RESUMEN
The approaches and tools of health promotion can be useful for civil society groups, local and national governments and multilateral organizations that are working to operationalize the 2030 agenda for sustainable development. Health promotion and sustainable development share several core priorities, such as equity, intersectoral approaches and sustainability, that help maximize their impact across traditional sectoral boundaries. In the Region of the Americas, each of these priorities has strong resonance because of prominent and long-standing health inequities that are proving resistant to interventions driven solely by the health sector. We describe several cases from the World Health Organization's (WHO) Region of the Americas in which the approaches and tools of health promotion, with a focus on cities, healthy settings and multisectoral collaboration, have been used to put the agenda into practice. We highlight areas where such approaches and tools can be applied effectively and provide evidence of the transformative potential of health promotion in efforts to achieve the sustainable development goals.
Les approches et outils de promotion de la santé peuvent être utiles aux groupes de la société civile, aux gouvernements locaux et nationaux et aux organismes multilatéraux qui s'efforcent de mettre en Åuvre le Programme de développement durable à l'horizon 2030. La promotion de la santé et le développement durable ont plusieurs priorités centrales en commun, telles que l'équité, la collaboration intersectorielle et la durabilité, qui contribuent à optimiser leur impact au-delà des limites sectorielles habituelles. Chacune de ces priorités a une forte résonance dans la Région des Amériques, où les importantes inégalités en termes de santé durent depuis longtemps et semblent résister aux interventions menées à la seule initiative du secteur de la santé. Dans cet article, nous décrivons divers exemples provenant de la Région des Amériques de l'Organisation mondiale de la Santé (OMS), où plusieurs approches et outils de promotion de la santé (ciblant principalement les populations urbaines, la création d'environnements-santé et une collaboration multisectorielle) sont actuellement employés pour mettre en Åuvre le Programme de développement durable. Nous mettons l'accent sur les domaines dans lesquels ces approches et outils peuvent être efficacement appliqués et nous proposons des données probantes sur le potentiel de transformation de la promotion de la santé dans les efforts menés pour atteindre les objectifs de développement durable.
Los enfoques y las herramientas para el fomento de la salud son útiles para los grupos de la sociedad civil, los gobiernos locales y nacionales y las organizaciones multilaterales que trabajan para poner en marcha el programa de desarrollo sostenible de 2030. El fomento de la salud y el desarrollo sostenible comparten varias prioridades básicas, como la equidad, los enfoques intersectoriales y la sostenibilidad, que ayudan a maximizar el impacto dentro de los límites sectoriales tradicionales. En la Región de las Américas, cada una de estas prioridades tiene una fuerte repercusión debido a las inequidades sanitarias prominentes y prolongadas que resisten a las intervenciones impulsadas únicamente por el sector de la salud. Se describen varios casos de la Región de las Américas de la Organización Mundial de la Salud (OMS) en los que los enfoques y las herramientas para el fomento de la salud, centrado en ciudades, entornos saludables y colaboración multisectorial, se han utilizado para poner en práctica el programa. Se destacan las áreas donde tales enfoques y herramientas se pueden aplicar de manera efectiva y ofrecer pruebas del potencial transformador del fomento de la salud en los esfuerzos por alcanzar los objetivos de desarrollo sostenible.
Asunto(s)
Conservación de los Recursos Naturales , Promoción de la Salud , Estilo de Vida Saludable , Américas , Ciudades , Humanos , Organización Mundial de la SaludRESUMEN
Conceived in 2003 and born in 2005 with the launch of its first report and country profiles, the Countdown to 2015 for Maternal, Newborn, and Child Survival has reached its originally proposed lifespan. Major reductions in the deaths of mothers and children have occurred since Countdown's inception, even though most of the 75 priority countries failed to achieve Millennium Development Goals 4 and 5. The coverage of life-saving interventions tracked in Countdown increased steadily over time, but wide inequalities persist between and within countries. Key drivers of coverage such as financing, human resources, commodities, and conducive health policies also showed important, yet insufficient increases. As a multistakeholder initiative of more than 40 academic, international, bilateral, and civil society institutions, Countdown was successful in monitoring progress and raising the visibility of the health of mothers, newborns, and children. Lessons learned from this initiative have direct bearing on monitoring progress during the Sustainable Development Goals era.
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Mortalidad del Niño/tendencias , Mortalidad Infantil/tendencias , Mortalidad Materna/tendencias , Causas de Muerte/tendencias , Niño , Servicios de Salud del Niño/tendencias , Preescolar , Conservación de los Recursos Naturales/tendencias , Femenino , Salud Global/tendencias , Disparidades en Atención de Salud/tendencias , Humanos , Lactante , Recién Nacido , Servicios de Salud Materna/tendencias , EmbarazoRESUMEN
The end of 2015 will signal the end of the Millennium Development Goal era, when the world can take stock of what has been achieved. The Countdown to 2015 for Maternal, Newborn, and Child Survival (Countdown) has focused its 2014 report on how much has been achieved in intervention coverage in these groups, and on how best to sustain, focus, and intensify efforts to progress for this and future generations. Our 2014 results show unfinished business in achievement of high, sustained, and equitable coverage of essential interventions. Progress has accelerated in the past decade in most Countdown countries, suggesting that further gains are possible with intensified actions. Some of the greatest coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases. Although inequities are pervasive, country successes in reaching of the poorest populations provide lessons for other countries to follow. As we transition to the next set of global goals, we must remember the centrality of data to accountability, and the importance of support of country capacity to collect and use high-quality data on intervention coverage and inequities for decision making. To fulfill the health agenda for women and children both now and beyond 2015 requires continued monitoring of country and global progress; Countdown is committed to playing its part in this effort.
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Servicios de Salud del Niño/tendencias , Servicios de Salud para Mujeres/tendencias , Niño , Preescolar , Femenino , Predicción , Planificación en Salud , Política de Salud/tendencias , Prioridades en Salud , Humanos , Responsabilidad SocialRESUMEN
There is a broad consensus and evidence that shows qualified, accessible, and responsive human resources for health (HRH) can make a major impact on the health of the populations. At the same time, there is widespread recognition that HRH crises particularly in low- and middle-income countries (LMICs) impede the achievement of better health outcomes/targets. In order to achieve the Sustainable Development Goals (SDGs), equitable access to a skilled and motivated health worker within a performing health system is need to be ensured. This review contributes to the vast pool of literature towards the assessment of HRH for maternal health and is focused on interventions delivered by skilled birth attendants (SBAs). Studies were included if (a) any HRH interventions in management system, policy, finance, education, partnership, and leadership were implemented; (b) these were related to SBA; (c) reported outcomes related to maternal health; (d) the studies were conducted in LMICs; and (e) studies were in English. Studies were excluded if traditional birth attendants and/or community health workers were trained. The review identified 25 studies which revealed reasons for poor maternal health outcomes in LMICs despite the efforts and policies implemented throughout these years. This review suggested an urgent and immediate need for formative evidence-based research on effective HRH interventions for improved maternal health outcomes. Other initiatives such as education and empowerment of women, alleviating poverty, establishing gender equality, and provision of infrastructure, equipment, drugs, and supplies are all integral components that are required to achieve SDGs by reducing maternal mortality and improving maternal health.
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Agentes Comunitarios de Salud , Países en Desarrollo , Accesibilidad a los Servicios de Salud , Servicios de Salud Materna , Salud Materna , Partería , Desarrollo de Personal , Femenino , Recursos en Salud , Humanos , Servicios de Salud Materna/normas , Embarazo , Recursos HumanosRESUMEN
A new Global Investment Framework for Women's and Children's Health demonstrates how investment in women's and children's health will secure high health, social, and economic returns. We costed health systems strengthening and six investment packages for: maternal and newborn health, child health, immunisation, family planning, HIV/AIDS, and malaria. Nutrition is a cross-cutting theme. We then used simulation modelling to estimate the health and socioeconomic returns of these investments. Increasing health expenditure by just $5 per person per year up to 2035 in 74 high-burden countries could yield up to nine times that value in economic and social benefits. These returns include greater gross domestic product (GDP) growth through improved productivity, and prevention of the needless deaths of 147 million children, 32 million stillbirths, and 5 million women by 2035. These gains could be achieved by an additional investment of $30 billion per year, equivalent to a 2% increase above current spending.
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Protección a la Infancia , Desarrollo Económico , Salud Global , Política de Salud , Salud de la Mujer , Niño , Mortalidad del Niño , Preescolar , Países en Desarrollo , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Inversiones en Salud , Masculino , Mortalidad MaternaRESUMEN
Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women's and Children's Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula--fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women's and children's health towards 2015 and beyond.
La réduction de la mortalité maternelle et infantile est une priorité des objectifs du Millénaire pour le développement (OMD) et le restera probablement après l'échéance de 2015. Il existe des données sur les investissements, les interventions et les politiques habilitantes nécessaires. On comprend mal pourquoi certains pays ont réalisé des progrès plus rapidement que d'autres pays comparables. Les Facteurs de réussite des études sur la santé des femmes et des enfants ont cherché à combler ce manque de connaissances en utilisant les analyses statistiques et économétriques des données provenant de 144 pays à faible revenu et à revenu intermédiaire et recueillies depuis 20 ans: une analyse comparative qualitative booléenne; une étude bibliographique et des études spécifiques à chaque pays pour les 10 pays à progression rapide pour les points 4 et 5a des OMD. Il n'existe pas de formule standard les pays à progression rapide ont déployé des stratégies personnalisées et se sont adaptés rapidement aux changements. Cependant, ces pays ont en commun des approches efficaces visant 3 grands axes afin de réduire la mortalité maternelle et infantile. Premièrement, ils impliquent de nombreux secteurs pour traiter les facteurs déterminants et cruciaux pour la santé. Près de la moitié de la réduction de la mortalité infantile dans les pays à faible revenu et à revenu intermédiaire depuis 1990 résulte des investissements dans le secteur de la santé, l'autre moitié étant attribuée aux investissements réalisés dans les secteurs extérieurs à la santé. Deuxièmement, ces pays utilisent des stratégies pour mobiliser les partenaires dans la société, en utilisant des données solides et opportunes pour la prise de décisions et la responsabilisation, ainsi qu'une approche de planification triple pour prendre en considération les besoins immédiats, la vision à long terme et l'adaptation aux changements. Troisièmement, ces pays établissent des principes directeurs qui orientent les progrès, harmonisent les actions des parties prenantes et génèrent des résultats dans le temps. Cette synthèse de données contribue à l'ensemble des connaissances requises pour accélérer les améliorations sur la santé des femmes et des enfants en vue de l'échéance de 2015 et au-delà.
La reducción de la mortalidad materna e infantil es una prioridad en los Objetivos de Desarrollo del Milenio (ODM), y probablemente lo seguirá siendo después de 2015. Existen evidencias sobre las inversiones, las intervenciones y las políticas necesarias, pero se sabe menos acerca de por qué algunos países logran un progreso más rápido que otros países comparables. Los estudios relativos a los Factores de Éxito en la Salud de las Mujeres y los Niños han tratado de abordar esta brecha de conocimiento por medio de análisis estadísticos y econométricos de datos de 144 países de ingresos bajos y medianos (PIBM) a lo largo de más de 20 años, análisis comparativos cualitativos booleanos, revisión de la literatura y revisiones específicas de cada país en 10 países bien encarrilados para los ODM 4 y 5a. No existe una fórmula estándar, estos países despliegan estrategias a medida y se adaptan rápidamente a los cambios. Sin embargo, comparten ciertos enfoques eficaces a la hora de abordar tres áreas principales para reducir la mortalidad materna e infantil. En primer lugar, involucran a numerosos sectores para hacer frente a los factores sanitarios decisivos. Alrededor de la mitad de la reducción de la mortalidad infantil en los PIBM desde 1990 es el resultado de inversiones en el sector de la salud, y la otra mitad se atribuye a las inversiones realizadas en sectores fuera del ámbito sanitario. En segundo lugar, estos países utilizan estrategias para movilizar a socios a través de la sociedad, utilizando evidencias oportunas y sólidas para la toma de decisiones y la rendición de cuentas, así como un enfoque de planificación triple para considerar las necesidades inmediatas, la visión a largo plazo y la adaptación al cambio. En tercer lugar, los países establecen principios rectores que orientan el progreso, armonizan las acciones de las partes interesadas y logran resultados en el tiempo. Este compendio de evidencias contribuye al aprendizaje global sobre cómo acelerar las mejoras en la salud de mujeres y niños hacia el 2015 y más adelante.
Asunto(s)
Servicios de Salud del Niño/organización & administración , Mortalidad del Niño/tendencias , Salud Global , Objetivos , Servicios de Salud Materna/organización & administración , Mortalidad Materna/tendencias , Adolescente , Adulto , Niño , Servicios de Salud del Niño/economía , Preescolar , Países en Desarrollo , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Servicios de Salud Materna/economía , Naciones Unidas , Organización Mundial de la SaludRESUMEN
The Countdown to 2015 for Maternal, Newborn, and Child Survival monitors coverage of priority interventions to achieve the Millennium Development Goals (MDGs) for child mortality and maternal health. We reviewed progress between 1990 and 2010 in coverage of 26 key interventions in 68 Countdown priority countries accounting for more than 90% of maternal and child deaths worldwide. 19 countries studied were on track to meet MDG 4, in 47 we noted acceleration in the yearly rate of reduction in mortality of children younger than 5 years, and in 12 countries progress had decelerated since 2000. Progress towards reduction of neonatal deaths has been slow, and maternal mortality remains high in most Countdown countries, with little evidence of progress. Wide and persistent disparities exist in the coverage of interventions between and within countries, but some regions have successfully reduced longstanding inequities. Coverage of interventions delivered directly in the community on scheduled occasions was higher than for interventions relying on functional health systems. Although overseas development assistance for maternal, newborn, and child health has increased, funding for this sector accounted for only 31% of all development assistance for health in 2007. We provide evidence from several countries showing that rapid progress is possible and that focused and targeted interventions can reduce inequities related to socioeconomic status and sex. However, much more can and should be done to address maternal and newborn health and improve coverage of interventions related to family planning, care around childbirth, and case management of childhood illnesses.
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Mortalidad del Niño/tendencias , Comparación Transcultural , Mortalidad Infantil/tendencias , Mortalidad Materna/tendencias , Planificación Social , Niño , Preescolar , Países en Desarrollo/estadística & datos numéricos , Servicios de Planificación Familiar/tendencias , Femenino , Predicción , Humanos , Lactante , Recién Nacido , Cobertura del Seguro/tendencias , Embarazo , Asistencia Pública/tendencias , Factores SocioeconómicosAsunto(s)
Mortalidad del Niño/tendencias , Países en Desarrollo , Planificación en Salud/organización & administración , Salud , Mortalidad Materna/tendencias , Adolescente , Salud del Adolescente , Niño , Salud Infantil , Conducta Cooperativa , Humanos , Cooperación Internacional , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Salud de la Mujer , Organización Mundial de la Salud , Adulto JovenRESUMEN
This article reviews the importance of regional initiatives in the context of global efforts to achieve the Millennium Development Goal 4 and 5 and describes the action-oriented multi-country healthcare professional association (HCPA) workshops organized by the Partnership for Maternal, Newborn and Child Health. The South Asian HCPA workshop served as a catalyst for strengthening the ability of HCPAs in South Asian countries to organize and coordinate their activities effectively, play a larger role in national planning, and collaborate with other key stakeholders in maternal, newborn and child health.
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Protección a la Infancia , Bienestar del Lactante , Agencias Internacionales , Cooperación Internacional , Bienestar Materno , Adulto , Asia , Creación de Capacidad , Niño , Protección a la Infancia/tendencias , Preescolar , Femenino , Planificación en Salud , Prioridades en Salud , Humanos , Lactante , Bienestar del Lactante/tendencias , Recién Nacido , Agencias Internacionales/organización & administración , Masculino , Bienestar Materno/tendencias , EmbarazoRESUMEN
The principles agreed at Alma-Ata 30 years ago apply just as much now as they did then. "Health for all" by the year 2000 was not achieved, and the Millennium Development Goals (MDGs) for 2015 will not be met in most low-income countries without substantial acceleration of primary health care. Factors have included insufficient political prioritisation of health, structural adjustment policies, poor governance, population growth, inadequate health systems, and scarce research and assessment on primary health care. We propose the following priorities for revitalising primary health care. Health-service infrastructure, including human resources and essential drugs, needs strengthening, and user fees should be removed for primary health-care services to improve use. A continuum of care for maternal, newborn, and child health services, including family planning, is needed. Evidence-based, integrated packages of community and primary curative and preventive care should be adapted to country contexts, assessed, and scaled up. Community participation and community health workers linked to strengthened primary-care facilities and first-referral services are needed. Furthermore, intersectoral action linking health and development is necessary, including that for better water, sanitation, nutrition, food security, and HIV control. Chronic diseases, mental health, and child development should be addressed. Progress should be measured and accountability assured. We prioritise research questions and suggest actions and measures for stakeholders both locally and globally, which are required to revitalise primary health care.
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Servicios de Salud Comunitaria/estadística & datos numéricos , Salud Global , Prioridades en Salud , Atención Primaria de Salud/estadística & datos numéricos , Servicios de Salud Comunitaria/organización & administración , Servicios de Salud Comunitaria/tendencias , Objetivos , Humanos , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/tendenciasRESUMEN
OBJECTIVES: To assess a birth registry to explore maternal mortality and morbidity and their association with other factors. STUDY DESIGN: Exploratory multicentre cross-sectional analysis with over 700 thousand childbirths from twelve Latin American and Caribbean countries between 2009 and 2012. The WHO criteria for maternal morbidity were employed to split women, following a gradient of severity of conditions, into (1) maternal death (MD); (2) maternal near miss (MNM); (3) potentially life-threatening conditions (PLTC); (4) less severe maternal morbidity (LSMM); (5) any maternal morbidity; and (6) women with no maternal morbidity. Their prevalence and estimated risks of adverse maternal outcomes were assessed. RESULTS: 712,081 childbirths had a prevalence of MD and MNM of 0.14% and 3.1%, respectively, while 38% of women had experienced morbidity. Previous maternal morbidity was associated with higher risk of adverse maternal outcomes and also the extremes of reproductive ages, nonwhite ethnicity, no stable partner, no prenatal care, smoking, drug and alcohol use, elective C-section, or induction of labour. Poorer perinatal outcomes were proportional to the severity of maternal outcomes. CONCLUSIONS: The findings corroborate WHO concept regarding continuum of maternal morbidity, reinforcing its importance in preventing adverse maternal outcomes and improving maternal healthcare in different settings.
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Salud Materna , Mortalidad Materna , Complicaciones del Embarazo/mortalidad , Reproducción/fisiología , Región del Caribe/epidemiología , Cesárea/efectos adversos , Femenino , Humanos , América Latina/epidemiología , Embarazo , Complicaciones del Embarazo/fisiopatología , Estados UnidosRESUMEN
BACKGROUND: National nutrition programs in Bangladesh have included prenatal food supplementation to reduce maternal and child malnutrition. The knowledge base is weak regarding the effect of prenatal food supplementation on the birth weight (BW) of infants in populations in whom low BW is prevalent and regarding any variation in effect based on maternal nutritional status. OBJECTIVE: We examined whether observational data support an effect of daily prenatal food supplementation on BW by considering the duration of supplementation and whether the effect is modified by maternal postpartum weight (a proxy of prepregnancy weight) groups. DESIGN: A cohort of undernourished pregnant women (n = 777) who received prenatal food supplementation (608 kcal/d) was followed. The association between the uptake of food supplements and BW was analyzed after adjustment for potential confounders (n = 619 with complete information). Differential effects in lower and higher maternal postpartum weight groups were examined. RESULTS: The average BW was 2521 g. On average, the women received daily supplements for 4 mo, which resulted in an increase in BW of 118 g (1.0 g/d). The strongest effect was found for births occurring in January and February. There was a linear dose-response relation between duration of supplementation and BW for women with higher postpartum weights (> or = 42 kg, above the median). In women with lower weights (< 42 kg, below median), a shorter duration of supplementation (< 4 mo) had no such dose-response relation with BW, but there was a linear dose-response relation for longer durations of supplementation. CONCLUSIONS: The association between duration of prenatal food supplementation and BW varies with maternal postpartum weight. A large effect was observed after the season with food insecurity (mid-August to mid-November).
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Peso al Nacer , Suplementos Dietéticos , Fenómenos Fisiologicos Nutricionales Maternos , Adulto , Bangladesh , Femenino , Humanos , Recién Nacido , Estado Nutricional , Embarazo , Análisis de Regresión , Estaciones del AñoRESUMEN
OBJECTIVE: To examine whether the reduction in childhood mortality after immunization can be explained by the prevention of measles and its long-term effects. METHODS: and Data We re-analysed an existing data set from Matlab, Bangladesh. During 1982-1985, measles immunization was used from 9 months of age in half of the study area, and the other half was used as an unvaccinated control area. A total of 8134 immunized children had been matched by age with 8134 non-immunized children; 578 children died during the follow-up period of 3 years. Using these data, we calculated the vaccine effectiveness against death (VED) controlling for significant factors in a matched analysis. In the absence of measles, there should be no difference in mortality between immunized, uninfected children and non-immunized, uninfected children. We therefore calculated VED after the exclusion of all measles cases in the survival analysis. To assess the long-term effects of measles, we compared survival of unvaccinated children after measles disease with children who had not yet contracted measles. RESULTS: Prior to immunization and again after 1985, childhood mortality rates were 10% lower in the area that had received immunization. Though measles deaths only constituted 12.4% of the non-accidental deaths, the VED controlling for significant factors was 49% (95% CI: 38-58%). The vaccine was protective against measles death throughout the study, but it also had a marked effect against other causes of death, particularly diarrhoea and oedema. This effect may have been particularly strong in the first 6 months after immunization (VED = 74, 95% CI: 57-84%). The VED was only reduced from 49% to 43% (95% CI: 31-54%) when measles cases were excluded in the survival analysis. Controlling for background factors, mortality among measles cases was increased during the acute phase (0-45 days) (mortality ratio [MR] = 17.35, 95% CI: 11.9-25.3) and in the following 1(1/2) months (MR = 2.35, 95% CI: 0.95-5.84). However, post-measles cases had significantly lower mortality than uninfected, non-immunized children in the following 9 months (MR = 0.40, 95% CI: 0.16, 0.98). CONCLUSIONS: The non-randomized character of the original study and the possibility of uncontrolled confounding between the two areas prevent a precise estimate of the effectiveness of measles vaccine, but it is likely to have been substantial. Though there may have been some underreporting of cases of measles, the prevention of measles infection can only explain a limited part of the observed impact of measles immunization in Bangladesh. Furthermore, mortality may be reduced after the acute phase of measles infection. The observations from Bangladesh are consistent with recent research from Africa suggesting that measles immunization may have non-specific beneficial effects on survival.
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Mortalidad Infantil , Vacuna Antisarampión/administración & dosificación , Sarampión/prevención & control , Población Rural , Bangladesh/epidemiología , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Preescolar , Diarrea/prevención & control , Femenino , Humanos , Incidencia , Lactante , Masculino , Sarampión/epidemiología , Sarampión/mortalidad , SobrevidaRESUMEN
Two hundred and ninety-three randomly-selected members of the staff of ICDDR,B: Centre for Health and Population Research were surveyed anonymously in June 1998, using a pre-tested and self-administered questionnaire, to assess their knowledge on, and attitude toward, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). All except 4 (1.4%) heard of AIDS. Main sources of information were radio and television (93%), newspapers and magazines (84.8%), posters and leaflets (70.2%), and friends (59.2%). About 94% of the respondents believed that HIV might spread in Bangladesh. Only 61.6% knew about the causative agent for AIDS. More than 96% had knowledge that HIV could be detected through blood test. The respondents were aware that unprotected sexual intercourse (92%), transfusion of blood and blood components (93.8%), sharing unsterile needles for injections (94.1%), and delivery of babies by infected mothers (82.7%) could transmit HIV. Similarly, the respondents had the knowledge that HIV infection could be prevented by using condom during sexual intercourse (85.5%), having sex only with an HIV-negative faithful partner (87.2%), avoiding transfusion of blood not screened for HIV (88.9%), and taking injections with sterile needles (86.5%). However, only 33.0% had the knowledge that HIV-infected persons can look healthy, and 56.4% were unaware of transmission through breastmilk. Most members of the staff, particularly at lower level, had misconceptions about transmission and prevention of HIV/AIDS. More than 40% of the respondents had the attitude that HIV-infected persons should not be allowed to work, while another 10% did not have any idea about it. The findings of the study suggest that the members of the Centre's staff have a satisfactory level of essential knowledge on HIV/AIDS, although half of them have poor attitudes toward persons with HIV/AIDS. Therefore, preventive strategy for the staff should be directed toward behaviour change communication.
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Síndrome de Inmunodeficiencia Adquirida/psicología , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Adulto , Anciano , Bangladesh , Estudios Transversales , Femenino , Humanos , Agencias Internacionales , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To map mental health research capacity and resources in low-and-middle-income countries (LAMIC) for the years 1993-2003. METHOD: Mental health researchers from 114 LAMIC in three continents were identified through their publications in two databases (Medline and PsycInfo) and from local grey literature. A questionnaire was developed and sent to authors to elicit information about researchers' background, available resources and details of up to three recent projects. RESULTS: 4208 researchers from 83 countries were identified through 6340 mental health indexed-publications and 3598 publications from the grey literature. 912 researchers from 52 countries completed the questionnaires. Researchers and publications were concentrated in 10% of the countries. Respondents reported participation in 1847 projects, most of which were devoted to depression and anxiety disorders, substance misuse and psychoses. Epidemiologic studies, social, psychological and clinical research accounted for 80% of all projects. Two-thirds of projects had received external funding, and less than one-third of them were conducted in collaboration with other countries. CONCLUSION: Mental health research capacity is scarce and unequally distributed in LAMIC. Global agencies for health research as well as LAMIC with higher concentrations of researchers and scientific output should play a more decisive role in strengthening the capacity of other LAMIC enhancing South-South partnerships and networks.