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Query: UMLS:C0002453 (amenorrhea)
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Seven patients with systemic lupus erythematosus (SLE), persistent thrombocytopenia (TP), in whom it was considered undesirable to institute an increase in steroid or immunosuppressive agents, were treated with danazol. Five patients completed the minimum period of 8 weeks. Two patients showed early response to danazol but were switched over to cyclophosphamide or azathioprine after 4 weeks because of systemic disease. Of the remaining five patients, four had complete responses. In one patient who failed treatment the TP was considered to be related to another drug (ranitidine). Other manifestations of SLE also improved with treatment. Side effects included amenorrhea in one patient, and hypoglycemia and hyponatremia in another. Infections were absent. Danazol can be a useful alternative treatment of lupus TP.
Asian Pac J Allergy Immunol 1991 Dec
PMID:Danazol in treatment of lupus thrombocytopenia. 180 60

Despite recent progress in birth data collection and analysis techniques, it remains difficult to establish convincingly that a quantum fall in fertility due to control practices within unions is beginning to be appreciable in a population. A precise measurement of the size of fall associated with such alterations in behavior is difficult. 1 reason for the difficulty of defining measures of significance is the lack of accurate and detailed data. Another reason is the concommitant changes in other demographic characteristics that often occur at the same time as the adoption of control practices. Some of the most common are increases in age at marriage, reduction in length of postpartum amenorrhea, and shorter delays between marriage or cohabitation. Despite evidence of fertility falls over some 15 years, it has been hard to establish the size and nature of this change. The technique for doing so is the life table analysis of birth intervals. The strength of the life table approach is that it adjusts for populations at risk, such as the number of women in an age group of incomplete fertility who have experienced differing numbers of births at different intervals before the survey. The life table analysis deals with the problem of censoring. However, the estimates are seriously biased by selection for speed of reproduction. For some populations the control methods do not seem satisfactory. The most straightforward and effective approach is to subdivide the women by age at earlier birth for any particular interval by order, and to calculate separate life tables for the subdivisions. Individual countries are discussed to illustrate particular features of the analysis (Sri Lanka, Nepal, Korea, Pakistan, Latin America). The approach has been very successful in delineating trends in the parity progression ratios of higher order births. More research is needed on cutoff points of cohort and birth order for the indices, and the best ways of combining the measures to show trends.
Asian Pac Cens Forum 1983 Aug
PMID:Censored cohort parity progression ratios from birth histories. 1226 87

This article considers the role of breastfeeding (BF) in infant health and child survival, with a special reference to the available information from countries in the Asian and Pacific Region. A simplified framework is proposed for the systematic investigation of the direct influence of BF on infant and child health through its protective effects against infections, especially of the gastrointestinal tract, and the indirect influences on infant mortality through lactational amenorrhea (birth spacing). Despite some methodological constraints, the weight of the available evidence suggests that BF lowers the incidence of infant morbidity and mortality. Increased prevalence and duration of breastfeeding can potentially reduce mortality from diarrhea in developing countries by as much as 25%. For children born to underprivileged couples and in poorer countries, a high prevalence of BF for prolonged durations is critically important in reducing the levels of morbidity and mortality. The framework shows the relationships among many factors. Maternal factors influence a mother's decision to breastfeed and duration of BF. Theses factors also have an independent relationship with infant health and survival. These are the "independent" variables. There are 3 chief intermediate variables: 1) the method of infant feeding; 2) birth spacing; and 3) birth weight. The independent variables affect the mother's choice of the infant feeding methods, which affects the birth interval and birth weight of the next child. The outcome of the relationship between intermediate and independent variables is the infant's health status and its survival probability. Information on key indicators for 25 selected countries and areas in the Pacific and Asian Region are shown in tabular form. Infant mortality rates range from 5/1000 live births in Japan to 171 in Afghanistan. The proportion of infants with a low birth weight also varies a lot. Similar differentials are in effect for other indicators. Countries with better access to health services and lower infant mortality are also the ones which have a lower prevalence of BF. It seems that more hygienic environments seem to affect the sequelae of prevalence and short time of BF. A high prevalence and more time spent at BF helps to reduce the consequences of poor hygienic environment in less economically developed countries.
Asia Pac Popul J 1990 Mar
PMID:Breast-feeding, infant health and child survival in the Asia-Pacific context. 1228 46

This review considers some of the many reasons why researchers and policy makers are increasingly concerned about breastfeeding (BF). It discusses the contraceptive effect and health benefits of BF, and review major BF trends and patterns in selected countries and areas of Asia. It also discusses the complementarity between BF and contraceptive use, and highlights the findings of the studies contained in this special issue of the "Journal." In populations without access to modern contraception, birth intervals (BIs) are determined by the length of BF. The contraceptive effect of BF has been well documented. BF plays an important role in child nutrition and health in 3rd world countries. There are lower incidence of infant morbidity in Asia. Maternal antibodies in breast milk protect the infant from gastrointestinal illness and respiratory infections. Breastfeeding is very economical. The risk of transmission of the human immunodeficiency virus which causes the acquired immunodeficiency syndrome from the infected mother to the child in the breast milk is a new contraindication to BF. However, BF is not as effective as a contraceptive after 6 months. Modern methods of postpartum contraception must be used. Introduction of contraceptive pills in some setting may be done too early. Family planning programs can help women use BF as a contraceptive method. BF should be seen as a "lactational amenorrhea method" in the "cafeteria" of FP methods. Users of the lactational amenorrhea method need to be represented in service statistics. FP surveys should find out if BR is used for fertility regulation. The other articles in the journal are summarized.
Asia Pac Popul J 1990 Mar
PMID:Breast-feeding in Asia: an overview. 1228 50

This study examines the trends in and determinants of length of postpartum amenorrhea during 1978-90 in Bangladesh. Data are obtained from the Matlab project. The sample comprises 6000 women per cohort for cohorts born in two year periods during 1978-80 and 1988-89. Reproductive and lactation records are available for up to 36 months following the birth of the index child. Findings indicate that the duration of postpartum amenorrhea is around 13 months for births during 1978-83. The median duration is 13.5 months for the birth cohort for 1982-83 and 9.4 months for the birth cohort for 1988-89. For 1989 alone the median duration is a further decline to 8.6 months. The seven year decline amounts to a 36% reduction. Findings indicate that age and duration of postpartum amenorrhea are positively related. All age groups show a decline in median duration. The shorter median durations occur among women with fewer than two living children and higher levels of education. Duration of breast feeding peaks in 1984-85 at 34.3 months and then declines to 30.7 months in 1986-87. Full breast feeding duration declines from around 6 months for cohorts 1978-79 to cohorts 1982-88 to 5.2 months in 1986-87 and lags behind durations of postpartum amenorrhea. Full breast feeding declines occur after the 1982-83 cohort among mothers with higher education and after the 1984-85 cohort for uneducated and less educated women. Age patterns of breast feeding women are inconsistent. The oldest mothers have the shortest breast feeding durations. The youngest cohorts show a decreasing trend. Breast feeding durations increase with an increase in the number of living children. However another trend shows initial increases in duration and then declines regardless of the number of living children. The suggestion is that full breast feeding may be important in determining the length of postpartum amenorrhea duration. Contraceptive use increases from 24% in 1977 to 39% in 1984. Median birth intervals increase from 38.7 to 48.8 months and increases pertain to all age and parity groups. Malnutrition is considered to be unrelated to postpartum amenorrhea periods. The trend is clearly reflective of declining postpartum amenorrhea duration, but the nature of the impact of breast feeding or contraceptive use is not clear.
Asia Pac Popul J 1993 Jun
PMID:Levels and trends in post-partum amenorrhoea, breast-feeding and birth intervals in Matlab, Bangladesh: 1978-1989. 1228 23

Data from the 1989 Bangladesh Fertility Survey and actuarial life table methods are used to estimate breast feeding differences by other socioeconomic, health, and demographic characteristics. Findings indicate that the average breast feeding duration for surviving children was 28.2 months (27.1 months for urban women and 28.6 months for rural women). Breast feeding duration was longer among mothers with no schooling compared to mothers or fathers with a higher education. Older mothers had different breast feeding patterns than younger mothers. Muslim women breast fed for 28.1 months; non-Muslim women did so for 18.8 months. Working women breast fed for 19.0 months compared to 28.1 months among non-working women. Duration of breast feeding increased with increased parity. Breast feeding duration averaged 17.5 months among wives of service workers and business men, 28.3 months among wives of production workers, and 29.0 and 27.9, respectively, for wives of farmers and land-owners. Contraceptive use was unrelated to breast feeding duration. Women who possessed specific household items had a shorter breast feeding period. Women who were visited by health workers had a longer breast feeding duration. There were only marginal differences between durations by whether husbands controlled health decision making or whether there was joint decision making. Gender was unrelated to duration. Differences in the significance between variables and survival are reported. Multivariate findings among women who ceased breast feeding indicate that breast feeding had a positive significant effect on amenorrhea and directly determined both closed and open birth intervals. The effect of breast feeding on amenorrhea was stronger in the closed interval. Breast feeding explained 18.9% of variation in postpartum amenorrhea (9.8% in the current open interval). 86.9% of the variance was explained by place of residence, maternal education and age, parity, maternal work status, and every use of contraception.
Asia Pac Popul J 1995 Dec
PMID:Breast-feeding in Bangladesh: patterns and impact on fertility. 1229 30

Data from the 1988 Vietnam Demographic and Health Survey and the 1994 Demographic Survey are used to determine the trends in breast feeding and amenorrhea among ever married women of reproductive age. Life table procedures are used to calculate monthly probabilities of weaning. Then five month moving averages of equal weight are computed for observed monthly probabilities of weaning. The smoothed probabilities are used to calculate the cumulative proportion weaned at successive monthly ages. Breast feeding is universal in Vietnam. Infants are put to the breast earlier when delivery occurs at home. Almost all children are breast fed through the first six months, and 80% are breast fed for a year. The median duration was 15.3 months in the 1988 survey and 15.9 months in the 1994 survey based on life table methods. Calculations based on current status methods were slightly higher for both years. Rural women tended to breast feed longer than urban women. Children who had mothers working in agriculture were breast fed longer than children whose mothers had other occupations. Socioeconomic factors did not correlate well with breast feeding duration. Findings indicate that over 66% of breast fed infants aged under 3 months were given plain water, and over 90% of infants aged 3-5 months were given plain water. Fresh cow's milk is not given to Vietnamese infants. Juices were given to children aged older than 6 months. Sugar water was given to younger infants. The introduction of supplemental liquids was more common in urban areas. Few infants during the first few months of life were given solid or mushy foods. But by 4 months of age, 50% of infants were given solid or mushy foods, and the practice was more common in rural areas. The urban-rural gap closed by 6 months of age. Over 90% of infants received solids at 9 months. It is expected that modernization will negatively impact on breast feeding.
Asia Pac Popul J 1995 Dec
PMID:Infant feeding practices in Viet Nam. 1229 31

In Bangladesh, long durations of intensive breast-feeding have traditionally resulted in extended durations of postpartum amenorrhea and long intervals between births even in the absence of contraception. For example, the national Bangladesh Fertility Survey (BFS) of 1975 reported a median duration of postpartum amenorrhea of 14.6 months, while analyses of data from the 1989 BFS suggest that lactational amenorrhea still has an important contraceptive effect, reducing fertility overall by 35%. Findings are presented from an analysis of longitudinal survey data conducted to gain insight into the issue of lactational protection against pregnancy among Bangladeshi women. Data were drawn from surveillance systems maintained in 2 research sites of the International Center for Diarrheal Disease Research, Bangladesh: the Record Keeping System of the Matlab MCH-FP project treatment area and the Urban Surveillance System of the Dhaka slum study area of the Urban Health Extension Project. The results from both study populations indicate a high degree of protection against pregnancy for amenorrheic women.
Asia Pac Popul J 1998 Dec
PMID:The contraceptive potential of lactation for Bangladeshi women. 1229 63

From November 1997 to February 1998, a survey was conducted to evaluate postpartum family planning (FP) services in the Philippines. Data were gathered from records at 86 clinics in 28 provinces and from interviews with 338 FP providers and 3452 clients who began to use FP within 6 months of delivery. Only 7% of women began using FP within 6 months of delivery, and most postpartum attention was devoted to child care issues. Among the women surveyed, most resumed sexual intercourse at 2.4 months postpartum and experienced a return of menses at 4.4 months postpartum despite breast feeding for 6.2 months. The most commonly recommended method to space births was the IUD followed by the injectable contraceptive. Very few providers recommended use of barrier methods. The results indicate that many breast-feeding women are receiving hormonal contraceptives too soon and that IUD insertion may not be occurring at the ideal time postpartum. While a significant percentage of providers recommended use of the lactational amenorrhea method (LAM) and 16% of the women relied on it, the providers lacked sufficient understanding of LAM. In addition, many women switched or discontinued methods. The study led to the recommendations that postpartum FP services be promoted as an essential part of maternal-child health care and that FP providers receive improved training about contraception and LAM.
Asia Pac Pop Policy 1998 Oct
PMID:Family planning for new mothers in the Philippines. 1229 50

A matrix of 5 intermediate variables affecting fertility, and 5 direct and 3 indirect variables built into development programs is presented to analyze how development initiatives affect fertility. The framework evolved from a meeting in Pakistan intended to create a population-development impact monitoring framework. This model connects development and fertility through proximate, rather than intermediate, variables; treats development in a project-specific and region-specific manner; and takes data requirements into account. The fertility variables are: proportion of women 15-49 currently married; proportion of these women seeking to avoid pregnancy; proportion of these women in lactational amenorrhea; proportion of these women suffering nutrition-related or other impaired fecundity; other social structural factors affecting fertility, such as taboos or separation. Examples of direct program variables are supplying contraceptives, promoting favorable attitudes, promoting breast-feeding, increasing female age at marriage. Indirect program variables might be increasing health, nutrition, education, income, productivity, technology, or social change such as land redistribution. Another matrix can be constructed with data sources on the y axis. The goal is to quantify the framework. Program effects are more measurable when they are divided into direct and indirect effects, and when they are analyzed at the project level. Most countries already collect many of the data that this framework requires.
Asia Pac Popul J 1988 Sep
PMID:The impact of development programmes on fertility: a framework for analysis. 1231 14


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