Hepatitis B vaccination rates among staff at a district general hospital.

OBJECTIVE: To evaluate the uptake of hepatitis B vaccination by staff of a metropolitan district general hospital and associated community health service in order to determine if the existing vaccination program was adequate. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional survey of all 1464 staff of a 304-bed district general hospital and associated community health service, serving a population of approximately 240,000 people in a middle socioeconomic area of northern Sydney, by means of a self-reported anonymous questionnaire. RESULTS: The overall response rate was 56.4%, with 61.9% of high-risk and 48.7% of low-risk staff responding to the survey. The overall vaccination rate was 55.8%. Of high-risk respondents, 70.7% had been or were in the process of being vaccinated, compared with 29.4% of low-risk respondents. Of those already vaccinated, only 45.9% had subsequently been tested for antibody to hepatitis B surface antigen (anti-HBs); 12% of this group did not know whether their response to the vaccine had been adequate and 18% reported being advised to have another anti-HBs test later. Vaccination rates were higher in younger staff (68.7% of 20-29-year-olds) than in older staff (42.7% of 50-59-year-olds). There was no significant difference in vaccination rates between men (55.6%) and women (55.8%). Vaccination rates for doctors, dentists and nurses were 69%, 80% and 74.6%, respectively. CONCLUSION: The vaccination rate among high-risk staff is suboptimal: more than half did not know whether their vaccination had induced a suitable level of antibodies; more than 10% had been vaccinated more than five years previously; and 5% had not completed the full course of three injections. High-risk staff should be targeted in future vaccination programs.

The percutaneous electrocoagulation vasectomy technique--a comparative trial with the standard incision technique at Marie Stopes House, London.

One-hundred-and-one men requesting vasectomy in 1985 for the purpose of limiting family size were admitted to a study of standard incision and monopolar diathermy, and a new percutaneous electrocoagulation vasectomy procedure. Semen specimens were tested at 10 and 12 weeks after surgery. Men were telephoned at 2, 12 and 24 weeks post-surgery to elicit complications and complaints. Half of the men having the standard incision procedure and about one-third of the men undergoing the percutaneous procedure complained of discomfort during the surgery. At the two-week telephone contact, 23% of those having the standard incision and 66% of those having the percutaneous procedure reported complications. There were few complications or complaints reported at the long-term follow-up contacts with either method; although twice as many men in the percutaneous group were not declared sterile by the end of the study period. Failure rates were 2.0% for the standard incision procedure and 7.8% for the percutaneous approach.

Post-coital intrauterine device insertion - a further evaluation.

A total of 191 patients have undergone post-coital insertion of an intrauterine contraceptive device up to ten days post-coitus. The majority of patients were nulliparous and underwent insertion of a standard Gravigard [Copper 7] device. The subsequent expulsion and medical removal rates were normal for this group of patients but the non-medical removal rates were higher. There was one possible post-coital contraceptive failure (0.6%) and one pregnancy at six months due to the device exhibiting a failure to conventional contraceptive action.

PIP: A total of 191 women who chose to use an IUD for post-coital contraception were recruited. The majority of patients were nulliparous and underwent insertion of a standard Gravigard (Copper 7) IUD. Post-coital IUD insertion was performed from day 0 to 10 days after unprotected coitus. 175 women underwent insertion within 5 days and the remainder between 5 and 10 days post-coital. There were no major complications during the insertion. The discontinuation rate was higher than that normally associated with IUD use. This was because of the relatively high non-medical removal rates, i.e., patients who wanted to use the IUD solely as a 'morning after' contraceptive rather than as a method in its own right. Termination of IUD use was recorded for the 1st followup visit 4-6 weeks after insertion and 1 month later at the 2nd followup visit. There were 19 terminations of use for all reasons at the 1st followup and another 20 terminations at the 2nd followup. The expulsion rate of 2% and the medical removal rate for pain and bleeding of 7% were in keeping with event rates obtained from larger and more detailed studies. The non-medical removal rate was higher at the 2nd followup visit. There was 1 possible post-coital contraceptive failure (0.6%) and 1 pregnancy at 6 months due to the device exhibiting a failure of conventional contraceptive action. Due to the fact that the mechanism of action of the IUD is unclear, it is uncertain if the insertion of a post-coital device is effective only before the implantation occurs or whether there is some effect after early implantation has occurred.

The application of market research in contraceptive social mass marketing in a rural area of Kenya.

Because of the restricted nature of clinic systems, commercial channels and social marketing techniques are now being mobilized for family planning purposes. Market research is fundamental to the success of such programs. In addition to normal survey procedures and the limitations of analysis merely in terms of pairwise relationships, systems models are applied to the survey findings of a Kenya contraceptive social marketing experiment in order to gain insights into the enogenous and exogenous variables relating to consumer behavior using bivariate techniques. The results of such analysis on the survey findings are presented. The conclusion is drawn that model building methodologies as described for evaluating contraceptive social marketing programs do not present any significant difficulties and that it is a practical and useful technique that provides useful insights into the dynamics of adoption of socially desirable products such as contraceptives.

Retailers in social program strategy: the case of family planning.

PIP: The provision of contraceptive agents and devices through hospitals and clinics is not a cost-efficient procedure, therefore the distribution through retailers in a preexisting network is an attractive prospect. To really distribute contraceptives, e.g., birth control pills, the retailer would have to be trained in a format of questions. Two studies of retail marketing were conducted, one in Jamaica for condoms and one in Kenya where a subsidized marketing program for condoms was started in rural areas. More urban shops, which were larger in size, carried condoms than rural shops. Retailers in both areas were completely oriented to their immediate vicinity. Their concerns were with volume and with aggregate demand both before and after subsidized programs. The distribution system requires the additional support of advertising and marketing, but since the structure is in place it can be used with relatively little capital outlay. Research of retailers' attitudes and perceptions is inexpensive and often indicates customer preference and local market conditions.^ieng

A report on a contraceptive social marketing experiment in rural Kenya.

There is a recognized need for the development of nonmedical, grassroots family planning delivery systems. This report describes the results of a two-year experiment in rural Kenya in which local marketing resources were utilized to promote and distribute condoms through village stores. The impact of the extensive advertising campaign on the test market area was measured by comparison with a control area and by before, during, and after sample surveys. In addition to achieving a condom sales level of 0.21 pieces per capita after 12 months, the program had a marked impact on family planning knowledge and practice, although not on attitudes. The authors assess the program's performance in relation to its goals and suggest how such social marketing programs could have far-reaching significance in most developing countries.