Which factors have the greater influence on family planning performance: fixed background variables such as racial composition, urbanization, and mortality, which are affected by level of development, or program inputs such as assignment of personnel and location of clinics, which are subject to manipulation by administrators? An analysis of differences in family planning acceptance among 70 districts of Malaysia shows that two main program-manipulable variables--level of personnel deployment and accessibility of clinics--have the largest direct effect upon acceptance levels. Variations in background factors explain a smaller proportion.
PIP: The application to the Malaysian family planning program of a conceptual model in which background factors, affected by the level of development, are distinguished from program input variables, subject to program manipulation, is considered in an effort to examine reasons for variations in program performance. Focus is particularly on the inputs of workers, who provide services and distribute supplies, and clinic facilities, through which services and supplies are made available. The questions asked concerned how their availability and use are affected by background factors, which themselves reflect to some extent the population's readiness to accept family planning. Distinguishing the program-manipulable factors from the background factors involved determination of the impact of both groups of variables, separately and together on levels of program acceptance, using appropriate bivariate and multivariate techniques. The evidence shows that in addition to background factors, over which program administrators can exercise no direct influence, there is a major contribution made to program acceptance through program factors over which the planner and administrator do have control. The 2 program variables contributed more in explaining performance levels than all 5 selected background variables combined, and the relative contribution of these program factors has increased over time. The key finding emerging from the different analyses is that program manipulable inputs are the dominant direct determinants of subsequent levels of family planning acceptance in Malayasia. Clearly, higher levels of development, as reflected in the measures of background variables, have facilitated acceptance, and background variables contributed significantly. Yet, whatever the level of development, the extent of deployment of program resources does significantly influence the level of program performance.
Septal perforation from intranasal cocaine abuse is well recognised. We present a case of progressive septal as well as palatal perforation. Progression from septal perforation to palatal perforation occurred after cessation of intranasal cocaine abuse. This patient had a weakly positive cytoplasmic antineutrophilic cytoplasmic antibody (C-ANCA) but no histologic evidence of Wegener's Granulomatosis. The differential diagnosis for septal and palatal perforation is reviewed. This case represents the fifth reported case of palatal perforation secondary to cocaine abuse in the literature, and the second associated with positive C-ANCA.