Oral contraceptives: considerations of safety in nonclinical distribution.
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Experimental studies demonstrating the effectiveness of nonclinical distribution of contraceptives are typically conducted in settings where contraceptive use is low and unmet need is extensive. Determining the long-term role of active outreach programs after initial demand is met represents an increasingly important policy issue in Asia, where contraceptive prevalence is high and fixed service points are conveniently available. This article examines the long-term rationale for household family planning in Bangladesh-where growing use of contraceptives, rapid fertility decline, and normative change in reproductive preferences are in progress, bringing into question the rationale for large-scale deployment of paid outreach workers. Longitudinal data are analyzed that record outreach encounters and contraceptive use dynamics in a large rural population. Findings demonstrate that outreach has a continuing impact on program effectiveness, even after a decade of household visitation. The policy implications of this finding are reviewed.
The 1968 decision of the Sir Lanka Ministry of Health to allow paramedical distribution of oral conctraceptives at a reduced price greatly expanded availability. Available data on the immediate effects of this policy indicate that oral contraceptive acceptors increased significantly and there was no reduction in the number of other contraceptive acceptors. A policy decision on nonclinical distribution must be implemented rigorously by adequate training of distributors, by ensuring adequate supplies, by assigning importance and responsiblity for this activity to the paramedics, and by educating and motivating acceptors.
OBJECTIVE: We sought to examine the relative importance of genetic and environmental factors for the MOS SF-36; a widely used, valid, and reliable measure of health-related quality of life and to discuss incorporating genetic influences into health services research. DATA SOURCES: Data are from a nationally distributed, nonclinical cohort of 2928 middle age, middle-class, male-male twin members of the Vietnam Era Twin Registry. STUDY DESIGN: This was a secondary data analysis, classic twin heritability analysis. DATA COLLECTION: A telephone survey was used to collect information on alcohol-related problems and health services use, including the SF-36. PRINCIPAL FINDINGS: Variance component analyses indicated that additive genetic factors accounted for 17% to 33% of the variance for each of the 8 domains of the SF-36. Shared environment accounted for 0% to 12% of the variance for each domain, with the majority of variance for each domain accounted for by nonshared, or unique environment and error. Physical and mental health summary measures indicated that approximately one-third of the variance was accounted for by additive genetic factors and the remainder accounted for by nonshared environment and error. Clinical condition, history of alcohol dependence, had a small-but-significant influence for all domains. Including condition proved to be a better-fitting model. However, confidence intervals temper uniform statistical significance for genetic factors. CONCLUSIONS: This study assessed the heritability of the SF-36 in a nonclinical, community sample of middle age, middle-class all-male twins. The moderate genetic effects on SF-36 domain and summary measures are new findings and thus may affect interpretations of SF-36 as a measure of health-related quality of life. Ideally, trait-based measures should identify genetic sources of variation and thus help understand any bias of the true effects of SF-36. Still the majority of variance is accounted for by nonshared or unique environmental factors and error. By extension, increased understanding of the importance of genetic and environmental factors that influence either predictors or outcomes of interest will expand the level of scientific debate in health services research and improve predictability.
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The CEDPA Nepal Country Office (NCO), directed by Mana Rana (WIM 5 and S&E 13), has launched an expanded leadership training program for women's NGOs and new service delivery projects under a 5-year grant extension from USAID. With additional support from the UNFPA, the NCO will undertake a new project with the Mothers' Club, a national women's NGO. The project will mobilize women and women's organizations to address grassroots needs. The CEDPA ACCESS Project recently funded the Nepal Red Cross and Family Planning Association of Nepal to begin community-based family planning projects. Trained volunteers will distribute nonclinical contraceptives from their homes, provide services through home visits, and refer clients to clinics. Nancy Russell, a nonprofit manager with 20 years of experience, has been appointed CEDPA resident coordinator for Nepal.
Contact tracing has become the most important tool in the control of sexually transmitted diseases (STDs) world-wide, and different strategies have been introduced into it in recent years to improve its effectiveness. Of all these strategy components, index patient counselling and co-operation to do their own contact tracing by themselves has been identified as the most important one. In Ibadan, it is the only component of the contact tracing strategies that has proven worthwhile. This study has assessed the contribution of supplementary mail reminders to defaulting index patients and their defaulting contacts to our control efforts in the first two years of its usage. It demonstrates that, like the other components of the contact tracing strategies, it is not successful in improving the contact or defaulting index patient attendance, thus only contributing to success in 7 of 141 patients. The intensification of efforts towards encouraging the index patient in contact tracing must therefore be ever more strongly emphasised as the top priority in STD control in Nigeria and similar developing countries for the success of this strategy.
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Oral contraceptives were offered to all married, fecund women 15-44 years of age living in 38 Egyptian villages with a population of 200,000. Before the household distribution, contraceptive prevalence was 19.1 percent. Nine months after the distribution, the contraceptive prevalence increased to 27.7 percent, a relative increase of 45 percent. Based on this study, a modified delivery system is currently being tested on a governoratewide basis. The modified system will include a wider range of fertility regulation methods and will also have health and community development components.
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