PIP: In Thailand "granny" midwives are being tested and trained to take part in modern family planning and public health programs. In Malaysia a survey of conditions relating to an increase in induced early termination or abortion of pregnancies is in progress. The International Development Research Centre (IDRC) supports these projects as well as others in Asia. Local paramedical workers, like the "barefoot doctors" in China, are being trained. In Thailand a growth plan is attempting to reduce the annual rate of population increase from about 3.3% to 2.5%. Many granny midwives have been contacted. Several methods of incentive and training are being tried and will be evaluated. Eventually granny midwives in all of Thailand's 60,000 villages will be enlisted in the national planning program. Of Thailand's 6 million married women of reproductive age less than half use modern birth control methods. Abortion is illegal in Thailand which is a predominantly Buddhist country. The project in Malaysia is being carried out by the University of Malaysia and the Federation of Family Planning Associations. Abortion is also illegal in Islamic Malaysia, although there are illegal abortion clinics. Trends so far reported to IDRC indicate that 1) lower class women are more cooperative interviewees than others, 2) most couples use some method of birth control, 3) many wish to interrupt their pregnancies, 4) poorer families have more children than wealthier ones, 5) the Chinese and Indian people show a greater tendency to limit families than do the Malays, and 6) most couples want 3 or 4 children.
PIP: Observations are made related to the review of family planning activities in East Asia in 1973. The number of new acceptors for the region increased from 2.7 million in 1972 to 3.4 million in 1973. The leaders were Indonesia, which almost doubled its achievement of calendar year 1972, the Philippines, and Korea. In Thailand, the number of new acceptors dropped by about 10%. South Vietnam is the only country in the region without an official policy. Most couples still think that the ideal number of children is 4, with at least 2 sons. Some religious opposition does exist, particularly with reference to sterlization and abortion. More attention is being paid to women in their 20s. Sterilization and condoms are becoming more popular. Korea reports a sharp increase in vasectomies. Better methods and continuation rates should be stressed. In Taiwan a couple who start with 1 method and continue to practice some method lower their reproduction rate by 80%. More responsibility is being delegated to nurses and midwives, but too slowly. In Indonesia, the number of field workers rose from 3774 in 1972 to 6275 in 1973. The Philippines and Thailand are experimenting to see what kind of workers get best results and under what kind of salary and incentive arrangements. In-service training tends to be neglected, but preservice training is improving. Costs, in general, have risen, though in Korea the cost per acceptor has dropped from US$8.00 to US$7.80. Korea and Taiwan have reduced their annual population growth rates by more than 1/3 in 10 years, from 30 to 19-20 per 1000 each. Singapore's rate is 17 and Hong Kong's 14 (exclusive of inmigration). The number of couples currently practicing contraception in Singapore is 71%. Target systems assigning quotas to clinics are generally used except in Thailand and Malaysia, where programs emphasize maternal and child health, rather than population planning. Most programs require about 10 years to get the annual growth rate down to 2% by voluntary family planning. To get it down to 1.5% will probably take another 10 years.
Plaque reduction neutralization tests, using five group A arboviruses (chikungunya, Ross River, Getah, Bebaru and Sindbis), were done on sera from human populations in 44 Southeast Asia and Pacific island localities. Specificity of the plaque neutralization test was determined by examining convalescent sera from patients with known alphavirus infections. Chikungunya-specific neutralizing antibodies were demonstrated in sera of persons living in South Vietnam, Northern Malaysia, Indonesia (Kalimantan and Sulawesi), as well as Luzon, Marinduque, Cebu and Mindanao islands in the Philippines. Evidence of Ross River virus infection was found among populations living in West New Guinea and Papua New Guinea mainland, the Bismark Archipelago, Rossel Island and the Solomon Islands. There appeared to be no geographic overlap in the distribution of chikungunya and Ross River viruses, with the separation in their distribution corresponding with Weber's line in the Pacific. Sindbis neutralizing antibodies were found in 7 of 21 populations sampled, but in general the prevalence of infection was low. Four sera, from Vietnam, Malaysia and Mindanao gave monospecific reactions with Getah virus. No evidence of specific Bebaru virus infection was detected. The epidemiology of these five alphaviruses in Southeast Asia and the Pacific islands is discussed.
PIP: Traditional midwives are active in most villages and many urban areas of Asia, Africa, and Latin America. They deliver babies, provide prenatal and postpartum care, teach folk methods of birth control, treat infertility, and enjoy the confidence of many women. Most official family planning programs make little or no use of these traditional midwives. Research should be conducted into the most effective ways of recruiting and rewarding midwives in family planning programs. They seem to function best when provided with adequate training, supervision, and incentives. Traditional midwives are participating in the national family planning programs in Pakistan, Indonesia, Malaysia, and the Philippines. Only in Iran do they participate in the medical aspects of family planning. Midwives in Iran do IUD insertions and their performance compares favorably with that of medical personnel.
PIP: In the 3 day workshop of the Southeast Asian Region on the Financial Management of Population/Family Planning Programs held from March 15 to 17 it was recommended that there by standardization of financial reporting procedures by country programs for population planning. Related to this recommendation was the proposal that measurement of cost benefit and cost effective analysis of country programs be undertaken by the Research and Evaluation Units of the respective population organizations in close coordination with the financial managers. Other major recommendations included: 1) closer coordination between donor agencies and policy making bodies of country programs in the disbursement of funds; 2) more exchange of experiences, ideas, technical knowledge on the financial management of country programs in the Inter G overnmental Coordinating Committee for Southeast Asian countries; and 3) inclusion of applicable financial management topics in the training of clinical staff and followup in actual operation. The priority areas identified for the Inter Governmental Coordinating Committee countries (Nepal, Malaysia, Thailand, Singapore, and the Philippines) are financial planning; generation of resources and budgeting and allocation of funds; accounting and disbursement of funds; financial management at the clinic level; use of and control of foreign aid; and cost effectiveness, benefit analysis and financial reporting.
PIP: 40 experts representing Nepal, Malaysia, Thailand, Singapore, Korea, and the Philippines participated in a 3-day workshop in Manila in March 1976 for the purpose of discussing and proposing ways of dealing with the financial problems confronting the population programs of the individual countries. The Inter-Governmental Coordinating Committee for Southeast Asia Family/Population Planning sponsored the workshop. The recommendations made at the meeting were: 1) standardization of financing reporting procedures by the region's country programs on family planning; 2) closer coordination between donor agencies and policy-making bodies of country programs in the disbursement of funds; 3) frequent exchanges of experiences, ideas, technicaL knowledge, and other matters pertaining to the financial management of such programs; and 4) inclusion of applicable financial management topics in the training of clinical staffs and those involved in follow-up operations. Additionally, a proposal was made that national population organizations or committees develop research and evaluation units. Workshop discussion sessions focused on financial planning and management, accounting and disbursement of funds, use and control of foreign aid, cost of effectiveness and benefit analysis, and financial reporting.
Following the suggestion that it was possible that cases of melioidosis amongst those who had been exposed abroad in the past, might be escaping notice, 487 Royal Marines were examined by indirect haemagglutination studies. Four hundred and eleven of these subjects had served for variable times in areas where melioidosis has been known to occur in Indonesia and Malaya, between 1960 and 1974, occupied in activities in the jungle and paddy fields during which exposure to the disease was to be expected. No evidence of residual subclinical melioidosis was found and it seems unlikely that recrudescent disease will prove to be a problem in the future for English servicemen who have been in South East Asia.
PIP: At the Inter-Governmental Coordinating Committee Workshop on an Integrated Approach towards Family Planning and Health Programs held at Kuala Lumpur from March 23 to 25, 1977, the feasibility of integrating family planning with nutrition and parasite control through the proper planning of motivational considerations, resource allocation and coordination was studied in detail. Discussion focused on the experience of participating countries in generating community participation in total health programs. Malaysia reported that in the expansion of the national program into the rural areas functional integration has been the approach. In Indonesia nutrition has been an important objective of maternal and child health services. A total integrated development approach has been the objective in the Philippines where family planning information-education-communication has been integrated with nutrition programs and a pilot project on integration of family planning and parasite control has been conducted. Thailand reported on the introduction of an integrated family planning and parasite control program, while Sri Lanka reported on an integrated approach that included family planning with maternity and child health services. A recommendation of the meeting was that experimental pilot projects be established which include nutrition and parasite control elements within the framework of family planning services.