Volume 7, Number 24
2 July 2007

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FAMILY PLANNING RESEARCH

The effects of oral contraceptives on androgen levels and their relevance to premenstrual mood and sexual interest: A comparison of two triphasic formulations containing norgestimate and either 35 or 25 micrograms of ethinyl estradiol
(Abstract; subscription needed for full text; Global)
Contraception. 2007 Jun;76(1):8-17.
Greco T | Graham C | Bancroft J | Tanner A | Doll H
This study compared two oral contraceptives (OCs) with the same triphasic regimen of progestin (norgestimate 0.18, 0.215 and 0.25 mg) but differing doses of ethinyl estradiol (EE) - 25 and 35 macrog EE - in their effects on androgens, mood and sexual interest in women starting on OCs. Total testosterone (T), free testosterone (FT), sex-hormone-binding globulin (SHBG) and dehydroepiandrosterone sulphate (DHEA-S), together with measures of mood [Beck Depression Inventory (BDI)], sexual interest [Dyadic and Solitary subscales of the Sexual Desire Inventory (SDI)] and self-reported side effects were assessed before starting on the OC and again after 3 months of use. Sixty women, all university students, were randomized to receive either the 25 macrog EE (N/EE25) or the 35 macrog EE (N/EE35) pill; 12 women discontinued, leaving 48 who completed the 3-month study. Their mean age was 19.7 years (18-30) and they were predominantly white and single. Both OCs produced reductions in mean T [N/EE35: from 1.33 to 0.60 nmol/L, p less than .001; N/EE25: from 1.12 to 1.02 nmol/L; nonsignificant (NS)] and FT (N/EE35: from 41.3 to 4.4 pmol/L, p less than .001; N/EE25: from 25.4 to 7.9 pmol/L, p less than .01), but the reduction in both T and FT was significantly greater with the higher EE dose (N/EE35) (p=.05 and p=.03, respectively). DHEA-S was also reduced with both formulations (N/EE35: from 7.26 to 5.22 macromol/L); N/EE25: from 7.50 to 5.39 macromol/L), although the reduction was only significant in the N/EE35 group (p less than .02). Considerable variability in changes in mood was evident with both OCs, with some women showing predominantly negative effects (10 in N/EE35, 5 in N/EE25); others, positive effects (9 in N/EE35, 17 in N/EE25) and some, no change (four in each group). Women using N/EE25 were significantly more likely to show improvement in premenstrual mood than those in the N/EE35 group (p less than .02), although there was no correlation between changes in BDI and FT or DHEA-S. Sexual interest scores did not change significantly from baseline to posttreatment with either OC (N/EE35: dyadic, from 40.5 to 39.6, NS; solitary, from 5.9 to 6.4, NS; N/EE25: dyadic, from 36.7 to 37.0, NS; solitary, from 5.0 to 4.2, NS). The lower EE pill reduced FT less and was associated with greater improvement in premenstrual mood. A causal relation between these two effects is uncertain.

Women's responses to menses and nonbleeding intervals in the USA, Brazil and Germany
(Abstract; subscription needed for full text; North America | Europe | South America)
Contraception. 2007 Jul;76(1):23-29.
Snow R | Hardy E | Kneuper E | Hebling E | Hall G
Studies from several countries suggest women differ in their preferred length of nonbleeding intervals, yet studies to date have not explored the social determinants of such preferences. We report results from a menstrual preference and social survey of 1207 healthy women in three age groups (18-20, 25-34 and 45-49 years) and two educational strata (high and low educational attainment), from Campinas (Brazil), Heidelberg (Germany) and Ann Arbor (USA) (~400 women from each country). Women's preferred length of nonbleeding intervals differed significantly between countries. In Ann Arbor, only 15.5% of women preferred to bleed monthly, vs. 30.2% in Heidelberg. In both Ann Arbor and Campinas, approximately one-third of women preferred to "never" have menses, compared to 8.2% in Heidelberg. Multivariate analyses indicated that country, church attendance, stress and menstrual pain were significant predictors of women's preferences. The most common preference among women was to bleed once every 3 months, but preferences varied substantially by country groups. Preferences for nonbleeding intervals were, in part, explained by personal experiences of stress or menstrual pain, but unexplained cultural differences persist between country groups.

The effect of oral contraceptives on uterine contractility and menstrual pain: An assessment with cine MR imaging
(Abstract; subscription needed for full text; Asia)
Human Reproduction . 2007 Jul;22(7):2066-2071.
Kido A | Togashi K | Kataoka M | Maetani Y | Nakai A
Low-dose oral contraceptives (OC) have been reported to control primary dysmenorrhea. Furthermore, a close relationship between dysmenorrhea and uterine contractions has been visualized with magnetic resonance imaging (MRI). This study aimed to use cine MR to demonstrate the effects of OC on myometrial contractility during menstruation and to associate the findings with dysmenorrhea. MR studies were obtained of 21 healthy female volunteers (22-47 years old) taking OC, and 20 control women (24-39 years old) not taking OC. Cine- and static MR images were obtained with a 1.5 T magnet during menstruation. Uterine contractility was assessed by the presence of endometrial distortion on cine MR, the area of the mid-sagittal uterine myometrium, and the thickness of the subendometrial low-intensity area on static images. Dysmenorrhea were assessed via a questionnaire. A total of 21 OC users and 20 controls were included in the analysis. Endometrial distortion was significantly less prominent and the subendometrial low-intensity area was significantly thinner in the OC group. Furthermore in the OC group, the uterine myometrial area was larger (although not significantly) and the degree of assessed pain was significantly lower. Both cine- and static MR images demonstrate that myometrial contractility was relatively suppressed in OC users, which may represent one of the reasons explaining the reduced menstrual pain experienced by OC users.

Elevated end-of-treatment serum INSL3 is associated with failure to completely suppress spermatogenesis in men receiving male hormonal contraception
(Abstract; subscription needed for full text; North America)
Journal of Andrology . 2007 Jul-Aug;28(4):548-554.
Amory JK | Page ST | Anawalt BD | Coviello AD | Matsumoto AM
The administration of testosterone plus a progestogen functions as a male contraceptive by inhibiting the release of pituitary gonadotropins. After 3 to 4 months of treatment, most men are azoospermic or severely oligospermic (less than or equal to 1 million sperm/mL). However, 10% to 20% of men have persistent sperm production despite profound gonadotropin suppression. Since insulin-like factor 3 (INSL3) has been shown to prevent germ cell apoptosis in mice, we hypothesized that INSL3 might be higher in men with persistent spermatogenesis during treatment with male hormonal contraceptives. In a retrospective analysis, we measured serum INSL3 in 107 men from 3 recent male hormonal contraceptive studies and determined the relationship between suppression of spermatogenesis and serum INSL3. At the end of treatment 63 men (59%) were azoospermic and 44 men (41%) had detectable sperm in their ejaculates. Baseline INSL3 did not predict azoospermia; however, end of treatment serum INSL3 was significantly higher in nonazoospermic men compared with those with azoospermia (median [interquartile range]: 95 [73-127] pg/mL vs 80 [67-101] pg/mL; P = .03). Furthermore, serum INSL3 was positively correlated with sperm concentration (r = .25; P = .009) at the end of treatment and was significantly associated with nonazoospermia by multivariate logistic regression (P = .03). After 6 months of treatment with a hormonal male contraceptive regimen, higher serum INSL3 concentrations were associated with persistent sperm production. INSL3 may play a role in preventing complete suppression of spermatogenesis in some men on hormonal contraceptive regimens. This finding suggests that INSL3 may be a potential target for male contraceptive development.

FAMILY PLANNING NEWS

Philippines: No-scalpel vasectomy operation offered free in Cebu
(News Article; Asia)
28 Jun 2007
Dalumpines E, Philippine Information Agency

India: Low response to vasectomy, says study
(News Article; Asia)
2007 Jun 27
Mallady S

HIV/AIDS and STIs RESEARCH

Care and support services for people living with HIV/AIDS (PLHA) in Zambia
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Population Review. 2007;46(1):59-74.
Mutombo N
With an HIV prevalence of 17 percent, Zambia is one of the countries that are bearing the brunt of HIV/AIDS. Coupled with high poverty levels, the task of providing care, treatment and support services for more than one million PLHA is a major developmental challenge to an economy that is reeling from three decades of economic stagnation. Over the years, HIV/AIDS has produced severe consequences at all levels (POLICY 2001:28). In many cases, it has been observed that older and poor women are left with the task of looking after PLHA. These women lack both the material and technical resources required for the care and support of PLHA. This has implications for prevention as well as treatment programmes as PLHA may not receive the counsel they need. Consequently, adherence to antiretroviral therapy and treatment of opportunistic diseases may also be affected. After the adoption of the '3 by 5 strategy' in 2004, the Zambian government facilitated the establishment of various HIV/AIDS services and set a target of providing ART to 100,0002 people by the end of 2005. However, as of 2006, only 65,000 people were on ART. There is also anecdotal evidence suggesting that many people have continued to die from AIDS because they are failing to access the much needed antiretroviral (ARV) drugs on time as they tend to rely more on traditional healers than modern health institutions. In many places, including the city centre of Zambia's capital, Lusaka, there is enough evidence of HIV/AIDS patients seeking medical assistance from traditional healers. Using data from the Zambia HIV Voluntary Counselling and Testing Study (ZHVCTS), this report discusses care and support services for PHWA in Zambia with a view to providing insights into the main challenges facing HIV/AIDS programmes in Zambia.

Size matters: The number of prostitutes and the global HIV/AIDS pandemic
(Research Article; Global)
PLoS One . 2007 Jun 20;2(6):e543.
Talbott JR
HIV/AIDS prevalence rates across countries of the world vary more than 500-fold from .06% in Hungary to 33.4% in Swaziland. One of the most cited research papers in the field, utilizing cross country regression analysis to analyze other correlates with this HIV prevalence data, is flawed in that it weights each country's results by the country's population. Based on cross-country linear and multiple regressions using newly gathered data from UNAIDS, the number of female commercial sex workers as a percentage of the female adult population is robustly positively correlated with countrywide HIV/AIDS prevalence levels. Confirming earlier studies, female illiteracy levels, gender illiteracy differences and income inequality within countries are also significantly positively correlated with HIV/AIDS levels. Muslims as a percentage of the population, itself highly correlated with country circumcision rates and previously found to be negatively correlated with HIV/AIDS prevalence, is insignificant when the percentage of commercial sex workers in a population is included in the analysis. This paper provides strong evidence that when conducted properly, cross country regression data does not support the theory that male circumcision is the key to slowing the AIDS epidemic. Rather, it is the number of infected prostitutes in a country that is highly significant and robust in explaining HIV prevalence levels across countries. An explanation is offered for why Africa has been hit the hardest by the AIDS pandemic and why there appears to be very little correlation between HIV/AIDS infection rates and country wealth.

Prevalence of HIV infection in conflict-affected and displaced people in seven sub-Saharan African countries: A systematic review
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Lancet. 2007 Jul 6;369(9580)
Spiegel P | Bennedsen AR | Claass J | Bruns L | Patterson N | Yiweza D | Schilperoord M
Related News Article: Wars don't fuel African HIV crisis: study
Violence and rape are believed to fuel the HIV epidemic in countries affected by conflict. We compared HIV prevalence in populations directly affected by conflict with that in those not directly affected and in refugees versus the nearest surrounding host communities in sub-Saharan African countries. Seven countries affected by conflict (Democratic Republic of Congo, southern Sudan, Rwanda, Uganda, Sierra Leone, Somalia, and Burundi) were chosen since HIV prevalence surveys within the past 5 years had been done and data, including original antenatal-care sentinel surveillance data, were available. We did a systematic and comprehensive literature search using Medline and Embase. Only articles and reports that contained original data for prevalence of HIV infection were included. All survey reports were independently evaluated by two epidemiologists to assess internationally accepted guidelines for HIV sentinel surveillance and population-based surveys. Whenever possible, data from the nearest antenatal care and host country sentinel site of the neighbouring countries were presented. 95% CIs were provided when available. Of the 295 articles that met our search criteria, 88 had original prevalence data and 65 had data from the seven selected countries. Data from these countries did not show an increase in prevalence of HIV infection during periods of conflict, irrespective of prevalence when conflict began. Prevalence in urban areas affected by conflict decreased in Burundi, Rwanda, and Uganda at similar rates to urban areas unaffected by conflict in their respective countries. Prevalence in conflict-affected rural areas remained low and fairly stable in these countries. Of the 12 sets of refugee camps, nine had a lower prevalence of HIV infection, two a similar prevalence, and one a higher prevalence than their respective host communities. Despite wide-scale rape in many countries, there are no data to show that rape increased prevalence of HIV infection at the population level. We have shown that there is a need for mechanisms to provide time-sensitive information on the effect of conflict on incidence of HIV infection, since we found insufficient data to support the assertions that conflict, forced displacement, and wide-scale rape increase prevalence or that refugees spread HIV infection in host communities.

"Life is still going on": Reproductive intentions among HIV-positive women and men in South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Social Science and Medicine. 2007 Jul;65(2):274-283.
Cooper D | Harries J | Myer L | Orner P | Bracken H
This article reports on qualitative research investigating HIV positive individuals' reproductive intentions and their influencing factors in Cape Town, South Africa. In-depth interviews were held with 61 HIV positive women and men; at the time of interview, half had been receiving antiretroviral treatment (ART) for over 6 months and half were not receiving ART. Being HIV positive modified but did not remove reproductive desires, and diversity existed in reproductive intentions. Some HIV positive individuals wished to avoid pregnancy. Fears of partner and infant infection and having a previously infected baby were important factors deterring some individuals from considering having children. There was also strongly perceived community disapproval associated with HIV and reproduction. Strong desires to experience parenthood, mediated by prevailing social and cultural norms that encouraged childbearing in society more broadly, were reported by others. Motherhood was an important component of married women's identity and important for women's social status. Family, husbands' and societal expectations for childbearing were important influences on women's reproductive intentions, for some counterbalancing HIV as a factor discouraging reproduction. There was evidence that prevention of perinatal transmission programs in combination with ART may alter women and men's attitudes in favour of childbearing. Most HIV positive women had not discussed their reproductive desires and intentions with health care providers in HIV care or general health services because of anticipated negative reactions. The few who had done so perceived the counselling environment to be mostly unsupportive of open discussion on these issues. The findings highlight the need for explicit policies recognizing reproductive rights and choice. They support the need for health counselling and service interventions that advance safer and healthier reproductive options for HIV positive individuals in this region of the world which is experiencing a generalised and advanced HIV/AIDS pandemic.

Understanding the slow depletion of memory CD4+ T cells in HIV infection
(Abstract; Global)
PLoS Medicine. 2007 May 22;4(5):e177.
Yates A | Stark J | Klein N | Antia R | Callard R
Related News Article: HIV infection theory challenged
The asymptomatic phase of HIV infection is characterised by a slow decline of peripheral blood CD4+ T cells. Why this decline is slow is not understood. One potential explanation is that the low average rate of homeostatic proliferation or immune activation dictates the pace of a "runaway" decline of memory CD4+ T cells, in which activation drives infection, higher viral loads, more recruitment of cells into an activated state, and further infection events. We explore this hypothesis using mathematical models. Using simple mathematical models of the dynamics of T cell homeostasis and proliferation, we find that this mechanism fails to explain the time scale of CD4+ memory T cell loss. Instead it predicts the rapid attainment of a stable set point, so other mechanisms must be invoked to explain the slow decline in CD4+ cells. A runaway cycle in which elevated CD4+ T cell activation and proliferation drive HIV production and vice versa cannot explain the pace of depletion during chronic HIV infection. We summarize some alternative mechanisms by which the CD4+ memory T cell homeostatic set point might slowly diminish. While none are mutually exclusive, the phenomenon of viral rebound, in which interruption of antiretroviral therapy causes a rapid return to pretreatment viral load and T cell counts, supports the model of virus adaptation as a major force driving depletion.

HIV/AIDS and STIs NEWS

Uganda: Church leaders asked to support condom use
(News Article; Sub-Saharan Africa)
26 Jun 2007
Ahimbisibwe C, New Vision (Kampala)

Uganda drafting bill that would penalize people who knowingly transmit HIV
(News Article; Sub-Saharan Africa)
22 Jun 2007
Kaiser Network

Kenya says AIDS rate down to 5.9 percent
(News Article; Sub-Saharan Africa)
25 Jun 2007
Reuters

India's HIV caseload may fall by nearly two-thirds
(News Article; Asia)
28 Jun 2007
Zaheer K, Reuters

MATERNAL AND CHILD HEALTH RESEARCH

Daily intake of 100 mg ascorbic acid as urinary tract infection prophylactic agent during pregnancy
(Abstract; subscription needed for full text; Global)
Acta Obstetricia et Gynecologica Scandinavica . 2007 Jul;86(7):783-787.
Ochoa-Brust GJ | Fernandez AR | Villanueva-Ruiz GJ | Velasco R | Trujillo-Hernandez B
The objective was to evaluate the role a daily intake of 100 mg of ascorbic acid plays in urinary infection prophylaxis during pregnancy. A single-blind clinical trial was carried out on pregnant women randomly assigned to the following treatment groups - Group A: oral treatment with ferrous sulphate (200 mg per day), folic acid (5 mg per day) and ascorbic acid (100 mg per day) for 3 months, and Group B: oral treatment with ferrous sulphate (200 mg per day) and folic acid (5 mg per day) for 3 months. All patients were clinically evaluated, and a urine culture was carried out each month for a period of 3 months. The x/2 and odds ratio were used to compare effects with and without ascorbic acid, and statistical significance was considered at p less than 0.05. Global frequency of urinary infections was 25%. The presence of urinary infections in Group A (12.7%) was significantly lower than in Group B (29.1%), (p = 0.03, OR = 0.35, CI 95% = 0.13-0.91). Daily intake of 100 mg of ascorbic acid played an important role in the reduction of urinary infections, improving the health level of the gestating women. We recommend additional vitamin C intake for pregnant women in populations which have a high incidence of bacteriuria and urinary infections.

Impact of written information on women's use of postpartum services: A randomised controlled trial
(Abstract; subscription needed for full text; Middle East)
Acta Obstetricia et Gynecologica Scandinavica . 2007 Jul;86(7):793-798.
Kabakian-Khasholian T | Campbell OM
This study evaluates the impact of providing women with written educational material on their satisfaction with care, and use of health services postpartum. All women having a live birth at 4 private hospitals in Lebanon were eligible. The sample consisted of 187 women in the intervention and 191 in the control arms. An intervention booklet was developed following a qualitative study of women's information needs; placebo material was 2 leaflets about childproofing the house. Field workers administered a baseline questionnaire to recruit all eligible women, and conducted follow-up interviews 6-20 weeks postpartum at the women's residences. The written material was handed out to women just before discharge from hospital. At the baseline interview, interviewers and women were blinded to the nature of the written material. Outcome measures were a postpartum visit to a health professional after discharge and before the follow-up interview, and satisfaction with maternity care received during pregnancy, delivery and postpartum. Satisfaction with care during the postpartum period was 57.2% in the intervention and 38.9% in the control arm (p less than 0.001). Some 85% of women in the intervention arm had a postpartum visit compared to 55% in the control arm (p less than 0.001). In the context of high female literacy, the intervention is effective and requires few resources.

Serum adiponectin and lipid concentrations in pregnant women with polycystic ovary syndrome
(Abstract; subscription needed for full text; Global)
Human Reproduction . 2007 Jul;22(7):1830-1836.
Sir-Petermann T | Echiburu B | Maliqueo MM | Crisosto N | Sanchez F
We aimed to evaluate the serum adiponectin and lipid concentrations in normal and polycystic ovary syndrome (PCOS) women during pregnancy in order to establish whether PCOS induces abnormal lipid and adiponectin levels that could constitute potential metabolic risk factors for pregnancy complications. Women with singleton pregnancies and of similar age were included (48 pregnant PCOS and 51 normal pregnant women). During gestational weeks 10-16 and 22-28, a 2 h, 75 g oral glucose tolerance test was performed, with measurement of glucose and insulin in each sample. Adiponectin and lipid concentrations were determined in the fasting sample. The incidence of gestational diabetes mellitus (GDM) was significantly higher in the PCOS group (12.2%) compared with the control group (2%). In PCOS patients, triglyceride (TG) concentrations and area under the curve of glucose and insulin were higher in both study periods and adiponectin concentrations were significantly lower in the second period, compared with normal women. Moreover, adiponectin concentrations were lower in women with GDM than in those with normal glucose tolerance in the two study periods. Low adiponectin and high insulin levels are associated with GDM in pregnant PCOS patients. High TG levels seem not to be directly related to pregnancy complications in these patients.

Achieving child survival goals: Potential contribution of community health workers
(Abstract; subscription needed for full text; Global)
Lancet. 2007 Jun 23;369(9579):2121-2131.
Haines A | Sanders D | Lehmann U | Rowe AK | Lawn JE
There is renewed interest in the potential contribution of community health workers to child survival. Community health workers can undertake various tasks, including case management of childhood illnesses (e.g., pneumonia, malaria, and neonatal sepsis) and delivery of preventive interventions such as immunisation, promotion of healthy behaviour, and mobilisation of communities. Several trials show substantial reductions in child mortality, particularly through case management of ill children by these types of community interventions. However, community health workers are not a panacea for weak health systems and will need focussed tasks, adequate remuneration, training, supervision, and the active involvement of the communities in which they work. The introduction of large-scale programmes for community health workers requires evaluation to document the impact on child survival and cost effectiveness and to elucidate factors associated with success and sustainability.

MATERNAL AND CHILD HEALTH NEWS

Pakistan: New plan for child protection mapped out
(News Article; Asia)
27 Jun 2007
Khalid S | Ghauri I, Daily Times

Rwanda: Frw5m kits for maternal health
(News Article; Sub-Saharan Africa)
27 Jun 2007
Gahigana I, The New Times Online Version

Philippines: Oledan: Social equity
(Commentary; Asia)
25 Jun 2007
Oledan R, Sun Star Davao

Nigeria: Safe motherhood is advancing family health - IBEAWUCHI
(News Article; Sub-Saharan Africa)
26 Jun 2007
Vanguard

GENDER and HEALTH RESEARCH

Women's perception of self-worth and access to health care
(Abstract; subscription needed for full text; North America | Middle East | Sub-Saharan Africa)
International Journal of Gynecology and Obstetrics. 2007 Jul;98(1):75-79.
Chamberlain J | Watt S | Mohide P | Muggah H | Trim K
Research has shown differences in health status and health care utilization related to culture, economic status, and health care development. This paper reports on a study comparing attitudes of women in three countries, at various stages of development, about their own health and self-worth and asks if these differences account for differences in health care utilization and inequities in health status. A questionnaire, administered to 100 women in each of Yemen, Uganda and Canada, explored women's perception of their own health and health care seeking behavior. Women's perception of themselves as worthy of care was positively related to utilization. The ability to make one's own health care decisions varied with her country's development level. Implementation strategies must consider women's decision-making capacity. To achieve improved health status, policies and programs must commit to encouraging appropriate social and cultural changes, using a 'cross-sectoral approach', involving both gender and development issues.

The Pap smear for detection of bacterial vaginosis
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of Gynecology and Obstetrics. 2007 Jul;98(1):20-23.
Karani A | De Vuyst H | Luchters S | Othigo J | Mandaliya K
The objective was to assess validity of Pap smears in diagnosing bacterial vaginosis. The method was a prospective diagnostic accuracy study with 533 women in Mombasa, Kenya. Diagnosis of bacterial vaginosis using clinical observations scored with simplified Amsel's criteria and Bethesda system for Pap smears was compared with a reference standard (Nugent criteria for gram stains). Both laboratory tests were interpreted blindly. Bacterial vaginosis prevalence was 36.7% (191/ 521) with Nugent criteria. Pap smear sensitivity and specificity were 59.4% (111/187) and 83.3% (270/324), with corresponding figures for simplified Amsel's criteria of 44.8% (81/181) and 84.8% (263/310). For Pap smear and simplified Amsel's criteria, positive predictive values were 67.3 and 63.3%, and negative predictive values 78.0% and 72.5%. In diagnosing bacterial vaginosis, Pap smears have moderate sensitivity (though higher than simplified Amsel's criteria). Specificity of Pap smears is adequate. Including bacterial vaginosis assessment as a standard component of Pap smears warrants consideration.

Multiparameter calibration of a natural history model of cervical cancer
(Abstract; subscription needed for full text; Global)
American Journal of Epidemiology. 2007 May;166(2):137-150.
Kim JJ | Kuntz KM | Stout NK | Mahmud S| Villa LL | Franco EL | Goldie SJ
The objective of this study was to develop a comprehensive natural history model of human papillomavirus (HPV) and cervical cancer using a two-step approach to model calibration. In the first step, the authors utilized primary epidemiologic data from a longitudinal study of women in Brazil and identified a plausible range for each input parameter that produced model output within the 95% confidence intervals of the data. In the second step, they performed a simultaneous search over all input parameters to identify parameter sets that produced output consistent with data from multiple sources. A goodness-of-fit score was computed for 555,000 unique parameter sets using a likelihood-based approach, and a sample of good-fitting parameter sets was used in the model to illustrate the advantage of the calibration approach by projecting a range of benefits associated with cervical cancer prevention policies. The calibrated model had reasonable fit to the data in terms of duration and prevalence of HPV infection for high-risk types, prevalence of precancerous lesions, and incidence of cancer. The authors found that leveraging primary data from longitudinal studies provides unique opportunities for model parameterization of the unobservable nature of HPV infection and its role in the development of cervical cancer.

GENDER and HEALTH NEWS

Death of 12-year-old circumcised girl shocks Egypt, prompts ban on rite
(News Article; North Africa)
29 Jun 2007
Associated Press

Argentine prostitutes fight back
(News Article; South America)
24 Jun 2007
Schweimler D, BBC News, Buenos Aires

Southern Africa: SADC grapples with gender-based violence
(News Article; Sub-Saharan Africa)
26 Jun 2007
Sasman C, New Era (Windhoek)

Namibia: Causes and effects of gender-based violence
(News Article; Sub-Saharan Africa)
26 Jun 2007
New Era (Windhoek)

Vaccine ninety percent effective against cervical cancer
(News Article; Global)
28 Jun 2007
Agence France-Presse (AFP)

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Path-dependency and path-creation perspectives on migration trajectories: The economic experiences of Vietnamese migrants in Slovakia
(Abstract; subscription needed for full text; Asia | Europe)
International Migration . 2007 Jun;45(2):37-67.
Balaz V | Williams AM
There has been only limited research on the Vietnamese diaspora, and that has mostly focussed on Western market economies. This paper explores the distinctive migration, dictated by Cold War geopolitics, from Viet Nam to the Eastern bloc countries. It examines how the intersection of migration policies and politico-economic conditions, before and after the end of state socialism in 1989, produced two distinctive migration phases. Faced with economic constraints, and mediated by their relationships with the Slovak population, most Vietnamese who stayed in, or migrated to, Slovakia after 1989 survived economically by finding a niche in market trading. This paper adopts a path-creating path-dependent perspective to examine these migration trajectories through an analysis based on in-depth interviews with Vietnamese migrants.

Options for fertility policy transition in China
(Abstract; subscription needed for full text; Asia)
Population and Development Review . 2007 Jun;33(2):215-246.
Yi Z
In China since the 1980s a dramatic decline in fertility rates combined with the entry of large numbers of young people into the labor force has resulted in a demographic dividend, arising from a low child dependency ratio, an elderly dependency ratio that is still not high, and a large labor force supply. Although the social and political costs of the fertility decline were high, the demographic dividend has contributed significantly to China's economic boom in the past 20 years. However, this dividend will disappear in about two decades. What would be the social and economic consequences of a continuation of China's current strict fertility control policy over the long run? Is it necessary to change the current policy? If so, what are the options and what course would be desirable and feasible? This article addresses these important questions. The unique features of this study include a comparative analysis of possible options for fertility policy transition based on consideration of demographic projections of population aging, elderly living arrangements, weighted total dependency ratios, pension deficits, labor force supply, the marriage squeeze, and economic costs.

Report from Africa: Population, health, environment, and conflict
(Report; North Africa | Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
26 Jun 2007;(12):1-50.
Maathai W | Ravalomanana M | Katunga J | Mbonile M | Poku N | Nyong A | et. al., Woodrow Wilson International Centre for Scholars
Authors in the latest ECSP Report argue that we should not miss the quiet-yet often more lethal-conflicts for shrinking resources, which are increasingly depleted by population growth, environmental degradation, poverty, and over-consumption. Eight African leaders and scholars-including Nobel Peace Prize-winner Wangari Maathai-describe their continent's struggle with resource conflict. Population and health are also linked to conflict and fragile states, say Report authors. But efforts to promote sustainability-and use natural resources as peacebuilding tools-could help turn deadly environments into safe, sustainable neighborhoods

Challenges and opportunities: The population of the Middle East and North Africa
(Report; North Africa | Middle East)
(You need Adobe Acrobat Reader to access this document)
Population Bulletin. 2007 Jun;62(2):[24] p.
Roudi-Fahimi F | Kent MM
The countries of the Middle East and North Africa (MENA) continue to fascinate and concern the rest of the world. With two-thirds of the world's known petroleum reserves, the region's economic and political importance far outweighs its population size. It has the world's second-fastest growing population, after sub-Saharan Africa. Its demographic trends-especially the rapidly growing youth population-are complicating the region's capacity to adapt to social change, economic strains, and sometimes wrenching political transformations. The people of the Middle East and North Africa have long played an integral, if sometimes volatile, role in the history of human civilization. Three of the world's major religions originated in the region-Judaism, Christianity, and Islam. MENA contains some of the world's oldest cities; universities existed here long before they emerged in Europe. Today, the population is overwhelmingly Islamic, yet includes substantial Jewish and Christian minorities. And, while Arabic is the predominant language, two of the region's largest countries-Iran and Turkey-and Israel, are not Arabic-speaking. Thanks to rapidly declining death rates and slowly declining fertility rates, MENA's population size quadrupled in the last half of the 20th century. It stands at about 430 million in 2007. Despite recent fertility declines, MENA's population is projected to surpass 700 million by 2050.

State of the world population 2007
(Report; Global)
(You need Adobe Acrobat Reader to access this document)
26 Jun 2007;:1-108.
United Nations Population Fund
In 2008, the world reaches an invisible but momentous milestone: For the first time in history, more than half its human population, 3.3 billion people, will be living in urban areas. By 2030, this is expected to swell to almost 5 billion. Many of the new urbanites will be poor. Their future, the future of cities in developing countries, the future of humanity itself, all depend very much on decisions made now in preparation for this growth. The Report attempts to look beyond current problems, yet it is also a call to action. The Report tries to grasp the implications of the imminent doubling of the developing world's urban population and discusses what needs to be done to prepare for this massive increase. It looks more closely at the demographic processes underlying urban growth in developing areas and their policy implications. It specifically examines the consequences of the urban transition for poverty reduction and sustainability.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Yemeni population increases by 700,000 annually
(News Article; Middle East)
27 Jun 2007
Yemen Times

China: Lure of prosperity brings migrants to a Guangdong boom town
(News Article; Asia)
26 Jun 2007
United Nations Population Fund

ADOLESCENT HEALTH RESEARCH

The use of emergency contraception in young Polish women
(Abstract; subscription needed for full text; Europe)
Acta Obstetricia et Gynecologica Scandinavica . 2007 Jul;86(7):861-869.
Olszewski J | Olszewska H | Abacjew A | Chmylko L | Gaworska-Krzeminska A
The aim of this work was to assess the frequency of use of emergency contraception (EC) and the factors that influence young women in Poland to choose this method of contraception. The study included 1,154 randomly chosen young women of whom 843 were students of the four largest universities and 311 were pupils aged 18 and over of six randomly chosen secondary schools in the Gdansk region of Poland. A diagnostic review was made by means of a survey based on an anonymous self-administered questionnaire, that was handed directly to the respondents. The factors affecting EC choice were assessed. The characteristics of women who used EC and those who did not were described and compared. The mean age of the respondents was 21.6 plus or minus 2.10. In a group of young sexually active women EC was used by only 14%, and among these the frequency with which it had been used varied from once to eight times. The students who most often turned to the EC were from institutions of higher education, came from large cities, and did not have a steady partner. Women in Poland have a general familiarity with the possibility of using EC, but there is insufficient exact knowledge of the way it works, as evidenced by the high proportion of women (68.3%) who regarded the EC as a means of early termination of pregnancy. EC is not routinely employed in Poland. Thus there is a need for thorough and comprehensive sexual education which covers EC.

Adverse perinatal outcomes of adolescent pregnancies in Cameroon
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Maternal and Child Health Journal. Online access June 12, 2007.
Kongnyuy EJ | Nana PN | Fomulu N | Wiysonge SC | Kouam L | Doh AS
There are geographic variations in fetal outcomes of adolescent pregnancies because of socio-economic differences between regions and countries. The aim of our study was to determine adverse fetal outcomes associated with adolescent pregnancies in Cameroon. A cross-sectional study to compare the outcomes of 268 singleton, adolescent pregnancies with 832 controls, delivered in four referral hospitals in Yaounde (Cameroon), between November 2004 and April 2005. The adverse fetal outcomes related to adolescent pregnancies were low birth weight (less than 2,500 g) (odds ratios [OR], 1.71; confidence interval [CI], 1.15-2.50), premature babies (less than 37 weeks) (OR, 1.77; CI, 1.24-2.52) and early neonatal death (OR, 2.18; CI, 1.04-4.48). The rates of stillbirth and intrauterine growth retardation were not significantly higher among adolescents. Adverse maternal outcome associated with adolescent pregnancies were eclampsia (OR, 3.18; CI, 1.21-8.32), preeclampsia (OR, 1.99; CI, 1.24-3.15), perineal tear (OR, 1.45; CI, 1.06-1.99) and episiotomy (OR, 1.82; CI, 1.20-2.73). Caesarean delivery, instrumental delivery and premature rupture of membranes were not significantly associated with adolescent pregnancy. Maternal factors associated with adverse fetal outcome in adolescents were maternal age, number of prenatal visits less than 4, and the state of being unemployed. Adolescent pregnancies are associated with both adverse fetal and maternal outcomes in Cameroon. Improving compliance with prenatal care could significantly reduce the frequency of adverse fetal outcomes in adolescent populations in Cameroon.

Three-dimensional transrectal ultrasonography in adolescent patients with polycystic ovarian syndrome
(Abstract; subscription needed for full text; Global)
International Journal of Gynecology and Obstetrics . 2007 Jul;98(1):34-38.
Sun L | Fu Q
The objectives were to evaluate the diagnostic value of 3-dimensional transrectal ultrasonography (3DTRS) in adolescent patients with polycystic ovarian syndrome (PCOS). Ovarian follicle number, ovarian volume, ovarian stromal area, total ovarian area, and stromal area to total area ratio (S/A) were evaluated using 3D-TRS in 75 amenorrheic, oligomenorrheic, or asymptomatic virgin patients and 25 healthy controls. Serum biochemical markers of PCOS were assayed during the early follicular phase of the menstrual cycle in menstruating patients and controls, and on a randomly selected day in amenorrheic patients. When assessing the delicate structure of the ovary in virgin patients, 3D-TRS was convenient, accurate, specific, sensitive, and more reliable overall than transabdominal ultrasonography. Ovarian stromal area and S/A ratio were significantly greater in patients with PCOS than in controls, and also in the patients who had ultrasonically diagnosed polycystic ovaries without clinical or biochemical evidence of PCOS. The S/A ratio was the studied variable most significantly correlated with androgen levels. These findings indicated that, in adolescent patients, 3D-TRS combined with transabdominal ultrasonography can improve the precision of the diagnosis of PCOS. The S/A ratio may become the ultrasonographic diagnostic marker for PCOS.

ADOLESCENT HEALTH NEWS

South Africa: HIV pregnancies decrease in 2006
(News Article; Sub-Saharan Africa)
28 Jun 2007
The Citizen

UNICEF calls for awareness-raising measures to stem spread of HIV in Iran
(News Article; Middle East)
28 Jun 2007
UN News Centre

Rwanda: Youth and HIV/Aids - the unsung age-old Bedfellows
(News Article; Sub-Saharan Africa)
25 Jun 2007
Kigali GM, All Africa

South Africa: 48Fest film contest for Africa
(News Article; Sub-Saharan Africa)
27 Jun 2007
BizCommunity

Taiwan: Hotline to answer teen sex queries
(News Article; Asia)
27 Jun 2007
Hirsch M, Taipei Times

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Volume 7, Number 24 2 July 2007