FOR THE YEARS 1949 & 1950 I. PUBLIC HEALTH ADMINISTRATION.

W ORLD HEALTH ORGANIZA TION 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) Q uarantine Work.

2)

Epidemiological W ork.

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.

+++++++++++++

!\RABIE SEOUDITE

AS<\IST " N CE REQUISE DE L'O.M.S. POUR LES ANNEEa 1949

ET

1950

I. ADMINISffiATIOII DE L'HYGIENE PUBLIQ UE.

(a) 00ncour8 d'un expert en HygHne Publ1que pour

1949.

(b) Bo urses 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

+-++++++++

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) Exp ert 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.

IV. JIlhTEF:'1AL & CHI:;:',) WELFARE.

Expert advice: One for 1949.

V. PUBLIC HErlLTH ADMINISTRATION.

One f ell owship 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'ALTH F.DUCfi'l'ION.

Doctwents and educa tiona l films,pamphlets,posters,etc.

for public hualth,

",--.. ++++++++

;,ORLD HE.4TH ORGANIS ... TIUN FEBRJ"RY 8, 1949.

P A K 1ST A N.

Nature and Extent of the Problems and Assistance required fran the World Health Organisation

uu.d uK ~949 a-i d ~950.

Malaria is by far the most important disease in Pakistan where at least 25 million individuals suffer from this disease every year. Through the lowering of .the resistance of the patient to other diseases, malaria is also indirectly responsible for a great deal of sickness causing between 10 to 20 million cases of illness each year.

As reg ards mortality it is believed to cause quarter million deaths in Pakistan, ...,ilo periodic epidemic outbreaks to which flestern Pakistan is pecu- liarly liable may e":!.'e the figure by <lDther 100,000. Including the indlaot .·ff • .>cts of m.::ll::lri;:\~ :: ~nntl~l dp::lt.h r.':It-.p. or A pAr t,honsRnri of populdt.ion is a reasonable estima tL.

Realising the importance of this disease the Government of Pakistan

noon oftcr ito ocp~r~tion from Indi~ ost~blishod a Malaria InstitutQ at Karachi.

In the short time of its existence the Institute has been provided with adequalla

"Lff and equipment.· ·<n extensi V8 building program has been sanctioned and will

"', completed in the course of ooxt few weeks. It is confidently expected that

~ll tt~~t:: t:£.fur L::i '11111 t:wi:iultl 1..11~ Iu~ L.ll,..u t...e: Lv un...! t:r I..a.kt: t.he trc;lin.ing of the me- dic ,1 officers in o.dvar.ced malariology during 1949.

Field activities of the Institute during .,948 have ban devoted chiefly to aSFisting

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 the magnitude of the pro- blem is so enormous that Paldstan cannot view the present rate of developments wi th complacency. Tho following demands are therefore put forward chiefly wi th the Clh,iect of h.;l.stening tht3 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 ranks high as a public health problem in Pakistan. It is now almost certainly one of the main public health problems ranking certainly next to rr...l3ria in this respect. No accurate estimd.te of the incidence of the disease cr_ of the average annual number of deaths resulting from it Cal be rna:::le. ^1'1.

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rough cotimotc o£ ~bcrculooio mortal~t7 might be made on the ~coumption

tha t about 10 to 20 per cent of the deaths under fevers and about 20 per cent tf those under respiratory diseases were actually due to p1l1mon~ry

tuberculosis. The aVerage number of deaths from fevers during the decennium 19J2-41 in the area now compo.:;ing Paki~t.un wao 400,000 GXi of re3piril.t.ory di3ea3- es abrut 120,000. Using these figures, the avera!" number of deaths per

year from pulmonary tuberculosis in Pakistan will r~e bet?reen 120,000 and 200,000. Mortality figures for cities show tuberculosis death rate from cOO 'to L6U per nunctred thrusand'as Hlr as r:an be i;.I.scert,alIlcd. lnvestlgat.jons have shown th,.lt in small up-country tovms the infection rate is nearly as high asin the largdr cities and that in the villages it is lower but still considerable. I t can be sa,'ely estim~ted that there are at leClst 120,000 deaths from tubu culosis annually in tho whole of P"kistan and i f the gemral European standard 'of about

5

caSdS of active tuberculosis to one tuberculosis death is accepted, there will be at least 600,000 active cases of tuber- culosis in Pakistan. These figures bring out the magnitude of the pro- blem with which Pakistan is faced from the point of view of providing ade- quate medical relief md of ins!:'ituting tl'E requirad preventive measures.

The increasing urbanisation and· industrialisation program which Pakistan h"s adopted will lead, unless prompt measures are taken, to a further spread of the disease in the country. The continuous exchange of population tho. t is likely to take ~"lace between the expected industrial

ecnbre~ und ~he rural crca~ ~ll haotcn the pace at which ~ho ~nfoction

m<ly spread and take gigantic pr·oportions.

The above gives a rough idea of our problem relating to tubercu-

10::11::1 10 PC:ik.l~t..Ull d .. WJ l..ht: £vl.luwlug motlt:::::1 t. tlt:Jllauu 1::; €:.:s t..imated :o'J

1949.

(1) ~ix Fellowships:

i . One in Administration.

11. One in Epidemiology.

iii. Two in Laboratory. i v. Two in clinic.:ll l".'Ork.

(2) . Training in mcthods of B.C.G. vaccination. (3) Literature.

(I) Four Fel lowships and two visiting experts. i. Administration.

ii. Epidemiology.

i i i . Laboratory work • iv. Clinical work.

(2) Training in methods of B.C.G. vaccination.

0 ) Litarature •

-3-

No reasonably accurate estimate of the incidence of venereal diseases in Pak istan is available. ^A rough enquiry in the area ·now com- prising P,.kistan VI.S made in 1933 md it was estimated that there were probably about one million caS8S of syphilis and one million cases of gonorrhea. The data suggest that something like one million of people in rokistan actually show signs of syphilis so that. i f account . e taken of thos~ who have had the diseas0 and h'1 ve lost all obviou.s Signs, it would prob", ly beW')ll within the mark to assume that

5

to 10 per cent of the inhabitants suffer from """hilis at some time or other du ring their life.! tilDe. Existinp' st.;~tisti..cs relating to these diseases are those of cases c.ttending hospi ti:l.ls i"iud outpatient clinics. Such figures are of much valua in assessing the extent of their pr2valenca in the population as El. whole ¹⁰ I t will be seen that 'V'lhile no correct estimates of the pro- bable incidence of these diseases c:m be given, their prevalenc3 cannot be considered to be low. Even the rough esti~tes Jre sufficient+y high to justify 9.. serious view of the situation

a m

to demand that adGquate· measures should be taken to invBstigate the probable extent of their prevalence in the country and that appropriate measures for their

control should be taken in the light of such investigations. The follow- ing demands are submitted :

(I) Two Fellowships and two vi"iting experts.

(2) Expert advice on the diagnostic, therapeutic, legal and social aspects dnd venereal diseases control.

(3) Expert advice on educaticll of public.

(4) Distribution of technical infa-mation.

(1) Four Fellowships and one visiting expert.

(2) Expert advice on the diagnostic, therl!peutic, legal ald social aspects and v8nerrJal diseases control ..

(3) Expert advice on education of public. (4) Distribution of t.'chnical inf'lJJlIation.

~NITY "ND CllILIl HE •• LTH.

Nearly one half of the. total deaths at all ages in J:>akistan takes place among children under 10 years. Of these nearly hdlf is among inf<Ults under one year. it conservative est:im&te of the annual number of deaths

?!!long women in tho reproductive ages from causes associated with pregnancy and child bearing is

50,om .

The health of the people depands primarily upon the social and envirorunental conditions under which they ~1ve and work, upon security against fear and want, upon nutritional standards, upon educational faCility and upon facility for exercise and 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 later periods of child life. The provisions to achieve these objectives is totally inadequate to meet the needs of the cOOtmunity.

The following demands are submitted :-

(I)

Two Fellowships.

(2) Li terat.ure on administration of program.

(3) Material for use of health education of mother md children.

(I) EAl'ert advice on administration of maternal and child health program.

(2) Two Fellowships and one visiting expert.

(3) Experts or teams to demonstrate speCial serv1ces.

(4)

Distribution of information on results of r6search and investigations.

Current procedures of administrative practices.

(5)

Proparation and distribution of materials for use in health, education of mothers and children (leaflets, posters, statistics, etc.)

~THEti DEM.,ND:J Fat 1950. Nutri tion.

i. One Fellowship.

i i. Li tt?rature ..

Environment'll S ani td tion ..

i. One Fellowship.

ii.. Medical Literature. Public Health Jldministration. i. Two fellowships.

ii. Medi cal Li tara. turu • Parasitic diseases. 1. Two Fellowships. ii. Medicdl literature.