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Volume 4, Number 41
11 October 2004

The USAID-funded Knowledge and Information for Optimal Health (INFO) Project of the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP) announces the October 2004 launch of an electronic magazine for family planning and reproductive health care providers, policy-makers, and researchers in the Latin America region. The Pop Reporter en Español, a collaboration of the INFO Project and its Latin America-based joint programming partner, Bibliomed, Inc., is slated to deliver its first issue soon. For more information and to sign up, go to http://www.infoforhealth.org/popreporter/spanishpressrelease.shtml

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Investigating Ethnic Inequalities in the Incidence of Sexually Transmitted Infections: Mathematical Modelling Study (research abstract)
This study investigates ethnic differences in rates of gonorrhoea using empirical sexual behavior data to explore the impact of different intervention strategies in a simulated population. It compares predicted and observed rates of infection and simulated effects of targeted and population-wide intervention strategies. Researchers posit that targeting effective services to particular ethnic groups can have a disproportionate influence on disease reduction in the whole community.

Modelling the Healthcare Costs of an Opportunistic Chlamydia Screening Programme (research abstract)
The authors estimate the average cost per screening offer, cost per testing episode, and cost per chlamydia positive episode for an opportunistic chlamydia screening program and explore the uncertainty of parameter assumptions, based on the costs to the healthcare system. The greatest impact on the outcomes in both the univariate and multivariate sensitivity analyses was due to the proportion of individuals accepting screening, the clinician (general practitioner/nurse) time and their relative involvement in discussing screening, the test cost, the time to notify patients of their results, and the receptionist time recruiting patients. Results from this costing study may be used to inform resource allocation for current and future chlamydia screening program implementation.

Service Accountability and Community Participation in the Context of Health Sector Reforms in Asia: Implications for Sexual and Reproductive Health Services (research abstract)
This paper examines the concept and practice of community participation in World Bank-supported health sector reforms in Asia, and how far such participation has strengthened accountability with regard to provision of sexual and reproductive health services. It argues that the envisaged scope of community participation within a majority of reforms in Asia has been limited to program management and service delivery, and it is occurring within the boundaries of priorities that are defined through non-participatory processes.

Microbial and Cytopathological Study of Intrauterine Contraceptive Device Users (PubMed abstract)
Researchers from the Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur, India, studied the clinical, microbial, and cytopathological changes in IUCD users in a tertiary care hospital. The found that the chief complaints of IUCD users included backache (54%), vaginal discharge (46%), pain lower abdomen (34%), dyspareunia (22%), menorrhagia (18%), and dysmenorrhea (14%).

Risk Factors Associated with Failure of Syndromic Treatment of Sexually Transmitted Diseases among Women Seeking Primary Care in Addis Ababa (research abstract)
Researchers investigate risk factors associated with the failure of syndromic management of STDs among women seeking treatment in primary healthcare center in Addis Ababa, Ethiopia. Of the 106 women enrolled and presenting with symptomatic STDs, 67% were HIV seropositive. Syndromic STD treatment did not result in clinical improvement in 30% of the women. Only genital ulcer disease was significantly associated with treatment failure. The association between HIV and genital ulcer disease caused by herpes may, therefore, be the reason for the failure of treatment.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Argentina: Major Shift in Political Support for Reproductive Health (news article)
The Argentine government of Néstor Kirchner is forging ahead with a strong agenda of sexual and reproductive health policies that is in line with demands by women's groups.

Low Fertility Rate "Reflects Well on South Africa" (news article)
South Africa has the lowest fertility rate on mainland Africa, attributed to improved primary health care and progress made in the provision of education in the rural areas.

Sexy Scents for Zambia's Well-heeled Set (news article)
An NGO has introduced chocolate, banana, and strawberry-scented condoms, saying they would attract even the most reluctant users in Zambia, state media reported. The condoms, intended as a novelty for the rich, who would be able to afford them, were introduced in the mining town of Kitwe in the Copperbelt region by the Society for Family Health.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Health Sector Reform and Reproductive Health Services in Poor Rural China (research abstract)
This paper describes and analyzes the major reforms and changes that have occurred in the rural health sector of China, at the ground level, rather than what should have been happening as stated by rural health sector reform polices. The ongoing rural health reform has produced both negative and positive implications for reproductive health services, and there is a need for both the state, and for women, to play a much stronger role in this reform.

Bridging the Gap Between Evidence-based Innovation and National Health-sector Reform in Ghana (working paper)
(You need Adobe Acrobat Reader to access this document)
This paper discusses the effect of Community-based Health Planning and Services on Nkwanta's family planning and safe-motherhood indicators as an example of the successful
application of the Navrongo model in other districts in Ghana.

Pakistan: NA Body Okays Draft Law Enhancing Punishment of Honor Killings (news article)
The National Assembly's standing committee on law, justice, and human rights approved the draft of Criminal Law (Amendment) Bill 2004 providing severe punishment to ensure the crackdown on "honor killing" and crimes against women. The draft law approved by the House body would be moved in the National Assembly to enact it as the new law treating honor killing as murder.

Islam and Family Planning (policy brief)
This overview of Islam and family planning is part of a series of Population Reference Bureau policy briefs on the Middle East and North Africa that analyze population, environment, reproductive health, and development linkages. It reviews Islamic jurisprudence and justifications for sanctioning family planning and concludes that Islam should not be considered a barrier toward the increased use of contraception in Islamic communities.

South Africa: The AIDS Plan That Never Saw Light of Day (news article)
This news article claims that the ANC government's prejudice against anything that involved the apartheid state denied South Africans a comprehensive national plan to deal with HIV and AIDS. The plan to tackle the disease was formulated with the help of high-ranking ANC officials, including Health Minister Manto Tshabalala-Msimang and her predecessor Nkosazana Dlamini-Zuma, but was shelved, apparently because of its ties with the former government.

Sweden: Tax on Men for Violence on Women Proposed (news article)
A group of Swedish parliamentarians proposed levying a "man tax" to cover the social cost of violence against women. "It must be obvious to all of us that society has a huge problem with male violence against women and that has a cost," Left Party deputy Gudrun Schyman told Swedish radio on Monday. "We must have a discussion where men understand they as a group have a responsibility."

HIV/AIDS RESEARCH

Mortality of Infected and Uninfected Infants Born to HIV-infected Mothers in Africa: a Pooled Analysis (research article)
Using individual data from seven randomised mother-to-child transmission intervention trials, the authors estimate mortality in African children born to HIV-infected mothers and analyse selected risk factors. Findings show mortality was not associated with either ever breastfeeding and never breastfeeding in infected or uninfected children. In infected children, mortality was significantly higher for those with early infection, highlighting the necessity for timely antiretroviral care.

Factors Associated with the Acceptance of an AIDS Vaccine: An Exploratory Study (research article)
This exploratory study identified factors that may preclude people from accepting an AIDS vaccine when one is developed and approved for use. A cross-sectional survey of 278 adults, from different at-risk populations, was conducted. Three factors achieved satisfactory inter-item reliability: labeled as (1) personal issues, (2) product concerns, and (3) stigma-associated worry. Subsequent studies should use these exploratory findings to tailor intervention programs aimed at promoting an AIDS vaccine.

Analysis of a Database of Materials for HIV Prevention Program Evaluation (research article)
The Centers for Disease Control and Prevention reviewed available program evaluation materials relevant to HIV prevention and developed a database of those materials. Materials were classified according to appropriate audience, level of evaluation expertise required, steps in the evaluation process addressed, and other criteria. These queries revealed that for certain audiences and steps in the evaluation process there are few materials, especially usable by individuals without evaluation experience, necessitating the development of more evaluation technology transfer materials.

HIV/AIDS NEWS

South Africa: Mbeki in Hot Water Over Rape Claims, HIV/AIDS (news article)
President Thabo Mbeki will be called to account for his statements on rape and his failure to lead the national response against HIV/AIDS when he faces questions in the National Assembly this month. About 10 days ago Mbeki took aim at critics of the latest crime statistics, particularly those who claimed that rape was highly prevalent in South Africa. He is to be asked on what basis he claims rape is not a frequent occurrence in the country. Mbeki has in recent years also largely been absent from the HIV/AIDS debate following his questioning of whether HIV caused the AIDS syndrome.

Cote d'Ivoire: AIDS Prevention Measures Collapse in Rebel-held City (news article)
In the Northern stronghold of Man, and throughout the rebel-held territory, what few AIDS prevention and treatment efforts that may have existed have been all but entirely obliterated.

Angola: AIDS Infections Rising (news article)
Angola, the southern African nation least hit so far by the HIV/AIDS epidemic, has recorded a sharp rise in the number of people infected with the deadly virus.

China Takes Active Measures to Control HIV/AIDS (news article)
As local governments in China change their conception of control and prevention of HIV/AIDS, so does the central government confront the reality more positively and open.

Kenyan Nobel Peace Laureate Claims HIV Virus Deliberately Created (news article)
Related: news article: Africa Laureate Dismisses AIDS "Bioweapon" Flap
Kenyan ecologist Wangari Maathai, the first African woman to win the Nobel Peace Prize, on Saturday reiterated her claim that the AIDS virus was a deliberately created biological agent.

Uganda: Global Fund Gives $70 Million for ARVs (news article)
The Ugandan government's efforts to scale up anti-retroviral drugs to cater for about 120,000 people living with HIV/AIDS, received a boost with the recent donation of US$70.35 million dollars from the Global Fund on AIDS, Tuberculosis and Malaria.

China: Beijing to Install More Condom Machines (news article)
Beijing plans to install about 1,000 condom vending machines in hotels, bars, universities, and on construction sites this month to fight the spread of AIDS.

Chinese Media Urged to Join National Campaign Against HIV/AIDS (news article)
The Chinese government has further eased curbs on condom advertisements to encourage safer sex and help arrest the spread of HIV/AIDS.

MATERNAL AND CHILD HEALTH RESEARCH

Chlamydia and Gonorrhoea in Pregnancy: Effectiveness of Diagnosis and Treatment in Botswana (research abstract)
This study investigates ethnic differences in rates of gonorrhoea using empirical sexual behavior data to explore the impact of different intervention strategies in asimulated population. It compares predicted and observed rates of infection and simulated the effects of targeted and population-wide intervention strategies. Researchers posit that interventions to reduce duration of infection were most effective when targeted at black Caribbeans, suggesting the need for targeting effective services to particular ethnic groups can have a disproportionate influence on disease reduction in the whole community.

Brazilian Women and Physicians' Viewpoints on Their Preferred Route of Delivery (research abstract)
This paper describes women's preferred route of delivery and physicians' viewpoint on that. Researchers found that a majority of women preferred vaginal delivery.

Complicated Deliveries, Critical Care and Quality in Emergency Obstetric Care in Northern Tanzania (research article)
(You need Adobe Acrobat Reader to access this document)
This study determined the availability and quality of emergency obstetric care (EmOC) in northern Tanzania. Nearly 60% of the expected complicated deliveries in the study population were conducted at EmOC-qualified health facilities, while 81.2% of the expected complicated deliveries are conducted in any facility. Voluntary agencies provide most services in rural settings. Findings show there is an inadequate level of critical services provided and all indicators show large variations with the setting (urban/rural location, level, and ownership of facilities).

Episiotomy Versus Fetal Manipulation in Managing Severe Shoulder Dystocia: A Comparison of Outcomes (news article)
Related: news article: Study Warns Against Unnecessary Episiotomies
Episiotomies (incisions that widen the vagina during childbirth) don't reduce the risk of injury to babies when their shoulders are stuck in the birth canal, says a Johns Hopkins University School of Medicine study. The study authors wrote that, instead of an episiotomy, doctors should physically maneuver the infant to realign the shoulders to fit within the mother's pelvis.

MATERNAL AND CHILD HEALTH NEWS

Maternal Mortality Threatens Africa's Post-Independence Socioeconomic Gains: WHO (news article)
High maternal mortality rates in Africa are threatening to reverse all the socioeconomic gains recorded in the post-independence period, according to the World Health Organization Regional Office for Africa.

Afghan Midwives Aim to Reduce Maternal and Child Mortality (news article)
In order to reduce maternal and child mortality in western Afghanistan, World Vision is currently training 50 midwives at the Institute of Health Sciences facility in the city of Herat.

Zimbabwe Sets Out to Reduce Maternal Deaths (news article)
The Zimbabwean Health Ministry has set up a Reproductive Health Taskforce aimed at strengthening health care delivery system as a way of reducing maternal and new-born deaths in Zimbabwe.

MEN'S HEALTH RESEARCH

Sexual Behaviour of Male Teenagers Attending a City Department for Skin and Venereal Diseases in Belgrade (research abstract)
This study investigates sexual behavior of 380 teenaged males in Belgrade in the period from January 2000 to June 2001. Two groups were compared, "STD cases" (attending for suspected STDs) and controls (with skin mycotic diseases). Sex on the same day as the first encounter, history of previous STD, and never using a condom with an irregular partner were found to be higher in "STD cases".

Love, Sex, and Masculinity in Sociocultural Context: HIV Concerns and Condom Use among African American Men in Heterosexual Relationships (research abstract)
This article posits that two theoretical frameworks—masculinity ideologies (MI) and sociocultural context—are important for comprehending Black men’s condom use. This study involved semi-structured interviews with lower-middle-income African American men (N = 13) between the ages of 24 and 50 in emotionally and sexually intimate heterosexual relationships. Analyses revealed that although many articulated traditional MI that have implications for HIV risk, some also expressed unconventional MI that also have implications for reducing risk in Black heterosexual relationships.

MEN'S HEALTH NEWS

Swaziland: Men Urged to Take More Responsibility in Curbing HIV/AIDS (news article)
Related: news article: How Men Can Make a Difference in Women's Health
Heterosexual men need to take more responsibility for trying to stop the spread of HIV/AIDS in Southern Africa, according to regional health experts.

POPULATION RESEARCH

The Sensitivity of Estimates of the Change in Population Behaviour to Realistic Changes in Bias in Repeated Surveys (research abstract)
This abstract discusses the sensitivity of biases in repeated surveys within changing populations as well as potential strategies for reducing error/bias in findings.

A Comparison of Univariate and Multivariate Multilevel Models for Repeated Measures of Use of Antenatal Care in Uttar Pradesh (research abstract)
The authors compare two different multilevel modelling approaches to the analysis of repeated measures data to assess the effect of mother level characteristics on women's use of prenatal care services in Uttar Pradesh, India.

Urban Poverty and Health in Developing Countries: Household and Neighborhood Effects (working paper)
(You need Adobe Acrobat Reader to access this document)
This paper investigates whether in developing-country cities the health of women and young children is influenced by both household and neighborhood standards of living. Using data from the urban samples of 85 Demographic and Health Surveys, and modeling living standards using factor-analytic MIMIC methods, the authors find, first, that the neighborhoods of poor households are more heterogeneous than is often asserted. It appears that as a rule, poor urban households do not tend to live in uniformly poor communities; indeed, about one in ten of a poor household's neighbors is relatively affluent, belonging to the upper quartile of the urban distribution of living standards. Applying multivariate models with controls for other socioeconomic variables, we discover that household living standards have a substantial influence on three measures of health: unmet need for modern contraception; attendance of a trained provider at childbirth; and children's height for age.

POPULATION NEWS

Now, Dangers of a Population Implosion (news article)
For decades, much has been written about the world's exploding population. But 60 countries, about a third of all nations, have fertility rates today below 2.1 children per woman, the number necessary to maintain a stable population.

India's Aging Gradually (news article)
While the proportion of people over 60 years has crossed 7% of India's 1.02 billion population, qualifying it to be an "aging" country as defined by the UN, it is still far from ballooning to the 8.1% that the World Health Organization had projected for 2001.

WOMEN'S HEALTH RESEARCH

Sexual and Reproductive Behaviour Among Single Women Aged 15–24 in Eight Latin American Countries: A Comparative Analysis (research abstract)
A comparative analysis of exposure to sexual activity, contraceptive use, conceptions, and pregnancy resolutions among single women aged 15–24 in eight Latin American countries is presented. In all eight countries, virginity accounts for over half of all single woman-years of exposure between age 15 and 24, but the percentage of sexually active time protected by contraception is less than 20% in five countries. Results indicate contraceptive uptake, particularly of condoms, is increasing but not sufficiently to offset the decline in virginity.

Screening for Chlamydia Trachomatis in Women 15 to 29 Years of Age: A Cost-Effectiveness Analysis (research abstract)
Related: news article: Repeated Re-testing of Women with a History of Chlamydia is a Cost-effective Strategy for Preserving Reproductive Health
This study to assess the cost-effectiveness of recently proposed strategies for chlamydia screening found that annual screening in women 15 to 29 years of age followed by semiannual screening for those with a history of infection was the most effective and cost-effective strategy.

The Emergence of Political Priority for Safe Motherhood in Honduras (research abstract)
This paper draws on political science literatures to explain how political priority for safe motherhood emerged in Honduras, a factor that underpinned a 40% decline from 1990 to 1997, one of the largest reductions ever documented in such a short time span in the developing world. Central to the explanation is the unusually cooperative relationship that developed between international donors and national health officials, resulting in effective transfer of policy and institutionalization of the cause within the domestic political system. The paper draws out implications of the case for understanding the political dynamics of women's health priority generation in developing countries.

Profiling Domestic Violence: A Multi-Country Study (report)
(You need Adobe Acrobat Reader to access this document)
Related: news article: Report: Domestic Violence Threatens Health of Children with Lower Immunization Rates, Higher Mortality Rates, Poor Nutrition
MEASURE DHS just released this report, a comprehensive analysis of domestic violence in nine developing countries based on Demographic and Health Surveys data. The report finds high rates of domestic violence in all countries studied, with over 40% of women in several countries reporting spousal or intimate partner abuse. The number of ever-married women reporting spousal physical or sexual abuse was highest in Zambia (48%), Colombia (44%), and Peru (42%) and lowest in Cambodia (18%), India (19%), and the Dominican Republic (22%). About one in three women in Egypt (34%), Nicaragua (30%) and Haiti (29%) reported such abuse. In most countries, the highest rates of violence occur in moderately wealthy households, and not, as often assumed, among poorest households. The report .pdf file is 141 pages.

Pakistani Obstetricians' Recognition of and Attitude Towards Domestic Violence Screening (PubMed abstract)
This study assesses Pakistani obstetricians knowledge of the prevalence of domestic violence in clinical practice and attitudes towards instituting screening protocols during routine antenatal care. They found that nearly 70% of obstetricians reported that more than 30% of Pakistani women are victims of domestic abuse. Almost half of the respondents were favorably inclined to screen patients. Professional, personal, and patient-related barriers were identified as the main hurdles preventing instituting screening.

Healing Wounds, Instilling Hope: The Tanzanian Partnership against Obstetric Fistula (resource material)
(You need Adobe Acrobat Reader to access this document)
This edition of Quality/Calidad/Qualité, a publication of the Population Council, describes a partnership formed to combat obstetric fistula in Tanzania. The Bugando Medical Center, the Women’s Dignity Project, the Tanzania Midwives Association, and the government cooperate on an extensive program for surgical repair, prevention, and policy research and activities. Lessons learned include the following: 1) Fistula programs need to address social as well as medical issues; 2) most repairs are successful, making an enormous difference in women’s lives; 3) relatively little funds are necessary to start up a fistula program; 4) fistula programs are vehicles for broader conversations about gender and poverty.

WOMEN'S HEALTH NEWS

'No Gains' for African Women (news article)
African women have not made any tangible gains since the Beijing summit on women's affairs 10 years ago, according to an announcement at the start in Addis Ababa of the "African Women's NGO Forum on Beijing +10".

HIV/AIDS Intervention Messages Not Gender-Balanced (news article)
An analysis of the findings of the UN Secretary General's Task Force on Women report shows that gender inequality weakens women's position in negotiating safer sex and thus fuels HIV infection.

Chinese Woman Fired, Tortured After Having Second Child (news article)
International human rights advocates are protesting China's torturing of a woman who has been imprisoned for fighting the country's one-child policy. Mao Hengfeng was fired from her job at a soap factory in Shanghai 16 years ago after she refused to have an abortion when she became pregnant with her second child, in violation of China's strict population controls. Since then, she has been petitioning the government to give her back her job, and other basic rights she says she has been denied. Tired of her complaints, authorities in Shanghai last April ordered Ms. Mao to undergo 18 months of reeducation at a labor camp. Nicolas Becquelin of the group Human Rights in China says Ms. Mao has been subjected to torture during her detention.

YOUTH HEALTH RESEARCH

Sexual Risk Attitudes and Behaviours Among Young Adult Indonesians (research abstract)
This research explores the beliefs of 18- to 24-year-old Indonesians of Javanese and Chinese background regarding perceptions of sexual behavior and condom use. "Safe sex" was mainly associated with pregnancy prevention. The risk of contracting an STI was regarded as low and condoms were believed not to be used often for disease prevention, suggesting prevention interventions should specifically address such dangerous misconceptions.

Socioeconomic Disadvantage and Unsafe Sexual Behaviors Among Young Women and Men in South Africa (working paper)
(You need Adobe Acrobat Reader to access this document)
Using household survey data collected in 2001, this study investigates how relative socioeconomic status influences the sexual behaviors of young women and men aged 14–24 years in KwaZulu-Natal Province, South Africa, an environment characterized by high HIV prevalence and high rates of poverty and inequality. Relative economic disadvantage is found to significantly increase the likelihood of a variety of unsafe sexual behaviors and experiences.

Youth InfoNet No. 10 - September 2004 (resource material)
This issue of Youth InfoNet, a publication of Family Health International, summarizes 18 major resources on global issues published from 2002-2004 and offers a "South-to-South" resource, with eight recent publications from Asia and the Near East that may provide lessons to other regions.

Adolescent and Young Adult Women’s Misunderstanding of the Term Pap Smear (research abstract)
Related: news article: Few Teen Girls Know What a Pap Smear Is
Researchers investigated teen girls' understanding of the term pap smear. Remarkably few patients who participated in this study understood the meaning of the term (2.7%). Confusion about gynecologic terms may hinder efforts to enhance compliance with sexually transmitted disease and cervical cancer screening. Educational initiatives are needed to improve young people’s comprehension and communication with care providers.

Growing Up in Pakistan: The Separate Experiences of Males and Females (working paper)
(You need Adobe Acrobat Reader to access this document)
This paper examines gender differences in transitions to adulthood in Pakistan. The analysis is based on data from the 2001–02 Adolescent and Youth Survey of Pakistan, a nationally representative survey of young people aged 15–24 undertaken by the Population Council's Islamabad office. The survey covers key aspects of adolescents' lives, including the timing of several adult transitions and a detailed accounting of time use over the previous 24 hours. The results of the analysis confirm the fundamental importance of schooling to transitions to adulthood.

YOUTH HEALTH NEWS

Singapore: Youths Make Film on Teen Sex (news article)
A group of youngsters involved in community work with the South East CDC, got together to produce the movie TOAD! It was made in a month and cost $5,000, and it aims to raise awareness of the rising number of teenage girls having sex in Singapore.

SPECIAL REPORTS/PROFILES/RESOURCES

Population Briefs, Volume 10, Number 3, September 2004 (resource material)
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This volume of Population Briefs, a research newsletter of the Population Council, includes articles on "Reproductive Health Program for Youth Successful in Kenya," "Door-to-Door Delivery Enhances Women’s Status in Bangladesh," and "Potential Long-Acting Male Contraceptive Studied".

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 Bloomberg School of Public Health: The INFO Project

Volume 4, Number 4111 October 2004