Oral contraceptives: considerations of safety in nonclinical distribution.
Explore the source record for details and available documents.
SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
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.
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.
Explore the source record for details and available documents.
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.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Couples in rural areas of many Arab societies, including Egypt, have consistently reported strong preferences for having sons. However, these reported preferences are not always reflected in reproductive behavior. In 38 rural villages in Menoufia Governorate in Egypt, women's responses to a community-based contraceptive distribution program were examined, taking into consideration both the number of living children and the number of living sons each women reported having. Controlling for number of living children, women with more sons were more likely to be using contraception before the distribution program began. Among women not using contraception before the program, those with more sons were more likely to initiate contraceptive use and were more likely to continue use for a nine-month period following the distribution. These findings imply that in addition to obstacles related to contraceptive availability, there are several cultural, social, and economic factors that influence fertility behavior and exert considerable pressure on married couples to have large families, including several sons. Unless the pressure exerted by these factors is changed or reduced, the impact of family planning programs is likely to reach a plateau at a relatively low prevalence level.
A community-based family planning operations research project was undertaken in selected low income communities of Rio de Janeiro; project field work began in February 1982. Prevalence data were collected and service delivery strategies were tested, including home visits promoting family planning, home distribution of condoms, and the introduction of community family planning depots. A high baseline contraceptive prevalence rate (CPR) of 70.1 percent was found for nonpregnant women currently in union, as well as substantial use of the private sector for contraceptive supply, despite the presence of free or subsidized sources within the communities. However, the most economically disadvantaged subgroups made the greatest use of the subsidized sources. The provision of additional service delivery sites may have contributed to a small increase in contraceptive prevalence noted over the life of the project; however, the high baseline CPR precluded a large increase in contraceptive use as a result of the program.
Explore the source record for details and available documents.
The availability and cost of antibiotics for treating pelvic inflammatory disease (PID) were assessed in 17 drug-dispensing outlets in 5 districts of the Central Region, Ghana. The outlets included the dispensaries of 2 regional and 4 district hospitals, 4 privately-owned pharmacies and 7 chemical seller shops. The most common antibiotics available, including co-trimoxazole, metronidazole, benzylpenicillin, amoxycillin, chloramphenicol and gentamicin, were also the lowest-priced drugs. Conversely, the most expensive antibiotics including ceftriaxone, ciprofloxacin, cefuroxime and spectinomycin, were also the least commonly available. Recommended anti-gonococcal antibiotics (ciprofloxacin, ceftriaxone) may not be prescribed if they are not available in the districts.
In August 1987, a letter, informational pamphlet and order coupon for free mail-order condoms were sent to an experimental group of teenage males 16-17 years of age. An experimental design was used to measure the impact of the mailing on teenagers' knowledge, attitudes and behavior. Approximately five weeks after the mailing, 985 members of this group and 1,033 members of the control group (who received no mailing) were interviewed by telephone. About seven months after the mailing, members of the experimental group who claimed they had ordered the free condoms were reinterviewed by phone. The results of the initial interviews revealed that about three-fourths of the teenagers in the experimental group had received the materials, and about two-thirds had read them. Moreover, males in the experimental group, particularly those who reported having received and read the pamphlet, were slightly but statistically significantly more knowledgeable about sexually transmitted diseases (STDs), pregnancy and contraceptives. On the other hand, there were no differences between males in the experimental and control groups in attitudes toward STDs or birth control, nor were there differences in actual sexual activity or in the use of birth control. However, the experimental group was significantly more likely to have ordered condoms by mail, presumably as a result of having received the free mail-order condom offer. Many of those who ordered condoms had previously had sex and had used condoms. However, a sizeable portion of those who ordered condoms did so prior to first intercourse, suggesting a possibly important early intervention.
Explore the source record for details and available documents.
In Guatemala, as is the case in many of the other Central American countries, the pharmacy is often the only health resource used outside the household. This paper analyzes knowledge, attitudes and practices of the personnel from seven pharmacies located in marginal-urban areas of Guatemala. It also studies their interaction with 3,277 users related to all diseases, specifically those related to diarrheal disease and its treatment. Findings revealed that the pharmacies' personnel handle diarrheal disease in an empirical way, using medicines to treat the cause of the diarrhea, instead of trying to prevent dehydration. There are limitations and deficiencies of knowledge and practices related to the use and abuse of non-indicative medicines, insofar as the pharmacies' personnel and users are concerned. Findings also revealed that the Oral Rehydration Salts (ORS) are not used, and prepared oral serum is used in very small amounts, because these do not fit in popular expectations of a medicine that reduces diarrheic evacuations.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
In 1990 a community-based programme of onchocerciasis control, involving the use of ivermectin, was introduced in Uganda. The problems confronting it are discussed and suggestions are made for making it sustainable.