Volume 8, Number 3
22 January 2008

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ADOLESCENT HEALTH NEWS

Nigeria: Jitters in Suleja as..men seeking Aids cure rape teenaged girls!
(News Article; Sub-Saharan Africa)
13 Jan 2008
Mosadomi W, Vanguard (Lagos)

Ghana: A viable sheanut industry can curb migration of girls
(News Article; Sub-Saharan Africa)
15 Jan 2008
Public Agenda (Accra)

Tanzania: Girl guides enthuse street kids with life skills
(News Article; Sub-Saharan Africa)
11 Jan 2008
Arusha Times (Arusha)

ADOLESCENT HEALTH RESEARCH

The association between school attendance, HIV infection and sexual behaviour among young people in rural South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Epidemiology and Community Health. 2008 Feb;62(2):113-119.
Hargreaves JR | Morison LA | Kim JC | Bonell CP | Porter JD | Watts C | Busza J | Phetla G | Pronyk PM
The objectives were to investigate whether the prevalence of HIV infection among young people, and sexual behaviours associated with increased HIV risk, are differentially distributed between students and those not attending school or college. The design used was a random population sample of unmarried young people (916 males, 1003 females) aged 14-25 years from rural South Africa in 2001. Data on school attendance and HIV risk characteristics came from structured face-to-face interviews. HIV serostatus was assessed by oral fluid ELISA. Logistic regression models specified HIV serostatus and high-risk behaviours as outcome variables. The primary exposure was school attendance. Models were adjusted for potential confounders. HIV knowledge, communication about sex and HIV testing were similarly distributed among students and non-students. The lifetime number of partners was lower for students of both sexes (adjusted odds ratio (aOR) for more than three partners for men 0.67; 95% CI 0.44 to 1.00; aOR for more than two partners for women 0.69; 95% CI 0.46 to 1.04). Among young women, fewer students reported having partners more than three years older than themselves (aOR 0.58; 95% CI 0.37 to 0.92), having sex more than five times with a partner (aOR 0.57; 95% CI 0.37 to 0.87) and unprotected intercourse during the past year (aOR 0.60; 95% CI 0.40 to 0.91). Male students were less likely to be HIV positive than nonstudents (aOR 0.21; 95% CI 0.06 to 0.71). Attending school was associated with lower-risk sexual behaviours and, among young men, lower HIV prevalence. Secondary school attendance may influence the structure of sexual networks and reduce HIV risk. Maximising school attendance may reduce HIV transmission among young people.

Traditional values of virginity and sexual behaviour in rural Ethiopian youth: Results from a cross-sectional study
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMC Public Health. 2008 Jan 9;8:9.
Molla M | Berhane Y | Lindtjorn B
Delaying sexual initiation has been promoted as one of the methods of decreasing risks of HIV among young people. In traditional countries, such as Ethiopia, retaining virginity until marriage is the norm. However, no one has examined the impact of this traditional norm on sexual behaviour and risk of HIV in marriage. This study examined the effect of virginity norm on having sex before marriage and sexual behaviour after marriage among rural Ethiopian youth. We did a cross-sectional survey in 9 rural and 1 urban area using a probabilistic sample of 3,743 youth, 15-24 years of age. Univariate analysis was used to assess associations between virginity norm and gender stratified by area, and between sexual behaviour and marital status. We applied Kaplan-Meier and Cox regression analysis to estimate age at sexual debut and assessed the predictors of premarital sex among the never-married using SPSS. We found that maintaining virginity is still a way of securing marriage for girls, especially in rural areas; the odds of belief and intention to marry a virgin among boys was 3-4 times higher among rural young males. As age increased, the likelihood of remaining a virgin decreased. There was no significant difference between married and unmarried young people in terms of number of partners and visiting commercial sex workers. Married men were twice more likely to have multiple sexual partners than their female counterparts. A Cox regression show that those who did not believe in traditional values of preserving virginity (adjusted hazard ratio [AHR] = 2.91 [1.92-4.40]), alcohol drinkers (AHR = 2.91 [1.97-4.29]), Khat chewers (AHR = 2.36 [1.45-3.85]), literates (AHR = 18.01 [4.34-74.42]), and the older age group (AHR = 1.85 [1.19-2.91]) were more likely to have premarital sex than their counterparts. Although virginity norms help delay age at sexual debut among rural Ethiopian youth, and thus reduces vulnerability to sexually transmitted infections and HIV infection, vulnerability among females may increase after marriage due to unprotected multiple risky sexual behaviours by spouses. The use of preventive services, such as VCT before marriage and condom use in marriage should be part of the HIV/AIDS prevention and control strategies.

Correlates of current cigarette smoking among school-going adolescents in Punjab, India: Results from the Global Youth Tobacco Survey 2003
(Research Article; Asia)
(You need Adobe Acrobat Reader to access this document)
BMC International Health and Human Rights. 2008 Jan 14;8:1.
Siziya S | Muula AS | Rudatsikira E
Smoking is a leading cause of morbidity and mortality globally. There is therefore need to identify relevant factors associated with smoking among adolescents in order to better tailor public health interventions aimed at preventing smoking. We used data from the Global Youth Tobacco Survey (GYTS) conducted in 2003 in Punjab, India, on 2014 adolescents of whom 58.9% were males. We conducted a weighted logistic regression analysis, adjusting for age and sex, to determine associations between predictor variables and current tobacco smoking status. A total of 2014 adolescents participated in the survey in 2003, and of these 58.9% were males. Male respondents tended to be older than females (21.2% of males, and 13.1% of females were of age 16 years or above). The percent of males and females in the other age groups were: 23.0% and 28.6% for less than 14 years, 27.3% and 31.0% for 14 years, and 28.4% and 27.0% for 15 years, respectively. The following factors were positively associated with smoking: adolescents who received pocket money; adolescents who had parents who smoked, chewed or applied tobacco; adolescents who said that boys or girls who smoke or chew tobacco have more friends; adolescents who said that smoking or chewing tobacco makes boys look less attractive; adolescents who said that there is no difference in weight between smokers and non-smokers; adolescents who said that smoking makes one gain weight; and adolescents who had most or all of their closest friends who smoked. The factors that were negatively associated with smoking were: adolescents who said that boys or girls who smoke or chew tobacco have less number of friends; adolescents who said that girls who smoke or chew tobacco are less attractive; and adolescents who had some of their closest friends who smoked. The observed associations between current smoking on one hand and peer smoking, and perception that boys who smoke are less attractive on the other, deserve further studies. The factors reported in the current study should be considered in the design of public health interventions aimed to reduce adolescent cigarette smoking.

Elevated risk for HIV-1 infection in adolescents and young adults in Sao Paulo, Brazil
(Research Article; South America)
PLoS One. 2008 Jan;3(1):e1423.
Bassichetto KC | Bergamaschi DP | Oliveira SM | Deienno MC | Bortolato R | Vilma de Rezende H | Arthur T | Tomiyama H | Watkins C | Mesquita F | Abbate MC | Kallas EG
Recent studies have sought to describe HIV infection and transmission characteristics around the world. Identification of early HIV-1 infection is essential to proper surveillance and description of regional transmission trends. In this study we compare people recently infected (RI) with HIV-1, as defined by Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), to those with chronic infection. Subjects were identified from 2002-2004 at four testing sites in Sao Paulo. Of 485 HIV-1-positive subjects, 57 (12%) were defined as RI. Of the participants, 165 (34.0%) were aware of their serostatus at the time of HIV-1 testing. This proportion was statistically larger (p less than 0.001) among the individuals without recent infection (n = 158, 95.8%) compared to 7 individuals (4.2%) with recently acquired HIV-1 infection. In the univariate analysis, RI was more frequent in less than 25 and greater than 59 years-old age strata (p less than 0.001). The majority of study participants were male (78.4%), 25 to 45 years-old (65.8%), white (63.2%), single (61.7%), with family income of four or more times the minimum wage (41.0%), but with an equally distributed educational level. Of those individuals infected with HIV-1, the predominant route of infection was sexual contact (89.4%), with both hetero (47.5%) and homosexual (34.5%) exposure. Regarding sexual activity in these individuals, 43.9% reported possible HIV-1 exposure through a seropositive partner, and 49.4% reported multiple partners, with 47% having 2 to 10 partners and 37.4% 11 or more; 53.4% of infected individuals reported condom use sometimes; 34.2% reported non-injecting, recreational drug use and 23.6% were reactive for syphilis by VDRL. Subjects younger than 25 years of age were most vulnerable according to the multivariate analysis. In this study, we evaluated RI individuals and discovered that HIV-1 has been spreading among younger individuals in Sao Paulo and preventive approaches should, therefore, target this age stratum.

FAMILY PLANNING NEWS

China: Association raises 620 mln yuan for family planning service
(News Article; Asia)
16 Jan 2008
Mingxin B, China View

Vietnam: Today’s teenagers need schooling in sex ed
(News Article; Asia)
16 Jan 2008
Viet Nam News, Vietnam News Agency

FAMILY PLANNING RESEARCH

Sterilization
(Abstract; subscription needed for full text; Global)
Obstetrics and Gynecology. 2008 Jan;111(1):189-203.
Peterson HB
Worldwide, sterilization (tubal sterilization and vasectomy) is used by more people than any other method of contraception. All techniques of tubal sterilization in widespread use in the United States have low risks of surgical complications. Although tubal sterilization is highly effective, the risk of pregnancy varies by age and method of occlusion. Pregnancies can occur many years after the procedure, and when they do, the risk of ectopic gestation is high. There is now strong evidence against the existence of a post-tubal ligation syndrome of menstrual abnormalities. Although women who have undergone tubal sterilization are more likely than other women to undergo hysterectomy subsequently, there is no known biologic basis for this relationship. Although sterilization is intended to be permanent, expressions of regret and requests for reversal are not uncommon and are much more likely to occur among women sterilized at young ages. Tubal sterilization has little or no effect on sexual function for most women. Vasectomy is less likely than tubal sterilization to result in serious complications. Minor complications, however, are not uncommon. Vasectomy does not increase the risk of heart disease, and available evidence argues against an increase in the risk of prostate cancer, testicular cancer, or overall mortality. Whether a postvasectomy pain syndrome exists remains controversial. Although the long-term effectiveness of vasectomy is less well-studied than that for tubal sterilization, it seems likely to be at least as effective. Intrauterine devices and progestin implants are long-acting, highly effective alternatives to sterilization.

Oral contraceptive use, hormone replacement therapy, reproductive history and risk of colorectal cancer in women
(Abstract; subscription needed for full text; North America)
International Journal of Cancer. 2008 Feb 1;122(3):643-646.
Kabat GC | Miller AB | Rohan TE
Evidence from epidemiologic studies suggests a possible role of exogenous and endogenous hormones in colorectal carcinogenesis in women. However, with respect to exogenous hormones, in contrast to hormone replacement therapy, few cohort studies have examined oral contraceptive use in relation to colorectal cancer risk. We used data from a large cohort study of Canadian women enrolled in a randomized controlled trial of breast cancer screening to assess the association of oral contraceptive use, hormone replacement therapy and reproductive factors with risk of colorectal cancer, overall and by subsite within the colorectum. Cancer incidence and mortality were ascertained by linkage to national databases. Among 89,835 women aged 40-59 at enrollment and followed for an average of 16.4 years, we identified 1,142 incident colorectal cancer cases. Proportional hazards models were used to estimate the associations between the exposures of interest and risk of colorectal cancer. Ever use of oral contraceptives at baseline was associated with a modest reduction in the risk of colorectal cancer (hazard ratio 0.83, 95% confidence interval 0.73-0.94), with similar effects for different subsites within the colorectum. No trend was seen in the hazard ratios with increasing duration of oral contraceptive use. No associations were seen with use of hormone replacement therapy (ever use or duration of use) or reproductive factors. Our results are suggestive of an inverse association between oral contraceptive use and colorectal carcinogenesis. However, given the lack of a dose-response relationship and the potential for confounding, studies with more complete assessment of exogenous hormone use throughout the life course are needed to clarify this association.

Association of intimate partner physical and sexual violence with unintended pregnancy among pregnant women in Peru
(Abstract; subscription needed for full text)
International Journal of Gynecology and Obstetrics. 2008 Feb;100(2):104-108.
Cripe SM | Sanchez SE | Perales MT | Lam N | Garcia P | Williams MA
The objective was to examine the associations between lifetime physical and/or sexual intimate partner violence (IPV) with pregnancy intent among pregnant women in Lima, Peru. A total of 2167 women who delivered at the Instituto Nacional Materno Perinatal, Lima, Peru were interviewed during the postpartum recovery period. Logistic regression was used to estimate multivariable adjusted odds ratios and 95% confidence intervals. Lifetime physical or sexual violence (40.0%) and unintended pregnancies (65.3%) were common in the study population. Compared with non-abused women, abused women had a 1.63-fold increased risk for unintended pregnancy. Unintended pregnancy risk was 3.31-fold higher among women who experienced both physical and sexual abuse compared with non-abused women. The prevalence and severity of physical violence during pregnancy was greater among women with unintended pregnancies compared with women with planned pregnancies. The findings indicate the need to include IPV screening and treatment in prenatal care and reproductive health settings.

GENDER and HEALTH NEWS

Uganda: We escaped female circumcision
(News Article; Sub-Saharan Africa)
17 Jan 2008
Nandutu A, The Monitor (Kampala)

Kenya: Health workers grappling with conflict-related sexual violence
(News Article; Sub-Saharan Africa)
15 Jan 2008
Integrated Regional Information Networks (IRIN)

Botswana: Women advised to go for pap smears
(News Article; Sub-Saharan Africa)
14 Jan 2008
Chwaane H, Mmegi/The Reporter (Gaborone)

Nigeria: Stemming violence against women
(News Article; Sub-Saharan Africa)
14 Jan 2008
Yussuf G, Daily Champion (Lagos)

The war against women: The use of rape as a weapon in Congo's civil war
(News Article; Sub-Saharan Africa)
13 Jan 2008
CBS News

GENDER and HEALTH RESEARCH

Intimate partner violence and unplanned pregnancy in the Pacific Islands Families Study
(Abstract; subscription needed for full text; Oceania)
International Journal of Gynecology and Obstetrics. 2008 Feb;100(2):109-115.
Gao W | Paterson J | Carter S | Iusitini L
The objective was to examine the association between maternal intimate partner violence (IPV) victimization and unplanned pregnancy. Mothers of the Pacific Islands Families (PIF) Study cohort of Pacific infants born in Auckland, New Zealand during 2000 were interviewed when the children were 6 weeks old. A total of 1088 mothers cohabiting in married or de-facto partnerships were questioned about IPV and whether their pregnancy had been planned. Women identified as victims of physical violence were more likely to report an unplanned pregnancy than those who were not victims (68.7% vs 55.1%, odds ratio [OR] 1.78; 95% confidence interval [CI], 1.32-2.40). The adjusted odds remained statistically significant (OR 1.52; 95% CI, 1.01-2.26). The findings of this study suggest an association between IPV and unplanned pregnancy in the Pacific birth cohort.

Insights from a survey of sexual behavior among a group of at-risk women in Tehran, Iran, 2006
(Abstract; subscription needed for full text; Middle East)
AIDS Education and Prevention. 2007;19(6):519-530.
Hajiabdolbaghi M | Razani N | Karami N | Kheirandish P | Mohraz M | Rasoolinejad M | Arefnia K | Kourorian Z | Rutherford G | McFarland W
Despite high rates of HIV among male injection drug users, the sexual behaviors of at-risk women in Iran remain unknown. A questionnaire on HIV knowledge and risk behavior was administered in a Tehran nongovernmental organization targeting runaways and other women seeking safe haven. Half (total N = 50) were less than 24 years old; baseline HIV knowledge was high. The few who acknowledged using illicit substances said they used "frequently." Nonresponse rates to questions regarding sexual behavior were high (12 of 50). Half admitted a history of sexual activity; 40% of those reported their first sexual contact with someone other than their husband; three people had multiple partners. Three women reported a history of rape. Zero (97.5% one-sided confidence interval [CI] = 0, 0.17) of 35 women tested positive for HIV or syphilis. This study documents the existence of sexual behavior in a population of Iranian women, represents one of the first attempts at sexual research in the Iranian context, and highlights challenges in surveying this vulnerable group.

HIV/AIDS and STIs NEWS

Zimbabwe: Rural women struggle to set treatment
(News Article; Sub-Saharan Africa)
15 Jan 2008
Integrated Regional Information Networks (IRIN News)

Africa: Stopping infections
(News Article; Sub-Saharan Africa)
14 Jan 2008
Ochieng Z, The East African (Nairobi)

United States: FDA approves HIV drug etravirine
(Press Release; North America)
18 Jan 2008
U.S. Food and Drug Administration

HIV/AIDS and STIs RESEARCH

Early effects of antiretroviral therapy on work performance: Preliminary results from a cohort study of Kenyan agricultural workers
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2008 Jan 30;22(3):421-425.
Larson BA | Fox MP | Rosen S | Bii M | Sigei C | Shaffer DC | Sawe FB | Wasunna MB | Simon JLA
This paper estimates the impact of antiretroviral therapy (ART) on days harvesting tea per month for tea-estate workers in Kenya. Such information is needed to assess the potential economic benefits of providing treatment to working adults. Data for this analysis come from company payroll records for 59 HIV-infected workers and a comparison group of all workers assigned to the same work teams (reference group, n = 1992) for a period covering 2 years before and 1 year after initiating ART. Mean difference tests were used to obtain overall trends in days harvesting tea by month. A difference in difference approach was used to estimate the impact of HIV/AIDS on days working in the pre-ART period. Information on likely trends in the absence of the therapy was used to estimate the positive impacts on days harvesting tea over the initial 12 months on ART. No significant difference existed in days plucking tea each month until the ninth month before initiating ART, when workers worked -2.79 fewer days than references (15% less). This difference grew to 5.09 fewer days (27% less) in the final month before initiating ART. After 12 months on ART, we conservatively estimate that workers worked at least twice as many days in the month than they would have in the absence of ART. Treatment had a large, positive impact on the ability of workers to undertake their primary work activity, harvesting tea, in the first year on ART.

Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa
(Abstract; subscription needed for full text; Global | Sub-Saharan Africa)
AIDS. 2008 Jan 30;22(3):403-414.
Hargreaves JR | Bonell CP | Boler T | Boccia D | Birdthistle I Fletcher A | Pronyk PM | Glynn JR
The objective was to assess the evidence that the association between educational attainment and risk of HIV infection is changing over time in sub-Saharan Africa. Systematic review of published peer-reviewed articles. Articles were identified that reported original data comparing individually measured educational attainment and HIV status among at least 300 individuals representative of the general population of countries or regions of sub-Saharan Africa. Statistical analyses were required to adjust for potential confounders but not over-adjust for variables on the causal pathway. Approximately 4000 abstracts and 1200 full papers were reviewed. Thirty-six articles were included in the study, containing data on 72 discrete populations from 11 countries between 1987 and 2003, representing over 200 000 individuals. Studies on data collected prior to 1996 generally found either no association or the highest risk of HIV infection among the most educated. Studies conducted from 1996 onwards were more likely to find a lower risk of HIV infection among the most educated. Where data over time were available, HIV prevalence fell more consistently among highly educated groups than among less educated groups, in whom HIV prevalence sometimes rose while overall population prevalence was falling. In several populations, associations suggesting greater HIV risk in the more educated at earlier time points were replaced by weaker associations later. HIV infections appear to be shifting towards higher prevalence among the least educated in sub-Saharan Africa, reversing previous patterns. Policy responses that ensure HIV-prevention measures reach all strata of society and increase education levels are urgently needed.

Diffusion of positive AIDS care messages among service providers in China
(Abstract; subscription needed for full text; Asia)
AIDS Education and Prevention. 2007;19(6):511-516.
Li L | Cao H | Wu Z | Wu S | Xiao L
There is great potential in adapting the popular opinion leader (POL) intervention model to address HIV-related stigma and quality of care among service providers in China. Using a representative sample of 1,101 service providers in China, this study provides preliminary descriptions of POL provider characteristics. Multiple regression analyses revealed that diffusion of positive AIDS care messages among service providers in China was associated with factors such as gender, ethnicity, medical education, level of care, personal contact with people living with HIV/AIDS, and HIV-related training. Those who were more knowledgeable about HIV and those with a lower level of discriminatory attitude at work were more likely to diffuse the positive messages to co-workers and friends. Reported characteristics of a potential provider opinion leader in China will inform the design and implementation of future intervention programs.

MATERNAL AND CHILD HEALTH NEWS

Nigeria: Maternal death decreases in Kebbi-UNFPA
(News Article; Sub-Saharan Africa)
16 Jan 2008
Daily Champion (Lagos)

Uganda: Free nets changing lives of women in Amuria
(News Article; Sub-Saharan Africa)
13 Jan 2008
Ouma F, New Vision (Kampala)

India: Exclusive breast-feeding will reduce infant mortality
(News Article; Asia)
17 Jan 2008
Newindpress

MATERNAL AND CHILD HEALTH RESEARCH

Intermittent preventive treatment of malaria in pregnancy: A community-based delivery system and its effect on parasitemia, anemia and low birth weight in Uganda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of Infectious Diseases. 2008;12:22-29.
Mbonye AK | Bygbjerg I | Magnussen P
The main objective of the study was to assess the impact of a community-based delivery system of intermittent preventive treatment (IPT) for malaria in pregnancy with sulfadoxine-pyrimethamine (SP) on access, parasitemia, anemia and low birth weight as primary outcome measures. A study was designed to test the community-based delivery system of IPT through traditional birth attendants (TBAs), drug-shop vendors (DSVs), community reproductive health workers (CRHWs) and adolescent peer mobilizers (APMs), and to compare these with IPT at health units in an area of high malaria transmission - Mukono District, Uganda. Two thousand seven hundred and eighty-five pregnant women participated in the study. The majority of the women (92.4%) at the community-based approaches received their first dose of IPT during their second trimester compared to 76.1% at health units (p less than 0.0001). At both health units and the community-based approaches, IPT increased mean hemoglobin by 6.7% (p less than 0.0001) for all parities and by 10.2% among primigravidae. IPT reduced the prevalence of severe anemia from 5.7% to 3.1% (p less than 0.04). The prevalence of parasitemia was reduced from 24.5% to 16.1% (p less than 0.001), and parasite density reduced significantly (p less than 0.02) after the first dose and remained stable with the second dose. Overall the proportion of low birth weight was 6.3% (8.3% at health units versus 6.0% at the community-based approaches, p less than 0.03) highlighting the importance of access and adherence to IPT. This intervention was acceptable to 89.6% of the women at the community-based approaches intending to use IPT in the future, while 48.1% of them had recommended it to other women. The community-based approaches increased access and adherence to IPT with an effect on anemia, severe anemia, parasitemia and low birth weight. However, the reduced effect of IPT on parasitemia points to drug resistance with SP and this requires further evaluation; research into the identification of other more efficacious drugs for malaria prevention in pregnancy is also required.

Consequences of poor maternal micronutrition before and during early pregnancy
(Abstract; subscription needed for full text; Global)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 Feb;102(2):103-104.
Owens S | Fall CD
In developing countries, micronutrient deficiencies are common and associated with poor pregnancy outcomes, which may in turn have longer-term effects on human health. The peri-conceptional period represents a particularly sensitive window of feto-placental development, during which suboptimal maternal micronutrition may have far-reaching consequences. The effects of targeted interventions during this period have been little studied in humans.

Maternal education and child healthcare in Bangladesh
(Abstract; subscription needed for full text; Asia)
Maternal and Child Health Journal. 2008 Jan;12(1):43-51.
Huq MN | Tasnim T
Child health is one of the important indicators for describing mortality conditions, health progress and the overall social and economic well being of a country. During the last 15 years, although Bangladesh has achieved a significant reduction in the child mortality rate, the levels still remain very high. The utilization of qualified providers does not lead to the desired level; only a third relies on qualified providers. This study is mainly aimed at investigating the influence of maternal education on health status and the utilization of child healthcare services in Bangladesh. This study is based on the data of the Household Income Expenditure Survey (HIES) conducted by the Bangladesh Bureau of Statistics (BBS) during 2000. The analysis of the findings reveals that 19.4% of the children under five reported sickness during 30 days prior to the survey date. Moreover, approximately one out of every thirteen children suffers from diarrhoea in the country. It is striking to note that a significant portion of the parents relied on unqualified or traditional providers for the children's healthcare because of low cost, easy accessibility and familiarity of the services. The study suggests that maternal education is a powerful and significant determinant of child health status in Bangladesh. Maternal education also positively affects the number of children receiving vaccination. In order to improve the health condition of children in Bangladesh maternal education should be given top priority. The public policies should not just focus on education alone, but also consider other factors, such as access to health facilities and quality of services. Health awareness campaigns should be strengthened as part of the public health promotion efforts. More emphasis should also be given to government-NGO (Non Government Organization) partnerships that make vaccination programs successful and, thereby, reduce the incidence of preventable diseases.

Perceptions of pregnancy complications in Haiti
(Abstract; subscription needed for full text; Central America and the Caribbean)
International Journal of Gynecology and Obstetrics. 2008 Feb;100(2):116-123.
Anderson FW | Naik SI | Feresu SA | Gebrian B | Karki M | Harlow SD
The objective was to determine the incidence of perceived pregnancy complications and associated factors. During a census, 450 women identified themselves as pregnant and 388 were interviewed postpartum. Complications were reported by 58.6%. Bleeding post-delivery was the most frequent complication (42.5%), followed by great pain (33.8%), bleeding during pregnancy (20.1%), and fever post-delivery (11.6%). Prenatal care at either a dispensary or a clinic was associated with reports of bleeding during pregnancy (odds ratio [OR] 9.06; 95% confidence interval [CI], 1.71-48.00 and OR 7.58; 95% CI, 1.53-37.48, respectively). Women who visited a doctor were less likely to report bleeding during pregnancy (OR 0.20; 95% CI, 0.08-0.55) or fever post-delivery (P=0.015). Herb use was associated with reported bleeding during pregnancy (OR 2.22; 95% CI, 1.12-4.40) and great pain (OR 1.94; 95% CI, 1.05-3.58). The perceived pregnancy complication rate in Haiti is high and is associated with access to health care. The association between use of herbs and pregnancy complications warrants investigation.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Philippines: RP to grow at 200 babies born per hour
(News Article; Asia)
15 Jan 2008
Amojelar DG, The Manila Times

India: Buddhists in Ladakh call for end to family planning
(News Article; Asia)
16 Jan 2008
Daily Times

Kenya: Exploding population
(News Article; Sub-Saharan Africa)
17 Jan 2008
International Herald Tribune

Chinese farmers are losing their land
(News Article; Asia)
16 Jan 2008
People and Planet

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Exclusive breast feeding and children immunization as demographic determinants of child mortality in Delta State
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Pakistan Journal of Nutrition. 2008 Jan-Feb;7(1):35-39.
Ogbe JO
This study on exclusive breast-feeding and child immunization on child mortality provides opportunities to continuously improve child health and reduce mortality. The ex-post facto design was employed while two research questions and two hypotheses gave direction to the study. The population was all children below their fifth birthday in 300 hundred households. The multi-stage sampling technique was combined with the ballot and systematic method to select 20 households in the state. The research instrument was standardized multi topic household survey instrument designed by Grosh and Glewwe (2002). It was reliable at 0.90. It was found that exclusive breast feeding and child immunization have no significant relationship on child mortality. This is so because exclusive breast-feeding and child immunization is not significantly practiced in Delta State, Nigeria. The practical implication of this study was the call for inhabitant of Delta State, Nigeria to pay more serious attention to child immunization and exclusive breast-feeding through organized Health Education Programme in Schools, Churches and Community Health Programme and through the media. This study has revealed the low child immunization coverage and low participation of reproductive women in exclusive breast-feeding in Delta State, Nigeria. Hence child immunization and exclusive breast-feeding cannot be a determinant of child mortality at the present level of practice in Delta State, Nigeria.

Demographic and dispersal constraints for domestic infestation by non-domicilated Chagas disease vectors in the Yucatan Peninsula, Mexico
(Abstract; subscription needed for full text; North America)
American Journal of Tropical Medicine and Hygiene. 2008 Jan;78(1):133-139.
Gourbiere S | Dumonteil E | Rabinovich JE | Minkoue R | Menu F
Chagas disease is one of the most important diseases in Latin America. Insecticides have been sprayed to control domiciliated vectors. However, some triatomine species are not strictly domiciliated, and the transmission risk posed by immigrants is identified as a major challenge. The design of new control strategies requires disentangling the importance of demography and immigration in vector occurrence inside houses. Using a population dynamics model, we confirmed that dispersal can explain satisfactorily the domestic abundance of Triatoma dimidiata in Yucatan, Mexico. A surprisingly low fecundity was also required (no more than one to two female offspring per female per trimester). A wide range of survival probabilities was possible, although the best fit was obtained for a very low immature survival (less than or equal to 0.01/trimester). Our model predicted that domestic populations are not sustainable, and up to 90% of the individuals found in houses are immigrants. We discuss the potential of different strategies to control the transmission of Chagas disease by non-domiciliated vectors.

Fertility decline driven by poverty: The case of Addis Ababa, Ethiopia
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Biosocial Science. 2008 Jan;:[20] p.
Gurmu E | Mace R
Demographic transition theory states that fertility declines in response to development, thus wealth and fertility are negatively correlated. Evolutionary theory, however, suggests a positive relationship between wealth and fertility. Fertility transition as a result of industrialization and economic development started in the late 19th and early 20th centuries in Western Europe; and it extended to some of the Asian and Latin American countries later on. However, economic crises since the 1980s have been co-incident with fertility decline in sub-Sahara Africa and other developing countries like Thailand, Nepal and Bangladesh in the last decade of the 20th century. A very low level of fertility is observed in Addis Ababa (TFR=1.9) where contraceptive prevalence rate is modest and recurrent famine as well as drought have been major causes of economic crisis in the country for more than three consecutive decades, which is surprising given the high rural fertility. Detailed socioeconomic and demographic characteristics of 2976 women of reproductive age (i.e. 15-49 years) residing in Addis Ababa were collected during the first quarter of 2003 using an event history calendar and individual women questionnaire. Controlling for the confounding effects of maternal birth cohort, education, marital status and accessible income level, the poor (those who have access to less than a dollar per day or 250 birr a month) were observed to elongate the timing of having first and second births, while relatively better-off women were found to have shorter birth intervals. Results were also the same among the ever-married women only model. More than 50% of women currently in their 20s are also predicted to fail to reproduce as most of the unmarried men and women are 'retreating from marriage' due to economic stress. Qualitative information collected through focus group discussions and in-depth interviews also supports the statistical findings that poverty is at the root of this collapse in fertility. Whilst across countries wealth and fertility have been negatively correlated, this study shows that within one uniform population the relationship is clearly positive.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 8, Number 322 January 2008