The gap of economic development expanding between eastern China and middle, western China.
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In 1989 the Ministry of Health in Tanzania decided that all patients suspected to be HIV-infected should be counselled in order to prevent or reduce the risk of HIV-transmission and to help people cope with the disease. This article describes the introduction of a counselling service at the Regional Hospitals of Arusha and Kilimanjaro and provides an overview of our experiences during the period 1990-92. Patients at the two hospitals received pre-test, post-test and follow-up counselling. Of 1,194 persons pre-test counselled, 95% gave their informed consent to be tested 62% were HIV-positive. Data on clinical pretest assessment of the patients matched the HIV-test assessment of the patients matched the HIV-test results for those assessed to have full blown AIDS, but there was more discrepancy for patients assessed to have early signs of AIDS or to be in the terminal phase. The majority of the HIV-positive patients accepted their diagnosis when informed. The routines at the hospitals are still functional five years after the introduction of the counselling service.
A health and nutrition survey was conducted on tribals in three ecological zones of Madhya Pradesh namely Jhabua (West Zone), Bastar (South Zone) and Sarguja (East Zone) taking into consideration the relative contribution of agriculture, forest and a combination of both to the economy, respectively. The consumption of both foods and nutrients appear to be worse among preschool children of Jhabua compared to Bastar and Sarguja. Clinically overt forms of Protein Energy Malnutrition and other vitamin deficiency signs were strikingly low. However, 4% of children in Sarguja exhibited signs of goitre. Both by extent and severity of malnutrition, the children of Jhabua appear to be worse followed by Bastar and Sarguja.
About half the users of contraceptives in Turkey employ traditional methods of family planning, particularly withdrawal. This report presents data from a 1988 national survey to examine Turkish couples' use of and opinions about these methods. Use of traditional methods is widespread across all geographic, demographic, and socioeconomic groups. The principal reasons reported for not using methods generally considered to be highly reliable were fear of health problems and side effects and the opposition of husbands to such methods. Most couples who practice withdrawal also feel that it is as effective as modern methods. These findings imply that a major focus of family planning efforts should be the education of women, of their partners, and of health-care and family planning providers concerning the benefits, risks, and failure rates of both traditional and modern contraceptive methods.
What is the likelihood that each of the 37 developing countries with populations of 15 million or more in 1990 will reach replacement fertility by the year 2015? These countries have a combined population of 3.9 billion, 91 percent of the population of all developing countries. For this article, a composite index was used as the basis for predicting future levels of total fertility. The index was constructed from socioeconomic variables (life expectancy at birth, infant mortality rates, percent adult literacy, ratio of children enrolled in primary or secondary school, percent of the labor force in nonagricultural occupations, gross national product per capita, and percent of the population living in urban areas), total fertility rates for the years 1985-90, total fertility rate decline from 1960-65 to 1985-90, family planning program effort scores in 1989, and the level of contraceptive prevalence in 1990. Eight countries are classified as certain to reach replacement fertility by 2015, and an additional thirteen probably will also. Five countries are classified as possibly reaching replacement fertility, and eleven as unlikely to do so.
Birthweight is sensitive index of social and economic change. The objectives of this study are to establish baseline birthweight, per cent of low birthweight and to determine maternal characteristics on LBW among Thai mothers. The study was based on data from birth records which was collected in 1982. The total number of samples used was 28,952. The lowest mean birthweight occurred in the North and Northeastern regions. These two regions had a mean birthweight of less than 3,000 g. The incidence of LBW was highest in the North at 12.8 per cent. The per cent of birthweight showed the highest with maternal age less than 20 years or parity equal to zero. Unskilled workers showed the highest per cent of LBW in the Northeast, North and the East and housewives in the West and South and farmers in the North.
In 1987, as part of the World Health Organization's Inter-Health Programme, we carried out a noncommunicable diseases survey in six rural villages in Tanzania. Each women completed a questionnaire, part of which was concerned with obstetric history, and underwent a physical examination. Our findings of unacceptably high perinatal mortality and abortion rates are described below.
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We address several key hypotheses about the effects of socioeconomic development on women's labour force participation during the transition from agriculture to industrialism. To this end, we explore differences in women's labour force participation in Brazil by education, marital status, age, and urban or rural residence. We also show how socioeconomic development affects the overall level of women's participation and the differentials by education, etc. Our data are drawn from a large 1973 PNAD (Pequisa Nacional por Amostra de Domicilos) survey conducted by the Brazilian census bureau. Socioeconomic development in different parts of Brazil ranges from pre-industrial agriculture to heavy industry. Using logistic regression, we show that the general level of women's labour force participation does not change with the level of development. Highly educated women are much more likely than the less educated to be in the labour force (net of other influences); this difference is substantially greater than in post-industrial societies. Somewhat surprisingly, the influence of education is the same across the range of development levels in Brazil. Single women are more likely to be in the labour force than married women, and the difference grows during development. Age has a curvilinear relationship to labour force participation, and the old are much less likely to participate in more developed places. Rural women are slightly more likely to be in the labour force at all levels of development.
The International Federation of Pediatric and Adolescent Gynecology surveyed physicians from 11 European countries to ascertain the countries' adolescent pregnancy and abortion rates. Pregnancy rates tended to remain stable or decrease through the 1980s, with some notable exceptions. Germany, Federal Republic exhibited the highest adolescent pregnancy rates; the rate increased from 16% to 21% among 16- to 18-year-olds from 1985 to 1987, and then decreased to 13% by 1989. The United Kingdom had the second highest rate of adolescent pregnancy, although in the 16- to 18-year-old group, the rate decreased from 9.1% in 1985 to 8.6% by 1989. The Netherlands and Denmark had the lowest adolescent pregnancy rates, with a cumulative total of 0.9% in both countries for adolescents under age 18 years in 1985 and 1987; data for 1989 were not available at the time of the survey. Abortion rates among adolescents--expressed as a percentage of the total number of abortions performed in each country--increased in most countries during the 1980s. By 1989, Hungary and Finland had the highest abortion rates, 11% and 9.5%, respectively. Belgium had the lowest rate; only 1% of abortions performed were in women aged 18 years and younger. Most of the countries included in this survey require parental consent for termination of pregnancy. Although the medical complications of pregnancy and birth in adolescents can be minimized with good management and follow-up, the social and psychological implications continue to take a toll. Sex-education programs are one means of reducing the rate of adolescent pregnancy. For adolescents who do become pregnant, however, psychological and social support must be provided in addition to medical care.
More than 18 million persons in the world are estimated to have been infected with human immunodeficiency virus (HIV), the cause of the acquired immunodeficiency syndrome (AIDS). As immunodeficiency progresses, these persons become susceptible to a wide variety of opportunistic infections (OIs) The spectrum of OIs varies among regions of the world. Tuberculosis is the most common serious OI in sub-Saharan Africa and is also more common in Latin America and in Asia than in the United States. Bacterial and parasitic infections are prevalent in Africa; protozoal infections such as toxoplasmosis, cryptosporidiosis, and isosporiasis are also common in Latin America. Fungal infections, including cryptococcosis and Penicillium marneffei infection, appear to be prevalent in Southeast Asia. Despite limited health resources in these regions, some measures that are recommended to prevent OIs in the United States may be useful for prolonging and improving the quality of life of HIV-infected persons. These include trimethoprim-sulfamethoxazole to prevent Pneumocystis carinii pneumonia, toxoplasmosis, and bacterial infections; isoniazid to prevent tuberculosis; and 23-valent pneumococcal vaccine to prevent disease due to Streptococcus pneumoniae. Research is needed to determine the spectrum of OIs and the efficacy of various prevention measures in resource-poor nations, and health officials need to determine a minimum standard of care for HIV-infected persons. An increasing problem in the developing world, HIV/AIDS should receive attention comparable to other tropical diseases.
In 1994, almost 6.6 million women received contraceptive services from more than 7,000 subsidized family planning clinics; these providers were located in 85% of U.S. counties. Health department clinics and Planned Parenthood sites served the largest proportions of these women (32% and 30%, respectively), followed by hospital outpatient sites (16%), independent clinics (13%) and community or migrant health centers (9%). The mix of agency types varied considerably by region and state, and the average annual number of contraceptive clients served per clinic also varied from fewer than 500 at community and migrant health centers to more than 2,000 at Planned Parenthood clinics. Nearly two-thirds of all women served (4.2 million) obtained care at one of the 4,200 clinics receiving funds from the federal Title X family planning program. Health department sites were the most likely to receive Title X funding (78%), followed by independent clinics and Planned Parenthood sites (66% each), hospital clinics (28%) and community and migrant health centers (18%). Overall, clinics receiving Title X funds serve an average of 25% more contraceptive clients than do clinics not receiving such funds.
Fertility in the United Kingdom has now been at a level below that needed for natural replacement of the population (TPFR of 2.1) for more than twenty years. Whilst fertility in many parts of the world (eg most of Europe, and much of the developing world) has declined sharply in recent years, the overall rate in the United Kingdom has been fairly stable (TPFR about 1.8) since 1980. Women are having their children at older ages: fertility rates have been falling for women aged under 30 and rising for women above that age. The mean age at motherhood rose by 1.4 years to 28.4 in England and Wales between 1984 and 1994. The proportion of women in England and Wales who were still childless at age 45 rose to 13 per cent in 1994, and will increase further in the future. One third of births are now to women who are not married, but the recent rapid increase in this proportion may not continue. The percentage of all births which are both outside marriage and registered solely by the mother has been fairly stable (around 7 per cent) for several years. Fertility rates are higher in Northern Ireland than in the rest of the United Kingdom, and lowest in Scotland and in the North of England. Northern Ireland has the lowest proportion of births outside marriage.