Culturally based goal displacement in an egyptian FP-MCH program
The adoption of an integrated family planning-maternal and child health care strategy in a cultural context non-supportive of family planning invites a shift in emphasis in which the means, MCH services, rather than the achievement of the goals, fertility reduction, become the focus of activities. This paper presents a case of such an occurrence of goal displacement. We conclude that without a carefully considered response which addresses the general cultural and organizational influences that affect project personnel, the effectiveness of integrated family planning/MCH programs in reducing fertility rates will be limited.
The Strategic Management of Development Programmes
The purpose of this paper is to report the findings of an international study of the managerial and institutional interventions associated with six relatively successful development programmes selected from different parts of the Third World (1). The important role played by managerial/organisational variables in project/programme performance has all along been recognised by development planners and policy makers, though this has been a neglected area of observation and study (2). As a result, the basic understanding of how these variables operate and interact in the public context and
A controlled, randomized trial of highly selective vagotomy versus selective vagotomy and pyloroplasty in the treatment of duodenal ulcer.
The results of highly selective vagotomy without drainage and selective vagotomy with pyloroplasty for duodenal ulcer were compared in a randomized, controlled trial of a series of 100 patients. The frequency of dumping, diarrhoea, and epigastric fullness was significantly lower after highly selective (6, 6, and 8 percent) than after selective vagotomy (30, 20, and 28 percent) one year after the operations. Recurrent and persisting duodenal ulcers appearing from one to four years after the operations were significantly more frequent after highly selective (22 percent) than after selective vagotomy (8 percent). No significant relationships were found between recurrent ulceration and gastric acid secretion measurements after the two operations. The Hollander response was early positive in 28 percent and late positive in 30 percent of the patients subjected to highly selective vagotomy, while the corresponding figures after selective vagotomy were 26 and 32 percent. The overall clinical results of the two operations were not different according to the classification of Visick. Excluding the patients with recurrence resulted in significantly better clinical results after highly selective vagotomy.