Trends in cervical cancer mortality in the Americas

This article presents an assessment of cervical cancer mortality trends in the Americas based on PAHO data. Trends were estimated for countries where data were available for at least 10 consecutive years, the number of cervical cancer deaths was considerable, and at least 75 percent of the deaths from all causes were registered. In contrast to Canada and the United States, whose general populations had been screened for many years and where cervical cancer mortality has declined steadily (to about 1.4 and 1.7 deaths per 100,000 women, respectively, as of 1990), most Latin American and Caribbean countries with available data have experienced fairly constant levels of cervical cancer mortality (typically in the range of 5-6 deaths per 100,00 women). In addition, several other countries (Chile, Costa Rica, and Mexico) have exhibited higher cervical cancer mortality as well as a number of noteworthy changes in this mortality over time. Overall, while actaul declining trends could be masked by special circumstances in some countries, cervical cancer has not declined in Latin America as it has in developing countries. Correlations between declining mortality and the intensity of screening in developing countries suggest that a lack of screening or screening programs shortcomings in Latin America could account for this. Among other things, where large-scale cervical cancer screening efforts have been instituted in Latin America and Caribbean, these efforts have generally been linked to family planning and prenatal care programs serving women who are typically under 30; while the real need is for screening of older women who are at substantially higher risk.(AU)

Influence of PAHO publications on scientific production in the health field in Latin America and the Caribbean

The influence and impact of PAHO publications on scientific production in the field of health in Latin America and the Caribbean was the subject of a study based on a sample of 45 biomedical journals published between 1985 and 1992 in 17 countries of the Region. A total of 8644 works (mostly articles), containing 82,143 citations, were studied. Of these, 3,806 citations were found to refer to works published by PAHO Headquarters in Washington, D.C. - the Boletin de la Oficina Sanitaria Panamericana receiving 1,444 (38 percent of the total), the English-language Bulletin of PAHO receiving 1064 (28 percent) , and works in other PAHO publications receiving 1076 (28 percent). Overall PAHO publications appeared to account for a significant share of the citations studies (AU).

Measles elimination in the Americas: evolving strategies

The strategy currently used to control measles in most countries has been to immunize each successive birth cohort through the routine health services delivery system. While measles vaccine coverage has increased markedly, significant measles outbreaks have continued to recur. During the past five years, experience in the Americas suggests that measles transmission has been interrupted in a number of countries (Cuba, Chile, and countries in the English-Speaking Caribbean and successfully controlled in all remaining countries. Since 1991 these countries have implemented one-time "catch-up" vaccination campaigns (conducted during a short period, usually 1 week to 1 month, and targeting all children 9 months through 14 years of age, regardless of previous vaccination status or measles disease history). These campaigns have been followed by improvements in routine vaccination services and in surveillance systems, so that the progress of the measles elimination efforts can be sustained and monitored. Follow-up mass vaccination campaigns for children younger than 5 years are planned to take place every 3 to 5 years (AU)

National plan for prevention and control of cholera: objectives for the Bahamas

Cholera has not occured in epidemic form in the Americas since the last century, and although most Caribbean countries and the Bahamas may not be overwhelmed by the current cholera epidemic in Latin America, it is important that urgent and immediate preventive measures be established within New Providence and the Family Islands as a first step in ensuring that the country remains free from infection. Consistent with the above, the Bahamas, through PAHO/WHO support, has developed this National Cholera Plan for donor consideration. The plan emphasises regional and subregional co-operation, the establishment of a high level national intersectorial committee or cholera command center, increased survellance, training and public education and expanded coverage in water, wastewater and sanitation and coastal zone pollution. The intersectorial committee or Cholera Command Center which is the pivotal element in the overall plan and strategy, would be supported by a Secretariat whose function includes, among other things, the development of inputs for continuous monitoring and evaluation. The request for donor funds (external) is identified in the overall budget and plan componment (AU)

Prescribers' formularies and rational drug use - abstract

Traditional formularies were comprehensive "recipe books". As a result of initiatives of the Pan American Health Organisation, five Caribbean countries created National Formularies which were merely limited lists of from 400 (St. Vincent) to 850 (Jamaica) chemical entities. These lists often bore little relation to drugs available, and initially had little impact on prescribing. In 1989, Barbados established an effective Formulary Committee, with mechanisms for annual revision of a National Formulary. The third edition was a "Prescribers' Formulary", with guidance on selection and prescribing of drugs; a twelfth edition appeared in 1990. The Eastern Caribbean Drug Service produces a similar formulary for the members of the OECS (Organisation of Eastern Caribbean States). The impact of both formularies on local prescribing has been increasing steadily. A Drug Utilisation Review (DUR) Pilot Study was carried out at major private Bridgetown pharmacies early in 1991, to assess the extent of use of formulary drugs and Benefit Service schemes. Fifty-one percent of all scripts were for benefit Service items (free for patients of certain ages, under 16 or over 65, or with certain chronic diseases or cancer). Seventy-four per cent of all prescribed items were for formulary drugs. Of the remaining 26 per cent, 6 per cent were the same generic name but a different brand from the formulary drug. These figures show that the Barbados National Formulary markedly influences prescribing practices, including use of generic names and the learning of new brand names associated with lower cost and locally manufactured drugs. The promotion of rational drug use at lower cost depends on an effective formulary process, and a respected prescribers' formulary. The essential components are: a restricted list (never more than 500 drugs), use of generic names, rigorous testing of quality (there is a Caribbean Regional Drug Testing Laboratory in Jamaica), continuity of selection of drugs for chronic diseases, a "cost effective" approach, participation of health professionals in drug selection and protocols and, above all, recognition by all of the formulary as a national guide to rational drug use. The failure of most Caribbean countries to develop national drug policies or effective formularies is due both to the lack of appropriately trained professionals and to the failure of Governments and health planners to recognise these principles (AU)

A retrospective study of the PAHO fellowships programme in the Caribbean, 1970-1979

In the past, lack of information about international fellowship programs for health workers raised questions about such programes effectiveness, especially about whether the trained fellows found jobs when they returned to their home countries or whether they returned at all. The account that follows reports the results of a pilot survey that examined the PAHO fellowships program in the Caribbean for the purpose of answering these questions (AU)

The Caribbean Epidemiology Centre (CAREC)

The Caribbean Epidemiology Centre began operating on 1 January 1975 under the adminstrative management of the Pan American Health Organization (PAHO) at the request of the Caribbean Health Ministers' Conference held in the Bahamas in 1974. This presentation outlines the events leading to formation of the Centre and describes its structure, objectives, and development from January 1975 through 1978 (AU)

Problems of venereal infections in Latin America and the Caribbean and means of fighting them

Campaigns against sexually transmitted diseases (STD) in Latin America and the Caribbean encounter a number of special conditions. This article describes some of those conditions and points out the rising interest that PAHO's Member Governments have recently shown in STD control (AU)

The research programme of the Pan American Health Organization - abstract

The programme emphasizes: (1) Support of individual investigators and of research training schemes in fields that are directly relevant to health problems in the Americas; (2) Development of multi-national programmes to make the best possible use of existing resources in the Region and to encourage co-operative efforts in research and research training; (3) Application of operations research methodologies to the planning and administration of health programmes so as to assure maximum returns from investments in this sector; (4) Strengthening of communications among biomedical scientists in the Hemisphere; and (5) Involvement of distinguished scientists from all parts of the world in the research being planned and carried out in the region. Examples of specific activities being carried out under each of these areas wil be presented (AU)