*** EXECUTIVE SUMMARY: SRI LANKA Health Statistics Report*** This report is part of a series of Country Health Profiles produced by the Center for International Health Information (CIHI). Each profile contains statistical data on current health conditions, population dynamics, health and family planning behavior, and health and population trends in a given developing country. Information is compiled from CIHI's health statistics database, which draws data from a diverse range of sources listed at the end of this profile. Hard-copy editions of CIHI's profiles, available from our publications department, include visual presentation of data through tables and graphs. The intent of these text-only profiles is to convey the same information without the graphic presentation. Facsimiles of the hard copy editions will soon be available on this website (www.cihi.com) in Portable Document Format (.pdf). Because PDF files require special viewing software, these text-only editions will also remain on the CIHI website. Any feedback you may have on the content or presentation of this report would be greatly appreciated. We would also appreciate receiving any more recent, more accurate, or more representative information. Contact us at one of the following addresses: *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** Center for International Health Information (CIHI) 1601 N. Kent St., Suite 1014 Arlington, VA 22209 U.S.A. E-mail address: info@cihi.com Phone: 703/524-5225 FAX: 703/243-4669 *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** The Center for International Health Information (CIHI), a USAID project managed by Information Management Consultants, Inc. (IMC), with the International Science and Technology Institute (ISTI) and The Futures Group (FUTURES), prepared this document under the Data for Decision Making Project, 936-5991.05 (CIHI-II), contract number HRN-5991-C-003041-00, with the Office of Health and Nutrition, Center for Population, Health and Nutrition, Bureau for Global Programs, Field Support and Research, U.S. Agency for International Development (USAID). *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** CIHI Health Statistics Report: *** SRI LANKA Table of Contents January 1996 I: Health & Demographic Overview Current Demographic and Health Indicators Trends in Selected Demographic and Health Indicators Population Estimates Trends in Selected Health and Child Survival Indicators Vaccination Coverage Rates ORS Access, ORS and/or RHF Use Rates Contraceptive Prevalence Rate Access to Potable Water Access to Adequate Sanitation Comparative Indicators Comparative IMR Rates Comparative Vaccination Coverage Rates Comparative ORS Access, ORS and/or RHF Use Rates II: Data Notes III: Sources *** *** *** *** *** *** *** NOTE on SOURCES *** *** *** *** *** *** Sources in this profile are referred to by a seven-digit code. Generally, the first three letters refer to an organization, agency, etc., and the first two numbers indicate the year of the publication or other source document. A complete list of sources appears at the end of the profile. *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** --------------------------------------------------------------- I. A. Current Demographic and Health Indicators: SRI LANKA 1/21/96 DEMOGRAPHIC INDICATORS VALUE YEAR SOURCE Total Population (000s) 18,130 1994 BUC9401 Urban Percent 22 1994 UNP9400 Women Ages 15-49 (000s) 4,885 1994 UNP9400 Infant Mortality Rate 22 1994 JEE9512 Under 5 Mortality Rate 29 1994 JEE9507 Life Expectancy At Birth 72 1994 BUC9401 Number Of Births (000s) 336 1994 CAL9602 Annual Infant Deaths (000s) 7.4 1994 CAL9603 Total Fertility Rate 2.4 1994 UNP9400 CHILD SURVIVAL INDICATORS VALUE YEAR SOURCE BCG 86 1994 WHE9502 DPT 3 88 1994 WHE9502 Measles 83 1994 WHE9502 Polio 3 88 1994 WHE9502 TT 2+ 81 1994 WHE9502 ORS access rate 100 1993 WHD9401 ORT use rate 76 1993 WHD9401 CPR, Modern Methods 41 1987 DHS8807 CPR, All Methods 62 1987 DHS8807 Adequate nutritional status 58 1987 DHS8807 Exclusive breastfeeding 14 1987 DHS8807 Exclusive breastfeeding 12 1987 DHS8807 Complementary feeding 47 1987 DHS8807 Continued breastfeeding 71 1987 DHS8807 OTHER HEALTH INDICATORS VALUE YEAR SOURCE HIV-1 seroprevalence, urban 0.0 1991 BUC9103 Access to potable water, urban 100 1991 JMP9301 Access to potable water, rural 64 1991 JMP9301 Access to sanitation, urban 73 1991 JMP9301 Access to sanitation, rural 56 1991 JMP9301 Deliveries/trained attendant (%) 94 1987 DHS8807 Deliveries/trained attendant (%) 97 1987 DHS8807 Deliveries/trained attendant (%) 94 1987 DHS8807 ________________________________________________________________________________ I. B. Trends in selected Demographic and Health Indicators: SRI LANKA 1/21/96 UNDER CRUDE CRUDE AVG ANNUAL TOTAL INFANT FIVE BIRTH DEATH GROWTH FERTILITY MORTALITY MORTALITY RATE RATE RATE RATE 1960 71 99 36 9 2.5 5.3 1965 63 88 33 8 2.4 4.9 1970 59 82 30 8 2.0 4.3 1975 50 69 29 8 1.7 3.9 1980 40 54 28 7 1.7 3.5 1985 30 40 25 6 1.5 3.0 1990 24 32 22 6 1.3 2.6 1995 21 28 20 6 1.3 2.4 2000 19 25 18 6 1.2 2.2 SOURCE JEE9512 JEE9507 UNP9400 UNP9400 UNP9400 UNP9400 ________________________________________________________________________________ I. C. Population Estimates: SRI LANKA 1/21/96 YEAR VALUE SOURCE 1960 9,879,000 BUC9401 1965 11,202,000 BUC9401 1970 12,532,000 BUC9401 1975 13,660,000 BUC9401 1980 14,900,000 BUC9401 1985 16,021,000 BUC9401 1990 17,227,000 BUC9401 1995 18,343,000 BUC9401 2000 19,377,000 BUC9401 ________________________________________________________________________________ I. D. BCG Vaccination Coverage: SRI LANKA 1/21/96 YEAR PERCENT SOURCE 1980 61 WHE8700 1981 58 WHE8700 1982 64 WHE8700 1983 62 WHE8700 1984 67 WHE8700 1985 74 WHE8701 1986 76 WHE8701 1987 76 WHE8900 1988 85 WHE8900 1989 97 WHE9100 1990 88 WHE9200 1991 89 WHE9202 1992 89 WHE9401 1993 88 WHE9403 1994 86 WHE9502 ________________________________________________________________________________ I. E. DPT 3 Vaccination Coverage: SRI LANKA 1/21/96 YEAR PERCENT SOURCE 1980 46 WHE8700 1981 45 WHE8801 1982 56 WHE8900 1983 66 WHE8801 1984 66 WHE8900 1985 65 WHE8801 1986 77 WHE8701 1987 77 WHE8900 1988 68 WHE8900 1989 89 WHE9100 1990 90 WHE9200 1991 86 WHE9202 1992 90 WHE9401 1993 90 WHE9403 1994 88 WHE9502 ________________________________________________________________________________ I. F. Measles Vaccination Coverage: SRI LANKA 1/21/96 YEAR PERCENT SOURCE 1980 1981 2 WHE8700 1982 2 WHE8700 1983 11 WHE8700 1984 3 WHE8700 1985 20 WHE8701 1986 47 WHE8701 1987 60 WHE8900 1988 55 WHE8900 1989 81 WHE9100 1990 83 WHE9200 1991 79 WHE9202 1992 83 WHE9401 1993 86 WHE9403 1994 83 WHE9502 ________________________________________________________________________________ I. G. Polio 3 Vaccination Coverage: SRI LANKA 1/21/96 YEAR PERCENT SOURCE 1980 48 WHE8700 1981 49 WHE8700 1982 57 WHE8700 1983 66 WHE8900 1984 65 WHE8700 1985 65 WHE8800 1986 77 WHE8900 1987 78 WHE8900 1988 69 WHE8900 1989 87 WHE9100 1990 90 WHE9200 1991 86 WHE9202 1992 90 WHE9401 1993 89 WHE9403 1994 88 WHE9502 ________________________________________________________________________________ I. H. Tetanus 2 (TT2+) Vaccination Coverage: SRI LANKA 1/21/96 YEAR PERCENT SOURCE 1980 50 WHE8700 1981 48 WHE8700 1982 46 WHE8700 1983 59 WHE8701 1984 56 WHE8701 1985 36 WHE8800 1986 44 WHE8701 1987 51 WHE8900 1988 42 WHE8900 1989 39 WHE9100 1990 60 WHE9200 1991 57 WHE9202 1992 85 WHE9401 1993 84 WHE9403 1994 81 WHE9502 ________________________________________________________________________________ I. I. ORS Access, ORS and/or RHF Use Rates: SRI LANKA 1/21/96 ORS ORT/RHF YEAR ACCESS SOURCE USE SOURCE 1980 1981 1982 1983 20 WHD8500 1984 16 WHD8700 1985 61 WHD8700 15 WHD8700 1986 64 WHD8800 15 WHD8800 1987 78 WHD8900 40 DHS8807 1988 95 WHD9000 77 WHD9000 1989 95 WHD9100 58 WHD9100 1990 1991 95 WHD9201 76 WHD9201 1992 72 WHD9300 1993 100 WHD9401 76 WHD9401 1994 ________________________________________________________________________________ I. J. Contraceptive Prevalence Rate: SRI LANKA 1/21/96 ALL MODERN YEAR METHODS SOURCE METHODS SOURCE 1980 1981 1982 55 BUC9401 29 BUC9401 1983 1984 1985 1986 1987 62 DHS8807 41 DHS8807 1988 1989 1990 1991 1992 1993 1994 ________________________________________________________________________________ I. K. Access to Potable Water: SRI LANKA 1/21/96 YEAR RURAL SOURCE URBAN SOURCE 1980 18 WHO9101 65 WHO9101 1981 1982 1983 26 WHO9101 76 WHO9101 1984 1985 29 WHO9101 82 WHO9101 1986 1987 1988 40 WHO9101 87 WHO9101 1989 1990 55 WHO9200 80 WHO9200 1991 64 JMP9301 100 JMP9301 1992 1993 1994 ________________________________________________________________________________ I. L. Access to Adequate Sanitation: SRI LANKA 1/21/96 YEAR RURAL SOURCE URBAN SOURCE 1980 63 WHO9101 80 WHO9101 1981 1982 1983 1984 1985 39 WHO9101 65 WHO9101 1986 1987 1988 44 WHO9101 74 WHO9101 1989 1990 45 WHO9200 68 WHO9200 1991 56 JMP9301 73 JMP9301 1992 1993 1994 ________________________________________________________________________________ I. M. Cross Country Comparisons Infant Mortality Rates: SRI LANKA 1/21/96 COUNTRY 1960 SOURCE 1995 SOURCE SRI LANKA 71 JEE9512 21 JEE9512 ASIA 139 CAL9512 50 CAL9512 LOW INCOME COUNTRIES 164 CAL9512 103 CAL9512 DEVELOPING COUNTRIES 146 CAL9512 67 CAL9512 ________________________________________________________________________________ I. N. Cross Country Comparisons Vaccination Coverage Rates: SRI LANKA 1/21/96 Median values for country groupings: (CAL9512) Vaccination SRI LANKA ASIA LOW INCOME Developing Coverage Year Source COUNTRIES Countries BCG 86 1994 WHE9502 93 80 85 DPT3 88 1994 WHE9502 84 60 74 MEASLES 83 1994 WHE9502 80 58 71 POLIO3 88 1994 WHE9502 85 61 78 TT2+ 81 1994 WHE9502 50 45 47 ________________________________________________________________________________ I. O. Cross Country Comparisons ORS Access, ORS and/or RHF Use Rates: SRI LANKA 1/21/96 ORT ORS COUNTRY USE YEAR ACCESS YEAR SRI LANKA 76 1993 100 1993 SOURCE WHD9401 WHD9401 Median values for country groupings: ASIA 57 1994 85 1994 Low Income Countries 45 1994 69 1994 Developing Countries 52 1994 80 1994 SOURCE CAL9512 ________________________________________________________________________________ II. Data Notes NOTE ON MORTALITY ESTIMATION Various organizations produce mortality estimates for the developing countries and regions. The three major sources are the United Nations Population Division, the World Bank, and the United States Bureau of the Census. CIHI's Health Statistics Database draws upon the work of these three larger organizations as well as other sources in order to reconcile the various estimates and provide the most reasonable current and historical estimates available. CIHI has also created a comprehensive time series of under-five mortality estimates for all developing countries. This has been accomplished by developing mathematical equations from empirical data that describe the relationship between infant and under-five mortality. Using these equations it is possible to make estimates of under-five mortality from infant mortality or vice-versa. More details regarding CIHI's methodology for specific data sets are provided in the source references. DEFINITIONS DEMOGRAPHIC INDICATORS Total Population: The mid-year estimate of the total number of individuals in a country. Urban Percent: Percentage of population living in urban areas as defined according to the national definiton used in the most recent population census. Infant Mortality Rate: The estimated number of deaths in infants (children under age one) in a given year per 1,000 live births in that same year. This rate may be calculated by direct methods (counting births and deaths) or by indirect methods (applying well-established demographic models). Under 5 Mortality Rate: The estimated number of children born in a given year who will die before reaching age five per thousand live births in that same year. This rate may also be calculated by direct or indirect methods. Maternal Mortality Rate: The estimated number of maternal deaths per 100,000 live births where a maternal death is one which occurs when a woman is pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management. Although commonly referred to as a rate, this measure is actually a ratio because the unit of measurement of the numerator (women) is different than that of the denominator (births). Extremely difficult to measure, maternal mortality can be derived from vital registration systems (usually underestimated), community studies and surveys (requires very large sample sizes) or hospital registration (usually overestimated). Life Expectancy At Birth: An estimate of the average number of years a newborn can expect to live. Life expectancy is computed from age-specific death rates for a given year. It should be noted that low life expectancies in developing countries are, in large part, due to high infant mortality. Number of Births: An estimate of the number of births occurring in a given year. Annual Infant Deaths: An estimate of the number of deaths occurring to children under age one in a given year. Total Fertility Rate: An estimate of the average number of children a woman would bear during her lifetime given current age- specific fertility rates. Crude Birth Rate: An estimate of the number of live births per 1,000 population in a given year. Crude Death Rate: An estimate of the number of deaths per 1,000 population in a given year. Average Annual Rate of Growth: An estimate of the rate at which a population is increasing (or decreasing) in a given year. CHILD SURVIVAL INDICATORS Vaccination Coverage Rate (vcr %) in Children: An estimate of the proportion of living children between the ages of 12 and 23 months who have been vaccinated before their first birthday -- three times in the cases of polio and DPT and once for both measles and BCG. Vaccination coverage rates are calculated in two ways. Administrative estimates are based on reports of the number of inoculations of an antigen given during a year to children who have not yet reached their first birthday divided by an estimate of the pool of children under one year of age eligible for vaccination. Survey estimates are based on samples of children between the ages of 12 and 23 months. Vaccination Coverage Rate (vcr %) in Mothers, Tetanus Toxoid 2+ (TT2+): An estimate of the proportion of women in a given time period who have received two doses of tetanus toxoid during their pregnancies. This indicator is being changed in many countries to account for the cumulative effect of tetanus toxoid boosters. A woman and her baby are protected against tetanus when a mother has had only one or, perhaps, no boosters during a given pregnancy so long as the woman had received the appropriate number of boosters in the years preceding the pregnancy in question. (The appropriate number of boosters required during any given pregnancy varies with number received previously and the time elapsed.) The revised indicator is referred to as TT2+. Rates are computed using administrative methods or surveys. DPT Drop-out Rate: An estimate of the proportion of living children between the ages of 12 and 23 months who received at least one DPT vaccination but who did not receive the entire series of three vaccinations before their first birthdays. Oral Rehydration Salts (ORS) Access Rate: An estimate of the proportion of the population under age five with reasonable access to a trained provider of oral rehydration salts who receives adequate supplies. This is a particularly difficult indicator to measure and, therefore, it may fluctuate dramatically from year to year as improved methods of estimation are devised. Oral Rehydration Therapy (ORT) Use Rate: An estimate of the proportion of all cases of diarrhea in children under age five treated with ORS and/or a recommended home fluid. ORT use may be determined using administrative means or surveys. In general, administrative estimates are based on estimates of the number of episodes of diarrhea in the target population for a given year and the quantity of ORS available. Thus, changes in the estimates of the frequency of diarrhea episodes can alter the ORT use rate as well as real changes in the pattern of use. Surveys are more precise in that they focus on the actual behavior of mothers in treating diarrhea in the two-week period prior to the survey. Contraceptive Prevalence Rate (CPR): An estimate of the proportion of women, aged 15 through 44 (or, in some countries, 15 through 49), in union or married, currently using a method of contraception. Where sources fail to distinguish modern and traditional methods, the combined rate is shown. Adequate Nutritional Status: An individual child of a certain age is said to be adequately nourished if his/her weight is greater than the weight corresponding to two Z-scores (two standard deviations) below the median weight achieved by children of that age. The median weight and the distribution of weights around that median in a healthy population are taken from a standard established by the National Center for Health Statistics, endorsed by the World Health Organization (WHO). The indicator for the population as a whole is the proportion of children 12 through 23 months of age who are adequately nourished. Exclusive Breastfeeding: An estimate of the proportion of infants less than four months (120 days) of age who receive no foods or liquids other than breast milk. Complementary Feeding: An estimate of the proportion of infants six to nine months of age (181 days to 299 days) still breastfeeding but also receiving complementary weaning foods. Continued Breastfeeding: An estimate of the proportion of children breastfed for at least one year. In this report, all values presented for this indicator are the proportion of children 12 to 15 months of age at the time of the survey still receiving breast milk. OTHER HEALTH INDICATORS HIV-1 Seroprevalence, Urban: An estimate of the proportion of all persons living in urban areas infected with HIV-1, the most virulent and globally prevalent strain of the human immunodeficiency virus. Where data are disaggregated by risk group, data for Low-Risk Population are typically drawn from test results among pregnant women, the general population, or blood donors. High-Risk Population includes persons with known risk factors; these estimates are typically drawn from test results among commercial sex workers, their clients, or patients at STD clinics. HIV-1 Seroprevalence, Rural: An estimate of the proportion of all persons living in rural areas infected with HIV-1. Access to Potable Water, Urban: An estimate of the proportion of all persons living in urban areas (defined roughly as population centers of 2,000 or more persons) who live within 200 meters of a stand pipe or fountain source of water. Access to Potable Water, Rural: An estimate of the proportion of all persons not living in urban areas with a source of water close enough to home that family members do not spend a disproportionate amount of time fetching water. Access to Sanitation, Urban: An estimate of the proportion of all persons living in urban areas with sanitation service provided through sewer systems or individual in-house or in-compound excreta disposal facilities (latrines). Access to Sanitation, Rural: An estimate of the proportion of all persons not living in urban areas with sanitation coverage provided through individual in-house or in-compound excreta disposal facilities (latrines). Deliveries By Trained Attendants: An estimate of the proportion of deliveries attended by at least one physician, nurse, midwife, or trained traditional birth attendant. Comparative Tables. Unless otherwise specified, indicator values for country groupings are median values for the countries in each aggregate grouping for which data are available. Regional groupings may include: (1) Sub-Saharan Africa which includes the 47 countries comprising USAID's Africa Region; (2) No. Africa & Mideast which corresponds to USAID's Near East Sub-region, and includes 21 countries from Morocco in the west to Afghanistan in the east; (3) Asia which corresponds to USAID's Asia Sub-region and includes 24 developing countries from Pakistan eastward; (4) Latin Am. & Carib. which includes 46 countries of Central and South America and the Caribbean and corresponds to USAID's Latin American and Caribbean region. Income groupings are based on the classifications used by the United Nations' Human Development Report, 1994 which are defined as: (1) Low Income Countries (GNP/capita =$650 or less), (2) Middle Income Countries (GNP/capita $651-$6,000); (3) High income countries (GNP/capita >$6,000). "Developing Countries" indicators pertain to those 152 countries which are not regarded as "Established Market Economies" by the World Bank's World Development Report, 1993. ________________________________________________________________________________ III. Sources BUC9103 Bureau of Census, Center for International Research, Recent HIV Seroprevalence Levels By Country, April, 1992 BUC9401 U.S. Bureau of the Census (BUCEN). International Data Base. Version dated March, 1994. CAL9512 Calculated medians for aggregates of countries using best available data from the CIHI Health Statistics Database CAL9602 Calculations of the annual number of live births based on the preferred estimates of total population and crude birth rat CAL9603 Calculations of the annual number of infant and/or under five deaths based on the preferred estimates of total population and infant and/or under five mortality rates. DHS8807 Department of Census and Statistics, Ministry of Implementation, and Institute for Resource Development/Westinghouse. Sri Lanka Demographic and Health Survey 1987. Columbia, MD: IRD, 1988 JEE9507 Under Five Mortality Rate (5Q0) calculated from Infant Mortality Rate (1Q0) using the "ABSS" (all but Sub-Saharan Africa) equation: 5Q0 = 1.14855*((1Q0)^1.04799) JEE9512 Infant mortality curve based on BUC9302 estimates supplemented by UNP9400 estimates. JMP9301 WHO/UNICEF Joint Monitoring Programme. Water Supply and Sanitation Sector Monitoring Report 1993. Sector Status as of December 1991. WHO and UNICEF. August, 1993. UNP9400 Department of International Economic and Social Affairs, United Nations. World Population Prospects 1994. (Tape) New York: UN, 1994. WHD8500 World Health Organization. Programme for Control of Diarrhoeal Diseases: Fourth Programme Report 1983-1984. (WHO/CDD/85.13) Geneva: WHO, 1985. WHD8700 World Health Organization. Programme for Control of Diarrhoeal Diseases: Interim Programme Report 1986. (WHO/CDD/87.26) Geneva: WHO, 1987. WHD8800 World Health Organization. Programme for Control of Diarrhoeal Diseases: Sixth Programme Report 1986-1987. (WHO/CDD/88.28) Geneva: WHO, 1988. WHD8900 World Health Organization. Programme for Control of Diarrhoeal Diseases: Programme Report (WHO/CDD/89.31) Geneva: WHO, 1989. WHD9000 World Health Organization, Programme for Control of Diarrhoeal Diseases facsimile, February 14, 1990. WHD9100 World Health Organization. Programme for Control of Diarrhoeal Diseases: Interim Programme Report 1990. (WHO/CDD/91.36) Geneva: WHO, 1991. WHD9201 Programme For Control Of Diarrhoeal Diseases. Eighth Programme Report 1990-1991. WHO/CDD/92.38. Geneva: World Health Organization, 1992. WHD9300 World Health Organization, Programme for Control of Diarrhoeal Diseases; provisional data for Annex 1 of the Ninth Programme Report. Received by personal communication, February 16, 1993. WHD9401 Advanced Copy of Annex 1 of the WHO/CDR Annual Report, Received by facsimile, March 29, 1994. WHE8700 World Health Organization. Expanded Programme on Immunization Information System Report, January 1987. Geneva: WHO, 1987. WHE8701 World Health Organization. Expanded Programme on Immunization Information System Report, July 1987. Geneva: WHO, 1987. WHE8800 World Health Organization. Expanded Programme on Immunization Information System Report, January 1988. Geneva: WHO, 1988. WHE8801 World Health Organization. Expanded Programme on Immunization Information System Report, July 1988. Geneva: WHO, 1988. WHE8900 World Health Organization. Expanded Programme on Immunization Information System Report, July 1989. (WHO/EPI/GEN/89.2) Geneva: WHO, 1989. WHE9100 World Health Organization. Expanded Programme on Immunization Information System Report, April 1991. (WHO/EPI/CEIS/91.1) Geneva: WHO, 1991. WHE9200 World Health Organization. Expanded Programme on Immunization Information System Report, April 1992. (WHO/EPI/CEIS/92.1) Geneva: WHO, 1992. WHE9202 World Health Organization. Expanded Programme on Immunization Information System Report, October 1992. (WHO/EPI/CEIS/92.2) Geneva: WHO, 1992. WHE9401 Download of WHO/EPI vaccination coverage files from INTERNET, March 24, 1994. WHE9403 Download of WHO/EPI vaccination coverage files from INTERNET, August 29, 1994. WHE9502 Download of WHO/EPI vaccination coverage files from INTERNET, September 20, 1995 WHO9101 World Health Organization. World Health Organization Disk: Water Supply and Sanitation Service Coverage. Geneva: WHO, October 29, 1991. WHO9200 The International Drinking Water and Sanitation Decade, 1981-90: End of decade review, (as of December 1990), August 1992. CWS Unit, Division of Enviromental Health, World Health Organization, 1211 Geneva 27, Switzerland