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Community-based distribution (CBD) of low cost family planning and maternal and child health services in rural Nigeria (expansion).
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (NGA-02)A community-based distribution (CBD) project has been in operation since 1980 in Oyo State, Nigeria. As a result of word-of-mouth communication among health professionals, television coverage of graduation ceremonies, and positive political feedback from the pilot area, the state government requested assistance in expanding the program. In collaboration with the State Health Council, the Pathfinder Fund, University College Hospital, and the Center for Population and Family Health of Columbia University, the program was expanded in 1982 at a cost of US $237,517. In each of the 4 health zones of the expansion area, a Primary Health Center (PHC) became the training and supervisory center. The expanded program was modified in light of experience in the pilot area. Monthly stipends to CBD workers were eliminated and, because of government policy, no fees were to be charged for services. (This policy was later reversed.) Also, a full-time CBD supervisor was assigned to each zone, rather than relying on individual maternity staff members for supervision. Each zone was limited to 100 CBD workers. Data collection included baseline and post-intervention knowledge, attitudes, and practice surveys and a village documentation survey to estimate the service population. The project also carried out in-depth CBD worker interviews, structured observations of training, mini-surveys, analyses of supervision records and service statistics, and a case study of the impact of the CBD program in which villagers were interviewed about the educational and clinical roles of the CBD workers. Although initial family planning (FP) acceptance was low, ever use of a modern method has increased from 2 to 25% in the pilot area. About half of the married women of reproductive ages in the project area are not sexually active at any one time because of postpartum abstinence. Most of the acceptance of modern contraceptives replaces use of traditional abstinence. Male promoters have proved to be an asset to male acceptance of FP services. Individual monetary incentives are not required to motivate CBD workers; however, once incentives are given, difficulties are created if they are stopped, as they were in the pilot area. The CBD approach has changed the concept of health care from that of providing services to clients who come to a fixed site to reaching out to provide services to all people living within a particular catchment area. The expanded project was subsequently extended into additional areas of Oyo State by the State Health Council. In addition, a conference to discuss the project, held in January 1985, was attended by health program managers and policymakers from all parts of Nigeria. The conference stimulated planning by State and Federal Ministries of Health to undertake CBD as a major strategy for primary health care in rural areas.
In: Sexual behaviour and networking: anthropological and socio-cultural studies on the transmission of HIV, edited by Tim Dyson. Liege, Belgium, Editions Derouaux-Ordina, . 249-67.Using a modified form of the WHO partner relations survey questionnaire on a sample of 222 adults, the authors explore seasonal out-migration from the rural area of Mlomp, Senegal, as it relates to coital frequency. Generally low levels of coital frequency were revealed. Unmarried individuals had sex less often than those married. Among married couples, 19% had last intercourse 1-6 days previously and 20% had last intercourse more than 1 year previously. Eliminating those never having experienced sexual intercourse and those having last sex at least 1 year previously, mean duration in the group since last intercourse was about 2 months. A taboo against postpartum sex and the absence of married men during the dry season of palm wine harvesting partially account for these long periods of relative abstinence. Coital frequency is also probably influenced by the overlap of menstrual cycles, seasonal out-migration cycles, and pregnancy and lactation. The authors note that while men are away from their homes during seasonal harvests, however, they definitely partake of extramarital sex. Accordingly, efforts must be made to educate these men about condoms and the risks of unprotected sexual intercourse.