Volume 8, Number 19
12 May 2008

Change to The Pop Reporter: Starting with the June 2, 2008, issue of The Pop Reporter, the scope will change to include only research items. News, guest editorials, and events will be discontinued until further notice.

Guest Editorials (free with every subscription)

Youth, HIV, and the Demographic Dividend

Author: Noman Farooq, Program Assistant, Pakistan AIDS Control Federation

resourcecentre@pnac.net.pk

The demographic dividend is a rise in the rate of economic growth due to a rising share of working age people in a population. This usually occurs late in the demographic transition when the fertility rate falls and the youth dependency rate declines. During this demographic window of opportunity, output per capita rises. It has been argued that the demographic dividend played a role in the "economic miracles" of the East Asian Tigers and that the economic boom in Ireland in the 1990s (the Celtic tiger) was in part due to the legalization of contraception in 1979 and subsequent decline in the fertility rate . In Ireland the ratio of workers to dependents improved due to lower fertility but was raised further by increased female labor market participation and a reversal from outward migration of working age population to a net inflow. Africa, on the other hand, continues to have high fertility and youth dependency rates, which contribute to its economic stagnation. The magnitude of the demographic dividend appears to be dependent on the ability of the economy to absorb and productively employ the extra workers, rather than a pure demographic gift.

The youth stage of the life cycle is critical from a social perspective since it is the time when young people make key decisions in terms of their life style, living arrangements, partnering, and family formation. There are decisions among youth that have been significantly affected by globalization. Moreover globalization has facilitated the spread of Western cultural practices and exposed them to different ways of doing things. Undoubtedly this has seen them challenge many traditional authority structures and perhaps also experience disorientation caused by the dilemmas of day-to-day experience of clashes between traditional and modern values and norms.

Pakistan Demographics and Youth

Population growth and size have remained the focus of debate for centuries but the recent demographic transition in developing countries has made social scientists take note of the changing age structure of the population as well. As a result of declining population growth and consequent changes
in age structure, the proportion of working-age population is increasing in most developing countries, with an associated decline in the dependent age population, offering a window of opportunity to these countries that is referred to as the "demographic dividend." Pakistan is also going through the demographic transition, and is experiencing a once-in-a-lifetime demographic dividend as the working-age population bulges and the dependency
ratio declines.

For economic benefits to materialize, there is a need for policies dealing with education, public health, and those that promote labor market flexibility and provide incentives for investment and savings. On the contrary, if appropriate policies are not formulated, the demographic dividend might in fact be a cost, leading to unemployment and an unbearable strain on education, health, and old age security.

The number of youth relative to other age groups in today's Pakistan is higher than it has ever been, and arguably higher than it will ever be. This peak in youth population presents the community with a unique "window of opportunity," which, if seized, could propel growth and prosperity. But if we miss this opportunity, we could face widespread disillusionment, mass unemployment, and possibly a downturn in economic growth.

A substantial increase in the size of the labor force can lead to greater per capita output and economic growth, producing the "demographic dividend." The dividend most often occurs in countries late in the demographic transition, when birth rates are falling. Resources shift from dependent children and elders to youth -- the age group that comprises the bulk of the productive labor force. While the large number of youth can put pressure on schools, labor markets, and services, it is also noted that the declining
dependency ratios of the demographic dividend also allow for increased investment in education and family welfare.

Young people are considered as more vulnerable to the HIV epidemic because of lack of guidance and information on sexuality and on safe-sex behavior. Young people are more susceptible to risk activities and adoption of unsafe sexual practices. In Pakistani society, open discussion on sex is considered shameful and sharing information about sex is discouraged culturally. Thus they are more susceptible to risk activities and adoption of unsafe sexual practices. Normally young people receive little or no guidance on sex by their elders and their source of information are generally inadequate and misleading. In general, people avoid disclosing their sex health problems and usually
trust the quacks that pose themselves as experts on
sexual health. Their counseling skills and the privacy that they provide to each client help them to flourish their business, but their practices are no more up to any medical standards and may be a serious threat to public
health.

Youth as the most vulnerable age group for HIV infection needs awareness of anatomy and physiology of the reproductive system, psychological changes during puberty, sexual health, STDs, and HIV/AIDS. There is a need to change the attitudes of adults to provide information on the above. It’s time for expressing their opinion on the need for information to prevent HIV/AIDS as well as the importance of youth participation in the designing and the implementation of projects addressing youth.

References:

Pakistan AIDS Control Federation
http://www.pnac.net.pk/

ADOLESCENT HEALTH NEWS

Botswana: GIPS Students Tackle HIV
(News Article; Sub-Saharan Africa)
6 May 2008
The Voice (Francistown)

Uganda: Children Lack Aids Treatment
(News Article; Sub-Saharan Africa)
5 May 2008
New Vision (Kampala)

Kenya: Study Rings Alarm Over Teen Sex
(News Article; Sub-Saharan Africa)
7 May 2008
The Nation (Nairobi)

ADOLESCENT HEALTH RESEARCH

Education and HIV and AIDS in Malawi: The role of open, distance and flexible learning
(Report; Sub-Saharan Africa)
London, United Kingdom, University of London, Institute of Education, Department of Education and International Development, SOFIE, 2008. (SOFIE Opening Up Access Series No. 3)
Streuli N | Moleni CM
In a context in which HIV and AIDS is affecting many lives around the globe, education has been described as the most effective 'social vaccine' against this pandemic. Getting every child into school seems to be essential to mitigate the impact of HIV and AIDS. However, worldwide evidence suggests that HIV and AIDS have swamped education sectors with a range of challenges, especially in countries were education sectors were already weak. As a result, many children are not accessing education or are leaving school before achieving basic literacy and numeracy skills. This paper is one of the background documents developed as part of SOFIE research project funded by the Joint DFID-ESRC Scheme that explores the potential role of open, distance and flexible learning (ODFL) as a complement to conventional schooling in Malawi and Lesotho to overcome the barriers to education presented by HIV and AIDS. Drawing mostly on secondary data, the analysis of documents, reports and academic articles, as well as on primary data from interviews and discussions with key informants in Malawi, this paper reviews the way in which the education sector in Malawi is responding to support students' access to education and achievement in the context of the AIDS epidemic. It also identifies and analyses key ODFL initiatives and structures used to address challenges in the education system. Available research evidence suggests that ODFL should be supported alongside conventional schooling because it has the potential to alleviate the huge demands that the system is facing. The evidence also recommends the design of inclusive programmes that reach out to all vulnerable children, not only orphans, and particularly those from the lowest socio-economic quintiles. Some good practices are discussed.

Sexual risk reduction needs of adolescents living with HIV in a clinical care setting
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Care. 2008 Apr;20(4):426-433.
Bakeera-Kitaka S | Nabukeera-Barungi N | Nostlinger C | Addy K | Colebunders R
As anti-retroviral therapy becomes increasingly available, young people living with HIV need tailored support to adopt healthy sexual behaviors. There has been a gap in the availability of culturally appropriate techniques for secondary prevention and sexual risk reduction in this target group. This formative study assessed sexual and reproductive health needs and problems, as well as determinants of sexual risk-taking among young people living with HIV aged 11-21 years attending the Paediatric Infectious Disease Clinic in Kampala, Uganda. Theoretical guidance was provided by the Information-Motivation-Behavioral Skills Model. Socio-demographic and selected psychosexual data were assessed using a brief anonymous questionnaire. A total of 75 young people living with HIV participated in eight focus group discussions. In addition, one focus group was conducted with adult key informants (service providers). About a quarter of the young participants reported prior or current sexual experience. The study revealed knowledge gaps relating to reproductive health, HIV transmission, and contraceptive methods. Motivations for protection included hope for the future, good counseling, and fear of the consequences of sexual activity such as unwanted pregnancies. Barriers to adopting preventive behaviors included peer pressure, poverty, HIV-related stigma, ignorance of their partners, alcohol use, and a desire to have children for the older ones. Young sero-positive people in this setting lacked specific behavioral skills, such as disclosure of HIV status to their sexual partners, this being closely linked to fear of rejection and stigma. HIV-positive youths need support in developing the appropriate behavioral skills to adopt healthy sexual behaviors. Interventions in this field need to be developmentally appropriate and tailored to young people's specific needs. Structural interventions should at the same time address and reduce HIV-related stigma and socio-economic needs of young people living with HIV.

Home-based sexuality education: Nigerian parents discussing sex with their children
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Youth and Society. 2008 Jun;39(4):575-600.
Izugbara CO
This article explores how and why parents in rural Nigeria discuss sexuality-related matters with their adolescent children. The data presented here demonstrate that parents relegate sexuality to the domain of the dangerous, unpleasant, and unsavory while speaking to their children about it. Family sexuality communications offer parents a veritable cultural space to manage and control young people's sexuality. It is asserted that many Nigerian parents who discuss sexuality issues with their adolescent children compound the difficulties the young people encounter in accessing accurate and adequate sexuality information and in developing the associated power and mastery over their own sexual identity. Interventions that will enable parents to both give and allow their children early access to quality information on matters of sexuality are urgently needed.

Youth risk-taking behavior in Brazil: Drug use and teenage pregnancy
(Working Paper; South America)
Washington, D.C., World Bank, Sustainable Development Division, 2008 Mar. 14 p. (Policy Research Working Paper No. 4548)
Cardoso AR | Verner D
Using an extensive survey that addresses risk factors faced by the population in the shantytowns (favelas) of Fortaleza, Brazil, the aim of this paper is to study risk-taking behavior by youth, focusing on drug use and teenage pregnancy. The paper analyzes the impact of factors such as exposure to mass media, the existence of support networks, self-esteem, and the occurrence of violence at home and in the neighborhood, on the probability of risk-taking behavior. A bivariate probit model is estimated. The findings indicate that reliance on support networks and exposure to mass media are associated with a lower probability of either type of risk behavior. Living in a violent home increases drug consumption. Race does not have a significant impact on either type of behavior.

Living on the edge: Risk, protection, behavior, and outcomes of Argentine youth
(Working Paper; South America)
Washington, D.C., World Bank, Latin America and the Caribbean Region, Social Development Family, 2008 Jan. 32 p. (Policy Research Working Paper No. 4485)
Justesen M
Risk and protective factors influence behaviors and outcomes for youth. While risk factors expose youth to risk-taking behavior that compromises well-being and hinders personal development, protective factors mediate risk and act as protective mechanisms that insulate youth from negative outcomes. This paper groups youth by risk levels using a cluster analysis methodology, and identifies the risk and protective factors that characterize these groups. Using data from a new household survey covering youth in four urban areas of Argentina in 2005, youth are clustered by characteristics in relation to family and health, education and income, substance abuse, and crime and violence as indicators of risk and protective factors, and behaviors and consequences. Almost half of Argentine youth are at an elevated risk level, and one in four is at serious risk of experiencing negative outcomes or already suffering the consequences. The findings show, for example, that higher income protects against risk factors, such as an insecure neighborhood, and facilitates youth attending school. Furthermore, parents' lack of education is negatively related to the behaviors and outcomes of their children.

FAMILY PLANNING NEWS

Indonesia: Govt to earmark Rp1.6 trillion for family planning program
(News Article; Asia)
6 May 2008
Antara News

Malaysia: Community: Getting them to use it is the hardest part
(News Article; Asia)
3 May 2008
Mei Ling C, The New Straits Times Online

FAMILY PLANNING RESEARCH

Jordanian women's experiences with the use of traditional family planning
(Abstract; subscription needed for full text; Middle East)
Health Care for Women International. 2008 May;29(5):527-538.
Khalaf IA | Abu-Moghli F | Callister LC | Rasheed R
Kingdom of Jordan Ministry of Health (MOH) have identified the importance of strengthening national capacity through the integration of reproductive health (RH) services into the primary health care system. It is reported that a high percentage of Jordanian women use traditional family planning (TFP) methods, frequently using them incorrectly. Our purpose in this qualitative descriptive study was to explore the issues and challenges related to the use of TFP among Jordanian women. Six focus groups with women of childbearing age (18-44 years of age; n = 51) were held in the northern, central, and southern regions of Jordan. Study participants used traditional methods such as withdrawal, periodic abstinence, and breastfeeding. Often TFP methods were used incorrectly, resulting in a high failure rate with unplanned pregnancies occurring within short inter pregnancy intervals. Women preferred using TFP because of side effects experienced while using modern family planning (MFP) methods, misconceptions, and lack of correct information about MFP methods. Husbands often declined to use condoms but supported the use of TFP methods. Women indicated that they have unmet needs for family planning and that they would consider using MFP methods if accurate information was available at health centers. They emphasized the importance of competent and knowledgeable health care providers (HCPs) who contribute to decision making regarding use of family planning.

The effect of family size and composition on fertility desires, contraceptive adoption, and method choice in South Asia
(Report; Asia)
2008 Mar;Calverton, Maryland, Macro International, MEASURE DHS, 2008 Mar. 26 p. (Array)
Jayaraman A | Mishra V | Arnold F
We examine the influence of family size and composition on reproductive behavior in three South Asian countries - Nepal, India, and Bangladesh - that are known for strong son preference. Using data from recent Demographic and Health Surveys, we analyze whether the choice of contraceptive method adopted (modern versus traditional; temporary versus permanent) and desire for another child differ by parity and sex composition of surviving children. In addition, for India we pool data for four northern states (Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh) and four southern states (Andhra Pradesh, Karnataka, Kerala, and Tamil Nadu) in order to capture the north-south variation within the country. We also compare West Bengal and Bangladesh to understand how son preference in these culturally similar regions affects fertility desires and contraceptive adoption. The effects of parity and sex composition on fertility desire and contraceptive use are estimated using binary and multinomial logistic regression after controlling for key socioeconomic factors, including education, work status, media exposure, household wealth status, woman's participation in household decision-making, and urban/rural residence. We find that, independent of socioeconomic factors, women with more sons have a lower desire to have another child and are more likely to use contraception than those with more daughters. These effects are more prominent in Nepal and India than in Bangladesh. Within India, the effects are stronger in north India than in south India or West Bengal. However, considerable proportions of women also express a desire for at least one daughter, especially in Bangladesh after having a son. There is a clear shift towards permanent methods of contraception with an increase in the number of sons, but we find no systematic pattern in the use of traditional methods by parity or sex composition of children. We conclude that son preference remains widespread in all three countries, and it has a major influence on reproductive behavior. The preference for boys is embedded in the cultural and traditional beliefs of these countries. Reducing such preference would require a change in social norms and attitudes of the people and an improvement of the status of women within the household.

Advances in male contraception
(Abstract; Global | Global)
Endocrine Reviews. 2008 Apr 24;:[59] p..
Page ST | Amory JK | Bremner WJ
Despite significant advances in contraceptive options for women over the last 50 years, world population continues to grow rapidly. Scientists and activists alike point to the devastating environmental impacts that population pressures have caused including global warming from the developed world and hunger and disease in less developed areas. Moreover, almost of half of all pregnancies are still unwanted or unplanned. Clearly, there is a need for expanded, reversible, contraceptive options. Multicultural surveys demonstrate men's willingness to participate in contraception, and their female partners to trust them to do so. Notwithstanding their paucity of options, male methods including vasectomy and condoms account for almost a third of contraceptive use in the United States and other countries. Recent, international, clinical research efforts have demonstrated high efficacy rates (90-95%) for hormonally-based male contraceptives. Current barriers to expanded use include limited delivery methods and perceived regulatory obstacles, stymieing introduction to the marketplace. However, advances in oral and injectable androgen delivery are cause for optimism that these hurdles may be overcome. Non-hormonal methods, such as compounds that target sperm motility, are attractive in their theoretical promise of specificity for the reproductive tract. Gene and protein array technologies continue to identify potential targets for this approach. Such non-hormonal agents will likely reach clinical trials in the near future. Great strides have been made in understanding male reproductive physiology; the combined efforts of scientists, clinicians, industry and governmental funding agencies could make an effective, reversible, male contraceptive an option for family planning over the next decade.

GENDER and HEALTH NEWS

Kenya: Teen Mothers Face Ridicule in Schools
(News Article; Sub-Saharan Africa)
7 May 2008
Omondi G, The Nation (Nairobi)

Congo-Kinshasa: ARU - Launch of an Awareness Campaign Against Sexual Violence
(News Article; Sub-Saharan Africa)
5 May 2008
Waberi F, UN Mission in the DR Congo

Uganda: Machine to Test Vaginal Bacteria Launched
(News Article; Sub-Saharan Africa)
4 May 2008
Ahimbazwe R | Kariuki J, New Vision (Kampala)

GENDER and HEALTH RESEARCH

Micro-credit, women's groups, control of own money: HIV-related negotiation among partnered Dominican women
(Abstract; subscription needed for full text; Central America and the Caribbean)
AIDS and Behavior. 2008 May;12(3):396-403.
Ashburn K | Kerrigan D | Sweat M
A sample of 356 members of women's groups, aged 18-49, in the Dominican Republic were interviewed by trained female interviewers. Data among 273 partnered women were analyzed. The dependent variable, a measure of HIV-related negotiation, was examined for associations with control of own money, level of women's group participation, and ever having received a loan through a micro-credit program. Findings suggest control of own money to be significantly associated with HIV-related negotiation. Ever having received a loan and level of women's group participation, however, were not significantly associated with HIV-related negotiation. Empowerment measured as control of own money may influence HIV protective behavior among partnered women in this setting.

Acceptability of male circumcision among mothers with male children in Mysore, India
(Abstract; subscription needed for full text; Asia)
AIDS. 2008 May 11;22(8):983-988.
Madhivanan P | Krupp K | Chandrasekaran V | Karat SC | Reingold AL
There is currently little information on the acceptability of male circumcision in India. This study investigated the acceptability of male circumcision among Indian mothers with male children. A cross-sectional survey was conducted among a convenience sample of 795 women attending a reproductive health clinic in Mysore, India, between January and April 2007. Of the 1012 invited eligible participants, 795 women agreed to participate (response rate = 78.5%). The majority of women were Hindus (78%), 18% were Muslims, and 4% were Christians. About 26% of respondents had no schooling, 29% had 7 years of schooling, 42% had 8-12 years, and 3% had more than 12 years. After women were informed about the risks and benefits of male circumcision, a majority of women with uncircumcised children (n = 564, 81%) said they would definitely circumcise their children if the procedure were offered in a safe hospital setting, free of charge, and a smaller number (n = 50, 7%) said they would probably consider the procedure. Only seven women (1%) said that they would definitely/ probably not consider male circumcision, and 63 (9%) were unsure. Since male circumcision has been found to decrease risk of HIV infection among men, it is important to determine its acceptability as a potential HIV prevention strategy in India. This study found male circumcision to be highly acceptable among a broad range of mothers with male children in Mysore, India. Further studies of acceptability among fathers and other populations are warranted.

Gender attitudes, sexual power, HIV risk: A model for understanding HIV risk behavior of South African men
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Care. 2008 Apr;20(4):434-441.
Kaufman MR | Shefer T | Crawford M | Simbayi LC | Kalichman SC
The Gender Attitudes-Power-Risk (GAPR) model of HIV risk behavior was tested using survey data collected from among 309 men who were attending STI services in a primary health care clinic in Cape Town, South Africa. Results showed that negative attitudes towards women were significantly positively associated with a high level of HIV risk behavior, and that endorsement of traditional male roles was negatively associated with HIV risk behavior. Endorsement of traditional male gender roles was also inversely related to relationship control but positively to a high degree of decision-making dominance in one's relationship. Sexual relationship power did not significantly mediate the relationships between gender attitudes and HIV risk behavior. A better understanding of gender roles and ideologies in combination with one's power in sexual relationships as they relate to HIV risk behavior among men could better inform future HIV prevention interventions.

HIV/AIDS and STIs NEWS

South Africa: Media's Critical Role in Fighting HIV/Aids
(News Article; Sub-Saharan Africa)
6 May 2008
Da Silva IS, Biz-Community/AllAfrica

Afghanistan: Can condoms fulfill multiple expectations?
(News Article; Asia)
6 May 2008
IRIN/PlusNews
Related News Article: Afghanistan to promote condom usage

HIV funding priority shift call
(News Article; Sub-Saharan Africa)
9 May 2008
BBC News

HIV/AIDS and STIs RESEARCH

Impact of five years of peer-mediated interventions on sexual behavior and sexually transmitted infections among female sex workers in Mombasa, Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMC Public Health. 2008 Apr 29;8:143.
Luchters S | Chersich MF | Rinyiru A | Barasa MS | King'ola N
Since 2000, peer-mediated interventions among female sex workers (FSW) in Mombasa Kenya have promoted behavioural change through improving knowledge, attitudes and awareness of HIV serostatus, and aimed to prevent HIV and other sexually transmitted infection (STI) by facilitating early STI treatment. Impact of these interventions was evaluated among those who attended peer education and at the FSW population level. A pre-intervention survey in 2000, recruited 503 FSW using snowball sampling. Thereafter, peer educators provided STI/HIV education, condoms, and facilitated HIV testing, treatment and care services. In 2005, data were collected using identical survey methods, allowing comparison with historical controls, and between FSW who had or had not received peer interventions. Over five years, sex work became predominately a full-time activity, with increased mean sexual partners (2.8 versus 4.9/week; P less than 0.001). Consistent condom use with clients increased from 28.8% (145/503) to 70.4% (356/506; P less than 0.001) as well as the likelihood of refusing clients who were unwilling to use condoms (OR=4.9, 95%CI=3.7-6.6). In 2005, FSW who received peer interventions (28.7%, 145/506), had more consistent condom use with clients compared with unexposed FSW (86.2% versus 64.0%; AOR=3.6, 95%CI=2.1-6.1). These differences were larger among FSW with greater peer-intervention exposure. HIV prevalence was 25% (17/69) in FSW attending greater than or equal to 4 peer-education sessions, compared with 34% (25/73) in those attending 1-3 sessions (P=0.21). Overall HIV prevalence was 30.6 (151/493) in 2000 and 33.3% (166/498) in 2005 (P=0.36). Peer-mediated interventions were associated with an increase in protected sex. Though peer-mediated interventions remain important, higher coverage is needed and more efficacious interventions to reduce overall vulnerability and risk.

Some factors associated with condom use among bar maids in Tanzania
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Biosocial Science. 2008;:[13] p..
Akarro RR
Some socioeconomic and demographic factors contributing to the use of condoms among bar maids were studied in selected urban areas in Tanzania. Bar maids were classified according to whether or not they use condoms, and logistic regression was used in the analysis. Of the demographic variables studied, age, marital status, education level, use of alcohol and wage rate showed a significant relationship at the 1% level between individual factors and use of condoms. The odds ratios show that girls aged 10-14 are over 18,000 times more likely not to use condoms compared with women aged 30 and above. Those who drink are 6.6 times (1/0.165) less likely to use condoms compared with those who do not drink. In other words, alcohol consumption can be a stimulus for an individual not to use condoms. It is clear that young girls who drink are at the highest risk of contracting HIV/AIDS in comparison with older females. A multiple logistic regression model shows all the aforementioned factors to be significant at the 1% level. A policy recommendation is made that the government should impose restrictions as far as employment of bar maids is concerned.

Reduced mother-to-child transmission of HIV associated with infant but not maternal GB virus C infection
(Abstract; subscription needed for full text; Asia)
Journal of Infectious Diseases. 2008 May 15;197(10):1369-1377.
Supapol WB | Remis RS | Raboud J | Millson M | Tappero J
Prolonged coinfection with GB virus C (GBV-C) has been associated with improved survival in human immunodeficiency virus (HIV)-infected adults. We investigated whether maternal or infant GBV-C infection was associated with mother-to-child transmission (MTCT) of HIV-1 infection. The study population included 1364 HIV-infected pregnant women enrolled in 3 studies of MTCT of HIV in Bangkok, Thailand (the studies were conducted from 1992-1994, 1996-1997, and 1999-2004, respectively). We tested plasma collected from pregnant women at delivery for GBV-C RNA, GBV-C antibody, and GBV-C viral genotype. If GBV-CRNA was detected in the maternal samples, the 4- or 6-month infant sample was tested for GBV-C RNA. The rates of MTCT of HIV among GBV-C-infected women and infants were compared with the rates among women and infants without GBV-C infection. The prevalence of GBV-C RNA in maternal samples was 19%. Of 245 women who were GBV-C RNA positive, 101 (41%) transmitted GBV-C to their infants. Of 101 infants who were GBV-C RNA positive, 2 (2%) were infected with HIV, compared with 162 (13%) of 1232 infants who were GBV-C RNA negative (odds ratio [OR] adjusted for study, 0.13 [95% confidence interval {CI}, 0.03-0.54]). This association remained after adjustment for maternal HIV viral load, receipt of antiretroviral prophylaxis, CD4+ count, and other covariates. MTCT of HIV was not associated with the presence of GBV-C RNA (adjusted OR [aOR], 0.94 [95% CI, 0.62-1.42]) or GBV-C antibody (aOR, 0.90 [95% CI, 0.54 -1.50]) in maternal samples. Reduced MTCT of HIV was significantly associated with infant acquisition of GBV-C but not with maternal GBV-C infection. The mechanism for this association remains unknown.

Assessment of the routine, occupation-based gonorrhea and syphilis screening program in Moscow, Russia: An analysis of sexually transmitted infection prevalence and cost-effectiveness
(Abstract; subscription needed for full text; Asia)
Sexually Transmitted Diseases. 2008 May;35(5):453-460.
Kourbatova EV | Akovbyan VA | Chesson HW | Lytkina IN | Dmitriev GA
In the Russian Federation, large sectors of the population regularly undergo mandatory occupational screening for sexually transmitted infections (STIs). Objectives of our study were to determine the prevalence of syphilis and gonorrhea in the screened occupational groups in Moscow and to conduct a cost-effectiveness evaluation of the occupational screening program. Serum samples from 4 main occupational groups (food handlers and other food industry workers, market salespersons, education and health care providers, and hotel and other public utility workers) were tested for syphilis and gonorrhea. We conducted a cost-effectiveness analysis (in 2003 rubles) of the screening program using decision analysis models. In the total sample of 1000 study participants, overall prevalence for syphilis was 1.2% with the highest rate in market salespersons (4.4%) and for gonorrhea 0.3%. The incremental cost per case of STI treated was 8409 rubles ($252) for syphilis screening (compared with no screening) with higher incremental costs associated with expanding the program to include gonorrhea screening. The relatively low STI prevalence in the screened groups and the poor performance of the diagnostic tests used were important factors in the estimated cost-effectiveness of occupation-based screening. Modifications to occupation-based screening, including an increased focus on higher risk population and the adoption of more current diagnostic technologies, could help to use prevention resources more effectively.

Epidemiology of genital chlamydia trachomatis infection among young women in Costa Rica
(Abstract; subscription needed for full text; Central America and the Caribbean)
Sexually Transmitted Diseases. 2008 May;35(5):461-468.
Porras C | Safaeian M | Gonzalez P | Hildesheim A | Silva S
The objective was to investigate Chlamydia trachomatis (Ct) epidemiology among 5829 women 18 to 25 years old, in Costa Rica. Data are from a community-based human papillomavirus 16/18 vaccine trial. Before randomization, eligible women who reported previous sexual activity were interviewed and tested for Ct DNA by Hybrid Capture 2 and polymerase chain reaction-based genotyping. Multivariate models were developed. Overall prevalence was 14.2% (95% confidence interval, 13.3-15.1). Among Ct genotypes, serovar E was the most common (4.3%), followed by serovar F (3.0%), serovar D/Da (2.9%), and serovar I/Ia (2.1%). Ct increased with lifetime sexual partners of the women, and among women with 1 lifetime partner, with sexual partners of the partner. Current intrauterine device users had an increase in Ct detection [odds ratio (OR) 1.6, 1.1-2.5] but hormonal contraceptives or condom users did not. Miscarriages were associated with a reduction in Ct detection (OR 0.7, 0.5-1.0) while current regular smoking increased it (OR 1.7, 1.2-2.5). Vaginal discharge, reactive changes, ASCUS or LSIL and moderate to severe inflammation in the cytology were significantly more common among Ct positive women (P less than 0.001). Gonorrhea prevalence was 0.8%, and it was, as other STIs, highly correlated with Ct detection. This is a high-prevalence population where we confirmed the strong link between Ct and sexual behavior of women and their partners. The establishment of a screening program in the age group included in this study should be considered. More studies are needed in developing countries to further investigate the role of intrauterine devices and the lack of protection by condoms, in addition to the interplay between Ct and other STIs, ectopy, inflammation, and epithelial abnormalities.

MATERNAL AND CHILD HEALTH NEWS

Tanzania: Cancer 'stalks breastfeeding women'
(News Article; Sub-Saharan Africa)
5 May 2008
Rugonzibwa P, The Citizen (Dar es Salaam)

India children's health 'ignored'
(News Article; Asia)
8 May 2008
BBC News

India: UP toes Gujarat line to improve maternal, infant mortality rate
(News Article; Asia)
4 May 2008
Seth M, ExpressIndia

MATERNAL AND CHILD HEALTH RESEARCH

Microarray technology applied to the complex disorder of preeclampsia
(Abstract; subscription needed for full text; Global)
Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2008 Mar-Apr;37(2):146-157.
Founds SA | Dorman JS | Conley YP
Preeclampsia is a life-threatening perinatal complication with unknown etiology. Microarray technology has characterized global gene expression in complex disorders such as preeclampsia. Nursing research and future practice may incorporate findings from microarray analyses to identify susceptibility to and prevent disease, to diagnose early, and to design and monitor personalized therapies. This overview of microarray technology, with emphasis on how it can inform genomics of preeclampsia, may provide concepts to improve future maternal-neonatal nursing care.

Periodontal disease and adverse birth outcomes: A study from Pakistan
(Abstract; subscription needed for full text; Asia)
American Journal of Obstetrics and Gynecology. 2008 May;198(5):514.e1-514.e8.
Mobeen N | Jehan I | Banday N | Moore J | McClure EM | Pasha O | Wright LL | Goldenberg RL
Periodontal disease may increase the risk of adverse birth outcomes; however, results have been mixed. Few studies have examined periodontal disease in developing countries. We describe the relationship between periodontal disease and birth outcomes in a community setting in Pakistan. This was a prospective cohort study. Enrollment occurred at 20-26 weeks of gestation. A study dentist performed the periodontal examination to assess probing depth, clinical attachment level, gingival index, and plaque index. Outcomes included stillbirth, neonatal death, perinatal death, less than 32 weeks preterm birth, 32-36 weeks preterm birth, and low birthweight and are presented for increasing periodontal disease severity by quartiles. Dental examinations and outcome data were completed for 1152 women: 81% of the women were multiparous, with a mean age of 27 years; 33% of the women had no education. Forty-seven percent of the women had dental caries; 27% of the women had missing teeth, and 91% of the women had had no dental care in the last year. Periodontal disease was common: 76% of the women had greater than or equal to 3 teeth with a probing depth of greater than or equal to 3 mm; 87% of the women had greater than or equal to 4 teeth with a clinical attachment level of greater than or equal to 3 mm; 56% of the women had greater than or equal to 4 teeth with a plaque index of 3; and 60% of the women had greater than or equal to 4 teeth with a gingival index of 3. As the measures of periodontal disease increased from the 1st to 4th quartile, stillbirth and neonatal and perinatal death also increased, with relative risks of approximately 1.3. Early preterm birth increased, but the results were not significant. Late preterm birth and low birthweight were not related to measures of periodontal disease. Pregnant Pakistani women have high levels of moderate-to-severe dental disease. Stillbirth and neonatal and perinatal deaths increased with the severity of periodontal disease.

Measuring progress in reducing maternal mortality
(Abstract; subscription needed for full text; Global)
Best Practice and Research Clinical Obstetrics and Gynaecology. 2008;22(3):425-445.
Graham WJ | Foster LB | Davidson L | Hauke E | Campbell OM
The need to monitor progress in reducing maternal mortality has a long history, which can be traced back to the 1700s in some parts of the Western world. Today, however, this need is felt most acutely in developing countries, where the priority is to stimulate, evaluate and sustain action to prevent these essentially avoidable deaths. Over the last two decades, considerable efforts have been made to understand and overcome the measurement challenges of maternal mortality in the context of weak information systems, and new and enhanced methods and tools have emerged.

Reviewing maternal deaths to make pregnancy safer
(Abstract; subscription needed for full text; Global)
Best Practice and Research Clinical Obstetrics and Gynaecology. 2008;22(3):447-463.
Lewis G
Every year, some eight million women around the world suffer pregnancy-related complications; over half a million of these women die. Although most of these deaths could be averted at little or no extra cost, even where resources are limited, if we are to take action and develop and implement changes to maternity services to save the lives of mothers and newborns, we need the right kind of information. This more in-depth information might not be available through national statistics on maternal mortality rates or death certificate data; what is required is a detailed understanding of the clinical, social, cultural and other underlying factors that result in a mother's death. The World Health Organization's programme and philosophy for such maternal death or disability reviews is called Beyond the numbers. It outlines the five key methodologies for reviewing maternal deaths or disabilities that are now being introduced in a number of countries around the world.

Working with communities, governments and academic institutions to make pregnancy safer
(Abstract; subscription needed for full text; Global)
Best Practice and Research Clinical Obstetrics and Gynaecology. 2008;22(3):465-476.
Mathai M
The major medical causes of maternal death and the effective interventions to prevent maternal death due to these causes are known. Yet, every year, an estimated 529,000 women die during and following pregnancy and childbirth. Most of these deaths occur in developing countries where other non-medical determinants of maternal health influence the accessibility to these interventions. Improvements in maternal health can be achieved through a health systems approach. Care should be provided as a continuum throughout the life cycle and across health facilities through the health system. Communities, professional organizations and academic institutions should work actively with the government to: provide a package of service, based on population health needs, that is close to home; ensure availability of essential medicines and commodities; address financial barriers to receiving care; strengthen the health workforce; and gather and use information to improve maternal health.

Community-based Kangaroo Mother Care to prevent neonatal and infant mortality: A randomized, controlled cluster trial
(Abstract; subscription needed for full text; Asia)
Pediatrics. 2008 May;121(5):e1047-e1059.
Sloan NL | Ahmed S | Mitra SN | Choudhury N | Chowdhury M | Rob U | Winikoff B
The authors adapted kangaroo mother care for immediate postnatal community-based application in rural Bangladesh, where the incidence of home delivery, low birth weight, and neonatal and infant mortality is high and neonatal intensive care is unavailable. This trial tested whether community-based kangaroo mother care reduces the overall neonatal mortality rate by 27.5%, infant mortality rate by 25%, and low birth weight neonatal mortality rate by 30%. Half of 42 unions in 2 Bangladesh divisions with the highest infant mortality rates were randomly assigned to community-based kangaroo mother care, and half were not. One village per union was randomly selected proportionate to union population size. A baseline survey of 39 888 eligible consenting women collected sociodemographic information. Community-based workers were taught to teach community-based kangaroo mother care to all expectant and postpartum women in the intervention villages. A total of 4165 live births were identified and enrolled. Newborns were followed for 30 to 45 days and infants were followed quarterly through their first birthday to record infant care, feeding, growth, health, and vital status. Forty percent overall and approximately 65% of newborns who died were not weighed at birth, and missing birth weight was differential by study group. There was no difference in overall neonatal mortality rate or infant mortality rate. Except for care seeking, community-based kangaroo mother care behaviors were more common in the intervention than control group, but implementation was weak compared with the pilot study. The extensive missing birth weight and its potential bias render the evidence insufficient to justify implementing community-based kangaroo mother care. Additional experimental research ensuring baseline comparability of mortality, adequate kangaroo mother care implementation, and birth weight assessment is necessary to clarify the effect of community-based kangaroo mother care on survival.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Opinion: In food crisis, family planning helps
(Commentary; Global)
28 Apr 2008
projo.com

Liberia: Country's population to triple mid-century
(News Article; Sub-Saharan Africa)
7 May 2008
The NEWS

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

A gendered assessment of the brain drain
(Research Article; Global)
Washington, D.C., World Bank, Development Research Group, Trade Team, 2008 May. 32 p. (Policy Research Working Paper No. 4613)
Docquier F | Lowell BL | Marfouk A
This paper updates and extends the Docquier-Marfouk data set on international migration by educational attainment. The authors use new sources, homogenize definitions of what a migrant is, and compute gender-disaggregated indicators of the brain drain. Emigration stocks and rates are provided by level of schooling and gender for 195 source countries in 1990 and 2000. The data set can be used to capture the recent trend in women's skilled migration and to analyze its causes and consequences for developing countries. The findings show that women represent an increasing share of the OECD immigration stock and exhibit relatively higher rates of brain drain than men. The gender gap in skilled migration is strongly correlated with the gender gap in educational attainment at origin. Equating women's and men's access to education would probably reduce gender differences in the brain drain.

The global distribution of infant mortality: A subnational spatial view
(Abstract; subscription needed for full text; Global)
Population, Space and Place. 2008 May-Jun;14(3):209-229.
Storeygard A | Balk D | Levy M | Deane G
We describe the compilation of a spatially explicit data-set detailing infant mortality rates in over 10,000 national and subnational units worldwide, benchmarked to the year 2000. Although their resolution is highly variable, subnational data are available for countries representing over 90% of the non-OECD population. Concentration of global infant deaths is higher than implied by national data alone. Assigning both national and subnational data to map grid cells so that they may be easily integrated with other geographical data, we generate infant mortality rates for environmental regions, including biomes and coastal zones, by continent. Rates for these regions also show striking refinements from the use of the higher resolution data. Possibilities and limitations for related work are discussed.

Gender role beliefs and family migration
(Abstract; subscription needed for full text; Global)
Population, Space and Place. 2008 May-Jun;14(3):163-175.
Cooke TJ
Consistent empirical evidence demonstrates that demographic indicators associated with traditional gender roles, such as the presence of children, are linked to the negative effect of moving on married women's employment and earnings. However, very few studies have directly examined how gender role beliefs are related to family migration behaviour. This analysis demonstrates that when a couple shares egalitarian gender role beliefs, the family has a lower probability of moving when the wife is employed and has a higher probability of moving when the wife is unemployed and wants to work. Among couples that do not share traditional gender role beliefs, migration appears to be unaffected by the employment status of the wife. This study is one of the few which clearly demonstrates that family migration is contingent on the gender role beliefs of husbands and wives.

"The Pop Reporter" (R) Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs/INFO Project. When you click on any link, your Internet browser will access a Web site not connected to "The Pop Reporter." Information accessed through these links and contained in this issue of "The Pop Reporter" does not necessarily state or reflect the views of the INFO Project, Johns Hopkins University, or the US Agency for International Development. All links were verified at the date of mailing. Your computer and/or network configuration regarding Java script, cookies, and other security issues may not allow you to view certain Web sites. Consult your computer technician if you are having problems.

Problems and comments can be addressed to mdadamo@jhuccp.org.

Archives available at http://www.infoforhealth.org/popreporter/.

Subscribe at http://prds.infoforhealth.org/signup.php.

Modify your account at http://prds.infoforhealth.org/modify.php.

Forward this message to a friend who could benefit from INFO project activities!

The Pop Reporter--Delivering thought-provoking global health news to your desktop.

Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 8, Number 1912 May 2008