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  1. 1

    Contraceptives and cancer: looking for the evidence.

    World Health Organization [WHO]. Regional Office for the Western Pacific


    The WHO has published partial results of an epidemiological study of the safety with respect to breast cancer of the injectable contraceptive depomedroxyprogesterone acetate, known as DMPA or Depo-Provera. The WHO Special Program of Research, Development and Research Training in Human Reproduction has been conducting a collaborative retrospective study of cancer and DMPA in 3 developed and 8 developing countries. Results from Kenya, Mexico and Thailand are published in Lancet on October 5, 1991. Comparing 869 women with breast cancer <64 years old and 11,890 matched hospital-based controls, the relative risk was 1.21, not statistically significant. 12.5% of the cases and 12.2% of the controls had used DMPA. Fine analysis pointed to a possibility of increased risk over the 1st 4 years of use. The data were not compatible with the hypothesis that DMPA. Fine analysis pointed to a possibility of increased risk over the 1st 4 years of use. The data were not compatible with the hypothesis that DMPA causes cancer, but only that it may speed the growth of early pre-existing cancer. When contemplating the choice of DMPA, people should evaluate their risks relative to the excellence of DMPA as a highly effective, convenient, long-acting, but reversible method.
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  2. 2

    GTZ -- working for health in Africa. The need for family planning.

    Brandrup-Lukanow A

    NEW AFRICAN. 1991 Sep; (288):43-4.

    This article, which explains the severe need for family planning in Africa, serves as an introductory piece to a supplement dealing the problems faced by the medical community in dealing with the health of families in the continent. The articles in the supplement are written by medical staff workers of the Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ) GmbH, an agency of the German government designed to assist in the planning and execution of health development projects. As the article explains, Africa has the highest maternal mortality in the world, ranging anywhere from 400/100,000 live births to 1000/100,000 live births. The risk is greatest among very young or very old women. Maternal mortality rate among women aged 15-19 is twice that of women 20-24. And for girls under 15, the risk is 5x to 7x greater. The risk is also very high among women over 35. Furthermore, a high frequency of birth endangers the health of the mother and infant. Unwanted pregnancies often result in illegal abortions, which can cost the life of the mother. Many couples in Africa say that they would like to limit family size to 2 or 3 children. Also, knowledge of modern contraceptive methods runs as high as 80-90%. Yet most couples do not have access to family planning services, and in the instances when they do have access, services are often ill-equipped to handle the demand. In order to address these concerns, GTZ has supported family planning programs throughout Africa.
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  3. 3

    Evaluation of the EPI survey methodology for estimating relative risk.

    Harris DR; Lemeshow S


    Logistical and managerial constraints have prompted classical probability-proportional-to-size (PPS) cluster sampling to be modified for application to surveys of immunization coverage. This World Health Organization Expanded Program on Immunization (EPI) methodology aims to estimate population rates accurate to within 10% of the true level. Concerned with the accuracy and reliability of the methodology, researchers have employed a Monte Carlo computer simulation model to evaluate the approach's precision in estimating relative risks. Mimicking characteristics of typical African populations, the Monte Carlo model suggests the proposed survey strategy to be a viable alternative to simple random sampling (SRS) at the 2nd stage of cluster sampling. Varying seroprevalence rate, nonresponse rate, and rate of misclassification of exposure failed to prove 1 method advantageous over the other. Given the cost and difficulty of classical sampling techniques, researchers should consider the advantages of using the EPI methodology.
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