the great failures of the global responses to these diseases. Drug policy that is dismissive of extensive evidence of its own negative impact and of approaches that could improve health outcomes is bad for all concerned. Countries have failed to recognise and correct the health and human rights harms that pursuit of prohibition and drug suppression have caused and in so doing neglect their legal responsibilities. They readily incarcerate people for minor offenses but then neglect their duty to provide health services in custodial settings. They recognize uncontrolled illegal markets as the consequence of their policies, but they do little to protect people from toxic, adulterated drugs that are inevitable in illegal markets or the violence of organized criminals, often made worse by policing. They waste public resources on policies that do not demonstrably impede the functioning of drug markets, and they miss opportunities to invest public resources wisely in proven health services for people often too frightened to seek services. To move toward the balanced policy that UN member states have called for, we offer the following recommendations: Decriminalisation: Decriminalise minor, non-violent drug offenses – use, possession, and petty sale – and strengthen health and social-sector alternatives to criminal sanctions.Reducing violence and discrimination in policing: Reduce the violence and other harms of drug policing, including phasing out the use of military forces in drug policing, better targeting of policing on the most violent armed criminals, allowing possession of syringes, not targeting harm reduction services to boost arrest totals, and eliminating racial and ethnic discrimination in policing.Reducing harms: Ensure easy access for all who need them to harm reduction services as a part of responding to drugs, recognizing the effectiveness and cost-effectiveness of scaling up and sustaining these services. OST, NSP, supervised injection sites, and access to naloxone – brought to a scale adequate to meet demand – should all figure in health services and should include meaningful participation of PWUD in planning and implementation. Harm reduction services are crucial in prison and pretrial detention and should be scaled up in these settings. The 2016 UNGASS should do better than the UN Commission on Narcotic Drugs (CND) in naming harm reduction explicitly and endorsing its centrality to drug policy.Treatment and care for PWUD: Prioritize PWUD in treatment for HIV, HCV, TB, and ensure that services are adequate to ensure access for all who need care. Ensure availability of humane and scientifically sound treatment for drug dependence, including scaled-up OST in the community as well as in prisons, rejecting compulsory detention and abuse in the name of treatment.Access to controlled medicines: Ensure access to controlled medicines, establishing inter-sectoral national authorities to determine levels of need and giving the World Health Organization (WHO) the resources to assist the International Narcotics Control Board (INCB) in using the best science to determine the level of need for controlled medicines in all countries.Gender-responsive policies: Reduce the negative impact of drug policy and law on women and their families, especially minimizing custodial sentences for women who commit non-violent offenses and developing appropriate health and social support, including gender-appropriate treatment of drug dependence, for those who need it.Crop production: Efforts to address drug crop production must take health into account. Aerial spraying of toxic herbicides should be stopped, and alternative development programmes should be part of integrated development strategies, developed and implemented in meaningful consultation with the people affected.Improve research: There is a need for a more diverse donor base to fund the best new science on drug policy experiences in a non-ideological way that, among other things, interrogates and moves beyond the excessive pathologising of drug use.UN governance of drug control: UN governance of drug policy must be improved, including by respecting WHO’s authority to determine the dangerousness of drugs. Countries should be urged to include high-level health officials in their delegations to CND. Improved representation of health officials in national delegations to CND would, in turn, be a likely result of giving health authorities an important day-to-day role in multi-sectoral national drug policy-making bodies.Better metrics: Health, development, and human rights indicators should be included in metrics to judge success of drug policy; WHO and UNDP should help formulate them. UNDP has already suggested that indicators such as access to treatment, rate of overdose deaths, and access to social welfare programmes for people who use drugs would be useful indicators. All drug policies should also be monitored and evaluated as to their impact on racial and ethnic minorities, women, children and young people, and people living in poverty.Scientific approach to regulated markets: Move gradually toward regulated drug markets and apply the scientific method to their evaluation. While regulated legal drug markets are not politically possible in the short term in some places, the harms of criminal markets and other consequences of prohibition catalogued in this report are likely to lead more countries (and more US states) to move gradually in that direction, a direction we endorse. As those decisions are taken, we urge governments and researchers to apply the scientific method and ensure independent, multidisciplinary and rigorous evaluation of regulated markets to draw lessons and inform improvements in regulatory practices, and to continue evaluating and improving. We urge health professionals in all countries to inform themselves and join debates on drug policy at all levels. True to the stated goals of the international drug control regime, it is possible to have drug policy that contributes to the health and well-being of humankind, but not without bringing to bear the evidence of the health sciences and the voices of health professionals. PMID:27021149