The unmet need for family planning services is remarkably constant across all five countries because of the interaction of fertility intentions and fertility control: as more women use contraception, more of them want fewer children.
PIP: A great deal of attention is being devoted to the use of nonphysicians to provide such fertility control services as contraception, sterilization, and abortion. Legal obstacles exist, however, which must be overcome before the role of nonphysicians can be expanded. Such obstacles include medical practice statutes, nursing and midwifery legislation, and laws and regulations directly related to such fertility control measures as the provision of contraceptions and the performance of sterilizations. On the other hand, the following 3 main approaches have been used to permit increased participation of nonphysicians: delegation of tasks by physicians, liberal interpretation of existing laws, and authorization. Thus, the important elements in expanding the roles of nonphysicians are 1) authorization; 2) training; 3) qualification; 4) supervision; and 5) opportunities for referrals to physicians. The ultimate role of paramedicals will depend upon the continued simplification of technology, the results of research on the quality of care which they can provide, the attitudes of the medical profession, and the elimination of the legal ambiguities and obstacles which exist.
PIP: Responses to questions relating to breastfeeding in the World Fertility Surveys of South Korea, Indonesia, Nepal, Sri Lanka, Malaysia, and Bangladesh are analyzed. Of these countries, the percentage of ever-married women who had breastfed in the last closed interval was between 94-99%, except for Malaysia (81%) and average number of months breastfeeding took place was from 16.5-19.2, except for Malaysia (7.3). The infant mortality rate in these countries was 33/1000 live births for South Korea, 45/1000 for Malaysia, 51/1000 for Sri Lanka, 137/1000 for Indonesia, 150/1000 for Bangladesh, and 152/1000 for Nepal. Responses, however, might vary according to different interview situations. Assuming that the reporting errors are of similar magnitude and direction, the relationship between duration of breastfeeding and the birth interval can be studied. But it is possible that breastfeeding was prolonged due to other reasons for which conception was delayed; thus the regression of breastfeeding duration on the birth interval is not as logical as the regression of the birth interval on the breastfeeding is, especially when habitual breastfeeding can be avoided. The negative relationship between breastfeeding and infant mortality does exist, assuming that a woman breastfeeds all her children for similar durations. Some breastfeeding differentials are place of residence (less for rural areas), education (reduces duration), and religion (Christians have shorter duration than Muslims, Hindus, or Buddhists). In South Korea the mean length of breastfeeding of women aged 25-34 and 35-44 are 17.5 and 20.5, and women using contraceptives are 26% for 25-34 and 20% for 35-44. South Korea also has the highest level of breastfeeding, highest incidence of ever use of contraceptives, and a very low level of fertility. Nepal and Bangladesh have a high level of breastfeeding but since their contraceptive incidence is low, their fertility level remains high. Some areas of further research include influence of breastfeeding on infant and child mortality.
Analysis of World Fertility Survey data from five countries--Colombia, Costa Rica, Korea, Malaysia and Nepal--shows that the availability of contraceptive services and supplies is a major determinant of use. In Nepal, where few women know where to obtain supplies, only two percent are contracepting. In Costa Rica, where almost all married women know an outlet nearby, 53 percent use effective methods.
Fertility differentials between rural and urban populations are investigated using World Fertility Survey data for Bangladesh, Fiji, Indonesia, Malaysia, Nepal, Pakistan, the Philippines, the Republic of Korea, Sri Lanka, and Thailand. "The fertility measure used in this analysis is the number of children ever born to a woman. An attempt is made first to establish the differential in fertility levels between urban and rural areas after necessary control of the demographic factors..., and then the possible explanation of the differential is sought in terms of socio-economic variables such as education of the respondent, and occupation, work pattern, work status and place of work of the respondent as well as that of the husband." Data concerning the fertility differentials and the associated explanatory variables are presented in tables and charts. "The results tend to show that the countries of Asia are undergoing similar patterns of fertility transition as was experienced in the advanced countries. Perhaps one can graduate the countries in the transition scale as follows: Bangladesh, Indonesia, Nepal, Pakistan and Malaysia are in the initial stage; Fiji, the Philippines, the Republic of Korea, Sri Lanka and Thailand are in the middle stage of transition."
PIP:
This paper presents data on contraceptive prevalence from 26 national sample surveys conducted in the Asian and Pacific region during the 1966-84 period. The basic data presented are: contraceptive prevalence rates, cross-classified by age where possible; the percentage of couples using each contraceptive method, also cross-classified by age where possible. To facilitate comparison between countries and across time, the data are presented in a standardized form, both numerically and graphically. Contraceptive prevalence rates range from 1-85% (the highest and lowest ever reported). In the Asian and Pacific region as a whole, the prevalence rate was around 40%, which was about the same level as in the Latin American region. In Africa the prevalence rate was around 12%, and in developed countries around 70%. In the late 1960s, prevalence rates in the Asian and Pacific region were less than 20%. By the early 1980s, contraception had spread throughout all parts of society so that the rates in many countries were over 50%, and in some over 60%. Most of the countries with high prevalence rates were in East and Southeast Asia, and most of those with low prevalence in South Asia. Displayed graphically with the age of wife (from 15-49 years) on the x axis, contraceptive prevalence rates appear as an inverted U, low at both ends of the age range and high in the middle. Curves skewed to the left generally have stronger effects on fertility than those skewed to the right. This is due to the fact that most births occur among younger couples and contraception used by younger couples prevents more births than contraception used by older couples. The curves of countries relying primarily on sterilization are generally skewed to the right. The data show a wide variation in the mix of contraceptives used in each country. The use of various contraceptives by age is similar throughout the region. Young couples generally use oral contraceptives (OCs), those in the middle of the reproductive ages the IUD, and those near the end of the childbearing ages sterilization. Rhythm and withdrawal methods appear to be preferred both by couples in the youngest and oldest age groups. Contraceptive needs change as couples progress through the life cycle. Consequently, family planning programs must work to provide a broad mix of contraceptives. The tables show that Thailand and the Republic of Korea, 2 countries which are thought to have excellent family planning programs, have provided well-balanced mixes of contraceptives. Other countries in the region have depended on only 1 or 2 methods.
Restriction fragment length polymorphism and virulence analyses were used to evaluate the population structure of Xanthomonas oryzae pv. oryzae, the rice bacterial blight pathogen, from several rice-growing countries in Asia. Two DNA sequences from X. oryzae pv. oryzae, IS1112, an insertion sequence, and avrXa10, a member of a family of avirulence genes, were used as probes to analyze the genomes of 308 strains of X. oryzae pv. oryzae collected from China, India, Indonesia, Korea, Malaysia, Nepal, and the Philippines. On the basis of the consensus of three clustering statistics, the collection formed five clusters. Genetic distances within the five clusters ranged from 0.16 to 0.51, and distances between clusters ranged from 0.48 to 0.64. Three of the five clusters consisted of strains from a single country. Strains within two clusters, however, were found in more than one country, suggesting patterns of movement of the pathogen. The pathotype of X. oryzae pv. oryzae was determined for 226 strains by inoculating five rice differential cultivars. More than one pathotype was associated with each cluster; however, some pathotypes were associated with only one cluster. Most strains from South Asia (Nepal and India) were virulent to cultivars containing the bacterial blight resistance gene xa-5, while most strains from other countries were avirulent to xa-5. The regional differentiation of clusters of X. oryzae pv. oryzae in Asia and the association of some pathotypes of X. oryzae pv. oryzae with single clusters suggested that strategies that target regional resistance breeding and gene deployment are feasible.
This paper sheds light on infectious diseases and the status of malnutrition in Nepal, a Himalayan country located in South Asia. In spite of efforts by both Government and non-government sectors, infectious diseases are rampant in the countries constituting a major cause of morbidity and mortality, which in turn, impose a socio-economic and public health burden for the country. Intestinal parasitic infection has been implicated in the causation of malnutrition. Malnutrition associated with child mortality is more common among children aged less than five years. Nepalese women suffer from chronic malnutrition. People in rural areas are more affected by malnutrition than those in urban areas. This has been attributed to poverty, lack of education, and rampant infectious diseases.