Volume 7, Number 17
14 May 2007

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FAMILY PLANNING RESEARCH

Improving adherence to family planning guidelines in Kenya: An experiment
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal for Quality in Health Care. 2007 Apr;19(2):68-73.
Stanback J | Griffey S | Lynam P | Ruto C | Cummings S
Quality problem: Research in Kenya in the mid-1990s suggested poor quality family planning services and limited access to services. Clinical guidelines for family planning and reproductive health were published in 1991 and updated in 1997, but never widely distributed. Choice of solution: Managers and trainers chose intensive, district-level training workshops to disseminate guidelines and update health workers on guideline content and best practices. Intervention: Training workshops were held in 41 districts in 1999. Trainees were instructed to update their untrained co-workers afterwards. As a reinforcement, providers in randomly selected areas received a 'cascade training package' of instructional materials and training tips. Providers in 15 randomly selected clinics also received 'supportive supervision' visits as a second reinforcement. Evaluation methodology: A cluster-randomized experiment in 72 clinics assessed the overall impact of the training and the marginal benefits of the two reinforcing activities. Researchers and trainers created several dozen indicators of provider knowledge, attitudes, beliefs and practices. Binomial and multivariate analyses were used to compare changes over time in indicators and in aggregated summary scores. Data from patient interviews were analysed to corroborate provider practice self-reports. Cost data were collected for an economic evaluation. Results: Post-test data collected in 2000 showed that quality of care and access increased after the intervention. The cascade training package showed less impact than supportive supervision, but the former was more cost-effective. Lessons learned: Service delivery guidelines, when properly disseminated, can improve family planning practices in sub-Saharan Africa.

Getting results used: Evidence from reproductive health programmatic research in Guatemala
(Abstract; subscription needed for full text; Central America and the Caribbean)
Health Policy and Planning. 2007;Online access May 2, 2007.
Brambila C | Ottolenghi E | Marin C | Bertrand JT
This article reviews 44 operations research projects aiming to improve reproductive health services in Guatemala, conducted by the Population Council from 1988 to 2001. It documents the experience of the research programme, traces the extent to which research results are identifiable in existing programmes, and analyses factors influencing utilization. Utilization of research results occurs as a gradual process of information sharing, where researchers influence decision-makers through a continual stream of information rather than a single set of findings. Utilization depends on leadership, collaborative planning and implementation, close monitoring, and feasible research designs, among other factors. To influence policy formulation, organizations should form enduring links among institutions and develop critical research skills among personnel who collaborate with or manage service programmes. To understand how operations research affects policy and programme change, one must consider not just individual projects, but rather the synergistic impact of multiple projects on a broad range of themes over time.

Contraceptive counseling by gynecologists -- which issues are discussed and does gender play a role?
(Abstract; subscription needed for full text; Global)
Journal of Psychosomatic Obstetrics and Gynecology . 2007 Mar;28(1):13-19.
Tschudin S | Alder J | Bitzer J | Merki SG
Explorative pilot study with the aim of gaining insight into the contraceptive counseling practices and possible gender differences of a selected group of male and female gynecologists. Semi-structured telephone-interviews of 48 gynecologists concerning the content and strategies of their contraceptive counseling with special focus on aspects relevant to patient adherence. Male and female gynecologists inform equally frequently about various methods and reproductive health aspects such as risks, the advantages and disadvantages of the methods and side effects. Male physicians speak more often about the efficiency and benefits of the methods, while their female colleagues emphasize STI and emergency contraception. Sexual health aspects were seldom mentioned as issues of discussion. For the choice of a contraceptive method efficiency was considered very important by 100%, reversibility by 83%, side effects by 85% and convenience by 79%. Naturalness and costs were more often quoted as important by female, and benefits by male gynecologists. Side effects are considered the most important factor for patient adherence by 60%, counseling and information is predominantly cited by female, and patient's character and personality by male doctors. While contraceptive counseling by practising gynecologists includes basic information about available methods and their efficiency, as well as some reproductive health issues, sexual health issues are often neglected. Gender differences occasionally influence the choice of the topics as well as the attitude towards the patient.

Early pregnancy loss in women stimulated with gonadotropin-releasing hormone antagonist protocols according to oral contraceptive pill pretreatment
(Abstract; subscription needed for full text; Global)
Fertility and Sterility . 2007 May;87(5):1098-1101.
Bellver J | Albert C | Labarta E | Pellicer A
The objective was to evaluate and compare the risk of early pregnancy loss in patients stimulated with GnRH antagonist protocols according to oral contraceptive pill (OCP) pretreatment. The design of the study was a Retrospective case-control study. The study took place at the Instituto Valenciano de Infertilidad. University of Valencia. Spain. The patient(s) used in the study were one thousand five hundred thirty-nine patients, aged less than 36, stimulated with GnRH antagonists for IVF between January 1, 2000 and November 1, 2005. Reproductive outcome was compared based on the application (or not) of OCP pretreatment: 944 women were included in the OCP group and 595 in the non-OCP group. The Student's t test was used for statistics. Main Outcome Measure(s): Pregnancy, biochemical pregnancy, ectopic pregnancy, early clinical pregnancy loss, early pregnancy loss, and ongoing pregnancy rates. No significant differences were observed in any of the outcome parameters. Early pregnancy loss rates were similar: 23% in the OCP pretreatment group versus 19.2% in the non-OCP pretreatment group. However, longer periods of ovarian stimulation and higher doses of gonadotropins needed to be employed in the OCP group. There is not sufficient evidence to confirm OCP pretreatment as a risk factor for miscarriage in patients stimulated with GnRH antagonist protocols.

Reproductive medicine in northwest Argentina: Traditional and institutional systems
(Research Article; South America)
Journal of Ethnobiology and Ethnomedicine. 2007;Online Access May 2, 2007 3(19)
Hilgert NI | Gil GE
Background: The state of conservation of the traditional cultures of Northwest Argentina is variable and somewhat problematic but to a lesser or a greater extent all the peoples are related to an hegemonic culture. We present a case study carried out in the rural communities of the Yungas biome (Salta) where the extent of isolation varies as does the type of access to public health services. The use of medicinal plants in the area is ordinary and widely spread. Methods: The data can be organized in two categories, as medical systems public records (for the regional hospital at Los Toldos), and as ethnobotanical sets. A total of 59 surveys to 40 interviewees were undertaken using a semi structured questionnaire. We present an analysis of the relative importance of the medicinal herbs used in reproductive medicine considering the plants used in the traditional medical system and the factors that can affect the relationship between formal medicine and patients. We further analyzed how the degree of accessibility to the local hospital influences the diversity of use of plant species used to assist deliveries and to decrease infant mortality in children minor than one year of age. Results: In reproductive medicine, 13 ailments and/or different physiological states are locally identified and treated. Local population uses 108 ethnospecies for these kinds of illnesses. According to the local conception the hot/cold imbalance could be the principal cause for reproductive illnesses; pregnancy may have natural or supernatural origin, postpartum and menstruation involve similar sanitary risks, and neonatal care has a strong magic connotation. In relation to formal medicine, the health center is more accessible and used by women. We have not found a relation between accessibility and infant mortality. Conclusion: In the local reproductive medicine, most of the practices are concerned with the hot/cold balance. According to their importance the factors involved are: the family medicine, the midwife, and the formal doctors. Plants have an important role; however, there is a lack of total agreement among the families who use them. Reluctance to institutional deliveries may be due to the weak relationship between patients and doctors, and the lack of logistic assistance to delivering mothers coming from far away locations.

FAMILY PLANNING NEWS

Family planning initiatives central to reducing child mortality in developing countries
(News Article; Global)
9 May 2007
MedIndia

Botswana: PSI pulls out controversial condoms adverts
(News Article; Sub-Saharan Africa)
10 May 2007
Motlogelwa T, Mmegi/The Reporter (Gaborone)

Kenya: Controversial technology brings hope to many couples all over the world
(News Article; Sub-Saharan Africa)
8 May 2007
Okwemba A, The Nation (Nairobi)

HIV/AIDS and STIs RESEARCH

Six-month natural history of oral versus cervical human papillomavirus infection
(Abstract; subscription needed for full text; Global)
International Journal of Cancer. Online access March 12, 2007. 121(1):143 - 150.
D'Souza G | Fakhry C | Sugar EA | Seaberg EC | Weber K | Minkoff HL | Anastos K | Palefsky JM | Gillison ML
Related News Article: Virus spread by oral sex is linked to throat cancer
Human papillomavirus (HPV) infection is etiologically associated with a subset of oral cancers, and yet, the natural history of oral HPV infection remains unexplored. The feasibility of studying oral HPV natural history was evaluated by collecting oral rinse samples on 2 occasions at a 6-month interval from 136 HIV-positive and 63 HIV-negative participants. Cervical vaginal lavage samples were concurrently collected for comparison. HPV genomic DNA was detected in oral and cervical samples by consensus primer PCR and type-specified for 37 HPV types. The six-month cumulative prevalence of oral HPV infection was significantly less than for cervical infection (p less than 0.0001). HIV-positive women were more likely than HIV-negative women to have an oral (33 vs. 15%, p = 0.016) or cervical (78 vs. 51%, p less than 0.001) infection detected. Oral HPV infections detected at baseline were as likely as cervical infections to persist to 6 months among HIV-negative (60% vs. 51%, p = 0.70) and HIV-positive (55% vs. 63%, p = 0.27) women. Factors that independently elevated odds for oral HPV persistence differed from cervical infection and included current smoking (OR = 8, 95% CI = 1.3-53), age above 44 years (OR = 20, 95% CI = 4.1-83), CD4 less than 500 (OR = 6, 95% CI = 1.1-26), use of HAART therapy (OR = 12, 95% CI = 1.0-156), and time on HAART therapy (trend p = 0.04). The rate of oral HPV infections newly detected at follow-up was significantly lower than cervical infection among HIV-positive (p less than 0.001) and HIV-negative women (p less than 0.001). Our study not only demonstrates that it is feasible to study the natural history of oral HPV infection with oral rinse sampling, but also indicates that oral and cervical HPV natural history may differ.

Successful introduction of routine opt-out HIV testing in antenatal care in Botswana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Acquired Immune Deficiency Syndromes (JAIDS). 2007 May 1;45(1):102-107.
Creek TL | Ntumy R | Seipone K | Smith M | Mogodi M
Botswana has high HIV prevalence among pregnant women (37.4% in 2003) and provides free services for prevention of mother-to-child transmission (PMTCT) of HIV. Nearly all pregnant women (greater than 95%) have antenatal care (ANC) and deliver in hospitals. Uptake of antenatal HIV testing was low from 1999 through 2003. In 2004, Botswana's President declared that HIV testing should be "routine but not compulsory" in medical settings. Health workers were trained to provide group education and recommend HIV testing as part of routine ANC services. Logbook data on ANC attendance, HIV testing, and uptake of PMTCT interventions were reviewed before and after routine testing training, and ANC clients were interviewed. After routine testing started, the percentage of all HIV-infected women delivering in the regional hospital who knew their HIV status increased from 47% to 78% and the percentage receiving PMTCT interventions increased from 29% to 56%. ANC attendance and the percentage of HIV-positive women who disclosed their HIV status to others remained stable. Interviews indicated that ANC clients supported the policy. Routine HIV testing was more accepted than voluntary testing in this setting and led to substantial increases in the uptake of testing and PMTCT interventions without detectable adverse consequences. Routine testing in other settings may strengthen HIV care and prevention efforts.

The inevitability of infidelity: Sexual reputation, social geographies, and marital HIV risk in rural Mexico
(Abstract; subscription needed for full text; Central America and the Caribbean)
American Journal of Public Health. Online access April 27, 2007.
Hirsch JS | Meneses S | Thompson B | Negroni M | Pelcastre B | del Rio C
Related News Article: Mexico: Women's risk of HIV from husbands
Marriage presents the single greatest risk for HIV infection among women in rural Mexico. We drew on 6 months of participant observation, 20 marital case studies, 37 key informant interviews, and archival research to explore the factors that shape HIV risk among married women in one of the country's rural communities. We found that culturally constructed notions of reputation in this community lead to sexual behavior designed to minimize men's social risk (ones that endanger one's social status), rather than viral risks and that men's desire for companionate intimacy may actually increase women's risk for HIV infection. We also describe the intertwining of reputation-based sexual identities with structurally patterned sexual geographies. We propose that, because of the structural nature of men's extramarital sexual behavior, intervention development should concentrate on sexual geographies (i.e., the social spaces that shape sexual behavior) and risky spaces rather than risky behaviors or identities.

China and HIV -- a window of opportunity
(Feature Article; Asia)
(You need Adobe Acrobat Reader to access this document)
New England Journal of Medicine . 2007 May 3;356(18):1801-1805.
Gill B | Okie S
Last December in Wuhan, China, two middle-aged rural women who had become infected with HIV in the 1990s struggled to describe to foreign visitors how China's new HIV-treatment program had changed their lives. Suddenly, one woman's 12-year-old daughter spoke up. Her mother, she said, had been too sick to get out of bed, and the girl had left school to help at home and on the farm. But when the woman began taking antiretroviral drugs, she improved quickly, returned to work in the fields, and sent her daughter back to the classroom. Such stories are increasingly common in China, reflecting a striking shift in the government's approach to HIV. Although China's first AIDS cases were discovered in 1989, the government did not publicly acknowledge the existence of a major epidemic until 2001. Two years later, as international attention mounted after the outbreak of severe acute respiratory syndrome (SARS), the government abruptly changed course, launching aggressive measures against AIDS. An interagency committee was created to coordinate a government-wide response, and a national AIDS treatment program was established. The national budget for HIV-AIDS grew from approximately $12.5 million in 2002 to about $100 million in 2005 and about $185 million in 2006. In January 2006, the Chinese Cabinet issued regulations for HIV-AIDS prevention and control, outlining the responsibilities of the central and local governments and stipulating the rights and responsibilities of infected persons. The law requires county-level jurisdictions to provide free antiretroviral drugs to poor citizens who need treatment and free consultations and treatment to prevent mother-to-child transmission. Infected persons must take steps to avoid knowingly spreading HIV, but the statute forbids discrimination against them in employment, education, marriage, and health care.

Continuation with cotrimoxazole prophylaxis for the prevention of opportunistic infections in HIV-infected persons in rural Zimbabwe: Feasibility, obstacles and opportunities
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Care . 2007 Apr;19(4):478-481.
Alkatout I | Vineberg R | Schulz U | Anlauf M | Thistle P
We examined the outcomes of a World Health Organization (WHO) recommended programme offering cotrimoxazole (CTM) prophylaxis to 908 HIV-positive individuals in rural Zimbabwe, who accepted enrollment in the treatment programme. Outcomes included duration in programme, time between visits, relationship and marital status. Mean duration of participation in the programme was 224 days. The mean time between visits decreased from 11.2 weeks, between visit 1 and 2, to 4.3 weeks between visit 11 and 12. Statistical analysis showed significant positive correlations between duration in programme and participant age, participant relationship status and the partner's state of affairs. Statistical analysis showed no significant correlation between duration in programme and gender. Results indicate that if continuation is demonstrated for the first 4 to 6 months, participants will continue with the CTM programme. Results also reflect the constrained feasibility of CTM prophylaxis in rural Africa as well as the need to target subpopulations, such as young people, patients and their spouses for focused HIV/AIDS education initiatives.

Late presentation for HIV care in central Haiti: Factors limiting access to care
(Abstract; subscription needed for full text; Central America and the Caribbean)
AIDS Care. 2007 Apr;19(4):487-491.
Louis C | Ivers LC | Fawzi MC | Freedberg KA | Castro A
Many patients with HIV infection present for care late in the course of their disease, a factor which is associated with poor prognosis. Our objective was to identify factors associated with late presentation for HIV care among patients in central Haiti. Thirty-one HIV-positive adults, approximately 10% of the HIV-infected population followed at a central Haiti hospital, participated in this research study. A two-part research tool that included a structured questionnaire and an ethnographic life history interview was used to collect quantitative as well as qualitative data about demographic factors related to presentation for HIV care. Sixty-five percent of the patients in this study presented late for HIV care, as defined by CD4 cell count below 350 cells/mm3. Factors associated with late presentation included male sex, older age, patient belief that symptoms are not caused by a medical condition, greater distance from the medical clinic, lack of prior access to effective medical care, previous requirement to pay for medical care, and prior negative experience at local hospitals. Harsh poverty was a striking theme among all patients interviewed. Delays in presentation for HIV care in rural Haiti are linked to demographic, socioeconomic and structural factors, many of which are rooted in poverty. These data suggest that a multifaceted approach is needed to overcome barriers to early presentation for care. This approach might include poverty alleviation strategies; provision of effective, reliable and free medical care; patient outreach through community health workers and collaboration with traditional healers.

Partner notification for sexually transmitted diseases in Peru: Knowledge, attitudes, and practices in a high-risk community
(Abstract; subscription needed for full text; South America)
Sexually Transmitted Diseases . 2007 May;34(5):309-313.
Clark JL | Long CM | Giron JM | Cuadros JA | Caceres CF
Notification and treatment of sex partners after diagnosis of a sexually transmitted disease (STD) is essential to reduce reinfection and further transmission. The goal of this study was to determine the prevalence of partner notification and subsequent health-seeking behavior in a high risk population in Lima, Peru. STD-infected participants of an HIV/STD prevention trial completed a questionnaire concerning partner notification. Of the 502 STD-positive subjects, 287 completed the survey. Among survey participants, 65% informed their primary partner and 10.5% informed casual or anonymous partners. Reasons for failure to notify varied by partner type and included not understanding the importance of partner notification, embarrassment, fear of rejection, and inability to locate the partner. When notified, approximately one third of all partners sought medical attention. Partner notification in Peru is limited by relationship dynamics, social stigma, and limited contact information. Interventions could emphasize the importance of notification, improvement of communication skills, and introduce contact tracing programs (including Internet-based systems) and expedited partner therapy.

HIV/AIDS and STIs NEWS

South Africa: Lack of ARVs increases hospice workload
(News Article; Sub-Saharan Africa)
10 May 2007
Thom A, Health-e (Cape Town)

Clinton unveils Aids drugs deal
(News Article; Asia)
9 May 2007
BBC News

Mozambique: Road show spreads the word about HIV
(News Article; Sub-Saharan Africa)
7 May 2007
IRIN

Mali's children with HIV are told they have virus
(News Article; Sub-Saharan Africa)
8 May 2007
Colombant N, Voice of America (VOA)

Afghanistan: AIDS diagnostic centre opened in Mazar
(News Article; Asia)
8 May 2007
Pajhwok Afghan News

MATERNAL AND CHILD HEALTH RESEARCH

State of the world's mothers report
(Report; Global)
(You need Adobe Acrobat Reader to access this document)
2007 May 8;Westport, CT, Save the Children, 2007 :1-70.
Save the Children
Related News Article: Egypt makes the most progress and Iraq the least in reducing child deaths, report finds
The report includes the first-ever Child Survival Progress Rankings of 60 developing countries, which together account for 94 percent of all child deaths worldwide. This report helps to bring attention to low-cost solutions that have the greatest potential to save lives. It also identifies countries that are succeeding in tackling this problem, showing that effective solutions to this challenge are affordable -- even in the world's poorest countries.

Non-professional health practitioners and referrals to facilities: Lessons from maternal care in Bangladesh
(Research Article; Asia)
Health Policy and Planning . 2007 May;22(3):149-155.
Parkhurst JO | Rahman SA
Over half a million women in the developing world die of pregnancy and childbirth related causes each year, despite well-known interventions to manage most maternal complications. One problem facing policy makers is that women in low-income settings often seek care from a range of non-professional sources when they have trouble with pregnancy and childbirth. Questions remain as to the best way to engage with such providers to encourage use of professional care, in part because little policy-oriented research has attempted to study the roles of non-professional practitioners, and the specific situations which can encourage or discourage referral behaviour. This paper investigates the roles played by alternative health practitioners in referral to facilities for maternal care in Bangladesh. In-depth case studies were used to investigate labour experiences, decision-making processes and the roles played by key individuals in deciding to use professional services. Findings show that the commonly used heading of 'traditional birth attendant' is often too broad for programmatic use, as it encompasses a range of individuals with different reasons to work with, or oppose, professional services. It was found that women seek care from multiple non-professional cadres who each have differing services, scopes and linkages to professional care. Policy makers need to understand the roles of different providers and potential links to professional care which can be built upon to encourage the use of professional emergency care for maternal complications in low-income settings.

Fetal conditions and fatal decisions: Ethical dilemmas in ultrasound screening in Vietnam
(Abstract; subscription needed for full text; Asia)
Social Science and Medicine. 2007 May;64(11):2248-2259.
Gammeltoft T | Hanh Thi Thuy Nguyen
In the context of globalization, new technologies of pregnancy are spreading rapidly from affluent to low-income countries. Yet, to date, there is very little research on the application of prenatal diagnostic technology in developing country settings or the dilemmas that prenatal screening may give rise to in situations where health-care resources are scarce. In this article, we describe how obstetrical ultrasound scanning is used as the most important technology for prenatal diagnosis in Vietnam. We explore the social context that shapes moral sentiments and ethical deliberations within everyday medical interactions, drawing attention to the complex social processes through which ethical dilemmas are configured. The data include observations in the scanning room, and semi-structured interviews with patients and staff at a major maternity hospital in the country's capital Hanoi. We found that pregnant women received very limited information and support when a fetal anomaly was detected by ultrasound. Most women left the hospital feeling uncertain about what was wrong with the fetus. We conclude that the ethical problems surrounding prenatal screening are intensified in low-income settings such as Vietnam and point to the need for research that takes into account the wider social context that structures ethical dilemmas.

MATERNAL AND CHILD HEALTH NEWS

Hail Caesarean: Such births rising in East Asia
(News Article; Asia)
2007 May 9;
Fuller T, International Herald Tribune

Maternal attachment may reduce anemia in children
(News Article; Global)
2007 May 9;
Huliq.com

Malawi: Transport problems contributing to high maternal mortality rate
(News Article; Sub-Saharan Africa)
2007 May 7;
Msundwe P, The Chronicle Newspaper

Expectant mothers take big risks
(News Article; Asia)
2007 May 7;
Xhinhua News Agency

GENDER and HEALTH RESEARCH

Acceptability of male circumcision for prevention of HIV infection in Zambia
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Care . 2007 Apr;19(4):471-477.
Lukobo MD | Bailey RC
Numerous observational studies and three clinical trials have shown male circumcision (MC) to be partially protective against HIV acquisition in heterosexual men. This has led to consideration of introducing circumcision as an HIV prevention strategy in parts of sub-Saharan Africa. This study assesses the acceptability of male circumcision as an intervention to improve male genital hygiene and reduce sexually transmitted infections, including HIV-1 in Zambia. Thirty-four focus group discussions were conducted -- 17 with men and 17 with women -- in four districts chosen to represent urban and rural communities where circumcision is and is not traditionally practiced. In communities where circumcision is little practiced, the main facilitators for acceptance were improved genital hygiene, HIV/STI prevention, and low cost. The main barriers were cultural tradition, high cost, pain, and concerns for safety. If MC is proven to reduce risk for HIV and STIs, most participants reported that they would seek circumcision for themselves or their partners or their sons if it was free or at a minimal cost. Acceptability of male circumcision for STI and HIV prevention appears to be high in Zambia.

Mycoplasma genitalium infection and persistence in a cohort of female sex workers in Nairobi, Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Diseases. 2007 May;34(5):274-279.
Cohen CR | Nosek M | Meier A | Astete SG | Iverson-Cabral S
The objective of this study was to assess the risk factors for and persistence of Mycoplasma genitalium (MG) in a highly exposed female population in Kenya. Two hundred fifty-eight sex workers in Nairobi, Kenya, 18 to 35 years of age, were enrolled. Every 2 months, cervical samples were collected for MG, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (GC) testing by polymerase chain reaction. At enrollment, 16% were infected with MG. Seventy-seven subjects acquired 107 MG infections, giving an incidence of 22.7 per 100 women-years. Incident CT (adjusted hazard ratio [HR] = 2.4; 95% confidence interval [CI] = 1.5- 4.0), GC (HR = 2.0; 95% CI =1.2-3.5), and HIV infection (adjusted HR = 2.2; 95% CI = 1.3-3.7) were associated with an increased risk of MG. Seventeen percent, 9%, and 21% of MG infections persisted 3, 5, and greater than or equal to 7 months, respectively. The high incidence of MG, greater than that for both CT (14.0%) and GC (8%), association with common sexually transmitted infection risk factors, and persistence in the female genital tract supports its role as a common sexually transmitted infection in Kenyan women.

A rational combination pharmacotherapy in men with erectile dysfunction who initially failed to oral sildenafil citrate alone: A pilot study
(Abstract; subscription needed for full text; Global)
Journal of Sexual Medicine. 2007;:[6] p.
Taneja R
Introduction: Erectile dysfunction (ED) is a complex condition wherein men with minimal organic ED may develop a variable degree of psychogenic component sufficient to reduce the efficacy of medical management. A combination of trazodone with sildenafil has been used to overcome both organic as well as psychogenic components, thus improving the results of medical management. Aim: To evaluate the efficacy of combination of trazodone with sildenafil citrate in treatment of ED in men with initial failure to sildenafil citrate alone. Main Outcome Measures: The symptoms of ED were evaluated using the Erectile Dysfunction Intensity Scale (EDIS) before and after the treatment. Methods: Eighteen men with ED who initially failed to respond to sildenafil citrate alone were enrolled in the study between February 2004 and December 2004. All these men were given a priming dose of trazodone for a 2-week period before giving them sildenafil citrate. Results: Of the 18 men, 12 responded favorably to the above treatment and continued to enjoy good sexual activity while on trazodone and sildenafil. The score on EDIS improved considerably in 12 (66.7%) men, marginally in two (11.1%) men, and did not improve at all in four (22.2%) men. Conclusions: Priming the patients with trazodone appears to be a reasonably good alternative in patients who have initial failure to oral sildenafil citrate and have been found to have no organic cause of ED. However, large double-blind studies are required to potentiate this hypothesis.

GENDER and HEALTH NEWS

Zimbabwe: 'Promote circumcision in acceptable manner'
(News Article; Sub-Saharan Africa)
8 May 2007
The Herald (Harare)

Gambia: Circumcisers drop their knives
(News Article; Sub-Saharan Africa)
7 May 2007
Sillah A | Gaye A, FOROYAA Newspaper (Serrekunda)

Rwanda: Handicrafts to combat gender based violence
(News Article; Sub-Saharan Africa)
7 May 2007
Karibwije D, East African Business Week (Kampala)

Kenya: Where many schoolgirls miss class over old, harmful ritual
(News Article; Sub-Saharan Africa)
9 May 2007
Masibo K | Kiragu S, The Nation (Nairobi)

Namibia: Victims to recount bashings
(News Article; Sub-Saharan Africa)
9 May 2007
Sibeene P, New Era (Windhoek)

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

High fertility Gambians in low fertility Spain: The dynamics of child accumulation across transnational space
(Abstract; subscription needed for full text; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Demographic Research . 2007 May 3;16(12):375-412.
Bledsoe C | Houle R | Sow P
Based on an analysis of the Spanish census and the January 1, 2005 municipal register and on exploratory fieldwork in Catalonia, this paper combines ethnography and demography, in conjunction with current Spanish reunification law, to examine the dynamics of what appears to be high fertility among Gambian immigrants living in Spain. We suggest that this high fertility rate reflects several things. One is the high costs of living in Spain for an unskilled, often-undocumented, but also relatively longstanding Sub-Saharan group from a homeland with high rates of fertility: a homeland with which close ties remain vital for migrants in highly marginal conditions. Another is the replacement, in some cases, of older wives by younger ones from Africa, resulting in high rates of reproduction for short slices of time by a circulating pool of young women. We focus, however, on the role of Spanish and European policies themselves in shaping these numbers, particularly those policies that place restrictions on the free movement of people. We conclude that the most interesting demographic facet of this population may not be high fertility but rather the paradoxical dynamics of child accumulation in particular geographic regions as an artifact of Spanish law itself.

Family, obligations, and migration: The role of kinship in Cameroon
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Demographic Research . 2007 May 8;16(13):413-440.
Fleischer A
The aim of this paper is to investigate the influence of family and kin networks on the individual decision to migrate. The study is based on qualitative ethnographic data collected during field research in Cameroon and shows the considerable impact of the extended family on the migrant's decision to leave Cameroon for Germany. Migrants do not necessarily set out to pursue individual goals. They are often delegated to leave by authority figures in their extended family. The individual is part of an informal reciprocal system of exchange, which is based on trust, has social consequences, and includes duties and responsibilities for both sides.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Infant mortality in Iraq soars as young pay the price for war
(News Article; Middle East)
08 May 2007
Buncombe A., The Independent

Pakistan: No plans to teach schoolchildren family planning: Minister
(News Article; Asia)
09 May 2007
Achakzai J., Daily Times

Demographic trends in Northeast Asia
(News Article; Asia)
08 May 2007
Eberstadt N., American Enterprise Institute

Uganda: How population growth rate is threatening environment
(Commentary; Sub-Saharan Africa)
07 May 2007
Mugasi S., East African Business Week

Egypt's child healthcare lessons
(News Article; North Africa)
08 May 2007
Carroll J, Christian Science Monitor

ADOLESCENT HEALTH RESEARCH

Community involvement in youth reproductive health and HIV prevention
(Review/Synthesis; Global)
2007;(19)
Interagency Youth Working Group/Family Health International
Projects working with youth have often focused on clinics, schools, the workplace, media outlets, or other discrete interventions. Increasingly, youth projects are now turning to a more holistic approach that involves community members, including adults and youth, in the belief that reproductive health(RH) and HIV outcomes for youth will be better and that program efforts will be sustained.

Escaping the triple trap: Coping strategies of pregnant adolescent survivors of domestic violence in Mulago hospital, Uganda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Scandinavian Journal of Public Health. 2007;35(2):180-186.
Kaye DK | Ekstrom AM | Johansson A | Bantebya G | Mirembe FM
Why domestic violence survivors develop adverse outcomes following domestic violence during pregnancy is unclear, but may depend on how survivors cope with the stress of violence. The objective was to describe strategies pregnant adolescents employ in coping with domestic violence. This was a qualitative study involving 16 in-depth interviews with adolescent domestic violence survivors who attended the antenatal clinic in Mulago hospital, Kampala, Uganda, from January to May 2004. Theoretical sampling, necessitated by the emergent theory from sequential data collection and analysis, further provided diversity of experiences from adolescents of different ages, parity, pregnancy duration, and socioeconomic status until saturation was reached. Data were analyzed using grounded theory. Survivors described varied experiences of physical, sexual, and psychological violence. Coping strategies employed were analyzed as: Minimizing damage -- decreasing impact and severity of violence, withdrawal -- physical or social withdrawal, seeking help and retaliation (fighting back). Coping strategies were influenced by adolescence and pregnancy, and are explained in relation to theories of coping with stress. Coping strategies adopted by pregnant adolescent survivors range from problem-focused approaches to emotion-focused approaches. Coping strategies are influenced markedly by adolescence and pregnancy.

Children and adolescents victimized by sexual abuse in the city of Rio de Janeiro: An appraisal of cases
(Abstract; subscription needed for full text; South America)
Journal of Forensic and Legal Medicine. 2007 May;14(4):216-220.
de Oliveira Aded NL | de Oliveira SF | da Silva Dalcin BL | de Moraes TM | Cavalcanti MT
Physical and/or sexual abuse, negligence, and psychological abuse against children and adolescents, constitute a socially important syndrome, demanding preventive public policies and rules for its eradication. Sexual abuse, as a troublesome occurrence, or even its mere presumption, does not regularly undergo official notification. We have examined legal investigative registers at the Instituto Medico-Legal do Rio de Janeiro - Sede set up from January to March 2000, including women, children and adolescents, with medico-legal histories suggestive of sexual assault. From a sample of 1419 cases, we selected those involving vaginal coitus or other libidinous practices, with an upper age limit of 17 years, reducing our sample to 44 subjects. 84.09% of the assaults occurred between ages 0 and 14 years. In 62.36% of the studied cases there was no mention about perpetrators. Material for laboratory researches had not been collected in 84.09% of the cases.

ADOLESCENT HEALTH NEWS

Preventing teenage pregnancy in Mexico
(News Article; Central America and the Caribbean)
2007 May 9;
IBN Live

Aids control panel ready to review sex education
(News Article; Asia)
2007 May 8;
Khaleej Times Online
Related News Article: NACO ready to review sex education material for schools

Calendar of Events

See All Events

May 29, 2007
Making it Work: Private Sector Partnerships to Improve Women's Health
Special Session When: Tuesday, May 29, 2007 12:30 PM -- 1:00 PM, Registration 1:00 PM -- 4:00 PM, Panel discussion Where: Omni Shoreham Hotel, Washington, DC, Diplomat Ballroom RSVP: RSVP@psp-one.com You do not need to be registered for GHC to attend. The theme for this year's Global Health Council Conference is "Partnerships for Health." Come learn about partnerships before the conference and get a sneak preview of a range of different health partnerships, varying in type and scale. USAID's PSP-One Project-- a leader in private sector partnerships in health -- offers you a chance to hear from both sides of a partnership to understand why more developing country private-sector individuals and organizations are engaging in efforts to improve women's health. The partners will discuss, from their perspectives, what motivated them to enter into the partnership, their expectations, the obstacles they encountered and their views on the future of their partnerships. The three examples demonstrate the various ways partnerships with the private sector help to improve women's health in developing countries: 1. Companies partnering with NGOs: Providing RH/FP and other health services to women workers, their families, and communities in Indonesia Dr. Adi Sasongko, Director for Health Care, Yayasan Kusuma Buana Ms. Debby Sanderson, Factory Manager, PT Dewhirst 2. Maternal health financing in Gujarat: Issues and options for public-private partnerships Dr. Amarjit Singh, Secretary of Health and Family Welfare, Government of Gujarat 3. Building sustainable markets in Nigeria through south-to-south partnerships Mr. Venkatesh Iyer, Vice President International Marketing, FamyCare Limited Ms. Francoise Armand, Director of Social Marketing & Pharmaceutical Partnerships, PSP-One Project Refreshments will be served.
E-Mail: RSVP@psp-one.comEvent Location: Omni Shoreham Hotel, Washington, DC, Diplomat Ballroom

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Volume 7, Number 1714 May 2007