Volume 7, Number 29
6 August 2007

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Guest Editorials (free with every subscription)

Malaria in Pregnancy: Preventing Low Birth Weight

Author: Dr. Bill Brieger, JHPIEGO, Malaria Expert

bbbrieger@yahoo.com

The American Journal of Tropical Medicine and Hygiene published a unique article in its May 2007 issue that documents how the timing and number of malaria infections during pregnancy influences child birth weight outcomes in Burkina Faso(1). Infection after 6 months of pregnancy was the strongest factor associated with low birth weight (LBW), but LBW was also associated with infection in early pregnancy. The challenge in determining the latter is that women in the study, as is the case in much of Africa, tended to register for antenatal care (ANC) later in pregnancy. Fortunately in this study one-third of the women enrolled had first attended ANC in the first trimester and could be followed longer. This helped provide information for another important finding, that LBW is also more likely when women are infected with malaria multiple times during pregnancy.

These findings highlight the challenges of reaching pregnant women in a timely manner with malaria prevention measures including insecticide treated nets (ITNs) and intermittent preventive therapy during pregnancy (IPTp). Intermittent preventive treatment in pregnancy (IPTp) with the drug sulfadoxine-pryimethamine (SP) is a key strategy for controlling morbidity and mortality associated with malaria in both pregnant women and newborns. When given at least twice, one month apart after quickening, IPTp reduces maternal anemia, placental malaria, and risk of low birth weight. IPTp with SP has many characteristics of a good public health intervention in that it is relatively low cost, easy to deliver, and is generally acceptable and available(2). The longer half-life of SP gives it comparative advantage over alternatives(3).

The authors note the value of a full course of IPTp in preventing LBW, but lament that there are currently no safe drugs to use for IPTp in the first trimester(4). An additional challenge is that many women register for ANC too late or attend too infrequently to benefit from at least two doses after quickening at one month apart.

This points to the need to ensure that all ANC clinics have ITNs to give women on their very first visit. For those who attend and are not yet eligible for IPTp, ITNs too, prevent LBW and will provide the protection for the early infections that lead to LBW(5). Then if a woman gets a net early in pregnancy, she will be less likely to suffer multiple malaria infections, another risk factor for LBW.

The challenge is one of policy versus logistics. Although most malaria endemic countries point to guidelines that say a pregnant should sleep under an ITN, few have figured out the logistics of guaranteeing a regular and dedicated supply of ITNs for ANC clinics. At present ITN distribution favors campaigns as opposed to integration into routine Maternal and Child Health services. While this may favor achieving large targets among children under five years of age, it usually bypasses pregnant women.

Last week a colleague at JHPIEGO suggested that all women of reproductive age should be given an ITN. This would certainly help keep them safe from malaria whenever they get pregnant. Are donors willing to take up this challenge?

References:

1. Cottrell, G., Mary, J.Y., Barro, D., and Cot, M. The importance of the period of malarial infection during pregnancy on birth weight in tropical Africa. American Journal of Tropical Medicine and Hygiene 76(5):849-854. May 2007.

2. Newman, R.D., Parise, M.E., Slutsker, L., Nahlen, B., and Steketee, R.W. Safety, efficacy and determinants of effectiveness of antimalarial drugs during pregnancy: implications for prevention programmes in Plasmodium falciparum-endemic sub-Saharan Africa. Tropical Medicine and International Health 8(6):488-506. Jun. 2003.

3. O'Meara, W.P., Smith, D.L., McKenzie, F.E. Potential impact of intermittent preventive treatment (IPT) on spread of drug-resistant malaria. PLoS Medicine 3(5):e141. May 2006.

4. Sirima, S.B., Cotte, A.H., Konate, A., Moran, A.C., and Asamoa, K. Malaria prevention during pregnancy: assessing the disease burden one year after implementing a program of intermittent preventive treatment in Koupela district, Burkina Faso. American Journal of Tropical Medicine and Hygiene 75(2):205-211. Aug. 2006.

5. Gamble C; Ekwaru JP; ter Kuile FO. Insecticide-treated nets for preventing malaria in pregnancy (Review). Cochrane Database of Systematic Reviews (2):[33]p. 2006.

FAMILY PLANNING RESEARCH

Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy
(Abstract; subscription needed for full text; Global)
Cochrane Database of Systematic Reviews. Online access July 18, 2007. (3)
Power J | French R | Cowan F
Related Abstract; subscription needed for full text: Implantable contraceptives very effective
This review aimed to assess how effective contraceptive implants were at preventing pregnancy and how acceptable women found them compared to other methods of contraception. All the trials identified compared different types of contraceptive implant. No trials were found that compared implants to other contraceptive methods. All the implants were highly effective methods of contraception in the selected women. The majority of women using contraceptive implants chose to continue with the method long term; over 80% of women were still using their implant at two years. Women in developed country studies were less likely to continue with these methods when compared to women in developing country studies. The most common reported side-effect was irregular vaginal bleeding. Bleeding with all implants became less frequent with time. Removal was quicker for Implanon and Jadelle than for Norplant. Insertion problems were rare with any of the implants. Problems at removal were uncommon but were significantly more likely to occur in Norplant users than Implanon users.

The effect of husbands' fertility preferences on couples' reproductive behaviour in rural Bangladesh
(Abstract; subscription needed for full text; Asia)
Journal of Biosocial Science. 2007 Sep;39(5):745-757.
Hossain MB | Phillips JF | Mozumder AB
Bangladesh society is profoundly gender stratified, and yet male roles in reproductive health processes have not been rigorously investigated. This study examines the association between men's reproductive health knowledge, attitude and behaviour and their wives' subsequent reproductive behaviour using longitudinal data from the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). A total of 4969 matched husband-and-wife data from a 1998 survey and women's contraceptive use history data following this survey are used. Results show a significant association between husbands' fertility preferences and current use of any family planning method. When wives' background characteristics, and husbands' background and socioeconomic characteristics are controlled for, the predicted probability of using a method of contraception among non-educated wives whose husbands want more children is 0.49 compared with 0.64 for those whose husbands do not want more children. However, the net effect of husbands' preference for additional children diminishes as wives' level of education increases. Among wives who had completed high school, the predicted probability of using a method of contraception is 0.70 for those whose husbands want more children compared with 0.69 for those whose husbands do not want more children.

In vivo assessment of the human sperm acrosome reaction and the expression of glycodelin-A in human endometrium after levonorgestrel-emergency contraceptive pill administration
(Abstract; subscription needed for full text; Global)
Human Reproduction. 2007 Aug;22(8):2190-2195.
do Nascimento JA | Seppala M | Perdigao A | Espejo-Arce X | Munuce MJ
The objectives were firstly to assess acrosome reaction (AR) status of spermatozoa following uterine flushing, secondly to measure levonorgestrel (LNG) levels in serum and in uterine flushing fluid and finally to measure endometrial glycodelin-A expression after administration of LNG as a form of emergency contraception (EC). Forty-eight experiments were conducted on 15 regularly menstruating women. Four groups were formed based on different intercourse to treatment interval and treatment to recovery of spermatozoa and the biopsies. Twenty-four and forty-eight hours after treatment, there were 14.5 plus or minus 3.9 x 10/6 and 17.3 plus or minus 6.8 x 10/6 sperm recovered from the uterus, respectively. There were no differences between the AR rate and the endometrial glycodelin-A staining intensity in an LNG or placebo treated cycles. The LNG in uterine flushing medium represented 1.38% of the values observed in serum 24 h after the LNG intake. Twenty-four and forty-eight hours after administration of EC, neither the proportion of AR sperm, nor the glycodelin-A level was influenced by 1.5 mg of LNG. LNG did not impair the cervical mucus either because viable spermatozoa were found in the genital tract 36-60 h after coitus and 24-48 h after LNG intake. The mechanism of action of LNG as EC remains unknown.

Pregnancy among sex workers participating in a condom intervention trial highlights the need for dual protection
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Contraception. 2007 Aug;76(2):105-110.
Feldblum PJ | Nasution MD | Hoke TH | Damme KV | Turner AN
Little is known about pregnancy rates among sex workers (SWs) or the factors that predispose SWs to this risk. We aimed to estimate the pregnancy incidence rate among Madagascar SWs participating in an intervention trial promoting use of male and female condoms and assess the influence of various predictive factors on pregnancy risk. SWs from two study clinics in Madagascar participated in a randomized trial to assess the effect of peer education and clinic-based counseling on use of male and female condoms and prevalence of sexually transmitted infections (STIs). Women were seen every 2 months for up to 18 months; they received structured interviews at every visit, and physical exams at baseline and every 6 months thereafter. Site staff recorded information on pregnancies during interviews; pregnancy data were then merged with trial data for this analysis. Of 935 SWs in the analysis population, 250 became pregnant during follow-up. The cumulative probability of pregnancy was 0.149 at 6 months and 0.227 at 12 months. Comparable proportions of nonpregnant and pregnant SWs reported using highly effective contraception at baseline (about 16%); these users were younger and were more consistent condom users. Method switching and discontinuation were frequent. In multivariate analysis, nonuse of effective contraceptives and any self-reported unprotected sex were associated with higher incidence of pregnancy. Approximately 51% of women delivered, 13% reported a spontaneous abortion, 13% reported an induced abortion and 23% had missing pregnancy outcomes. Women traditionally targeted for STI/HIV preventive interventions need more comprehensive reproductive health services. In particular, SWs could benefit from targeted family planning counseling and services.

FAMILY PLANNING NEWS

Angola: Family planning opens African women event
(News Article; Sub-Saharan Africa)
27 Jul 2007
Angola Press Agency

Philippines: NSO launches census survey
(News Article; Asia)
31 Jul 2007
Adorador D, Sun Star

HIV/AIDS and STIs RESEARCH

Limitations of rapid HIV-1 tests during screening for trials in Uganda: Diagnostic test accuracy study
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMJ. British Medical Journal. 2007 Jul 28;335(7612):[4] p..
Gray RH | Makumbi F | Serwadda D | Lutalo T | Nalugoda F
The objective was to evaluate the limitations of rapid tests for HIV-1. Diagnostic test accuracy study was used for the research. Rural Rakai, Uganda was the setting for the study. 1517 males aged 15-49 screened for trials of circumcision for HIV prevention were used in the study. Sensitivity, specificity, negative predictive values, and positive predictive values of an algorithm using three rapid tests for HIV, compared with the results of enzyme immunoassay and western blotting as the optimal methods. Rapid test results were evaluated by enzyme immunoassay and western blotting. Sensitivity was 97.7%. Among 639 samples where the strength of positive bands was coded if the sample showed positivity for HIV, the algorithm had low specificity (94.1%) and a low positive predictive value (74.0%). Exclusion of 37 samples (5.8%) with a weak positive band improved the specificity (99.6%) and positive predictive value (97.7%). Weak positive bands on rapid tests for HIV should be confirmed by enzyme immunoassay and western blotting before disclosing the diagnosis. Programmes using rapid tests routinely should use standard serological assays for quality control.

Symptom burden of fatigue in men and women living with HIV/AIDS in Southern Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of the Association of Nurses in AIDS Care. 2007 Jul-Aug;18(4):22-31.
Voss JG | Sukati NA | Seboni NM | Makoae LN | Moleko M
HIV-related fatigue is a debilitating and disabling symptom that persists for months and years. In 743 HIV/AIDS patients from Southern Africa, the authors found ratings of HIV-related fatigue to be highly prevalent. The authors conducted a secondary data analysis within the theoretical context of the University of California, San Francisco Symptom Management Model. The analysis focused on 538 patients who reported fatigue to investigate correlates and predictors of fatigue severity in relationship to demographic and HIV/AIDS illness indicators, as well as HIV-specific physical and psychological symptoms. A hierarchical regression model explored the contributions of those five blocks on fatigue severity. Of the 47% of the total variance in fatigue severity, a combination of variables within the health and illness block (6%), the physical symptoms block (7%) and the psychological symptom block (2%) contributed significantly to the increase in fatigue severity scores. Fatigue severity in Southern Africa was moderate, and the factors contributing to the perceived fatigue were most likely related to symptoms of acute HIV disease (such as fever and gastrointestinal problems). In conclusion, fatigue severity is less impacted by demographic or environmental variables, but much more by co-occurring symptoms and HIV disease severity. The results of this study imply the need for more research to understand if improvements in water quality and access to food would prevent infection and diarrhea and whether sufficient access to antiretroviral treatments to manage the HIV infection would improve fatigue and co-occurring symptom profiles.

Identifying what rural health workers in Malawi need to become HIV prevention leaders
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of the Association of Nurses in AIDS Care. 2007 Jul-Aug;18(4):41-50.
Talashek ML | Kaponda CP | Jere DL | Kafulafula U | Mbeba MM
Health workers have high potential as HIV prevention leaders, but health system and individual barriers limit their impact. This descriptive qualitative study identified the HIV prevention needs of rural health workers to use as a basis for tailoring an HIV/AIDS risk-reduction intervention. Data included interviews with 9 health administrators, 22 focus groups with 200 health workers, and 12 observations of caregivers in two rural districts. Health system barriers identified included lack of essential supplies, staff shortages, overcrowded facilities, and lack of training. Individual barriers included hopelessness, stigmatizing attitudes, knowledge gaps, and risky personal behaviors. Health workers also expressed willingness to be HIV prevention leaders and role models. Most results agree with previous African studies. Personal risky behaviors and willingness to be HIV prevention leaders have not been previously reported. Results provide insights for developing effective interventions and health policies to address health workers' HIV prevention needs.

HIV/AIDS and STIs NEWS

Uganda: HIV microbicide trial stopped
(News Article; Sub-Saharan Africa)
26 Jul 2007
Natukunda C | Onyalla H, New Vision (Kampala)
Related Press Release: Final HIV results of Ushercell trials presented at IAS Conference in Sydney

South Africa: Breakthrough in study on treating HIV babies
(News Article; Sub-Saharan Africa)
26 Jul 2007
Kahn T, Business Day (Johannesburg)
Related Abstract: Antiretroviral therapy initiated before 12 weeks of age reduces early mortality in young HIV-infected infants: Evidence from the children with HIV early antiretroviral therapy (CHER) study

Kenya: HIV rate drops just below six percent
(News Article; Sub-Saharan Africa)
31 Jul 2007
Kimani D, East African (Nairobi)

South Africa: 'Dual therapy' not policy yet for HIV-positive pregnancies
(News Article; Sub-Saharan Africa)
29 Jul 2007
Cullinan K, Health-e (Cape Town)

Namibia: HIV/AIDS rate down, but...
(News Article; Sub-Saharan Africa)
31 Jul 2007
Gaomas S, New Era (Windhoek)

Angola: Huambo - government to open AIDS testing centre
(News Article; Sub-Saharan Africa)
29 Jul 2007
Angola Press Agency (Luanda)

South Africa: Clamping down on botched circumcisions
(News Article; Sub-Saharan Africa)
1 Aug 2007
UN Integrated Regional Information Networks

MATERNAL AND CHILD HEALTH RESEARCH

HIV and infant feeding counselling: Challenges faced by nurse-counsellors in northern Tanzania
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Human Resources for Health. 2007 Jul 24;5(1)
Leshabari SC | Blystad A | de Paoli M | Moland KM
Related Report: Better Breastfeeding, Healthier Lives: How programs and providers can help women improve breastfeeding practices
Related Abstract; subscription needed for full text: Breastfeeding Questions Answered: A Guide for Providers
Background: Infant feeding is a subject of worry in prevention of mother to child transmission (pMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in pMTCT programmes in the Kilimanjaro region, northern Tanzania. Methods: A qualitative study was conducted using in-depth interviews and focus group discussions (FGDs) with 25 nurse-counsellors at four pMTCT sites. Interviews were handwritten and FGDs were tape-recorded and transcribed, and the programme Open Code assisted in sorting and structuring the data. Analysis was performed using 'content analysis.' Results: The findings revealed a high level of stress and frustration among the nurse-counsellors. They found themselves unable to give qualified and relevant advice to HIV-positive women on how best to feed their infants. They were confused regarding the appropriateness of the feeding options they were expected to advise HIV-positive women to employ, and perceived both exclusive breastfeeding and exclusive replacement feeding as culturally and socially unsuitable. However, most counsellors believed that formula feeding was the right way for an HIV-positive woman to feed her infant. They expressed a lack of confidence in their own knowledge of HIV and infant feeding, as well as in their own skills in assessing a woman's possibilities of adhering to a particular method of feeding. Moreover, the nurses were in general not comfortable in their newly gained role as counsellors and felt that it undermined the authority and trust traditionally vested in nursing as a knowledgeable and caring profession. Conclusion: The findings illuminate the immense burden placed on nurses in their role as infant feeding counsellors in pMTCT programmes and the urgent need to provide the training and support structure necessary to promote professional confidence and skills. The organisation of counselling services must to a larger extent take into account the local realities in which nurses construct their role as counsellors to HIV-positive childbearing women.

Reassessmemnt of baby-friendly hospitals in Brazil
(Abstract; subscription needed for full text; South America)
Journal of Human Lactation. 2007 Aug;23(3):246-252.
Moura de Araujo MF | Soares Schmitz BA
The purpose of this descriptive, cross-sectional study was to assess adherence to the Baby-friendly Hospital Initiative "Ten Steps to Successful Breastfeeding" in certified hospitals in Brazil in 2002. The Ministry of Health ordered that all 172 hospitals certified from 1992 to 2000 be reassessed. Of the 167 eligible Baby-friendly Hospitals assessed, 137 (82%) met all of the 10 steps. Steps 2 and 3 presented the lowest adherence rates (91% and 92%, respectively), followed by steps 4, 5, and 10, with 95% each. Steps 7 and 9 reflected the highest adherence rate of 99% among all eligible Baby-friendly Hospitals. These findings suggest the need to intensify regular health training programs for professionals working in Baby-friendly Hospitals on managing and promoting breastfeeding and to implement strategies that favor steps 3 and 10, to further promote and support breastfeeding before and after delivery.

Access to health: Women's status and utilization of maternal health services in Nepal
(Abstract; subscription needed for full text; Asia)
Journal of Biosocial Science. 2007 Sep;39(5):671-692.
Sharma SK | Sawangdee Y | Sirirassamee B
With the objective of reducing maternal and neonatal mortality, the Safe Motherhood Program was implemented in Nepal in 1997. It was launched as a priority programme during the ninth five-year plan period, 1997-2002, with the aim of increasing women's access to health care and raising their status. This paper examines the association of access to health services and women's status with utilization of prenatal, delivery, and postnatal care during the plan period. The 1996 Nepal Family Health Survey and the 2001 Nepal Demographic and Health Survey data were pooled and the likelihood of women's using maternal health care was examined in 2001 in comparison with 1996. Multiple logistic regression analysis indicates that the utilization of maternal health services increased over the period. Programme interventions such as outreach worker's visits, radio programmes on maternal health, maternal health information disseminated through various mass media sources and raising women's status through education were able to explain the observed change in utilization. Health worker visits and educational status of women showed a large association, but radio programmes and other mass media information were only partially successful in increasing use of maternal health services. Socioeconomic and demographic variables such as household economic status, number of living children and place of residence showed stronger association with use of maternal health services then did intervention programmes.

MATERNAL AND CHILD HEALTH NEWS

UN agencies urge breastfeeding right after birth to reduce infant deaths
(News Article; Global)
1 Aug 2007
UN News Centre
Related Abstract; subscription needed for full text: World breastfeeding week

Uganda: Breastfeeding: Why the first hour is crucial
(News Article; Sub-Saharan Africa)
30 Jul 2007
Ruhweza C, The New Vision

Zimbabwe: Country commemorates 2007 world breastfeeding week
(News Article; Sub-Saharan Africa)
1 Aug 2007
The Herald

Kenya: Maternity fee waiver a feather in health's cap
(Commentary; Sub-Saharan Africa)
1 Aug 2007
Kago K, The Standard

GENDER and HEALTH RESEARCH

Cost-effectiveness of HPV 16, 18 vaccination in Brazil
(Abstract; subscription needed for full text; South America)
Vaccine. 2007 Aug 14;25(33):6257-6270.
Goldie SJ | Kim JJ | Kobus K | Goldhaber-Fiebert JD | Salomon J
We use an empirically calibrated model to estimate the cost-effectiveness of cervical cancer prevention in Brazil, a country with a high cervical cancer burden. Assuming 70% coverage, HPV 16, 18 vaccination of adolescent girls is expected to reduce the lifetime risk of cancer by approximately 42.7% (range, 33.2-53.5%); screening three times per lifetime is expected to reduce risk by 21.9-30.7% depending on the screening test, and a combined approach of vaccination and screening is expected to reduce cancer risk by a mean of 60.8% (range, 52.8-70.1%). In Brazil, provided the cost per vaccinated woman is less than I$ 25, implying a per dose cost of approximately I$ 5, vaccination before age 12, followed by screening three times per lifetime between ages 35 and 45, would be considered very cost-effective using the country's per capita gross domestic product as a cost-effectiveness threshold. Assuming a coverage rate of 70%, this strategy would be expected to prevent approximately 100,000 cases of invasive cervical cancer over a 5-year period. Vaccination strategies identified as cost-effective may be unaffordable in countries with similar socioeconomic profiles as Brazil without assistance; these results can provide guidance to the global community by identifying health investments of highest priority and with the greatest promise.

Physical spousal violence against women in India: Some risk factors
(Abstract; subscription needed for full text; Asia)
Journal of Biosocial Science. 2007 Sep;39(5):657-670.
Jeyaseelan L | Kumar S | Neelakantan N | Peedicayil A | Pillai R
Domestic spousal violence against women in developing countries such as India is now beginning to be recognized as a widespread health problem impeding development. This study aimed to explore the risk and protective factors for lifetime spousal physical violence. A cross-sectional household survey was carried out in rural, urban and urban-slum areas across seven sites in India, among women aged 15-49 years, living with a child less than 18 years of age. The sample was selected using the probability proportionate to size method. Trained field workers administered a structured questionnaire to elicit information on spousal physical violence. The main hypothesized variables were social support, witnessed father beating mother and experience of harsh physical violence during childhood, alcohol abuse by spouse and socioeconomic variables. The outcome variables included three physical violence behaviours of hit, kick and beat. Odds ratios were calculated for risk and protective factors of violence using logistic regression. Of 9938 women surveyed, 26% reported experiencing spousal physical violence during the lifetime of their marriage. Adjusted odds ratios calculated using multiple logistic regression analysis suggest that women whose husbands regularly consumed alcohol (OR 5.6; 95% CI 4.7-6.6); who experienced dowry harassment (OR 3.2; 95% CI 2.7-3.8); had reported experiencing harsh physical punishment during childhood (OR 1.6; 95% CI 1.4-1.8) and had witnessed their fathers beat their mothers (OR 1.9; 95% CI 1.6-2.1), were at increased risk of spousal physical violence (beat, hit and kick). Higher socioeconomic status and good social support acted as protective buffers against spousal physical violence. The findings provide compelling evidence of the potential risk factors for spousal physical violence, which in turn could help in planning interventions.

Parental gender preferences and reproductive behaviour: A review of recent literature
(Abstract; subscription needed for full text; Global)
Journal of Biosocial Science. 2007 Sep;39(5):759-767.
Hank K
This paper reviews various theoretical approaches towards an explanation of parental gender preferences and empirical findings from developing as well as from industrialized countries, focusing on the role of gender preferences in reproductive decisions. Although various attempts have been made to shed light on the mechanisms underlying the observed patterns of sex preferences for children, a fully satisfying theoretical explanation is still not at hand. Empirically, a distinct and stable preference for at least one child of each sex can be observed as a common pattern of parental sex preferences across many different social, economic and cultural contexts. Further -- and ideally multidisciplinary -- research that helps to improve our understanding of this phenomenon is highly desirable.

GENDER and HEALTH NEWS

Namibia: Circumcision arouses interest in country
(News Article; Sub-Saharan Africa)
30 Jul 2007
Sibeene P, New Era (Windhoek)

Nigeria: Domestic violence - calls for zero tolerance
(News Article; Sub-Saharan Africa)
31 Jul 2007
Akosile A, This Day (Lagos)

Ethiopia: Female circumcision declines in southern region
(News Article; Sub-Saharan Africa)
31 Jul 2007
UN Integrated Regional Information Networks

Uganda: Sexual abuse on the rise in Kitgum
(News Article; Sub-Saharan Africa)
29 Jul 2007
Lubangakene C, New Vision (Kampala)

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Differential mortality in Iran
(Abstract; subscription needed for full text; Middle East)
(You need Adobe Acrobat Reader to access this document)
Population Health Metrics. 2007 Jul 28;5(1):7.
Khosravi A | Taylor R | Naghavi M | Lopez AD
Among the available data provided by health information systems, data on mortality are commonly used not only as health indicators but also as socioeconomic development indices. Recognizing that in Iran accurate data on causes of death were not available, the Deputy of Health in the Ministry of Health and Medical Education (MOH&ME) established a new comprehensive system for death registration which started in one province (Bushehr) as a pilot in 1997, and was subsequently expanded to include all other provinces, except Tehran province. These data can be used to investigate the nature and extent of differences in mortality in Iran. The objective of this paper is to estimate provincial differences in the level of mortality using this death registration system. Data from the death registration system for 2004 for each province were evaluated for data completeness, and life tables were created for provinces after correction for under-enumeration of death registration. For those provinces where it was not possible to adjust the data on adult deaths by using the Brass Growth Balance method, adult mortality was predicted based on adult literacy using information from provinces with reliable data. Child mortality (risk of a newborn dying before age 5) in 2004 varied between 47 per 1000 live births for both sexes in Sistan and Baluchistan province, and 25 per 1000 live births in Tehran and Gilan provinces. For adults, provincial differences in mortality were much greater for males than females. Adult mortality (risk of dying between ages 15 and 60 for females varied between 0.133 in Kerman province and 0.117 in Tehran province; for males the range was from 0.218 in Kerman to 0.149 in Tehran province. Life expectancy for females was highest in Tehran province (73.8 years) and lowest in Sistan and Baluchistan (70.9 years). For males, life expectancy ranged from 65.7 years in Sistan and Baluchistan province to 70.9 years in Tehran. Substantial differences in survival exist among the provinces of Iran. While the completeness of the death registration system operated by the Iranian MOH&ME appears to be acceptable in the majority of provinces, further efforts are needed to improve the quality of data on mortality in Iran, and to expand death registration to Tehran province.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Kenya: World Bank birth rates rising as family planning ignored
(News Article; Sub-Saharan Africa)
31 Jul 2007
East African Standard

How to deal with a falling population
(Commentary; Global)
26 Jul 2007
The Economist

Government moves to boost Armenian birth rate
(News Article; Asia)
26 Jul 2007
Armenia Liberty

ADOLESCENT HEALTH RESEARCH

Age at first marriage in Nepal: Differentials and determinants
(Abstract; subscription needed for full text; Asia)
Journal of Biosocial Science. 2007 Sep;39(5):693-706.
Aryal TR
The aim of this paper is to investigate the differentials and determinants of female age at first marriage in rural Nepal. The life table technique was employed to calculate median age at marriage. The proportional hazard model was used to study the effect of various socioeconomic variables, and to identify the magnitude and significance of their effects on the timing of first marriage. The data were taken from a sample survey of Palpa and Rupandehi districts in rural Nepal. Both married and unmarried females of marriageable age were included in the survey. Median age at marriage was about 17 years for data from only married females, whereas it was about 18 years for data from married as well as unmarried females of marriageable age. Median age at marriage was about 16 years for uneducated females and 19 years for females educated up to intermediate or higher level. The analysis underestimates the median age at marriage for married females, probably due to right censoring. The risk of getting married early decreased gradually with increasing year-of-birth cohort. The risk of early marriage was higher among females of high socioeconomic status compared with those of low socioeconomic status. Females engaged in service married earlier than those engaged in household work. High socioeconomic status families are motivated, for religious and prestige reasons, to get their daughters married at an early age, preferably before menarche. Thus, education, occupation and age at menarche are the most powerful factors in deciding the timing of first marriage in Nepal.

Knowledge and attitudes toward HIV/AIDS and risky sexual behaviors among Caribbean African American female adolescents
(Abstract; subscription needed for full text)
Journal of the Association of Nurses in AIDS Care. 2007 Jul-Aug;18(4):64-72.
Archibald C
The incidence of HIV/AIDS among African Americans in culturally blended south Florida constantly challenges the health care community to reconsider prevention efforts. Very few studies examine the Caribbean population. This study was performed to identify and describe knowledge and attitudes toward HIV/AIDS and risky sexual behaviors in Caribbean African American female adolescents. Three focus group sessions were conducted using a sample of 22 adolescents. The questions included, "What do you know about HIV/AIDS?" "How would a friend's diagnosis of HIV affect your friendship?" and "Why do your peers engage in risky sexual behaviors?" Adolescents abstained from sexual activity mainly because of parental fear and church teachings. Some had accurate knowledge of HIV/AIDS, but all expressed reluctance to share space and personal items with an HIV/AIDS-infected friend. Sharing personal items with a close friend is a common Caribbean practice. This unwillingness suggests a need and direction for further inquiry.

ADOLESCENT HEALTH NEWS

India: For youngest girls enslaved in sex trade, more woe
(News Article; Asia)
1 Aug 2007
Donnelly J, Boston Globe
Related Abstract; subscription needed for full text: HIV prevalence and predictors of infection in sex-trafficked Nepalese girls and women

Uganda: Anti-sugar daddy campaign launched
(News Article; Sub-Saharan Africa)
1 Aug 2007
Natukunda C, New Vision

Zimbabwe: Work with govt to fight Aids
(News Article; Sub-Saharan Africa)
31 Jul 2007
The Herald

Uganda: Sex education is important for youth
(News Article; Sub-Saharan Africa)
30 Jul 2007
Abongowath J, New Vision

SPECIAL REPORTS/PROFILES/RESOURCES

Wall chart: Do You Know Your Family Planning Choices? Your family planning provider can help. Please ask!
(Tool)
2007;
Johns Hopkins Bloomberg School of Public Health
This wall chart: Presents basic information for clients about eleven contraceptive methods--advantages, instructions for use, side effects, who can use, and more; Ranks effectiveness of each method and features tips for making a selected method more effective; Is designed to be hung in clinic waiting rooms for clients to see while they wait for service; Serves as a tool to comply with a requirement of the Tiarht Amendment--features a medical eligibility chart listing certain methods that are not advised with certain medical conditions; Can be used to train providers about family planning; Can be used by providers as a job aid during counseling sessions; Is also included with each copy of Family Planning: A Global Handbook for Providers (www.fphandbook.org); and, Was prepared through a unique collaboration between the Johns Hopkins Bloomberg School of Public Health, technical experts from USAID, WHO, and other organizations around the world. It is available free of charge in English, French, and Spanish from the Johns Hopkins INFO Project.

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The Pop Reporter--Delivering thought-provoking global health news to your desktop.

Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 7, Number 29 6 August 2007