Third world family planning programs: measuring the costs.

PIP: The use of cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA) is explained and demonstrated in evaluating Third World family planning programs. CBA, which aids decisions on alternate uses of investment funds, e.g., family planning versus new schools, helped convince Third World governments to adopt family planning programs because of their economic value in overall development. CEA is a technique which can show which family planning delivery systems work best for the money expended as measured, e.g., by cost per acceptor, per "couple-year of protection" against the risk of pregnancy, or per birth averted. This is increasingly necessary in the 1980s as funds for family planning are being pinched in both developing and donor countries. At the same time it is estimated that annual expenditures on family planning in the Third World must rise from the current $1 billion to $64 billion by the year 2000 if this population is to be eventually stabilized. Following a general description of the 2 techniques, 9 case studies from Brazil, Colombia, Ghana, Haiti, India, Thailand, and Zaire are presented to demonstrate what cost-effectiveness analysis has revealed about such issues as integration of family planning with health services, use of paramedical staff and community-based distribution to promote contraceptive use, and important factors to include to ensure comparability of findings. Such studies have already aided family planning program decisions. Several ways that cost-effectiveness analysis can be improved in practice to make it most useful include: 1) all inputs must be included, 2) services and methods need to be evaluated, 3) cost per acceptor should be relied on less, 4) user characteristics must be taken into account, and 5) anticipating cost-effectiveness analysis, the data needed should be built into the project at the planning stage.^ieng

Age-related immunity to measles, mumps and rubella in Middle American and United States children.

Serum samples from 3000 1 to 15-year-old children residing in the Dominican Republic, Honduras and the Republic of Panama were analyzed for measles, mumps and rubella susceptibility. These data were compared with results obtained on sera drawn from 2221 United States children of similar ages. It was found that children in all areas usually acquired immunity to measles early in life and tended to contract mumps and rubella somewhat later. Immunity data from the urban areas of the United States closely resembled that from the urban areas of the Dominican Republic. Honduran and Panamanian children showed much higher age-related frequencies of rubella, susceptibility. When compared to the other Middle American countries studied, the rural Honduran sample showed significantly higher age-grouped susceptibility rates for measles and simultaneous triple rate revealed a consistent bias, indicating that the attack rates of the three infections are not entirely independent.