Volume 8, Number 1
7 January 2008

SPECIAL DOUBLE ISSUE!
Welcome to the first issue of The Pop Reporter for 2008! This begins our eighth year of publishing The Pop Reporter e-zine. Today's issue is a special double length issue in order to cover news and research published since our December 17, 2007 issue. As always, we welcome your contributions of new research publications and guest commentaries on global health topics. Happy reading!

ADOLESCENT HEALTH NEWS

Ethiopia: 30,000 Signed to Help Children Impacted By HIV/Aids
(News Article; Sub-Saharan Africa)
20 Dec 2007
Tamene B, The Daily Monitor (Addis Ababa)

Nigeria: Groups empower women, youths
(News Article; Oceania)
18 Dec 2007
Esin H | Lasisi O, This Day (Lagos)

ADOLESCENT HEALTH RESEARCH

The Internet as a source of reproductive health information among adolescent girls in an urban city in Nigeria
(Research Article; Sub-Saharan Africa)
BMC Public Health. 2007 Dec 20;7(354):[31] p..
Nwagwu WE
There exists some research evidence regarding how adolescents utilize the Internet for health information seeking purposes. The purpose of this study is to understand how in-school and out-of-school adolescent girls in Owerri, Nigeria use online resources to meet their reproductive health information needs. The result could be considered very crucial in assessing the potential role of the Internet in providing health information to adolescent girls in a typical Nigerian urban city. A questionnaire was used to collect data from 1011 adolescent girls in selected secondary schools in the communities, and also from 134 out-of-school girls selected from the same communities. More than 73% of the girls reported having ever used the Internet; more than 74% and 68% of them being in-school and out-of-school respectively. The in-school girls (43.9%) reported having home access more than the out-of-school (5.6%) although the out-of-school have used the Internet for finding reproductive and related information more than the in-school. While parents (66.22%) and teachers (56.15%) are the two sources most used to the in-school girls, friends (63.18%) and the Internet (55.19%) were reported by the out-of-school youth as the two most used sources of information to them. The Internet is not a first choice of source of reproductive health information for both the in-school and out-of-school adolescent girls in Owerri, Nigeria. The source is however, more commonly used by the out-of-school than the in-school, but the in-school have a more favorable assessment of the quality of information they obtain from the Internet.

Differences in young people's reports of sexual behaviors according to interview methodology: A randomized trial in India
(Abstract; subscription needed for full text; Asia)
American Journal of Public Health. 2008 Jan;98(1):169-174.
Jaya | Hindin MJ | Ahmed S
We compared reports of sexual behaviors given in standard face-to-face interviews with reports given in audio computer-assisted self-interviews (ACASIs) and culturally specific interactive interviews among adolescents in India. We sought to determine which of the interview methods leads to higher reporting of sexual behaviors among economically disadvantaged 15-19-year-olds in urban India. We conducted a randomized trial in which each participant (583 boys and 475 girls) was assigned to 2 interview methods: face-to-face interview and ACASI or interactive interview. We used matched case-control analyses to assess differences in the individual's reporting on the 2 methods. Female participants consistently reported fewer sexual behaviors in ACASIs than in face-to-face interviews, whereas male participants' reports differed according to type of sexual behavior and interview mode. Both male and female participants reported more sexual behaviors during interactive interviews than during face-to-face interviews. Twenty-eight percent of male participants reported having engaged in heterosexual intercourse in interactive interviews, as compared with 20% in face-to-face interviews (P less than .01); the corresponding percentages for female participants were 7% and 2% (P less than .01). Our results showed that young people were more likely to report sexual behaviors in culturally specific interactive interviews than in face-to-face interviews. By contrast, ACASIs did not uniformly lead to higher reporting levels than did face-to-face interviews.

Inclusion of adolescents in preventive HIV vaccine trials: Public health policy and research design at a crossroads
(Abstract; subscription needed for full text; Global)
JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Jan 1;47(1):86-92.
Jaspan HB | Cunningham CK | Tucker TJ | Wright PF | Self SG
The search for a safe effective HIV vaccine has been a centerpiece of HIV research for almost 2 decades. More than 60 clinical HIV vaccine trials have been conducted to date. Several promising candidate HIV vaccines are in advanced clinical development. To date, however, no trial has included adolescents, one of the most important target groups for any preventive HIV vaccine. To license a vaccine for use in this age group, efficacy data or, at a minimum, bridging safety and immunogenicity data in this population are needed. To accomplish this, several critical issues and special challenges in the development and implementation of HIV vaccine trials in adolescents must be addressed, including regulatory considerations, potential differentials in safety and immunogenicity, alternative trial design strategies, recruitment and retention challenges, community involvement models, and approaches to informed consent/assent. This article examines these issues and proposes specific next steps to facilitate the routine inclusion of this high-priority population in preventive HIV vaccine trials as early and seamlessly as possible.

Responses to VCT for HIV among young people in Kampala, Uganda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
African Journal of AIDS Research. 2007 Nov;6(3):215-222.
Rassjo EB | Darj E | Konde-Lule J | Olsson P
Attitudes to voluntary counselling and testing (VCT) for HIV among young men and women in a slum area of Kampala, Uganda, were studied through 22 individual semi-structured interviews and 5 focus group discussions. Attitudes to VCT ranged from having no problem with the procedure to being very reluctant. Despite fear of stigma, the participants perceived 'positive living' after HIV testing as realistic. VCT was regarded as an important step to avoid HIV infection, but informants expressed the need for the service to be more accessible in terms of cost, time and quality of pre- and post-test counselling. We argue that counselling without HIV testing should be available for those who are reluctant to test. Poverty and gender power imbalances appeared to limit youths' possibility of making rational decisions about sexual behaviour and accessing VCT. The importance of considering the context in which such issues are being negotiated and decided is highlighted.

Vulnerability to HIV infection among Luo female adolescent orphans in western Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
African Journal of AIDS Research. 2007 Nov;6(3):287-295.
Nyambedha EO
Large-scale surveys have reported that about 55% of orphans worldwide are adolescents. In Kenya, the majority of HIV-infected adolescents are females. The current study used the anthropological methods of in-depth case studies to analyse how migratory life situations of individual female adolescent orphans in the Luo community of Western Kenya may increase their exposure to HIV. The study shows that the ability of the female adolescent orphans to adopt risk-preventive behaviour in relation to HIV is determined by a range of factors beyond their control of individual sexual behaviour. Although analysis of a single case study limits generalisation of the findings, the results provide insights into the reason for sex differentials in HIV infection rates among adolescents as reported in some large-scale surveys. The paper recommends that HIV prevention strategies for adolescents should examine the specific life situations of female orphans by focusing on the impacts of HIV and AIDS and poverty on the protective role of the family. It also recommends that keeping female adolescent orphans in school or in vocational training can be an effective HIV prevention strategy for them.

Ethical and human rights perspectives on providers' obligation to ensure adolescents' rights to privacy
(Abstract; subscription needed for full text; Global)
Studies in Family Planning. 2007 Dec;38(4):245-252.
Ringheim K
The rights of adolescents to privacy and confidentiality as stipulated in international human rights conventions are poorly protected in reproductive health-care settings. Fear that their private information will become known, particularly to a parent, has been shown to be a major factor in adolescents' failure to seek the services they need. The tension between parental interests in guiding the development of children and public interest in maintaining a healthy population is considered in light of the ethical principles that bear upon these decisions. In practice, health-care workers are the intermediaries who must ensure that the privacy rights of adolescent clients are protected. They are bound through obligations engendered in human rights conventions as well as by ethical principles, especially that of nonmaleficence, to provide the young with information and confidential services, skills that must be acquired through training. Enhancing the survival of adolescents promotes the greater social good.

FAMILY PLANNING NEWS

Report: Rich flout China child policy
(News Article; Asia)
2 Jan 2008
Associated Press

Population growth and the environment
(News Article; Global)
29 Dec 2007
Earth Talk, www.HealthNewsDigest.com

Niger intends to promote family planning to curb swelling population
(News Article; Sub-Saharan Africa)
25 Dec 2007
Agence France Presse

India: Under control
(News Article; Asia)
20 Dec 2007
Radhakrishnan MG, India Today

FAMILY PLANNING RESEARCH

A question of ethics: Research and practice in reproductive health
(Abstract; subscription needed for full text; Global | Global)
Studies in Family Planning. 2007 Dec;38(4):229-241.
RamaRao S | Friedland B | Townsend JW
The intent of the ethical guidelines and regulations, developed over time, that govern research on human subjects is to ensure that research participants are well-informed volunteers, protected from harm, ensured potential benefit, and enrolled in an egalitarian fashion. This study discusses ethical issues that researchers and program planners grapple with in the area of sexual and reproductive health. We illustrate the dilemmas that arise in the application of the ethical principles, how they have been addressed, lessons learned, and remaining challenges. The illustrations come both from research and from service-delivery situations.

Economic status, informal exchange, and sexual risk in Kisumu, Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Economic Development and Cultural Change. 2008 Jan;56(2):375-396.
Luke N
Despite the escalating attention focused on the role of informal exchange in fueling the HIV/AIDS epidemic in Africa, there has been no empirical investigation of the connection between economic status, transfers, and sexual risk behavior. One potential reason for the paucity of studies examining these important linkages is the lack of quality data on economic status in African populations and transfers within sexual partnerships. I overcome this shortcoming by using survey data I collected in urban Kisumu that contain information on the economic status of working-age men and sexual risk behavior in their nonmarital partnerships. Mine is also one of the only existing surveys to collect detailed data on men's involvement in informal exchange relationships and the value of transfers given to their partners. In this article, I investigate various mechanisms through which economic status is associated with sexual risk behavior, as measured by the nonuse of condoms within sexual partnerships, to shed light on the role that wealthy men play in spreading infection in a high HIV/AIDS environment.

Evaluation of a pregnancy prevention programme using the Contraceptive Behavior Change model
(Abstract; subscription needed for full text; Global)
Journal of Advanced Nursing. 2008 Jan;61(1):81-91.
Chung-Park MS
This paper is a report of the findings of a study to examine the effects of application of the Contraceptive Behavior Change model on knowledge, attitudes, perceived benefits and barriers, self-efficacy (SE), stages of change (SOC) and contraceptive behaviours. Unintended pregnancy is a global issue; it is also a concern for the military, as it impacts on mission readiness. Effective sexuality education programmes are needed but, to date, an evaluation of existing programmes using a conceptual model is lacking in the health literature. A sample of 198 single, junior enlisted females was randomly recruited from United States of America Navy ships. An experimental design was adopted. The experimental group received two class sessions, 2 months apart, while the control group received none. The variables measured were: knowledge, attitudes, perceived benefits and barriers, SE, SOC and contraceptive behaviours. Data were collected on three separate occasions at 2-month intervals over a 4-month period in 2004-2005. Initially, a striking lack of knowledge was evident among study participants. The experimental groups' knowledge increased statistically significantly with repeated interventions, while the control group's knowledge did not change over the same period. Both groups started with no pregnancies, and at the end of the study, the pregnancy rate between the two groups was statistically significant: experimental group 0%, and control group 14%. The intervention led to increased knowledge, which in turn led to avoidance of pregnancy. The proposed model was appropriate for the evaluation and consequently can be considered as an effective tool to use for development or refinement of existing programmes.

Effectiveness of training supervisors to improve reproductive health quality of care: A cluster-randomized trial in Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Health Policy and Planning. 2008 Jan;23(1):56-66.
Reynolds HW | Toroitich-Ruto C | Nasution M | Beaston-Blaakman A | Janowitz B
Health facility supervisors are in a position to increase motivation, manage resources, facilitate communication, increase accountability and conduct outreach. This study evaluated the effectiveness of a training intervention for on-site, in-charge reproductive health supervisors in Kenya using an experimental design with pre- and post-test measures in 60 health facilities. Cost information and data from supervisors, providers, clients and facilities were collected. Regression models with the generalized estimating equation approach were used to test differences between study groups and over time, accounting for clustering and matching. Total accounting costs per person trained were calculated. The intervention resulted in significant improvements in quality of care at the supervisor, provider and client-provider interaction levels. Indicators of improvements in the facility environment and client satisfaction were not apparent. The costs of delivering the supervision training intervention totalled US$2113 per supervisor trained. In making decisions about whether to expand the intervention, the costs of this intervention should be compared with other interventions designed to improve quality.

Effects on serum hormone levels of low-dose estrogen in place of placebo during the hormone-free interval of an oral contraceptive
(Abstract; subscription needed for full text; Global)
Contraception. 2008 Jan;77(1):34-39.
Reape KZ | DiLiberti CE | Hendy CH | Volpe EJ
The study was conducted to evaluate the effects of low-dose estrogen compared to placebo on ovarian activity during the traditional 7-day hormone-free interval (HFI) of an oral contraceptive (OC). Women were randomized to placebo or low-dose estrogen for 7 days during the HFI. Serum levels of estradiol, follicle-stimulating hormone (FSH), luteinizing hormone and inhibin B were obtained before, during and after treatment. Mean hormone levels remained constant or only increased slightly for the low-dose estrogen group compared to greater more sustained increases observed for the placebo group. Estradiol, FSH and inhibin B levels were substantially higher for those on placebo. Differences were most noticeable by the end of the HFI and persisted into the subsequent cycle. Subjects receiving low-dose estrogen for 7 days during the HFI demonstrated more pronounced ovarian suppression compared to placebo as evidenced by attenuation of increases in serum inhibin B, FSH and estradiol levels.

GENDER and HEALTH NEWS

Liberia: Afell boss challenges victims of SGBV
(News Article; Sub-Saharan Africa)
20 Dec 2007
The Inquirer (Monrovia)

Zambia: Abuses against women obstruct HIV treatment
(Press Release; Sub-Saharan Africa)
18 Dec 2007
Human Rights Watch (Washington, DC)
Related Report: Hidden in the Mealie Meal: Gender-Based Abuses and Women’s HIV Treatment in Zambia

Liberia: Gender Ministry, LCP fuse against GBV
(News Article; Sub-Saharan Africa)
18 Dec 2007
The Analyst (Monrovia)

Kenya: Rape cases likely to increase rate of HIV infection
(News Article; Sub-Saharan Africa)
3 Jan 2008
The Nation (Nairobi)

GENDER and HEALTH RESEARCH

The global gender gap report 2007
(Report; Global)
Geneva, Switzerland, World Economic Forum, 2007. 160 p.
Hausmann R | Tyson LD | Zahidi S
Gender-based inequality is a phenomenon that affects the majority of the world's cultures, religions, nations and income groups. Yet there are differences in the way gender disparities manifest themselves and how they have evolved over time. It is vital to develop frameworks for capturing the magnitude of these disparities in order to design effective measures for reducing them. A challenge that can be measured can be addressed. The Global Gender Gap Index, introduced by the World Economic Forum last year, is one such framework. It aims to be a tool for benchmarking and tracking global gender-based inequalities on economic, political, education and health-based criteria. The country rankings are meant to serve a dual purpose. They are designed to create greater awareness among a global audience of the challenges posed by gender gaps and the opportunities created by reducing them. It is also hoped that the rankings, together with the detailed country profiles, will serve as a catalyst for change by providing policy-makers with a snapshot of their country's relative strengths and weaknesses of their country's performance compared to that of other nations.

Association of polymorphism in MDM-2 and p53 genes with breast cancer risk in Indian women
(Abstract; subscription needed for full text; Asia)
Annals of Epidemiology. 2008 Jan;18(1):48-57.
Singh V | Rastogi N | Mathur N | Singh K | Singh MP
Single nucleotide polymorphism (SNP) at position -309 (T309G) in MDM-2 promoter induces tumor formation in the individuals possessing inherited p53 mutations. The present study was undertaken to investigate the association of MDM-2 SNP309, p53 Arg72Pro, and p53 intron-6 G/A polymorphism with total, premenopausal, and postmenopausal breast cancer risks in Indian women. Genotyping of MDM-2 SNP309, p53 Arg72Pro, and p53 intron-6 G/A in 104 patients and 105 controls was performed either by ARMS-PCR or by polymerase chain reaction and direct sequencing. The p53 Arg72Pro heterozygous variant and in combination with its homozygous variant exhibited a significant protective association with total (odds ratio [95% confidence interval]: 0.42 [0.22-0.81] and 0.46 [0.25-0.85], p value; 0.007 and 0.012) and postmenopausal breast cancer risk (odds ratio [95% confidence interval]: 0.25 [0.07-0.73] and 0.27 [0.08-0.77], p value; 0.009 and 0.013]. Neither combined nor homozygous/heterozygous MDM-2 SNP309G was associated with total, premenopausal, or postmenopausal breast cancer risk; however, MDM-2 SNP309G, along with p53 Arg72Pro heterozygous variant, showed a significant protective association with premenopausal breast cancer risk (odds ratio [95% confidence interval]: 0.18 [0.02-1.20], p value; 0.041 for homozygous + heterozygous MDM-2 SNP309G). The results indicate protective associations of p53 Arg72Pro heterozygous variant with postmenopausal and MDM-2 SNP309G along with p53 Arg72Pro heterozygous variant with premenopausal breast cancer risk.

Prevalence of sexual problems and its association with social, psychological and physical factors among men in a Malaysian population: A cross-sectional study
(Abstract; subscription needed for full text; Asia)
Journal of Sexual Medicine. 2008 Jan;5(1):70-76.
Quek KF | Abdul Sallam A | Ng CH | Chua CB
Sexual problems are common in the general population. Studies have shown that most of these sexual problems are related to their social lives, medical illnesses, and psychological status. Among the sexual problems in men, premature ejaculation (PE) is one of the most frequent, yet it is the least well-understood of the sexual dysfunctions of men. The aim was to determine the prevalence of sexual problem particularly PE and erectile dysfunction (ED) among people living in urban areas and to investigate the characteristics associated with these sexual problems in a Malaysian population. The PE which is defined as an intravaginal ejaculation latency time less than 2 minutes was assessed in the ED and non-ED group. The Hospital Anxiety and Depression scale is used as a measure of the psychological status [30]. The ED status was assessed using the International Index of Erectile Function questionnaire. The prevalence of self-reported sexual problems for ED and PE were 41.6% and 22.3%, respectively. In those subjects with ED, 33.5% reported to have PE. Of the total of 430 subjects, anxiety was present in 8.1%, while depression was 5.3%. The prevalence of PE accounted for 25% anxiety and 14.6% for depression respectively in the population. EDs were associated with diabetes and hypertension (OR [95% CI]: 5.33 [2.33, 10.16], 3.40 [1.76, 6.57], P less than 0.05), respectively, while factors associated with PE were anxiety and depression (OR [95% CI]: 1.29 [0.68, 2.45], 1.39 [0.69, 2.78]), respectively. Prevalence of ED is associated with medical symptoms such as diabetes and hypertension and a rise in the prevalence of age while psychological distress such as anxiety and depression also contribute to a higher PE rate.

What we know about intimate partner violence in the Middle East and North Africa
(Abstract; subscription needed for full text; North Africa | Middle East)
Violence Against Women. 2008 Jan;14(1):53-70.
Boy A | Kulczycki A
Little is known about intimate partner violence in the Middle East and North Africa. This review synthesizes and critically evaluates the literature. Of 59 studies found, only 21 reported data on the prevalence of such violence or on beliefs regarding its justification, covering just 9 countries. Spousal abuse is pervasive and widely accepted. Victims are of all ages and are more likely to be rural and less educated. National data from Egypt and Jordan indicate almost 9 in 10 ever-married women accept at least one reason for wife beating. Change is possible but will require increased research, coalition building, and intervention efforts.

Human papillomavirus infection and the development of cervical cancer and related genital neoplasias
(Abstract; subscription needed for full text; Global)
International Journal of Infectious Diseases. 2007 Dec;11 Suppl 2:S3-S9.
Paavonen J
The human papillomaviruses (HPV) are simple, nonenveloped, double-stranded DNA viruses, which are responsible for an enormous global burden of genital disease. HPV is associated with 500,000 new cases of cervical cancer and 250,000 cervical cancer deaths worldwide each year. Oncogenic HPV types 16 and 18 are responsible for a majority of cervical cancers and can also cause low- and high-grade cervical lesions (CIN 1, 2, 3) as well as high-grade vulvar or vaginal intraepithelial neoplasia (VIN or VaIN 2/3). Nononcogenic types HPV 6 and 11 also contribute to the overall burden of HPV disease, giving rise to CIN 1, anogenital warts, cutaneous lesions, and respiratory papillomatosis. A substantial body of clinical evidence demonstrates the effectiveness of cytological screening in preventing cervical cancer, but these techniques have not eradicated the disease and are not widely available in most developing countries. Furthermore, evaluation and management of HPV-associated cytologic abnormalities is costly, drains health care resources, and increases the risk for adverse pregnancy outcome. Targeting cervical cancer through universal immunization with a quadrivalent HPV 6, 11, 16, 18 vaccine may herald the beginning of the end of this deadly disease and substantially reduce the overall global burden of HPV-related genital diseases.

HIV/AIDS and STIs NEWS

India: Female condoms, an emerging market in India
(News Article; Asia)
31 Dec 2007
Basu N, India eNews

Uganda needs more HIV solutions
(Commentary; Sub-Saharan Africa)
31 Dec 2007
Ssengooba F, The New Vision

HIV/AIDS and STIs RESEARCH

Bacterial contamination and over-dilution of commercial infant formula prepared by HIV-infected mothers in a prevention of mother-to-child transmission (PMTCT) programme, South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Tropical Pediatrics. 2007 Dec;53(6):409-414.
Andresen E | Rollins NC | Sturm AW | Conana N | Greiner T
To examine the safety of formula feeds used by mothers participating in a Prevention of Mother-to-Child Transmission (PMTCT) programme, contents of 94 feeding bottles collected at a PMTCT-clinic were analysed. An additional 17 samples were taken from already prepared feeds during home visits, as well as 21 samples from bottles prepared under observation. Living conditions and educational levels were overall good and mothers had been counselled on safe formula preparation. Samples were analysed for faecal bacteria, using Escherichia coli and Enterococcus sp. as indicators. Protein concentration was used as an indicator of concentration of the formula. Out of 94, 63 (67%) of samples obtained at the clinic and 13/16 (81%) of available home samples were contaminated with faecal bacteria, compared to 8/21 (38%) of those prepared under observation. Out of 94, 58 (62%) of the clinic samples containing E. coli and 23/94 (24%) of those containing Enterococcus sp. were contaminated with more than the US government recommended limit of 10 CFU/ml. Out of 94, 26 (28%) of samples obtained at the clinic, 8/17 (47%) of home samples and 3/21 (14%) of those prepared under observation were over-diluted, compared to standards. Many mothers did not follow recommended practices in preparing and feeding the bottles.

HIV prevalence, previous HIV testing, and condom use with clients and regular partners among Senegalese commercial sex workers
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2007 Dec 1;83(7):534-540.
Wang C | Hawes SE | Gaye A | Sow PS | Ndoye I
The objectives were to assess HIV prevalence and risk factors for HIV infection, to investigate condom use among registered female commercial sex workers (CSWs) in Senegal, West Africa, and to examine the association between previous HIV testing, knowledge of HIV serostatus and condom use with both regular sex partners and clients within this population. A cross-sectional study was conducted at three sexually transmitted disease clinics among 1052 Senegalese registered CSWs between 2000 and 2004. Inperson interviews soliciting information concerning demographic characteristics, medical history, sexual behaviour with clients and regular partners, and previous HIV testing history were performed. Blood samples were collected for determination of HIV-1 and/or HIV-2 serostatus. Multivariable, Poisson and log-binomial models were used to calculate prevalence ratios. The overall HIV prevalence was 19.8%. Over 95% of CSWs reported always using a condom with clients, but only 18% reported always using a condom with their regular partners. A history of previous HIV testing was not associated with condom use with clients (adjusted prevalence ratio (APR) = 0.98, 95% confidence intervals, CI: 0.90 to 1.06). However, prior HIV testing was associated with decreased condom use with their regular partners (APR = 0.44, 95% CI: 0.28 to 0.69), especially in women who tested HIV negative (APR = 0.17, 95% CI: 0.08 to 0.36). CSWs in Senegal have a high HIV prevalence; therefore preventing HIV transmission from this population to the general population is important. Condom use with regular partners is low among registered CSWs in Senegal, and a prior HIV negative test is associated with even less condom use with regular partners. Intervention efforts to increase condom use with regular sexual partners are needed.

Characteristics and outcomes of adult patients lost to follow-up at an antiretroviral treatment clinic in Johannesburg, South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Jan 1;47(1):101-107.
Dalal RP | MacPhail C | Mqhayi M | Wing J | Feldman C
A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes for discontinuing ART follow-up in resource-limited settings are not well understood. A retrospective analysis was conducted of all adult patients receiving ART at an urban public clinic in Johannesburg, South Africa between April 2004 and June 2005. Patients discontinuing follow-up for at least 6 weeks were identified and further studied, and causes for treatment default were tabulated. Of 1631 adult patients studied, 267 (16.4%) discontinued follow-up during the study period. Gender, ethnicity, and age were not predictive of loss to follow-up. Of those discontinuing follow-up, 173 (64.8%) were successfully traced. Death accounted for 48% (n = 83) of those traced. Characteristics associated with death were older age at ART initiation (P = 0.022), lower baseline CD4 cell count (P = 0.0073), higher initial HIV RNA load (P = 0.024), and loss of weight on ART (P = 0.033). Date of death was known for 71% (n = 59) of patients traced deceased, of whom 83% (n = 49) had died within 30 days of active ART. Common nonmortality losses included relocation or clinic transfer (25.4%) and hospitalization or illness not resulting in death (10.4%). Few cited financial difficulty or medication toxicity as reasons for discontinuing follow-up. Nearly 1 in 6 patients receiving ART in a resource-constrained setting had discontinued follow-up over a 15-month period. Early mortality was high, especially in those with profound immunosuppression. Improving access to care and streamlining patient tracking may improve ART outcomes.

Acceptability of hypothetical microbicides among women in sex establishments in rural areas in southern China
(Abstract; subscription needed for full text; Asia)
Sexually Transmitted Diseases. 2008 Jan;35(1):102-110.
Wang Y | Liao SS | Weeks MR | Jiang JM | Abbott M
The objectives of this study were to measure the potential acceptability of a hypothetical microbicide among women in sex establishments in rural areas of Southern China and demographic, behavioral, and social context factors likely to affect microbicide acceptability. This was a cross-sectional survey, using a quota sampling, among 300 women from sex establishments in 3 rural towns. An interviewer-administered standardized questionnaire was used to measure the acceptability score of hypothetical microbicides' characteristics, as well as sexual relationships and behaviors and other contextual factors. Findings showed a generally positive response to microbicides, indicated by an acceptability index score of 2.89 (SD, 0.56, scale of 1-4) in the overall sample. Multivariate analysis shows that the acceptability score varied significantly by study sites, type of sex-work establishments, marital status, sex partner type, vaginal product experience, locus of control by partners, and locus of control by chance. Microbicides may be acceptable among sex workers in rural settings in China; however, contextual factors should be carefully considered in education and promotion of microbicides in the future.

Ethical and public health considerations in HIV counseling and testing: Policy implications
(Abstract; subscription needed for full text; Global | Sub-Saharan Africa)
Studies in Family Planning. 2007 Dec;38(4):271-278.
Yeatman SE
Related Abstract; subscription needed for full text: Should caregivers be compelled to disclose patients' HIV infection to the patients' sex partners without consent?
Related Abstract; subscription needed for full text: Routine testing for HIV/AIDS in sub-Saharan Africa: A philosopher's perspective
HIV counseling and testing is broadly considered a critical component of HIV transmission-prevention and treatment efforts. Given the severity of the AIDS pandemic in sub-Saharan Africa, the potential societal benefit of testing is invoked to call for its massive expansion and to justify a shift from voluntary to routine testing. Surprisingly little evidence has demonstrated, however, that such a shift will result in the intended benefits to communities, particularly that of reducing the horizontal transmission of HIV. This analysis addresses and critiques the assumptions underlying a serostatus-based approach to behavior change and discusses the ethical consequences of transferring control of the decision to be tested from the individual to the provider. It concludes with a discussion of the implications for HIV counseling and testing policies and proposes alternatives to routine testing that have the potential to be effective while preserving the right to know one's HIV status.

Should caregivers be compelled to disclose patients' HIV infection to the patients' sex partners without consent?
(Abstract; subscription needed for full text; Global)
Studies in Family Planning. 2007 Dec;38(4):297-306.
Odunsi B
The emergence of the HIV/AIDS pandemic has added to the tension between patients' private interests and public health interests regarding medical confidentiality. Many people become infected with HIV because they are unaware of the positive serostatus of their sexual partners. Informing or warning the sexual partners of HIV-positive patients of the patients' serostatus could assist in curtailing the spread of HIV/AIDS because sexual partners can thereby choose to avoid having unprotected sex with infected persons. By law, however, doctors have a duty to their patients to protect their medical confidentiality. Doctors, therefore, face a dilemma concerning which should prevail: patients' right to privacy and confidentiality or the importance to society of controlling the spread of the pandemic. Most medical regulatory bodies do not take clear-cut positions on the issue, leaving the decision to the discretion of individual doctors. The question of whether doctors should be legally empowered to breach the confidence of patients to protect the patients' sexual partners is discussed here with reference to the existing laws of Canada, the United States, and Nigeria.

Using mystery clients to assess condom negotiation in Malawi: Some ethical concerns
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Studies in Family Planning. 2007 Dec;38(4):322-330.
van den Borne F
To halt the HIV/AIDS epidemic in Malawi, donors supported the government in promoting safer sex among women who solicit sex with men in and around bars. In 1996, a qualitative study explored the changing dynamics of concurrent sexual partnerships, using a variety of researchers and methods. Although most international ethical research codes prescribe the informed consent of research subjects, the present author, as principal investigator for that study, included the mystery-client method, which omits informants' consent. Five trained, pilot-tested, and closely supervised male researchers contacted 101 bar girls and "freelancing" women in trading and urban centers to assess the women's ability to negotiate condom use. The men posed as clients but were instructed not to have sex with their informants. This approach provided important contextualized information to improve HIV transmission-prevention programs, yet it raises ethical concerns. This article is intended to contribute to the dialogue and debate on ethical research involving mystery clients and to encourage other researchers to share their ethical dilemmas and show how they have addressed them.

MATERNAL AND CHILD HEALTH NEWS

Ghana: Central region health service targets zero maternal mortality
(News Article; Sub-Saharan Africa)
21 Dec 2007
Paintsil D A, Ghanaian Chronicle (Accra)

Nigeria: NGO proposes law on free maternal health
(News Article; Sub-Saharan Africa)
16 Dec 2007
Daily Trust (Abuja)

Niger: Botched birth survivors battle fistula
(News Article; Sub-Saharan Africa)
21 Dec 2007
Integrated Regional Information Networks
Related News Article: Niger: Where childhood ends on the marriage bed
Related News Article: Niger: Why are so many mothers dying?

Southern Africa: Malaria - life threatening during pregnancy
(News Article; Sub-Saharan Africa)
31 Dec 2007
Jamieson P, The Chronicle Newspaper (Lilongwe)

MATERNAL AND CHILD HEALTH RESEARCH

Auxologic, biochemical and clinical (ABC) profile of low birth weight babies: A 2-year prospective study
(Abstract; subscription needed for full text; Asia)
Journal of Tropical Pediatrics. 2007 Dec;53(6):374-382.
Elizabeth KE | Krishnan V | Zachariah P
Low Birth Weight (LBW) is a key determinant of neonatal mortality, morbidity, subsequent growth and development as well as early onset of adulthood diseases. It represents a conflation of two outcomes-preterm- and term 'light for date' (LFD) babies. This study looks at key auxologic, biochemical and clinical (ABC) parameters of a cohort of LBW babies, both preterm- and term in comparison to a group of normal-term (control) babies. An attempt was also made to see how these parameters were at the end of a 2 year follow-up period with the currently available interventions. A cohort of 500 babies was selected at birth from a tertiary care teaching hospital in Kerala, India, key ABC indices were measured including relevant maternal data. The initial biochemical measurements were done using umbilical cord blood. Currently recommended nutritional interventions were provided to all the normal and LBW babies. At the end of 2 years, the measurements were repeated in a subset of babies available for follow-up (n = 147). From the cohort of 500 babies, two had to be eliminated as biochemical parameters could not be done due to technical reasons from the available umbilical cord blood. They were categorized into three groups: preterm-LBW (11.85%), term-LBW (38.55%) and normal-term controls (49.6%). The maternal characteristics like socio-economic status, maternal weight, height, BMI and hemoglobin levels were comparable in the three subsets. All of them belonged to middle or low-socio-economic status representing the non-affluent. In the initial group (n = 498), all the auxologic measurements and the nutrients measured namely, total protein, albumin, total cholesterol, triglycerides, calcium, magnesium, zinc and iron levels were significantly lower (p less than 0.05) among LBW, lowest in preterm followed by term-LBW, compared to term controls. Total iron binding capacity showed inverse correlation with iron level. Protein, albumin, calcium and iron levels were low in many babies, and mean calcium and iron levels were below the normal range in all the three subsets reflecting reduced transfer from the mother. At the end of 2 years, calcium, magnesium, zinc and iron were significantly lower in preterm- and term-LBW (p less than 0.05) compared to controls and mean value of serum calcium continued to be below the normal range in all the three subsets. At final follow-up, majority of the LBW babies had varying grades of malnutrition and only 1 (7%) of preterm-LBW subset and 13 (28%) of term-LBW subset had optimum catch up growth resulting in normal nutritional status with the existing interventions. Three (3.5%) of the normal babies were noted to slip down to malnutrition at the end of 2 years. Preterm- and term-LBW babies are born with significantly lower nutrient reserves at birth compared to term-normal babies, this was lowest among the preterm babies. As this reserve may be further lowered by recurrent infections and inappropriate feeding habits, there is a need for special feeding and nutrient supplements in this group. Calcium and iron levels were suboptimum at birth and calcium levels remained suboptimum even at the end of 2 years in all three subsets including controls in this non-affluent group. Currently available interventions may prevent the occurrence of overt clinical nutrient deficiencies, but do not ensure optimum growth, even among normal birth weight babies as some of these babies were seen to slip into the pool of malnutrition subsequently. Specialized nutritional surveillance and supplements are recommended for LBW babies to promote optimum growth and prevent subclinical nutrient deficiencies. Infant feeding practices should be strengthened and integrated with the existing health care programs to reach all the beneficiaries. Along with the existing special supplementation programs like iron folic acid, vitamin A, iodine etc., calcium supplementation should also be considered. It is also essential to concentrate on the girl child, the adolescent girl, prospective mother and prenatal mother to ensure optimum nutrition and nutrient transfer to future offsprings.

Equity of skilled birth attendant utilization in developing countries: Financing and policy determinants
(Abstract; subscription needed for full text; Global)
American Journal of Public Health. 2008 Jan;98(1):142-147.
Kruk ME | Prescott MR | Galea S
Developing countries with higher health care spending have greater overall utilization of maternal health services than do countries with lower spending. However, the rich tend to disproportionately use these services. The authors assessed whether redistributive government policies in the context of higher levels of health spending were associated with more-equitable use of skilled birth attendants (doctors, nurses, or midwives) between rich and poor. The authors used data from Demographic and Health Surveys of 45 developing countries and disaggregated by wealth quintile. Multivariable regression analyses were used to assess the joint effect of higher health care expenditures, the wealth distribution of women's fifth-grade education (a proxy for redistributive policy environment within the central government) and the overall proportion of women with fifth-grade education (a proxy for female literacy and an indicator of governments' commitment to girls' education). The authors found that utilization of skilled birth attendants was more equitable when higher health expenditures were accompanied by redistributive education policies. Higher health care expenditures should be accompanied by redistributive policies to reduce the gap in utilization of skilled birth attendants between poorer and richer women in developing countries.

HIV-associated orphanhood and children's psychosocial distress: Theoretical framework tested with data from Zimbabwe
(Abstract; subscription needed for full text; Sub-Saharan Africa)
American Journal of Public Health. 2008 Jan;98(1):133-141.
Nyamukapa CA | Gregson S | Lopman B | Saito S | Watts HJ | Monasch R | Jukes MCH
The authors measured the psychosocial effect of orphanhood in a sub-Saharan African population and evaluated a new framework for understanding the causes and consequences of psychosocial distress among orphans and other vulnerable children. The framework was evaluated using data from 5321 children aged 12 to 17 years who were interviewed in a 2004 national survey in Zimbabwe. The authors constructed a measure of psychosocial distress using principle components analysis. The authors used regression analyses to obtain standardized parameter estimates of psychosocial distress and odds ratios of early sexual activity. Orphans had more psychosocial distress than did nonorphans. For both genders, paternal, maternal, and double orphans exhibited more-severe distress than did nonorphaned, nonvulnerable children. Orphanhood remained associated with psychosocial distress after the authors controlled for differences in more-proximate determinants. Maternal and paternal orphans were significantly more likely than were nonorphaned, nonvulnerable children to have engaged in sexual activity. These differences were reduced after we controlled for psychosocial distress. Orphaned adolescents in Zimbabwe suffer greater psychosocial distress than do nonorphaned, nonvulnerable children, which may lead to increased likelihood of early onset of sexual intercourse and HIV infection. The effect of strategies to provide psychosocial support should be evaluated scientifically.

Midwifery provision in two districts in Indonesia: How well are rural areas served?
(Abstract; subscription needed for full text; Asia)
Health Policy and Planning. 2008 Jan;23(1):67-75.
Makowiecka K | Achadi E | Izati Y | Ronsmans C
Attention has focused recently on the importance of adequate and equitable provision of health personnel to raise levels of skilled attendance at delivery and thereby reduce maternal mortality. Indonesia has a village-based midwife programme that was intended to increase the rate of professional delivery care and redress the urban/rural imbalance in service provision by posting a trained midwife in every village in the country. The authors present findings on the distribution of midwifery provision in our study area: 10% of villages do not have a midwife but a nurse as a midwifery provider; there is a deficit in midwife density in remote villages compared with urban areas; those assigned to remote areas are less experienced; midwives manage few births and this may compromise their capacity to maintain professional skills; over 90% of non-hospital deliveries take place in the woman's (64%) or the midwife's (28%) home; three-quarters of midwives did not make regular use of the fee exemption scheme; midwives who live in their assigned village spend more days per month on clinical work there. The authors conclude that adequate provider density is an important factor in effective health care and that efforts should be made to redress the imbalance in provision, but that this can only contribute to reducing maternal mortality in the context of a supportive professional environment and timely access to emergency obstetric care.

Paying the price: The cost and consequences of emergency obstetric care in Burkina Faso
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Social Science and Medicine. 2008 Feb;66(3):545-557.
Storeng KT | Baggaley RF | Ganaba R | Ouattara F | Akoum MS | Filippi V
Substantial healthcare expenses can impoverish households or push them further into poverty. In this paper, the authors examine the cost of obstetric care and the social and economic consequences associated with exposure to economic shocks up to a year following the end of pregnancy in Burkina Faso. Burkina Faso is a low-income country with poor health outcomes and a poorly functioning health system. The authors present an inter-disciplinary analysis of an ethnographic study of 82 women nested in a prospective cohort study of 1013 women. The authors compare the experiences of women who survived life-threatening obstetric complications ('near-miss' events) with women who delivered without complications in hospitals. The cost of emergency obstetric care was significantly higher than the cost of care for uncomplicated delivery. Compared with women who had uncomplicated deliveries, women who survived near-miss events experienced substantial difficulties meeting the costs of care, reflecting the high cost of emergency obstetric care and the low socioeconomic status of their households. They reported more frequent sale of assets, borrowing and slower repayment of debt in the year following the expenditure. Healthcare costs consumed a large part of households' resources and women who survived near-miss events continued to spend significantly more on healthcare in the year following the event, while at the same time experiencing continued cost barriers to accessing healthcare. In-depth interviews confirm that the economic burden of emergency obstetric care contributed to severe and long-lasting consequences for women and their households. The necessity of meeting unexpectedly high costs challenged social expectations and patterns of reciprocity between husbands, wives and wider social networks, placed enormous strain on everyday survival and shaped physical, social and economic well-being in the year that followed the event. In conclusion, the authors consider the implications of our findings for financing mechanisms for maternity care in low-income settings.

Prescribing in maternity care in Russia: The legacy of Soviet medicine
(Abstract; subscription needed for full text; Europe)
Health Policy. 2008 Feb;85(2):242-251.
Danichevski K | McKee M | Balabanova D
Remarkably, there has been very little detailed research on clinical practice in Russia and its neighbours in what was the USSR, even though it is known that the USSR was isolated from many international developments, in particular evidence-based medicine. In this study the authors examine obstetric practice, an area of practice where there is an extensive body of evidence on the appropriateness of many interventions. The study is undertaken in Tula, a region 200 km south of Moscow. Building on earlier detailed analyses of data from the facilities in the region, it reports a series of structured interviews with 52 obstetricians from all 19 facilities in the region, designed to identify patterns of prescribing, supplemented by 36 more detailed re-interviews to explore reasons for the differing practices. The study demonstrates a widespread divergence from internationally accepted practice. Maternity care is extremely medicalised but many non-evidence based medicines are used. Some are heavily marketed by large pharmaceutical companies, some were widely used during the Soviet period but never evaluated, and a few are not known to be used anywhere else in the world. For several conditions, the most widely used drugs are clearly inferior to alternative products and some are used for indications quite different from those in other countries. This study contributes to the growing evidence that much of the care provided in Russian maternity units is ineffective or potentially dangerous but also begins to offer some explanations for why this is, including a lack of access to information and a lack of awareness of the concept of evidence-based practice.

Efficacy of a pentavalent rotavirus vaccine in reducing rotavirus-associated health care utilization across three regions (11 countries)
(Abstract; subscription needed for full text; Global)
International Journal of Infectious Diseases. 2007 Dec;11 Suppl 2:S29-S35.
Vesikari T | Itzler R | Matson DO | Santosham M | Christie CD | Coia M | Cook JR | Koch G | Heaton P
The objective was to evaluate the effect of a human-bovine reassortant pentavalent rotavirus vaccine (PRV) on health care encounters in nearly 70 000 subjects randomized in three regions - Europe, the United States, and Latin America/the Caribbean - in the Rotavirus Efficacy and Safety Trial (REST). Healthy 6- to 12-week-old infants received 3 doses of PRV or placebo at 4- to 10-week intervals. The exact binomial method for ratios of Poisson counts was used to evaluate the effect of PRV on the rate of rotavirus-related hospitalizations and emergency department (ED) visits involving rotavirus G-types 1-4 occurring greater than or equal to 14 days after the third dose of vaccine for up to 2 years. In fully vaccinated infants, reductions in rotavirus-associated hospitalizations and ED visits were 94.7% (95% CI: 90.9, 96.9) in Europe, 94.9% (95% CI: 84.0, 98.9) in the United States, and 90.0% (95% CI: 29.4, 99.8) in the Latin American/Caribbean regions. PRV reduced hospitalizations and ED visits within each region in REST. Results were consistent across regions and across the overall study cohort.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

90 million Filipinos
(News Article; Asia)
2 Jan 2008
Manila Standard Today

Fast population growth menacing Yemen’s economy
(News Article; Middle East)
31 Dec 2007
Middle East Online

Russian population dropped this year
(News Article; Asia)
29 Dec 2007
United Press International

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

The decline of son preference in South Korea: The roles of development and public policy
(Abstract; subscription needed for full text; Asia)
Population and Development Review. 2007 Dec;33(4):757-783.
Chung W | Das Gupta M
Since the mid-1990s, sex ratios at birth in South Korea have steadily declined, setting a precedent in Asia. What light does the South Korean experience shed on the relationship between development and son preference? Further, what are the implications of the South Korean experience for trends in other countries such as China and India, and what policies might help reduce son preference there? Will those countries have to wait until they are as highly developed as South Korea before child sex ratios begin to normalize?

Brain drain potential in Botswana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Migration. 2007 Dec;45(5):115-145.
Campbell EK
This paper examines the prospect of emigration of skilled professional citizens from Botswana. Since 1980, international migration of skilled people from, and within, sub-Saharan Africa (SSA) has surpassed anything previously witnessed in the twentieth century. One consequence of the increasing frequency of such migration is growing governmental resistance in developed countries to free movement of skilled labour. Unlike most SSA countries, Botswana's robust economy and long-standing democratic political structure make it appear an unlikely candidate for massive brain drain, but there are already indicators pointing towards its occurrence (Campbell, 2001). This study was designed primarily to determine whether professionals persist in their intention to leave the country and, if so, why they want to migrate. The results point towards a likelihood of massive brain drain in Botswana in the near future, although the prospects of this being realized cannot be ascertained by the instruments employed in this study. Among the key findings are that: 1) the unhappiness of future professionals seems to derive from poor opportunities for professional advancement resulting in disequilibrium between income distribution and a taste for luxury goods; 2) the prospects for emigration have improved because of increased earnings and but better access to information technology, and; 3) that technology may now be a more important motivation for emigration than family members living abroad. Nonetheless, there is evidence that a vigorous and sustained economy-enhancing campaign by the government would encourage Botswana professionals to stay and work in the country.

The healthy migrant effect: New findings from the Mexican Family Life Survey
(Abstract; subscription needed for full text; North America)
American Journal of Public Health. 2008 Jan;98(1):78-84.
Rubalcava LN | Teruel GM | Thomas D | Goldman N
We used nationally representative longitudinal data from the Mexican Family Life Survey to determine whether recent migrants from Mexico to the United States are healthier than other Mexicans. Previous research has provided little scientific evidence that tests the "healthy migrant" hypothesis. Estimates were derived from logistic regressions of whether respondents moved to the United States between surveys in 2002 and 2005, by gender and urban versus rural residence. Covariates included physical health measurements, self-reported health, and education measured in 2002. Our primary sample comprised 6446 respondents aged 15 to 29 years. Health significantly predicted subsequent migration among females and rural males. However, the associations were weak, few health indicators were statistically significant, and there was substantial variation in the estimates between males and females and between urban and rural dwellers. On the basis of recent data for Mexico, the largest source of migrants to the United States, we found generally weak support for the healthy migrant hypothesis.

Implementation of a new birth record in three hospitals in Jordan: A study of health system improvement
(Abstract; subscription needed for full text; Middle East)
Health Policy and Planning. 2008 Jan;23(1):76-82.
Khresheh R | Barclay L
This study tested the introduction of a new integrated clinical record in Jordan where currently no clinical report links antenatal, birth and postnatal care for women. As a result, no continuity of information is provided to clinicians nor are there national statistics on trends, or performance of hospitals around birth. Our study was conducted in the Jordanian Ministry of Health, the maternity wards and registration departments of three hospitals in Jordan and in the Maternal and Child Health Centres located near these hospitals. We used an exploratory, descriptive design and practice-research engagement to investigate and report on the process of change to improve and implement the new birth record. Through engaging practitioners in research, care improved, the quality of reporting changed, managers developed more effective measures of hospital performance and policy makers were provided with information that could form the basis of a national maternity data monitoring system. Quantitative and qualitative audit data demonstrated improved clinical reporting, organizational development and sustained commitment to the new record from clinicians, managers and policy leaders.

Fertility differences by housing type: The effect of housing conditions or of selective moves?
(Abstract; subscription needed for full text; Europe)
(You need Adobe Acrobat Reader to access this document)
Demographic Research. 2007 Dec 20;17(26):775-802.
Kulu H | Vikat A
This study examines fertility variation across housing types and childbearing patterns following housing changes. While the effect of family changes on housing choices has been studied in detail, little is known about childbearing patterns within various housing types, and this despite the fact that many studies suggest housing to be an important determinant of fertility. We use longitudinal register data from Finland and apply hazard regression. First, we observe a significant variation in fertility levels across housing types - fertility is highest among couples living in single-family houses and lowest among those residing in apartments, with the variation remaining significant even after controlling for the demographic and socio-economic characteristics of women. Second, our results show elevated fertility levels after couples have changed dwellings, suggesting that much of the fertility variation across housing types is attributed to selective moves. Third, the study reveals a relatively high risk of third birth for couples in single-family houses several years after the move. This suggests that living in spacious housing and in a family-friendly environment for a relatively long time leads to higher fertility.

Migration and union dissolution in a changing socio-economic context: The case of Russia
(Abstract; subscription needed for full text; Asia)
(You need Adobe Acrobat Reader to access this document)
Demographic Research. 2007 Dec 20;17(27):803-820.
Muszynska M | Kulu H
Previous studies show that family migration is usually to the benefit of the man's professional career and that it has a negative impact on the woman's economic well-being and employment. This study extends previous research by examining the effect of family migration on union dissolution. We use the event-history data of two retrospective surveys from Russia and apply hazard regression. The analysis shows that couples who move frequently over long distances have a significantly higher risk of union dissolution than couples who do not move or move only once. Our further analysis reveals that the risk of disruption for frequent movers is high when the migrant woman has a job. Frequent migrants had a high risk of union dissolution during the Soviet period but they faced no such risk during the post-Soviet socio-economic transition. We argue that frequent moving increases union instability through a variety of mechanisms, the effect of which may vary across socio-economic contexts.

DSS and DHS: Longitudinal and cross-sectional viewpoints on child and adolescent mortality in Ethiopia
(Research Article; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Population Health Metrics. 2007 Dec 27;5(12):[20] p..
Byass P | Worku A | Emmelin A | Berhane Y
In countries where routine vital registration data are scarce, Demographic Surveillance Sites (DSS: locally defined populations under longitudinal surveillance for vital events and other characteristics) and Demographic and Health Surveys (DHS: periodic national cluster samples responding to cross-sectional surveys) have become standard approaches for gathering at least some data. This paper aims to compare DSS and DHS approaches, seeing how they complement each other in the specific instance of child and adolescent mortality in Ethiopia. Data from the Butajira DSS 1987-2004 and the Ethiopia DHS rounds for 2000 and 2005 formed the basis of comparative analyses of mortality rates among those aged under 20 years, using Poisson regression models for adjusted rate ratios. Patterns of mortality over time were broadly comparable using DSS and DHS approaches. DSS data were more susceptible to local epidemic variations, while DHS data tended to smooth out local variation, and be more subject to recall bias. Both DSS and DHS approaches to mortality surveillance gave similar overall results, but both showed method-dependent advantages and disadvantages. In many settings, this kind of joint-source data analysis could offer significant added value to results.

The reach and impact of social marketing and reproductive health communication campaigns in Zambia
(Research Article; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
BMC Public Health. 2007 Dec 18;7(352):[33] p..
Van Rossem R | Meekers D
Like many sub-Saharan African countries, Zambia is dealing with major health issues, including HIV/AIDS, family planning, and reproductive health. To address reproductive health problems and the HIV/AIDS epidemic in Zambia, several social marketing and health communication programs focusing on reproductive and HIV/AIDS prevention programs are being implemented. This paper describes the reach of these programs and assesses their impact on condom use. This paper assesses the reach of selected radio and television programs about family planning and HIV/AIDS and of communications about the socially marketed Maximum condoms in Zambia, as well as their impact on condom use, using data from the 2001-2002 Zambia Demographic and Health Survey. To control for self-selection and endogeneity, we use a two-stage regression model to estimate the effect of program exposure on the behavioural outcomes. Those who were exposed to radio and television programs about family planning and HIV/AIDS were more likely to have ever used a condom (OR=1.16 for men and 1.06 for women). Men highly exposed to Maximum condoms social marketing communication were more likely than those with low exposure to the program to have ever used a condom (OR=1.48), and to have used a condom at their last sexual intercourse (OR=1.23). Findings suggest that the reproductive health and social marketing campaigns in Zambia reached a large portion of the population and had a significant impact on condom use. The results suggest that future reproductive health communication campaigns that invest in radio programming may be more effective than those investing in television programming, and that future campaigns should seek to increase their impact among women, perhaps by focusing on the specific constrains that prevent females from using condoms.

Intrinsic growth rates and net reproduction rates in the presence of migration
(Abstract; subscription needed for full text; Global)
Population and Development Review. 2007 Dec;33(4):657-666.
Preston SH | Wang H
Fertility rates in all developed countries are now below the replacement level. Partly in response to these low levels and their age-distributional consequences, international migration flows to the developed world have increased sharply (United Nations 2006: 84). Many developed countries face the prospect of population decline over the next decades unless they admit larger numbers of immigrants or find the means to promote higher fertility levels. Many of the conventional measures used in demography are not well suited to a world in which migration plays a major role, because they refer to hypothetical populations or cohorts that are assumed to be closed to migration. These classic measures demonstrate the implications of keeping age-specific rates of fertility and/or mortality fixed at some observed level and setting age-specific migration rates at zero. Such measures include the net reproduction rate, the gross reproduction rate, the total fertility rate, life expectancy at birth, and "intrinsic" rates of growth, birth, and death (i.e., rates that would eventually emerge if current age-specific fertility and mortality rates were indefinitely maintained with zero migration).

SPECIAL REPORTS/PROFILES/RESOURCES

Promoting safety of medicines for children
(Book; Global)
Geneva, Switzerland, World Health Organization, 2007. :59 p..
World Health Organization (WHO)
Monitoring the safety of medicine use in children is of paramount importance since, during the clinical development of medicines, only limited data on this aspect are generated through clinical trials. Use of medicines outside the specifications described in the licence (e.g. in terms of formulation, indications, contraindications or age) constitutes off-label and off-licence use and these are
a major area of concern. These guidelines are intended to improve awareness of medicine safety issues
among everyone who has an interest in the safety of medicines in children and to provide guidance on effective systems for monitoring medicine safety in the paediatric populations. The document will be of interest to all health-care professionals, medicine regulatory authorities, pharmacovigilance centres, academia, the pharmaceutical industry and policy-makers. Systems for monitoring medicine safety are described in Annex 1 - Pharmacovigilance
methods and some examples of recent information on adverse reactions to marketed medicines are discussed in Annex 2.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 8, Number 1 7 January 2008