Johns Hopkins Bloomberg School of Public Health: The INFO Project

Your knowledge-sharing resource on family planning and reproductive health

Shopping Basket

The Pop Reporter®

Volume 3, Number 48
1 December 2003

"The Pop Reporter" (R) Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs INFO Project When you click on any link below, 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.

GUEST EDITORIAL

Identifying Worthy Medical Research

by David A. Grimes, MD

dgrimes@fhi.org

Each year, some 25,000 biomedical journals publish millions of articles. Abstracts from more than 12 million of these articles are already archived and free through PubMed to anyone in the world with an Internet connection. Regrettably, many developing country health care providers lack computers with Internet connections, are not adequately trained to obtain information through the Internet, or do not have access to other medical databases (1). In addition, much published research is of poor quality (2), some is unimportant (3), and some is fraudulent (4). Identifying worthy medical research is an important but challenging task, since many readers lack the necessary skills to analyze technical reports.

The inability to identify sound medical research leads to continued use of inappropriate or poor practices and failure to adopt useful practices in a timely manner. For example, 13 years passed between emergence of clear evidence that giving thrombolytic drugs ("clot busters") to victims of heart attack saves lives and when the treatment was finally recommended by at least half of cardiology texts and review articles (5).

Women's health care has long suffered many unproved, worthless, and harmful practices based on faulty (or no) medical research evidence. Examples in obstetrics include routine shaving of the perineum before delivery, routine elective low forceps, routine episiotomy, routine electronic fetal monitoring in labor, urinary estriol collection to monitor fetal well-being, and home uterine-activity monitoring (6). Examples in family planning include requiring a blood test or Pap smear before starting a woman on hormonal contraceptives (7).

Such inappropriate medical practices can be reduced, however, if health care providers embrace evidence-based medicine: a systematic, diligent search for the best available evidence on a given clinical question. After reviewing the evidence, the practitioner must use his or her skills and unique understanding of patients and their wishes to evaluate that evidence (8).

How can health care providers find and identify research results worthy of putting into practice?

First, they can turn to systematic reviews of the medical literature and practice guidelines based on evidence. These include the Cochrane Library, an international effort to identify, analyze, and disseminate the world's randomized controlled trials in many areas of medicine. While the Cochrane Library is available by subscription, those Cochrane reviews related to reproductive health are available free to researchers and health care providers in developing countries through the Reproductive Health Library of the World Health Organization (WHO).

Several major organizations use evidence-based medicine to generate practice guidelines. The Canadian Task Force on the Periodic Health Examination and the U.S. Preventive Services Task Force both develop guidelines that rate the quality of evidence and strength of recommendations that the evidence supports. Specialty societies, such as the London-based Royal College of Obstetricians and Gynaecologists, produce evidence-based, practical guidelines that also reflect the strength of the recommendations. In addition, WHO has helped to place family planning practice on a more secure scientific footing. WHO's medical eligibility criteria for contraceptive use blend recent research evidence with the judgment of experienced health care providers. These guidelines have helped eliminate needless barriers to safe contraception.

In summary, much research is flawed or inconsequential, and some is fabricated. Hence, health care providers need to approach with skepticism reports of new findings, especially those from observational studies. Evidence-based systematic reviews of the literature and evidence-based practice guidelines are sound, practical tools for improving medical and public health practice around the world.

References:

1. Geyoushi B, Matthews Z, Stones R. Pathways to evidence-based reproductive healthcare in developing countries. Br J Obstet Gynaecol 2003;110(5):500-7.

2. Schulz KF, Chalmers I, Grimes DA, et al. Assessing the quality of randomization from reports of controlled trials published in obstetrics and gynecology journals. JAMA 1994;272(2):125-28; Vandekerckhove P, O'Donovan PA, Lilford RJ, et al. Infertility treatment: from cookery to science. The epidemiology of randomised controlled trials. Br J Obstet Gynaecol 1993;100(11):1005-36; Halpern SD, Karlawish JH, Berlin JA. The continuing unethical conduct of underpowered clinical trials. JAMA 2002;288(3):358-62.

3. Abraham P. Duplicate and salami publications. J Postgrad Med 2000;46(2):67-69.

4. Rossiter EJ. Reflections of a whistle-blower. Nature 1992;357(6378):434-46; Heymsfield SB, Glenn JF. Decreased myocardial taurine levels and hypertaurinuria in a kindred with mitral-valve prolapse and congestive cardiomyopathy. N Engl J Med 1983;308(23):1400. Retraction of: Darsee JR, Heymsfield SB. Decreased myocardial taurine levels and hypertaurinuria in a kindred with mitral-valve prolapse and congestive cardiomyopathy. N Engl J Med 1981;304(3):129-35.

5. Antman EM, Lau J, Kupelnick B, et al. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA 1992;268(2):240-48.

6. Enkin M, Keirse MJ, Neilson J, et al. Effective care in pregnancy and childbirth: a synopsis. Birth 2001;28(1):41-51.

7. Stewart FH, Harper CC, Ellertson CE, et al. Clinical breast and pelvic examination requirements for hormonal contraception: current practice vs evidence. JAMA 2001;285(17):2232-39.

8. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn't. BMJ 1996;312(7023):71-72.

Dr. Grimes is an obstetrician/gynecologist with training in public health. He is Family Health International Vice President of Biomedical Affairs.

Reprinted from "Network," courtesy of Family Health International.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

What's Said and What's Done: The Reality of Sexually Transmitted Disease Consultations (research abstract)
Researchers observed 18 private practitioners in Madras, India, who provided service to STD patients. Interviews with physicians and observations by identified researchers indicated more favorable practice than was seen during simulated client visits. The authors write that these differences were substantial and would lead to a severe misrepresentation of the actual situation, and thus of intervention needs, if data from interviews or observations were relied upon.

The Contribution of Sexual and Reproductive Health Services to the Fight against HIV/AIDS: A Review (research abstract)
This paper reviews and assesses the contributions made by sexual and reproductive health services to HIV/AIDS prevention and treatment, mainly by services for family planning, sexually transmitted infections, and antenatal and delivery care. It also describes other sexual and reproductive health problems experienced by HIV-positive women. This paper shows that sexual and reproductive health programs can make an important contribution to HIV prevention and treatment, and that STI control is important both for sexual and reproductive health and HIV/AIDS control. It concludes that more integrated programs of sexual and reproductive health care and STI/HIV/AIDS control should be developed that jointly offer certain services, expand outreach to new population groups, and create well-functioning referral links to optimize the outreach and impact of what are, to date, essentially vertical programs.

Adolescent Mothers’ Utilization of Contraceptive Services in South Africa (research abstract)
This paper reports on an exploratory descriptive survey, utilizing questionnaires and convenience sampling. The researchers found that most of the participating 250 adolescent mothers lacked knowledge about contraceptives and emergency contraceptives.

Estimated Maximum Failure Rates of Cycle Monitors Using Daily Conception Probabilities in the Menstrual Cycle (research abstract)
Related news article: Researchers Call for Trials Menstrual Cycle Monitors Used for Natural Family Planning
Research is urgently needed to test the accuracy of the monitors used by couples practicing natural family planning methods, according to German researchers. The researchers say that reliable independent data on most of the systems used are still not available and that monitors differ enormously in price and effectiveness.

Do Mothers-In-Law Matter? Family Dynamics and Fertility Decision-Making in Urban Squatter Settlements of Karachi, Pakistan (research abstract)
This study reports on the perspectives of mothers-in-law about intra-household decision-making, family size, and family planning, and compares their views with those of their sons and daughters-in-law. Women (717 daughters-in-law), their husbands (717 sons), and their 522 mothers-in-law were interviewed in eight squatter settlements in Karachi, Pakistan. There was a difference in mothers-in-law’s, daughters-in-law’s, and sons’ desire to have more children: 28% of mothers-in-law versus 58% of daughters-in-law did not want more grandsons/sons, and 36% of mothers-in-law versus 66% of daughters-in-law did not want more granddaughters/daughters. The difference was markedly greater among the mother-in-law/daughter-in-law pairs than in the mother/son pairs. Overall, the mother-in-law’s role seems to be somewhat overshadowed by that of her son (family male member), except for limiting family size.

Self-reported Difficulty in Conceiving as a Measure of Infertility (research abstract)
This study aimed to explore the meaning and potential use of women’s self-reported difficulties in conceiving as a measure of infertility in epidemiological studies, and to compare women’s stated reasons for infertility with information in their medical records. Data were available from a population-based case–control study of ovarian cancer involving 1,638 women. The sensitivity of women’s self-reported difficulty in conceiving was 66% and 69%, respectively, when compared with calendar-derived and self-reported times taken trying to conceive; its specificity was 95%.

Unlocking the Mechanism of Androgen Action (research summary)
Conducting basic biomedical research, such as illuminating the events in cells at a molecular level, is a painstaking endeavor that can take decades to produce major results. But knowledge garnered from this type of study is crucial to the formulation of new drugs and the development of successful strategies for tackling health problems. For more than 15 years, Population Council biomedical researcher, James F. Catterall and his colleagues have been studying the genetic mechanisms of action of male sex hormones. His lab has devised ingenious ways of gleaning information about how androgens regulate the activity of genes and why they affect certain tissues and not others.

Improved Care Increases Contraceptive Use (research summary)
Improving family planning services provided at health facilities can significantly increase contraceptive use and continuation rates, according to a recent study completed by Population Council researchers and collaborators. Known as the Davao project, the investigation is one of four field studies being undertaken under the Impact Studies Program, designed to document the feasibility of improving quality of care and the effect of improved quality on women’s reproductive behavior.

New Fertility Twist to Male Oestrogen Levels (news article)
While overexposure to estrogen has long been suspected as a cause of male infertility, Melbourne scientists now believe a shortage of the female sex hormone may lead to the same problem. Scientists at Prince Henry's Institute of Medical Research found that mice rendered incapable of producing estrogen developed fertility prob lems. When they applied this knowledge to a human male with fertility problems, they found that he, too, had difficulties with estrogen production.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Soaps Save Lives in Third World (news article)
In parts of the Third World, television soap operas are saving lives, promoting social change, and leading the fight against AIDS -- and mostly without even peeping into the bedroom.

Spray-on Female Contraceptive to Start Trial (news article)
The world's first trial of a female contraceptive spray will begin in Australia early in 2004. The approach involves a new technique for transferring hormones across the skin and a novel low-dose contraceptive hormone.

Jamaica: 'Morning After' Scare; Postinor 2 Abuse Worries Pharmacists (news article)
Pharmacists across the island are reporting that the popular "morning after" pill, Postinor 2, is being abused by persons including schoolchildren, and they are calling on officials in the Ministry of Health to rethink the decision which made the pill available over the counter some 6 months ago. They are also reporting falling condom sales, which they have attributed to easier access to Postinor 2. The pharmacists fear that the drop in condom sales and the increasing demand for the "morning after" pill are clear indications that more persons are engaging in unprotected sex.

Female Condom a Hit with Cambodian Sex Workers (feature article)
The female condom has proved a hit with sex workers in Cambodia since its introduction by a non-government organization as part of its battle against HIV/AIDS last year.

China Runs First Officially Backed Condom Ads on TV (news article)
Communist China is running its first officially backed condom commercials on TV to try to slow the spread of AIDS, state media reported on Friday. Images of a woman saying she feels safer using condoms with her boyfriend were being screened in a 30-second advert on China's main television network ahead of World Aids Day on December 1. Condom ads appeared on the backs of buses and briefly on television in the late 1990s but were then pulled.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Let Africans Decide How to Fight AIDS (commentary)
As the US prepares to implement President Bush's 5-year, $15 billion Emergency Plan for AIDS Relief, special interests on both sides of the social-political spectrum are attempting to export some of the worst of America's prejudices to Africa. At issue is funding for prevention and, in particular, the widely debated approach to AIDS prevention known as ABC: Abstain, Be faithful or (for those especially at risk) use a Condom.

'Castrate Zambia's Child Rapists' (news article)
Zambian members of parliament have called for child rapists to be castrated to curb a growing problem. Police say that 400 cases of child rape were reported in the first half of 2003, a 68% increase from the previous year. Some men say they rape children in the belief that having sex with a virgin can cure AIDS. Some 20% of Zambians are HIV positive.

Uganda: Sebei Leader Bans Female Circumcision (news article)
A Sebei prominent leader has banned female genital mutilation ahead of cultural festivities.

HIV/AIDS RESEARCH

HIV/AIDS in Latin American Countries: The Challenges Ahead (report)
Related news article: Latin America at Risk for Spread of AIDS
This report presents new and updated information about the extent and trends of the HIV/AIDS epidemic in Latin America. It evaluates current national surveillance capacities, and assesses the national responses of the health sector to the epidemic on a country-by-country basis. Based on analyses of secondary information and on new World Bank–sponsored research and country-level data, the study looks at 17 countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, República Bolivariana de Venezuela, and Uruguay.

"Typhoid Mary" and "HIV Jane": Responsibility, Agency and Disease Prevention (research abstract)
Using the case of "Typhoid Mary" and a hypothetical case of "HIV Jane", this paper explores some of the problems with making sex workers responsible for the prevention of HIV transmission. The authors argue that for the notion of "responsibility" to make any sense, the HIV-positive person must be in a position to exercise responsibility, and for this they must have agency.

HIV/AIDS NEWS

World Losing Fight Against AIDS, Says Annan (news article)
The world is losing the fight against the AIDS epidemic, the UN secretary general, Kofi Annan, warned last week. Describing the disease as a "weapon of mass destruction", Mr. Annan urged governments to do more to combat its spread.

World Health Organization and UNAIDS Unveil Plan to Get 3 Million AIDS Patients on Treatment by 2005 (news article)
Related resource material: The 3 by 5 Initiative
The WHO and UNAIDS today release a detailed and concrete plan to reach the 3 by 5 target of providing antiretroviral treatment to 3 million people living with AIDS in developing countries and those in transition by the end of 2005. The press release stated that this is a vital step towards the ultimate goal of providing universal access to AIDS treatment to all those who need it.

African Churches Refuse to Back Condom Use (news article)
African churches have resisted calls ahead of World AIDS Day to agree to promote condoms to fight the disease,
drawing fire from activists who said they would end up preaching over the graves of the epidemic's victims.

Uganda to Launch Door to Door Anonymous Testing for HIV (news article)
Uganda will soon launch a door to door blood testing survey to get a more accurate picture of the number of Ugandans with HIV or AIDS. An estimated 100,000 people in Uganda have AIDS, out of a population of 25 million. Many are in urgent need of antiretroviral drugs. Critics have disputed Uganda’s figures, saying they are based mostly on data from pregnant women who visit antenatal clinics, among whom the disease may be more prevalent than in the general population.

UK: Government Doubles AIDS Funding (news article)
The government has marked world AIDS day by announcing a doubling of its funding to six million pounds to fight the global epidemic. Secretary of State for International Development Hilary Benn announced the increase at a news conference to launch a UK call to action on HIV/AIDS, which killed 3 million worldwide in 2003 and infected 5 million.

Thailand Has AIDS Drug Plan, Some Doctors Resist (news article)
Thailand pledged on Monday to provide life-saving AIDS drugs to 50,000 patients each year, but said it was facing resistance from some doctors.

Orphans Unaware of Plight as AIDS Ravages Guatemala (feature article)
Guatemala has emerged as the nation with the most AIDS orphans in Central America, where tens of thousands of children have lost parents to the rapidly spreading disease. Some of the orphans are healthy. But many are infected, some of them born to prostitutes who charged an extra dollar to customers who didn't want to use a condom. Many others were born to women whose husbands came home with the disease and passed it on.

Breaking the Wall of Silence Around AIDS in Egypt (feature article)
Most Egyptians don’t know what HIV/AIDS is. Those who do will often express disapproving views of AIDS patients, or groundless fears of contracting the illness from them. As activists and health specialists all note, the greatest obstacle facing AIDS prevention efforts in Egypt is general ignorance on the subject, and the accompanying stigma.

India: Delhi Barbers Hand Out Condoms to Prevent AIDS (feature article)
This feature article an innovative program in India to use barbers to hand out free condoms with each haircut.

Large Proportion of Chinese Public Ignorant of AIDS Information: Survey (news article)
According to a recent survey, nearly 20% of Chinese people say they have never heard of AIDS or HIV, and only 4.7% has ever had an HIV test.

Rural Haitians Are Vanguard in AIDS Battle (feature article)
This feature article describes the work of the Boston-based group Partners in Health, which has enlisted Haitians to make regular rounds to villages, mostly on foot, delivering drugs to poor people with AIDS and tuberculosis.

Russia Needs $1.5bn to Treat AIDS Infected People (news article)
Russia will need about $1.5bn for the treatment of HIV and AIDS infected people, if it continues buying necessary medicines at market prices. This is more than the whole annual budget of the Russian Health Ministry, the UN Secretary General representative for HIV/AIDS in Eastern Europe declared at a news conference in Moscow today. He noted that Russia should initiate negotiations with the world's largest pharmaceutical companies on decreasing prices of antiretroviral medicines. Another way out is to start purchasing generic medicines produced in India and China. Moreover, he believes that Russia is able to produce antiretroviral medicines developed by its own pharmaceutical industry.

MATERNAL AND CHILD HEALTH RESEARCH

Determinants of Caesarean Delivery Among Women Hospitalized for Childbirth in a Remote Population in China (PubMed abstract)
The purpose of this study was to assess the determinants of a high Caesarean delivery rate in a remote population in China. A cohort study included 20,891 women who gave birth between January 1, 1997, and June 30, 1998, in one of 18 hospitals participating in a regional perinatal surveillance system in Guangdong province, China. Of these women, 7.5% were delivered by elective Caesarean section, and 18.4% were delivered by non-elective Caesarean section. The most common indications for elective Caesarean delivery were socio-cultural, non-medical reasons, such as the woman's fear of pain, her wish to give birth on a particular date or time, or her belief that delivery by Caesarean section would protect the baby's brain. Non-medical causes, including a woman's insurance status and her personal and social demands, accounted for a large proportion of elective Caesarean deliveries in this remote population in China.

Placental Malaria and Perinatal Transmission of Human Immunodeficiency Virus Type 1 (research abstract)
Researchers examined the prevalence of placental malaria in HIV type 1 infected and uninfected women and the effect of placental malaria on genital shedding and perinatal transmission. Genital samples for HIV-1 DNA RNA were collected during labor. Infants were tested for HIV-1 at 1 day and 6 weeks postpartum. Placental malaria was diagnosed by histopathological examination: 372 placentas of HIV-1 infected women and 277 of HIV-1 uninfected women were processed. A higher prevalence of placental malaria was seen in HIV-1infected women. No association was found between placental malaria and either maternal virus load, genital HIV-1 DNA, or HIV-1 RNA. Placental malaria did not correlate with in utero or peripartal transmission of HIV-1.

Prevalence and Magnitude of Human Immunodeficiency Virus (HIV) Type 1 Specific Lymphocyte Responses in Breast Milk from HIV-1 Seropositive Women (research abstract)
Breast-milk specimens were collected during the first month postpartum from HIV-1 seropositive women in Nairobi, Kenya. HIV-1 gag specific cellular responses were detected in 17 (47%) of 36, and env-specific cellular responses were present in 20 (40%) of 50. Peripheral blood lymphocyte responses against either gag or env were detected in 35 (66%) of the 53 subjects, 18 (51%) of whom had positive gag or env responses in their breast milk. In paired analyses of blood and breast milk, the mean magnitude of responses to env or gag stimulation in breast milk was significantly higher than that in blood and remained higher in breast milk after normalization of responses according to CD8+ lymphocyte count. These results suggest that CD8+ lymphocytes present in breast milk have the capacity to recognize HIV-1 infected cells and may be selectively transported to breast milk to reduce either viral replication or transmission in breast milk.

Assessing the Net Effect of Young Maternal Age on Birthweight (research abstract)
The authors examined the effect of being an adolescent mother on risk pathways for birthweight, then estimated the net effect of maternal age on birthweight (weight in grams or low birthweight (<2,500 g)) after controlling for these risks. They used data on 214 adolescent and 415 adult primiparae and their infants from a community-based survey in Metro Cebu, Philippines. Bivariate analyses showed that infants of adolescents had a lower mean birthweight and were more at risk of low birthweight compared to those born to older mothers. When socioeconomic, biological, and behavioral risk factors were controlled for, young maternal age ceased to have an effect on birthweight in grams but remained a significant predictor of low birthweight. The common pathways through which maternal age influenced both birthweight variables were through its effects on maternal height and weight-for-height during pregnancy.

Infant Feeding Practices and Chronic Child Malnutrition in the Indian States of Karnataka and Uttar Pradesh (research abstract)
Researchers used data from the 1998–1999 National Family Health Survey to assess whether recommended infant feeding practices help to alleviate the prevalence of stunting. Study results support some recommended practices, including the advice that mothers not squeeze the colostrum from her breasts, not use a feeding bottle with a nipple, exclusive breastfeeding for the first 4 to 6 months and feeding supplementary foods (solids and mushy foods) at about 7 months. Findings also suggest that, for some children, better feeding practices could reduce the prevalence of severe stunting by up to 30%. The paper also examines a range of other issues related to stunting––whether medical supplementations and inoculations have an effect, whether mothers more actively involved in health decisions have less stunted children, and the links between stunting, diarrhea, and anemia.

Vaginal Breech Delivery: Is It Still an Option? (research abstract)
Research was undertaken in Sweden to provide future guidance on the negative health implications of term breech delivery. Study results did not disqualify selective vaginal breech delivery at term and beyond as an appropriate option.

Does Caffeine and Alcohol Intake Before Pregnancy Predict the Occurrence of Spontaneous Abortion? (research abstract)
Researchers performed a nested case–control study using prospective data from a population-based cohort comprising 11,088 women aged 20–29 years. From this cohort, women who experienced either a spontaneous abortion (n = 303) or who gave birth (n = 1381) during follow-up (mean time, 2.1 years) were selected. Associations between self-reported exposures to caffeine and/or alcohol at enrolment and spontaneous abortion were analysed by means of logistic regression. Compared with women with a pre-pregnancy intake of less than 75 mg caffeine per day, the adjusted odds ratio (95% confidence interval) for spontaneous abortion was 1.26 (0.77–2.06), 1.45 (0.87–2.41), 1.44 (0.87–2.37) and 1.72 (1.00–2.96) for a pre-pregnancy intake of 75–300, 301–500, 501–900, and more than 900 mg caffeine per day, respectively (P = 0.05 for trend). A pre-pregnancy intake of alcohol was not a predictor for spontaneous abortion.

POPULATION RESEARCH

Urban Growth in Developing Countries: A Review of Current Trends and a Caution Regarding Existing Forecasts (research abstract)
This paper provides a broad overview of the available evidence on patterns and trends in urban growth in developing countries, highlighting regional differences where appropriate. The paper also examines the quality of past urban population projections and finds that there has been considerable diversity in their quality by geographic region, level of development, and size of country.

A Re-Examination of Levels and Differential in Fertility in South Africa from Recent Evidence (research abstract)
This study re-examines levels and differential in fertility in South Africa from recent evidence in order to assess whether or not the fertility inputs in projections of South Africa's population during the apartheid era overestimated fertility.

Transformation in World's Cities Explored (research summary)
Historically, developing countries have been largely rural. As a result, demographers have focused on life cycle events in mainly rural contexts. During the next 30 years, however, most of the world’s population growth will occur in the cities and towns of Africa, Asia, and Latin America. Recognizing the need for a better understanding of issues related to urban population growth, the National Research Council formed the Panel on Urban Dynamics, co-chaired by Population Council economist Mark Montgomery. The members reviewed existing literature and conducted new analyses. A report of their findings was published by National Academies Press.

Estimating Variability in Models for Recurrent Epidemics: Assessing the Use of Moment Closure Techniques (research abstract)
In this study, the authors assess and compare the use of two moment closure approximations to estimate the variability seen about the average behavior of stochastic models for the recurrent epidemics seen in childhood diseases. The performance of the approximations are assessed using analytic techniques available for the simplest epidemiological model and using numerical simulations in more complex settings. The authors also present epidemiologically important extensions of previous work, considering variability in the SEIR model and in situations for which there is seasonal variation in disease transmission.

Cultural Niche Construction and the Evolution of Small Family Size (research abstract)
This paper examines a model of cultural niche construction with two culturally transmitted traits. The frequency of individuals with a certain general predisposition, which is transmitted vertically, plays a role as the cultural background, or the cultural niche, of the population. The cultural background determines the rate of oblique, relative to vertical, transmission of another cultural trait that affects fertility of individuals. It is assumed that individuals with fewer offspring are more likely to achieve social roles that influence the succeeding generation and are therefore overrepresented as transmitters in the process of oblique transmission. This model suggests that even a slight overrepresentation of those with fewer offspring can drive the evolution of small family size, provided that the rate of oblique transmission depends strongly on the cultural background. In addition, this model may help to explain the time lag between the decrease in death rates and the subsequent decrease in birth rates during the demographic transition of industrializing societies.

POPULATION NEWS

More Nigerian Women Want Additional Children - Report (news article)
Preference for more children is still high in Nigeria, with an average woman desiring at least one more child in addition to the four she has already. The preliminary report of Demographic and Health Survey, carried out by the National Population Commission from March to August this year, revealed that two-thirds of women who have four living children say they want another child either sooner or later. In contrast, more than half of women who have had six or more children say they want no more children.

Australia's Population Hits a Cool 20 Million (news article)
This article reports that the population in Australia reached 20 million last week.

WOMEN'S HEALTH RESEARCH

Primary Obstetrics and Gynecology in Developing Countries: Shifting the Focus to Older Women's Health (research abstract)
This article focuses on some of the existing health problems, such as breast and cervical cancer, and their barriers in prevention, diagnosis, and treatment in older women in developing countries. It then discusses the emerging issues from a neglect of the multifaceted problems of older women's health. Finally, there is a call for a multidisciplinary approach to proposed solutions for future directions in this desperately needed field.

Female Genital Mutilation: Have We Made Progress? (research abstract)
This paper reviews progress made in the fight against female genital mutilation.

WOMEN'S HEALTH NEWS

Palestinian Territory: Killing Family Member to Save Honor on the Rise (feature article)
Police in Israel investigated at least 18 honor killings in the past 3 years. And Palestinian police reported 31 such killings in 2002, up from five during the first half of 1999. But the number of killings is likely higher, given that Palestinian police investigate only crimes that have been reported. Research shows the likely number to be 15 times higher than the number of reported cases.

YOUTH HEALTH RESEARCH

High Rates of Pregnancy among Vocational School Students: Results of Audio Computer-assisted Self-interview Survey in Chiang Rai, Thailand (research abstract)
Researchers examined the prevalence of and factors associated with pregnancy and abortion among 1,725 consenting vocational school students in northern Thailand. Results from an audio computer-assisted self-interview showed that 48% of the male and 43% of the female students reported ever having had sexual intercourse. Among those who had had intercourse, 27% of the women and 17% of the men said they or their partner had ever been pregnant. Among the last reported pregnancies that resulted in delivery or abortion, 95% were aborted. Age, current contraceptive use, early initiation of sexual intercourse (16 years), alcohol and drug use, and sexual coercion were associated with self or partner pregnancy.

YOUTH HEALTH NEWS

Thai Students Block Condom Plan (news article)
Thailand's university student leaders say they have voted against government proposals to put condom machines on campuses. Students complained that having ready access to condoms on the campus of prestigious institutions could lead to promiscuity.

---

Problems and comments can be addressed to rjacoby@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. Have an item to contribute for consideration in The Pop Reporter? E-mail the URL and description to rjacoby@jhuccp.org. Forward this message to a friend who could benefit from INFO project activities! Sincerely, Robert Jacoby, rjacoby@jhuccp.org Editor, The Pop Reporter Johns Hopkins Center for Communication Programs

Disclaimer: The information provided on this web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development, the U.S. Government or The Johns Hopkins University.