Perception about AIDS among residents of a Calcutta slum.

A study was carried out in a slum area of South Calcutta to assess the impact of the current mass education programme against AIDS. Two hundred and six residents, mainly of lower middle class, aged 18-60 years of both sexes were selected at random. They were interviewed to know their perception and sources of information about AIDS. Two-third of them had their own TV and radio, which they watched/heard for about three and half hours each day. Another 28% watched TV outside for about one and half hours a day. About 46% were daily readers and 20% occasional readers of newspapers. Fifty nine percent knew about persons vulnerable to get AIDS, but most of them associated it to promiscuity only. Avoiding it was the main means known to them for preventing AIDS. The role of condom in it was known to only 2.5% residents. The source of their knowledge was mainly TV, either alone or with other mass media (67%). Such knowledge was related to higher education. To make perception about AIDS more effective, it is suggested that local health and voluntary agencies should involve the community in the AIDS education programme along with the back-up of mass media. An apex agency solely responsible for AIDS education should be set up for each big city to co-ordinate the activities of local agencies.

PIP: 206 mainly poor and lower middle-class residents of the Chetla slum of South Calcutta were interviewed with regard to their perceptions and sources of information about AIDS. The goal was to assess the impact of the current mass education program against AIDS. One member was randomly selected from each of 206 families to participate in the study. Respondents were aged 16-80 years, of mean age 35-42 years, 43.7% male, 80% married, 19% illiterate, and 94% Hindu. 66% had their own television and radio which they watched/heard for approximately 3.5 hours daily. Another 28% watched television outside for approximately 1.5 hours each day. Approximately 46% and 20% were daily and occasional newspaper readers, respectively. 59% knew about people vulnerable to contracting AIDS, but most associated HIV risk only with promiscuity and prostitution. Avoiding such behavior was deemed to be the best way to avoid contracting HIV. Only 2.5% knew that condom use can protect against HIV infection. The source of that knowledge was mainly television, either alone or with other mass media. Such knowledge was related to higher education. The authors suggest that local health and voluntary agencies involve the community in the AIDS education program, backed up by the mass media. An agency solely responsible for AIDS education should be established in each major city to coordinate local agency activities.

Country watch: India.

PIP: In North Bengal, India, more than 340 tea plantations (estates) are registered with the State Tea Board; estate workers contribute to the spread of human immunodeficiency virus (HIV) infection and sexually transmitted disease (STD) through their use of multiple sex partners and alcohol, and via the drug and prostitute trafficking in the region. The West Bengal Voluntary Health Association (WBVHA) convinced estate managers to offer HIV/STD education to their workforce, which numbers more than 250,000. Three employers' associations were mobilized. Initial activities included the organization of education seminars and meetings at estates for plantation managers, physicians, social workers, and workers. Labor leaders motivated workers to participate. WBVHA and government health institute staff used lectures, printed materials, flipcharts, videos, and audiocassettes to provide basic information on HIV and acquired immunodeficiency syndrome (AIDS), STDs, and condom use. At the request of the estate managers, WBVHA has prepared an action plan. It includes development of an HIV/STD policy, regular collection of KABP data, periodic meetings with managers and workers to provide updated information, and peer educator training. Some of the estates have begun distributing condoms and offering STD treatment through their health clinics. Workers requesting HIV testing are referred to medical institutes where WBVHA conducts weekly counseling. Ladies' clubs have been established; some of the peer educators will be recruited from these groups.^ieng

Vaginal sterilisation--a simplified technique by postcolpotomy.

PIP: The salient points regarding a simplified technique for female sterilization by postcolpotomy are described. The technique has been used for vaginal ligation of the tube at N.R.S. Medical College, Calcutta, India, in over 200 cases with follow-up. The cases involved women who had 3 or more children. Those with tubo-ovarian masses or any pelvic pathology were excluded. It was more convenient to operate in the first 1/2 of the menstrual cycle. Preoperative preparation included shaving and antiseptic measures. Gas and oxygen anesthesia is preferable. No special instruments are required to perform the operation except an angled forcepts and a vaginal retractor. The lithotomy position is employed. A posterior vaginal speculum is inserted and the posterior lip of the cervix is held with a pair of volsellum and the cervix is pulled up to expose the posterior vault of vagina. A transverse incision is placed on the vaginal wall covering the cervix well below the external os at the level of pouch of Douglas. The vaginal mucous membrane is pushed downwards with gauze until the fold of peritoneum is exposed. The peritoneal fold is held with peritoneal forceps and it is opened with a transverse cut with a pair of scissors. The vaginal retractor is then introduced through the incision and the vaginal speculum is removed. On manipulating the retractor, the uterus and pelvic organ are exposed and seen well. The ovary on either side is seen either posteriorly or laterally and with the angled forceps, the ovary is brought down and the corresponding tube is easily found. The tube is held, clamped, and cut at the lateral part and tied with unabsorbable silk sutures on either side. The procedure is repeated on the other side so that both the tubes are cut and tied. The tubes are then pushed inside and the peritoneum and the vaginal mucous membrane are sutured separately with a continuous cat gut suture. The operation takes 5-10 minutes. Patients are usually discharged after 24 hours and advised on the importance of avoiding vaginal infection. This method is particularly suitable for mass programs.^ieng

Acceptability of intrauterine contraceptive device.

PIP: As a result of increasing removal rates and rising unacceptability of the IUD from 1965 to 1967, Calcutta's Nilratan Sircar Medical College Hospital evaluated side effects, socioeconomic status, nutritional level, and hemoglobin levels among 630 women who had been using Lippes loop for 12 to 24 months. Mean age for the sample group was 27.6 years and mean parity was 4.8, with 60% having 4 children and above. The majority of the women came from poor families and educational levels were low. Among 200 users, 86% suffered from "poor" nutritional intake and the mean hemoglobin level was 8.1 gm%. The main side effects were excess bleeding, weakness, and leucorrhea in women with low hemoglobin levels. Irritation of the loop on the thin endometrium of anemic women was thought to be the cause of excess bleeding. There is a higher incidence of these side effects during Months 12-24 than during Months 1-12 of use, leading to high second-year removal rates. It is suggested that women found to be anemic at initial IUD insertion should receive a routine oral iron supplement. Sterilization rather than the IUD might be the preferred method for aneimic women with low income, high fertility, and high parity.^ieng

Female sterilisation as a method of population control. Presented at the 14th All India Obstetric and Gynecology Congress, Nagpur, November 26-28, 1967.

PIP: 210 puerperally sterilized women (1-20 years age) and 500 women of similar age and parity served as the experimental and control groups in a Calcutta hospital study. 96% of the sterilized women had the operation for socioeconomic reasons and multiparity. At sterilization mean age was 27 years 10 months and mean parity was 4.8. The group after sterilization had significantly higher rates of menorrhagia (27.6%), dysmenorrhea (18.09%), and pelvic pain (10%) than had the controls. Rates of dyspareunia and excess libido were 2.3% and 5.2% in the sterilized women, as compared with nil rates in the controls. After operation rates of hydrosalpinx, pelvic adhesions, abdominal incision hernias, and scar endometriosis were 4.76%, 3.8% 4.7%, and .4%, respectively. No significant psychological sequelae occurred. The pregnancy rate after sterilization was .4%. It is concluded that sterilization will be more acceptable to poor women if the method can be improved so less side effects occur.^ieng

Fetal haemoglobin and pregnancy in homozygous sickle cell disease.

The pregnancy related changes in fetal haemoglobin (HbF) have been observed in 152 pregnancies in 125 women with homozygous sickle cell (SS) disease and related to steady state levels in the same individual. Statistically significant increases in the first and second trimesters, were followed by significant falls below steady state levels in the third trimester and postpartum period. Although these corresponded to a mean increase of 0.7% and a mean decrease of 1.6%, much greater changes occurred in some individuals. Mean levels had not returned to steady state values 1 year after delivery. The hormonal changes in pregnancy appear to have profound effects on HbF level in SS disease, the mechanisms of which require further study.

Pregnancy in Jamaican women with homozygous sickle cell disease. Fetal and maternal outcome.

The outcome of 664 pregnancies in 297 Jamaican women with homozygous sickle cell (SS) disease over the period 1959-1984 was reviewed. Overall, the spontaneous abortion rate was 118 per 1000 pregnancies, the stillbirth rate 128 per 1000 births, and perinatal mortality 171 per 1000 births. There was a striking secular increase in both spontaneous abortions and stillbirths which was accounted for, in part, by a trend for abortions to increase with maternal age up to the age of 30 years, a greater proportion of patients in the high-risk 25-29 year age group occurring in the 1980-1984 period. Another factor contributing to the poor obstetric performance in the 1980-1984 period was probably an increased survival and pregnancy rate in high-risk patients. Seven women had pregnancy-related deaths giving a pregnancy mortality rate of 1.1%.

Haematological risk factors for pregnancy outcome in Jamaican women with homozygous sickle cell disease.

OBJECTIVE: To examine the association between fetal outcome and the steady state haematology of mothers with homozygous sickle cell disease. DESIGN: A retrospective observational study. The data were taken from dockets kept at the Sickle Cell Clinic and verified by interview with 45% of the patients. SETTING: The Sickle Cell Clinic at the University Hospital of the West Indies or two peripheral clinics operated by the staff of the MRC Laboratories. SUBJECTS: All women aged 14 years or older with homozygous sickle cell disease who had experienced at least one pregnancy in the period 1977 to 1986. MAIN OUTCOME MEASURES: Three fetal outcomes including miscarriages, perinatal deaths, and birthweight. RESULTS: There were 270 singleton pregnancies in 175 women with an overall fetal wastage of 32.2%. There was a significant increased risk of perinatal death with low maternal fetal haemoglobin level, but there were no haematological associations with miscarriages or birthweight. CONCLUSIONS: These data suggest that maternal steady-state haematology has little influence on fetal outcome, with the exception that mothers with high HbF levels are less prone to perinatal deaths. Further study is required to investigate acute haematological changes associated with pregnancy.