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  1. 1

    Oral rehydration salts: an analysis of AID's options.

    Elliott V

    [Columbia Maryland], Westinghouse Electric Corporation, Public Applied Systems, 1984 Sep. 26, [13] p. (Contract No. PDC-1406-I-02-4062-00, W.0.2; Project No. 936-5939-12)

    Westinghouse Health Systems, under a US Agency for International Development (USAID) contract, ass ssed the global supply and demand of oral rehydration salts (ORS) and developed a set of recommendations concerning USAID's future role as a supplier of ORS. 1.5 billion ORS packets (assuming each packet is equivalent to 1 liter of ORS solution) would be required to treat all ORS treatable cases of diarrhea which occur annually among the world's children under 5 years of age. Currently, about 200 million packets are manufactured/year. In 1983, international sources supplied slightly less than 37 million packets, and the remaining packets were produced by local or in-country manufacturers. UN Children's Fund (UNICEF), which currently provides 81% of the international supply, contracts with private firms to manufacture ORS and then distributes the packets to developing countries, either at cost or free of charge. UNICEF purchases the packets for about US$.04-US$.05. USAID provides about 12.3% of the international supply. Prior to 1981, USAID distributed UNICEF packets. Since 1981, USAID has distributed ORS packets manufactured by the US firm of Jianas Brothers. USAID must pay a relatively high price for the packets (US$.08-US$.09) since the manufacturer is required to produce the packets on an as needed basis. Other international suppliers of ORS include the International Dispensary Association, the Swedish International Development Authority, the International Red Cross, and the World Health Organization. Currently, 38 developing countries manufacture and distrubute their own ORS products. These findings indicate that there is a need to increase the supply of ORS; however, the supply and demand in the future is unpredictable. Factors which may alter the supply and demand in the future include 1) the development of superior alternative formulations and different type of ORS products, 2) a reduction in the incidence of diarrhea due to improved environmental conditions or the development of a vaccine for diarrhea, 3) increased production of ORS in developing countries, 4) increased commercial sector involvement in the production and sale of ORS products, and 5) the use of more effective marketing techniques and more efficient distribution systems for ORS products. USAID options as a future supplier of ORS include 1) purchasing and distributing UNICEF packets; 2) contracting with a US firm to develop a central procurement system, similar to USAID's current contraceptive procurement system; 3) contracting with the a US firm to establish a ORS stockpile of a specified amount; 4) promoting private and public sector production of ORS within developing countries; 5) including ORS as 1 of the commodities available to all USAID assisted countries. The investigators recommended that USAID should contribute toward increasing the global supply of ORS; however, given the unpredictability of the ORS demand and supply, USAID should adopt a short-term and flexible strategy. This strategy precludes the establishment of a central procurement system; instead, USAID should contract a private firm to establish an ORS stockpile and to fill orders from the stockpile. Consideration should be given to altering the ORS packets size and to alternative ORS presentations. USAID should also promote the production of quality ORS products within developing countries and continue to support research on other diarrhea intervention strategies. This report also discusses some of the problems involved in manufacturing and packaging ORS. The appendices contain 1) a WHO and UNICEF statement on the ORS formulation made with citrate instead of bicarbonate, 2) a list of developing countries which manufacture ORS, and 3) statistical information on distribution of ORS by international sources.
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  2. 2

    Magazine versus physicians: the influence of information source on intentions to use oral contraceptives.

    Halpern DF Blackman SL

    Women and Health. 1985 Spring; 10(1):9-23.

    An experiment was conducted among a group of college students to assess the relative influence of various information sources on the subjects' intentions to either use or recommend the use of oral contraceptives (OCs) to others. 162 females and 90 male students at the University of California were presented with a questionnaire concerning the subjects' background characteristics, their attitudes about OCs. The subjects were then asked to read 600-word passages containing information on OCs. All of the passages contained identical statistical information; but 1/2 of the students were given passages in which the statistical information was used to support the use of OCs, and the remaining students were given passages in which the data was used to discourage OC usage. The students were told that the passage was a summary of a published article and that the article was attributable either to a traditional physician, a nontraditional physician, a traditional women's magazine, or a nontraditional (feminist) women's magazine. After reading the passages, the students were presented with another questionnaire concerning their attitudes toward OCs. The subjects' attitudes both before and after reading the passage were evaluated using a 9-point Likert scale, and analysis of variance was used to determine if the students significantly altered their attitudes toward OCs after reading the passages. Students who read supporting passages had more positive attitudes toward OCs than they had before reading the passages, and students who read opposing passages had more negative attitudes toward OCs than they had before the experiment. Students who read opposing passages attributed to physicians made greater negative shifts in their attitudes than students who read opposing passages attributed to magazines. Students who read supporting passages attributed to physicians made greater positive shifts than students who read supporting passages attributed to magazines. Opposing passages had a greater impact than supporting passages. No significant differences were observed in reference to the traditional and nontraditional variable. These findings indicate that despite the growing discontentment with the medical professions, especially among women who are concerned with the negative side effects of OCs, physician are still more influential in shaping attitudes than womenHs magazines, even feminist magazines. Males were included in the study because women are often influenced by their male partners in the choice of a contraceptive. Male subjects were much more likely to be influenced by the passages than females. Previous studies have found that individuals who are less involved in an issue can more easily be persuaded to alter their attitudes than individuals with a strong involvement in the issue. The statistical information presented in the passages was similar to the type of information contained on OC packages. The fact that this information could be interpreted both negatively and positively and the fact that these interpretations were accepted by the subjects, raises many questions about how the information provided by the manufacturers is interpreted by the women who read the information.
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