The impact of religion and cultural values on AIDS education programs in Malaysia and the Philippines.

This paper examines the impact of cultural values and government policies on the content of AIDS educational literature prepared by public health agencies in Malaysia and the Philippines. The literature from these countries, which has been distributed to the public and is intended to inform them of the danger of AIDS, how the HIV is and is not transmitted, and how to avoid infection, is analyzed and evaluated for effectiveness and congruence with the dominant religious tenets and cultural practices in each country, and attitudes to sexual behavior. The paper also describes the response of these countries to the AIDS pandemic, and concludes with suggestions about how this form of AIDS education can be improved.

PIP: AIDS is a pandemic that threatens the public health of every country in the world. In Southeast Asia, the impact of AIDS has been less than in other areas like Africa, or the West. Like many other countries from the region, the Philippines and Malaysia are classified as type 3 countries in terms of AIDS transmission. Thus, the response to AIDS has been less vigorous than in other countries. Malaysia is a diverse country with 60% of its population Malay, 31% Chinese, and 8% Indian. The malays are Muslim and the laws of the country can be described as consistent with conservative islamic customs. This means that laws are directed towards traditional family values of marriage and monogamy for women and against alternative life-styles like homosexuality, drug use, prostitution, premarital, and extramarital sexual activity. This context makes AIDS education very difficult since the lifestyles that put people at risk are illegal. The AIDS education campaign designed by the malaysian government is very naive in its presentation and relies on fear as a primary motivation to control the spread of AIDS. This strategy will fail because telling people to stop using drugs or prostituting themselves will not work. Evidence has shown in other countries that education about risk factors, rather than fear, is much more effective in slowing the transmission of AIDS. In the Philippines, 90% of the country's 60 million inhabitants are Roman Catholic. Their response to AIDS has been a public education campaign that includes elementary, high school, and college level education programs. Communication programs give information on HIV infection and transmission and prevention programs promoting condom usage for risk groups. The Filipino literature differs from the Malaysian literature in that it is more explicate in discussing risk factors and prevention advise is also more realistic. Every country must do something to help fight the spread of AIDS, but education programs that serve to reinforce traditional values instead of sale life practices will be less effective.

A comparative analysis of three different dose combinations of oral contraceptives.

Three different low-dose formulations of oral contraceptives were compared to determine the most suitable preparation for Filipino women as reflected in the first year continuation rates, incidence of side effects and failure rates. A total of 1,800 subjects were enrolled in the study from 18 health centers in six provinces in two regions of the Philippines, covering a total of 18,282 women-months of use. Sociodemographic characteristics were comparable. The monophasic levonorgestrel group showed the best performance followed by the triphasic preparation. The norethindrone group consistently showed higher drop-out rates, which may be due to the relatively higher incidence of side effects. For all three preparations, bleeding irregularities were low. There were no major side effects and no pregnancy was reported in one year of use. Noted was a distinct regional and provincial difference in recruitment and follow-up performance, possibly due to clinic, client or program factors.

Recent trends in urbanization in the ASEAN region: implications for health programmes.

"This paper examines recent trends in urbanization in four selected ASEAN countries--Indonesia, Malaysia, the Philippines and Thailand--giving particular attention to the scale and pace of urbanization, the unique features of urban communities, and the health changes and adjustments that accompany urban development in these countries."

Effect of oral contraceptive on liver function tests of women with schistosomiasis in the Philippines.

A prospective study was undertaken to determine the effect on liver function tests of a combined oral contraceptive containing norethisterone 1 mg and mestranol 0.05 mg, in women with schistosomiasis japonica in Leyte, Philippines. Women who volunteered and met the standard criteria for oral contraception, with and without infection, were followed for six months of pill intake. Concurrently, non-pill users, both infected and uninfected, were similarly followed. Baseline and six-month liver function tests were compared. Of the 466 subjects admitted in the study, 383 completed six months, and 83 discontinued. At the start of the study, there were no significant differences among the four groups in liver function tests except that the infected women had a higher total protein and alkaline phosphatase, and lower alanine aminotransferase levels. After six months, the only statistically significant finding was a lesser decrease in total protein among the infected pill users compared to the uninfected pill users. This finding was not clinically significant since there was no associated clinical complications; there were fewer number of subjects with abnormal values at the sixth month; and the mean values of this variable remained within normal limits. Our findings show that the use of low dose progestin and estrogen oral contraceptive in the presence of mild schistosomiasis japonica infection does not appear to have adverse effect on liver function tests of young women after six months of contraceptive use.

PIP: A prospective study was undertaken to determine the effect on liver function test of a combined oral contraceptive containing norethisterone 1mg and mestranol 0.05mg, in women with schistosomiasis japonica in Leyte, Philippines. Women who volunteered and met the standard criteria for oral contraception, with and without infection, were followed for 6 months of pill intake. Cocurrently, non-pill users, both infected and uninfected, were similarly followed. Baseline and 6-month liver function tests were compared. Of the 466 subjects in the study, 383 completed six months, and 83 discontinued. At the start of the study, there were no significant differences among the 4 groups in liver function tests except that the infected women had a higher total protein and alkaline phosphatase, and lower alanine aminotrasferase levels. After 6 months, the only statistically significant finding was a lesser decrease in total protein among the infected pill users compared to the uninfected pill users. This finding was not clinically significant since there was no associated clinical complications; there were a number of subjects with abnormal values at the 6th month; and the mean values of this variable remained within normal limits. The findings show that the use of a low dose progestin and estrogen oral contraceptive in the presence of mild schistosomiasis japonica infection does not appear to have adverse effects on liver function tests of young women after 6 months of contraceptive use.

Nutritional status and menarche in a rural community in the Philippines.

PIP: To examine the relationship between nutritional status and onset of menarche, anthropometric measurements and information on age at menarche were obtained from 1844 females aged 6-17 years in a rural community in the Philippines. The mean age at the initiation of the growth spurt in height was 13.5 years, while the spurt in weight occurred at the age of 11.5 years. 25.2% of respondents had attained menarche by age 11.5 years, 43.6% by age 13.5 years, 88.2% by age 14.5 years, and 96.6% by age 15.5 years. This contrasts with data from Bangladesh, where only 3.5% of girls attain menarche by age 13.5 years and only 35.1% reach this point by age 15.5 years. Further analysis indicated that both age and weight are related to the proportion achieving menarche. The effect of height is not as marked as that of body weight. A minimum level of fatness (about 17% of body weight) is associated with the onset of menstruation and its continued maintenance. Malnutrition results in a shorter reproductive span, later age at menarche, and early menopause. Since improvements in nutritional status in developing countries can be expected to result in a pattern of early menarche, late menopause, short birth intervals, and shorter periods of adolescent subfecundity, increasing attention must be given to family planning counseling of adolescents.^ieng

Lactation and childhood mortality in an urban area in the Philippines.

Based on a longitudinal study of 794 married women who delivered at F. Fabella Memorial Hospital in June-July 1973, the relationship between lactation and childhood mortality was extricated. The median length of breastfeeding was 9.1 months. The probability of dying for infants was highest in the 1st quarter of life. Of the 98 children who died in the first 2 years of life, 55 (56%) were not breastfed at all and 18 (18%) were weaned before death. 1/3 of the women who got pregnant were still lactating and 13% did so until the 4th month. The crucial period in intervention is the first 2 months of life when mortality is highest.

Maternal nutrition, infant health, and subsequent fertility.

PIP: This paper focuses on the influence of maternal nutrition on infant survival and growth and on subsequent fertility. During pregnancy, modifications in the maternal hormonal system help maintain availability of nutrients to the fetus relatively independently of maternal nutrition. When maternal dietary deficiencies reach critical levels, the effectiveness of these mechanisms in maintaining fetal nutrition decreases. Studies have confirmed the correlation of severe maternal malnutrition and lowered birth weight, neurological disorders, impaired physical growth, mental retardation, and poor school performance. Marginal nutritional status affects milk production capacity. The basis of most recommendations for lactating mothers is that the average mother produces 850 ml of milk each day. Depending on the anticipatory reserves of fat from pregnancy still available and the level of physical activity of the mother, from 2750 to 3300 Kcal/day may be needed. When the mother's energy intake is good, milk fat resembles that of her dietary fat, but when there is a shortage of food energy, the milk fatty acid pattern resembles the mother's subcutaneous fat stores. The lactose content and overall protein content of milk seem stable despite changes in the maternal diet, but the vitamin content, particularly water soluble vitamins, is very sensitive to dietary intake. Birth weight has consistently been found to be associated with infant mortality through 2 main mechanisms: maternal malnutrition may lead to a smaller placental size and decreased nutrient supply to the fetus, resulting in developmental retardation during intrauterine life, or maternal malnutrition may result in suboptimal lactation performance which will contribute to malnutrition and growth retardation of the child. Maternal nutritional status has an independent effect on the duration of postpartum amenorrhea. Improving maternal diet without concurrently introducing contraception may shorten the birth interval and consequently elevate the birthrate.^ieng

A survey of sterilization acceptors in a family planning program in rural Bangladesh.

The results of a survey of 275 Bangladeshi women who were sterilized at a rural family planning clinic are presented. The survey comprised two interviews of each woman: one conducted immediately prior to the sterilization procedure and the second conducted one month after each woman was sterilized. Sociodemographic data were gathered for the survey from the patients' clinic records. Reasons for the choice of sterilization and sociodemographic impact of the procedure are discussed, as are implications of the results on other rural family planning programs.

PIP: 275 Bangladeshi women who were sterilized at a rural family planning clinic were surveyed. 1 interview was conducted immediately prior to the sterilization procedure and the 2nd interview was conducted 1 month after the sterilization. Sociodemographic data were gathered for the survey from the patients' clinic records. The clinic records showed that 1 in 4 clients was younger than age 30 and 1 in 10 was older than age 40. 1/3 of the acceptors had children under 12 months and 27% had children 1-2 years old. The average number of living children was almost 5 but more than 1/3 had fewer than 4 children. 55.1% of the acceptors had used some form of contraception prior to the acceptance of sterilization. Prior to the sterilization, 81.4% of the women turned to their female relatives, usually sisters-in-law, to discuss the procedure. The major single concern, cited by 49.5% of the women in discussion of the method, was the operation's impact on the physical activities of the woman. The response and attitude of the sisters-in-law and other female relatives with whom the operation was discussed was positive in 86.5% of cases. Results of the 1st interview with the clients suggested a pattern leading to acceptance of sterilization. After the sterilization, 81.5% of the clients reported that they were able to conduct their usual household work immediately after returning home. 78.9% of the women did not experience any side effects; 11.3% had vague complaints and 2.2% had induration or inflammation at the surgical incision site. The mean time of resumption of regular sexual relations was 27 days after sterilization.

A comparative study of Trichomonas vaginalis prevalence in Filipino women.

A comparative study of Trichomonas vaginalis prevalence among Filipino women is presented herein. A total of 288 women randomly drawn from various sources, including Social Hygiene clinics, Health Centers, and Family Planning Centers in the Metropolitan Manila Area were examined for T. vaginalis. Nineteen or (6.8%) were found positive either by wet mount or stained smear methods. Prevalence was significantly higher among the group of single than married women and five times higher among the waitress/hostess group than in the housewife/other group. Infection was related to parity and is significantly higher among nulliparous women. Likewise, a significant relationship was observed between prevalence of infection and gravidity. Prevalence decreases with increasing gravidity. No relationship in prevalence was observed between the use and non-use of contraceptives, and the method of contraceptive used. There was no significant association between the presence of the parasite and symptoms.

PIP: To study the Trichomonas vaginalis infection rate in the Philippines, 280 women were examined, by either wet mount or stained smear methods, in the greater Manilla area. chi-square with 1 degree of freedom=9.5). Among a waitress/hostess group the prevalence of infection was 5 times higher (15.2%) than in a housewife/other group designation (2.7%). Infection was related to parity and was significantly higher among nulliparous women (5/41 cases or 12.2%); prevalence decreased as parity increased. A similar significant relationship obtained between prevalence of infection and gravidity; here, prevalence decreased with increasing gravidity from 14.3% in nongravid women to 7.7% in gravida 1-2 women to 3.3% in gravida 3 and over women. No relationship was shown between use or nonuse of contraception and T. vaginalis infection prevalence. Although the prevalence was noted to be slightly higher among nonacceptors (7.4%) than acceptors (5.1%), the difference was not statistically significant. There was no relationship revealed between the type of contraceptive method used and presence of infection. Finally, no significant association was found between the presence of the parasite and symptoms.