The Country Partnership Framework (CPF) will succeed the Myanmar interim strategy note (FY13-14) and be the first full country strategy for Myanmar since 1984. This CPF comes at a time of great opportunity for Myanmar; over the three year period covered in this CPF, the reforms initiated in 2011 have the potential to bring Myanmar into a new era of peace and prosperity. Myanmar s history, ethnic diversity, and geography combine into a unique set of development challenges and opportunities, including (i) emergence from a long period of international isolation; (ii) widespread poverty, despite rich land, water, and mineral resource endowments; (iii) a strategic location in the fastest-growing region in the world; (iv) the role of the military and associated groups in the economy; and (v) long standing armed conflict and ethnic and religious tensions. Myanmar is on a path of fundamental transformation, seeking to address all these challenges and opportunities simultaneously. Along with unique opportunities, the CPF supported program will also face substantial risks. Political risks associated with the elections in late 2015 include a polarization among stakeholders, policy discontinuity, and a slow-down of reforms. The national peace process to resolve decades-old conflicts remains fragile. On the economic front, risks include vulnerability to volatile oil and gas prices, spending pressures, an underdeveloped financial sector, and a weak regulatory framework, while overall capacity constraints may limit the country s ability to effectively manage macro-financial shocks. The design of the WBG program will help manage and mitigate these risks, and the WBG will regularly review risks and opportunities and adapt the CPF during implementation as warranted. A performance and learning review planned for late FY16 will facilitate the adaptation of the WBG program to country developments as needed.
The aim of this report is to provide a broad overview of the current state of gender equality in Tajikistan. While the Europe and Central Asia (ECA) region traditionally surpassed many other regions in terms of gender equality, this advantage has been eroding in recent decades. Particularly in Tajikistan, concerns have been raised that men and women have unequally born the consequences of economic, political, and social transitions after independence in 1991. The report examines several dimensions of gender equality both quantitatively and qualitatively. Tajikistan has set up a legal framework that enshrines principles of equality and non-discrimination, but better implementation results require continued efforts. Prevailing social norms and patriarchal systems of decision-making limit women s ability to make effective choices be it at home or at work. The paper is structured along the following lines. The first section introduces the idea of agency that will remain an important issue throughout the report. This is followed by an analysis of disparities in human capital endowment, including health and education. Gender gaps in the Tajik labor market and entrepreneurial activities of men and women are discussed in the fourth and fifth section. The final section concludes with some policy recommendations that might be beneficial for discussions among policy-makers, civil society actors, and development partners.
The World Bank initiated a review of HIV prevention among injection drug users in Thailand, with the objective of providing technical assistance to strengthen national capacity to develop state-of-the-art injecting drug use harm reduction interventions. Thailand has received international recognition for its successful interventions to reduce the transmission of HIV among female sex workers and military recruits. It is looked upon as a role model for HIV education and awareness campaigns that include the extensive promotion and wide acceptance of condoms as an HIV prevention strategy. Thailand has the most progressive and comprehensive antiretroviral program in the region with a reported coverage of over 80 percent of eligible individuals. In 2001, it embarked on a progressive universal health care program that provides free access to a wide array of health care diagnostics and therapeutics for the people of Thailand. With these impressive achievements, it is remarkable how poorly Thailand has responded to the HIV epidemic among injection drug users (IDUs). From available data, it appears that the HIV prevalence rates among IDUs have remained high and stagnant over the last decade. Failure to provide effective interventions to reduce HIV transmission among drug users has resulted in unnecessary suffering, and for many, HIV-related death. Continued inaction threatens to undermine successful HIV prevention efforts in the country through ongoing HIV transmission among injection drug users and their sexual partners. The current focus on enforcement and punishment, along with the reliance on compulsory drug treatment centers, has done little to control drug use in Thailand. The unintended consequence of this approach has been to push drug users into precarious and dangerous environments that have directly led to risky drug using patterns and persistently high rates of HIV transmission. Adopting a harm reduction approach to deal with injection drug use could have a major impact on reducing HIV transmission as well as engaging drug users into better health care and effective drug treatment. This will require strong leadership in key government Ministries and related agencies so that the central stakeholders can roll out harm reduction programs. Thailand has the potential to greatly reduce the transmission of HIV among injection drug users and become a regional leader in harm reduction.
This brief summarizes some of the significant constraints women in Middle East and North Africa (MENA) face: limited labor market mobility, a mismatch between skills acquired in school and what is in demand in the labor market, and legal or institutional factors related to cultural norms, all of which inhibit the transition from school to work. The brief identifies various policy options and outlines the World Bank's strategy for supporting governments in achieving gender parity in the region. Rigorous analytical work, experimental policy pilots and lending operations with a strong gender focus all form part of the Bank's strategy towards reducing gender gaps in economic opportunities.
Many analysts consider that lack of security is a major obstacle to growth in Colombia. This paper identifies a structural downturn in economic growth-of nearly two percentage points per year-as a result of the increase in illicit crops and crime rates after 1980. A decline in total factor productivity has been the key channel linking crime and economic growth. Political upheavals and high levels of inequality and poverty motivated the adoption of a new constitution in 1991. The constitution mandated additional fiscal expenditures to curb social tensions. Major progress has been made in terms of public safety and, to a lesser extent, in the provision of health and education. However, long?run growth will continue to be constrained by inadequate transport infrastructure and low international trade volumes.
The incentives of politicians to provide broad public goods and reduce poverty vary across countries. Even in democracies, politicians often have incentives to divert resources to political rents and private transfers that benefit a few citizens at the expense of many. These distortions can be traced to imperfections in political markets that are greater in some countries than in others. This article reviews the theory and evidence on the impact on political incentives of incomplete information for voters, the lack of credibility of political promises, and social polarization. The analysis has implications for policy and for reforms to improve public goods provision and reduce poverty.
In my postgraduate formation during the last years of the 80's, we had close to thirty hospital beds in a pavilion called "sépticas" (1). In Colombia, where abortion was completely penalized, the pavilion was mostly filled with women with insecure, complicated abortions. The focus we received was technical: management of intensive care; performance of hysterectomies, colostomies, bowel resection, etc. In those times, some nurses were nuns and limited themselves to interrogating the patients to get them to "confess" what they had done to themselves in order to abort. It always disturbed me that the women who left alive, left without any advice or contraceptive method. Having asked a professor of mine, he responded with disdain: "This is a third level hospital, those things are done by nurses of the first level". Seeing so much pain and death, I decided to talk to patients, and I began to understand their decision. I still remember so many deaths with sadness, but one case in particular pains me: it was a woman close to being fifty who arrived with a uterine perforation in a state of advanced sepsis. Despite the surgery and the intensive care, she passed away. I had talked to her, and she told me she was a widow, had two adult kids and had aborted because of "embarrassment towards them" because they were going to find out that she had an active sexual life. A few days after her passing, the pathology professor called me, surprised, to tell me that the uterus we had sent for pathological examination showed no pregnancy. She was a woman in a perimenopausal state with a pregnancy exam that gave a false positive due to the high levels of FSH/LH typical of her age. SHE WAS NOT PREGNANT!!! She didn't have menstruation because she was premenopausal and a false positive led her to an unsafe abortion. Of course, the injuries caused in the attempted abortion caused the fatal conclusion, but the real underlying cause was the social taboo in respect to sexuality. I had to watch many adolescents and young women leave the hospital alive, but without a uterus, sometime without ovaries and with colostomies, to be looked down on by a society that blamed them for deciding to not be mothers. I had to see situation of women that arrived with their intestines protruding from their vaginas because of unsafe abortions. I saw women, who in their despair, self-inflicted injuries attempting to abort with elements such as stick, branches, onion wedges, alum bars and clothing hooks among others. Among so many deaths, it was hard not having at least one woman per day in the morgue due to an unsafe abortion. During those time, healthcare was not handled from the biopsychosocial, but only from the technical (2); nonetheless, in the academic evaluations that were performed, when asked about the definition of health, we had to recite the text from the International Organization of Health that included these three aspects. How contradictory! To give response to the health need of women and guarantee their right when I was already a professor, I began an obstetric contraceptive service in that third level hospital. There was resistance from the directors, but fortunately I was able to acquire international donations for the institution, which facilitated its acceptance. I decided to undertake a teaching career with the hope of being able to sensitize health professionals towards an integral focus of health and illness. When the International Conference of Population and Development (ICPD) was held in Cairo in 1994, I had already spent various years in teaching, and when I read their Action Program, I found a name for what I was working on: Sexual and Reproductive Rights. I began to incorporate the tools given by this document into my professional and teaching life. I was able to sensitize people at my countries Health Ministry, and we worked together moving it to an approach of human rights in areas of sexual and reproductive health (SRH). This new viewpoint, in addition to being integral, sought to give answers to old problems like maternal mortality, adolescent pregnancy, low contraceptive prevalence, unplanned or unwanted pregnancy or violence against women. With other sensitized people, we began with these SRH issues to permeate the Colombian Society of Obstetrics and Gynecology, some universities, and university hospitals. We are still fighting in a country that despite many difficulties has improved its indicators of SRH. With the experience of having labored in all sphere of these topics, we manage to create, with a handful of colleagues and friend at the Universidad El Bosque, a Master's Program in Sexual and Reproductive Health, open to all professions, in which we broke several paradigms. A program was initiated in which the qualitative and quantitative investigation had the same weight, and some alumni of the program are now in positions of leadership in governmental and international institutions, replicating integral models. In the Latin American Federation of Obstetrics and Gynecology (FLASOG, English acronym) and in the International Federation of Obstetrics and Gynecology (FIGO), I was able to apply my experience for many years in the SRH committees of these association to benefit women and girls in the regional and global environments. When I think of who has inspired me in these fights, I should highlight the great feminist who have taught me and been with me in so many fights. I cannot mention them all, but I have admired the story of the life of Margaret Sanger with her persistence and visionary outlook. She fought throughout her whole life to help the women of the 20th century to be able to obtain the right to decide when and whether or not they wanted to have children (3). Of current feminist, I have had the privilege of sharing experiences with Carmen Barroso, Giselle Carino, Debora Diniz and Alejandra Meglioli, leaders of the International Planned Parenthood Federation – Western Hemisphere Region (IPPF-RHO). From my country, I want to mention my countrywoman Florence Thomas, psychologist, columnist, writer and Colombo-French feminist. She is one of the most influential and important voices in the movement for women rights in Colombia and the region. She arrived from France in the 1960's, in the years of counterculture, the Beatles, hippies, Simone de Beauvoir, and Jean-Paul Sartre, a time in which capitalism and consumer culture began to be criticized (4). It was then when they began to talk about the female body, female sexuality and when the contraceptive pill arrived like a total revolution for women. Upon its arrival in 1967, she experimented a shock because she had just assisted in a revolution and only found a country of mothers, not women (5). That was the only destiny for a woman, to be quiet and submissive. Then she realized that this could not continue, speaking of "revolutionary vanguards" in such a patriarchal environment. In 1986 with the North American and European feminism waves and with her academic team, they created the group "Mujer y Sociedad de la Universidad Nacional de Colombia", incubator of great initiatives and achievements for the country (6). She has led great changes with her courage, the strength of her arguments, and a simultaneously passionate and agreeable discourse. Among her multiple books, I highlight "Conversaciones con Violeta" (7), motivated by the disdain towards feminism of some young women. She writes it as a dialogue with an imaginary daughter in which, in an intimate manner, she reconstructs the history of women throughout the centuries and gives new light of the fundamental role of feminism in the life of modern women. Another book that shows her bravery is "Había que decirlo" (8), in which she narrates the experience of her own abortion at age twenty-two in sixty's France. My work experience in the IPPF-RHO has allowed me to meet leaders of all ages in diverse countries of the region, who with great mysticism and dedication, voluntarily, work to achieve a more equal and just society. I have been particularly impressed by the appropriation of the concept of sexual and reproductive rights by young people, and this has given me great hope for the future of the planet. We continue to have an incomplete agenda of the action plan of the ICPD of Cairo but seeing how the youth bravely confront the challenges motivates me to continue ahead and give my years of experience in an intergenerational work. In their policies and programs, the IPPF-RHO evidences great commitment for the rights and the SRH of adolescent, that are consistent with what the organization promotes, for example, 20% of the places for decision making are in hands of the young. Member organizations, that base their labor on volunteers, are true incubators of youth that will make that unassailable and necessary change of generations. In contrast to what many of us experienced, working in this complicated agenda of sexual and reproductive health without theoretical bases, today we see committed people with a solid formation to replace us. In the college of medicine at the Universidad Nacional de Colombia and the College of Nursing at the Universidad El Bosque, the new generations are more motivated and empowered, with great desire to change the strict underlying structures. Our great worry is the onslaught of the ultra-right, a lot of times better organized than us who do support rights, that supports anti-rights group and are truly pro-life (9). Faced with this scenario, we should organize ourselves better, giving battle to guarantee the rights of women in the local, regional, and global level, aggregating the efforts of all pro-right organizations. We are now committed to the Objectives of Sustainable Development (10), understood as those that satisfy the necessities of the current generation without jeopardizing the capacity of future generations to satisfy their own necessities. This new agenda is based on: - The unfinished work of the Millennium Development Goals - Pending commitments (international environmental conventions) - The emergent topics of the three dimensions of sustainable development: social, economic, and environmental. We now have 17 objectives of sustainable development and 169 goals (11). These goals mention "universal access to reproductive health" many times. In objective 3 of this list is included guaranteeing, before the year 2030, "universal access to sexual and reproductive health services, including those of family planning, information, and education." Likewise, objective 5, "obtain gender equality and empower all women and girls", establishes the goal of "assuring the universal access to sexual and reproductive health and reproductive rights in conformity with the action program of the International Conference on Population and Development, the Action Platform of Beijing". It cannot be forgotten that the term universal access to sexual and reproductive health includes universal access to abortion and contraception. Currently, 830 women die every day through preventable maternal causes; of these deaths, 99% occur in developing countries, more than half in fragile environments and in humanitarian contexts (12). 216 million women cannot access modern contraception methods and the majority live in the nine poorest countries in the world and in a cultural environment proper to the decades of the seventies (13). This number only includes women from 15 to 49 years in any marital state, that is to say, the number that takes all women into account is much greater. Achieving the proposed objectives would entail preventing 67 million unwanted pregnancies and reducing maternal deaths by two thirds. We currently have a high, unsatisfied demand for modern contraceptives, with extremely low use of reversible, long term methods (intrauterine devices and subdermal implants) which are the most effect ones with best adherence (14). There is not a single objective among the 17 Objectives of Sustainable Development where contraception does not have a prominent role: from the first one that refers to ending poverty, going through the fifth one about gender equality, the tenth of inequality reduction among countries and within the same country, until the sixteenth related with peace and justice. If we want to change the world, we should procure universal access to contraception without myths or barriers. We have the moral obligation of achieving the irradiation of extreme poverty and advancing the construction of more equal, just, and happy societies. In emergency contraception (EC), we are very far from reaching expectations. If in reversible, long-term methods we have low prevalence, in EC the situation gets worse. Not all faculties in the region look at this topic, and where it is looked at, there is no homogeneity in content, not even within the same country. There are still myths about their real action mechanisms. There are countries, like Honduras, where it is prohibited and there is no specific medicine, the same case as in Haiti. Where it is available, access is dismal, particularly among girls, adolescents, youth, migrants, afro-descendent, and indigenous. The multiple barriers for the effective use of emergency contraceptives must be knocked down, and to work toward that we have to destroy myths and erroneous perceptions, taboos and cultural norms; achieve changes in laws and restrictive rules within countries, achieve access without barriers to the EC; work in union with other sectors; train health personnel and the community. It is necessary to transform the attitude of health personal to a service above personal opinion. Reflecting on what has occurred after the ICPD in Cairo, their Action Program changed how we look at the dynamics of population from an emphasis on demographics to a focus on the people and human rights. The governments agreed that, in this new focus, success was the empowerment of women and the possibility of choice through expanded access to education, health, services, and employment among others. Nonetheless, there have been unequal advances and inequality persists in our region, all the goals were not met, the sexual and reproductive goals continue beyond the reach of many women (15). There is a long road ahead until women and girls of the world can claim their rights and liberty of deciding. Globally, maternal deaths have been reduced, there is more qualified assistance of births, more contraception prevalence, integral sexuality education, and access to SRH services for adolescents are now recognized rights with great advances, and additionally there have been concrete gains in terms of more favorable legal frameworks, particularly in our region; nonetheless, although it's true that the access condition have improved, the restrictive laws of the region expose the most vulnerable women to insecure abortions. There are great challenges for governments to recognize SRH and the DSR as integral parts of health systems, there is an ample agenda against women. In that sense, access to SRH is threatened and oppressed, it requires multi-sector mobilization and litigation strategies, investigation and support for the support of women's rights as a multi-sector agenda. Looking forward, we must make an effort to work more with youth to advance not only the Action Program of the ICPD, but also all social movements. They are one of the most vulnerable groups, and the biggest catalyzers for change. The young population still faces many challenges, especially women and girls; young girls are in particularly high risk due to lack of friendly and confidential services related with sexual and reproductive health, gender violence, and lack of access to services. In addition, access to abortion must be improved; it is the responsibility of states to guarantee the quality and security of this access. In our region there still exist countries with completely restrictive frameworks. New technologies facilitate self-care (16), which will allow expansion of universal access, but governments cannot detach themselves from their responsibility. Self-care is expanding in the world and can be strategic for reaching the most vulnerable populations. There are new challenges for the same problems, that require a re-interpretation of the measures necessary to guaranty the DSR of all people, in particular women, girls, and in general, marginalized and vulnerable populations. It is necessary to take into account migrations, climate change, the impact of digital media, the resurgence of hate discourse, oppression, violence, xenophobia, homo/transphobia, and other emergent problems, as SRH should be seen within a framework of justice, not isolated. We should demand accountability of the 179 governments that participate in the ICPD 25 years ago and the 193 countries that signed the Sustainable Development Objectives. They should reaffirm their commitments and expand their agenda to topics not considered at that time. Our region has given the world an example with the Agreement of Montevideo, that becomes a blueprint for achieving the action plan of the CIPD and we should not allow retreat. This agreement puts people at the center, especially women, and includes the topic of abortion, inviting the state to consider the possibility of legalizing it, which opens the doors for all governments of the world to recognize that women have the right to choose on maternity. This agreement is much more inclusive: Considering that the gaps in health continue to abound in the region and the average statistics hide the high levels of maternal mortality, of sexually transmitted diseases, of infection by HIV/AIDS, and the unsatisfied demand for contraception in the population that lives in poverty and rural areas, among indigenous communities, and afro-descendants and groups in conditions of vulnerability like women, adolescents and incapacitated people, it is agreed: 33- To promote, protect, and guarantee the health and the sexual and reproductive rights that contribute to the complete fulfillment of people and social justice in a society free of any form of discrimination and violence. 37- Guarantee universal access to quality sexual and reproductive health services, taking into consideration the specific needs of men and women, adolescents and young, LGBT people, older people and people with incapacity, paying particular attention to people in a condition of vulnerability and people who live in rural and remote zone, promoting citizen participation in the completing of these commitments. 42- To guarantee, in cases in which abortion is legal or decriminalized in the national legislation, the existence of safe and quality abortion for non-desired or non-accepted pregnancies and instigate the other States to consider the possibility of modifying public laws, norms, strategies, and public policy on the voluntary interruption of pregnancy to save the life and health of pregnant adolescent women, improving their quality of life and decreasing the number of abortions (17).
Introductions The breeding Saker Falcon (Falco cherrug) population on the mountain ridges of eastern Kazakhstan has been monitored since 2000, The monitoring program has revealed an overall population decline over the nine years of study from an estimated 66 breeding pairs in 2000 to 22 in 2008 (75.8%). Methods Eastern Kazakhstan has several large and many small mountain ridges that provide a large area of suitable Saker Falcon nesting habitat. The Saker Falcon breeding population of eastern Kazakhstan was monitored in the Tarbagatai Mountains, including its southern foothills of Arkaly and Karabas Mountains, and in the Manrak Mountains, which are situated to the north of the Tarbagatai range. The study areas were chosen because relatively high Saker Falcon densities were previously recorded in these regions and human activity is curtailed in this border zone. Survey routes were covered by 4WD vehicle UAZ 452 over a period of three months from the beginning of April, when most clutches are laid, until the end of June, when chicks have fledged. Nest locations were recorded with a Garmin GPS unit and recorded in an electronic database which also included a description of the nest site. Nest locations were then plotted on computerized maps and satellite images. Nest contents were recorded wherever possible, though in recent years we have avoided disturbing sitting birds during incubation. The breeding population of the region was estimated from the survey data obtained from 92 territories that had evidence of occupation in at least one year from 2000-08. For logistic reasons, it was not possible to visit every territory each year and the number of territories checked ranged from 10 in 2000 to 76 in 2007. Territories were classified as occupied if: there was an active nest, one or more adults were seen in the territory or signs of recent occupation such as fresh prey remains and mutes were found. Breeding was confirmed within occupied territories if eggs or young were seen in the nest. In order to estimate the number of breeding pairs at territories that were not visited it was necessary to multiply the number of unvisited territories by the proportion of confirmed breeding attempts at checked territories. This estimate was then added to the number of confirmed breeders to produce an overall population estimate for the 92 territories in the survey area. Distribution and Number The first Saker survey in eastern Kazakhstan was made in 1997 by Mark Watson, a British biologist who worked in closely with zoologists from Kazakhstan (Watson, 1997). This was the first time that nests had been recorded in Dzhungarsky Alatau, Tarbagatai and the Manrak Mountains. Since 1999 the study area has been expanded to include a considerable area of Tarbagatai Mountains including its southern and northern foothills as well as the Saur ridge, Kalbinsky Altai Mountains, Altai Mountains (Kurchumsky and the Narymsky ridges). For the first time in 50 years the largest of eastern Kazakhstan's forests were explored with the aim of locating raptor nests. The study located 25 Saker Falcon nests and 49 nests of the Imperial Eagle (Aquila heliaca), whose disused nests are the main source of nesting sites for Sakers (Karyakin et al., 2005; Levin et al., 2007). The foothills of the Kalba Mountains were surveyed in 2006 by a Kazakhstan-Russian team; three Saker Falcon breeding territories were recorded there (Smelansky et al., 2006). Before the 1960's the Saker was regarded as common, occupying almost all the mountain ridges and long cliffs of Kazakhstan (Korelov, 1962) and it is believed that this status remained the same up to the 1990's. Following the collapse of the former Soviet Union, the number of Saker Falcons in the wild began to decline sharply in parts of Kazakstan, primarily due to uncontrolled exploitation of the species for the Arabic falconry market with the greatest decline reported in the south-east of the country (Levin, 2001; 2003). Over nine years, from 2000-08 inclusive, a total of 92 Saker Falcon breeding territories were recorded in the eastern region of Kazakhstan. In Tarbagatai as well as other large mountain ridges, the density of Saker Falcon nests is low. Two attempts were made to find Saker nests in the montane zone of the Tarbagatai Mountains in 2006 and 2007 but no nests were found and only one Saker was seen in the area. Most breeding Sakers were located on the periphery of the main Tarbagatai Mountain range i.e., in the foothills. High breeding densities were recorded in the Arkaly and Karabas Mountains, located close to the Chinese border. A comparatively high density of nests was also observed in the Manrak Mountains, which are located to the north of the Tarbagatai Mountain range. Long-term monitoring of the Saker Falcon breeding population has allowed us to estimate the number of breeding pairs in our survey area over the period 2000-2008 (table 1). Our data indicates that over this 9-year period the breeding population has declined by 65% (fig. 4). In line with this decline the proportion of territories that are occupied by non-breeding birds has increased. Single males were found at over half the occupied territories where at least one Saker was observed but there was no evidence of breeding. Breeding Biology The nesting distribution of Sakers in the surveyed area of Eastern Kazakhstan revealed that the highest breeding densities are found in the foothills of the mountain ranges of the region, which is no doubt related to the availability of mammalian prey such as Great Gerbils (Rhomhomys opimus), Red-cheeked Sousliks (Spermophilus inlermedius) and Long-tailed Sousliks (Spermophilus undulatus), as well as the availability of suitable nesting sites. All Saker nests in Eastern Kazakhstan are located on open cliffs, under overhanging peaks and occasionally partly in niches. The main nest producers for the Saker Falcon in Eastern Kazakhstan are the Long-Legged and the Upland Buzzards (Buteo rufinus and B. hemilasius). Of 86 instances of Saker Falcon nesting, birds used nests of the Golden Eagle (Aquila chrysaetos) in two occasions, the Steppe Eagle (A. nipalensis) two occasions and Raven (Corvus corax) also in two. One clutch was found in a nest of the Eastern Imperial Eagle. In all the other instances the Saker used Buzzard nests. In the mountains of Eastern Kazakhstan Sakers start egg-laying from the middle of March and most pairs have completed clutches by the end of April, with a peak period in the third ten-day period of March. The mean and modal clutch size of 31 clutches was 3.9 eggs (range 3 to 6 eggs). The mean and modal size of 156 broods was 3.7 and 4 chicks respectively (range 1 to 6 chicks). There was no decline in brood size at successful nests over the study period (fig. 8). The number of breeding pairs was highest in 2002, which coincided with a peak in the number of Red-cheeked Soushks across the region. Discussion There being no apparent change to the habitat and no perceptible reduction in food supply the breeding population has steadily declined over the study period and the proportion of non-breeding territory holders has increased over the same period. This current breeding population decline in Eastern Kazakhstan mirrors the decline of the breeding Saker population in Southern Kazakhstan over the last decade of the 20th Century, which coincided with the illegal trapping for the falconry trade. We do not know the cause (or causes) of the current decline in eastern Kazakhstan but it is unlikely to be as a result of local factors in the breeding area. The breeding area is afforded some protection from human interference because of the restrictions on human access due to its close proximity to the Chinese border. Consequently, nest disturbance and trapping of breeding adults in the region is relatively low. However, after the breeding season young Sakers and most of the adult birds move from the Tarbagatai foothills and, around the same time, Sakers arrive in the flat, southern region of the Zaysan Valley where there are the colonies of Yellow Lemming (Lagurus luteus), and in the Balkhash-Alakol depression where there are high densities of Great Gerbil. Falcon trappers from Syria and other countries (including Kazakhstan) operate in these regions and catch Sakers from late June to December. Unfortunately, due to its illegality there is no data on the number, age profile or natal origin of the Sakers trapped in these regions, so it is not possible to gauge its impact on the population of eastern Kazakhstan, but with a rapidly declining regional breeding population the illegal trapping and trade of Sakers is certainly not helping the species. Whilst excessive illegal trapping of birds outside the breeding/natal area is a possible (if not probable) cause of the regional decline of Sakers in eastern Kazakhstan, there are other potential factors that could be implicated such as a decline in food availability in the breeding and/or wintering areas and increased mortality through electrocution on power lines. Conclusion In 2007 a reintroduction programme was initiated by the Government in response to the severe decline in the breeding population of southeast Kazakhstan. Under the framework of this program 60 Sakers (30 female, 30 male) were taken on July from «Sunkar» Falcon Facility, Almaty to the Sugary Valley. In 2008 another 50 birds were released and this programme is planned to continue for several years. ; Introductions The breeding Saker Falcon (Falco cherrug) population on the mountain ridges of eastern Kazakhstan has been monitored since 2000, The monitoring program has revealed an overall population decline over the nine years of study from an estimated 66 breeding pairs in 2000 to 22 in 2008 (75.8%). Methods Eastern Kazakhstan has several large and many small mountain ridges that provide a large area of suitable Saker Falcon nesting habitat. The Saker Falcon breeding population of eastern Kazakhstan was monitored in the Tarbagatai Mountains, including its southern foothills of Arkaly and Karabas Mountains, and in the Manrak Mountains, which are situated to the north of the Tarbagatai range. The study areas were chosen because relatively high Saker Falcon densities were previously recorded in these regions and human activity is curtailed in this border zone. Survey routes were covered by 4WD vehicle UAZ 452 over a period of three months from the beginning of April, when most clutches are laid, until the end of June, when chicks have fledged. Nest locations were recorded with a Garmin GPS unit and recorded in an electronic database which also included a description of the nest site. Nest locations were then plotted on computerized maps and satellite images. Nest contents were recorded wherever possible, though in recent years we have avoided disturbing sitting birds during incubation. The breeding population of the region was estimated from the survey data obtained from 92 territories that had evidence of occupation in at least one year from 2000-08. For logistic reasons, it was not possible to visit every territory each year and the number of territories checked ranged from 10 in 2000 to 76 in 2007. Territories were classified as occupied if: there was an active nest, one or more adults were seen in the territory or signs of recent occupation such as fresh prey remains and mutes were found. Breeding was confirmed within occupied territories if eggs or young were seen in the nest. In order to estimate the number of breeding pairs at territories that were not visited it was necessary to multiply the number of unvisited territories by the proportion of confirmed breeding attempts at checked territories. This estimate was then added to the number of confirmed breeders to produce an overall population estimate for the 92 territories in the survey area. Distribution and Number The first Saker survey in eastern Kazakhstan was made in 1997 by Mark Watson, a British biologist who worked in closely with zoologists from Kazakhstan (Watson, 1997). This was the first time that nests had been recorded in Dzhungarsky Alatau, Tarbagatai and the Manrak Mountains. Since 1999 the study area has been expanded to include a considerable area of Tarbagatai Mountains including its southern and northern foothills as well as the Saur ridge, Kalbinsky Altai Mountains, Altai Mountains (Kurchumsky and the Narymsky ridges). For the first time in 50 years the largest of eastern Kazakhstan's forests were explored with the aim of locating raptor nests. The study located 25 Saker Falcon nests and 49 nests of the Imperial Eagle (Aquila heliaca), whose disused nests are the main source of nesting sites for Sakers (Karyakin et al., 2005; Levin et al., 2007). The foothills of the Kalba Mountains were surveyed in 2006 by a Kazakhstan-Russian team; three Saker Falcon breeding territories were recorded there (Smelansky et al., 2006). Before the 1960's the Saker was regarded as common, occupying almost all the mountain ridges and long cliffs of Kazakhstan (Korelov, 1962) and it is believed that this status remained the same up to the 1990's. Following the collapse of the former Soviet Union, the number of Saker Falcons in the wild began to decline sharply in parts of Kazakstan, primarily due to uncontrolled exploitation of the species for the Arabic falconry market with the greatest decline reported in the south-east of the country (Levin, 2001; 2003). Over nine years, from 2000-08 inclusive, a total of 92 Saker Falcon breeding territories were recorded in the eastern region of Kazakhstan. In Tarbagatai as well as other large mountain ridges, the density of Saker Falcon nests is low. Two attempts were made to find Saker nests in the montane zone of the Tarbagatai Mountains in 2006 and 2007 but no nests were found and only one Saker was seen in the area. Most breeding Sakers were located on the periphery of the main Tarbagatai Mountain range i.e., in the foothills. High breeding densities were recorded in the Arkaly and Karabas Mountains, located close to the Chinese border. A comparatively high density of nests was also observed in the Manrak Mountains, which are located to the north of the Tarbagatai Mountain range. Long-term monitoring of the Saker Falcon breeding population has allowed us to estimate the number of breeding pairs in our survey area over the period 2000-2008 (table 1). Our data indicates that over this 9-year period the breeding population has declined by 65% (fig. 4). In line with this decline the proportion of territories that are occupied by non-breeding birds has increased. Single males were found at over half the occupied territories where at least one Saker was observed but there was no evidence of breeding. Breeding Biology The nesting distribution of Sakers in the surveyed area of Eastern Kazakhstan revealed that the highest breeding densities are found in the foothills of the mountain ranges of the region, which is no doubt related to the availability of mammalian prey such as Great Gerbils (Rhomhomys opimus), Red-cheeked Sousliks (Spermophilus inlermedius) and Long-tailed Sousliks (Spermophilus undulatus), as well as the availability of suitable nesting sites. All Saker nests in Eastern Kazakhstan are located on open cliffs, under overhanging peaks and occasionally partly in niches. The main nest producers for the Saker Falcon in Eastern Kazakhstan are the Long-Legged and the Upland Buzzards (Buteo rufinus and B. hemilasius). Of 86 instances of Saker Falcon nesting, birds used nests of the Golden Eagle (Aquila chrysaetos) in two occasions, the Steppe Eagle (A. nipalensis) two occasions and Raven (Corvus corax) also in two. One clutch was found in a nest of the Eastern Imperial Eagle. In all the other instances the Saker used Buzzard nests. In the mountains of Eastern Kazakhstan Sakers start egg-laying from the middle of March and most pairs have completed clutches by the end of April, with a peak period in the third ten-day period of March. The mean and modal clutch size of 31 clutches was 3.9 eggs (range 3 to 6 eggs). The mean and modal size of 156 broods was 3.7 and 4 chicks respectively (range 1 to 6 chicks). There was no decline in brood size at successful nests over the study period (fig. 8). The number of breeding pairs was highest in 2002, which coincided with a peak in the number of Red-cheeked Soushks across the region. Discussion There being no apparent change to the habitat and no perceptible reduction in food supply the breeding population has steadily declined over the study period and the proportion of non-breeding territory holders has increased over the same period. This current breeding population decline in Eastern Kazakhstan mirrors the decline of the breeding Saker population in Southern Kazakhstan over the last decade of the 20th Century, which coincided with the illegal trapping for the falconry trade. We do not know the cause (or causes) of the current decline in eastern Kazakhstan but it is unlikely to be as a result of local factors in the breeding area. The breeding area is afforded some protection from human interference because of the restrictions on human access due to its close proximity to the Chinese border. Consequently, nest disturbance and trapping of breeding adults in the region is relatively low. However, after the breeding season young Sakers and most of the adult birds move from the Tarbagatai foothills and, around the same time, Sakers arrive in the flat, southern region of the Zaysan Valley where there are the colonies of Yellow Lemming (Lagurus luteus), and in the Balkhash-Alakol depression where there are high densities of Great Gerbil. Falcon trappers from Syria and other countries (including Kazakhstan) operate in these regions and catch Sakers from late June to December. Unfortunately, due to its illegality there is no data on the number, age profile or natal origin of the Sakers trapped in these regions, so it is not possible to gauge its impact on the population of eastern Kazakhstan, but with a rapidly declining regional breeding population the illegal trapping and trade of Sakers is certainly not helping the species. Whilst excessive illegal trapping of birds outside the breeding/natal area is a possible (if not probable) cause of the regional decline of Sakers in eastern Kazakhstan, there are other potential factors that could be implicated such as a decline in food availability in the breeding and/or wintering areas and increased mortality through electrocution on power lines. Conclusion In 2007 a reintroduction programme was initiated by the Government in response to the severe decline in the breeding population of southeast Kazakhstan. Under the framework of this program 60 Sakers (30 female, 30 male) were taken on July from «Sunkar» Falcon Facility, Almaty to the Sugary Valley. In 2008 another 50 birds were released and this programme is planned to continue for several years.
Welcome to the second issue of IASSIST Quarterly for the year 2023 - IQ vol. 47(2).
I am very happy with the 'International' in IASSIST. It is important to learn from outside your own center. In this issue we have a focus on the United States and some African countries with a special focus on South Africa. The first article investigates LibGuides across the many states of the United States. The second article is centered on one of the data resources often found in the LibGuides pages, but the data itself is about all of the United States. In the third article we shift to the African continent and the described project has a base in South Africa with a connection to the United Kingdom - still part of Europe although not of the EU - and with research being conducted in several African countries. We can't promise to cover the whole world in each IQ issue – but this issue is quite international.
The first article is 'Taking count: A computational analysis of data resources on academic LibGuides in the U.S.'. Cody Hennesy, Alicia Kubas and Jenny McBurney have undertaken the task of collecting links to data and statistical resources from over 10,000 LibGuide pages at 123 R1 research institutions in the United States. The LibGuides platform has become the universal resource discovery platform in academic libraries in the U.S. LibGuides not only support researchers, they also help librarians in orientation among the many resources. The authors reach the conclusion that freely available resources from U.S. government agencies are the most widely used. Resources requiring paid licenses or memberships (like ICPSR) are also frequent. The analysis suggest traditional licensed statistical resources are more likely to be shared than complex microdata resources. Data cleaning of the nearly 200,000 links from the 10,000 guide pages was an essential part of the analysis. The authors cite the data scientist joke that 90% of the work is data cleaning, and they find that the actual number for the cleaning and normalization in this analysis was even larger, performed through Python and OpenRefine. The data process included accessing the LibGuide pages based on the keywords of 'data' and 'statistic' and then extracting the content links. The links were then cleaned, filtered and further normalized. The data cleaning showed a high degree of inconsistency and dead links, leading the authors to suggest a more centralized management of data resources. The most frequently found links to resources are through ICPSR and data.gov, and a table with the 20 most common resources shows that even the most uncommon resource among these 20 are included in more than 73% of the institutions. This demonstrates a high consistency across the institutions. However, the authors remark that they believe that the very few institutions that didn't include a link to the popular data.gov would benefit from having information about this resource available for their researchers. Cody Hennesy and Jenny McBurney are the Journalism & Digital Media Librarian and a Social Sciences Librarian at the University of Minnesota, Twin Cities, and Alicia Kubas is a librarian at the U.S. Government Publishing Office.
The second article concerns metadata from IPUMS projects at the Institute for Social Research and Data Innovation (ISRDI) at the University of Minnesota (note, these are among the central sources of data LibGuides, mentioned several times in the first article). The authors are Diana L. Magnuson, curator and historian at the Institute for Social Research and Data Innovation, and Wendy L. Thomas, now retired curator from the same institution. The title is 'Expanding our perspective: building a sustainable metadata culture'. The article describes the learning obtained by ISRDI through the submission of an application for certification to the Core Trust Seal (CTS). When applying for certification the institution must document that it follows the standards and guidelines for the certification. In the case of the CTS - as in many other cases of certification - the building of a portfolio of documentation of procedures makes the applicant more self-aware of its history, as well as of the routines delivering the final products. The conclusion is also that the certification process has led to a better internal understanding at the ISRDI that can support future development as well as preserve the work done. IPUMS has over the last thirty years created the world's largest accessible database of census microdata starting with the 1880 Historical Census Project that has been extended in both time directions and now covering more than a hundred years. Naturally, processing of data has changed over the years and keeping track of the documentation proved difficult. The decision to use digital object identifiers (DOIs) led to a persistency and uniqueness that supported the users. This also had internal benefits as references and publications were more easily trackable and the preservation work more accurate and complete for each product version. Among the figures of the article, you will find the workflow using the open archival information system (OAIS) model as well as the IPUMS business process model.
The third article concerns the dilemma of personal data protection versus the benefit of using data for life improvement. The title of the submission is 'Data management instruments to protect the personal information of children and adolescents in sub-Saharan Africa' and concerns health research in this group. On the one hand the researchers naturally must follow the data regulations as they appear in the Protection of Personal Information (POPI) Act in South Africa and the General Data Protection Regulation (GDPR) in the European Union, and with special attention to high-risk and vulnerable groups such as children and adolescents. On the other hand, these vulnerable groups are also at risk from a health viewpoint, especially from infectious diseases like infantile paralysis, measles and pneumococci. Research and data collected from children has contributed to the development of vaccines, which has led to a dramatic reduction in child mortality and improvements in the quality of life. The project described is a large-scale one that involves many countries and many researchers, making governance and data management crucial to achieving data availability and data security. The article discusses the strategies and instruments used, and addresses the many considerations from both ethical sides and when building a data management plan and decisions on sharing data. The authors behind the article are Lucas Hertzog, Jenny Chen-Charles, Camille Wittesaele, Kristen de Graaf, Raylene Titus, Jane Kelly, Nontokozo Langwenya, Lauren Baerecke, Boladé Hamed Banougnin, Wylene Saal, John Southall, Lucie Cluver, and Elona Toska. Many of these are affiliated to the Centre for Social Science Research at the University of Cape Town in South Africa and some are connected to the University of Oxford. It is important to mention that in addition to the central participation from South Africa and the UK, the project is based on partnerships with researchers in Zambia, Malawi, Nigeria, Lesotho, Tanzania, and Kenya.
Submissions of papers for the IASSIST Quarterly are always very welcome. We welcome input from IASSIST conferences or other conferences and workshops, from local presentations or papers especially written for the IQ. When you are preparing such a presentation, give a thought to turning your one-time presentation into a lasting contribution. Doing that after the event also gives you the opportunity of improving your work after feedback. We encourage you to login or create an author profile at https://www.iassistquarterly.com (our Open Journal System application). We permit authors to have 'deep links' into the IQ as well as deposition of the paper in your local repository. Chairing a conference session or workshop with the purpose of aggregating and integrating papers for a special issue IQ is also much appreciated as the information reaches many more people than the limited number of session participants and will be readily available on the IASSIST Quarterly website at https://www.iassistquarterly.com. Should you be interested in compiling a special issue for the IQ as guest editor(s) you can also contact the IQ. Take a look at the instructions, layout, and contact at:
https://www.iassistquarterly.com/index.php/iassist/about/submissions
On a personal note, I have since 1997 been the editor of the IASSIST Quarterly. All good things must end. New people will take over and improve the journal. I find there have been many improvements in the IQ during my tenure. Special thanks to my good friends Walter and Jane for their work on the journal. For many years, Walter Piovesan helped with layout and production, and he established contact with the Open Journal System staff before retiring from the IQ editorial team. Jane Roberts turned my Danglish into English in my IQ editorials. I am very happy to quit now, especially because you IASSISTers will have very competent replacements in Michele Hayslett and Ofira Schwartz. They have already for long worked behind the scenes at IQ, and have also edited the recent special issue on Systemic Racism. The IQ is in good hands.
Karsten Boye Rasmussen - June 2023
Indonesia is a country that has a high potential for natural disasters. Picture story book is a form of disaster management learning that can help children from an early age to prepare for a natural disaster. The aims of this study to develop story books as a disaster management learning media, to improve knowledge and skills of children and teacher about the understanding, principles, and actions of rescue when facing the natural disasters, to increase the teacher's learning quality in disaster management. Developmental research approach is used to execute the study. A total of 48 children aged 5-6 years have to carry out pre-test and post-test. Pre-test data shows that children's knowledge about disaster management with an average of 47.92% and its improved at post-test with 76,88%. Five theme of story books involves floods, landslides, earthquakes, tsunamis, lands and forest fires is the product. 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Parents with children in preschool children ' s picture book review elections. 15, 1906–1910. https://doi.org/10.1016/j.sbspro.2011.04.025 Peek, L. (2008). Children and Disasters: Understanding Vulnerability, Developing Capacities, and Promoting Resilience - An Introduction. Children, Youth and Environments, 18(1), 1– 29. Plomp, T., & Nieveen, N. (2007). An introduction to educational design research. Enschede: The Netherlands: SLO. Pramitasari, M., Yetti, E., & Hapidin. (2018). Pengembangan Media Sliding Book Untuk Media Pengenalan Sains Kehidupan (Life Science) Kelautan untuk Anak Usia Dini. Jurnal Pendidikan Usia Dini, 12(November), 281–290. Proulx, K., & Aboud, F. (2019). Disaster risk reduction in early childhood education: Effects on preschool quality and child outcomes. International Journal of Educational Development, 66(October 2017), 1–7. https://doi.org/10.1016/j.ijedudev.2019.01.007 Pyle, A., & Danniels, E. (2016). Using a picture book to gain assent in research with young children. 4430(March). https://doi.org/10.1080/03004430.2015.1100175 Raj, A., & Kasi, S. (2015). International Journal of Disaster Risk Reduction Psychosocial disaster preparedness for school children by teachers. International Journal of Disaster Risk Reduction, 12, 119–124. https://doi.org/10.1016/j.ijdrr.2014.12.007 Raynaudo, G., & Peralta, O. (2019). Children learning a concept with a book and an e-book: a comparison with matched instruction. European Journal of Psychology of Education, 34(1), 87–99. https://doi.org/10.1007/s10212-018-0370-4 Sawyer, B., Atkins-burnett, S., Sandilos, L., Hammer, C. S., Lopez, L., Blair, C., . Hammer, C. S. (2018). Variations in Classroom Language Environments of Preschool Children Who Are Low Income and Linguistically Diverse. Early Education and Development, 29(3), 398– 416. https://doi.org/10.1080/10409289.2017.1408373 Simcock, G., & Heron-delaney, M. (2016). 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[English version below] Les usagers de drogues illicites (UDI) font l'expérience d'un vaste ensemble de dommages liés à cette consommation de drogues. Dans le monde entier, les Etats ont, depuis de nombreuses années, développé diverses options politiques en matière de drogues qui visent à réduire de tels dommages, lesdites politiques de Réduction des risques (Csete et al., 2016; Strang et al., 2012). Cette composante désigne les politiques, les programmes et les pratiques visant principalement la réduction des conséquences négatives connexes à l'usage de drogues psychoactives, légales ou illégales, sur les plans sanitaire, social et économique, sans pour autant viser la réduction de la consommation elle-même. La Réduction des Risques est basée sur un modèle de santé publique dont l'objectif premier est d'améliorer l'état de santé et de bien-être des usagers de drogues tout en réduisant les dommages pour la population et la société. Il s'agit donc d'un complément aux approches qui visent la prévention et la réduction de l'usage de drogues en général (EMCDDA, 2010). Des organisations internationales considèrent les interventions de Réduction des risques comme des good practices. Celles-ci incluent les traitements de substitution aux opiacés, les programmes d'échange et d'accès aux seringues et aux aiguilles, ou les traitements par délivrance d'héroïne contrôlée. L'une des interventions spécifiques de Réduction des Risques sont les salles de consommation à moindre risque (SMCR), que l'on définit comme des lieux reconnus légalement, offrant un environnement hygiéniquement sûr, où des individus peuvent consommer les drogues qu'ils ont obtenues préalablement, sans jugement moral, et sous la supervision d'un personnel qualifié. Bien que les SMCR peuvent varient quant à leurs procédures opérationnelles et leurs modèles de fonctionnement, leurs objectifs sont similaires. La finalité générale des SMCR est d'entrer en contact avec les populations d'UDI les plus à risque et de répondre à leurs problèmes, principalement les usagers injecteurs et ceux qui consomment en public. Pour cette population, les SMCR visent à réduire les risques de transmission d'infections, ainsi qu'à diminuer les problèmes de morbidité et de mortalité liés aux overdoses et aux autres dommages associés à l'usage de drogues en milieu non-hygiénique ou peu sûr. En plus de ces objectifs sanitaires, les SMCR visent également à réduire les nuisances liées à l'usage de drogues dans des lieux publics et de diminuer la présence de seringues et d'aiguilles usagées sur la voie publique, ainsi que d'autres problèmes d'ordre public en relation avec les scènes ouvertes de consommation de drogues. Ainsi, les SMCR visent à diminuer les conséquences négatives de l'usage de drogues illicites, tant au plan individuel que social. DRUGROOM │ 4 De tels services de Réduction des Risques sont opérationnels depuis 1986. En 2017, l'Europe compte 90 SMCR officielles dans huit pays: au Danemark, en Norvège, en Espagne, en Suisse, et dans les quatre pays voisins de la Belgique: en France, en Allemagne, au Luxembourg et aux Pays-Bas. Des preuves scientifiques substantielles ont été obtenues au cours des trente dernières années à propos de l'efficacité des SMCR. Malgré des différences opérationnelles, on a montré des effets positifs des SMCR tant pour les UDI que pour la population générale, en particulier lorsqu'elles sont intégrées dans le tissu des autres services d'assistance locale. En outre, la fréquentation et l'utilisation des SMCR ont été associées à une réduction significative des accidents par overdose et des problèmes liés à l'échange de seringues usagées, des blessures par injection, sans pour autant engendrer une augmentation du nombre d'UDI et sans affecter les taux de rechute. Les SMCR constituent aussi un point d'entrée important vers les services de soins et autres services sociaux pour usagers de drogues. Sur le plan social, la mise en place de SMCR a permis d'améliorer l'ordre public en réduisant la présence de déchets liés à l'injection sans pour autant avoir augmenté la criminalité associée à l'usage de drogues. Ainsi, les SMCR ont été évaluées comme ayant atteint leurs objectifs de santé et de sécurité publique, et trouvent donc leur place dans l'ensemble des services destinés aux UDI (Kennedy, Karamouzian, & Kerr, 2017; Potier et al., 2014). Cependant, malgré l'abondance de preuves scientifiques, la mise en place de SMCR reste un sujet très controversé, bien que ce soit à l'agenda politique d'un grand nombre de pays dans le monde (par ex. en Irlande, en Ecosse, ou aux Etats-Unis). Pourtant, à ce jour, il n'existe pas de SMCR en Belgique. La Cellule Générale de Politique Drogues a publié un document de travail en 2016 à ce sujet (CGPD, 2016). Ce document s'interroge sur la faisabilité et les conditions préalables à remplir pour la mise en place de SMCR en Belgique, avec une attention spécifique aux besoins et aux aspects organisationnels, budgétaires et légaux. Une des sept conclusions finales du document était qu'une étude de faisabilité était nécessaire si l'on voulait mettre en place de telles SMCR. C'est donc dans ce contexte que la Politique Scientifique Fédérale (BELSPO) a commandité, pour la première fois, une recherche évaluant cette faisabilité en Belgique. --- People who use illicit drugs (PWUD) experience a wide range of drug-related harms. Worldwide, countries have been converging on a core of drug policy options aimed at reducing these drug-related harms for many years, including harm reduction (Csete et al., 2016; Strang et al., 2012). This latter component, harm reduction, refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs, without necessarily reducing drug consumption. Harm reduction is grounded within a public health model, which primarily aims to improve the health and well-being of drug users alongside reducing community and societal level harms, and complements approaches that seek to prevent or reduce the overall level of drug use (EMCDDA, 2010). International bodies identify harm reduction interventions as good practices, including opioid substitution treatment, needle and syringe (exchange) programmes, and heroin-assisted treatment (EMCDDA, 2010). One specific intervention includes drug consumption rooms1 (DCRs), defined as legally sanctioned facilities offering a hygienic environment where individuals can use pre-obtained drugs in a non-judgemental environment and under supervision of trained staff. Although DCRs vary in operational procedures and design, the aims of DCRs are similar across sites. The overall rationale for DCRs is reach out to, and address the problems of, specific high-risk populations of PWUD, especially injectors and those who consume in public. For this group, DCRs aim to reduce the risk of transmission of blood-borne infections, to reduce the likelihood of morbidity and mortality resulting from overdose, and to help people who use drugs avoid other harms associated with drug consumption under unhygienic or unsafe conditions. In addition to these health-oriented goals, DCRs also aim to contribute to a reduction in drug use in public places and the presence of discarded needles and other related public order problems linked with open drug scenes. In sum, DCRs aim to reduce both individual-level and public-level harms associated with illicit drug use. These harm reduction facilities have been operating since 1986; anno 2017, Europe counted 90 official DCRs in eight countries: Denmark, Norway, Spain, Switzerland, and Belgium's four neighbouring countries: France, Germany, Luxembourg, and the Netherlands (EMCDDA, 2017). A substantial body of scientific evidence has accumulated over the past three decades to support the effectiveness of DCRs; although heterogeneous in design and operation, DCRs have demonstrated that they can 1 The term 'drug consumption room' is often used interchangeably with supervised injection facility (SIF), safe injection site (SIS), and medically supervised injection centre (MSIC). DRUGROOM │ 4 produce beneficial effects, both for PWUD and for the community, particularly when they are part of a wider continuum of local interventions. Moreover, (frequent) DCR use has been associated with reductions in overdose-related harms, syringe sharing and injection-related injuries, without increasing either the number of local PWUD or rates of relapse. DCRs also serve as important entry points to external drug treatment and other health and social services for PWUD. At the community level, the establishment of DCRs has contributed to improvements in public order through reductions in public drug use and publicly-discarded injection-related litter, and has not been associated with increases in drug-related crime. Collectively, the available evidence suggests that DCRs are effectively meeting their primary public health and order objectives and therefore supports their role within a continuum of services for PWUD (Kennedy, Karamouzian, & Kerr, 2017; Potier et al., 2014). Despite this abundance of evidence, implementation of DCRs remains highly controversial. Yet, the debate about implementing new DCRs remains high on the political agenda in a number of countries worldwide (e.g., Ireland, Scotland, United States). To date, Belgium does not offer a DCR to its drug using population. The General Drugs Policy Cell published a working paper in 2016 devoted to the topic of DCRs in Belgium (ACD, 2016). They sought to investigate the feasibility and preconditions for the implementation of DCRs in Belgium, with specific attention to needs, and organisational, budgetary and legal aspects. One of the seven final conclusions was that, if one wishes to implement a DCR, a prior feasibility study is essential. Against this background, the Belgian Science Policy Office (BELSPO) commissioned a first-ever study to assess the feasibility of DCRs in Belgium.
[English version below] Les usagers de drogues illicites (UDI) font l'expérience d'un vaste ensemble de dommages liés à cette consommation de drogues. Dans le monde entier, les Etats ont, depuis de nombreuses années, développé diverses options politiques en matière de drogues qui visent à réduire de tels dommages, lesdites politiques de Réduction des risques (Csete et al., 2016; Strang et al., 2012). Cette composante désigne les politiques, les programmes et les pratiques visant principalement la réduction des conséquences négatives connexes à l'usage de drogues psychoactives, légales ou illégales, sur les plans sanitaire, social et économique, sans pour autant viser la réduction de la consommation elle-même. La Réduction des Risques est basée sur un modèle de santé publique dont l'objectif premier est d'améliorer l'état de santé et de bien-être des usagers de drogues tout en réduisant les dommages pour la population et la société. Il s'agit donc d'un complément aux approches qui visent la prévention et la réduction de l'usage de drogues en général (EMCDDA, 2010). Des organisations internationales considèrent les interventions de Réduction des risques comme des good practices. Celles-ci incluent les traitements de substitution aux opiacés, les programmes d'échange et d'accès aux seringues et aux aiguilles, ou les traitements par délivrance d'héroïne contrôlée. L'une des interventions spécifiques de Réduction des Risques sont les salles de consommation à moindre risque (SMCR), que l'on définit comme des lieux reconnus légalement, offrant un environnement hygiéniquement sûr, où des individus peuvent consommer les drogues qu'ils ont obtenues préalablement, sans jugement moral, et sous la supervision d'un personnel qualifié. Bien que les SMCR peuvent varient quant à leurs procédures opérationnelles et leurs modèles de fonctionnement, leurs objectifs sont similaires. La finalité générale des SMCR est d'entrer en contact avec les populations d'UDI les plus à risque et de répondre à leurs problèmes, principalement les usagers injecteurs et ceux qui consomment en public. Pour cette population, les SMCR visent à réduire les risques de transmission d'infections, ainsi qu'à diminuer les problèmes de morbidité et de mortalité liés aux overdoses et aux autres dommages associés à l'usage de drogues en milieu non-hygiénique ou peu sûr. En plus de ces objectifs sanitaires, les SMCR visent également à réduire les nuisances liées à l'usage de drogues dans des lieux publics et de diminuer la présence de seringues et d'aiguilles usagées sur la voie publique, ainsi que d'autres problèmes d'ordre public en relation avec les scènes ouvertes de consommation de drogues. Ainsi, les SMCR visent à diminuer les conséquences négatives de l'usage de drogues illicites, tant au plan individuel que social. DRUGROOM │ 4 De tels services de Réduction des Risques sont opérationnels depuis 1986. En 2017, l'Europe compte 90 SMCR officielles dans huit pays: au Danemark, en Norvège, en Espagne, en Suisse, et dans les quatre pays voisins de la Belgique: en France, en Allemagne, au Luxembourg et aux Pays-Bas. Des preuves scientifiques substantielles ont été obtenues au cours des trente dernières années à propos de l'efficacité des SMCR. Malgré des différences opérationnelles, on a montré des effets positifs des SMCR tant pour les UDI que pour la population générale, en particulier lorsqu'elles sont intégrées dans le tissu des autres services d'assistance locale. En outre, la fréquentation et l'utilisation des SMCR ont été associées à une réduction significative des accidents par overdose et des problèmes liés à l'échange de seringues usagées, des blessures par injection, sans pour autant engendrer une augmentation du nombre d'UDI et sans affecter les taux de rechute. Les SMCR constituent aussi un point d'entrée important vers les services de soins et autres services sociaux pour usagers de drogues. Sur le plan social, la mise en place de SMCR a permis d'améliorer l'ordre public en réduisant la présence de déchets liés à l'injection sans pour autant avoir augmenté la criminalité associée à l'usage de drogues. Ainsi, les SMCR ont été évaluées comme ayant atteint leurs objectifs de santé et de sécurité publique, et trouvent donc leur place dans l'ensemble des services destinés aux UDI (Kennedy, Karamouzian, & Kerr, 2017; Potier et al., 2014). Cependant, malgré l'abondance de preuves scientifiques, la mise en place de SMCR reste un sujet très controversé, bien que ce soit à l'agenda politique d'un grand nombre de pays dans le monde (par ex. en Irlande, en Ecosse, ou aux Etats-Unis). Pourtant, à ce jour, il n'existe pas de SMCR en Belgique. La Cellule Générale de Politique Drogues a publié un document de travail en 2016 à ce sujet (CGPD, 2016). Ce document s'interroge sur la faisabilité et les conditions préalables à remplir pour la mise en place de SMCR en Belgique, avec une attention spécifique aux besoins et aux aspects organisationnels, budgétaires et légaux. Une des sept conclusions finales du document était qu'une étude de faisabilité était nécessaire si l'on voulait mettre en place de telles SMCR. C'est donc dans ce contexte que la Politique Scientifique Fédérale (BELSPO) a commandité, pour la première fois, une recherche évaluant cette faisabilité en Belgique. --- People who use illicit drugs (PWUD) experience a wide range of drug-related harms. Worldwide, countries have been converging on a core of drug policy options aimed at reducing these drug-related harms for many years, including harm reduction (Csete et al., 2016; Strang et al., 2012). This latter component, harm reduction, refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs, without necessarily reducing drug consumption. Harm reduction is grounded within a public health model, which primarily aims to improve the health and well-being of drug users alongside reducing community and societal level harms, and complements approaches that seek to prevent or reduce the overall level of drug use (EMCDDA, 2010). International bodies identify harm reduction interventions as good practices, including opioid substitution treatment, needle and syringe (exchange) programmes, and heroin-assisted treatment (EMCDDA, 2010). One specific intervention includes drug consumption rooms1 (DCRs), defined as legally sanctioned facilities offering a hygienic environment where individuals can use pre-obtained drugs in a non-judgemental environment and under supervision of trained staff. Although DCRs vary in operational procedures and design, the aims of DCRs are similar across sites. The overall rationale for DCRs is reach out to, and address the problems of, specific high-risk populations of PWUD, especially injectors and those who consume in public. For this group, DCRs aim to reduce the risk of transmission of blood-borne infections, to reduce the likelihood of morbidity and mortality resulting from overdose, and to help people who use drugs avoid other harms associated with drug consumption under unhygienic or unsafe conditions. In addition to these health-oriented goals, DCRs also aim to contribute to a reduction in drug use in public places and the presence of discarded needles and other related public order problems linked with open drug scenes. In sum, DCRs aim to reduce both individual-level and public-level harms associated with illicit drug use. These harm reduction facilities have been operating since 1986; anno 2017, Europe counted 90 official DCRs in eight countries: Denmark, Norway, Spain, Switzerland, and Belgium's four neighbouring countries: France, Germany, Luxembourg, and the Netherlands (EMCDDA, 2017). A substantial body of scientific evidence has accumulated over the past three decades to support the effectiveness of DCRs; although heterogeneous in design and operation, DCRs have demonstrated that they can 1 The term 'drug consumption room' is often used interchangeably with supervised injection facility (SIF), safe injection site (SIS), and medically supervised injection centre (MSIC). DRUGROOM │ 4 produce beneficial effects, both for PWUD and for the community, particularly when they are part of a wider continuum of local interventions. Moreover, (frequent) DCR use has been associated with reductions in overdose-related harms, syringe sharing and injection-related injuries, without increasing either the number of local PWUD or rates of relapse. DCRs also serve as important entry points to external drug treatment and other health and social services for PWUD. At the community level, the establishment of DCRs has contributed to improvements in public order through reductions in public drug use and publicly-discarded injection-related litter, and has not been associated with increases in drug-related crime. Collectively, the available evidence suggests that DCRs are effectively meeting their primary public health and order objectives and therefore supports their role within a continuum of services for PWUD (Kennedy, Karamouzian, & Kerr, 2017; Potier et al., 2014). Despite this abundance of evidence, implementation of DCRs remains highly controversial. Yet, the debate about implementing new DCRs remains high on the political agenda in a number of countries worldwide (e.g., Ireland, Scotland, United States). To date, Belgium does not offer a DCR to its drug using population. The General Drugs Policy Cell published a working paper in 2016 devoted to the topic of DCRs in Belgium (ACD, 2016). They sought to investigate the feasibility and preconditions for the implementation of DCRs in Belgium, with specific attention to needs, and organisational, budgetary and legal aspects. One of the seven final conclusions was that, if one wishes to implement a DCR, a prior feasibility study is essential. Against this background, the Belgian Science Policy Office (BELSPO) commissioned a first-ever study to assess the feasibility of DCRs in Belgium.
This report presents the synthesis of household level surveys in five intervention countries (Angola, Malawi, Mozambique, Zambia, and Zimbabwe) of the Drought Tolerant Maize for Africa (DTMA) project designed and implemented by the International Maize and Wheat Improvement Center (CIMMYT), International Institute for Tropical Agriculture (IITA) and national research and extension institutions in 13 countries of Sub-Saharan Africa (SSA). In each of the study countries, two districts were randomly selected provided that the districts fall in predetermined categories (20-40%) of probability of failed season (PFS). A total sample of 1108 households was randomly drawn with sample sizes varying country to country. The report has different sections that focus, in order, on description of the sample households, extent and determinants of poverty and inequality among the sample population, characteristics of maize production, perception and management of drought risk, and determinants of likelihood and intensity of adoption of improved maize varieties. The distribution of the age of the sample population shows that the population below the age of 16 years is 54% in Zambia, 47% in Malawi and more than 42% in the other three countries. Most of the sample households in each of the countries are headed by males. Only, Malawian sample has about one third of the households headed by women. The literacy level of household heads is considerably high by African standards. The proportion of literate household head ranges from 67% in Angola to 97% in Zimbabwe. The details of the literacy level show that about 48% of Zimbabweans have attended secondary school or higher followed by 32% in Zambia and to 28% in Angola. Most of the literate household heads in Malawi and Mozambique fall in the primary school category. The farming systems in the study areas are predominantly traditional and semi-subsistence oriented. The plough culture is an important feature of the systems and hence the traction power of draft animals is indispensable. Nonetheless, only Zambian (44%) and Zimbabwean (42%) farmers use draft animals. No sample household in Angola and Malawi owns a draft animal. The livestock owned per household, in tropical livestock units (TLU), ranges from 0.41 in Malawi to 2.9 in Zambia. Accordingly, the current value in US$ of the livestock owned by a typical household ranges from 102.7 in Malawi to 1051 in Zambia. The average farm land holding is highest in Mozambique where a typical household owns nearly 8 hectares of land, followed by Zambia at 6.63 hectares, and Zimbabwe at 3 hectares. The smallest average farmland was observed in Malawi with a typical household owning 1.25 ha. Wealth indices were computed based on asset holdings to look into the relative welfare distribution of the sample communities. Forty four percent of the sample households in Angola have negative wealth index. The households with negative indices can generally be considered as poor. Nearly 55% Malawian, 57% Mozambican, and 54% Zambian sample households do have negative wealth indices. Sixty two percent of the sample households in Zimbabwe have negative wealth indices, which is higher than any other country in the study.Asset wealth based rough classification of the households has shown that most of the sampling households are poor. A more detailed analysis of poverty and inequality was done based on reported income and expenditure. Household level determinants of poverty were identified using quantile regression. Generally, sample households in Mozambique and Zambia were found to be poorer than the sample households in Angola and Malawi. The poverty profiles show that the absolutely poor households in four of the countries (Angola, Malawi, Mozambique, and Zambia) do have significantly smaller family size, smaller number of illiterate household members, less number of important assets such as phones and radio, livestock and smaller farm sizes. An important observation is that the proportion of total land allocated to maize by absolutely poor households is significantly higher than that of better-off households. The study has also detailed the extent and determinants of poverty and inequality in the countries. The importance of maize technology use and resource allocation to the crop in determining magnitude of poverty and inequality is an important finding in view of the fact that the sample population is essentially semi-subsistent with limited market orientation. This finding also justifies the effort being exerted on development and deployment of maize and maize related technologies in rural communities of the study countries. Maize production in the region has peculiar characteristics with important distinctions across countries. The land allocated to maize ranges from 45.9% in Mozambique to 69.8% in Malawi of the whole farmland. In Angola, Malawi and Mozambique, most of the maize land is covered with land races; whereas in Zambia and Zimbabwe, hybrid maize covers most of the maize area. All the sample farmers in Zimbabwe are aware of the difference between improved Open pollinated varieties (OPVs) and hybrid maize varieties. On the contrary, about 95% of the sample farmers in Angola do not know the difference between OPV and hybrid maize. Most of the sample farmers in Malawi (72.0%), Mozambique (98.0%), and Zambia (78.0%) are in fact aware of the difference between OPVs and hybrid maize varieties. Regarding recycling of hybrid seeds, it was found out that Zimbabweans hardly recycle, whereas Mozambicans do on average recycle 1.5 times. This pattern of recycling also applies to improved OPVs. Despite considerable number of farmers depending on the market to fetch maize seeds, 90.7% of the farmers in Angola purchased and planted only local maize varieties. Malawian and Zambian farmers, followed by Mozambicans and Zimbabweans, do mostly purchase and grow improved seeds. In terms of the proportion of seed types used, Zimbabwe stands out well-above others with 94.6% of the seed used being improved, followed by Zambia (64.3%) and Malawi (24.8%). In Malawi, the most preferred varieties, in order of preference are: local, MH36, Kanyani, and Makolo. In Mozambique, Ndau ou Chindau, Matuba, SC513, Laposta, and Pan 67 were indicated to be the most preferred varieties in that order. In Zambia, the four most preferred varieties were identified to be Gankata, SC513, Pool 16, and Obatampa. In Zimbabwe, SC513 is the most preferred variety followed by ZM521 and the local Heckory King variety. Drought was reported to be the most important challenge on the livelihoods of people in Malawi, Zambia and Zimbabwe, whereas it was indicated to be second, next to sickness and mortality of a family member, in Angola and Mozambique. Maize varieties in general and improved OPVs and hybrids in particular are being considered very risky in terms of predictability and reliability of yields. Given the importance of maize and the vulnerability of the farming communities in the region, drought and risks associated with it will have paramount and potentially irreversible consequences on the poor sections of the region. The decisions regarding level and intensity of improved maize adoption have also been investigated to show that gender based intra-household division of labor was an important factor considered in deciding to adopt or not improved maize varieties. Asset endowments such as farm size and livestock wealth were found to be important determinants of level and intensity of adoption in the region. Similarly, membership in social groupings and engagement of off-farm activities influenced adoption decisions. Access to extension services has universally been identified as an important factor in determining the level and, when relevant, the intensity of adoption of improved maize varieties in the region. As important as this service is, however, the extent to which farmers are getting the service is not that encouraging according to respondents. It is, therefore, imperative to underline again the need for investment in the agricultural extension system and the effort that shall be exerted in enabling the private sector to engage in generation and deployment of agricultural information. In designing and implementing any intervention that aims at contributing to the risk coping ability of farmers, it is essential to take into account heterogeneity of the farming communities. Due consideration of this heterogeneity shall be made while assessing the importance of drought risk and while analyzing the effectiveness of the contributions to be made with the intention of strengthening drought risk coping strategies. The trait preferences of farmers are for instance an important indicator of the heterogenous demand structure. This study has shown that despite the fact that yield size is among the most preferred traits, farmers' strong reference to maize as a risky crop urges refocusing breeding activities to generation of germplasms with reliable yield distribution. Farmers have also shown strong interest in traits such as drought tolerance, early maturity, and good performance under poor rainfall implying the need for multi-trait focused breeding schemes. Public agricultural extension institutions and public mass media are by far the two most important sources of agricultural information in the region. Despite the political importance of agriculture in general and maize in particular, there is always a lack of incentive in publicly owned institutions to deliver the information as timely and as adequately it is needed. Agricultural extension efforts in the region should in fact be accompanied by comprehensive microfinance institutions to relieve farmers of the seasonal cash shortage which almost all of them experience every year. So far, except in Zimbabwe, access to rural credit and finance seems to be farfetched.
Children with chronic diseases Chronic viral hepatitis Among human hepatitis viruses, hepatitis B (HBV) and C (HCV) viruses are able to persist in the host for years and thereby causing chronic hepatitis. Three hundred and seventy and 130 million people is estimated to be infected with HBV and HCV, respectively, worldwide (1). In endemic areas, HBV infection is often acquired perinatally or early in childhood and becomes chronic in a high proportion of cases. Universal vaccination of newborns has been effective in reducing the spread of infection. However, hepatitis B is still a social and health problem in underdeveloped areas where immunisation policies are unavailable, and even in developed countries, where the reservoir of infection is maintained by immigration and adoption. In some endemic areas children with chronic hepatitis B are also at risk for superinfection with the hepatitis delta virus (HDV), which worsens the prognosis of liver disease. HCV is not a less important problem. The prevalence of circulating anti-HCV antibodies in the pediatric population averaged 0.3% in Italy in the early 1990s (2), but a national observational study suggest that the number of "new" pediatric infections dropped by approximately 40% in 2000-2004 compared with the previous 5 years (3). The lower prevalence of HCV in children reflects the disappearance of transfusion-related hepatitis and the reduced efficiency of mother-to-child (vertical or perinatal) transmission, although the latter form of transmission is currently responsible for most "new" infections in the developed world and contributes to maintaining the reservoir of infection worldwide (4-7). This favourable epidemiologic trend is balanced, however, by the strong tendency of HCV infection acquired early in life (either perinatally or following blood transfusions) to become chronic (8-14). In the absence of a specific vaccination, HCV infection remains a major global health problem and HCV-related end-stage liver disease is still the most frequent indication for liver transplantation in adult patients. Chronic viral hepatitis acquired in childhood is a long-lasting process based on host-virus interaction, which may change over the years. A number of factors related to the virus (genotype, therapy), to the host (hormonal status, immunocompetence, therapy) and to the environment (alcohol, drugs, co-infections) affects the natural history of the disease, especially during adolescence and early adulthood. Strategies to improve the prevention and treatment of HBV and HCV infection, and the related liver disease in children, before the possible development of irreversible complications, should be investigated and implemented. HIV infection Countries most heavily affected, HIV has reduced life expectancy by more than 20 years, hampered economic growth, and deepened household poverty (UNAIDS. Data from: www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp). Mother-to-child transmission (MTCT) is the main source of pediatric HIV-1 infection. MTCT of HIV-1 mainly occurs around the time of delivery, but breastfeeding is an additional route of viral transmission and accounts for about one-third of pediatric infections in resource-poor Countries (15). In the absence of antiretroviral therapy, about 30% of women transmit the virus to their infants. The estimated number of perinatally acquired AIDS cases in the United States peaked at 945 in 1992 and declined rapidly with expanding prenatal testing and implementation of appropriate preventive interventions (16). At the end of 2007, there were 2 million children living with HIV around the world, an estimated 370,000 children became newly infected with HIV in 2007, and, of the 2 millions people who died of AIDS during 2007, more than one in seven were children. Every hour, around 31 children die as a result of AIDS. HIV can affects a child's life through its effects directly on the child, on that child's family, and on the community within the child is growing up: - Many children are themselves infected with HIV - Children live with family members who are infected with HIV - Children act as carers for sick parents who have AIDS - Many children have lost one or both parents to AIDS, and are orphaned - An increasing number of households are headed by children, as AIDS erodes traditional community support systems - Children end up being their family's principal wage earners, as AIDS prevents adults from working, and creates expensive medical bills - As AIDS ravages a community, schools lose teachers and children are unable to access education - Doctors and nurses die, and children find it difficult to gain care for childhood diseases - Children may lose their friends to AIDS - Children who have HIV in their family may be stigmatized and affected by discrimination In the last 10 years, dramatic advances in medical management of HIV infection have followed the results of clinical trials of antiretroviral combination therapies in children. The use of antiretroviral therapy during pregnancy in HIV-infected women has resulted in a dramatic decrease in the transmission rate to infants, which is currently less than 2% in most high-income Countries (17). In parallel, the introduction of highly active antiretroviral therapy (HAART) has changed the natural history of HIV-1 infection and the life expectancy of HIV-1-infected adults (18,19) and children (20-26). Although in developed Countries children living with HIV infection are expected to live a long life, they still need to face major emotional burden, social stigma and global exclusion from the social contest (27). Being a child or an adolescent with HIV implies major problems in terms of management of multiple drugs, adherence to antiretroviral therapy, drug resistance, quality of life, frequency at school and social interactions with peers (28). Immunization in at risk children Vaccinations programs are one of the greatest public health interventions of the last century and have dramatically improved quality of life (29). Benefits of vaccination to the individual include partial or complete protection against infections and symptoms of illness, improved quality of life, and prevention of up to 3 million pediatric deaths per year worldwide (29,30). Benefits of a universal vaccination program to society include creation and maintenance of herd immunity, prevention of disease outbreaks, and reduced health care costs (30). Despite the availability of safe and effective vaccines and substantial progresses in reducing vaccine-preventable diseases, delivery to and acceptance of vaccinations by targeted populations are essential to further reducing and eliminating vaccine-preventable causes of morbidity and mortality (31). Children who are not vaccinated endanger public health representing a risk for other nonimmunized individuals, including subjects who cannot be immunized due to underlying health problems, and the small percentage of individuals in whom vaccination does not confer protection (29). They also contribute to increase health care costs (29). Access to immunizations, prevalence of vaccine-preventable diseases, and vaccination rates varies by geographic area or country. Throughout the United States and European Countries, immunization rates of children and adults are rising, but coverage levels have not reached established goals (32). As a result of low immunization rates, vaccine-preventable diseases still occur as evidenced by the measles epidemic, the large number of annual cases of varicella, pertussis, and hepatitis B, and the more than 50,000 annual deaths in adults from influenza or pneumococcal infections (33-36). In an attempt to eliminate the risk of outbreaks of some diseases, governments and other institutions have instituted policies requiring vaccination for all people (compulsory vaccinations). For example, actual vaccination policies in most developed Counties require that children receive common vaccinations before entering school. In addition to compulsory vaccines, certain populations should receive additional vaccinations. Subjects with chronic medical conditions are at increased risk for severe complications related to vaccine-preventable infections, such as influenza and pneumococcal infections (34,37). In Italy, compulsory vaccines are generally administered in vaccination centers and complementary vaccinations are actively offered to children with chronic conditions and are included in the Essential Levels of Care (38). Despite long-standing recommendations to provide recommended vaccinations to children with chronic medical conditions, immunisation rates in these vulnerable populations remain poor (39). Several conditions hamper implementation of these vaccinations, including problems in identifying at risk children, ineffective organizational strategies and lack of awareness of disease severity or poor confidence by parents in specific recommendations (40,41). Often, the presence of a chronic condition is erroneously considered a contraindication rather than an indication to vaccination. It is important to ensure that patients comply with the vaccination schedule to the extent possible, and to provide education to parents who may have concerns about pediatric vaccinations. Goals of the thesis In this PhD thesis, the organization and management of pediatric infectious diseases, with a perspective of public health, are investigated. Specific chronic diseases, as chronic viral hepatitis and HIV infection, have been selected as models to investigate the main aspects of prevention, management and treatment. The goal is to investigate the efficiency of organization and propose interventions with specific reference to treatment of infectious diseases, their direct and indirect results and how these conditions affect quality of life of at risk children and their families. The final goal of this research is to provide strategies to optimize public health system.
Lesotho is one of the poorest countries in Southern Africa, and has one of the highest income inequality in the world. Home to about 2 million people, Lesotho is surrounded by South Africa, the second largest and most industrialized economy in Africa. Lesotho generates income mainly by exporting textiles, water, and diamonds, and is a member of the Southern African Customs Union (SACU), the Southern African Development Community (SADC), and the Common Monetary Area (CMA). The national currency, the loti, is pegged to the South African rand. Lesotho's main trading partners are South Africa and the United States. The CPF will seek to mitigate four substantial risks to the implementation of the WBG program: (a) political and governance; (b) macroeconomic; (c) climate change and climate- induced disasters; and (d) operating risks (capacity and fiduciary). The lessons from the Country Assistance Strategy Completion and Learning Report (CPS CLR) will play an important role in addressing these risks. The CPF will give high importance to quality and risks at entry for new operations, and continue strong monitoring and supervision. These mitigation factors are essential for achieving sustainable results.
