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Journal of Nurse-Midwifery. 1982 Fall-Winter; 8(2):31-4.This study investigates the contraceptive decision-making processes of 132 sexually active 15 to 19 year old girls. The subjects completed a questionnaire designed to elicit information on their assessment of the personal and social costs of contraceptive use; the personal and social benefits of pregnancy, and their biological ability to become pregnant. Approximately 175 questionnaires were collected from 3 Planned Parenthood clinic sites in Indiana. The only questionnaire item which significantly predicted contraceptive use was the girl's assessment of the financial costs related to contraceptive use. The study confirmed several demographic trends demonstrated in earlier empirical studies: the older a sexually active girl becomes, between the ages of 15 and 19, the more likely she is to be a good contraceptor and the longer a sexually active girl has been dating a particular person the more likely she is to be a good contraceptor. Within the sexually active subsample, only 6.1% agreed that hindrance to spontaneity was a reason for nonuse of contraception, and only 7.1% stated that their partner objected to birth control use. The common assumption that teenagers do not like to appear prepared for sex received only minimal support: 15% said they did not like to think of themselves as prepared, and 8% said they did not like their partners to think of them as prepared for sex. A theme of general embarrassment over the whole process of obtaining birth control was evident, however: 47% said they found going to a clinic for birth control embarrassing; 53.5% said going to a private doctor was embarrassing; and 61.2% agreed that buying foam or condoms in a drug store embarrassing. The study attempted to determine which of the costs of contraception, and which of the benefits of pregnancy, are perceived by teenagers to weigh most heavily in their own informal process of deciding whether or not to use contraception.
Bangkok, Thailand, DEEMAR, 1983 Nov. , 27,  p. (UNFPA/FAO Project THA/83/PO4; J.9616)This evaluation research reports on the effectiveness of the Thai learning program for 500 civil servants who then incorporate the population education into their jobs as trainers. A sample of 100 trainers representing 6 provinces and regions were evaluated for content and process of integration information, for innovative approaches, for identifying systems which facilitate integration, and for identifying bottlenecks. Informal contact and monthly meetings or already formal groups have been the vehicles for transmission of information. Horizontal integration among staff and co-workers is high as well as among villagers in vertical integration. No follow-up is made after contact and little active participation occurs after POPED. In order to expand contact with the rural population, more training among middle management position needs to be addressed within the organization. Interorganization is overall 86%. The most talked about topics among villagers were population growth and natural resources (86%), age at marriage (81%), population density and land distribution (79%), and nutrition (70%). The most difficult topics were migration (21%), planning for a family (13%), economic and social consideration in marriage (14%), and sex of children (14%). Trainers perceived family planning in general as the most important topic and key to the success of the effort.
In: A census of one billion people. Papers for International Seminar on China's 1982 Population Census, edited by Li Chengrui. Boulder, Colorado, Westview Press, 1986. 37-52.This paper examines how the 1982 China census met the standards prevalent in the world at large and formulated by the international community into recommendations under UN guidance. It also examines to what extent the China census met the recommendations, what alternatives were adopted and why, and what methods it used to carry them out. China's 1982 census met the criteria of individual enumeration, universality, simultaneity, and defined periodicity. The 1982 census was a register-based de jure census in which the field interview and its checks determined the final content of census information. It was necesary to restrict the number of census questions to fewer than would have been desirable. The questionnaire included 5 household and 13 individual topics. Questions on live births and deaths in the household since 1981 were included, although not generally recommended. Age data is unusually accurate due to people's awareness of what animal sign they were born under. Housing questions were not asked in this census, but may be included in the next census. Sampling was used only in the small-scale post-enumeration survey. In China, the administrative network is so complete and reaches down to so small a unit that no further subdivision for census purposes is needed at all. A most unconventional feature of the censuses of China has been the virtually complete absence of mapping. An extensive program of 4887 pilot censuses ensured the success of the full census. The publicity effort involved 2-way communication from the national office to the public and back. The issue of confidentiality was felt to be problematical in China and best solved by not asking questions that people would be reluctant to answer. The method of enumeration differed greatly from the usual ones in that it centered on enumeration stations with home visits used to a lesser extent. Several questions were precoded, but the enumerator had to write in the number as well as circle the correct item. 10% advance tabulations were made for all units and found to be very representative.
Fourth population inquiry among government in 1978: review and appraisal of the World Population Plan of Action.
New York, New York, United Nations, 1978. 52 p. (78-40195)Add to my documents.
[Unpublished] 1987 Apr 30. , 53 p.Neonatal tetanus, caused by the toxin of Clostridium tetani, is transmitted via unclean instruments used to cut the umbilical cord or contaminated dressings applied to the stump. The symptoms are inability to suck, trismus, convulsions, and (in 80-90% of cases) death on the 7th or 8th day. In the US between 1982 and 1984 only 2 cases of neonatal tetanus were reported; in the developing world an estimated 800,000 infants die of neonatal tetanus every year. The survey methodology used to determine the neonatal tetanus death rate was a 2-stage sampling method, known as the Expanded Program on Immunization 30 cluster sampling method, followed by questionnaires. Such surveys contain a certain amount of built-in bias due both to fact that the final selection of households is never completely random and that retrospectively gathered information is subject to recall bias. The surveys indicated that neonatal tetanus incidence was highest in rural areas, especially where animals were present; in the slums of cities; among families with many children; where mothers received no prenatal care; and where birth attendants were untrained. The best preventive strategy against neonatal tetanus is provided through immunization of the mother with tetanus toxoid, since the antibodies cross the placenta and protect the infant through the neonatal period. Unfortunately, the tetanus vaccination program lags at least 30% behind other World Health Organization Expanded Program on Immunization coverage. The World Health Organization recommends an initial immunization with .01 antitoxin International Units per milliliter of serum, a 2nd dose 4 weeks later (at least 2 weeks before delivery) and booster doses on each successive pregnancy up to 5; the 5th booster provides lifetime protection. Immunization should also be carried out among nonpregnant women of childbearing age and children. The World Health Organization has proposed that neonatal tetanus be made a reportable disease, which should be combatted by prenatal immunization of mothers and training of traditional birth attendants. Between 60% and 80% of all births in developing countries are attended by traditional birth attendants, but, except in China, the training of traditional birth attendants has not contributed as much to reduction of neonatal tetanus as has immunization. Alternative strategies for carrying out tetanus immunization programs include integrating them into prenatal clinics, schools, family planning programs, maternal food distribution programs, well-baby care centers, mass campaigns (especially in urban areas), and mobile team outreach strategies in rural areas. Tetanus immunization could also be linked to other Expanded Program on Immunization programs even though these are mainly targeted at children rather than mothers and other women of childbearing age. Indonesia initiated a tetanus immunization program in 1977 and a traditional birth attendant training program with assistance from the UN Childrens Fund in 1978. However, 3 neonatal tetanus surveys, conducted in 19 provinces, the city of Jakarta, and Java, estimated the total number of deaths/year from neonatal tetanus as 71,150--a neonatal tetanus mortality rate of 11/1000. 3 provincial level studies, also using the Expanded Program on Immunization 30 cluster sampling method, in Nusa Tenggara Barat, West Sumatra Province, and Daerah Istemewah Aceh revealed neonatal tetanus mortality rates of 8.3/1000, 18.5/1000, and 8.4/1000 respectively. In the Health portion of Indonesia's 4th 5-year plan (Pelita IV), the 1st priority is given to reducing the neonatal death rate of 93/1000 live births; the 7th priority is reduction of mortality due to neonatal tetanus by ensuring adequate immunization as part of routine health services and by requiring 2 tetanus immunizations of all women applying for a marriage certificate.
London, England, International Planned Parenthood Federation, 1986. [ix], 130 p.This publication is a practical guide to help those family planning, or planned parenthood, associations (FPAs) who wish to establish contraception and counseling services for young people. It draws its examples from the considerable experience of selected European countries in what can be controversial and difficult areas. Published as part of the International Planned Parenthood Federation's (IPPF) Youth Year 1985, it is hoped this information will be relevant to FPAs and other organizations in both developed and developing countries. The introduction describes IPPF Europe's Regional Adolescent Services Project (RASP) (1982-1985) that attempted to provide family planning services closely tailored to the needs and expectations of adolescents. Section 2 looks at adolescent sexuality and contraception . Section 3 examines several actual contraceptive and counseling programs for adolescents. Section 4 summarizes service provision. Section 5 tells how to set up a contraceptive/counseling service for adolescents. Section 6 describes new projects. Section 7 discusses opposition. The appendices contain the project questionnaire, the IPPF policy on youth, and a statement on Acquired Immunodeficiency Syndrome (AIDS).
[Unpublished] 1988. , 39 p. (GPA/HPR/88.1)Acquired immunodeficiency syndrome (AIDS) health promotion involves the use of information and education to change the behaviors of individuals and groups in ways that will control the spread of the virus. Effective promotional activities can make AIDS prevention a high public health priority, promote social support for positive behavioral changes, establish public support for the community and institutional responses required to control the transmission of AIDS, and support the training of workers in the health care field. Through its reliance on multiple communication channels and cooperation with the health and social service sectors, health promotion seeks to achieve sustained change in practices crucial to public health. The key to effective health promotion is adequate planning, services, and the supplies. This guide is aimed at providing planners, manages, and technical staff with a frame of reference for planning, implementing, implementing, monitoring, and evaluating AIDS health promotion programs. Discussed in detail are the following elements of program planning: establishing goals, initial assessment, targeting audiences, setting objectives and targets, developing messages and materials, developing communication strategies, providing support services, monitoring and evaluation, scheduling and budget, and reassessing the program. Dispersed throughout are examples of promotional materials and strategies.
[Unpublished] 1989 Feb. 3,  p.The Siriraj Family Planning (FP) Research Center in Bangkok, Thailand has developed a protocol to conduct acceptability studies of the female condom Femshield. The study aims to assess participants' attitudes towards this new contraceptive which also protects against sexually transmitted diseases (STDs). Since barrier method use (condom and vaginal spermicide) is low in Thailand, the center has introduced the WHO supplied Femshield to increase protection against sexually transmitted diseases (STDs). 3 advantages of Femshield are it allows free movement of the penis; can be inserted before intercourse; and protects the perineum (where lesions may exist), urethra (an entrance of infection), and the roots of the penis. The Femshield is made of a polyurethane sac (dimensions 8 cm x 15.5 cm; .045 mm thickness) with a removable internal ring to help in insertion and an external ring to hold it in place. The study should include 10-15 sexually active women from each FP clinic who currently use a contraceptive method, are either married or living with a male partner, are willing to participate, and whose willing partners will complete a questionnaire after use. 1st FP personnel will use a screening form to ask each current user of any FP method her attitude based on her perception of Femshield and to participate in the study. Once she decides to participate, she formally consents. A FP worker then uses an admission form to interview her. She next receives 5 Femshields, verbal instruction on how to use them, and a small instructional manual. A FP worker interviews her during the 1 month follow up (follow up form). Study workers send a questionnaire to the partner (husband's form) with instructions to complete the form and return it to the FP clinic. Researchers use the 4 completed forms to analyze the data. (The protocol includes copies of all the standardized forms.)
HEALTH POLICY AND PLANNING. 1992 Sep; 7(3):251-9.Policymakers and program managers rely on the oral rehydration solution (ORS) use rate as an indicator of program performance. The ORS use rate has several limitations, e.g., it disregards other program objectives. Other diarrheal disease control program objectives may include reducing the source of infection, promotion of effective home-based treatment, and training of health workers in appropriate diarrhea case management. WHO and the Demographic and Health Surveys (DHS) try to standardize the methodology for estimating ORS use rates, but they have not looked at them as cross-country indicators. Error sources lie in the terms used for diarrhea, the reference period, and the sequence of questions referring to treatment. In Bangladesh, the people recognize different types of diarrhea and treat each type differently. In 1 instance, health workers informed mothers to prepare and give a homemade sugar salt solution. Later they learned that mothers did not use ORS very much because they only used ORS for the type of diarrhea the health workers described. There has been considerable variation of ORS use rates in Bangladesh, perhaps because of the differences in meanings of the words used for diarrhea. The DHS uses a 2-week reference period, yet a Bangladesh survey finds underreporting of diarrheal episodes which occur early in the week of the survey. Other surveys do not use a specific reference period and mothers tend to remember only serious diarrheal episodes. A direct question about ORS use in surveys is too leading as indicated by higher ORS use rates when interviewers prompt respondents. ORS use rates do not give a true picture of a program and can even be counterproductive. No consensus exists as to what is high ORS use rate and what is low ORS use rate. Managers should not use ORS use rates as the only program indicator.
[Unpublished] 1992. Presented at the 8th International Conference on AIDS / 3rd STD World Congress, Amsterdam, Netherlands, July 19-24, 1992.  p.Three questionnaires which ask questions about prostitutes' sexual contacts with clients, short-term casual partners, and long-term partners were compared to determine whether the most detailed of the 3 would obtain data on unsafe sex practices otherwise overlooked by the other 2 versions. A World Health Organization (WHO) questionnaire, a revised version of the WHO questionnaire developed for a Toronto-based study involving IV-drug users, and a 3rd specifically targeting prostitutes were employed. Unsafe sex practices, albeit some considered high-risk and others low-risk, include: anal and/or vaginal intercourse with or without a condom, fellatio without a condom, cunnilingus without a barrier during menses, and the sharing of sex toys. Toronto prostitutes pre-tested the most detailed of the 3 questionnaires. Results indicate that all unsafe sex activities with clients would be reported equally well by each of the questionnaires. The 2 less detailed questionnaires would, however, miss a number of unsafe sex practices between prostitutes and lovers reported in the most detailed questionnaire. Missing data would not be obtained even if both of the less-detailed versions were used. This study highlights the need to develop and use questionnaires which assess all data on unsafe sex behavior which are relevant to the formulation and implementation of effective HIV prevention programs.
New York, New York, United Nations, 1992. xvii, 265 p.This directory of population centers in Europe, the US, and Canada was based on responses to a survey of 170 demographic research and/or training centers. Published information was available on 130 centers, due to deadlines. Countries providing information included Austria (3), belgium (5), Bulgaria (2), Canada (9), Cyprus (1), Czech and Slovak Federal Republic (2), Denmark (5), Finland (3), France (6), Germany (12), Greece (2), Hungary (1), Ireland (2), Italy (3), Luxembourg (1), Malta (2), Netherlands (6), Norway (2), Poland (5), Portugal (1), Rumania (2), Russian Federation (2), Spain (1), Switzerland (4), Turkey (3), Ukraine (1), UK (15), US (28), and the former Yugoslavia (3). The questionnaire distributed to the centers is included. Information requested included the following topics: name of institution, name of parent organization, name of director, postal address, telephone number, telex number, cable address, fax number, major functions (4 options indicated), status of institution (4 options), major areas of work in training and research and analysis (22 options), names of professional staff members, titles of major publications, titles of current major research projects of the institution, and titles of major surveys conducted since 1985.
CONTRACEPTION. 1993 Apr; 47(4):359-66.To determine whether the known adverse effects of IUD use were kept to a minimum, 432 doctors were asked to complete questionnaires about their training and practice in IUD insertion, providing information about the insertion and the patient during a 3-month period. 349 doctors returned the first questionnaire. 93% of doctors had received some formal training in IUD insertion, although 54% had performed fewer than 5 supervised insertions before carrying out an unsupervised insertion. Only 8% had performed 10 or more supervised insertions. 58% had performed only 1 or no insertions in the month before the study period. 91% of respondents carried out more than 1 pelvic examination per week. Only 12% of doctors reported always prescribing prophylactic antibiotics. More doctors routinely took vaginal and cervical swabs for culture and cervical smears. 66% of doctors routinely arranged follow-up appointments. 98% of doctors routinely gave some information to women after IUD insertion. 90% of doctors provided a description of symptoms of infection. Information about women using an IUD was obtained from 129 doctors in 460 completed questionnaires about IUD insertions. Relative contraindications to IUD use included nulliparity, a history of suspected or proven pelvic inflammatory disease (PID), a significant risk of sexually transmitted disease (STD), and uncompleted family. Excluding uncompleted family, there were 126 insertions (27%) with at least 1 relative contraindication. Gynecologists performed 30% of the insertions in cases with relative contraindications compared with 48% for other doctors. 35 women who had IUDs inserted were nulliparous, and 4 of these were aged under 20, 11 women (2%) had an IUD inserted despite a history of suspected or proved PID. 12% of the women with IUDs were not in a stable sexual relationship; 9% had a history of STD, and 28% intended to have children in the future. 5% had both a risk factor for PID and an uncompleted family.
[Unpublished] 1993. Presented at the International Population Conference / Congres International de la Population, Montreal, Canada, August 24 - September 1, 1993. Sponsored by the International Union for the Scientific Study of Population [IUSSP]. 48 p.Findings from a survey on population-related software of institutions worldwide involved in demographic data analysis, in population policy formulation, or in training in population and development are presented. The software packages were developed by UN organizations, UNFPA-supported projects, government offices, universities, nongovernmental organizations and NGOs. In all, 286 questionnaires were received from institutions in 108 countries that reported the possession of 1747 software packages with an average of 6.1 packages/institution. 12 packages were distributed free of charge by the project Computer Software and Support for Population Activities. Only 31% of the 1747 packages were reported as being used frequently, 23% were reported to be seldom used, while 19% were never used and/or not planned to be used. Only MortPak-Lite, ISSA, and IMPS were used frequently in 24-33% of institutions. Less than 5% of institutions owned IMPECC, Blaise, POP-ILO, PopSyn, Recall Analysis, CAPPA, and HOST. UNFPA was directly involved in the development of PopMap which was frequently used at only 10% of institutions. 31% of the packages were mainly used as an aid in teaching demographic concepts in training courses. Target-Cost was found in 43% of the institutions, where it was used mainly for training. The corresponding percentages for some other packages were: MortPak-Lite (26%), PopMap (7%), Pc-Edit (17%), and DemProj (25%). Individually, PC-Edit (37%), ISSA (38%), and IMPS (30%) were used mainly for data entry and analysis. The projection programs DemProj (38%), FivFiv-SinSin (47%), and PEOPLE (55%) were mainly used for general demographic analysis and population projections. The most common reasons for not using packages were insufficient or unclear documentation and/or lack of trained personnel, and user-unfriendliness. Among the 283 institutions, around 6700 micros were reported to be in use, an average of almost 24 micros per institution.
Interview schedule for Knowledge, Attitudes, Beliefs and Practices on AIDS. Phase I: African countries. A. Household form. B. Community characteristics. C. Individual questionnaire.
[Unpublished] 1989 Feb. 28 p.The household interview form has spaces in which to designate a household's location and track interviewer visits with notation of visit results. Basic information can be recorded about the people over age 10 years who usually live in the household or who slept in the household on the preceding night. Data are then taken on the community characteristics form on the type of locality, travel time to the nearest large town, and facilities available in the community. The individual questionnaire is for people aged 15-64 years who slept in the household on the preceding night and is comprised of the following sections: identification; individual characteristics; awareness of AIDS; knowledge on AIDS; sources of information; beliefs, attitudes, and behavior; knowledge of and attitudes toward condoms; sexual practices; injection practices; locus of control; IV drug use; and drinking habits.
Indicators for assessing health facility practices that affect breastfeeding. Report of the Joint WHO / UNICEF Informal Interagency Meeting, 9-10 June 1992, WHO, Geneva.
Geneva, Switzerland, WHO, 1993. , 32 p. (WHO/CDR/93.1; UNICEF/SM/93.1)In March and June 1992, WHO and UNICEF held a joint informal interagency meeting on breast feeding at WHO headquarters in Geneva. The goal of the meeting was to reach consensus on the definitions of key breast feeding indicators which would allow one to assess whether health care facilities' procedures support, protect, and promote breast feeding practices. Section 2 of the meeting's summary report covers these indicators and their potential users. Identified potential users are maternity services, postnatal outpatient clinics including maternal and child health care services, pediatric inpatient services, and family planning services. Section 3 provides precise definitions of the indicators and the rational for their selection. Representatives from participating activities were asked to propose data collection methodologies to measure these indicators. The participating agencies included UNICEF, the WHO Working Group on Infant Feeding, The Population Council, World Alliance for Breastfeeding Action, Wellstart, the Institute for Reproductive Health at Georgetown University, USAID, the Swedish International Development Agency, and WHO. They agreed on health facility-based indicators of breast feeding. Section 4 discusses mainly indicators based on interviews with mothers at the time of infants' discharge or at the time of attending a clinic. It briefly covers those based on information collected from health facility staff or observation at the facility. The interviews with mothers were the basis for all the indicators agreed upon at the meeting, except for maternity services indicator 2 (breast milk substitutes and supplies receipt rate). Section 5 addresses methodological issues to be developed and sampling considerations. The annexes include a list of participants in the March and June meetings, sample data collection instruments (i.e., questionnaires), and breast feeding indicators for health facilities.
New York, New York, UNDP, . 4 p.There is also a need for greater insight into why and how men and women enter into sexually-defined spaces and relations. For women, this may have to do with cultural imperatives which place high value on mother-hood and on the continuation of the lineage. Or the reason may have to do with economic imperatives, an inability to survive economically without the support of a man or except by commercial sex work. Or with a desire for the intimacy or companionship which a sexual relationship may give them or with a need for protection, a critical social role that men play. A women-centered analysis of desire and sexuality, of power and its impact, of relations of production and reproduction, of the social construction of kinship and gender, of the value of compassion and solidarity, that is, of the experience of being a woman, all contribute to a better understanding of why, for an individual woman, it may be so very difficult to remain uninfected. (excerpt)
A qualitative evaluation of the impact of the Stepping Stones sexual health programme on domestic violence and relationship power in rural Gambia.
[Unpublished] 2002. Presented at the 6th Global Forum for Health Research, Arusha, Tanzania, November, 2002.  p.The work presented here came from a preliminary evaluation and was followed up by several applications for funding to carry out a prospective community randomised trial. So far none have been accepted. This may be partly due to the fact that such an evaluation runs against current funding culture. Because of it's holistic approach and focus on core skills in couple communication, the Stepping Stones programme is neither just an HIV prevention or just a domestic violence prevention programme, but has something to contribute to both (and would see the two problems as inter-related). Funding on the other hand is often organised 'vertically' by problem, and evaluation criteria may differ from one problem to another. For example donors who fund evaluation of HIV prevention activities usually require a biological outcome, and hence concentrate on geographical areas with high HIV incidence where the epidemic is seen as most severe. Where sociological outcomes are used this tends to be either the use of quantitative tools to assist in risk factor analysis, or qualitative tools which can assist in replication of the intervention. As such they are usually considered secondary to the primary (biological) outcomes. The hope here is that these interventions may provide a 'blueprint' which can subsequently be applied in low prevalence areas. However by concentrating on proximal rather than distal determinants of infection these blueprints may only capture 'half the story', leading to locally inappropriate assumptions about which groups or behaviours HIV prevention programmes should target. An example would be the demand by some donors that interventions should have an exclusive focus on adolescents, when in a polygamous society adolescent's risk is often mediated by the older generation. On the other hand community interventions against domestic violence are forced to rely on self reported behaviour (perhaps backed up by participant observation) as an outcome. If the intervention is also a reflexive process then qualitative studies become essential to describe a process of change which contains empowerment, group dynamic and normative dimensions. The locally appropriate nature of such interventions is used to justify participatory interventions as being more effective than didactic approaches, but at the same time in the epidemiological-evaluation paradigm it can be seen as problematic, because (I would argue incorrectly) a participatory process is assumed to generate a wide spectrum of outcomes (low replicability), which mitigates against quantitative evaluation. (excerpt)
Vadodara, India, Centre for Operations Research and Training [CORT], 2000.  p.Street children live and work in conditions that are not conducive for healthy development. They are exposed to the street subculture such as smoking, drug, alcohol and substance abuse, gambling, engaging in sexual activities or selling sex for survival. The few studies that exist on the sexual behaviour of street children show that these children are more prone to high-risk behaviour and are sexually active at an early age. Often such relationships start as abusive. The circumstances in which they live and work increase their vulnerability also to sexual exploitation and abuse and put them at a higher risk of unintended pregnancies, sexually transmitted infections and even HIV/AIDS. The problem is further compounded by the lack of access to reproductive health information and services. UNICEF, recognising the magnitude of the problem, has undertaken to promote programmes to reduce children's vulnerability to HIV/AIDS, to diminish its impact on children, families and community and to take care of orphans and people living with AIDS. The present study is a situation analysis of children and adolescents carried out CORT to inform programme planning. (excerpt)
Nutritional status of vegetarian and omnivorous adolescent girls. [Estado nutricional de adolescentes vegetarianas y omnívoras]
Nutrition Research. 2001 May; 21(5):689-702.This study compared the dietary and anthropometric profile of 24 ovo-lacto-vegetarian and 36 omnivorous female adolescents, between 15 and 18 years old. Weight, height and skinfolds were measured. Food frequency questionnaires and a three day food record were used for dietary assessment. Vegetarians presented subscapular, suprailiac and midaxillary skinfolds statistically higher than omnivores, but the percent body fat was not different. The vegetarian diet provided smaller amounts of energy than that of the omnivores ( p < 0.05) and only 17% of the vegetarians was able to reach the recommended allowance for protein. Regarding calcium, 83% of the vegetarians and 69% of the omnivores ate less than 2/3 of the recommended allowances and a significantly higher percentage of vegetarians presented low ingestion of iron, riboflavin, and niacin than omnivores ( p < 0.05). It was concluded that the intake of vegetarians was lower in fat and cholesterol, and less adequate in micronutrients than the omnivores ones. (author's)
Vitamin A deficiency and increased mortality among human immunodeficiency virus-infected adults in Uganda.
Nutrition Research. 2003 May; 23(5):595-605.The specific aims of the study were to determine the prevalence of vitamin A deficiency and to examine the relationship between vitamin A deficiency and mortality among human immunodeficiency virus (HIV)-infected adults in sub-Saharan Africa. A prospective cohort study was conducted at the outpatient clinic of Mulago Hospital, Kampala, Uganda, among HIV-infected adults enrolled in the placebo arms of a randomized clinical trial to prevent Mycobacterium tuberculosis infection. Of 519 subjects at enrollment, 186 (36%) had serum vitamin A concentrations consistent with deficiency (<1.05 µmol/L). During follow-up (median 17 months), the mortality among subjects with and without vitamin A deficiency at enrollment was 30% and 17%, respectively (P = 0.01). In a multivariate model adjusting for CD4+ lymphocyte count, age, sex, anergy status, body mass index, and diarrhea, vitamin A deficiency was associated with a significantly elevated risk of death [relative risk (RR) = 1.78, 95% confidence interval (CI) 1.2-2.6]. Vitamin A deficiency is common among HIV-infected adults in this sub-Saharan population and is associated with higher mortality. (author's)
Prophylactic use of cotrimoxazole against opportunistic infections in HIV-positive patients: knowledge and practices of health care providers in Cote d'Ivoire.
AIDS Care. 2003 Oct; 15(5):629-637.We present here the results of a survey conducted in Côte d’Ivoire, Africa, among health care providers, on the knowledge of prophylactic use of cotrimoxazole to prevent opportunistic infections in HIV-infected persons. The survey was conducted in 15 health centres, involved or not in the ‘initiative of access to treatment for HIV infected people’. Between December 1999 and March 2000, 145 physicians and 297 other health care providers were interviewed. In the analysis, the health centres were divided into three groups: health centres implicated in the initiative of access to treatment for HIV-infected people with a great deal of caring for HIV-infected people, health centres implicated in this initiative but caring for few HIV-infected people, and health centres not specifically involved in the care of HIV-infected people. Six per cent of physicians and 50% of other health care providers had never heard of cotrimoxazole prophylaxis. The level of information about this prophylaxis is related to the level of HIV-related activities in the health centre. Among health care providers informed, knowledge on the exact terms of prescription of the cotrimoxazole is poor. In conclusion, it appears that the recommendations for primary cotrimoxazole prophylaxis of HIV-infected people did not reach the whole health care provider population. Most physicians are informed but not other health workers, even if the latter are often the only contact of the patient with the health centre. The only medical staff correctly informed are the physicians already strongly engaged in the care of HIV-infected people. (author's)
Indian Journal of Medical Sciences. 2002 Feb; 56(2):73-78.Tuberculosis remains a global problem inspite of the excellent drugs available to cure it. According to an estimate in 1995 there were 9 million cases of tuberculosis worldwide and 3 million deaths. Tuberculosis was declared a global emergency by WHO in 1990 as it had reemerged in countries where it was supposed to be on a decline. Global explosion of HIV infection coupled with chaotic treatment of tuberculosis, the world today is threatened with untreatable epidemic of tuberculosis. Inappropriate and inadequate treatment leads to acquired drug resistance, which may result in treatment failure and spread of resistant organisms to other persons. The only way to prevent this is uniformity in the treatment of such patients both in governmental programs and private practice. In India under national tuberculosis control program 1.5 million cases are detected every year but still 1200 cases die due to it daily. The reason for this could be lack of compliance by the patients, faulty drug distribution, emergence of MDR-TB and inappropriate prescriptions of anti TB drugs due to lack of knowledge regarding the guidelines. Our study was aimed at finding out the knowledge, attitude and practice of resident doctors and consultants treating tuberculosis in two medical institutes in two different states of India. (author's)
Comparison of patient evaluations of health care quality in relation to WHO measures of achievement in 12 European countries.
Bulletin of the World Health Organization. 2004 Feb; 82(2):106-114.To gain insight into similarities and differences in patient evaluations of quality of primary care across 12 European countries and to correlate patient evaluations with WHO health system performance measures (for example, responsiveness) of these countries. Patient evaluations were derived from a series of Quote (QUality of care Through patients’ Eyes) instruments designed to measure the quality of primary care. Various research groups provided a total sample of 5133 patients from 12 countries: Belarus, Denmark, Finland, Greece, Ireland, Israel, Italy, the Netherlands, Norway, Portugal, United Kingdom, and Ukraine. Intra-class correlations of 10 Quote items were calculated to measure differences between countries. The world health report 2000 — Health systems: improving performance performance measures in the same countries were correlated with mean Quote scores. Intra–class correlation coefficients ranged from low to very high, which indicated little variation between countries in some respects (for example, primary care providers have a good understanding of patients’ problems in all countries) and large variation in other respects (for example, with respect to prescription of medication and communication between primary care providers). Most correlations between mean Quote scores per country and WHO performance measures were positive. The highest correlation (0.86) was between the primary care provider’s understanding of patients’ problems and responsiveness according to WHO. Patient evaluations of the quality of primary care showed large differences across countries and related positively to WHO’s performance measures of health care systems. (author's)
Working with adolescent boys: programme experiences. Consolidated findings from regional surveys in Africa, the Americas, Eastern Mediterranean, South-East Asia, and Western Pacific.
Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2000.  p. (WHO/FCH/CAH/00.10)The survey and this report seek to contribute to the understanding of working with adolescent boys in health and health promotion. Pursuant to this purpose, the consultants contacted programmes working in health promotion with adolescent boys in four regions of the world. These contacts did not aspire to include all of the programmes which are working with adolescent boys in these regions, nor do they necessarily represent a random sample of those programmes. Where possible, the survey included a relatively small but representative number of organizations working with adolescent boys in other regions. The organizations were identified via colleague organizations, WHO regional and local offices, the literature review, personal contacts of the survey authors and via non-governmental organizations (NGOs) working in health/health promotion. As detailed below, the survey sought to gather information in a dozen specific areas of interest by means of a questionnaire, which was translated into Spanish and Arabic. Programme staff were requested to fill out the questionnaire and return it to the consultants. (excerpt)
Journal of Family Planning and Reproductive Health Care. 2004; 30(4):253-254.The Clinical Effectiveness Unit (CEU) presents an illustrative response of a frequently asked question to the Members’ Enquiry Service on whether or not hormonal contraceptive use by women with a history of pregnancy-related cholestasis is safe or associated with recurrence of cholestasis. The Summaries of Product Characteristics (SPCs) for combined oral contraceptives (COCs) and progestogen-only pills (POPs) advise against use by women with a history of cholestatic jaundice or with severe pruritis in pregnancy. The World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use (WHOMEC), however, recommends that for women with pregnancy-related cholestasis the benefits of COC use outweigh the risks (WHO Category 2) and progestogen-only methods or non-hormonal methods can be used without restriction (WHO Category 1). No evidence was identified to support an increased risk of recurrence of symptoms with hormonal contraceptive use. The CEU advises that women with a history of pregnancy-related cholestasis should be informed about the unknown risk of recurrence with hormonal contraceptive use. After counselling regarding non-hormonal methods, women with a history of pregnancy-related cholestasis may choose to use hormonal methods (COCs, POPs, progestogen-only injectables, implant or intrauterine system). Women should be informed that the use of COCs and POPs in this situation is outside the product licence. (excerpt)