Volume 8, Number 14
7 April 2008

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ADOLESCENT HEALTH NEWS

South Africa: Campaign moves to prevent HIV among youth
(News Article; Sub-Saharan Africa)
1 Apr 2008
Biz-Community (Cape Town)

Malawi launches program aimed at preventing HIV, improving sexual health among young people
(News Article; Sub-Saharan Africa)
2 Apr 2008
Kaiser Network

India: Jharkhand girls campaign for safe sex
(News Article; Asia)
2 Apr 2008
Daily India

ADOLESCENT HEALTH RESEARCH

Teenage pregnancies: Obstetric characteristics and outcome
(Abstract; subscription needed for full text; Europe)
European Journal of Obstetrics, Gynecology and Reproductive Biology. 2008 Apr;137(2):165-171.
Gupta N | Kiran U | Bhal K
The objective was to quantify the age related risk of adverse obstetric outcome in primigravid women less than 20 years of age. The study sample was drawn from Cardiff Births Survey (a computerized maternity information database) comprising 66,271 pregnancies in the South Glamorgan region during 1990-1999. Pregnancy outcomes of primigravid women were compared in age groups less than 20 years (n = 4126) and 20 to less than 35 years (n = 17,615). SPSS version 11 was used for statistical analysis. Student's t-test was used for continuous variables, Chi square, Fishers exact test was used for categorical variables. There was a lower incidence of multiple pregnancies (OR = 0.3(0.2-0.4)), spontaneous rupture of membranes greater than 24 h (OR = 0.7(0.6-0.9)), and pregnancy-induced hypertension (OR = 0.8(0.6-0.8)) amongst teenage primigravidae but a higher incidence of anaemia (OR = 1.8(1.6-2.0)), and pyelonephritis (OR = 1.5(1.1-2.0)). There was a lower incidence of induction of labour (OR = 0.7(0.7-0.8)) and use of regional analgesia in the teenage group. Teenage women were more likely to have a spontaneous vaginal delivery (OR = 2.1(2.0-2.3)) with a significantly lower incidence of instrumental delivery (OR = 0.5(0.5-0.6)), and Caesarean section (OR = 0.4(0.4-0.5)). Inspite of a higher incidence of preterm labour (corrected OR = 1.4(1.1-1.7)) the perinatal outcome measures between the teenage group and the older group were not significantly different. Teenage primigravidae are more likely to have a spontaneous vaginal delivery, without compromising the maternal or neonatal outcome.

Personal involvement of young people in HIV prevention campaign messages: The role of message format, culture, and gender
(Abstract; subscription needed for full text; Global)
Health Education and Behavior. 2008 Apr 1;35(2):190-206.
Geary CW | Burke HM | Johnson L | Liku J | Castelnau L
To examine young people's reactions to and understanding of HIV prevention messages developed for MTV's global HIV prevention campaign Staying Alive, videotaped campaign materials were shown to focus group discussion (FGD) participants living in urban areas of Brazil, Kenya, Nepal, and Senegal. Responses related to "personal involvement" with the message were identified in the data from these FGDs and were examined in relationship to the emerging message themes, the message format (public service announcements [PSAs] vs. documentary), cultural context (site), and participant gender. Across groups, greater personal involvement (measured by personal connections, emotional reactions, and lessons learned) was found in responses about the documentary format compared to the PSA format. Exceptions were found for specific PSAs that were considered more relevant within specific gender or cultural contexts. Implications of findings for global campaigns were considered.

FAMILY PLANNING NEWS

Philippines: Local Government Units (LGUs) urged to use family planning budget
(News Article; Asia)
4 Apr 2008
Rimaliza, O, Phillipine News- Sun Star Davao

Zimbabwe: Firm embarks on family planning distributors training project
(News Article; Sub-Saharan Africa)
1 Apr 2008
The Herald

FAMILY PLANNING RESEARCH

Effects of third-generation oral contraceptives on high-sensitivity C-reactive protein and homocysteine in young women
(Abstract; subscription needed for full text; Global | Europe)
Obstetrics and Gynecology. 2008 Apr;111(4):857-864.
Cauci S | Di Santolo M | Culhane JF | Stel G | Gonano F
The objective was to evaluate the effect of third-generation oral contraceptives on high-sensitivity C-reactive protein (CRP), homocysteine, and lipids levels in a population of young, fertile, nonobese women. Blood markers were evaluated in 277 healthy white women (mean age 23 years and mean body-mass index 21 kg/m2). Seventy-seven oral contraceptive users were compared with 200 non-oral contraceptive users. Progressive cutoffs of high-sensitivity CRP and homocysteine levels were examined. Levels of high-sensitivity CRP posing a high risk of cardiovascular disease (3.0 to less than 10.0 mg/L) were found in 27.3% of oral contraceptive users and in 8.5% of non-oral contraceptive users (odds ratio 4.04; 95% confidence interval [CI] 1.99-8.18). Levels of high-sensitivity CRP at intermediate risk (1.0 to less than 3.0 mg/L) were found in 32.5% of oral contraceptive users and in 11.0% of non-oral contraceptive users (odds ratio 3.89; 95% CI 2.03-7.46). Notably, non-oral contraceptive users were 8.65 (95% CI 4.39 -17.1) times as likely to demonstrate a protective level of high-sensitivity CRP (less than 0.5 mg/L) compared with oral contraceptive users. Oral contraceptive use increased serum triglycerides (P less than .001) and total cholesterol P = .001); however, high-density lipoprotein, not low-density lipoprotein, contributed to this increase. A decreased ratio of low-density lipoprotein to high-density lipoprotein cholesterol was observed in oral contraceptive users compared with nonusers (P = .016). Oral contraceptive use did not affect homocysteine levels. Third-generation oral contraceptive use increases low-grade inflammatory status measured by high-sensitivity CRP concentrations. Alteration of inflammatory status in oral contraceptive users could affect the risk of venous thromboembolism, cardiovascular disease, and other oral contraceptive-associated adverse conditions in young women.

An open-label, multicentre trial to evaluate the vaginal bleeding pattern of the combined contraceptive vaginal ring NuvaRing
(Abstract; subscription needed for full text; Europe)
European Journal of Obstetrics, Gynecology and Reproductive Biology. 2008;:[7] p..
Bruni V | Pontello V | Luisi S | Petraglia F
The objective of this multicentre, non-controlled, open-label study is the evaluation of the bleeding patterns during the use of a vaginal combined contraceptive, its safety in relation to occurrence of adverse effects, its efficacy as a contraceptive method and user compliance. Healthy female volunteers (N = 165), asking for contraception, were enrolled to participate in the study. Each subject was given seven vaginal rings, releasing an average amount of 120 microg etonogestrel (ENG) and 15 microg ethinylestradiol (EE) per day. Study period was 7 cycles. A total of 878 cycles was valid for statistical analysis. The primary parameter, (breakthrough bleeding and/or spotting), was recorded for each cycle. The subjects were asked to report any adverse effect experienced during the treatment period, general physical and gynaecological examinations were performed and haematological blood tests were taken. Breakthrough bleeding/spotting occurred in 5.01% cycles (44 out of 878 cycles, of whom 37 were breakthrough spotting only). Absence of withdrawal bleeding during the ring-free period was reported in 1.94% cycles (17 out of 878). Forty-one subjects (24.8%) reported 66 events that were potentially drug-related. The most frequently drug-related events were weight increase (10 cases), headache (9 cases), nausea (4 cases). No pregnancy was reported during the study period. Haematology and chemical chemistry tests showed no clinically significant abnormality. In the present study, NuvaRing has shown to be a valid contraceptive method to ensure optimal cycle control with low incidence of irregular bleeding and altered withdrawal bleeding. The low incidence of gastrointestinal side effects (nausea, vomiting) may be related the low hormonal dose and to the vaginal delivery of hormones which avoids the gastrointestinal tract.

Hormonal contraception and HIV prevalence in four African countries
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Contraception. 2008;:[5] p..
Leclerc PM | Dubois-Colas N | Garenne M
The HIV seroprevalence among women aged 15-24 years was compared according to their pattern of contraceptive use in four African countries: Kenya, Lesotho, Malawi and Zimbabwe. Data were derived from Demographic and Health Surveys (DHS) conducted between 2003 and 2006 on representative samples, totaling 4549 women. It is indicated that users of depo-medroxyprogesterone acetate (DMPA) have a significantly higher seroprevalence than nonusers [odds ratio (OR)=1.82, 95% CI=1.63-2.03] and higher than users of oral contraceptives and users of traditional methods. The results were confirmed in a multivariate analysis including as controls, age, duration since first intercourse, urban residence, education, number of sexual partners in the last 12 months and marital status. A somewhat smaller net effect (OR=1.34, 95% CI=1.10-1.63) was found. In contrast, oral contraceptives and traditional methods did not show any risk for HIV (OR=0.96 and 0.92, respectively). The increased risk of DMPA was present in three of the four countries investigated, and significant in Zimbabwe and Lesotho, the countries with the highest HIV seroprevalence. The HIV risk attributable to DMPA remained small altogether and was estimated as 6% in the four countries combined.

Disputing contraception: Muslim reform, secular change and fertility
(Abstract; subscription needed for full text; Asia)
Modern Asian Studies. 2008;42(2-3):519-548.
Jeffery P | Jeffery R | Jeffrey C
In South Asia, Muslim reformers have often attempted to 'rationalize' and gentrify the everyday behaviour of ordinary Muslims. Yet, despite the existence of discussions of contraceptive techniques in the yunan-itibb curricula of 19th century India and the apparent affinity between rationalism and fertility regulation, contraception was rarely discussed in public debates involving Muslim reformers. In this paper we discuss some of the relationships between ´elite debates among Muslim leaders and the grassroots behaviour of villagers in rural Bijnor, in western Uttar Pradesh. Villagers' voices are ambiguous, with fears for mother and child health surfacing as often as concerns for religious orthodoxy and one's destiny in the afterlife. In addition, many of the villagers' views of Islam were much more restrictive than those of the locally accepted authoritative voices: although the staff at Daru'l 'Ulum, Deoband, saw much modern contraception as an unwelcome sign of modernity, their discussions of the acceptability of family planning circled round notions of majburi [compulsion], repentance, and the unfathomable mercy of Allah. We conclude that focusing on local notions of Islam to understand the fertility behaviour of rural Muslims is less fruitful than considering a "political economy of hopelessness" that, increasingly since 1947, affects many Muslims in north India.

GENDER and HEALTH NEWS

Liberia: Rape has two-fold consequences
(News Article; Sub-Saharan Africa)
2 Apr 2008
The Analyst (Monrovia)

Congo-Kinshasa: One day workshop held on the promotion of new sexual violence law
(News Article)
1 Apr 2008
Koumbo S, United Nations Mission in the Democratic Republic of Congo

Sierra Leone: UN raises awareness of laws to curb violence against women
(News Article; Sub-Saharan Africa)
28 Mar 2008
UN News Service

GENDER and HEALTH RESEARCH

HIV/AIDS and home-based health care
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal for Equity in Health. 2008 Mar 18;7:8.
Opiyo PA | Yamano T | Jayne TS
This paper highlights the socio-economic impacts of HIV/AIDS on women. It argues that the socio-cultural beliefs that value the male and female lives differently lead to differential access to health care services. The position of women is exacerbated by their low financial base especially in the rural community where their main source of livelihood, agricultural production does not pay much. But even their active involvement in agricultural production or any other income ventures is hindered when they have to give care to the sick and bedridden friends and relatives. This in itself is a threat to household food security. The paper proposes that gender sensitive policies and programming of intervention at community level would lessen the burden on women who bear the brunt of AIDS as caregivers and livelihood generators at household level. Improvement of medical facilities and quality of services at local dispensaries is seen as feasible since they are in the rural areas. Other interventions should target freeing women's and girls' time for education and involvement in income generating ventures. Two separate data sets from Western Kenya, one being quantitative and another qualitative data have been used.

Gender progress and government expenditure as determinants of femicide
(Abstract; subscription needed for full text; Global)
Annals of Epidemiology. 2008 Apr;18(4):322-329.
Palma-Solis M | Vives-Cases C | Alvarez-Dardet C
We sought to explore the effect of economic/political factors and gender progress on femicide. An ecological and retrospective study was undertaken that focused on 61 countries and analyzed the relationships of femicide with the following statistics from the period 1990 to 1999: economic indicators (domestic consumption, gross capital formation, imports and exports per capita, unemployment rate and percentage of urban population), political indicators (government final consumption expenditure, GINI coefficientda summary measure of the extent to which the actual distribution of income or consumption expenditure or a related variable differs from a hypothetical distribution in which each person receives an identical sharedcivil liberties and political rights index), and gender progress indicators (female and male unemployment rates, percentage of girls in primary education, gender ratio for primary and secondary education, and percentage of parliamentary seats occupied by women). Bivariate and multivariate logistic regression analyses (likelihood ratio) were performed to explore the relationships between these variables. The bivariate analysis revealed strong links between reductions in government final consumption expenditure per capita (odds ratio [OR] 20.83;95% confidence interval [95% CI] 5.622-77.205), domestic consumption and gross capital formation (both with OR 16.67, 95% CI 4.715-58.911), and the civil liberties and political rights index (OR 7.91, 95% CI 2.526-24.747). In the multivariate stage, statistically significant associations were only observed between government expenditure per capita (OR 61.75;95% CI 7.064-539.81) and occupation of parliamentary seats by women (OR 10.95;95% CI 1.26-95.06). The reduction in government final consumption expenditure and democratic backwardness in terms of gender equality appear to be relevant factors in deaths caused by gender-based violence. To fight femicide effectively, gender-related structural, political, and economic responses should be considered.

Influence of socioeconomic status, wealth and financial empowerment on gender differences in health and healthcare utilization in later life: Evidence from India
(Abstract; subscription needed for full text; Asia)
Social Science and Medicine. 2008 Mar;66(9):1951-1962.
Roy K | Chaudhuri A
Empirical studies from developed countries observe that women report worse health and higher healthcare utilization than men, but the health disadvantage diminishes with age; gender differences in self-rated health often vanish or are reversed in older ages. Comparable assessments of health during later life from developing countries are limited because of the lack of large-scale surveys that include older women. Our study attempts to address the shortage of developing country studies by examining gender differences in health and healthcare utilization among older adults in India. Both ordered and binary logit specifications were used to assess significant gender differences in subjective and objective health, and healthcare utilization after controlling for demographics, medical conditions, traditional indicators of socioeconomic status like education and income, and additional wealth indicators. The wealth indicators, measured by property ownership and economic independence, are regarded as financially empowering older adults to exercise greater control over their health and well-being. Data are drawn from a nationally representative decennial socioeconomic and health survey of 120,942 Indian households conducted during 1995-1996. The study sample comprises 34,086 older men and women aged greater than or equal to 60 years. Our results indicate that older women report worse self-rated health, higher prevalence of disabilities, marginally lower chronic conditions, and lower healthcare utilization than men. The health disadvantage and lower utilization among women cannot be explained by demographics and the differential distribution of medical conditions. While successive controls for education, income, and property ownership narrows the gender gap in both health and healthcare utilization, significant differentials still persist. Upon controlling for economic independence, gender differentials disappear or are reversed, with older women having equal or better health than otherwise similar men. Financial empowerment might confer older women the health advantage reflected in developed societies by enhancing a woman's ability to undertake primary and secondary prevention during the life course.

HIV/AIDS and STIs NEWS

U.S. House approves $50 billion to fights AIDS
(News Article; North America)
3 Apr 2008
Associated Press

Ethiopia: HIV/Aids workplace policy launched for more than 35 NGOs
(News Article; Sub-Saharan Africa)
31 Mar 2008
Tesfaye F, The Daily Monitor (Addis Ababa)

Society stigmatises HIV/AIDS afflicted women worldwide: survey
(News Article; Global)
1 Apr 2008
Indo-Asian News Service (IANS)

Malawi: Malawi launches youth sexual health and HIV action plan
(News Article; Sub-Saharan Africa)
1 Apr 2008
The Daily Times

HIV/AIDS and STIs RESEARCH

Antiretroviral therapy in resource-limited settings 1996 to 2006: Patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America
(Abstract; subscription needed for full text; Global)
Tropical Medicine and International Health. 2008 Jul;13(7):[10] p..
The objectives were to describe temporal trends in baseline clinical characteristics, initial treatment regimens and monitoring of patients starting antiretroviral therapy (ART) in resource-limited settings. We analysed data from 17 ART programmes in 12 countries in sub-Saharan Africa, South America and Asia. Patients aged 16 years or older with documented date of start of highly active ART (HAART) were included. Data were analysed by calculating medians, interquartile ranges (IQR) and percentages by regions and time periods. Not all centres provided data for 2006 and 2005 and 2006 were therefore combined. A total of 36 715 patients who started ART 1996-2006 were included in the analysis. Patient numbers increased substantially in sub-Saharan Africa and Asia, and the number of initial regimens declined, to four and five, respectively, in 2005-2006. In South America 20 regimes were used in 2005-2006. A combination of 3TC/D4T/NVP was used for 56% of African patients and 42% of Asian patients; AZT/3TC/ EFV was used in 33% of patients in South America. The median baseline CD4 count increased in recent years, to 122 cells/microl (IQR 53-194) in 2005-2006 in Africa, 134 cells/microl (IQR 72-191) in Asia, and 197 cells/microl (IQR 61-277) in South America, but 77%, 78% and 51%, respectively, started with less than 200 cells/microl in 2005-2006. In all regions baseline CD4 cell counts were higher in women than men: differences were 22cells/microl in Africa, 65 cells/microl in Asia and 10 cells/microl in South America. In 2005-2006 a viral load at 6 months was available in 21% of patients Africa, 8% of Asian patients and 73% of patients in South America. Corresponding figures for 6-month CD4 cell counts were 74%, 77% and 81%. The public health approach to providing ART proposed by the World Health Organization has been implemented in sub-Saharan Africa and Asia. Although CD4 cell counts at the start of ART have increased in recent years, most patients continue to start with counts well below the recommended threshold. Particular attention should be paid to more timely initiation of ART in HIV-infected men.

Spousal sexual violence and poverty are risk factors for sexually transmitted infections in women: A longitudinal study of women in Goa, India
(Abstract; subscription needed for full text; Asia)
Sexually Transmitted Infections. 2008 Mar;84(2):133-139.
Weiss HA | Patel V | West B | Peeling RW | Kirkwook BR
The objectives were to describe factors associated with incident sexually transmitted infections (STI) in a population-based sample of women in Goa, India. A random sample of women aged 18-45 years was enrolled in Goa from November 2001 to May 2003. All subjects who consented to participate and completed the recruitment procedure were interviewed six and 12 months after recruitment. Incident chlamydia, gonorrhoea or trichomoniasis from vaginal and/or urine specimens were detected using a commercial polymerase chain reaction and the InPouch TV Culture Kit. Of the 2180 women followed up, 64 had an incident STI (incidence of 1.8% in the first six months, and 1.4% in the second six months). Incident STI was associated with low socioeconomic status, marital status, and with concurrent bacterial vaginosis. Incidence was highest among women who were married and exposed to sexual violence (10.9%), were concerned about their husbands' affairs (10.5%), or were separated, divorced or widowed women (11.0%). Socially disadvantaged women are at increased risk of STI in this population. Sexual intercourse outside marriage was rarely reported in this population, and women are at risk of becoming infected within marriage, especially those with sexual violence. This highlights the vulnerabilities of socially disadvantaged married women in India, and the need for healthcare professionals to screen STI patients for violence, and provide the necessary support. The results also stress the importance of effectively diagnosing and treating married men with STI and promoting safer sex within marriage.

Reproductive tract infections including sexually transmitted infections: A population-based study of women of reproductive age in a rural district of Vietnam
(Abstract; subscription needed for full text; Asia)
Sexually Transmitted Infections. 2008 Mar;84(2):126-132.
Lan PT | Lundborg CS | Phic HD | Sihavong A | Unemo M
The objectives were to investigate the prevalences of reproductive tract infections (RTI)/sexually transmitted infections (STI) among married women in a rural district of Vietnam, and analyse the influence of socioeconomic, sociodemographic, and other determinants possibly related to RTI/STI. The method used was a community-based cross-sectional study. Married women aged 18-49 years (n = 1012) were interviewed and underwent a gynaecological examination. Specimens were collected for laboratory diagnosis of chlamydia, gonorrhoea, trichomonas, bacterial vaginosis (BV), candidiasis, hepatitis B, HIV, and syphilis. In total, 37% of the women were clinically diagnosed with an RTI/STI. Aetiologically confirmed RTI/ STI was identified in 39% of the women (including 6% with STI). Endogenous infections were most prevalent (candidiasis 26%, BV 11%) followed by hepatitis B 8.3%, Chlamydia trachomatis 4.3%, Trichomonas vaginalis 1%, Neisseria gonorrhoeae 0.7%, genital warts 0.2%, and HIV and syphilis 0%. Fifty per cent of the STI cases were asymptomatic. Younger age and intrauterine devices were significantly associated with an increased risk of BV. Determinants of candidiasis were vaginal douching, high education level and low economic status, whereas a determinant of chlamydia was high economic status. Outmigration of the husband was associated with an increased risk of hepatitis B surface antigen seroposivity among women. RTI/STI were prevalent among married women in a rural population of Vietnam. Syndromic algorithms should be consistently supplemented by risk assessment in order to reduce under and overtreatment. Microscopic diagnosis could be applied in primary care settings to achieve more accurate diagnoses. The promotion of health education aimed at reducing RTI/STI prevalences is an important tool in STI/HIV control programmes. Vaccination to prevent hepatitis B for migrants should be considered.

Growth in HIV-infected children receiving antiretroviral therapy at a pediatric infectious diseases clinic in Uganda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Patient Care and STDs. 2008 Mar;22(3):245-251.
Kabue MM | Kekitiinwa A | Maganda A | Risser JM | Chan W
Antiretroviral therapy (ART) improves growth and survival of HIV-infected individuals. We designed a retrospective cohort study to assess clinical factors associated with growth in HIV-infected children on ART in Uganda between July 2003 and March 2006. Height and weight measurements taken pre- and post-ART initiation for at least 6 months were age- and gender-standardized to CDC 2000 reference. We analyzed medical records of 749 children receiving ART. Descriptive and logistic regression analyses were conducted to identify covariates associated with risk of either stunting or being underweight. Longitudinal regression analysis with a mixed model using autoregressive covariance structure was used to compare change in height and weight before and after initiation of ART. The mean age of the study population at first visit was 7.5 years. Mean height-for-age, weight-for-age, and weight-for-height percentiles at first visit were 8.6, 7.7, and 7.9, respectively. At last visit mean height-for-age, weight-for-age, and weight-for-height percentiles were 8.6, 13.3, and 13.8, respectively. Baseline weight-for-age z score of 1 or more was protective against stunting (odds ratio [OR] 0.25, confidence interval [CI] 0.18-0.35) while baseline height-for-age z score of 1 or more was protective against becoming underweight (OR 0.75, CI 0.63-0.88). Children in World Health Organization (WHO) stages II, III, and IV at baseline were 1.5 times more likely to become underweight (OR 1.51, CI 1.07-2.14). Initiation of ART resulted in improvement in mean standardized weight-for-age z score and weight-for-age percentiles (p less than 0.001). Weight-for-age percentile and z score improved significantly after initiation of ART. This pediatric population gained weight more rapidly than height after initiation of ART.

Is social capital associated with HIV risk in rural South Africa?
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Social Science and Medicine. 2008 May;66(9):1999-2010.
Pronyk PM | Harpham T | Morison LA | Hargreaves JR | Kim JC
The role of social capital in promoting health is now widely debated within international public health. In relation to HIV, the results of previous observational and cross-sectional studies have been mixed. In some settings it has been suggested that high levels of social capital and community cohesion might be protective and facilitate more effective collective responses to the epidemic. In others, group membership has been a risk factor for HIV infection. There have been few attempts to strengthen social capital, particularly in developing countries, and examine its effect on vulnerability to HIV. Employing data from an intervention study, we examined associations between social capital and HIV risk among 1063 14 to 35-year-old male and female residents of 750 poor households from 8 villages in rural Limpopo province, South Africa. We assessed cognitive social capital (CSC) and structural social capital (SSC) separately, and examined associations with numerous aspects of HIV-related psychosocial attributes, risk behavior, prevalence and incidence. Among males, after adjusting for potential confounders, residing in households with greater levels of CSC was linked to lower HIV prevalence and higher levels of condom use. Among females, similar patterns of relationships with CSC were observed. However, while greater SSC was associated with protective psychosocial attributes and risk behavior, it was also associated with higher rates of HIV infection. This work underscores the complex and nuanced relationship between social capital and HIV risk in a rural African context. We suggest that not all social capital is protective or health promotive, and that getting the balance right is critical to informing HIV prevention efforts.

Asia-Pacific operational framework for linking HIV/STI services with reproductive, adolescent, maternal, newborn and child health services
(Report; Oceania)
Geneva, Switzerland, WHO Regional Office for the Western Pacific, 2008.
Distinct interventions are needed to improve reproductive health (RH), adolescent reproductive health (ARH), maternal, neonatal and child health (MNCH), and prevention and management of HIV and other sexually transmitted infections (STI). Yet common underlying causes and shared solutions provide the basis for linkages that can strengthen all services and increase the reach of HIV prevention and testing. This Operational Framework provides information about how to create these linkages and what factors to take into account in doing so. The emphasis is not on creating all possible linkages, but on doing what is possible and advisable given local factors such as epidemiology, current skill sets, the current organization of the health system, resources available, and health system usage patterns. In settings with low HIV prevalence, for example, outreach to specific populations may be more important than forming linkages between two broad-based services. Especially when resources are limited, linkages that add information (such as prevention messages or a simple screening) will be easier to implement than linkages that require extensive clinical judgment for referral or clinical treatment. Central policies are needed to support the introduction of linkages, but they should incorporate community input and allow for local-level modification and ownership. If these factors are taken into account, linkages between RH, ARH, MNCH and HIV/STI services have great potential to achieve efficiency gains and increased targeting of client populations.

MATERNAL AND CHILD HEALTH NEWS

Benin: Sisters' clinic a big boost to maternal and child health
(News Article; Sub-Saharan Africa)
1 Apr 2008
Catholic Information Service for Africa

Nigeria: Maternal mortality - UNICEF meets 10 states
(News Article; Sub-Saharan Africa)
3 Apr 2008
Isiguzo C, This Day (Lagos)

Yemeni babies still suffering from malnutrition
(News Article; Middle East)
1 Apr 2008
Ghaleb T, Yemen Observer

MATERNAL AND CHILD HEALTH RESEARCH

Cost-effectiveness of ritodrine and fenoterol for treatment of preterm labor in a low-middle-income country: A case study
(Abstract; subscription needed for full text; Europe)
Value in Health. 2008 Mar-Apr;11(2):149-153.
Jakovljevic M | Varjacic M | Jankovic SM
In countries with high income, tocolytic therapy with b-mimetic agents is a cost-effective strategy compared to placebo. In this study, the cost-effectiveness of two beta-mimetic agents, ritodrine and fenoterol, used in the management of preterm labor was compared in the setting of a low-middle-income transitional country, Serbia & Montenegro. This case study was conducted at the Gynecology-Obstetrics Clinic, Clinical Center "Kragujevac," in Kragujevac, Serbia & Montenegro, between October 2004 and January 2006. In total, 235 pregnant patients with threatened preterm labor were enrolled, but 35 were lost to follow-up. Of the remaining 200 patients, 85 were given ritodrine, and 115 fenoterol. The perspective of Republic Institute for Health Insurance in Serbia was taken into account. Only direct costs were calculated; primary outcomes of the study were length of pregnancy (in weeks), time passed from the onset of uterine contractions to delivery (in weeks), and score on modified Flanagan's quality-of-life scale for chronic diseases, measured after discharge from hospital. Prolongation of pregnancy was significantly longer in the fenoterol group (12.7 plus or minus 8.4 weeks) than in the ritodrine group (11.6 plus or minus 7.1 weeks). The mean duration of hospitalization was shorter in the fenoterol group (11.9 plus or minus 8.8 days) than in the ritodrine group (14.9 plus or minus 11.3 days). The treatment with fenoterol was less costly and more cost-effective than the treatment with ritodrine, but the difference in cost-effectiveness was not statistically significant. The cost of treatment per gained week of pregnancy prolongation was 3345.51 plus or minus 7668.04 CSD in the fenoterol group, and 4181.96 plus or minus 12,069.83 CSD in the ritodrine group. The observed differences in treatment costs and duration of hospitalization per patient did not translate into significant differences in cost-effectiveness ratios, because of low costs of hospitalization and human labor in Serbian health system. Nevertheless, fenoterol treatment still has a tendency to be more cost-effective, and its lower acquisition cost is an advantage to this treatment option.

Duration and magnitude of mortality after pregnancy in rural Bangladesh
(Abstract; subscription needed for full text; Asia)
International Journal of Epidemiology. 2008 Apr;37(2):397-404.
Hurt LS | Alam N | Dieltiens G | Aktar N | Ronsmans C
Women remain at increased risk of mortality for some time after pregnancy although the length of this period is unclear. The aim of this study is to examine mortality after pregnancy in rural Bangladesh using data from a unique demographic surveillance system. The authors included all person-time in women aged 15-50 between 1983 and 2001 and compared mortality rates by time since pregnancy outcome (live birth, stillbirth, induced and spontaneous abortion) using Poisson regression, adjusting for socio-demographic factors. Mortality was highest on the first day after pregnancy (adjusted RR compared with third to fourth year post-partum 105.74, 95% CI: 76.08, 146.95) and remained elevated until 180 days (adjusted RR 1.55, 95% CI: 1.13, 2.11). Pregnancies ending in abortions and stillbirths accounted for 50% of deaths in women within 6 weeks of the end of pregnancy, and mortality after these outcomes was between two and four times as high as mortality after a live-birth. The high mortality rates immediately after birth provide strong support for a skilled attendance strategy. After abortions or stillbirths, women should be under surveillance for up to 1 week. Further work on the cause of deaths in the late post-partum period is required to understand the mechanisms behind increased mortality risks at these times.

Adhesion molecules changes at 20 gestation weeks in pregnancies complicated by preeclampsia
(Abstract; subscription needed for full text; North America)
European Journal of Obstetrics, Gynecology and Reproductive Biology. 2008 Apr;137(2):157-164.
Chavarria ME | Lara-Gonzalez L | Garcia-Paleta Y | Vital-Reyes VS | Reyes A
The objectives were to examine soluble E-selectin, L-selectin, P-selectin, ICAM-1, and VCAM-1 levels in normotensive and preeclamptic pregnancies. To determine cut-offs useful for preeclampsia early detection. A cohort of nulliparous women was recruited at family medicine clinics in Mexico City. Preeclampsia developed in 75 patients; 125 normotensive controls were matched. Adhesion molecules were assessed in serum obtained at 20 gestation weeks and in third trimester pregnancies. Predictive values and odds ratios for preeclampsia development were calculated with the 20 gestation week results. Threshold values were selected based on ROC curves values. In women with subsequent preeclampsia, sL-selectin and sVCAM-1 concentrations were significantly lower, whereas sE-selectin, sP-selectin and sICAM-1 levels were significantly higher, compared with controls at mid-pregnancy (p less than 0.05). The odds ratio for low sL-selectin was 25.6 (95% CI, 8.9-73.5; cut-off, 1414 ng/ml). The sensitivity, specificity, and positive and negative predictive values of low sL-selectin for preeclampsia development were 84, 90, 39, and 98%, respectively, whereas its sensitivity, specificity, and positive and negative predictive values for severe preeclampsia development (cut-off, 1210 ng/ml) were 100, 98, 60, and 100%, respectively. Early enhanced activation of endothelial cells, platelets and leukocytes seem to be present in preeclamptic patients, especially in those that develop severe preeclampsia. Low sL-selectin levels at 20 gestation weeks may be an indicator of preeclampsia development.

Unreported births and deaths, a severe obstacle for improved neonatal survival in low-income countries; a population based study
(Abstract; subscription needed for full text; Asia)
BMC International Health and Human Rights. 2008 Mar 28;8:4.
Malqvist M | Eriksson L | Nga NT | Fagerland LI | Hoa DP
In order to improve child survival there is a need to target neonatal mortality. In this pursuit, valid local and national statistics on child health are essential. We analyze to what extent births and neonatal deaths are unreported in a low-income country and discuss the consequences at local and international levels for efforts to save newborn lives. Information on all births and neonatal deaths in Quang Ninh province in Northern Vietnam in 2005 was ascertained by systematic inventory through group interviews with key informants, questionnaires and examination of health facility records. Health care staff at 187 Community Health Centers (CHC) and 18 hospitals, in addition to 1372 Village Health Workers (VHW), were included in the study. Results were compared with the official reports of the Provincial Health Bureau. The neonatal mortality rate (NMR) was 16/1000 (284 neonatal deaths/17 519 births), as compared to the official rate of 4.2/1000. The NMR varied between 44/1000 and 10/1000 in the different districts of the province. The under-reporting was mainly attributable to a dysfunctional reporting system and the fact that families, not the health system, were made responsible to register births and deaths. This under-reporting has severe consequences at local, national and international levels. At a local level, it results in a lack of awareness of the magnitude and differentials in NMR, leading to an indifference towards the problem. At a national and international level the perceived low mortality rate is manifested in a lack of investments in perinatal health programs. This example of a faulty health information system is reportedly not unique in low and middle income countries where needs for neonatal health reforms are greatest. Improving reporting systems on births and neonatal deaths is a matter of human rights and a prerequisite for reducing neonatal mortality in order to reach the fourth millennium goal.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Gender equality one key to sustainable world
(News Article; Global)
1 Apr 2008
Hanley P, The Star Phoenix

Russia: Ivanovo becoming a city of mothers
(News Article; Asia)
1 Apr 2008
Humber Y, The Moscow Times

Uganda: It's not our large numbers making us go hungry
(News Article; Sub-Saharan Africa)
30 Mar 2008
Kasambuzi E, The Monitor

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Fertility trends by social status
(Abstract; subscription needed for full text; Global)
Demographic Research. 2008 Mar;18(5):145-180.
Skirbekk V
This article discusses how fertility relates to social status with the use of a new dataset, several times larger than the ones used so far. The status-fertility relation is investigated over several centuries, across world regions and by the type of status-measure. The study reveals that as fertility declines, there is a general shift from a positive to a negative or neutral status-fertility relation. Those with high income/wealth or high occupation/social class switch from having relatively many to fewer or the same number of children as others. Education, however, depresses fertility for as long as this relation is observed (from early in the 20th century).

Rural household demographics, livelihoods and the environment
(Abstract; subscription needed for full text; Global)
Global Environmental Change. 2008 Feb;18(1):38-53.
de Sherbinin A | VanWey LK | McSweeney K | Aggarwal R | Babbieri A
This paper reviews and synthesizes findings from scholarly work on linkages among rural household demographics, livelihoods and the environment. Using the livelihood approach as an organizing framework, we examine evidence on the multiple pathways linking environmental variables and the following demographic variables: fertility, migration, morbidity and mortality, and lifecycles. Although the review draws on studies from the entire developing world, we find the majority of microlevel studies have been conducted in either marginal (mountainous or arid) or frontier environments, especially Amazonia. Though the linkages are mediated by many complex and often context-specific factors, there is strong evidence that dependence on natural resources intensifies when households lose human and social capital through adult morbidity and mortality, and qualified evidence for the influence of environmental factors on household decision-making regarding fertility and migration. Two decades of research on lifecycles and land cover change at the farm level have yielded a number of insights about how households make use of different land-use and natural resource management strategies at different stages. A thread running throughout the review is the importance of managing risk through livelihood diversification, ensuring future income security, and culture-specific norms regarding appropriate and desirable activities and demographic responses. Recommendations for future research are provided.

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Volume 8, Number 14 7 April 2008