High and equitable tuberculosis awareness coverage in the community-driven Axshya TB control project in India.

Data from surveys on knowledge, attitudes and practice (KAP) on tuberculosis (TB) conducted under the Axshya project at two time points (baseline 2010-2011 and mid-line 2012-2013) were analysed for changes in coverage and equity of TB awareness after project interventions. Overall coverage increased from 84% at baseline to 88% at midline (5% increase, P < 0.05). In comparison to baseline results, coverage at the midline survey had significantly increased, from 81% to 87% among the rural population, from 81% to 86% among women, from 73% to 85% in the ⩾55 years age group, from 71% to 80% among illiterates and from 73% to 81% in the south zone (P < 0.05). The equity gap among the different study groups (settlement, sex, age, education and zones) decreased from 6-23% at baseline to 3-11% during the midline survey. The maximum decline was observed for type of settlement (rural vs. urban), from 10% to 3% (P < 0.05). This community-driven TB control project has achieved high and equitable coverage of TB awareness, offering valuable lessons for the global community.

Des données émanant d'enquêtes « connaissances, attitudes, pratiques ¼ (KAP) en matière de tuberculose (TB) réalisées dans le cadre du projet « Axshya ¼ à deux périodes (de 2010 à 2011 au départ et de 2012 à 2013 à mi-parcours) ont été analysées à la recherche de modifications dans la couverture et l'équité en matière de connaissances de la TB à la suite des interventions du projet. La couverture d'ensemble a augmenté de 84% au départ à 88% à mi-parcours (augmentation de 5% ; P < 0,05). En comparaison au point de départ, la couverture de l'enquête à mi-parcours a augmenté significativement de 81% à 87% dans la population rurale, de 81% à 86% chez les femmes, de 73% à 85% dans la tranche d'âge ⩾55 ans, de 71% à 80% chez les personnes illettrées et de 73% à 81% dans la zone sud (P < 0,05). La différence en termes d'équité parmi les divers groupes d'étude (lieu, sexe, âge, instruction et zones) a diminué de 6% à 23% au départ jusqu'à 3% à 11% lors de l'enquête à mi-parcours. Le déclin maximal a été observé pour la localisation (rurale contre urbaine), de 10% à 3% (P < 0,05). Le projet à base communautaire de lutte contre la TB a abouti à une couverture élevée et équitable des connaissances en matière de TB, ce qui offre des leçons à portée universelle.

Se llevó a cabo un análisis de la evolución de la cobertura y la equidad en la sensibilización a la tuberculosis (TB) después de las intervenciones realizadas en el marco del Proyecto Axshya, a partir de los resultados de las encuestas del proyecto sobre los conocimientos, las actitudes y las prácticas en materia de TB que se realizaron al comienzo entre el 2010 y el 2011 y a medio término de la intervención, del 2012 al 2013. La cobertura global aumentó de 84% al comienzo del proyecto a 88% a medio término (aumento de un 5% ; P < 0,05). En comparación con los datos iniciales, en la encuesta de mitad del período, la cobertura observada aumentó de manera considerable en la población rural de 81% a 87%, en las mujeres de 81% a 86%, en el grupo de ⩾55 años de 73% a 85%, en la población analfabeta de 71% a 80% y en la región del sur aumentó de 73% a 81% (P < 0,05). La amplitud de la brecha de equidad en los diferentes grupos del estudio (en función del asentamiento, el sexo, la edad, la educación y las zonas) disminuyó de 6% a 23% al comienzo hasta 3% a 11% en la encuesta de medio término. La máxima disminución se observó con respecto al asentamiento (rural contra urbano), de 10% a 3% (P < 0,05). Este proyecto de control de la TB dirigido por la comunidad ha logrado una alta cobertura y gran equidad en la sensibilización sobre la TB y ofrece enseñanzas valiosas a otros entornos similares en todo el mundo.

High-risk adolescents and female condoms: knowledge, attitudes, and use patterns.

PURPOSE: To explore data on high-risk male and female adolescents' attitudes towards female condoms, compared with male condoms. METHODS: Exploratory survey research was utilized with a convenience sample of 65 high-risk adolescents at an emergency homeless shelter. A peer-led intervention was conducted and pre-test and post-test interviews explored barriers to female condom use. The intervention consisted of 15- to 30-minute small group sessions, discussing female condoms' construction; purpose of the rings; efficacy preventing pregnancy and sexually transmitted infection (STIs); and how to lubricate, insert, and use. Content and Chi-square analyses were utilized. RESULTS: Sixty-three percent used male condoms as their primary contraceptive method; almost half (48%) said they always used male condoms, but 44% reported having sex without a male condom at least once in the 2 weeks prior to pre-test. Ninety-five percent had heard of the female condom, half 'good' and 24% 'bad' things, but only 15% had ever used one. At post-test all respondents gave reasons they might use female condoms in the future, and 77% gave reasons why they might not. Most (73%) adolescents said they would still prefer the male to the female condom. The major potential barriers to adolescents' female condom use were not having female condoms available and/or females feeling uncomfortable inserting them. CONCLUSIONS: Female condoms should be offered to adolescents as an additional choice rather than as replacements for male condoms. Further research is needed to assure access, availability, and comfort with female condoms and male participation in their use.

PIP: The aim of this study was to explore data on high-risk male and female adolescents' attitudes towards the female condom as compared with the male condom. Exploratory survey research was utilized with convenience sample of 65 high-risk adolescents at an emergency homeless shelter. A peer-led intervention was conducted and pre- and post-test interviews explored barriers to female condom use. The intervention consisted of 15- to 30-minute small-group sessions, discussing the female condom's construction; purpose of the rings; its efficacy in preventing pregnancy and sexually transmitted infections; and how to lubricate, insert, and use it. Content and Chi-square analyses were utilized. 63% used the male condom as their primary contraceptive method; almost half (48%) said they always used a male condom, but 44% reported having sex without using one at least once in the 2 weeks prior to the pre-test. 95% had heard of the female condom (half had heard "good" things and 24% had heard "bad" things), but only 15% had ever used one. At post-test all respondents gave reasons they might use a female condom in the future, and 77% gave reasons why they might not. Most (73%) adolescents said they would still prefer the male condom to the female condom. The major potential barriers to adolescents' female condom use were not having a female condom available and/or females feeling uncomfortable inserting them. The female condom should be offered to adolescents as an additional choice rather than as a replacement for the male condom. Further research is needed to assure access to, availability of, and comfort with the female condom and male participation in its use.

Teenagers, young people and family planning: a survey in five Romanian high schools.

Family planning was for a long time prohibited in Romania. This has reduced the demand for contraceptives. Even though contraceptives were made accessible and their use promoted since the beginning of December 1989, abortion has still been the preferred form of fertility regulation, as the people of Romania are unaware of the advantages of contraception. The purpose of the present survey was to assess the level of sexual knowledge, attitudes and practice of teenagers and young people from urban areas of Romania and to identify if there was any significant difference in terms of age, education and sexual activity. A baseline examination was undertaken in which data were collected from 279 students who attended five high schools and six post high schools from the Moldavia cities, Iassy, Piatra-Neamt and Bîrlad. Students were asked to complete a self administered questionnaire, and a 97.5% response rate for the whole survey was achieved. Difference between answers were tested using chi-square test from 2x2 table and median test, average. A P-value <0.05 was considered to be significant. The study established that knowledge, attitudes and practice vary by age (adolescents (< or =19y) vs young people (>19y)) and education (high school vs post high school) in some regards. At the aggregate level, regarding knowledge, a statistically significant difference was found between adolescents and young people; but no statistically significant difference was found between high school and post high school students. Apart from lack of basic knowledge the study confirmed that many false beliefs regarding contraceptives are held by the survey participants. People who were sexually active were no better informed than the rest of survey participants, but they had a significantly higher percentage of positive attitudes regarding effectiveness of pills and withdrawal. Both, the knowledge and attitudes of students necessarily required appropriate sex education which, ideally should be introduced before young people become sexually active.

PIP: This survey aimed to explore the association between sexual knowledge, attitudes, and practices and selected sociodemographic factors among students. A baseline investigation was conducted among 279 students attending 5 high schools and 6 post-high schools from the cities of Iassy, Piatra-Neamt, and Birlad. A response rate of 97.5% was achieved after completing the self-administered questionnaire. The study indicated that sexual knowledge, attitudes, and practices vary by age and education. A significant difference on knowledge was noted between adolescents and young people, but was insignificant among high school and post-high school students. Apart from the lack of knowledge, the study confirmed that many false beliefs regarding family planning, particularly contraceptives, are held by the surveyed participants. In addition, sexually active participants have a higher percentage of positive attitudes towards the efficacy of pills and the withdrawal method. Knowledge and attitudes of students, as reflected in the study, necessitates appropriate sex education, which ideally should be introduced before they become sexually active.

Knowledge, attitudes and practices of mothers and knowledge of health workers regarding care of the newborn umbilical cord.

OBJECTIVE: To determine the knowledge, attitudes and practices (KAP) of mothers and the knowledge of health workers regarding care of the newborn umbilical cord. DESIGN: Cross-sectional survey. SUBJECTS: Mothers with infants less than three months of age attending well child clinics and health workers (HW) in the clinics, maternity and newborn units of public health, facilities serving an urban slum area in Nairobi, Kenya. RESULTS: Of the 307 mothers interviewed, 91% and 28% of mothers knew of the need for hygiene whilst cutting and tying the cord, respectively. Regarding postnatal cord care, 40% had good knowledge and 66% good practice. Fifty-one percent of mothers knew and 54% practised postnatal cord care for the appropriate duration of time. Seventy-nine percent of mothers were afraid of handling an unhealed cord. After multivariate analysis, the following variables showed significant independent association with good maternal KAP; increased level of education (OR 2.3, p < 0.001), living in middle class areas rather than slums (OR 1.5, p < 0.03), increased maternal age (OR 1.8, p < 0.001), acquisition of knowledge from a HW rather than from other sources (OR 1.5, p < 0.001), and living in stone/brick houses rather than mud houses (p = 0.01). Fifty per cent of HW had correct knowledge on type of postnatal cord care, and 79% had correct knowledge on duration required for the same. The knowledge of 50% on type of care was incorrect by international standards, but was in keeping with Nursing Council of Kenya teaching. CONCLUSION: Mothers had good knowledge on the need for hygiene when cutting the cord, had poor knowledge and practice in other aspects of cord care, and were afraid of handling the cord. Poor KAP was associated with young, poor mothers of low education, who had acquired their knowledge from sources other than HW. The knowledge of a large proportion of HW was incorrect and outdated. We recommend that health education on cord care be given at all levels of contact with mothers and that knowledge of all primary HW on cord care be updated.

PIP: Using a cross-sectional survey, this study investigated the knowledge, attitudes, and practices (KAP) of mothers and the knowledge of health workers regarding care of the umbilical cord. The study interviewed a total of 307 mothers with infants less than 3 months old and 64 health workers (HWs) in an urban slum area in Nairobi, Kenya. The results showed that 91% and 28% of mothers knew of the need for hygiene while cutting and tying the cord, respectively. As to postnatal cord care, 40% had good knowledge and 66% had good practice. However, 79% of mothers were afraid of handling an unhealed cord. Results of multivariate analysis showed that the following variables had significant independent association with good maternal KAP: increased level of education, living in middle class areas, increased maternal age, and acquisition of knowledge from HWs rather than from other sources. 50% of HWs had correct knowledge on type of postnatal cord care, but the knowledge of 50% on type of care was incorrect by international standards. Based on the findings, it was recommended that good health and cord care practices be taught at all levels of contact with mothers and that knowledge of all primary HWs on cord care be updated.

Knowledge, attitudes, and practices regarding emergency contraception among nurses and nursing students in two hospitals in Nairobi, Kenya.

A cross-sectional descriptive study on knowledge, attitudes, and practice about emergency contraception (EC) was conducted among nurses and nursing students using a self-administered questionnaire. One-hundred-sixty-seven qualified nurses and 63 nursing students completed the questionnaire. Over 95% listed at least one regular contraceptive method but only 2.6% spontaneously listed EC as a contraceptive method, whereas 48% of the respondents had heard of EC. Significantly more nursing students than qualified nurses were familiar with EC. Knowledge about the types of EC, applications, and side effects was poor and 49% of the respondents considered EC as an abortifacient. Of those familiar with EC, 77% approved its use for rape victims and 21% for adolescents and schoolgirls. Only 3.5% of all respondents had personally used EC in the past, 23% of those familiar with EC intend to use it in the future, whereas 53% intend to provide or promote it. The view that EC was abortifacient negatively influenced the decision to use or provide EC in the future. The present findings suggest that the level of knowledge of EC is poor and more information is needed. These findings indicate the potential to popularize emergency contraception in Kenya among nurses and nursing students.

PIP: A descriptive research study on knowledge, attitudes and practices with regard to emergency contraception (EC) was conducted using a questionnaire among 167 nurses and 63 nursing students in Nairobi, Kenya. Results revealed that 95% recorded at least one regular contraceptive method. About 48% of the respondents had heard about EC, but only 2.6% had used it. More nursing students than qualified nurses were aware of EC. There was poor knowledge about the types, applications and side effects of EC. Some 49% of the subjects regarded EC as an abortifacient. About 77% of those knowledgeable about EC approved its use for rape victims and 21% for adolescents and schoolgirls. Only about 3.5% had personally used it. Some 23% of those aware of EC intended to use it in the future. About 53% planned to provide or promote it. The perception that EC is abortifacient affected the decision whether to use or provide it. The data imply that there is potential for effective promotion of EC among nurses and nursing students in Kenya.

Rapid ethnographic assessment of breastfeeding practices in periurban Mexico City.

Before carrying out a breastfeeding promotion programme in a periurban area of Mexico City, we conducted a rapid ethnographic study to determine the factors associated with absence of exclusive breastfeeding. The responses to pilot interviews were used to develop a standardized questionnaire regarding reasons for infant feeding choice, sources of advice, and barriers to breastfeeding. We interviewed a random sample of 150 mothers with a child < 5 years of age; 136 (91%) of them had initiated breastfeeding; but only 2% exclusively breastfed up to 4 months. The mothers consistently stated that the child's nutrition, health, growth, and hygiene were the main reasons for the type of feeding selected; cost, comfort, and the husband's opinion were less important. Physicians were ranked as the most important source of advice. Reduction or cessation of breastfeeding occurred on the doctor's advice (68%); or when the mothers encountered local folk illnesses such as "coraje" (52%) or "susto" (54%), which are associated with anger or fright; or had "not enough milk" (62%) or "bad milk" (56%); or because of illness of the mother (56%) or child (43%). During childhood illnesses and conditions, breastfeeding was reduced and the use of supplementary foods was increased. This study emphasizes the importance of cultural values in infant feeding choices, defines specific barriers to breastfeeding, and provides a basis for interventions to promote exclusive breastfeeding in the study population.

PIP: Prior to initiating a community-based intervention program to promote exclusive breast feeding in San Pedro Martir, Mexico, a 2-month (1994) rapid ethnographic assessment was conducted. 150 mothers whose youngest child was under 5 years of age were interviewed. 136 mothers (91%) had breast-fed their infant, for a median duration of 6 months, but only 2% exclusively breast-fed for up to 4 months. Mothers consistently described breast feeding as the best nutrition for their infant. However, the dominant feeding pattern was mixed breast and bottle-feeding. Formula, tea, and water were introduced during the first postpartum day. By the end of the third month, 63% of mothers had introduced solid food to promote growth. It was common practice to reduce breast feeding and increase feeding of supplementary foods when a child was ill. Physicians were the most respected source of knowledge on breast feeding. 42% of mothers reported that, at some point when they were breast feeding, a doctor had advised them to stop and half these mothers complied. The data collected in this rapid survey were used to guide a peer counseling program to promote exclusive breast feeding in the community.

Report on reproductive health survey.

PIP: This report focuses on the individual reproductive health status of women of childbearing age in China. The sample population included 90.1% rural women and 9.9% urban women; 89.5% Han women and 10.5% ethnic minority women. 53.7% of the women had knowledge about menstruation, 68% had not attended any organized gynecological examinations in the past 2 years, and only a few of them (11.9%) had knowledge about breast self-examination. Furthermore, induced abortion was more frequent among urban women; the highest rate was found in the 35-49 age group. Although more women had prenatal health examination, the frequency was from 1 to 5 times, indicating unsatisfactory maternal and child health care. Contraceptive use was found among 87.2% of the women mostly following suggestions of family planning workers. Most of these women had a high degree of satisfaction for the method used. Awareness of IUDs was highest, followed by female sterilization. Finally, awareness of reproductive tract infections was below average level; awareness decreased with an increase in age.^ieng

KAP survey on parliamentarians assists advocacy targeting.

PIP: A survey on knowledge, attitudes, and practices concerning population issues was conducted by JOICFP among 752 Japanese parliamentarians for future advocacy targeting. The findings showed that the majority of parliamentarians related population issues to concerns involving food shortage. Awareness of and interest in domestic issues involving the declining fertility rate and aging of society were high, but familiarity with the issues of reproductive health and rights (RH/RR) in developing countries was low. This was mostly observed among young and male parliamentarians. This study designated those parliamentarians who were less aware of RH/RR in addressing population issues as targets for future advocacy campaigns. In dealing with the population issue, male respondents opted for economic solutions, while females also included the improvement of public awareness of these issues. Concrete action addressing population issues in developing countries had been taken by only 25% of the respondents. Willingness to make future plans was found in another 25%. Support for the role of NGOs as equal partners in international cooperation activities was expressed by 80% of the respondents. All parties were most concerned about the falling national birth rate. These findings suggest that a quarterly newsletter exclusively devoted to increasing the knowledge of Japanese lawmakers on global population issues should be published.^ieng

Emergency contraception in Nairobi, Kenya: knowledge, attitudes and practices among policymakers, family planning providers and clients, and university students.

To gauge knowledge, attitudes, and practices about emergency contraception in Nairobi, Kenya, we conducted a five-part study. We searched government and professional association policy documents, and clinic guidelines and service records for references to emergency contraception. We conducted in-depth interviews with five key policymakers, and with 93 family planning providers randomly selected to represent both the public and private sectors. We also surveyed 282 family planning clients attending 10 clinics, again representing both sectors. Finally, we conducted four focus groups with university students. Although one specially packaged emergency contraceptive (Postinor levonorgestrel tablets) is registered in Kenya, the method is scarcely known or used. No extant policy or service guidelines address the method specifically, although revisions to several documents were planned. Yet policymakers felt that expanding access to emergency contraception would require few overt policy changes, as much of the guidance for oral contraception is already broad enough to cover this alternative use of those same commodities. Participants in all parts of the study generally supported expanded access to emergency contraception in Kenya. They did, however, want additional, detailed information, particularly about health effects. They also differed over exactly who should have access to emergency contraception and how it should be provided.

PIP: A five-part study was conducted to gauge knowledge, attitudes, and practices about emergency contraception (EC) among policymakers, family planning providers and clients, and university students in Nairobi, Kenya. Government and professional association policy documents, and clinic guidelines and service records were searched for references to EC. In-depth interviews were conducted with 5 key policymakers, and with 93 family planning providers randomly selected to represent both the public and private sectors. Furthermore, 282 family planning clients attending 10 clinics were also surveyed and four focus groups were conducted with university students. Although one specially packaged EC was registered in Kenya, the method was scarcely known or used. No extant policy or service guidelines address the method specifically, although revisions to several documents were planned. Yet policymakers felt that expanding access to EC would require few overt policy changes, as much of the guidance for oral contraception was already broad enough to cover this alternative use of those same commodities. Participants in all parts of the study generally supported expanded access to EC in Kenya. They did, however, want additional detailed information, particularly on the health effects of EC. They also differed on who should have access to EC and how it should be provided.

Emergency contraception in Mexico City: what do health care providers and potential users know and think about it?

Emergency contraception promises to reduce Mexico's high unwanted pregnancy and unsafe abortion rates. Because oral contraceptives are sold over-the-counter, several emergency contraceptive regimens are already potentially available to those women who know about the method. Soon, specially packaged emergency contraceptives may also arrive in Mexico. To initiate campaigns promoting emergency contraception, we interviewed health care providers and clients at health clinics in Mexico City, ascertaining knowledge, attitudes, and practices concerning the method. We found limited knowledge, but nevertheless cautious support for emergency contraception in Mexico. Health care providers and clients greatly overestimated the negative health effects of emergency contraception, although clients overwhelmingly reported that they would use or recommend it if needed. Although providers typically advocated medically controlled distribution, clients believed emergency contraception should be more widely available, including in schools and vending machines with information prevalent in the mass media and elsewhere.

PIP: An interview was conducted to ascertain knowledge, attitudes, and practices concerning emergency contraception (EC) among health care providers and potential EC users in metropolitan Mexico. Findings showed that there was a limited knowledge about EC per se and its method, but nevertheless, most of the participants were cautious to support EC in Mexico. Health care providers and clients greatly overestimated the negative health effects of EC, although clients overwhelmingly reported that they would use or recommend it if needed. Although providers typically advocated medically controlled distribution, clients believe EC should be more widely available, including in schools and vending machines, with information prevalent in the mass media and elsewhere.

Sex on campus: a preliminary study of knowledge, attitudes and behaviour of university students in Delhi, India.

Eight hundred and eighty-seven students from two major universities in Delhi, India, were surveyed, using a self-administered questionnaire, about their sexual knowledge, attitudes and behaviour. The data show that female students seem to be rejecting traditional Indian repressive sexual standards of premarital and non-procreative sex and the gender differences are beginning to narrow. Despite their sexual awareness, the students were highly ignorant of the facts of life. Being male and married did not make them more knowledgeable.

PIP: This baseline study examines student attitudes, knowledge, and sexual behavior in India. The sample includes 887 students from two universities in Delhi, of which 76.8% were female and 82.1% were unmarried. 62.7% were Hindus or Sikhs, 22.1% were Christians, and 11% were Muslims. 40.9% were nursing students, 37.6% were social work students, and 22.5% were in the humanities. Attitudes were assessed about the acceptance of premarital sexual relations and masturbation. Findings indicate that 58% of women and 79.1% of men viewed intimate or casual sexual relations as acceptable before marriage. Only 32.1% supported the chastity of women. 72.4% agreed that it would be better if women were free to express their sexual desires with as much initiative and aggressiveness as men. Women were more sexually conservative than men in sexual attitudes and sexual behavior. 49.5% of males and 36.1% of females had a steady dating partner with whom they were romantically involved. 39.3% of males and 20.4% of females had engaged in premarital sex. About 50% of males and females approved of parents allowing their daughters as much sexual freedom as their sons. Females found premarital sex slightly more acceptable for a man than for a woman. Males supported premarital sex equally for men or women. 61.7% of men and 40.6% of women regarded love as the key to satisfying sexual relations. 50.4% of males and 38.6% of females accepted masturbation as healthy. 66.7% of females and 62.4% of males viewed infidelity as unacceptable for both partners. 72.2% of females and 57.6% of males agreed that extramarital relations were almost always harmful to a marriage. 60.7% of students correctly identified only 33% or less of the sexual anatomy and functioning knowledge questions; only 8.2% answered over 50% correctly. Males and females were equally uninformed. The most common source of information about sex was friends.

Births, deaths and medical emergencies in the district: a rapid participatory appraisal in Nepal.

Two qualitative rapid appraisal techniques were used in a community-based study to investigate health beliefs, attitudes and practices in a rural district in Nepal. Pregnancy and childbirth remain non-medical activities managed at home. Deaths may be avoided by better access to hospital emergency services. Health awareness of some problems, e.g. oral rehydration and diarrhoeal disease, is high; but of others, e.g. association of haemoptysis with tuberculosis, is poor. These methods require few resources, are efficient in time and manpower required, and generate useful relevant information on a target population. They are recommended for district health development programmes elsewhere.

PIP: A community-based study using two qualitative rapid appraisal techniques was conducted to investigate health beliefs, attitudes, and practices in a rural district in Nepal. Based on the reports given, the availability of primary health care has not yet led to a medicalization of pregnancy and childbirth. There exists a strong felt need for accessible emergency and surgical services in the district. Moreover, awareness on some health problems, such as oral rehydration in diarrheal disease is high, but the level of awareness concerning tuberculosis is poor. Health education can therefore be targeted with high prevalence and low-awareness areas. Finally, the study recommended a rapid participatory appraisal for use in district health development programs.

[AIDS: knowledge, attitudes and sex behavior of young people attending AIED family planning health services]. / AIDS: conoscenze, attitudini e comportamenti sessuali di giovani utenti dei consultori familiari AIED.

PIP: A research group of the G. Sanarelli Institute of La Sapienza University, Rome, Italy, conducted a survey on the knowledge, attitudes, and sexual behavior of young people at 14 family planning counseling centers of the Italian Association of Demographic Education (AIED). Data were collected by means of an anonymous, self-administered questionnaire containing 70 questions during the 12-month period from March 1, 1995 to February 29, 1996. Respondents were 19-24 years old. The purpose was to gain information about AIDS-related risk behavior. A total of 1085 questionnaires were collected representing the views of 978 women (90.1%) and 107 men (9.9%) with an average age of 21.9 years for the women and 21.7 years for the men. For 84% of the females and 78% of males, the source of information about AIDS was television; for 61% of males and 59% of females it was daily newspapers; and only 33% of men and 40% of women obtained such information from school. The average score of accurate knowledge about the transmission of HIV was 78% vs. 75.6% of a national sample. The respondents were more sexually active than the subjects of the national sample. 96% of males and 91% of females had experienced sexual intercourse; the average age of sexual debut was 17.7 years for males and 18.0 years for females, with an average of 4.2 partners for males and 3.0 partners for females. 6% of males had sex with prostitutes (16% in the national sample), while some women had had bisexuals (4%) or drug addicts (6.5%) as partners. The practice of anal sex was above the national average (29% for males and 24% for females). 73% of males and 79% of females always used condoms with casual sexual partners, but only 20% of males and 15% of females used condoms with steady partners.^ieng

Diet and nutrition: a knowledge, attitude and practice study of pregnant women in Karachi.

PIP: This study determines knowledge, attitude, and practice of diet and nutrition during pregnancy among women in Karachi, Pakistan. Quantitative and qualitative data were obtained from a randomized convenience sample of 150 pregnant women from outpatient clinics of 3 hospitals: Aga Khan University Hospital (AKUH), Karachi Adventist Hospital, and Civil Hospital. Daily caloric intake was based on a single day. Two dietary patterns were observed. Meals among individuals with monthly income under Rs. 5000 consisted of flatbread, lentils, and/or vegetables. Meat was eaten under twice/week. Calories came primarily from flatbread, cereals, and cooking oil. Those with income over Rs. 10,000/month ate a great variety of foods and meat frequently. The source of calories was diverse and more balanced. The women preferred milk and fresh fruit during pregnancy. Milk was desired for fetal bone development, enhanced lactation, good skin, and a settled stomach. Desired foods were described as cold and justified since the womb was a source of heat production. Lower socioeconomic status (SES) groups did not trust their judgment about beneficial foods and could not afford the foods they desired. Many women had food avoidances, such as hot foods. The percentage of women with food avoidances increased with increased SES. Most women valued increased food consumption during pregnancy, but 68% did not increase their caloric intake and 40% decreased caloric intake. The mean caloric intakes, from low to high SES, were 1087, 1656, and 1750 kcal/day/woman, respectively.^ieng

Awareness and use of family planning methods among married women in Ibadan, Nigeria.

A study of awareness and use of family planning methods among 1188 married women aged 15-40 years, attending antenatal clinic in four different locations, conducted in Ibadan, Nigeria between May to December 1995 is reported. Most respondents (94.3%) were aware of the use of family planning but only 12.0% had ever visited a family planning clinic. Awareness of specific methods was 82.6% for condoms, 75.7% for oral contraceptives, 75.5% for injectable contraceptives and 65.3% for intrauterine device. Current use of family planning methods was low with 10.0% using withdrawal, 8.1% oral contraceptives, 5.2% using intrauterine devices and 4.7% using condoms. Perceived constraints to the use of family planning methods included husband's opposition, fear of complications and perceived insufficient knowledge about family planning methods. It is concluded that there is a knowledge-practice gap in the use of family planning methods among married women in Ibadan, Nigeria. Improved education strategies and better access to services are needed to solve these problems.

PIP: This study examined the level of awareness and the rate of family planning method use among women of reproductive age in Ibadan, Nigeria. The participants included 1188 married women, aged 15-40 years, attending antenatal clinics at four sites in Ibadan: University College Hospital; Adeoyo State Hospital; Primary Health Center, Oiomi; and Omotayo Maternity Center, a private maternity center in Oke-Ado. Most of the respondents (94.3%) were aware of family planning methods, but only 12% had visited a family planning clinic. Awareness of specific methods was 82.6% for condoms, 75.7% for oral contraceptives, 75.5% for injectable contraceptives, and 65.3% for IUDs. Current use of family planning methods was low, with 10% using withdrawal, 8.1% using oral contraceptives, 5.2% using IUDs, and 4.7% using condoms. Perceived constraints to the use of family planning methods included husband's opposition, fear of complications, and perceived insufficient knowledge about family planning methods. Based on these results, it is concluded that there is a knowledge-practice gap concerning family planning methods among married women in Ibadan, which will require improvement in education strategies and better access to services.

Validity and reliability in reporting sexual partners and condom use in a Swiss population survey.

OBJECTIVES: To examine the validity and reliability of indicators of sexual behaviour and condom use in annual telephone surveys (n=2800) of the general population aged 17 to 45 for the evaluation of AIDS prevention in Switzerland. METHODS: A test-retest study with additional focused interviews was conducted on a subsample (n=138) of the respondents aged 17 to 22 years. RESULTS: The subsample included more French speaking respondents (OR: 1.7, CI: 1.1-2.5) and more people in a stable relationship (OR: 2.2, CI: 1.5-3-3) than the initial sample but did not differ in any other way, although no data is available on their attitudes towards sex. The reliability of the indicators considered was high: number of lifetime, casual sex partners in the last 6 months and condom use with them, acquisition of a new steady partner during the year and condom use with this partner, condom use at last intercourse. However, the focused interviews raised questions about the validity of some of these indicators, presumably due to imprecise wording of the questionnaire items. Among sexually active respondents, 12.5% (95% CI: 4.7-25.5) of the men included non-penetrative sex in the definition of 'sexual intercourse', but only 1.9% (95% CI: 0.1-10.3) of the women. The propensity for men of counting acts or partners with whom no penetration had taken place in the total reported sex acts or partners was not significantly associated with any socio-demographic variables. In addition, among the 15 respondents who had reported consistent condom use with casual sex partners at interview, 40% (95% CI: 16.3-67.7) admitted at reinterview that sometimes they also had unprotected sex. CONCLUSIONS: The reliability of reports on sexual behaviour and condom use in this Swiss evaluation survey is good. The indicators derived from the annual surveys are robust measures and the monitoring of trends seems to be based on reliable measurement. However, more research is required on the validity of the data.

PIP: To monitor the impact of its AIDS prevention efforts, Switzerland conducts an annual telephone survey about AIDS-related knowledge, attitudes, and preventive behavior in the general population aged 17-45 years. Based upon a test-retest study with additional focused interviews conducted upon a subsample of 138 respondents aged 17-22, the authors report their findings from an investigation of the validity and reliability of indicators of sexual behavior and condom use in those surveys. The initial survey sample was comprised of 2800 respondents aged 17-45 in October 1992. The subsample included more French-speaking respondents and more people in stable relationships than did the initial sample. Survey indicators are the number of lifetime sex partners, casual sex during lifetime and number of casual sex partners during the preceding 6 months, condom use with casual partners during the past 6 months, the acquisition of a new steady partner during the year, condom use with that partner, age at first intercourse, and condom use at last intercourse. These indicators were determined to be highly reliable, although more research is needed on the validity of the data. Among sexually active respondents, 12.5% of the men and 1.9% of women included nonpenetrative sex in their definitions of sexual intercourse. Furthermore, 40% of the 15 respondents who reported consistent condom use with casual sex partners at the initial interview later admitted at reinterview that they sometimes have unprotected sex.

The effect of changing sexual, marital and contraceptive behaviour on conceptions, abortions, and births.

PIP: This study proposed a model for estimating conceptions and tested the model in the Puglia region of Italy. Data were obtained from a 1989 KAP Survey among 2014 sexually active women aged 15-24 years, 25-34 years, and 35-44 years. Data for 1979 and 1994 were distributed based on the census. The model differentiated women by marital status, contraceptive use, pregnancy state, and pregnancy outcomes and wantedness. The analysis revealed differences in intensity and tempo of fertility by age. Less educated women had children at younger ages. The number of unwanted births, conceptions, and abortions was influenced by the spread of safe contraception, sex behavior of the unmarried, and the propensity to marry and have babies. Simulations revealed that increased birth control resulted in fewer abortions and influenced unwanted conceptions and births. Fertility declined in the 1980s-90s, due to later age at marriage, wanted fertility, and nonacceptors. Contraceptors increased, as did the failure rate, which led to more abortions. Simulations for 1979 and 1994 revealed changes among singles in sex and contraceptive behavior. More conceptions among singles in the 1980s were due to earlier sexual relations. Fewer conceptions in the 1990s were due to improvement in contraceptive failure. Wanted conceptions among married women declined faster than unwanted ones. Fewer unwanted conceptions were attributed to more married acceptors and safer method use. Fewer wanted conceptions were attributed to married nonacceptors and pregnancy. Couples in the 1990s who conceived due to contraceptive failure were less inclined to abort.^ieng

A bulletin on survey findings of China's national population and reproductive health in 1997.

PIP: This article presents findings from the 1997 State Family Planning Commission's KAP survey in China. The aim was to assess reproductive health and contraception and the future needs for family planning management. The national sample included 1041 sampling points in 337 counties among 186,089 registered persons in the first demographic stage and 15,213 persons in the second in-depth KAP stage of the survey. The average age at first marriage of women was 1.5 years higher in 1997 than in 1990. The birthrate declined, and fertility remained stable at below replacement levels. Contraceptive usage among women of childbearing ages was 83.4%. 9.2% relied on male sterilization, 40% relied on female sterilization, 43.4% used IUDs, and 4.1% used condoms. 25.5% of married reproductive age women had an unwanted pregnancy due to contraceptive failure. 62.5% of women of childbearing age received contraceptives free of charge. 28.6% received contraceptive supplies from retail shops. 39.1% who had a contraceptive operation had access to pre-operative counseling, and 50.9% received post-operative counseling. 23.5% had follow-up visits. The average age of menarche was 15.2 years. The average age of menopause was 44.8 years. Gynecological discomfort increased with age. 63% consulted doctors. 58.5% fully breast-fed for over 6 months. 57.3% had knowledge of sexually transmitted diseases, and 63.5% had heard of AIDS. 75% were happy with their sexual lives. 7.8% nationally had received at least one kind of economic assistance or skill training, of whom 50.6% had access to loans or poverty alleviation funds.^ieng

Knowledge, attitude and practices related to dengue in rural and slum areas of Delhi after the dengue epidemic of 1996.

To assess the knowledge and attitudes about dengue and practice of prevention followed by the residents of a rural area and an urban resettlement colony of East Delhi, an interview based cross sectional KAP study was undertaken in Jan 97 to Feb 97, a few months after the dengue epidemic in rural area and urban areas of East Delhi. A pre-structured and pre-tested format containing the relevant questions was administered to the subjects. A total of 687 subjects (334 rural and 353 urban) were interviewed. Nearly four fifth (82.3%) of these were aware of Dengue. Audiovisual media was the most common source of information in both the areas. Knowledge about the disease was fair to good. Fever was the commonest symptom of the disease known to 92% urban and 83% rural respondents followed by symptoms of bleeding and headache. Mosquito was known to spread the disease to 71% rural and 89% urban respondents. More than two third respondents in urban and two fifth in rural areas had used some method of mosquito control or personal protection during the epidemic.

PIP: This study evaluated the knowledge, attitude and practices concerning dengue and the practice of prevention in the rural and urban resettlement areas of New Delhi during January-February 1997, after the 1996 dengue epidemic. A pre-structured and pre-tested format was used by physicians to interview 334 rural and 353 urban residents (n = 687) who visited health centers. A high level of dengue awareness (87.3%) was observed among the respondents who can be attributed to the health education and information campaign of the audiovisual media and health care personnel. Knowledge about dengue was fair to good particularly among urban residents. 92% urban and 83% rural residents reported fever as the most common symptom, followed by bleeding and headache. About 71% rural and 89% urban respondents claimed mosquitoes as the source of the disease and used some method of mosquito control or protection during the epidemic. It has been suggested that prevention of dengue must start within the locality to ensure that the people are receptive to the messages and to make desired behavioral changes easier to adopt.

Getting the word out in Guatemala.

PIP: In Guatemala, a 1997 KAP (knowledge, attitude, practice) survey conducted in three areas of the country revealed that 88% of the people knew about the family planning (FP) program conducted by the Family Welfare Association of Guatemala (APROFAM), but only a few respondents understood modern contraceptive methods. The survey results were used by participants in a national workshop to create a work plan for 1998. The KAP survey also revealed that, while traditional birth attendants may recommend that a pregnant woman be referred to a hospital, husbands usually make the final decision. Meanwhile, a Japanese "Overseas Cooperation Volunteer" public health nurse based at a clinic in Solola State (a referral center for APROFAM clinics) has been providing counseling and FP guidance to local people. This nurse has uncovered an urgent need to treat and prevent reproductive tract infections and to delivery high-quality, low-cost reproductive health care in the area.^ieng