Volume 8, Number 6
11 February 2008

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ADOLESCENT HEALTH NEWS

Nigeria: Youths advised on MDGs, needs
(News Article; Sub-Saharan Africa)
5 Feb 2008
This Day (Lagos)

Kenya: Teenage girls targeted for sexual exploitation
(News Article; Sub-Saharan Africa)
7 Feb 2008
Obwocha B, The East African Standard (Nairobi)

Tanzania: Class seven girl escapes from home fleeing forced marriage
(News Article; Sub-Saharan Africa)
2 Feb 2008
Marc Nkwame V, Arusha Times

ADOLESCENT HEALTH RESEARCH

Hidden love: Sexual ideologies and relationship ideals among rural South African adolescents in the context of HIV/AIDS
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Culture, Health and Sexuality. 2008 Feb;10(2):175-189.
Harrison A
In KwaZulu/Natal, South Africa, the social construction of young people's sexuality reflects both a complex historical process of cultural and religious integration, as well as the contemporary resurgence of 'traditionalism'. How do young people interpret these factors to construct and give meaning to their own sexualities? This multi-method qualitative study examined sexuality and relationship formation among sexually experienced young people aged 14-19 in a rural sub-district. In this setting, sexual activity is highly stigmatised, particularly for young teenage women. Dominant sexual ideologies centre on 'good behaviour', the idea that 'sex is wrong', and abstinence as a preferred prevention strategy. Young women's relationships are often hidden but sexual relationships are also an important part of the transition to adulthood. These dichotomies of love and romance versus stigma and secrecy frame young people's discourse about sexuality. A discourse about healthy sexuality is largely absent, impeding the prevention of HIV in this setting.

Preventing mother-to-child HIV transmission among South African adolescents
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Adolescent Research. 2008 Mar;23(2):172-205.
Varga C | Brookes H
Although prevention of mother-to-child HIV transmission (PMTCT) programs are predicated on maternal behavior change, little is known about sociocultural factors affecting maternal-child care practices in this arena. The authors used narrative methods (key informant workshops, questionnaires, focus groups, and case study analysis) to explore how sociocultural context shapes adolescent mothers' ability to adhere to programmatic recommendations in rural and urban South Africa. The study aims were to understand the extent to which mothers' decisions are borne out in PMTCT-related practices and to identify contextual elements that affect the link between individual resolutions and action. The results revealed rural adolescents as less likely than urbanites to successfully implement most PMTCT-related practices. HIV stigma, family decision making, and cultural norms surrounding infant feeding hampered mothers' efforts to implement practices that would decrease the risk for infant infection. Barriers to behavior change were analyzed along four domains: history, culture, gender, and power. Methodological aspects and programmatic implications are discussed.

HIV risk-related attitudes, interpersonal influences, and intentions among at-risk urban, early adolescent girls
(Abstract; subscription needed for full text; North America)
American Journal of Health Behavior. 2008;32(5):497-507.
Noia JD | Schinke SP
The objective was to examine correlates of sexual experimentation and risk among urban, early adolescent girls (N = 236, 12.38 plus or minus 1.2 years). Measures of HIV risk-related attitudes, interpersonal influences, and intentions were compared based on girls' degree of sexual experimentation and risk. Girls in high sexual experimentation and risk groups scored highest on deviant peer norms; endorsements of risky behaviors; and inability to refuse unprotected sex, offset negative partner influences, avoid intercourse, and assert sexual desires. Greater experimentation occurred among girls with older versus same-age or younger partners. Risk correlates should be considered in designing HIV prevention programs.

FAMILY PLANNING NEWS

Chile’s policy of free emergency contraception under threat
(News Article; South America)
6 Feb 2008
Ms. Magazine

Philippines: Family planning cleared for class
(News Article; Asia)
6 Feb 2008
Sy Egco JM, Manila Standard Today

FAMILY PLANNING RESEARCH

Public policy and franchising reproductive health: Current evidence and future directions. Guidance from a technical consultation meeting
(Technical Report; Global)
(You need Adobe Acrobat Reader to access this document)
Geneva, Switzerland, World Health Organization [WHO], Department of Reproductive Health and Research, 2007. [30] p.
Huntington D | Sulzbach S | O'Hanlon B
To assist policymakers and researchers to take advantage of lessons learned in the area of private-provider networks, particularly franchises, and to explore the types of policy options available to facilitate a greater role for the private sector, the World Health Organization's Department of Reproductive Health and Research, in collaboration with the United States Agency for International Development's (USAID) Private Sector Partnerships-One project, convened a technical consultation from 7 to 9 December, 2006 in Geneva, Switzerland. The meeting, entitled "Public Policy and Franchising Reproductive Health: current evidence and future directions", brought together experts in private-provider networks and franchises as well as in public policy. The consultation: reviewed the evidence to date on the performance and impact of health networks and franchises in low- and middle-income countries; explored public policy options that can facilitate and support the delivery of reproductive health through private-provider networks and health franchises in low- and middle-income countries. This Guidance Note is based on the proceedings of the meeting and offers policymakers and researchers the latest evidence on private-provider networks and franchises, lessons learned in the field, and policy recommendations on how to mobilize private-provider networks and health franchises to help address reproductive health care needs in developing countries.

Multicenter comparison of the contraceptive ring and patch: A randomized controlled trial
(Abstract; subscription needed for full text; Global)
Obstetrics and Gynecology. 2008 Feb;111(2 Pt 1):267-277.
Creinin MD | Meyn LA | Borgatta L | Barnhart K | Jensen J | Burke AE | Westhoff C | Gilliam M | Dutton C | Ballagh SA
The objective was to understand if the contraceptive ring or patch was more acceptable, as measured primarily by continuation, to women using an oral contraceptive and interested in a nondaily, combined hormonal contraceptive. Five hundred women were randomly assigned to use the contraceptive ring (n=249) or contraceptive patch (n=251) for four consecutive menstrual cycles, starting with their next menses. Participants returned for a single follow-up visit during the fourth cycle for an evaluation, which included a questionnaire to assess acceptability and adverse effects. Rates of completion of three cycles were 94.6% (95% confidence interval [CI] 91.0-97.1%) and 88.2% (95% CI 83.4-92.0%) for ring and patch users, respectively (P=.03). Of these women, 71.0% (95% CI 64.8-76.6%) and 26.5% (95% CI 21.0-32.6%), respectively, planned to continue their method after the study (P less than .001). Women switching to the patch were significantly more likely than women switching to the ring to experience longer periods (38% compared with 9%), increased dysmenorrhea (29% compared with 16%), frequent nausea (8% compared with 1%), frequent mood swings (14% compared with 8%), and frequent skin rash (12% compared with 2%) and were less likely to experience frequent vaginal discharge (8% compared with 17%). Ring users preferred the ring to the oral contraceptive (P less than .001), and patch users preferred the oral contraceptive to the patch (P less than .001). Nugent scores increased only in patch users (P=.01), although most of these women were asymptomatic. Women satisfied with combined oral contraceptives and interested in a nondaily method are more likely to continue using the contraceptive ring than the contraceptive patch.

GENDER and HEALTH NEWS

Africa: UN calls for end to female mutilation
(News Article; North Africa | Sub-Saharan Africa)
6 Feb 2008
Lirri E, The Monitor (Kampala)

Police and authorities 'afraid to act against honour crimes in case they are called racist', claims report
(News Article; Asia | Europe)
4 Feb 2008
Moynihan , Press Association Newsfile

Heavy cell phone use tied to poor sperm quality
(Abstract; subscription needed for full text; Global)
6 Feb 2008
Reuters
Related Abstract; subscription needed for full text: Effect of cell phone usage on semen analysis in men attending infertility clinic: An observational study

GENDER and HEALTH RESEARCH

Accounting for institutional change in health economic evaluation: A program to tackle HIV/AIDS and gender violence in Southern Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Social Science and Medicine. 2008 Feb;66(4):922-932.
Jan S | Pronyk P | Kim J
There has been growing interest in the application of institutionalist perspectives in the health economics literature. This paper investigates the institutionalist notion of social value and its use in economic evaluation with particular reference to a program to address HIV/AIDS and gender violence in Southern Africa (IMAGE). Institutions are the rules that govern the conduct between individuals, groups and organisations. Their social value stems from their capacity to reduce the uncertainty in human interactions thereby both reducing transaction costs and, importantly, enabling the initiation and sustainability of various activities (instrumental value). Furthermore, institutions tend to be formed around certain ethical positions and as a consequence, act in binding future decision making to these positions (intrinsic value). Incorporating such notions of social value within a conventional welfare-based measure of benefit is problematic as institutional development is not necessarily consistent with individual utility. An institutionalist approach allows for these additional domains to be factored into economic evaluation. IMAGE is an intervention to reduce gender violence and HIV through microfinance, health education and community development, and involves significant initial investment in institution-building activities, notably through training activities with program staff and community members. The key to employing an institutionalist approach to the evaluation of IMAGE is in understanding the nature of those actions that can be seen as institution-building and determining: (1) the instrumental value of follow-up activities by appropriate amortisation of transaction costs over an horizon that reflects the economies gained from the intervention; and (2) the intrinsic value of any transformation in the community through a cost-consequences approach informed by an a priori conceptual model. This case study highlights how health sector interventions can effect institutional changes and how these are captured within a theory-based economic evaluation framework.

Client-perpetuated violence and condom failure among female sex workers in southwestern China
(Abstract; subscription needed for full text; Asia)
Sexually Transmitted Diseases. 2008 Feb;35(2):141-146.
Choi SY | Chen KL | Jiang ZQ
This research examined factors associated with condom failure, i.e., slippage or breakage, among female sex workers (FSWs) in China. Special attention was paid to the association between client-perpetuated violence and condom failure. Two hundred FSWs were recruited for a community-based voluntary human immunodeficiency virus prevention project. Participants completed a face-to-face structured questionnaire that collected information on their sociodemographic characteristics, working conditions, experience of client-perpetuated violence, and sexual risk behavior. The prevalence of condom slippage and condom breakage in the 3 months before the survey was reported at 36.2% and 34%, respectively, of all sexual contact in which a condom was used. The prevalence of client-perpetuated violence in the previous year was 68.4%. Logistic regression analysis showed that after adjusting for other factors, condom failure was significantly associated with drug use [adjusted odds ratios (aOR = 4.01)], condom use of coworkers (aOR = 0.39), and client-perpetuated violence [aOR = 2.30 (low violence vs. high violence)]. Condom failure is a common problem among FSWs, particularly drug-using sex workers and those who have experienced client-perpetuated violence. On the other hand, condom use of coworkers is negatively associated with condom failure.

Hidden in the mealie meal: Gender-based abuses and women's HIV treatment in Zambia
(Report; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
New York, New York, Human Rights Watch, 2007 Dec. 96 p. (Human Rights Watch Vol 19, No. 18(A))
Zambia is one of many countries setting ambitious targets for rapidly scaling up antiretroviral treatment for HIV/AIDS and is making impressive progress. It is addressing a range of obstacles to treatment and receiving substantial donor support to overcome them. However, women's unequal status in Zambian society gravely undermines their ability to access and adhere to antiretroviral treatment (ART), and the government is paying little if any attention to the gender dimension of treatment, especially the impact of entrenched discrimination and gender-based violence and abuse. Women in Zambia report that gender-based human rights abuses are, in fact, very real barriers to accessing and adhering to treatment. HIV programs, activists, and policy makers are increasingly recognizing that discrimination and violence against women must be addressed if the world is to combat the AIDS pandemic. But treatment policies and programs still tend to ignore the connection between domestic violence or women's insecure property rights and their ability to seek, access, and adhere to HIV treatment. Although the Zambian government has taken some steps to address violence and discrimination against women generally, major gaps remain in legislation, HIV treatment programs, and support services to address poverty among women living with HIV/AIDS. This must change if HIV treatment is to be provided equitably and to succeed in saving women's lives.

HIV/AIDS and STIs NEWS

AIDS vaccine research--back to the drawing board
(News Article; Global)
6 Feb 2008
Russell S, San Francisco Chronicle
Related Report: New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications
(You need Adobe Acrobat Reader to access this document)

Botswana achieves MDG-6 on HIV
(News Article; Sub-Saharan Africa)
4 Feb 2008
Chwaane T, Mmegi/The Reporter (Gaborone)

South Africa: Hope in a colourless gel
(Editorial; Sub-Saharan Africa)
6 Feb 2008
Naidoo A, Daily News

SAfrica questions circumcision advice
(News Article; Sub-Saharan Africa)
07 Feb 2008;7 Feb 2008
Nullis C, Associated Press

HIV/AIDS and STIs RESEARCH

Community-based study on seroprevalence of herpes simplex virus type 2 infection in New Delhi
(Abstract; subscription needed for full text; Asia)
Indian Journal of Medical Microbiology. 2008 Jan-Mar;26(1):34-39.
Chawla R | Bhalla P | Bhalla K | Singh MM | Garg S
The purpose was to determine the seroprevalence of herpes simplex virus type 2 (HSV-2) in two urban communities in Delhi and to correlate the presence of HSV-2 seroprevalence with sociodemographic profile, risk factors and presence of other reproductive tract infections (RTIs). Men and women age between 15-49 years from an urban slum and an urban middle class colony were invited to participate in the study. They provided interview information; blood for HSV-2, HIV and syphilis serology; first void urine specimens for diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis infection; and genital specimens for diagnosis of bacterial vaginosis, vaginal candidiasis and trichomoniasis. The prevalence of HSV-2 seropositivity was found to be 7 and 8.6% in men and women, respectively. HSV-2 seropositivity was found to be significantly associated with urban middle class community and older age. No statistically significant correlation was found between HSV-2 seropositivity and other laboratory-confirmed RTIs. The findings of out study indicate a relatively low prevalence of HSV-2 seropositivity and other sexually transmitted infections in the two communities that were studied.

Differentiating normal from abnormal rates of genital epithelial findings in vaginal microbicide trials
(Abstract; subscription needed for full text; Asia)
Contraception. 2008 Feb;77(2):122-129.
van de Wijgert JH | Kilmarx PH | Jones HE | Karon JM | Chaikummao S
Candidate vaginal microbicides could cause genital irritation, which in turn could facilitate HIV transmission instead of preventing it. While genital epithelial findings are documented in a standardized manner in most microbicide trials, little is known about background rates and predictors for many types of genital findings. A secondary analysis was conducted using data from a Phase II expanded safety study of the candidate microbicide Carraguard gel (Population Council, NY, USA) in Thailand. Genital findings were identified by visual inspection of the cervix, vaginal walls and external genitalia during pelvic exams prior to gel use (screening and enrollment) and during gel use (at 2 weeks and Months 1-12). Women were interviewed about potential risk factors for genital findings at every visit and tested routinely for sexually transmitted and vaginal infections. A total of 258 genital findings were identified in 152 woman-years of follow-up. Genital findings were positively associated with older age, increased parity, self-report of genital symptoms, positive HSV-2 serology, bacterial vaginosis by Nugent scoring and the presence of a genital finding at baseline. Furthermore, vaginal findings were positively associated with vaginal practices and yeast infections. Genital findings were negatively associated with use of hormonal contraception, inconsistently associated with frequency of sex and applicator use, and not associated with condom use. Several factors that are common in women of reproductive age account for the background rate of genital epithelial findings in this population.

Measuring effectiveness in community randomized trials of HIV prevention
(Abstract; subscription needed for full text; Global | Sub-Saharan Africa)
International Journal of Epidemiology. 2008 Feb;37(1):77-87.
Hallett TB | Garnett GP | Mupamberiyi Z | Gregson S
Complicated HIV transmission dynamics make it unclear how to design and interpret results from community-randomized controlled trials (CRCT) of interventions to prevent infection. Mathematical modelling was used to investigate the effectiveness of interventions to prevent HIV transmission aimed at high-risk groups and factors related to the chance of recording a statistically significant result. Behaviour change by high-risk groups can substantially reduce HIV incidence in the whole population, although its effect is sensitive to the structure of the sexual network and the phase of the epidemic. There is a delay between the behaviour change happening and its full effect being realized in the low-risk group and this can pull the measured incidence rate ratio towards one and reduce the chance of recording a statistically significant result in a CRCT. Our simulations suggest that only with unrealistically favourable study conditions would a statistically significant result be likely with 5 years follow-up or less. Small differences in the epidemiological parameters between communities can lead to misleading incidence rate ratios. Behaviour change independent of the intervention can increase the epidemiological impact of the intervention and the chance of recording a statistically significant result. HIV prevention interventions, especially those targeted at high-risk groups may take longer to work at the population level and need more follow-up time in a CRCT to generate statistically significant results. Mathematical modelling can be used in the design and analysis of CRCTs to understand how the impact of the intervention could develop and the implications this has for statistical power.

HIV incidence in 3 years of follow-up of a Zimbabwe cohort -- 1998 -- 2000 to 2001 -- 03: Contributions of proximate and underlying determinants to transmission
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of Epidemiology. 2008 Feb;37(1):88-105.
Lopman B | Nyamukapa C | Mushati P | Mupambireyi Z | Mason P
In recent years, HIV prevalence has begun to decline in Zimbabwe, which has been associated with reductions in sexual risk behaviour. Here, we analyse the determinants of HIV incidence in this period of decline and estimate the population-level impact of identified risk factors. A population-based cohort of 1672 HIV-negative adult males and 2465 HIV-negative adult females was recruited between 1998 and 2000. Each individual was then followed-up 3 years later. The influence and inter-relationship of social, behavioural and demographic variables were examined using a proximate determinants framework. To explore the population-level influence of a variable, methods were developed for estimating a risk factor's contribution to the reproductive number (CRN). HIV incidence was 19.9 [95% confidence interval (CI) 16.3-24.2] per 1000 person years in men and 15.7 (95% CI 13.0-18.9) in women. Multiple sexual partners, having an unwell partner, and reporting another sexually transmitted disease were risk factors that captured the main aspects of the proximate determinants framework: individual behaviour, partnership characteristics and the probability of transmission, respectively. If the proximate determinants fully captured risk of HIV infection, underlying factors would not influence a fully parameterized model. However, a number of underlying social and demographic determinants remained important in regression models after including the proximate determinants. For both sexes, having multiple sexual partners made a substantial CRN, but, for women, no behaviour explained more than 10% of new infections. The proximate determinants did not explain the majority of new infections at the population level. This may be because we have been unable to measure some risks, but identifying risk factors assumes that those acquiring infections are somehow different from others who do not acquire infections. That they are not suggests that in this generalized epidemic there is little difference in readily identifiable characteristics of the individual between those who acquire infection and those who do not.

Caregivers' and non-caregivers' knowledge regarding HIV/AIDS and attitude towards HIV/AIDS and orphans in Nigeria
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Health and Social Care in the Community. 2008 Feb 04;
Ohnishi M | Nakamura K | Kizuki M | Seino K | Inose T
Nigeria has an estimated 930 000 AIDS orphans, which has a marked impact on family and community. This study was performed to characterise caregivers' knowledge regarding HIV/AIDS and their attitude towards HIV/AIDS, orphans in general and AIDS orphans in particular. Caregivers and non-caregivers aged 25-70 years in Nigeria were interviewed from January and March 2003, and logistic regression analysis was used to determine associations between caregivers' knowledge regarding HIV/ AIDS and attitudes towards HIV/AIDS, orphans and AIDS orphans, and demographic characteristics and background status regarding HIV/AIDS and orphans. A total of 824 interviewees participated in the survey (82.4% response rate), of whom 290 (35.2%) were current caregivers of orphans. The mean number of orphans per current caregiver was 1.8 (standard deviation 1.4). Factors related to higher knowledge level regarding HIV/AIDS were female gender [odds ratio (OR) = 3.49; 95% confidence interval (CI): 2.33, 5.22] and belief that AIDS is a common disease (OR = 3.39; 95% CI: 2.19, 5.26). Factors associated with positive attitudes towards HIV/AIDS, orphans in general and AIDS orphans in particular were age 35-44 years (OR = 1.73; 95% CI: 1.11, 2.69), Koranic schooling (OR = 8.69; 95% CI: 2.42, 31.19), polygamy (OR = 1.76; 95% CI: 1.17, 2.62), belief that there are increasing numbers of orphans in the community (OR = 2.59; 95% CI: 1.32, 5.08) and having relatives or friends with HIV/AIDS (OR = 2.88; 95% CI: 1.61, 1.58). There was a slight correlation (r = 0.17, P less than 0.001) between caregivers' knowledge regarding HIV/AIDS and positive attitudes towards HIV/AIDS, orphans and AIDS orphans. Demographic characteristics and personal experience should be taken into consideration to improve attitudes and behaviour related to HIV/AIDS and caring for orphans and AIDS orphans.

HIV voluntary counselling and testing in Nakuru, Kenya: Findings from a community survey
(Abstract; subscription needed for full text; Sub-Saharan Africa)
HIV Medicine. 2008 Feb;9(2):111-117.
Irungu TK | Varkey P | Cha S | Patterson JM
HIV voluntary counselling and testing (VCT) is important for prevention, detection and treatment of HIV infection. A study was conducted to determine the extent of utilization of VCT, and to study the attitudes and preferences of the community regarding VCT. A total of 301 adults, aged 18-49 years, residing in Nakuru, Kenya were randomly selected using a two-stage sampling process. A self-administered questionnaire delivered during home visits was used to collect data over a 4-week period. The majority of study participants (184 of 287; 64.1%) had never been tested for HIV; 77 (26.8%) had received VCT, and 26 (9.1%) had received HIV testing without counselling. A total of 219 (78.2%) of the 280 responding participants expressed readiness to have VCT. The majority of participants (216 of 296; 73%) preferred VCT, while 46 (15.5%) preferred testing without counselling. The majority (227; 76.7%) preferred couple testing and dedicated clinics and private doctors' offices as testing facilities. The choice of a nearby facility was ranked above the provision of anonymity by most participants (162 of 298; 54.4%; vice versa for 136 of 298; 45.6%). With HIV/AIDS continuing to be a major public health concern in Kenya, the issues surrounding acceptance and use of VCT need to be addressed. Enhancing community awareness of the benefits of early HIV diagnosis, providing couple-based VCT as an integral part of VCT and increasing access to VCT testing sites may enhance utilization of VCT.

MATERNAL AND CHILD HEALTH NEWS

Breast-feeding now safer for infants of HIV-infected mothers
(Press Release; Global)
4 Feb 2008
The Johns Hopkins University
Related Report: Better breastfedding healthier lives

HIV/AIDS tests for children in sub-Saharan Africa
(News Article; Sub-Saharan Africa)
5 Feb 2008
Accra Mail (Accra)

Philippines: Efforts to curb maternal death doubled
(Press Release; Asia)
1 Feb 2008
Gulliermo JB, Philippine Information Agency

Ghana: Northern region records high maternal deaths
(News Article; Sub-Saharan Africa)
6 Feb 2008
Ghana News Agency (GNA)

MATERNAL AND CHILD HEALTH RESEARCH

Methodological considerations in implementing the WHO global survey for monitoring maternal and perinatal health
(Report; Global)
Bulletin of the World Health Organization. 2008 Feb;86(2):126-131.
Shah A | Faundes A | Machoki M | Bataglia V | Amokrane F | Donner A | Mugerwa K | Carroli G | Fawole B | Langer A | Wolomby JJ | Navarez A | Nafiou I | Kublickas M | Valladares E | Velasco A | Zavaleta N | Neves I | Villar J
The objective was to set up a global system for monitoring maternal and perinatal health in 54 countries worldwide. The WHO Global Survey for Monitoring Maternal and Perinatal Health was implemented through a network of health institutions, selected using a stratified multistage cluster sampling design. Focused information on maternal and perinatal health was abstracted from hospital records and entered in a specially developed online data management system. Data were collected over a two- to three-month period in each institution. The project was coordinated by WHO and supported by WHO regional offices and country coordinators in Africa and the Americas. The initial survey was implemented between September 2004 and March 2005 in the African and American regions. A total of 125 institutions in seven African countries and 119 institutions in eight Latin American countries participated. This project has created a technologically simple and scientifically sound system for large-scale data management, which can facilitate programme monitoring in countries.

Accuracy of child morbidity data in demographic and health surveys
(Abstract; subscription needed for full text; Global | Middle East)
International Journal of Epidemiology. 2008 Feb;37(1):194-200.
Manesh AO | Sheldon TA | Pickett KE | Carr-Hill R
The Demographic and Health Surveys (DHSs) have been used throughout the developing world for the last 20 years to provide data on the distribution of disease in order to inform planning. Data on child illness and death are reported by mothers and are susceptible to error. The authors conducted an in-depth study of the Iranian DHS carried out in 2000-2001 and reviewed 110 DHS carried out around the world to check for bias by assessing the social gradient in reported child morbidity and mortality. We found that the reported under-5 child morbidity and mortality rates for the 28 Iranian provinces were inversely correlated (r = -0.592, P less than 0.001) and that the adjusted social gradient of child morbidity implied increased illness in those who had literate vs illiterate mothers (OR = 1.26, 95% CI 1.20-1.32) compared with a decrease in mortality with increased literacy (OR = 0.52, 95% CI 0.46-0.59). Many of the other DHSs also show increased rates of reported child diarrhoea in households with higher levels of maternal education, access to piped water and urban (vs rural) dwellings, the reverse of what is found with mortality rates. This suggests that there may be significant recall and reporting bias in under-5 childhood morbidity in DHSs. Caution should be used in the interpretation and use of data from DHSs and the survey methods should be reviewed.

Risk screening, emergency care, and lay concepts of complications during pregnancy in Chiapas, Mexico
(Abstract; subscription needed for full text; North America)
Social Science and Medicine. 2008 Mar;66(5):1057-1069.
Tinoco-Ojanguren R | Glantz NM | Martinez-Hernandez I | Ovando-Meza I
Maternal morbidity and mortality are widespread in Chiapas, Mexico's southernmost state, as in many developing regions. Globally, the utility of three approaches to addressing such problems has been debated: (a) obstetric risk screening (i.e. screening women for risk during pregnancy and channeling those at risk to preventive care); (b) emergency obstetric care (i.e. identifying complications during pregnancy or birth and providing prompt effective treatment); and (c) combined risk screening and emergency care. Unaddressed to date in peer-reviewed journals are the lay perceptions of complications and risk that precede and incite the quest for obstetric care in Mexico. High incidence of maternal mortality in Chiapas, exacerbated by the predominantly rural, highly indigenous, geographically dispersed, and economically marginalized nature of the state's southern Border Region, prompted us to conduct 45 open-ended interviews with a convenience sample of women and their close relative/s, including indigenous and nonindigenous informants in urban and rural areas of four municipalities in this region. Interviews suggest that none of the three approaches is effective in this context, and we detail reasons why each approach has fallen short. Specific obstacles identified include that (1) many women do not access adequate prenatal screening care on a regular basis; (2) emergency obstetric care in this region is severely circumscribed; and (3) lay notions of pregnancy-related risk and complications contrast with official clinical criteria, such that neither clinical nor extra-clinical prenatal monitoring encompasses the entire range of physical and social risk factors and danger signs. Findings reported here center on a rich description of the latter: lay versus clinical criteria for risk of antepartum complication.

Growth and metabolism of infants born to women infected with human immunodeficiency virus and fed acidified whey-adapted starter formulas
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Nutrition. 2008 Mar;24(3):203-211.
Velaphi SC | Cooper PA | Bolton KD | Mokhachane M | Mphahlele RM | Beckh-Arnold E
The objective was to compare the effects of a biologically and chemically acidified formula with or without probiotics with a standard formula on growth of infants negative for human immunodeficiency virus (HIV). This was a double-masked, randomized, clinical trial. Infants born to consenting HIV-positive women who had decided not to breast-feed before being approached for participating in the study were randomized to receive one of four milk formulas: a chemically acidified formula with or without probiotics (Bifidobacterium lactis), a biologically acidified formula, or a standard whey formula. Infants who subsequently became HIV-positive according to polymerase chain reaction at 6 wk were excluded. Their growth and biochemical status were monitored for 4-6 mo. The z scores at the last visit of infants in each of the four formula groups were compared using analysis of covariance correcting for the z scores at baseline. Blood gases and pH were analyzed using a two-way analysis of variance corrected for center. One hundred thirty-two HIV-negative infants were monitored for growth and biochemical parameters for 4-6 mo. There was an improvement of z scores for all formulas, and there were no differences in weight for age (P = 0.22), length for age (P = 0.56), head circumference for age (P = 0.66), or weight for length (P = 0.13). There were no differences in blood pH and biochemical parameters among the formula groups. The growth of infants fed one of the three acidified formulas was not inferior to the standard formula. Growth and metabolism in HIV-negative infants fed the acidified formulas were not affected by the method of milk acidification.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Prevention better than cure
(News Article; Asia)
4 Feb 2008
Heng J, CIO Asia

Bahrain accused of population cover-up
(News Article; Middle East)
6 Feb 2008
Glass A, Arabian Business

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Violence-related mortality in Iraq from 2002 to 2006: Iraq family health survey study group
(Abstract; subscription needed for full text; Middle East)
New England Journal of Medicine. 2008 Jan 31;358(5):484-493.
Estimates of the death toll in Iraq from the time of the U.S.-led invasion in March 2003 until June 2006 have ranged from 47,668 (from the Iraq Body Count) to 601,027 (from a national survey). Results from the Iraq Family Health Survey (IFHS), which was conducted in 2006 and 2007, provide new evidence on mortality in Iraq. The IFHS is a nationally representative survey of 9345 households that collected information on deaths in the household since June 2001. We used multiple methods for estimating the level of underreporting and compared reported rates of death with those from other sources. Interviewers visited 89.4% of 1086 household clusters during the study period; the household response rate was 96.2%. From January 2002 through June 2006, there were 1325 reported deaths. After adjustment for missing clusters, the overall rate of death per 1000 person-years was 5.31 (95% confidence interval [CI], 4.89 to 5.77); the estimated rate of violence-related death was 1.09 (95% CI, 0.81 to 1.50). When underreporting was taken into account, the rate of violence-related death was estimated to be 1.67 (95% uncertainty range, 1.24 to 2.30). This rate translates into an estimated number of violent deaths of 151,000 (95% uncertainty range, 104,000 to 223,000) from March 2003 through June 2006. Violence is a leading cause of death for Iraqi adults and was the main cause of death in men between the ages of 15 and 59 years during the first 3 years after the 2003 invasion. Although the estimated range is substantially lower than a recent survey-based estimate, it nonetheless points to a massive death toll, only one of the many health and human consequences of an ongoing humanitarian crisis.

Motherhood in sub-Saharan Africa: The social consequences of infertility in an urban population in northern Tanzania
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Culture, Health and Sexuality. 2008 Feb;10(2):159-173.
Hollos M | Larsen U
This paper examines the personal and social ramifications of infertility in an African urban population with low fertility. The study was conducted in Moshi, Tanzania, a multi-ethnic community with relatively high levels of education and a well developed health services infrastructure. The major question to be addressed was whether in a low fertility urban population, both primary and secondary infertility bring about serious personal ramifications for women similar to those in rural areas. The methodology included a survey of 2,019 women and in-depth interviews with 25 fertile and 25 infertile women. Of the 1,549 sexually active women in a regular union, 2.7% had never had a child in spite of trying to conceive for at least two years. Of the 1,352 women who had previously had a child, an additional 6.1% were subsequently infertile. The most important finding from the qualitative analysis concerns the major difference between childlessness and subsequent infertility (or primary and secondary infertility) in terms of implications for the effected women. These findings underline the importance of bearing a child in sub-Saharan African populations.

Gender and migration in the central valleys of Oaxaca
(Abstract; subscription needed for full text; North America)
International Migration. 2008 Mar;46(1):79-101.
Cohen JH | Rodriguez L | Fox M
In this paper, we examine the gendered nature of international and internal migration that originates in the central valleys of Oaxaca, Mexico. Our goals are to define migration patterns and outcomes for Oaxacan women from the central valleys region and note the differences that mark migrant men and women. We use ethnographic data from anthropological research in 12 of Oaxaca's central valley communities to argue that local concepts of what defines correct behaviour (for both men and women) are critical to the outcomes and the differences that exist in the practices of migrant men and women.

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Volume 8, Number 611 February 2008