Contraceptive failure: levels, trends and determinants in Matlab, Bangladesh

This study investigated the levels, trends and determinants of contraceptive use-failure in Matlab, Bangladesh, using a set of prospective data on 25,960 women of reproductive age. The data were extracted from the Record Keeping System (RKS) of Matlab for the period 1978-94. If there was any live birth during the use or within 7 months after the discontinuation of use, it was considered as a failure. The life table technique and hazard model were used as analytical tools. The results suggest that use-failure for pills, IUDs (TCu 200) and injectables and other temporary methods increased from 1978 to 1988, but began to decline after 1988. The cumulative probability of first-method failure within 1 year of method acceptance of the cohort of 1990-94 acceptors was 12.9% for pills, 2.0% for IUDs, 0.5% for injectables, 22.0% for condoms and 13.4% for 'other' methods (sampoon, foam, jelly and traditional methods). For pills, condoms and 'other' methods, the likelihood of failure declined with the duration of use; by contrast, the probability of an IUD failure increased over time, peaking at 3 years of use. The injectables maintained a low likelihood of failure regardless of the duration of use. The quality of Community Health Workers' (CHWs) performance was associated with the risk of failure of all temporary methods except condoms; women's background characteristics associated with failure varied by method. The effect of the quality of the CHWs' performance and the background variables on failure did not change much over time. It is felt that contraceptive failure deserves the serious attention of programme managers and policy makers to make the Bangladesh national family planning programme more successful.     

Contraceptive use patterns in Matlab, Bangladesh: insights from a 1984 survey

An experimental maternal and child health and family planning programme has been in existence in Matlab for almost 10 years. During this time the project has achieved remarkable success in the area of family planning. Based upon a 1984 survey, this study examines the pattern of contraceptive use in the Matlab treatment area, and contrasts it with the regular government programme in the neighbouring comparison area. Important differences between the two areas are observed, with the treatment area characterized by substantially higher levels of current contraceptive use, greater reliance upon temporary methods for birth spacing and, among acceptors of sterilization, more prior experimentation with other methods. In the comparison area lower rates of contraceptive use are observed, with heavy reliance upon tubectomy for limiting family size. The findings suggest that an intensive and innovative family planning programme in rural Bangladesh can achieve success not only in terms of contraceptive prevalence, but can also attract users interested in child spacing and others wanting to limit their family size, by offering the widest range of contraceptive methods.     

Increased Childhood Mortality and Arsenic in Drinking Water in Matlab,Bangladesh: A Population-Based Cohort Study

Background

Arsenic in drinking water was associated with increased risk of all-cause, cancer, and cardiovascular death in adults. However, the extent to which exposure is related to all-cause and deaths from cancer and cardiovascular condition in young age is unknown. Therefore, we prospectively assessed whether long-term and recent arsenic exposures are associated with all-cause and cancer and cardiovascular mortalities in Bangladeshi childhood population.

Methods and Findings

We assembled a cohort of 58406 children aged 5–18 years from the Health and Demographic Surveillance System of icddrb in Bangladesh and followed during 2003–2010. There were 185 non-accidental deaths registered in-about 0.4 million person-years of observation. We calculated hazard ratios for cause-specific death in relation to exposure at baseline (µg/L), time-weighted lifetime average (µg/L) and cumulative concentration (µg-years/L). After adjusting covariates, hazard ratios (HRs) for all-cause childhood deaths comparing lifetime average exposure 10–50.0, 50.1–150.0, 150.1–300.0 and ≥300.1µg/L were 1.37 (95% confidence interval [CI], 0.74–2.57), 1.44 (95% CI, 0.88–2.38), 1.22 (95% CI, 0.75–1.98) and 1.88 (95% CI, 1.14–3.10) respectively. Significant increased risk was also observed for baseline (P for trend = 0.023) and cumulative exposure categories (P for trend = 0.036). Girls had higher mortality risk compared to boys (HR for girls 1.79, 1.21, 1.64, 2.31; HR for boys 0.52, 0.53, 1.14, 0.99) in relation to baseline exposure. For all cancers and cardiovascular deaths combined, multivariable adjusted HRs amounted to 1.53 (95% CI 0.51–4.57); 1.29 (95% CI 0.43–3.87); 2.18 (95%CI 1.15–4.16) for 10.0–50.0, 50.1–150.0, and ≥150.1, comparing lowest exposure as reference (P for trend = 0.009). Adolescents had higher mortality risk compared to children (HRs = 1.53, 95% CI 1.03–2.28 vs. HRs = 1.30, 95% CI 0.78–2.17).

Conclusions

Arsenic exposure was associated with substantial increased risk of deaths at young age from all-cause, and cancers and cardiovascular conditions. Girls and adolescents (12–18 years) had higher risk compared to boys and child.     

A hazard logit model analysis of covariates of childhood mortality in Matlab, Bangladesh.

In a prospective study in Matlab, a rural area in Bangladesh, the relationship between a variety of covariates and childhood mortality was examined. Economic status of household, education of mother, sex of the children, health intervention programmes, age of mother, and live birth order of the children were identified as having a statistically significant impact on child survival when the effect of age was controlled. The effects of sex of the children, health programmes, age of mother, and birth order were found to be dependent on the age of the children, but the effect of mother's education was dependent on sex of the children.     

Family configuration and family size

In a sample of 61,829 US families, the probability of having an additional child is higher in those families with all the children the same sex as compared to those families with children of both sexes. Data are from families of American high school students who took the National Merit Scholarship Qualifying test in 1965. All families with 3 or 4 children were selected. Families with only boys were more likely to have an additional child than families with all girls. Less than 1% of the variance in family size is explained by family configuration. Although the sample size makes these results unequivocal for the population involved, the population is clearly biased in favor of white middle class families.     

Family configuration and family size

Abstract

In a sample of 61,829 families, the probability of having an additional child is higher in those families with all children of the same sex as compared to those families with children of both sexes. In addition, families with only boys were more likely to have an additional child than families with all girls.     

Family unit in a children's psychiatric hospital.

The need for effective management of disorders of parent/child relationships is repeatedly stressed. Despite the bulk of theoretical work on the subject there is little information on the practical management of the clinical problems that arise. We describe a unit designed and staffed for the management of such disorders. In our view it meets a need in a way that could be difficult or impossible for most paediatric, psychiatric, and social services as they are at present organized.     

Family size and religious denomination in Northern Ireland

During the summer of 1983, a provincewide representative sample of all ever-married women and single women with children, under the age of 60, was interviewed to examine variations in family size in Northern Ireland. The valuation list of domestic dwellings was used as the sample frame and a clustered sample was drawn from this using the 526 electoral wards as individual clusters. Wards were stratified according to socioeconomic structure, religion, location within Northern Ireland, and whether they were predominatly rural or urban. Sampling within selected clusters was on a systematic basis and proportional to population size. For women currently married, 1 in 5 of the husbands was interviewed using a shorter questionnaire focusing on attitudes to fertility. Of the 3914 houseolds where contact was made and which contained an eligible female, there were 2997 successful interviews with females, giving an effective response rate of 77%. An additional 392 interviews were obtained from husbands. The most persistent fertility differential in Northern Ireland going back at least to the beginning of the 20th century has been that between Protestants and Roman Catholics. According to these preliminary findings, this remains the case. The average number of children born alive to ever-married Roman Catholic females was 3.24 in 1983, compared with 2.29 children for the corresponding group of non-Catholic women. Yet, the survey relates to an instant during a peirod of considerable flux in Roman Catholic fertliity, and comparison of these 1983 data with those collected at the 1971 census of population shows that Roman Catholic family size declined by 11% over the intervening 12 years, although this is marginally reduced after standardization for changes in the age structure of ever-married women. Non-Catholic family size, by contrast, remained virtually static during the same time period. The pace of change has been more pronounced in Belfast and its suburbs. Data are not yet available from the survey to chart these processes by marriage cohort, but some pointers can be obtained from the tabulation of family size by denomination and age of mother. With the exception of the under-20 age group, the average size of Roman Catholic families was consistently and substantially larger than that of the corresponding non-Catholic age group. The absolute difference in terms of mean numbers of children widened steadily with increasing age. These preliminary data also show that there is still a strong geographical dimension to the religious differential in fertility. Average family size was larger in rural than urban areas but moreso for Roman Catholics (16% larger) than for non-Catholics (9% larger). Although differences in family size between Roman Catholics and non-Catholics still prevail, there has been a considerable degree of overall convergence since 1971.     

Family physician anesthetists: continuing education,observations, evaluation

A method is described whereby continuing education for family practitioner anesthetists is taken to community hospitals, where patterns of practice, local problems and facilities are different from those of larger urban areas. Five Ontario communities were visited for 4½ days each, by invitation, providing the visiting clinician with an opportunity to observe the quality of anesthesia services and to measure, through a self-evaluation test, the deficiencies in applied basic and clinical knowledge thought to be necessary for modern, safe practice. These programs were well received and thought to be of real benefit to the participants. Similar programs could be provided in general medicine, cardiology, gastroenterology, pediatrics and psychiatry.     

Family size and evolution of Rh polymorphism

A reproductive compensation model has been proposed, where each family produces exactly the same number of live offspring. Under that condition, the frequency of d alleles in the Rh blood group always increases. This would account for populations with high frequency of d alleles.     

Family size,the physical environment,and socioeconomic effects across the stature distribution

A neglected area in historical stature studies is the relationship between stature and family size. Using robust statistics and a large 19th century data set, this study documents a positive relationship between stature and family size across the stature distribution. The relationship between material inequality and health is the subject of considerable debate, and there was a positive relationship between stature and wealth and an inverse relationship between stature and material inequality. After controlling for family size and wealth variables, the paper reports a positive relationship between the physical environment and stature.     

The influence of female education,labor force participation,and age at marriage on fertility behavior in Bangladesh

Abstract

This paper studies the relationship between three aspects of female status (education, work experience, and age at marriage) and the use of contraception and fertility in Bangladesh. Education is found to be the variable most strongly correlated with use of contraception and is also one of the significant variables explaining fertility behavior. The most important factor explaining fertility behavior is age at marriage. The higher the age at marriage, the lower the fertility, when all other factors are held constant. Work experience has very little or no effect on current use of contraception and fertility.     

Malnutrition, menarche, and marriage in rural Bangladesh

In order to assess the impact of nutritional status on the onset of menarche and the association between age at menarche and age at marriage, a survey of 1155 girls, ages 10 through 20, was conducted in a rural area of Bangladesh in March 1976. In order to obtain an estimated mean of age of menarche, probit analysis was used. The mean age of menarche using this technique is estimated at 15.65 for Muslims and 15.91 for Hindus. It was learned that in recent years the age of menarche has increased in a rural area. This increase seems to be associated with malnutrition caused by the war, postwar inflation, floods and famines during the 1971-75 period. When age is controlled for, the prominent effect of weight on menstrual status is evident. 98% of the girls whose weights were 88 pounds or greater had reached menarche compared to only 1% of those weighing less than 66 pounds. Body weight appears to be 1 of the most important factors for the determination of onset of menarche. There exists a seasonality of onset of menarche with a peak in winter. Age of marriage among this rural population has increased and may be associated with the increasing age of menarche. Since both age of menarche and age of marriage have increased, fertility among females age 15-19 may be expected to decrease in the future if this pattern continues.