Distribution and prevalence of major risk factors of noncommunicable diseases in selected countries: the WHO Inter-Health Programme.

The Inter-Health Programme was launched in 1986 by WHO, with the collaboration of a coordination centre (National Public Health Institute, Finland) to control and prevent chronic noncommunicable diseases (CNCDs) among adults. Programmes for action were organized based on the concept that most major CNCDs share common risk factors and that those that are lifestyle related are modifiable through efficient interventions using multifactorial strategies involving community participation and behaviour changes carried out at the primary health care level. Twelve countries from all WHO Regions have joined the programme. A baseline survey was undertaken in all countries with a common protocol, following the criteria and methods employed in the MONICA Project. Altogether 36815 men and women aged 35-64 years were included in the present analysis from the following Inter-Health countries: Chile, China, Cyprus, Finland, Lithuanian SSR, Malta, Mauritius, Russian SFSR, United Republic of Tanzania, and USA. In addition to individual country analysis, centralized analysis was carried out at the Finnish National Public Health Institute and the Department of Community Health, Kuopio University, Finland. Reported here are the mean values of blood pressure, body mass index, and serum total cholesterol as well as specific prevalences of smoking, hypertension, obesity, and hypercholesterolaemia.

PIP: The Inter-Health Program was launched in 1986 by the World Health Organization (WHO) with the collaboration of Finland's National Public Health Institute to control and prevent chronic noncommunicable diseases (CNCDs) among adults. The program consists of interventions designed to modify the levels of the major risk factors of CNCDs in the community through an integrated, community-oriented approach to health promotion and maintenance. 12 countries from all WHO regions have joined the program. The effects of intervention activities were measured by examining changes in the status of risk factors in populations before and after a given intervention. A baseline survey was conducted in all of the Inter-Health countries with a common protocol to identify the relevant risk factors. 36,815 men and women aged 35-64 from Chile, China, Cyprus, Finland, Lithuania, Malta, Mauritius, Russia, Tanzania, and the US were surveyed. This paper reports the mean values of blood pressure, body mass index, and serum total cholesterol as well as specific prevalences of smoking, hypertension, obesity, and hypercholesterolemia.

Programme's research on determinants of abortion has impact on policy.

PIP: Induced abortion remains a relatively uncharted research topic in medical demography, social science, and to a lesser extent, in epidemiology. Up to 20% of the 500,000 maternal deaths which occur annually throughout the world, however, may be a consequence of complications of unsafe abortion procedures. The UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction started a number of studies in 1989 in developing countries on the determinants and consequences of induced abortion. The program's research has produced a wealth of data, with many countries taking important steps to change abortion policy in the interest of improving reproductive health. For example, a study in Mauritius of women hospitalized for abortion revealed that 20% of them had not been using a method of contraception when they became pregnant; a motion was subsequently tabled in the National Assembly to decriminalize abortion. Another study in Chile showed the incidence of induced abortions to be generally under-reported by women and that interventions based upon sound policy can reduce their incidence and improve reproductive health.^ieng

Lessons learned from pilot projects on school-based AIDS education.

PIP: The World Health Organization and UNESCO have collaborated to establish and evaluate 7 pilot projects for school-based AIDS education in Ethiopia, Mauritius, Sierra Leone, Tanzania, Jamaica, Venezuela, and the Pacific. By training teachers and developing appropriate teaching and learning materials, they hope to add AIDS education into school curricula. Thus far, 4 projects have been completed. Review indicates that given parental support, school-based AIDS education may work in developing countries at both primary and secondary levels; initial assessment studies are valuable in program design; these programs help to increase family and community awareness; students gain knowledge and may also tend to discriminate less against those infected with HIV; prevention skills are the most difficult to teach and are rarely of primary focus; information in curricula on condom value and use is acceptable to education authorities; teaching and learning material prototypes are useful to educational planners and trainers; and teacher training should include small-group discussions on personal attitudes toward sexuality.^ieng

Physicians' views of periodic abstinence methods: a study in four countries.

A study of the knowledge, perceptions, and behavioral intentions of physicians regarding periodic abstinence (PA) methods was undertaken in Mauritius, Peru, the Philippines, and Sri Lanka. Most respondents considered PA to be useful, although even the PA providers prescribed mainly non-PA methods. Detailed knowledge of PA methods was not evident, but most physicians were willing to initiate general discussion about PA with patients. Physicians favored methods perceived as "scientific" and "modern," which primarily prevent pregnancy and secondarily avoid other health risks. When carefully presented as "scientific" and "modern," methods presented to medical audiences may find acceptance and be more likely to result in referral.

PIP: This study attempts to assess the level of knowledge about periodic abstinence methods and willingness to communicate that knowledge to patients among a sample of 375 physicians from 4 developing countries: Mauritius, Peru, the Philippines, and Sri Lanka. For purposes of this study, periodic abstinence includes the calendar method (rhythm), the Billings method (ovulation method), the temperature method (basal body temperature), and the sympto-thermal method (temperature and cervical mucus observation). 54% of the doctors interviewed did not provide periodic abstinence services. 67% were male, 60% were over 40, 92% were not strongly Catholic, and 42% were general practitioners. Older doctors, female doctors, and strongly Catholic doctors were most likely to provide periodic abstinence services. 54% of providers were general practitioners, 46% were gynecologists, and 36% were clinicians. Both providers and nonproviders were most likely to recommend the pill or the IUD as a contraceptive method. The calendar method was the most commonly provided abstinence method. Providers, in general, had more knowledge about abstinence methods than did nonproviders, but even providers were deficient in knowledge about methods that they did not supply. Of the 3 main abstinence methods, the calendar method was perceived as most traditional, the Billings method as most modern. The sympto-thermal method was perceived as modern but also as "artificial." On a scale of 1 to 7 from bad/nonscientific to good/scientific, the pill scored highest (6.4), while the temperature, Billings, and calendar methods scored 5.2 or 5.1. 47% of all the physicians surveyed said that they would not recommend periodic abstinence to their patients. The majority said that they would respond to inquiries about these methods but would not initiate discussions about them. Among nonproviders, 12% said they would seek future training, but 17% said they had no future plans for either training or service.

Biological effectiveness of the sympto thermal rhythm method. An international study. A preliminary report.

PIP: A 2-year prospective study of the sympto-thermal method of rhythm was conducted. The primary objective was the statistical evaluation of the biological effectiveness of sympto-thermal rhythm. The study was international in scope, comprising over 1000 couples living in 5 countries of the world (Canada, Colombia, France, Mauritius, and the United States). The image many people have of rhythm users is that of older couples with 5 or 6 children desperately trying to avoid another child. Analysis of the study participants shows otherwises. The age of the wives on January 1, 1971 varied from 20-44, and the size of the families was from 1-9 with the curve skewed heavily to the left. Only 205 of 1014 couples registered in the study failed to complete the full 24 months. During this time there were 236 pregnancies, 103 of which were planned and 133 unplanned. Most countries had a use effectiveness of between 6 and 7.5 conceptions/100 woman years. Colombia was the notable exception with slightly over 22 conceptions/100 woman years. For those using sympto-thermal only, 9 of 110 unplanned pregnancies were judged to be due to method failure and 101 to user failure. The user effectiveness is 7.18 pregnancies/100 woman years of exposure, and the biological effectiveness rate is 0.64 pregnancies/100 woman years of exposure.^ieng