Volume 7, Number 10
26 March 2007

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FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Desired family size, family planning and fertility in Ethiopia
(Abstract; subscription needed for full text; South America)
Journal of Biosocial Science. 2007 May 1;39(3):367-381.
Bhargava A
This paper models the proximate determinants of children born to over 13,000 Ethiopian women and of the women’s stated preferences for additional births using the data from the Ethiopian Demographic and Health Survey 2000. Empirical models for the number of children born to women were estimated using Poisson and ordinal regressions. The results show the importance of variables such as maternal education for smaller family size, and that variables reflecting desired family size are strong predictors of the numbers of children born to women. Secondly, binary logistic models for dichotomous variables for women not wanting more children and if getting pregnant would be a "big problem" showed non-linear effects of the surviving and "ideal" number of children. Moreover, the results indicated a desire on the part of women to limit family size, especially as the number of surviving children increased. Probit models were estimated to address potential endogeneity of certain variables. Overall, the results indicated that counselling couples about small family size and increasing the utilization of health care services can lower fertility in Ethiopia.

Anogenital warts knowledge and counseling practices of US clinicians: Results from a national survey
(Abstract; subscription needed for full text; North America)
Sexually Transmitted Diseases. 2007 Mar 21;Online access March 21, 2007.
Henderson Z | Irwin K | Montano D | Kasprzyk D | Carlin, L | Greek, A | Freeman C | Barnes R | Jain N
The objective of this study was to examine messages U.S. clinicians use when counseling patients diagnosed with anogenital warts. In mid-2004, researchers conducted a confidential mail survey of nationally representative samples of physicians practicing internal and adolescent medicine, family/general practice, obstetrics/gynecology, urology, or dermatology; nurse midwives; physician assistants; and nurse practitioners. The survey assessed knowledge and counseling practices of clinicians who had diagnosed anogenital warts. After adjusting for survey eligibility, 81% responded. Most (89%) were aware that human papillomavirus (HPV) causes anogenital warts, but only 48% were aware that oncogenic and wart-related HPV genotypes usually differ. Most (greater than 95%) clinicians reported telling patients with warts that warts are an STD, are caused by a virus, or that their sex partners may have or may acquire warts. Many clinicians (greater than or equal to 85%) also reported discussing STD prevention or assessing STD risk with such patients. Most reported addressing ways to prevent HPV (89%), including using condoms; limiting sex partners or practicing monogamy; or abstinence. Many also reported recommending prompt (82%) or more frequent (52%) Pap testing to female patients with anogenital warts. Potential barriers to counseling included providing definitive answers on how HPV infection was acquired, dealing with patients' psychosocial issues, and inadequate reimbursement. Most surveyed clinicians appropriately counseled patients about the cause and prevention of anogenital warts. However, many clinicians were unaware that oncogenic and wart-related HPV types usually differ, and this may explain why many reported recommending more aggressive cervical cancer screening for female patients with warts.

Efficacy of cervical mucus observations plus electronic hormonal fertility monitoring as a method of natural family planning
(Abstract; subscription needed for full text; North America)
Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2007 Mar-Apr;36(2):152-160.
Fehring RJ | Schneider M | Raviele K | Barron ML
The objective of this study was to determine the effectiveness of an electronic hormonal fertility monitor plus cervical mucus monitoring to avoid pregnancy. One hundred ninety five (195) women (mean age 29.8 years) seeking to avoid pregnancy with a natural method at 5 clinical sites in 4 cities took part. Each participant was taught to track fertility by self-observation of cervical mucus and an electronic monitor that measures urinary levels of estrone-3-glucuronide and luteinizing hormone. Main outcome measures were correct- and typical-use unintended pregnancy rates. There were a total of 26 unintended pregnancies, 3 with correct use. With 1,795 months of use, the correct-use pregnancy rate was 2.1% per 12 months of use (i.e., 97.9% effective in avoiding pregnancy when rules of the method were always followed) and the imperfect-use pregnancy rate was 14.2% per 12 months of use (i.e., 85.8% effective in avoiding pregnancy when rules of the method were not always followed and all unintended pregnancies and months of use were included in the calculations). Correct use of an electronic hormonal fertility monitor with cervical mucus observations can be as effective as other fertility awareness–based methods of natural family planning. Comparative studies are needed to confirm this conclusion.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Rwanda: Cycle-Beads to limit untimely pregnancies
(News Article; Sub-Saharan Africa)
20 Mar 2007
Gahigana I, The New Times

Reduce ovarian cancer risk with low-dose birth control pills
(News Article; North America)
18 Mar 2007
Martin L, Top Cancer News

HIV/AIDS RESEARCH

Early growth of infants of HIV-infected and uninfected Zambian women
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Tropical Medicine and International Health. 2007 May;Online access March 23, 2007. 12(5)
Makasa M | Kasonka L | Chisenga M | Sinkala M | Chintu C | Tomkins A | Filteau S
Parental HIV infection may affect even those exposed children who remain uninfected. Researchers investigated early growth, an indicator of overall health, of infants born to Zambian mothers recruited for a study of breastfeeding and postpartum health. HIV-infected and uninfected women in Lusaka were followed regularly from late pregnancy to 16 weeks postpartum. Infant weight and length were measured at birth, 6 and 16 weeks. Infant HIV status could not be specifically determined in this cohort so comparisons were between all infants of HIV-uninfected mothers (n=184) and those infants of HIV-infected mothers who were known to be alive and showed no clinical evidence of HIV infection at age 2–4 years (n=85). Most infants were exclusively or predominantly breastfed until 16 weeks. At all time points infants of HIV-infected mothers tended to have lower weight and length standard deviation (Z) scores (significant for weight at 6 weeks; P=0.04), even after adjustment for their lower gestational age at birth, compared with infants of uninfected mothers. In multivariate analyses the major factors affecting weight or length at 6 or 16 weeks of age were birth weight or length, and maternal subclinical mastitis, primiparity and weight during pregnancy. Early growth of infants of HIV-infected mothers is less than that of uninfected mothers, in part associated with subclinical mastitis, and this effect cannot be overcome with intensive support of mothers to follow international recommendations regarding exclusive breastfeeding.

Epidemiological features of HIV infection among pregnant women in Makurdi, Benue State, Nigeria
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Biosocial Science. 2007 May;Online access March 23, 2007. 39(3):397-408.
Utulu SN | Lawoyin TO
Women in Benue State have for years had the highest HIV rate in the country, but because the sentinel surveys are anonymized and unlinked, not much is known about the socio-demographic, behavioural and other risk factors that predispose these women to the disease. The HIV/AIDS epidemic in Nigeria does not appear to be a single epidemic but rather multiple epidemics of varying magnitude and trends. This cross-sectional study was therefore carried out to identify the risk factors for HIV/AIDS among these women. A total of 404 consecutive consenting mothers enrolled at the booking clinic were followed up until delivery of their babies. They were interviewed using a semi-structured questionnaire and tested for HIV infection using an ELISA-based kit after obtaining informed consent. Mean age of the mothers was 26 plus or minus 6.1 years, 94.8% were married while 50.5% had at least secondary level education. Sixty-one (15.1%) mothers were HIV positive with mothers aged 15–24 years being responsible for 50.8% of all infection. Following bivariate analysis, being single, having a partner with low level of formal education, living in a rural location, being in a polygamous/multiple partner union, being a higher order polygamous wife, being married more than once and reporting a history of a sexually transmitted infection were significantly associated with HIV infection. Monogamous women who lived apart from their partners and women who had ever had blood transfusion were also more likely to be HIV positive. Following multivariate logistic regression, a young age of 15–24 years (multivariate OR=3.3, 95% CI=1.2–8.4, p=0.02); ever had other STIs (OR=1.6, 95% CI 1.1–2.3, p=0.009); no formal maternal education (OR=0.6, 95% CI 0.4–0.9, p=0.021) and having one lifetime sexual partner (OR=0.4, 95% CI 0.3–0.5, p less than 0.00001) were significantly associated with HIV infection in the study population. Appropriate interventions must be directed at young people and should include STI control and abstinence education. Blood safety must be ensured as well as a general improvement in the level of formal and health education in this community.

Perceptions of vaginal microbicides as an HIV prevention method among health care providers in KwaZulu-Natal, South Africa
(Research Article; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
AIDS Research and Therapy. 2007 Mar;Online access March 21, 2007. 4(7)
Ramjee G | Morar N | Mtimkulu J | Mantell J | Gharbharan V
The promise of microbicides as an HIV prevention method will not be realized if not supported by health care providers. They are the primary source of sexual health information for potential users, in both the public and private health sectors. Therefore, the aim of this study was to determine perceptions of vaginal microbicides as a potential HIV prevention method among health care providers in Durban and Hlabisa, South Africa, using a combination of quantitative and qualitative methods. During 2004, semi-structured interviews with 149 health care providers were conducted. Fifty seven percent of hospital managers, 40% of pharmacists and 35% of nurses possessed some basic knowledge of microbicides, such as the product being used intra-vaginally before sex to prevent HIV infection. The majority of them were positive about microbicides and were willing to counsel users regarding potential use. Providers from both public and private sectors felt that an effective microbicide should be available to all people, regardless of HIV status. Providers felt that the product should be accessed over-the-counter in pharmacies and in retail stores. They also felt a need for potential microbicides to be available free of charge, and packaged with clear instructions. The media was seen by health care providers as being an effective strategy for promoting microbicides. Overall, health care providers were very positive about the possible introduction of an effective microbicide for HIV prevention. The findings generated by this study illustrated the need for training health care providers prior to making the product accessible, as well as the importance of addressing the potential barriers to use of the product by women. These are important concerns in the health care community, and this study also served to educate them for the day when research becomes reality.

Should voluntary counseling and testing counselors address alcohol use with clients? Findings from an operations research study in Kenya
(Research Article; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Horizons Research Update. 2007 Jan;Online access March 20, 2007.
Population Council
This study showed that many clients at a VCT clinic in Kenya are affected by alcohol as a result of their own or their partners' drinking; therefore, voluntary counseling and test (VCT) providers have an important role to play in discussing alcohol use with clients regarding HIV transmission and risky behavior and in making referrals as appropriate. The study also shows, however, that VCT providers frequently miss the opportunity to discuss alcohol use in the context of HIV.

HIV/AIDS NEWS

Medical experts appeal for global attention to growing HIV/AIDS
(News Article; Asia)
22 Mar 2007
Associated Press

HIV/AIDS creep into Afghanistan
(News Article; Asia)
20 Mar 2007
Pak Tribune

Botswana: The HIV/AIDS pandemic: Suffering in silence
(Editorial; Sub-Saharan Africa)
21 Mar 2007
Mmegi/The Reporter

Nigeria: Lack of information helps spread of HIV/AIDS
(News Article; Sub-Saharan Africa)
22 Mar 2007
Nigerian Tribune

MATERNAL AND CHILD HEALTH RESEARCH

Impact of prenatal care on infant survival in Bangladesh
(Research Article; Asia)
Maternal and Child Health Journal. 2007 Mar 1;11(2):299-206.
Hong R | Ruiz-Beltran M
Despite improvements in public health in recent decades, levels of infant and child mortality remain unacceptably high, particularly in developing countries where primary healthcare services including prenatal care services are not universally available. Using information on 7,001 childbirths in five years preceding the 2004 Bangladesh Demographic and Health Survey, this study examined the relationship between receiving prenatal care during pregnancy and infant mortality using multivariate survival analysis. The results are presented in hazard ratios (HR) with 95% confidence intervals (95% CI). Results indicate that children of mothers who did not receive prenatal care during pregnancy were more than twice as likely to die during infancy as children whose mothers received prenatal care during pregnancy (HR=2.40, 95% CI: 1.74, 3.31) independent of child's sex, delivery assistance, birth order; mother's age at child birth, nutritional status, education level; household living conditions, and other factors. Children born to older mothers living in households without safe drinking water were at an increased risk. The study concludes that prenatal care is strongly negatively associated with infant mortality in Bangladesh independent of other risk factors. The results suggest that improving prenatal care services at the community level is key to improving child survival in Bangladesh.

Paediatric malaria case-management with artemether-lumefantrine in Zambia: A repeat cross-sectional study
(Research Article; Sub-Saharan Africa)
Malaria Journal. 2007 Mar 16;6(31):1-27.
Zurovac D | Ndhlovu M | Sipilanyambe N | Chanda P | Hamer DH
An evaluation of the improvements in administration of artemetherlumefantrine for antimalarial treatment in Zambia was conducted. Cross-sectional surveys were used to evaluate changes in health facility and health worker readiness to deliver artemether-lumefantrine, and changes in case-management practices for children below five
years of age presenting with uncomplicated malaria as defined by national guidelines. Although significant improvements in malaria case-management have occurred over two years in Zambia, the quality of treatment is not yet optimal. Strengthening weak health systems and improving the delivery of effective interventions should remain high priority in all countries implementing new treatment policies for malaria.

MATERNAL AND CHILD HEALTH NEWS

South Africa: Eastern cape kick-starts maternal health plan
(News Article; Sub-Saharan Africa)
2007 Mar 22;
Mbola B, BuaNews

Qatar: Delivery after age 35 poses major health hazards: Expert
(News Article; Middle East)
2007 Mar 22;
The Penninsula

MEN'S HEALTH RESEARCH

Vasectomy in men with primary progressive aphasia
(Abstract; subscription needed for full text; Global | North America)
Cognitive & Behavioral Neurology. 2006 Dec;Online access March 21, 2007. 19(4):190-193.
Fahey C | Johnson N | Mesulam MM | Gitelman DR | Weitner BB
Related News Article: Vasectomy may be linked to dementia
This study sought to study the frequency of vasectomy in men with primary progressive aphasia (PPA). It used a case control design. Forty-seven men with PPA and 57 men with no cognitive impairment (NC) between 55 and 80 years of age were surveyed about a history of vasectomy. The age-adjusted rate of vasectomy in PPA patients (40%) was higher than in NC (16%, P=0.02). There was a younger age at onset for the patients with vasectomy (58.8 vs. 62.9 y, P=0.03). Therefore, vasectomy may constitute one risk factor for PPA in men.

Men's health in China
(Abstract; subscription needed for full text; Asia)
The Journal of Men's Health and Gender. 2007 Mar 1;Online access March 22, 2007. 4(1):13-17.
Sun Y | Liu Z
Less attention has been paid to the gender-specific needs of men compared with women's health care. It is time to increase awareness of, and reinvigorate interest in, men's health concerns and to enhance understanding, improve clinical care and help set health policy goals for men's health. Fortunately, men's health has come to the forefront in the world and China is no exception. However, as a developing country with a long history and a versatile traditional culture, China has some unique definitions and emphases that differ from those of Western countries, so far as men's health is concerned. Three topics were chosen for discussion in this article on the theme of men's health in China: erectile dysfunction, the most embarrassing topic; partial androgen deficiency of the ageing male, the most ignored topic; and prostate cancer, the most pressing topic. Moreover, the emphasis for these topics focus on the differences between China and Western countries.

Antibiotic treatment can delay ejaculation in patients with premature ejaculation and chronic bacterial prostatitis
(Abstract; subscription needed for full text; Global | North America)
The Journal of Sexual Medicine. 2007 Mar 1;Online access March 22, 2007. 4(2):491-496.
El-Nashaar A | Shamloul S
Premature ejaculation (PE) is regarded as the most common male sexual disorder. This study aims to examine the effect of antibiotic treatment in delaying ejaculation in patients with PE and chronic prostatitis. A total of 145 consecutive men attending of secondary premature ejaculation (SPE) were included in this study. Sequential microbiologic specimens were obtained from urine and prostatic fluid. Antibiotics were given for 1 month according to the results of their culture and sensitivity test. All patients were instructed to follow up with our clinic monthly for at least 4 months. At the end of the 4-month follow-up, another prostatic secretion analysis was performed. Based on expressed prostatic secretion culture and white blood cell (WBC) count, 94 (64.8%) were having chronic bacterial prostatitis. The remaining 51 (35.2%) patients had negative WBC count. Of the 94 patients with SPE and chronic bacterial prostatitis, 20 patients were left untreated and considered as a control group. All 74 patients with PE and chronic prostatitis continued the 1-month treatment duration. Following 1-month antibiotic treatment, all 74 patients with initially positive cultures had sterile final cultures (P less than 0.05). Sixty-two (83.9%) patients showed increases in their ejaculatory latency time and reported good control of their ejaculation and were considered treatment responsive. None of the control group patients experienced any improvement either in their prostatic infection condition or in their ejaculation time. The follow-up of treatment-responsive patients (N=62) revealed no recurrence of PE with negative prostatic culture. Successful eradication of causative organisms in patients with PE and chronic prostatitis may lead to marked improvement in intravaginal ejaculatory latency time and ejaculatory control.

The male sexual quotient: A brief, self-administered questionnaire to assess male sexual satisfaction
(Abstract; subscription needed for full text; South America)
The Journal of Sexual Medicine. 2007 Mar 1;Online access March 22, 2007. 4(2):382-389.
Abdo CH
Sexual satisfaction is an important aspect of overall life satisfaction. This study aims to assess responses to the Male Sexual Quotient (MSQ) in men with sexual dysfunction (SD). Items for inclusion in the MSQ were developed through interviewing 612 randomly recruited men in São Paulo, Brazil, about factors considered to influence sexual quality of life. Validation of the MSQ was conducted in two phases in men with and without SD. The main outcome of interest was the correlation between patients' total MSQ score and scores on the Sexual Health Inventory for Men (SHIM). MSQ scores correlated well with SHIM scores, and scores were inversely related to the severity of erectile dysfunction or PE and other male SDs. These preliminary findings suggest that the MSQ possesses good convergent validity. Nearly half of men reported problems with ejaculatory control, indicating an association between PE and other SD. Further validation of the MSQ in a double-blind trial is needed. The MSQ may aid in decision making for the treatment of SD.

MEN'S HEALTH NEWS

US: Ongoing studies addressing questions about HPV in men, effect on women
(News Article; Global | North America)
21 Mar 2007
Medical News Today
Related News Article: Masculine side of HPV

POPULATION RESEARCH

Period and cohort dynamics in fertility norms at the onset of the demographic transition in Keyna 1978-1998
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Biosocial Science. 2007 May;39(3):443-454.
White RG | Hall C | Wolff B
A characteristic of African pre-transitional fertility regimes is large ideal family size. This has been used to support claims of cultural entrenchment of high fertility. Yet in Kenya fertility rates have fallen. In this paper this fall is explored in relation to trends in fertility norms and attitudes using four sequential cross-sectional surveys spanning the fertility transition in Kenya (1978, 1984, 1989 and 1998). The most rapid fall in the reported ideal family size occurred between 1984 and 1989, whilst the most rapid fall in the total fertility rate occurred 5 to 10 years later, between 1989 and 1998. Thus these data, spanning the fertility transition in Kenya, support the traditional demographic model that demand for fertility limitation drives fertility decline. These data also suggest that the decline in fertility norms over time was partly a period effect, as the reported ideal family size was seen to fall simultaneously in all age cohorts, and partly a cohort effect, as older age cohorts reporting higher ideal family sizes were replaced by younger cohorts reporting lower ideal family sizes. These data also suggest that a new fertility norm of four children may have developed by 1989 and continued until 1998. This is consistent with, and perhaps could have been used to predict, the stall in the Kenyan fertility decline after 1998.

The complexity of reproductive decision-making in asymptomatic carriers of the Huntington mutation
(Abstract; subscription needed for full text; Global)
European Journal of Human Genetics. 2007 April;Online access January 24, 2007. 15:453–462.
Decruyenaere M | Kiebooms GE | Boogaerts A | Philippe K | Demyttenaere K | Dom R | Vandenberghe W | Fryns JP
The aim of this study was to describe reproductive decisions in mutation carriers after predictive testing for Huntington's disease (HD) and to identify factors that play a role in decision-making. In 1987–2004, 245 individuals received a predictive test result; 89 of them were carriers and seven received an equivocal result. Quantitative data on reproductive behaviour have been collected during all follow-up contacts. The follow-up time in this study was 1–16 years (mean: 7.1 years). Qualitative data on reproductive decision-making have been collected by the means of semistructured interviews during the 5-year follow-up study.

For 46 carriers and two persons with an equivocal result, family planning was one of the motives for predictive testing. In this group, slightly more than half of the carriers (58%) had chosen to have children with prenatal diagnosis or preimplantation genetic diagnosis and about one in three (35%) decided to have no children anymore after the test. A minority (7%) was undecided or had no children for other reasons. Factors playing a role in the decision-making process were the carrier's sex, ethical issues about PD and PGD, the strength of the desire to have children, illness representations including personal experiences with HD in the family and the technological imperative. Some of these elements were in conflict and induced ambivalence towards reproductive choices. The results illustrate the complexity of the decision-making process and the necessity of in-depth counselling. Counselling should pay special attention to conflicting values and beliefs and to all kinds of pressure.

POPULATION NEWS

East Africa: Drop in AIDS deaths will boost EA population
(News Article)
20 Mar 2007
Kelley K, All Africa

Uganda: Forests in danger
(News Article; Sub-Saharan Africa)
21 Mar 2007
The New Vision

Cuba: Growing old without a staff to lean on
(Feature Article; Central America and the Caribbean)
20 Mar 2007
Patricia Grogg, Inter Press Service News Agency

China: Money can't justify having more kids
(Commentary; Asia)
19 Mar 2007
People's Daily Online

WOMEN'S HEALTH RESEARCH

Prevalence and correlates of domestic violence by husbands against wives in Bangladesh: Evidence from a national survey
(Abstract; subscription needed for full text; Asia)
The Journal of Men's Health and Gender. 2007 Mar;Online access March 23, 2007. 4(1):52-63.
Aklimunnessa K | Khan MM | Kabir M | Mori M
The aim of this study was to determine the prevalence of domestic violence by husbands against wives (DVHW) and its correlates using the data of ever married men from a national survey. This subset of ever married men (equal to 2823 if weighted and 3165 if unweighted) was extracted from 4297 men (including single) aged 14–54 years, who were interviewed during the Bangladesh Demographic and Health Survey (BDHS) in 2004. The BDHS 2004 applied a pre-tested structured questionnaire for men to collect much information including socio-demographic, life-style, violence (physical and sexual) against wives and reasons for violence. SPSS version 10 was used to perform all of the analyses. The prevalence of physical, sexual and overall DVHW was 68%, 27% and 72%, respectively within the year preceding the survey. Slapping/twisting (61%) and pushing/shaking/throwing something (40%) were the most common forms of physical DVHW. Age, place of residence, education, religion and number of children showed significant associations (by odds ratio) with at least one form of violence using multiple logistic regression analysis. Both cross-tabs analysis and logistic regression analysis (adjusted for age, place of residence, education, religion and number of children) indicated a significantly higher prevalence and higher odds ratio of DVHW among those husbands who: did not watch television everyday, had experience of pre-marital and post-marital sex, smoked cigarettes/bidi, chewed tobacco and took illicit drugs. The estimates of the lifestyle variables sharply attenuated when all of the variables were included in the same model, although the significance levels were changed for only some of them. The high prevalence of DVHW deserves immediate attention and intervention in Bangladesh. For effective intervention, the significant correlates of DVHW, especially the lifestyle-related factors, must be taken into consideration to reduce the prevalence and consequences of DVHW in Bangladesh.

Age at menopause and cause-specific mortality in South Korean women: Kangwha Cohort Study
(Abstract; subscription needed for full text; Asia)
Maturitas. 2007 Apr;Online access March 23, 2007. 56(4):411-419.
Hong JS | Yi SW | Kang HC | Jee SH | Kang HG
This study used the data of the Kangwha Cohort that was followed up from 1985 to 2001, in particular, for the group of 55 years or older women (n=2658). Researchers calculated the hazard ratio of mortality by the group of age at menopause using the Cox proportional hazards model with adjustment for age, alcohol consumption, education, age at first birth, self-cognitive health level, chronic disease, marital partner, parity, age at menarche, oral contraceptive use and hypertension. The mean (standard deviation) age at menopause was 46.9 (4.9) years, and the median age was 48 years. After adjusting for the relevant variables, the risk of total death in the early menopause group (less than 40 years at menopause) was 1.32 times higher than that of the reference group (45–49 years at menopause) (95% confidence interval [CI], 1.05–1.66, p=0.02). For the early menopause group, relative to the reference group, the adjusted hazard ratios of death due to cardiovascular disease and cancer were 1.53 (95% CI, 1.00-2.39, p=0.04) and 2.01 (95% CI, 1.06–3.82, p=0.03), respectively. Through this study, the age at menopause was found to be different between Asian and Caucasian women and the association of age at menopause with death, particularly caused by cardiovascular disease and cancer, was validated. The study is one of rare studies regarding the age at menopause of Asian women and their risk of mortality, which could be considered to be meaningful.

Cervical cancer screening practices among general practitioners in Lagos Nigeria
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Obstetrics and Gynaecology. 2007;Online access March 23, 2007. 27(2):181-184.
Anorlu RI | Ribiu KA | Abudu OO | Ola ER
Cervical cancer is the most common genital cancer in women in Nigeria. Researchers studied the cervical cancer screening practices of 503 general practitioners in two urban and two rural areas of Lagos state. Only 60 (11.9%) ever informed their patients about cervical cancer screening and female doctors did this more often than their male counterparts (x2=4.74, p=0.001). A total of 89 (17.8%) had facilities for Pap smears, but only 27(5.4%) screened their patients. A total of 6 out of 27 (22.2%) did routine screening and 21 (77.8%) did selective screening. Only 6 out of 503 (1.2%), therefore, did routine screening. Some 126 (25.0%) and 109 (21.7%) would do Pap smears for patients with post-coital bleeding and post-menopausal bleeding. Screening services were more available in the urban than in the rural areas (p=0.0000). Thus, cervical cancer screening practices and services in Lagos are inadequate, which is no different from other parts of Nigeria and sub-Saharan Africa. Cervical cancer should be accorded the same attention as HIV, malaria, TB and childhood immunisations.

WOMEN'S HEALTH NEWS

Uganda: There are alternatives to the pap smear
(Editorial; Sub-Saharan Africa)
20 Mar 2007
New Vision

Uganda: Sabiny 'surgeon' who renounced female genital mutilation
(Feature Article; Sub-Saharan Africa)
19 Mar 2007
New Vision

YOUTH HEALTH RESEARCH

Quasi-experimental evaluation of a national primary school HIV intervention in Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Evaluation and Program Planning. 2007 May;Online access March 23, 2007. 30(2):172-186.
Maticka-Tyndale E | Wildish J | Gichuru M
This study examined the impact of a primary-school HIV education initiative on the knowledge, self-efficacy and sexual and condom use activities of upper primary-school pupils in Kenya. A quasi-experimental mixed qualitative–quantitative pre- and 18-month post-design using 40 intervention and 40 matched control schools demonstrated significant program impact on targeted objectives of (1) adequate program delivery and, for standard 6 and 7 pupils (ages 11–16 years), (2) increased HIV-related knowledge; (3) increased communication with parents and teachers about HIV and sexuality; (4) increased assistance to fellow pupils to avoid sexual activity; (5) increased self-efficacy related to abstinence and condom use; (6) decreased exposure to HIV through delayed first intercourse, decreased sexual activity and increased condom. Results support the conclusions that the existing infrastructure is adequate for national roll-out of the program; that the program has its most beneficial effect on sexually inexperienced youth and should therefore be implemented with the youngest age groups possible; and that gains are gender specific, with boys reporting increased condom use while girls are more likely to decrease or delay sexual activity. Based on these results, the program began national roll-out to all primary schools in 2005. By June 2006, the program was operating in 11,000 of the country's nearly 19,000 schools.

Predictors of dual method use for pregnancy and HIV prevention among adolescent South African women
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Contraception. 2007 Mar;Online access March 23, 2007.
MacPhail C | Pettifor A | Pascoe S | Rees H
Dual contraceptive method use is advocated for adolescent women to prevent pregnancy, sexually transmitted diseases and HIV. Researchers examined data from a nationally representative sample of South African women aged 15–24 years to establish factors associated with dual method use. Only 7% of current contraceptive users reported using dual methods, although this percentage increased to 28.1% when women reporting hormonal contraception and condom use at last sex were included. In multivariate analyses, having talked about condoms with a partner was most strongly associated with dual method use (adjusted odds ratio (AOR), 12.3; 95% confidence interval (CI), 6.1–25.1) and suggests that communication skills might be the most effective way of increasing dual method use. Difficulty in accessing condoms was associated with lower odds of dual method use (AOR, 0.5; 95% CI, 0.2–1.0). Researchers concluded with recommendations to increase male involvement and encourage communication between partners for the integration of HIV prevention and other reproductive health care services.

YOUTH HEALTH NEWS

Zambia: Co-sex education needed - Routledge
(News Article; Sub-Saharan Africa)
21 Mar 2007
Independent Online

India: No sex education, only yoga in MP
(News Article; Asia)
22 Mar 2007
CNN-IBN

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Volume 7, Number 1026 March 2007