RESUMO
PIP: According to research conducted in Chile, the Dominican Republic, Egypt, Finland, Singapore, Thailand, and the US, the levonorgestrel contraceptive implant Norplant offers up to 7 years of effective protection from pregnancy. The research involved two independent studies of 1210 women aged 18-40 in the seven countries using soft-tubing as well as hard-tubing Norplant implants. Overall, results indicated that cumulative 7-year pregnancy rates among Norplant users are comparable to rates among women who have been surgically sterilized. Moreover, among women ages 18-33 the 7-year Norplant pregnancy rates are comparable to the median rates of tubal sterilization methods for women of the same age and duration of use. For women ages 34 and older, without regard to weight at admission, the 7-year effectiveness of soft-tubing Norplant equals or surpasses that of tubal sterilization.^ieng
Assuntos
Anticoncepção , Estudos de Avaliação como Assunto , Levanogestrel , Segurança , África , África do Norte , América , Ásia , Sudeste Asiático , Região do Caribe , Chile , Anticoncepcionais , Anticoncepcionais Femininos , Países Desenvolvidos , Países em Desenvolvimento , República Dominicana , Egito , Europa (Continente) , Serviços de Planejamento Familiar , Finlândia , Saúde , América Latina , Oriente Médio , América do Norte , Saúde Pública , Países Escandinavos e Nórdicos , Singapura , América do Sul , Tailândia , Estados UnidosRESUMO
PIP: The politics of fertility control refers to the role of the state in regulating individual behavior. It is about the influence of academics and intellectuals, the motivations of officials and bureaucrats, and the interests of international donors. The politics of fertility control is also about the control which one class or ethnic group exerts over another, and the gender relations within and beyond the household. The Population Council's book, "Do Population Policies Matter? Fertility and Politics in Egypt, India, Kenya, and Mexico," examines what makes the population policies of those four countries either succeed or fail. The analyses show how and why the creation, implementation, and effectiveness of population policies vary over time both within and between countries. Furthermore, the authors demonstrate that effective population policies require political commitment and courage, broad support, adequate funding, good design and management, and a sound concept. The volume's case studies explore population policy-making from both historical and contemporary perspectives in the individual country contexts.^ieng
Assuntos
Fertilidade , Política , Política Pública , África , África Subsaariana , África Oriental , África do Norte , América , Ásia , Demografia , Países em Desenvolvimento , Egito , Índia , Quênia , América Latina , México , Oriente Médio , América do Norte , População , Dinâmica PopulacionalRESUMO
PIP: The 1994 International Conference on Population and Development held in Cairo and the two preceding conferences in Bucharest and Mexico City all addressed the negative relation between population growth and economic development in the developing countries. World population nearly quadrupled in the 20th century, from 1.6 billion to 6 billion. Existing economic and social systems have not been capable of offering even the most urgently needed goods and services to all of the world¿s inhabitants. Each conference has produced a Program of Action committing the member nations. The Cairo conference was distinguished by the reduced weight given to technical issues and the introduction of women¿s perspective and reproductive rights. In Cairo, representatives of the international women¿s movement were able to discuss with governments the most humane and rational manner of managing demographic growth, not by imposing goals of population control, but by facilitating the decisions of women. Not all governments were in agreement with the entire Program of Action, with the Vatican in particular expressing numerous reservations. In 1999, the UN Population Fund will convene ¿Cairo plus Five¿, halfway between the Cairo conference and the fourth conference projected for 2004. The concrete results in each country in implementing the Program of Action will be assessed, financial obstacles will be explored, and countries will be encouraged to complete their programs.^ieng
Assuntos
Congressos como Assunto , Planejamento em Saúde , Controle da População , Política Pública , África , África do Norte , Países em Desenvolvimento , Economia , Egito , Agências Internacionais , Oriente Médio , Organização e Administração , Organizações , Fatores Socioeconômicos , Nações Unidas , Direitos da MulherRESUMO
PIP: The 184 governments represented at the 1994 International Conference on Population and Development in Cairo achieved consensus on a Program of Action with goals for the next 20 years. The Conference recognized that population policies could not be separated from the decisions of men and women regarding their human rights to sexuality and reproduction and that healthy economic and social development must consider the balance between population and environmental resources. Women in particular must be given information, sex education, and contraceptive methods to allow them to implement their reproductive choices. The participation of thousands of independently organized women in sessions preparing for the Cairo conference and in the conference itself facilitated the change of emphasis away from imposition of family planning goals and toward a more humanist demography centering on women. An accord at the Cairo conference called for the donor countries to contribute one-third of the resources needed to carry out the Program of Action. A regular flow of funds was observed in 1994 and 1995, but external aid began to decline in 1996. Every effort must be made to ensure that the goals of the Program of Action are met.^ieng
Assuntos
Economia , Planejamento em Saúde , Desenvolvimento de Programas , Política Pública , Mudança Social , África , África do Norte , Países em Desenvolvimento , Egito , Estudos de Avaliação como Assunto , Agências Internacionais , Oriente Médio , Organização e Administração , Organizações , Nações UnidasRESUMO
PIP: The International Reproductive Rights Research Action Group was founded in 1992 to conduct international research on the meanings of "reproductive rights" for grassroots women in different settings. The qualitative ethnographic study conducted in Brazil, Egypt, Malaysia, Mexico, Nigeria, the Philippines, and the US sought to determine 1) concepts of entitlement about reproduction and sexuality; 2) how reproductive decisions are made; 3) how women practice resistance and accommodation in relation to self-identity and reproductive decision-making; and 4) what social, economic, legal, and political conditions and services affect women's decisions and reproductive life and rights. A number of interview techniques were employed with relatively small numbers of low-income people from diverse backgrounds in each country. The study revealed that significant similarities as well as differences existed among and within the study countries. The women studied exhibited a strong sense of entitlement over reproductive decisions, marriage, and sexual relations. In order to secure their needs, the women accommodated themselves to local expectations when they were unable to rely on a supportive environment to translate their sense of entitlement into effective rights.^ieng
Assuntos
Estudos de Avaliação como Assunto , Direitos Humanos , Medicina Reprodutiva , Pesquisa , Mulheres , África , África Subsaariana , África do Norte , África Ocidental , América , Ásia , Sudeste Asiático , Brasil , Países Desenvolvidos , Países em Desenvolvimento , Egito , Saúde , América Latina , Malásia , México , Oriente Médio , Nigéria , América do Norte , Filipinas , Política , Opinião Pública , América do Sul , Estados UnidosRESUMO
PIP: Dr. Nafis Sadik, Executive Director of the UN Population Fund, notes that in the wake of the 1994 International Conference on Population and Development (ICPD), governments have been persuaded to abandon demographic targets and instead set specific social goals such as reductions in maternal, child, and infant mortality, and improvements in education, especially for girls. Progress is being made with regard to health and education, with all countries having set target dates for the enrollment of all children in school. The meaning of basic health services for all remains unclear. Progress is also being made against female genital mutilation and sexual violence, and improving women's status and the delivery of reproductive health care. Most countries could, however, do a lot more, and greater public support and resources are needed for programs. India, Brazil, Egypt, and Peru are cited as examples of countries which have begun to change policy following the ICPD. Developing countries and donors, with the exception of the US in 1996, have made efforts to increase their levels of spending on reproductive health services; the US has reduced its aid budget by 35%.^ieng
Assuntos
Países Desenvolvidos , Países em Desenvolvimento , Política de Planejamento Familiar , Administração Financeira , Necessidades e Demandas de Serviços de Saúde , Cooperação Internacional , Política Pública , Medicina Reprodutiva , Nações Unidas , África , África do Norte , América , Ásia , Brasil , Economia , Egito , Saúde , Índia , Agências Internacionais , América Latina , Oriente Médio , Organizações , Peru , América do SulRESUMO
OBJECTIVE: To compare the safety and efficacy of an oral rehydration solution (ORS) containing 75 mmol/L of sodium and glucose each with the standard World Health Organization (WHO) ORS among Egyptian children with acute diarrhea. METHODS: One hundred ninety boys, aged 1 to 24 months, who were admitted to the hospital with acute diarrhea and signs of dehydration were randomly assigned to receive either standard ORS (311 mmol/L) or a reduced osmolarity ORS (245 mmol/L). Intake and output were measured every 3 hours. RESULTS: In the group treated with reduced osmolarity ORS, the mean stool output during the rehydration phase was 36% lower (95% confidence interval, 1%, 100%) than in those treated with WHO ORS. The relative risk of vomiting during the rehydration phase was significantly lower in children treated with reduced osmolarity ORS (relative risk, 2.4; 95% confidence interval, 1.2, 4.8). During the maintenance phase, stool output, mean intake of food and ORS, duration of diarrhea, and weight gain were similar in the treatment groups. The relative risk of treatment failure (need for unscheduled administration of intravenous fluids) was significantly increased in children receiving standard WHO ORS (relative risk, 7.9; 95% confidence interval, 1.1, 60.9). The mean serum sodium concentration at 24 hours was significantly lower in children receiving the reduced osmolarity ORS solution (134 +/- 6 mEq/L) than in children receiving the standard WHO ORS (138 +/- 7 mEq/L) (p < 0.001). The relative risk of the development or worsening of hyponatremia was not increased in children given the reduced osmolarity ORS, and urine output was similar in the treatment groups. CONCLUSION: The reduced osmolarity ORS has beneficial effects on the clinical course of acute diarrhea in children by reducing stool output, and the proportion of children with vomiting during the rehydration phase, and by reducing the need for supplemental intravenous therapy. These results provide support for the use of a reduced osmolarity ORS in children with acute noncholera diarrhea.
PIP: Between July 1993 and March 1994, clinical researchers in Egypt enrolled 190 male children aged 1-24 months with acute diarrhea at the Abu El Reeche Hospital in Cairo in a randomized double-blind clinical trial to evaluate the relative efficacy of a reduced osmolarity oral rehydration solution (ORS) containing 75 mmol/l of both sodium and glucose (total osmolarity, 245 vs. 311 mmol/l for the standard ORS recommended by the World Health Organization and UNICEF) for treating acute noncholera diarrhea. They measured intake and output every three hours. Over the entire course of the study, the mean stool output was significantly lower in the reduced osmolarity ORS group than the standard ORS group (4.3 vs. 5 g/kg/hour; p 0.05). During the rehydration phase, the mean stool output was 36% lower in the reduced osmolarity ORS group than in the standard ORS group (p 0.05). The proportion of children vomiting during rehydration was much lower in the reduced osmolarity ORS group than the standard ORS group (17% vs. 33%; relative risk [RR] = 2.4; p 0.01). During the maintenance phase, the two groups shared similar stool output, mean intake of food and ORS, duration of diarrhea, and weight gain. Treatment failure was significantly more common in the standard ORS group than the reduced osmolarity ORS group (8% vs. 1%; RR = 7.9; p 0.01). The mean serum sodium level at 24 hours were much lower in the reduced osmolarity ORS group (134 vs. 138 mEq/l; p 0.001) but remained within the normal range in both groups. Children in both groups developed hyponatremia or their hyponatremia worsened at the same rate. Urine output was about the same in both groups. These findings suggest that the reduced osmolarity ORS has advantages over the standard ORS as a treatment for acute noncholera diarrhea. This safe and effective rehydration treatment reduces stool output and vomiting during rehydration as well as reduces the need for supplemental intravenous therapy.
Assuntos
Diarreia Infantil/terapia , Hidratação/métodos , Glucose/análise , Soluções para Reidratação/química , Soluções para Reidratação/uso terapêutico , Sódio/análise , Doença Aguda , Método Duplo-Cego , Egito , Humanos , Lactente , Masculino , Concentração Osmolar , Risco , Resultado do Tratamento , Organização Mundial da SaúdeRESUMO
PIP: This article presents extracts from comments made by young people in various parts of the world about the meaning of the term "safe motherhood." A Ghanian woman noted that young girls, who often bear a heavier workload than boys but receive less food, need to be given the same diet as boys. A young Senegalese mother relayed that she found out she was pregnant when she went to a hospital with stomach pains shortly before her 14th birthday. Until then she had no idea that sexual intercourse led to pregnancy. A Mexican youth cited the problems that accompany adolescent pregnancy and motherhood, and a young woman in India called for delivery of proper medical care to all young mothers and presentation of health education about safe motherhood in schools. An Egyptian youth extolled the benefits of a project that involved young people from rural youth organizations in safe motherhood IEC (information, education, and communication) activities. Previously, adolescents had not received any special attention. Finally, a youth working in a family planning educational booth in Botswana stated that many youth who engage in sexual intercourse at an early age have no idea of the consequences of their actions.^ieng
Assuntos
Adolescente , Coleta de Dados , Estudos de Avaliação como Assunto , Bem-Estar Materno , Medicina Reprodutiva , África , África Subsaariana , África do Norte , África Austral , África Ocidental , Fatores Etários , América , Ásia , Botsuana , Demografia , Países em Desenvolvimento , Egito , Gana , Saúde , Índia , América Latina , México , Oriente Médio , América do Norte , População , Características da População , Pesquisa , Estudos de Amostragem , SenegalRESUMO
OBJECTIVES: To examine the probability of inadequacy of schoolchild nutrient intakes; to compare the predicted adequacy of schoolchild diets to previously published data for toddler diets and to examine the relative adequacy of the diets of sibling pairs. DESIGN: Food consumption data were measured 2 days per month across approximately one year. Mean nutrient intakes were calculated and compared to international standards using a probability approach. SETTING: Villages in Egypt, Kenya, and Mexico. SUBJECTS: 285 school-age children (7-9 years of age) and 255 toddlers (18-30 months of age) including 94 sibling pairs. RESULTS: Within a country, there was a striking similarity between the nutrients predicted to be inadequate in schoolchild and toddler diets across all nutrients except vitamin B12, which was more likely to be inadequate among schoolchildren. Nutrients of concern for both ages in one or more countries included iron, zinc, calcium, riboflavin, and vitamins B12, D, E, and A. For 94 toddler-schoolchild pairs, siblings at high risk of nutrient inadequacy could be identified from an indicator child with a sensitivity of 43-100% and a specificity of 59-100%. CONCLUSIONS: Nutrient adequacy tends to be a household characteristic for these two ages of children. Nutritional interventions that target the household have a high probability of benefitting multiple age groups of children.
PIP: The authors investigated the probability of inadequacy of schoolchild nutrient intakes in order to compare the predicted adequacy of schoolchild diets to previously published data for toddler diets, and to examine the relative adequacy of the diets of sibling pairs. Food consumption data were measured two days per month for approximately one year for 285 children aged 7-9 years and 255 infants aged 18-30 months, including 94 sibling pairs, in villages in Egypt, Kenya, and Mexico. Mean nutrient intakes were calculated and compared to international standards using a probability approach. Within a country, there was close similarity between the nutrients predicted to be inadequate in schoolchild and toddler diets across all nutrients except vitamin B(12), D, E, and A. For 94 toddler-schoolchild pairs, siblings at high risk of nutrient inadequacy could be identified from an indicator child with a sensitivity of 43-100% and a specificity of 59-100%. Nutritional interventions which target the household have a high probability of benefiting multiple age groups of children.
Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Saúde Suburbana , Criança , Pré-Escolar , Egito/epidemiologia , Humanos , Lactente , Quênia/epidemiologia , México/epidemiologia , Inquéritos Nutricionais , Prevalência , Sensibilidade e EspecificidadeRESUMO
A multicenter, international, randomized, comparative trial was conducted to assess the acceptability, efficacy and safety of two different schedules of a contraceptive pill, containing 250 micrograms levonorgestrel and 50 micrograms ethinyl estradiol, administered by the vaginal route. One schedule of daily administration for 21 days with a seven-day interruption to allow withdrawal bleeding was compared to daily administration without interruption for bleeding. A total of 900 women were recruited in three countries, Brazil, Egypt and China; 7,090 women-months of vaginal pill use were recorded (3,364 using the pills intermittently and 3,726 continuously). Four undesired pregnancies occurred, one in Egypt and three in China, all four in women using the pills intermittently. There was a statistically significant difference (p = 0.486) in pregnancy rate between the two groups. There were no other significant differences in discontinuation rates despite marked differences in bleeding patterns, amenorrhea predominating in the continuous use group. Hemoglobin levels increased significantly in the two groups but hematocrit was significantly higher in the continuous use group.
PIP: 900 healthy women 16-42 years old were recruited in Brazil, China, and Egypt for a multicenter, randomized, comparative clinical trial to determine the acceptability, efficacy, and safety of two different schedules of a contraceptive pill with 250 mcg levonorgestrel and 50 mcg ethinyl estradiol administered vaginally. The two schedules were: 1) daily vaginal use of the pill for 21 days, followed by withdrawal for regular bleeding, and restarted 7 days later, and 2) use of the pill by the vaginal route nonstop for one year. There were no significant difference in cumulative discontinuation rates between the two groups (total, 15.5 for intermittent group and 14.64 for continuous group), except for unwanted pregnancy. The only unwanted pregnancies occurred to 4 women in the intermittent group (1.04%) (p = 0.0486). Women in the continuous use group were more likely than those in the intermittent group to have spotting at least once (20.6% vs. 4.4%; p 0.001). Women in the continuous group were more likely than those in the intermittent group to have amenorrhea. For example, the mean number of bleeding/spotting days during all time intervals was lower for the continuous group than for the intermittent group (p 0.001; last interval, 0.97 vs. 12.83). Hemoglobin levels increased considerably in both groups between baseline and one year of use (11.61 vs. 11.9 g/dl for intermittent group and 11.54 vs. 11.81 g/dl for continuous use; p 0.001). The mean value of hematocrit at 12 months for the continuous group was higher than that at baseline (38.8% vs. 38.2%; p = 0.011). It did not increase in the intermittent group, however. Women in both groups gained weight during the 12 months of pill use. The weight gain was significant for the continuous group only. These findings suggest that continuous use of vaginal contraceptive pills may be more advantageous than intermittent use oral contraceptives and may benefit anemic women and those who bleed heavily during menstruation.
Assuntos
Anticoncepcionais Femininos/administração & dosagem , Congêneres do Estradiol/administração & dosagem , Etinilestradiol/administração & dosagem , Levanogestrel/administração & dosagem , Administração Intravaginal , Adolescente , Adulto , Brasil , China , Anticoncepcionais Femininos/efeitos adversos , Anticoncepcionais Femininos/normas , Formas de Dosagem , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Egito , Contagem de Eritrócitos , Congêneres do Estradiol/efeitos adversos , Congêneres do Estradiol/normas , Etinilestradiol/efeitos adversos , Etinilestradiol/normas , Feminino , Hematócrito , Hemoglobinas/análise , Humanos , Cooperação Internacional , Levanogestrel/efeitos adversos , Levanogestrel/normas , Fatores de TempoRESUMO
The overall objective of both the Institute of Nutrition of Central America and Panama (INCAP) studies and the Nutrition Collaborative Research Support Program (CRSP) was to determine if marginal malnutrition affects human function. The conclusions from the two studies were consistent, notably that growth stunting occurs early in life and is accompanied by functional impairments. These consequences of early malnutrition persist later in life. The comparison of INCAP and Nutrition CRSP results also illustrates that the Guatemalan children were more malnourished and stunted than those in Kenya, Mexico or Egypt and that this greater degree of stunting occurs before 18 months of age. Even the Atole did not bring the average size of supplemented children in Guatemala up to those of the unsupplemented children in the CRSP populations. It is also likely that their functional potential was not realized fully by supplementation. The CRSP studies provide evidence of multiple micronutrient deficiencies associated with poor growth and function and it is probable that these associations exist in Guatemala as well. The overall conclusion is that our attention should be directed to determining the adequacy of micronutrient status in the perinatal period and to the development of approaches that prevent early growth failure.
PIP: This study compares data between the Institute of Nutrition of Central America and Panama studies and the Nutrition Collaborative Research Support Program (CRSP) in order to determine if marginal malnutrition affects human function. Findings from both studies were consistent and revealed that growth stunting occurs early in life and was accompanied by functional impairments in which these consequences persists later in life. The comparative studies also illustrates that Guatemalan children were more malnourished and stunted compared to those in Kenya, Mexico, or Egypt and that this greater degree of stunting occurred before 18 months of age. In addition, CRSP studies provide evidence of multiple micronutrient deficiencies associated with poor growth and function and it was probable that these associations exist in Guatemala as well. The overall conclusion is that attention should be directed in determining the adequacy of micronutrient status in the perinatal period and to the development of approaches that prevent early growth failure.
Assuntos
Transtornos da Nutrição Infantil/complicações , Deficiências do Desenvolvimento/etiologia , Transtornos do Crescimento/etiologia , Adolescente , Criança , Transtornos da Nutrição Infantil/dietoterapia , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Egito/epidemiologia , Feminino , Alimentos Fortificados , Guatemala/epidemiologia , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Estudos Longitudinais , Masculino , México/epidemiologia , Estudos Multicêntricos como Assunto , Inquéritos Nutricionais , Gravidez , Prevalência , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
PIP: Interpersonal communication skills are not often emphasized during the professional training of health workers. Accordingly, many people who visit health facilities do not receive the attention and information they need due to poor interpersonal communication. The Quality Assurance Project developed a course to train 26 health workers in Honduras in one-to-one communication skills under the assumption that people who are relatively better satisfied with the service they receive from health workers will be more likely to follow health workers' advice and enjoy improved health. The course addressed good social skills, problem solving skills, and counseling and education methods. Participants practiced their new skills through role play and discussion with their peers of tape-recorded consultations with an actual patient. New communication skills were then summarized in a pocket-sized booklet given to all participants as a reminder of what they learned, while each participant was also given a more detailed training manual. Initial results indicate that training resulted in a significant improvement in communication skills and a decrease in poor communication behavior such as criticizing people or interrupting them. The Ministry of Health expressed interest in incorporating the training course into its ongoing staff training. The course has now been adapted and run in Egypt and Trinidad, demonstrating that it can be adapted to suit different settings and cultures.^ieng
Assuntos
Comunicação , Educação , Relações Médico-Paciente , África , África do Norte , América , Comportamento , Região do Caribe , América Central , Países em Desenvolvimento , Egito , Honduras , Relações Interpessoais , América Latina , Oriente Médio , América do Norte , Trinidad e TobagoRESUMO
PIP: Through the use of case studies from Kenya, Malaysia, Mexico, and Morocco, the influence of environmental degradation on women's livelihoods and fertility is broadly examined. The aim is to show how the environment impacts on women's childbearing decisions, and the consequences. The evidence appears to support the notion that environmental pressures on women will contribute to higher fertility, under conditions of gender division of labor, a very low social status for women, and women's limited educational opportunity. The Kenya experiences were among rural villages in various agro-ecological zones in Embu, on the slopes of Mt. Kenya, and involved coping strategies with poor soils and very little rainfall. The Malaysian research focused on river communities in the rain forests of Limbang River Basin in Sarawak and the logging industry and government regulation of tribal land use rights. In mountainous Tetouan and A1 Hoceimain, Moroccan populations struggle with poor social services and little rainfall. The study areas in Morocco and Kenya had very high population growth, but declining growth rates nationally. The study areas suffered from deforestation, declines in water quality and availability, and soil erosion and depletion. Family planning services would be welcome: 1) when women do not have to solely bear the responsibility for the additional work involved in environmentally degraded areas; and 2) when the value of children is not increased. Policy must recognize that where rigid gender division of labor is prominent, children are a crucial resource for women in the provision of household support. The Morocco case exemplified the extremes of men's refusal to ease women's workloads with time and labor saving technology. Family planning promotion in such situations must be accompanied by provision of alternative resources to address the adverse environmental impacts on women. Blaming women for environmental problems and family planning promotion will fail to gain credibility and the trust of women unless they are provided options.^ieng
Assuntos
Países em Desenvolvimento , Emprego , Estudos de Avaliação como Assunto , Dinâmica Populacional , Crescimento Demográfico , África , África Subsaariana , África Oriental , África do Norte , América , Ásia , Sudeste Asiático , Conservação dos Recursos Naturais , Demografia , Economia , Meio Ambiente , Fertilidade , Mão de Obra em Saúde , Quênia , América Latina , Malásia , México , Oriente Médio , Marrocos , América do Norte , População , PesquisaRESUMO
Vitamin intakes of 255 toddlers (aged 18-30 mo) were estimated from food consumption recorded during 1 y at sites in Egypt, Kenya, and Mexico. Mean intakes were compared with requirements standards by using a probability approach to estimate the prevalence of inadequate intakes. There were predicted inadequacies for vitamin A (32%) and riboflavin (20%) in Egypt, vitamins A (68%) and C (63%) and riboflavin (52%) in Mexico, and vitamin B-12 (44%) in Kenya. Vitamin E was inadequate in all diets, but in relation to polyunsaturated fatty acids only the intake in Mexico was low. No diet provided the recommended amount of vitamin D, but its dietary requirement is uncertain. Correlations among nutrient intakes suggest factors that may contribute to reported associations of consumption of animal products with improved growth or development among these children: provision of vitamin B-12 and available minerals, displacement of fiber and phytate-rich energy sources, and increased energy density.
PIP: Data on 255 children, 18-30 months old, in Kalama village on the Nile delta in Egypt, the Embu district in Kenya, and the Solis Valley in Mexico were analyzed over a 1-year period to study the relationships of energy and animal protein intakes with vitamins, minerals, and two factors that affect bioavailability, dietary fiber and phytate. The researchers used the probability approach to determine the prevalence of inadequate intakes. Estimated intake inadequacies were 32% for vitamin A and 20% for riboflavin in Egypt; 68% for vitamin A, 63% for vitamin C, and 52% for riboflavin in Mexico, and 44% for vitamin B12 in Kenya. All the diets were deficient in vitamin E. Yet, when researchers compared vitamin E in relation to polyunsaturated fatty acids, the vitamin E intake was low only in Mexico. None of the diets had the recommended amount of vitamin D, but actual dietary requirements were unknown. Further, the researchers had no information on solar exposure. Provision of vitamin B12 and available minerals, displacement of fiber and phytate-rich energy sources, and increased energy density were associated with improved growth or development among children ingesting animal products (p 0.05). Intakes of folacin, niacin, and thiamin were negatively related to animal protein intake (p 0.05).
Assuntos
Deficiência de Vitaminas/epidemiologia , Dieta , Vitaminas , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Egito/epidemiologia , Ingestão de Energia , Feminino , Previsões , Humanos , Lactente , Quênia/epidemiologia , Masculino , México/epidemiologia , PrevalênciaRESUMO
The efficacy and acceptability of two widely used oral contraceptive tablets, one containing 250 mg levonorgestrel and 50 micrograms ethinyl estradiol and the other containing 150 micrograms desogestrel and 30 micrograms ethinyl estradiol, administered by the vaginal route were compared in 1055 women studied over 12,630 woman-months of vaginal contraceptive pill use. This multicenter clinical trial was performed in nine countries of the developing world by the "South to South Cooperation in Reproductive Health," an organization founded by scientists from the Third World working in the area of reproductive health, and the study was developed and coordinated by one of these centers. The findings of this study confirm the efficacy of both these tablets when administered by the vaginal route. Involuntary pregnancy rates at 1 year of 2.78 for subjects in the levonorgestrel group and 4.54 for subjects the desogestrel group showed no statistically significant difference between the two groups. However, total discontinuation rates of 47.01 for subjects in the levonorgestrel group and 56.33 for subjects in the desogestrel group showed a statistically significant difference between the two groups, and discontinuation rates attributable to prolonged bleeding of 0.6 for subjects in the levonorgestrel group and 3.2 for subjects in the desogestrel group were also significantly higher in the group of subjects using the desogestrel vaginal contraceptive pill. Blood pressure remained at admission values throughout treatment. A statistically significant weight increase from admission values occurred in both groups of subjects.
PIP: Efficacy and acceptability of 2 combined oral contraceptive pills administered vaginally are summarized. This is the 1st collaborative trial published by the South to South Cooperation in Reproductive Health. 1055 women participated in 12,630 cycles, in 9 countries, from June 1988 to May 1991. The pills were commercially available tablets containing 50 mcg ethinyl estradiol and 250 mg levonorgestrel (Schering AG, Sao Paulo, Brazil), or 30 mcg ethinyl estradiol and 15 mcg desogestrel (Organon, Sao Paulo, Brazil). Subjects were aged 17-39 younger and of lower parity from Mexico and Dominican Republic and older from Egypt and China. All had at least 1 pregnancy. 675 participated for 6 months, 470 for 1 year, 364 for 18 months, and 210 for 2 years. The 1-year discontinuation rate averaged 47.01% for the levonorgestrel group and 56.33% for the desogestrel group (p = 0.0061); 2-year discontinuation rates were 48.01% and 69.36, respectively, explained in part by higher involuntary pregnancy rates and prolonged bleeding rates in the desogestrel group. The most common medical reasons for stopping contraception were unplanned pregnancy, vaginal or vulval irritation, nausea, vaginal discharge and headache. Vaginal irritation was reported by 1%, 9 in each group. There were 32 pregnancies, 14 in the levonorgestrel and 18 in the desogestrel group. 17 were in missed pill cycles and the rest were method failures, 6 in the levonorgestrel group and 9 in the desogestrel group. The Pearl index varied from 0 in Nigeria to 12.24 in Mexico, and was 2.45 for levonorgestrel vs. 3.74 for desogestrel. There was a wide variation in discontinuation rates by center: Brazil and China had few, while many women from Dominican Republic, Mexico and Zambia left the study. Bleeding problems were common complaints, more so in the desogestrel group. There were 363 women with intermenstrual bleeding (only once in 80%), 148 with spotting (only twice in 65%). Bleeding duration was significantly less in pill cycles than baseline, pressure. Women gained an average of 1 kg over 2 years, more in the desogestrel group. The pregnancy rate of 2.78 is within the range reported for levonorgestrel rings.
Assuntos
Desogestrel/administração & dosagem , Etinilestradiol/administração & dosagem , Levanogestrel/administração & dosagem , Administração Intravaginal , Adolescente , Adulto , Desogestrel/efeitos adversos , Países em Desenvolvimento , Combinação de Medicamentos , Etinilestradiol/efeitos adversos , Feminino , Humanos , Levanogestrel/efeitos adversos , Estudos Multicêntricos como Assunto , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Distribuição Aleatória , VaginaRESUMO
PIP: The advent of the development gap between the industrialized countries and the underdeveloped countries is explored through an examination of early attempts to industrialize in Latin America and the Middle East in the years 1770-1870. The beginning of the development gap can be dated to 1830-60, with the diffusion of the industrial revolution in Western Europe and the US. The periphery remained poorly defined and still enjoyed a significant degree of economic autonomy through 1870, but lowered cost of international freight, the increasing cost and technological complexity of machinery,and other factors after that date combined to assure increasing economic integration of nations. Latin America and the Middle East were selected for study because they were the only present-day developing regions to have developed modern industry before 1850-60 except for Bengal, which was already colonized by the British. The industrial revolution was a decisive development in the history of human societies, marked by a drastic acceleration of the rate of economic growth as much as by an unprecedented increase in inequality of development between countries. Societies bypassed by technological innovations thus seemed doomed sooner or later to depend on societies at the center of development. Third world contemporaries of the early industrial revolution appear to have been aware of this, and some peripheral states made serious efforts to avoid the worst forms of external dependence and to resist the deindustrialization, pauperization, and direct colonization of underdevelopment. 3 types of attempts at industrialization in Latin America and the Middle East before 1860-80 are distinguished and described, including partial and unsuccessful public efforts in several countries, isolated private initiatives going against prevailing trends in Mexico and Brazil, and industrial development directed step by step by the state in Egypt and Paraguay. It is argued that the model of industrialization in Egypt and Paraguay anticipated the Japanese experience in certain respects and would have had a good chance of success hand not devastating warfare destroyed the economics of both countries. The author explores 5 questions to assess the relevance of the Paraguayan and Egyptian model: 1) whether the natural environment of the 2 countries offered favorable conditions for modern factories, 2) whether peripheral states had the resources for financing a true industrialization policy, 3) whether the sociocultural context of the 2 countries would have permitted them to develop an industrial culture, 4) whether the West would have tolerated the competition implied by their economic development and industrialization, and 5) whether this model of industrialization was adjusted to the specific conditions of the periphery.^ieng
Assuntos
Países Desenvolvidos , Países em Desenvolvimento , Economia , Estudos de Avaliação como Assunto , Indústrias , Política , Pobreza , Poder Psicológico , África , África do Norte , América , Ásia , Ásia Ocidental , Brasil , Colômbia , Egito , Irã (Geográfico) , América Latina , México , Oriente Médio , América do Norte , Paraguai , Fatores Socioeconômicos , América do Sul , Tunísia , TurquiaRESUMO
PIP: Refuting research findings on IUDs from the early 1980s, and controversy over the safety of the Dalkon Shield, research published over the past 10 years indicates that modern IUDs are safe and effective for most women. Better understanding of pelvic inflammatory disease (PID) reveals PID to present no more frequently among IUD user selection, insertion, and monitoring techniques are followed. Following such guidelines, and avoiding use in women at high risk for infection from sexually transmitted diseases (STD) will generally provide effective, acceptable, and inexpensive protection against pregnancy. The TCu 380 A IUD has in fact proved to be as effective as injectables or newly- developed hormonal implants. Accordingly, expanded use around the world is encouraged. The IUD has already become the most widely used from of reversible contraceptive with 85 million users in China, developed nations, Indonesia, Mexico, Egypt, and India. China claims 60/85 million users. Family Health International clinical trials involving 10,000 women in 23 developing countries during the period 1985-89, found declining removals due to complications, with increasing rates of method continuation. Women having a baby are ideal candidates for IUD acceptance and insertion. Such women may receive IUD insertion 10 minutes following expulsion of the placenta, while not posing risks to safe breastfeeding. Method drawbacks include the need for trained health professionals in insertion, removal, and follow-up exams over the 1st 3 months following insertion. IUDs also do not protect against STDs.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Aleitamento Materno , Anticoncepção , Países Desenvolvidos , Países em Desenvolvimento , Infecções por HIV , Dispositivos Intrauterinos de Cobre , Aceitação pelo Paciente de Cuidados de Saúde , Período Pós-Parto , Gravidez não Desejada , Infecções Sexualmente Transmissíveis , Fatores de Tempo , África , África do Norte , América , Ásia , Sudeste Asiático , China , Comportamento Contraceptivo , Demografia , Doença , Egito , Europa (Continente) , Serviços de Planejamento Familiar , Ásia Oriental , Fertilidade , Saúde , Índia , Indonésia , Fenômenos Fisiológicos da Nutrição do Lactente , Infecções , Dispositivos Intrauterinos , América Latina , México , Oriente Médio , América do Norte , Fenômenos Fisiológicos da Nutrição , População , Dinâmica Populacional , Reprodução , Comportamento Sexual , Terapêutica , Estados Unidos , VirosesRESUMO
PIP: Mexico and the US share a long border as well as strong cultural and economic ties. Mexico bought $25 billion worth of American goods in 1989. 1 million workers enter the labor market in Mexico every year. Mexico City is heavily polluted, 40% of the rural population is malnourished, and deforestation and desertification further damage the environment. Mexican real wages dropped 25% in the 1980s as oil prices declined. Egypt's arable land area is only 4% of the total, water supplies are scarce, but its human resources are abundant. 3 million Egyptians work overseas. The runaway population growth means that at the current rate it will double by 2012 from 50 million in 1990 threatening the stability of the country. Food production is off because of salinization caused by the Aswan Dam. Kenya has weathered droughts in the 1980s without major upheavals, but the softening of world coffee and tea prices, fears of European tourists, and more expensive imported oil have weakened the economy. The population doubled from 8 million in 1960 to 16 million in 1980 with a fertility rate of 8 children/woman. The prospect is 40 million by 2000 and 80 million by 2020. Deforestation caused by fuelwood needs has increased erosion resulting in reduced agricultural productivity. Agroforestry training and more energy efficiency are required, and water supplies are also insufficient. The Philippines uplands have experienced environmental degradation caused by population pressure: increase from 19 million in 1948 to 63 million in 1988. Since ownership of good cropland is concentrated in a few wealthy families landless people clear forests for cultivation leading to erosion. Logging also contributes to deforestation, but environmental destruction is not among government priorities.^ieng
Assuntos
Agricultura , Conservação dos Recursos Naturais , Poluição Ambiental , Dinâmica Populacional , África , África Subsaariana , África Oriental , África do Norte , América , Ásia , Sudeste Asiático , Países em Desenvolvimento , Egito , Meio Ambiente , Quênia , América Latina , México , Oriente Médio , América do Norte , FilipinasRESUMO
Follow-up surveys were carried out in six countries (Bangladesh, Columbia, El Salvador, Guatemala, Indonesia, and Tunisia) between 1984 and 1986 to assess client decision-making regarding sterilization. The results revealed that women made well-informed, voluntary decisions to be sterilized. They were knowledgeable about other family planning methods and made the decision to be sterilized after consulting their partners, friends, relatives, or other sterilized women. Although their decisions were voluntary, other findings revealed areas for improvement such as client information and education about the risks of the procedure. These data were used to improve program services by emphasizing the need for better information, education, and counseling programs.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Esterilização Tubária , Adulto , Bangladesh , Serviços de Saúde Comunitária/organização & administração , El Salvador , Feminino , Seguimentos , Guatemala , Humanos , Esterilização Tubária/psicologiaRESUMO
In 1986-87, a qualitative research project was conducted in the Dominican Republic, Egypt, Indonesia, and Thailand to expand understanding of the acceptability of NORPLANT contraceptive implants beyond inferences made on the basis of continuation rates. In each of the four study sites, focus group discussions or in-depth interviews were held with potential acceptors, current NORPLANT users, discontinuers, husbands of women in these three groups, and service providers. Nonclinical participants generally had little formal education and lived primarily in urban or semi-urban areas where NORPLANT has been available for at least five years. The study focused on attitudes, perceptions, and experiences of each group regarding NORPLANT implants. Results suggest that factors having an impact on the acceptability of NORPLANT implants fall into three general categories: medical/technical, cultural/religious, and informational/educational. This article discusses each of these categories, including programmatic implications of the findings, and puts forward recommendations for enhancing NORPLANT introduction efforts on the basis of these findings.
PIP: In 1986-87, a qualitative research project was done in Thailand, Egypt, Indonesia, and the Dominican Republic to expand knowledge of the acceptability of NORPLANT contraceptive implants beyond continuation rates. In each of the 4 studies, in-depth interviews or focus group discussions were held with current NORPLANT users, potential acceptors, discontinuers, husband of women in the 3 groups, and service providers. The 4 countries were chosen because of their diverse cultures and religions. Most participants favored family planning. Many had used other contraceptives. Men and women in all countries were worried that oral female contraceptive agents (the pill) caused cancer. There were many objections to the IUD. In all countries but Thailand, there was little knowledge of NORPLANT. In the Dominican Republic, NORPLANT was used mostly as a child spacing method. In Indonesia, it was used for child spacing and termination of childbearing. Perceived advantages were alike in all countries. Pain during insertion and removal was a big concern of potential users. Men and women in all countries said that religion and traditional beliefs did not influence their family planning decisions. But many said that religion influenced their tolerance of side effects. In Egypt and Indonesia sterilization is unpopular because it is seen as violating Islamic law. Irregular bleeding was the major side effect and the main reason for discontinuation. Many satisfied users felt that the advantaged outweighed the side effects. Primary reasons for removal in all countries were irregular bleeding, amenorrhea, and the desire to give birth. The need for information was mentioned in all countries. In Egypt, Indonesia, and Thailand services providers reported the need for more thorough training in insertion and removal as well as continuing education sessions.