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PubMed1993

Contraception and women's health.

More and more women all over the world are opting for fertility by choice not by chance. Contraceptive use has a tremendous impact on women's health. The ability to regulate and control fertility is a basic component of health, positively defined as a state of physical, mental and social well-being. Contraception is saving the lives of women around the world from the hazards of unwanted pregnancy. Optimal childbearing is also contributing to infant and child survival. Contraception has a complex relationship to sexually-transmitted diseases. Contraceptive safety is a major public health concern. The risk/benefit assessment will differ for different populations, for different individuals, and even for the same individual at different periods of life. The family planning movement started as a movement by women for women. Women's perspectives and women's concerns should guide the future of contraceptive research and development.

Adolescent↗
PubMedDate not supplied

Decreased prevalence of Chlamydia trachomatis infection associated with a selective screening program in family planning clinics in Wisconsin.

The effectiveness of selective screening for control of Chlamydia trachomatis is unknown. In 1986, a statewide screening program began in family planning clinics in Wisconsin after the prevalence of infection among women was found to be 10.7% in four nonurban clinics and 13.7% in an urban Milwaukee clinic. In 1990, endocervical specimens were obtained from 1,757 women attending these same clinics; 5.2% of women in the non-urban clinics and 6.9% in the Milwaukee clinic tested positive for C. trachomatis. Prevalence of infection had decreased similarly (by 53% overall) in both high- and low-risk groups in all five clinics. Although reported condom use increased from 16% to 31%, most other demographic and behavioral risk factors for infection did not significantly change; in contrast, the prevalence of clinical signs of infection decreased. The percentage of infections identified by selective screening criteria decreased from 77% to 55%. Selective screening and attendant activities, as well as an increase in condom use, were associated with a decrease in prevalence of C. trachomatis infection in this population.

Adult↗
PubMed1995

Decreasing HIV-1 seroprevalence in young adults in a rural Ugandan cohort.

OBJECTIVE: To assess the trend in HIV-1 seroprevalence in an adult population in Uganda. DESIGN: An observational cohort study with four year follow up. SETTING: A cluster of 15 villages in rural Uganda. SUBJECTS: All residents of the 15 villages--about 10,000 people. MAIN OUTCOME MEASURE: Prevalence of HIV-1 infection as assessed by enzyme immunoassay. RESULTS: During the five year period the overall standardised seroprevalence of HIV-1 showed little change; 8.2% in 1990, 7.6% in 1994. Among males aged 13-24 years the prevalence decreased from 3.4% to 1.0% (P for trend < 0.001); among females of the same age the corresponding values were 9.9% and 7.3%. The decrease was greatest in males aged 20-24 years and females aged 13-19 years. CONCLUSION: This is the first report of a decline in HIV-1 prevalence among young adults in a general population in sub-Saharan Africa with high overall HIV-1 prevalence. It is too early to conclude that the epidemic in this population is in decline, but the results of this study should be reason for some cautious optimism and encourage the vigorous pursuit of AIDS control measures.

Adolescent↗
PubMedDate not supplied

HIV seroprevalence in healthy blood donors in northeastern Zaire.

Despite high seroprevalence rates in some parts of Africa, there is notable variation in prevalence between population subgroups. To document changes and trends in HIV seroprevalence in northeastern Zaire, 1989 to 1992 blood donor data were reviewed. Overall, 2453 donors were tested with seropositivity varying from 2.8% in 1989 to 6.9% in 1992. The increase in seropositivity was significant for men (2.5 to 5.8%, P = 0.017) and for people residing in rural areas (2.0 to 6.1%, P = 0.0008) but not for women (5.4 to 8.6%, P = 0.15) nor for urban individuals (10.5 to 8.6%, P = 0.55). These findings suggest that: 1) HIV infection is spreading in previously less-affected population subgroups rather than increasing widely in the entire population, 2) the HIV epidemic could be reaching a plateau or endemic phase in northeastern Zaire, and, 3) continued blood donor screening and wise transfusion practices are needed.

Blood Donors↗
PubMedDate not supplied

Distribution and trends of HIV infection in blood donors of four metropolitan cities.

Screening for HIV infection has been made mandatory for every unit of blood collected for transfusion in major cities of the country, having facilities for such screening. Results of HIV screening among blood donors received from the 4 Metropolitan cities of Delhi, Bombay, Calcutta and Madras have been analysed year wise from 1989 to 1991 to determine the magnitude and trends of HIV infection in different categories of blood donors and the seropositivity rates seems to be increasing over time. Universal coverage of HIV screening for donated blood has not been fully achieved and the justification and urgency for achieving complete coverage is highlighted.

Adult↗
PubMed1992

Rising trend of HIV infection with special reference to blood donors.

This paper describes the experience in testing for antibodies to the human immunodeficiency virus (anti-HIV) at a private institution. A total of 31,003 persons were tested between August 1986 and June 1990 including 20, 321 blood donors. The other 10,712 were visitors to the Ohso International Commune (OIC), a commune for followers of Osho Rajneesh. Another 133 patients, 45 of whom had been repeatedly transfused, were also tested. Thirty two persons tested positive-22 blood donors, 4 visitors to OIC and 6 patients. The seropositivity of unselected blood donors was O of 273 donors in 1986, 1 of 2836 in 1987 (0.04%), 2 of 5373 in 1988 (0.04%), 11 of 7201 in 1989 (0.15%) and 8 of 4640 in the first half of 1990 (0.17%). Since non-professional blood donors represent a sample of the general population, a rise in seropositivity in the former may imply a rise in the latter.

Adult↗
PubMed1989

Human immunodeficiency virus type 1 (HIV-1) infection among female prostitutes in Borno State of Nigeria: one year follow-up.

Serological investigations on female prostitutes resident in Borno State in northeastern Nigeria have shown that the seroprevalence of HIV-1 infection has increased 9.81%--fold in one year. The highest sero-prevalence rates were found amongst prostitutes who had not benefited from previous health education campaigns. Prostitution appears to be on the increase in spite of AIDS probably because of the difficulty in finding alternative means of making a living. Attempts to halt the spread of HIV infection are hampered by the fact that most prostitutes are indifferent to the use of condoms and do not appreciate the importance of protecting themselves from the risks of HIV infection. Their frequent mobility also poses a problem as it makes it difficult for them to benefit from health education campaigns. The prevalence of HIV-1 infection among female prostitutes in Borno State (as indeed in other States in Nigeria) is likely to rise sharply in the next few years unless serious efforts are made to intensify health education campaigns targeted at the high risk groups.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Integrating health services into an MCH-FP program in Matlab, Bangladesh: an analytical update.

This is a follow-up to a 1984 study that analyzed the relationship between areal variation in the contraceptive prevalence time series and in the intensity of maternal and child health (MCH) services of the Matlab Family Planning Health Services Project. Results based on 69 months of observation suggested that the addition of MCH components to a program with basic MCH and comprehensive family planning services had no incremental impact on family planning efficacy. However, basic MCH services, involving clinical back-up to family planning and child care since the beginning of the program in Matlab, may have contributed to clients' faith in the clinic staff and the overall efficacy of the Matlab program. In the 18 months that followed the cut-off date for this analysis, contraceptive prevalence increased markedly in the study areas. The present analysis repeats the earlier one for the extended time series to determine if the intensification of health services in Matlab contributed to this secondary increase in prevalence, and to ascertain whether the MCH service regimes have long-run differential impacts. Results for the 87-month time series are similar to those of the previous analysis, suggesting that the introduction of additional MCH inputs in the Matlab service area over the 1982-83 period had no incremental impact on the contraceptive prevalence rate time trend.

Bangladesh↗
PubMedDate not supplied

Integrating health services into an MCH-FP program: lessons from Matlab, Bangladesh.

Since 1977 the International Centre for Diarrhoeal Disease Research, Bangladesh, has conducted a field experiment in family planning and MCH in its Matlab research station. The project began with an emphasis on family planning and MCH services were added in stages. This paper uses time series regression methods to address the question of whether the addition of health services contributed to family planning efficacy in Matlab in a program launched with minimal MCH services. The results show that some MCH interventions increased contraceptive prevalence, some decreased it, and others had no effect. The broader significance of these findings for implementing integrated programs is discussed.

Bangladesh↗
PubMedDate not supplied

The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania.

A national household survey of 4,861 women aged 15-44 on reproductive health issues was conducted in Romania in 1993. The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. After abortion became legal, the total fertility rate dropped to below replacement level, while the induced abortion rate doubled. Contraceptive prevalence increased 20 percent, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70 percent of the increase. Limited sex education and contraceptive information, mistrust and misinformation about modern methods, a lack of adequately trained providers, and a shortage or uneven distribution of contraceptive supplies are major reasons for the continued high rates of unintended pregnancy.

Abortion, Induced↗
PubMed1994

Effort and achievement in national family planning programmes.

New data show that national family planning programmes have made impressive progress in the last 25 years. Fertility rates have been reduced dramatically, but during the current decade even greater achievements will be called for.

Family Planning Services↗
PubMed1993

Role of primary health care in the control of schistosomiasis. The experience in Riyadh, Saudi Arabia.

The control programme for schistosomiasis in Saudi Arabia was started in 1975 as a central vertical programme. With the adoption of the primary health care approach a pilot scheme that integrated the control of all endemic diseases, including schistosomiasis, within the functions of primary health care centres was carried out. In Riyadh, the scheme was started in 1984 when subcentres for the control programme were established as a first step for complete integration. A training programme was extended to personnel in primary health care centres, including physicians, nurses, and health inspectors with the help of experts from World Health Organization (WHO). A survey of the population at risk in areas with high prevalence was done regularly accompanied by treatment of cases. Snail control was an important activity of the health inspectors with a three months repeat of the control procedures. The result of this programme is a significant reduction in the prevalence of both urinary and intestinal schistosomiasis, from 13.2% in 1983 to 0.17% in 1989. Among the 7453 water sources surveyed in 1989, only 7 were positive for snails (0.1%). About two thirds of those who were affected were expatriates coming from areas of high prevalence of schistosomiasis. Details of the control programme and its impact on the control of the disease are presented in this paper.

Animals↗
PubMed1994

HIV infection among pregnant women. A worsening situation in Maiduguri, Nigeria.

A serosurvey of 1,233 pregnant women aged 15-41 years, and attending antenatal clinics in Maiduguri, Nigeria from July 1991 to February 1993 showed that 28 (2.3%) of the women were positive for HIV antibodies. Twenty-four (1.9%) were positive for HIV-1 only, 1 (0.08%) was positive for HIV-2 only and 3 (0.24%) were reactive for both HIV-1 and HIV-2. The overall seroprevalence rose gradually from 2.1% in 1991 to 2.3% in 1992, and to 2.6% so far in 1993. From July 1992 to February 1993 6 children aged 24 hours to 8 months were found HIV-positive in the same hospital where this survey was carried out. The only known risk factor for HIV infection applicable to the pregnant women studied was heterosexual intercourse.

Adolescent↗