W O R L D H E A L T H rJWt &I iLy" ORGANISATION MONDIALE ORGANIZATION DE LA S A M E

REGIONAL OFFICE FOR THE BUREAU REGIONAL DB LA EASTERN MEDITERRANEAN MBDmERRANEE ORIENTALB

REGIONAL WMMIYEF, FOR TKE EASTERN M m I r n N E A N

Fourteenth Session _I---_ ORIGINAL^ ENGLISH

smc0MMfm B

Agenda i t e m 14

WPORT OF SUEb COMMfTlEF, 3

OF THE

F'OURTEENTH SESSION

OF !I'm

REGIONAL COMMITTEE FOR THI?, EASTERN MEDITERRANEAN

PART I - INlRODUClTON

1. General 2. Opening of the Session 3. Election of Officers 4, Adoption of the Agenda

PART 15: - lUPORTS AN3 STATEMEWS

1. Annual Repor t of the Regional Direc to r t o the Regional Committee 2

2. Co- operation with 0.-"anizatlons and Agencies in Fie lds Related t o Health - Statemenks and Reports by Representatives and Observers of Organizations and Agencies 2

PART 111 - PROGRAMME

1. Proposed Propamme and Budget Estimates fo r 1966 fo r the Eastern F,!editerranean Region 3

PART rv - TECWICAL M A m S

1. 'Public Health Aspects of Measles in the Eastern Mediterranean Region

2. The Public Health Laboratory Scrviae 3 Review of Some Aspects of Mediaal Educatian 4. Hospital Fkarmacy and Medical Stores as Part o f

Hospital Administration

PART V - 'mCHNICAL DISCUSSIONS

1. Infantile Diayrhoea

PART VI - OT3ER i'k4YlXRS

1, Use of the Arabic Language in the Regional Office for the Eastern Mediterranean 6

2. Resolutions o f Regional Interest Adopted by the Seventeenth World Health Assembly and by the Executive Board at its Thirty-Third and Thirty-Fourth Sessions 6

3 Representative of Subcommittee B 6 4. ~ i & t of Vote 6

PmT VII - RESOT.AM!IOHS 6

ANNEX 1 - Agenda: Sub-Committee 3 of the Regional Committee f o r thed3astern Mediterranean, Fourteenth Session

ANNEX I1 - L i s t of Representatives, Alternates, Advisers and Observers t o Sub-committee B of the Regional Cofipnittee, Fourteenth Session

ANNEX 111 - Sum- Technical Report - Technical Discussions on Infantile Diarrhoea - Sub-Committee B of the Regional Cornittee for the Eastern Mediterranean, Fourteenth Session

PART I

I m O D u C T I O N

Sub-Committee B of t h e Fourteenth Session of the Regional Committee fo r the ~ a s t e 6 n ' ~ e d i terranean m & t at the World' Health Organization Headquarters, Geneva, on 22 and 23 September 1964, Three plenary meetings were held.

The Proposed Fromame and Budget Estimates for 1966 (Agenda item 9) and Technical Matters (Agenda item 10) were discussed in plenary session.

. .

Technical ~lsoussions on "Infantile ~iarrhoea" took place on the morning of 23 ~e~tember 1964.

The following Sta tes were represented:

Ethiopia Fkano e I ~ a n Israel Uni-Led Kingdom of Great Britain

and Northern Ireland

The United,Nations and the Technical Assistance Board were represented by the Deputy Rep~~esentat ive fox Europe of the Technical Assistance Bowd and Special Fund.

Five non-governmental organizations, as well as the International 1 Childrent s Centre, were represented .

2 OPENING OF THE .__I*- SESSION (Agenda item 1)

Tn the absence ot both the Chairman and VFce-Chairman of the previous sesston, t he 1iegiona.l Director, Dr, A.H. Taba, opened the session and welcomed. represent-atives of blember States and other organizations,

ELJICTIOA O? OFFICETiS {~genda item 2) 3- - . - . . , --* ,-.-*--,.*--

The S u b C o m i t t e e elected its off icers as follows:

Chairman: Dr. P.W. Dill-Russell

vice- hair man: MBdecin Colonel H, Morin (Rrance ) - --,-- -..-*-

4, ADOPTSON OP EIE AGTNDA (~genda item 3, nocwnent -~14/1) - ... . .*.*, - -. --- a s i

2 The i3r;oviEf'ona3 Agenda was adopted as presented .

- ' - 'see: - L i s t df Representatives, Alternates, Advisers and Observers to Sub-Committee R,, I,:cl;c:.u I1

PART f I

REPORTS A N D STATEMENTS

1. ANNUAL R E W T OF TfU3 REGIONAL DIRECTOR TO TNE REGIONAL COMMIm (~gehda itern 5 , ~ o o h m e n t m 4 / ' 2 , Resolution EM/~cL~B/R.P) '

The Regional Director Introduced h i s report on the work of WHO, and first recalled that July 1964 marked the 15th anniversary of the inception of the Regional Office; he therefore highlighted brief ly the work and developments which took place during this 15-yew period. He a lso paid t r i b u t e t o the memory of Dr. A.T. Shouska, former and first Director of %he Regional Off ice , whose death was deeply felt in the Region by both country representatives and WHO staff. He then outlined in some more detail t h e work of the World Health Organization whlch was carried out during the period 1 July 1963 to 30 June 1964.

Zlrte following points emerged from the discussions that took place under this item:

(a) W l e general appreciation was expressed on the work carried out by WHO, especially in the f l e l d of education and training, emphasis was laid again on the importance of developing more and more this aspect of work, the number of qualified medical and para-medical personnel being still far behind the actual needs of most of the countries, The need f o r c loser collaboration Between the ministries of health and medical faculties and o'ther medical teaching institutions was fu r the r stressed.

The Representative of Is rae l merrtioned the training facilities which his country of fers to WHO trainees In -both undergraduate and postgraduate teaching, and he referred especially to the establishment of a new medioal school in the University of Tel-Avfv, He a lso expressed the hope that his Government would, by participation in future inter-regional and regional activities of WHO, be able to make appreciable contribution.

(b) In the f i e l d o f cancer, more attehtion should be given t o research and t o the desirability of establishing a national cancer register. Epidemiological studies should be carried out on both cancer mortality and cancer morbidity. Concerted e f fo r t s on research, planning, ease-finding and crwative aspects should be pursued,

( c ) .Particular attention should be given to t h e problem of trachoma, Research 'is proceeding especially towards the preparation or vaccines against trachoma.

2. CO-OPERATION WITH ORGANIZATIONS A N D AGENCIES I N FIELDS RELATED TO HEALTH - -- STATEMENTS AND REPORTS BY R E P R E W A T m S AND OB3EBVERS OF ORCfANIZATfONS - AND AGENCIES (Agenda item 6 ) I__- I-

The observer front the International Children's Centre indicated that the Centre has zlso entered i t s fifteenth year of aotivity, during which period an important number of teaching a c t i v i t i e s have been organized, a lso to the benefit of countries from the,Eastern Mediterranean Region which participated in some of them.

The teaching provided by the Centre is essentially directed at social. paediatrics, L.e, social medicine applied t o childhood. Up to now 111 courses have been given in 26 countries and have grouped a t o t a l of over 3,000 participants.

The idea which resided at the organization of those activities has been the consideration 'of the ent ire childhood, i , e , since conception till adu l t age, and of all children, i.e. normal, physically or mentally handi- capped as well as socially-mladJusted children, These activities are of interest, not only t o t h e medical, p~ofession, but also to t h e legal, '

medico-social and social ones. If many ICC activities have taken place in t he past in Paris, a powlng number of them are now being organized outside Europe, and in this respect a course on public health problems to be held in Tunis in 1955 can be c l t e d as an example. Of pasticular importance is the I C C International Documentation Centre which contains publications from 54 countries in 18 languages. h e ICC appreciates the collaboration which the Regional Office for the Eastern Mediterranean is always extending t o it.

The representative of the International Council of Nurses indicated tha t her organization would be most willing to assist governments in the Eastern Mediterranean Region, pwticularly in their education programmes, w i t h a view to meeting the growing demand fo r nurses and improving the sftua- t i o n from both a quantitative and qualitative point of view.

PART 111

PROGRAMME

1. PROPOSED PROGBJMT@ AN33 BUDI;ET ESTJNATBS FOR 1966 FOR THE EAS'PERN --YYYW--

MEDITERRANEAN REGION ( ~ g e n d a item 9, Document E M / R c ~ ~ / ~ and Corr. 1, c-----.-r*---- ---- Resolution EM/Rc~~R/R.~ )

The.Regiona1 Director introduced the document which s e t out the proposed programme and budget estjmates for 1966, and in addition contained the revised propamm for 1965. Tne form of presentation and the method of computation were similar to that used i n brevious years.

The overal l costs of the proposals under Regular Funds, including Regional Office, FEIO representatives, country and inter-country. projects, as well as the estimates for the Regional Cowanittee sessions, amount to app;r?oximatelp $ 361,000 more than the comparable budgets for 1965. This represents an increase in a c t i v l t i e s of approximately 10% of which only about $ 25,000 is fo r t h e Regional Office so that m o m than 9% of the increase is designed to strengLhen the field activities.

The imgoPtanoe of approaching a number of activities on an inter-country basis was styeasedm Most of these projects would benefit the countries of the Region as a whole, and others would benefit p o u p s of countries. However, the additional cost in 1966 over that budgetted for 1965 had been limited to some $ 56,000 so that the g r e a t e r share of the proposed increase in the budget f e l l under the individual country promamrnes.

Attention was drawn to the t h e e annexes, m e first described supplementmy mala~ia activities designed t o accelerate malaria eradication, the second suitable activities in the development of cornunity water.aup&:Sg.

Common for these t w o was that their implementation depgnded on sufficient voluntary contributions fowlthcoming under the appropriate special aaoounts. The thf rd annex - the green pages - presented a c t i v i t i e s requested by govements but for which there were not suff icient funds within the tentative regional ceiling to permit their inclusion in the 1966 proposed programme.

The Representative of Iran expxlessed his satisfaction that additional finds were foreseen to support the more comprehensive and long-term projects being sponsored by MHO and needed by the member govements , I n view of the 'new health hazard8 whloh had been touched upon in 'cahect ion with the previous discussions an t h e Regional ~irectoi-' s report, he wondered t o what extent budgetary provision had been mde. The Regional Direator replied that gradually increasing provisions in this respect had been made i n the programme and budget proposals, As speai f ic examples he referred to the aumwy table on page XI1 of the document, under Radiation and Isotopes, to specific training courses undef the Inter-Country programme and to the fellowship p~ovision designed t o enable public health administrators t o obtain f'urther t ra in ing in radiation protection,

Zrze Sub-Co,@!s$e F0w.d that the proposed programme presented a mitable balance between the various types of aotivlt ies and endorsed the proposed programme and budget estimates,

PART IV

mCHN JCAL MATTERS

1. PUBLIC HEALTH ASPECTS OF MEASLES IN TME GASTERN MEDITERRANEAN REGION (Agenda item 10(a), Document EN/Rcl4/4, Resolution w ~ 1 4 ~ h . 6 )

Measles constitute an important problem f a r most countries in.the Eastern MedAterranean Region. To meet the desire expressed by some govern- ments to receive more information on the subject, a document w+s prepared by the Regional Office. It contafns two parts: (a) the epidemiological aspect - which was based on answers to a questiomalre airculated among countries in and outside the Region in 1963; and (b) vaccination.

In Israel there are four regular sources of information about measles: Annual statfs-tics o f mortality showing death from oomplication and the extent to which they are correctly noti.fied; annual statistics of hospitals estimated on samples; annual.and monthly sumaxlies of communicable diseases notification covering the high percentage of cases seen by a physician; annual suimnazy of cases recorded in siclaless insurance fund clinics, ?he morbidity statistics were published one t o two years after the year of registration and those of hospitalizatian and s ichess insmarice fund clinics after an even longer delay, The same sort of data could probably Be obtained In other countries through similar sources,

Summing up the discussion the Chairman was s t ruck by the point that the length of time of immunity cdnferred by such vaooines was unknown, and m % & t n o t belife-long. If such was to be the case, there would only be a shift of the incidenca to an older age group, which would entail possible dangers; f o r instance, there could be an adverse repemuasion t o the foetus if women were to be increasingly exposed to measles at an age when they might be pregnant.

2. TEE PU3LIC HEAL!tY LAEORAMRY SERVICE (Agenda item lO(b) , Document W/RC14/5, Resolution ~ ~ h ~ 1 4 ~ f i . 7 )

Although the public health laboraeory service I s now recognized as an integral anG essential par t of health services in general, it has as y e t not developed as desired in all countries alike. &sides the highly specialized laboratories, there still exist a dissociation and duplication of services whioh, if they were connected, would result in appreciable savings in personnel and funds. If, fo r large-size countries, it would be advisable to have laboratories producing prophylactic and therapeutic material, fo r smaller countries it would be cheaper to impowlt this material,

Inter-country arrangements for subjects like nut~ition would be valuable f o r cases where they Could be applied*

Although it is realized that it would be difficult f o r public health laboratory services in most countries to dispose of an autonomous budget, it is, however, considered that a certain degree of autonon~y would help the better functioning of the service.

3 H3VIWOFSOMEASPECTSOFMEDICALEDUCATfON (Agenda i temlO(c),Document E M / R ~ m z s g n FM/Rc~~B/R , 8 )

The need f o r medically qualifies personnel is felt throughout the Region. This was already stressed at the Conference on Medical Education held in Teheran in 1962 and.was fu r thzr discussed,by.the Specfal Group

fy@:',.6fi':M&ajlc&y 'Edis&eidn' 'in *iexandria 2963,

The noticeable increase in Wle number of medical schools i n the Region (8 in 1940 against 33 in 1964) is a great s t e p forward, Tbe creation of new schools of medicine should, however, be envisaged cautiously and only when the availability of sufficient and qualified teaching personnel has been ascertained. There is need fo r more adequate c o l l a h r a t i o n between ministries of health and faculties of medicine. The select ion of candidates for medical studies should be done mare careful ly . The training of well- informed r n e d l c a l l i h a ~ i e , n x i s very valuable. The idea of a regional asso- ciation of medical educators deserves to be pursued.

4. - HOSPITAL PHARMACY AND MEDICAL STOWS AS PART OF HOSPITAL ADMINI$TRATION - (Agenda item 10(d), Document EI@~14/7 and Add.1, Resolution ~ r n c 1 4 ~ h . 9 )

Although specialization in pharmacy was stressed, it was pointed out that the r o l e of hospital pharmacy should not be over-estimated; it should be a p a r t of health services but not a service in itself, and would more particularly ?:>ply to teaching hospitals, Quality control laboratories should certainly be under the control of Ministries of Health and regulated by laws. In fact, no drugs, whether imported or manufactured locally, should be allowed on the market before havlng been t e s t e d and accepted by Ministries o f Health. One year ' s in- service t r e in ;nc ~ h o u l d bc m d e c o m p u l s o ~ for pharmacy graduates ; they definitely require increased and advanced training, A drug information centre is of v i t a l necissity.

TECHNICAL DISCUSSIONS

1. INFANTIIB DIARRHOEA (Agenda item 12, D o c u m e n k ~ ~ l 4 / ~ c h . D i s c . 1 - 3 , Re solution ' E I @ c L ~ B ~ . 10)

1 Teohnioal dlscussiona on infantile Diarrhoea were held on Wednesday,

23 September 1964 under the Chairmanship o f Dr. P. W. Dill-Russell (United Kingdom) , Chairnian of - t ; ~ i ' Sbb-Cormittee,

One basic document prepared by the Regional Office and one grouping the contributions of eight experts from oountries in the Re$ion formed t he back- ground to the disoussiona.

PART VS

1. U S OF T'HE ARABIC LANGUAC-E IN DIE REGIONAL OWICE IWR THE EASTERN 3 _ - , . --..-- MEDIZERRANEAN (Agenda item 7 , Document - --- ]C~~B/R. 3)

The Sub-Comit.tee reviewed the document submitted by the Regional Director and took note of Resolution EB33.RS on the subject.

2. FE3OLUTIONS 05 REGIONAL jXl%REST ADOPTED BY THE ~~~ WORLD SIEALm - I _ _ - _ - _ _ . L U _ * - r . I _ L

A S S E ~ I B A ~ Q BY THE E X E ~ T ~ V E NARD AT ITS mmm-mm AND TH~TY- FOUR^ - - . " . - ' l m - C I .-llu .<-r---n

SESSIOW (Agenda Item 8, Document m-10, Resolution E M $ ~ c ~ ~ B / R 4) ----.

The Sub-Conmittce reviewed the resolutions included in the document and Look note o f their contents.

3* REEiESENTAT!.71E 08 WJ3-COMb!TZTE;E B ( R W 47 OF RULES OF PROCEDURE) -1-- r * (nsedi item 13)

The SubComi-Ltce req1esY-2 the Regional Director t o act on i t s behalf fo r the implementation of Rule 47 of the Rules of Procedure.

The Government of Israel exercised its right of vote in Sub-Coramittee B.

RESOLUTIONS

I n the course o f i t s plenawy sessions, Subcommittee B adopted the fol lowing resolutions:

EN/~c~ 43b. -- 1 A D O F E O N OF THE FROVISIONAL AWNPA

The Sub- Comrn!.ttee,

ADOPTS the Provisional Agenda (Document J?,M/h~14/1) as presented.

- 'see Annex I11 for Sum8.zy Technical Report

EM/F(c~~B/~. 2 ANNUAL REPORT OF THE REGIONAL DITZCTOR TO 'fS1E F m w SESSION OF THE REGIONAL COMMIm

The Sub- Commi tt e e ,

Having reviewed the Annual Repor t of t h e Regional Director fo r the period 1 July 1963 to 30 June 1964 (Document ~M/Rc14/2);

Noting w i t h satisfaction the progress made during t he last fifteen years and especially during the last one;

Considering the transformations and developments which are taking place in the economic and social s t ruc ture o f most of the countries of the Region and their repercussions on the health programme;

Realizing that these new pPograme trends will require more specialists, technicians and research workers and that their training constitutes a high pr io r t t y o f national development and health plans,

1. REQUESTS the Regional Direc to r t o continue to render advisory assistance to Member S t a t e s in t h e strengthening of their health servlces and particularly with t heSr p ropames for training of medical and pwarnedical personnel ;

2. ENDORSES the emphasis being given to t h e field of medical education in general and to the training o f specialists In various f ields of public health in part icul 'ar;

3. URGES governments to give due consideration in their national health planning schemes t o the new health hazards which are gradually appearing In the Region and t o appropriate research in these fields;

4. COMMENDS the Regional Director on his clear and comprehensive report .

E M J R c ~ ~ B / ~ . 3 USE OF ARABIC LANGUAGE IN THE REGIONAL OFFICE FOR THE EASTERN MEDIT!JRRANXAN

The Sub-committee,

Having reviewed the document submitted by t h e Regional Director ( E M / R c ~ ~ / ~ ) on the subject of the U s e of Arabic Language in the Regional Office f o r the Eastern Mediterranean,

TAKES M O T E o f the.Resolution adopted by the Executive Boaxld during its thirty- thik;d session on t h l s sub3ect1.

EM/Rc143/%. 4 RESOLUTION3 OF REGIONAL ITJTEREST AlXPT'ED ', THE: ~~~H WORLD HEALTH ASSEHBLY AND BY TEE EXECUTIVE WARD AT ITS THIRTY-THIRD AND THIfiW-FOURm SESS f ONS

The Sub-Committee,

Having reviewed the document submitted by the Regional Director (E3I/R~14/10) ,

heso lu t ion EB33.~36 (see: Off. Reo . Wld. Hlth. Org. 132)

drawing attention to resolutions o f regional in teres t adopted by the Seventeenth World Health ~ s s e r n b l ~ m d by the Executive Roard at i t s Thirty-Third and '&ir%y-burth Sessions,

1 TAKES NOTE of the contents of these resolutions . E M , / R C ~ ~ B / ~ . 5 PftOfOSED PROGRAMME AND HEGET ESTZMATES WR 1966 IXR

THE EASTERN M E D I T E X W M N REGION

The SubCommittee,

Having examined the Proposed Programm~ and Budget E*atimates proposed by the Regional Director fo r the year 1966 (~ocuments~M/R~14/3 and Corr. 1) ;

Bearing in mind that projects financed under ihe Expanded Programme of Technical Assist.wce m e planned fo r their estimated duration;

1. FINDS that the p r o g r m e as presented assures a suitable balanoe between the mJor sub3ect headings;

2. NOTES with satisfaction the prominence given to education and tralning in t h e Reglonal programme, the general approach t o health planning i n relat ion Lo national socio-economic development plans, and the continued emphasis' on provisions for fellowships;

3. REITERATES the impoxltance of inter-country programmes, and supports the requests submitted to t h e Technical Assistance Board for act iv i t ies ipclude'd under this heading in the biennium 1%5/1966;

4. ENDORSES the proposed programme and budget for 1966 to be implemented f r o m the Regular Budget of the World Health Organization, the Expanded *ogranune of Technical Assistance funds, and the activities proposed to be financed from Special Accounts under the Voluntary Fund for Health Promotion3

5 THANKS UNICEF for its constapt cooperation and continued valuable support.

E m ~ 1 4 B f i . 6 PUBLIC lBALTZ3 ASPECTS OF MEASLES IN THE E A S W M E D r n N E A M REGION

The Sub-committee,

Having examined w i t h interest the document (EM/b~l4/4) on the Public Health Aspects of Measles in the Eastern Mediterranean Region, presented by the Regional Director, particularly in respect of ( A ) epidemiological aahects and (B) vaccination;

Considering t,bt measles is one of the most important diaeases of .childhood, with hl gb morbidity' rate and signif i c s n t death ra te :

Notiw the new developments in vaccination,

1. URGES the Qavernments of the Region t o give due consideration to bio- statistics s o that rel iable information oould be made available on the spread of the discase,and death resulting from this disease and its complications;

2 ~ C O ~ that no large scale use of measles vaccine be undertaken a t the present, t i m e , wi thout cweful consideration and preparation, including plans fo r step-by-step pxlogression;

3. REQUESTS the Regional Director to'provide teohnical assistmoe to Cavernments, on request, in organizing l imited measles vaccination trials prior to- I m g e scale campaigns;

4. FURTHER RECOMMENDS the continuation of research gar a mare attenuated measles s t ra in giving low reaction ra tes , but conferring adequate p~otection, as well as the setting up of standards for control of safety and potency.

EM/Rc~ 4 ~ h . 7 THE PUBLIC IiE3ALTEI LABORATORY SmVICF,

The Sub-Committee,

Having studied with interest the document (EM/Rcl4/5) on the Public Health Laboratory Service, presented by the Regional Director;

Considering that the Public Health Laboratory Service is an essential and intewal, part of health services in general;

Noting with satisfaction that due consideration is being given to t h i s activity by the count~ieq of the Reglon;

Weln3ming the views expressed in the document.

1. URGES the Governments of the Region to give due priority.$o their public health laboratory services;

2. RECOMMENDS that the Governments give urgent attention to the solution of organizational and fiscal problems necessary fo r the development of these services;

3. FURTHER recommends that more attention should be paid to the training and status of laboratory personnel;

4. REQWTS the Regional Director t o continue to make available to the Governments expert advice related to public health laboratory service and t o promote and assist the development of facilities for the t ra ining at different levels of specia l i s t s required t o operate, manage and maintain this essential service,

lWJTE?d OF SOME ASPECTS OF D I C A L E;DWCATION

The SubComrnittee,

Having revi~wed the document (mhc1'4/6) submitted by the Regional Direct o r , on the subJect of Medical Education;

Considering the future realization of this programme as an important basis f o r the development o f sound public health and medical oare prowammes in t h e Region;

EMI"RC14W3 page 10

1. EXPRESSES its satisfactiori with the work done so far in this field;

2. ENDORSES t h e proposals made by t he Special Group Meeting on Medical Education as s u h t t e d in the docwneht under review;

3. CALLS the attention of Member Governments which have wide faci1Lties in medical education to the importance of research i n medical edbcatidli'by the Use of one of the existing medical schools in the i r country as a model medical school thus making it possible to adjus t the trairdng of f i t u r e doctors to the particular needs of a social ly and econom;lcally growing socie ty and to the demands of changing c o ~ i t i e s ;

4, REQUESTS the Regional Director t o proceed further in strengtherilne; the general programme for medical education pa r t i cu l a r l y i n assisting the Member States in khe establishmknt of nati o m 1 model medical schools through advisory services and the award of fellowships.

EMfRcl4~fi. 9 HOSPITAL PHARMACY AND MEDICAL SmR35S AS PART OF HOSPITAL ADMIN~ST~#~TION

P i e Sub-Committee ,

Having studied the documen@ (EN/%~l4fi and Add. 1) on Hospital Pharmacy and Medical Stores as pmt of Hospital Administration, subm3tted by the

'

Regional Director;

Considering the role t h e pharmacist can play by specializing i n hospi tal phamnacy administration and t h e important part he p l a y s in promoting quality control of drugs, production o f pharmaceutical preparations, hospi tal formulary, drug information centre and medical supply services;

1. COMMENDS the Regional Director on h i s interest i n general i n the management of pharmacy and medlcal stores and t o his assistance in t h i s f i e l d to maw member Qovernmehts;

2. FIBQUESTS the Regional Director t o explore t h e possibilities of establishing advanced t ra in ing o f hospi tal pharmacy administration i n any of the faculties of pharmacy in t h i s Region and to assist fur ther t he Governments in the i r efforts with the planning and development of t h e i r medical supply services.

EM/Rc~~B/~. 10 INFANTILE DIARRHOEA

The Sub-Committee ,

Having studied with interest t he documentation on I d a n t i l e Diarrhoea in %he Eastern Mediterranean Region, presented by the Regional Director ( m ~ 1 4 / ~ech.~isc ./2 and 3 ) ;

Considering that Infantile Diarrhoea is one o f t h e major health problems i n this Region and the most important cause of high mo~bidi ty and rnbrta1i.t~ in infancy and early childhood;

Noting the development of preventive measures taken by various countries i n the Region to decrease the incidence of infan+ile diarrhoea;

Mc14B/3 page 11

J . EXMSSES its satisfaction wlth the surveys carried out by the World Health Organization i n a few countries of the Region t o study the problems related to dlarrhoeal diseases;

2. EMDOFBES the recornmendat ions made in document ~M/h?14/~ech .~isc. /2 with regard t o both the prevent$ve and curatlve aspects of the problem;

3. R E C O ~ ~ that the Governments gZva high p r i o r i t y t o Maternal and Child Health and give urgent attention t o the development of related services to remedy the problem of Infantile Diarrhoea;

4. REQWEBTS t h e Regional Director to explore Wle possibilities of carrying out further surveys on Diarrhoea1 Diseases in t he Region and to continue -to provide technical assistance to the Governments as required, in order to develop and promote training facilities fo r specialized health personnel.

The SubCommittee,

1. ADOPTS t h e report of Sub-Committee B of the Fourteenth Session of %he Regional Committee (~M/Rc143/3) ;

2. ~ Q ~ S T S the Regional Director t o deal with the repor t in accordance with the Rules of Procedure.

EMhc14B/3 Annex I

SUB-COMMITTEE B OF THE REGIONAL COMMITTEX FOR THE ERSTEXN MEDITE2MNEAW, FOURTJBWH SESSION

1. Opening of the Session

2 Election of Officers

3. Adoption of the Agenda

4, Appointment of t he Sub-DPvision on Frogramme

Annual Report of the Regional D i r e c t o r t o the Fourteenth Session of the Regional Committee; (mhc14/2 1 Statements and r e p o r t s by Representatives of Member States

Cooperation w i t h other Organizations and Agencies; (m/Rc14/9) Statements and reports by Representatives and Observers of Organizations and Agencies

U s e of the Arabic Language in the Regional Office for the Eastern Mediterranean (DI/RC~~/~ 1

Resolutions of Regional interest adopted by the Seventeenth World Health Assembly alSd by the Executive Board at i ts Thirty-third and ~ h f r e y - fourth Sessions (?3M/Rc14/10)

Proposed Programme and Budget Estimates fo r 1966 for the Eastern Mediterranean Region (E34/~~14/3 and Add .l)

Technical Matters:

a, Fublfc Health Aspects of Measles in the Eastern Mediterranean Region

b. The Public Health Laboratory.Service ( ~ ~ h c 1 4 / 5

c. Review of some aspects of Medioal Education ( ~ ' ~ ~ 1 4 / 6

d . Hosp i t a l Pharmacy and Medical Stores as part of Hospi ta l Adminietration (EM/Rc14/7 and ~dd.1)

Approval of the Report of the Sub-Division on Programme

Technical Diseuesions: "infantile ~iarrhoea" ( E @ I / R C L ~ / T W ~ D i s c . /I-3)

Other business

Adoption of the Report

EM/Rc14~/3 Annex II Page 1

LIST OF REPRESJXPATTVES, ALTEBNATES, ADVISERS AND OWERVERS M SUbGOMTllB 3. OF THE F E G JONAL COMMIWF&

WUR- SESSION

ETHIOPIA

Representative --

Represents t i ve -

Adviser --

Representative

M r . Aberra Jernbere Secretary General t o the

Council of Ministers Addis Ababa

FRANCE

MBdecinColonel Hemi Morin Directeur de la Sante publique en' Cate *angaise des Somalis

Djibouti

Dr. A.T. biba Technical Adviser on WHO Affalrs to We Iranian Permanent Delegation to the European Office of the United Nations

Geneva

Dr. Raphael Fjebin DSrec tor-General Minis,try of Health Jerusalem

M r . N,M. Bavli Israeli Permanent Delegation,to the European Office of the United Nations

Geneva

IJiUTtD KINGDOM

Dr. P,W, Dill-Russell ~ e ~ b t ~ Medical ~ d v i s e r Department o f Technical Co-operation Ministry of Health London

m c k 4 B / 3 Annex If page ti

REPRESJiSTATNES OF THE UNITED NATIONS AND SPECIALIZED AGENCES

UNITED NATIONS 1 M r . A,E, Saenger 1 Deputy Representative fo r Europe of the Technical

TECMCAL ASSISTANCX Assistance Board and Special Fund, Geneva BOARD (UNTAB) 1

REPRESENTATIVES AND OBSEBVEBS OP INTUWATTONAL MON-GO-&, INTH7-GOlERlWE~AL A N D NATIONAL ORGANIZATIONS

XITIERNATIONAL CHILDREN' S Dr. E .D, Berthet (observer) mNm - INTERNATIONAL COUNCIL Miss M . J . Marriott (~epresentatlve)

INTERNATIONAL DENTAL Dr. C,L. Eouvier (Representative)

LEAGUE OF RED CROSS SOCIETIES Dr. H. Zielinski (Repwlessntative) -,

WORLD FEDE3ATION FOR Dr. A . Auddoud-~aville (~epresentative) MENTAL HEALTH

WORLD MEDICAL ASSOCIATION b. Jean Maystre (Representative)

EM/hC14~/3 Annex I11 Page 1

A W X I11

S ~ Y TECHNICAL mPORT TECHNICAL DISCUSSIONS ON ImANTffrE DIARRHOEA SU13-00MMTm I3 OF TNE: REGIONAL C O M M I m FOR THE EAS!ERN MEDITERRANEAN, FOtfRTEENW SESSION

Sub-Committee B had chosen ''~nfantile ~ia r rhoea ' as the subject fo r Technfoal DiscussPons a t the Fourteenth Session o$ the Regism1 Committee,

Dr. P.W. Di l l -Russe l l (United ~ingdom) , Chairman of the SubComi t t e e , presided over the discussions,

As a basis for discussfon, the Rep~esentatives had b e f ~ r e them two documents, one prepared by the seore ta r ia t of the Regional Office. and yo the r grouping the contributfons of eight experts from countries in the RegSon . 2. -- SUMMARY OF BACKGROUND INFORMATION

Diarrhoea, whiah has been lmown sinoe antiquity, is a very important problem In paediatrics, and I s of veat conoern to the countries o f the Eastern Mediterra- nean Region where, in moat of them, infantile diarrhoea accounts for more than 6G$ t o 758 of bases seen o r admitted i n health centres, and fo r more than 50% of a l l fatalities among infants and children under two years of age. Although the term "infantile diamhoea" should refer to t h i s disease among infmCs only , i, e. children of 0-12 months, pre-school age chlldren up to s i x years have been included in t h i s group, countries in this Region having repor ted them under this term i n t h e i r answers t o the WHO questionnaire which was sent to them.

Diarrhoea, i n fact , is much more a symptom o f diseases such as cholera, typhoid fever, intestinal p::.rasitism, enteric virus infect ions , malriutrition, and others, than a disease in itself, The c lass i f ica t ion of diawlrhoeal diseases presents many difficulties, similar o r even identical e n t i t i e s appearing under different names in different local i t ies , and deaths being c la s s i f i ed under d i f ferent categories. The International Statistical Classification of Diseases, Injury and Causes of Death does not help t o clarify the s i tuat ion,

Infant death from infantile diaxlrhoea is still very high in many countries i n t he world, and particularly in this Region, the most critical period appearing t o be between the ages of six and twenty-fou~ months,

Varlous fac tors m a y influence the disease, and among them age, sex (the Incidence is higher among males than females), season and f l ies deserve special. attention.

Environmental sanitary factors r e f l e c t t o some extent on the infar l t l le diarrhoea death rates as it r e f l e c t s on infant mortality. The decline i n morbidity .?-a.l mo?-.-? a l t t y rs.t"tce J,n illarrhoeal diseases in the beat developed areas in the wo,rld has been largely attributed'to improvemen%s i n environmental health. Contaminated water, unsuitable sewage disposal and refuse disposal , non-sterilized or non-pasteurized milk favour the spread of enter ic infections.

Poverty, promiscuity and malnutrikion have an important bearing on the incidence o f diar~hoea. That o f the new-born is due t o infection by bcteria or viruses'and is of great Importance In nurseries.

I For Agenda and list o f documents, see page iv of t h i s Annex

m c 1 4 w 3 Annex 1x1 page ii

Other conditions which cause diarrhoea are pa ras i t i c infestation, food poisoning, nutritional deficiencies,

&om a bacteriological ppin3 o f 'view, agents of ikdbctious diarrhoea may be divided i n to f ive c a t e g o ~ l e s : ' shigellosis , salmonellosis , enteropathogenf c E. Coli, viral infections and doubtful pathogens.

During the survey which was carried out in 1961 in one of the coun-hries v i s i t ed by' the 'WHb '~iarrhdea:l Disease Advlsory Team, interesting data were found: the percentage of positive cultures of children under six yems of age w l t h ac t fve diarrhoea was 23.2% i n rural areas against 16.1% i n urban areas; shigella of a l l types appeared to be the' most frequent organi srn &d accounted f o r 67.8% in rural awleas and 5G$ in urban areas. Sensi t ivi ty tests showed that approximately TO$ of shigella stratds were sulf onamide-resistant,

Giardia (Lambia.) , Entamoeba histolyca and Entamoeba Colt appear to be the most cornon parasitological agents found in diarrhoea1 disease cases, a l though not being necessarily t h e cause of t h e disease.

The most serious complication observed in diarrhoea1 diseases is dehydration, and rehydration therapy is therefore the most important and life-saving measure to be taken, especfally in case of severe dehydration.

Measures to combat and prevent xne uisease should include:,, t h e improvement and extension of MCH services; the development of health educatiorr and health services; the establishment o r development of suitable v i t a l and health statis- tics services; the training of personnel; +he establishment o r improvement of laboratory and research faciltties; the extenston and improvement of nutrition education; %he development of family planning and cbmunity development programmes.

The classification of the various types o f dimrhoeal diseases .~&$ dinoussed and t h e opinion that diarrhoea I s a qmptom of various diseases was confirmed.

It was felt that e~:rironmen$al factors had been tob much emphasized, the transmission being more a,human to human factor.

Safe water, food handling methods in shops, restaurants, etc. , . should be more stressed.

Vital space 1s of prime importance and is in direct relation with family planning,

E f f o r t s Ln health education should be intensified, arid doctors, nurses and health,,workers should give due p r io r l t q to this aspect of therib work,

The impw'ovement of l iving standards. will play an. important r o l e inbthe prevention of diarrhoea1 diseases; It is in direct relation w i t h the socio- economic devekopment which is taking plaae in the countries of *e Ragioi?.

m/RC14= Annex I11 page iii

The consciousness of the population should be awakened as to meir responsSbilities in preventing and combating infantile d i m h o e a l diseases through,better personal hygiene, more appropriate nutritional diet and a better appreciation o f the seriousness of the disease. Mothem should receive special training in t h i s respect. This educational action would particularly f ind its place in MCH centres, the number of which should be increased.

For the resolution an Infantile Diarrhoea, see p a g e 11 0 11 14n the body of this r e p o r t ,

~M/h~143/3 Annex 111 page iv

AC1ENDA

! l E W C A f ; ' DISCUSS IONS - INFANTXU3 DURRHOm

Opening r e m k s b3; +& Regional Direolor

ELeotiOn of Chaimnm stnd Rapporteur

Adoption of t h e . ~ o v i s i o n a l Agenda for Techniual Discussions

Introduction and Definition of Infantile Diarrhoea

The extent of the problem

Epidemiological fac tors influencing the morbidity and mortality

Soclo-economic and environmental sanitary conditions

Etiological studies and bacteriological findings

Dehydration and Rehydration

Measures taken for prevention and oontrol of diarrhoea1 diseases

Recommendations

Ust of Documents

Infantile Diarrhoea In t h e Eastern Mediterranean RegAon, EM/R~14/~ech.~isc./2

Infantile Diarrhoea - Contributions f r o m Various Experts In the Eastern Mediterranean R ~ ~ L ; (In origfnal language of presentation) EM/klb/~e ch, ~i sc , &