One hundred and ninety-nine children brought by 181 adults to a child health clinic based in a rural health sub-centre in Peninsular Malaysia are studied. It is noted that the families from which they come are relatively poor, with a large number of children, and that they are fairly highly motivated. Forty-four per cent of children attending the clinic at the time of the study are symptomatic indicating the need to organise the child health clinic on a "preventive-curative" basis. It is also noted that the young child is initially seen in early infancy but is lost to the clinic when he is older making it judicious to formulate immunization schedules that take this into account.
Pneumonia and diarrhoeas are an important cause of toddler mortality and morbidity in developing countries. Of the 147 children admitted to the University Hospital at Kuala Lumpur in 1971 for pneumonia and diarrhoeas 50 (34%) were found to be suffering from protein-calorie malnutrition of varying degrees of severity. The malnourished children tended to come from poorer homes, and to have a larger number of siblings born in rapid succession when compared with normal weight children. Anemia was more common among the malnourished children. The interaction of infection and malnutrition and the social implications of these diseases are important. It is vital that hospitals in developing countries promote health in addition to their traditional curative role.
The objectives of this article are (1) review the contribution of traditional midwives to family planning communication in several Asian countries; (2) organize knowledge gathered from various studies into general guidelines for the most effective use of traditional midwives in family planning programs; and (3) present hypotheses for future research. In certain countries where pilot projects have tested the potential performance of traditional midwives in family planning programs, results have been encouraging. In other nations, more research is needed to determine the contribution traditional midwives can make to the family planning program.
PIP: Traditional midwives are found in almost every village and in many urban neighborhoods in the developing world, delivering the majority of births in these areas. Several Asian nations have begun to recognize the potential contribution of traditional midwives to modern family planning and health programs. A total of about 17,000 traditional midwives have been trained as family planning recruiters in Indonesia, Malaysia, the Philippines, and Thailand. Because traditional midwives deliver a large number of births in Asian nations, the potential is great for them to reach large numbers of women regarding family planning -- particularly poor, illiterate women. There is much to be learned from the traditional health system and governmental health and family planning programs should join hands with these older systems.
This study presents clinical observations in pregnancy made on aborigines of the deep jungle and "outside" populations. Migration out of the jungle results in lowered nutritional status as a result of low socio-economic status in the "outside" aborigine. This, together with food habits, increased family size and higher incidence of helminthic infestations, results in lower mean values of Hb, PVC and MCHC and a higher prevalence of anaemia in pregnancy in the migrant aborigine. A higher population density in the "outside" population resulting in frequent intermingling and increased chances of cross-contamination probably explains the increased vaginal bacterial growth in the "outside" Aborigine women. A higher prevalence of vaginal candidiasis in the "outside" aborigine woman is probably related to exposure to oral contraceptives and broad-spectrum antibiotics. On the other hand, better medical and obstetrical services become more readily available to the "outside" aborigine and this results in a favourable influence on perinatal health.
Analysis of histories and genealogies from seven relatively unacculturated, swidden-farming Semai settlements shows that the composition of local groups fluctuates through time. This instability is similar to a pattern which Neel and his colleagues have suggested is typical of primitive society, the fission-fusion model. In addition, the individuals comprising Semai fission groups are kinsmen which implies that the number of independent genomes represented is markedly less than the number of individual migrants (the lineal effect). Fission groups may form new villages or fuse with an established settlement. In either case, the genetic effects of such migration are more pronounced than would be expected on the basis of founder effect or random migration. Despite several conspicuous differences in social organization between the Semai and the South American Indians (e.g., bilateral vs. unilineal descent) whose population structure provided the empirical basis for the fission-fusion, lineal effect model, the basic similarities are striking. The Semai case thus lends support to the proposition that this pattern may be of some generality in technologically primitive populations.
PIP: A traditional birth attendant, also known as an indigenous midwife, is the main provider in many developing countries of obstetric services. Due to this unique position, the traditional birth attendant has been considered as possibly the ideal person to deliver family planning services in her local community. This consideration has influenced program policy in many countries and consequently there is information available to aid in the determination of whether to involve traditional birth attendants and, if so, how to best use them. There have been 2 opposing views in response to the involvement of traditional birth attendants. 1 view regards them as potential innovators. She is seen as ideally placed both physically and socially to act as a representative of the family planning program to her patients. The traditional birth attendant is the acknowledged and often prestigous expert on obstetrics matters, including at times traditional methods of birth control. The alternative view is less hopeful for rather than identifying the traditional birth attendant as an innovator it regards her as a firm opponent of innovation, a determined conventionalist. Pro gram experience in India, Pakistan, Indonesia and East Java and experime ntal studies in the Philippines, Malaysia, and Thailand along with anthr opological inquiries generally support the skeptical view but none of the findings imply that the traditional birth attendant should be ignored by the family planning programs. In the intermediate positions of many actual programs, the wisest plan seems to be to ensure that the potential contribution of the traditional birth attendant is neither overlooked nor exaggerated
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.