Volume 7, Number 18
21 May 2007

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FAMILY PLANNING RESEARCH

The safety of a drospirenone-containing oral contraceptive: Final results from the European Active Surveillance study on oral contraceptives based on 142,475 women-years of observation
(Abstract; subscription needed for full text; Europe)
Contraception . 2007 May;75(5):344-354.
Dinger J | Heinemann L | Kuhl-Habich D
The study was conducted to compare risks of adverse cardiovascular and other events associated with the use of drospirenone (DRSP)-containing oral contraceptives (OCs) and other OCs. The European Active Surveillance study (EURAS) was a multinational, prospective, noninterventional cohort study of new users of DRSP, levonorgestrel (LNG) and other progestin-containing OCs. Semiannual follow-up was based on mailed questionnaires, with additional follow-up procedures when needed. Overall, 58,674 women were followed for 142,475 women-years of observation. Loss to follow-up was 2.4%. Serious adverse and fatal events were rare, and rate ratios were close to unity (1.0). Cox regression analysis of cardiovascular outcomes yielded hazard ratios for DRSP-containing vs. LNG-containing and other OCs of 1.0 and 0.8 (upper 95% confidence limits, 1.8 and 1.3) for venous, and 0.3 and 0.3 (upper 95% confidence limits, 1.2 and 1.5) for arterial thromboembolism, respectively. Risks of adverse cardiovascular and other serious events in users of a DRSP-containing OC are similar to those associated with the use of other OCs.

Prospective study of hormonal contraception and women's risk of HIV infection in South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of Epidemiology. 2007 Feb;36(1):166-174.
Myer L | Denny L | Wright TC | Kuhn L
Background: Many women using hormonal contraceptives are also at risk of sexually transmitted HIV infection, but data are mixed on whether hormonal contraception increases women's risk of HIV. We investigated associations between HIV incidence and use of combined oral contraceptives (COC), norethindrone enanthate (NET-EN) or depot medroxyprogesterone acetate (DMPA) in a cohort of South African women. Methods: Participants were 4200 HIV-negative women aged 35-49 years enrolled into a cervical cancer screening trial. At enrollment, women were tested for sexually transmitted infections and reported on their sexual behaviour and contraceptive use. During the 24 months of follow-up, women reported on their sexual behaviours and contraceptive use and underwent repeat HIV testing. Results: During the 5010 person-years of follow-up, 111 incident HIV infections were observed (HIV incidence, 2.2 infections/100 person-years). At enrollment, 21% of women reported using hormonal contraception, primarily DMPA (14% of all women) or NET-EN (5%). After adjusting for sexual risk behaviours and sexually transmitted infections, the incidence of HIV was similar among women using COC, NET-EN or DMPA compared with women not using any hormonal method [incidence rate ratios and 95% confidence intervals, 0.65, 0.16-2.66; 0.79, 0.31-2.02 and 0.96, 0.58-1.59, respectively]. There was also no association between increased duration of DMPA use and HIV incidence (P-value for trend, 0.51). Conclusions: These findings contribute to the evidence from general population cohorts of women that hormonal contraceptive use is not associated with increased risk of HIV acquisition. Nonetheless, family planning services are an important venue for HIV prevention activities.

Pregnancy intention and contraceptive use among adult women
(Abstract; subscription needed for full text; North America)
Maternal and Child Health Journal . 2007 Jul;11(4):347-351.
Ahluwalia I | Whitehead N | Bensyl D
We examined pregnancy intention measures and contraceptive use behaviors among reproductive-age women using data from two CDC-based surveillance systems. We analyzed data for women aged 18-44 from 4 states that collected information on pregnancy and contraceptive use from both the Behavioral Risk Factor Surveillance System (BRFSS, n = 4201) and the Pregnancy Risk Assessment Monitoring System (PRAMS, n = 7761) in 2000. Standard definitions of intended and unintended pregnancy were used. BRFSS data show that 4% (95% CI: 2.8-5.2) of the women were pregnant at the time of interview and that 57% (95% CI: 41.9-71.9) of these pregnancies were intended. Women who had been pregnant within the last 5 years but were not currently pregnant reported that 61% (95% CI: 55.9-65.3) of their most recent pregnancies had been intended. According to PRAMS, 58% (95% CI: 56.5-60.5) of women with live births had intended pregnancies. Contraceptive use varied across the surveys; 68% (95% CI: 65.7-70.7) of all non-pregnant women from BRFSS and 87% (95% CI: 85.1-87.9) of women with a recent live birth from PRAMS reported using contraceptives. Although contraceptive use differed between the BRFSS and PRAMS, the patterns of pregnancy intention were similar for women who had a pregnancy within the past 5 years, those who recently delivered a live-born infant, and those who were currently pregnant. It appears that reporting of pregnancy intention is not affected by timing of assessment across the two surveys.

FAMILY PLANNING NEWS

Philippines: UN presses for population control, health program
(News Article; Asia)
14 May 2007
Caber M, Manila Standard Today

Jamaica: 75 percent of pregnancies in persons under 24 unplanned
(News Article; Central America and the Caribbean)
16 May 2007
BROWN I, The Jamaica Observer

HIV/AIDS and STIs RESEARCH

Scaling up priority health interventions in Tanzania: The human resources challenge
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Health Policy and Planning. 2007 May;22(3):113-127.
Kurowski C | Wyss K | Abdulla S | Mills A
The international community has set ambitious goals (Millennium Development Goals) to improve health in developing countries by 2015. Effective and often cheap interventions exist to achieve these goals. In the mainland of Tanzania, one of the poorest countries of the world, we explored the human resources challenges of expanding the coverage of such priority interventions. We projected human resources for health (HRH) availability using a standard approach and estimated human resource requirements using a novel method (QTP) that produces estimates by task-specific skill categories and explicitly considers productivity. In this paper, we present the findings of the case study in Tanzania and discuss the strengths and weaknesses of the QTP model. On the whole, the HRH challenge of expanding priority interventions in mainland Tanzania is daunting. HRH requirements exceed by far the estimates of HRH availability for 2015. The scaling up of the HIV/AIDS related intervention cluster, in particular the treatment and care of people living with HIV/AIDS, was the primary driver of increases in HRH requirements between the study's base year, 2002, and 2015, and thus of the overall imbalance. Scenario analysis points to three key areas for change in HRH policy and practice to reduce future imbalances: the increment-attrition balance, staff and service productivity, and the match between task-specific skill and occupational categories. However, even in an optimistic scenario, human resource availability will limit the extent to which priority interventions can be expanded in the mainland of Tanzania, and the government will not be able to avoid adjusting the globally set targets for service coverage and health outcomes to local realities and priorities.

Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases
(Research Article; Global)
The New England Journal of Medicine. 2007 May 10;356(19):1928-1943.
Garland SM | Hernandez-Avila M | Wheeler CM | Perez G | Harper DM | Leodolter S | Tang GWK | Ferris DG | Steben M | Bryan J | Taddeo FJ | Railkar R | Esser MT | Sings HL | Nelson M | Boslego J | Sattler C | Barr E | Koutsky LA
Related Research Article: Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions
Related News Article: Efficacy of HPV vaccine gardasil among women previously infected with HPV lower than expected, study says
A phase 3 trial was conducted to evaluate the efficacy of a prophylactic quadrivalent vaccine in preventing anogenital diseases associated with human papillomavirus (HPV) types 6, 11, 16, and 18. In this randomized, placebo-controlled, double-blind trial involving 5455 women between the ages of 16 and 24 years, we assigned 2723 women to receive vaccine and 2732 to receive placebo at day 1, month 2, and month 6. The coprimary composite end points were the incidence of genital warts, vulvar or vaginal intraepithelial neoplasia, or cancer and the incidence of cervical intraepithelial neoplasia, adenocarcinoma in situ, or cancer associated with HPV type 6, 11, 16, or 18. Data for the primary analysis were collected for a per-protocol susceptible population of women who had no virologic evidence of HPV type 6, 11, 16, or 18 through 1 month after administration of the third dose. The women were followed for an average of 3 years after administration of the first dose. In the per-protocol population, those followed for vulvar, vaginal, or perianal disease included 2261 women (83%) in the vaccine group and 2279 (83%) in the placebo group. Those followed for cervical disease included 2241 women (82%) in the vaccine group and 2258 (83%) in the placebo group. Vaccine efficacy was 100% for each of the coprimary end points. In an intention-to-treat analysis, including those with prevalent infection or disease caused by vaccine-type and non-vaccine-type HPV, vaccination reduced the rate of any vulvar or vaginal perianal lesions regardless of the causal HPV type by 34% (95% confidence interval [CI], 15 to 49), and the rate of cervical lesions regardless of the causal HPV type by 20% (95% CI, 8 to 31). The quadrivalent vaccine significantly reduced the incidence of HPV-associated anogenital diseases in young women.

Herpes simplex virus type 2 (HSV-2) infection in women attending an antenatal clinic in the South Pacific island nation of Vanuatu
(Abstract; subscription needed for full text; Oceania)
Sexually Transmitted Diseases. 2007 May;34(5):258-261.
Haddow LJ | Sullivan EA | Taylor J | Abel M | Cunningham AL
The objective of this study was to estimate the prevalence and correlates of herpes simplex virus type 2 infection in women in an antenatal clinic in the South Pacific island nation of Vanuatu. A prevalence survey of sexually transmitted infections of pregnant women attending an antenatal clinic at Vila Central Hospital was conducted in 1999-2000. Serum samples were tested for HSV-1 and HSV-2 antibodies by enzyme-linked immunosorbent assay. Results for other sexually transmitted infections and demographic and obstetric variables were analyzed for their association with HSV-2 serostatus. HSV-2 serum antibody results were obtained on 535 women and HSV-1 results on 134. The seroprevalence of HSV-2 was 30% and HSV-1 was 100%. On multivariate analysis, the independent predictors of HSV-2 infection were age, marital status, and trichomoniasis. HSV-2 was common in this sample of sexually active women in Vanuatu. This is the first study of HSV in Vanuatu and one of very few studies in the Pacific region.

"We are also dying like any other people, we are also people": Perceptions of the impact of HIV/AIDS on health workers in two districts in Zambia
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Health Policy and Planning. 2007 May;22(3):139-148.
Dieleman M | Biemba G | Mphuka S | Sichinga-Sichali K | Sissolak D
In countries with a high AIDS prevalence, the health workforce is affected by AIDS in several ways. In Zambia, which has a prevalence rate of 16.5%, a study was carried out in 2004 with the aim to: explore the impact of HIV/AIDS on health workers, describe their coping mechanisms and recommend supportive measures. The qualitative study was complemented by a survey using self-administered questionnaires in four selected health facilities in two rural districts in Zambia, Mpika and Mazabuka. It is one of the few studies to have explored the impact of HIV/AIDS from the perspective of health workers and managers in the region. Thirty-four in-depth interviews and five group discussions were conducted with health workers, managers and volunteers, and 82 self-administered questionnaires were filled out by health workers. In addition, burnout among 42 health workers was measured using the Maslach Burnout Inventory (MBI). The MBI measures three components that contribute to burnout: emotional exhaustion, depersonalization and personal accomplishment. The results show that in both districts, HIV/AIDS has had a negative impact on workload and has considerably changed or added tasks to already overburdened health workers. In Mpika, 76% of respondents (29/38), and in Mazabuka, 79% (34/44) of respondents, expressed fear of infection at the workplace. HIV-positive health workers remained 'in hiding', did not talk about their illness and suffered in silence. Despite the fact that health workers were still relatively motivated, emotional exhaustion occurred among 62% of the respondents (26/42). The interviews revealed that counsellors and nurses were especially at risk for emotional exhaustion. In each of the selected facilities, organizational support for health workers to deal with HIV/ AIDS was either haphazardly in place or not in place at all. AIDS complicates the already difficult work environment. In addition to health workers, management also needs support in dealing with AIDS at the workplace.

Media and education play a tremendous role in mounting AIDS awareness among married couples in Bangladesh
(Abstract; subscription needed for full text; Asia)
AIDS Research and Therapy. 2007 May 12;4(1):10.
Rahman MS | Rahman ML
To quarantine the spreading possibility of HIV virus to general population boosting public awareness is must. But the proper awareness level is substantially low in Bangladesh. This paper aims to identify the factors associated with the awareness regarding HIV/AIDS through a bivariate and multivariate analysis using the data extracted from Bangladesh Demography and Health Survey (BDHS) 1999-2000. The findings of both techniques show that education, occupation, socioeconomic status, status of household food consumption, area of residence and media exposure have significant (p less than 0.001) contribution in determining HIV/AIDS awareness level. It also reveals that media, particularly TV, and education play the leading role regarding this issue while the others have an indirect relationship. The odds of awareness among higher educated women and men were 4.69 and 77.73 times of no educated women and men respectively. In addition, both women and men those who regularly watch TV were 8.6 times more likely to be aware about AIDS compared to those who never watch TV. This phenomenon holds true for both women and men. At this instant it is urgent to give emphasis on education, alleviation of poverty, ensuring electronic media exposure, head to head communication program, institutional based sex education and necessary information to learn about HIV/AIDS for the young, adult and adolescents all over the country.

HIV/AIDS and STIs NEWS

Nigerian government approves policy to address HIV and AIDS in workplace
(News Article; Sub-Saharan Africa)
16 May 2007
Kaiser Network

Namibia: Major boost for HIV/AIDS
(News Article; Sub-Saharan Africa)
15 May 2007
Gaomas S, New Era (Windhoek)

Comics teach chauvinistic Indian men about safe sex
(News Article; Asia)
16 May 2007
Mukherjee K, Reuters

Russia warns of AIDS epidemic, 1.3 mln with HIV
(News Article; Asia)
15 May 2007
Reuters

Health workers worried about AIDS in Chad's refugee camps
(News Article; Sub-Saharan Africa)
14 May 2007
Tran P, Voice of America (VOA)

MATERNAL AND CHILD HEALTH RESEARCH

Maternal mortality and the consequences on infant and child survival in rural Haiti
(Abstract; subscription needed for full text; Central America and the Caribbean)
Maternal and Child Health Journal. 2007 Jul;11(4):395-401.
Anderson FW | Morton SU | Naik S | Gebrian B
The objective was to determine the odds of death of children when a woman of reproductive age dies from maternal or non-maternal causes in rural Haiti. Deaths among reproductive aged women between 1997 and 1999 in and around Jeremie, Haiti were classified as maternal or non- maternal and matched to female, non-deceasesd controls based on village, age, and parity. Information regarding the health and survival of all of the offspring under 12 years old of the identified women was extracted from the Haitian Health Foundation (HHF) Health Information System (HIS). Additional demographic information was obtained through interviews with the mothers for controls and with family members for cases. Two analyses on child death were conducted: 1) the odds of death for each individual child after a mother's death and 2) the odds of one of the children in a family dying after the mother's death. If a family experiences a maternal death, that family has a 55.0% increased odds of experiencing the loss of a child less than 12, whereas when a non-maternal death occurs, no increased odds exists. When children of cases were compared to children of controls, mean weight z-scores were the same for the periods corresponding to before and after the maternal deaths. After a maternal death, dosage of BCG (Bacillus Calmette-Guerin) TB (tuberculosis) immunization for the surviving child is significantly lower, as are dosage of measles immunization and the first dose of vitamin A. This study shows that a maternal death significantly effects the survival of children in a family in a greater way than a non-maternal death.

Implementation examined in a health center-delivered, educational intervention that improved infant growth in Trujillo, Peru: Successes and challenges
(Abstract; subscription needed for full text; South America)
Health Education Research. 2007 Jun;22(3):318-331.
Robert RC | Gittelsohn J | Creed-Kanashiro HM | Penny ME | Caulfield LE
Process evaluation was used to examine the implementation of a randomized, controlled trial of an education intervention that improved infant growth in Trujillo, Peru. Health personnel delivered the multi-component intervention as part of usual care in the government health centers. Quantitative and qualitative methods were used to examine process indicators, which included the extent of delivery (dose), fidelity to intervention protocol, barriers to implementation and context. Results demonstrated that most intervention components were delivered at a level of 50-90% of expectations. Fidelity to intervention protocol, where measured, was lower (28-70% of expectations). However, when compared with existing nutrition education, as represented by the control centers, significant improvements were demonstrated. This included both improved delivery of existing educational activities as well as delivery of new intervention components to strengthen overall nutrition education. Barriers to, and facilitators of, implementation were explored with health personnel and helped to explain results. This study demonstrates the importance of examining actual versus planned implementation in order to improve our understanding of how interventions succeed. The information gained from this study will inform future evaluation designs, and lead to the development and implementation of more effective intervention programs for child health.

Obstetric fistulae: A study of women managed at the Monze Mission Hospital, Zambia
(Abstract; subscription needed for full text; Sub-Saharan Africa)
British Journal of Obstetrics and Gynaecology. Online access May 16, 2007.
Holme A | Breen M | MacArthur C
The objective of this study was to describe and compare characteristics of women with obstetric fistula. The design used was a retrospective cross-sectional study. The setting for the study was Zambia's primary fistula repair centre, Monze Mission Hospital. The sample taken was all women, August 2003 to December 2005. Review of case notes to obtain data on sociodemographic and obstetric characteristics, causative pregnancy, clinical details, and treatment. Comparison of characteristics with national data was undertaken. Of 259 women, 239 had socio-demographic and obstetric records and 254 had surgical records. Educational status and height of women were significantly below the national averages, while antenatal care uptake (97.5%) and proportion from the Northern Province were significantly above. Most women (77.9%) weighed less than or equal to 50 kg. Median age at marriage was 18 and at development of fistula was 22 years. 15.1% of women were divorced, 49.0% were primiparous, and 27.6% were parity four +. 67.5% of women had spent 2 days or longer in labour. Delays in receiving emergency obstetric care (EmOC) were experienced at home (67.5%) and at clinics (49.4%), usually due to transport difficulties. 89.1% delivered in a health facility, 50.2% of deliveries were by caesarean section, and 78.1% of babies were stillborn. 72.9% of repairs were successful, 17.3% resulted in residual stress incontinence, and 9.8% failed. Failure was significantly associated with previous repair. More obstetric fistulae occur in areas where early marriage and pregnancy before pelvic maturity is attained is common and where obstetric care is inaccessible. In this study, age at marriage and fistula development was older than usually found, which may indicate that poor access to EmOC contributes more to this problem within Zambia.

Whom can I rely on? Mothers' approaches to support for feeding: An interview study in suburban Dar es Salaam, Tanzania
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Midwifery. 2007 Jun;23(2):172-183.
Omer-Salim A | Persson LA | Olsson P
The objective was to explore and describe mothers' perceptions of baby feeding and approaches to support for baby feeding. The design of the study was qualitative semi-structured interviews conducted with mothers. Method used for analysis was qualitative content analysis. The setting for the study was the suburban Dar es Salaam, Tanzania. 8 mothers with babies under 6 months of age were the participants. The study revealed four categories of mothers' perceptions of baby feeding: (1) baby feeding, housework and paid work have to adjust to each other; (2) breast feeding has many benefits; (3) water or breast milk can be given to quench baby's thirst; and (4) crying provides guidance for baby feeding. Four different themes describing approaches to support emerged from the data: (1) adhering to diverse sources; (2) relying wholeheartedly on a mother figure; (3) working as a parental team; and (4) making arrangements for absence from the child. Knowledge of the different approaches to support for baby feeding described in this study can help define counselling and promotional strategies in order to reach mothers with more effective messages and support for optimal baby-feeding practices.

MATERNAL AND CHILD HEALTH NEWS

MP reports a child death every five minutes, maternal death every hour
(News Article; Asia)
2007 May 15;
Gulati A, Countercurrents.org

Has Uganda's maternal death ratio dropped?
(News Article; Sub-Saharan Africa)
2007 May 15;
Ouma F, New Vision

Indonesia: Men share responsibility for improving women's lives: Govt
(News Article; Asia)
2007 May 16;
The Jakarta Post

GENDER and HEALTH RESEARCH

Sexual and reproductive health needs of sex workers: Two feminist projects in Brazil
(Abstract; subscription needed for full text; South America)
Reproductive Health Matters. 2007 May;15(29):108-118.
Chachama AS | Dinizb SG | Maiac MB | Galatid AF | Mirime LA
The sexual and reproductive health needs of sex workers have been neglected both in research and public health interventions, which have almost exclusively focused on STI/HIV prevention. Among the reasons for this are the condemnation, stigma and ambiguous legal status of sex work. This paper describes work carried out by two feminist NGOs in Brazil, Mulher e Saúde (MUSA) in Belo Horizonte and Coletivo Feminista Sexualidade e Saúde in São Paulo, to promote sexual and reproductive health for sex workers. MUSA's project "In the Battle for Health", was begun in 1992; sex workers were trained as peer educators and workshops were offered on self-care for sex workers and their clients. In São Paulo, the Coletivo project "Get Friendly with Her", begun in 2002, offers clinic consultations and self-care workshops on sexuality, contraception, STI/HIV prevention and self-examination. Health care needs during menstruation and unhealthy vaginal practices led to promotion of the diaphragm as a contraceptive, for prevention of reproductive tract infection and to catch menstrual blood. Meeting the sexual and reproductive health needs of sex workers depends on the promotion of their human rights, access to health care without discrimination, and attention to psychosocial health issues, alcohol and drug abuse, and violence from clients, partners, pimps and police.

Roundtable: "You can also cut my finger!": Social construction of male circumcision in West Africa, a case study of Senegal and Guinea-Bissau
(Research Article; Sub-Saharan Africa)
Reproductive Health Matters. 2007 May;15(29):22-32.
Nianga CI | Boirob H
The aim of this study was to contribute to the current debate on male circumcision through an analysis of the cultural concepts, practices and social relations associated with male circumcision in two West African countries, Senegal and Guinea-Bissau. The research methodology was qualitative. The findings highlight the complex conceptualisation of male circumcision present among a wide variety of ethnic groups, which cover religious, spiritual and biomedical aspects. An understanding of local concepts of male circumcision and the world views represented can lay the foundations for the development of holistic approaches to promoting male circumcision in the struggle against HIV. The findings also illustrate the central place of women in male circumcision traditions at many levels. The preparation and carrying out of the surgical operation and the processes of traditional initiation are marked by complex interactions linked to the philosophy and social organisation of the societies studied. The findings reveal the need for reflection on how to create synergy between traditional and modern perspectives when developing programmes for male circumcision in West African societies.

GENDER and HEALTH NEWS

Burundi: Armed banditry, sexual violence increasing, says watchdog
(News Article; Sub-Saharan Africa)
16 May 2007
UN Integrated Regional Information Networks

Lancet publishes opinion pieces responding to studies finding that male circumcision reduces men's HIV infection risk
(News Article; Global)
16 May 2007
Medical News Today

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Prevalence of female infertility and its socio-economic factors in tribal communities of Central India
(Research Article; Asia)
(You need Adobe Acrobat Reader to access this document)
Rural and Remote Health. Online access May 8, 2007. 7(2)
Kumar D
Introduction: The Khairwar tribe of India is dwindling due to infertility and migration. The study investigates an extensive infertility problem among Khairwar and non-Khairwar tribes in the same geographical area. The objective of the study was to determine for the first time the prevalence of infertility in these two tribal groups. Method: The study was carried out in the Kusmi block of the Sidhi district of Madhya Pradesh in Central India. The data were collected by trained investigators through a structured interview scheduled in April 2002. A total of 1305 people were studied from 284 households. Of a population of 778 people, 133 eligible couples belonged to the Khairwar tribe; out of a population of 527 people, 99 eligible couples belonged to non-Khairwar tribes. Results: The prevalence of infertility of the study population was 33 (14.2%) out of 232 women. In the Khairwars, infertility was found in 23 (17.2%) significantly higher than in non-Khairwars--10 (10%). The mean age of infertile women among the Khairwars was 31.3 +/- 8.9 years and 27.5 +/- 9.2 years among non-Khairwars. The average duration of marriage of infertile women in the Khairwars and non-Khairwars was estimated as 14.9 +/- 7.7 years and 11.1 +/- 7.9 years respectively. Conclusion: The prevalence of infertility is higher in the Khairwars compared with non-Khairwars. It is suggested that further study needs to determine the causes and necessary interventions.

Equity in health and healthcare in Malawi: Analysis of trends
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMC Public Health. 2007 May 15;7:78.
Zere E | Moeti M | Kirigia J | Mwase T | Kataika E
Growing scientific evidence points to the pervasiveness of inequities in health and health care and the persistence of the inverse care law, that is the availability of good quality healthcare seems to be inversely related to the need for it in developing countries. Achievement of the Millennium Development Goals is likely to be compromised if inequities in health/healthcare are not properly addressed. This study attempts to assess trends in inequities in selected indicators of health status and health service utilization in Malawi using data from the Demographic and Health Surveys of 1992, 2000 and 2004. Data from Demographic and Health Surveys of 1992, 2000 and 2004 are analysed for inequities in health/healthcare using quintile ratios and concentration curves /indices. Overall, the findings indicate that in most of the selected indicators there are pro-rich inequities and that they have been widening during the period under consideration. Furthermore, vertical inequities are observed in the use of interventions (treatment of diarrhoea, ARI among under-five children), in that the non-poor who experience less burden from these diseases receive more of the treatment/interventions, whereas the poor who have a greater proportion of the disease burden use less of the interventions. It is also observed that the publicly provided services for some of the selected interventions (e.g., child delivery) benefit the non-poor more than the poor. The widening trend in inequities, in particular healthcare utilization for proven cost-effective interventions is likely to jeopardize the achievement of the Millennium Development Goals and other national and regional targets. To counteract the inequities it is recommended that coverage in poor communities be increased through appropriate targeting mechanisms and effective service delivery strategies. There is also a need for studies to identify which service delivery mechanisms are effective in the Malawian context.

Maternal mortality in Yunnan, China: Recent trends and associated factors
(Abstract; subscription needed for full text; Asia)
British Journal of Obstetrics and Gyneacology. 2007;:10 p.
Li J | Luo C | Deng R | Jacoby P | de Klerk N
Yunnan Province, located in southwest China, is one of the poorest provinces in China. The maternal mortality ratio (MMR) is about twice the national average (56.2/100 000 live births), and in remote mountainous regions, the rate is five times higher. This study aimed to examine the progress in reduction of maternal mortality in the 1990s and early 2000s and the factors associated with this reduction in Yunnan. The design used was a population-based, longitudinal, ecological correlation study. A remote province of China with a proportionately large indigenous population was the setting of the study. The population studied was the population at county, prefecture and provincial level. Using maternal mortality data collected at the province, prefecture/region and county levels, trend and time series analyses and multivariate linear regression analyses were performed using SPSS (Version 13). Main outcome measure: MMR and its change over time. MMR declined substantially in the 1990s at a rate of 3.0% per year. Utilisation of prenatal and obstetric care increased and was significantly correlated with the declining trend in MMR. Hospital delivery was a strong predictor of MMR, independent of social and economic development. Both low income and illiteracy were significantly associated with increased MMR. Declines in maternal mortality in Yunnan over the past 14 years appear to reflect health, social and economic interventions implemented in the 1990s. The association of hospital delivery with maternal mortality may be due to the effective management of severe pregnancy and birth complications. Low income and illiteracy were associated with MMR but primarily through their impact on the use of prenatal and obstetric care.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Population drops in Cuba in 2006
(News Article; Central America and the Caribbean)
2007 May 18;
Caribbean Net News

Climate change may force mass migration
(News Article; Global)
2007 May 17;
Vidal J, The Hindu

Zimbabwe gets safe migration info center
(News Article; Sub-Saharan Africa)
2007 May 15;
The Zimbabwean

ADOLESCENT HEALTH RESEARCH

Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Care. 2007 May;19(5):677-684.
Jemmott JB 3rd | Heeren GA | Ngwane Z | Hewitt N | Jemmott LS | Shell R | O'leary A
HIV/AIDS is taking a heavy toll on South African youth. Reducing their risk for HIV requires an understanding of the determinants of their HIV risk behaviours that are amendable to intervention-induced change. This study draws upon the theory of planned behaviour to identify the modifiable determinants of the intention to use condoms among Xhosa-speaking South African adolescents. The participants were 390 Xhosa-speaking 6th grade students (mean age = 12.1 years) in public schools in the township of Mdantsane, South Africa who completed an anonymous questionnaire. Multiple regression revealed that attitude and perceived behavioural control were significantly related to the intention to use condoms, whereas subjective norm was not, controlling for sexual experience, gender, and language preference. Consistent with this were additional analyses using beliefs as predictors: Hedonistic behavioural beliefs and control beliefs about condom-use negotiation and technical skills predicted intention, whereas normative beliefs did not. The theory of planned behaviour may be a useful model of condom use among Xhosa-speaking South African adolescents. An emphasis on beliefs about the adverse effects of condom use on sexual enjoyment, the ability to negotiate condom use, and the ability to use condoms correctly might improve the efficacy of HIV/STD interventions for such adolescents.

Enrolling adolescents in HIV vaccine trials: Reflections on legal complexities from South Africa
(Research Article; Sub-Saharan Africa)
BMC Medical Ethics. Online access May 13, 2007. 8(5)
Slack C | Strode A | Fleischer T | Gray G | Ranchod C
Background: South Africa is likely to be the first country in the world to host an adolescent HIV vaccine trial. Adolescents may be enrolled in late 2007. In the development and review of adolescent HIV vaccine trial protocols there are many complexities to consider, and much work to be done if these important trials are to become a reality. Discussion: This article sets out essential requirements for the lawful conduct of adolescent research in South Africa including compliance with consent requirements, child protection laws, and processes for the ethical and regulatory approval of research. Summary: This article outlines likely complexities for researchers and research ethics committees, including determining that trial interventions meet current risk standards for child research. Explicit recommendations are made for role-players in other jurisdictions who may also be planning such trials. This article concludes with concrete steps for implementing these important trials in South Africa and other jurisdictions, including planning for consent processes; delineating privacy rights; compiling information necessary for ethics committees to assess risks to child participants; training trial site staff to recognize when disclosures trigger a mandatory reporting response; networking among relevant ethics commitees; and lobbying the National Regulatory Authority for guidance. (provisional PDF online)

ADOLESCENT HEALTH NEWS

Sri Lanka: Growing demand for reproductive health education
(News Article; Asia)
2007 May 15;
Gunatilleke N, Daily News

Youth prefer peer educators: Assifi
(News Article; Oceania)
2007 May 12;
Fiji Times Online

Jamaica: More must be done to reduce unplanned pregnancies - Dr. Hughes
(News Article; Central America and the Caribbean)
2007 May 16;
Jamaica Information Service

A quiet scourge
(News Article; Global)
2007 May 15;
Kantrowitz B | Wingert P, Newsweek

Sumita Kale: Sex education in schools
(Commentary; Asia)
2007 May 16;
Kale S, Business Standard

Continuous Identification of Research Evidence (CIRE) Related to Family Planning Guidance

Bonny AE, Ziegler J, Harvey R, Debanne SM, and Secic M. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Archives of Pediatrics and Adolescent Medicine. 2006 Jan;160(1):40-45
The objective was to examine weight changes in a large cohort of obese and nonobese adolescent girls initiating depot medroxyprogesterone acetate (DMPA), an oral contraceptive (OC), or no hormonal contraceptive method (control). Prospective study of 450 adolescent girls, aged 12 to 18 years, who attended 4 urban health clinics and selected DMPA, OC, or control. Data collection occurred at baseline and at 6, 12, and 18 months; consisted of structured interview and measurement of height and weight; and occurred from April 19, 2000, through September 26, 2003. Weight was examined as mean change over 18 months and actual weight at each study visit. On the basis of preliminary analyses, we stratified the sample according to baseline obesity status (nonobese, body mass index [calculated as weight in kilograms divided by the square of height in meters] _30; obese, body mass index less than 30). Adolescent girls who were obese at initiation of DMPA gained significantly more weight than did obese girls starting OC or control (P_.001 for both). At 18 months, mean weight gain was 9.4, 0.2, and 3.1 kg for obese girls receiving DMPA, receiving OC, and control, respectively. Weight gain in obese girls receiving DMPA was also greater than weight gain in all nonobese categories (4.0 kg, DMPA; 2.8 kg, OC; 3.5 kg, control; P less than .001). A significant interaction (P = .006) between length of time receiving DMPA and weight gain was evident for obese subjects. Over 18 months, DMPA use was associated with increasing rates of weight gain in obese subjects. The potential contribution to severe obesity in this population is concerning. (author's)

Link to CIRE evidence: http://www.infoforhealth.org/cire_pub.pl?cire_input=POI.fat..2829.3813.Y

Calendar of Events

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May 29, 2007 - June 1, 2007
34th Annual International Conference on Global Health
The conference theme is "Partnerships: Working Together for Global Health." Conference presentations related to Gender and Health include "Marital Relationships and Women’s Status: Intergenerational Effects on Age at First Sex in the Philippines" (May 30, 5-6:30 p.m.) and related to Family Planning include "Developing an Online Toolkit for Revitalizing the IUD" (May 31, 2:30-4:30 p.m.), among many others.
Event Location: Washington, D.C.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 7, Number 1821 May 2007