Postpartum amenorrhea: how is it affected by maternal nutritional status?

The average length of postpartum amenorrhea reported by breast-feeding women in rural Bangladesh in 1975 was 18 to 20 months. Its duration was found to be only slightly related to maternal nutritional status. There was no evidence of a threshold of weight for height necessary for the resumption of menses postpartum. Factors related to the duration of postpartum amenorrhea were maternal age, socioeconomic status, and supplemental feeding of the infant.

The relationship of cholera to water source and use in rural Bangladesh.

The cholera experience of a sample of families in a rural area of Bangladesh is reported in relation to water supply and use. Tanks were the primary source for 65% of families, canals for 20% and the river for 14%. The highest attack rate was associated with access to canal water (13%). Attack rates did not vary markedly according to the purpose for which a source was used. The importance of cultural patterns in water use is identified.

The challenge of world health.

PIP: 2 development specialists have expounded on the demands world health has placed on public health. Striking declines in infant and child mortality occurred with the advent of biomedical and technical interventions in developing countries after World War II. At the same time, these interventions promoted longer lives by curing and/or treating chronic diseases in developed countries. In the 1970s, however, it was apparent that the hospital based, curative approach could not meet health needs and was very costly. In developed countries, biomedical and social sciences showed that chronic diseases did not occur due to modernization but from unhealthy behaviors, diet, and lifestyle. In fact, in 1975, the US Centers for Disease Control announced that unhealthy lifestyles contributed to 50% of all deaths while the medical system was responsible for only 11%. The US and other developed countries then began to promote healthy lifestyles, and in the 1980s, considerable improvements in health occurred, especially among adults. Developing countries which depended on the Western medical model did not experience health gains in the 1970s. Yet developing countries where health systems concentrated on carrying essential services to all people and promoted basic hygiene and sound dietary practices continued to achieve considerable health gains. In 1978, WHO an UNICEF hosted the International Conference on Primary Health Care in Alma Ata, the Soviet Union to hold these developing countries with community based health systems as models of primary health care (PHC). The 1980s witnessed the spread of PHC especially in the form of child survival which focused on oral rehydration therapy and breast feeding. The biomedical and social sciences are needed to move this health policy and program strategy forward. Governments must see to policies that promote healthy people. Political will is needed to make human welfare a high priority.^ieng

Introductory statement: methodologic issues in population planning.

PIP: The methodologies used in policy formation, program planning and implementation in the field of population are limited. It is, therefore, difficult to critically analyze the issues in population policy. The inability to develop adequate methodologies is probably due to the inability to rationally define the problem. Nevertheless, until nations consider population planning as a means of controlling the size and distribution of the population, (rather than as a means of accomodating it) methodologies will be of limited use.^ieng

Application of demographic methods in population planning.

PIP: Although demographic methods help population program planning by providing quantitative formulas, the validity of the projections depend on the assumptions made and the quality of input data. Particularly in the case of reproductive performance, which is independently influenced by a variety of factors, projections present problems. In order to develop effective population programs planners must recognize all dimensions of population change.^ieng

Experience with norethisterone enanthate as injectable contraceptive.

Norethisterone Enanthate (NE) was used in 151 women as injectable contraceptive. Pregnancy due to method failure was 2% whereas the overall pregnancy was 4%. The results have been discussed.

Editorial: World population year and the APHA.

PIP: The August 1974 World Population Conference in Bucharest is unique as the first political conference on population ever held. It is also the first time that the United Nations has made population the sole subject of a major conference. The American Public Health Association, which recognized in 1959 the moral and ethical issues involved in the population increase, is urged to continue to have a voice in these decisions.^ieng

Population change, health planning and human resource development in the health sector.

As a result of the demographic and epidemiological transitions now occurring rapidly in many developed countries, a dramatic shift in the age structures of populations and the burden of disease towards the middle-aged and elderly is expected to take place over the next several decades. In the 1990s, however, there remains great diversity across countries in fertility levels and mortality patterns. The World Bank's 1993 World Development Report assessed the global burden of disease in order to define the minimum packages of public health measures and clinical interventions that would improve health conditions in low-income countries in a cost-effective and affordable way. Strategically implementing these programmes will require that government investments be directed toward a limited number of cost-effective health interventions, delivered equitably to the entire population. At the same time, steps must be taken to improve the efficiency and contain the costs of health care delivery in the public and private sectors. Such a population-based health strategy will require the development of a wide range of scientific, analytical and technical capacities, currently rare in most ministries of health. This will require the involvement of epidemiologists, demographers, sociologists, analysts, operations research specialists and environmental health scientists. Building up these capabilities in health ministries, universities or the private sector will be an essential ingredient of health system reform.

PIP: In the 1990s, the demographic transition in the less developed countries is characterized by great variation in fertility, mortality, population age structure, age pattern, and cause of death. This heterogeneity is reviewed in selected demographic indicators from 7 major less developed regions of the world. At one extreme is Sub-Saharan Africa, with high fertility and high mortality, where 46% of the population is under age 15, and 60% of all deaths are found in this age group (the majority of deaths occur under the age of 5). At the other extreme is China, with low fertility and a high life expectancy, where only 27% of the population and 13% of all deaths are in the youngest age group. The 1993 World Development Report proposed a minimum package of public health measures and essential clinical interventions which would cost only $12 per capita a year in a low-income country, and would reduce diseases by 31%. Interventions are primarily directed toward preventing and treating diseases. The interventions for children include immunizations, micronutrient supplementation, and treatment of worm infections, while for adults they entail prenatal and delivery care, family planning, short-course chemotherapy for tuberculosis, and treatment of sexually transmitted diseases. The traditional Western-model, high-technology medical health care systems in developing countries have been institution-based, with hospitals and health personnel most concerned with one-on-one sickness care. The 1993 World Development Report puts priority on a population-based health development strategy that will require major reform of the health system in many countries. The medical education institutions are to be reoriented in developing and developed countries to curtail specialist training and promote primary care. The International Network of Community-Oriented Educational Institutions in the Health Sciences adopted one model of curriculum reforms that emphasize community-based and problem-based learning.

[Biological and socioeconomic determinants of child survival]. / Determinantes biológicos y socioeconómicos de la sobrevivencia en la infancia.

PIP: This document describes advances in a conceptual framework under development since 1984 for research on child survival in developing countries. The framework links variables explaining biologically determined disease processes to social determinants in the family and community. The major addition is the extension of previous models of proximate determinants to include fertility-child survival interactions, as well as the interaction between child growth and child survival. The role of health policies within the framework of proximate determinants is also explored. A strategy oriented toward specific diseases will not prove successful in developing countries, where most infant and child deaths are not due to a single cause but rather are the final product of a series of episodes of infection combined with malnutrition. Health policies must therefore identify the risk factors that reduce probabilities of survival as well as the pathologies that actually cause death. Risk factors can be classified as proximate determinants, the basic biological mechanisms that directly influence risks of morbidity and mortality, and underlying determinants, all the other social and environmental determinants that operate indirectly through the proximate determinants to influence infant survival. The 1st step in applying the focus on proximate determinants is to achieve a clear understanding of some measurable biological indicators of health and child survival or of their opposites, illness and death. Abnormal growth has been found to be a sensitive and nonspecific indicator of morbidity in children. Measurement of height and weight could serve as the social science counterpart of mortality measurement for a demographer. Mortality and permanent growth stunting are both indicators reflecting different points of chronic and irreversible physical deterioration on the continuum that ranges from good health to death. The proposed conceptual framework integrates Bongaarts' proximate fertility determinants with the proximate child survival determinants proposed in an earlier work by Mosley and Chen. 9 specific determinants are divided into 4 categories of factors that influence both child survival and fertility: factors regulating exposure to conception (sexual union, coital frequency), lactation, ecological risk (dietary deficiency, environmental contamination, accidents), and direct interventions (personal preventive measures, curative measures, and intentionally inflicted lesions). 5 groups of underlying determinants operate through the proximate determinants: individual factors, family factors, cultural factors, institutional factors, and environmental factors.^ieng

Disease control priorities in developing countries: health policy responses to epidemiological change.

Health systems in developing countries are facing major challenges in the 1990s and beyond because of a growing epidemiological diversity as a consequence of rapid economic development and declining fertility. The infectious and parasitic diseases of childhood must remain a priority at the same time the chronic diseases among adults are emerging as a serious problem. Health policymakers must engage in undertaking an epidemiological and economic analysis of the major disease problems, evaluating the cost-effectiveness of alternative intervention strategies; designing health care delivery systems; and, choosing what governments can do through persuasion, taxation, regulation, and provision of services. The World Bank has commissioned studies of over two dozen diseases in developing countries which have confirmed the priority of child survival interventions and revealed that interventions for many neglected and emerging adult health problems have comparable cost-effectiveness. Most developing countries lack information about most major diseases among adults, reflecting lack of national capacities in epidemiological and economic analyses, health technology assessment, and environmental monitoring and control. There is a critical need for national and international investment in capacity building and essential national health research to build the base for health policies.

Active and passive immunization in the adult rabbit ileal loop model as an assay for production of antitoxin immunity by cholera vaccines.

Three field trial cholera vaccines did not induce antitoxic immunity. A choleragenic toxin induced high-serum neutralizing antibody, but protection to loop challenge with toxin was minimal.

Selective destruction of skin permeability activity in cholera toxin: effect of acid on cholera enterotoxin.

The effect of treatment of purified cholera enterotoxin with acid at pH 2.0 for 1 h followed by neutralization of the acid on the biological activity of the toxin has been studied. It was found that the material loses 85 to 96% of its skin permeability activity and this loss is neither reversed nor increased after 28 days of storage at 5 to 10 C. Other biological properties such as diarrheagenic activity, lipolysis-stimulating activity, and the lethal dose for mice remain unaffected by acid treatment. These observations indicate that the skin permeability activity is more sensitive to relatively minor changes in molecular structure than are the diarrheal, lipolytic, and mouse lethality activities.

The effectiveness of family planning education on acceptance of contraception by postpartum mothers.

A prospective controlled study on the maternity service of the American University Medical Center, Beirut, Lebanon, tested the effect of family planning education during the postpartum lying-in period on recruiting contraceptive acceptors. The study further determined how women with different socio-demographic backgrounds, life styles, and levels of readiness for the practice of family planning responded to the educational program. The results revealed that a postpartum educational effort could almost double family planning acceptance among women who returned to the postpartum clinic within the first 9 weeks after delivery and that the educational impact was evident irrespective of the respondents' socio-demographic characteristics, life styles, and levels of readiness for family planning.

A serological survey for cholera antibodies in rural east Pakistan. 2. A comparison of antibody titres in the innunized and control populationd of a cholera-vaccine field-trial area and the relation of antibody titre to cholera case rate.

Controlled field trials of a highly antigenic cholera vaccine were held in Matlab Bazar in rural East Pakistan in 1963 and again in 1964. In July-September 1965, a serological survey for cholera antibodies was carried out on a random sample of the field-trial population. This survey revealed that it was possible to demonstrate the effect of a single injection of the cholera vaccine per head on the proportion of the population with detectable vibriocidal and agglutinating antibody 10 and 22 months after injection. More significantly, the reduction in cholera case rate caused by the vaccine could be correlated with the rise in vibriocidal antibody after vaccination, suggesting that the serological response to vaccine in man may be a useful measure of vaccine potency. The survey also indicated that in this endemic cholera area, with a high level of immunity in adults, a single injection of cholera vaccine was in fact a booster dose for the majority of the population. Thus, the results of cholera vaccine field trials in endemic areas cannot be directly extrapolated to predict the effects of the same vaccine in non-endemic areas.