Maternal And Child Health And Family Planning Research Articles

Does ORT reduce diarrhoeal mortality?

Researchers analyzed 1976-88 data from rural Matlab in Bangladesh to examine changes in diarrhea and in acute watery diarrhea mortality among infants and children before and after the implementation of an oral rehydration therapy (ORT) program. Overall diarrhea mortality among infants increased consistently (3-13) in both the area with maternal and child health-family planning (MCH-FP) services and the comparison area (p<.001). Mortality from acute watery diarrhea among infants also rose in both areas (1-7; p<.001). Trends in diarrhea mortality among children were not as straightforward however. It peaked in 1983-84 due to a dysentery epidemic. 92% of mothers in both areas knew about the benefits of glucose and oral rehydration salts (G-ORS) packets or homemade ORT solutions but most mothers (78% in MCH-FP area and 85% in comparison area) incorrectly believed ORT would stop diarrhea. Only 58% of G-ORS local distributors had G-ORS packets on the day the community health worker visited. Infants with severe acute watery diarrhea ingested a mean of 400 ml of ORS during the 1st 2 days of illness which is inadequate to treat infants with severe dehydration or high purging rates. ORT promotion and home distribution of G-ORS did not decrease infant and child deaths from acute watery diarrhea. Possible reasons for this phenomenon are suggested: complications other than dehydration the small amounts of ORS used and reduced reliance on hospitals and increased delays before taking severely ill children to the hospital. The question of whether the relative increase in diarrhea deaths among infants was due to the decline in infant mortality from other diseases thus making diarrhea a predominant replacing disease in the Matlab was considered. The results indicated that health educators should work toward formulating clear messages which promote correct use of ORT. Health workers should consider ORT as 1 component among others in diarrheal disease control programs.

Noncompliance Among Oral Contraceptive Acceptors in Rural Bangladesh

The levels of noncompliance among 175 oral contraceptive acceptors in a rural area of Bangladesh were monitored for three to four months. Unexpectedly high levels of noncompliance were observed, including both overconsumption and underconsumption of oral contraceptive pills. Although the study was designed to investigate only the levels of noncompliance and not the causes and consequences of noncompliance, some useful indications of the factors associated with noncompliance were obtained. The results indicate that noncompliance is a significant factor in family planning programs and, as such, warrants further in-depth investigation.

An Attempt to Reduce Infant and Child Mortality in Bohol, Philippines

PIP: This discussion describes the experience of 1 local area, Bohol, Philippines, that, despite an active maternal and child health/family planning (MCH/FP) program, failed to experience a decline in mortality during the project period (1975-1979). The specific health services to be delivered were determined during the early years of the project. The project managers believed that a package of basic primary health services with an emphasis on MCH would make a measurable impact on child health and, hopefully, on mortality. It was felt that increased use of family planning, particularly on the part of high risk mothers, would also contribute to a decline in infant and child mortality. The project recruited and trained 44 new midwives and others were added later. By 1979, 100 small Primary Health Care Centers, each staffed by a midwife had been established in the project area. 50 small community drugstores were also opened. The 4 public health hospitals and 21 rural health units, 1 in each town of the project area, participated in the project. The Bohol project increased the number of health staff, supervised them, and provided logistic support. As an immediate goal, the project sought to reach all children under age 5 with basic health services. Based on census and survey data, it is probably safe to say that mortality declined in Bohol between 1970 and 1975-79, but during the project period the crude death rate for the project area showed only a slight but statistically insignificant downward trend. Even though improvements were demonstrated in health service coverage in the project area, these improvements might have worked against other trends, thus explaining the lack of a clear decline in infant and child mortality during the project period. The project collected information on trends in fertility, abortion, nutrition, breastfeeding, and general living conditions. Although the results were at times mixed, none of the 5 appeared to have had a major effect on mortality trends. Except fertility, little change was noted. Although fertility declined, it was not clear whether higher or lower risk births were being prevented. A number of plausible explanations are evaluated as to why infant and child mortality failed to show a clear decline in Bohol: health services were of inadequate quantity or quality; midwives had too many tasks; there was a lack of fit between health services and local health conditions; local health problems were intractable to current technology; resources were insufficient to provide comprehensive primary health care; the MCH program was used primarily as a vehicle for family planning; too little attention was given to curative services; MCH programs are not designed to have a demograhic impact, and the project had too short a time period to have a demographic effect on such a large population.

The Bohol Project and Its Impact

A pilot project on the island of Bohol was initiated to provide MCH/FP (maternal and child health and family planning) services. The project objectives were: improving mother and child health care, improving family planning services, improving MCH/FP personnel training, and undertaking operational and other studies to determine the optimal resources to obtain the best program results. In conjunction with RHUs (Rural Health Units), midwives are staffing PHCCs (Pprimary Health Care Centers) to provide vaccinations; health and nutrition education; prenatal, delivery, and postpartum care; and family planning counseling and supplies to approximately 3000-5000 persons. In addition, there are more than 600 trained birth attendants to assist. Of 47,900 women, 88% have obtained some health services. The rate of infant deaths due to tetanus neonatorum has decreased but the maternal mortality rate has shown no statistical decline. 82% of the children are receiving health care with 3000-4000 well chidlren and 2500 sick children seen monthly suggesting preventive care is being given. Despite the increase in contraceptive usage and sterilization procedures over a 27-month period, the fertility decline cannot be attributed to the health services as the decline began before the services were available. This project has had no vital demographic impact on vital rates of the 420,000 population, but it has shown the feasibility of setting up the MCH/FP project with midwives as the major providers of services.