Use of tetanus toxoid for the prevention of neonatal tetanus. 2. Immunization acceptance among pregnant women in rural Bangladesh.
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Adolescent↗
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Immunisation in a curative setting.
OBJECTIVE: To study the uptake of vaccination offered to women and children attending a curative health facility. DESIGN: Prospective survey over eight months of the uptake of vaccination offered to unimmunised women and children attending a diarrhoeal treatment centre as patients or attendants. SETTING: The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. SUBJECTS: An estimated 19,349 unimmunised women aged 15 to 45 and 17,372 children attending the centre for treatment or accompanying patients between 1 January and 31 August 1989. MAIN OUTCOME MEASURES: The number of women and children who were unimmunised or incompletely immunised was calculated and the percentage of this target population accepting vaccination was recorded. RESULTS: 7530 (84.2%) Of 8944 eligible children and 7730 (40.4%) of 19,138 eligible women were vaccinated. Of the children, 63.8% were boys, 75.9% were aged under 1 year, and 23.0% were aged 1 to 2 years. The estimated number of missed opportunities for vaccination was 716 among the children (8.0% of the target population) and 11,408 among the women (59.6% of those eligible). CONCLUSION: It is possible to establish immunisation services at a health facility treating acutely ill patients.
Bangladesh↗
Simulating smokers' acceptance of modifications in a cessation program.
Recent research has underscored the importance of assessing barriers to smokers' acceptance of cessation programs. This paper illustrates the use of computer simulations to gauge smokers' response to program modifications which may produce barriers to participation. It also highlights methodological issues encountered in conducting this work. Computer simulations were based on conjoint analysis, a consumer research method which enables measurement of smokers' relative preference for various modifications of cessation programs. Results from two studies are presented in this paper. The primary study used a randomly selected sample of 218 adult smokers who participated in a computer-assisted phone interview. Initially, the study assessed smokers' relative utility rating of 30 features of cessation programs. Utility data were used in computer-simulated comparisons of a low-cost, self-help oriented program under development and five other existing programs. A baseline version of the program under development and two modifications (for example, use of a support group with a higher level of cost) were simulated. Both the baseline version and modifications received a favorable response vis-à-vis comparison programs. Modifications requiring higher program costs were, however, associated with moderately reduced levels of favorable consumer response. The second study used a sample of 70 smokers who responded to an expanded set of smoking cessation program features focusing on program packaging. This secondary study incorporate in-person, computer-assisted interviews at a shopping mall, with smokers viewing an artist's mock-up of various program options on display. A similar pattern of responses to simulated program modifications emerged, with monetary cost apparently playing a key role. The significance of conjoint-based computer simulation as a tool in program development or dissemination, salient methodological issues, and implications for further research are discussed.
Adolescent↗
The influence of health care on contraceptive acceptance in rural Mexico.
This paper offers two types of evidence in support of the idea that family planning services are most expediently provided as an integral part of the health and medical organization for maternity care. First, prenatal care and medical attention at delivery are found to be closely associated with postpartum contraceptive acceptance in a 1981 survey of family planning in rural Mexico. Second, interviews of a sample of doctors, nurses, and auxiliaries who provide maternal health services to the rural population reveal that these practitioners favor long birth intervals and small completed families, that they recommend the use of modern contraceptive methods including female sterilization, and that those in the employ of public institutions are motivated to recruit acceptors of these methods. The main impediment to contraceptive acceptance in this context is believed to be fear of side effects and permanent health consequences rather than the desire for additional children.
Attitude of Health Personnel↗
Cultural influences on health care use: two regional groups in India.
While health care services are increasingly being seen as a major proximate determinant of decreased mortality in a population, it also seems to be the case that the mere provision of services does not lead to their better utilization. However, in general, it is difficult to explore differences in utilization because the availability of services itself varies so greatly. This report presents the results of a study in India of two distinct regional groups of similar socioeconomic status, residing in the same locality and, therefore, theoretically exposed to the same health services. Both groups share a strong faith in modern medicine (especially if it is obtained from a private practitioner) for the treatment of most common illnesses. However, important cultural differentials exist in the medical services sought for childbirth and in the treatment of morbidity in children of different ages and sexes. These cultural commonalities and differentials are described, their possible causes--primary among these being the status of women--explored, and some policy recommendations made.
Aged↗
Fetal loss and contraceptive acceptance among the Bhopal gas victims.
The rates of fetal loss and family planning acceptance among Bhopal gas victims from 1984 to 1989 were compared to those of a control group. In all, 136 eligible women in the affected area and 139 women in the control area were interviewed. Care was taken to ensure that these women had conceived at least once during the previous five years. The The fetal loss rate among the gas-affected women was abnormally high (26.3 per cent) compared to that of women in the control area (7.8 per cent). Family planning acceptance in both areas was similar, with most women using permanent methods. In the case of temporary methods, the percentage of use was higher in the gas-affected area.
Abortion, Spontaneous↗
Japan's experience in pertussis epidemiology and vaccination in the past thirty years.
The experience in Japan that pertussis was controlled by the nation-wide regular vaccination and that the reincrease of case notification occurred recently after the decrease of vaccine acceptance rate upholds the view that pertussis vaccine produced under the national control system is fully protective. Though the recent decrease of the vaccine acceptance rate was due to the public reaction to rather imbalaanced arguments concerning the vaccine risk, it is also true that a more potent and less toxic component vaccine is urgently needed at this moment.
Adolescent↗
Indicators of accessibility to primary health care coverage in rural Odukpani, Nigeria.
Indicators of accessibility were investigated in Odukpani Local Government Area using a structured questionnaire administered to mothers or heads of households in the study area. The indicators considered included proportion of births attended by trained health personnel, proportion of children with diarrhea treated with oral rehydration therapy (ORT), distance from home to regular immunization site, and acceptability of primary health care services to the target population. Sociodemographic data revealed a typical developing country population profile and surprisingly high literacy rate (57.8%) relative to the national rate, an observation which may account for the appreciable level of awareness.
Female↗
Indian experience of home based mothers card: ICMR task force study.
To improve the quality of MCH services, a Home Based Mothers Card (HBMC) prepared and recommended by World Health Organization was adapted to Indian situation, and introduced in 1.5 lakh population of rural area covered by 6 participating centres under the aegis of Indian Council of Medical Research. Two thousand four hundred and forty six mothers were given this card and were followed up for a period of 2 years. Only 89.2 percent retrieval of the cards was possible after a period of 18 months. Screening of the population for "at risk" women monitoring and referral could be undertaken with the help of this card. Improved antenatal, and referral services were observed during the study period. The card (HBMC) was acceptable to the mothers as well as to the health workers, as a tool for improving the quality and coverage of MCH services being rendered at the Primary Health Centre.
Feasibility Studies↗
Low-income women's perceptions of family planning service alternatives.
A sample of 665 low-income women from a predominantly rural area of north central Florida rated the value of 25 features of family planning providers and reported their perceptions of how characteristic each feature was of different types of providers. A well-trained, trustworthy and friendly staff, the presence of a doctor if you need one and a staff that is gentle with the examination were the most desirable features of family planning services. The respondents' perceptions of public health clinics suggest that the strongest qualities of such facilities are that they treat people from different backgrounds, accept Medicaid, are easy to find and teach you how to avoid pregnancy and how to take care of yourself and stay healthy. Features thought most characteristic of private physician services were a well-trained staff, privacy and the presence of a doctor if you need one. Voluntary organizations were seen as providing services for people of different backgrounds, having a friendly staff, serving as a referral agency and teaching about staying healthy and avoiding pregnancy. However, voluntary organizations were rated lower than public health clinics or private physicians on nearly all features. The total scores for public health clinics and private physicians were not significantly different from each other, but both were noticeably higher than the score for voluntary organizations. Ethnicity affected ratings dramatically, with black respondents clearly more favorable toward public health clinics and private physicians than white respondents; conversely, whites were more positive toward voluntary organizations than were blacks. For many of these low-income respondents, the high ratings of private physicians may have represented their expectations rather than their actual experience.
Adolescent↗
The acceptability of electric shock programs.
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Adolescent↗
[Psychological and social evaluation].
The purpose of psychological and social assessment of health programs is the measurement of psychological well-being and lifestyle in targeted populations (i.e. pregnant women, mothers, children or teenagers) and interactive effects on other family members. A psychological and social evaluation should contain the following elements: social and/or cultural factors that facilitate participation in a health program, the opinion of and satisfaction with the program, the psychological and social consequences of the program. Three types of tools can be utilized to measure psychological and social indicators: standardized questionnaires, questionnaires designed specifically for the study in question, and interviews. Study protocols, data collection and analyses must be done using the same methods as those used in any other type of medical evaluation. The investigator must be particularly sensitive to the quality of the measurement tools, the size of the sample and the effects of confounding factors. Social and psychological aspects are essential in the evaluation of a health program. On the one hand, they allow for an understanding of how a health program is accepted and applied within a population. On the other hand, they enable the verification of whether or not there has been any change in the quality of life among individuals and their families.
Adult↗
Comparing participants' and managers' perception of services in a congregate meals program.
Managers and participants in a Title III C meals program were surveyed to explore how differences in perception of program and service quality affect participant acceptance and evaluation of the program. A nutrition monitoring instrument was designed for managers at 14 meal sites to assess major components of the foodservice operation. A survey addressing participant perception of meal quality, meal acceptance, program administration and management, and foodservice personnel was designed and administered to 264 participants. The two surveys contained 17 identical or similar questions to determine any perceptual differences. The influence of social variables on participant response was examined. A significant positive correlation was found for age vs. food temperature, age vs. frequency of participation, and education level vs. evaluation of foodservice workers. Significant negative correlations were found for sex vs. special diets, sex vs. food aversion, education level vs. food temperature, and education level vs. evaluation of the nutrition education component. Manager vs. participant response significantly differed for food temperature, special diets, nutrition education, transportation, and accuracy of posted menus. Assessment of participant vs. manager perception of meal and service quality is recommended to management for more effective program planning, evaluation, and continuous quality assurance.
Administrative Personnel↗
Developing a teenage pregnancy program the community will accept.
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Adolescent↗
Women's acceptance of a preterm birth prevention program.
A major modification in French national perinatal policy was proposed in 1970. Its primary aim was to reduce preterm births, and a specific program has been progressively applied to all pregnant women in France since 1971. Because the policy was introduced at a national level, it was possible to use a district hospital in Haguenau (northeastern France) as an observation site for measuring the effects of the change. A longitudinal study was begun in 1971 and continued for 12 years, during which time a total of 16,004 singleton pregnancies were followed. This article focuses on acceptance by the pregnant women in Haguenau in response to the new prenatal care proposals. A major reduction in preterm births is demonstrated, and the relationship between acceptance and observed changes in preterm birth is discussed. Certain time-related patterns were observed: it took time for the policy modification to be measurable; while the outcomes showed general improvement, results were closely related to the patient's social status; there were significant time-lag differences between social class groups with regard to acceptance of specific interventions.
Birth Weight↗
Grade animals in Canadian dairy cattle improvement.
Grade dairy animals in Canada are an important resource in genetic evaluations of the populations. A program was established in 1972 to provide accurate identification of grade animals. This paper describes Canada's National Identification Program, its acceptance, and its procedures and use in Canada. National Identification Program has proven to be an excellent program to identify grade animals on milk recording programs in Canada.
Animals↗
Ten-year experience with an exercise-based outpatient life-style modification program in the treatment of diabetes mellitus.
Exercise is frequently recommended in the treatment of diabetes mellitus. Nevertheless, its use has been limited in clinical practice, and concerns about safety and efficacy persist. We have reviewed a 10-yr experience with 255 patients enrolled in a comprehensive diabetes program that emphasized physical training. A low maximal oxygen uptake (VO2max) was found in patients with non-insulin-dependent diabetes mellitus compared with sedentary control subjects. This was not accounted for by autonomic neuropathy and is unlikely to be due to subtle differences in life-style. Exercise-related proteinuria was common and occurred in 29% of patients and was associated with higher blood pressure levels at rest and during exercise, impaired VO2max, and decreased R-R interval variation. Regular exercise was associated with a modest decrease in resting and exercise blood pressure. Glycosylated hemoglobin levels and plasma triglycerides improved only in patients with non-insulin-dependent diabetes mellitus. Insulin requirements were significantly reduced in patients with insulin-dependent diabetes mellitus. Compliance for up to 3 mo in the program was acceptable but longer-term compliance was poor. Serious complications during the program were rare. Our experience suggests a program of regular aerobic training can be safely and effectively used in an outpatient population with diabetes mellitus for up to 3 mo.
Adult↗
Practical mastitis control in the field.
Research has shown the effectiveness of teat dipping and medically treating all nonlactating cows to control mastitis. However, there is a problem of getting dairy-men to accept the program. Improved educational programs might be helpful. Some means of visual evaluation is essential to acceptance. Use of indirect tests for estimating cell content can be helpful in evaluating control efforts and in demonstrating results. More intense coordinated effort by professional persons advising dairy-men is necessary.
Animals↗