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  • Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem

    Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem

    Indonesia recently completed the last of its annual large-scale treatment for lymphatic filariasis (also known as elephantiasis or Penyakit Kaki Gajah) in Malaka District located in its southernmost province, East Nusa Tenggara. Unprecedented
    progress by the National Lymphatic Filariasis Elimination Programme has strongly placed the country on the path to achieving the elimination of lymphatic filariasis as a public health problem.

    “We reached an estimated number of 40.7 million people living in the 118 high-risk districts during this month-long treatment campaign in October 2019” said Dr Anung Sugihantono, who recently retired as Director General of Diseases
    Prevention and Control, Ministry of Health Indonesia. “
    Single doses of diethylcarbamazine citrate and albendazole facilitated by WHO were delivered to all eligible populations.”

    In 2010, an estimated 125 million Indonesians were still at risk of the disease and required treatment.

    But things changed considerably in 2015 when Indonesia mounted an annual national campaign to resolutely address transmission of the disease and to tackle the morbidity and disability associated with it. The results were apparent as early as 2017, with
    remarkable progress.

    In Indonesia, LF is considered a significant public health concern. In 2009, risk mapping identified a population of 124.5 million people needing treatment for LF. The country initiated a national level LF elimination campaign in 2015, addressing both
    disease prevention and management. 

    “In 2017 and in just two years we managed to achieve 100% geographical coverage of all people requiring treatment” said Dr Sugihantono. “It meant achieving more than 78% epidemiological coverage – much higher than the generally recommended 65% to stop transmission.”

    Transmission of lymphatic filariasis can be stopped through large-scale treatment (or mass drug administration – MDA) of entire at- risk communities with recommended medicines once a year. These medicines kill the microfilariae in an infected patient’s
    blood preventing mosquitoes to transmit1 the disease to others. Through mass treatment, the aim is to reduce the reservoir of microfilariae in the blood to a level insufficient to maintain transmission by the mosquito vector.

    This strategy to interrupt transmission is the corner-stone of the World Health Organization’s (WHO) Global Program to Eliminate Lymphatic Filariasis (GPELF). Indonesia has been using the GPELF’s strategy since 2002 using a district or city
    as its implementation unit.

    In 2005, it listed the elimination of LF as a national priority for controlling infectious diseases and the medicines it has been using in large-scale treatment programmes are diethylcarbamazine citrate (DEC) and albendazole2 which are
    largely distributed by volunteer community health workers3.

    “Community health volunteers are themselves members of the community and know how to reach people effectively to improve compliance” said Dr. Stefanus Bria Seran, the Regent of Malaka District, one of LF endemic district in Indonesia. “Besides ensuring every single person ingests the medicine given to them, these community workers help in disseminating information well before a large-scale treatment campaign and also assist in reporting activities related to each treatment campaign”. 

    Indonesia’s efforts to eliminate lymphatic filariasis began in the 1970s but faced numerous challenges including programme coordination in the many inhabited islands, conducting information, education and awareness programmes, lack of capacity and
    insufficient medicines.

    Furthermore, the situation in Indonesia is unusual than in many other countries endemic for lymphatic filariasis as the country is endemic for all three species of thread-like filarial worms – Brugia malayi, Brugia timori, and Wuchereria bancrofti –
    that cause the disease. Most of the infections in Indonesia, however, are caused by B. malayi.

    In the past, some of the factors that prevented access to the medicines (DEC and albendazole) were social stigmatization linked to the disease, the vast geography of the territory and challenges in reaching remote populations.

    With an estimated population of 242 million, Indonesia is the world’s largest island nation and consists of approximately 17,000 islands, of which 5,000–6,000 are inhabited. It is the fourth most populated nation behind China, India, and the United
    States.

    Indonesia is endemic for many other neglected tropical diseases and an estimated 110 million Indonesians are believed to suffer from at least one neglected tropical disease (NTD), including lymphatic filariasis and soil-transmitted helminth infections.
    Leptospirosis (not classified as NTD) is also widespread.

    Indonesia is the only country of WHO’s South East Asia Region with endemic schistosomiasis. Like many other countries of the Region, it also faces recurrent threats of dengue outbreaks.

    Global progress

    The world has made significant progress towards the elimination of lymphatic filariasis as a public health problem.

    Sixteen countries4 and one territory are now acknowledged by WHO to have achieved elimination of lymphatic filariasis as a public health problem.  

    Seven additional countries have successfully implemented recommended strategies, stopped large-scale treatment and are under surveillance to demonstrate that elimination has been achieved.

    The disease

    Lymphatic filariasis is caused by infection with parasitic worms living in the lymphatic system. The larval stages of the parasite (microfilaria) circulate in the blood and are transmitted from person to person by mosquitoes.

    Infection involves asymptomatic, acute, and chronic conditions. Most infections are asymptomatic, showing no external signs while contributing to transmission of the parasite. Although asymptomatic, these infections still cause damage to the lymphatic
    system and the kidneys and alter the body’s immune system.

    When lymphatic filariasis develops into chronic conditions it leads to lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and hydrocele (scrotal swelling). Involvement of breasts and genital organs are common.

    Manifestation of the disease after infection takes time and can result in an altered lymphatic system, causing abnormal enlargement of body parts, and leading to severe disability and social stigmatization of those affected.

     


    1Lymphatic filariasis is transmitted by different types of mosquitoes – e.g the Culex mosquito which widespread across urban and semi-urban areas; Anopheles, mainly found in rural areas; and, Aedes, mainly
    in endemic islands in the Pacific.

    2In 2017, WHO recommended an alternative three drug treatment to accelerate the global elimination of lymphatic filariasis. The treatment, known as IDA, involves a combination of ivermectin, diethylcarbamazine citrate and albendazole.
    It is recommended annually in settings where its use is expected to have the greatest impact.

    3Community health workers, also called ‘cadres’, are volunteers who form part of the communities they serve and work with local
    communities to educate families. Their contribution in promoting health has been significant in the country.

    4Cambodia, The Cook Islands, Egypt, Kiribati, Maldives, Marshall Islands, Niue, Palau, Sri Lanka, Thailand, Togo, Tonga, Vanuatu, Viet Nam, Wallis and Futuna, and Yemen

    Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem
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  • New estimates highlight need to step up the response to hepatitis D

    Lyon, France, 29 April 2020 – In a study published in the Journal of Hepatology, 1 Professor Anna Maria Geretti and Dr Alexander Stockdale from the University of Liverpool (United Kingdom), in collaboration with researchers
    from the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), estimate that worldwide, hepatitis D virus (HDV) affects nearly 5% of people who have a chronic infection with hepatitis B virus (HBV) and that HDV
    co-infection could explain about 1 in 5 cases of liver disease and liver cancer in people with HBV infection..

    To map the epidemiology of HDV infection in the world, Professor Geretti and Dr Stockdale joined forces with the WHO Global Hepatitis Programme and IARC, alongside investigators in Germany, Malawi, and the United Kingdom. “Infection with HDV occurs
    in about 1 in 22 cases of chronic HBV infection in the world,” Dr Stockdale says. “More high-quality data are needed, but we have identified several geographical hotspots of high prevalence of HDV infection: in Mongolia, the Republic of
    Moldova, and countries in Western and Middle Africa.”

    “Although it is less common than hepatitis B, hepatitis D is a serious disease that often affects underprivileged and vulnerable populations,” says Dr Meg Doherty, Director of the WHO Global Hepatitis Programme. Those who are more likely to
    have HBV and HDV co-infection include people who inject drugs and people with hepatitis C virus or HIV infection. The risk of co-infection also appears to be higher in recipients of haemodialysis, men who have sex with men, and commercial sex workers.
    Dr Doherty points out, “This information helps in identifying the groups with HBV among whom we should be looking for HDV.”

    HDV (formerly known as the Delta agent) is a small virus – one of the smallest that is known to cause disease in humans – and can replicate only in the presence of HBV, from which HDV borrows some of its structures. Compared with people with
    HBV infection alone, those who have a chronic infection with both HBV and HDV have a much higher risk of developing disease in the form of cirrhosis and liver cancer. “HDV is a significant contributor to severe liver disease and liver cancer,”
    says IARC scientist Dr Catherine de Martel. “The findings from this study inform our work on the association between viral infections and cancer, which is focused on developing improved prevention strategies.”

    Professor Geretti concludes, “HDV has long been neglected, because for decades the prevalence of infection remained uncertain and effective treatment was lacking. Mapping the epidemiology of the infection is just the first step. More efforts are
    needed to reduce the global burden of chronic hepatitis B and develop medicines that are safe and effective against hepatitis D and are affordable enough to be deployed on a large scale to those who are most in need.”

    1 Stockdale AJ, Kreuels B, Henrion MYR, Giorgi E, Kyomuhangi I, de Martel C, Hutin Y, Geretti AM (2020). The global prevalence of hepatitis D virus infection: systematic review and meta-analysis. J Hepatol. Published online 23 April 2020;
    https://doi.org/10.1016/j.jhep.2020.04.008

    For more information, please contact

    Véronique Terrasse, Communications Group, at +33 (0)6 45 28 49 52 or terrassev@iarc.fr or IARC Communications, at com@iarc.fr

    The International Agency for Research on Cancer (IARC) is part of the World Health Organization. Its mission is to coordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis, and to develop scientific strategies for
    cancer control. The Agency is involved in both epidemiological and laboratory research and disseminates scientific information through publications, meetings, courses, and fellowships. If you wish your name to be removed from our press release emailing
    list, please write to com@iarc.fr. 

    About University of Liverpool

    Founded in 1881 as the original ‘red brick’, the University of Liverpool is one of the UK’s leading research-intensive higher education institutions. Consistently ranked in the top 200 universities worldwide, we are a member of the prestigious
    Russell Group and have a global reach and influence that reflects our academic heritage as one of the country’s largest civic institutions. For more information please visit us at www.liverpool.ac.uk

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  • WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic

    WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic

    On World Day for Safety and Health at Work, the World Health Organization calls upon all governments, employers and workers organizations and the global community to take urgent measures for strengthen countries’ capacities to protect occupational health and safety of health workers and emergency responders respect their rights to decent working conditions, and develop national programmes for occupational health of health workers and to provide them with occupational health services. Amidst the COVID-19 pandemic, ILO has dedicated World Day for Safety and Health at Work 2020 in addressing the outbreak of infectious diseases at work, in particular, on the COVID-19 pandemic.

    Health workers are at the front line of the COVID-19 outbreak response and as such are exposed to hazards that put them at risk of infection. Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence.

    Infections with COVID-19, insufficient measures for infection prevention and control, occupational safety and health, mental health and psychosocial support for health workers result in high rates of absenteeism and deplete the health workforce – the most precision resources for stopping the COVID outbreak. 

    Key Messages and Facts

    COVID-19 infections among health workers:

    • As of 21 April 2020 countries reported to WHO that over 35, 000 health workers were infected with COVID19. This number is significantly higher because of underreporting.
    • The major occupational risks for COVID19 infection among health workers are: late recognition or suspicion of COVID-19 in patients, working in a higher-risk department, longer duty hours, sub-optimal adherence to infection prevention and control measures, such as hand hygiene practices, and lack of or improper use of personal protective equipment (PPE). Other factors have also been documented, such as inadequate or insufficient IPC training for respiratory pathogens, including the COVID-19 virus, as well as long exposure in areas in healthcare facilities where large numbers of COVID-19 patients were being cared for.
    • The prevention of infections requires the use of appropriate infection prevention and control measures by all health workers, with a special focus on the adherence to hand hygiene and personal protective equipment when caring for COVID-19 patients, as well as a combination of environmental and administrative controls
    • Health workers infected with COVID-19 following exposure in the workplace should have the right to employment injury benefits for occupational disease, including compensation, rehabilitation, and curative services.

    Violence and stigma against health workers:

    • Health workers are at high risk of violence all over the world. Between 8% and 38% of health workers suffer physical violence at some point in their careers. Many more are threatened or exposed to verbal aggression and social stigma because of their work.
    • In the COVID19 crisis, shortage of staff and resources and increasing social tensions result in increased level of violence against health workers and even attacks against health care facilities. Doctors, nurses, security personnel and those who are assisting in testing, tracing contacts and enforcing physical distancing measures to stop COVID-19 experience threats and aggression.
    • WHO calls upon governments, employers and workers organizations to institute measures for zero-tolerance to violence against health workers at the workplace and at the way to and from their workplace, and for intensifying social support and respect for health workers and their families.

    Long working hours and psychosocial hazards for health workers:

    • Many health workers have to work longer or irregular hours because of the increasing demand for health services. In addition, many countries experience shortage of health workers, or junior staff are working in demanding new roles.
    • Health workers face psychosocial hazards, which are exacerbated during emergencies where demands increase and they have to experience risk of infection witness higher suffering or mortality.
    • Long working hours, shift work, high workload and other psychosocial hazards can lead to fatigue, occupational burnout, increased psychological distress or declining mental health – affecting the health of health workers, and the quality and safety of care delivered.
    • WHO calls for adequate staffing levels and clinical rotation in healthcare facilities, measures to minimize psychosocial hazards, and provision of access to mental health and psychosocial support for health workers.

    The annual World Day for Safety and Health at Work on 28 April promotes the prevention of occupational accidents and diseases globally. It is an awareness-raising campaign intended to focus international attention on the magnitude of the problem and on how promoting and creating a safety and health culture can help reduce the number of work-related deaths and injuries.

     

    WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic
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  • Commitment and call to action: Global collaboration to accelerate new COVID-19 health technologies

    Commitment and call to action: Global collaboration to accelerate new COVID-19 health technologies

    Our Vision and Mission

    Grounded in a vision of a planet protected from human suffering
    and the devastating social and economic consequences of
    COVID-19, we, an initial group of global health actors (BMGF,
    CEPI, Gavi, Global Fund, UNITAID, Wellcome Trust, WHO) and
    private sector partners and other stakeholders, are launching
    a landmark, global and time-limited collaboration to accelerate the
    development, production and equitable global access to new COVID-19 essential health technologies.

    We know that as long as anyone is at risk from this virus, the entire
    world is at risk – every single person on the planet needs to be
    protected from this disease.

    We agree that alongside evidence-based public health measures,
    innovative COVID-19 diagnostics, therapeutics and vaccines are
    needed – in record time and at record scale and access – to save
    millions of lives and countless trillions of dollars, and to return
    the world to a sense of ‘normalcy’.

    We recognize the significant amount of critical work, investment
    and initiatives already ongoing around the world to expedite
    the development and deployment of innovative COVID-19 related
    products and interventions.

    We appreciate that while development and deployment of
    innovative products is essential, it will not be enough. We must
    simultaneously and urgently accelerate the strengthening of
    sustainable health systems and capacities to enable delivery of
    the new COVID-19 tools to those who need them and to mitigate
    the knock-on impact on other diseases.

    We remember lessons from the past, which have shown that even
    when effective tools are available to the world, too often some
    are protected, while others are not. This inequity is unacceptable –
    all tools to address COVID-19 must be available to all. In the fight
    against COVID-19, no one should be left behind.

    We understand we cannot do this alone, and that we need to
    work together in unprecedented and inclusive partnership with all
    stakeholders – political leaders, public and private sector partners,
    civil society, academia, and all other stakeholders across society
    – jointly leveraging our comparative strengths and respective
    voices to drive towards collective solutions, an accelerated path,
    and access for all. We are stronger, faster and more effective
    working together.

    Our Mission is not only accelerated development and availability
    of new COVID-19 tools – it is to accelerate equitable global access
    to safe, quality, effective, and affordable COVID-19 diagnostics,
    therapeutics and vaccines, and thus to ensure that in the fight
    against COVID-19, no one is left behind.

    Our Commitment

    1. We commit to the shared aim of equitable global
      access to innovative tools for COVID-19 for all.
    2. We commit to an unprecedented level of partnership
      – proactively engaging stakeholders, aligning and
      coordinating efforts, building on existing collaborations, collectively devising solutions, and grounding
      our partnership in transparency, and science.
    3. We commit to create a strong unified voice to
      maximize impact, recognizing this is not about
      singular decision-making authority, but rather
      collective problem-solving, interconnectedness and
      inclusivity, where all stakeholders can connect and
      benefit from the expertise, knowledge and activities
      of this shared action-oriented platform.
    4. We commit to build on past experiences towards
      achieving this objective, including ensuring that
      every activity we undertake is executed through the
      lens of equitable global access, and that the voices
      of the communities most affected are heard.
    5. We commit to be accountable to the world, to
      communities, and to one another. We are coming
      together in the spirit of solidarity, and in the service
      of humanity, to achieve our mission and vision.

    Our Call

    We ask the global community and political leaders to
    support this landmark collaboration, and for donors to
    provide the necessary resources to accelerate achievement
    of the objectives of this global collaboration, capitalizing
    on the opportunity provided by the rolling pledging
    campaign that will start on 4 May 2020.

    Commitment and call to action: Global collaboration to accelerate new COVID-19 health technologies
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  • WHO urges countries to move quickly to save lives from malaria in sub-Saharan Africa

    WHO urges countries to move quickly to save lives from malaria in sub-Saharan Africa

    Severe disruptions to insecticide-treated net campaigns and in access to antimalarial medicines could lead to a doubling in the number of malaria deaths in sub-Saharan Africa this year compared to 2018, according to a new modelling analysis released by
    WHO and partners ahead of World Malaria Day (25 April).

    WHO urges countries to move fast and distribute malaria prevention and treatment tools at this stage of the COVID-19 outbreak in sub-Saharan Africa, and to do their utmost to safely maintain these essential malaria control services.

    The analysis considers nine scenarios for potential disruptions in access to core malaria control tools during the pandemic in 41 countries, and the resulting increases that may be seen in cases and deaths. 

    Under the worst-case scenario, in which all insecticide-treated net (ITN) campaigns are suspended and there is a 75% reduction in access to effective antimalarial medicines, the estimated tally of malaria deaths in sub-Saharan Africa in 2020 would reach
    769 000, twice the number of deaths reported in the region in 2018. This would represent a return to malaria mortality levels last seen 20 years ago.

    According to the World malaria report 2019, sub-Saharan Africa accounted for approximately 93% of all malaria cases and 94% of deaths in 2018. More than two-thirds of deaths were among children under the age of five.

    A window of opportunity

    To date, the number of reported cases of COVID-19 in sub-Saharan Africa has represented only a small proportion of the global total, though cases are increasing every week. This means that countries across the region have a critical window of opportunity
    to minimize disruptions in malaria prevention and treatment and save lives at this stage of the COVID-19 outbreak.

    Mass vector control campaigns should be accelerated, while ensuring that they are deployed in ways that protect health workers and communities against potential COVID-19 transmission. WHO and partners commend the leaders of Benin, the Democratic Republic of the Congo, Sierra Leone and Chad
    for initiating ITN campaigns during the pandemic. Other countries are adapting their net distribution strategies to ensure households receive the nets as quickly and safely as possible.

    Preventive therapies for pregnant women and children must be maintained. The provision of prompt diagnostic testing and effective antimalarial medicines are also essential to prevent a mild case of malaria from progressing to severe illness and death.

    WHO and partners have developed guidance to ensure that those suffering from malaria can safely receive the care they need within the package of essential health services to be delivered in COVID-19 settings. Tailoring malaria interventions in COVID-19 response includes guidance on the prevention of infection through vector control and chemoprevention, testing, treatment of cases, clinical services, supply chain and laboratory activities.

    Note to the editor

    The modelling analysis was conducted by WHO in close collaboration with partners, including PATH, the Malaria Atlas Project and the Bill & Melinda Gates Foundation. 

    The analysis is subject to uncertainties. It does not consider, for example, the effects of an interruption in indoor residual spraying or seasonal malaria chemoprevention (except in Burkina Faso); a suspension of these core malaria prevention tools would
    also lead to considerable loss of life.

    In addition, there is limited understanding of the spread of COVID-19, its epidemiology and interactions with malaria. The model will be updated as such data become available, and countries will be provided with relevant information to tailor their responses
    accordingly.

    WHO urges countries to move quickly to save lives from malaria in sub-Saharan Africa
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  • Hard fought gains in immunization coverage at risk without critical health services, warns WHO

    Hard fought gains in immunization coverage at risk without critical health services, warns WHO

    Shutting down immunization services in the COVID-19 pandemic risks triggering a resurgence of diseases that can be prevented with safe and effective vaccines, warns WHO in the lead-up to World Immunization Week (24-30 April). 

    When immunization services are disrupted, even for brief periods during emergencies, the risk of vaccine-preventable disease outbreaks, such as measles and polio, increase. Last year’s deadly measles outbreak in the Democratic Republic of the
    Congo, which took more than 6000 lives in a country already facing its largest Ebola outbreak, highlights the importance of maintaining essential health services, such as immunization in times of emergency. Further disease outbreaks will also overwhelm
    health systems already battling the impacts of COVID-19.

    “Disease outbreaks must not remain a threat when we have safe and effective vaccines to protect us,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “While the world strives to develop a new vaccine for COVID-19 at record speed,
    we must not risk losing the fight to protect everyone, everywhere against vaccine-preventable diseases. These diseases will come roaring back if we do not vaccinate.”

    WHO is working with partners all over the world to accelerate research and development of a safe and effective vaccine and ensure equitable access for the billions of people who will need it.

    But even with an expedited process, development of a vaccine for COVID-19 will take time. Precautionary measures are essential now to help keep us safe from disease, including diseases for which vaccines already protect children and adults.

    Too many people are still excluded from the benefits of vaccines

    Prior to the COVID-19 pandemic, the world had made immense progress in ensuring that children are vaccinated. In 2018, 86 percent of children under the age of five globally were vaccinated with three doses of diphtheria, tetanus and pertussis (DTP3) and
    one dose of the measles vaccine, up from 72 percent in 2000 and 20 percent in 1980. The number of children paralyzed by polio has been reduced by 99.9 percent worldwide. 

    Yet, global vaccination coverage is still far from the 95 per cent coverage needed to fully protect communities against outbreaks of this vaccine-preventable disease. 

    In 2018 nearly 20 million children worldwide – more than 1 in 10 – missed out on lifesaving vaccines, such as measles, diphtheria and tetanus. Roughly, 13 million of the children have never received any vaccines, putting them and their communities
    at risk of disease and death. The majority of these children live in countries with already fragile health systems, further limiting their access to essential health services when they fall sick.

    Measles continues to remain an ever-present threat, especially if vaccination rates drops. Current projections indicate that the number of reported measles cases for 2019 will be at least 800 000. In 2020 there are increasing concerns about another
    resurgence, especially if vaccination rates fall due to delay or suspension of scheduled immunization activities as a result of COVID-19. 

    Outbreaks of polio, diphtheria and yellow fever are also of high concern, especially in the countries least able to respond quickly and decisively to address an emerging outbreak, as seen in previous emergencies such as the polio outbreak in Syria in
    2013. 

    Maintaining immunization services during COVID-19

    As the response to COVID-19 continues, countries must act now protect immunization services, in order to further minimize disease outbreaks and loss of life. This includes, facilitating urgent catch up programmes in places where
    services have been disrupted, ensuring strong supply chains, disease surveillance and trained health workers. Caregivers should also make sure they continue to vaccinate their children in line with national policies.

    New WHO guidelines on immunization and COVID-19 recommend that governments temporarily pause preventive immunization
    campaigns where there is no active outbreak of a vaccine-preventable disease. But it urges countries prioritize the continuation of routine immunization of children in essential service delivery, as well as adult vaccinations such as influenza
    for groups most at risk. If immunization services must be suspended, urgent catch-up vaccinations should be rescheduled as soon as possible, prioritizing those most at risk.

    Hard fought gains in immunization coverage at risk without critical health services, warns WHO
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  • What matters to women in the postnatal period?

    What matters to women in the postnatal period?

    The right to a positive maternity healthcare experience at every stage 

    Each pregnancy is unique and clinical needs can change across the pregnancy, childbirth and postnatal periods. One thing that never changes is the right to a positive experience at every stage. 

    Achieving the best possible physical, emotional, and psychological outcomes for every individual and newborn requires health systems to take a human rights-based approach: not only preventing maternal death and morbidity, but prioritising person-centred
    care and well-being.

    WHO is developing new guidelines for a positive experience of postnatal care, due to be published next year. To inform these guidelines and ensure that postnatal services can better meet the needs of women and their babies, WHO undertook a qualitative
    systematic review on what matters to women in the postnatal period.

    Joys and challenges in the postnatal period

    There is limited research about values and preferences in the postnatal period, defined by WHO as the first six weeks after childbirth. Studies have often focused on the results of specific postnatal interventions, rather than on the individuals who use
    them. 

    ‘What matters to women in the postnatal period: A meta-synthesis of qualitative studies,’ published in PLOS ONE, gives long-overdue respect to the authority of women’s own experiences. The authors review first-hand data from 15 countries
    and 36 studies published after the year 2000 relating to women’s beliefs, expectations and values at this significant time of life.  

    These studies affirm that a positive postnatal experience can result in joy, self-confidence and enhanced capacity to thrive as both a person and a parent.

    They are also vocal about the potential challenges of adjusting to a ‘new normal’ following childbirth, including changes in self-identity, relationships, and sexual behaviour.

    What is a positive postnatal experience? 

    A positive postnatal experience for a woman will be one that responds to her specific context and preferences. 

    It will provide the confidence, knowledge and skills women need in the weeks following childbirth, supporting them to adjust to any changes in their intimate relationships and build new family ones. Women will be better equipped to navigate physical and
    emotional challenges and to experience the dynamic achievement of personal growth. 

    This should be a shared responsibility, not a solitary one. Community has a critical role in enabling a positive postnatal experience, including partners, family and elders.

    It is crucial that healthcare providers meet each woman’s needs, as well as those of their babies. 

    Supporting choices and rights to improve postnatal health outcomes

    There are an estimated 303 000 maternal deaths annually, according to recent WHO figures. Most of these deaths occur postnatally. 

    The postnatal period is therefore a vital opportunity to improve both maternal and neonatal health and wellbeing: supporting healthy behaviors, providing life-skills education, facilitating breastfeeding, counselling women about family planning options,
    supporting good mental health, preventing and treating childbirth-related complications. 

    Health care systems that empower individuals by supporting their values, preferences and rights are fundamental to improving maternal and newborn health outcomes. 

    WHO’s guidance for positive maternity care

    WHO has recently released recommendations on antenatal care for a positive pregnancy experience, and on intrapartum care for a positive childbirth experience.

    These publications made important clinical updates, including an increase from four to eight recommended antenatal contacts, and a revision to the decision-making process for interventions to accelerate labour. 

    They also uphold every woman’s right to a positive maternity care experience: one where her pregnancy does not erase her competency, autonomy and right to participate in decision-making for her own care and the care of her newborn. 

    Women’s choices and rights to sexual and reproductive health care, including maternity care, should be respected at every stage of the continuum of maternal and newborn care. This is true across all income settings, as well as in humanitarian settings
    and during public health emergencies.

    When WHO’s postnatal guidelines are released next year, they will complete the maternity care series built around what matters to women.

    Rather than dividing care into three periods of antenatal, intrapartum and postnatal, these publications can be used to establish a model in which health systems support women, their baby and wider network physically, psychologically, socially and emotionally
    through this significant life event. 

    Other resources

     

    What matters to women in the postnatal period?
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  • THE RIGHT OF A CHILD TO A KNOWLEDGE OF SEX

    Social conditions of childhood changed.—The social conditions of childhood have changed much in the last fifty years. Just as our children have opportunities and possibilities far greater than had we when we were children; so they are exposed to temptations and dangers greater than were we, when we were children. The suggestive, and oft-times positively obscene pictures on post cards, in books and on billboards; the viciously immoral literature; the cheap moving picture shows of to-day, were not social problems threatening the purity of our childhood.

    Knowledge of self important.—There were ethical, biological and vital truths that our parents, because of mock modesty and a false and inadequate education, failed to give us in our childhood. This was a serious defect in our early education. We met with temptations, were often overcome by them and we are not what we might have been had we been safeguarded by a better knowledge of ourselves. But, because of the better social conditions of our childhood, we were better able to grow up without this information and with less injury to ourselves, than our children can, without this information, under present social conditions. If we would safeguard the character of the children of to-day and the youths of to-morrow and the manhood and the womanhood of the succeeding day we must give our children a correct knowledge of themselves.

    The confidence of childhood.—When children are born, they have a capacity for learning how to stand alone, crawl, walk, love and hate, speak and read, to judge of what is right and wrong. All they may come to know in the future, true or false, good or evil, they must learn. Coming into our homes without knowledge and utterly helpless, they naturally come to recognize their parents as their rightful teachers and to have absolute confidence in them. Ask a child from three to ten years old who he thinks is the best man in the world. The reply will be, “my papa.” Ask him who he thinks is the best woman in the world. The instinctive reply will be, “my mamma.” The answer may be true or false, but we do not question the sincerity of the child. The greatest calamity that can come to that child, comes when he is compelled by convincing evidence to reverse in his judgment this sincereand implicit faith in the goodness of his parents. No greater misfortune than this, can come to the parents. This natural and complete confidence and dependence of the child gives the parents a very decided advantage over all other teachers in the future training of the child.

    Inquisitiveness of childhood.—It is because of this natural confidence that the child goes to the parents with his many questions. The almost ceaseless activity and playfulness of a child, are in response to nature’s call for exercise in the natural and healthful development of every organ of the body. The many questions of a child are in response to nature’s call for exercise in the development of every faculty of the mind. The unfolding, growing, developing mind of a child naturally asks questions. It is for this reason that a child is said to be an animated interrogation point. Some of the questions of a child may perplex a philosopher, tax the patience of a Job, or embarrass a brass monkey; but the naturalness and sincerity of the child demand honesty, frankness and wisdom on the part of parents.

    How did I get into this world?—At the age of three, four and five the child will begin to ask questions as, “Where does the rain come from? Where does the snow come from? Where do the clouds come from?” When kittens, pups, pigs, a calf, a colt are born, the child very naturally asks about their origin. The child is told repeatedly that he is four, five or six years old; that he has had that number of birthdays and has seen that number of Christmases. He remembers only half of them. He listens with interest to his parents as they relate some thrilling event of years gone by. A bright inquiring child will naturally ask, “Mamma, was I in the world at that time?” The mamma replies, “No, darling, that happened six months before you were born.” How very natural it was for the child to ask, “Well, mamma, where was I at that time? How did I get into the world?” An angel could not be more sincere, or ask a purer question. This was no evidence of the child’s depravity. When I find a child of seven or eight years old who has not asked about his origin, I know that one of three conditions will explain this unusual mental state of the child. (1) The parents have not encouraged the child’s mental development by permitting him to be free in asking questions. (2) The child has heard the story of life told by vicious companions, in half truths, clothed in vulgar language and is keeping his information a secret from his parents. (3) The child is not developing quite as fast as I would like for my child to develop.

    The unsatisfied mind.—When the inquiring mind of a child has once become interested in this question, it is not possible for him to be satisfied until a plausible answer has been received. The child’s future, physical, mental and moral life more largely depends upon the answer given to this question, than to any other question of his childhood.

    The most vital part of a child’s education neglected.—In the past, parents, teachers, reformers and ministers have very largely held to the old theory, that, if children are to be kept pure and innocent, they must be kept ignorant of all information pertaining to sex. We have them learn the physiology, anatomy and hygiene of their brain, heart, lungs, digestive and nervous systems as if their very lives depended upon a correct knowledge of these parts; but we have allowed them to grow up in total ignorance concerning the sacred sanctuary and function of human reproduction, upon which so much of health, happiness and success in life depends.

    Mistakes of the past.—In the past all faithful parents have loved their children as much as we have loved our children. They were as much interested in safeguarding the virtue of their children as are the parents of to-day. They endeavored to train their children in harmony with their ideals of right. Our parents, in their childhood, got the idea that all language and information concerning sex was essentially impure. All their information was received from vicious, ignorant sources. In matured life, they came to see that all the words and language they had heard pertaining to sex and all the mental and moral impressions they had received, had done them great harm. Their experience led them unwisely to conclude that all information of this kind is injurious to a child. They failed to see the difference between receiving only half-truths, expressed in vulgar words and phrases, taught by the vicious and ignorant; and in receiving the pure truth, in chaste language from the lips of a wise teacher, a noble father or a pure mother. A nugget of gold may be pure gold, whether found in a mud hole, a slop bucket, a tar bucket, or a clear stream of water. But, if you come in contact with the surroundings of the gold, your remaining clean, becoming cleaner, or becoming soiled, will depend on the place where you find the gold. The effects, good or bad, of sex knowledge, upon a child are largely determined by where and how he gets his information. If he gets this information from a careful and wise teacher no harm can come from it. If he gets the information from the misinformed and the impure, only harm will follow.

    To teach sex truths, two qualifications necessary.—You would not think of having your child taught mathematics by one, who, himself, was never properly taught, or who knew only half-truths about mathematics. You might not demand of him a moral qualification, if he possessed the intellectual equipment. But, in the teaching of sex, a moral qualification is even more necessary than the intellectual. But few adults are prepared to tell the story of life to a child, and fewer still are prepared to give additional instruction as the child grows older. For one to do this work successfully two qualifications are absolutely necessary. (1) Parents and teachers must have a moral qualification. They must regard the organs of sex and their functions as pure and sacred. If they have the taint of lasciviousness in their thoughts of the creative function, it would be a dangerous experiment for them to attempt to teach their children about the origin of life, or to give other instruction to those more advanced in years. The misinformation and false education they received in childhood and the consequent mock modesty, are the greatest difficulties in the way of their performing this sacred duty to their children. For this reason the adult classes are as much in need of correct instruction in sex as are the children. (2) Parents and teachers must have a mental qualification. One-fifth of the names referring to the organs of sex, their functions and their abuse, that adults are forced to use when they try to express their thoughts about sex, could not be found in the dictionary, and, one-half of those that could be found in the dictionary would not refer in their meaning, even remotely, to the sexual system. They picked up these words in childhood from ignorant schoolmates and companions whose minds were tainted with debasing thoughts of sex. The use of these vulgar words, in the presence of a boy who has heard them before, suggests to his mind that which is lascivious. Those who would teach these things, to the young or old, should be able to command a chaste, clean, plain, language.

    How a father failed.—During one of my courses of lectures, a cultured lawyer invited me to his office for an interview. He reproduced, in language and gesture as best he could, a speech he had made to his twelve-year old boy warning him of the dangers of the secret sin. I saw the lawyer was deeply interested in his boy. He loved him and was deeply concerned about his future. The language he used was the same he had learned when a boy and the same his boy had evidently heard on the playground. I question whether the father’s advice did his son much good. Here was a case where good service was neutralized by suggestive language.

    How a teacher failed.—A few months ago I lectured in a city where immorality was appalling. The superintendent of schools called into the chapel about six hundred boys, from ten to eighteen, and attempted to lecture them on social purity. He soon became embarrassed, used some street terms, excited lascivious thoughts, looks, smiles and laughter among the boys and utterly failed in his efforts. If this lawyer and teacher failed with the advantages and solicitude they must have had, would not the great mass of parents, teachers and ministers fail for the same reasons.

    Parents not wholly responsible.—A few editors, doctors and reformers have censured parents severely for not teaching their children the truth on these subjects. They should remember that ten years ago a very few parents had read a sane book or listened to an intelligent lecture on these subjects. Their only information had been gained from the playground and street on the sly. Courses of lectures, adapted to age and sex, should be given in every community. Ministers, teachers, physicians, merchants, parents, young and old, educated and uneducated, all should hear them. A few standard books on sex-hygiene and social purity should be put in every home. Jesus said, “Ye shall know the truth and the truth shall make you free.” More people are in physical, mental and moral slavery because of ignorance concerning the laws of sex, than all other causes combined. It follows that those who have learned the truth should impart it to those who have it not.

    How children have been treated in the past.—We have seen how parents have been led in the past to conclude that all information as to the origin of life is injurious to a child. For a child to inquire, “Where was I before I was born? How did I get into this world?” was a sure sign of his depravity. As a result of these traditionary ideas some parents have slapped a child for asking about his origin. Still, others have scolded and ordered the child from the room, commanding him never to ask such ugly questions again. What must be the feelings of a child treated in such an unappreciative and heartless way! Such treatment has never satisfied the inquiring mind of any child. Under such treatment a child will go off alone, pained and puzzled to know what was wrong in that simple, natural, honest question. In most cases the child’s question has been evaded by some one of a hundred falsehoods about “swamps,” “sinkholes,” “hollow logs and stumps,” “bird nests,” “storks,” “old women,” “doctor’s satchel,” and “under a cabbage head.” When only a small boy, I was called from my bed early one spring morning to see a beautiful colt the mare had found. For awhile I looked at the colt with admiration and wonder. Then I very naturally inquired, “Where did the mare find her colt?” I was told that she found it in a nearby brush pile. For the next six months no brush pile escaped my eager eyes.

    An example.—On my second lecture trip through Canada, a father told me how he answered his little girl’s question, “Papa, how did I get into this world?” His answer was as follows: “Daughter, God dropped you out of heaven one day while it was raining. Papa saw you falling from a cloud and ran out and caught you in his arms and brought you into the house.” That father was boasting of his tact and wisdom.

    Another example.—A mother in the South, in reply to a similar question asked by her five-year-old boy, said: “Son, God sent you into this town on the Cotton Belt train, about three o’clock one afternoon. The doctor was at the depot and saw you. He knew that we wanted a little boy, so he put you in his satchel and brought you to mamma.” When this mother related this to me, her boy was nine years old and had not asked her another word about his origin. At the close of my lecture, with tears in her eyes, she said: “Professor, do you suppose that my little boy has been hearing vulgar stories and is keeping his information a secret from mamma?” “Yes, nine times out of ten, if you have a bright boy,” was my reply. Upon investigation she found that her boy had been hearing vulgar talk for about three years. How long do you suppose it will take that boy to eradicate from his mind and heart the evil effects of such training? It is not a question whether your child and mine shall get this information or not. That question is settled. The child will get the information. The questions for us to settle are: When shall this information be given? Who shall give it? What shall be given? How shall it be given?

    Results of the old method.—I shall not call in question the love, sincerity and honesty of these parents. In most cases they were sincere and did the best they knew how. I am concerned about the results of this time-honored method. Did the old method of deception, misleading and false replies ever satisfy the inquiring mind of a child? Did the old method ever make a child wiser? Did it ever lead a child to regard human reproduction as delicate, sacred and pure? Did it ever lead a child to greater love and faith in its parents? Only negative answers can be given to all these questions.

    How the child finds out.—As a rule, it is not long after a child becomes interested in his origin until some older child, a playmate or servant will say, “I know something that you do not know. You would like to know it. It is how little children come into this world. I will tell you all about it, if you will not tell your mamma and papa about it.” I do not care how good the child may be, how well trained, or how obedient: such is the intense interest of a child in the mystery of his life that he will agree to keep the story a secret. Now the child listens eagerly to the half-truths, couched in impure language and gets a perverted vision of the origin of life.

    What are some of the results?—Five very sad misfortunes have come to the child. (1) The child has learned that his parents evaded his question; in most cases, he discovers the answer to have been a falsehood. (2) To the extent that the child comprehends the falsehood, does he lose confidence in his parents. (3) He has learned to keep these vital matters a secret from his parents. (4) The child cannot think of his parents’ relation to the initial of his life, except in terms of vulgarity. Early images do not easily leave the mind of a child. Ugly words, impure pictures, obscene language, with all their vile suggestiveness, ofttimes remain through life. (5) He regards the organs of sex and their functions as vile and sinful. God never planned that any human being should entertain any such degrading and demoralizing views of the divinely created organs and function of human reproduction. It is impossible to estimate the evil effects of this false training. Yet, there are many people, often very religious, who estimate their modesty, refinement and culture by the degree of conscious shame they have when questions of sex are referred to. Just to the extent that we fail to see that God is the author of sex, that sex is sacred and pure, our glory and not our shame, has a false training degraded us.

    Boys lose confidence in their parents.—You ask, does a child lose confidence in his parents when he has discovered that they have told him a falsehood about his origin? Certainly he does. In the past three years not fewer than seven hundred and fifty young men from eighteen to thirty-five have written me for advice in regard to their youthful indiscretions. One question I have invariably asked those young men, “Did your father ever warn you of your sexual dangers?” Only two have replied in the affirmative. Those young men were once as innocent and pure as your little boy. They first went to their parents for information about these delicate matters. They were treated as I have described. They received their information from sources and in a way that led to sexual abuse.

    Girls lose confidence in mother.—While on a seven thousand-mile lecture trip, in company with twenty other lecturers, conducting purity conventions in many of the large cities in the United States and Canada, after the evening sessions were over, in company with one or two detectives and other parties of our crowd, we visited the “red light” districts and saw several thousand erring girls from twelve to twenty years old. Those girls were once as innocent, pure and sweet as yours or mine. They first went to their mothers and asked about the origin of their lives. Those were golden opportunities for safeguarding the virtue of those girls. More easily than at any other time in life could those girls have been impressed with the sacredness of sex. At no other time in life is it so true that “an ounce of prevention is worth a pound of cure.” Much more of Christian effort is put forth to rescue the fallen than to prevent the youths from falling. More churches are open to lectures on rescue work than on preventive work. More money can be raised for rescue work than can be raised to prevent youths from falling.

    Boys and girls want to know the real truth.—One morning a number of high school boys requested that I give them a lecture more advanced than the one I had given. While passing through the hall, at the close of this special lecture to the young men, I was approached by the lady principal with the request from the high school girls for a special lecture. She told me that fourteen had made the request and that several added: “We wish that Prof. Shannon was a lady lecturer. There are so many things we would like to know, but would hesitate to ask a gentleman lecturer.” Then the lady teacher added, “I said, girls, why do you not ask your mamma for such information?” With hands uplifted, a look of surprise, a gasp for breath, those girls replied: “I would not think of asking mamma such questions.” Why not? Let me tell you why. When they were little innocent girls they went to their mothers with their first questions of sex. They were treated as already indicated. Their inquiring minds and unsatisfied interests in the mysteries of life led them to go elsewhere for this information. It was at this point in their lives that a chasm started to form between themselves and their mothers. There is not one boy in twenty-five who will go voluntarily to his father for information or advice about his sex-nature. The same statement is almost as true about girls and their mothers.

    1,000,000 children adrift.—1,500,000 children are born annually in this Christian nation. One-third of this number die before they are ten years old. Annually one million children inquire, “How did I get into this world?” Not more than one in twenty receive a kind, truthful and intelligent reply. More than nine-tenths are treated in one of the following ways: (1) Told some one of fifty falsehoods. (2) A slap, with orders to clear out. (3) Some form of ridicule, such as “shame on you.” “Don’t let me hear you ask such an ugly question again.” “I am disgusted with you.” That settles it. The golden cords of confidence and influence are severed. Never again will those children go to their parents for information pertaining to sex. Elsewhere, they will find friends who will gladly give them the information. These children, one million strong, are now adrift on the storm-tossed sea of passion, without chart or compass; drifting, drifting, drifting for years toward ports, to them, unknown.
    Danger!

    Danger!

     

    The virtue of a quarter of a million of boys sacrificed.—Time passes. The boys are now sixteen to twenty-five. They have boon and base companions. Their imaginations are at fever heat with morbid interest and their ambitions are aflame with daring. One quarter of a million young men annually sacrifice the priceless gem of manhood’s virtue just here. Now, they are nearing the fearful rapids of vice where most of this number annually become diseased and many perish as sex-maniacs in the awful maelstrom of lust.

    60,000 girls annually.—With the passing of time, the girls from twelve to seventeen, many without the safeguard of knowledge, are associating freely, gayly with their boon male companions, exposed to all the temptations and dangers incident to young womanhood. Many, many thousand young women annually sacrifice the priceless gem of womanhood’s virtue just here. Owing to the double standard of morals, sixty thousand of this number are forced against their own wills into the public maelstroms of immorality.

    Who is to blame.—Thousands of poor prudish parents line the shores, and, with broken, bleeding hearts are crying out in anguish, “My God, my God, why has this awful blow fallen on us?” The poor, ignorant, diseased, exiled, passion-ridden children, in many cases beyond the reach of the home, society and the church, exclaim, “Oh, if I had only been told of these dangers!”

    All along the almost socially inaccessible rock-bound shores of this sea of human passion, the churches and philanthropists are building and maintaining rescue and foundling homes at an outlay of millions in money. They are not, and cannot, rescue one in twenty. The foundling homes are crowded to a dangerous, unsanitary overflowing with illegitimate children, whose mothers are out in the rapids of vice, or entirely lost in the maelstrom of immorality. Too long have the churches been satisfied with snatching, here and there, a piece of human wreckage from the waves of vice, instead of erecting a lighthouse system of properly warning and informing the childhood of the land.

    The new way.—We have seen the results of the old way of dealing with children in matters of sex. Is there a new and better way? We shall see. “Ye shall know the truth and the truth shall make you free.” The new and better way is to tell the truth to the child.

    How shall a child be told.—One day when our little girls were four and six, wife said, “Husband, I am in trouble about our little girls. They are asking where they were before they were born and how they got into this world. How am I to answer them?” “Tell them the truth,” was my reply. “But, they are not old enough to be told the whole truth,” was her reply. We talked over the problem and arrived at the following solution of the problem: Since I had been a teacher of biology for years, and it was presumed that I was familiar with the stories of life among the plants and animals, it was agreed that I should at once tell them a nice little story about God’s beautiful plan of bringing all the little plants into the world. Six months later I was to tell them the story of life about the oysters and fish. Every six months to a year I was to tell them a more advanced story. As they were girls, wife reserved the right to tell them the last story to be told when they were nine and ten.

    These stories were all told in the order given. Our girls are now twelve and fourteen. We have never had an occasion to regret that we have followed this natural method of instructing them. They seem to have no morbid curiosity about questions of sex. They look upon the facts as being natural, sacred and pure. Wife and I can approach them on these subjects without embarrassment to them or us.

    When should a child be told?—The average boy should be told all these stories by the time he is eight, not later than nine. The average girl should be told all these stories by the time she is nine, not later than ten. The developing mind of the average child and the social influences to which he is exposed, demand that he be safeguarded by the whole truth, this early in life. While the girl and boy develop alike until they are ten or eleven, the boy being exposed to vicious companions more than is his sister, he should be told the story of life earlier than she. At the age of seven, boys know more about these things than the girls do at ten and twelve. You had better tell the child the truth at six, than to have him told by the vicious at the age of seven. If a child could understand the story of life at three, and was properly trained afterward, this information could not do him one particle of harm. This statement is either absolutely true, or God is the author of a plan of human increase, the knowledge of which is essentially sinful. Personally, I decline to believe the latter.

    If the child has been informed by vicious playmates or servants and his mind has been tainted, the only sane and safe method is to tell him the full truth as quickly as possible, regardless of his age.

    If the child has been allowed to grow up to the age of nine or ten, ignorant of the story of life, I would tell him all the stories, beginning with the first story, telling them only a few days apart. Where parents are not prepared to do this, I would advise them to place a suitable book, presenting these stories in a clear, chaste and interesting way, in the hands of the child, saying, “Here is a very interesting little book telling you just what you will be interested in knowing and what I would like for you to understand.”

    The ideal way.—The ideal way would be to start with the child when he first inquires about his origin, telling him the first story about the plants. Promise to tell him other stories about the oysters, fish, insects, birds, animals and man as he grows older and can understand them. Where a child is naturally very inquisitive and insists on knowing more, I would not hold him off too long for the next story.

    How to introduce each new story.—I would introduce each new story by reviewing the story of the plants and flowers. There are at least three reasons for this. (1) You can go into all the details of reproduction in the flower without danger of awakening the sex consciousness of the child. (2) It saves going into the detail when you have come to the higher animals and man. The child’s mind usually comprehends more than we give it credit for. If he understands the details of reproduction in the flower, his innocent fancy will fill in the details when he hears the other stories. (3) If he has been so unfortunate as to fall in with bad company at any time and his mind has been tainted with their stories, there is no means you can use in ridding his mind of impurity, quite so effectively, as by telling him the story of life in the flower.

    Teaching these truths in the public schools.—The violation of the laws of sex is the chief cause of physical, mental and moral degeneracy. The degenerate classes are increasing at an appalling rate. Correct sex-instruction in childhood is the most important and effective step in the solution of this problem. There is a growing conviction among the students of sociology that sex-hygiene should be taught in the public schools. There are some teachers in all departments of school work, who, in morals at least, are not fitted for this delicate work. At present, an extremely few have the educational qualification for this delicate work. When teachers are required to take a course of training in these subjects, there will still be but few who are possessed of the natural talent for effectively and wisely presenting these subjects to children of the different grades.

    Already colleges and universities and even a few high schools have begun to teach sex hygiene in a limited scientific way. This work will first be introduced into the high school work and later, gradually be introduced into the lower grades. Definite instruction will not be given, for many years at least, and possibly never, to boys under eight, and girls under ten or eleven. If this statement is true, it will be seen that the schools will have left the first and most important part of this training to be done in the home. The teaching of morals in the public school can never be substituted for the teaching of morals in the home. The present great awakening on these subjects will shortly result in three-fourths of the parents teaching these truths in their homes. Since one-fourth of the children do not get any moral instruction in the home and they do not go to Sunday school or church, the public school is the only place where they can be given moral training for citizenship.

    How this can be done.—In my opinion, the safest and most effective method of dealing with these questions in the public schools, for the present at least, would be for the school boards in two or three counties to select and employ a gentleman and a lady lecturer, having natural gifts, moral and educational qualifications, whose duty it shall be to lecture to all the boys and girls; the male lecturer, lecturing to the boys and the lady lecturer, lecturing to the girls. All other teachers should be required to be sufficiently versed in these matters to enable them to solve any individual problems that may arise in their social relations to the pupils in school.

    Extract from EBook of Self Knowledge and Guide to Sex Instruction, by T. W. Shannon

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  • Blogging for Marketing 101

    The average blog reader views 77% more pages than an average user, and believe it or not, those blog readers are likely to have an average income of $75,000 or more according to Clickz. Well that sounds like a great target audience, but with over 50 million blogs out there, how do you get your blog to stand out of the woodwork and get noticed? We’ve been doing some research of our own in an effort to redesign the new Mequoda Daily 2.0 and here’s some fun stuff that research has shown us…

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  • MIEA warns public to beware of property scams

    MIEA warns public to beware of property scams

    MIEA warns public to beware of property scams 1

    KUALA LUMPUR: The Malaysian Institute of Estate Agents (MIEA) is advising the public to be cautious in buying and selling properties during the Movement Control Order (MCO) period to avoid falling prey to scams.

    MIEA noted that amid the MCO, the majority of Malaysians who are keen to buy or sell property will be relying on online platforms.

    “Be extra vigilant as there are still a high number of cases where the general public has fallen prey to these property pitfalls,” it said yesterday.

    MIEA president Lim Boon Ping highlighted that registered estate agents (REA) and negotiators (REN) are recognised as professionals under Malaysian law and that there are firm requirements that need to be adhered to when publishing an advertisement in order to protect the public’s interest.

    Among others, they are required to include their name, REN/REA number, contact number and the real estate firm they represent with its E registration number and the firm’s telephone number, which the public can verify on www.lppeh.gov.my.

    “There will a sudden surge on online and offline advertisement by those illegal brokers who will take advantage on the Covid-19 rise in low priced property deals and these advertisements will not contain the before-mentioned authenticity information and the public should avoid calling them,“ warned Lim.

    He reminded that if one sees an advertisement or a property deal that looks “too good to be true”, be extra cautious and do your research”.

    “Always engage a registered estate agent or a certified negotiator to verify these potential property deals,“ added Lim. — Bernama

    MIEA warns public to beware of property scams
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