• Journal of Preventive Medicine and Public Health
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• v.20 no.1 s.21
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

• Korean Journal of Agricultural Science
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• v.2 no.1
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• pp.9-47
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• 1975

These experiments were caried out to study the effects of caponization and various hormone treatments upon meat production and improvement of meat quality of growing chicken. Sixtyseven days old 160 New Hampshire cockerels were treated and growth rate, carcass yield, change of weight of individual organs, meat composition and change of amino acid were measured and analysed. Otherwise change of testis and thyroid gland by hormone treatment were investigated histologically. The results obtained were as follows. 1. The effectst of caponization and hormone treatment upon meat production were; 1) Body weight of cockerels in D. E. S. group without caponization was increased. upon 96.86% than initial period and A. C. T. H. group was 104.22% but other groups and all carponization groups were lighter than those of control group. 2) Weekly body gain of D. E. S. group without caponization was best showing the significance (102.69 g) and the group with caponization were lower than those groups without caponization. 3) Carcass yield was best in Testo. group without caponization (831.2 g) and the group with caponization were lower than the group without caponization. 4) Carcass rate was highest in A. C. T. H. group with caponization and (67.22%) lowest in Testo. group without caponization (63.37%), but any significance was not recognized. 2. The effects of caponizatitn and hormone treatments upon the coposition of meat and amino acids were; 1) Any significance was not recognized between treated and untreated group about change of moisture, crude protein, crude ash and glycogen contents in meat. 2) Fat co tent in muscle in the all treated groups were higher than that of control group. 3) Extracts of group without caponization were higher than those of groups with caponization. 4) Lysin contents were highest in D. E. S. group with caponization (11. 12/ 16.0 g N) and generelly Testo. group was lower compared with D. E. S. group. 5) Histidine and Arginine contents were higher in the groups with caponization than without caponization. 6) Aspartic acid content were higher in D. E. S. group and A. C. T. H. group without depend on caponization. 7) Treonine content was higher in Testo. group without caponization and in the group with caponization and without hormone treatment compared with those of control group without caponization. 8) Serine content was decreased in the group with caponization and increased by D. E. S. and A. C. T. H treatment groups and glutamic acid was also decreased in Testo. group with out caponization. 9) Cystine content was decreased by Testo. treatment and was not appeared in Testo. group without caponization. 10) Valine content was lower in control group with caponization but significance was not recognized between other groups and control group without caponization. 11) Glycine, Alanine, Methionine. Isoleucine, Leucine, Thyrosine and Phenylalanine contents were not so difference between hormone treated groups and control group without caponization. 3. The effects of caponization and hormone treatment upon the change of organs were: 1) The weight of all organs were heaviest in D. E. S. group without caponization (18.5g) and lightest in A. C. T. H. group without caponization (155. 3g) but no significance was recognized between hormone treatment groups. 2) Heart weight was heaviest in D. E. S. group without caponization (7.46 g) and lightest in Testo. group without caponization (5.95 g). 3) Liver weight was heaviest in D. E. S. group without caponization(32.89g) and lightest in hormone untreated group with caponization(29.66g). Significance was not recognized. 4) Spleen weight was heaivest in Testo. group with caponization (3.22 g) and lightest in D. E. S. group without caponization(2.00g) in contrast with the other groups. High significance was recognized among the groups (P<0.01). 5) Cloacal thymus weight was lightest in D. E. S. group with or without caponization compared with control group without caponization. High significance was recognized among the groups. 6) Muscle fat content was not appeared in A. C. T. H. group with caponization, but it was highly increased in D. E. S. group with or without caponization. 7) Testis weight was lightest in D. E. S. group (0.38g) compared with control group (2.66g). Significance was recognized among the groups. 8) Large intestine, small intestine and cecum weight and length were heavier and longer in D. E. S. group without caponization and control group without caponization was lighter than those of hormone treated groups. 4. The effects of caponization and hormone treatment upon histological change of testis and thyroid gland: 1) The histological change of testis was significantly appeared in D. E. S. group that seminifirous tubles was slowly atrophied, the funtion of spernatogenesis was ceased, spermatocyte was changed as degeneration by pyknosis and karyorrhexis and interstitial cell was also atrophied, but in Testo. and A. C. T. H. group were similar as control group. 2) The histological change of thyroid gland in Testo. and A. C. T. H. groups without caponization were similar to that of control group without caponization, but in D. E. S. group without caponization, was changed squamously. Thyroid gland of the groups with caponization, epithelium of was atrophied and changed squamously as degeneration by pyknosis and karyorrhexis and the function of thyroid gland was slowly ceased in colloid and in hormone treated group with caponization.

• Magazine of the Korean Society of Agricultural Engineers
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• v.15 no.3
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• pp.3059-3088
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• 1973

The Object of research was laid on the dry paddy field which had a low level of underground water, rather than on a paddy field with a high level of underground water. In the treatment of the clay paddy field before transplanting we employed 3 kinds of methods; deep plowing, development of cracks by drying the surface of the field under which pipe drain was built. This study was to find which one, among these three methods, is the most effective to let roots extend to deep zone and increase the yield of rice and at the same time, for trafficability of large scale machinery which will be introduced to the harvest, in the light of the earth bearing capacity in relation with underground drainage. In the treatments of plots, 1) the kyong plot was plowed 39 days before transplanting and dried, 2) the kyun plot was plowed again 2days before transplanting after plowing 39 days before transplanting, leveling field surface in the saturation with water and developing the cracks by drying, 3) the kyunam plot was plowed again 2 days before transplanting after setting the drainage pipe and at the same time plowing 39 days before transplanting, leveling field surface in the saturation with water and developing the cracks by drying. Also each plot above had three different levels of soil depth, respectively; that is 15cm, 25cm, 35cm. The kyong plot with 15cm-depth was he control. The results obtained were as follows; 1. The kyunam plot showed a remarkably lager amount of water consumption by better underground drainage than the kyong and the kyun plot, and the kyong plot indicated a greater amount of water consumption than the kyun plot. Therefore the amount of available rainfall was decreased in the order of kyunam>kyong>kyun. The net duty of water decreased in the order of kyunam>kyong>kyun and its showed about 105cm in depth at the kyunam plot, about 70cm in depth at the kyong plot and about 45cm in depth at kyun plot, regardless of soil depth. 2. According to the tendency that the weight of the total root was effected by the maximum depth of the crack, it seemed that the root development was more affected by the depth of the crack than by only the crack itself. The weight of the total roots tended to increase as the depth of the crack got deeper and deeper, and the weight of the total roots was increased in the order of kyun<kyunam<kyong. 3. In the growing of the plant height, the difference did not appear at the beginning of growing(peak period of tillering) of any plot, But for the mid period of growing(ending period of tillering) to the period of young panicle formation, the deeper the depth of plot is, the more the growing goes down. On the contrary at the late period of growing, growth was more vigorous in the plot with deep depth than in the plot with shallow depth. Since the midperiod of growing, in the light of experimental treatment, the kyun plot was not better in growing than the other two plots and no remarkable defference was shown between the kyunam and the kyong plot, but the kyunam plot had the tendency of superiority in growing plant height. 4. As the depth of plot went deeper, the decreasing tendency was shown in the number of tillers through a whole period of growingi. When the above results were observed concering each plot of experimental treatment, the kyun plot was always smaller in the number of tiilers than the kyunam and the kvong plot, and the kyong plot was slightly larger than the kyunam plot in the number of tillers. 5. When each plot of the different experimental treatments was compared with the control plot(15-kyong), yield(weight of grains) was increased by 17% for the 35-kyong plot, by 10% for the 35-kyunam and yields for the other plots were less or nomore than the control plot. On the whole, as the depth of plot went deeper, yields for plots was increased in the order of kyong>kyunam>kyun. 1% of significance between the levels of depths and 5% of significance between the treatments were shown. 6. The depth of consumptive water which was more effective on the weight of grains is that of the last half period. When the depth of consumptive water was increased at the range of less than 2.7cm/day in the 15cm plot, 3.0cm/day in the 25cm plot and 3.3cm/day in the 35cm plot, the weight of grains was increased, and at the same time the weight of grains was increased as the depth of plot went deeper. The deeper plots was of advantage to the productivity at the same depth of consumptive water. 7. The increase in the weight of grains in propertion to the weighte of root showed a tendency to increase depending on the depth of plot at each plot of the same weight of roots. The weight of roots and grains together increasezd in the order of kyun>kyunam>kyong, considering each treatment of experimental plot. The weight of grains was in relation to the minimum water content ratio during the midperiod of surface drainage and the average earth temperature was mainly affected by the minimum water content ratio because it was relatively increased in proportion to the water content ratio(at less than 40%) 8. The weight ratio of straw to grain showed an increasing tendency at the plot of shallow depth and had a relation of an inversely exponental function to the weight of roots. At the same depth of plot except the 15cm plot, the weight ratio of straw to grain was increased in proportion to the depth of consumptive water. The weight of grains was increased as the depth of consumptive water was increased to some extent, but at the same time the weight of ratio of straw to grain was increased. 9. At a certain texture of soils the increase in the amount of the cracks depends on meteorological conditions, especially increase in amounts of pan evaporation. So if it rains during the progressing of field drying the cracks largely decrease. The amount of cracks of clay soil had relation of inversely exponental function to the water content ratio(at more than 25%). The maximum depth of crack kept generally a constant value at less than 30% of water content ratio. 10. The cone index showed the tendency that it was propertional to the amount of cracks within a certain limit but more or less inversely proportional over a certain limit. The water content ratio at the limit may be about 25%. 11. The increase in the cone index with the progressing of time after final surface drainage showed the tendency that it was proportional to the depth of consumptive water at the last half of growing period. Based on the same depth of if the cone index in the kyunam plot was much larger than in the other two plots and that in the kyong plot was much smaller than in the kyun plott, as long as the depth of plot was deeper, especially in the 35-kyong plot. 12. In the light of a situation where water content ratio of soil decreased and the cone index increased after final surface drainage the porogress of the field dryness was much more rapid in the kyunam plot than in the kyong plot and the kyun plot, especially slowest in the kyong plot. In the plot with deeper zone the progress was much slower. The progress requiring the value of the cone index, $2.5kg/cm^2$, that working machinary can move easily on the field changed with the time of final surface drainage and the amount of rainfall, but without nay rain it required, in the kyunam plot, about 44mm in total amount of pan evaporation and more than 50mm in the other two plots. Therefore the drying in the kyunam plot was generally more rapid in the kyunam plot was generally more rapid over 2days than in the kyun plot, and especially may be more rapid over 5days than in the 35-kyong plot.