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PubMed1990

The use of evaluation to improve the Expanded Programme on Immunization in Mozambique.

Reported are the results of an evaluation of process indicators and outputs for the Expanded Programme on Immunization (EPI) in Mozambique which were used to modify immunization strategies from 1985 to 1987. In 1986 according to cluster sample surveys, 84% of children in Maputo, the capital, were fully vaccinated. In other cities in the country, vaccination coverage increased from an average of 36% in 1985 to 55% in 1987. The major determinants of low vaccination coverage were provision of vaccination services at health centres on less than 3 days per week; missed opportunities; and vaccinating too early or with too short an interval between doses. The results of sentinel site surveillance in Maputo indicated that EPI had a marked impact on neonatal tetanus and to a lesser extent on poliomyelitis and measles. Evaluation led to changes in EPI policy in Mozambique (e.g., adoption of a uniform national vaccination schedule and discontinuation of the use of expired vaccine) and strategies (elaboration of different strategies for urban areas, rural areas, and displaced people). Also, performance was improved by involving programme managers and implementors in evaluation, and by providing timely and widespread feedback of results to policy-makers, peripheral health workers, and the community.

Child↗
PubMedDate not supplied

[The symptom-diagnosis interval: a possible approximation to the natural history of neoplasms].

In order to assess the influence that age, sex, site of the primary tumor (SPT), the extension and histology may have on the interval first symptom-diagnosis (ISD), 1.149 cases of lung, breast, stomach, colon and rectum cancer registered in the Tumor Registry of the Hospital del Mar (Barcelona) were analyzed. Overall, mean ISD was 5.7 months. 12.7% of women and 5.5% of men (p less than 0.0001) had an ISD greater than one year. Age does not appear to influence ISD in this population (r = 0.014). Among women, the ISD for each SPT was as follows: breast cancer, 9.1 months; rectal cancer, 6.5; stomach, 4.9; colon, 4.7; lung, 2.7. Men's ISD were: rectum, 6.2; stomach, 5.9; colon, 5.7; lung 3.2. Age, sex, SPT, the extension and histology jointly explain only 18% of the ISD variability (multiple r = 0.42 p less than 0.0001). SPT and histology appear to be the strongest predictors, both remaining statistically significant when adjusting for the other four factors. While only breast cancer clearly showed a positive association between ISD and tumor extension, an unexpected inverse relationship was observed in rectal cancer. In some tumors, the ISD may just be an indicator for the rate of tumor growth. ISD data registered in a Tumor Registry can contribute to the study of a part of the natural history of neoplasms. Such analyses are also relevant for studies of secondary prevention and screening programs, access to and quality of care, and psychosocial predictors of the care seeking process.

Adult↗
PubMedDate not supplied

Women's health: an alternative perspective for choosing interventions.

This paper outlines the health problems of mothers, discusses the links between maternal health and child health, and emphasizes the need to focus attention more clearly on the problems of women and the interventions that might help them as a way to improve both maternal and child health. The special problems of girls and women in the developing world--including maternity care, abortion, and maternal mortality and morbidity--and the ways in which these problems affect mothers and their children, are examined. Nutritional morbidity and infectious morbidity are described in terms of their effects on maternal and infant health, including low birth weight. It is shown how the cultural, social, and economic factors that affect women and children interact with their health problems. Recommendations are made to: reexamine well established interventions to determine if new program designs might improve long-term results; conduct research on the efficacy of retraining health personnel; broaden and improve service delivery; reassess the cost-effectiveness of highly targeted interventions; reexamine the locus of certain interventions; and emphasize long-term as well as short-term results. Attention should be given to women's health not only during pregnancy, but throughout the life cycle.

Adult↗
PubMedDate not supplied

Abortion services in the United States, 1984 and 1985.

In 1984 and 1985, the number of abortions, the abortion rate and the abortion ratio stayed at approximately the same levels as in the previous three years. Just under 1.6 million abortions were performed, about three percent of women of reproductive age obtained an abortion, and about 30 percent of pregnancies (excluding those ending in stillbirths and miscarriages) were terminated by abortion. However, the number of abortion providers declined by five percent between 1982 and 1985, and the geographic distribution of abortion services continued to be markedly uneven. Eighty-two percent of all U.S. counties--50 percent of those classified as metropolitan and 91 percent of those classified as nonmetropolitan--lacked an abortion provider in 1985. The long-term trend away from hospital abortions persisted during the period: Eighty-seven percent of the abortions performed in 1985 were done in nonhospital facilities, an increase of five percentage points over the 1982 level. Although abortion clinics constituted only 15 percent of all providers, they were responsible for 60 percent of the procedures performed in 1985. Among all abortion facilities, only 43 percent provided services to women after the 12th week of pregnancy. Abortion clinics were far more likely to offer second-trimester procedures than were other types of abortion providers (75 percent, compared with 13-50 percent). As of mid-1986, charges for a first-trimester nonhospital abortion ranged from $75 to nearly $900. The average amount paid was $213. In 1985, only 39 percent of nonhospital abortion facilities accepted state reimbursement for abortions provided to low-income women, and only 55 percent of facilities offered some reduction in charges to such women.

Abortion Applicants↗
PubMedDate not supplied

Sterilization approval and follow-through in Brazil.

The purpose of this study was to examine the factors that affect approval for and completion of sterilization in Rio de Janeiro. Of 2,186 new female family planning clients, 1,256 requested sterilization and 925 were approved for surgery. Among the approved women, 639 scheduled surgery and, of these, 595 were sterilized within three months of approval. While approval is dependent mainly on demographic variables, especially age and parity, follow-through by a woman is related to her education and income. The steps that a woman must complete to obtain a sterilization also affect whether she ultimately undergoes surgery. Almost no women were scheduled for sterilization during their initial clinic visit. Women who were not scheduled because they lacked certain documentation were more likely to follow through than women who, in addition to lacking documentation, were asked to switch from an inefficient contraceptive method (or no method) to a more modern one. The lessons to be learned from this study provide useful information to programs in other countries that are concerned about maintaining high standards but do not want to discourage women in their efforts to be sterilized.

Adult↗
PubMedDate not supplied

The effectiveness of family planning clinics in serving adolescents.

Data from surveys conducted by The Alan Guttmacher Institute (AGI) in 1981 have been used to create three indicators of the effectiveness of family planning clinics in serving teenagers: the mean delay between first intercourse and first clinic visit (which for teenage clinic patients is 13.2 months); teenage patient retention (67 percent; and the average excess of patient satisfaction over dissatisfaction with clinic policies and services (33 percent). Clinics run by Planned Parenthood are more effective than other types of facility, according to the mean delay indicator, whereas other clinics, such as those associated with community action programs and neighborhood health centers, rank highest in levels of patient satisfaction and patient retention. All three measures indicate that clinics serving 1,000-2,499 family planning patients per year are more effective in serving teenagers than either smaller or larger clinics, and that nonmetropolitan clinics are more effective in providing services than those in cities. Regression analysis shows that clinic administrators might take a number of actions to shorten the mean delay among teenagers between first intercourse and first clinic visit. These include offering community education programs for teenagers, enlisting the support of local churches, developing relationships with local youth groups, opening the clinic during evenings and weekends, accepting more teenagers as walk-in patients and locating a clinic in or near neighborhoods where many teenagers live. Two of the same factors--developing an active relationship with youth groups and opening the clinic to teenagers on evenings and weekends--were also found to be particularly effective in keeping teenagers as clinic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Sterilization in Honduras: assessing the unmet demand.

The purpose of this study was to evaluate and compare the availability of sterilization services at two hospitals in Honduras. Approximately 7,000 women who had given birth at the Hospital Materno Infantil in Tegucigalpa and the Hospital Leonardo Martinez in San Pedro Sula were asked about their desire for sterilization. Of the women who wanted to be sterilized, a considerable percentage had not been sterilized four months after they had given birth--58 percent of those who had delivered at Materno Infantil and 79 percent of those who had delivered at Leonardo Martinez. Twenty-three percent of the women who delivered at Materno Infantil and 4 percent of the women who delivered at Leonardo Martinez were sterilized before they were discharged. The difference may be attributed to the poor quality of the facilities at Leonardo Martinez.

Adolescent↗