Volume 8, Number 2
15 January 2008

Pop Reporter Tip: Would you like to comment on a research or news article in The Pop Reporter? Let your voice be heard by adding your comments to the INFOforhealth Blog at: http://www.infoforhealth.org/blog/.

ADOLESCENT HEALTH NEWS

Nigeria: Child rape in Kano on the increase
(News Article; Sub-Saharan Africa)
3 Jan 2008
UN Integrated Regional Information Networks

Nigeria: Aids killed 2.9m in 2006 - Unicef
(News Article; Sub-Saharan Africa)
3 Jan 2008
Buhari R, This Day (Lagos)

Uganda: School pregnancies - does anybody care?
(Feature Article; Sub-Saharan Africa)
4 Jan 2008
Namubiru L, New Vision (Kampala)

ADOLESCENT HEALTH RESEARCH

Contraceptive use by 15-year-old students at their last sexual intercourse
(Abstract; subscription needed for full text; Global)
Archives of Pediatrics and Adolescent Medicine. 2008 Jan;162(1):66-73.
Godeau E | Gabhainn SN | Vignes C | Ross J | Boyce W | Todd J
The objectives were to identify and report cross-national patterns in contraceptive use among sexually active adolescents. The design used was a cross-national cross-sectional survey. Data was collected in 2002 by self-report questionnaire from students in school classrooms. The participants in the study were a cluster sample of 33 943 students aged 15 years from 24 countries. The main outcome measures were international standardized questions on ever having had sexual intercourse and contraceptive use at last sexual intercourse. The percentages of students reporting having had sexual intercourse ranged from 14.1% in Croatia to 37.6% in England; 82.3% of those who were sexually active reported that they used condoms and/or birth control pills at last intercourse. Condom use only was most frequent and ranged from 52.7% in Sweden to 89.2% in Greece. Dual use of condoms and contraceptive pills was also relatively frequent, ranging from 2.6% in Croatia to 28.8% in Canada. The use of contraceptive pills was most frequent in northern and western Europe. No contraceptive use at last intercourse was reported by 13.2% of students. A substantial minority of 15-year-olds have engaged in sexual intercourse. Condom use is the most frequent method of contraception reported by the sexually active respondents, followed by the dual use of condoms and contraceptive pills and contraceptive pills only. The proportions of poorly protected and unprotected youth remain high, and attention to international policy and practice determinants of young sexual behavior and contraceptive use is required.

Systematic review of effectiveness of school-based sexual health interventions in sub-Saharan Africa
(Research Article; Sub-Saharan Africa)
BMC Public Health. 2008 Jan 7;8:4.
Paul-Ebhohimhen VA | Poobalan A | van Teijlingen ER
The HIV/AIDS epidemic remains of global significance and there is a need to target (a) the adolescent age-groups in which most new infections occur; and (b) sub-Saharan Africa where the greatest burden of the epidemic lies. A focused systematic review of school-based sexual health interventions in sub-Saharan Africa to prevent HIV/AIDS and Sexually Transmitted Infections (STI) in this age group was therefore conducted. Searches were conducted in Medline, Embase, Cinahl and PsychINFO according to agreed a priori criteria for studies published between 1986 and 2006. Further searches were conducted in UNAIDS and WHO (World Health Organization) websites, and 'Google'. Relevant journals were hand-searched and references cited in identified articles were followed up. Data extraction and quality assessment was carried out on studies selected for full text appraisal, and results were analysed and presented in narrative format. Some 1,020 possible titles and abstracts were found, 23 full text articles were critically appraised, and 12 articles (10 studies) reviewed, reflecting the paucity of published studies conducted relative to the magnitude of the HIV epidemic in sub-Saharan Africa. Knowledge and attitude-related outcomes were the most associated with statistically significant change. Behavioural intentions were more difficult to change and actual behaviour change was least likely to occur. Behaviour change in favour of abstinence and condom use appeared to be greatly influenced by pre-intervention sexual history. There is a great need in sub-Saharan Africa for well-evaluated and effective school-based sexual health interventions.

FAMILY PLANNING NEWS

Philippines: WV women second in contraceptive use prevalence rate
(News Article; Asia)
10 Jan 2008
Kalibo A, The News Today

Malaysia: Focus on parenting and reproductive health
(News Article; Asia)
10 Jan 2008
Chan D, The Star

FAMILY PLANNING RESEARCH

Provider perspectives on barriers to family planning quality in Uganda: A qualitative study
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Family Planning and Reproductive Health Care. 2008;34(1):37-41.
Mugisha JF | Reynolds H
Provider perspectives on the quality of family planning services have been overlooked in quality of care research and interventions. This qualitative study was carried out in four districts in Uganda, a country where lack of access to quality family planning services remains a challenge. Using four focus group discussions, 16 provider in-depth interviews and nine manager in-depth interviews, this study documented providers' perceptions of quality of care and of barriers to quality services at the organisational and societal levels. To guide study development, analysis and interpretation, the authors relied on an ecological framework where providers' abilities are shaped by the larger organisational and societal environments in which providers live and work. Providers felt that organisational factors, such as supply availability, workload and their own knowledge and skills, affected their abilities to offer quality care. At the same time, providers were challenged by societal factors such as male partner participation, financial constraints, misconceptions and leadership support. While making changes to the elements of quality care that clients experience is important, it is not sufficient in view of the organisational and social barriers. Across the different levels of the ecological framework, providers face barriers to providing quality family planning services that are synergistic. Solutions to improve quality of care must address also limitations at the organisational and societal levels since efforts to overcome a particular constraint are less likely to be successful if this interdependence is not taken into account.

Oral contraceptives in polycystic ovary syndrome: Risk-benefit assessment
(Abstract; subscription needed for full text; Global)
Seminars in Reproductive Medicine. 2008 Jan;26(1):111-120.
Yildiz BO
Combined oral contraceptive pills (OCPs) have been a key component of the chronic treatment of polycystic ovary syndrome (PCOS) by improving androgen excess and regulating menstrual cycles. Earlier epidemiologic studies with second- and third-generation OCPs in the general population have raised important questions regarding long-term cardiometabolic effects of these agents. In PCOS, there are only a few short-term studies with contradictory results evaluating potential adverse effects of OCPs on cardiovascular risk factors and glucose homeostasis. These studies included a small number of participants and did not take into account several confounding factors that might influence the outcome. Nevertheless, limited available data support the benefits of long-term OCP use in PCOS. By contrast, solid evidence for cardiometabolic adverse outcome with the use of these agents, especially with newer OCPs containing antiandrogenic progestins, is lacking. More studies are needed to resolve controversies regarding the safety of long-term OCP use in PCOS. Meanwhile, assessment of each PCOS patient's personal cardiometabolic risk profile should be an essential component of the evaluation before prescribing OCPs and also during follow-up.

The contraceptive vaginal ring: Female adolescents' knowledge, attitudes and plans for use
(Abstract; subscription needed for full text; Global)
Contraception. 2007 Dec;76(6):444-450.
Carey AS | Chiappetta L | Tremont K | Murray PJ | Gold MA
This study aimed to determine female adolescents' knowledge about the contraceptive vaginal ring and to assess their attitudes toward and consideration of ring use. We recruited 164 participants, ages 14-21, who completed a 62-item, 15-min interview assessing tampon and vaginal product use history, reproductive health history and ring awareness. Among those who had heard of the ring, knowledge was assessed with a 15-item pretest. All participants received a 2-min description of the ring with a demonstration, after which attitudes, consideration of use and posttest knowledge were assessed. Our study population is unique in that 92% had been sexually active and 22% who had been sexually active had also been pregnant. The mean age of coitarche was 15.2 years, and 35% had ever used emergency contraception. More than half (52%) had never heard of the ring. Of those who had heard of it, only 35% had sufficient knowledge. After a brief demonstration with a vaginal model, 98.2% acquired sufficient knowledge to use the ring correctly. More than half (57.9%) liked the idea of the ring, and 45.7% said that they would consider using it. Logistic regression demonstrated that liking the idea of the ring and considering its use were associated with comfort using at least one vaginal product, with those who were comfortable using a vaginal product being 3.1 times more likely to like the idea of the ring compared to those who were not comfortable using a vaginal product. Logistic regression also showed that liking the idea of the ring was associated with having had at least one pelvic exam. Most participants had limited or no prior ring knowledge. Once briefly educated, all had sufficient knowledge and a substantial percentage would consider using it. The ring appeals to adolescents and should be routinely offered as a method of contraception. Comfort using at least one vaginal product is associated with liking the idea of the ring and considering its use.

GENDER and HEALTH NEWS

Afghanistan: Marriage practice victimizes young girls, society
(News Article; Asia)
4 Jan 2008
Najibullah F, Radio Free Europe, Radio Liberty

Zambia: Gender violence haunts HIV positive women
(Report; Sub-Saharan Africa)
7 Jan 2008
Ochieng Z, The East African (Nairobi)
Related Report: Hidden in the mealie meal: Gender-based abuses and women’s HIV treatment in Zambia

Paraguay's traffic hub imperils female teens
(News Article; South America)
8 Jan 2008
Footner A, Women's Enews

GENDER and HEALTH RESEARCH

Gender, institutions and development: Better data, better policies
(Report; Global)
(You need Adobe Acrobat Reader to access this document)
Poverty in Focus. 2008 Jan;(13):10-11.
Drechsler D
Gender equality represents an untapped source when it comes to stimulating economic growth and promoting social development. This is particularly true in the developing world, where women are often systematically deprived from having equal access to social services as well as to physical and social capital. In fact, increased gender equality promises significant returns. Apart from being an important goal in itself, empowering women by improving their living conditions and enabling them to actively participate in the social and economic life of a country may well be the key for long-term sustainable development. According to the World Bank's World Development Report 2000/01, closing the gender gap in schooling would have significantly increased and sometimes more than doubled economic growth in sub-Saharan Africa, South Asia, and the Middle East and North Africa. Despite international declarations on gender equality, as examplified by the Millenium Development Goals, only few countries have actually achieved gender equality in primary and secondary education. The differences are even more pronounced in higher education. In South Asia and sub-Saharan Africa, for example, girls only make up half of the number of students in tertiary education.

Hypertension among females in a highly disadvantaged community in Jordan
(Abstract; subscription needed for full text; Middle East)
Health Care for Women International. 2008 Jan;29(1):39-53.
Shakhatreh FM | Suleiman AA | Mohammed FI | Alwan A
This study was conducted with the aim of finding the prevalence rate of hypertension and the relationship between hypertension and selected socioeconomic and dietary parameters in females aged 15-49 years in a disadvantaged community in Jordan. A household survey was carried out, using a questionnaire as an instrument for interviewing subjects. About 19% of females had hypertension, ranging between 7.5% in the very young to 58% in women aged 45-49 years. Hypertension was significantly associated with almost all variables studied such as age, education, marital status, parity, obesity, and dietary patterns. Some strategies were suggested to improve the situation in the future.

Health-related quality of life and sexual function in women with stress urinary incontinence and overactive bladder
(Abstract; subscription needed for full text; Asia)
International Journal of Urology. 2008 Jan;15(1):62-67.
Oh SJ | Ku JH | Choo MS | Yun JM | Kim DY | Park WH
We evaluated the impact of stress urinary incontinence (SUI) and overactive bladder (OAB) on health-related quality of life (HRQOL) and sexual function. A total of 245 women (SUI; n = 123 and OAB; n = 122) from 21 to 79 years old (mean 50.4) were included in the primary analyses. To obtain HRQOL and sexual function assessments, patients were asked to fill in the 'Bristol Female Lower Urinary Tract Symptoms (BFLUTS)' and the 'Medical Outcomes Study Short Form (SF-36)' questionnaires. Of the eight domains in the SF-36 questionnaire, only 'general health' was significantly different between the groups. Patients with SUI had a better general health than those with OAB (P = 0.016). When comparing the BFLUTS scores in the two groups, the score for 'BFLUTS-filling symptoms' was higher in the OAB group (P =0.002) but that for 'BFLUTS-incontinence symptoms' was higher in the SUI group (P less than 0.001). The score for 'BFLUTS-sex' was higher in the SUI group than in the OAB group but this was not statistically significant (P = 0.096). Of the 169 patients who had a sex life, the SUI group had experienced pain (P = 0.033) and leakage (P = 0.056) more frequently during intercourse than the OAB group. Both SUI and OAB have a detrimental impact on patient HRQOL in Korean women. In addition, our findings suggest that women with SUI had more frequently experienced pain during intercourse and coital incontinence than those with OAB.

Cervical cancer associated with pregnancy: Results of a multicenter retrospective Korean study (KGOG-1006)
(Abstract; subscription needed for full text; Asia)
American Journal of Obstetrics and Gynecology. 2008 Jan;198(1):92.e1-92.e6.
Lee JM | Lee KB | Kim YT | Ryu HS | Kim YT
The objective of the study was to analyze the characteristics of cervical cancer associated with pregnancy. Forty patients with cervical cancer associated with pregnancy were retrospectively identified between 1995-2003. Three controls for each case were matched on the basis of age, stage, histology, and date of treatment. Sampling of cervical cytology after the second trimester was the most common cause of delayed diagnosis. Among 12 patients who delayed treatment for fetal maturity, 2 died of disease. There was no difference in overall survival between pregnant and nonpregnant patients with stage Ib tumors. In contrast to nonpregnant patients, the depth of stromal invasion was not correlated with the incidence of lymph vascular space involvement and lymph node metastasis in pregnant patients. Thorough evaluation is warranted before deciding whether to delay treatment until fetal maturity. Pregnancy does not adversely affect the prognosis of early-stage cervical cancer significantly.

HIV/AIDS and STIs NEWS

Study finds possible targets for AIDS drugs
(News Article; Global)
11 Jan 2008
Mcneil D, International Herald Tribune
Related News Article: Proteins that could be used to halt HIV are identified

Bangladesh: HIV medicines to be produced in Bangladesh
(News Article; Asia)
12 Jan 2008
The Daily Star

India: Corporate India aiding AIDS awareness
(News Article; Asia)
12 Jan 2008
CNBC-TV18

HIV/AIDS and STIs RESEARCH

Do targeted HIV programs improve overall care for pregnant women? Antenatal syphilis management in Zambia before and after implementation of prevention of mother-to-child HIV transmission programs
(Abstract; subscription needed for full text; Sub-Saharan Africa)
JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Jan;47(1):79-85.
Potter D | Goldenberg RL | Chao A | Sinkala M | Degroot A | Stringer JSA | Bulterys M | Vermund SH
The implementation of disease-specific research or service programs may have an ancillary beneficial or harmful impact on routine clinical services. We reviewed the records of 5801 first visits to 22 antenatal clinics from 1997 to 2004 in Lusaka, Zambia and examined documented syphilis rapid plasma reagin (RPR) screening and syphilis treatment before and after implementation of research and/or service programs in prevention of mother-to-child (PMTCT) HIV transmission. Compared with before PMTCT program implementation, the prevalence odds ratios (PORs) and 95% confidence intervals (CIs) for documented RPR screening were 0.9 (0.7 to 1.1) after implementation of research, 0.7 (0.6 to 0.8) after service, and 2.5 (2.1 to 3.0) after research and service programs. Documented RPR screening was improved after implementation of PMTCT research and service were operating simultaneously and not with research or service alone. Health policy makers and researchers should plan explicitly for how the targeted HIV programs, service, and/or research can have a broader primary care impact.

Participatory change in a campaign led by sex workers: Connecting resistance to action-oriented agency
(Abstract; subscription needed for full text; Asia)
Qualitative Health Research. 2008 Jan;18(1):106-119.
Basu A | Dutta MJ
Studies predict that the number of HIV infections among commercial sex workers (CSWers) in India may rise to 3.93 million. Efforts have been made to stem the tide. But most campaigns have been designed to ensure condom compliance among CSWers by spreading awareness and increasing availability. Absent from the discursive space of such campaigns are the agency of CSWers and their ability to resist dominant social structures. The authors respond to this lacuna in health communication by foregrounding voices of CSWers participating in two HIV/AIDS interventions in India. Based on the culture-centered approach to health communication and subaltern studies theory, it examines data from two sites to analyze how communicative narratives of agency and resistance are enacted in the marginalized lives of sex workers.

High-resolution molecular epidemiology and evolutionary history of HIV-1 subtypes in Albania
(Research Article; Europe)
PLoS One. 2008 Jan;3(1):e1390.
Salemi M | de Oliveira T | Ciccozzi M | Rezza G | Goodenow MM
The HIV-1 epidemic in Western Europe is largely due to subtype B. Little is known about the HIV-1 in Eastern Europe, but a few studies have shown that non-B subtypes are quite common. In Albania, where a recent study estimated a ten-fold increase of AIDS incidence during the last six years, subtype A and B account for 90% of the known infections. We investigated the demographic history of HIV-1 subtype A and B in Albania by using a statistical framework based on coalescent theory and phylogeography. High-resolution phylogenetic and molecular clock analysis showed a limited introduction to the Balkan country of subtype A during the late 1980s followed by an epidemic outburst in the early 1990s. In contrast, subtype B was apparently introduced multiple times between the mid-1970s and mid-1980s. Both subtypes are growing exponentially, although the HIV-1A epidemic displays a faster growth rate, and a significantly higher basic reproductive number R/o. HIV-1A gene flow occurs primarily from the capital Tirane, in the center of the country, to the periphery, while HIV-1B flow is characterized by a balanced exchange between center and periphery. Finally, we calculated that the actual number of infections in Albania is at least two orders of magnitude higher than previously thought. Our analysis demonstrates the power of recently developed computational tools to investigate molecular epidemiology of pathogens, and emphasize the complex factors involved in the establishment of HIV-1 epidemics. We suggest that a significant correlation exists between HIV-1 exponential spread and the socio-political changes occurred during the Balkan wars. The fast growth of a relatively new non-B epidemic in the Balkans may have significant consequences for the evolution of HIV-1 epidemiology in neighboring countries in Eastern and Western Europe.

The evidence for using conjugate vaccines to protect HIV-infected children against pneumococcal disease
(Abstract; subscription needed for full text; Global)
Lancet Infectious Diseases. 2008 Jan;8(1):67-80.
Bliss SJ | O'Brien KL | Janoff EN | Cotton MF | Musoke P | Coovadia H | Levine OS
Pneumococcal conjugate vaccines (PCVs) are a potentially useful complement to existing treatment strategies in HIV-infected children, for whom pneumococcal infections are common and serious. This Review summarises available data on the burden of pneumococcal disease and the safety and efficacy of PCVs in HIV-infected children. The data demonstrate that children with HIV have significantly increased risk of pneumococcal disease compared with uninfected children; the serotypes included in currently licensed or near-licensure conjugate vaccines include most serotypes that cause invasive pneumococcal disease (IPD) in HIV-infected children and adults; PCVs provide substantial protection against IPD and clinical pneumonia when given to HIV-infected infants; and HIV-infected adults gain an indirect benefit when children in the community are vaccinated. PCV should be considered as an important intervention for improving the lives of HIV-infected children.

Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries
(Report; Global)
Bulletin of the World Health Organization. 2008 Jan;86(1):57-62.
Stringer EM | Chi BH | Chintu N | Creek TL | Ekouevi DK | Coetzee D | Tih P | Boulle A | Dabis F | Shaffer N | Wilfert CM | Stringer JSA
Ambitious goals for paediatric AIDS control have been set by various international bodies, including a 50% reduction in new paediatric infections by 2010. While these goals are clearly appropriate in their scope, the lack of clarity and consensus around how to monitor the effectiveness of programmes to prevent mother-to-child HIV transmission (PMTCT) makes it difficult for policy-makers to mount a coordinated response. In this paper, we develop the case for using population HIV-free child survival as a gold standard metric to measure the effectiveness of PMTCT programmes, and go on to consider multiple study designs and source populations. Finally, we propose a novel community survey-based approach that could be implemented widely throughout the developing world with minor modifications to ongoing Demographic and Health Surveys.

MATERNAL AND CHILD HEALTH NEWS

Uganda: Centre for premature babies opened
(News Article; Sub-Saharan Africa)
6 Jan 2008
Shaban H, New Vision

Investing in the health of Africa's mothers
(News Article; Sub-Saharan Africa)
4 Jan 2008
Kimani M, Africa Renewal

Nigeria: SACA tasks pregnant women on HIV test
(News Article; Sub-Saharan Africa)
3 Jan 2008
Suleiman T, This Day

MATERNAL AND CHILD HEALTH RESEARCH

Ambulatory short-course high-dose oral amoxicillin for treatment of severe pneumonia in children: A randomised equivalency trial
(Abstract; subscription needed for full text; Asia)
Lancet. 2008 Jan 5;371(9606):49-56.
Hazir T | Fox LM | Nisar YB | Fox MP | Ashraf YP | MacLeod WB | Ramzan A | Maqbool S | Masood T | Hussain W | Murtaza A | Khawar N | Tariq P | Asghar R | Simon JL | Thea DM | Qazi SA
WHO case management guidelines for severe pneumonia involve referral to hospital for treatment with parenteral antibiotics. If equally as effective as parenteral treatment, home-based oral antibiotic treatment could reduce referral, admission, and treatment costs. The authors' aim was to determine whether home treatment with high-dose oral amoxicillin and inpatient treatment with parenteral ampicillin were equivalent for the treatment of severe pneumonia in children. This randomised, open-label equivalency trial was done at seven study sites in Pakistan. 2037 children aged 3-59 months with severe pneumonia were randomly allocated to either initial hospitalisation and parenteral ampicillin (100 mg/kg per day in four doses) for 48 h, followed by 3 days of oral amoxicillin (80-90 mg/kg per day; n=1012) or to home-based treatment for 5 days with oral amoxicillin (80-90 mg/kg per day in two doses; n=1025). Follow-up assessments were done at 1, 3, 6, and 14 days after enrolment. The primary outcome was treatment failure (clinical deterioration) by day 6. Analyses were done per protocol and by intention to treat. This trial is registered, ISRCTN95821329. In the per-protocol population, 36 individuals were excluded from the hospitalised group and 37 from the ambulatory group, mainly because of protocol violations or loss to follow-up. There were 87 (8.6%) treatment failures in the hospitalised group and 77 (7.5%) in the ambulatory group (risk difference 1.1%; 95% CI -1.3 to 3.5) by day 6. Five (0.2%) children died within 14 days of enrolment, one in the ambulatory group and four in the hospitalised group. In each case, treatment failure was declared before death and the antibiotic had been changed. None of the deaths were considered to be associated with treatment allocation; there were no serious adverse events reported in the trial. Home treatment with high-dose oral amoxicillin is equivalent to currently recommended hospitalisation and parenteral ampicillin for treatment of severe pneumonia without underlying complications, suggesting that WHO recommendations for treatment of severe pneumonia need to be revised.

Infection control in paediatrics
(Abstract; subscription needed for full text; Global)
Lancet Infectious Diseases. 2008 Jan;8(1):19-31.
Posfay-Barbe KM | Zerr DM | Pittet D
Infection control has a particularly important role in paediatric hospitals and must take into account the specificity of the needs and environment of the paediatric patient. Children are susceptible to infections that are prevented in older patients by vaccination or previous natural exposure. Consequently, the nosocomial pathogens and most common health-care-associated infection sites in children differ from those observed among adults. The immunological naivety of young children, especially neonates, translates into an enhanced susceptibility to many infections with important health consequences as well as higher rates and longer duration of microorganism shedding. In particular, respiratory virus infections, rotavirus, varicella zoster virus, and pertussis represent persistent challenges in children's hospitals. Specific factors such as the use of breastmilk, toys, or therapy animals are associated with an increased risk for health-care-associated infections. The review the emergence of antimicrobial-resistant organisms and strategies to prevent health-care-associated infections in the paediatric setting.

Estimating the costs of achieving the WHO-UNICEF global immunization vision and strategy, 2006 -- 2015
(Report; Global)
Bulletin of the World Health Organization. 2008 Jan;86(1):27-39.
Wolfson LJ | Gasse F | Lee-Martin SP | Lydon P | Magan A | Tibouti A | Johns B | Hutubessy R | Salama P | Okwo-Bele JM
The objective was to estimate the cost of scaling up childhood immunization services required to reach the WHO-UNICEF Global Immunization Vision and Strategy (GIVS) goal of reducing mortality due to vaccine-preventable diseases by two-thirds by 2015. A model was developed to estimate the total cost of reaching GIVS goals by 2015 in 117 low- and lower-middle-income countries. Current spending was estimated by analysing data from country planning documents, and scale-up costs were estimated using a bottom-up, ingredients-based approach. Financial costs were estimated by country and year for reaching 90% coverage with all existing vaccines; introducing a discrete set of new vaccines (rotavirus, conjugate pneumococcal, conjugate meningococcal A and Japanese encephalitis); and conducting immunization campaigns to protect at-risk populations against polio, tetanus, measles, yellow fever and meningococcal meningitis. The 72 poorest countries of the world spent US$ 2.5 (range: US$ 1.8-4.2) billion on immunization in 2005, an increase from US$ 1.1 (range: US$ 0.9-1.6) billion in 2000. By 2015 annual immunization costs will on average increase to about US$ 4.0 (range US$ 2.9-6.7) billion. Total immunization costs for 2006-2015 are estimated at US$ 35 (range US$ 13-40) billion; of this, US$ 16.2 billion are incremental costs, comprised of US$ 5.6 billion for system scale-up and US$ 8.7 billion for vaccines; US$ 19.3 billion is required to maintain immunization programmes at 2005 levels. In all 117 low- and lower-middle-income countries, total costs for 2006-2015 are estimated at US$ 76 (range: US$ 23-110) billion, with US$ 49 billion for maintaining current systems and $27 billion for scaling-up. In the 72 poorest countries, US$ 11-15 billion (30%-40%) of the overall resource needs are unmet if the GIVS goals are to be reached. The methods developed in this paper are approximate estimates with limitations, but provide a roadmap of financing gaps that need to be filled to scale up immunization by 2015.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Sub-Saharan Africa: The population emergency
(News Article; Sub-Saharan Africa)
8 Jan 2008
Flechet G, EurekaAlert

The power of education
(News Article; Global)
17 Jan 2008
SUR

Kenya and Jamaica
(Commentary; Sub-Saharan Africa)
06 Jan 2007
Robotham D, Jamaica Gleaner

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Global costs of attaining the Millennium Development Goal for water supply and sanitation
(Report; Global)
Bulletin of the World Health Organization. 2008 Jan;86(1):13-19.
Hutton G | Bartram J
Target 10 of the Millennium Development Goals (MDGs) is to "halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation". Because of its impacts on a range of diseases, it is a health-related MDG target. This study presents cost estimates of attaining MDG target 10. We estimate the population to be covered to attain the MDG target using data on household use of improved water and sanitation for 1990 and 2004, and taking into account population growth. We assume this estimate is achieved in equal annual increments from the base year, 2005, until 2014. Costs per capita for investment and recurrent costs are applied. Country data is aggregated to 11 WHO developing country subregions and globally. Estimated spending required in developing countries on new coverage to meet the MDG target is US$ 42 billion for water and US$ 142 billion for sanitation, a combined annual equivalent of US$ 18 billion. The cost of maintaining existing services totals an additional US$ 322 billion for water supply and US $216 billion for sanitation, a combined annual equivalent of US$ 54 billion. Spending for new coverage is largely rural (64%), while for maintaining existing coverage it is largely urban (73%). Additional programme costs, incurred administratively outside the point of delivery of interventions, of between 10% and 30% are required for effective implementation. In assessing financing requirements, estimates of cost should include the operation, maintenance and replacement of existing coverage as well as new services and programme costs. Country-level costing studies are needed to guide sector financing.

Simple formulas for gauging the potential impacts of population stratification bias
(Abstract; subscription needed for full text; Asia)
American Journal of Epidemiology. 2008;167(1):86-89.
Lee WC | Wang LY
The case-control study design is popular for genetic association studies of complex human diseases. However, case-control studies may suffer from bias due to population stratification. In this paper, the authors present simple formulas that can set a limit to the havoc population stratification bias can wreak (the lower and upper bounds of the confounding rate ratio and the upper bound of the type I error rate). The authors demonstrate applications of these formulas using two examples. The formulas can help researchers make more prudent interpretations of their (potentially biased) results.

Health status and geographic mobility among semi-nomadic pastoralists in Mongolia
(Abstract; subscription needed for full text; Asia)
Health and Place. 2008;14(2):228-242.
Mocellin J | Foggin P
This paper sets out to examine the impact on health of a key aspect of the semi-nomadic lifestyle, namely geographic mobility. The relevant literature suggests that seasonal migrations of pastoralists tend to increase the risk of a poor health. Highlighted in this paper is an inverse association between spatial mobility and health status among the herders of rural Mongolia. Two types of mobility are involved in this process. For households, seasonal migration has a significant influence on health. At the level of individuals, however, there is another kind of mobility: that of travelling to meet personal needs. At both of these levels, statistically significant impacts on health were observed.

"The Pop Reporter" (R) Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs/INFO Project. When you click on any link, your Internet browser will access a Web site not connected to "The Pop Reporter." Information accessed through these links and contained in this issue of "The Pop Reporter" does not necessarily state or reflect the views of the INFO Project, Johns Hopkins University, or the US Agency for International Development. All links were verified at the date of mailing. Your computer and/or network configuration regarding Java script, cookies, and other security issues may not allow you to view certain Web sites. Consult your computer technician if you are having problems.

Problems and comments can be addressed to mdadamo@jhuccp.org.

Archives available at http://www.infoforhealth.org/popreporter/.

Subscribe at http://prds.infoforhealth.org/signup.php.

Modify your account at http://prds.infoforhealth.org/modify.php.

Forward this message to a friend who could benefit from INFO project activities!

The Pop Reporter--Delivering thought-provoking global health news to your desktop.

Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 8, Number 215 January 2008