One hundred and twenty-four women from a semi-urban area who came for consultation for unplanned pregnancy during an eight month period are analysed. It is found that women with a high risk of unplanned pregnancy are mostly housewives, aged between 20 and 34, who have given birth to one or three children, the last of whom is usually below one or two years old. They belong to the lower socio-economic class and are lowly-educated. Most of them have not completed their families. Although most of them have either used or heard of contraceptives begore, the majority were not using any contraceptive at the time of consultation or were using an ineffective method. Their reasons for non-use or default are identified, many of which are related to the pill. Proper motivation of would-be contraceptive receptors and regular follow-up of acceptors by general practitioners or Family Planning Clinic Staff who are knwoledgable in all available methods of contraception are offered as a solutionto the problem of high rate of defaulting and consequent high rate of unplanned pregnancies.
Study site: private general practice clinic, Perak, Malaysia
MeSH terms: Ambulatory Care Facilities; Contraception; Family Practice; Humans; Malaysia; Pregnancy; Prospective Studies; Women; Private Facilities
In developing countries, the family persists as a key institution, the centre of the emotional, spiritual and economic life of the individual and the context of the individual's interactions with the community. The majority of the population still live in rural areas where the family-community interaction is close, indeed intense. This remains true too of peasants migrating to urban slums to exist in a new culture of poverty. The family in developing countries represents a more closely shared, psychological, sociological and economic destiny than is perhaps represented by the family in the wealthy nations of the West.
'Health for all by the year 2000' is the promise of the Declaration of Alma-Ata to which all our governments have put their signatures. It is a noble ambition which is impossible to achieve unless the issues of poverty and maldistribution of wealth are seriously addressed. Nevertheless, much progress can be made during a campaign to achieve 'Health 2000' because an opportunity presents to discuss the prerequisites to achieving 'Health for all' and there is pressure to make some progress towards this.
An important opportunity now presents itself to put into effect the new concepts of family practice on a global scale. Hitherto the World Health Organization, (of which WONCA has just become a non-governmental organization affiliate) has not found it necessary to turn to family physicians for advice or expertise whilst organizations of family physicians for their part have shown little interest in the primary health care movement. Family physicians have practised under constraints that have favoured chargeable procedures as against the preventive approach, episodic care as against continuing care, caring for the fee-paying individual as against caring for the family and large panels as against small populations. This practice falls short of our ideals. In developing countries, there is a need for a community-oriented, family-based practice in which the physician and the health care team accept responsibility to work with their community to achieve health for all. We must now give attention to develop this atrophied wing of family practice.
This is truly a historic opportunity that we must seize to make available the concepts and skills of family practice and to universalize the relevance of our way of delivering primary health care. All of us in a great co-operative endeavour can do much for the health of the people of this small globe that we share.
'There is a tide in the affairs of men,
Which, taken at the flood, leads on to fortune;
Omitted, all the voyages of their life
Is found in shallows and miseries.
On such a full sea are we now afloat,
And we must take the current when it serves,
Or lose our venture.'
[Notes added by TCL: Full text of article. The quoted phrase was uttered by Brutus in William Shakespear's Julius Caesar Act 4, scene 3]
Most of the population in certain areas of Melanesia have one alpha-globin gene deletion (alpha thal2). It is thought that the high frequencies of alpha thal2 in this population is due to a selective advantage given by malaria infection to carriers of alpha thal2. We are interested in neighboring Polynesia which, although adjacent to Melanesia, has always been free of malaria due to the absence of the vector anopheles. We studied 60 Polynesian Samoans and 150 Malaysians by restriction endonuclease gene mapping using Eco RI, Bam HI, and Bgl II and hybridization to 32P-labeled alpha-globin gene probe. Seven among the 60 (11.7%) Samoans had triplicated alpha-globin loci type 1, while none had alpha thal2. On digestion with Bgl II the third alpha-globin gene was found in an additional 3.7 kb fragment in all seven Samoans with triplicated alpha-globin loci, while digestion with Bam HI produced an abnormal elongated 18.2 kb fragment carrying alpha-globin genes in addition to the normal 14.5 kb fragment. None of the Polynesian Samoans had alpha thal2 or alpha thal1. Only two of the Malaysians had triplicated alpha-globin loci.
MeSH terms: Adult; Chromosome Mapping*; DNA Restriction Enzymes; Electrophoresis, Agar Gel; Ethnic Groups*; Gene Frequency; Globins/genetics*; Humans; Malaysia; Thalassemia/genetics*; Thalassemia/epidemiology; Trisomy*; Independent State of Samoa