MEE.TING CF THE BEGIONAL ADVISCRY

COM-n'l"m.E ON fila-lEDICAL RESEARCH

Alexandria. 6 - 8 April 1976

EM/ADV.COM.moMED.RSR/5 F.M/RSR/l

ENGLISH ONLY

The Tina upreased 1n tbia Report do not neceaaril.J Ntlect the official policy ot the World Health Oz-ganisat1on.

REPORT

ON THE f�EETING OF THE

REGIONAL ADVISORY comrntTTEE

ON BIOMEDICAL RESEARCH

Alexandria, 6 .. 8 April I 9 7 6

WORLD HEALTH ORGANIZATION

EASTERH MEDITERRANEAN REGION

WHO Er-RO EM/ADV. COM .mo?-E> .RSR/5 EM/1IBR/l page 1

TABLE OF CONl'ENTS

I ItmlOIIJCTION

II EIECTION OF OFFICERS AND ADOPl'ION OP AGENDA

III REVIEW OF THE RESEARCH·RESCXJRCES AND PC7l'ENTIALS IN THE REGION WITH PARTICULAR REFERENCE TO Mml!ODS FCR COMPILING 'mIS INFCEMATIOH

IV HEAL'ni PROBI.Effi AND IIBSEARCH PRICIU'l'IES WITH REIEVAHCE TO THE HEALTH NEEDS IN THE ·F.ASTERN MEDI'mRRANEAN REGION l. Del1vel"7 at health care am health mmpower

denlopment in relation to health problems ot the Region

2. Environmental problems

,. Parasitic and other ooammioable diseases

,.1 Parasitic diseases ,.2 other colllllmicable diseases

4. Nutrition

s. Drugs

6. Other diseases problem of regional intereat 6.1 Stone 1n urinar,- tract 6.2 other problem

V DEVELOPl£NT OF RF.GIONAL RF.SF.ARCH PROORAMJIES l. Parmtion of a natianal biomedical research body' 2. Regional co-operation 1n h1.omdical research

,. International co-operation 1n biomedical reaearoh

-- . Standardization and exchange ot research im'or,mtion

5. Method.a ot raising tlmda tor the support of national and regional research programnea

6. other reconnendations

VI S0191ARY OF RECOMMENDATIONS

ANNEX I ADmESS BY IR A.H. TABA, DIRECTCR, WHO EAST.EllN MEDI'TERRANEAN REGION TO THE WHO REGIONAL ADVISCRY COMMIT'l'EE ON mCJl!EDICAL RESEARCH, ALEXANmIA, 6 TO 8 AIRIL 1976

ANNEX II LIST OF RF.SF.ARCH IWTI'lVl'IONS IN TH\ F.ASTEltN )EDI� REGION

Page

l

2

6

7

7

9

10 10 11 11 11

11 11 11

12 12 1,

1,

13

FJVADV .CCJ,1.mCl€D.RSRJ.5, EMfttSR/1 page 11

TAILE OF CONl.'ENTS (CON1' 1D)

ANNEX III LIST CR COt«I'l"lEE � PAR'l'lCIPA'l"INO

ANNEX IV AGENDA

ANNEX V QUEST.I�AIRE ON mCJEDICAL RESEARCH

ANNEX VI SIXTH GENERAL PROGRAMP£ OF WCJUC COVERIHO A SPECIFIC fERICD (1978-198, I!CWSIVE) �C25A,ffl..l2

ANNEX VII MA'fflIX

ANNEX VIII URGENr PRC>lllX3

ANNEX IX REGIONAL REFERFliCE CElffilES Cfi CANCER

WHO El-RO

WHO EMRO

I INTROIXJCTION

EM/ADV.COM.BIC1'1ED.RSR/5 EM/RSR/1 page 1

The first meeting of the Regional Advisory Connittee on Biolll8dical Research, established by the Director of the Regional ot'fice for the Eastern Mediter­ranean of the World Health Organization was held from 6 - 8 April 1976 in the Conference Room of the Eastern Mediterranean Regional Office, Alexandria, F.gypt. Dr A.H. Taba, Director, WHO Eastern Mediterranean Region,expressed his pleasure1 in welcoming the members of the WHO Regional Advisory Colllld.ttee on Biomedical Research (RACMR), and obserYers. He said that the Colllllittee had been formed as a result of a proposal by the WHO Advisory Colllnittee on Medical Research, supported by resolutions of the World Health Assembly and the Executive Board (WHA27.61 and EB'55.R35) ., for the greater involvement of Regional Offices in research activities in their Regions. The RACMR at present consists of twelve scientists selected, on the basis of merit, from the scientific conmunity in the Region., while maintaining., as far as practi­cable, a Judicious mixture of different disciplines and a balanced geographical distriwtion.

Dr Taba pointed out that the Regional Office had in fact been involved in medical research since the first Group Meeting held in Alexandria in February 1966, by assisting and promoting medical and health research in the Region, as deemed appropriate and feasible.

However., the meeting marked a milestone in that it provided a unique opportunity tor this group to recoa:mend a prograame ot research relevant to the specific needs. ot countries ot this particular Region, With a plan of work which could be followed and implemented for further promotion of health research within the Region, to the benefit of all concemed.

'Ibe first step would be to define the aim and the areas ot the research programme, and then to develop the strategy for these ai� In the light of' the strategy, the appropriate management system would then bave to be designed. The ilffllediate and .edium-term aim should be to promote the type ot research in countries that would be most appropriate tor their needs: the long-term aims would be to develop and co-ordinate th1a with act1Yitiea elsewhere in the Region or outside it.

At the country leTel, the strategy to-be adopted should lead to the illlllediate invobement of countries and governments in 1dentif'1ing their priorities tor research and in developing mechanisms to an.age this research. Signi n.cant gaps in basic knowledge 'Which required attention would become more and mre obvious as countries of the Region became aware ot one another's biomedical research progranmes. An exchange ot knowledge between countries should also indicate areas of research that might help 1n dealing with national health problems. 'lhe more complete such an exchange., the more the objectives and priorities of the research programnes would comply with the economic realities and socio-economic goals of the indiTidual countries.

1see Annex I tor full text

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WHO EMRO

Until Yery recently. the Organization's activities were largely.focussed on the urgent problem or establishing technical principles and polieies in selected biomedical fields and disciplines {e.g. biomedical standards. micro­biology, iammology. cancer, comnunicable diseases, and nutrition) that would be of world-wide service.

'lberefore. change of emphasis in research was needed to preserve the ability of the Organization to meet the problems created by this rapidly developing and changing Eastern Mediterranean Region.

He concluded by stating that the RACMR cruld assist WHO in all above areas. In addition, it could be very useful in identifying sources of extra­bldgetar,- funds within the Region to support research or special regional interest and could promote the organization ot regional technical working groups, panels and meetings, and identif'J those research centres where collabo::at1Ye research on priority problems could be undertaken (Annex II}.

II ELECTION OF OFFICERS AND ADOPrION OF AGENDA

The following officers were elected by the part1c1pants1:

Chairman:

Vice-Chairman:

Rapporteur:

Dr M.M. Mahfouz• Professor of Radiotherapy, Faculty of Medicine, Cairo University, Cairo

Dr K. Zaki Hasan, Professor of Neurology Jinnah Post-graduate Medical Centre. Karachi

Dr C.M.H. Jlbt'idi. Professor of Human Ecology and Deputy Qu.ncellor, University of Teheran. Teheran

'lbe Agenda was approved w1 th some ainendments (Annex I V).

III REVIEW OF nIE RESF.ARCH RESWRCES AND POTENTIALS IN THE REGION WI'IH PARTICULAR REFERENCE TO METHCDS FOR CCMPIL!NO THIS INFORMATION

The World Health Assembly. in ita Resolution WHA27. 61. welcomed •greater involvement ot regional offices in research activities". I t proposed that particular attention be paid tor

1see Annex III for list of participants

WHO EMRO F.M/ADV .COM.BICfilED.RSR/5 EM,!RSR/1 page 3

"(1) increased international co-operation and co-ordination of biomedical research activities and exchange or research information by' WHO throo.gh medical research councils and similar national bodies and other institu­tions. keeping public health authorities intormed as appropriate. and

(2) promtion and initiation or research in developing countries and the strengthening or research and training centres in these c01mtries., particularly with respect to disease problems or importance to the area. such as parasitic infections and other endemic diseases".

For this purpose. a simple definition of biomedical research is "systematic investigations aimed at developing E!! knowledge in biology., medicine. public health and related activities". 'lhis includes the entire research spectnim ranging from fundamental laboratory research to the application of results 1n the field.

'lhe first step towards implementing these goals is the identification of research resources and potentials in the Region. - Such information is of paramount inportance in planning a coherent research prograD1De. Special attention should be ginn to the nature and adainistratin affiliation of research institutions (governmental and otherwise. medical and related non­medical)., availability of adequately trained research workers and aupportiTe personnel., on-going research projects., including graduate research progra1111es. financial resources, laboratory and field fac1lit1e■., scientific equip11ent., libraries, workshops, access to computer facilities. teaching capabilities tor research workers., the role of co-ordinating bodies., publications, poten­tial! ties tor regional co-operation. When a directory containing the above information has been compiled., it will be eaS7 to •1nta1n contact on a continuous basis w1 th research institutions, follow-up their act1T1 ties and output. assist in dissemination of research finding■., and in establishing co-operation between them. PUrther intormtion could. be provided with the assistance of .embers of the RACMR.

In its renew of research rescurces and potential. the RACMR noted that the manpower available for medical research in the foreseeable future will continue to be limited in any c0'Ulltr1es of the Region., becau■e ot the con­siderable 111gration of trained statf that has alread7 taken place. and the unwillingness of the biomedical research scienti■ts serving abroad to return home on the terms and conditions being ottered.

It also recognized that ccmaiderable investigations relnant to health need.a of the countries are being undertaken outside traditional health research institutions. tor example., in 1nst1tutiona dnoted to agriculture, Hterinary science, industry., social sciences., education, public health engineerblg., etc. lherefore an inventory of research resources should include these institutions., lfhereTer applicable.

'!he RACfoR renewed the draft questionnaire which had been prepared for this purpose bJ WHO and test.eel in thirty-two 1nat1tut1ona in the Region.

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WHO EMRO

'lbe Comd.ttee recomiended that everz effort should be mde to collect as complete 1nrorinat1on as possible and from all institutions 1n•olved 1n bio­medical research or related fields.

It was suggested that this cCJUld be done bJ one or all of the following meansz

(a) sending the questionnaire direct to the heads of inst1tut1onsJ

(b) assigning an officer from the Regional Office, or a consultant.,

to visit institutions and complete �e form in �'

(c) asking, whenever available, the ·country WHO Representative, after adequate briefing, to complete the questionnaire with the help of directors of the inst1 tutionsJ

(d) designating a local scientist, well versed in the biomedical research prograaues and institutions in his country, to collect the necessary in­for111at1on.

It was pointed out that members of RACMR should aas1st the Regional Office in the completion of the directory of' 11cient1f'ic institutions of the Region or their own country to the best of their knowledge, 'lbe RACMR f\ally realized th.at this task will Just be the first 11tep in a series of co..ordinated efforts aimed at strengthening research institutions and personnel, identifying those centres and groups which could co-operate .with WHO in carrying out research activities of priority interest to the whole Region, and wilding up regional self-sufficiency progressively."

It was also reconmended that these data, when assembled and analyzed, should be presented to the next meeting of the RACMR Which should then advise on other aspects of this activ1ty1 namely how and When to complete and update the ini'ormation as well as the way the data should be presented.

IV HEALTH PROBIEMS AND RESEARCH PRICJUTIF.S WITH REIEVANCE TO THE HEAL'ffl NEEDS IN 'lHE EASTERN MEDITERRANEAN REGI�

'lbe countries of this Region in recent years have taken considerable steps to improve the delivery of health care to their population. However, this effort at best has been sporadic and it is fair to state that it resembles the �ilding of aiany magnificent solid columns in the middle of a deset of different lengths without having a cover.for them. It Seellll!I also obvious that great emphasis baa been placed on the education of physicians and the creation of sophisticated medical facilities, with the hope that this approach to medical care will filter down to all those in need or health coverage. 'lhe experience in this Region and elsewhere clearly demonstrates that not only is this an expensive process but it is also an ineffective one, because it will only lead to an increase of expenditure on social care. It is, therefore, felt that health planning should be based on the priorities with due consideration to the available resources.

WHO EMRO F'lVADV .COM.BICMED.RSR/5 DI/RSR/1 page 5

The RACMR took note of the priority health progranme objectives approved by the Regional Committee for the Eastern Mediterranean. Twenty-firth se·ssion­Sub-Commi ttee A - EM/RC 25A/R.12, 10 October 1975 (Annex VI) and agreed that these health problems basically evolve from three major factors: demographic dynamics, with their reflection on the stnicture of population, environment which is grossly unprotected, and nutritional insufficiencies. Taking the priority health problems as basic terms of reference. the research priorities may be selected by identifying the critical aspects of some problems which are impediments or resistant to solution. It is evident that in many.cases there is a lack of adequate information to rank and evaluate health problems in order of priority on a scientific basis, as well as a lack of agreed method for development of criteria for selection.of priorities. It 1s ti.me that all concerned in the countries of this Re�on recognize the utility of bio­medical research in general and applied research, 1 .e. epidemiological research in its broader sense, to provide information and strengthen the health inform­tion system for planning and nanagement purposes, and that research should be integrated in the planning system.

The RACMR agreed that a 1118Jor, sustained, long-term effort is needed to establish a solid data base on which to t:uild sound health planning policies and practices. Health Sciences research would haYe to become an integral part of the health care delivery process., continuously feeding a7atemat1o and relevant information to decision-nkers at all levels.

'!be process of establishing priori ties 1s a cybernetic or "teed-back" process between the need and the optiona. 'lh1s imobea four questionsi

(a) What are.the needs? Is it appropriate that something be done about them?

{b) What are the options for allocating resources?

(c) How do we evaluate the options open?

(d) Which option will then be selected?

<:tle of the ways through which priorities could be established would be to study each problem by using the matrix giYen in Annex VII.

In the light or available information about the health status of the people in the .Eastern Mediterranean Region. the fact that biomedical research should be undertaken on those problems which are of an urgent nature and directly related to the health of the people, and the solutions sought and applied requiring WHO's support and participation,would have a direct impact on socio-economic development of the Region., the connittee atte11Pted to define the following areas suitable for research endeavours at regional level.

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WHO Effi.O

1. Delivery of health care and health manpower development in relation to health problem of the Region

"Although it was agreed that the greatest break-through has been in basic research and that special talents have to be looked f'or and supported, first priority has to be given to the application of health-related knowledge".

Research in the me thodology of health care delivery, including training of health manpower, operations research, organization and planning of health services. has to be considered in a holistic maMer. It would be presumptuous to think that medical staff could be trained in isolationJ they should be trained to lead aulti-d1sciplinary teams involving a broad spectrum of health workers, ranging from frontline auxiliaries to highly skilled specialists.

Health services delivery cannot be separated from the development of health manpower: they are closely inter-linked. Much research is needed, in specific country conditions, in areas of task specification, student characteristics, educational environment and instructional methods, evalua­tion techniques of teaching and learning obJectlves and methods. In parti­cular, research into methods of training a large number of auxiliary and frontline health workers quickly should be emphasized..

'lbe RACMR was conscious of the fact that considerable knowledge about coJ!IJllllicable and tropical diseases, rru.tritional disorders, population dynamics and environmental control is available bit that ISUCh knowledge has not made enough impact so far on existing health care systems.

'lbe RACMR felt that available information suggests that classical schemes of health mnpower training have not succeeded 1n improving greatly the health status of the population in this Region. More attention ought to be paid to organizing the development of health resources, including coaunity participa­tion; more research is needed on the validity ot present practices and trends; more advantage should be taken of ex.1s1sting teed-back mechanisms between the health care system and health manpower development schemes. In this context, the development of a health infrastructure and primary health care should be given the most important place they deserve since they will become the best investment in health care delivery systems.

Mobilization of human resources at rural level should perllit a more rational and efficient delivery of services, thereby improving the overall health situation. Field research, epidemiological and operational, should be emphasized as a first priority and tlrus should help in understanding the properties of the existing and proposed delivery systems. 'lbese efforts would have to be closely co-ordinated with those of 110re basic research workers, so as to direct their attention towards specific practical problems in need of solution.

2. Environmental problems

l-bst health problems in the Region arise from poor environmental conditions, leading to the spread of parasitic and other collllllnicable diseases. Simple, innovative, cost-effective methods are needed for the disposal of lmman excreta and refuse.

WHO EMRO EM/ADV. COM.Bia-E>.RSR/5 ffl/RSB/1 page 7

F\Jrthermore. as the pace of 1ndustrial1zation in the countries of this Region accelerates. environmental pollution increases. so that research on levels. indicators and effects of pollution will be needed as well as on preventive means.

3. Parasitic and other conm.micable diseases

3.1 Parasitic diseases

In the age of advanced biomedical science and technology. hundreds of millions of people are still faced with maJor health problems which cause them pain and suffering. '!hose living in tropical and sub-tropical zones suffer not only from the diseases of temperate climates - such as tubercu­losis. measles. gastro•inte■t1nal 1nfections and diseases of the respiratory tract - b.lt also from a whole range of parasitic infections which affects every aspect of human lite. Health and econolllics are interdependent. Without a healthy and well-nourished population. economc b1provement cannot be achieved. On the other hand• some parasitic disea11es of mn (trypano­somiasis and onchocerciasis) cause fertile land to be abandoned and• there• fore. are the direct cause or insufficient protein production. Others (sch1stosom1asis. malaria• arboYii,iaes. filariasia) are increasing 1n extent and severity because of uncontrolled and newly created water surfaces for electric power and agricultural deTelopment.

Although the lack of epidemiological. sociological and econolllio baseline data on parasitic diseases prevents presentation of the exact economic impaot of such diseases. eccording to present knowledge of prnalence. 110rtal1ty. morbidity and incapacitation of productive sections of the population. the magnitude of health and economic loss resulting fro■ parasitic diseases is considerable.

Parasitic infections are spreading and even the impressive prevalence figures given in 1947 by Nor11111n Stoll 1n his classical address "'lhis Wormy World" should now be considered as largely underestimated.

'!be rapid development and ecological cha?lges resulting from population increases and movement, uncontrolled urbanization. agricultural expansion. large-scale water resources deTelopment schemes, all have a direct bearing on the extent, prevalence and severity or �arasitic diseases.

In the industrially advanced countries t.here has been a vast expansion in biomedical research b.lt, because they now are given little importance. the research etforts devoted to parasitic diseases have wtfered both a relative and a real decline. Formerly greatly interested research and educational institutions have shifted their maJor concern to other subjects. Many pharmceutical firms devote their attention to finding products saleable in developed countries. tut are losing interest in the search for therapeutic and prophylactic dnlgs for parasitic diseases and their production.

Because there are too few workers and too few organizations. there is not only a 6hortage of research directl.7 concerned with parasitic diseases problems, but also a serious delay in applying scientific progress in other fields to similar problems in the field of parasitic disease research and subsequent control.

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WHO D1RO

"lbere has been a failure to apply available knowledge to control or reduce transmission. not because the methods are faulty but because in most instances efforts were unco-ord1nated, plam1ng was on a short-term basis. there was a lack of proficient technicians. and financial resources were insecure.

Research progranmes and pilot control projects for parasitic diseases have y1.elded ruch new knowledge relevant to their control. However. many of the control methods developed proved to be beyond the financial and man­power resources of countries when attempts were made to apply them on a nation-wide scale.

Facing this fact from experience. and realizing that its regular budget would be insufficient to remedy the parasitic diseases situation, and that auch research is needed, WHO set up a "Special Progranne for Research and Training in Tropical Diseases" and addressed itself for assistance to national and international sources of finance.as well as to those anxious to alleviate human offering and to develop the econo!Q' of tropical countries through better health.

"lbe proposed objectives aim at developing methods specifically suited to countries affected by tropical diseases, which will (a) cure tropical diseases. and (b) protect the population from infection. with the proviso that as far as possible the methods devised should be capable of implementa­tion at a cost supportable by the poorest country, without requiring special skills or strict supervision• and in a manner that permits them to be inte­grated easil7 1ntb health delivery systems ancl/orthepublic health service.

"lbe training of personnel and strengthening of research institutions are interdependent and related to the above obJecUves.

Co a global basis. the ACMR, the Executive Foard (EB55.R35) and the World Health Assembly (WHA27.52) approved that six diseases: malaria• sch1stosom1asis, filarial infection (including onchocerciasia). trypano­somiasis, le18hmaniasis and leprosy, are the disease problems to be included in the WHO "Special Progranne of Tropical Diseases and Research Training".

All conditions of these six diseases are prevalent in the Region in varying degrees as to their spread, preT&lence and/or aeverit7. '!here are also other contagious and parasitic infections inter-related With eI1Tironmental. social. nutritional and genetic factors. which might play a leading role. A trans-disease epidemiological inTestigation, associated with socio-econollic and nutritional conditions would enable identification of priori ties in the Region.

Meanwhile, the RACMR proposed some research problem related to parasitic and other colllll'Ull1cable diseases of regional relevance which are briefly mentioned hereunder, while urgent problems which need laboratory or field investigations are shown in Annex VIII.

WHO EMRO

J. l.l Schistosomiasis

EM/ADV.COl:.BIOMED.RSR/5 EM/RSR/1 page 9

'Ihis Region was the first to proclaim that sch1stosom1as1s is a major impediment to health and economic development thus presenting an optimal scientific milieu for biomedical research. While some international development agencies still seek economic Justification for control on the basis of the cost-}?enefi t ratio. there is no doubt whatsoever of the need for urgent action within the- Region. Most countries of the Region are affected by the disease. For the special research areas on schistosomiasis see Annex VIII.

J.1.2 Malaria

Malaria 1s currently reappearing in epidemic torm. 'lbe resistance of anopheUnes to insecticides. especially to chlorinated. hydrocarbons. the exophilic habits of certain Teeters. moveaent of population and possible resistance of Plasmodium falciparum to �-amino-quinolines are encountered in some regions.

:,. L:, Onchocerciasis

(See Annex VIII) .

3. 1.4 Leishmaniasis

Visceral or cutaneous leishmaniasis may not be an urgent pressing problem in all countries of the Region• but epidemiological and/or para­sitological factors of species and sub-species differentiation. and host reaction are extremely interesting biomedical problems (See Annex VIII) .

J.1.5 Trypanosom1as1s

. '!here is a need. for epidemiological studies in Ethiopia and Southern Sudan in_�l!I Region and 1n Uganda to (a) identit, Gallbian and Rhodesian species as the aetiological agents or this disease. {b) to clarify the geographical d1str1bltion and (c) to develop suitable policies for control and therapy wbich differ for the Gambian and Rhodesian Trypanosomaais.

,.1.6 Soil transmitted helmnths (ascariasis1 hookwor111 etc.)

(See Annex VIII).

J.2 Other coammicable diseases

3.2.1 rvcot1c infection

M,ycotic infection of the skin and scalp is frequent in th1s Region. Although this condition m:r not have an impact on the general health situa­tion or be of economic importance. it is important because of the psycholo­gical and social aspects tor children.

M;ycotic infectionasuch as 111&duromycosis cause disability and resultant occupancy of hospital beds.

FJVADV .COM.BICMED.RSR/5 ™/RSR/1 page 10

:,.2.2 Leprosy

WHO EMRO

The problem of leprosy is confined to small geographical areas in countries, rut the long duration of the disease, the disability it causes and the human and social consequences render it a cau.ee of concern. Attention should be devoted to new therapeutic substances which might help to control the disease.

3.2.3 Tuberculosis

Tuberculosis cont1:mies to be a problem in several countries of the Region. It is no longer confined to oTercrowded urban areas, bit is found also in rural areas. It is a matter of concern even with adequate preventive measures which can be easily., and safely combined with other protectiTe inoculations. Research should be directed towards finding the most effective and practical case -finding methods tor this Region (see Annex VIII).

3.2.4 Diarrhoeal diseases

Research should be carried out on the simplification of therapeutic mearsures, specifically development of rehydration flu.id., preferably oralJ epidemiological studies and follow-up of aenaitivity of cholera strairus, R!typing of Salmonellae and Escherichia strains, and finally naluat1on of effects of sanitation.

,.2.5 Eye diseasesTrachoaa1 conjuncti"fitia, etc. )

(See Amlex VIII).

4. Nutrition

Although nutrition is primarily related to the overall socio-economic situation in a country, attention zshould be paid to methods of avoiding nutritional imbalances and trying to optimize the dietary intake with existing resources. Other areas of research could include:

Development of recipes for low-cost, nutritia.ts weaning diets baaed on locally anilable foods; studies on prevention and control of nutritional blindness; studies on prevention and control of nutritional anaemia (in­cluding studies on the effects of iron-fortified co111110n aalt)J b1o .availa­bility of drugs under varying nutritional condition.e and other environmental factorsJ blocking agents; goitre; food-associated toxins, with special reference to 1117cotoxins and inter-relations of mi.trition and infection.

Since drugs, vaccines and sera constitute a rnaJor segment of the techoology of health care delivery, research 111 needed on methods of quality control, efficiency and effectiveness, storage and distribution systems., and on the ultimate potency and efficacy of drugs administered.

�eeistance

WHO Em.O

6 . other di seases problems of regional interest

6. 1 Stone in urinary tract

EM/ADV. COM.BI CNED .RSR/5 EM/RSR/1 page 11

Bladder stme is prevalent in a belt covering a large area from 'lbailand through the Eastern Mediterranean Regi on and North Africa. wi th peak pre­valence in boys from 2-5 years of age . '!be epidemiology and pathophyst ology of these manifestations (malnutrition, diarrhoeal dehydration, heat. linked with genetic factors such as G.-6- P.D. deficiency etc.) and their comparison with other parts of the world where such problems do not occur {Scandi navia) is of paramount import ance.

6 . 2 Other problems

Other problems are vi ral hepatitis, cirrhosia and cancer of the liver: bladder;. oesophagus, breast and cervical cancerJ carcinoma of the naso­pharymc and ]Y.mphomas; problems related to mental health, including drug addiction, and finally industrial hazards.

'!be Coum.ttee stressed that the listing given above should not be taken as complete or exhaustive and that research areas should be selected according to the pressing needs of the Region. It was felt1 howner1 that the questi on of deliver:,: of health care and manpower development shou ld be regarded as the most important 1Bsu e. Co nsequently, the coani ttee recownded that a detailed researc h programme be developed bz the WHO Regional Offic e on th1a BUbJ ect, to be discussed by �e committee in its forthcoming ••ting.

V DEVELOPMENT OF REGIOOAL RESF.ARCH PROORAloM'.S

1. Formation of a national bi omedical research body

'!be RACMR endorsed the recommendationa of the Group Meeting on Medical Research, Alexandria, 22 - 26 February 1966, concerning the importance of establishing research machinery 1n each country and considered the existence or such a body (a conmittee or • council) of prime importance for the develop­me nt or biomedical research and the co-ordination of endeavours on a regional basis . '!be RACMR also took note of the successful efforts in some countries of' the Region to establish such research bodi es.

2. Regional co-operation in biomedi cal research

'Ihe development of improv ed control methods for diseases of regional interest and of health technology for health caN delivery, pa rticularly at primarJ care level, am finally the strengthening of bi omedi cal research capabilities in the countries of the Eastern Mediterranean Region, requ ire proper planning and co-operation between the countri es involved in J oint research endeavours, and co-ordi nation for whi ch WHO shall have responsi­bility and take the lead.

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WHO EmO

Depending on the nature and extent of the problem. these progranmes_ could have the followi ng modalities:

( a) bilateral program:nes. in particu lar between neighbouring coun�riesJ

(b) intraregi onal programesJ

(c) interregional progrannes;

(d) development of regional collaborating or reference centres. designated according to specific techni cal criteria (Annex IX).

'I.be RACMR heartily endorsed the WHO activities carried out up to now in the Region for the exchange of scientific workers and visiting professors. distrib.l tion of scientific information and documentation. and the support to the training of research personnel, and reco!IINnded their continuation and expansion. Also the activities for the development of medical libraries and training of medical librarians could be considered as an important con­trib.lt1on to development of the research capabilities of countries of the Region. 'I.be o rganization of seminars and workshops. in parti cular on bio­medi cal research projects of a regional nature. 1n which collaborati ng o r interested scientists from the Region could participate and exchange their views. should similarly be continued wherever and whenever possible.

International co-operation in biomedi cal research

'llle interest C?f some of the important research and educational centres in the western world. who have been contrib.lting to a large extent to research on problems of developing countries. is being slowly reduced and some have already planned a shift in their areas of interest. 'lb1 s ahould be co nsidered very detrimental and every effort should be made to prevent stoppage of these activities for the benefit of the whole world.

Joint arrangements by these institutions with similar institutes in the developing world lllight be one solution.

4. Standardization and exchange of research infor•tion

The exchange of research information and its diatribu.tion to all interested research workers has been one ot the mJor concerns ot WHO and other International agencies involved in science and teclmology, who have thus rendered an important service to the pro110tion and encouragement of research.

Standardization of research information co uld greatly facilitate these activities. and comparability of researc h data. Standardiz ation and co­ordination of regional research prograanes should be one of the min t\l nctions ot WHO. o r of the designated collaborating reference centres.

In addition. the traini ng of librarians and librarJ workers. and the allocation of a suitable portion of the budget o f each research institution to support their libraries. are of paramount importance. F1 nall1 there should be an effective prograaie tor training research workers and other staff in the use of library and reference materials.

WHO EMRO EM/ ADV. CCJI!:. BIOMED. RSR/5 EN/RSR/1 page 13

Methods of rai sing funds for the Sl.lpport of nationa l and regiona l research progranmes

The RACMR expressed hope that WHO would continue to try to attract funds from international agencies, countrie s of the Region and philanthropi c founda­ti ons to support bi omedical research.

Careful prepa�ation of . re search protocols Wi th visible importance would normally encourage positive response from the funding agencies . In addition, the presentation of some of the research projects on prevalent di seases in deve loping countries, as models for research and for elucidation ot various aspects of ce llular biology, enzymology, i11J1Jnology, oncology etc. , may also receive special attention from funding ag�ncies in deve loped countries,

International development agencies should be persuaded of the value of allocating a sui table portion of t\inds on researc h to m:d.adze health and co11111Unity development,

'Ihe RACMR recogni zed the importance of availability of a tree floating fUnd and a seed fund to initiate, promote and support research activities in the countries of thi s Region. In addition, such f'unda would be useful for careers in re search.

'Ihe Committee recomnended that the Regional Di rector study the possibility of establ ishing a special fund at the Regional Office for the support of bio­medical research and of obtaining donations for this purpose from member coun­tries, international agencie s and philanthropic !cnmdationa.

6 , other recommend& ti ons

'Ihe RACMR., expressing 1 ts appreciation to the Regional Director for bi s trust i n its capability, and drawing his attention t o the recoaaendations incorporated in the body of this report, proposed that it should meet again some time in 1976, after the answers to the questionnaire on research re­sources and potentials in the Region have been analyzed.

I t also reconne nded that the Regional Director ehould conside r the preparation of detailed progra.lllDl!la on one or two of the researc h areas proposed in section IV and Annex VIII, and include them in the agenda of a ruture meeting of the RACMR.

It was also agreed that, in addition to the proposed meeting in 1976, the �CMR should meet thereafter regularly on an annual basis.

The Conni ttee appreciated the 1nv1 tation or Dr a. Motamidi for the RACMR to meet in 1977 in Isfahan, Iran.

VI SUMMARY OF RECOMMENDATI(J{S

'Ihe recol!'lllendations of the RACMR are suirmari zed be low in their order of appeare nce in this report:

EM/ADV.COM,BIOMED.RSR/5 EM/RSR/1 page 14

WHO EMRO

l. As comple te information a s possible should be collected. from a ll institu­tions involved in biomedical researc h or related fields.

2 . 'lbe RACMR should advise on presentation. completion and up-dating of' the analyzed data at 1 ts next meeting.

3, A detailed research progranme should be developed. by the WHO Regional Office on the subject of' delivery of health care and IIIBllpower development and prese nted. to the RACMR at its next meeting.

4. 'lhe WHO Regional Director should stud7 the possibilit7 of a spe cial biomedical researc h f'Und, with donations from member countries, international agencies and philanthropic foundations .

5. The WHO Regional Director should consider the preparation o f detai led. progra11111es i n one or two pr1or1t7 research areas tor diacussion by the f!ACMR at a future meeting.

6. The RACMR ahould 111eet aJU1uall7.

WHO EMRO

ANNEX I

ADmF.SS BY DR A .H. TABA

DIRECTOR

EM/ADV.COM.BICNED.RSR/5 EM/RSR/1 Annex I page i

. WHO EAS'IERN MEDITERRANEAN REGION to the

WHO REGIONAL ADVISCRY COfitllTl'EE ON BIOMEDICAL RESF.ARCH

ALEXANDRIA, 6 to 8 APRIL 1976

It gives me great pleasure to welcome you today as members ot the WHO Regional Advisory Coamittee on Biomedic al Research. 'lhi s Comnittee has been formed as a result of a proposal by the WHO Advisory Collln1ttee on Medical Research, supported by resoluti ons of the World Health Assembly and the Executive Board (WHA27.61 and EB'j5.R35), tor the greater involvement of the Regional Offic es in the researc h activities in their regions, of course within the WHO glob&l Bi omedi c al Research progranne. '!be RACMR at present c onsists of twelve scientists, your goodaelvea, selected from the sc ientific c oll'llllll1.ty in the Region, on the basis of merit, while maintaining, as far as practicable, a Judicious mixture of different di sciplines and a balanced geographic al di strihltion.

As you are aware, this Regional Offic e has in tact been involved in medical research sinc e the first Group Meeting held 1n Alexandria in February 1966, by assisting and pro1110t1ng medical and health researc h in the Region, as deemed appropriate and feasible. 'lbis bas been done aainly through {a) assistance to all Schools of Public Health., a:,st medical schools and other health inatitutiorus in the Region: ( b) the Regional Visiting Scientists progranne; (c ) establishment of regional advi sory panels; (d) designation of regional collaborating centresJ and (e) a 11W11ber of studies whic h were undertaken in WHO- assisted proj ects in the Region dealing with subj ects such as epidemiologic al features of certain prevalent diseases., treatment procedures, approaches to disease control, and health care dellverr.

However, today marks a milestone 1n that it provide a unique opportunity for your distinguished group to recoamend a progrume of research relevant to the specific needs of c ountries of thi s particular Region, enabling us to follow and implement a plan of work towards further promotion of health researc h w1 thin the Region,. to the benefit of all conc emed.

'!he first step wi ll be to define the aims of the research programme, and then to develop the strategy for these aim-;- In the light of the strategy, the appropriate management system would then haYe to be designed. As I men• tioned,. the long•term aim should be to develop research in countries that would be most appropriate for their needs; the imecll ate and medium-term aims would be to promote and co-ordinate this development.

FJ',/ADV.COM.BIOMED.RSR/5 EM/RSR/1

WHO EmO

Annex I page 11

At the country level, the strategy to be adopted should lead to the inmediate i nvolvement or countries i n i dentif)ing thei r pri ori ti es tor research and i n developing mechanisms to manage this research. Significant gaps i n basic knowledge whi ch require attention will beoome 1110re and mre obvious as different countries or the Region becoae aware of one another's bi omedical research progrannes. An ex change of knowledge between countries should also indi cate areas of research tha t might help in deali ng with nati onal health problems. '!he more complete auch an exchange., the 110re would the obj ectives and pri oriti es of the research prograanes comply with the economic reali ti es and socio•economic goals of the i ndi vidual countri es.

One can safely say th.at until very recently the Organi zati on's activi ties were largely focussed on the urgent problem of establishing techni cal pri n­ciples and policies i n selected. bi omedi cal fi elds and disciplines (. e. g. bio­medical standard.! , microbi ology, iammology., cancer, conmmicable diseases, and nutri tion} that would be of worldwide sen-ice .

'lberefore., change of emphasis i n research is needed to preserve the abi lity of the Organizati on to meet the problems created b7 a rapidly changing world.

'lbe challenges now faci ng our Region could be br1 e!l7 sumaarized as follows:

- To cover untouched or neglected fi elds of research within the priority progra11111e_ areaa of WHO., 8\l.Ch as the deU ven of health serri ces, educati onal techniques and other aspects or manpower development and training, and certai n aspects of disease preventi on and control {e. g. tropical diseases, mental disorders., environmental health). A careful selection of problems tor attack aust be mde. based on relati ve im­portance and th e extent to 1fhi ch they are likely to be solved.

- To develop potential and exploit existi ng res earch resources { manpower and i nstituti ons) and activities in the Region i nvolving a auch more acti Ye parti cipati on ot Member States.

To tap the reservoir of reeearch i nst! tut1 ona. national sci entifi c research councils, and sci entists i n developed and developi ng countri es alike and to collaborate with them i n the deYelopment of WHO ' s techni cal eotivities. The resou rces available could be amplified many times by exploi ti ng the Organization ' s collaborative mech&n1H m.

- To develop mechanisms tor the rapid and effici ent application to particular local condi tion.s of existing knowledge as well as of new sci entific knowledge as i t emerges. Operati onal research and a ruch more effect! ve exchange of infonnati on on bioJDedical research.

- Adapt approaches and solutions to the political and soci o• economi c situati ons i n different countries.

WHO EMlO EM/ADV .COM.Bl(J,El).RSR/5 F.M/RSR/1 Annex I page 11 1

In addition to the benefits to be derived by the Region from the activities of this Advisory Committee already mentioned. it could also be very useful in identifying sources of extra-budgetary funds W1 thin the Region to support re­search of special regional interest. It can also assist i n the collection of up-to-date information on relevant research institutions. research workers and research programmes in the Regi on41 to be maintained by the Regi onal Office. It can promote the organization of regional technical working groups. panels and meetings, and can identify those reeearch centres where collaborative research on priority problems could be undertaken.

In conclusion, I should like to menti'on the responsibility that all ot us v1.ll henceforth share w1 th regard to the promotion and conduct of medical re­search in this Regi on. 'Ibis respons1 b111 t1 is • heaT)' one, in view of the disproportionate balance between the enormity ot problems arid the scarcity of our resources. I am, however. sure that your d.111cu.aaiona during this meeting and the resulting recomendations will go a long way tovarda ensuring that our regional research progra11111e will give the optimal results.

WHO EmO

ANNEX ll

LIST OF RF.SEARCH I�'ltJTIONS

IN THE EASTElUf MEDITERRANEAN REGION

EM/ADV .COM.BICJ£D.RSR/5 EM,fflSR/1 Ami.ex II

WORLD HEALTH OroANIZATION

REGIONAL OFFICE FOR THE EASTERN MEDITERRANEAN

AFGHANISTAN

The Dean Faculty of Medicine and Phannacy Kabul University �

President Institute ot Public Health �

The Dean Faculty of Medicine University of Nanga.rhar Jalalabad

WORLD HEALTH OmANIZATI0N

REGIONAL OFFICE FOR '!HE F.ASTERN' M&DITERRANEAN

IEM0CRATIC Y™EN

'1'1.e Dean Faculty of Medicine University of Aden Aden

WORLD HEAL'IH ORlANIZATION

REGIONAL OFFICE FOR THE EAS'mRN MEDITERRANF.AN

The Dean Faculty of Medicine Alexandria University Sbatby'. Alexandria

The Dean Faoult7 . ot Medicine Assiut Un1vers1ty­Ass1ut

The Dean Faoul ty- ot Medicine Cairo University Kasr--el-Aini Str. �

The Dean Faculty of Medicine E1n Shams University Abbesia, �

The Dean Faculty of Medicine Azhar University �

The Dean Faculty of Medicine College tor Girls Azhar University Cairo ·-

The Dean Fa.cul ty of Medicine Mansoureh University Mansourah

The Dean Faculty- ot Medicine Tanta University �

1'he Dean Pacul t7 or Medicine Zagazig University Zagazig

IDYPr

The Dea.n Hif#J. Institute or Public Health Alexandria University Ha.dare.• Alexandria

1'he Dean Medical &search Institute Alexandria Universit:r H&d&ra, Alexandria

The Dean Cancer Inst! tute Cairo Universit7 Kasr-el-A1n1 Str. �

'lbe D!an Faoult:r ot Veterina?'T Medicine Cairo Un1vers1t7 fil!:!

The Dean Faculty ot Agriculture Cairo University fil!!

The Dean Faculty or Agriculture Aleundria University Sbatby • Ale:mndria

Director Memorial Institute ot Opb.thalmolog,y Ministry or Public Health Giza

Director Institute or Nutrition Ministry ot Public Health Kasr-el-A1n1 Str. �

Director Diabetes Research Institute M1nist17 ot Public Health Xasr-el-Aini Str. Cairo ./ . .

2.

EGYPT (cont1 d)

Dire ctor Re search Institute or Tropieal Medicine Ministry or Public Heal th Kasr-el-Ain1 S tr. �

Director Research Institute of Medical Entomology Ministry or Public Health Dokk1. �

Director Poliaey-elitis Research Institute Ministry ot Public Health &!babe., ·�

Director Serum and Vaccine Laboratories Ministry or Public Health Agouza, Cairo

Director B ilharzia Control Section Ministry of Public Health Cairo

President National Research Centre Al-Tahrir Str. Dokk i, �

Director B ilharz iasis Research Institute National Research Council Dokki, £!!!:2.

Lake Nasser Developnent Ce ntre P.O .B . 129 Asswan

lB Naval Me dical Research Unit No.:, (NAMRU) Abbe.aia, �

Director Dnig Research and Control Ce ntre Abou Al-Hazam Str. Ouiza

0iairman B iology O!partment Atanic Energy Establishment Enshas

Director Isotope Re gional Centre for Arab

Countries Dokki • .£!!!:2_

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR THE EASn::RN MEDI'l'ERRANF.AN

E'MIOPIA

The n,an Faculty of Medicine

- P.O.B. 117 6 Addia Ababa

Dire ctor Central Laboratorr and Research Institute P.O.B. 1242 Add is Ababa

U3 Naval Medical Piesearch Unit Ho.3 (NAMRU) P.O.B. 1014 Addis Ababa

The Iban Public Health College and Training Centre Gondar

WORLD H&ALTH ORGANIZATION

REGIONAL OFFICE FOR 'l'HE EASTERN MEDITERRAN&AN

The Iean Fa.cul ty of Medicine Jundi Shahpour University Ahwaz

The Iean Faculty of Medicine Isfahan University Isfahan

The Dean Faculty of Medicine University of Ferdowsi Meshed

The Dean Faculty of Medicine Fahlavi University Shiraz

'lhe Dean Faculty of Medicine University of Aza:raba.degan Tabriz

'lhe Iean School of Medicine National University of Iran Teheran

The Iean School of Basic Medical Sciences University of Teheran Teheran

The Iean Pahlavi Medical Centre University of Teheran Teheran

'!be Dean Raz! Medical Centre University or Teheran Teheran

IRAN

'!be Dean Iariu.sh Kabir Medical Centre University of Teheran Teheran

Executive Director Food and Nutrition Institute o f Iran Teheran

'l'he Dean S chool of Public Health University of Teheran Teheran

'!be Iean College of Agriculture P.ezaieh Teheran

Director Pasteur Institute Koutcheh Firouz Teheran

Director TaJ Pahlavi Cancer Institute Teheran

National Iranian 011 Co . Medical Division Teheran

Director Nutrition Section Ministry of Agriculture Teheran

Director Veterinary Medicine Section Ministry of Agriculture Teheran

'!'he Red Lion and Sun Society Medical Division Teheran

./ . .

2 .

IRAN (cont'd)

Director Institute of Reproductive Biology Ministry of Health and Social Welfare

Teheran

Imperial Commission for Studies on Health and Medical Education

Imperial Organization tor Social Services Teheran

'!he tean Faculty of' Dental Medicine Isfahan UniversitT Isfahan

'ftle tean Faculty of' Pharmacy and

Phannaceutieal Services Isfahan University Isfahan

Qtl.et Micotoxin National Centre Isfahan University Ista.han

Olainnan Population Studies Centre Ist'ahan Un1wrs1ty Istahan

Oiairman Environmental Studies Isfahan Un1Ters1t7 Isfahan

01.&ii,nan University Council tor Jlesearch Isfahan Universit7 Isfahan

WORLD HEALTH ORGANIZATION

REGIONAL OWICE FOR THE: EASTERN MEDI'mHRANF.AN

IRAQ.

'lbe :tean College of Medi cine University of Baghdad Baghdad

'l'he I:ean College of Me dicine University of Mosul �

'lbe O!an College of Me dicine Univers ity of Basrah Basrah

Dire cto r Me dical Research Centre Republic Hospital. &F}1dad

Directo r Institute of Endemic Diseases Alwy Baghdad

WORLD HEAL'm OROANJ2ATION

REXJIONAL OWICE FOR THE FAS'mRlf MEDITERRAHEAN'

ISRAEL

'nle �an Hadassah Medical school The Hebrew University P.O.B. 1172 Jerusalem

'l'he Dean Medical School Tel Aviv University P,ama:t A v1 v Tel Aviv

'!he Dean Faculty or Medicine Ben Ouricn University' ot tbt X.giar Beersheba

'lhe Dean 'lhe Aba Khou.shy Faculty ot Medicine Haifa Uniwreity �

Isre.e1 Institute tor Biologioal Research P.O .B. 19 Ness-Ziona

'nle Volcani Institute ot Agricul:tural Research Department ot Animal Baienoes P.O .B. 15 Rohovot

Veterinary Institute Ministry or Agr1cul ture P.O .B. 12 Beit Dagan

WORLD HEAL'llt ORc.ANIZATION

RF.OIONAL OFFICE FOR 'lliE EAS'IERN MEDITERRANEAN

JORMN

'lb.e Dean Faculty of Medicine University of Jordan

WORLD HEALTH O:mANJZA'l'ION

REGIONAL OFFICE FOR THE EAS'.IERN MEDITERRANEAN

Director S abah Hospital Kuwait

'1be Dean Faculty of Medicine University- of Kuwait Kuwait

Qi.airman Department of Zoology University- of Kuwait Kuwait

WORLD HEALTH OIDANIZATION

RroIONA.L OFFICE FOR 'lliE F.AS'lERN MEDITERRA.NFAN

LEBANON

The D!an School of Medicine American University Beirut

The O!an School of Public Health American University Beirut

M . Le Doyen Faeulte Fran,;aise de Medecine et de Phamacie Un1vers1U Saint-Joseph Bemu;th

Director Central Public Heal th IAboratory Ministry- of Public Heal th Beirut

WORLD HEALm ORGANIZATION

REGIONAL OFFICE FOR THE EASTERN MEDITERRANF.AN

LIBYAN ARAB mPUBLIC

. The Dean Facult7 ot Medicine University ot Tripoli Tripoli

The �an Faculty ot Medicine University ot Benghazi Benghazi

WORLD HEALTH OROANlZATION

RF!OIONAL OFFICE FOR THE EASTERN MEDITERRANEAN

The Principal Liaquat Medical College Jamshoro, Hyderabad

The Principal Lahore Medical College Lahore

The Principal

PAKISTAN

Fat.Ina Jinn.ah Medical College for Women Queens Road Lahore

The Principal King Edward Medical College Nila Oumbe.d, Lahore

The Principal Nishtar Medical College Multan

The Principal Rhyber Medical College Peshawar

The Principal Quadi-Azam Medical College Bahawalpur

The Principal Bolen Medical College Quetta

The Principal Sind Medical College Karachi

Chairman Academic Council Dow Medical College Karachi

The Principal Nawabshah Medical College for Girls Karachi

The Principal Lyallpur Medical College Lyallpur

'!be Principal Qlandka Medical College Iarkana

The Principal Medical College Rawalpindi

The D,an Institute o f Hygiene and Preventive

Medicine Lahore

Director

Jinnah Post-graduate Medical r.entre Karachi

Director

National Health Laboratories Islamabad

Director PMRC Tuberculosis Research Unit Mayo Hospital Lahore

Director FMR.C Research 0!11 Khyber Medical College Peshawar

Director IMRC Research r.e11 Fatma Jinnah Medical College Lahore

Director FMRC Research Ce 11 Jinnah Post-graduate Medical Centre Karachi

WORLD HFALm ORaANlZATION

REGIONAL OFFia: FOR 'IEE EAS'JERM MEDITERRANEAN

SAUDI ARABIA

The Dean Faculty ot Medicine University ot Riyad P.O.B. 2925 Riyad

The Dean Faculty or Medicine King Faisal Un1versit7 numnam

1be Dean College ot Medicine and Allied Sciences King Abdulaziz 'O'n1Yers1t1 Jeddah

WORLD H&ALTH ORGANIZATION

REGIONAL OFFICE FOR THE EAS'lERN MEDITERRANEAN

ScmLIA

'Ille Dean Faculty of Medicine Nat ional Univers ity Mogadishu

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR THE EAS'IERN MEDI'l'ERRAHEAN

London Khartoum Bilharzia Project P.O.B. 2371 Kha.rtoum

Director Institute tor Tropical Medicine P.O.B. 1,04 Khartoum

Director Hospital tor Tropical Diseases P.O.B. 1065 Omdurman

Director S eba University Hospital P.O.B. 8081 Amarat. !hartoum

Director National Health laboratory P.O.B. 287 JChartoum

Director Division or Malaria Ministry or Health P.O.B. :,:>:, Khartoum

The Dean Faculty ot Medicine University or Kha.rtoum Khartoum

SUDAN

Director C::mmunicable Eye Diseases and

Filariasi.s Control Division P.O.B. 191 KhartO\D

Direator Ophthalmic P.esearch Department Khartoum Eye Hosp! tal P.O.B. 1012 JChartcum

WORLD HEAL'IH ORGANIZATION

REOlONAL OFFICE Ft>R 'mE EASTERN MEDITERRANEAN

SYRIAN ARAB REPUBLIC

'llle Iean Faculty of Medicine University of Iama.scus Dama.sous

The Iean Faculty of Medicine University or Aleppo Aleppo

The Iean Faculty of Medicine I.attakia University lattakia

WOHLD HF.At.fl ORGANIZATION

REXITONAL OFFICS POR 'mE EAS'mRN MEDITERRA.NF.AN

TUNISIA

M. Le Doyen Facul U de M,deoine. Uni vera 1 ti de Tunis �

Mme IA Doyenne FaoultfS de M�cine t1n1vers1U de Sousse Sousse

M. Le Doyen J'acult& de M,deaine tJniverait& de Sfax. !!.!!!.

M • Le D:trecteur Inatitut Pasteur Tmtis

M. L9 Directeur Institut Salah Azaiez '!\mis

M. Ie Directeur Institut National de la Sant& de l 1Enfance �

M. Le Directeur Institut de Nutrition �

M. Le Dire cteur Centre d1 ophtalmolog1.e !!:!l!!. .

WHO EMRO

ANNEX III

EM/ADV. COM. BICMED. RSR/5 EM/RSR/1 Annex III page i

LIST OF COMfiTTEE MEMBERS PARTICIPATI NG

Dr Farhan Bakir Professor of Medicine Faculty of Medi cine Baghdad

Dr Amor Chadli Director Pasteur I nstitute �

Dr El Sayed Daoud Director General of the

National Public Health Laboratory Services

Ministry of Health Kha rtoum

Dr M.E.D.A. El Kharadly Dean Institute of Medical Researc h Alexandria

Dr M.H. Ghanein Professor of Internal Medi cine Faculty of Medicine Alexandria University Alexandria

Dr K. Zaki Hasan Professor of Neurology Jinnah Post-graduate Medical Centre Department of Neuropsychiatry Karachi

Dr M.M. Mahfouz Professor of Radiotherapy Faculty of Medi cine Cairo University Cairo

Dr Chamsedd1 ne Mofid1 Deputy Chancellor Teheran University Teheran

Fl1/AIN.COM.BICJ,1ED.RSR/5 EM/RSR/1 Annex III page 11

Dr A .H. Taba

Dr M.O. Shoib

Dr N. Ansari

Dr P.B.G. Mansourian

Miss c. Cartoudis

Mrs E. Rizgallah

Dr G. Motamedi Chancellor Isfahan University Isfahan

Dr N. Mourali Director Salah Azaiz Institute Tunis

Dr Mohsen Ziai Dean College of Health Sciences Rez a Pahlavi Medical Centre Teheran

OBSERVER TO THE MEETING

Professor Ahmed El Halawani

WHO EMRO

Former Director of the Institute of Tropical Medicine. Ceiro. Egypt and Former Director of the Medical Research Centre. Baghdad. Iraq

Alexandria

WHO SECRETARIAT

Director

Director Health Services Secretary of the Meeting

Temporary Adviser

Medical Officer

Conference Officer

Secretary

Regional Office for the Eastern Mediterranean Region

Regional Office for the Eastern Mediterranean Region

Former Chief. Parasitic Diseases, WHO Headquarters

Office of Research Promotion and Development, WHO Headquarters

Regional Office for the Eastern Mediterranean Region

Regional Office for the Eastern Mediterranean Region

WHO EMRO

ANNEX IV

AGENDA

FJli/ADV .COM.BIOMED.RSR/5 El-VRSR/1 Annex IV

l. Review cf the research resources and potentials in the Region with particular reference to methods for compiling this 1nform t1on.

2. Health probl ems and research priori ties with relevance to the health needs in the Eastern Medi terranean Region.

2. 1 Research on Delivery of Health Care.

2.2 Research on Health Manpower Development and Medical F.ducaU on.

2., Research on tropical and paras1Uc diseases with particular reference to the Eastern Mediterranean Region.

:,. Development of Regional Research Programmes.

,.1 Regional co•operation in biomedical research.

:,. 2 International co•operat1 on in biomedical research.

:,.:, Standardization and exchange of research intormauon.

:,.4 Formation of national biomedi cal research councils.

:,.5 Methods of raising fUnds for support or nationa l and regiona l research progrannes.

4. Other Ntters,

WHO EMRO

ANNEX V

QUESTIONNAIRE

ON

mOMEDICAL RESF.ARCH

™/ADV.COM.mCt-1ED.P.SR/5 F.M.fflSR/1 Annex V

WORID HF.AL'lH ORGANIZATION REGIONAL OFFICE FOR 'lHE EAS'l'fEf MEDITERRANEAN

QUESTIONNAJm: ON filOMEDICAL RESEARCH (lNSTRUCTIONS FOR COM.PIBTION)

PIEASE READ CARERILLY THE FOI..UMING INSTRUCTIONS BEFORE CCMPLETINO 'lHE FORM. REFEREl-H::E IS GIVEN' 'ro 'llIE ITEM NUMEE:R al '!HE QUESTiamAIRE• SELF•EXPLANA'l'ORY l'l'EMS m:ma EXCUJDED. IF NECESSARY, ADDmoNAL INFORMATial MAY BE GIVm ON A SEPARATE SHEET• DIDICATING 'lHE 1TFl1 NUMBER(S) •

l.

2.

4.

a.

Kind of Institution: indicate the kind of institution and give the nMte as appropriate. e.g.,

University of Alexandria, Egypt g;J University(• • • • • • • • • • • • • • • • • • • • •• • • • • • • • • • >

Whatever be the kind or institution , · indicate its affiliation. viz •• governmental, semi-governmental (e.g., public sector� or autonomous foundation with govetnment supervision) or private. To help us to have as complete a 11st of research institutions as possible,please give the names of other institutions possi� engaged in biomedical research, belonging to . the same university/research council/foundation. (If not already contacted, a similar questionnaire will be sent to them. ) Total f'Ul.l.-time staff according to level and education backgrowld. Beside, "Doctorate or equivalent" ;:rou IIlay' include M.D. degree. if it is preoeded by another university degree. 'lhus. if the medical degree is the f'irst university degree (e.g., M.B • • B.ai. or equivalent) and there are no higher qualifications it should not be entered here, but in front of "University degree only-" . Last line deals w1 th part-time professional staf'f only, who are likely to be taken into account elsewhere. Expatriate (foreign) scientists on the staff. whether tull•time or part-time. Fl.ldgets state the currency and the year to which the data refer. If part of the budget comes from other national, bilateral, United Nations Agencies or other sources, please give below the name of the donor (e.g. , NIH-USA) ; agreement title, (e.g • • 'lB control feasibility study) ; and, 1dentif'ication number (e.g. , ™/SUD/mS/002) • Give, if possible. total actual expenditure for 1975, or latest year. (indicating the currency) and estimated proportion thereof spent on research. Cleek for all the facilities available. (e.g • • University Computation Centre. Central Public Health Engineering Laboratory-• etc • ) Write in f'Ull important tields ot research carried out at ;:rour institution. e.g •• Gazette Faculty of Medicine. It is important to include all research carried out at the inst1 tution, whether by its own staff members or others, rather than research by staff members of the institution carried out elsewhere. Evaluation of nursing progr8lmlle• sutmitted. to Health Ministr,Y Number of post-graduate students for each degree level (e.g • • Doctorate. Master) . By a check mark indicate the number of visiting research scientists you are "Nilling to accept at your institution. (Not implying an;y f'inancial commitment) . (e.g • • serves as WHO Reference Centre, distinguished awards to the institution or the staff'.)

WORID HFALTH ORGA11IZATION REGIONAL OFFICE FOR THE FASTERN MEDITERRANEAN

QUESTIONNAIRE ON BIOMEDICAL RESEARCH

Name of institution: ··--··-··-······•·•·-------····--·····---···--.. -···-···········-· ..................... _ ............ ........ _ ............... . Address: ._ ..... _ ............. ________________ _ Telephone:

Ci ty: ··--·-····-------- -----···· Country: ····--- ----·----···-·-··· ......... .. .

Year established: -----· Name of director: ....... --···-.. -···················••·••·· ··· .. ······---·········-· .. ····· .. ···•· .... -......

(A) SET-UP

1 . Kind o f institution (please give the name ) : 0 University .. ........................... _ .................... _ ......... -.................. _ ............................................................. -................ .................. . 0 Research counci l or academy .......... ......................... _ ............................. ·-·-····· ........ ................................................ .. _ ..

□

D

Foundation ........ _ ............................................................................................................................................ ·--··· .. ·······-· ................. .

Government department ··-··--····-··· .. ··•· .... -.. -.......... _ ... _ ......................................... -...................................... .......... .

□

D

Indus try .......... _ ............... ·--·--··· .. ····-.................. . ·-·-·-· .. ····· .. ··· .. ······-·--··-·· .. ----· .. ·-··· .. ··--··---·-··· ............. .

Other (please speci fy) ....... ••·········-··· .. ····-········

2 . Affiliation : 0 Governmental 0 Semi-governmental 0 Private

3. Activities in addition to research: O None. i . e • • only research

0 Teaching D Production D Public service D Other (please specify): ....... -............................. _ ...... ·-----·····-·-········---····•······-·········-···-···-···· ... • ..... .

4 . Names of other institutions possibly engaged i n biomedical research and belonging to the same university/research council/foundation:

(B) MANPCMER RESOURCES

5 . Number of full-time staff: - Professional (scientific ) staff: Doctorate or equivalent

Other post-graduate studies

University degree only

Other categories

Total professionals - Technicians

- Other staff

Total full-time staff

Number of part-time professional {scienti fic ) staff

6. Number of foreign scienti sts on the staff

- 2 -

(C) FINANCIAL RESOURCES

7. Budget: annual oodget f'or the year --- expressed in (currency) __ _ Distribution: Salaries

Sources :

Equipnent and supplies Other costs ·

Total budget Regular budget Other national sources* Bilateral assistance* UN agencies* Other sources*

Total budget

* Where applicable. please give the name of the donor, agreement t1 tle and identification number:

---------------------------·--·· ... ····· ---

8 . Actual total expenditure in 1975 (indicating currency), ---·-----­If possible, estimate proportion thereof spent on research:

(D) PHYSICAL RESOURCES

Facilities available : 0 Hospital beds 0 Iaboratories (total surface area ···------ rf-/yd2/ft2 )

0 Field training area O Animal house D Computer facilities 0 Electron microscope 0 Library facill ties (no.of books ___ _ periodicals 0 Other (specify) :

10. Names of related institutions whose facilities are freely accessible to the reporting inst! tution: ··----·-· .. -.......... __________________ _

- 3 -

(F.) HESEAFCH ACTIVITIFB

11 . Organization : Please give names of departments/uni ts in this insti tutl on: • ••• • • .. , , o • • • • • • • • • • • • • • •• • • • • .. •• • •••••••••••• •••••••••••• ••••• ........ .. n,•uH,u .. ,ou .. .-u .. 00 00< ••• •••••••••••••• •.o•••• ••• •••• ••••••H•••• ·••••••H • • , , , ,.

-••• • • •• •••• •••••••HH•HH••••••••••••••••• .. • .. •• .. ••uo,oH•H••••••••••••n••••••••H• •••H•n•••••H••••••••• .... • .. ••• .. ••• .. •• ...... ,o.,,,,,, .. u••u• .... •••••u••••••• .. • .. •••••••o .................. ..... . , , . ,,, , ,

12 . Main fields of research being caITied out at the institution ; • • • •••••••• ••••••••• .. •• • .. ••• .... ••••• .. ••••••••••••• • • • • • • • • ••••••••••••••••• •••t••••••• • • • • • •••••1••••••••tOtOt,t•ol♦•,.,,. ,,,,,.,..,.,,,, .. ,,.,.,.,,,,,,hH40n0oooooo.ououo •••••••••" •••••••••♦•n••• •••••••

13 . Names of publication media issued by the institution:

- Journals or periodicals:

- Monographs or books : ·---·-····---····-----·-······························· .... -..................................... .

14 . On a separate sheet1 please list articles published since January 1975 on research carri ed out at the institution.

15 . Also list special scienti fic reports submi tted to other authorities .

16. Post-graduate students :

Degree level No. of students % of time for research

17 . Research facilities for visiting research scientists (please give number of visiting research scientists who can be engaged) :

0 One to three 0 Four to ten O More than ten

18 . Areas of research offered for visiting research scientists : •••H-H•••••• • · • · oO•••••• ••··d• .. ••H• ............. H ........ HH••••··••·•·•·•••••••••••••••••H•••HHO·•••H•••• .. ••••••HH••••••••••••• .. •••• .. ••••hO• .. ••• .. • .................. U, ......... .............. , ................ .

19. Other relevant information: ······················ .. ··················-•·········•···•·· .. ·•···· .. ·•····················--·····················-··-··········-·········

Signature: ·······················•··•-· .. ·······•·····-·········-···-······················· Date: .............................. : ............................ .

WHO EmO

ANNEX VI

EM/ADV.COM.BICMED.RSR/5 EM/RSR/1 Annex VI

SIXTH GENERAL PROGRAMME OF WCIUC COVERING A. SPECIFIC PElUOD (1978-198:, INCWSIVE)

EM/RC25A/R.12

"'Ihe Sub-Commi ttee.

Havi ng revi ewed the document presented by the Regional Director on the Sixth General Progralllll8 of work covering a specifi c period (1978-1983)1 and Resolutions EM/RC20A,/R.:,2 and EM/RC24A/R.6' on the Fifth General Programme of Work 1973-1977;

Recognizi ng the need to establish pri ori ties for the heal th programmes of countries of the Regi on for a meaningtul tormlati on of the Sixth General Program,e or Work;

Realizi ng that rapidly changing s ocial and economic condi tions and the variet1 of degrees of development and priorities in different countries or the Regi on necessi tate a degree of flexibi lity in preparing and implementi ng a regional programme of workJ

1. RBWESTS the Regi onal Director to continue to keep the question of conformi ty of the WHO Programae of Work w1 th needs of countri es under constant review;

2 • . ANTICIPATES that the subject Wi ll be discussed further by the Executive Board and the World Health AssemblJ and that countries of the Region will be duly informed ;

:,. ENDORSES the pri ori ty given to specific objectives as indi cated by the Regi onal Director i n the document presented and as amended by the Sub-Committee".

1nocument EM/RC25/7 2&JEMRO Handbook of Resoluti ons, Section 1.2. page :, Rev. l and page 4

WHO EfoRO �ADV.COM.BICJi1ED.RSR/5 EM,/Rm\/1 Annex VII

ANNEX VII

MA'fflIX

Em. Technical Health Problem approaches

Population{l-) Envirorunenta1 <2) Nutritional (::,) aspect aspect aspect

Laboratdry research

Clinical research

Epidemiological research

Social science research (4)

Operational {health services) research

1 ) Population aspect includess birth rate, population age and sex structure. mortality pattern, population denait7. etc .

2) Environmental aspect: physical, biological, technological and social and economic environment.

,> Nutritional aspect: national, coam.mit7, �am:117, individual.

4 ) Social sciences: anthropology, sociology. behartoural ■cience, econollics, political science.

'!he research ettorts should be concentrated on "blank squares• ot the matrix. In this corme.xion, it was understood that certain solutions should be sought also through inter-sectoral research.

WHO EMRO EM/ADV. CCM.BICMD.RSR/5 EM/RSR/1 Annex VIII page 1

ANNEX VIII

URGENT PROBU:MS *

3.1.1 Seh1stosom1as1s

(a) Iamun1tz, 1mm.mology1 inm.mopathology

- Two clinical conditions with an immopathogenetic background are pot 1nrrequentl7 encountered in Egypt: schistosomal polyposis ot the colon and a nephrotic B)'J'ldrome associated w1 th Sohistosoma haematobium •

. 'lbere is a need for a detailed clinical and 1aamolog1o investigation ot each of these conditions to clarity the pathogenesis and to charac­terize the response to treatment.

- 'lbere is a need for epidemiological l'Ur'Yeys throughout the Region to establish whether these conditions are peculiar to Fapt or whether they occur in all or only some areas in the Region.

- Whether "1111U111ty" to repeated infections occurs in mn 111 unclear . '!be Sudan,. particularly the Gezira,. otters an uceptional location tor the study of this phenomenon. '!be canal cleaners or the area should be 1tud1ed (clinical,. egg outputs,. etc) 1n mch more detail than hitherto to assess 'Nhether "iaami ty" mats and,. it ao,. what are its features.

(b) EpidemioloQ and Control

- '!be prevalence,. incidence and intensity of infection with s.mnaoni and s.haematob1u11 ahould be studied in those areas or the Sudan where S .bona infection ia endemic llJld the findings contrasted with those t'ro■ areas where s.bov1s ts non--endemic yet S.mnaont and S.haema­tobi.1111 exist. 'lbia may lead to hypotheses on the presence or absence of "heterologous inunity".

- ibe control scheme in the Gezira could be utilized tor t"urther investi­gations or the phytotoxicity or molluscicides.

- Where oasis transmission exists and is discrete and focal,. there may be a case tor f'urther exploration or the ertect of' Heliosoma dur,:11 on the intermediate snail hosts of schistosomlasia.

- Additional studies are needed for development of tests to measure morbidity in the indiTidual and in the coammity. It has been shown that the m.tmber of eggs,. although indicative ot the severity ot in­fection,. is not indicative ot the severity ot the c:Usease •

• To be read in conjunction with the relevant paragraphs in Part IV, pp. 9 - 10

EM/ADV.COM.BIOMED.RSR/5 EM/RSR/1 Annex VIII page 11

(c) Chemotherapy:

WHO EMRO

- There is a need for standardization of clinical and technical protocols in chemotherapeutic evaluation of sch1stosom1cides and other anti­parasitic compounds, co-operation between countries within the Region and the formation of a local centre for this type of activity would be of most use in this field. Co-operation could be widened by Joint investigations associated w1 th the WHO Special Programme. In addition to those existing, two new candidate compounds (Bayer Embay 8440 and Ciba-Geigy 4540) are ready for strictly controlled clinical trials.

3 .1 .2 Malaria

The lack of long-acting blood and tissue schizontocide and drugs are the major technical problems to be resolved by research. Recent attempts to develop a malaria vaccine appear to give promising results. Experimental work has shown that protection can be given against both sporozoites and merozoites.

The success in this area requires the establishment of t1s8\le culture of the parasite . A pre-requisite research for use of live vaccine is to

study the kidney involvement in Plasmodium malariae such as glomerulonephrosis, before any vaccination can be attempted on man. Finally extensive research should be conducted to develop new anti -malaria drugs. For the time being, the compounds, melfoquine, 4-amino-quinoline.methanol and abechine, are available for clinical trials.

3 . 1 .3 Onchocerciasis

Recent research efforts and comparative studies of different endemic foci have concentrated on the vector-agent complex, which are to be continued. Little work has been carried out on the host factor to determine the difference between localized (Yemen) and generalized onchocerciasis (Savannah African Zone ).

3.1 .4 Leishmaniasis

Apart from the parasitic species. the variable factor determining this picture includes the virulence of the parasitic sub-species and strain and the response of the host. For example, in cutaneous leishmaniasis the skin disease takes the form of a widespread, non-ulcerating nodule, or diffuse form of cutaneous leishman1as1s. or persistent form of non-healing ulcer 1n the relapse form.

- --

There is a need to characterize the leishman1a species and strains corresponding to various aspects of clinical manifestations. Recent advances in electrophoretic properties of isoeru:ymes and the determination of the buoyant density of Parasitic K1netoplast WA, should be investigated parallel with the clinical studies (studied enzymes are malate d�ogenase. alanine amino­transferase, aspertate aminotransferase, and 1socitrate dehydrogenase } .

WHO EMRO FJVADV. Ca-!. filCJilED. R.SR/5 EM,fflSR/1 Annex VIII page 111

Clinical aspects of epidemic cutaneous leishmani asis due to the Leishma.nia tropica maj o r ( rodent as original host, man as secondary host) , the 1nrunol og1c respons e of the host and i ts different allergic manifestations due to the failure or the establishment of a Cell Mediated Inmmity (CMI) mould be investi gated (Afghani stan, Iran, I raq, Syria, desert area with oasis) .

In view of the doubt concerni ng the vector and host of Kala-azar in Iraq and the Sudan, these could be the subject of tuture research.

Leishmaniasis, vi sceral or cutaneous, might not be an urgent pressing health problem, b.tt "there i s a valid analogy be tween the response of the host to leishmama infected cells and to transplll'ltated or autochthonous twncur cells, the spread of infection from macrophage , to moropbage oorresponding to looal growth ot a tumour and. •rtaoeralbation" ot the inteo tian oorreaponding to metas'bls1• -ot the tua:iar" •

,.1. 6 Soil-transmitted hel.mnths(ascar1 asia1 hookworm etc. )

'lbese are subjects of prime i mportance tor infant mttr1t1on and child growth, tor example through a deficiency i n intake of am.no-acid.

It appears that ep1dem1ologr of ascariasis 1s well-known. However, detai led m1cro-ep1dell1olog1 cal i nnstigation 1s required for an i ntelligent enTironmental control. As far aa chemotherap7 1s concemed a field trial on coa t effi cacy of the giTen drug i n relation to seasonal or perennial tranam1ss1on i s requi red.

'lbe development ot an eftect1 ve Yaccine in add.1 tion to the armamen:tar1W'II ot drugs available agaJ.nst hookworm, and sanitary measure■ parallel with the produoti on of a Taccine (as was done in animals). should be encouraged.

Inter-relation of intestinal paras1 tes and malabsorpt1on of nutrients is a primary concern for a general nutri ti onal study.

,.2.2 Leprosy

Researc h should be conducted on elucidation of innme mechani smsJ development of immoprophJlactic methods• including naluati on of the efficacy of ECG; study or inamolog1c, chemotherapeuti c and prophylactic inter-re lati onship between leprosy and tuberculosis; development of long­acting drugs and ahort--cluration regimensJ development of simple tests for diagnosis and for detection ot persona at high riskJ chemoprophylUis and · finall7 rehabilitation of leprous patients.

,.2., Tuberculosis

Other topics suggested tor further research are: evaluation of the efficacy of ECG; development of short-duration and i ntermi ttent treatment regimens: elucidati on of iamme mechani sms and development of alternative inmmoprophylactic methods.

EM/ADV.COM.Bict,1ED.RSR/5 EM/RSR/1 Annex VIII page iv

3 .2.5. Eye Diseases (trachoma, con,Junctivit1s1 ete . )

WHO EmO

'!he epidemiology of trachoma, with particular reference to the transmission of causative agents through flies. the inm.mological aspects of the infection and herd 1mnun1ty. and the effect of sanitary measures. including fly control and mass therapy. should be investigated; the epidemiology of glaucoma in different local! ties in relation to environment and nutritional status com­bined with comprehensive studies on early diagnosis and evaluation of treatment.

WHO EMRO EM/ADV .CCM.BICH:D.RSR/5 EM/RSR/1 Armex IX

. ANNEX IX

REGIONAL REFERENCE CEN'mES ON CANCER

1. Regional Reference Centre on Urinary Bl adder Cancer and Cancer of the Head a nd Neck

(a} Cancer Institute Cairo University

(b) Medical Research Institute Alexandria

Dean� Professor I smail El Sebai

Dean: Profess or M.E.A. El Kharadly

2. Regional Reference Centre on Lymphomas and Oesophageal Cancer

Taj Pahlavi Cancer I nstitute P.O. Box 1\/1154 Teheran Directors Dr A. fibd,J taba1

J. Regional Reference Centre on Breast and Cerv1cak Uterine Cancer

Salah Azaiz Cancer Institute Tunis Di rector: Dr N. Mourall