[Prevalence of anemia in clients of a family planning clinic in Merida]
305 low income women living in marginal areas and without access to any kind of social security participated in a study of the prevalence of anemia conducted at a family planning clinic in the state of Yucatan, Mexico. The women were reproductive age, had a minimum of 2 children, and had not used oral contraceptives or injectable methods for a minimum of 3 and 6 months, respectively. 41 women were aged 15-19, 81 were 20-24, 70 were 25-29, 67 were 30-34, 33 were 35-39, and 13 were 40-44. 73 were illiterate, 192 had incomplete primary educations, 31 had complete primary educations, and 9 had higher educations. The majority of women had no history of serious pathology except that 270, or 88.5%, reported intestinal parasites. The average hemoglobin level was 10.88 g/dl with a standard deviation of 1.48. The majority of the women had hemoglobin values between 9-11.9 g/dl; 76% therefore were anemic according to a criterion of the World Health Organization (WHO), which considers 12.0 g/dl of hemoglobin as the lower limit in nonpregnant women. 48 women, or 20.68%, had iron deficiency anemia according to WHO definitions. Other findings of the hematological studies were an average hematocrit of 36%, serum iron level of 84.4 ug/dl, and an index of saturation of 23.8%. The women had a considerably higher rate of anemia than a group of young, healthy, childless, and well norished women studied in the same city. The higher frequency of anemia should be considered in prescribing contraceptive methods. (summary in ENG)
The changing employment pattern in the developing world.
The research of Michael Hopkins, carried out under the International Labor Organization (ILO) World Employment Program reaches the conclusion that industry and, especially, services are rapidly outstripping agriculture as the main providers of jobs and major contributors to gross domestic product (GDP) in the developing world. The background data for this analytical survey come from 92 developing countries and cover some 2254 million people or 97% of the developing world's population. The findings show that in the 1960-80 period, agriculture's share of GDP in the 92 countries almost halved, falling from 31-17%. Its share of the labor force, meanwhile, dropped from 72.6-59.1% during the same period. At the same time, industry boosted its GDP share in developing countries from 30-39% and its contingent of the labor force from 13-20%. Industry's great leap forward in the developing countries came in the 1960s, in the heyday of import substitutions, when its share of the GDP soared from 30-38%. Third world industrial expansion slowed considerably during the 1970s when its portion of GDP increased only by 0.5%. For most developing countries, the growth sector over the 1960-80 period has been that of services, which gained momentum in the 1970s and by the end of the decade accounted for about 44% of the developing world's GDP. The services share of the labor force also increased from 14.5-21%. Hopkins warns that the pace of change in the structure of the 3rd world labor force has to be reckoned against a worldwide recession, which has impeded economic growth and increased unemployment, and the persistence of widespread underemployment and poverty in many areas of the developing world. If growth rates continue to lag in the 3rd world, unemployment rates could rise substantially in the next few years. From now until the year 2000, the unemployment situation could worsen unless a growth momentum is restored along with greatly improved income distribution. The unemployment figures alone fail to provide a true picture of the job situation in the third world, for they fail to reflect the acute underemployment and poverty which exist there. Hopkins's extrapolations from available data reveal an increase in underemployment in developing countries (excluding China) from 421 million to 448 million persons over the 1974-82 period.
In postindependence Africa new and more efficient strategies were required to support educational expansion. Political independence was accompanied by an increased demand for education to meet the growing labor force needs of the emerging countries in Africa. It was considered that education, as a means for human resource development, was a viable capital investment necessary to support both social and economic development, yet in many African nations, the educational systems and the traditional teaching methods inherited from colonial rule were not adequate to satisfy the increased demand for trained personnel. In response to the need for educational reforms and expansion, governments of many African countries invested heavily in the development of their education systems. During the 1970s it is estimated that Africa spent between 15-20% of the national budget on education. That high level of expenditure was justified by the increased demand for education. The educational expansion efforts also increased shortages of qualified and competent teachers, shortages of adequate equipment, and physical facilities. New strategies and resources with required to solve these increasing problems. Many African countries began to experiment with the use of mass communication technologies to support their educational reform efforts. There was generally consensus that the mass media, particularly radio and television, had certain qualities that could be exploited either to replace or improve conventional methods of teaching. By the late 1960s at least 16 African countries were using educational broadcasting of 1 form or another. International aid agencies, govermental donor agencies, and private foundations in the industrially advanced countries provided the support base for many African countries in their efforts to use radio and television for educational improvement. Most of these efforts failed to make any significant impact on educational development in Africa. Educational analysts have generally concluded that post-independence educational reforms in Africa failed to achieve thier aims. Some recommendations are offered with the objective of contributing to the ongoing international effort to search for more effective approaches in using communication technologies to support educational development in Africa. Technical assistance programs supporting educational use of modern communication technologies should be perceived in the context of international cooperation, with a 2-way flow, rather than in the context of a donor recipient relationship. Greater emphasis should be placed on thorough country by country assessment of educational needs and problems in order to provide an adequate basis for designing project objectives and project contents to satisfy specific needs. Needs assessment should be tempered with pragmatism and flexibility in approach. Training and orientation for foreign and local exports and increased local participation are among the recommendations.
Use of laparoscopy to determine the microbiologic etiology of acute salpingitis.
To determine the microbiologic etiology of acute salpingitis, laparoscopy was used in 26 patients to obtain specimens for a variety of microorganisms directly from the fallopian tubes. Simultaneous culdocentesis was performed to obtain peritoneal fluid for microbiologic analysis. A variety of microorganisms were isolated from the fallopian tubes and cul-de-sac aspirate. However, the organisms isolated from the fallopian tube were not consistent with the cul-de-sac isolates. It appears that direct culture from the fallopian tube may be necessary to determine the microbiologic etiology and pathogenesis of acute salpingitis. N. gonorrhoeae was isolated from the cul-de-sac in 32% of cases and the fallopian tube in 19%. In patients with endocervical gonorrhea, the gonococcus was isolated from the fallopian tube in 38.5% of the cases. Aerobic and/or anaerobic bacteria were present in the cul-de-sac aspirate in 46% of patients and in the fallopian tube in 38%. (author's)
Genital infections in Swaziland.
The relative frequency of the sexually transmitted diseases (STD) problem presenting as urethral discharge, vaginal discharge, genital complaints, genital ulceration, and inguinal adenopathy (bubo) seen at outpatient departments of the Mbabane Government Hospital in Swaziland were estimated and their etiology was determined. Collection of this type of data is a 1st step towards the development of treatment and control strategies for STD in any country. The data of the STD presenting problems was recorded during the January-February 1978 period. During a 3-week period, in addition to a clinical examination a number of diagnostic tests were performed to establish the eitology of the STD problem. Over a 5-week period, 249 patients were seen with an STD problem--urethral discharge, vaginal discharge, or genital ulceration. No figures were obtained on patients who presented only inguinal adenopathies. In males, 42% presented with urethral discharge, 51% with genital ulceration, and 7% with both problems, showing clearing the high frequency of multiple STD in these patients. 71% of females presented with vaginal discharge and/or genital complaints, and 29% with genital ulcers, in some cases combined with vaginal discharge. 82% of the males with urethral discharge had gonorrhea, 14% had nongonococcal urethritis, and 4% had no urethritis. Of the 65 females with vaginal discharge and/or genital complaints, 21.5% had gonorrhea, 24.6% trichomoniasis, and 23.1% candidasis. In patients with genital ulceration the clinical diagnosis was syphilis in 26%, herpes in 4%, and the remaining 70% were diagnosed as chancroid. Lymphogranuloma venereum and probably also granuloma inguinale were seen, but as the distinction on clinical grounds is difficult all these cases were classified as chancroid. On the basis of these figures for a 5-week period, it can be estimated that at the outpatient department of the Mbabane Hospital (with catchment area of 40,000 population) between 2500 and 3000 patients are seen annually with STD problems. This illustrates the great burden imposed on the health services by STD control in African countries.
The neglected male [editorial]
Infertility should not be considered a condition that affects the male and female separately. The concept of evaluating and managing infertile couples as a unit is becoming well established among sophisticated physicians. The investigation and management of male related infertility continues to be a cause for concern among both physicians and the lay public. Generally, the male partner of an infertile union is neglected. Most physicians refer their infertile males to a urologist for initial evaluation or management of specific problems. A few urologists who have the expertise and experience to manage male infertility can be found in most large communities and medical centers, and some of these physicians have limited their entire practices to infertility. Many urology residency programs are deficient in subjects related to male reproductive biology and endocrinology. Urologists who graduate from such programs are unprepared to provide care for infertile men. The result of this system is that the male partner of the infertile couple is neglected by both the gynecologist and the urologist. In many localities it is common to see men who have been under the care of a physician for months and at times years without the benefit of adequate evaluation or treatment. The use of long discarded therapeutic modalities such as thyroid preparations for the treatment of oligospermia continues unabated. Another problem is the lack of laboratory facilities and trained technicians for semen analysis. Knowledge of the physiology of the male reproductive function is still rudimentary, and diagnostic tools are crude. Satisfactory tests to assess the capability of sperm to effect migration and survival in the female reproductive tract and fertilize the ovum have not been developed. The level of training of both gynecologists and urologists in reproductive sciences must be improved. Semen analysis should be performed in laboratories equipped to process the sample by trained technicians who will provide the physician with a comprehensive support. Research in male reproductive biology must continue with the purpose of elucidating parameters which indicate functional disorders of spermatozoa. Several new techniques have recently been developed for the investigation of functional defects in human spermatozoa.
The problem of infertility in western Equatoria.
A survey was conducted to investigate the problem of infertility among the tribes of Western Equatoria. The selection of these tribes was motivated particularly by reports of the magnitude of the problem of infertility and depopulation in this area. The total population of all the Chiefdoms surveyed in the 1962-63 period was 100,8484; the total number of married women surveyed was 7111. The incidence of infertility was very high among the tribes in the Zande and Moru districts ranging from 24% among the Avokaya to 60% among the Zande. The Zande and Makraka tribes showed exceptionally high infertility rates, 51% among the Zande and 47% among the Makraka. There was no problem of infertility among the tribes of Yei district except the Makraka. The Fajulla, Kakwa, and Kaliko were very fertile. Analysis of the obstetrical and family histories of 353 unselected Makraka couples yielded a primary infertility rate of 47% and a secondary infertility rate of 16%. All the women who were studied showed an extreme desire for children, and they willingly accepted repeated and painful examinations. Bimanual pelvic examinations were performed on 198 unselected women to detect evidence of pelvic inflammation or other abnormalities. The diagnoses of chronic pelvic infections were based on the history of the presence of vaginal discharge together with palpable tender adnexal abnormalities. The adnexal inflammatory tuboovarian masses were gross in 16 women (10%). Among the fertile women, 8 (22%) showed signs of infection. Tumors (other than inflammatory) were found in 17 infertile women (11%) and in none of the fertile women. Cervical erosion was encountered in 16 women (13.2%). The position of the uterus was checked in all cases and was retroverted in 16 of 36 fertile women and 60 of 153 infertile women (40%). Lateral displacement was occasionally found in association with adnexal inflammatory masses and tumors. The uterus was very small and conical in 5 infertile women. The Kahn serological test for syphilis was performed in 285 women; 28 (10%) were serologically positive for syphilis. The positive cases were equally shared by the fertile and infertile women. The clinical investigations performed on 241 infertile women and 228 men (from the Zande and Makraka tribes) included general physical examination, gynecological examination of the pelvic organs, vaginal and cervical smears, tubal insufflation, examination of the male genital organs, urethral smears, and semen analysis. The following were among the most clinical findings associated with infertility. In the female there was a high incidence of pelvic inflammatory lesions in 49% and blockage of the fallopian tubes in 58.2%. Gonococci were detected in 0.9% of the smears. In the males there was deficient semen in 60.5% associated with hydroceles (11.9%), varicoceles (4.4%), epididymoorchitis (6.6%), and clinical testicular atrophy (7%). The physical causes of infertility could be due to venereal diseases, postpartum pelvic infections, and filariasis.
Epidemiology and aetiology of urethritis in Swaziland.
The annual incidence of urethritis can be estimated to be at least 3750/100,000 population in Swaziland. In a study of 109 males with symptomatic urethritis, 80% had gonorrhea, 6% nongonococcal urethritis (ngu), and 14% were classified as having no objective urethritis (less than 5 polymorphonuclear leucocytes/highpower field in the urethral smear). The relative frequency of gonorrhea was 80-95% and of nongonococcal urethritis 5-20% according to which criteria are used for patient selection and/or diagnosis ngu. Chlamydia trachomatis was cultured in 3.4% of the cases with urethritis, comprising 1 positive culture in 70 patients with gonorrhea, 1 in 5 with ngu, and 1 in 12 with no objective urethritis. 71% of patients with a comparable percentage in each diagnostic group, had chlamydial antibodies when tested by the microimmunofluorescence test to pooled chlamydial antigens. Interpretation of the chlamydial serologic results indicates that lymphogranuloma venereum is probably endemic in the country, and that oculogenital chlamydial infections are not a problem; this corresponds with the low isolation rate of Chlamydia trachomatis in the urethritis cases. The study shows that the epidemiology and causes of urethritis are clearly of a different pattern to that seen in industrialized countries. This type of study is a sound basis for a simplified but effective urethritis control program which can be implemented in the paraurban and rural health centers in developing countries. (author's)
Post-mortem compared with clinical diagnosis of genito-urinary tuberculosis in adult males.
5424 necropsies performed on men aged 16 and over from 1935-44 were analyzed with regard to age; race; death from tuberculosis; unhealed tuberculosis in those dead from other causes; the relationship between pulmonary, renal, and genital tuberculosis; and comparison of the necropsy with the clinical diagnosis of genito-urinary tract tuberculosis. The incidence of genito-urinary tuberculosis was greater among the 565 nonwhites and among men under age 40. Tuberculous lesions were found in the genito-urinary organs in 3.1% of necropsies, in 4.5% of persons harboring unhealed tuberculous lesions who died from other causes, and in 26% of those who died from tuberculosis. 85% of men with tuberculous lesions in the genito-urinary system had caseous or cavitating pulmonary foci. 45.9% of those presenting tuberculous lesions in the genito-urinary system died from generalized miliary tuberculosis compared with only 3% of those with no tubercular foci. It is hypothesized that individuals who develop genito-urinary tuberculosis have an impaired resistance to infection in general. Renal lesions were twice as frequent as those in the prostate and 3 times as frequent as those in other genital organs. In tuberculosis of the genital system, the prostate, seminal vesicle, and epididymis were all involved in 63% of cases, the prostate alone in 29%, and the seminal vesicle or epididymis alone in no cases. Involvement of the prostate is believed to succeed renal involvement in a high proportion of cases. The 6 patients who had an epididymectomy prior to death all died from tuberculosis, with both prostate and seminal vesicles affected, indicating that the procedure is not effective in genital tuberculosis. A clinical diagnosis of tuberculosis was recorded in 80% of patients with genito-urinary tuberculosis, but genito-urinary disease was recognized in only 18%. Only half the patients with tuberculous renal cavity and 40% of those with necrotic but unexcavated renal lesions presented urinary symptoms. Determination of the sequence in which organs of the genito-urinary system are affected will require a meticulous search for minute tuberculous foci prior to clinical manifestation of disease or development of lesions noted at necropsy. Such study will permit confirmation of the assumption that tuberculous lesions of the genital organs are not secondary to tuberculous lesions in the kidney.
In utero infection of the fetus by herpes simplex virus.
Case histories are presented of 2 premature infants with herpes simplex virus (HSV) infection occurring in utero, probably as a result of transplacental transfer of the virus. Case 1, a 969 gm girl who died at 71 hours of age, was noted at birth to have vesicles and bullae filled with clear or serosanguineous fluid. Viral cultures of the skin lesions were positive for HSV. A significant amount of immunoglobulin M (IGm) was present in the infant's serum and the neutralizing antibody (NA) titer to HSV was 1:8, suggesting that the fetus produced antibody in utero. The mother's serum contained 240 mg % of IGm, with a NA titer of 1:32. The father's serum NA titer was 1:64. Case 2, a 1960 gm infant, showed small, circumscribed areas of erythema at 1 hour of age. The skin lesions progressed until death on day 11. A diagnosis of generalized HSV was made, and HSV was isolated from the brain at autopsy. This infant's serum did not contain neutralizing antibody to HSV. Neither infant was exposed to an infected mother, father, or hospital worker. Such exposure accounts for 40% of neonatal HSV disease. The presence of lesions at birth in these 2 cases rules out postnatal exposure since HSV has a minimum 4 day incubation period. An animal study has indicated that transplacental transmission of HSV is the route of infection in utero. Maternal viremia associated with subclinical infection may be a significant source of herpes virus. Another possible source of infection is ascent of HSV from the maternal genital tract, particularly when manipulative procedures are attempted during the pregnancy. Treatment of HSV infection in newborns with gamma globulin or convalescent serum is nonspecific and ineffective. Prevention of contact with infected individuals remains the most important factor for control of herpetic infection.
Bacteriologic observations derived by culdocentesis in 17 women with gonococcal endometritis-salpingitis from whom 1 or more bacteria were isolated are reported. Neisseria gonorrhoeae was cultured from the cul-de-sac in 11 cases and identified by Gram stain in 1 additional case. N. gonorrhoeae was the only isolate in 5 of these patients. Concomitantly with N. gonorrhoeae, aerobic bacteria were recovered in 2 cases and multiple anaerobic bacteria in 4 cases. In the remaining 6 cases, only aerobic and anaerobic organisms were isolated. Analysis of the Gram stain of the endocervix revealed the presence of intracellular gram-negative diplococci in 10 of 11 smears where N. gonorrhoeae was isolated. Diplococci were not demonstrated when N. gonorrhoeae was absent from the culdocentesis fluid. The data tend to refute the concept of a polymicrobial etiology for pelvic inflammatory disease, suggesting instead progressive anaerobic superinfection with nonrecovery and probable elimination of N. gonorrhoeae. The presence of aerobic/facultative anaerobes with obligatory anaerobes argues against an end-stage anaerobic environment.
Paired sera from 60 consecutive patients with acute salpingitis, confirmed by laparoscopy, were examined for serum antibodies to Chlamydia trachomatis, Mycoplasma hominis, and Neisseria gonorrhoeae. By a microimmunofluorescence (MIF) test, IgM or IgG antibodies to C. trachomatis or both were present in sera from 80% of the patients; by indirect hemagglutination (IHA) tests, antibodies to M. hominis and N. gonorrhoeae pilar antigens were present in 40% and 18% respectively. In a control group of 50 pregnant women, antibodies to the same 3 organisms occurred in 8%, 8%, and 6%. Evidence of current chlamydial infection was found in 35 (58%) and of current gonococcal infection in 5 (8%) of the 60 patients by culture or serological tests, or both. The results of chlamydial antibody tests correlated with the severity of the tubal inflammation (shown by laparoscopy) and the duration of lower abdominal pain before attendance. The predictive values of a positive and a negative MIF test result were 44% and 83% respectively and of the IHA gonococcal antibody test, 36% and 100% respectively. Significant rises in titer of antibodies to M. hominis were found in 12% of the patients. A 4-fold or greater rise in titer indicated probable double infections with chlamydia and mycoplasmas in 7% of patients. Thus, at the present, gonococcal salpingitis appears to form only a small proportion of all cases of salpingitis in southern Sweden, and in patients with nongonococcal salpingitis infections with C. trachomatis and M. hominis commonly occur. (author's modified)
In the Scandinavian countries, Chlamydia trachomatis seems to be the most common cause of sexually transmitted diseases, including acute pelvic inflammatory disease (PID). Chlamydial infection of the female genital tract may induce cervicitis. A correlation between the occurrence of C. trachomatis and cervical dysplasia has been found. The organism may reach the uterine endometrium via the cervical epithelium, producing endometritis. From the uterine mucosa, the infection may spread canalicularly to the fallopian tubes, where it may induce PID. Chlamydial infection is also associated with perihepatitis (Fitz-Hugh Curtis syndrome). In addition, chlamydial genital infection seems to be an important cause of sterility. Experimental infection in grivet monkeys with C. trachomatis results in cervicitis, endometritis, PID, and perihepatitis. (author's)
Antibodies to Mycoplasma hominis in patients with genital infections and in healthy controls.
To examine the relationship of Mycoplasma hominis to lower genital tract (LGT) infections, 355 sera from 52 women with acute salpingitis, 70 women with infection confined to the LGT, and 154 healthy women were analyzed for antibody to M. hominis by means of the indirect hemagglutination (IHA) technique. These results were compared with the finding of M. hominis in cultures. The distribution of IHA antibody to M. hominis among women of different ages (1-73 years) was found to be highly correlated with the occurrence of the organism in the LGT and with the prevalence of genital infections. 16 of the salpingitis patients from whom more than 1 serum specimen was collected had IHA antibody to M. hominis at a titer of 1:16 or greater. The organism was isolated from the cervix in all 16 of these cases and from the fallopian tubes in 3 patients. Overall, M. hominis was isolated from 36 (69.2%) of the 52 women with acute salpingitis and 25 of them had a titer of 1:16 or more. Antibody to M. hominis was found in 59.6% of the women. Among the women with LGT infection, M. hominis was recovered from 38.6% and IHA antibody to the organism at a titer of 1:16 or greater was found in the sera of 27%. Anitbody to M. hominis was noted in 10.5% of the sera of the 57 nonpregnant healthy women of childbearing age, 8.5% of healthy pregnant women, and in none of the prepubertal or postmenopausal healthy women. The organism was isolated from 14.9% of the healthy pregnant women, but from insignificant numbers of the prepubertal, menstruating, and postmenopausal cases. Overall, M. hominis was isolated from 73 women in the study and their sera contained antibody to the organism at a titer of 1:16 or greater in 42 instances (57.7%). The corresponding figure for the 203 women from whom the organism was not cultured was 16 (7.9%). The difference between these 2 incidences was highly significant (p>0.001). Of the 16 women whose sera contained antibody to M. hominis but from whom the organism was not cultured, 8 had signs of LGT infection and 4 had a recent history of infection. Additionally, 73 sera from male venereal disease clinic patients and from healthy men were compared. Antibody to M. hominis was found in 30% of sera from the former group but in only 4% of the latter group. (summary in FRE)
Chlamydia trachomatis infection in patients with acute salpingitis.
The prevalence of Chlamydia trachomatis in the cervix and fallopian tubes of patients with acute salpingitis was examined. Cycloheximide-treated McCoy cells were used as the growth medium. For purposes of comparison, women with infections confined to the lower genital tract and women without signs of genital infections were also studied. C. trachomatis was isolated from the cervix in 19 of 53 patients with acute salpingitis, in 1 of 18 lower genital tract infections, and in none of 12 without signs of genital infection. C. trachomatis was recovered from 6 of 20 valid specimens from the fallopian tubes of the patients with acute salpingitis. Our results indicate that chlamydia is a common etiologic agent in acute salpingitis. (author's modified)
South India: yesterday, today and tomorrow: Mysore villages revisited.
An interdisciplinary approach to the study of development at the micro-level was employed in an effort to examine the interaction between economic and other variables within a social system. The 1st field work was conducted in South India in 1954-56, when the impact of irrigation on the economic and social organization of 2 villages within a regional economy was studied. Dalena, a dry, and Wangala, a wet village, are situated close to each other within the same culture area near Mandya town in Mysore State, South India. These particular villages were chosen because of their multicaste compostion and because they were then still outside the sphere of the Community Development Project. Results wre published in 1962. The villages were revisited after a lapse of 15 years, and this study enables an identification of the trends of change in these 2 South Indian villages, and within the different sections and economic strata in each of them, and an analysis of the various economic, political, and social factors and their interactions responsible for the observed changes. The sample was random insofar as the actual households in the sample were selected at random, but it was at the same time stratified in as much as households had been previously put into economic categories on the basis of landholding and the size and age composition of the household. The Wangala sample was made up to 64 of the 192 village households; of the sample of 51 of Dalena's 153 households, 3 had to be discarded. Dalena's population has increased at an average annual rate of at least 2.5% over the last 15 years. Family planning, although widely advocated in Mandya district, has not been accepted by many villagers, natural population increase must be expected to continue at least at its present rate. Unless migration takes on unprecedented proportions, Dalena's population is likely to double within the next 30 years. There is little chance that within this period canal irrigation will bring water to Dalena, though there is a possibility of more efficient pump irrigation being introduced to irrigate the village dry land and thereby increase agricultural reproductivity. If this were accompanied by the introduction of high yielding varieties of millet and paddy seeds comparable in result with the high yielding wheat varieties, Dalena might be able to produce overall sufficient crops to feed its population for the next 10-15 years, but in view of past trends such expectations seem optimistic. More realistic is the assumption that population will continue to grow much faster than the increase in village food production. Wangala's population also must be expected to continue growing. Wangala men are even less interested in family planning than are their Dalena counterparts. Wangala's population will problably double in about 25 years. If in the meantime a high yielding variety of paddy can be successfully introduced this will obviously increase the carrying capacity of irrigated land. Although Wangala has been incorporated in the cash economy, farmers are still only secondarily cash croppers. Their basic concern is to grow sufficient subsistence food.
Article 19 of the Constitution of the International Labor Organization (ILO) provides that Members shall report to the Director General at appropriate intervals on the position of their law and practice in regard to the matters dealt with in unratified Conventions and Recommendations. The reports summarized in this volume concern the Migration for Employment Convention (Revised) (No. 97) and Recommendation (Revised) (No. 86), 1949, Migrant Workers (Supplementary Provisions) Convention, 1975 (No. 143) and Migrant Workers Recommendation, 1975 (No. 151). The governments of member States were asked to send their reports to the ILO Office by July 1, 1979, and this summary covers country reports received by the Office up to November 1, 1979. Reports are included for the following countries: Argentina, Austria, Belgium, Benin, Bolivia, Botswana, Brazil, Cameroon, Colombia, Congo, Cuba, Cyprus, Czechoslovakia, Dominican Republic, Egypt, El Salvador, Fiji, Finland, France, Gabon, German Democratic Republic, Guyana, Hungary, India, Japan, Kuwait, Lebanon, Luxembourg, Madagascar, Malaysia, Mali, Malta, Mauritius, Mexico, Mongolia, Morocco, Netherlands, Niger, Nigeria, Norway, Pakistan, Panama, Peru, Philippines, Poland, Portugal, Romania, Rwanda, Senegal, Sierra Leone, Singapore, Spain, Sri Lanka, Sudan, Surinam, Swaziland, Sweden, Switzerland, Tanzania, Turkey, USSR, UK, Uruguay, Venezuela, and Zambia.
In vitro fertilization's future looks bright.
The 1st birth of a human "in vitro baby," in England in 1978 was followed by successful pregnancies in Australia, England, and the US. At this time, more than 100 women are pregnant after in vitro fertilization procedures, and there have been about 40 live births. Conventional methods to predict ovulation--basal body temperature graphs, cervical mucus changes, vaginal cytology, and serum hormone parameters--can predict only approximate time, and more precise methods of timing are essential to success. To ensure the recovery of mature oocytes, ovulatory function is monitored with real time ultrasound and rapid estrogen determinations. Real time is good for watching follicular changes on a daily basis. The 1st scan is performed with a real time sector scanner 1 day after the last clomiphene dose. At that time, the dominant follicle or follicles visualized should be at least 14 mm in diameter. If no follicle is adequately developed, therapy is extended 1-3 days, with the addition of hMG. Daily monitoring is continued until the follicle reaches 18 to 20 mm in diameter. At this point, blood samples are obtained twice daily and estradiol is measured by rapid radioimmunoassay. Once the preovulatory surge of estradiol appears 4000 IU of human chorionic gonadotropins (hCG) is given, and laparoscopy is performed precisely 36 hours later. This timing is essential because the eggs will be released spontaneously 38-40 hours after the hCG injection. Mature oocytes were obtained in 23 of 23 treatment cycles. This method, which combines ultrasound monitoring of the follicles' growth with the production of estradiol, ensures that the aspirated oocytes are mature and capable of fertilization. As long as luteinizing hormone (LH) levels are basal, the laparoscopy is performed. The male partner supplies a semen sample by masturbation approximately 5-7 hours after successful oocyte recovery. The sperm count and motility are estimated, and if these parameters are adequate, a 0.5 mL aliquot of the semen is washed in Ham's F-10 solution by a 2 wash technique. After removing the seminal plasma, the spermatozoa are incubated for an additional 40 minutes. Then 500,000 motile spermatozoa are added to each oocyte culture tube and incubated for 18 hours. The embryos are deposited by injecting 0.05 mL of Hepes buffer solution through a catheter. After 10 hours in Trendelenburg position, the patient leaves the hospital to remain at bedrest for the next 36 hours. Before 1981, overall pregnancy success ranged from 1% to 8% worldwide. Today the worldwide pregnancy statistics are between 17-20%. Before the rate of successful pregnancies can be increased further, several factors need to be improved.
Malarial infection of the placenta and foetal Nutrition.
The data in this study of malarial infection of the placenta and fetal nutrition were otbained from consecutive live singleton births to African women, mostly of the Sukuma, Nyamwezi, and Luo tribes at the Government Hospital, Mwanza (East Africa). Thick smears were made from the maternal side of the placenta and the sex and birth weight of the child noted. The slides were stained with Giemsa stain and each examined by 2 laboratory technicians for at least 1/2 hour by each, i.e., 1 hour in all, before being pronounced negative. Of a total of 400 smears, 21.5% contained malaria parasites and of these 82.6% were Plasmodium falciparum, 14.0% P. vivax, and 3.5% mixed infections. The placenta frequently contained large numbers of schizonts in various stages of growth although the peripheral blood of the mother may have few or no parasites present. Conditions in the placenta would seem to be suitable for the multiplication of malaria parasites in isolation from the rest of the circulation. Some placental smears were so closely packed with segmenting parasites that the appearance resembled that seen in the peripheral blood in cerebral malaria. Biochemical determinations were begun after the placental smear examinations had been under way for some time. Cord blood was taken during the 3rd stage of labor and a sample of venous blood obtained from the mother within a few hours of delivery. Whole blood was taken for hemoglobin, packed cell volume, and ergothioneine determinations, the latter after storage in the deep freeze. In plasma, estimations of proteins and vitamin A were carried out, deep freezing until required. The data of the Nigerian workers and these results are presented in table form for comparison. All showed a lower mean birth weight in the infected group. After division of the data on the basis of sex of the fetus the mean birth weight in the infected males was actually higher than in the noninfected. This tended to minimize the lowering effect of the female group when the sexes were considered together. Sex differences were not apparent for the biochemical data and the pooled results for mean corpuscular hemoglobin concentration, plasma vitamin A, red cell ergothioneine, and plasma proteins did not show any differences between infected and noninfected groups. Vitamin A was selectively absorbed by the fetus in the presence of maternal deficiency.
The occurrence of classic Mycoplasma, T-strain Mycoplasma, bacteria, and Trichomonas vaginalis in the uterine tubes of laparoscopized patients with acute salpingitis was investigated. Cervical and urethral specimens were also obtained. Women with infections confined to the lower genital tract and healthy females were investigated also. The 50 patients in the salpingitis group presented with a history and clinical signs suggestive of acute salpingitis. In all cases the diagnosis was confirmed by laparoscopy. In 50 women with infections confined to the lower genital tract, 2 of the following signs had to be present as diagnostic criteria: purulent or sanguino purulent discharge from the cervical os, abnormal pain on bimanual palpation of the cervix, or reddened vaginal mucosa. None of the group of 50 noninfected controls had any symptoms referable to infection in the genital tract. M. hominis was isolated from the cervix in 62% of the cases of salpingitis, in 46% of the cases of infection of the lower genital tract, and in 4% of the healthy women. M. hominis was isolated in pure culutre from the fallopian tubes in 12.9% of the patients with salpingitis who harbored M. hominis in the cervix. No significant difference was demonstrated in the occurrence of T-strain Mycoplasma in women with (50%) and without genital infections (44%). In 2 cases of salpingitis, T-strains were recovered from the uterine tubes. N. gonorrhoeae was cultured from the cervix in 34% of the patients with salpingitis but from the uterine tubes in only 4 cases. In only 3 cases were bacteria, apart from N. gonorrhoeae, isolated from the fallopian tubes in cases of salpingitis. T. vaginalis was recovered from the uterine tubes from 1 patient with infection of the lower genital tract, but there were no isolations from any of the patients with salpingitis. In addition to providing an objective means of diagnosing acute salpingitis, laparoscopy has offered excellent possibilities for obtaining samples directly from the fallopian tubes.
Impact of VD on the fertility of the U.S. black population, 1880-1950.
Despite the absence of hard data about venereal disease (VD) and fecundity changes in the black population, it is possible to go beyond speculation and suggestion to areas of circumstantial evidence concerning these variable sand their relationship. The only detailed effort in this direction appears to be the work of Reynolds Farley. In "Growth of the Black Population" (1970), Farley examines variables that might be used to explain the black fertility decline between 1880 and 1936. He concludes that this decrease appeared to be brought about by alterations in health conditions which were unfavorable to fecundity. The principal fertility inhibiting pathologies which Farley studied were pellagra and VD. Farley sees changes in VD prevalence as an important determinant of the fertility decline before the Depression and the following rise in the birthrate. Discussion examines some of the arguments used to support this conclusion and will offer a more conservative interpretation regarding the importance of VD as it relates to the history of the black population. Attention is directed to 3 questions: did VD actually become more prevalent between 1880 and 1935; was the sudden increase in fertility around 1936 preceded by the effective control of VD in the black population; and what was the quantitative physiological impact of VD on black fertility. Farley's effort to show that VD prevalence increased from 6.5% to 25.2% between 1918-40 damages his argument that an increase in VD prevalence was an important determinant in the trend toward lower fertility rates. Almost 80% of the black fertility decline between 1880 and 1936 occurred prior to 1918. In sum, it is difficult to infer from these sources that VD prevalence increased anywhere near 4 fold between 1918-40. A considerably lower figure seems likely. It is unlikely that the quality of treatment before the mid 1940s was at a level which could be expected to substantially reduce the prevalence of syphilis or gonorrhea. Regardless of treatment quality and government programs, the question is how likely were rural and urban blacks to avail themselves of proper treatment. It appears that during the late 1930s and early 1940s the level of public knowledge about such matters as where to receive treatment was unequivocally poor, particularly among blacks. The sudden rise in fertility around 1936 does not appear to have been preceded by the effective control of VD in the black population. Even if the unrealistic assumptions of a zero to 25% syphilis prevalence increase and a zero to 50% gonorrhea prevalence increase are accurate, such increases could account for only about 20% of the observed natality change.
The politics of the barrios of Venezuela.
In the barrios--the squatter settlements--clustered in and around every city in Venezuela live most of the hundreds of thousands of poor peasants who have migrated to the cities from rural areas during the last 25 years. This study provides background information regarding this migration and examines the physical, economic, and social conditions of the barrios; analyzes the political behavior and attitudes of the barrio residents, describing how these people have been affected by the urban environment and particularly by the process of modernization, by the municipal and state governments, and by the political parties; assesses the role that the barrios have played in national politics; and reviews certain problems related to their current political status. The study is an outgrowth of work over the 1961-64 period with a private, nonprofit, urban community development organization called ACCION en Venezuela. There were 4 main sources for the material on which the study is based: observations of the daily political behavior of the barrio residents; innumerable conversations with men and women of the barrios along with officials, social workers, and other outsiders who were in contact with barrio residents; the project reports of the ACCION workers; and individual censuses taken by barrio leaders in conjunction with ACCION workers. The number of inhabitants of most barrios ranges between 1500-2500. The density of population varies considerably. When one compares the living conditions of families in different barrios, it is clear that some have been more fortunate than others. Their private and community facilites are in widely varying stages of development. The 2 factors most responsible for the variations are the terrain on which a particular barrio is built and the age of the barrio. The Revolution of January 1958 ushered in a new and totally unprecedented phase of barrio development. Restrictions on land settlement were immediately lifted, and families poured out of their crowded ranchos to grab vacant land on the outskirts of the cities as quickly as possible. The process by which a barrio is formed determines to a high degree the subsequent political life and activities of the residents. Most of the factors which later play an important role in community affairs are introduced at the inception of a barrio. With a few exceptions, barrios are created by the illegal possession of public or private land--a mass movement popularly termed an "invasion." In some instances, the settlement process is slow and may take several months to complete, but in most barrios created since 1958 the settlement may take several months to complete, but in most barrios created since 1958 the settlement process is completed within a few days. As the barrio people are increasingly affected by the process of modernization taking place in their various cities, social and economic differences develop among them. One can detect a definite evolution of the political convictions of the barrio people as they come increasingly under the influence of modernization and industrialization.
Ethnic differences in mortality in the nineteenth century: a case study of Philadelphia, 1880-81.
Comparisons of the mortality levels of Philadelphia's population differentiated by race and place of birth show that only the black/white differential in mortality is substantial in 1880. The native white population and the German population had levels of mortality which were very similar to each other and only slightly lower than that of the Irish population. The life chances of the ethnic groups were consistent with the occupational status of the groups. However, an indirect standardization procedure indicated that the mortality levels of white men could be explained by their occupational status, while black men had considerably higher mortality than would be expected from their distribution by large occupational categories. Members of ethnic groups did not face consistently worse life chances in areas inhabited by many other members of the same group. This result is probably explained by both the low levels of ethnic segregation and the lack of effective medical and public health services in the 19th century city. All ethnic groups did face worse mortality conditions when living in areas inhabited by many low status people. This mortality differential appeared to be largely a result of the individual level correlation between occupational status and mortality, but a small ecological effect on life chances was also observed. (author's modified)
Slums and squatters in South and Southeast Asia.
Discussion relies on a review of the data available in terms of slums and squatters in Asia and in other developing countries, focusing primarily on the question of whether slums and squatters are developmental or not. The question is divided into what slums and squatters mean in terms of economic and social (including political) development. The economically relevant questions asked include: do squatters and slum dwellers contribute to production of goods and services; are they integrated with the urban and/or national economic system; and do they contribute to capital formation; and are squatters and slum dwellers upwardly mobile economically. For social development, relatively simple indices were used: social stability or the absence of disruptive events such as revolutions and riots in the urban areas; social and political participation of squatters and slum dwellers in community, city, and national affairs; integration of squatters and slum dwellers with the larger society; and openness of squatters and slum dwellers to external influences and values. Throughout the limited literature on slum dwellers and squatters in South and Southeast Asia, there is an air of optimism, based in part on a distinction between urban processes in South and Southeast Asian cities and those that occurred in the West. Mainly, it is founded on actual studies and surveys that have attempted to view the slum and squatter communities as they are related to the larger urban and national processes of which they form a part. The evidence suggests that slums and squatter communities contribute to economic production in several ways. They appear to be more closely integrated with the larger economic system than a structural and sectoral economic analysis tends to show. Living in the slums and squatter areas offers many opportunities for saving and for capital formation. Also, there is evidence of economic social mobility in the slums. Socially, slum and squatter areas do not appear as disruptive and unstable as their physical appearance often suggests. The value system of slums continues to be largely rooted in a traditional rural origin and it tends to be conservative even as it emphasizes personal and community improvement. Survival of the rural value system accounts for high social and political participation, yet as slum and squatter communities grow older, organizational behavior akin to labor unions and other more structured organizations replace the traditional practices. The politicalization of the slum contributes to its greater integration into the larger polity and society. Empirical studies and surveys of a comparative nature are required to validate these optimistic assertions of the nature and function of the slum and squatter community in South and Southeast Asia.
Slums are for people. The Barrio Magsaysay Pilot Project in Philippine Urban Community Development.
This study of Barrio Magsaysay, a pilot project in Philippine Urban Community Development, raises certain questions, including: what, in reality, is a slum; what physical, social, and psychological factors mark an area as a slum and another as a run-down, but viable community with character; what value judgments are expressed when an area is termed a slum; and how do these value judgments affect the ability to do something about the slum problem. An attempt is made in this book to take a second look at urban slum squatters, especially in the developing countries. It provides a close-up view of 1 community in the Philippines. The 10 chapters cover the following: slums and squatters (the extent of the problem, dealing with slums in terms of on-site housing, relocation, reasons for relocation and on-site housing failures); the Barrio Magsaysay Project (rural community development precedents and urban community development--basic urban community development approach, advantages and disadvantages of urban community development, program initiation, theoretical moorings, action research orientation, training the urban community development workers, and previous training), physical characteristics and legislative history of the Barrio Magsaysay; the people--general profile, age, education, income, and length of stay in Barrio Magsaysay); community leadership; entry (research survey, service impact, political officials, traditional government workers, social activities, economic appeals, and appeal to main community interest); interagency cooperation; urban community development projects (service impact projects, community organization projects, and income-producing projects); savings and slum life; and the future of urban slums. The research findings in Barrio Magsaysay revealed the existence of a sense of community among urban squatters and slum dwellers. Research surveys pointed to the fact that slums are the real "transitional societies" that social scientists have been describing in their analytical models. For most slum dwellers are rurall migrants in the process of becoming rural men. The slum and squatter problem at this time is not dependent on overpopulation. The main cause is the maldistribution of the population into certain growth points. Policies and action programs are most urgently needed because the rural programs of the government are already bearing fruit, and 1 side effect of their success would be rural-urban migration. With roads improved, the people displaced from agricultural employment will find their way to the cities. Clearly, solving 1 set of problems creates another.
Statistics of international migration.
This discussion of statistics on international migration considers the need for data on international migration, recent patterns of international migration, sources of the data; and national definitions of international immigrants and emigrants. Primarily, the text is based on 3 studies prepared by the Department of International Economic and Social Affairs on the UN Secretariat. Due to the large numbers involved and, more particularly, because the sex and age structure of migrants frequently differs substantially from that of the rest of the population, migration can have pronounced effects on population composition, the rate of natural increase, and the supply of human resources. Information on the number, sex, and ages of individuals entering or leaving a defined area during a given period of time, together with data on the number of persons enumerated in that area at the beginning of the time interval and the births and deaths occurring during the interval, is important for the estimation of the size and structure of the population at the end of the interval and for the preparation of population projections. Thus, the data on migration forms an integral part of the totality of a country's demographic statistics. For the calculation of merely crude rates of population increase, it is sufficient to have only the net difference between the numbers moving into a territory and the numbers moving out of it. Absolute numbers alone are not sufficient for preparing population projections and for the examination of the impact of migrants on the various economic, social, and cultural aspects of normal life and of the concurrent effect on the migrants themselves. Since 1950 important changes have taken place in international migration patterns. Primarily, the main currents of migration are now from the less developed countries to the industrialized countries as a result of differential economic and demogrpahic conditions. It is conservatively estimated that in mid 1974 there were about 9.5 million immigrants from the world's less developed regions living in the industrialized nations of Northern and Western Europe, Northern America, and Oceania. Migration statistics are obtainable from border collection, from registration, and from field inquiries, and each of these sources is reviewed. The advantages and disadvantages of each of the 3 methods of obtaining information are identified. As a guide to users of the data presented in the statistical tables on migrant flow, 2 tables present available national definitions of immigrants and emigrants respectively along with analysis of the elements of the concepts used in the definitions. The tables are abridged from results of the study of national practices which was conducted by sending a questionnaire on national practices to each national statistical office. 116 countries reponded to the request for the national definition of an immigrant, and 96 countries supplied a definition of an emigrant.
International migration policies and programmes: the view since Bucharest.
Since the World Population Plan of Action was drafted in 1974, there have been important changes in the volume, direction, and characteristics of international migration flows. Discussion focuses on recent policy developments with respect to permanent immigration, labor migration in developed and in developing countries, undocumented/illegal migration, and refugees. The number of places for permanent immigrants is relatively small in all world regions. The 4 traditional immigration countries--the US, Canada, Australia, and New Zealand--have accepted a total of less than 1 million immigrants per annum in recent years. All of these countries revised their immigration policies beginning in the 1960s, with the policies becoming more "universalist" (in the sense that they accepted immigrants on a wider geographical basis) yet generally more restrictive. Utilizing quotas and, in some countries, "point systems" or numerical weightings, the policies of the traditional immigration countries remain heavily biased toward family reunion, but also give preference to immigrants with assets, education, and specific skills. Given the current economic prospects and domestic political concerns of these countries, their restrictive immigration policies are likely to remain in force in the foreseeable future. A clear and growing preference exists in all world regions for temporary rather than permanent workers. As the size of the foreign population in and outside the labor force has continued to increase in most of the countries of Western Europe, as a result both of family immigration and of natural increase, a major challenge facing the host governments has ben devising policies to promote the integration of these workers and their families without incurring domestic political resentment. In recent years there has been slow but steady progress in improving the economic and social position of foreign workers and in granting them limited political rights. The decision to halt migration after 1973, which had profound effects on the sending countries, was a unilateral decision that was made by the immigration countries. Until the 1970s, the capital rich countries in Northern Africa and the Middle East maintained a "laissez faire" position with respect to their labor shortages, permitting migrant workers from neighboring Arab countries to enter with a minimum of control. By the mid and late 1970s, the receiving countries needed increasingly large supplies of labor, which they obtained from a number of Asian countries. The future of the large numbers of foreign workers who remain in the receiving countries remains uncertain. The policies of the countries that export labor to the captial rich countries have focused largely on recruitment, although they cover a broad range of approaches, from the highly organized "project package" approach to simple manpower export. Illegal migration has become an area of active policy concern. There is a tendency for a large number of governments to be moving in the direction of stricter controls over illegal migration. Governments have at times reverted to a unilateral position in regard to refugees, lowering quotas, contributing less, or even completely revising their policies.
Economic development and urbanization.
The current rapid pace of urbanization in developing countries, and particularly in Asia, should be taken as a welcome indication of development, yet this rapid pace is regarded with alarm by many eocnomists, sociologists, and political scientists interested in the developing world as well as by political authorities in the countries involved. The search for an acceptable allocation of resources between large cities and small and between the development of urban centers and hinterland may conveniently begin with a review of arguments and theories critical of the current state of affairs, followed by an attempt to define an efficient urbanization strategy congruent with economic and social development goals. In appraising the overurbanization argument, it is necessary to separate fact from fiction. Asia's urbanization occurs under conditions of greater rural population pressure than was the case in 19th century Europe. Asia's current rate of industrial job creation barely surpasses the rate of population growth. Consequently, a large proportion of the inmigrants into urban areas goes into work in the "unorganized" industrial sector, into trade, tertiary activities, and varieties of more or less casual work. This being the case, the distinction between rural "push" and urban "pull" remains irrelevant. What causes migration is the difference between rural and urban livelihood opportunities. The fact that migration into urban areas continues shows that there is a continuing difference between levels. If restrictive measures were taken to slow down migration, the potential migrants would be condemned to a lower living standard. It is also too easy to overstate the drain of the hinterland argument. Overurbanization does not mean that the cities of the Indo Pakistani subcontinent are unduly favored. On the contrary a progressive deterioration of conditions in a number of major urban centers is all too visible. India and Pakistan face a serious problem of underinvestment in urban housing and in urban amenities. Given the limited resourcet in urban housing and in urban amenities. Given the limited resources and the rapid rate of urbanization, the problem is formidable. It is aggravated by the "urban bias" which makes for an uneconomically fast growth of cities. Were urban job creation relatively slower, and rural job creation relatively faster, the rate of urbanization and the need for urban investment would be correspondingly reduced. India and Pakistan work to defend a decent standard of urbanization in the face of growing needs and of limited means by enforcing minimum standards applicable to private and public urban construction. The long run remedy must be sought in a technological breakthrough, either in the construction field for the building of cheap permanent urban structures, or in the transportation field, to allow the suburbanization of low income poulation without an excessive burden of transport costs. An interim solution, increasingly albeit reluctantaly accepted in India, consists of the construction of "controlled slums." A rational urbanization policy requires an end to the urban bias in planning. s and the rapid rate of urbanization, the problem is formidable. It is aggravated by the "urban bias" which makes for an une
Compensatory financing facility.
This pamphlet describes the obejctives and modus operandi of the International Monetary Fund's compensatory financing facility. It summarizes the main features of the facility, analyzes the nature of export earnings fluctuations, and explains how the facility operates. The pamphlet includes 4 appendixes which reproduce the compensatory financing decision adopted in August 1979 and list purchases made under the facility until March 1980, illustrate the statistics required for a compensatory financing request, present an algebraic analysis of expert shortfalls, and compare the main features of STABEX with those of the compensatory financing facility. The facility was established by the Fund to provide additional assistance to member countries experiencing balance of payments difficulties arising from expert shortfalls, provided the latter are temporary and largely attributable to circumstances beyond the member's control. Ideally, the facility should enable the member to borrow when its export earnings and financial reserves are low and to repay when they are high, so that its import capacity is unaffected by fluctuations in export earning caused by external events. Assistance extended to the Fund under the compensatory financing facility is additional to other forms of Fund assistance. Because the facility's aim is to cushion the adverse effects which could otherwise have resulted from temporary export shortfalls, assistance under the facility should be provided as soon as the existence of a shortfall can be established. When the shortfall results primarily from a decline in the volume of exports, it is not always easy to determine whether it is due mainly to circumstances beyond the member's control or to inappropriate policies which need to be corrected. The member is generally given the benefit fo the doubt in borderline cases, especially if it has been cooperating with the Fund to find appropriate solutions to its balance of payments difficulties. As with any other drawing from the Fund, a member can draw under the compensatory financing facility only if it has a need to do so in terms of its balance of payments or reserve position or because of developments in its reserves. The amount that a member can draw under the facility is based on the net shortfall in its total export earnings.
AID's course in basic education.
In recent years, steadily declining resources along with an increasing awareness of other development problems gradually led to reduced emphasis on education in the US Agency for International Development (USAID). Commitment to education has stabilized over the past 5 years, but during the 1970s there was a precipitous decline in USAID's funding for human resources developnent in general and basic education in particular. Grant assistance dropped form about US$336 million for the 1960-65 period to about $234 million for the 1971-76 period. Loan assistance underwent a comparable, though less severe decline, dropping 45% form 1966-1976. For comparison, total education and human resources development assistance currently averages US$100 million to US$120 million annually. These trends were in part of a response to budget constraints and challenges in program emphases. Lacking evidence of the overall impact and significance of past USAID educational programs, the growth debate within USAID on whether involvement in the education sector was the best use of foreign assistance funds was not empirically well grounded. Thus, impact evaluations were conducted to assess the extent that completed USAID funded education projects left a lasting social, economic, or institutional imprint on countries in which they were done. The lessons derived from these evaluations are reflected in the Agency policy paper on Basic Education and Technical Training (December 1982) and are being applied to programs in education. The projects and programs evaluated included 2 in Africa, 4 in Asia, 1 in the Near East, and 4 in Latin America. They covered a wide range of USAID development activities over the last 30 years, including the founding of institutions and institutional processes; curricula reform; distance teaching; vocational and nonformal education for out-of-school adults; teacher training; construction and equipping of facilities; and 3rd country training for professional educators. USAID's total expense for these projects and programs was conservatively estimated at US$235 million. Projects and programs that have had the most pervasive impact involved a wide variety of well-financed interventions aimed at solving several interrelated sector problems. Evidence on USAID contributions to economic and social change is sparse and should possibly be the focus of more systematic study. Evidence of institutional impact is much stronger and well documented by the evaluation reports. USAID efforts to reform school curricula appear to have had less than lasting impact. The relative ineffectiveness of curricula reform can be traced to several causes, 1 of which was simply the required investment in equipment, materials, and training. In sum, the impact evaluations confirm that in almost all developing countries there has been enormous progress in the education sector over the past 30 years, and that USAID contributed to this progress.
Impact of foreign remittances: a case study of Chavakkad village in Kerala.
Many Keralites are working abroad and their families depend to a great extent on the money sent by them. This study attempts to examine the impact of foreign money in Kerala (India) based on a survey of 95 households in Chavakkad village. The village was selected as the study area because a large number of persons have left the village for Gulf countries. The area is backward and the main occupation of the people is agriculture. The only industrial activity worth mentioning is beedi making, which provides employment to about 5000 persons. 1 to 3 persons had gone abroad from the 95 households, and the total number of persons abroad was 136. An inquiry as to the previous job of the persons working abroad revealed that 49 of them were unemployed before going abroad. The remainder were employed as beedi makers, tailors, small businessmen, helpers in shops, hotel workers, drivers. 14 persons refused to provide information on previous jobs. Many of the migrants were able to go abroad because of the help provided by persons already at work abroad. 34 persons were helped by relatives, 23 by friends, and 21 went by launch. 21 persons went to Gulf countries in launch from Bombay without any travel documents, but later they obtained the visa and the necessary documents. The 136 persons had gone abroad since the early 1950s but 94 of the 136 had left in the 1970s. Of the 136 persons, 19 were working as construction workers, 18 as hotel workers, 15 in partnership small business, 9 as military helpers, 9 as tailors, 8 as drivers, 4 each as clerks, typists, and houseboys. Other jobs include petrol bunk helper, welder, and carpenter. Money was not received from abroad regularly every month. In a majority of cases, money was sent once in 2 or 3 months. In some cases, money was also sent through a friend who comes home for vacation. 59 persons sent a sum ranging from Rs. 500 to Rs. 750, each per month, to their respective families. 15 persons sent a sum ranging from Rs. 1000 to Rs. 1250, each permonth. Of the 102 persons sending money, most were sending Rs. 400 or more per month. The families receiving money enjoyed fairly good consumption levels. The monthly consumption expenditure varied between Rs. 250 and Rs. 1000. The majority of the households possessed either a radio or a transistor. There has been substantial investment in land and houses. The increasing demand for land has resulted in an increase in the price of land within a 5-year period. The entire income earned by the persons working abroad is either being used for consumption or invested in land and houses.
In accordance with article 19 of the International Labor Office (ILO) Constitution, the Governing Body decided at its 201st Session (November 1976) to request reports on the Migration for Employment Convention (Revised), 1949 (No. 97), and the Migrant Workers (Supplementary Provisions) Convention, 1975 (No 143) from governments which have not ratified them, as well as reports on the Migration for Employment Recommendation (Revised), 1949 (No. 86), and the Migrant Workers Recommendation, 1975 (No. 151). These reports, dealing with the state of law and practice in relation to the standards laid down by the instruments in question, and the reports supplied under article 22 of the Constitution by govenments that have ratified 1 or both of the Conventions, have enabled the Committee of Experts to make a general survey of the situation. Reports have been received from 109 countries either under article 19 of the Constitution of the ILO on Conventions Nos. 97 and 143 and Recommendations Nos. 86 and 151 or under article 22 on the 2 Conventions when they have ratified them. An appendix provides detailed information on the countries that have communicated reports. The plan adopted for this present survey is as follows: preliminary measures of protection--information and assistance and recruitment, introduction, and placement of migrant workers; protection against abusive conditions (migrations in abusive conditions, the illegal employment of migrant workers, and minimum standards of protection); equality of opportunity and treatment and social policy; and certain aspects of the employment, residence, and departure of migrant workers. The vast range of subjects covered illustrates the complexity of the subject of migration for employment. The measures needed for the protection of migrant workers extend beyond their period of actual employment and must cover the initial phase of information, recruitment, travel, and settlement into the country of employment and the regulation of rights arising out of the employment but continuing after its termination. During the period of employment, they go beyond measures dealing exclusively with conditions of work to cover various other aspects of conditions of life which affect the context in which the migrant worker has to work and form the broader framework of the conditions of work and life of migrant workers. Thus, it is possibly understandable that few governments have covered all the subjects dealt with in the instruments in their reports. Convention No. 97 has been ratified to date by 34 countries and Convention 143 has been ratified by 8 States. Problems exist in many member States in affording to migrant workers the guarantees provided for in the instruments.
The fiesta system in the northern Bolivian highlands was analyzed. As social interaction is simplified in the fiesta system, the latter provides a useful tool for analyzing complex or changing social relationships. Fiestas in the northern highlands of Bolivia are based on a variety of systems of sponsorship combined with a system of reciprocal presentations. Sponsors who agree to accept a specific commission, or "cargo," are aided by relatives, friends, community, or neighborhood members, and by persons who want to "pass" a cargo at some later date. Most fiestas include 2 types of sponsors: the prestes and the dance group leaders. Sponsorship obligations often accompany political office. Because Aymaras and Mestizos are involved in wide networks of social relationships, they participate in fiestas at considerable distances from their homes. The relationships between the ritual and social dimensions of a small fraction of this network are analyzed, i.e., the fiesta participation of Aymara peasants from Compi, a Lake Titicaca community. Such an analysis entails a step by step description of fiestas in Compi itself, followed by those in the county capital and ending with the fiestas in the city of La Paz where many Compenos have migrated. The analysis revealed that the relationship between the center and the periphery of old La Paz is very similar to that of counties and their surrounding free communities. Similarities in La Paz market fiestas and town fiestas demonstrate that La Paz constitutes merely 1 of a multitude of interconnected market sites, albeit a more complex one. The dance group formation in voluntary associations reveals that La Paz is not a closed system, because these associations maintain intimate ties with the home towns of their members. La Paz fiestas are not unique in kind. The city's fiesta system viewed as a whole is distinguished not so much by individual ritual patterns as by the concentration of such a large number of different patterns and the extent of their linkages outside the city's boundaries. 1 La Paz informant compared the fiesta system to a root growing in many directions at the same time. The analysis of fiestas indicates that it is through such linkages and parallels with institutions in smaller settlements rather than by seeing cities, towns, and peasant communities as separate, bounded entities, that changing Andean social systems can best be studied.
The Cochabamba-Santa Cruz highway in Bolivia.
In Bolivia geographic facts must dominate any discussion of possible strategies for development and the place of transportation in that development. The country is divided between the cold, highly populated, poverty stricken Andean highland region in the western third of the country and the flat eastern lowlands, mainly lush, unpopulated jungles, in the remaining two thirds. Clearly, this geography limits the choice of development policies which are feasible and makes problematical the success of those attempted. The geography makes transportation between regions difficult, and it also makes the provision of better transportation facilities very expensive. It is a prime objective of Bolivian policymakers to open up the lowlands to exploitation by Bolivians. The exploitation of the lowlands by Bolivians has and will require transportation linkage with the highlands. An attempt is made to evaluate the costs and benefits of 1 such linkage, the Cochabamba-Santa Cruz highway, which was opened to traffic in 1954. The hope is that the methodology illustrated by this computation will have applications in other contexts, particularly cases in which the purpose of a facility is to open up an undeveloped and underpopulated area. The internal rate of return is used as a measure of benefit over costs. In this method a discount rate (internal rate of return) is chosen which equates the present value of the stream of costs with the present value of the stream of benefits. In calculating the costs it is necessary to take account of the fact that the benefits of the Cochabamba-Santa Cruz highway would have been smaller had it not been for the investment in feeder roads, in sugar mills, rice mills, and so on, which have been made in the area surrounding the Santa Cruz end of the highway. As it is impossible to separate out the benefits due to the highway alone, it is best to consider all of the investments as a cost "package." Th cost of the highway and associated investment in Santa Cruz (without discounting) is estimated to be between $73-83 million. Benefits, present and future, can be expected under the following categories: net increase in production for which the highway was a condition; higher standard of living available to those remaining in highlands because of higher average (and marginal) productivity; benefits from colonization, excluding present production of agricultural goods; stimulation of manufacturing because of higher demand and raw material supply; and balance of payments benefits. The net benefits have been calculated as currently running at US$11.3-11.8 million /annum.
The effects of labor emigration on rural life in Malawi.
Great numbers of Malawians have emigrated from their predominantly rural country during the past 80 years to search for work throughout East, Central, and Southern Africa. The Ministry of Labor Report (1962-67) indicated that between 1948-62 a total of 544,000 men, 70,000 women, and 70,000 juveniles had gone to Southern Rhodesia; between 1953-67 approximately 360,000 men went to South Africa; and during those years roughly 69,000 men, 25,000 women, and 30,000 juveniles had made the journey to neighboring Zambia. Smaller numbers have traveled to Mozambique, Zaire, and Tanzania, but the total number of Malawians affected by emigration during the 20th century numbers into the millions. Early accounts of the exodus emphasized the suffering in rural areas resulting from the absence of so many men. This paper, while not denying this fact, suggests that the disastrous effects may have been exaggerated initially, that communal institutions absorbed some of the social shock, and that after the mid 1930s interterritorial labor agreements mitigated the worst economic consequences of emigration. The number of men who could be away from home at any 1 time without causing undue distress to village life has been the topic of diverse estimates. Van Velsen figured that 60-75% of Tonga adult men were absent but stated that there were no serious signs of disorganization in Tonga society. A Belgian Congo Commission reported that not more than 5% of the men could be absent for long periods without adversely affecting local life. Since most migrant analysts concur that the primary motive behind Malawian emigration is economic, encouraging the planning of cash crops must be the proper inducement for men to remain at home. Malawi's 1939 Labor Department Report stated that "emigration is unjust to women in every way," but the songs of the women reveal a less dogmatic attitude toward the traveling of their menfolk. Throughout the 20th century governmental authorities have sought ways to control "free flow" independent emigration which has been more popular than contractual arrangements. Malawians always preferred to choose their own employer rather than to offer themselves to the merices of recruiting agents, but controls were needed. The entire question of the internal effects of labor migration on Malawi's social and economic development needs further study. The relationship of migrants to the government's long range plans to replace traditional land tenure arrangements with private ownerhsip of land is a vital area of study.
It is contended that certain general patterns of city size distributions can be discovered by statistical analysis of changing absolute and relative population sizes for these cities. The 1st stage of the analysis is to determine the degree to which a system of cities may be said to conform to the Paretian hypothesis of lognormality in their size distribution. It was alleged by Pareto that the lognormal distribution of cities was in fact "normal" for a diversified economy subject to a wide variety of competing forces. He applied his analysis in the late 19th century to Italian cities and found a significant correlation between fact and hypothesis. Concern here is with the opportunity to test the conformance of city size distributions in 8 Latin American countries with the Paretian hypothesis. In the period since World War 2 it has become a matter of conventional wisdom to refer to the hyperencephalization of Latin America's system of cities. The data presented demonstrate that this situation of primacy is a recent phenomenon, i.e., a phenomenon of the 20th century. At the end of the colonial period only 1 country had developed an "excessively" primate pattern. The country is Mexico. The condition of lognormality in the 18th and early 19th centuries is not an idicator that the economies of the other 7 countries were then successfully integrated into a systematic hierarchy. There is some possiblity that such a condition could occur simply by chance, given particularly that the Paretian hypothesis already supposed the prior ranking of cities with regard to size. Yet, the conformance between hypothesis and fact was statistically significant. In the 19th and 20th centuries all city systems stopped being identifiably lognormal and became essentially primate. A hypothesis of growing openness of the economies was considered as a possible cause of the shift from lognormal to primate systems. The higher were per capita exports, the more the city size distribution diverged from the lognormal. The finding conformed to Berry's suggestion that as a system is subjected to the greater influence of a single force, the less it will succumb to general forces of entropy which, he contends, produce the lognormal city distribution. The case of Mexico is anomalous since Mexico was the 1st country in the sample to diverge from the lognormal pattern yet had quite low exports per capita. The data may unfairly understate Mexico's true position as a producer of exports. It may be fruitful to consider other causes for the rise of primacy among Latin American cities.
FPA Hong Kong extends services to refugees.
In the 2 years since the 1st Vietnamese refugees reached Hong Kong a total of 2575 births have been recorded, an average of 21/week. This is no surprise since 30% of the female population in the refugee camps is of childbearing age. Of the 22,109 refugees remaining in Hong Kong, 9212 or 38% are children under age 15. The Family Planning Association of Hong Kong, with these statistics in mind, launched a comprehensive project with funds from Population Concern and Oxfam to provide family planning information and clinic services to the refugees. At the start the Association had considerable difficulty convincing the authorities that the refugees needed family planning services. Eventually, the Association convinced the authorities and from June 1978 to February 1979, a total of 960 of the early refugees staying at that time in hotels, tenement flats, and colleges were visited. Last year the Association's field workers contacted 33,000 refugees now staying in camps, only 35 did not want any advice and only 108 wanted no more children. The project has 3 facets: publicity and education; person to person motivation; and clinic services. The working team consists of a project coordinator, a family planning advisor, a Vietnamese nurse, a fieldworker, and 2 Vietnamese fieldworkers. The Association conducts clinic sessions once or twice a week in each camp. 1 of the camps in which the Association project operates is Cape Collinson camp, where 250 refugees are held as prisoners. The women inmates seemed obviously pleased to see the family planning fieldworker with whom they discussed personal problems and from whom they obtained family planning information and contraceptive supplies. In the Chimawan prison camp on the island of Lantau, the Association launched a community-based program for distributing contraceptives. The inmates of Argyle camp and Kai Tak North camp go out to work during the day, the the Association runs its clinic in the afternoons and evenings to cater to those workers. There seemed to be more people attending the family planning clinic than the health clinic, suggesting the high regard the refugees have for the warm and friendly family planning workers.
Towards a system of recompense for international labour migration.
The discussion traces the forerunners of the concept of recompense and the reasons why foreigners are admitted and international migration occurs. It is on these fundamental factors that the idea of pay for another country's labor can and must be established. Attention is also directed to migration characterized by human resource transfer (scope, official or business migration, contract migration, settlement migration, free migration, and irregular migration) and they why, how and how much of recompense (justification, procedure, and amount). Recompense is meant to designate a payment for another country's human resources when one wants to use them. It stands a chance of becoming accepted and acted upon only if 2 conditions are met: it must related to economic or production requirements; and it must be powerfully supported in national and international political arenas. Jagdish Bhagwati was the first to articulate distinct links between the apparent inability of 3rd world countries to catch up with the developed nations and the large scale movement of professional, technical, and kindred workers from the 3rd world to the developed one. He proposed to levy a surtax on the income accruing to brain drain immigrants in developed countries with a veiw toward transferring the receipts to developing countries. It is the state as an institution rather than the migrant as an actor who crucially determines contemporary patterns of migration. A summary table provides a first impression of the kinds of movements that may be liable to recompense. An effort is made to make categories as homogeneous as possible and yet to make them mutually exclusively. Immigration countries should pay recompense to emigration countries whose citizens are admitted because they are needed for the purpose of employment. The philosophy of international distributive justice can be drawn upon to provide a secondary justification for recompense through an analysis of the differential gains from labor migation between immigration and emigration countries. Immigration countries have the undisputed right to close their borders to foreigners when it is in their interest to do so. Emigration countries are denied the right indefinitely to hold back citizens who are "bona fide" emigrants. Again, this provides a supplementary justification for recompense if viewed from the standpoint of international distributive justice. The economic and the legal inequities attaching to international labor migration lend strong moral support to the concept of recompense. A system of recompense needs to be solidly based to prevent a tug of war at the implementation stage.
Shadow households and competing auspices: migration behavior in the Philippines.
The concepts of shadow households and competing auspices are introduced and developed in an attempt to assist in clarifying the role of households and families in migration processes. The household is defined as including all persons committed to a set of residentially centered interpersonal relationships and can be analytically decomposed into a residential household component and a shadow household component. The shadow household consists of all former members who are not now living in a household but whose principal obligations and commitments are to that household. The concept of competing auspices is related to both the gravity theory of migration and the theory of intervening opportunities. It is hypothesized that intentions to move from point X to point Y are, "ceteris paribus," positively related to the presence of relatives and close friends who can help a person at point Y and negatively related to such links at any other point Z. All potential destinations are considered regardless of their location, and the attraction of a destination is measured by the availability and strength of auspices, rather than by sheer population size or economic opportunities. Auspices comprise only one of the many factors influencing migration decisions, but they are frequently an important consideration in the choice of destinations. The concept of competing auspices could be broadened to include other "pull" factors, if desired. The data are derived from a 1980 cross-sectional survey of 1744 adults in the province of Ilocos Norte in the Philippines. Data on remittances, correspondence, and future migration plans all pointed to a strong continuing commitment to the Ilocos Norte household among former household members and those who intend to move out in the future. The survey also confirmed the importance of auspices in potential destinations in both internal and international migration decision making. The presence of auspices also was found to be one of the most important determinants of migration intentions in multivariate analyses. The findings suggest that both shadow households and competing auspices are useful concepts in migration theory. Available data from Ilocos Norte are not ideal for quantifying and testing these concepts, but data from later stages of the Philippine Migration Study will provide additional indicators.
Present-day management of male infertility.
An overview is presented of the management of impaired fertility in men. Laboratory examination of semen, the primary determination of fertility status, is complicated by the lack of criteria of "normal" parameters. Most seminologists agree that fertility is compatible with a count below 20 million/ml, but the quality of motility and morphology is the critical factor. Consecutive semen analyses in the same person can also show great variation, so several specimens should be studied over a period of months. A definite cause for infertility can be found in less than 10% of cases. Half of those with a known cause are azoospermic due to an obstructive lesion of the conducting pathways or to total failure of spermatogenesis. Varicocele and immunolgoic aspects of infertility have attracted recent interest. New investigational methods have identified a substantial retrograde flow down the internal spermatic vein whenever a true varicocele is palpable. Suprainguinal ligation of the internal spermatic vein has been performed in these cases and estimates of improvement in the semen profile range from 30-80% of cases. However, many clinicians have reservations about the overall role of spermatic venous reflex in male infertility. When a significant titer of antibodies is noted, corticosteroids are generally administered. Despite little evident benefit, the trend toward prolonged treatment of infertility with pituitary hormones and stimulants continues. Increasingly, the infertile couple is being treated as a unit. Since specific measures seldom improve the semen profile, attention should be focused on improvement of opportunity for any effective sperm to achieve fertilization. There has been renewed interest in the cervical insemination cap method. About 14% of couples where the man shows seminal impairment conceived by this method, provided some of the sperm are of normal morphology. Artificial insemination with pooled stored sperm has produced disappointing results.
Epidemic kepone poisoning in chemical workers.
From March 1974-July 1975, 76 (57%) of 133 persons who had worked at a pesticide plant that produced Kepone, a chlorinated hydrocarbon insecticide, contracted a previously unrecognized clinical illness characterized by nervousness, tremor, weight loss, opsoclonus, pleuritic and joint pain, and oligospermia. Illness incidence rates for production workers (64%) were significantly higher than for nonproduction personnel (16%). The mean blood Kepone level for workers with illness was 2.53 ppm and for those without disease 0.60 ppm (p<0.001). Blood Kepone levels in current workers (mean, 3.12 ppm) were higher than those in former employees (1.22 ppm). Blood Kepone levels for workers in nearby businesses and for residents of a community within 1.6 km of the plant ranged from undetectable to 32.5 ppb. Illness attributable to Kepone was found in wives of 2 Kepone workers; there was no apparent association between frequency of symptoms and proximity to the plant in the survey of the community population. (author's modified)
Uterine specimens removed from 154 women who attended an infertiltiy clinic in 1967-70 were examined histopathologically. The majority of the women were in the 20-40 year age group. The presenting symptoms included infertiltiy in 56 cases, dysfunctional uterine hemorrhage in 30, and amenorrhea in 27. Postcoital bleeding was reported in only 8 cases; however, this is important since it represents cases of cervical tuberculosis that are often mistaken for carcinoma of the cervix. The endometrium was the site of the lesion in 120 cases. The fallopian tubes were found to be involved in only 11 cases, but this is considered an inaccurate figure because laparotomy was not used. In 1 case, tubercular infection was found in tubes removed due to ectopic pregnancy. The endometrium was in a proliferative phase in 86.6% of cases, secretory in 1.63%, and atrophic in 4.91%. Caseation was present in 6.5%. Genital tuberculosis was found in 6.48% of women with primary infertility and 6.52% with secondary infertility. 5% of the women had a healed pulmonary infection, 5% had abdominal tuberculosis, and 3.27% had adenitis. Treatment was most effective in women with menstrual disorders. Amenorrhea could not be cured in cases where the endometrium was completely destroyed.
Sexually transmitted diseases (STD) in tropical countries differ from those in more developed countries in 4 respects: 1) they are more prevalent, 2) their patterns differ, 3) their diagnosis and management must be modified and simplified due to technological and economic constraints, and 4) complications are more frequently encountered or are the presenting features. Rural and tropical areas show alarmingly high rates of gonorrhea and its complications (especially urethral stricture, epididymitis, pelvic inflammatory disease, and infertility), gonococcal ophthalmia neonatorum, and all stages of syphilis. The whole spectrum of each disease is usually seen, either because treatment facilities are not available, people do not utilize existing services, or treatment is not adequate. This book, aimed at medical practitioners and students in tropical countries, includes chapters on the incidence, clinical manifestations, differential diagnosis, and treatment of syphilis, endemic treponematoses, chancroid, gonorrhea, nongonococcal and nonspecific inflammatory disease and Reiter's syndrome, lymphogranuloma venereum, granuloma inguinale, and other sexually transmitted conditions. An initial approach to STD control should be to establish a model unit with up-to-date facilites for diagnosis and treatment and research and training in the national referral or teaching hospitals. This could be followed by more widespread services, including microscopy, in peripheral units, and more sophisticated testing, such as culturing the serology, at the district or provincial levels. Large cities with a considerable STD problem might consider separate STD clinics within the larger health centers. The private doctors who treat many STD patients should be drawn into the STD control program by offering them free facilities for diagnosis, contact tracing, and postgraduate education. Medical education on STD should also be directed at auxiliary health workers who provide much of the primary care in the tropics. Community education should focus on sexual behavior, condom use, avoidance of self-medication, symptom recognition, early reporting for treatment, and cooperation in contact tracing. Descriptive studies based on adequate district records and limited morbidity surveys should be carried out by community medical officers to determine STD prevalence and identify the groups at greatest risk.
Venereal problems in a developing country.
Venereal disease is a main public health problem, and it was recently placed on the priority list in Uganda. Mulago Hospital in Kampala was found as a venereal disease (VD) clinic at the beginning of the century by Sir Alber Cook. In 1972 about 32,000 new patients were seen in these clinics. During the 1st year of the reestablished clinic paramedical staff were trained to diagnose and treat venereal diseases. All patients with genital sores are examined by darkground microscopy for Treponema pallidum. The staff are also trained in contact tracing. The treatment is provided in the clinic by nursing staff and strict guidelines for treatment of the various venereal and paravenereal diseases are enforced. The main problem in any VD campaign is that of convincing women to come for early examination and treatment, as symptoms of acute gonorrhea are so mild in females they are usually unaware of the possibility of being infected. Another problem concerning women patients is that the microscopical demonstration of gonococci is often insufficient. Culturing of gonococci is essential in diagnosing gonorrhea in females. Since 1972 a central laboratory for this purpose has been established at Mulago Hospital. When in full operation, this laboratory should be able to examine 400-500 specimens a day and can offer its services to other hospitals and to the southern part of Uganda. Diagnosis of syphilis in women is also more difficult. About 75% of men with syphilis are diagnosed in the primary stage of the disease. In contrast, 75% of the females attending the VD clinic are initially diagnosed in the secondary stage of the infection. The importance of careful contact is obvious. A high proportion of false positive tests have been demonstrated in serological testing for syphilis. Many false negative reactions can occur even in secondary syphilis. The introduction of a general VD law in Uganda cannot be recommended at this time. A special legislation for prostitutes has proved to be quite useless in other countries. A single dose treatment with a very high cure rate is of special importance for clinics treating many thousand cases of gonorrhea each year. Gonococci have gradually developed increasing resistance to treatment with penicillin, but full resistance to penicillin has never been demonstrated. In contrast to Neisseria gonorrhoeae, Treponema pallidum is just as sensitive to penicillin as it was when the treatment of syphilis under this drug was introduced in 1943. Chancroid is a common disease in Uganda and the diagnosis is made purely on the clinical aspect of the genital sores and the presence of enlarged lymph nodes in the groin. Lymphogranuloma venereum was not very common in the clinic and granuloma inguinale was not diagnosed in the VD clinic.
Epidemiologic and experimental studies in drinking and pregnancy: the state of the art.
Epidemiologic and experimental studies of the consequences of maternal drinking during pregnancy confirm clinical reports that alcohol in high doses is teratogenic. Alcohol consumed in lower doses has been correlated with intrauterine growth retardation, increased risk of anomalies, behavioral decrements in infants and children, and increased risk of fetal wastage. While evidence linking these effects to moderate levels of alcohol use is growing, there is little agreement on the actual dose at which risks begin, due to the questionable validity of self-reported consumption. Many of the subtle effects correlated with lower amounts of alcohol--growth retardation, minor anomalies, and behavioral alterations--are the same effects which occur in severe degree with high amounts. Thus, a dose-response curve may be emerging, although its existence must be substantiated by further studies. (author's)
A normally progressing pregnancy has been established by implanting an 8-cell embryo into the uterine cavity of an infertile woman. The embryo was obtained by in vitro fertilization of a preovulatory egg aspirated at laparoscopy 28 hours after the beginning of the luteinizing hormone surge during the patient's natural menstrual cycle. Elevated levels of serum human chorionic gonadotropin and progressively increasing levels of total urinary estrogens and pregnanediol confirmed the presence of an early pregnancy. Ultrasound examination revealed an intrauterine gestational sac at 5 weeks, a 1 cm fetus with fetal heartbeat at 7 weeks, and an active, normally growing fetus at 13 and 16 weeks. Chromosome analysis at this time revealed no abnormality, and the alpha fetoprotein level was within normal limits. The patient is due to be delivered on or about June 28. (author's)
T mycoplasmas on spermatozoa and infertility.
The finding that pregnancy was achieved in 30% of couples after eradication of T mycoplasmas led to an investigation of the role of these organisms in infertility. Sperm samples from 7 infertile men with T mycoplasmas in their ejaculate and from 5 fertile controls without T mycoplasmas were analyzed. 1 portion of the sperm specimen was washed in phosphate-buffered saline (PBS). The washed spermatozoa and the supernatants were inoculated onto Shepard's A3 agar and incubated. The percentage of colonies originating from the spermatozoa was estimated. Some of the plates were fixed in 2.5% glutaraldehyde-5% sucrose solution, dehydrated in alcohol, gold shadowed, and examined in a scanning electron microscope. The remainder of some specimens was diluted in PBS, fixed in 2.5% glutaraldehyde, dehydrated in acetone, and examined by scanning electron microscopy. Growth was exhibited in 6 of the 7 cultures of men with T mycoplasma infection, but in none of the controls. 85-97% of the randomly selected T mycoplasmas isolated form the seminal fluid of the 5 cases originated from spermatozoa. Data were not available for the 6th case. Scanning electron microscopy indicated that the colonies originated from the anterior or middle piece of the spermatozoa. Moreover, some of the spermatozoa from the cases had rounded, bud-like outgrowths on the posterior part of the sperm head or on the middle pieces. These outgrowths were not observed in control specimens. These results suggest that T mycoplasmas are attached to sperm cells. However, it is not known whether the T mycoplasma cells adhere to the sperm cells during the passage of the ejaculate through the urethra or at an earlier point. It is possible that T mycoplasmas produce neuraminidase-like substances that interfere with fertilization or development of the fertilized egg. Investigations of this possibility are in progress.
The varicocele and male infertility.
Varicocele, found in 8-22% of the general population but in 21-39% of men attending infertility clinics, is now accepted as an important cause of male infertiltiy. The mechanisms by which varicocele affects fertility remain undetermined; however, decreased testicular size, abnormal testicular histology, and abnormal semen parameters have been noted in patients with varicocele. Sinc the size of the varicocele is not related to the degree of fertility impairment, care must be taken to detect subclinical varicocele. The presence of a small varicocele is suggested by an equivocal venous thrill during the Valsalva maneuver. This can be confirmed by noninvasive diagnostic tests in which the Doppler stethoscope is utilized. Before surgical intervention, other possible causes of subfertility (including factors in the female partner) should be excluded. If no other abnormality is found, and if both decreased sperm motility and increased numbers of tapered sperm and immature germinal cells in the semen are noted, varicocelectomy is indicated. The suprainguinal and high inguinal approaches are currently used for ligation and division of the internal spermatic vein. The safety of the suprainguinal division of the internal spermatic artery in the absence of prior dissection of the spermatic cord at a lower level has been demonstrated by experimental and clinical data. Reviews of the results of varicocele ligation in subfertile men have noted improved semen quality in 55-85% and pregnancy in 25-55% of wives.
Women alcoholics. A review of social and psychological studies.
Research on the social and psychological aspects of female alcoholism is summarized. The literature review is limited to English-language reports appearing since 1950. Women alcoholics, conservatively estimated to comprise 20% of the total number of alcoholics, are often lumped together with male alcoholics in both research and treatment efforts. However, women have been noted to show differences in the pattern and etiology of excessive drinking. In general, women alcoholics have a high incidence of alcoholic parents and are more likely than men to begin drinking heavily in response to a specific environmental stress such as divorce of death in the family. They tend to become problem drinkers at a later age than men, and many have more severely disturbed personalities. Female alcoholism has also been linked to low self-esteem and sex role confusion. However, women alcoholics are not a homogeneous group. There are distinct subgroups differentiated on the basis of race, socioeconomic class, and existence of prior psychological disorders. Some research has related the onset of female alcoholism to dysmenorrhea and menopause, and has pinpointed a relationship between eipsides of heavy drinking and premenstrual tension. Additionally, alcoholism has been found to be highly correlated with specific gyncological disorders such as repeated spontaneous abortion and infertility. However, it has not bee possible to separate out the effects of heavy drinking on physiological functioning from difficulties such as a hormonal imbalance that precede or cause the alcoholism. Future research efforts should extend the use of appropriate control groups. Areas in which more research is needed include the level of masculine identification among women alcoholics, the impact of the changing roles of women, and the characteristics of the various subgroups of female alcoholics, the impact of the changing roles of women, and the characteristics of the various subgroups of female alcoholics. Such research could be used to improve the low treatment effectiveness and poor prognosis that some studies have noted among women alcoholics.
Chlamydia trachomatis as a cause of acute "idiopathic" epididymitis.
To assess the etiologic role of C. trachomatis and other microorganisms in idiopathic epididymitis, 23 men underwent microbiologic studies, including cultures of epididymal aspirates in 16. 11 of 13 men under age 35 had C. trachomatis infection whereas 8 of 10 over age 35 had coliform urinary tract infection. Cultures of epididymal aspirates yielded C. trachomatis alone in 5 of 6 men under 35, and coliform bacteria alone in 5 of 10 over 35. These results suggests that C. trachomatis is the major cause of idiopathic epididymitis, and coliform bacteria the major cause of epididymitis in older men. Expressible urethral discharge and inguinal pain were more common in the chlamydial cases, whereas concurrent genitourinary abnormality and scrotal edema and erythema occurred more commonly in the coliform cases. The morbidity attributable to C. trachomatis is as serious as that attributable to Neisseria gonorrhoeae. (author's modified)
Etiology, manifestations and therapy of acute epididymitis: prospective study of 50 cases.
There were 50 patients with acute epididymitis who were evaluated prospectively by history, examination, and microbiologic studies, including studies for aerobes, anaerobes, Neisseria gonorrhoeae, Chlamydia trachomatis, and Ureaplasma urealyticum. Escherichia coli was the predominant pathogen isolated from the urine of men more than 35 years old, while Chlamydia trachomatis and Neisseria gonorrhoeae were the predominant pathogens isolated from the urethra of men under age 35. The etiologic role of Escherichia coli and Chlamydia trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine or urethral cultures for these agents. Chlamydia trachomatis epididymitis accounted for 2/3 of idiopathic epididymitis in young men and was often associated with oligospermia. Of 9 female sexual partners of men with Chlamydia trachomatis infection, 6 had antibody to Chlamydia trachomatis, of whom 2 had positive cervical cultures for this organism and 2 others had nongonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with Chlamydia trachomatis epididymitis and should be offered to the female sex partners. (author's)
Results of heavy drinking in pregnancy.
The outcome of pregnancy is reported for 23 women who had been drinking alcohol heavily and who were delivered in Belfast maternity hospitals during the last 4 years. 21 (91%) of the babies were small-for-gestational age and many had head circumference measurements <5th percentile. 10 babies (44%) had abnormal facies consistent with the 'fetal alcohol syndrome' and 10 babies had congenital malformations of the heart, palate, genitalia, and kidneys. Perinatal problems which included breech presentation, birth asphyxia, hypoglycemia, polycythemia, hypocalcemia, and withdrawal symptoms were frequently present. Most of the babies have shown delayed postnatal growth and 6 of 10 over age 1 have delayed development. (author's modified)
Mycoplasma hominis and postpartum febrile complications.
Patients delivering on the residents' service at Johns Hopkins Hospital between February 1, 1967 and May 15, 1967 who had oral temperature elevations greater than 99.6 degrees Fahrenheit or rectal temperatures greater than 100.4 degrees Fahrenheit between the completion of the 3rd stage of labor and discharge from the hospital were assessed for large colony mycoplasmas. A patient having entirely uncomplicated labor and delivery on the same day with uneventful postpartum hospitalization was selected as a control for each febrile patient, and 25 late 3rd trimster prepartum patients formed another control groups. Cervical cultures, blood cultures, and an acute-phase serum specimen were collected for each patient. Including all febrile patients, the overall rate of postpartum fever was 7%. After patients with other causes of postpartum fever were excluded, 37 patients with postpartum fever, 37 with uncomplicated deliveries, and 25 3rd trimester prepartum patients remained in the group. The postpartum groups were comparable in age, race, parity, and marital status. Mycoplasma hominis was recovered from the genital tract of 12 of 37 febrile patients, 4 of 37 postpartum controls, and 4 of 25 3rd trimester prepartum patients. Frequency of antibody response was also higher in febrile patients. M. hominis was recovered in 2 blood cultures from 1 febrile patient. No other patient had a positive blood culture. Results of serologic testing and evaluation of cultures in 16 patients and 16 controls demonstrated a significant association between M. hominis and postpartum fever. A significantly greater number of febrile patients had undergone cesarean section, but neither cesarean delivery nor prematurely ruptured amniotic membranes was associated with increased isolation of M. hominis.
Laparotomy for female infertility.
Laparotomy continues to be the only method available in India for dealing with female infertility. 45 consecutive cases of laparotomy for infertility were collected from among the new and follow-up patients who attended the Gynecological and Antenatal Clinic of Telco Maternity Hospital, Jamshedpur, India over the January 1977 to April 1979 period. Neither human pituitary gonadotropin nor ergobromocryptine were used in this unit. Only clomiphene citrate was used for treatment of infrequent ovulation. None of the patients had prior laparoscopy. All patients taken for laparotomy had transcervical dye test and transuterine injection of saline to check the tubal patency. All patients had healthy husbands. The proportion of primary and secondary infertility in this series was 62.22% and 37.77%, respectively. The single major indication for laparotomy was bilaterally blocked tubes on hysterosalpingogram which was present in 20 cases. Among other indications infrequent ovulation (with or without bilaterally enlarged ovaries) was present in 10 (22.2%) cases. All the 10 patients had clomiphene citrate in the usual regimen for 3 consecutive cycles in increasing doses up to 150 mg a day but without success. In terms of laparotomy findings, in no case was there any evidence of tuberculosis or pelvic endometriosis (apart from the case who had chocolate cyst). In all the 3 cases where the only abnormality was peritubal adhesions preoperative hysterosalpingograms were normal and in all of them laparotomy was performed as a final method of investigation. Of the 12 cases who showed bilateral cornual block in preoperative hysterosalpingogram, tubal patency tests at laparotomy showed unilateral blockage in 4 and no blockage at all in another 4. Of the 13 cases where no lesion was found, the indication of laparotomy was bilateral cornual block (4 cases) and in 9 cases it was performed simply as a method of investigation. In 10 of the 45 cases, the ovaries appeared to be like those found in Stein Leventhal syndrome.
Pattern of malformation in offspring of chronic alcoholic mothers.
Case histories are presented of 8 unrelated children born to mothers who were chronic alcoholics. These children showed a similar pattern of craniofacial, limb, and cardiovascular defects associated with prenatal-onset growth deficiency and developmental delay. This is the 1st report to document an association between maternal alcoholism and aberrant morphogenesis in the offspring. The mean duration of maternal alcoholism was 9.4 years. 3 of the cases were black, 3 were Native American, and 2 were white. The mean gestational age was 38 weeks. The degree of linear growth deficiency was more severe than the deficit of weight at birth, suggesting that a factor other than maternal undernutrition alone affected prenatal growth. Developmental delay, prenatal and postnatal growth deficiency, and short palbebral fissures were observed in all 8 children. 7 of the 8 children also demonstrated microcephaly and maxillary hypoplasia with relative prognathism. 6 had an altered palmar crease pattern, 5 showed cardiac and joint anomalies, and 4 had epicanthal folds. Although adequate nutrition was provided to the children during hospital admission and/or foster care placement, no catch-up growth was observed. After 1 year, the average linear growth rate was 65% of normal and the average rate of weight gain was only 38% of normal. By 1 year, head circumference fell below the 3rd percentile for height and chronological age in 5 of the 6 children in whom measurements were taken. Fine motor dysfunction was present in 5 of the 6 children tested, and most were delayed in gross motor performance as well. The similarity in pattern of malformation noted among these 8 children suggests a singular mode of etiology related to an as yet unknown effect of maternal alcoholism. Direct ethanol toxicity is the most likely possibility.
An evaluation of etiologic factors and therapy in 555 private patients with primary infertility.
Some 12 years ago a form was designed for the tabulation of information in the study of infertility and female endocrine disorders in an effort to collect data suitable for coding and mechanical sorting. This study deals with the records so tabulated of 555 consecutive private patients complaining of primary infertility. The evaluation of etiologic factors is obviously subject to individual bias in many instances. The final diagnosis was made with the use of all findings and, in some cases, a retrospective diagnosis, not possible at the patient's initial study, was made. An effort was made to use only therapeutic measures which were indicated by the physical or laboratory findings, but as the investigation and therapy of these patients was carried over a 12-year period, changes in therapeutic approaches occurred. Follow-up information was available for 542 of the 555 patients. Of the 542, 204 or 37.4%, were known to have achieved a pregnancy. This correlated wtih the age of the patients and the duration of the inferitliy to as great an extent as the etiologic factor responsible for that infertility. Of the 315 patients between the ages of 20-35 years with infertility of 1 or more years duration who had completed the study or had 5 or more visits, 143 or 46% achieved a pregnancy. 28 pregnancies terminated in abortions, 7 in premature delivery of a normal child, and 1 in an ectopic pregnancy. Surgical therapy for the entire group of 55 patients was as follows: 16 tubal plastic procedures; 7 myomectomies; 29 endometrial resections; 8 cervical procedures; 15 ovarian wedge resections, and 3 vaginal plastic procedures consisting of removal of a vaginal septum. There were 131 patients with infertility primarily due to tubal factors. The etiology of the tubal pathology was not determined in the majority of the cases. An effort was made to subdivide further the cases in the category of ovarian factors according to the estimated etiology of the ovarian failure: Stein-Leventhal Syndrome; unknown dysfunction; ovarian failure; nutritional insufficiency; chronic disease; metabolic disease; neurological and psychogenic disease. 65 patients, in addition to the 17 reported under tubal factors, had endometriosis. There wre a total of 54 couples in whom the infertility was judged to be due to male factors, with no additional factors found in the wife. 20 patients had infertility judged to be due primarily to a cervical factor. 9 patients had anatomical abnormalities of the uterus. In 3 patients age was found to be the etiologic factor, with no other factor detectable. In addition to 4 patients reported under ovarian factors, there were 15 patients in whom malnutrition was judged to be the sole cause of infertility. 11 patients, in addition to the 9 reported under ovarian factors, were diagnosed as having infertility due to psychogenic factors. 9 patients had infertility primarily due to intercourse problems, and 90 patients were classified as having infertility of unknown etiology.
Correlation between serum antichlamydial antibodies and tubal factor as a cause of infertility.
Although salpingitis frequently produces tubal damage and infertility, many women with tubal factor as a cause of their infertility do not have a clinical history of salpingitis. In order to investigate whether or not some such cases might be due to subclinical chlamydial infections, we measured antichlamydial antibodies in the serum of 172 women consecutively undergoing infertility evaluation. Only 16 (9.3%) had a prior history of salpingitis. 61 (35%) had antichlamydial antibodies (S+) and of these, 75% had tubal factor as a sole or contributing cause of their infertility, vs 28% of the seronegative (S-) women (chi square=34, P<0.001). There was no association between chlamydial seropositivity and any infertility factor other than tubal factor in multivariant analyses. Subclinical infections with Chlamydia trachomatis may be a major cause of tubal infertility in the US, and chlamydia serologic studies may be useful in identifying that subset of infertile women likely to have tubal factor. (author's modified)
Congenital syphilis in Lusaka--II. Incidence at birth and potential risk among deliveries.
To determine the incidence of congenital syphilis among infants born at the University Teaching Hospital in Lusaka, Zambia, cord blood was tested for reagin antibody in 469 consecutive deliveries (464 livebirths and 5 stillbirths) during the 1st 2 weeks of March 1981. The Treponema pallidum hemagglutination assay test was positive in 30 (6.5%) of the infant-mother pairs. Seroreactive mother were younger and of lower socioeconomic status than seronegative mothers, but marital status, education, and parity were comparable. The incidence of abortion and stillbirth in earlier pregnancies was significantly higher in seroreactive mothers (p>0.05). 396 mothers (85.3%) had attended antenatal clinics, but only 284 (71.7%) had been screened for syphilis. Of the 30 seroreactive mothers, 10 had a reactive test during pregnancy (only 8 of whom received treatment), 10 had negative tests, and 10 were not tested. 4 of the 30 seroreactive infants had clinical signs of congenital syphilis at birth. An additional 2 babies were stillborn, and 8 others required intensive care due to prematurity, asphyxia, or conjunctivitis. Although other infants in this group may have had subclinical or latent syphilis, follow-up was not attempted. On the basis of the high risk of congenital syphilis identified in this study it is recommended that: 1) every pregnant women be screened for syphilis early in pregnancy and again in late pregnancy in order to detect infection acquired in the interim, 2) both sexual partners receive simultaneous treatment to prevent reinfection, 3) cord blood be screened in infants of mothers who did not receive antenatal care, and 4) infants of women who did not deliver in a health care facility should be evaluated for syphilis either at primary vaccination or at earliest contact with a health facility.
An information handbook on infertility services.
The guide, based on information culled from several sources, helps Title 10 grantees assess the needs of their clients, the resources in their communities, and their own capabilities to provide infertility services. Such careful assessment is needed if Title 10 grantees are to plan an effective