Volume 8, Number 4
28 January 2008

Family Planning Handbook Now in Spanish: The World Health Organization, Johns Hopkins, and the United States Agency for International Development (USAID) are proud to announce that "Family Planning: A Global Handbook for Providers" is now available in Spanish. The Spanish title is "Planificación Familiar: Un manual mundial para proveedores." The handbook is an essential tool for health care providers who need quick-references to different family planning methods, how to prevent sexually transmitted infections, and other health-related topics. The handbook is currently available at no cost to readers in developing countries. For orders, contact orders@jhuccp.org or order on-line at http://www.fphandbook.org/.

ADOLESCENT HEALTH NEWS

Burkina Faso: Concern about rise in unwanted teenage pregnancies
(News Article; Sub-Saharan Africa)
17 Jan 2008
UN Integrated Regional Information Networks

Hung Yen young people need sex education
(News Article; Asia)
23 Jan 2008
Viet Nam News

India: No response yet to SCERT adolescent education programme
(News Article; Asia)
23 Jan 2008;
Kurian S, The Hindu

ADOLESCENT HEALTH RESEARCH

Sexual behavior, knowledge and information sources of very young adolescents in four Sub-Saharan African countries
(Abstract; subscription needed for full text; Sub-Saharan Africa)
African Journal of Reproductive Health. 2007;11(3):28-43.
Bankole A | Biddlecom A | Guiella G | Singh S | Zula E
Adolescents are a key target group for HIV and pregnancy prevention efforts, yet very little is known about the youngest adolescents: those under age 15. New survey data from 12-14 year olds in Burkina Faso, Ghana, Malawi and Uganda are used to describe their sexual activity, knowledge about HIV, STIs and pregnancy prevention, and sources of sexual and reproductive health information, including sex education in schools. Results show that very young adolescents are already beginning to be sexually active and many believe their close friends are sexually active. They have high levels of awareness but little in-depth knowledge about pregnancy and HIV prevention. Multiple information sources are used and preferred by very young adolescents. Given their needs for HIV, STI and pregnancy prevention information that is specific and practical and considering that the large majority are attending school in most countries in Sub-Saharan Africa, school-based sex education is a particularly promising avenue for reaching adolescents under age 15.

A novel economic intervention to reduce HIV risk among school-going AIDS orphans in rural Uganda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Adolescent Health. 2008 Jan;42(1):102-104.
Ssewamala FM | Alicea S | Bannon WM Jr | Ismayilova L
This study tested an economic intervention to reduce HIV risks among AIDS-orphaned adolescents. Adolescents (n = 96) were randomly assigned to receive the intervention or usual care for orphans in Uganda. Data obtained at baseline and 12-month follow-up revealed significant differences between the treatment and control groups in HIV prevention attitudes and educational planning.

The timing and role of initiation rites in preparing young people for adolescence and responsible sexual and reproductive behaviour in Malawi
(Abstract; subscription needed for full text; Sub-Saharan Africa)
African Journal of Reproductive Health. 2007;11(3):150-167.
Munthali AC | Zulu EM
This paper examines timing of puberty and mechanisms through which society prepares adolescents to understand and deal with it in Malawi. Data from a national representative survey of adolescents and indepth interviews also conducted with adolescents are used. SPSS was used to analyse survey data while N6 was used to analyse qualitative data. Results show that the onset of menarche in girls and various pubertal body changes in boys can be a cause of joy, excitement, or distress depending on how adolescents understand what this means to them at this critical stage when they start defining and comprehending their sexuality. Much more emphasis is put on educating girls about reproductive implications of menarche than on what is expected of boys as sexual beings, which may contribute to boys' greater indulgence in risky sexual behaviors than girls. The significance of initiation ceremonies in some communities provides an important platform through which programs can reach many adolescents and intervene, particularly in addressing the widely held notion among initiates that attending these ceremonies symbolizes that one is not a child anymore and can have sex.

Improving health, improving lives: Impact of the African Youth Alliance and new opportunities for programmes
(Abstract; subscription needed for full text; Sub-Saharan Africa)
African Journal of Reproductive Health. 2007;11(3):18-27.
Daniels U
The African Youth Alliance (AYA) was a partnership to improve adolescent sexual and reproductive health, and prevent HIV/AIDS in Botswana, Ghana, Tanzania and Uganda. The AYA model was a comprehensive range of integrated interventions, implemented concurrently and at scale using a multi-sectoral approach. AYA was funded for five years (2000-2005) with $56.7 million from the Bill and Melinda Gates Foundation. Over 35,000,000 stakeholders were reached through media campaigns, almost 400,000 young people received Life Planning Skills training, and over 2,500,000 visits were made by young people to static clinics and outreach services. A post-test evaluation was conducted by John Snow Inc. (JSI) in 2006 and combined case-control and self-reported exposure design. Case-control design data were analyzed using Propensity Score Matching (PSM), and the Self-Reported Exposure design data were analyzed using PSM and Instrumental Variable (two-stage regression) (IV). The results show AYA's significant and positive treatment effects on sexual knowledge, attitudes, and behaviours. The research suggests a comprehensive, multi-component approach such as AYA's can be effective in improving some key ASRH variables.

FAMILY PLANNING NEWS

Uganda: New condoms
(News Article; Sub-Saharan Africa)
20 Jan 2008
Serunjogi T, New Vision (Kampala)

China’s one child left behind
(News Article; Asia)
28 Jan 2008
Liu M, Newsweek

Philippines: Davao City supports "No scalpel vasectomy"
(News Article; Asia)
23 Jan 2008
www.mindanao.com

FAMILY PLANNING RESEARCH

Male circumcision in Slovenia: Results from a national probability sample survey
(Abstract; subscription needed for full text; Europe)
Sexually Transmitted Infections. 2008 Feb 1;84(1):49-50.
Klavs I | Hamers FF
The objectives were to estimate the prevalence of male circumcision and to explore its association with demographic characteristics and self-reported sexually transmitted infection (STI) diagnosis in Slovenia. Data were collected over 1999-2001 from a national probability sample of the general population aged 18-49 years at respondents' homes by a combination of face-to-face interviews and anonymous self-administration of questionnaires. Statistical methods for complex survey data were used to account for stratification, clustered sampling and weighting. Overall, 4.5% (95% CI 3.2 to 6.5) of Slovenian male citizens reported being circumcised. Major variations in the prevalence of circumcision were observed across religious groups, with 92.4% (95% CI 59.8 to 99.0) of Muslims being circumcised, 1.7% (95% CI 0.9 to 3.1) of Roman Catholics, 0% of other religious affiliations (Evangelic, Serbian Orthodox, other), and 7.1% (95% CI 4.4 to 11.2) of those with no religious affiliation (p less than 0.001). The prevalence of circumcision did not vary across age groups. There were no significant differences in the proportion of circumcised and uncircumcised Slovenian men reporting ever being diagnosed with bacterial STI or viral STI. The prevalence of circumcision among Slovenian men is low. No evidence was found for an association between STI diagnosis and circumcision status, which may be due to the low prevalence of both STI and circumcision in this population as well as a small sample size. In Slovenia, where HIV prevalence is less than 1/1000 citizens and HIV infection is concentrated in men who have sex with men, promoting male circumcision in the general population may not be effective for HIV prevention purposes.

No-scalpel vasectomy curriculum: A training course for vasectomy providers and assistants. 2nd edition.
(Teaching and Training Material; Global)
New York, New York, EngenderHealth, 2007.
This curriculum on no-scalpel vasectomy (NSV) is a clinical course designed to train vasectomists and vasectomy assistants to provide NSV. This course emphasizes the information needed to provide safe and effective NSV services and may require extensive practice time. It assumes that participants will bring skills, knowledge, and self-motivation to the training. In many areas, NSV services are provided as part of a team effort; thus, this course includes instructions for training vasectomy assistants. This curriculum has been designed to be used by trainers who are skilled, experienced NSV providers and who have previously conducted clinical skills training. While this curriculum contains information to guide the trainer during a workshop and to assist the trainer in making decisions that will enhance the learning experience, it is assumed that the trainer understands adult learning concepts, has experience with a variety of training methods and techniques, and knows how to adapt materials to meet participants' needs. The trainer for this course may or may not be affiliated with the site where the training is conducted or with the institution sponsoring the training. Though the trainer's affiliation will not affect the clinical content of this course, the trainer must be aware of the institution's standards and guidelines regarding certification, training follow-up, and ongoing supervision. While reviewing the curriculum in preparation for conducting this course, trainers should be sure to address these issues.

GENDER and HEALTH NEWS

South Africa: UN heads petition to curb gender violence
(News Article; Sub-Saharan Africa)
23 Jan 2008
BuaNews (Tshwane)

Kenya: Top UN official spotlights spike in sexual violence during crisis
(News Article; Sub-Saharan Africa)
22 Jan 2008
UN News Service

Tanzania: Women and polygamy - A controversial issue
(News Article; Sub-Saharan Africa)
19 Jan 2008
Toure I, Arusha Times

Rwanda: Domestic violence - get out of this vicious circle of hell
(News Article; Sub-Saharan Africa)
19 Jan 2008
Pande R, The New Times (Kigali)

GENDER and HEALTH RESEARCH

Women's participation in a cervical cancer screening program in northern Peru
(Abstract; subscription needed for full text; South America)
Health Education Research. 2008 Feb;23(1):10-24.
Winkler J | Bingham A | Coffey P | Handwerker WP
Cervical cancer is often the most common cancer among women in developing countries, yet current screening efforts have not been effective in reducing incidence and mortality rates in these settings. In an effort to increase knowledge about screening participation in low-resource settings, this study sought to identify key factors affecting women's participation in a cervical screening program in north central Peru. We studied women who were exposed to various health promotion educational activities and compared a total of 156 women who sought screening between July 2001 and October 2003 with 155 women who did not. Results from logistic regression identified four significant predictors of screening: higher relative wealth, knowing other screened women, seeking care from a health facility when sick and satisfaction with services at the health facility. When we restricted our analysis to women who had experienced screening in the past, two additional predictors emerged: having a husband who was supportive of screening participation and attending an awareness-raising session. These results have important programmatic value for tailoring outreach efforts for women and indicate that different strategies may be required to best reach women who have never been screened.

Menstrual and reproductive factors in the risk of differentiated thyroid carcinoma in native women in French Polynesia: A population-based case-control study
(Abstract; subscription needed for full text; Oceania)
American Journal of Epidemiology. 2008;167(2):219-229.
Brindel P | Doyon F | Rachedi F | Boissin JL | Sebbag J | Shan L | Chungue V | Sun LYK | Bost-Bezeaud F | Petitdidier P | Paoaafaite J | Teuri J | Vathaire F
French Polynesia has one of the world's highest incidence rates of thyroid cancer. A case-control study among native residents of French Polynesia included 201 women diagnosed with differentiated thyroid cancer before the age of 56 years, between 1981 and 2004, matched to 324 population controls on date of birth. Face-to-face interviews were conducted from 2002 to 2004. Odds ratios were calculated by using conditional logistic regression and were reported in the total group and by ethnic group ("Polynesian" vs. "mixed"). The risk of thyroid cancer increased with natural (odds ratio = 1.9) or artificial (odds ratio = 4.5) menopause compared with that associated with a premenopausal status and with number of births (p for trend = 0.03): odds ratios for one, two, three, four or five, six or seven, and eight or more births were, respectively, 0.90, 1.6, 2.3, 2.2, 2.7, and 1.7 compared with a nulliparous status. Similar results were observed for Polynesian women. No association was observed with irregular menstrual cycles, age at menopause, history of miscarriage or induced abortion, time since last birth, age at and outcome of first pregnancy, or breastfeeding. This study confirms the role of menstrual and reproductive factors in the risk of differentiated thyroid cancer in Pacific island populations.

Identifying types of domestic violence and its associated risk factors in a pregnant population in Kerman hospitals, Iran Republic
(Abstract; subscription needed for full text; Middle East)
Asia-Pacific Journal of Public Health. 2008 Jan;20(1):49-55.
Salari Z | Nakhaee N
The objective of this study was to estimate the prevalence of different kinds of physical and emotional violence in an Iranian pregnant population and to examine its associated risk factors. This cross-sectional study was done from March through July 2005 in the 4 main hospitals of Kerman, Iran, which had maternity units. In total, 416 out of 460 women who were asked to participate agreed to be interviewed, a 90.4% response rate. All respondents were interviewed privately during the first 48 hours after delivery. The mean age (plus or minus} SD) was 28.0 plus or minus 5.6, and all were married. Most of the women were urban residents (89.2%), and the majority of them were multiparous (78.8%). Nearly 16% of mothers said the pregnancies were unintended. In total, 35% (95% confidence interval: 30%-40%) of women had experienced 1 or more episodes of emotional violence during the pregnancy inflicted by their husbands, and 106 women (25%; 95% confidence interval: 21%-30%) had experienced at least 1 episode of physical violence. The highest odds of domestic violence during pregnancy was associated with unintended pregnancies (odds ratio: 7.66; 95% confidence interval: 3.45-16.99) and multiparous pregnancies (odds ratio: 6.88; 95% confidence interval: 3.46-13.68). Considering the high prevalence of different types of domestic violence during pregnancy, it should be regarded as a priority for health policy experts in Kerman and possibly Iran.

Can microcredit help improve the health of poor women? Some findings from a cross-sectional study in Kerala, India
(Abstract; subscription needed for full text; Asia)
International Journal for Equity in Health. 2008 Jan 10;7(2):[30] p.
Mohindra KS | Haddad S | Narayana D
This study examines associations between female participation in a microcredit program in India, known as self help groups (SHGs), and women's health in the south Indian state of Kerala. Because SHGs do not have a formal health program, this provides a unique opportunity to assess whether SHG participation influences women's health via the social determinants of health. This cross-sectional study used special survey data collected in 2003 from one Panchayat (territorial decentralized unit). Information was collected on women's characteristics, health determinants (exclusion to health care, exposure to health risks, decision-making agency), and health achievements (self assessed health, markers of mental health). The study sample included 928 non elderly poor women. The primary finding is that compared to non-participants living in a household without a SHG member, the odds of facing exclusion is significantly lower among early joiners, women who were members for more than 2 years (OR=0.58, CI=0.41-0.80), late joiners, members for 2 years and less (OR=0.60, CI=0.39-0.94), and non-participants who live in a household with a SHG member (OR=0.53, CI=0.32-0.90). We also found that after controlling for key women's characteristics, early joiners of a SHG are less likely to report emotional stress and poor life satisfaction compared to non-members (OR=0.52, CI=0.30-0.93; OR=0.32, CI=0.14-0.71). No associations were found between SHG participation and self assessed health or exposure to health risks. The relationship between SHG participation and decision-making agency is unclear. Microcredit is not a panacea, but could help to improve the health of poor women by addressing certain issues relevant to the context. In Kerala, SHG participation can help protect poor women against exclusion to health care and possibly aid in promoting their mental health.

HIV/AIDS and STIs NEWS

Mozambique: Brazil renews pledge on anti-retroviral factory
(News Article; Sub-Saharan Africa)
18 Jan 2008
Agencia de Informacao de Mocambique

South Africa: Government under pressure to introduce a new PMTCT regime
(News Article; Sub-Saharan Africa)
23 Jan 2008
IRIN

HIV/AIDS and STIs RESEARCH

HIV type 1 infection is a risk factor for mortality in hospitalized Zambian children with measles
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Clinical Infectious Diseases. 2008 Feb 15;46(4):523-527.
Moss WJ | Fisher C | Scott S | Monze M | Ryon JJ | Quinn TC | Griffin DE | Cutts FT
Measles remains a significant cause of vaccine-preventable mortality in sub-Saharan Africa, yet few studies have investigated risk factors for measles mortality in regions of high human immunodeficiency virus type 1 (HIV-1) prevalence. Between January 1998 and July 2003, children with clinically diagnosed measles who were hospitalized at the University Teaching Hospital in Lusaka, Zambia, were enrolled in an observational study. Demographic and clinical information was recorded at enrollment and at discharge or death. Measles was confirmed by detection of antimeasles virus immunoglobulin M antibodies, and HIV-1 infection was confirmed by detection of HIV-1 RNA. Of 1474 enrolled children, 1227 (83%) had confirmed measles and known HIV-1 infection status. Almost one-third of the HIV-1-infected children with measles were less than 9 months of age, the age of routine measles vaccination, compared with one-fourth of the uninfected children (P = .07). Death occurred during hospitalization in 23 (12.2%) of the HIV-1-infected children and 45 (4.3%) of the HIV-1-uninfected children (P less than .001) with measles. After adjusting for age, sex, and measles vaccination status, HIV-1 infection (odds ratio, 2.5; 95% confidence interval, 1.4-4.6), less than or greater to 8 years of maternal education (odds ratio, 2.4; 95% confidence interval, 1.2-4.8), and the presence of a desquamating rash (odds ratio, 2.2, 95% confidence interval, 1.3-3.6) were significant predictors of mortality due to measles. In a region of high HIV-1 prevalence, coinfection with HIV-1 more than doubled the odds of death in hospitalized children with measles. Increased mortality among HIV-1-infected children is further evidence that greater efforts are necessary to reduce transmission of the measles virus in regions of high HIV-1 prevalence.

Maternal 12-month response to antiretroviral therapy following prevention of mother-to-child transmission of HIV type 1, Ivory Coast, 2003 -- 2006
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Clinical Infectious Diseases. 2008 Feb 15;46(4):611-621.
Coffie PA | Ekouevi DK | Chaix ML | Tonwe-Gold B | Clarisse AB | Becquet R | Viho I | N’dri‐Yoman T | Leroy V | Abrams EJ | Rouzioux C | Dabis F
Our aim was to study the response to antiretroviral treatment among women exposed to singledose nevirapine (NVP) and/or short-course zidovudine (ZDV; with or without lamivudine [3TC]) for the prevention of mother-to-child transmission of human immunodeficiency virus (HIV) infection. All HIV type 1-infected women who initiated antiretroviral treatment with stavudine or ZDV, 3TC, and NVP or efavirenz were eligible for the MTCT-Plus program in Abidjan, Ivory Coast. Exposed women had received either single-dose NVP alone or short-course ZDV (with or without 3TC) plus single-dose NVP during previous pregnancy. Genotypic resistance testing was performed at week 4 after delivery. Virologic failure was defined as a plasma HIV RNA level 1500 copies/mL 12 months after initiation of antiretroviral treatment. Among 247 women who received antiretroviral treatment, 109 (44%) were unexposed; 81 had received short-course ZDV with 3TC, as well as single-dose NVP; 5 had received short-course ZDV plus 3TC; 50 had received short-course ZDV plus single-dose NVP; and 2 had received single-dose NVP alone. No ZDV mutation was detected in the 115 women whose specimens were available for genotypic testing; 11 (15.1%) of 73 women with 3TC exposure who were tested after delivery had 3TC resistance mutations. Three (4.3%) of 69 women exposed to short-course ZDV and 3TC plus single-dose NVP and 16 (38.1%) of 42 women exposed to short-course ZDV plus single-dose NVP had NVP resistance mutations. Antiretroviral treatment was initiated a median of 21 months after the intervention to prevent mother-to-child HIV transmission (median CD4+ T lymphocyte count, 188 cells/mm3). Month 12 virologic failure was identified in 42 (19.2%) of 219 women for whom data were available, and multivariate analysis revealed that it was associated with poor adherence to treatment (adjusted odds ratio [aOR], 12.7; 95% confidence interval [CI], 3.0-53.9), postpartum 3TC resistance mutations (aOR, 6.9; 95% CI, 1.1-42.9), and a baseline CD4+ T lymphocyte count !200 cells/mm3 (aOR, 0.3; 95% CI, 0.2-0.8). NVP resistance was not associated with virological failure (aOR, 1.8; 95% CI, 0.5-6.5). Our study found that poor adherence and 3TC resistance acquired after the intervention to prevent mother-to-child transmission of HIV infection were associated with virologic failure in women who initiated antiretroviral treatment.

Sex worker incarceration in the People's Republic of China
(Editorial; Asia)
Sexually Transmitted Infections. 2008 Feb 1;84(1):34-35.
Tucker JD | Ren X
Tens of thousands of commercial sex workers in China are administratively detained each year in female re-education through labor (RTL) centres for moral education and vocational training. Recent increases in syphilis and heterosexual HIV make tailored HIV prevention efforts for sex workers increasingly important in many regions of China. However, RTL centres focused on detaining commercial sex workers have not traditionally been linked to sexually transmitted infections (STI)/HIV programmes. The stigma of being incarcerated and selling sex complicates STI/HIV prevention for these women. Incarcerated sex workers represent a particularly marginalised HIV risk group that has been excluded from domestic and international HIV programmes to date. Although several laws and administrative decrees provide a legal mandate for sex worker STI/HIV testing, treatment and rights, there is still substantial variation in how laws are implemented. Creating devoted medical services and legal aid for incarcerated sex workers is important in curbing the spread of heterosexual HIV and other STIs in China. Recent legal and social developments suggest that China's RTL system will be transformed in the near future, gaining momentum for reform that could improve the sexual and human rights of incarcerated sex workers.

Herpes simplex virus type 2 infection among young uncircumcised men in Kisumu, Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2008 Feb 1;84(1):42-48.
Mehta SD | Moses S | Agot K | Agingu W | Parker C | Ndinya-Achola JO | Bailey RC
The objectives were to identify factors associated with herpes simplex virus type 2 (HSV-2) infection among men aged 18-24 in Kisumu, Kenya. Baseline data from a randomised trial of male circumcision were analysed. Participants were interviewed for sociodemographic and behavioural risks. The outcome was HSV-2 by antibody status. Risk factors were considered singly and in combination through logistic regression models. Among 2771 uncircumcised men, 766 (27.6%; 95% confidence interval (CI) 26.0% to 29.3%) tested antibody positive for HSV-2. The median age at first sex was 16 years, and the median number of lifetime sexual partners was four. HSV-2 seroprevalence increased from 19% among 18-year-olds to 43% among 24-year-olds (p less than 0.001). In multivariable analysis, statistically significant risks for infection were increasing age (adjusted odds ratio (AOR)=1.22-2.58), being married or having a live-in female partner (AOR=1.80; 95% CI 1.28 to 2.53), preferring "dry" sex (AOR=1.39; 95% CI 1.14 to 1.69), reported penile cuts or abrasions during sex (AOR=1.58; 95% CI 1.32 to 1.91), increasing lifetime sex partners (multiple response categories; AORs ranging from 1.65 to 1.97), and non-student occupation (multiple response categories; AORs ranging from 1.44 to 1.93). Risk decreased with reported condom used at last sex (AOR=0.82; 95% CI 0.68 to 0.99). Primary prevention efforts should be initiated at an early age. The same behavioural interventions used currently for HIV prevention-abstinence, reducing the number of sex partners and increasing condom use-should be effective for HSV-2 prevention.

Epidemiology of human papillomavirus infection among fishermen along Lake Victoria Shore in the Kisumu District, Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2008 Feb 1;84(1):62-66.
Ng'ayo MO | Bukusi E | Rowhani-Rahbar A | Koutsky LA | Feng Q | Kwena ZA | Holmes KK
The epidemiology of human papillomavirus (HPV) infection in men in Kenya is largely uncharacterised. We set out to determine the prevalence and determinants of HPV infection among sexually active fishermen along Lake Victoria in the Kisumu district of Kenya. Genital swabs were obtained from 250 consenting fishermen from 18 beaches and a detailed sociodemographic questionnaire was administered. HPV positivity was determined by polymerase chain reaction amplification and detected by dot blot hybridisation with generic HPV and beta-globin probes. HPV positive samples were genotyped using the Roche Linear array assay. Overall, 144 (57.6%) fishermen had detectable HPV DNA, 106 (42.4%) were infected with oncogenic HPV types, with HPV-16 being the most frequent type (12.4%). Among HPV positive men, 105 (72.9%) were infected with more than one HPV type and 20 (13.9%) were infected with more than six different types. HIV seropositive men (PR 1.49, 95% CI 1.19 to 1.86) and those divorced or separated (PR 1.62, 95% CI 1.13 to 2.33) were more likely to be infected with HPV. HIV infection (PR 1.22, 95% CI 1.01 to 1.47) was the only factor independently associated with infection with multiple types of HPV. The prevalence of oncogenic HPV infection is high among this population and is associated with HIV serostatus and marital status. This community could benefit from enhanced sexually transmitted infection and HIV prevention interventions.

MATERNAL AND CHILD HEALTH NEWS

Nigeria: Maternal mortality - safeguarding expectant mothers
(Editorial; Sub-Saharan Africa)
22 Jan 2008
Daily Champion (Lagos)

Cameroon: Free integrated medical package for infants, mothers
(News Article; Sub-Saharan Africa)
17 Jan 2008
Bongben L | Njechu CJ, The Postnewsline.com

MATERNAL AND CHILD HEALTH RESEARCH

Neonatal mortality in the empowered action group states of India: Trends and determinants
(Abstract; subscription needed for full text; Asia)
Journal of Biosocial Science. 2008 Mar;40(2):183-201.
Arokiasamy P | Gautam A
In India, the eight socioeconomically backward states of Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal and Uttar Pradesh, referred to as the Empowered Action Group (EAG) states, lag behind in the demographic transition and have the highest infant mortality rates in the country. Neonatal mortality constitutes about 60% of the total infant mortality in India and is highest in the EAG states. This study assesses the levels and trends in neonatal mortality in the EAG states and examines the impact of bio-demographic compared with health care determinants on neonatal mortality. Data from India's Sample Registration System (SRS) and National Family and Health Survey are used. Cox proportional hazard models are applied to estimate adjusted neonatal mortality rates by health care, bio-demographic and socioeconomic determinants. Variations in neonatal mortality by these determinants suggest that universal coverage of all pregnant women with full antenatal care, providing assistance at delivery and postnatal care including emergency care are critical inputs for achieving a reduction in neonatal mortality. Health interventions are also required that focus on curtailing the high risk of neonatal deaths arising from the mothers' younger age at childbirth, low birth weight of children and higher order births with short birth intervals.

Maternal and child undernutrition: Global and regional exposures and health consequences
(Abstract; subscription needed for full text; Global)
Lancet. 2008 Jan 19;371(9608):243-260.
Black RE | Allen LH | Bhutta ZA | Caulfield LE | de Onis M | Ezzati M | Mathers C | Rivera J
Maternal and child undernutrition is highly prevalent in low-income and middle-income countries, resulting in substantial increases in mortality and overall disease burden. In this paper, the authors present new analyses to estimate the effects of the risks related to measures of undernutrition, as well as to suboptimum breastfeeding practices on mortality and disease. The authors estimated that stunting, severe wasting, and intrauterine growth restriction together were responsible for 2.2 million deaths and 21% of disability-adjusted life-years (DALYs) for children younger than 5 years. Deficiencies of vitamin A and zinc were estimated to be responsible for 0.6 million and 0.4 million deaths, respectively, and a combined 9% of global childhood DALYs. Iron and iodine deficiencies resulted in few child deaths, and combined were responsible for about 0.2% of global childhood DALYs. Iron deficiency as a risk factor for maternal mortality added 115 000 deaths and 0.4% of global total DALYs. Suboptimum breastfeeding was estimated to be responsible for 1.4 million child deaths and 44 million DALYs (10% of DALYs in children younger than 5 years). In an analysis that accounted for co-exposure of these nutrition-related factors, they were together responsible for about 35% of child deaths and 11% of the total global disease burden. The high mortality and disease burden resulting from these nutrition-related factors make a compelling case for the urgent implementation of interventions to reduce their occurrence or ameliorate their consequences.

HIV-positive poor women may stop breast-feeding early to protect their infants from HIV infection although available replacement diets are grossly inadequate
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Nutrition. 2008 Feb;138:351-357.
Lunney KM | Jenkins AL | Tavengwa NV | Majo F | Chidhanguro D | Iliff P | Strickland TG | Piwoz E | Iannotti L | Humphrey JH
Related Abstract; subscription needed for full text: Better breastfeeding, healthier lives
Little is known about mothers' perspectives and experiences of early breast-feeding cessation as a strategy to reduce postnatal HIV transmission in rural, resource-constrained settings. We conducted in-depth interviews (IDI) with 15 HIV-positive breast-feeding mothers of infants aged 3-5 mo about their plans for feeding their infants after age 6 mo. The authors also conducted IDI with 12 HIV-positive mothers who intended to stop breast-feeding after receiving their infant's HIV-PCR negative test result at age 6 mo. Twenty-four-hour dietary recalls were conducted with the same 12 mothers and 16 HIV-negative or status unknown mothers who were breast-feeding their 6- to 9-mo-old infants. Of the 12 mothers who intended to stop breast-feeding, 11 did so by 9 mo. Median energy intake (percent requirement) was 1382 kJ (54%) among weaned infants compared with 2234 kJ (87%) among breast-feeding infants. Median intakes were less than 67% of the recommended levels for 9 and 7 of the 12 micronutrients assessed for weaned and breast-feeding infants, respectively. Factors facilitating early breast-feeding cessation were mothers' knowledge about HIV transmission, family support, and disclosure of their HIV status; food unavailability was the primary barrier. HIV-positive mothers in resource-constrained settings may be so motivated to protect their child from HIV that they stop breast-feeding early even when they cannot provide an adequate replacement diet. As reflected in the new World Health Organization guidance, HIV-positive mothers should continue breastfeeding their infants beyond 6 mo if replacement feeding is still not acceptable, feasible, affordable, sustainable, and safe.

Factors affecting the utilization of antenatal care in developing countries: Systematic review of the literature
(Abstract; subscription needed for full text; Europe)
Journal of Advanced Nursing. 2008 Feb;61(3):244-260.
Simkhada B | van Teijlingen ER | Porter M | Simkhada P
This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries. Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it. A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched. Review methods. A systematic review was carried out and both quantitative and qualitative studies were included. Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women's age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them. More qualitative research is required to explore the effect of women's satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women's overall (social, political and economic) status needs to be considered.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Envisioning world population growth
(News Article; Global)
22 Jan 2008
The Daily Green

Russia's birth, mortality rates to equal by 2011 - ministry
(News Article; Asia)
23 Jan 2008
Russian News and Information Agency

Mideast fertility rates plunge
(News Article; Middle East)
25 Jan 2008
Middle East Times

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

The preference for an additional child among married women in Seoul, Korea
(Abstract; subscription needed for full text; Asia)
Journal of Biosocial Science. 2008 Mar;40(2):269-281.
Park SM | Cho SI | Jang SN | Cho YT | Chung HW
South Korea reported a total fertility rate (TFR) of 1.08 in 2005. This is the lowest level of all nations in the Organisation for Economic Co-operation and Development (OECD). Recently, the decline in the fertility rate has been a dominant phenomenon in Korea's major cities. This study investigated the relationship between social environmental factors and fertility intentions for married women in Seoul, the capital of Korea, using a sample of 2211 married women who responded to the Seoul Citizens Health and Social Indicators Survey, 2005. Here, the effects of selected social environmental characteristics on fertility intentions are explored using multivariate logistic regression models. The relationships among a woman's age, number of living children, job type, housing type, and social group participation were strong indicators of the intention to have additional children. Younger women living with fewer children generally have a higher intention to have additional children. Among women's job types, blue-collar workers have a lower preference for additional children than white-collar workers and housewives. Married women participating in social groups have a lower preference for additional children than non-participants. Women's participation in social activities appears to have various benefits, both individually and socially. However, whereas women's participation in economic activities has been linked to questions of fertility in previous studies, the relationship between fertility and social activities has been downplayed. Women's participation in social activities has increased over the past several decades, and the trend continues to grow. Therefore, women's participation in social activities must be accepted as the status quo, and compatibility between women's participation in social activities and childrearing needs to be increased. Consequently, a strong foundation for a fertility-friendly environment is needed, focusing on blue-collar workers and participation in social activities by married women.

Exploratory analysis of spatial patterns in Brazil's fertility transition
(Abstract; subscription needed for full text; South America)
Population Research and Policy Review. 2008 Feb;27(1):1-15.
Schmertmann CP | Potter JE | Cavenaghi SM
We use census data to investigate fertility change across more than 500 Brazilian microregions during 1970-2000, before and after controlling for local covariates. We use semivariograms to analyze spatial patterns, in order to investigate the importance of diffusion or social interaction in the spread of fertility transition across a map. Our analysis shows that spatial patterns in Brazilian fertility change are strongly related to spatial patterns in measurable local conditions such as electrification, child mortality, and female education. Differences in local conditions are particularly good at explaining spatial correlations at distances greater than 500km. At shorter distances, there remains some unexplained spatial correlation in fertility change that could be attributed to diffusion or social interaction.

Unintended pregnancy in Egypt: Evidence from the national study on women giving birth in 1999
(Research Article; North Africa)
Eastern Mediterranean Health Journal. 2007 Nov-Dec;13(6):1392-1404.
Shaheen AA | Diaaeldin M | Chaaya M | El Roueiheb Z
The current study aimed to estimate the prevalence and correlates of unintended pregnancy among ever-married women. The study sample was 2349 ever-married women aged 15-49 years who gave birth in 1999. Unintended pregnancy was defined as unwanted and mistimed pregnancies. Of these, 431 (18.5%) women reported unintended pregnancy: 137 were mistimed (5.9%) and 294 were unwanted (12.6%). Women of older age, living in frontier governorates, with poor knowledge of the ovulatory cycle, having a more than ideal family size, using contraceptive methods and having 4 or more children were at increased odds of reporting unintended pregnancies. Fewer antenatal care visits and low child weight at birth were significantly associated with unintended pregnancy.

SPECIAL REPORTS/PROFILES/RESOURCES

The State of the World’s Children 2008
(Report; Global)
22 Jan 2008
UNICEF
The State of the World’s Children 2008 assesses the state of child survival and primary health care for mothers, newborns and children today. These issues serve as sensitive barometers of a country’s development and well being and as evidence of its priorities and values. Investing in the health of children and their mothers is a human rights imperative and one of the surest ways for a country to set its course towards a better future.

Toolkit for mainstreaming HIV and AIDS in the education sector: Guidelines for development cooperation agencies
(Tool; Global)
(You need Adobe Acrobat Reader to access this document)
Paris, UNESCO, 2008.
Sass J
This toolkit aims to help education staff from development cooperation agencies, including both development and humanitarian-oriented multilateral and bilateral agencies as well as non-governmental organizations (NGOs) and other civil society organizations, to support the process of mainstreaming HIV and AIDS into education sector planning and implementation. It provides resources and support to assess the progress countries have made with respect to HIV and AIDS mainstreaming; to identify entry points and opportunities; and to establish priorities for advocacy and action. It is designed to be used as a reference tool or a resource for training and discussion, depending on the local needs and context. The toolkit was developed for the UNAIDS Inter-Agency Task Team (IATT) on Education, expanding on materials used in a 2005 Seminar in Lusaka, Zambia hosted by the Swedish International Development Cooperation Agency (SIDA). Formed in 2002, the IATT on Education is convened by UNESCO and brings together UNAIDS Cosponsors, bilateral agencies and civil society organizations with the purpose of accelerating and improving a coordinated and harmonised education sector response to HIV and AIDS. Its specific objectives are to promote and support good practices in the education sector in relation to HIV and AIDS and to encourage alignment and harmonisation within and across agencies to support global and country-level actions. The IATT seeks to achieve these objectives by: strengthening the evidence base and disseminating findings to inform decision making and strategy development, encouraging information and materials exchange, and working jointly to bridge the education and AIDS communities and ensure a stronger education response to HIV and AIDS.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 8, Number 428 January 2008