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 .