The use of traditional and modern methods of fertility control in Kinshasa, Zaire

Abstract The practice of post-partum abstinence has been a long-standing tradition in many societies of tropical Africa, yet recent research suggests an erosion of the taboo on post-partum sexual relations as a means of fertility control. The current study among women in the lower income groups in Kinshasa, Zaire, provides evidence of this. There is strong motivation toward child-spacing, as shown by 80 per cent of the women who reported to be currently practising some means of fertility control: 73 per cent with traditional methods, only 7 per cent with modern contraceptives. There appears to be some carry-over of traditional practice, in that abstinence is related to the age and nursing status of the last born child. However, the most widely practised method is withdrawal. This suggests a desire on the part of this population for alternatives to abstinence, an issue with important implications for future family planning programs in Zaire.     

The role of client satisfaction in evaluating university counseling services

Though ubiquitously used for evaluating university counseling services, client satisfaction assessment has been hampered by inadequate instrumentation. Systematic use of a short form of the Client Satisfaction Questionnaire (CSQ) in one such center over the past 5 years is described, together with strategies to ensure maximal accuracy and utilization of results. Several method factors were investigated. Optional respondent identification was not found to reduce response rate or increase reported satisfaction compared to anonymity, while a substudy obtaining very high response suggested bias from nonresponse to the routine survey (response rate = 40%) was not great. The CSQ was found to have excellent psychometric properties and many advantages for use in student service settings. Relationships between satisfaction and a number of other variables such as demographics, precounseling expectancies, problem type and severity, counselor differences, and duration of counseling are reported. Ways such findings were incorporated in service planning are briefly discussed.     

Assessment of patient satisfaction: development and refinement of a service evaluation questionnaire

A series of seven studies was conducted by the authors and their colleagues to produce an efficient measure of service satisfaction that can easily be related to symptom level, demographic characteristics, and type and extent of service utilization. The resulting measure, the Service Evaluation Questionnaire (SEQ) is a brief, global index that has excellent internal consistency and solid psychometric properties. Data from an extensive SEQ field study can be used as a comparison base for future applications of the two SEQ component scales, the CSQ-8 and the SCL-10. A new hypothesis has emerged from this series of studies that will guide future research: Service recipients may find if difficult to formally express dissatisfaction in the face of significant caring--however ineffectual--when the technical capacity to offer definitive treatment is not yet fully developed and when criteria for evaluating the efficacy of treatment are not yet crystal clear.     

Patient satisfaction with mental health services: a meta-analysis to establish norms

Patients typically express high rates of satisfaction with their mental health care. This finding and the lack of well controlled studies on patient satisfaction in the literature underscore the need for meaningful guidelines for clinicians and program evaluators in interpreting patient satisfaction data. To address this problem a meta-analysis was undertaken to establish norms on patient satisfaction for various types of mental health programs. Programs were categorized according to three dimensions: inpatient vs. outpatient vs. residential care; chronic vs. non-chronic; and conventional vs. innovative. Meta-analysis procedures were modified to accommodate the single-group study designs that dominate the literature. The analysis revealed that chronic patients express less satisfaction with their treatment compared to non-chronic patients. Innovative programs are viewed more positively than conventional ones. No differences were found in rates of patient satisfaction between inpatient and outpatient programs. Acceptably reliable norms and confidence intervals of patient satisfaction were established for conventional inpatient programs serving either chronic or non-chronic patients; conventional outpatient programs for non-chronic patients; and for all programs combined according to chronic vs. non-chronic, inpatient vs. outpatient, and conventional vs. innovative. However, data were insufficient to compute norms for other program types. The norms thus established can be used for comparative purposes by program evaluators. A cumulative, national data base on patient satisfaction is recommended to further refine these norms.     

Analysis of social pathologies in a policy context: A paradigm for action

Prevention continues to gain importance among the strategies open for governmental development of social policy. This paper offers two exploratory conceptual discussions related to prevention in social policy. The first is a representation of the policy making environment with special reference to the informational requirements for the development of policy. The second is a discussion of social pathologies, broadly defined as patterns of behavior with important negative repercussions on individuals whom we refer to as victims, and of possible strategies toward the development of (at least partial) preventive measures. The two discussions are interrelated as the shape of the second is dictated by the desiderata outlined in the first. The paper is divided into five parts:

1. Introduction: the conundrum of prevention.
2. The Development of a paradigm of the policy context.
3. Dependent variables: social pathologies.
4. Independent variables: a focus on structural determinants.
5. Conclusion: information requirements for preventive action.

     

Demographic crisis: The impact of the Bangladesh civil war (1971) on births and deaths in a rural area of Bangladesh

Summary In Matlab Bazaar Thana the Cholera Research Laboratory has registered the births, deaths and migrations in a population of approximately 125,000 since 1966. Although this rural area was not the scene of any significant armed encounters, striking changes in birth and death rates were registered during and after the conflict. Birth rates did not change during the relatively brief period of the civil war, but a small decline was registered for one year after the war. Fertility rates which had been declining slightly and irregularly in the pre-war baseline period may have increased slightly during the war and fell substantially in all age groups in the year following the war. The crude death rate, which rose by 37 per cent during the war, was a very sensitive reflection of the administrative and economic problems. Overall infant mortality rose by only 15 per cent over pre-war levels because all of the increase was observed in the post-neo-natal component, which traditionally accounts for less than one-third of the total infant mortality in Bangladesh. Children and older adults accounted for the majority of excess deaths which were largely attributed to acute diarrhoeas and other gastro-intestinal causes. The death rate at ages 1-4 rose by 43 per cent and at ages 5-9 soared to 208 per cent above pre-war baseline rates. All increases in age-specific mortality rates fell to baseline levels during the year following the war, except the 5-9-year age group, in which rates continued to be high largely because of deaths due to dysentery.     

Multiproblem families: A social-psychological perspective

Summary It is generally conceded that our allied mental health professions have fallen short in our attempts to provide adequate services to those people whose need is most desperate, those individuals and families ambiguously and condescendingly designated multiproblem. It could be said that we, the caregivers, have been unwilling or unable to be good enough mothers to these, our motherless children. In fact, the early, formative experience of the people with whom we are concerned has invariably been marked by gross discontinuities in mothering; the consequent defects in controlling, regulatory psychic structure (ego defects) are most prominently manifested in the chaotic life-style which characterizes these individuals and families. Our task as caregivers, when viewed from this perspective, is clear: we must somehow bring order out of disorder. But, with tragic regularity, disorder prevails; the provider of service succumbs to the same painful feelings of disorganization, bewilderment, frustration, and helplessness with which his client struggles, and, eventually, both give up in despair. What is more, this sense of fragmentation and futility pervades the institutions responsible for provision of services. Client, caregiver, and institution, all are trapped in the same tortuous maze. How, then, are we to extricate ourselves? Certainly not by drafting yet another master plan which promises everything and delivers nothing. Both realistic and humanistic considerations dictate more modest goals: We might not be able to rescue everyone who needs assistance, but we can help a few. And, whatever approach we may adopt, the service we offer can only be effective if it is based upon a sustained and sustaining (in essence, maternal) relationship.Sometimes I Feel Like a Motherless Child