Primary health care in the Dominican Republic: a study of health worker effectiveness.

A comparison of the characteristics of the more effective community health workers with those of less effective community health workers in the Dominican Republic revealed no significant differences in mean age, martial status, or educational attainment. Male workers were more efficient in the provision of DPT vaccine than female health workers, but no sex differentials were apparent with regard to the effective provision of family planning services. A higher degree of job satisfaction was apparent on the part of the more effective health workers.

PIP: A comparison of the characteristics of the more effective community healthworkers with those of less effective community healthworkers in the Dominican Republic revealed no significant differences in mean age, marital status, or educational attainment. Male workers were more efficient in the provision of diptheria vaccine than female healthworkers, but no sex differentials were apparent with regard to the effective provision of family planning services. A higher degree of job satisfaction was apparent on the part of the more effective healthworkers.

Family size and malnutrition in Santo Domingo.

A case-control study of 82 urban Dominican women with a malnourished child and 82 women with a well-nourished child of the same age, sex, and neighborhood of residence revealed that the women of the control group had significantly lower parity and also had fewer living children. More women in the case group had used contraception at one time. Nevertheless, the prevalence of current contraceptive use was identical in the two groups. More women in the control group had undergone one or more spontaneous or induced abortions. Although the women in both groups were selected from the same neighborhoods, there is evidence to suggest that the the women in the control group may have had higher family incomes. The higher incomes could well account, at least in part, for the difference in parity between the two groups as well as for the difference in nutritional status in the preschool children of the mothers of these groups.

PIP: A study was undertaken in Santo Domingo, Dominican Republic, to identify the determinants of malnutrition in preschool children. The case-control study is explained. Women in the study with well-nourished children were found to have significantly lower parity and fewer living children than women in the study with malnourished children. More case than control women had at one time used contraception but current contraceptive use showed no such similar differences. A significantly greater number of the control women had experienced 1 or more abortion, spontaneous or induced. The findings tend to confirm previous findings in Colombia and Thailand of an association between family size and preschool-child malnutrition. There is, however, some evidence that women in the control group may have had higher family incomes which might account for the differences in parity observed between the 2 groups.

Family planning method change and dropouts in the Philippines.

PIP: Continuation rates among family planning acceptors in the Philippines were studied through data collected in 1971-1972. More than 1/2 the respondents were continuing with the original method. Coitus-independent methods were found to be more effective than coitus-dependent methods in preventing pregnancy. Health-related side effects accounted for nearly 1/2 the dropouts among women using a coitus-independent method; failure resulting in pregnancy was the reason cited for the majority of dropouts using coitus-dependent methods. Changes from 1 method to another tend in the direction of coitus-independent methods. Findings that 1/4 of the women dropped out of the program and 1/5 changed method indicate a high level of dissatisfaction with available methods.^ieng

How doctors in Bolivia and the Philippines view sterilization.

Attitudes toward sterilization of 165 Bolivian obstetrican/gynecologists surveyed in 1974 and those of a randomly selected group of 200 Philippine family planning physicians studied in 1972 are described. Although the attitudes of Bolivian respondents were less favorable to sterilization, a majority of both groups of physicians favored making sterilization available under certain conditions. In Bolivia, physicians with more favorable attitudes toward sterilization were more likely to be younger, to be male, to have a lower degree to religiosity, and to regard high fertility as a problem for the family rather than the state or society. Tentative explanations are offered for the differences in attitudes between the two groups of physicians. Finally, the increasing demand for, and availability of, sterilization in Latin America is noted.

A study of the effectiveness of family planning clinics in the Philippines.

A study of 190 Philippine family planning clinics revealed that certain clinic and physician characteristics were significantly and positively associated with clinic effectiveness, defined in terms of the mean number of monthly acceptors of family planning and the efficacy of the methods selected. Clinics with a high degree of effectiveness were more likely to be staffed by physicians who wanted three or fewer children, who relied more extensively on the IUD (intrauterine device) than physicians in less effective clinics, and who derived more satisfaction from working in family planning than physicians in less effective clinics. Autonomous clinics were more effective than integrated clinics, and clinics staffed by physicians trained by institutions with more experience in family planning were more effective than those staffed by physicians trained by institutions with less experience in this field. The findings regarding the following hypotheses were in the predicted direction: Clinic effectiveness will be greater in clinics staffed by female rather than by male physicians, in urban rather than in rural clinics, in clinics staffed by physicians with a low rather than a high degree of religiosity, and in clinics staffed by physicians with a high rather than a low degree of concern about population growth. The differences in clinic effectiveness, however, in these instances, were not significant.

Family planning method change and dropouts in the Philippines.

PIP: Pregnancy prevention techniques are classified into 2 general categories as the coitus-connected and coitus-independent. The former include rhythm, withdrawal, condom, and foam while the latter include such methods as oral contraception, IUDs, and male and female sterilization. The use of contraception hinges on motivation and the acceptability of the method. This article is a report on 1 particular study where data was collected in 1971-1972 through 1321 interviews resulting from a series of audits of family planning clinics with the purpose of determining the accuracy of information reported in clinic records and ascertaining the number of acceptors who had discontinued use of a family planning method or moved from the area served by the clinic. The findings revealed that: 1) Coitus-independent methods are more effective in the prevention of pregnancy that coitus-dependent ones, 2) Women who change from a coitus-dependent method are more likely to change to a coitus-independent method, while the changes from the latter method are usually to a method in the same general category, 3) In this population the IUD provides the maximum protection from conception with the minimum likelihood of program dropout.^ieng