Environmental Electrokinetics for a sustainable subsurface.

Soil and groundwater are key components in the sustainable management of the subsurface environment. Source contamination is one of its main threats and is commonly addressed using established remediation techniques such as in-situ chemical oxidation (ISCO), in-situ chemical reduction (ISCR; most notably using zero-valent iron [ZVI]), enhanced in-situ bioremediation (EISB), phytoremediation, soil-washing, pump-and-treat, soil vapour extraction (SVE), thermal treatment, and excavation and disposal. Decades of field applications have shown that these techniques can successfully treat or control contaminants in higher permeability subsurface materials such as sands, but achieve only limited success at sites where low permeability soils, such as silts and clays, prevail. Electrokinetics (EK), a soil remediation technique mostly recognized in in-situ treatment of low permeability soils, has, for the last decade, been combined with more conventional techniques and can significantly enhance the performance of several of these remediation technologies, including ISCO, ISCR, EISB and phytoremediation. Herein, we discuss the use of emerging EK techniques in tandem with conventional remediation techniques, to achieve improved remediation performance. Furthermore, we highlight new EK applications that may come to play a role in the sustainable treatment of the contaminated subsurface.

The site of attachment of umbilical cord and branching pattern of umbilical arteries within the placenta.

Placenta is the mirror of maternal and fetal status; it reflects the changes due to complication in pregnancy of mother. Numerous common and uncommon findings of the placenta, umbilical cord and membranes are associated with abnormal fetal development and perinatal morbidity. So, the examination of the placenta can yield information that may be important in the immediate and later management of mother and newborn. This information may also be essential for protecting the attending physician in the event of an adverse maternal or fetal outcome. This cross sectional descriptive study was carried out to determine the incidence of different types of placenta depending on attachment site and branching pattern of arteries of umbilical cord in Bangladeshi Women. To achieve this aim sixty placenta with umbilical cord were collected. Placenta was from 28 weeks to 42 weeks gestational age of normal pregnancy during normal labour at gynaecology and obstetric department of Mymensingh Medical College Hospital. After preservation in 10% formol saline, study was done in the Department of Anatomy of Mymensingh Medical College. In the present study, incidence of different types of placenta depending on attachment site of umbilical cord was 50% Central, 46% Paracentral and 18% Marginal in type. In this study it was also observed that 58% placenta were Disperse in type and 42% were Magistral in type depending on the distribution of umbilical arteries. Observed findings of this study were compared with those of Western and Bangladeshi researchers.

Histomorphological study of germinal centre of vermiform appendix in Bangladeshi cadaver.

The study was done to find out the number of germinal centre in human vermiform appendix of Bangladeshi people to magnify the knowledge regarding the diverse number of germinal centre of human vermiform appendix in our population in the department of Anatomy, Mymensingh Medical College, Bangladesh from July 2006 to June 2007. Total 40 appendices were collected for histological study of different age and sex during postmortem examination in the autopsy laboratory of department of Forensic Medicine, Mymensingh Medical College. This cross sectional study was done by convenient sampling technique. For convenience of differentiating the changes in number of germinal centre of vermiform appendix in relation to age and sex, findings were classified in four groups, Group A up to 20 years, Group B 21-35 years, Group C 36-55 years and Group D 56-70 years. In the present study the number of germinal centre was highest in Group B (52.38%) but in Group D it was nil. Here mean number of germinal centre in male (1.05) were more than in female (0.8).

Morphometric study of splenic volume in Bangladeshi cadaver.

To determine the volume of spleen of Bangladeshi people by water displacement method, this cross sectional descriptive study was carried out over 120 cadaveric spleen of which 87 male and 33 female, in the department of Anatomy of Mymensingh Medical College from July 2007 to June 2008. The maximum volume of male spleen was 200ml in group D (46-60 years) and female spleen was 150ml in group B (16-30 years). The minimum volume was 30ml in group A (up to15 years) in both male and female. The maximum mean volume of male was 84.23 ml in group B (16-30 years) and minimum mean volume was 47.75ml in group A (upto 15 years). The mean volume of female spleen was highest, 78.33ml in C (31-45 years) age group and lowest 45.62ml in A (upto 15 years) age group. From this study it was evident that the volume of spleen increases with age during childhood and adolescence remains stable in young adult and declined in older age groups. Volume of spleen shows positive correlation with age up to 60 years of age. Mean±SE volume of male spleen was 75.27±3.78ml, ranges from 30-200ml and in female; mean±SE volume was 60.51±4.90ml, ranges from 30-150ml. Here it is observed that volume of spleen was higher in male than in female but the difference was not statistically significant.

Evaluation of surgical management of primary spinal tumours.

Spinal tumours, which are 5-10% of skeletal tumours, cause considerable morbidity and present challenging situations in their management. Surgery is often used in the treatment of spinal tumours. Now a day only few specialized spinal care centers have developed in Bangladesh. The prospective study regarding surgical management of primary spinal tumour might be beneficial for proper planning and patient management. All patients who underwent surgical resection of a primary tumor of the spine between July 2006 and May 2008, at the Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Patients were uniformly staged before surgery and baseline demographic and surgical variables were recorded, as well as an evaluation of general health related quality of life were done. Thirty-two patients (16 males and 16 females) were eligible for the study. Average age was 43.25 (range 15 to 85). There were 8(25%) vertebral body and pedicle tumors and 3(9.37%) extradural, 16(50%) intradural-extramedullary and 05(15.67%) intradural intramedullary. Only 5(15.63%) developed complication. In this series out of 32 patients, 15(46.88%) achieved excellent result and 10(31.25%) got good result and 5(15.5%) achieved fair and remaining 2(6.25%) patients achieved poor results after the management. Complete neurological involvement of patient did not show complete recovery. In addition to surgery, radiotherapy and chemotherapy are needed to sterilize the tumour bed. Early detection and surgery of primary spinal tumour give satisfactory results and patient can return to their normal life.

Study of prenatal and postnatal development of spleen of Gallus Domesticus (deshi chicken).

Spleen is one of the secondary or peripheral lymphoid organs along with cecal tonsils in birds. The growth of the spleen of Gallus Domesticus (deshi chicken) from prenatal embryonic day fifteen (ED15) to postnatal day ninety (D90) were studied. In macroscopic study it was found that the shape of the spleen was rounded with slightly flattened from side to side at its middle part at prenatal period (ED15, ED18) and becomes rounded at postnatal stages of the deshi chicken (D90). Regarding position it lies close to the right side of the junction between proventriculus and gizzard and was similar in prenatal and postnatal stages. The result of the present study revealed that the mean diameter and weight of the spleen in deshi chicken gradually increases with increase of age, which were 2.00+/-0.136mm and 0.007+/-0.00gm respectively at ED15 stage and it reaches upto 10.40+/-0.331mm and .303+/-0.004gm respectively at day 90 (D90). It was observed that the differences of diameter & weight of the spleen between different ages were statistically significant (p<0.01). Histologically the spleen was surrounded by thin capsule in prenatal life, which gradually becomes thicker in postnatal life. The splenic pulps were not differentiated into white and red pulp on 15th day of embryonic life (ED15) but they were gradually differentiated into white and red pulp in the late prenatal (ED18) and postnatal period. The growth and development of spleen at each stage of the study period were found to be significantly high. Present study indicates that chicken splenic cell population, structure and function were similar to human spleen histologically. It was also found that the chicken embryo allows easy experimental access to all the stages of the splenic development, so the present study will be helpful for experimentation on lymphoid organs and to understand pathophysiology of immunological diseases of human.

Feeding green vegetables to the young children in rural Bangladesh: an analysis of intake following education to the caregivers.

PIP: The study was undertaken to increase the intake of vegetables rich in beta-carotene by young children through nutrition education of their caregivers. 156 children aged 6-59 months were selected from households of very poor socioeconomic status in the comparison area of Matlab MCH-FP Project. Nutrition education intervention was provided to the caregivers of these children on the importance of feeding vegetables rich in beta-carotene. This education included verbal communication and cooking demonstrations. It was provided by trained female community health workers once every 2 months over a period of 12 months from April 1994 to March 1995. Information on the consumption of green leafy vegetables by the children for the preceding 3 days was collected at baseline and after the 12-month intervention by interviewing the caregivers. The green leafy vegetables were categorized into high, medium, and low contents of beta-carotene. The proportion of children who consumed vegetables with high content of beta-carotene increased from 28% at the baseline to 96% after the intervention, showing a highly significant increase (p .000). The mean frequency of intake of vegetables rose from 0.65 per 3 days at baseline to 4.33 after the intervention. This increase in intake was also highly significant (p .000). The significant increase in the consumption of vegetables was achieved within a period of one year from the intervention. This shows that changes in the feeding practices of young children were feasible through education and motivation, which can develop confidence among the caregivers regarding the beneficial outcome of the recommended foods.^ieng

Effects of family sex composition on fertility preference and behaviour in rural Bangladesh.

The effects of family sex composition on fertility preferences and behaviour during the period 1977-88 are examined using longitudinal data from Matlab, Bangladesh. The sex composition of living children was found to be systematically related to fertility preferences and behaviour, with a higher number of sons at each family size associated with a higher percentage of women wanting no more children, a higher percentage currently using contraception, and lower subsequent fertility. However, the highest percentage wanting no more children, using contraception and having lowest subsequent fertility was found among women who already had one daughter as well as at least one son. The effects of sex preference on fertility preferences and behaviour were measured using an index developed by Arnold (1985). The results suggest that while sex preference remained largely unchanged during the study period, its effect on contraceptive use declined and its impact on actual fertility remained modest and fairly stable.

PIP: The hypothesis of this study is that the effect of sex preference on fertility is dependent on the level of contraceptive use, and the relative importance given to sex composition and family preference in determining contraceptive use. The effect of sex composition under different contraceptive prevalence conditions is examined by comparing in the Matlab intervention area 2 different periods: 1977-82 and low contraceptive use, and 1984-88 and higher use. The study area comprised 149 villages and a total population of 187,523. This research used data on 2111 women in the 1977 survey and 3140 women in the 1984 survey. Survey data were linked with the Matlab demographic surveillance system. The results showed that between 1977 and 1984 there was an increase in the percentage of women desiring no more children, a decline in family size preference, and an increase in contraceptive use. Contraceptive use was 20% for modern methods in 1977 and 38% in 1984. The general finding was that the higher the number of sons at any family size level, the higher the percentage of women desiring no more children. The effect of sex preference on the percentage of women desiring no more children did not change between 1977 and 1984 (9.5% during 1978-82 and 19.5% during 1984-88); what did change was the percentage of women desiring no more children, from 39.0% to 54.7%. Change would have occurred is there had been no sex preference; expected changes would have decreased the desire for no more children from 14.6% in 1977 to 16.4% in 1984. Without sex preference, contraceptive use would also have declined from an increased prevalence in 1977 of 20.4% and 9.9% in 1984. the sex preference effect measure (SPEM) of Arnold (1985) was used and modified to quantify the effect of sex preference on fertility preferences and behavior. Fertility was consistently and negatively related to the number of living children. Without sex preference, fertility would have decreased 9.5% during 1978-82 and 10.5% during 1984-88. Family size preference had increased in its importance in determining contraceptive use. The effect of sex composition on subsequent fertility remained constant between the 2 periods.

Effect of child survival on contraceptive use in Bangladesh.

A study in Bangladesh showed that couples who lost a child often stopped practising contraception in order to have another child. Logistic regression analysis revealed that contraceptive continuation was related to maternal age, parity, husband's education and the sex of the last child.

PIP: Logistic regression analysis was used to determine the effect of infant and child mortality upon couples' contraceptive behavior over a period of 24 months. Study data come from 2111 women surveyed in the Matlab area of Bangladesh in 1977, 1978, and 1979. 414 women were contraceptive users at baseline. 23% of those not practicing contraception at baseline, and not having lost their last child 1 year into the study, began to practice contraception. 14.8% of those having lost their last child over the same duration began to practice contraception. By the 2nd year, 28.1% and 21.8%, respectively, adopted contraception. Of those practicing contraception at baseline, and continuing over the same 1- and 2-year durations under the same mortality conditions, 73.6% and 57.7%, and 67.3% and 34.6%, respectively, continued to practice contraception. Contraception continuation rates were higher for women over age 30, of higher parity, with literate husbands, and where the most recent born was male. These results suggest that reducing mortality may help increase contraceptive use.

Predicting contraceptive use in Bangladesh: a logistic regression analysis.

Family planning knowledge, attitude and practice surveys typically assess respondents' reproductive attitudes and intentions to use contraception. Longitudinal observation of individual respondents nevertheless shows that such questions are not strongly predictive of subsequent behaviour. This study examines 3 years' data which show that a set of such responses to questions are nevertheless substantially superior in predicting behaviour than any single indicator. Thus statistical techniques which bring into account the apparent multidimensionality of contraceptive motivation can greatly improve upon the estimation of future practice of family planning in a population.

PIP: Using a sample of 2111 rural women in Matlab thana Bangladesh, this study tests whether cross-sectional survey responses reliably predict subsequent contraceptive behavior. The Family Planning Health Services Project collected the data in 3 rounds 1977-1979. Results show that the stated desire for additional children is apparently a somewhat better predictor of subsequent use than the stated intention to use contraception, but even this variable is weakly predictive; among users in 1977 who wanted no more children, contraceptive practice declined slightly with successive rounds. The data suggest that current behavior in round 1 is a better predictor than attitudes. The increasing use of contraception from 1977-1979 was most pronounced among women with many living children. The effect of husband's educational attainment declined in importance with time, perhaps because intensive initiation and follow-up over 2 years substituted for the effect of husband's education. Women who were from land owner households and other occupational types were early to accept contraception, while those from laborer class households were relatively slow. By 1979, however, differences in use levels between occupational classes were not pronounced, although families of fishermen still lagged behind. Multivariate analysis shows that the 1977 characteristics of respondents taken together are strongly predictive of contraceptive use in 1979. Only the husband's occupation has no effect. Current use is most predictive, followed by family size, and intentions. Younger women are more likely to use contraception once the number of living children is allowed for. Thus, the activities of the Matlab Family Planning Health Services Project can be reasonably predictive of contraceptive behavior when considered as a set of variables.

Epidemiology and cause of deaths among women in rural Bangladesh.

A total of 542 women aged 15 to 44 years died during the 10-year period 1976 to 1985 in the control area of Matlab, an area with a population of 90,000, representative of many other rural areas of southern Bangladesh. The corresponding age-specific mortality rate was 290 per 100,000 women 15-44 years. These deaths have been analysed retrospectively, using information collected through the Demographic Surveillance System set up by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) and verbal autopsies conducted in the homes. Of these deaths, 175 (32%) were due to infectious diseases, 163 (30%) to direct obstetric complications, 67 (12%) to injuries, and the remaining 26% to other causes. Cause-specific and proportionate mortality rates showed a positive association with age for deaths due to infectious diseases, non-infectious diseases and unspecified causes, and an inverse association with age for deaths due to injuries. These rates showed a peak in the intermediate age group 25 to 34 years for deaths due to direct obstetric causes. No consistent trends were visible when annual rates were studied over time. Prior to death, 42% of the women were attended by traditional practitioners, and 33% were not attended at all. Demographic impact is discussed, emphasizing the contribution of obstetric causes to overall mortality. Priorities for health policy implications are proposed, focusing upon a strong maternity care programme, and improved availability of female health personnel, in the context of the socio-cultural constraints imposed on women in poor rural areas.

Analysis of motivation to contraceptive use applying the weighting procedure.

This paper presents a technique for scaling contraceptive use motivation for the sample population of the Family Planning Health Services Project in Matlab. The project, which began in 1977, is conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh. The hypothesis of the research is that through the use of a scaling algorithm the power of demographic characteristics, attitudes, and intentions for predicting contraceptive use can be enhanced. The analysis shows that two factors explain use motivation. Scale 1 is weighted for demographic variables and desire for additional children, while Scale 2 is comprised of education and intentions of contraceptive use. Both scales have a pronounced independent predictive power. We conclude that scaling has improved upon the predictive power of indicators of reproductive motivations.

PIP: A technique for scaling contraceptive use motivation for the Family Planning Health Services Project (FPHSP) in Matlab, Bangladesh, is presented. The project started in 1977. Independent variables are hypothesized predisposing characteristics of users; the dependent variable is contraceptive usage. Factor analysis is applied. "Factor analysis of contraceptive use motivation with loadings for unrotated and varimax rotated matrices" is given. Items of information in the questionnaire included sociodemographics, knowledge and use of contraception, desire for more children, and intent of contraceptive usage in the future. 2111 respondents of 3 different surveys make up the analysis sample. Scale 1 is weighted for demographic variables and desire for more children. Scale 2 is made up of education and intentions of usage. Motivation to use contraception is seen as a proximate determinant of use. Motivation is affected by norms, attitudes, and beliefs. Demographic characteristics directly affect motivation and attitudes. Background variables also directly affect motivation. Varimax matrix rotation improves the precision of loadings. Scaling has improved the predictive power of indicators of reproductive motivation. Motivation to use contraceptives is multidimensional--it should not be measured by intentions alone. Attitude is also multidimensional with family size desires and demographics. Intentions and husband's education seem to reflect a separate factor--a "reproductive planning dimension." Husband's education is related to intention and use.

Maternal mortality in Matlab, Bangladesh: 1976-85.

This paper reports findings from a study of maternal mortality in Matlab, Bangladesh during the 1976-85 period. The study employed a multiple-step procedure to identify maternity-related deaths to all reproductive-aged women within the study area during this period. A total of 387 maternal deaths were identified, resulting in an overall maternal mortality ratio of 5.5 per 1,000 live births. The introduction of a family planning program in half of the Matlab study area led to a moderate but significant reduction in maternal mortality rates, relative to the comparison area. This appears to have been primarily due to a reduction in the overall number of pregnancies in the treatment area, since among women who became pregnant, mortality risks remained high. The results of this study underscore the need for a broad-based service strategy that includes but is not limited solely to family planning, in order to achieve significant reductions in maternal mortality levels in settings such as rural Bangladesh.

PIP: Developing countries account for 98% of the 1/2 million maternal deaths that occur each year. The number of maternal deaths per 1000 live births has been reported as 7.2 in Indonesia, 1.9 in Egypt, 1.2 in Zambia, and 5.5 in Matlab, Bangladesh -- the area of the present study. The Matlab area contains a population (1982) of 187,523 people living in 149 villages, 70 in the treatment area and 79 in the comparison area. The International Center for Diarrheal Disease Research, Bangladesh (ICDDR B) in 1977 launched a child health and family planning program in the treatment area, staffed by community health workers, who kept detailed records of maternal deaths. In the comparison area deaths were reported to community health workers. In both areas recorded and reported deaths were compared with death records in the Demographic Surveillance System. Between 1976 and 1985 a total of 387 maternity-related deaths were recorded for women between the ages of 15 and 44, 168 in the treatment area and 219 from the comparison area. The 387 maternity-related deaths accounted for 37.3% of all deaths (1037) among women between 15 and 44. 32% of maternal deaths occurred predelivery; 33% followed a live birth; and 18% followed a stillbirth. 15% were due to induced abortion, which is illegal in Bangladesh. Of the 123predelivery deaths 66 occurred antepartum and 57 during labor. 50% of the deaths were postpartum. Most deaths occurred in women under 20 (48%) and over 34. Mortality is also highest for women with no children (36%) and for women with more than 7 children. At each parity level mortality risk increases with age, and in a cohort of women of the same age the mortality risk goes up with parity. The average completed family size in Bangladesh is 6 children, and 3% of the mothers of 6 children can expect to die if they try to have a 7th child. 77% of the maternal deaths were from directly obstetrical causes. Of the 125 children born to mothers who died, 3/4 died themselves within 12 months. By 1985 the total maternal mortality in the treatment area was 1/2 that of the comparison area due to the success of the family planning program, which reduced fertility rates in the treatment area by 25%. But the mortality risk for those who became pregnant was not much different for the two areas, probably because what the family planning program did was shift the pattern of childbearing from the older, high parity women to the younger, nulliparous women, whose risk of maternal mortality is at least as large, if not greater.

Causes of maternal mortality in rural Bangladesh, 1976-85.

Of a total of 1037 women of reproductive age who died during the period 1976-85 in the Matlab area that was under demographic surveillance, 387 (37%) were maternal deaths. The mean maternal mortality over the 10-year period was 5.5 per 1000 live births (101 per 100 000 women of reproductive age). Major causes of maternal death, which were assessed using a combination of record review and field interviews, included postpartum haemorrhage (20%), complications of abortion (18%), eclampsia (12%), violence and injuries (9%), concomitant medical causes (9%), postpartum sepsis (7%), and obstructed labour (6.5%). Deaths caused by postpartum haemorrhage were positively associated with both maternal age and parity, whereas those caused by eclampsia and injuries were more common among young and low-parity women. If maternal deaths arising from complications of abortion are disregarded, 20% of all maternal deaths occurred during pregnancy, 44% during labour and the two days following delivery, and 36% during the remaining postpartum period.These findings support the need to develop a service strategy to address the risks of childbearing and childbirth in areas such as rural Bangladesh, where almost all deliveries take place at home. This strategy must be based not only on preventive and educational interventions, including family planning and antenatal care, but also on systematic attendance at home deliveries by trained professional midwives, backed up by an effective chain of referral.

Differentials of fertility between polygynous and monogamous marriages in rural Bangladesh.

PIP: This paper discusses polygynous marriages in rural Bangladesh, using marital status and birth registration data from the Demographic Surveillance System (DSS) of the International Center for Diarrheal Disease Research, for the period 1975-79. Of all the marriages recorded during this period about 5% were polygynous. To identify the women polygynously married, 1974 census data of the DSS area were used. The difference in age at marriage between the polygynous groom and his subsequent wife was 15 years on average. The socioeconomic indicators studied were education, occupation and area of dwelling space. In general, these indicators between women in monogamous marriages were significantly higher than between the women in polygynous unions. During the period 1976-79, 863 polygynous marriages were recorded (4.9% of all marriages in the study area). Polygynous marriages were found to be less frequent among men with 2ndary and higher levels of education. The highest proportion of polygynous marriages occurred among husbands with no schooling or Koranic education. The general fertility rate of women in monogamous marriages was significantly higher than for women in polygynous marriages, overall and in all age groups except 20-24. During the period 1975-79, the mean number of liveborn children for monogamous women was higher than that of polygynous women.^ieng

Risk factors for death in complicated diarrhoea of children.

A total of 1330 children with complicated diarrhoea who were admitted to the general ward of the International Centre for Diarrhoeal Diseases Research, Bangladesh Health Complex, during 1979 were examined. The risk of death by complication of diarrhoea, aetiology, age, and nutritional state was analysed by a logit regression model. Serum sodium concentration and coma were found to be significant predictors of death, death being related directly to coma and inversely to serum sodium concentration. An earlier study had shown that the incidence of hyponatraemia was directly related to the degree of malnutrition, but the results of logit regression analysis did not show the nutritional state to be a predictor of death. Owing to lack of data, however, serum albumin concentration could not be taken as a variable in the logit regression analysis. To determine the relation of serum albumin concentration to hyponatraemia and the cause of death in hyponatraemia further prospective studies would be necessary.

Integrating health services into an MCH-FP program: lessons from Matlab, Bangladesh.

Since 1977 the International Centre for Diarrhoeal Disease Research, Bangladesh, has conducted a field experiment in family planning and MCH in its Matlab research station. The project began with an emphasis on family planning and MCH services were added in stages. This paper uses time series regression methods to address the question of whether the addition of health services contributed to family planning efficacy in Matlab in a program launched with minimal MCH services. The results show that some MCH interventions increased contraceptive prevalence, some decreased it, and others had no effect. The broader significance of these findings for implementing integrated programs is discussed.

PIP: Since 1977, the International Centre for Diarrhoeal Disease Research, Bangladesh, has conducted a field experiment in family planning in its Matlab research station. The project began with an emphasis on family planning; maternal-child health (MCH) services were added in stages. This analysis aims to determine whether additional health and MCH services enhance effectiveness of a comprehensive family planning program that contained limited MCH components from the beginning. Initial Family Planning and Health Services Project (FPHSP) effects on contraceptive prevalance were pronounced. Use prevalence increased to 25% in the 1st 6 months and to 32% within a year. This was followed by a general fertility decline of 25%. Prevalence gradually converged to 43%. The tetanus toxoid program--introduced to prevent tetanus neonatorum--did not discrup the contraceptive prevalence trend. Prevalence increased until 2 interventions for treating diarrhea were introduced: 1) packets, consisting of a premixed sugar and electrolyte powder that is dissolved in water; and 2) "labon-gur,"--a homemade mixture of locally available salt and molasses that has been shown to be as effective as the packets and costs less. The tetanus program was changed to as mass maternal immunization program. A measles immunization program was launched. This result in rising prevalence. Household insertion of IUDs (Copper T) resulted in a pronounced increase in IUD prevalence and concomitant decline in the prevalance of other methods. An antenatal care program was launched. It was followed by a program to train traditional birth attendants. This did not have much of an effect on contraceptive prevalence.

Use of tetanus toxoid for the prevention of neonatal tetanus. 1. Reduction of neonatal mortality by immunization of non-pregnant and pregnant women in rural Bangladesh.

PIP: 1 approach to the prevention of tetanus neonatorum (a leading cause of infant death throughout the world) is improving the quality of prenatal, obstetric, and postnatal maternal and child health services. Another complementary approach is the active immunization of women before or during pregnancy with tetanus toxoid. Work in progress at the Matlab field station of the International Center for Diarrheal Disease Research in Bangladesh (ICDDR,B) provided a unique opportunity to study the effectiveness of certain aspects of these 2 strategies. In 1974, during a field trial of cholera toxoid vaccine, 2 injections of an aluminum phosphate tetanus-diphtheria toxoid were provided as a control to a randomly assigned group of nonpregnant women. Beginning in June 1978, a program of immunizing women during pregnancy with aluminum phosphate-absorbed tetanus toxoid was initiated in conjunction with the implementation of a village based maternal and child health and family planning program in half of the same Matlab surveillance area. Throughout the period of these 2 programs, the ICDDR,B maintained an independent, longitudinal, vital registration system, identifying all births and deaths in the study area. In this analysis, all live births registered in the Maternal and Child Health-Family Planning and comparison areas during the September 1, 1978 until December 31, 1979 period were identified. These records were linked with any deaths recorded within 28 days of birth. The acceptance of tetanus vaccination during the 1974 cholera vaccine trial, by the mothers of these live births, was ascertained from the 1974 vaccine registers. The acceptance of vaccination during the 1978-1979 program was obtained from the field registers. For infants whose mothers had received 2 tetanus injections 48-64 months prior to delivery, the neonatal mortality rate was 63.8/l000 live births compared with 78.3/1000 for infants whose mothers did not receive tetanus immunization. Immunization of women with 2 tetanus injections during pregnancy reduced neonatal mortality rates to 42.8/1000, a reduction of 35.5/1000. Mortality on days 4-14 was reduced by about 70%. 1 injection during pregnancy did not appear to provide protection against tetanus neonatorum.^ieng

Use of tetanus toxoid for the prevention of neonatal tetanus. 2. Immunization acceptance among pregnant women in rural Bangladesh.

PIP: In a rural area of Bangladesh, 2 injections of aluminum phosphate absorbed tetanus toxoid were offered to pregnant women within the context of a maternal-child health and family planning program. Over the first 16 months of the program, only 34.2% of pregnant women identified by fieldworkers accepted full immunization and 4.8% accepted partial immunization. A comparison of acceptors and nonacceptors of immunization showed only small differences between the 2 groups in terms of their sociodemographic characteristics, such as age, religion, education, number of children, and occupation. The main reasons reported for nonacceptance were objection by husbands and mothers-in-law, fear of harming the fetus exacerbated by village rumors, and failure to inform women sufficiently early during pregnancy. The most frequently reported reason for failure to accept the 2nd injection among the partially immunized was the temporary migration of women from the usual residence for confinement in their parents' house. Confusion caused by local names for neonatal tetanus may have adversely affected perception by the community of the effectiveness of the vaccine. The study demonstrated that previous use of injectable and other contraceptives did not decrease subsequent acceptance of tetanus immunization. The families of tetanus immunization acceptors appeared also to adopt home-based oral rehydration therapy for diarrhea more readily than families of nonacceptors. (author's)^ieng