Paul A. Harper

Neurological and intellectual status of prematures at three to five years of age.

Summary The present report compares the neurological and intellectual status of a group of 460 prematurely born children examined at 3 to 5 years of age with that of a matched group of 440 full-term children serving as controls. The findings at this examination are related to similar data pertaining to the same children obtained when they were 40 weeks of age. At both examinations the prematurely born group was found to rate somewhat lower in intellectual status and to have a smaller proportion classed as neurologically normal than the fullterm children. When the prematures were subdivided by birth weight the trend favoring those with larger birth weights was maintained. For example, those in the group with birth weights from 2,001 to 2,500 grams were only slightly different from the controls; those whose birth weights were under 1,501 grams were more seriously handicapped. Consequently, a statement about “prematures” is more useful when details regarding degree of prematurity are available. Also, it was found in comparing the 40 week and the 3 to 5 year results that a childs prognosis for improvement in classification or for maintaining an average or better rating increased with an increase in birth weight. The answer as to whether or not this finding is peculiar to this age interval or to the aspects of development discussed in this paper must await further study. Finally, while the prematurely born group performs less well than the full-term group on the two indices here studied, it should be emphasized that the great majority of those born prematurely fall within the normal range and their distribution of intelligence ratings closely approximates that found for those born at term although somewhat on the lower side.

High risk maternal factors related to retaled to fetel wastage in rural Banglandesh

An analysis of the relationship between fetal mortality (early fetal death and stillbirth) pregnancy order maternal age and previous fetal deaths in a rural Bangladesh population characterized by high fertility and mortality and the virtual absence of obstetric and other medical care indicates that early fetal wastage and stillbirth are higher among pregnancy orders 1 and 6 or higher than among orders 2 and 3 with the increased risk particularly apparent among those pregnancies following 2 or more previous fetal deaths. The data consist of the 21144 pregnancies that occurred to the women in Matlab Bangladesh 1966-1969. By a multiple regression technique allowing for pregnancy order and previous fetal deaths adjustments were made for age of the mother and after allowances were made for previous fetal deaths adjustments were made for pregnancy order. Results show the fewest fetal deaths in 2nd and 3rd pregnancies and most at the highest parities. 10% of all pregnancy terminations 1966-1969 were registered as fetal deaths. Women in the higher pregnancy orders who have not experienced previous fetal deaths or only 1 fetal death have only a slight increase in the risk of fetal death compared to women in pregnancy orders 2 and 3. It is concluded that the virtual absence of medical care facilities is responsible for the large numbers of fetal deaths due to complications of gestation delivery and environmental influences. It also results in a higher maternal mortality of women with pregnancy complications related to fetal deaths. This absence of obstetric care and the high maternal mortality in this population may allow only women without reproductive impairments to reach the higher pregnancy orders.

The relationship between fetal wastage and pregnancy spacing in Bangladesh.

Data from Matlab, Bangladesh, was used to study the relationship between early fetal wastage or stillbirth and pregnancy spacing. The population under study is characterized by prolonged lactation, minimal nutrition, and high fertility and mortality. A binary regression analysis was used to adjust for certain maternal factors, i.e., pregnancy order, maternal age, history of previous pregnancy and child loss, and outcome of the immediately preceding pregnancy. Adjusted rates showed significantly greater risk of second trimester fetal wastage for pregnancies conceived less than 12 months after the preceding pregnancy termination; the risk relationship was not apparent for 3rd trimester fetal deaths. This is surprising due to increased fetal weight gain and presumed nutrient demand during the third trimester. The greatest risk was among pregnancies conceived less than 12 months following a livebirth, breastfed infant. Among mothers with a history of 2 or more pregnancy losses, the risk of early fetal wastage and stillbirth was increased. Lactation may be a causal factor.

Age at marriage, family planning practices, and other variables as correlates of fertility in Korea

The relationships between fertility and thirteen variables are examined in three groups of married Korean women, about 400 each from urban, rural, and semi-rural areas. Data were obtained by interview. Age at marriage and family planning practice are the strongest predictors of fertility and account for about 10 percent and 7 percent of the total variance, respectively. Other factors which accounted for lesser fractions of variability are ideal number of children, rural versus urban residence, education, aspiration for daughters, exposure to mass media, and economic status. Most of the relationships appear to be stable over time; others, which are associated with modernization, appear to be changing. The thirteen variables combined can account for a maximum of 40 percent of the variance in fertility.

Iud retention in West Pakistan and methodology of assessment

In 1967 there was a sample survey of women who had had IUD insertions in West Pakistan during the first 18 months of the Pakistan National Family Planning Program which began in July, 1965. The 12 month retention rate, including reinsertions, per 100 respondents was 56. Certain gross relationships between respondent characteristics and IUD retention were found. Respondents age 35+ and with 5+ living children and respondents who had insertions within two months postpartum had relatively high retention rates. Respondent characteristics associated with low retention rates included: age 35+ with 0–4 living children; reasons other than family planning reported as reasons for insertion; less than one-half hour travel time required to obtain insertion; not informed at time of insertion about side-effects of IUD; and insertion during last six months of 1966. Consistency of response was evaluated by reinterviewing a sample of respondents. The significance of the 43 percent non-response rate was evaluated by making further attempts to interview a sample of non-respondents.

Use of the intra-uterine contraceptive device in rural West Pakistan

ResumenEste trabajo presenta aspectos seleccionados de una experiencia con dispositivos intrauterinos anticonceptivos (IUD) en la parte rural del Pakistán Occidental. Fueron estudiados 1162 casos con el objeto de averiguar la retención o no retención del dispositivo. Utilizando los métodos para la construcción de tablas de vida, se estimaron las tasas de retención, que resultaron ser entre 55 y 75 por ciento al año. La cifra más pequeña correspondió a los casos en que el dispositivo estaba en su sitio en el momento del último exámen, y la más alta se obtuvo cuando no existía evidencia de que el IUD se había salido, considerándose entonces que estaba en su sitio.Los sistemas de evaluación permanente (follow-up) afectan grandemente las estimaciones del tiempo que el IUD es retenido, y la retención varía tambíén con el tipo de IUD empleado, con excepción del loop 3 que posee la más alta tasa de retención la cual puede esperarse que supera a las demás en un valor comprendido entre 5 y 10 por ciento al año. Además de los anteriores, fueron examinados muchos otros factores que pueden explicar el fenómeno de no retención. Las variables objectivas examinadas en esta experiencia tales como edad, anteriores práctivas anticonceptivos yanalfabetismo del esposo, fueron predictores bastante pobres de la retención del IUD. La expulsión y otras complicaciones médicas aparecen como factores en la mayoría de los casos donde se descontinuó el uso del IUD.SummaryThis paper presents selected aspects of experience with the intra-uterine contraceptive device (IUD) in rural West Pakistan. There were 1,162 IUD cases analyzed with respect to retention or non-retention. Retention rates were estimated, using life table methods, to be between 55 and 75 percent at one year; the smaller figure was obtained when theIUD was considered to be in situ only until the last examination, when it was observed to be in place. The latter or larger figure was obtained when the IUD was considered to be in situ unless known to be out.The extent of follow-up greatly affects estimates of the length of time the IUD remains in situ. Retention also varies with the type of I UD employed; exclusive use of Loop 3, which has the best retention record of those used,may be expected to yield higher retention rates by as much as 5 to 10 percent for one year. A number of other factors were examined that might explain non-retention. The objective variables that were examined in this experience, such as age, previous contraception, and husbands illiteracy, were on the whole rather poor predictors of IUD retention. Expulsion and other medical complications appear to account for most discontinuance of use of the IUD.