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The Pop Reporter®

Volume 3, Number 25
23 June 2003

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FAMILY PLANNING / REPRODUCTIVE HEALTH RESEARCH

Evaluating Factors Associated with STD Infection in a Study with Interval-censored Event Times and an Unknown Proportion of Participants Not at Risk for Disease (research article)
Studies designed to evaluate factors associated with the transmission of STD can pose several statistical challenges, two being the interval-censored event times that result from spacing between follow-up test visits, and an unknown proportion of study participants who are not at risk for infection. This study uses data from a clinical trial designed to investigate the effectiveness of an intravaginal microbicide in preventing male-to-female transmission of STD. Factors associated with time to infection among at-risk women are initially identified by fitting right-truncated models to the interval-censored event times of participants who tested positive for STD, and hence are known to have been at risk. Subsequently, factors associated with the probability of being at risk are evaluated using mixture models that incorporate information contributed by the right-censored event-free times of uninfected study participants.

An Assessment of Preferential Attachment as a Mechanism for Human Sexual Network Formation (research abstract)
Researchers studied human sexual-contact networks to determine what impact, if any, public health interventions could have on reducing the transmissibility of STD pathogens.

Differentials of Fertility in Rural Butajira (research article)
The purpose of this study was to identify differentials of fertility in Rural Butajira, Meskan and Mareko District of
Southern Nations', Nationalities and Peoples Regional State, Ethiopia. A total of 219 women with number of children ever born alive less than 5 and 899 women with number of children ever born alive greater or equal to 5 were included. Of all the socio-demographic and reproductive variables, later age at first marriage and first birth showed lower number of children ever born alive. Breast-feeding duration of more than 6 months showed an association with less number of children ever born alive. Child mortality affected number of children ever born alive.

A Randomized Study Over 13 Cycles to Assess the Influence of Oral Contraceptives Containing Ethinylestradiol Combined with Drospirenone or Desogestrel on Carbohydrate Metabolism (PubMed abstract)
This open-label, randomized study compared the influence of a new oral contraceptive containing 30 micro-g ethinylestradiol and 3 mg drospirenone (Yasmin) with a reference preparation containing 30 micro-g ethinylestradiol and 150 micro-g desogestrel (Marvelon) on variables of carbohydrate metabolism by means of oral glucose tolerance tests at baseline and in the 6th and 13th treatment cycle. Yasmin, as well as the reference Marvelon, had little impact on carbohydrate metabolism when used for 1 year. The observed changes were small and not suggestive of a clinically relevant deterioration of carbohydrate metabolism.

All STDs are not Created Equal: An Analysis of the Differential Effects of Sexual Behaviour Changes on Different STDs (research abstract)
This study examined the assumption that preventive methods that are effective against HIV should be equally effective against other STDs. The authors applied a mathematical model of HIV/STD transmission to empirical data from a large HIV prevention intervention that stressed sexual behaviour change. They modelled the effects of two behavioural strategies (reducing the number of sex partners and increasing condom use) on the proportionate change in intervention participants' cumulative risk of acquiring HIV or a highly-infectious STD, such as gonorrhoea. The results of this modelling exercise indicate that decreasing the number of partners is a more effective strategy for reducing STD risk than it is for HIV risk. In contrast, condoms are somewhat more effective at reducing the cumulative transmission risk for HIV than for highly infectious STDs.

FAMILY PLANNING / REPRODUCTIVE HEALTH NEWS

Most Pacific Pregnancies Not Planned (news article)
Related news article: Study Uncovers Violent Women
Almost two-thirds of Pacific Island mothers in South Auckland did not plan their pregnancies, according to data collected by researchers from the Auckland University of Technology. About 60% of 1,376 women interviewed after giving birth at Middlemore Hospital in 2000 said their pregnancies were unplanned. In addition, 35.1% of those women admitted they were responsible for committing minor violence in the home in ways such as throwing objects, pushing, and slapping. And 19.3% said they had attacked their partners in a more serious manner through kicking, biting, strangling, or using a weapon. The total of nearly 55% is almost double those who say they are victims of domestic violence.

>Many Women Don't Discuss STDs with Partners, Docs (news article)
New survey findings show that although one in three new cases of HIV in the U.S. occur among women, many women feel too embarrassed to discuss sexually transmitted diseases (STDs) with their doctors or sex partners.

Pills that Promise More than Just Birth Control (feature article)
In the past, a woman turned to birth control pills for just one reason -- to prevent pregnancy. But in a world where multi-tasking has become a way of life, an oral contraceptive that offers more than one benefit has become the birth-control buzz of a new generation.

World's Largest Condom on Display (news article)
In a bid to create awareness about AIDS and role of condom in prevention of the deadly disease, a water condom, billed to be the world's largest, has been put on display at a lake near Chennai, India.

FAMILY PLANNING / REPRODUCTIVE HEALTH LAW AND POLICY

UN Report Adds to a Condom Debate (news article)
A draft report for the UN's AIDS agency has found that even when people use condoms consistently, the failure rate for protection against HIV is an estimated 10%, making them a larger risk than portrayed by many advocate groups. The report, which looked at two decades of scientific literature on condoms, is likely to add fuel to a heated political battle on US policy in fighting AIDS in the developing world.

Nigeria: Governor Alamieyeseigha Signs Genital Mutilation Prohibition Bill (news article)
The governor of Bayelsa has signed into law two bills passed by the state House of Assembly. The laws are, "the Bayelsa State Female Genital Mutilation Prohibition law 2002" and the "Revised Edition (Law of Bayelsa State) Law 2002".

Egypt Vows to Battle Female Circumcision at International Conference (news article)
Delegates from 28 countries across the Middle East and Africa gathered in Cairo to pledge their commitment to eradicating female circumcision, long considered a barbaric practice around the world. Between 120 and 130 million women, mainly in Africa and the Arab world, are circumcised, while two million girls annually undergo the procedure which entails the removal of the clitoris, the conference's organisers said. The gathering, dubbed the Afro-Arab Expert Consultation for the Prevention of Female Genital Mutilation, has attracted campaigners from Yemen as well as African countries like Senegal, Kenya, Mali, Burkina Faso and Chad.

Preventing HIV (editorial)
The writer, the president of Global Strategies for HIV Prevention, declares it is time to get serious about behavior change.

The Relationship of the Legalisation of Midwifery and Safe Motherhood (editorial)
The writer makes a case for midwifery skills that are protected by laws and how this would postively affect maternal mortality worldwide.

HIV / AIDS RESEARCH

Knowledge, Attitude and Behavior (KAB) on HIV/AIDS/STDs among Workers in the Informal Sector in Addis Ababa (research article)
The purpose of this study was to explore the level of knowledge and sexual behaviour on HIV/AIDS/STDs among
workers in the informal sector. Awareness of STDs was lower than AIDS in the study population (88.7% and 96.3%, respectively) with a wide variation with background characteristics. Awareness of AIDS declined as age increased and increased as education level increased. More males (7.5%) reported STDs than females (2.7%). Respondents in the core business area and working outside home, and the youth (15-29) years were highly affected. Misconception on mode of HIV transmission, as mosquito bites (34.1%) was observed. Condom use to avoid getting AIDS was reported by 57% males and by only 46% females. Females were less aware than males that healthy looking person could have the virus.

Community-based Organizations in HIV/AIDS Prevention, Patient Care and Control in Ethiopia (research abstract)
This review provides a preliminary evaluation of the suitability of community-based organizations to contribute to HIV/AIDS prevention, care/support, and control programs in Ethiopia.

Low Prevalence of HIV in the 'Window of Hope' Age Group in Northwest Ethiopia (research article)
The authors present their findings of HIV prevalence surveyed in a sample of young people from a rural small town in Ethiopia. Only two of the 141 were found to test positive using the rapid HIV test.

Knowledge, Attitudes, and Practices of Private Medical Practitioners on Tuberculosis among HIV/AIDS Patients in Eldoret, Kenya (research article)
This study found that most private medical practitioners in Eldoret, Kenya, were not aware of the correct diagnosis and treatment of TB and many used unrecommended treatment regimes. They were generally unfamiliar with the recording system of TB cases, and most did not know the definitions of the various re-treatment cases.

Prioritization of Prevention Activities to Combat the Spread of HIV/AIDS in Resource Constrained Settings: A Cost-effectiveness Analysis from Chad, Central Africa (research abstract)
This paper presents a cost-effectiveness analysis using a mixture of local and international information sources combined with appropriate assumptions to model the cost-effectiveness of feasible HIV prevention options in Chad, with estimates of the budget impact. The most cost-effective options at under US$100 per infection prevented were peer group education of sex workers and screening of blood donors to identify infected blood before transfusion. These options were followed by mass media and peer group education of high risk men and young people, at around US$500 per infection prevented. Anti-retroviral therapy for HIV infected pregnant women and voluntary counselling and testing were in the order of US$1000 per infection prevented.

The Newest Epidemic: A Review of HIV/AIDS in Central and Eastern Europe (research abstract)
This paper reviews HIV and STD data for all countries in the region, as well as behavioural, social, cultural, and other HIV epidemic enabling factors.

HIV / AIDS NEWS

FDA OKs Bristol-Myers Once-daily HIV Drug (news article)
The US Food and Drug Administration approved Bristol-Myers Squibb Co.'s new once-daily drug meant to help control the virus that causes AIDS.

Stigmatization Fuelling Chinese HIV (feature article)
A stigmatization of homosexual behaviour may be fuelling China's emerging HIV epidemic. Married men who have caught the infection from other men could be spreading the infection to their wives, new research suggests.

Ghana: Six Sites Identified with High HIV/AIDS Prevalence Rates (news article)
Ghana's highest HIV/AIDS prevalence rate of 8.5% has been recorded in Koforidua, the Eastern Regional capital, Professor Sekyi Amoa.

MATERNAL AND CHILD HEALTH RESEARCH

Needs Assessment Report: Findings from Nine African Countries (report)
Related press release: New Report Maps Fistula in Africa; Finds Hidden Condition Widespread
Related news article: UN: Hideous Pregnancy Disease Enveloped in Silence
The first report ever to map obstetric fistula in sub-Saharan Africa was launched today by UNFPA (United Nations Population Fund) and EngenderHealth. Obstetric fistula, a debilitating pregnancy-related condition caused by prolonged obstructed labour, leaves women constantly leaking urine and/or faeces. The new report indicates that current figures on the number of women living with fistula--estimated at 2 million--are too low, since they are based on patients who seek treatment in medical facilities. In Nigeria alone, there could be as many as 1 million women living with fistula, the report says.

Patterns of Maternity Care Service Utilization in Southern Ethiopia: Evidence from a Community and Family Survey (research article)
This study examined the levels and patterns of maternity care service use in the five densely populated zones of the Southern Region of Ethiopia. Only 26.1% and 3.3% of the women received antenatal and delivery care services, respectively. The probability of a woman having an antenatal care for her most recent birth was 0.280, but this was significantly higher if she had received a check-up for her previous birth (0.787). On the other hand, the probability of having received delivery care for the most recent birth given that the woman had attended for her immediately preceding birth was only 0.468. Findings also revealed that the use of both antenatal and delivery care services for subsequent pregnancies is less apparent among those women with more than one under-five children and those residing in rural area.

The Advice-giving Role of Female Friends and Relatives during Pregnancy (research abstract)
While women value their doctors' advice during pregnancy, close female friends and relatives also have an important and unique role. This study examines the advice-giving role of close female friends and relatives ('confidantes') during pregnancy, and assesses the utility of including them in an intervention.

Lactational Amenorrhea is Associated with Child Age at the Time of Introduction of Complementary Food: A Prospective Cohort Study in Rural Senegal, West Africa (research abstract)
The purpose of this study was to determine whether the early introduction of complementary food to infants is associated with an increased risk of menstruation resumption in rural African women. Senegalese women (n = 855) were included at 2-3 mo postpartum and followed up at 4-5 and 6-7 mo in dispensaries. A subsample of 502 women were followed up at 9-10 mo and twice yearly at home thereafter. Risk factors for menstruation resumption were assessed with logistic regression, with control for maternal parity, occupation, education, postpartum body mass index, child sex and weight-for-age, and season. The risk of menstruation resumption was 4.2% (95% CI: 2.8%, 5.6%) at 6-7 mo and 6.5% (4.0%, 8.9%) at 9-10 mo. Compared with the introduction of complementary food after 6-7 mo, introduction at 2-3, 4-5, or 6-7 mo was associated with a greater odds of menstruation resumption at 6-7 mo.

POPULATION RESEARCH

Gini Coefficient as a Life Table Function (research article)
This paper presents a toolkit for measuring and analyzing inter-individual inequality in length of life by Gini coefficient. Gini coefficient and four other inequality measures are defined on the length-of-life distribution. Properties of these measures and their empirical testing on mortality data suggest a possibility for different judgements about the direction of changes in the degree of inequality by using different measures. A new computational procedure for the estimation of Gini coefficient from life tables is developed and tested on about four hundred real life tables.

POPULATION NEWS

Bulgaria's Birth Rate Twice Down from 1989: Report (news article)
Bulgaria's birth rate has declined two times since the end of communism in 1989, according to a government report.

Uganda: Government Says Population Growth Must Be Slowed Down (news article)
The current rate of population growth in Uganda is unsustainable and threatens to strangle efforts to lift the country's inhabitants out of poverty, according to officials of the Ugandan government's population secretariat. At the same time, infant mortality remains one of the highest in the world, at 88 per 1,000, in spite of economic indicators suggesting that Uganda is prosperous when compared to other African countries.

Philippines' Population of 80 Million People Set to Double by 2031 (news article)
At the rate the Philippines' population is growing, its 80 million people are set to double by the year 2031.

Ethiopia: Population Growth Still too High - President (news article)
Ethiopia is facing enormous pressure from its spiraling population growth, which it needs to curb, Ethiopian President Girma Wolde Giorgis said recently. Despite the country's efforts to tackle the population explosion, "we cannot say we have gone a long way forward," Giorgis noted. "The fact of the matter is that our country is still one of those countries with high rates of population growth."

WOMEN'S HEALTH RESEARCH

Breast Cancer and Specific Types of Oral Contraceptives: A Large Norwegian Cohort Study (research abstract)
The aim of this study was to examine the risk of breast cancer according to specific types of estrogens and progestagens in oral contraceptives (OCs) based on the prospective Norwegian Women and Cancer study. Among the 96,362 women included in the study, 851 invasive breast cancer were diagnosed. The adjusted risk of breast cancer increased with 25% for ever use of OCs and the risk increased with increasing duration of use. No association between time since last use and breast cancer risk was found after stratification on duration of use. Positive trend was still found for total duration of use among women who used OCs more than 5 years ago. Second generation of OCs had an increased risk with increasing duration of use.

Human Papillomavirus and the Value of Screening: Young Women's Knowledge of Cervical Cancer (research abstract)
This study reports a questionnaire survey of female university students intended (1) to delineate their knowledge of cervical
cancer and screening and (2) to impute their valuation of the introduction of human papillomavirus (HPV) testing.

WOMEN'S HEALTH NEWS

Babies Aren't the Only Beneficiaries of Breast-Feeding (feature article)
An increasing body of research, most of it published in the last 10 years, finds breast-feeding particularly good for the physical and emotional health of mothers. Perhaps most compelling, the research shows, breast-feeding can significantly reduce the risks of breast and ovarian cancer. It is also said to decrease the long-term risk for osteoporosis.

YOUTH HEALTH RESEARCH

Reproductive Knowledge, Sexual Behaviour and Contraceptive Use among Adolescents in Niger State of Nigeria (PubMed abstract)
This study included 896 adolescents aged 11-25 years. About 33% had already had their first sexual experience, but more males than females reported having experienced a first sexual encounter. Half of the sexually experienced adolescents had more than one sexual partner at the time of the study. Most (92%) had heard of AIDS. For prevention of HIV/AIDS, more males than females thought that a condom was useful.

"I Am Happy that God Made Me a Boy": Zambian Adolescent Boys' Perceptions about Growing into Manhood (PubMed abstract)
This qualitative study of adolescent boys (15-19 years old) residing in two townships outside Lusaka and Kitwe, Zambia, show that growing up to become a man entails a certain level of ambiguity and contradictory perceptions in terms of supposedly appropriate social and sexual behaviour; but indicates few alternatives. The authors recommend that the information gap, misconceptions, and anxiety among boys regarding their male identity should be addressed. The respondents suggested that an educational program that will pay attention to their needs and answer their questions should be designed and implemented with active involvement of male adolescent peers.

No Sex or Safe Sex? Mothers' and Adolescents' Discussions about Sexuality and AIDS/HIV (research abstract)
Using observational rather than self-report measures, this study revealed that the extent to which mothers and adolescents discuss abstinence and safer sex can depend on individual (age, gender, socioeconomic status and religious involvement) and contextual (conversational topic) factors.

PROFILES / SPECIAL REPORTS / RESOURCES

The current issue of the British Medical Journal's Education and Debate section is dedicated to AIDS in the developing world.

Antiretroviral Treatment in Developing Countries: The Peril of Neglecting Private Providers (feature article)
The author describes antiretroviral treatment in developing countries and states that only 5% of people who need antiretroviral treatment receive it. Antiretroviral drugs seem to be getting into informal private markets, and uncontrolled use of drugs could lead to rapid development of HIV resistance.

Back to Basics in HIV Prevention: Focus on Exposure (feature article)
In comparing HIV transmission in five different countries, the authors found that patterns of transmission of HIV vary widely. They say that strategies to fight transmission should be based on an understanding of local issues.

Public Policies and the Orphans of AIDS in Africa (feature article)
The authors explore the economic factors related to the high mortality among parents in Africa and the problems faced by orphans. Subsidies for fostering, which could come from debt relief programs, can have a beneficial impact on orphans' school attendance, training, and productivity.

Tackling India's HIV Epidemic: Lessons from Africa (feature article)
Related press release: Researchers Warn that AIDS in India Could Become as Dire as in Africa
The cost of treating one person with antiretroviral drugs for a year is equivalent to that of preventing almost 50 cases. The authors of this article state that the priority should be prevention, not antiretroviral treatment. They explain the current impact of the epidemic in India and strategies available to contain it.

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