14 April 2003, PopReporter

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Volume 3, Number 15
14 April 2003

FAMILY PLANNING / REPRODUCTIVE HEALTH RESEARCH

Emergency Contraception (editorial)
This editorial reviews evidence related to emergency contraception prescription and use and discusses issues of access.

Estimating the Effectiveness of Emergency Contraceptive Pills (research abstract)
The authors use new estimates of conception probabilities by cycle day of intercourse to propose a new approach for estimating the effectiveness of emergency contraceptive pills. Based on conception probabilities by cycle day relative to the first day of bleeding, the expected pregnancy rates dropped to 5.4% and 5.2%, respectively, as compared to the conception probabilities by cycle day relative to day of ovulation.

Is Single Dose Levonorgestrel as Effective as Other Emergency Contraception Regimes? (research artcile)
Single-dose oral levonorgestrel 1.5 mg is as effective as oral mifepristone in preventing pregnancy when given within 120 hours of a single episode of unprotected intercourse. The lower cost, more rapid resumption of menses, increased availability, and ease of administration make oral levonorgestrel the more desirable option.

An Occupational Reproductive Research Agenda for the Third Millennium (PubMed abstract)
There is a significant public health concern about the potential effects of occupational exposure to toxic substances on reproductive outcomes. The objective of this article is to recommend future directions in occupational reproductive health research.

Cervical Cancer and Use of Hormonal Contraceptives: A Systematic Review (research abstract)
Results from published studies were combined to examine the relationship between invasive and in situ cervical cancer and duration and recency of use of hormonal contraceptives, with particular attention to HPV infection. Compared with never users of oral contraceptives, the relative risks of cervical cancer increased with increasing duration of use: for durations of approximately less than 5 years, 5-9 years, and 10 or more years, respectively, the summary relative risks were 1.1, 1.6, and 2.2 (1.9-2.4) for all women; and 0.9, 1.3 and 2.5 for HPV positive women.

Counseling Issues in Tubal Sterilization (research article)
Counseling issues include ensuring that the woman understands the permanence of the procedure and knowing the factors that correlate with future regret as well as information about the surgical procedure.

Comparison of Marie Stopes Scalpel and Electrocautery No-scalpel Vasectomy Techniques (research article)
A total of 325 men undergoing vasectomy between January and June 1999 were randomly allocated to the two study arms plus questionnaires at 4 and 14 weeks postoperatively. The ENSV technique was marginally quicker to perform. Pain levels intra-operatively were comparable. Response rates to the questionnaire were 84.6% and 37% at 4 and 14 weeks, respectively. The ENSV group experienced less pain and bleeding from the wound postoperatively and were quicker to heal. The time taken to return to sexual activity was marginally faster in the ENSV group.

An Innovative Approach to the Assessment of Laypersons' Knowledge of Contraceptive Methods, Followed by an Educational Intervention (research abstract)
A questionnaire with 10 questions about contraceptive methods was answered before a meeting between laypersons and health professionals. Small groups facilitated by a health professional discussed the answers. Of the 167 people who attended, only 39% handed over their anonymous answers for analysis. Those who did knew about the existence of contraceptive methods, but most of them showed incorrect or little knowledge about mechanism of action or risks.

Progesterone Increases Susceptibility and Decreases Immune Responses to Genital Herpes Infection (research abstract)
Related news article: Hormone Treatment May Increase Susceptibility to Genital Herpes
Certain types of hormone treatments may increase a woman's risk of contracting genital herpes, new animal research suggests.

The Acceptability of Combined Oral Hormonal Contraceptives in Shanghai, People's Republic of China (research abstract)
This survey aimed to explore the acceptability of combined oral hormonal contraceptives (COC) amongst women aged 18 to 35 years who attended a family planning clinic in Shanghai and amongst gynecologists who worked there. 500 clients and 89 gynecologists were recruited, and only 12% of the clients had ever used COC. Both groups were concerned about the risks and side effects of COC. The results of the survey suggest that it is necessary to provide improved training about COC to reproductive-aged women and professionals to dispel misunderstandings of the pill.

FAMILY PLANNING / REPRODUCTIVE HEALTH NEWS

Africa: Promotion of Contraception Should Be Heightened (news article)
The promotion of contraception among Sub-Saharan Africa's women should be heightened according to a resolution taken at the 28th Congress of the South African Society of Obstetricians and Gynaecologists.

Chinese Do 'Condom Tour' of Southern Africa (news article)
Chinese government officials looking to southern Africa to better understand effective condom distribution complete a "condom tour" in Johannesburg.

India: Female Contraceptive for Indian Market Soon (news article)
Hindustan Latex Ltd., one of the leading manufacturers of contraceptives, announced that it would launch a female contraceptive in the course of the current financial year ending March 2004.

FAMILY PLANNING / REPRODUCTIVE HEALTH LAW AND POLICY

British Court Reaffirms Embryo Screening (news article)
Couples can screen their test-tube embryos to ensure the baby's tissue provides a match to help cure a sick sibling, an appeals court ruled.

Court Awards Damages to Disabled Child for Having Been Born (news article)
For the first time in the Netherlands, a court has awarded damages to a severely disabled girl for the fact that she was born a so-called "wrongful life" judgment.

The Emergency Intrauterine Device: An Endangered Species (editorial)
Discusses the advantages of emergency IUD over emergency oral contraception and provider barriers to its provision.

South Africa: Update On Govt's HIV/Aids Plan (news article)
The HIV/AIDS budget is set to increase ten-fold from R342-million in 2001/02 to R3.6-billion in 2005/06.

Condoms are Medical Devices: Swiss (news article)
Condoms are medical devices and as such cannot be sold if defective, a Swiss court has ruled.

Indian Politicians May Be Told: 3 Tykes and You're Out (news article)
The Indian government is planning to introduce legislation that will prevent politicians with more than two children from contesting elections to the national Parliament and state assemblies. The proposal, born out of concern over the population explosion in the country, apparently seeks to get the ruling class to set an example. India's population, the second largest in the world, is more than 1 billion and growing at an annual rate of nearly 2%.

HIV / AIDS RESEARCH

Health and Economic Impact of HIV/AIDS on South African Households: Cohort Study (research article)
The authors compared households with an HIV-infected member, and unaffected neighbouring households, in one rural and one urban area in Free State province, South Africa. Interviews were conducted with one key informant in each household, at baseline and 6 months later. Members of affected households, compared to members of unaffected households, were independently more likely to be continuously ill (adjusted odds ratio 2.1) at follow up, and to die (adjusted OR 3.4) mainly due to infectious diseases. Affected households, and households with ill members, were poorer than unaffected households at baseline and at follow up.

Risk Factors for Incident HIV Infection Among Anonymous HIV Testing Site Clients in Santos, Brazil: 1996-1999 (research abstract)
Data and sera from persons testing for HIV from 1996 to 1999 were used to determine temporal trends. Exposures were abstracted from HIV testing risk assessments. Overall, estimated HIV incidence was 2% for the 4-year period. Incidence increased among women but remained stable among men. Exposures independently associated with incident infection included a history of sex work (OR= 5.4), concurrent syphilis infection (OR =4.1), anal sex (OR = 3.0), and having an HIV-positive sexual partner (OR=1.4).

The Association Between HIV and Fertility in a Cohort Study in Rural Tanzania (PubMed abstract)
This paper examines the association between HIV and fertility in Kisesa, a rural area in Tanzania. The analysis is based on data obtained through a demographic surveillance system in Kisesa during 1994-98 and two large sero-surveys of all residents in 1994-95 and 1996-97. The HIV-associated fertility reduction among women was investigated by estimating fertility rates by HIV status and prevalence rates by fertility status. A substantial reduction (29%) was observed in fertility among HIV-infected women compared with HIV-uninfected women. The fertility reduction was most pronounced during the terminal stages of infection.

Persuasive Communications to Change Actions: An Analysis of Behavioral and Cognitive Impact in HIV Prevention (research abstract)
This meta-analysis examined the validity of various theoretical assumptions about cognitive and behavioral change following a communication recommending condom use. The synthesis comprised 82 treatment and 29 control groups included in 46 longitudinal reports with measures of perceived severity and susceptibility, attitudes and expectancies, norms, perceptions of control, intentions, knowledge, behavioral skills, or condom use. Results indicated that across the sample of studies, communications taught recipients about facts related to HIV and also induced favorable attitudes and expectancies, greater control perceptions, and stronger intentions to use condoms in the future. Messages that presented attitudinal information and modeled behavioral skills led to increased condom use.

HIV / AIDS NEWS

Heimlich Courts Controversy with AIDS Malaria Tests (news article)
Dr. Henry Heimlich, inventor of the famous anti-choking maneuver, is working with doctors in several African countries to begin human tests of a controversial AIDS therapy in which patients are deliberately infected with malaria.

Malaysia: Sex-related AIDS Cases Up 50% (news article)
The number of new HIV/AIDS cases transmitted through sexual contact in Malaysia has increased by nearly 50%, causing concern among Malaysian health officials.

MATERNAL AND CHILD HEALTH RESEARCH

Evaluation of Midwifery Care: Results from a Survey in Rural Guatemala (research abstract)
The analysis is based on data from the 1995 Guatemalan Survey of Family Health and offers a mixed assessment of the efficacy of midwife training programs. For example, although trained midwives are much more likely than other midwives to refer their clients to biomedical providers, most pregnant women do not see a biomedical provider, and the quality of midwife care, as defined and measured in this study, is similar between trained and untrained midwives.

Comparison of Screening Methods for Anaemia in Pregnant Women in Awassa, Ethiopia (research abstract)
The authors compared the diagnostic accuracy of invasive and non-invasive screening methods in a cross-sectional survey of 403 pregnant women attending an urban health centre in Awassa, Ethiopia. Overall anaemia prevalence was 15.1%. Sensitivity, specificity and predictive values of conjunctival pallor and the WHO Hb colour scale were calculated for Hb cut-off points <11, <10 and <9 g/dl. All methods in combination with the symptoms and complaints reported by the mothers were entered into a predictive scoring system. None of the methods tested or models predicted anaemia with suitable accuracy in this population.

Termination of Breastfeeding after 12 Months of Age Due to a New Pregnancy and Other Causes is Associated with Increased Mortality in Guinea-Bissau (research abstract)
Children were identified and followed by the demographic health surveillance system. Breastfeeding status and survival were ascertained by 3-monthly follow-up home visits. At termination of breastfeeding, mothers were interviewed about her reasons for weaning. Median length of breastfeeding was 22 months. Following termination of breastfeeding, 66 children died before 36 months of age. In all, 62% were weaned because they were 'healthy'. Compared with the 'healthy' children, all other causes of weaning were associated with a higher mortality (mortality ratio [MR] = 2.97,). For 237 children weaned due to a new pregnancy, the MR was 3.25. Generally, children weaned for other reasons than 'being healthy' had higher mortality. The mother's reason for weaning could potentially be used as screening criteria in child monitoring programmes in areas with high mortality.

Risk of Subsequent Thromboembolism for Patients with Pre-eclampsia (research article)
Related news article: Pregnancy Complication Raises Clot Risk
New research suggests that women who suffer from the serious complication of pre-eclampsia during pregnancy have a higher risk of developing blood clots.

MATERNAL AND CHILD HEALTH NEWS

Netherlands to Offer HIV Test to All Pregnant Women (news article)
Starting next year, standard screening tests for HIV and other sexually transmitted diseases will be offered to all pregnant women in The Netherlands.

Chinese Would-be Mothers Prefer Girls: Survey (news article)
Chinese parents' traditional preference for sons, rather than daughters, has been turned around, according to a new survey.

MEN'S HEALTH RESEARCH

Reducing the Risk of Gonorrhoea in Black Caribbean Men: Can We Identify Risk Factors? (research abstract)
The aim of this study was to detect associations between gonorrhoea with differences in ancestry, degree of acculturation, and religious belief in young black Caribbean men. The authors conducted a questionnaire based case-control study of black Caribbean men with gonorrhoea and a community control group without gonorrhoea. The study identified a number of factors associated with an increased risk of gonorrhoea, which may be useful in designing healthcare interventions in young black Caribbean men. The authors recommend that healthcare interventions should include advice on reducing the number of partners and increasing the use of condoms.

Psychosocial Predictors of HIV/STI Risk Behaviours in a Sample of Homosexual Men (research abstract)
A sample of 123 users of a homosexual men's sexual health clinic completed a questionnaire which included demographic information, psychometric measures, history of sexual risk behaviour, and history of non-consensual sex (NCS). High rates of sexual risk were found in this sample behaviour (36% of men had risky sex in the previous month). Comparable rates of non-consensual sex were found in this sample (26% of the sample had experienced NCS). Depression and cognitions associated with controllability or predictability of risk were associated with increased HIV/STI risk behaviour.

MEN'S HEALTH NEWS

Argentine, Brazilian Truck Drivers at HIV Risk (news article)
Most Argentine truck drivers still engage in high-risk sexual activities, and they are suspected of contributing to the spread of HIV infection to poor teenagers and young women, according to new data presented at the Second Forum on HIV/AIDS/STD in Latin America and the Caribbean, in Havana, Cuba.

POPULATION RESEARCH

Population Dynamics in Latin America (report)
This report examines major demographic trends in Latin America during the second half of the 20th century and highlights the
demographic variations among Latin American countries. The report also considers the relationships between demographic and socioeconomic processes in the region. The report focuses on 18 Spanish-speaking countries of the Western Hemisphere, plus
Brazil and Haiti.

POPULATION NEWS

Korea: Demographic Alarm (editorial)
Korea's population grew by 0.63% over the past year, but demographers predict a net decline beginning in the next decade at the earliest. Seeing a red warning light flashing, social welfare officials are already working on high-fertility incentives, and other measures, to encourage child birth.

WOMEN'S HEALTH RESEARCH

Prevalence of Sexually Transmitted Infections and Performance of STI Syndromes Against Aetiological Diagnosis, in Female Sex Workers of Red Light Area in Surat, India (research abstract)
This research was conducted to measure prevalence of selected sexually transmitted infections (STI) and HIV among female sex workers (SWs) in the red light area of Surat, India, and to evaluate the performance of STI syndrome guidelines in this group against the standard aetiological diagnosis of STIs by laboratory methods. In a cross sectional study, a behavioural questionnaire was administered to 124 SWs, followed by clinical examination and specimen collection for different STIs. 118 SWs completed all aspects of the survey. HIV testing was unlinked and anonymous. On the basis of the results it was concluded that the prevalence of different STIs and HIV among the FSWs in the Surat red light area is high despite high reported condom use with clients. Syndromic case management is missing a large number of asymptomatic cases and providing treatment in the absence of disease. Therefore, it is necessary to explore alternative strategies for control of STIs in female sex workers.

Menstrual Cycle Differences Between Women With Type 1 Diabetes and Women Without Diabetes (research abstract)
Related news article: Type 1 Diabetes Linked to Menstrual Problems
Women younger than 30 with type 1 diabetes may be more likely than others to have problems with menstruation, including longer and heavier periods, new research suggests.

WOMEN'S HEALTH NEWS

New Ritual Replaces Female Genital Mutilation (news article)
Female genital mutilation rites are beginning to be replaced by an alternative rite of passage in Kenya known as "Cutting Through Words." The new ritual includes a week of seclusion and lessons on adult life. It is just like the traditional ritual, except that there is no cutting of their genitals.

YOUTH RESEARCH

Predictors of Papanicolaou Smear Return in a Hospital-based Adolescent and Young Adult Clinic (research article)
Sexually active young women have relatively high rates of abnormal cervical cytology, yet compliance with return for Papanicolaou smear screening and follow-up appointments is poor. The aim of this study was to determine whether a theory-based model could explain compliance with return visits. Participants in this longitudinal cohort study were sexually active young women 12-24 years of age presenting to a hospital-based adolescent clinic. The participants completed self-administered surveys and were then followed for up to 15 months to assess for the outcome measure, return. The study concluded that specific beliefs about Papanicolaou smears and providers, low self-reported impulsivity, and no family history of cervical cancer are associated with return for Papanicolaou smear screening and follow-up visits.

Understanding High School Students' Risk Behaviors to Help Reduce the HIV/AIDS Epidemic in KwaZulu-Natal, South Africa (PubMed abstract)
This article presents results from a survey of 901 rural learners (mean age 16.1, SD = 2.4) at 10 randomly selected high schools in KwaZulu-Natal. Thirty percent were sexually active, and 53.1% used a condom in the past 30 days. The odds of males being sexually active was 7.27 the likelihood of females. Only one-third of male respondents always used condoms. Of sexually active respondents, 46.5% had experienced coercive sex. With youth at increasing risk of HIV/AIDS, interventions to reduce learners' risk behaviors are required.

A Cluster Randomized Trial of a Sex Education Programme in Belize, Central America (research abstract)
This study's primary objective was to evaluate the effectiveness of a responsible sexuality education programme (RSP) in changing knowledge associated with sex and sexuality; secondary objectives were to evaluate changes in attitudes and behavioural intent. Seven schools in Belize City were selected; 8 classrooms were randomized to the intervention arm and 11 classrooms to the control arm (N = 399). Greater changes in knowledge were observed in the intervention group than in the control group following the intervention. Changes were not observed for the attitude or behavioural intent domain.

YOUTH NEWS

Australia: Concern on Sex Findings (news article)
A study on sexuality in Australia has called for an urgent review of sex education after finding teenagers are more sexually active than they were 40 years ago, and widespread ignorance about sexually transmitted infections.

PROFILES / SPECIAL REPORTS / RESOURCES

Population Reports®: Meeting the Urban Challenge (report)

Global Plagues and the Global Fund: Challenges in the Fight Against HIV, TB, and Malaria (commentary)
Although a grossly disproportionate burden of disease from HIV/AIDS, TB, and malaria remains in the Global South, these infectious diseases have finally risen to the top of the international agenda in recent years. Ideal strategies for combating these diseases must balance the advantages and disadvantages of 'vertical' disease control programs and 'horizontal' capacity-building approaches.

Spring 2003 Edition of PATH's Reproductive Health Outlook (resource)

Choices in Family Planning: Informed and Voluntary Decision Making (toolkit)

A Rural ICT Toolkit for Africa (toolkit)
The Toolkit has been prepared based on the results of a survey of ten African countries, selected to represent all regions. The study identified and sized typical rural ICT market opportunities and reviewed the hurdles to be overcome by policy makers, donors and investors. The toolkit brings together a compilation of essentials, best practices, and checklists for the planning, financing, and implementing of telecom and informatics projects in the rural African context.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 3, Number 15 14 April 2003