WORLD HEALTH ORGANIZATION
February 8, 1949
SAUDI-ARABIA
OR.GAiH<\A'l'LON IWNDIALE DE LA <\AN'l'1!O
8 Fevrier 1949
REQUIREMENTS FOR aSSISTANCE FROM W.H.O. FOR THE YEARS 1949 & 1950
I. PUBLIC HEALTH ADMINISTRATION.
a) One expert advice in Public Health Administration for 1949.
b) Two fellowshipa for 1949 and two for 1950 for the study of:
1) Quarantine Work. 2) Epidemiological Work.
II. VENEREAL DISEASES.
One fellowshlp for study of Venereal Disease~ Treatment and Prophylaxis for 1949.
III. HEALTH EDUCATION.
Documents,pamphlets,posters,educatlonal film,etc •• , ror Health Propaganda.
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!\RABIE SEOUDITE
AS<\IST"NCE REQUISE DE L'O.M.S. POUR LES ANNEEa 1949 ET 1950
I. ADMINISffiATIOII DE L'HYGIENE PUBLIQUE.
(a) 00ncour8 d'un expert en HygHne Publ1que pour 1949.
(b) Bourses d'etudes:
en vue de l'etude: (1) des questions (b) deo quootlon~
II. Ml.LADIES VENERIENNE3..
a pour 1949 :;; pour 1950,
quarantenairesj opidbn ioloSiquoo 9
une oourse a'l!:t;udea en 1949 puur ~'6t..ud" du t.'altemollt et de Ie. prophylaxie des maladies veneriennea.
III. INS'ffiUCTION SAlIITAmE.
Documentation, brochures, placards, fIbs Instructifs, etc., relat1fs A la propagande sanitaire
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WORLD HE!<LTH ORGANIZATION
February 8, 1949.
IRAK
!{l!.'1U ll'\~M~NTS U~· l\SSlS'l'l\Nl;~ ~'J:{UM W.li. u. FOR THE YEARS 1949 & 1950.
I. MALARIA.
a) Operational dell'.onstration team for 1949.
b) Fellowship medical officer to specialise in
malariology: One for 1949 & One for 1950.
II. VENERE!<L DISEASES . ----------------
D&monstration team to work in a part of the country.
III. TUBERCULOSIS.
a) Expert sdvice for the survey examination and
b) Fellowship fo r medical officer anti-tuberculosis study :
One for 1949 · & One for 1950.
c) Mass exa:Jil1ation X-Rays apparatus: One for 1949.
I V . JIlhTEF :'1AL & CHI:;:',) WELFARE.
Expert advice: One for 1949.
V. PUBLIC HErlLTH ADMINISTRATION.
One f ellowship for 1949 and one for 1950.
VI. ENVIRONMENTAL SANITf,TION.
One ad:,:iser especially for the problems of endemic
diseases e.g. Bilharzia and Ankylostoma.
VII. HF'A LTH F.DUCfi'l'ION .
Doctwents and educationa l films,pamphlets,posters,etc.
for public hualth,
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;,ORLD HE.4TH ORGANI S ... TIUN
FEBRJ"RY 8 , 1949.
P A K 1ST A N.
Nature and Extent of the Problems and Assistance r equired fran the World Health Organisation
uu.d uK ~949 a-i d ~950.
Mal aria is by far the most important disease in Pakis tan where at leas t 25 million individual s suffer from this di sease every year. Through the lowering of . the resistance of the patient to other diseas es, malaria is also indirectly responsible for a grea t deal of sickness causing be tween 10 to 20 million cases of illness each year .
As r eg ards mortality it is believed to cause quarter million deaths in Pakis tan, ...,ilo periodic epidemic outbreaks to which flestern Pakistan is peculiarly liable may e ":!.'e the figure by <lDther 100, 000. Including the indlaot .·ff • .>cts of m.::l l ::l ri;:\~ :: ~ nntl~ l dp::l t.h r .':I t-.p. or A pAr t,honsRnri of p opuldt.ion is a reasonable es tima tL .
Realis ing the importance of this disease the Government of Pakistan noon oftc r ito ocp~r~tion from Indi~ ost~blishod a Malaria InstitutQ at Karachi. I n the short time of its exis tence the Institute has been provided with adequalla "Lff a nd equipment.· ·<n extensi V8 building program has been sanctioned and will " ', complet ed in the course of ooxt few weeks . It is confidently expected that ~ll tt~~t:: t:£.fur L::i '111 1 1 t:wi:iultl 1..11~ Iu~ L.l l,..u t...e: Lv un...! t:r I..a.kt: t.he tr c;l in.ing of the medic ,1 officer s in o.dvar.ced mal ariology during 1949.
Field activities of the Institute during .,948 have ban devoted chiefly to aSF isting m guidi. ng the Provincial Governments of Punjab and Sind to devalop an "conomic method of m~laria control with D.D.T .
Much progress has been made in this field but th e magnitude of the problem is so enormous that Paldstan cannot view the present rat e of deve lopments wi th compl acency. Tho f ollowing demands are ther efo r e put forwa rd chiefly wi th the Clh,iect of h.;l. s tening th t3 program of control on a country "lids basis :-
(1) Four Fellowships.
(2) One Demonstration team.
(3) Lit , rature .
(1) Two Fellowships .
(2) Li terature .
fUBliliCULOO!S.
Tuberculosis r anks high as a public health problem in Pakis tan. It is now almost ce rtainly one of the main public health problems r anking certainly next to rr.....l3 ria in this respect . No accurate es timd.te of the incidence of the diseas e cr _ of th e average annual number of deaths resulting from it Cal be rna:::le. 1'1.
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r ough co t imotc o£ ~bcrculooi o mortal~t7 mi ght b e made on t he ~c oumpti on
tha t about 10 t o 20 per cent of the deat hs unde r f eve r s a nd a bout 20 per cent t f th ose under r espira tory diseases were a ctually due to p1l1mon~ry t uberculosis . The aVe r age number of dea ths f r om f evers dur ing t he decennium 19 J2- 41 in t he area now compo .:; ing Paki~ t.un wao 400 , 000 GXi of r e3piril.t.ory di3ea3-es a brut 120 , 000 . Us i ng t hese f i gur es , the ave ra!" numbe r of deaths pe r year from pulmonary tube rcul osi s in Paki s t an wil l r~e be t?reen 120 , 000 a nd 200, 000 . Mortali t y figures fo r cities s how tube rculos is death r ate f r om cOO 'to L6U pe r nunct r ed thrus and 'as Hlr as r:an be i;.I.s ce rt,a lIlcd . l nve stlgat.jons have shown th,.lt in smal l up- country tovms th e infecti on ra t e is nearly as high asi n t h e l a r gdr cities and t hat in the vi l l ages it i s l ower but s t i ll cons iderable . It can be sa ,'ely es tim~ted t hat th ere a r e a t l eCl st 120 , 000 deaths fr om t ubu culosis annually in tho whole of P"ki s tan and if the gem r a l European standa rd 'of about 5 c a SdS of active tu bercu l os i s t o one tuberculos is deat h i s a ccept ed , ther e wi l l be a t l eas t 600, 000 active cases of t ube r cu losis in Pakis t an . These f igur es br i ng ou t t he magnitude of th e pro-bl em with which Paki s t a n i s f aced f rom the poi nt of view of pr ovi di ng adequate me dica l r el i ef md of ins!:'itut ing tl'E requirad pr eventive measures .
The i ncreasing urbanisation and· i ndus t r i al i sation program whi ch Pakist an h" s adopt ed will lead , unl ess prompt measures are taken , to a furthe r spre ad of th e disease in t he country . The cont inuous exchange of popul a t ion tho. t i s likely to t ake ~" lace be tween the expec t ed indus t r i al ecnbre~ und ~ he rural c rca~ ~ll haot c n the pac e a t which ~ho ~nfocti on
m<ly spread and t ake giganti c pr·oport ion s.
The above gives a rough i dea of our probl em r e l a t ing t o t uber cu-1 0::11 ::1 10 P C:ik.l ~ t..Ull d .. WJ l..ht: £ vl.luwlug motl t:::::1 t. tlt:Jllauu 1::; €: .:s t..i mat ed : o'J
1949.
(1 ) ~ix Fellows hips :
i . One in Adminis t ration .
11. One i n Epidemiology.
iii. Two i n Lab orat ory .
i v. Two i n cl inic.:ll l".'O rk .
( 2) . Tr aining in mcth ods of B.C.G . vaccinati on .
(3) Liter at ur e .
( I ) Four Fellowships and two vis iting ex perts .
i. Adminis tra tion.
ii. Epidemiology.
iii. Labor a t ory work •
iv. Clinical work.
(2) Traini ng in methods of B.C.G. vaccina tion.
0 ) Litar atu re •
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No r easonably accurate es timate of the incidence of venereal diseases in Pak i s tan is available . A rough enquiry in the area ·now comprising P,. kistan VI.S made in 1933 md it was estimat ed that there were probably about one million caS8S of syphilis and one million cas es of gonorrhea . The data suggest that some thing like one million of peopl e in r okista n ac tu ally show signs of syphilis so that. if accoun t . e taken of thos~ who ha ve had the diseas0 and h'1 ve lost all obviou.s Signs, it would prob", ly be W')ll within the ma rk to assume that 5 to 10 pe r cent of the inhabitants suffer from """hilis at s ome time or other du ring their life.! tilDe. Existinp' st. ; ~ti s ti..cs r elating t o these diseas es a r e those of cases c. ttending hospi t i:l.ls i"iud out patient clinics . Such figures are of much valua in assessing the extent of th eir pr2valenca in the popul a t ion as El. whole 10 I t wil l b e seen that 'V'lhil e no co rrect estimates of th e probable incidence of these diseases c:m be given , their preval enc3 cannot be consider ed t o be low. Even the rough esti~ tes Jr e suffic i ent+y high to justify 9.. serious vi ew of the s itu a tion am t o demand that ad Gquate · measur es should be taken to invBstigate the pr obable extent of their prevalence in t he country and that appropriate measures for thei r contr ol should be taken in t he light of such investigations. The following demands are submit t ed :
( I ) Two Fe llowships and t wo vi"iting experts .
(2 ) Expert advice on the diagnos tic, therapeutic, legal and social aspects dnd venereal diseases contr ol .
(3) Expert advice on educati cll of public.
(4) Di str ibu tion of t echnical infa-mation.
(1) Four Fellowships and one visiting expert.
(2) Expert advice on the di agnostic, therl!peutic, legal ald social aspects and v8ner rJal d iseases contro l ..
(3) Expert advice on ed ucation of public .
(4) Distribution of t .' chnical inf'lJJlIation .
~NITY "ND CllILIl HE •• LTH.
Nearly one half of the. total deaths a t all a ges in J:>aki stan takes place among children under 10 ye ar s . Of t hese nearly hdlf is am ong inf<Ults under one year. it conservative est:im&te of the annua l number of deaths ?!!long women in t ho r eproductive ages from causes associated with pregnancy and child bearing is 50,om . The health of th e people de pands prima rily upon the social and envirorunental conditions under which they ~1ve and work, upon s ecurity against fear and want, upon nutritional standards, upon educational faCility and upon facility for exercise a nd leisure. The essential services to protect the health of mothers and children should provide for the antenatal supervision of expected mothers, for skilled assist~e at child-birth, including institutional facility when necessary, fer the post-natal care of mothers ond for adequate heath protection to
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children frOOt birth through the successive stdges of infancy and early "nd l ater periods of child life . The provisions to achieve these objectives is totally inadequate to meet the needs of the cOOtmunity .
The foll owing demands are submitted :-
(I) Two Fellowships.
(2) Li t erat.ure on administra tion of program.
(3) Mat eria l f or use of health education of mother md children.
(I) EAl'ert ad vice on administration of mate rnal and child health pr ogram.
( 2) Two Fell owships and one visiting expert.
(3) Experts or teams to demonstrate speCial serv1ces .
(4) Distribution of information on r esults of r6search and investigati ons. Current procedures of administrative practices .
(5) Proparation and distribut ion of materials for us e in health, education of mothe rs and children ( l eaflets, posters, sta tistics, etc.)
~THEti DEM.,ND:J Fat 1950 .
Nutri tion .
i. One Fellowship.
ii . Li t t? rature ..
Environment'll S ani t d tion ..
i. One Fellowship.
ii .. Medi cal Literature .
Public Health Jldministration .
i. Two fellowships .
ii. Medi cal Li tara. turu •
Parasitic diseases .
1. Two Fellowships .
ii. Medicdl literature .