Johns Hopkins Bloomberg School of Public Health: The INFO Project

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The Pop Reporter®

Volume 7, Number 15
30 April 2007

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Note: To better meet your information needs, starting May 7, 2007, The Pop Reporter will group research and news items under new topical categories. Watch for the change and an explanation of the categories in next week's issue of The Pop Reporter.

Guest Editorials (free with every subscription)

Achieving Healthy Pregnancy Outcomes Through Healthy Timing and Spacing of Pregnancies


Author: May Post, MD, MBBS, DP&TM, Senior Reproductive Health and Family Planning Advisor, with Shannon Pryor, Extending Service Delivery Project

mpost@esdproj.org

More than 500,000 women die annually during childbirth; 99 percent of these deaths occur in the developing world (1). Additionally, more than 4 million newborns die each year (2). A large proportion of these deaths are preventable. Healthy pregnancy outcomes can be improved immensely through the healthy timing and spacing of pregnancies (HTSP).

Women and families want to know the safest time to become pregnant. Analyses of data from several countries demonstrate that when a woman becomes pregnant too quickly following a previous birth, miscarriage, or abortion, she faces greater health risks. A short interval between a birth and the next pregnancy also places the newborn at increased health risk.

In June 2005, WHO, with USAID support, held a technical consultation to review the evidence from six papers on the relationship between timing and spacing of pregnancies and health outcomes. Within the context of informed choice about spacing or limiting future pregnancies, for those who choose to space, the following recommendations contained in the 2006 WHO Policy Brief, in conjunction with the preamble, should be incorporated into counseling and behavior change communication messages (3):

• After a live birth, the recommended interval before attempting the next pregnancy is at least 24 months to reduce the risk of adverse maternal, perinatal and infant outcomes.

• After a miscarriage or induced abortion, the recommended minimum interval to the next pregnancy is at least six months in order to reduce the risk of adverse maternal and perinatal outcomes (4).

To assist women and couples achieve healthy pregnancy intervals, counseling should include the range of contraceptive methods that are available, including long-acting methods, fertility awareness methods and appropriate methods for breastfeeding women in the first six weeks postpartum.

HTSP provides an opportunity to highlight that family planning is a health intervention using the framework of healthy mothers, healthy infants, and healthy communities. Men, religious and community leaders, and others, who were initially resistant to FP but eager to keep their families healthy, have valued counseling and training on HTSP and have become HTSP champions in their communities.

The Extending Service Delivery Project is working to operationalize the two recommendations in the WHO Policy Brief. To do so, ESD will develop an HTSP counseling module containing information to help a woman and her husband/partner make informed decisions about HTSP that support their RH/FP goals. Counseling information will include information on return to fertility, risks to mother and infant of intervals that are too close, benefits of healthy pregnancy timing and spacing, risk of FP discontinuation, information on the methods, and timing of first pregnancies in adolescents. To roll out HTSP and incorporate it into a wide range of programs, ESD has created an HTSP Core Group.

For more information on HTSP and the ESD project, please visit www.esdproj.org. If you are interested in joining the HTSP Core Group, please contact: info@esdproj.org.

References:

1. UNFPA. (2004). Saving Mother Lives: The challenge continues. New York: UNFPA.

2. Lawn, Joy E, Jelka Zupan. (2005). 4 Million Nenonatal deaths: When? Where? Why? The Lancet 365:891-900.

3. World Health Organization. (2006). Report of a WHO Technical Consultation on Birth Spacing Geneva, Switzerland, 13–15 June 2005. Geneva: World Health Organization.

4. Ibid.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Effect of single administration of levonorgestrel on the menstrual cycle
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Contraception . 2007 May;75(5):372-377.
Okewole IA | Arowojolu AO | Odusoga OL | Oloyede OA | Adeleye OA
Levonorgestrel (LNG) 1.5 mg administered within 72 h of unprotected coitus is an established method of emergency contraception. Currently, there is some, although incomplete, knowledge about the mechanism of action. The authors administered 1.5 mg LNG peri-ovulatory to determine the effects on serum gonadotrophins, estradiol and progesterone levels. Fourteen women were studied in a pretreatment and treatment cycle; eight women (Group A) took LNG 3 days before the expected day of ovulation, while 6 (Group B) took LNG a day before the expected day of ovulation. The women in Group A had a significant delay in their LH peak and onset of the next menses compared with their pretreatment cycles (26.4 vs. 39.1 days, p less than .05). Those in Group B had no significant changes in the endocrine parameters but there was a significant shortening of the mean cycle length in comparison with their pretreatment cycles (25.1 vs. 20.2 days). Levonorgestrel 1.5 mg acts as an emergency contraception by delaying the LH surge and interfering with ovulation. It may also disrupt corpus luteum formation causing premature luteinization of unruptured follicles.



Reaching providers is not enough to increase IUD use: A factorial experiment of 'academic detailing' in Kenya
(Review/Synthesis; Sub-Saharan Africa)
Journal of Biosocial Science . Online access April 20, 2007. :14 p.
Wesson J | Olawo A | Bukusi V | Solomon M | Pierre-Louis B
Related Review/Synthesis: Marketing and Communication Strategies for "Revitalizing" the IUD
(You need Adobe Acrobat Reader to access this document)
Although the IUD is an extremely effective and low-cost contraceptive method, its use has declined sharply in Kenya in the past 20 years. A study tested the effectiveness of an outreach intervention to family planning providers and community-based distribution (CBD) agents in promoting use of the IUD in western Kenya. Forty-five public health clinics were randomized to receive the intervention for providers only, for CBD agents only, for both providers and CBD agents, or no detailing at all. The intervention is based on pharmaceutical companies' 'detailing' models and included education/motivation visits to providers and CBD programmes, as well as provision of educational and promotional materials. District health supervisors were given updates on contraceptives, including the IUD, and were trained in communication and message development prior to making their detailing visits. Detailing only modestly increased the provision of IUDs, and only when both providers and CBD agents were targeted. The two detailing visits do not appear sufficient to sustain the effect of the intervention or to address poor provider attitudes and lack of technical skills. The cost per 3.5 years of pregnancy protection was US$49.57 for the detailing intervention including the cost of the IUD, compared with US$15.19 for the commodity costs of the current standard of care -- provision of the injectable contraceptive depotmedroxyprogesterone acetate (DMPA). The effectiveness of provider-based activities is amplified when concurrent demand creation activities are carried out. However, the cost of the detailing in comparison to the small number of IUDs inserted indicates that this intervention is not cost-effective.



Determinants of current contraceptive use and method choice in Mongolia
(Abstract; subscription needed for full text; Asia)
Journal of Biosocial Science . Online access April 20, 2007. :17 p.
Gereltuya A | Falkingham J | Brown J
This study examines the determinants of current contraceptive use and method choice in Mongolia using data from the 1998 Mongolian Reproductive Health Survey and 2000 Mongolian Population and Housing Census. Since 1976, access to modern contraceptives has been liberalized and all restrictions on the use, distribution and import of contraceptives were removed in 1989. There were some increases in the use of modern contraceptives among married women in the 1990s; however, at the start of the twenty-first century the IUD and periodic abstinence remain the most widely used methods. Women with higher levels of education are more likely to be current users of contraception, and if they are current users, they are more likely to choose the IUD and traditional methods. Women living in rural areas have a higher probability of using contraception and are more likely to choose the IUD and traditional methods. Significant variations exist between primary sampling units in current contraceptive use and in the choice of modern methods. Community-level variables were important predictors in reducing variation between primary sampling unit, when other modern methods were compared with traditional methods.



Sexually transmitted and reproductive tract infections in symptomatic clients of pharmacies in Lima, Peru
(Abstract; subscription needed for full text; South America)
Sexually Transmitted Infections . 2007 Apr;83(2):142-146.
Garcia PJ | Carcamo CP | Chiappe M | Holmes KK
The objective was to determine prevalences and predictors of sexually transmitted and reproductive tract infections among men and women seeking care at pharmacies. Men and women with urethral discharge or dysuria and vaginal discharge were enrolled at 12 central and 52 smaller pharmacies in Lima, Peru. All participants answered a questionnaire. Men provided urine for polymerase chain reaction (PCR) testing for Neisseria gonorrhoeae and Chlamydia trachomatis, and for leucocyte esterase testing. Women provided self-obtained vaginal swabs for PCR testing for N gonorrhoeae and C trachomatis, Trichomonas vaginalis culture and bacterial vaginosis and Candida. Among 106 symptomatic men, N gonorrhoeae and C trachomatis were detected in 34% and were associated with urethral discharge compared with dysuria only (odds ratio (OR) 4.3, p = 0.003), positive urine leucocyte esterase testing (OR 7.4, p = 0.009), less education (OR 5.5, p = 0.03), and with symptoms for less than 5 days (OR 2.5, p = 0.03). Among 121 symptomatic women, 39% had bacterial vaginosis or T vaginalis, and 7.7% had candidiasis. N gonorrhoeae and C trachomatis were detected in 12.4% of the women. Overall, 48.8% had one or more of these infections. No factors were associated with vaginal infection, and only symptoms of vaginal discharge for less than 5 days were associated with N gonorrhoeae and C trachomatis (OR 4.0, p = 0.02). The main reason reported for seeking advice at pharmacies by both men and women was trust in pharmacy workers. Among men and women presenting to pharmacies with urethral and vaginal symptoms, rates of urethral and vaginal infections were comparable to those found in other clinical settings. Pharmacies can contribute to the care and prevention of sexually transmitted infection in developing countries.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

World Bank's Wolfowitz pushes back
(News Article; North America)
24 Apr 2007
Mekay E, Inter Press Service News Agency



Family planning key to Afghan maternal deaths: U.N.
(News Article; Asia)
23 Apr 2007
Reuters



Expert calls for family planning in Philippines
(News Article; Asia)
24 Apr 2007
Dacanay BM, Gulf News



Pakistan: Nasim Lodhi stresses family planning awareness
(News Article; Asia)
23 Apr 2007
Daily Times

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Bangladesh: Planned population growth
(News Article; Asia)
26 Apr 2007
Ahmed Z, The Financial Express

HIV/AIDS RESEARCH

HIV drug resistance surveillance for prioritizing treatment in resource-limited settings
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2007 May 11;21(8):973-982.
Walensky RP | Weinstein MC | Yazdanpanah Y | Losina E | Mercincavage LM
Sentinel testing programs for HIV drug resistance in resource-limited settings can inform policy on antiretroviral therapy (ART) and drug sequencing. The objective was to examine the value of resistance surveillance in influencing recommendations toward effective and cost-effective sequencing of ART regimens. A state-transition model of HIV infection was adapted to simulate clinical care in Cote d'Ivoire and evaluate the incremental cost-effectiveness of (1) no ART; (2) ART beginning with a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen followed by a boosted protease inhibitor (PI)-based regimen; and (3) ART beginning with a boosted PI-based regimen followed by an NNRTI-based regimen. At a 5% prevalence of NNRTI resistance, a strategy that started with a PI-based regimen had a smaller health benefit and higher cost-effectiveness ratio than a strategy that started with an NNRTI-based regimen (cost-effectiveness ratio $910/year of life saved). Results consistently favored initiation with an NNRTI-based regimen, regardless of the population prevalence of NNRTI resistance (up to 76%) and the efficacy of an NNRTI-based regimen in the setting of resistance. The most influential parameters on the cost-effectiveness of sequencing strategies were boosted PI-based regimen costs and the efficacy of this regimen when used as second-line therapy. Drug costs and treatment efficacies, but not NNRTI resistance levels, were most influential in determining optimal HIV drug sequencing in Cote d'Ivoire. Results of surveillance for NNRTI resistance should not be used as a major guide to treatment policy in resource-limited settings.



Pregnancy and the risk of HIV-1 acquisition among women in Uganda and Zimbabwe
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2007 May 11;21(8):1027-1034.
Morrison CS | Wang J | Van Der Pol B | Padian N | Salata RA
Several studies have suggested that pregnancy is associated with an increased risk of HIV-1 acquisition. We used data from a large, prospective study of hormonal contraception and HIV-1 to evaluate the effect of pregnancy on the risk of HIV-1 acquisition. Design: A multicenter prospective cohort study. Methods: We examined 4439 women from family planning sites in Uganda and Zimbabwe contributing 31,369 follow-up visits during 1999-2004. Participants were aged 18-35 years, and had received pregnancy and HIV-1 testing quarterly for 15-24 months. Using proportional hazards modeling, we compared the time to HIV-1 acquisition among four groups: pregnant women, non-pregnant lactating (NP/L) women, and women neither pregnant nor lactating (NP/NL) who were either using or not using hormonal contraception. A total of 211 participants became HIV-1 infected (2.7 per 100 woman-years; wy), including 13 pregnant women (1.6 per 100 wy), 33 NP/L women (2.7 per 100 wy), 126 NP/NL women using hormonal contraception (2.9 per 100 wy), and 39 NP/NL women not using hormonal contraception (2.7 per 100 wy). In multivariable analysis adjusting for site, age, living with partner, risky sexual behaviors, and incident vaginal, cervical and herpes simplex virus 2 infections, neither pregnant, NP/L, nor NP/NL women using hormonal contraception were at an increased risk of HIV-1 acquisition compared with NP/NL women not using hormonal contraception. Neither pregnancy nor lactation placed women at increased risk of HIV-1 acquisition in this multisite, prospective study of African women. This information is important in planning interventions to reduce HIV-1 acquisition among women.



Treatment interruptions predict resistance in HIV-positive individuals purchasing fixed-dose combination antiretroviral therapy in Kampala, Uganda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2007 May 11;21(8):965-971.
Oyugi JH | Byakika-Tusiime J | Ragland K | Laeyendecker O | Mugerwa R
The objective was to evaluate adherence, treatment interruptions, and outcomes in patients purchasing antiretroviral fixed-dose combination (FDC) therapy. Ninety-seven participants were recruited into a prospective 24-week observational cohort study of HIV-positive, antiretroviral-naive individuals initiating self-pay Triomune or Maxivir therapy in Kampala, Uganda. Adherence was measured by monthly structured interview, unannounced home pill count, and electronic medication monitors (EMM). Treatment interruptions were measured as continuous intervals greater than 48 h without opening the EMM. The primary outcomes were survival with viral suppression below 400 copies/ml, CD4 cell increases, and genotypic drug resistance at 24 weeks. The median baseline CD4 cell count was 56 cells/ml and median log10 copies RNA/ml was 5.54; mean adherence ranged from 82 to 95% for all measures but declined significantly over time. In an intent-to-treat analysis, 70 (72%) patients had an undetectable plasma HIV-RNA level at week 24. Sixty-two of 95 (65%) individuals with continuous EMM data had a treatment interruption of greater than 48 h. Treatment interruptions accounted for 90% of missed doses. None of 33 participants who did not interrupt treatment for over 48 h had drug resistance, whereas eight of 62 (13%) participants who did interrupt therapy experienced drug resistance. Antiretroviral resistance was seen in 8% of individuals and overall mortality was 10% at 24 weeks. HIV-positive individuals purchasing generic FDC antiretroviral therapy have high rates of adherence and viral suppression, low rates of antiretroviral resistance, and robust CD4 cell responses. Adherence is an important predictor of survival with full viral suppression. Treatment interruptions are an important predictor of drug resistance.



Bacteremia in adult patients with acquired immunodeficiency syndrome in the northeast of Thailand
(Abstract; subscription needed for full text; Asia)
International Journal of Infectious Diseases. 2007 May;11(3):226-231.
Mootsikapun P
Bacteremia is a frequent complication found in HIV-infected patients and is usually associated with a poor prognosis. This study was undertaken to describe the bacterial pathogens causing bacteremia in adult Thai HIV-infected patients, and hence to give guidance in the choice of empirical antimicrobials. Blood culture results at Srinagarind Hospital, Khon Kaen during the period January 1996 to December 2001 were retrospectively reviewed. In HIV-infected and HIV-uninfected patients, 172 and 4082 episodes of bacteremia occurred, respectively. In HIV-infected patients, community-acquired and nosocomial bacteremia were found in 78.5% and 21.5%, respectively and most were monomicrobial. Gram-negative bacteria were the main pathogens isolated in both groups of bacteremia. Escherichia coli and methicillin-resistant Staphylococcus aureus were more common pathogens causing nosocomial bacteremia in HIV-infected patients, whereas Acinetobacter spp were more common in HIV-uninfected patients. Salmonella spp, especially Salmonella groups D and B, were the most common (62.2%) pathogen in community-acquired bacteremia in HIV-infected patients whereas Escherichia coli was the most common in HIV-uninfected patients. Only a fewepisodes of community-acquired bacteremia in HIVinfected patients had identified sources. Co-trimoxazole resistance was common in communityacquired bacteremia caused by Gram-negative bacilli in HIV-infected patients, with Salmonella group B being more resistant to co-trimoxazole than Salmonella group D (statistically significant, p less than 0.001). However, resistance rates to ceftriaxone and ofloxacin were low. Bacteremia in adult HIV-infected patients was usually caused by Gram-negative bacilli in both community-acquired and nosocomial settings. Salmonella spp was the most common organism identified, especially Salmonella group B and D. Ceftriaxone or fluoroquinolones such as ofloxacin or ciprofloxacin should be used as the initial empiric therapy for HIV-infected patients with suspected bacteremia.



Detection of pulmonary Mycoplasma pneumoniae infections in HIV-infected subjects using culture and serology
(Abstract; subscription needed for full text; Asia)
International Journal of Infectious Diseases. 2007 May;11(3):232-238.
Shankar EM | Kumarasamy N | Balakrishnan P | Saravanan S | Solomon S
The true prevalence of Mycoplasma pneumoniae infections involving the respiratory tracts of HIV-infected individuals is still unclear. This study examined the prevalence of M. pneumoniae in 100 HIV-infected individuals at an AIDS care center in Chennai, India, using conventional laboratory techniques and interpretation criteria. Diagnosis was based on culture, cold agglutination test, and commercial enzyme-linked immunosorbent assay (ELISA) for the qualitative determination of IgM antibodies against M. pneumoniae. The efficacies of the different diagnostic procedures used in the study were analyzed. The prevalence of M. pneumoniae was 31% by culture and 21% by IgM ELISA. Cough (p = 0.03, OR 3.8, 95% CI 1-17.8), myalgia (p = 0.04, OR 2.5, 95% CI 1-6.6), rales (p = 0.04, OR 2.4, 95% CI 1-6.6), and cervical adenopathy (p = 0.03, OR 2.7, 95% CI 1-7.1) were the symptoms that significantly corroborated culture positivity. Patients positive for M. pneumoniae by culture or IgM antibody had significantly greater CD4+ T-cell depletion and anemia than those without any evidence of infection. This study provides the means to diagnose M. pneumoniae infection and information on the prevalence of the pathogen in HIV-infected individuals in resource constrained settings. Although modern molecular techniques may provide more insight into the prevalence of M. pneumoniae in HIV-infected individuals, conventional methods can still be used in diagnosis.



Microsporidiosis in South Africa: PCR detection in stool samples of HIV-positive and HIV-negative individuals and school children in Vhembe district, Limpopo Province
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007 June;101(6):547-554.
Samie A | Obi CL | Tzipori S | Weiss LM | Guerrant RL
Microsporidia were initially recognized as pathogens of insects and fish but have recently emerged as an important group of human pathogens, especially in immune-compromised individuals, such as those with HIV infection. In this study, we used a PCR-RFLP assay confirmed by quantitative real-time PCR and trichrome staining to determine the prevalence of microsporidian infections among hospital patients and school children in Vhembe region. Enterocytozoon bieneusi was the only microsporidian species detected in these stool samples. It was found in 33 (12.9%) of 255 samples from the hospitals and in 3 (4.5%) of 67 samples from primary school children and was significantly associated (P = 0.039) with diarrhea in HIV-positive patients (21.6%) compared to HIV-negative individuals (9%). However, microsporidian infections were not associated with intestinal inflammation as indicated by the lactoferrin test. These results suggest that microsporidia might be a cause of secretory diarrhea in HIV-positive patients. To our knowledge, this is the first report of E. bieneusi in the Vhembe region of South Africa. Further investigations are needed in order to clarify the pathogenesis of E. bieneusi in HIV-positive patients.



Prevalence and risk factors for HIV-1 infection in rural Kilimanjaro region of Tanzania: Implications for prevention and treatment
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMC Public Health. 2007 Apr 19;7(58)
Mmbaga EJ | Hussain A | Leyna GH | Mnyika KS | Sam NE
Variability in stages of the HIV-1 epidemic and hence HIV-1 prevalence exists in different areas in sub-Saharan Africa. The purpose of this study was to investigate the magnitude of HIV-1 infection and identify HIV-1 risk factors that may help to develop preventive strategies in rural Kilimanjaro, Tanzania. A cross-sectional study was conducted between March and May of 2005 involving all individuals aged between 15-44 years having an address in Oria Village. All eligible individuals were registered and invited to participate. Participants were interviewed regarding their demographic characteristics, sexual behaviors, and medical history. Following a pre-test counseling, participants were offered an HIV test. Of the 2,093 eligible individuals, 1,528 (73.0%) participated. The overall age and sex adjusted HIV-1 prevalence was 5.6%. Women had 2.5 times higher prevalence (8.0% vs. 3.2%) as compared to men. The age group 25-44 years, marriage, separation and low education were associated with higher risk of HIV-1 infection for both sexes. HIV-1 infection was significantly associated with greater than 2 sexual partners in the past 12 months (women: Adjusted odds ratio[AOR], 2.5 (95% CI: 1.3-4.7), and past 5 years, [(men: AOR, 2.2 (95% CI:1.2-5.6); women: AOR, 2.5 (95% CI: 1.4-4.0)], unprotected casual sex (men: AOR,1.8 95% CI: 1.2-5.8), bottled alcohol (Men: AOR, 5.9 (95% CI:1.7-20.1) and local brew (men: AOR, 3.7 (95% CI: 1.5-9.2). Other factors included treatment for genital ulcers and genital discharge in the past 1 month. Health-related complaints were more common among HIV-1 seropositive as compared to seronegative participants and predicted the presence of HIV-1 infection. HIV-1 infection was highly prevalent in this population. As compared to our previous findings, a shift of the epidemic from a younger to an older age group and from educated to uneducated individuals was observed. Women and married or separated individuals remained at higher risk of infection. To prevent further escalation of the HIV epidemic, efforts to scale up HIV prevention programmes addressing females, people with low education, lower age at marriage, alcohol consumption, condom use and multiple sexual partners for all age groups remains a top priority. Care and treatment are urgently needed for those infected in rural areas.

HIV/AIDS NEWS

Tenofovir and Truvada licensed in South Africa
(News Article; Sub-Saharan Africa)
26 Apr 2007
Aidsmap



Africa: U.S. HIV/AIDS program blending food aid, anti-retroviral therapy
(News Article; Sub-Saharan Africa)
24 Apr 2007
U.S. Department of State



UNESCO fights HIV/AIDS in southern Africa's education sector
(News Article)
25 Apr 2007
Xinhua



amfAR's trek Africa will educate participants about the reality of AIDS in sub-Saharan Africa
(News Article; Sub-Saharan Africa)
26 Apr 2007
amfAR, The Foundation for AIDS Research



Pakistan's first 'outed' HIV patient turns social activist
(News Article; Asia)
25 Apr 2007
AFP

MATERNAL AND CHILD HEALTH RESEARCH

Effect of hygiene promotion on the risk of reinfection rate of intestinal parasites in children in rural Uzbekistan
(Abstract; subscription needed for full text; Asia)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007 Jun;101(6):564-569.
Gungoren B | Latipov R | Regallet G | Musabaev
A controlled prospective cohort study was designed to assess the effectiveness of hygiene promotion on the risk of reinfection by intestinal parasites in children in 276 rural Uzbek households over a 1-year period. The study included three groups: seasonality (no medicine, no hygiene promotion activity), treatment (medicine provided, no hygiene promotion activity), and hygiene promotion (medicine provided and hygiene promotion activity). The Participatory Hygiene and Sanitation Transformation methodology was utilized as the key tool in hygiene promotion activities. Three hygiene behaviors were targeted: hand washing with soap, safe feces disposal, and boiling drinking water. On average, more than 80% of all children tested were infected with Enterobius vermicularis, Hymenolepis nana, Ascaris lumbricoides, Giardia lamblia or Entamoeba coli. There were statistically significant differences between the three groups for the risk of reinfection rate: the risk of reinfection by parasites was 30% lower in the hygiene promotion group than in the treatment group and 37% lower than in the seasonality group. If properly designed and carried out, hygiene promotion is an effective tool in reducing the risk of intestinal parasite reinfection in children, thus improving children's health in rural communities.



Maternal factors in the etiology of fetal malnutrition in Nigeria
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Pediatrics International. 2007 Apr;49(2):150-155.
Adebami OJ | Oyedeji GA | Owa JA | Oyelami OA
The main objective of the study was to determine the role of maternal factors in the etiology of fetal malnutrition (FM) in Nigeria. Neonatal and Maternity Units of the Wesley Guild Hospital Ilesa, Nigeria, a unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife was the setting for the study. This was a prospective study of consecutive, singleton, term live babies delivered between January and August 2001. Fetal malnutrition was diagnosed using Clinical Assessment of Fetal Nutritional Status (CANS) and the score (CANSCORE) adapted by Metcoff. The maternal prenatal record was checked and additional history was obtained from the mother. This included history of maternal illness and drugs taken during pregnancy. The socioeconomic class of the parents was also documented. Nutritional status of the mother was determined using mid arm circumference (MAC) and the body mass index (BMI). Babies were stratified into babies with FM and babies without FM. The two groups of babies were compared. Of the 473 studied, 89 [18.8%] had FM. Maternal factors found associated with FM were: lack of antenatal care, young mother (less than 18 years), primiparity, maternal undernutrition (BMI less than 18.5 kg/m 2 and MAC less than 23.5 cm), low socioeconomic status, pregnancy-induced hypertension, antepatum hemorrhage, and maternal infections especially malaria, urinary tract infections and HIV (P less than 0.05). Improvement in the socioeconomic status of women and good antenatal care will reduce most of the maternal factors associated with FM in Nigeria. Therefore, antenatal should be made cheap and accessible to all pregnant mothers.



Social inequalities in perinatal mortality in Belo Horizonte, Brazil: The role of hospital care
(Abstract; subscription needed for full text; South America)
American Journal of Public Health . 2007 May;97(5):867-873.
Lansky S | Franca E | Kawachi I
We examined the contribution of hospital type and quality of care to perinatal mortality rates in the city of Belo Horizonte, Brazil. We used a cohort study of all births (40953) and perinatal deaths (826) in Belo Horizonte in 1999. After adjusting for maternal education and birthweight, we compared mortality rates according to hospital category -- defined by a hospital's relation to the national Universal Public Health System (SUS) -- and quality of care. We used the Wigglesworth Classification to examine perinatal deaths. After we controlled for birthweight and maternal education, the highest perinatal death rates were observed in private and philanthropic SUS-contracted hospitals (relative to private, non-SUS-contracted hospitals). Hospital quality was also directly associated with perinatal death rates. Mortality rates were especially high for normal-birthweight babies born in private SUS-contracted hospitals. Intrapartum asphyxia was the leading cause of preventable death. In a class-segregated health care system, such as Brazil's, disparities in quality of care between SUS-contracted and non-SUS-contracted hospitals contribute to the unacceptably high rates of perinatal mortality.

MATERNAL AND CHILD HEALTH NEWS

How can we reduce the death rates from pregnancy and childbirth?
(Feature Article; Global)
2007 Apr 17;
Fikree F, Population Reference Bureau



India 360: Cesarean for quick buck?
(News Article; Asia)
2007 Apr 25;
CNN-IBN

MEN'S HEALTH RESEARCH

Immune-related disease before and after vasectomy: An epidemiological database study
(Abstract; subscription needed for full text; Europe)
Human Reproduction. 2007 May;22(5):1273-1278.
Goldacre MJ | Wotton CJ | Seagroatt V | Yeates D
Vasectomy can be followed by an autoimmune-antibody response. We aimed to determine whether men with immune-related diseases were more or less likely than others to have a vasectomy and then to determine whether vasectomy is associated with the subsequent development of immune-related diseases. A database of linked records of hospital statistics was analysed. By comparing a population of men who underwent vasectomy with a reference population, we calculated the rate ratios for selected immune-related diseases before and after vasectomy. Some diseases studied (e.g., asthma and diabetes mellitus) were a little less common, prior to operation, in the vasectomy group than in the reference group. Others were not different. The mean period of follow-up was 13 years. We found no long-term elevation of risk following vasectomy of asthma, diabetes mellitus, ankylosing spondylitis, thyrotoxicosis, multiple sclerosis, myasthenia gravis, inflammatory bowel disease, rheumatoid arthritis or testicular atrophy. There was a short-term elevation of risk of orchitis/epididymitis. In this large study, with many years of follow-up, we found no evidence that vasectomy increases the subsequent long-term risk of immune-related diseases.



Does mode of delivery affect sexual functioning of the man partner?
(Abstract; subscription needed for full text; Europe)
Journal of Sexual Medicine. Online access April 19, 2007.
Gungor S | Baser I | Ceyhan T | Karasahin E | Kilic S
Recent surveys showed that the major reasons for avoiding vaginal delivery were the fear of childbirth and the concern for postpartum sexual health. Although sexual dysfunction is a disorder that affects a couple rather than an individual, all studies investigating the relationship between the mode of delivery and sexual problems have been conducted only in cohorts of women. The aim was to determine the effect of mode of delivery on quality of sexual relations and sexual functioning of men by using the Golombock-Rust Inventory of Sexual Satisfaction (GRISS). Mean score of sexual function and prevalence of sexual dysfunction in overall and specific areas of the GRISS were compared among the three groups. A total of 107 men accompanying their wives in outpatient clinics of obstetrics and gynecology met inclusion/exclusion criteria. Three groups of men were defined; men whose partners had: (i) "elective cesarean delivery" (N = 21; mean age 32.2 +or- 3.8 years); (ii) "vaginal delivery with mediolateral episiotomy" (N = 36; mean age 31.4 +or- 4.5 years); and (iii) "not given birth" (N = 50; mean age 28.8 +or- 4.0 years). Mean overall sexual function score (normal value < 25 points) was 20.5 +or- 8.2 in the elective caesarean group, 19.3 +or- 6.5 in the vaginal delivery group, and 18.8 +or- 9.3 in the nulliparae group (P = 0.731). Prevalence of sexual dysfunction in men was 28.6% in the elective caesarean group, 19.4% in the vaginal delivery group, and 30.0% in the nulliparae group (P = 0.526). Overall sexual function of men was not affected by their partner's parity and mode of delivery. An elective cesarean section simply because of concerns about sexual function would not provide additional benefit to men, and could deny women a possible vaginal delivery, which is generally assumed to be safer than cesarean section.



Obesity and benign prostatic enlargement: A large observational study in China
(Abstract; subscription needed for full text; Asia)
Urology. 2007 Apr;69(4):680-684.
Xie LP | Bai YB | Zhang XZ | Zheng XY | Yao KS
The objective was to investigate the associations of prostate enlargement with obesity and hypertension in Chinese men. A total of 649 men from Zhejiang, China were invited to the Family Planning Station of Wenlin to undergo prostate volume measurement with transrectal ultrasonography. Benign prostatic enlargement (BPE) has been defined as a prostate volume larger than 20 cm3. The associations between BPE and prostate volume with body mass index (BMI) and blood pressure were evaluated by multivariate linear and logistic regression analyses. Overweight (BMI of 25 or more but less than 28 kg/m2) and obese (BMI of 28 kg/m2 or more) men experienced a significantly increased age-adjusted risk of BPE compared with men with a lower BMI (odds ratio 1.63, 95% confidence interval 1.16 to 2.30, and odds ratio 2.26, 95% confidence interval 1.11 to 4.59, respectively). Each 0.37-kg/m2 increase (95% confidence interval 0.18 to 0.57, P less than 0.01) in the BMI was associated with a 1-cm3 increase in prostate volume. No associations were observed between hypertension and BPE. This is the first study to provide evidence that the BMI is positively associated with prostate volume in the Chinese population. Obese Chinese men are at increased risk of an enlarged prostate compared with nonobese Chinese men.



Comparison of prevalence between self-reported erectile dysfunction and erectile dysfunction as defined by five-item international index of erectile function in Taiwanese men older than 40 years
(Abstract; subscription needed for full text; Asia)
Urology. 2007 Apr;69(4):743-747.
Wu C | Hsieh J | Lin JS | Hwang TI | Jiann B
The objective was to conduct a cohort study in men older than 40 years in Taiwan to evaluate the prevalence of erectile dysfunction (ED) by self-report and the use of the abridged, five-item version of the International Index of Erectile Function (IIEF-5). From July to August 2003, 990 Taiwanese men older than 40 years of age completed a telephone survey designed to assess ED prevalence and sexual functioning. ED was identified through respondent self-report and investigator assessment using the IIEF-5 instrument. Data were analyzed using the analysis of variance test, t test, and chi-square test, with Yates' correction or Fisher's method. The prevalence of self-reported ED was 13.1%, with 26.2% of this subgroup subsequently deemed to not have ED by IIEF-5 assessment. Among the subgroup of men self-reported to not have ED, 18.8% were found to have ED by IIEF-5 assessment. In total, 26.0% of respondents had ED by IIEF-5 assessment. The ED prevalence increased with age and a history of chronic illness. The frequency of sexual contact and sexual satisfaction were also reduced in the respondents with ED. The prevalence of self-reported ED in Taiwanese men older than 40 years of age was 13.1% compared with 26.0% using the IIEF-5 assessment. Estimates of ED prevalence in the general population should not rely on self-reporting alone because it is likely to underestimate the true prevalence of ED.



Role of postcircumcision mucosal cuff length in lifelong premature ejaculation: A pilot study
(Abstract; subscription needed for full text; Middle East)
Journal of Sexual Medicine. Online access April 19, 2007.
Hosseini SR | Khazaeli MH | Atharikia D
Premature ejaculation (PE) is the most prevalent sexual dysfunction among men. Several theories about its etiology have been made. One of the conflicting factors is the effect of circumcision on ejaculation, and there are some concerns about leaving so much mucosa during circumcision. In our study the relationship between mucosal cuff length and PE was investigated. Eighty-four circumcised men were studied, including 42 men with PE and 42 men without. The following data and measurements were investigated: age, education, smoking, intravaginal ejaculation latency time (IELT), circumcision timing, stretched penile, penile skin, and mucosal cuff lengths. Main Outcome Measure: Penile, mucosal cuff, and penile skin lengths, the IELT. The mean penile, mucosal cuff, and penile skin lengths were 121.1 +or- 12.8, 15.4 +or- 4.8, and 80.8 +or- 21.0 mm in PE men, respectively, and were 130.1 +or- 10.4, 14.7 +or- 3.4, and 88.7 +or- 12.2 mm in the control group, respectively. No statistically significant differences were seen regarding the length of the penis (P = 0.80), mucosal cuff (P = 0.84), and penile skin (P = 0.99). The two groups were not different regarding education (P = 0.90), smoking (P = 0.70), and circumcision timing (P = 0.65). Postcircumcision mucosal cuff length is not a risk factor for PE.

MEN'S HEALTH NEWS

No-scalpel, no-needle vasectomy described
(Review/Synthesis; North America)
23 Apr 2007
Metro MJ, Medical News Today
Related Abstract; subscription needed for full text: No-scalpel, no-needle vasectomy
Related News Article: No-scalpel vasectomies by skilled surgeons may speed recovery



Outcomes of cryotherapy for prostate cancer
(News Article; North America)
23 Apr 2007
Evans CP
Related Abstract; subscription needed for full text: Cryoablation as primary treatment for localized prostate cancer followed by penile rehabilitation

POPULATION RESEARCH

Health workers and vaccination coverage in developing countries: An econometric analysis
(Abstract; subscription needed for full text; Global)
Lancet . 2007 Apr 14;369(9569):1277-1285.
Anand S | Barnighausen T
Vaccine-preventable diseases cause more than 1 million deaths among children in developing countries every year. Although health workers are needed to do vaccinations, the role of human resources for health as a determinant of vaccination coverage at the population level has not been investigated. Our aim was to test whether health worker density was positively associated with childhood vaccination coverage in developing countries. We did cross-country multiple regression analyses with coverage of three vaccinations-measles-containing vaccine (MCV); diphtheria, tetanus, and pertussis (DTP3); and poliomyelitis (polio3)-as dependent variables. Aggregate health worker density was an independent variable in one set of regressions; doctor and nurse densities were used separately in another set. We controlled for national income per person, female adult literacy, and land area. Health worker density was significantly associated with coverage of all three vaccinations (MCV p=0.0024; DTP3 p=0.0004; polio3 p=0.0008). However, when the effects of doctors and nurses were assessed separately, we found that nurse density was significantly associated with coverage of all three vaccinations (MCV p=0.0097; DTP3 p=0.0083; polio3 p=0.0089), but doctor density was not (MCV p=0.7953; DTP3 p=0.7971; polio3 p=0.7885). Female adult literacy was positively associated, and land area negatively associated, with vaccination coverage. National income per person had no effect on coverage. A higher density of health workers (nurses) increases the availability of vaccination services over time and space, making it more likely that children will be vaccinated. After controlling for other determinants, the level of income does not contribute to improved immunisation coverage. Health workers can be a major constraining factor on vaccination coverage in developing countries.



Population & Economic Development Linkages 2007 Data Sheet
(Tool; Global)
2007 Apr
Population Reference Bureau
The Population Reference Bureau's Population & Economic Development Linkages 2007 Data Sheet takes a close look at health, poverty, and economic indicators both within and among countries. This information should be of particular interest to policymakers and planners in guiding their countries' future economic development. The data sheet provides up-to-date data on population, inequalities within developing countries, and economic opportunities. Data covered includes the percent of married women using modern contraception by wealth group, number of working-age adults per dependent child, and percent of females enrolled in secondary school.



Tsunami mortality estimates and vulnerability mapping in Aceh, Indonesia
(Abstract; subscription needed for full text; Asia)
American Journal of Public Health . 2007 Apr;97(Suppl 1):S146-S151.
Doocy S | Gorokhovich Y | Burnham G | Balk D | Robinson C
The study aimed to quantify tsunami mortality and compare approaches to mortality assessment in the emergency context in Aceh, Indonesia, where the impact of the 2004 tsunami was greatest. Mortality was estimated using geographic information systems-based vulnerability models and demographic methods from surveys of tsunami-displaced populations. Tsunami mortality in Aceh as estimated by demographic models was 131066 and was similar to official figures of 128063; however, it was a conservative estimate of actual mortality and is substantially less than official estimates of 168561 presumed dead, which included those classified as missing. Tsunami impact was greatest in the district of Aceh Jaya, where an estimated 27.0% (n=23862) of the population perished; Aceh Besar and Banda Aceh were also severely affected, with mortality at 21.0% (n=61650) and 11.5% (n=25903), respectively. Mortality was estimated at 23.7% for the population at risk and 5.6% overall. Mortality estimates were derived using methodologies that can be applied in future disasters when predisaster demographic data are not available. Models could be useful in the early stages of disaster response by facilitating geographic targeting and management of humanitarian assistance.



The demography of Mau Mau: Fertility and mortality in Kenya in the 1950s: A demographer's viewpoint
(Abstract; subscription needed for full text; Sub-Saharan Africa)
African Affairs . 2007 Apr;106(423):205-227.
Blacker J
This article examines the allegation that up to 300,000 Kikuyu and others died as a result of the Mau Mau Emergency in Kenya in the 1950s. This figure was based on comparative numbers from the 1948 and 1962 censuses, but they failed to take into account the changes in the tribal classifications and differences in the coverage of the two censuses. Using data from the 1969 Kenya census, we have reconstructed the levels and patterns of mortality in the 1950s, and we show that mortality of the Kikuyu was consistently lower than those of the Kamba, Luhya and Luo peoples. We have also used unpublished data from the 1948 census to estimate infant mortality among the Kikuyu, Embu and Meru prior to the emergency. Using this figure as an indicator of 'normal' mortality, we have compared them with the estimates derived from the 1969 census, and so calculated the number of 'excess' deaths. They amount to perhaps 50,000; more than half of them were children under 10. Given the fragile nature of the data and assumptions, our estimates are subject to large margins of error, but they at least give us an order of magnitude.

POPULATION NEWS

Bangladesh: Permanent method to cut birth rate stressed
(News Article; Asia)
21 Apr 2007
The New Nation



Uganda: MP warns on population
(News Article; Sub-Saharan Africa)
26 Apr 2007
New Vision Online

WOMEN'S HEALTH RESEARCH

Using a community-based outreach program to improve breast health awareness among women in Hong Kong
(Abstract; subscription needed for full text; Asia)
Public Health Nursing. 2007 May-Jun;24(3):265-273.
Chan SS | Chow DM | Loh EK | Wong DC | Cheng KK
The objective was to evaluate the effectiveness of a community-based health education program via a mobile van to promote the awareness of breast cancer and breast self-examination (BSE) practice among women in Hong Kong. Design: One group pretest/posttest design. Sample and measurements: Seven hundred and seventy-seven women in Hong Kong completed a self-administered questionnaire before and after a breast health education program from May 2002 to March 2003. About half were aware of breast health and breast diseases (53.7%) and breast screening methods (48.6%) before the intervention. It was found that women who had received instruction on BSE practice, and those who were aware of breast screening methods, breast health, and breast diseases were more likely to have had prior BSE practice. Most indicated their willingness to practice BSE regularly (93.3%) and to pass on the BSE knowledge to their relatives and friends (92%) in the posttest. The outreach health education program has successfully reached women living in the 18 districts in Hong Kong. It appears to be useful in raising the awareness of breast health and BSE practice among the women, but longer term follow-up is required to ascertain its sustainability.



Effect of peppermint water on prevention of nipple cracks in lactating primiparous women: A randomized controlled trial
(Abstract; subscription needed for full text; Middle East)
International Breastfeeding Journal. 2007 Apr 19;2(1):7.
Sayyah Melli M | Rashidi MR | Delazar A | Madarek E | Maher MH
Nipple pain and damage in breastfeeding mothers are common causes of premature breastfeeding cessation. Peppermint water is popularly used for the prevention of nipple cracks in the North West of Iran. The aim of this study was to determine the effectiveness of peppermint water in the prevention of nipple cracks during breastfeeding in comparison with the application of expressed breast milk (EBM). One hundred and ninety-six primiparous breastfeeding women who gave birth between February and May 2005 in a teaching hospital in Tabriz, Iran, were randomized to receive either peppermint water or EBM. Each woman was followed for up to three visits or telephone calls within 14 days and then by telephone call at week six postpartum. Women who were randomized to receive peppermint water were less likely to experience nipple and areola cracks (9%) compared to women using EBM (27%; p less than 0.01). Women who used the peppermint water on a daily basis were less likely to have a cracked nipple than women who did not use peppermint water (relative risk 3.6, 95% CI: 2.9, 4.3). Nipple pain in the peppermint water group was lower than the expressed breast milk group (OR 5.6, 95% CI: 2.2, 14.6; p less than 0.005). This study suggests that peppermint water is effective in the prevention of nipple pain and damage. Further studies are needed to assess the usefulness of peppermint water in conjunction with correct breastfeeding techniques.

WOMEN'S HEALTH NEWS

Kenya: Lawyers: Three women raped daily in Mt Elgon
(News Article; Sub-Saharan Africa)
24 Apr 2007
Lucheli I, The East African Standard (Nairobi)



Uganda: Women Lawyers Ask Court to Abolish Female Circumcision
(News Article; Sub-Saharan Africa)
26 Apr 2007
New Vision (Kampala)

YOUTH HEALTH RESEARCH

Associations between sexual behaviour change among young people and decline in HIV prevalence in Zambia
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMC Public Health. 2007 Apr 23;7(60)
Sandoy IF | Michelo C | Siziya S | Fylkesnes K
Evidence suggests that HIV prevalence amongst young Zambians has declined recently, especially in higher-education groups. We studied trends in key sexual behaviour indicators among 15-24 year-olds from 1995 to 2003, including the associations between sexual behaviour change and education. The data stem from a series of three population-based surveys conducted in 1995 (n=1720), 1999 (n=1946) and 2003 (n=2637). Logistic regression and Extended Mantel Haenszel Chi Square for linear trends were used to compare the three surveys. Men and lower-education groups reported more than one sexual partner in the year immediately prior to the survey more frequently than did women and higher-education groups (p less than 0.01), but these proportions declined regardless of sex and residence. Substantial delays in child-bearing were observed, particularly among higher-education and urban respondents. Condom use at least for casual sexual intercourse increased from 1995 to 2003; the level was highest among urban and higher-education groups. The number of women reporting frequent dry sex using traditional agents fell during the period. Participants from the rural area and those with less education reported more sexual experience than urban and higher-education participants in 2003. The reported number of sexual partners during the year immediately prior to the survey was a factor that reduced the association between HIV and survey times among sexually active young urban men and women. High risk behaviours clearly decreased, especially in higher-educated and urban groups, and there is a probable association here with the decline in HIV prevalence in the study population. Fewer sexual partners and condom use were among the core factors involved for both sexes; and for women a further factor was delayed child-bearing.



Knowledge about safe motherhood and HIV/AIDS among school pupils in a rural area in Tanzania
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMC Pregnancy and Childbirth. 2007 Apr 24;7(5)
Mushi DL | Mpembeni RM | Jahn A
The majority of adolescents in Africa experience pregnancy, childbirth and enter motherhood without adequate information about maternal health issues. Information about these issues could help them reduce their pregnancy related health risks. Existing studies have concentrated on adolescents' knowledge of other areas of reproductive health, but little is known about their awareness and knowledge of safe motherhood issues. We sought to bridge this gap by assessing the knowledge of school pupils regarding safe motherhood in Mtwara Region, Tanzania. We used qualitative and quantitative descriptive methods to assess school pupils' knowledge of safe motherhood and HIV/AIDS in pregnancy. An anonymous questionnaire was used to assess the knowledge of 135 pupils ranging in age from 9 to 17 years. The pupils were randomly selected from 3 primary schools. Underlying beliefs and attitudes were assessed through focus group interviews with 35 school children. Key informant interviews were conducted with six schoolteachers, two community leaders, and two health staffs. Knowledge about safe motherhood and other related aspects was generally low. While 67% of pupils could not mention the age at which a girl may be able to conceive, 80% reported it is safe for a girl to be married before she reaches 18 years. Strikingly, many school pupils believed that complications during pregnancy and childbirth are due to non-observance of traditions and taboos during pregnancy. Birth preparedness, important risk factors, danger signs, postpartum care and vertical transmission of HIV/AIDS and its prevention measures were almost unknown to the pupils. Poor knowledge of safe motherhood issues among school pupils in rural Tanzania is related to lack of effective and coordinated interventions to address reproductive health and motherhood. For long-term and sustained impact, school children must be provided with appropriate safe motherhood information as early as possible through innovative school-based interventions.

YOUTH HEALTH NEWS

African teens and pain of fistula
(News Article; Sub-Saharan Africa)
23 Apr 2007
Palmer K, The Toronto Star



India: Protest against sex education in Jharkhand schools
(News Article; Asia)
25 Apr 2007
IndiaEduNews



Zimbabwe: Youth targeted in Safe Journey Campaign
(News Article; Sub-Saharan Africa)
27 Apr 2007
International Organization for Migration



Mali: Truth hurts for children living with HIV/AIDS
(Feature Article; Sub-Saharan Africa)
24 Apr 2007
Integrated Regional Information Networks

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