Volume 8, Number 7
18 February 2008

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ADOLESCENT HEALTH NEWS

No condoms in school, says Holness
(News Article; Central America and the Caribbean)
14 Feb 2008
Jamaica Gleaner

India: Sex and the city youth
(News Article; Asia)
15 Feb 2008
Rajadhyaksha M, The Times of India

ADOLESCENT HEALTH RESEARCH

Using risk factors to predict human papillomavirus infection: Implications for targeted vaccination strategies in young adult women
(Abstract; subscription needed for full text; Global)
Vaccine. 2008 Feb 20;26(8):1111-1117.
Dempsey AF | Gebremariam A | Koutsky LA | Manhart L
Targeting human papillomavirus (HPV) vaccines to sub-populations most likely to benefit could be necessary if sufficient financing is not available for comprehensive immunization. Using data from 3276 sexually active young adult women in Wave III of the National Longitudinal Study of Adolescent Health, we investigated the feasibility of using behavioral risk factors to target sub-populations for HPV vaccination. We found associations between specific risk factors and vaccine-type-specific HPV infection (OR 1.7-2.1), and the likelihood of having HPV increased with increasing numbers of risk factors. However, no threshold number of risk factors predicted HPV infection with adequate specificity and sensitivity. Furthermore, at a population level, our analyses indicated that targeted approaches to HPV vaccination using specific risk factors were a poor strategy for vaccine implementation as they would exclude up to 80% of the otherwise eligible population from vaccination. Our results support implementation of comprehensive HPV vaccination strategies.

Physical effects of sexually abused children and adolescents at Taksin Hospital
(Research Article; Asia)
Journal of the Medical Association of Thailand. 2007 Dec;90(12):2608-2615.
Boonma M | Bhoopat T | Treratwerapong T | Jintanadilog A
The objective was to study the incidences and physical effects of sexually abused children and adolescents. Rape records and records of 250 sexually abused children and adolescents treated at Taksin Hospital between January 1, 1999 and December 31, 2004 from Child-Women Protection Center were studied retrospectively. The incidence of sexual abuse in children and adolescents was 4.74 per 10,000 cases of age-adjusted patients at the OPD and 22.97 at the emergency department. Most of the cases (97.20%) were females. Mean age was 13.74 plus or minus 4.27 (2-20) years old. Most of the cases were early adolescents (52.40%), late adolescents 32.40%, and children 15.20%. Thirty-nine cases (15.60%) had physical injuries, 36 cases (14.40%) had external genital injuries, 25 cases (10.00%) had gonococcal infections, 15 cases (6.20%) had bleeding in the vaginal canal, and eight cases (3.20%) were pregnant. Two hundred and twenty six cases (90.40%) were reported to the police. There was correlation between age group and hymen tearing (p-value less than 0.001), gonococcal infection (p-value less than 0.01) and sperm finding (p-value less than 0.001). However, there was no correlation between age group and gender, physical injury, genital injury, bleeding in the vagina and acid phosphatase finding. In addition, there was correlation between physical injury and bleeding in the vagina (p-value less than 0.01) but no correlation between genital injury and hymen findings. Sexual abused victims need immediate attention for the traumatic impacts of their physical, psychological, and emotional conditions, as well as on their social impact. Thus, it is imperative that protection be exerted over the treatment to prevent recurrence.

Social inequalities in changes in health-related behaviour among Slovak adolescents aged between 15 and 19: A longitudinal study
(Research Article; Europe)
BMC Public Health. 2008 Feb 12;8(57):[32] p.
Salonna F | van Dijk JP | Geckova AM | Sleskova M | Groothoff JW
Lower socioeconomic position is generally associated with higher rates of smoking and alcohol consumption and lower levels of physical activity. Health-related behaviour is usually established during late childhood and adolescence. The aim of this study is to explore changes in health-related behaviour in a cohort of adolescents aged between 15 and 19, overall and by socioeconomic position. The sample consisted of 844 first-year students (42.8 % males, baseline in 1998 - mean age 14.9, follow-up in 2002 - mean age 18.8) from 31 secondary schools located in Kosice, Slovakia. This study focuses on changes in adolescents' smoking, alcohol use, experience with marijuana and lack of physical exercise with regard to their socioeconomic position. Four indicators of socioeconomic position were used - adolescents' current education level and employment status, and the highest education level and highest occupational status of their parents. We first made cross tabulations of HRB with these four indicators, using McNemar's test to assess differences. Next, we used logistic regression to assess adjusted associations, using likelihood ratio tests to assess statistical significance. Statistically significant increases were found in all health-related behaviours. Among males, the most obvious socioeconomic gradient was found in smoking, both at age 15 and at 19. Variations in socioeconomic differences in health-related behaviour were more apparent among females. Although at age 15, almost no socioeconomic differences in health-related behaviour were found, at age 19 differences were found for almost all socioeconomic indicators. Among males, only traditional socioeconomic gradients were found (the lower the socioeconomic position, the higher the prevalence of potentially harmful health-related behaviour), while among females reverse socioeconomic gradients were also found. We confirmed an increase in unhealthy health-related behaviour during adolescence. This increase was related to socioeconomic position, and was more apparent in females.

FAMILY PLANNING NEWS

Manila women fight contraception ban
(News Article; Asia)
13 Feb 2008
International Planned Parenthood Federation

Pakistan: Population Welfare Department motivating people to keep their family small
(News Article; Asia)
15 Feb 2008
Daily Times

Nigeria: Youths seek recognition of reproductive rights
(News Article; Sub-Saharan Africa)
12 Feb 2008
Babalola | Njoku I, Vanguard (Lagos)

FAMILY PLANNING RESEARCH

Changes in blood pressure, BMI and ECG patterns in women using low-dose contraceptives
(Research Article; Asia)
(You need Adobe Acrobat Reader to access this document)
Journal of the College of Physicians and Surgeons, Pakistan. 2008 Jan;18(1):31-36.
Syed S | Rahim M | Javed M | Qureshi MA
The objective was to determine the cardiovascular risk factors in users of second generation contraceptives by recording changes in body mass index, blood pressure and electrocardiogram. The design of the study was cross-sectional study. The setting for the study was The National Institute of Fertility Research Centers at Jinnah Postgraduate Medical Center and PIB Maternity Home Karachi, from July 1997 to 1999. Sixty four women volunteered for this study (age range 20-35 years), belonging to low-income group with similar socio-cultural background. The Body Mass Index (BMI) was calculated by measuring height and weight of the subjects; systolic and diastolic blood pressure and ECG recording by standard method. The group means, standard deviations and coefficient correlation for interrelationship among variables in respective groups of subjects were calculated using relevant statistical method and software program. There was no significant difference between BMI of two types of contraceptive users as compared to non users; but BMI was significantly correlated with both systolic and diastolic blood pressures in injectable users as compared to controls. ECG alterations frequently observed in contraceptive users (40%) as compared to controls were normal findings. It was observed that women aged less than 30 years and using contraceptives for more than three years had a tendency to gain weight and developed a mild increase in systolic and diastolic blood pressures.

Effect of oral contraceptives on risk of cervical cancer
(Research Article; Asia)
(You need Adobe Acrobat Reader to access this document)
Journal of the Medical Association of Thailand. 2008 Jan;91(1):7-12.
Vanakankovit N | Taneepanichskul S
The objective was to assess the risk of oral contraceptives on the occurrence of cervical cancer. A hospital-based case-control study was conducted. Sixty women patients with histologically confirmed invasive cervical cancer and 180 healthy women as the control group who attended the King Chulalongkorn Memorial Hospital, Bangkok, Thailand were recruited. Information about the use of oral contraceptives and other cervical cancer risk factors were obtained from personal interviews. The risk factors were evaluated by using odds ratio (OR). 60 women with invasive cervical cancer and 180 healthy controls were interviewed by the investigators. Compared with non-users, patients who had ever used or currently used oral contraceptive had an increased risk of cervical cancer (OR 1.45; 95% CI 0.79-2.64). However, the risk was not statistically significant. Considering the duration of use, patients who had used oral contraceptives for 3 years or less did not have an increased risk of cervical cancer (OR 0.78; 95% CI 0.39-1.77). Nevertheless, the odds ratio of oral contraceptive pill use for more than 3 years was 2.57 (95% CI 1.22-5.49) which was statistically significant. Long-term use of oral contraceptive might be a cofactor that increases the risk of cervical carcinoma. Further investigations should be conducted to confirm this risk. However, Pap smear has to be done routinely in long-term oral pill users.

Barriers to the use of modern contraceptives and implications for woman-controlled prevention of sexually transmitted infections in Madagascar
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Biosocial Science. 2008;:[15] p..
Randrianasolo B | Swezey T | Van Damme K | Khan MR | Ravelomanana N | Rabenja NL | Raharinivo M | Bell AJ | Jamieson D | Mad STI Prevention Group | Behets F
Globally, unplanned pregnancies and sexually transmitted infections (STIs) persist as significant threats to women's reproductive health. Barriers to the use of modern contraceptives by women might inhibit uptake of novel woman-controlled methods for preventing STIs/HIV. Use of modern contraceptives and perceptions and attitudes towards contraceptive use were investigated among women in Antananarivo, Madagascar, using qualitative research. The hypothetical acceptability of the diaphragm - a woman-controlled barrier contraceptive device that also holds promise of protecting against STIs/HIV - was assessed. Women consecutively seeking care for vaginal discharge at a public health clinic were recruited for participation in a semi-structured interview (SSI) or focus group discussion (FGD). Audio-taped SSIs and FGDs were transcribed, translated and coded for predetermined and emerging themes. Of 46 participating women, 70% reported occasional use of male condoms, mostly for preventing pregnancy during their fertile days. Although women could name effective contraceptive methods, only 14% reported using hormonal contraception. Three barriers to use of modern contraceptives emerged: gaps in knowledge about the range of available contraceptive methods; misinformation and negative perceptions about some methods; and concern about social opposition to contraceptive use, mainly from male partners. These results demonstrate the need for programmes in both family planning and STI prevention to improve women's knowledge of modern contraceptives and methods to prevent STI and to dispel misinformation and negative perceptions of methods. In addition, involvement of men will probably be a critical component of increased uptake of woman-controlled pregnancy and STI/HIV prevention methods and improved health.

The year-long effect of HIV-positive test results on pregnancy intentions, contraceptive use, and pregnancy incidence among Malawian women
(Abstract; subscription needed for full text; Sub-Saharan Africa)
JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008;:[7] p..
Hoffman IF | Martinson FE | Powers KA | Chilongozi DA | Msiska ED | Kachipapa EI | Mphande CD | Hosseinipour MC | Chanza HC | Stephenson R | Tsui AO
The objectives were to estimate the effect of receiving HIV-positive test results on intentions to have future children and on contraceptive use and to assess the association between pregnancy intentions and pregnancy incidence among HIV-positive women in Malawi. Women of unknown HIV status completed a questionnaire about pregnancy intentions and contraceptive use and then received HIV voluntary counseling and testing (VCT). Women who were HIV-positive and not pregnant were enrolled and followed for 1 year while receiving HIV care and access to family planning (FP) services. Before receiving their HIV test results, 33% of women reported a desire to have future children; this declined to 15% 1 week later (P less than 0.0001) and remained constant throughout follow-up. Contraceptive use increased from 38% before HIV testing to 52% 1 week later (P less than 0.0001) and then decreased to 46% by 12 months. The pregnancy incidence among women not reporting a desire to have future children after VCT was less than half of the incidence among women reporting this desire. With knowledge of their HIV-positive status, women were less likely to desire future pregnancies. Pregnancy incidence was lower among women not desiring future children. Integration of VCT, FP, and HIV care could prevent mother-to-child HIV transmission.

GENDER and HEALTH NEWS

Africa: 3 million women circumcised annually - UNFPA protests
(News Article; Sub-Saharan Africa)
11 Feb 2008
Mugabe D, East African Business Weekly (Kampala)

Namibia: Women robbed of motherhood
(News Article; Sub-Saharan Africa)
12 Feb 2008
Tjaronda W, New Era (Windhoek)

Botswana: Domestic violence bill sails through parliament
(News Article; Sub-Saharan Africa)
11 Feb 2008
Mooketsi L, Mmegi/The Reporter (Gaborone)

Gambia: International day on zero tolerance in FGM observed
(News Article; Sub-Saharan Africa)
11 Feb 2008
Ngum-Saidy M, The Daily Observer (Banjul)

GENDER and HEALTH RESEARCH

Hepatitis B virus infection among pregnant women in Taiwan: Comparison between women born in Taiwan and other southeast countries
(Research Article; Asia)
(You need Adobe Acrobat Reader to access this document)
BMC Public Health. 2008 Feb 7;8(49):[21] p.
Lin CC | Hsieh HS | Huang YJ | Huang YL | Ku MK
Taiwan's national vaccination program has successfully decreased the prevalence of hepatitis B infection after twenty years of implementation and might be indirectly beneficial to the second generation. In this study, we compared the hepatitis B infection status of two groups: pregnant Taiwanese women and other Southeast Asian women, who because they had immigrated later in life to Taiwan by marriage to a Taiwanese man, had not been exposed to that vaccination program to evaluate the effect of hepatitis vaccination program on women of child-bearing age and further explored the potential impact of immigration on the hepatitis B public health policy in Taiwan. Data was collected from 10,327 women born in Taiwan and 1,418 women born in other Southeast Asian countries, both groups receiving prenatal examinations at Fooyin University Hospital between 1996 and 2005. The results of serum hepatitis B s-Antigen (HBsAg) and hepatitis B e-Antigen (HBeAg) tests and other demographic data were obtained by medical chart review. The pregnant women from Taiwan had a higher HBsAg positive rate (15.5%) but lower HBeAg(+)/HBsAg(+) ratio (32.1%) than the women from other countries (8.9% and 52.4%). For those born before July, 1984, the period of no national vaccination program, Taiwanese women had a higher HBsAg positive rate than other Southeast Asian women (15.7% vs. 8.4%), but for women born after that day and before June 1986, the period of vaccination for high risk newborns, the HBsAg positive rates found to be slightly lower for Taiwanese women than for other Southeast Asian women (11.4% vs. 12.3%) and the difference was more significant (3.1% vs. 28.6%) after June 1986, the period of vaccination for all newborns. While the HBeAg(+)/HBsAg(+) ratios decreased with age in both groups, they were consistently higher in women from other Southeast Asian countries than in women born in Taiwan after age 20. In Taiwan, the neonatal vaccination program that was implemented in 1984 has successfully reduced hepatitis B infection among pregnant women in present day, and is likely to indirectly prevent hepatitis B infection in the next generation. However, the increasing number of pregnant women from other Southeast Asian countries without a national neonatal vaccination program or with a program that was introduced later than the one in Taiwan will likely lessen the positive impact of this program and should be further assessed.

Rwandan female genital modification: Elongation of the labia minora and the use of local botanical species
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Culture, Health and Sexuality. 2008 Feb;10(2):191-204.
Koster M | Price LL
The elongation of the labia minora is classified as a Type IV female genital mutilation by the World Health Organization. However, the term mutilation carries with it powerful negative connotations. In Rwanda, the elongation of the labia minora and the use of botanicals to do so is meant to increase male and female pleasure. Women regard these practices as a positive force in their lives. This paper aims to assess whether Rwandan vaginal practices should indeed be considered a form of female genital mutilation and whether the botanicals used by women are detrimental to their health. Research was carried out in the northeast of Rwanda over the course of 13 months. Semi-structured interviews were conducted with thirteen informants. Two botanicals applied during stretching sessions were identified as Solanum aculeastrum Dunal and Bidens pilosa L. Both have wide medicinal use and contain demonstrated beneficial bioactive compounds. We suggest that it is therefore more appropriate to describe Rwandan vaginal practices as female genital modification rather than mutilation.

"Injuries are beyond love": Physical violence in young South Africans' sexual relationships
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Medical Anthropology. 2008 Jan;27(1):43-69.
Wood K | Lambert H | Jewkes R
South Africa's complex social and political history has produced conditions for interpersonal violence of multiple kinds to flourish. Violence experienced by girls and young women, including within their sexual relationships, has become an area of intense research and policy interest since the end of apartheid. Drawing on a long-term ethnographic study of young people in an urban township, this article explores how violent practices are variously construed, differentiated, and legitimated, in particular through the assignment of blame and the significance accorded to bodily marking. Pointing to the cultural embeddedness of disciplining techniques in this setting, the article examines local understandings of gender hierarchy and power, young men's vulnerabilities in relation to their partners' actions, and the links between disciplining action and notions of anger, love, and shame. Violence is shown to configure lives and subjectivities and to be productive of relationships, in particular playing a part in the organization of inequality within sexual relationships.

Adverse health conditions and health risk behaviors associated with intimate partner violence - United States, 2005
(Abstract; subscription needed for full text; Global)
(You need Adobe Acrobat Reader to access this document)
MMWR. Morbidity and Mortality Weekly Report. 2008 Feb 8;57(5):113-117.
Intimate partner violence (IPV) is defined as threatened, attempted, or completed physical or sexual violence or emotional abuse by a current or former intimate partner. IPV can be committed by a spouse, an ex-spouse, a current or former boyfriend or girlfriend, or a dating partner. Each year, IPV results in an estimated 1,200 deaths and 2 million injuries among women and nearly 600,000 injuries among men. In addition to the risk for death and injury, IPV has been associated with certain adverse health conditions and health risk behaviors. To gather additional information regarding the prevalence of IPV and to assess the association between IPV and selected adverse health conditions and health risk behaviors, CDC included IPV-related questions in an optional module of the 2005 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report describes the results of that survey, which indicated that persons who report having experienced IPV during their lifetimes also are more likely to report current adverse health conditions and health risk behaviors. Although a causal link between IPV and adverse health conditions cannot be inferred from these results, they underscore the need for IPV assessment in health-care settings. In addition, the results indicate a need for secondary intervention strategies to address the health-related needs of IPV victims and reduce their risk for subsequent adverse health conditions and health risk behaviors.

HIV/AIDS and STIs NEWS

Red Cross Red Crescent appeal for $65 Million to fight AIDS in Eastern Africa
(News Article)
15 Feb 2008
De Capua J, Voice of America News

United States: HIV vaccine research hits impasse
(News Article; North America)
15 Feb 2008
Briggs H, BBC News

HIV/AIDS and STIs RESEARCH

Probability of HIV transmission during acute infection in Rakai, Uganda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS and Behavior. 2007 Dec 7;:[7] p..
Pinkerton SD
Accurate estimates of the probability of HIV transmission during various stages of infection are needed to inform epidemiological models. Very limited information is available about the probability of transmission during acute HIV infection. We conducted a secondary analysis of published data from the Rakai, Uganda seroconversion study. Mathematical and computer-based models were used to quantify the per-act and per-partnership transmission probabilities during acute and chronic HIV infection, and to estimate how many of the transmission events reported in the Rakai study were due to acute-phase HIV transmission. The average per-act transmission probability during acute infection equaled 0.03604 vs. 0.00084 for chronic HIV infection. Overall, HIV was transmitted during acute infection in 46.5% of 23 "incident index partner couples." Acute-phase transmission accounted for 89.1% of all transmission events in the first 20 months of follow-up. These results highlight the substantial risk of transmission during acute HIV infection.

Prophylactic antibiotics for the prevention of postpartum infectious morbidity in women infected with human immunodeficiency virus: A randomized controlled trial
(Abstract; subscription needed for full text; Sub-Saharan Africa)
American Journal of Obstetrics and Gynecology. 2008 Feb;198(2):189.e1-189.e6.
Sebitloane HM | Moodley J | Esterhuizen TM
The purpose of this study was to determine the effect of intrapartum prophylactic antibiotics in the prevention of postpartum sepsis in laboring women who were infected with HIV. In a double-blind, randomized trial that was conducted in Durban (South Africa), pregnant women who were infected with HIV in whom vaginal delivery was anticipated were randomized to receive either a single dose of cefoxitin (2 g) or placebo intrapartum. Signs of sepsis were evaluated within 72 hours and at 1 and 2 weeks postpartum. Of the 424 women who were enrolled, 213 women received cefoxitin, and 211 women received placebo. Both groups were comparable in all baseline parameters. The overall sepsis rate was 19% (40/211 women) in the placebo group and 16.9% (36/ 213 women) in the cefoxitin group (P = .581). There was a 53% reduction in risk of postpartum endometritis in the cefoxitin group (95% confidence interval, 0.24-0.9). The use of prophylactic intrapartum cefoxitin in HIV-infected women reduces the risk of postpartum endometritis.

Novel HIV prevention strategies: The case for Andhra Pradesh
(Abstract; subscription needed for full text; Asia)
Indian Journal of Medical Microbiology. 2008 Jan-Mar;26(1):1-4.
Schneider JA
Estimating the true prevalence and incidence of HIV infection in the general population and high-risk sub-populations in India continues to be a challenge reflected by the wide interval estimated by UNAIDS: 3.4.9.4 million, now amended by the more recent UNAIDS re-estimation of approximately 2.5 million adults living with HIV. Several groups have addressed this challenge through population-based studies; however, sub-group analyses of high-risk populations are limited by sample size and migrant populations such as truck drivers may not be represented accurately, especially those away from their primary residence the most. Although final analyses are pending, preliminary evidence from the most recent National Family Health Survey (NFHS-3) demonstrates that with an HIV prevalence of 0.97 (0.7-1.25) in Andhra Pradesh (AP) and 1.13 (0.82-1.44) in Manipur, these two states continue to have the highest prevalence of HIV infection among the six high-burden states in India (Andhra Pradesh, Manipur, Uttar Pradesh, Karnataka, Maharashatra and Tamil Nadu).

Potential initiators of HIV-related stigmatization: Ethical and programmatic challenges for PMTCT programs
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Developing World Bioethics. 2008;:[8] p..
Thorsen VC | Sundby J | Martinson F
HIV/AIDS continues to constitute a serious threat to the social and physical wellbeing of African mothers and their babies. In the hardest hit countries of sub-Saharan Africa, more than 60% of all new HIV infections are occurring in women, infants and young children. Mother-to-child transmission (MTCT) constitutes 90% of new HIV infections among infants and young children. Most of these infections can be prevented. However, the social stigma of HIV/AIDS insidiously continues to undermine the success of prevention programs. Ironically, some attributes or characteristics of prevention of mother-to-child transmission (PMTCT) programs may in fact serve as catalysts to the stigmatization process. This paper identifies and discusses six potential initiators: (1) Routine HIV testing, (2) Six months exclusive breastfeeding, (3) Incentives, (4) Home visits, (5) Location of PMTCT program, and (6) PMTCT terminology. In all these areas, there are practical strategies that may be applied to reduce the chances of being stigmatized. These strategies are introduced and discussed.

MATERNAL AND CHILD HEALTH NEWS

UN appeals for nearly $500 million to slash maternal deaths in 75 nations
(News Article; Global)
14 Feb 2008
UN News Centre

Uganda: Doctors demand more midwives
(News Article; Sub-Saharan Africa)
14 Feb 2008
Kameo E, The Weekly Observer (Kampala)

Test to predict pre-eclampsia
(News Article; Global)
13 Feb 2008
BBC News
Discovery took place in UK but applicable globally - SR

MATERNAL AND CHILD HEALTH RESEARCH

China: Policy and practice of MCH since the early 1990s
(Abstract; subscription needed for full text; Asia)
Maternal and Child Health Journal. 2008 Mar;12(2):139-148.
Guo Y | Zakus D | Liang H
Since the socioeconomic reforms in China in the late 1970s the improvement of maternal and child health (MCH), which was once considered one of the great achievements of China after 1949, has slowed and some indicators show that the situation in some regions, especially in rural areas, is getting worse instead of better. This article will focus on policy and policy-related issues in the delivery of MCH services. It will cover historical changes in policy and their effects, especially in the financing of MCH. In addition, it will also touch upon new practices of MCH in the new cooperative medical scheme (NCMS) in present-day rural China.

Risk factors for maternal death in the highlands of rural northern Tanzania: A case-control study
(Research Article; Sub-Saharan Africa)
BMC Public Health. 2008 Feb 8;8(52):[20] p.
Evjen-Olsen B | Hinderaker SG | Lie RT | Bergsjo P | Gasheka P | Kvale G
Tanzania has one of the highest maternal mortality ratios in sub-Saharan Africa. Due to the paucity of epidemiological information on maternal deaths, and the high maternal mortality estimates found earlier in the study area, our objective was to assess determinants of maternal deaths in a rural setting in the highlands of northern Tanzania by comparing the women dying of maternal causes with women from the same population who had attended antenatal clinics in the same time period. A case-control study was done in two administrative divisions in Mbulu and Hanang districts in rural Tanzania. Forty-five cases of maternal death were found through a comprehensive community- and health-facility based study in 1995 and 1996, while 135 antenatal attendees from four antenatal clinics in the same population, geographical area, and time-span of 1995-96 served as controls. The cases and controls were compared using multivariate logistic regression analyses. Odds ratios, with 95% confidence intervals, were used as an approximation of relative risk, and were adjusted for place of residence (ward) and age. Further adjustment was done for potentially confounding variables. An increased risk of maternal deaths was found for women from 35-49 years versus 15-24 years (OR 4.0; 95%CI 1.5-10.6). Women from ethnic groups other than the two indigenous groups of the area had an increased risk of maternal death (OR 13.6; 95%CI 2.5-75.0). There was an increased risk when women or husbands adhered to traditional beliefs, (OR 2.1; 95%CI 1.0-4.5) and (OR 2.6; 95%CI 1.2-5.7), respectively. Women whose husbands did not have any formal education appeared to have an increased risk (OR 2.2; 95%CI 1.0-5.0). Increasing maternal age, ethnic and religious affiliation, and low formal education of the husbands were associated with increased risk of maternal death. Increased attention needs to be given to formal education of both men and women. In addition, education of the male decision-makers should be given high priority in the community, especially in matters concerning pregnancy and delivery preparedness, since their choice greatly affects the survival of the pregnant and delivering women.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Uganda: Big population in the way of development goals
(News Article; Sub-Saharan Africa)
13 Feb 2008
The Monitor

Russia will regain demographic, economic, and military strength, Putin claims
(News Article; Asia)
14 Feb 2008
Felgenhauer P, Eurasia Daily Monitor

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Proceedings of the summit on environmental challenges to reproductive health and fertility: Executive summary
(Abstract; subscription needed for full text; Global)
Fertility and Sterility. 2008 Feb;89(2):281-300.
Woodruff TJ | Carlson A | Schwartz JM | Giudice LC
The 2007 Summit on Environmental Challenges to Reproductive Health and Fertility convened scientists, health care professionals, community groups, political representatives, and the media to hear presentations on the impact of environmental contaminants on reproductive health and fertility, and to discuss opportunities to improve health through research, education, communication, and policy. Environmental reproductive health focuses on exposures to environmental contaminants, particularly during critical periods of development, and their potential effects on future reproductive health, including conception, fertility, pregnancy, adolescent development, and adult health. Approximately 87,000 chemical substances are registered for commercial use in the United States, with ubiquitous human exposures to environmental contaminants in air, water, food, and consumer products. Exposures during critical windows of susceptibility may result in adverse effects with lifelong and even intergenerational health impacts. Effects can include impaired development and function of the reproductive tract and permanently altered gene expression, leading to metabolic and hormonal disorders, reduced fertility and fecundity, and illnesses such as testicular, prostate, uterine, and cervical cancers later in life. This executive summary reviews effects of pre- and postnatal exposures on male and female reproductive health, and provides a series of recommendations for advancing the field in the areas of research, policy, health care, and community action.

Denominational affiliation and fertility behaviour in an African context: An examination of couple data from Ghana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Biosocial Science. 2008;:[14] p..
Gyimah SO | Takyi B | Tenkorang EY
Although studies have examined religious differences in fertility in sub-Saharan Africa, it is argued in this paper that using women-only sample data may be conceptually problematic in patriarchal African societies where the influence of husbands on their wives' reproductive preferences is paramount. The present study contributes to this discourse by examining the relationship between religion and fertility behaviour using matched-couple data from Ghana. Guided by the 'religious values' and 'characteristics' hypotheses, the results indicate significant religious differences in fertility. Compared with Traditionalists, Christians and Muslims have lower fertility, albeit these differences diminish significantly after controlling for socioeconomic variables. The impact of wife's religious denomination on marital fertility is attenuated after controlling for husband's religious affiliation. Also, fertility was found to be higher if couples belong to the same faith compared with those of different faiths.

World population, world health and security: 20th century trends
(Abstract; subscription needed for full text; Global)
Journal of Epidemiology and Community Health. 2008;62:187-190.
Bashford J
The connection between infectious disease control and national security is now firmly entrenched. This article takes a historical look at another security issue once prominent in debate on foreign policy and international relations, but now more or less absent: overpopulation. It explores the nature of the debate on population as a security question, and its complicated historical relation to the development of world health.

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Volume 8, Number 718 February 2008