Volume 7, Number 22
18 June 2007

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FAMILY PLANNING RESEARCH

Factors associated with contraceptive use in Tehran, Iran
(Abstract; subscription needed for full text; Middle East)
European Journal of Contraception and Reproductive Health Care. 2007 Jun;12(2):148-153.
Sadat-Hashemi S | Ghorbani R | Majdabadi H | Farahani F
In spite of the government's efforts, the prevalence of contraceptive use in Iran is only 55.4%. Health concerns, side effects, failure of the methods and some demographic issues, among which education, age, and number of daughters, have a great influence on the enforcement of contraceptive measures. The aim of the present study was to identify factors affecting contraceptive use in Iran. Data from the project, "The study of contraceptive practice in Tehran, 1999-2000," were analyzed with regard to the factors associated with contraceptive use by Iranian couples. A total of 4042 women at reproductive ages who had delivered in one of the 12 teaching hospitals of Tehran and had at least one child that lived for at least 24 hours after birth, were interviewed using a questionnaire that gathered information about their sociodemographic status, fertility history, and other characteristics. Using a multinomial logistic regression, it was found that the woman's age, her own or her husband's level of education, previous awareness about contraceptive methods, number of abortions, and number of sons and daughters were factors that were significantly associated with contraceptive use. A number of factors affect the application of contraceptive measures. It is essential that health policy makers be aware of these to promote contraception and population control.

Supply and demand challenges to modern contraceptive use in Azerbaijan
(Abstract; subscription needed for full text; Asia)
European Journal of Contraception and Reproductive Health Care. 2007 Jun;12(2):175-183.
Bradley J | Mursagulova N | Nosa M | Searing H
We conducted a survey of health facilities and household members to determine supply and demand aspects of contraceptive use in Azerbaijan. In June 2005, we conducted interviews with 758 women and 253 men in a community-based survey in 40 communities in five districts. We also surveyed a sample of health facilities and pharmacies and conducted interviews with key informants. Both men and women in these communities desire small families, yet significant supply and demand impediments exist. Despite community interest, lack of knowledge of contraception is prevalent. Fear of side effects plays a role in non-use and discontinuation of modern methods, although little opportunity exists for counselling on side effects, since few health workers are trained. An obstacle to use is legislation that only allows contraception to be prescribed by gynaecologists, who are mostly concentrated in the hospitals of urban centres. However, the main handicap to increased use of modern contraception, is insufficient contraceptive supply. Not only is there a lack of method choice nationally, but few of the facilities we surveyed had any contraceptives available. This situation threatens to worsen as the United Nations Population Fund (UNFPA) retracts commodities' funding. The lack of knowledge of modern contraception, lack of trained staff, and poor commodity availability signals that much remains to be done for the people of Azerbaijan to achieve their fertility control goals.

Do perceived health risks outweigh the benefits of modern contraceptives? A qualitative study in a suburban population in Istanbul, Turkey
(Abstract; subscription needed for full text; Europe)
European Journal of Contraception and Reproductive Health Care . 2007 Jun;12(2):154-161.
Ay P | Hidiroglu S | Topuzoglu A | Ucar M | Kose O
The objectives were to evaluate the health concerns and the perceived non-contraceptive benefits of modern contraceptive methods through utilizing qualitative methods. Six focus group discussions were carried out with a total of 53 married women in a socio-economically disadvantaged community in Istanbul, Turkey. Women had a vague knowledge of the mechanism of menstruation. Some women believed that the uterus was filled with blood -- termed 'dirty blood' -- which should be eliminated during menstruation in order to stay healthy. For this reason, amenorrhoea was recognized as the important disadvantage of the progestin-only injectable contraceptives. While the participants mentioned fallacious and exaggerated side effects related to modern methods they did not recognize their non-contraceptive benefits. Most women gained the information concerning side effects through their social networks. Sometimes the information acquired was based on rumours that biased women against the modern contraceptives. Women outweighed the risks, some of which were fallacious and exaggerated, against the benefits of modern contraceptives. It is crucial to address health concerns of women and what they 'heard' from their peers during counselling sessions. Also the non-contraceptive health benefits of modern methods should be well emphasized. Since informal sources are prevalent, the effectiveness of peer education should be studied in this community.

FAMILY PLANNING NEWS

Brazil: New family planning program
(News Article; South America)
13 Jun 2007
Latinamerica Press

LAW AND POLICY

Indonesia: Population policy 'needs revamp'
(News Article; Asia)
9 Jun 2007
The Jakarta Post

HIV/AIDS and STIs RESEARCH

High potential of escalating HIV transmission in a low prevalence setting in rural Tanzania
(Research Article; Sub-Saharan Africa)
BMC Public Health . 2007 Jun 9;7:103.
Yahya-Malima KI | Matee MI | Evjen-Olsen B | Fylkesnes K
Previous surveillance among antenatal clinic (ANC) attendees within the remote rural Manyara and Singida regions in Tanzania identified an imminent but still, relatively low HIV epidemic. We conducted a population-based HIV study to identify risk factors and validate the representativeness of ANC-based estimates. Using a two-stage cluster sampling approach, we enrolled and then interviewed and collected saliva samples from 1,698 adults aged 15-49 years between December 2003 and May 2004. We anonymously tested saliva samples for IgG antibodies against HIV using Bionor HIV-1&2 assays. Risk factors for HIV infection were analysed by multivariate logistic regression using the rural population of the two regions as a standard. The prevalence of HIV in the general population was 1.8% (95% CI: 1.1-2.4), closely matching the ANC-based estimate (2.0%, 95% CI: 1.3-3.0). The female to male prevalence ratio was 0.8 (95%CI 0.4-1.7). HIV was associated with being a resident in a fishing community, and having recently moved into the area. Multiple sexual partners increased likelihood of HIV infection by 4.2 times (95% CI; 1.2-15.4) for men. In women, use of contraceptives other than condoms was associated with HIV infection (OR 6.5, 95% CI; 1.7-25.5), while most of the population (78%) have never used condoms. The HIV prevalence from the general population was comparable to that of pregnant women attending antenatal clinics. The revealed patterns of sexual risk behaviours, for example, close to 50% of men having multiple partners and 78% of the population have never used a condom; it is likely that HIV infection will rapidly escalate. Immediate and effective preventive efforts that consider the socio-cultural contexts are necessary to reduce the spread of the infection.

HIV-associated TB in an Giang Province, Vietnam, 2001 -- 2004: Epidemiology and TB treatment outcomes
(Research Article; Asia)
PLoS ONE. 2007 Jun;2(6):7.
Thuy TT | Shah NS | Anh MH | Nghia DT | Thom D
Mortality is high in HIV-infected TB patients, but few studies from Southeast Asia have documented the benefits of interventions, such as co-trimoxazole (CTX), in reducing mortality during TB treatment. To help guide policy in Vietnam, we studied the epidemiology of HIV-associated TB in one province and examined factors associated with outcomes, including the impact of CTX use. We retrospectively abstracted data for all HIV-infected persons diagnosed with TB from 2001-2004 in An Giang, a province in southern Vietnam in which TB patients receive HIV counseling and testing. We used standard WHO definitions to classify TB treatment outcomes. We conducted multivariate analysis to identify risk factors for the composite outcome of death, default, or treatment failure during TB treatment. From 2001-2004, 637 HIV-infected TB patients were diagnosed in An Giang. Of these, 501 (79%) were male, 321 (50%) were aged 25-34 years, and the most common self-reported HIV risk factor was sex with a commercial sex worker in 221 (35%). TB was classified as smear-positive in 531 (83%). During TB treatment, 167 (26%) patients died, 9 (1%) defaulted, and 6 (1%) failed treatment. Of 454 patients who took CTX, 116 (26%) had an unsuccessful outcome compared with 33 (70%) of 47 patients who did not take CTX (relative risk, 0.4; 95% confidence interval [CI], 0.3-0.5). Adjusting for male sex, rural residence, TB smear status and disease location, and the occurrence of adverse events during TB treatment in multivariate analysis, the benefit of CTX persisted (adjusted odds ratio for unsuccessful outcome 0.1; CI, 0.1-0.3). In An Giang, Vietnam, HIV-associated TB was associated with poor TB treatment outcomes. Outcomes were significantly better in those taking CTX. This finding suggests that Vietnam should consider applying WHO recommendations to prescribe CTX to all HIV-infected TB patients.

Endogenous reactivation and true treatment failure as causes of recurrent tuberculosis in a high incidence setting with a low HIV infection
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Tropical Medicine and International Health . 2007 Jun;12(6):700-708.
Shamputa IC | Van Deun A | Salim MA | Hossain MA | Fissette K
The objective was to determine the relative frequencies of reinfection vs. reactivation or treatment failure in patients from a high tuberculosis incidence setting with a low prevalence of HIV infection. We performed DNA fingerprinting on serial isolates from one and multiple TB episodes from 97 retreatment patients; 35 patients had been previously cured, whereas 62 had not. DNA fingerprinting patterns of recurrence Mycobacterium tuberculosis isolates of 5 of the 35 previously cured patients did not match with those of the corresponding initial isolates, indicating reinfection. We did not document reinfection during treatment. Isolates from each of the remaining 30 previously cured patients had identical DNA fingerprinting results, indicating reactivation. DNA fingerprinting patterns of isolates from the 62 patients with persistently positive sputum smears were identical, suggesting treatment failure. These findings suggest that reinfection is not a common cause of relapse and treatment failure in this rural predominantly HIV-free population despite the high incidence of TB.

A review of health behaviour theories: How useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS
(Research Article; Global)
BMC Public Health. 2007 Jun 11;7:104.
Munro SA | Lewin SA | Swart J | Volmink J
Suboptimal treatment adherence remains a barrier to the control of many infectious diseases, including tuberculosis and HIV/AIDS, which contribute significantly to the global disease burden. However, few of the many interventions developed to address this issue explicitly draw on theories of health behaviour. Such theories could contribute to the design of more effective interventions to promote treatment adherence and to improving assessments of the transferability of these interventions across different health issues and settings. This paper reviews behaviour change theories applicable to long-term treatment adherence; assesses the evidence for their effectiveness in predicting behaviour change; and examines the implications of these findings for developing strategies to improve TB and HIV/AIDS medication adherence. We searched a number of electronic databases for theories of behaviour change. Eleven theories were examined. Little empirical evidence was located on the effectiveness of these theories in promoting adherence. However, several models have the potential to both improve understanding of adherence behaviours and contribute to the design of more effective interventions to promote adherence to TB and HIV/AIDS medication. Further research and analysis is needed urgently to determine which models might best improve adherence to long-term treatment regimens.

HIV/AIDS and STIs NEWS

Number of Indians with HIV far lower than previously believed, study finds
(News Article; Asia)
8 Jun 2007
The Associated Press

South African AIDS delegates issue contraception call
(News Article; Sub-Saharan Africa)
8 Jun 2007
Agence France-Press (AFP)

Uganda: Government attacked over expired female condoms
(News Article; Sub-Saharan Africa)
10 Jun 2007
Namutebi J, The New Vision

MATERNAL AND CHILD HEALTH RESEARCH

The combined effect of employment status and transcultural marriage on breast feeding: A population-based survey in Taiwan
(Abstract; subscription needed for full text; Asia)
Paediatric and Perinatal Epidemiology. 2007 Jul;21(4):319-329.
Chuang CH | Chang PJ | Hsieh WS | Guo YL | Lin SH
In recent decades there has been a marked rise in both the labour market participation of women with infants and transcultural marriage in Taiwan. The objectives of this study were to explore the combined effect of employment status and transcultural marriage on the prevalence and factors relating to initiation and continuation of breast feeding in Taiwan. We used multistage stratified systematic sampling to recruit 2048 postpartum women from the Taiwan National Birth Registration database for the period November to December 2003. They were interviewed at home within 6 months of delivery using a structured questionnaire; 87% of the sampled population completed the interview. We used logistic regression analysis to estimate the odds ratio (OR) of breast-feeding initiation and Cox regression (survival) analysis to predict continued breast feeding. The prevalences of initial breast feeding for employed Taiwanese mothers, unemployed Taiwanese mothers, employed foreign-born mothers and unemployed foreign-born mothers were 84.4%, 83.7%, 79.1% and 79.7%, respectively. Among the four groups of mothers who initiated breast feeding, 12.9%, 27.2%, 14.7% and 39.7% of their infants, respectively, were still breast feeding at the age of 6 months. Factors associated with initiation of breast feeding were high maternal education (OR 3.80; 95% confidence interval [CI] 1.81, 7.98) and normal spontaneous delivery (OR 1.36; 95% CI 1.04, 1.78). The main reason for not breast feeding in 52% of the mothers was insufficient or no milk. There existed a combined effect of employment status and transcultural marriage on the continuation of breast feeding. Employed Taiwanese mothers were earlier than others at weaning. Unemployed foreign-born mothers breast fed the longest [hazard ratio (HR) 0.54; 95% CI 0.42, 0.70]. Other factors related to late weaning were high maternal education (HR 0.67; 95% CI 0.47, 0.96), older maternal age (HR 0.76; 95% CI 0.61, 0.94), mother sleeping with baby at night (HR 0.68; 95% CI 0.59, 0.78), and no supplemental baby food before the age of 6 months (HR 0.78; 95% CI 0.68, 0.90). The initiation of breast feeding was high but it decreased dramatically after the postpartum period in Taiwan. There was a significant combined effect of employment status and transcultural marriage on the continuation of breast feeding. Employment is a persistent barrier to continued breast feeding.

Screening for gestational diabetes at antenatal booking in a Malaysian university hospital: The role of risk factors and threshold value for the 50-g glucose challenge test
(Abstract; subscription needed for full text; Asia)
Australian and New Zealand Journal of Obstetrics and Gynaecology. 2007 Jun;47(3):191-197.
Tan PC | Ling LP | Omar SZ
The best method of screening for gestational diabetes (GDM) remains unsettled. The 50-g glucose challenge test (GCT) is used in a two-stage screening process, but its best threshold value can vary according to population. The aims were to evaluate the role of risk factors in conjunction with GCT and to determine an appropriate threshold for the one-hour venous plasma glucose with the GCT. In a prospective study, 1600 women at antenatal booking without a history of diabetes mellitus or GDM filled a form on risk factors before GCT. Women who had GCT greater than or equal to 7.2 mmol/L underwent the 75-g oral glucose tolerance test (OGTT). GDM was diagnosed according to WHO (1999) criteria. Thirty-five per cent had GCT greater than or equal to 7.2 mmol/L, 32.6% underwent OGTT and 34.5% of OGTT confirmed GDM. The GDM rate in our population was at least 11.4%. Examination of the receiver operator characteristic curve suggested that the best threshold value for the GCT in our population was greater than or equal to 7.6 mmol/L. Multivariable logistic regression demonstrated that only GCT greater than or equal to 7.6 mmol/L was an independent predictor for GDM (adjusted odds ratio 3.7: P less than 0.001). After GCT, maternal age and anthropometry, OGTT during the third trimester, family history, obstetric history and glycosuria were not independent predictors of GDM. Risk factors were not independent predictors of GDM in women with GCT greater than or equal to 7.2 mmol/L. GCT threshold value greater than or equal to 7.6 mmol is appropriate for the Malaysian population at high risk of GDM.

Infant programming of bone size and bone mass in 10-year-old black and white South African children
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Paediatric and Perinatal Epidemiology. 2007 Jul;21(4):354-362.
Vidulich L | Norris SA | Cameron N | Pettifor JM
In developed countries, the earliest of factors shown to identify those at a high risk of having low bone mass and so be prone to osteoporosis in later life is that of quality of early life reflected by low birthweight (BW) and size in infancy. It is unclear whether such relationships exist in developing countries and in black populations. Associations were studied between BW, weight (WT1) and length (LT1) at 1 year and bone size and bone mass in 476 children (boys: 182 black, 72 white; girls: 158 black, 64 white) aged 10 years, who formed part of a longitudinal cohort of children born in Johannesburg, South Africa, during 1990. Bone area (BA) and bone mineral content (BMC) measurements were made of the whole body, femoral neck and lumbar spine (L1-L4) by dual-energy X-ray absorptiometry (DXA). After adjusting BA and BMC for race, gender, age, socio-economic status, bone age, height and weight at 10 years, on which BA and BMC in children are so dependent, WT1, LT1 and BW were significant predictors of whole body BA (WT1, P less than 0.0001; LT1, P less than 0.01; BW, P less than 0.05) and BMC (WT1, P less than 0.01; LT1, P less than 0.05; BW, P less than 0.05) and of BMC of the femoral neck (WT1, P less than 0.01; LT1, P less than 0.05). When BMC was in addition corrected for BA, then BW, WT1 and LT1 were predictive of femoral neck BMC (BW, P less than 0.05; WT1, P less than 0.05; LT1, P less than 0.01) but not whole body BMC. Thus, BMC at 10 years appears to be independently associated with weight and length at 1 year, which is not completely mediated by the tracking of skeletal growth. Low BW and small size at 1 year resulted in smaller bones and/or bones of lower BMC at the femoral neck. The findings support the hypothesis that growth and development, both intrauterine and in the first year, which are measures of genetic, intrauterine and postnatal environmental factors, may have long-term consequences when compromised, and may be associated with the risk of osteoporosis in later life.

Effect of meteorological factors on clinical malaria risk among children: An assessment using village-based meteorological stations and community-based parasitological survey
(Research Article; Sub-Saharan Africa)
BMC Public Health . 2007 Jun 8;7:101.
Ye Y | Louis VR | Simboro S | Sauerborn R
Temperature, rainfall and humidity have been widely associated with the dynamics of malaria vector population and, therefore, with spread of the disease. However, at the local scale, there is a lack of a systematic quantification of the effect of these factors on malaria transmission. Further, most attempts to quantify this effect are based on proxy meteorological data acquired from satellites or interpolated from a different scale. This has led to controversies about the contribution of climate change to malaria transmission risk among others. Our study addresses the original question of relating meteorological factors measured at the local scale with malaria infection, using data collected at the same time and scale. 676 children (6-59 months) were selected randomly from three ecologically different sites (urban and rural). During weekly home visits between December 1, 2003, and November 30, 2004, field-workers tested children with fever for clinical malaria. They also collected data on possible confounders monthly. Digital meteorological stations measured ambient temperature, humidity, and rainfall in each site. Logistic regression was used to estimate the risk of clinical malaria given the previous month's meteorological conditions. The overall incidence of clinical malaria over the study period was 1.07 episodes per child. Meteorological factors were associated with clinical malaria with mean temperature having the largest effect. Temperature was the best predictor for clinical malaria among children under five. A systematic measurement of local temperature through ground stations and integration of such data in the routine health information system could support assessment of malaria transmission risk at the district level for well-targeted control efforts.

MATERNAL AND CHILD HEALTH NEWS

Indonesia combats widespread childhood anemia
(News Article; Asia)
2007 Jun 10;10 Jun 2007
VOA News

Tanzania: Pop star lends her voice to stop maternal, infant and child deaths
(News Article; Sub-Saharan Africa)
2007 Jun 11;11 Jun 2007
Walker A, UNFPA

Kenya: Programmes to boost child and maternal health launched
(News Article; Sub-Saharan Africa)
2007 Jun 8;8 Jun 2007
Karong'o C, CapitalFM

GENDER and HEALTH RESEARCH

Increased standardized incidence ratio of breast cancer in female electronics workers
(Research Article; Asia)
BMC Public Health. 2007 Jun 8;7:102.
Sung TI | Chen PC | Lee LJ | Lin YP | Hsieh GY
In 1994, a hazardous waste site, polluted by the dumping of solvents from a former electronics factory, was discovered in Taoyuan, Taiwan. This subsequently emerged as a serious case of contamination through chlorinated hydrocarbons with suspected occupational cancer. The objective of this study was to determine if there was any increased risk of breast cancer among female workers in a 23-year follow-up period. A total of 63,982 female workers were retrospectively recruited from the database of the Bureau of Labor Insurance (BLI) covering the period 1973-1997; the data were then linked with data, up to 2001, from the National Cancer Registry at the Taiwanese Department of Health, from which standardized incidence ratios (SIRs) for different types of cancer were calculated as compared to the general population. There were a total of 286 cases of breast cancer, and after adjustment for calendar year and age, the SIR was close to 1. When stratified by the year 1974 (the year in which the regulations on solvent use were promulgated), the SIR of the cohort of workers who were first employed prior to 1974 increased to 1.38 (95% confidence interval, 1.11-1.70). No such trend was discernible for workers employed after 1974. When 10 years of employment was considered, there was a further increase in the SIR for breast cancer, to 1.62. Those workers with breast cancer who were first employed prior to 1974 were employed at a younger age and for a longer period. Previous qualitative studies of interviews with the workers, corroborated by inspection records, showed a short-term high exposure to chlorinated alkanes and alkenes, particularly trichloroethylene before 1974. There were no similar findings on other types of cancer. Female workers with exposure to trichloroethylene and/or mixture of solvents, first employed prior to 1974, may have an excess risk of breast cancer.

Comparison of a community outreach service with opportunity screening for cervical cancer using Pap smears
(Abstract; subscription needed for full text; Asia)
Journal of Public Health. 2007 Jun;29(2):165-172.
Chang HC | Hsiung HY | Chen SI | Yen AM | Chen TH
We sought to compare the take-up of cervical screening with Pap smears in a new outreach and pre-existing hospital-based setting (1) to assess the extent to which the two means of provision would overlap; (2) to establish how the utilization rate is influenced by demographic features and geographical distance from the point of provision; and (3) to access whether an outreach service would lead to increased utilization. We used a pre-test-post-test design and used multiple linear regression to assess the effect an outreach service has on utilization after adjusting for participants age, education and martial status. We found that the outreach service independently provided screening to 89% of eligible women and that coverage was inversely associated with distance from the pre-existing hospital provision. After controlling for age, education and martial status, there was a statistically significant increase (53%; 95% CI: 25, 80%) in utilization. There was little overlap between the outreach and hospital-based cervical screening services so that overall accessibility was enhanced, particularly for the elderly, widowed and less well educated. The outreach service also reduced inequalities due to geography.

Laparoscopic-assisted vaginal hysterectomy for patients with extensive pelvic adhesions: A strategy to minimise conversion to laparotomy
(Abstract; subscription needed for full text; Asia)
Australian and New Zealand Journal of Obstetrics and Gynaecology. 2007 Jun;47(3):230-234.
Hsu WC | Chang WC | Huang SC | Sheu BC | Torng PL
The aim was to evaluate a strategy for successful laparoscopic-assisted vaginal hysterectomy (LAVH) in patients with extensive pelvic adhesion. Two hundred and thirty-six patients who underwent LAVH at National Taiwan University Hospital were retrospectively enrolled. Twenty-three patients (9.7%) had unexpected extensive pelvic adhesions. A special procedure of uterine artery preligation through retroperitoneal downstream ureter tracking was applied to overcome this problem. The clinical characteristics of the study group were analysed. The operative parameters and the outcome were compared between those with and without extensive pelvic adhesions. Having extensive adhesions, 17 patients were associated with endometriosis and the other six were secondary to previous Caesarean delivery or pelvic inflammation. The cul-de-sac was partially and totally obliterated in 10 and 13 patients, respectively. These 23 patients had longer operation time (184 vs 146 min, P less than 0.05), more blood loss (146 vs 89 mL, P less than 0.05), but smaller extirpated uteri (278 vs 372 g, P = 0.063), compared with the other 213 patients. The average hospital stay was comparable (3.2 vs 3.4 days) and there were no ureteral injuries or excessive bleeding. Most importantly, not a single case was converted to laparotomy. Pelvic adhesions of various underlying diseases are associated with increased complication and conversion rates during LAVH. Although this technique is not new, we believe that the special procedure of uterine artery preligation through retroperitoneal downstream ureter tracking may provide a safe approach for general gynecologists to complete successful LAVH in patients with unexpected extensive pelvic adhesions.

GENDER and HEALTH NEWS

Possible early signs of ovarian cancer identified
(News Article; Global)
14 Jun 2007
Associated Press

Circumcision in Eritrea: Custom trumps law
(News Article; Sub-Saharan Africa)
11 Jun 2007
Reuters

Uganda: Women call for own HIV measures
(News Article; Sub-Saharan Africa)
10 Jun 2007
Ajwang J | Natabalo G, The Monitor (Kampala)

Uganda: The feminisation of AIDS
(News Article; Sub-Saharan Africa)
11 Jun 2007
New Vision (Kampala)

Yemen: Female genital mutilation: Ritual or worship?
(News Article; Middle East)
11 Jun 2007
Yemen Times

Nigeria: 'Gender policy can impact on infant/maternal mortality'
(News Article; Sub-Saharan Africa)
12 Jun 2007
Amalu C, Vanguard Online

Guinea girl workers 'face abuse'
(News Article; Sub-Saharan Africa)
15 Jun 2007
Ross W, BBC News

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Epidemiologic transition interrupted: A reassessment of mortality trends in Thailand, 1980 -- 2000
(Abstract; subscription needed for full text; Asia)
International Journal of Epidemiology . 2007 Apr;36(2):374-384.
Hill K | Vapattanawong P | Prasartkul P | Porapakkham Y | Lim SS
In the late 1980s and early 1990s a generalized HIV epidemic affected Thailand which was relatively well controlled by an intensive national campaign by the mid 1990s. The extent to which the epidemic has slowed or possibly reversed the epidemiological transition in Thailand is relatively unknown. Under-five mortality rates (U5MR) were determined from various sources and weighted least squares regression conducted to determine U5MR over the years 1980â€“2000. Direct and indirect estimates of the completeness of death registration were used to estimate mortality levels in those aged more than 5 years for the 1980-90 and 1990-2000 periods. Life tables were constructed using the various estimates to determine changes in life-expectancy between the two time periods. U5MR in Thailand is estimated to have been 58/1000 live births in 1980, declining to 30 in 1990 and to 23 in 2000. The vital registration system clearly underestimates U5MR. Successive surveys of Population Change (SPC) imply coverage of death registration improving from 75-77% in 1985-86 to 95% in 1995-96, partly due to a reliance on self-reported registration in the latter survey. In contrast, the General Growth Balance-Synthetic Extinction Generations (GGB-SEG) method suggests coverage worsening from 78-85% in 1980-90 to 64-72% in 1990-2000. Life tables based on SPC adjustments show continued declines in female, and to a lesser extent, male adult mortality with corresponding increases in life-expectancy at birth of around 6 years for both sexes from 1980-90 to 1990-2000. In contrast, the indirect adjustments suggest a substantial increase in male adult mortality with female adult mortality unchanged; life expectancy decreased by 4 years for males and was only marginally higher in females. Given the conflicting evidence a definitive assessment of mortality change in Thailand between 1980 and 2000 is difficult to make. Indirect adjustments, based on demographic methods point to a major reversal in mortality decline among males, and a slowing in females. If adult mortality registration has declined, and given the continued under-registration of infant and child deaths, remedial measures are urgently required if the mortality system is to better inform and monitor health development in Thailand.

Start-stop funding, its causes and consequences: A case study of the delivery exemptions policy in Ghana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of Health Planning and Management . 2007 Apr-Jun;22(2):133-143.
Witter S | Adjei S
This article looks at the issue of sustaining funding for a public programme through the case study of the delivery exemptions policy in Ghana. The Government of Ghana introduced the policy of exempting users from delivery fees in September 2003 in the four most deprived regions of the country, and in April 2005 it was extended to the remaining six regions in Ghana. The aim of the policy of free delivery care was to reduce financial barriers to using maternity services. Using materials from key informant interviews at national and local levels in 2005, the article examines how the policy has been implemented and what the main constraints have been, as perceived by different actors in the health system. The interviews show that despite being a high-profile public policy and achieving positive results, the delivery exemptions policy quickly ran into implementation problems caused by inadequate funding. They suggest that facility and district managers bear the brunt of the damage that is caused when benefits that have been promised to the public cannot be delivered. There can be knock-on effects on other public programmes too. Despite these problems, start-stop funding and under-funding of public programmes is more the norm than the exception. Some of the factors causing erratic funding-such as party politics and intersectoral haggling over resources-are unavoidable, but others, such as communication and management failures can and should be addressed.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Heavy influx from Pakistan: Kashmir population doubles in two decades
(News Article; Asia)
17 Jun 2007
Sachar G, The Organiser

Comparing Russia and China: Human capital
(News Article; Asia)
12 Jun 2007
Aervitz I, Russia Profile

Malaysia: Public health needs attention, says Abdullah
(News Article; Asia)
15 Jun 2007
The Star

ADOLESCENT HEALTH RESEARCH

College students in Nigeria underestimate their risk of contracting HIV/AIDS infection
(Abstract; subscription needed for full text; Sub-Saharan Africa)
European Journal of Contraception and Reproductive Health Care . 2007 Jun;12(2):131-137.
Ijadunola KT | Abiona TC | Odu OO | Ijadunola MY
The objectives were to assess the perceptions of personal risk of acquiring HIV/AIDS infection among students of selected tertiary institutions in Osun State, Nigeria and to determine the correlates of perceptions of personal risk of infection. The study employed a cross-sectional descriptive design. An interviewer-administered questionnaire was applied to the 405 study participants and correlates of perceptions of personal risk of HIV infection were evaluated using multiple logistic regression analysis, confidence intervals and odd ratios. Only 15% of the students perceived themselves to be at moderate-to-high risk of acquiring HIV infection compared with 85% who perceived themselves to be at little or no risk. Investigators' assessment of risk status of the participants revealed that 77% of the participants were actually at high risk of infection and only 23% at low risk. The sensitivity, specificity and negative predictive value of the students' self-perception of personal risk compared with their assessed risk were 7, 58 and 16%, respectively, with a Kappa statistic of 0.178. The only significant correlate of self-perception of personal risk was a recent symptom of sexually transmitted infections. College students exhibited an 'optimism bias' associating high rates of HIV risk indicators with low levels of perceived personal risk of infection. This has implications for HIV/AIDS control in Nigeria.

Motherhood status and union formation in Moshi, Tanzania 2002 -- 2003
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Population Studies . 2007 Jul;61(2):185-199.
Hattori MK | Larsen U
Age at first union is increasing throughout much of sub-Saharan Africa at the same time that not all couples are waiting for marriage before their first sexual intercourse. We assessed the effect of a premarital first birth on entrance into a first union in an urban area in East Africa - Moshi, Tanzania. The data come from the Moshi Infertility Survey of 2002-2003. Women who spent less than a year in single motherhood were significantly more likely than childless women to enter into a first union, although the magnitude of this relationship was weaker for more recent cohorts. Women who had been single mothers for 5 or more years (about two-thirds of women with a premarital birth) were significantly less likely than women without children to enter into a first union.

Parent-adolescent sex communication in China
(Abstract; subscription needed for full text; Asia)
European Journal of Contraception and Reproductive Health Care . 2007 Jun;12(2):131-137.
Zhang L | Li X | Shah IH | Baldwin W | Stanton B
Communication concerning sexual matters between parents and their adolescent children serve as a protective factor and exerts a favourable influence on adolescents' sexual behaviours. As limited data regarding parent-adolescent sex communication are available in China, this study was undertaken with the aim of exploring the patterns and related factors of such communication and its relationship with adolescent sexual behaviour. Community-based data were collected in 2001 in Changchun, China. Unmarried adolescents 15-19 years of age (322 young men and 360 young women) were included in a survey using self-administered questionnaires. Overall, sex communication with parents was relatively infrequent. There was a significant gender difference in the pattern of sex communication, with male adolescents being more likely to talk with fathers and female adolescents with mothers. Logistic regression analysis revealed that gender of adolescents, quality of communication with mothers on general topics, and adolescent's perception of mother being the main source of sex knowledge were predictive of the level of sex communication between mother and her adolescent children. This study reveals that communication regarding sexual matters between parents and adolescents was limited in China. The quality of communication on general topics between parents and their adolescent children is one of the important factors related to sex communication between them. It is essential that Chinese parents are better informed and skilled to be involved, in addition to school and community, in the sex education of their adolescent children. They should be able to communicate appropriately on sex-related issues with them.

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Volume 7, Number 2218 June 2007