Johns Hopkins Bloomberg School of Public Health: The INFO Project

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The Pop Reporter®

Volume 7, Number 12
9 April 2007

Pop Reporter Tip: Did you know? You can see what type an item is before you click on the title to go to the text. Below every item’s title is a description of what that item is: "News Article", "Research Article", "Report", "Abstract", and so on. Sometimes we are unable to link to full-text articles because a personal or institutional subscription is necessary. But the research is still important. We identify these items with "Abstract; subscription needed for full text" so that you know what you'll be getting after you click the link.

Guest Editorials (free with every subscription)

Open source model for public health education in developing countries


Author: Mita Lovalekar(1), M.B.B.S., M.P.H.; Faina Linkov(1), Ph.D.; Eugene Shubnikov(2), M.D.; Ronald E. LaPorte(1), Ph.D.; 1. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA; 2. Institute of Internal Medicine, Novosibirsk, Russia

MitaL@pitt.edu

Many people from developing countries remember a time when they or their loved ones were at risk of dying from small pox, plague, poliomyelitis, and other scourges and epidemics. Since then, there has been a 25-year increase in life expectancy in both developing and developed countries, with a decline in the rates of infectious diseases. This is the most rapid increase in life expectancy ever seen in the world. Why did this happen? In spite of advances in clinical medicine, almost all of this improvement in life expectancy is due to public health -– improvement in lifestyles, better nutrition, sanitation, vaccination and education (1).

In spite of this improvement, there is a gap in the health situation between developing and developed countries. In developing countries, as seen in developed countries, there are strong expressions of political support for public health, which is viewed as one of the important approaches for achieving national health goals (2). But, in general, there is a serious lack of public health training in most of the developing countries, with very few schools of public health. Public health practitioners do not have information to support decision making, which limits the quality of public health services.

An effective method for public health education in developing countries may be the “open source” approach, where the source code is available to everyone. The process of open source software development can be compared to the scientific peer review process where openness accelerates and provides feedback to the process (3). The open source model can also be applied to public health education (4), which can be particularly helpful in resource-poor developing countries. This is in contrast to traditional distance learning, where access is restricted, and students have to pay to use course material.

An example of an open source initiative in public health education is the Global Health Network Supercourse, which was started in 1997 (5). The main aim of the Supercourse is to use the Internet to improve teaching in the field of public health. In the true sprit of an open source initiative, the entire content of the Supercourse is available for free for everyone, from the website of the Supercourse (http://www.pitt.edu/~super1/). The members of the Supercourse network are academics, researchers, members of the National Academy of Sciences and the Institute of Medicine, and Nobel Prize winners. They have contributed their best PowerPoint lectures to improve public health education in the world. The Supercourse is a "Library of Lectures" with passionate scientific lectures from around the world.

We currently have 40,000 participants from 151 countries, who have contributed more than 3,000 lectures. These lectures are freely available to everyone without copyright restrictions. The Supercourse uses a low bandwidth approach. The lectures are designed so that access is improved in developing countries with slow Internet connections. It is a technology for inexpensive, sustainable public health training. The Supercourse project was funded by NASA and the National Library of Medicine.

The Supercourse team has developed national Supercourse networks containing information pertinent to specific regions of the world, mostly developing countries. These national Supercourses include the Indian, Former Soviet Union (FSU), Islamic and Pakistani Supercourses. The Indian Supercourse Network was developed 3 years ago, as a part of the main Supercourse. The Indian Supercourse is a collection of lectures in public health, on topics of particular interest to teachers and students in India. Currently, we have about 6,500 active collaborators in India. We have more than 130 lectures on topics of interest to audiences in India, such as tropical diseases, family planning and diseases commonly seen in India such as endemic flourosis and iodine deficiency. These lectures are locally produced and also culturally appropriate, and available for free for everyone. They are available online at the Indian Supercourse website (http://www.pitt.edu/~super1/india/india.htm).

The goal of the Supercourse is to make public health knowledge available for everyone. Initiatives such as these will make the process of public health education in developing countries free, will involve multiple disciplines -- not just physicians -- and will be available to everyone interested in getting an education in public health.

Even though the open system model is well developed in the field of information technology, it is a relatively new concept in education. Open source educational systems need the development of standards before they can be widely used (4), such as guidelines for using intellectual property and an effective quality control system. Open source systems have the as-yet untapped potential to dramatically improve public health education in developing countries.

References:

1. World development report 1993: investing in health. Oxford: Oxford University Press, 1993.

2. Public health workforce: challenges and policy issues. Human Resources for Health. URL: http://www.human-resources-health.com/content/1/1/4. Accessed April 3, 2007.

3. C.J. McDonald, G. Schadow, M. Barnes et al., Open source software in medical informatics—why, how, and what. Int. J. Med. Inf. 69 (2003), pp. 175–184.

4. Sa E, Sekikawa A, Linkov F, Lovalekar M, LaPorte RE. Open source model for global collaboration in higher education. Int J Med Inf. 2003 Sep;71(2-3):165.

5. Supercourse Faculty. Global cooperation in higher education. Nat. Med. 6 (2000) 358.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Marriage means having children and forming your family, so what is the need of discussion?' Communication and negotiation of childbearing preferences among Bangladeshi couples
(Abstract; subscription needed for full text; Asia)
Culture, Health and Sexuality . 2007 Mar-Apr;9(2):185-198.
Gipson JD | Hindin MJ
This paper explores communication and negotiation regarding contraception and childbearing based on multiple semi-structured interviews with 19 married couples in southwestern Bangladesh. The narratives of three couples are presented to describe how sociocultural context and gender-based norms influence interactions between husbands and wives and their fertility decision-making. Despite national-level declines in fertility, the couples' stories illustrate the ongoing struggles to balance their desired number of male and female children with their financial and social well-being. The stories also indicate that the nature of the interactions between spouses evolves throughout the course of their marital and reproductive lifespans, resulting in a shift in fertility decision-making power. Both wives and husbands described the relative powerlessness of new wives in negotiating fertility with husbands and extended family; however, wives' preferences appeared to dominate as they became more established in their households. Many wives acted independently and often contrary to their husbands' desires, through their covert use or non-use of contraception and pregnancy termination. These findings illustrate that, despite efforts to increase contraceptive availability within Bangladesh, without concurrent changes in the opportunities available for women beyond their reproductive capacities, the demand for children, and particularly for male children, is not likely to change.



Emergency contraception: Knowledge and attitudes of Turkish nursing and midwifery students
(Abstract; subscription needed for full text; Europe)
European Journal of Contraception and Reproductive Health Care . 2007 Mar;12(1):63-69.
Celik M | Ekerbicer HC | Ergun UG | Tekin N
Objectives: To assess the knowledge and attitudes of emergency contraception (EC) among nursing and midwifery students of a university in the Eastern-Mediterranean region of Turkey. Methods: The survey was conducted among 210 nursing and midwifery students. Results: One hundred and twenty-five participants (59.5%) knew at least one method of EC. One hundred and fourteen participants (54.3%) had heard about emergency contraceptive pills (ECPs), but only 17 (8.1%) knew what they contained. Rates of hearing about ECPs were statistically higher in third and fourth classes than first and second classes, and in midwifery students than in nursing students (P<0.001). In spite of their very unsatisfactory level of knowledge, 166 students (79.0%) thought that ECPs should be sold in pharmacies. Conclusion: The nursing and midwifery students we assessed have a very insufficient knowledge of EC. Probably therefore, many are prejudiced against it. They should be much better acquainted with this modality of contraception since, after graduation, they will play an important role in the dissemination of information about EC in the population.



Oral contraceptive discontinuation: Do side effects matter?
(Abstract; subscription needed for full text; North America)
American Journal of Obstetrics and Gynecology . 2007 Apr;196(4):412.e1-412.e7. (Selected papers from the 25th annual scientific me)
Westhoff CL | Heartwell S | Edwards S | Zieman M | Stuart G
The purpose of this study was to assess self-reported side effects in women after they received the oral contraceptive (OC) and to compare discontinuation rates, according to presence or absence of side effects. The study comprised 1716 women aged < 25 years who initiated the OC at 3 publicly funded family planning clinics and completed structured interviews after 3 and 6 months. Nearly 60% of subjects discontinued the OC by 6 months. Most subjects reported no changes in headaches, weight, moodiness, and sexual satisfaction during the first 3 months of OC use. Subjects with any complaints, especially women with increased headaches or moodiness, were more likely to discontinue the OC prematurely. Nonetheless, most discontinuation occurred for reasons that were unrelated to side effects. Side effects are absent or mild among most OC users, but women with complaints are more likely to discontinue. Side effects are less important reasons for discontinuation than widely believed.



Contraceptive security in the Central Asian Republics: Kazakhstan, Kyrgyzstan, and Tajikistan
(Report; Asia)
Bethesda, Maryland, Abt Associates, Private Sector Partnerships-One [PSP-One], 2006 Sep. (USAID Contract No. GPO-I-00-04-00007-00)
Armand F | O'Hanlon B | Seligman B | Sarley D | Makarova T
Lack of contraceptive commodities has plagued the CAR region for many years. USAID has determined contraceptive security is a barrier to achieving the Mission's health objectives, identifying a need for more information on this topic in Kazakhstan, Kyrgyzstan, and Tajikistan. The PSP-One and DELIVER Projects assessed the state of family planning commodities as well as evaluated the private sector role in promoting contraceptive security. The report provides an overview of these two areas and offers specific recommendations for possible USAID interventions to improve the availability of affordable and quality family planning products in the three Central Asian countries.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

India: Deciding on family size parent's prerogative
(News Article; Asia)
2 Apr 2007
Sunita A, Kangla Online



Pakistan: Lady Health Workers, Lady Health Visitors to be trained on family planning, reproductive health issues
(News Article; Asia)
5 Apr 2007
Online - International News Network



Philippines: Sarangani ustadzes lectured on reproductive health
(News Article; Asia)
02 Apr 2007
Makalay NM, Minda News

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Racial classification regarding semen donor selection in Brazil
(Abstract; subscription needed for full text; South America)
Developing World Bioethics. 2007;:8.
Costa RG
Brazil has not yet approved legislation on assisted reproduction. For this reason, clinics, hospitals and semen banks active in the area follow Resolution 1358/92 of the Conselho Federal de Medicina, dated 30 September 1992. In respect to semen donation, the object of this article, the Resolution sets out that gamete donation shall be anonymous, that is, that the donor and recipients (and the children who might subsequently be born) shall not be informed of each other's identity. Thus, since recipients are unaware of the donor's identity, semen banks and the medical teams involved in assisted reproduction become the intermediaries in the process. The objective of this article is to show that, in practice, this represents disrespect for the ethical principles of autonomy, privacy and equality. The article also stresses that the problem is compounded by the racial question. In a country like Brazil, where racial classification is so flexible and goes side by side with racist attitudes, the intermediary role played by semen banks and medical teams is conditioned by their own criteria of racial classification, which are not always the same as those of donors and semen recipients. The data presented in this paper were taken from two semen banks located in the city of São Paulo (Brazil). At the time of my research, they were the only semen banks in the state of São Paulo and supplied semen to the capital (São Paulo city), the state of São Paulo, and to cities in other Brazilian states where semen banks were not available.

HIV/AIDS RESEARCH

HIV / AIDS-related knowledge and attitudes of Palestinian women in the Occupied Palestinian Territory
(Abstract; subscription needed for full text; Middle East)
American Journal of Health Behavior. 2007 May;Online access April 4, 2007. 31(3):323-334.
Husseini A | Abu-Rmeileh NM
The objective was to explore Palestinian women's knowledge, perceptions, and attitudes towards HIV/ AIDS. Data used in this study were collected as a part of the Demographic and Health Survey (DHS) 2004 in the Occupied Palestinian Territory (OPT). Most of the women in the OPT (93.4%) had heard of AIDS. They had fair general knowledge of HIV/AIDS prevention methods and transmission. TV was the main source of information about HIV/AIDS. Among the determinants of HIV/AIDS knowledge identified by this study were education, region, and locality. A research-informed policy concerning HIV/AIDS prevention should be formulated.



Infant feeding counselling for HIV-infected and uninfected women: Appropriateness of choice and practice
(Research Article; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Bulletin of the World Health Organization. 2007 April;Online access April 4, 2007. 85(4):289-296.
Bland RM | Rollins NC | Coovadia HM | Coutsoudis A | Newell ML
The objective was to examine infant feeding intentions of HIV-infected and uninfected women and the appropriateness of their choices according to their home resources; and to determine their adherence to their intentions in the first postnatal week. Feeding intentions of pregnant women were compared against four resources that facilitate replacement feeding: clean water, adequate fuel, access to a refrigerator and regular maternal income. First-week feeding practices were documented. The antenatal feeding intentions of 1253 HIV-infected women were: exclusive breastfeeding 73%; replacement feeding 9%; undecided 18%. Three percent had access to all four resources, of whom 23% chose replacement feeding. Of those choosing replacement feeding, 8% had access to all four resources. A clean water supply and regular maternal income were independently associated with intention to replacement feed (adjusted odds ratio (AOR) 1.94, 95% confidence interval (CI) 1.2-3.2; AOR 2.1, 95% CI: 1.2-3.5, respectively). Significantly more HIV-infected women intending to exclusively breastfeed, rather than replacement feed, adhered to their intention in week one (exclusive breastfeeding 78%; replacement feeding 42%; P < 0.001). Of 1238 HIV-uninfected women, 82% intended to exclusively breastfeed; 2% to replacement feed; and 16% were undecided. Seventy-five percent who intended to exclusively breastfeed adhered to this intention postnatally, and only 11 infants (< 1%) received no breast milk. The number of antenatal home visits significantly influenced adherence to feeding intention. Most HIV-infected women did not have the resources for safe replacement feeding, instead choosing appropriately to exclusively breastfeed. Adherence to feeding intention among HIV-infected women was higher in those who chose to exclusively breastfeed than to replacement feed. With appropriate counselling and support, spillover of suboptimal feeding practices to HIV-negative women is minimal.



Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: An intervention cohort study
(Abstract; subscription needed for full text; Sub-Saharan Africa)
The Lancet. 2007 Mar 31;Online access April 4, 2007. 369(9567):1107-1116.
Coovadia HM | Rollins NC | Bland RM | Little K | Coutsoudis A
Related Report: Better Breastfeeding, Healthier Lives
Exclusive breastfeeding, though better than other forms of infant feeding and associated with improved child survival, is uncommon. We assessed the HIV-1 transmission risks and survival associated with exclusive breastfeeding and other types of infant feeding. 2722 HIV-infected and uninfected pregnant women attending antenatal clinics in KwaZulu Natal, South Africa (seven rural, one semiurban, and one urban), were enrolled into a non-randomised intervention cohort study. Infant feeding data were obtained every week from mothers, and blood samples from infants were taken monthly at clinics to establish HIV infection status. Kaplan-Meier analyses conditional on exclusive breastfeeding were used to estimate transmission risks at 6 weeks and 22 weeks of age, and Cox's proportional hazard was used to quantify associations with maternal and infant factors. 1132 of 1372 (83%) infants born to HIV-infected mothers initiated exclusive breastfeeding from birth. Of 1276 infants with complete feeding data, median duration of cumulative exclusive breastfeeding was 159 days (first quartile [Q1] to third quartile [Q3], 122-174 days). 14.1% (95% CI 12.0-16.4) of exclusively breastfed infants were infected with HIV-1 by age 6 weeks and 19.5% (17.0-22.4) by 6 months; risk was significantly associated with maternal CD4-cell counts below 200 cells per µL (adjusted hazard ratio [HR] 3.79; 2.35-6.12) and birthweight less than 2500 g (1.81, 1.07-3.06). Kaplan-Meier estimated risk of acquisition of infection at 6 months of age was 4.04% (2.29-5.76). Breastfed infants who also received solids were significantly more likely to acquire infection than were exclusively breastfed children (HR 10.87, 1.51-78.00, p=0.018), as were infants who at 12 weeks received both breastmilk and formula milk (1.82, 0.98-3.36, p=0.057). Cumulative 3-month mortality in exclusively breastfed infants was 6.1% (4.74-7.92) versus 15.1% (7.63-28.73) in infants given replacement feeds (HR 2.06, 1.00-4.27, p=0.051). The association between mixed breastfeeding and increased HIV transmission risk, together with evidence that exclusive breastfeeding can be successfully supported in HIV-infected women, warrant revision of the present UNICEF, WHO, and UNAIDS infant feeding guidelines.



Views of the process and content of ethical review of HIV vaccine trials among members of US institutional review boards and South African research ethics committees
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Developing World Bioethics. 2007;Online access April 4, 2007. :12 p.
Klitzman R
Given the ethical controversies concerning HIV vaccine trials (HVTs), we aimed to understand through an exploratory study how members of institutional review boards (IRBs) in the United States (US) and research ethics committees (RECs) in South Africa (SA) view issues concerning the process and content of reviews of these studies. We mailed packets of 20 questionnaires to 12 US IRB chairs and administrators and seven REC chairs to distribute to their members. We received 113 questionnaires (76 from the US and 37 from SA). In both countries, members tended to be white males with advanced academic degrees. Compared to the US, SA members called for 'major changes' in HVT protocols more frequently (p = 0.004), and were less likely to think that HVT participants understood risks and benefits (p = 0.033) or informed consent forms (p = 0.000). In both countries, members were divided on several critical issues (e.g. the minimum standard for treatment for HVT participants who became infected during the HVT), but agreed that they needed more training. Of the SA respondents, 40% reported that they were 'self-taught' in ethics. This study, the first we know of to offer quantitative data comparing US vs. non-US IRBs/RECs, thus suggests key similarities and differences (e.g. compared to SA respondents, US respondents appeared to overestimate participants' understanding of informed consent), along with needs for education. These initial exploratory data in this area have important implications for IRBs, RECs, policy-makers and scholars concerning future practice, training, policy, and investigations in research ethics, and prevention and treatment of HIV and other diseases in the developing world and elsewhere.

HIV/AIDS NEWS

WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention
(Press Release; Global)
28 Mar 2007
World Health Organization and UNAIDS



UNHCR helps prepare new guidelines for HIV treatment in southern Africa
(News Article; Sub-Saharan Africa)
3 April 2007
United Nations High Council on Refugees



South Africa: Top Court Raps De Lille Over HIV Names
(News Article; Sub-Saharan Africa)
4 April 2007
Mabuza E, Business Day



Uganda: East African Experts Back Circumcision
(News Article; Sub-Saharan Africa)
1 April 2007
Olupot M, New Vision



South Africa: HIV-positive foreigners getting a rough deal in country
(News Article; Sub-Saharan Africa)
3 April 2007
Mphuthing P, Business Day



Liberia: Communities Benefit from HIV Awareness Exercise
(News Article; Sub-Saharan Africa)
4 April 2007
The Inquirer

MATERNAL AND CHILD HEALTH RESEARCH

Gestational weight gain and child adiposity at age 3 years
(Abstract; subscription needed for full text; Global | North America)
American Journal of Obstetrics and Gynecology. 2007 Mar 31;196(4):322e1-322e8.
Oken E | Taveras EM | Kleinman KP | Rich-Edwards JW | Gillman MW
Related News Article: Weight gain in pregnancy predicts weight of child
The purpose of this study was to examine the associations of gestational weight gain with child adiposity. Using multivariable regression, we studied associations of total gestational weight gain and weight gain according to 1990 Institute of Medicine guidelines with child outcomes among 1044 mother-child pairs in Project Viva. Greater weight gain was associated with higher child body mass index z-score (0.13 units per 5 kg [95% CI, 0.08, 0.19]), sum of subscapular and triceps skinfold thicknesses (0.26 mm [95% CI, 0.02, 0.51]), and systolic blood pressure (0.60 mm Hg [95% CI, 0.06, 1.13]). Compared with inadequate weight gain (0.17 units [95% CI, 0.01, 0.33]), women with adequate or excessive weight gain had children with higher body mass index z-scores (0.47 [95% CI, 0.37, 0.57] and 0.52 [95% CI, 0.44, 0.61], espectively) and risk of overweight (odds ratios, 3.77 [95% CI: 1.38, 10.27] and 4.35 [95% CI: 1.69, 11.24]). New recommendations for gestational weight gain may be required in this era of epidemic obesity.



Effects of birth spacing on maternal health: A systematic review
(Abstract; subscription needed for full text; Global | South America)
American Journal of Obstetrics and Gynecology. 2007 Apr;196(4):297-308.
Conde-Agudelo A | Rosas-Bermudez A | Kafury-Goeta AC
The objective of the study was to explore the association between birth spacing and risk of adverse maternal outcomes. The study was a systematic review of observational studies that examined the relationship between interpregnancy or birth intervals and adverse maternal outcomes. Twenty-two studies met the inclusion criteria. Overall, long interpregnancy intervals, possibly longer than 5 years, are independently associated with an increased risk of preeclampsia. There is emerging evidence that women with long interpregnancy intervals are at increased risk for labor dystocia and that short intervals are associated with increased risks of uterine rupture in women attempting a vaginal birth after previous cesarean delivery and uteroplacental bleeding disorders (placental abruption and placenta previa). Less clear is the association between short intervals and other adverse outcomes such as maternal death and anemia. Long interpregnancy intervals are independently associated with an increased risk of preeclampsia. Both short and long interpregnancy intervals seem to be related to other adverse maternal outcomes, but more research is needed.



A financial road map to scaling up essential child health interventions in 75 countries
(Research Article; Global)
Bulletin of the World Health Organization . 2007 Apr;85(4):305-314.
Stenberg K | Johns B | Scherpbier RW | Edejer TT
The objective was to estimate the additional resources required to scale up interventions to reduce child mortality and morbidity within the context of the fourth Millennium Development Goal's aim to reduce mortality among children aged < 5 years by two-thirds by 2015. A costing model was developed to estimate the financial resources needed in 75 countries to scale up priority interventions that address the major causes of mortality among children aged < 5 years, including malnutrition, pneumonia, diarrhoea, malaria and key newborn causes of death such as sepsis. Calculations were made using bottom-up and ingredients-based approaches; this allowed financial costs to be estimated for each intervention, country and year. Costs reflect WHO guidelines on inputs and delivery strategies and encompass the delivery of interventions at community and facility levels. These costs also include programme-specific investments needed at national level and district level. The scale-up scenario predicts that an additional US$ 52.4 billion will be required for the period 2006-2015. This represents an increase in total per-capita health expenditure in the 75 countries of US$ 0.47 in 2006; this is projected to increase to US$ 1.46 in 2015. Projected costs in 2015 are equivalent to increasing the average total health expenditure from all financial sources in the 75 countries by 8% and raising general government health expenditure by 26% over 2002 levels. (The latest data available at the time of the study were for 2002.) The scale-up scenario indicates that countries with weak health systems may experience difficulties mobilizing enough domestic public funds. While the results are approximate estimates, they show a substantial investment gap that low- and middle-income countries and their development partners need to bridge to reach the fourth Millennium Development Goal.



Estimated global resources needed to attain universal coverage of maternal and newborn health services
(Research Article; Global)
Bulletin of the World Health Organization. 2007 Apr;Online access April 4, 2007. 85(4):256-263.
Johns B | Sigurbjornsdottir K | Fogstad H | Zupan J | Mathai M
The objective was to estimate the amount of additional resources needed to scale up maternal and newborn health services within the context of the Millennium Development Goals, and to inform countries, donors and multilateral agencies about the resources needed to achieve these goals. A costing model based on WHO's clinical guidelines was used to estimate the incremental resource needs for maternal and newborn health care in 75 countries. The model estimated the costs for care during pregnancy, childbirth, the neonatal period and the postpartum period, as well as the costs for postpartum family planning and counselling, abortion and post-abortion care; programme-level costs were also estimated. An ingredients-based approach, with financial costs for the years 2006 to 2015 as the output, allowed estimates to be made of country-specific and year-specific populations, unit costs and scale-up rates. Two scenarios using different scale-up rates were used (moderate and rapid). The results show that a minimum yearly average increase in resources of US$ 3.9 billion is needed, although annual costs increase over the time period of the model. When more rapid rates of scale-up are assumed, this minimum figure may be as high as US$ 5.6 billion per year. The 10-year estimated incremental costs range from US$ 39.3 billion for a moderate scale-up scenario to US$ 55.7 billion for the rapid scale-up scenario. These projections of future financial costs may be used as a starting point for mobilizing global resources. Countries will have to further refine these estimates, but these figures may serve as goals towards which donors can direct their plans. Further research is needed to measure the costs of health system reforms, such as recruiting, training and retaining a sufficient number of personnel.

MATERNAL AND CHILD HEALTH NEWS

Malawi moves to ensure mother and child health
(News Article; Sub-Saharan Africa)
2007 Mar 30;
De Capua J



Maternal death is 'tip of iceberg', UNFPA executive director warns
(News Article; Global)
2007 Apr 2;
UNFPA



South Africa: Food for breastfeeding moms
(News Article; Sub-Saharan Africa)
2007 Apr 2;
Cullina K

MEN'S HEALTH RESEARCH

Male circumcision for prevention of HIV and other sexually transmitted diseases
(Abstract; subscription needed for full text; Global)
Pediatrics. 2007 Apr;119(4):821-822.
Flynn P | Havens P | Brady M | Emmanuel P | Read J
A recent commentary in Pediatrics reviewed the documented medical benefits of newborn male circumcision, including protection against balanoposthitis, phimosis, infections of the urinary tract in male infants, and protection against human papillomavirus-associated genital cancers and HIV and Chlamydia infection in adolescents and adults. Low rates of minor surgical complications (0.2%-0.6%) and safety and efficacy of local anesthesia were noted. The ability of newborn circumcision to protect against sexually transmitted diseases (STDs) was also shown in a recently published cohort study from New Zealand. Recent large randomized clinical trials in South Africa, Kenya, and Uganda demonstrated reduction of HIV-acquisition risk by male circumcision performed outside the newborn period, showing the role of adult male circumcision in prevention of STDs in adolescents and adults. An association between lack of male circumcision and acquisition of HIV infection was first noted in 1986. Over the next 10 years, more than 35 studies including ecologic, cross-sectional, case-control, and cohort studies in general and high-risk populations throughout the world evaluated the possible protective effect of male circumcision against HIV acquisition. A systematic review summarized the studies from sub-Saharan Africa and showed an estimate of the adjusted relative risk of HIV acquisition of 0.42 (95% confidence interval [CI]: 0.34-0.54; protection of 58%) in circumcised compared with uncircumcised male subjects. The impact of male circumcision on prevention of HIV acquisition was greater in high-risk groups than in the general population. A cohort study has also suggested that transmission of HIV to female partners of men with HIV may be lower when the male partner is circumcised. (excerpt)



Masculine beliefs, parental communication, and male adolescents' health care use
(Abstract; subscription needed for full text; North America)
Pediatrics. 2007 Apr;119(4):e966-e975.
Marcell AV | Ford CA | Pleck JH | Sonenstein FL
Male adolescents frequently become disconnected from health care, especially as they get older, which limits physicians' abilities to address their health needs and results in missed opportunities to connect them to the health care system as they enter adulthood. In this study we tested the ability of modifiable (beliefs about masculinity, parental communication, sex education, and health insurance) and nonmodifiable (age, race/ethnicity, and region of residence) factors to prospectively predict health care use by male adolescents. We conducted a prospective analysis of data from 1677 male participants aged 15 to 19 years who completed the National Survey of Adolescent Males, a household probability survey conducted throughout the United States in 1988 (wave 1, participation rate: 74%) and in 1990-1991 (wave 2, follow-up rate: 89%). We present percentages and adjusted relative risks of the factors that predict male adolescents' self-report of a physical examination by a regular provider in the past year measured at wave 2. On average, 1067 (66%) of 1677 male adolescents at wave 2 reported having a physical examination within the last year. Factors associated with a lower likelihood of a physical examination included living in the South, Midwest, and West; being older in age; and holding more traditional masculine beliefs. Factors associated with a higher likelihood of a physical examination included communicating about reproductive health with both parents and being insured. Male adolescents who were sexually active or engaged in = 2 other risk behaviors had neither a higher nor lower likelihood of a physical examination. Efforts to enhance male adolescents' health through health care should include work to modify masculine stereotypes, improve mothers' and fathers' communication about health with their sons, expand health insurance coverage, and identify interventions to connect male adolescents at increased risk for health problems with health care.

MEN'S HEALTH NEWS

PLoS Medicine publishes opinion pieces about male circumcision, HIV prevention
(Commentary; Sub-Saharan Africa)
2 Apr 2007
Medical News Today
Related Commentary: Circumcision for HIV prevention: failure to fully account for behavioral risk compensation
Related Commentary: Circumcision for HIV prevention: authors' reply



Ugandan men are queueing for the kindest cut
(News Article; Sub-Saharan Africa)
1 Apr 2007
Sunday Tribune & Independent Online



Prostate cancer risk factors identified
(News Article; Global | North America)
3 Apr 2007
Science Daily
Related Letter to the Editor: Multiple regions within 8q24 independently affect risk for prostate cancer
Related News Article: Prostate cancer risk factors identified

POPULATION RESEARCH

Moving lives: Migration and livelihoods in the Lao PDR
(Abstract; subscription needed for full text; Asia)
Population, Space and Place . 2007 May-Jun;13(3):163-178.
Rigg J
Laos is one of the poorest and most 'rural' countries in the world. Yet there is evidence of heightened levels of mobility as the country is drawn into the wider mainland Southeast Asian region. Mobility is becoming increasingly important in supporting and defining livelihoods for some households and villages. The paper reviews the evidence for growing levels of mobility in Laos and, drawing on the experience of the wider region, reflects upon the implications of this for source communities in terms of economy and society. The paper highlights the shifting nature of the meaning of mobility for migrants and, therefore, for villages of origin and those 'left behind'. The paper proposes that rather than searching out hard-and-fast views of migration and its impacts, the focus should be on 14 identified questions or lines of influence.



Vietman: Able to come and go: Reproducing gender in female rural-urban migration in the Red River Delta
(Abstract; subscription needed for full text; Asia)
Population, Space and Place. 2007 May-Jun;13(3):211-224.
Resurreccion BP | Khanh HT
By examining household gender relations between migrant women and their left-behind husbands, we aim to understand how gender shapes rural--urban migration and is being negotiated in the context of market-driven rural transformations in the Red River Delta. In this study, rural women ensure the survival of their households as they link up with urban informal labour markets, moving to the city to work as junk collectors and buyers. Female migration destabilises conventional gender roles as left-behind husbands take up social reproductive work that is partially relieved by wives' frequent home visits. Additionally, invoking women's traditional obligations, left-behind husbands continue to 'feel like men', underscoring the resilience of conventional gendered norms on work, even where men actually take up women's work in their wives' absence. The article argues for a more nuanced understanding of this resilience premised on the principles of structured agency, suggesting that actors may actively reproduce gendered notions of work in order to cope with changing spatial arrangements of household livelihood strategies brought about by political economic pressures and opportunities in rural and urban Vietnam.

POPULATION NEWS

Jordan: Development policies should match demographic transition, say experts
(News Article; Middle East)
04 Apr 2007
Namrouqa H, Jordan Times



Egyptian born 'every 23 seconds'
(News Article; North Africa)
03 Apr 2007
BBC News



China: Give birth at a price
(Commentary; Asia)
05 Apr 2007
Sahay N, The Telegraph



Nepal: Govt to Expand Drive to Curb Infant, Mother Mortality
(News Article; Asia)
03 Apr 2007
The Himalayan Times

WOMEN'S HEALTH RESEARCH

Cervical cancer prevention: safety, acceptability, and feasibility of a single-visit approach in Accra, Ghana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
American Journal of Obstetrics and Gynecology. 2007 Apr;196(4):407.e1-407.e9. (Selected papers from the 25th annual scientific me)
Blumenthal PD | Gaffikin L | Deganus S | Lewis R | Emerson M
The purpose of this study was to assess the safety and acceptability of a single-visit approach to cervical cancer prevention combining visual inspection of the cervix with acetic acid wash (VIA) and cryotherapy. The study was observational. Nine clinicians were trained in VIA and cryotherapy. Over 18 months 3665 women were VIA-tested. If positive and eligible, cryotherapy was offered immediately. Treated women were followed-up at 3 months and 1 year. The test-positive rate was 13.2%. Of those eligible, 70.2% and 21% received immediate or delayed treatment, respectively. No major complications were recorded, and 5.6% presented for a perceived problem post-cryotherapy. Among those treated over 90% expressed satisfaction with their experience, and 96% had an indentifiable squamo-columnar junction. Only 2.6% (6/232) were test positive, 1-year posttreatment. A single-visit approach using VIA and cryotherapy proved to be safe, acceptable, and feasible in an urban African setting.



One step forward, two steps back? Conundrums of the rape legal reform campaign in Malaysia
(Abstract; subscription needed for full text; Asia)
Gender, Technology and Development. 2007 Mar;11(1):53-74.
Hui TB
This article looks at how initiatives to improve laws relating to rape in Malaysia have affected the overall national discourse on sexuality and gender, including that on sexuality rights. Following the introduction which lays out the context in which the article's analysis is grounded, the article traces the history of the rape legal reform campaign--how this began, what its initial motivations were, and which demands were finally achieved out of the first phase of lobbying by women's groups in the mid- to late-1980s. An update and discussion on the outcome of the second phase of the anti-rape campaign (late-1990s to present day) is also provided. Through this, the article examines the movement's successes, shortcomings and the factors governing these, as well as critiques the actions by women's groups in advocating further reforms to the law. It concludes with a discussion on the lessons learnt and what needs to be considered to ensure that sexual spaces, discourses and rights are not marginalized further in the current political milieu.



Developing an HPV vaccine to prevent cervical cancer and genital warts
(Abstract; subscription needed for full text; Global)
Vaccine. 2007 Apr 20;25(16):3001-3006.
Bryan JT
The challenges of the journey from target identification through development of a prophylactic quadrivalent human papillomavirus (HPV) vaccine have been met in Gardasil. Cervical cancer is the second leading cause of cancer-related death in women worldwide. Approximately 70% of cervical cancer is caused by infection with HPV types 16 and 18 and ~90% of genital warts are caused by HPV types 6 and 11. The quadrivalent HPV vaccine was generated by expression of the major capsid protein (L1) of HPV types 16, 18, 6 and 11 in yeast. L1 proteins self assemble into pentamer structures and these pentamer structures come together to form virus-like particles (VLPs). The VLPs are antigenically indistinguishable from HPV virions. The VLPs contain no viral DNA and therefore the vaccine is non-infectious. Gardasil is composed of VLPs of HPV types 16, 18, 6 and 11 conjugated to a proprietary amorphous aluminum hydroxyphosphate sulfate adjuvant. The results of a rigorous clinical program have demonstrated that the vaccine is safe and highly efficacious in preventing dysplasias, cervical intraepithelial neoplasias (CIN 1-3) the precursors of cervical cancer and external genital lesions caused by vaccine-HPV types. In conclusion, Gardasil addresses a major medical need, that is, reduction of HPV-related disease including cervical cancer as a safe, immunogenic, and highly efficacious vaccine.

WOMEN'S HEALTH NEWS

Eritrea bans female circumcision
(News Article; Sub-Saharan Africa)
5 Apr 2007
Kimball J, Reuters



Nepal Ceasefire Allows Mobile Team to Care for Women's Health
(Feature Article; Asia)
UNFPA



Sierra Leone: Women, government launch campaign against sexual violence
(News Article; Sub-Saharan Africa)
4 Apr 2007
PlusNews

YOUTH HEALTH RESEARCH

Improving school ethos may reduce substance misuse and teenage pregnancy
(Research Article; Global)
BMJ. British Medical Journal. 2007 Mar 24;Online access April 4, 2007. 334(7594):614-616.
Bonell C | Fletcher A | McCambridge J
Substance misuse and teenage pregnancy are major public health challenges. Existing responses generally focus on individual characteristics, such as knowledge and attitudes about substances and sexual risk, rather than wider social and institutional influences, and seem to have brought about only limited benefits. We review evidence suggesting that interventions aiming to promote one such wider influence--positive school ethos--might provide an effective complement to existing interventions.



Pubertal transitions in health
(Research Article; Global)
Lancet. 2007 Mar 31;Online access April 4, 2007. 369(9567):1130-1139.
Patton GC | Viner R
Puberty is accompanied by physical, psychological, and emotional changes adapted to ensure reproductive and parenting success. Human puberty stands out in the animal world for its association with brain maturation and physical growth. Its effects on health and well-being are profound and paradoxical. On the one hand, physical maturation propels an individual into adolescence with peaks in strength, speed, and fitness. Clinicians have viewed puberty as a point of maturing out of childhood-onset conditions. However, puberty's relevance for health has shifted with a modern rise in psychosocial disorders of young people. It marks a transition in risks for depression and other mental disorders, psychosomatic syndromes, substance misuse, and antisocial behaviours. Recent secular trends in these psychosocial disorders coincide with a growing mismatch between biological and social maturation, and the emergence of more dominant youth cultures.

YOUTH HEALTH NEWS

Indian state bans sex education
(News Article; Asia)
3 April 2007
BBC



Botswana: Aya programme benefits Batswana youth
(News Article; Sub-Saharan Africa)
2 April 2007
Chwaane T, Mmegi

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