Volume 7, Number 31
20 August 2007

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FAMILY PLANNING RESEARCH

Emergency contraception among Finnish adolescents: Awareness, use and the effect of non-prescription status
(Research Article; Europe)
(You need Adobe Acrobat Reader to access this document)
BMC Public Health. 2007 Aug 9;7(201):[35] p..
Falah-Hassani K | Kosunen E | Shiri R | Rimpela A
Adolescents need to be aware that there is a method of preventing pregnancy even after unprotected intercourse. Limited information is available on the awareness of young adolescents and the effects of selling emergency contraception (EC) over-the-counter, and the findings are controversial. The aims of this study were to investigate awareness and use of EC among Finnish girls aged 12-18 years in 1999-2003, and to assess the effect of the 2002 nonprescription status on the use. A self-administered questionnaire was sent to a population-based sample of 12-18-year-old girls in 1999, 2001, and 2003. The response rate was 83% in 1999 (N=4,369), 79% in 2001 (N=4,024) and 77% in 2003 (N=3,728), altogether N=12,121. A logistic regression model was used to examine the association of unawareness and use of EC with socio-economic background and health behaviour. In 2001, nearly all 14-18-year-olds and a majority of 12-year-olds were aware of EC. Among 12-14-year-olds, a slight increase in awareness between 1999 and 2003 was observed but this was not related to non-prescription status. Health-compromising behavior (alcohol use, smoking), dating and having good school achievement were related to higher awareness of EC. Nine percent of 14-18-year-olds had used EC once and 1% three times or more. No statistically significant change in EC use was found after non-prescription status. EC use increased with increasing alcohol consumption, particularly at age 14. Smoking, dating, and poor school achievement were related to increased use as well as not living in a nuclear family. A lower use was observed if living in a rural area or if the father's education was high. The mother's education was not related to use. Adolescent girls were well aware of the existence of emergency contraception even before the non-prescription status. Over-the-counter selling did not increase the use.

Impact of use of combined oral contraceptive pill on the quality of life of Japanese women
(Abstract; subscription needed for full text; Asia)
Journal of Obstetrics and Gynaecology Research. 2007 Aug;33(4):529-535.
Matsumoto Y | Yamabe S | Ideta K | Kawabata M
The aim was to evaluate the impact of combined oral contraceptive pill (OC) use on quality of life (QOL) among Japanese women. We performed a prospective study using the Japanese version of the World Health Organization Quality of Life (WHOQOL) questionnaire. Women who consulted Chayamachi Lady's Clinic to get a prescription for OC for the first time were recruited for our questionnaire study and asked to complete the WHOQOL questionnaire twice, before taking OCs and more than 3 months after beginning OC use. Two hundred and seventeen women responded to our questionnaire before taking OCs and 110 patients completed the questionnaire. The patients were divided into six groups based on the reason they wanted to take OCs: contraception, relaxation of dysmenorrhea, regulation of menstrual cycles, improvement of acne, remission of menorrhagia, and improvement of premenstrual tension syndrome (PMS). WHOQOL scores showed significant improvement in all domains of the dysmenorrhea group; all domains but the social of overall participants; the social and overall domain of the irregular cycle group; physical, environmental, and overall domain of the acne group; and psychological and overall domain of the PMS group. The WHOQOL score worsened in the social domain of the contraception group; however, the score in the overall domain of that group improved. These results indicate that OCs can provide higher QOL for women with problems involving menstrual pain and/or hormonal abnormalities. However, those using OCs for contraception only were found to be unsatisfied with taking OCs in a relationship with their partners.

FAMILY PLANNING NEWS

Rwanda: Drama promotes family planning, wins US$1000
(News Article; Sub-Saharan Africa)
13 Aug 2007
Karibwije D, East African Business Week

Philippines: Arroyo legacy may include more mothers put at risk
(Feature Article; Asia)
13 Aug 2007
Jimeno J, GMA News and Public Affairs

Philippines: Church's gain in population policy is women's loss
(News Article; Asia)
14 Aug 2007
GMA News and Public Affairs

HIV/AIDS and STIs RESEARCH

Changes in sexual behavior during a safety and feasibility trial of a microbicide/diaphragm combination: An integrated qualitative and quantitative analysis
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Education and Prevention. 2007 Aug;19(4):310-320.
Guest G | Johnson L | Burke H | Rain-Taljaard R | Severy L
If proven effective, vaginal microbicides and diaphragms will likely be part of a larger HIV prevention model that includes condoms and other prevention strategies. It is, therefore, important to understand how introducing new prevention methods may affect overall patterns of sexual risk behavior. Data presented were collected as part of a safety and feasibility study of ACIDFORM gel with a diaphragm among 120 women in South Africa. Interviews were administered at enrollment and months 1, 3, 5, and 6 of the trial. Focus groups were conducted at trial exit. Frequency of sex increased significantly after enrollment. This increase appears to be owing to perceived protection from HIV and greater sexual pleasure afforded by the gel. Male condom use was high overall but increased significantly from enrollment. Data suggest this is because of increased partner involvement, increased negotiating power afforded by study participation, and provision of free condoms perceived to be of high quality.

Effect of pregnancy on HIV disease progression and survival among women in rural Uganda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Tropical Medicine and International Health. 2007 Aug;12(8):920-928.
Van der Paal L | Shafer LA | Mayanja BN | Whitworth JA | Grosskurth H
The objective was to investigate the effect of pregnancy on HIV disease progression and survival among HIV-infected women in rural Uganda, prior to the introduction of anti-retroviral therapy (ART). From a clinical cohort established in 1990, we selected records from HIV-infected women of reproductive age. We conducted two analyses: (1) all HIV-infected cases contributing to analysis of CD4 decline, using a linear regression model with random intercepts and slopes; (b) incident cases with known date of seroconversion contributed to analyses of median time to CD4 less than 200 cells/microl, AIDS and death. A total of 139 women were included in the analysis of CD4 decline. Women who subsequently became pregnant had higher CD4 counts at enrolment and had a slower CD4 decline than those who did not become pregnant. In women who became pregnant, CD4 decline was faster after pregnancy than before (P less than 0.0001). The survival analyses showed no significant differences between women who became pregnant and those who did not with respect to median time to CD4 count less than 200, AIDS or death. The initial comparative immunological advantage possessed by fertile women before they become pregnant is subsequently lost as a result of their pregnancy. Women should be informed about the potential negative effect of pregnancy on their immunological status and should be offered contraception. In resource-limited settings, women determined to become pregnant should be given priority for ART if eligible.

HIV/AIDS and STIs NEWS

Botswana: Educating the nation through drama
(News Article; Sub-Saharan Africa)
14 Aug 2007
Baraedi C, The Voice (Francistown)

Kenya: Want to take an Aids check? Self testing kit on the way
(News Article; Sub-Saharan Africa)
13 Aug 2007
Albert M, Business Daily (Nairobi)
Related Abstract; subscription needed for full text: Kenya: Educate public on Aids kit

Botswana: Artists take on HIV/Aids
(News Article; Sub-Saharan Africa)
14 Aug 2007
Maruping M, The Voice (Francistown)

Kenya: HIV, Aids prevalence declines
(News Article; Sub-Saharan Africa)
14 Aug 2007
BuaNews (Tshwane)

MATERNAL AND CHILD HEALTH RESEARCH

Effectiveness of the WHO/UNICEF guidelines on infant feeding for HIV-positive women: Results from a prospective cohort in South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2007 Aug 20;21(13):1791-1797.
Doherty T | Chopra M | Jackson D | Goga A | Colvin M | Lars-Ake P
Background: The World Health Organization (WHO) and UNICEF recommend that HIV-positive women should avoid all breastfeeding only if replacement feeding is acceptable, feasible, affordable, sustainable and safe. Little is known about the effectiveness of the implementation of these guidelines in developing country settings. Objective: To identify criteria to guide appropriate infant-feeding choices and to assess the effect of inappropriate choices on infant HIV-free survival. Method: Prospective cohort study of 635 HIV-positive mother-infant pairs across three sites in South Africa to assess mother to child transmission of HIV. Semistructured questionnaires were used during home visits between the antenatal period and 36 weeks after delivery to collect data concerning appropriateness of infant feeding choices based on the WHO/UNICEF recommendations. Results: Three criteria were found to be associated with improved infant HIV-free survival amongst women choosing to formula feed: piped water; electricity, gas or paraffin for fuel; and disclosing HIV status. Using these criteria as a measure of appropriateness of choice: 95 of 311 women who met the criteria (30.5%) chose to breastfeed and 195 of 289 women who did not meet the criteria (67.4%) chose to formula feed. Infants of women who chose to formula feed without fulfilling these three criteria had the highest risk of HIV transmission/death (hazard ratio, 3.63; 95% confidence interval, 1.48-8.89). Conclusions: Within operational settings, the WHO/UNICEF guidelines were not being implemented effectively, leading to inappropriate infant-feeding choices and consequent lower infant HIV-free survival. Counselling of mothers should include an assessment of individual and environmental criteria to support appropriate infant-feeding choices.

Health care financing and utilization of maternal health services in developing countries
(Abstract; subscription needed for full text; Global)
Health Policy and Planning. 2007 Aug;22(5):303-310.
Kruk ME | Galea S | Prescott M| Freedman LP
Background: The Millennium Development Goals call for a 75% reduction in maternal mortality between 1990 and 2015. Skilled birth attendance and emergency obstetric care, including Caesarean section, are two of the most important interventions to reduce maternal mortality. Although international pressure is rising to increase donor assistance for essential health services in developing countries, we know less about whether government or the private sector is more effective at financing these essential services in developing countries. Methods: We conducted a cross-national analysis to determine the association between government versus private financing of health services and utilization of antenatal care, skilled birth attendants and Caesarean section in 42 low-income and lower-middle-income countries. We controlled for possible confounding effects of total per capita health spending and female literacy. Findings In multivariable analysis, adjusting for confounders, government health expenditure as a percentage of total health expenditure is significantly associated with utilization of skilled birth attendants (P = 0.05) and Caesarean section (P = 0.01) but not antenatal care. Total health expenditure is also significantly associated with utilization of skilled birth attendants (P less than 0.01) and Caesarean section (P less than 0.01). Discussion: Greater government participation in health financing and higher levels of health spending are associated with increased utilization of two maternal health services: skilled birth attendants and Caesarean section. While government financing is associated with better access to some essential maternal health services, greater absolute levels of health spending will be required if developing countries are to achieve the Millennium Development Goal on maternal mortality.

Reducing financial barriers to emergency obstetric care: Experience of cost-sharing mechanism in a district hospital in Burkina Faso
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Tropical Medicine and International Health. 2007 Aug;12(8):972-981.
Richard F | Ouedraogo C | Compaore J | Dubourg D | De Brouwere V
The objective was to describe the implementation of a cost-sharing system for emergency obstetric care in an urban health district of Ouagadougou, Burkina Faso and analyse its results after 1 year of activity. Service availability and use, service quality, knowledge of the cost-sharing system in the community and financial viability of the system were measured before and after the system was implemented. Different sources of data were used: community survey, anthropological study, routine data from hospital files and registers and specific data collected on major obstetric interventions (MOI) in all the hospitals utilized by the district population. Direct costs of MOI were collected for each patient through an individual form and monitored during the year 2005. Rates of MOI for absolute maternal indications (AMI) were calculated for the period 2003-2005. The direct cost of a MOI was on average 136US$, including referral cost. Through the costsharing system this amount was shared between families (46US$), health centres (15US$), Ministry of Health (38US$) and local authority (37US$). The scheme was started in January 2005. The rate of cost recovery was 91.3% and the balance at the end of 2005 was slightly positive (4.7% of the total contribution). The number of emergency referrals by health centres increased from 84 in 2004 to 683 in 2005. MOI per 100 expected births increased from 1.95% in 2003 to 3.56% in 2005 and MOI for AMI increased from 0.75% to 1.42%. The dramatic increase in MOI suggests that the cost-sharing scheme decreased financial and geographical barriers to emergency obstetric care. Other positive effects on quality of care were documented but the sustainability of such a system remains uncertain in the dynamic context of Burkina Faso (decentralization).

MATERNAL AND CHILD HEALTH NEWS

How you can help save mothers' lives
(Commentary; Global)
7 Aug 2007
Kantrowitz B | Wingert P, Newsweek

Gambia: NaNA on global breastfeeding week
(News Article; Sub-Saharan Africa)
10 Aug 2007
Bajo Y, FOROYAA Newspaper

Uganda: Target educated mothers too
(Commentary; Sub-Saharan Africa)
13 Aug 2007
New Vision
Related Abstract; subscription needed for full text: Better breastfeeding, healthier lives
(You need Adobe Acrobat Reader to access this document)
Related Abstract; subscription needed for full text: Breastfeeding Questions Answered: A Guide for Providers

Ghana: President admits challenges in reaching millenium development goals
(News Article; Sub-Saharan Africa)
13 Aug 2007
Hanson E, Public Agenda

UN-backed conference to tackle needless deaths during pregnancy and childbirth
(News Article; Global)
14 Aug 2007
UN News Centre1

GENDER and HEALTH RESEARCH

Healthcare-seeking behaviours for sexually transmitted infections among women attending the National Institute of Dermatology and Venereology in Vietnam
(Abstract; subscription needed for full text; Asia)
Sexually Transmitted Infections. 2007 Aug 1;83(5):406-410.
Do HT | Ziersch A | Hart G
The objectives were to investigate the determinants of delay in seeking healthcare for sexually transmitted infections (STIs) among Vietnamese women attending the National Institute of Dermatology and Venereology (NIDV), through assessing to what extent women's sociodemographic backgrounds and their knowledge, attitudes and practices (KAP) relating to STIs/STI prevention influence their delay in seeking healthcare for STIs. A face-to-face semistructured interview of 60 women over 18 years old attending the NIDV, who were diagnosed with an STI by clinicians from the NIDV and volunteered to participate in the study. The relationship between demographic and KAP variables and delay (7 days or more between onset of symptoms and seeking care) and the interval of delay were assessed using x/2, Fisher's exact, Mann-Whitney U and Kruskal-Wallis tests. Of those women reporting delay before first seeking care, 82% delayed by greater than or equal to 7 days. Women with lower education and from rural or remote areas waited significantly longer before first seeking care than those with higher education and from urban areas. Women who delayed in seeking care knew significantly less routes of STI transmission and engaged significantly more in sex while having symptoms than women who did not delay in seeking care. No relationships existed between delay behaviours and women's income, age or attitudes towards STIs/STI prevention. Early healthcare-seeking behaviour for STIs could be facilitated through improving women's basic knowledge regarding STIs, changing their sexual behaviour and creating a social support environment for early care-seeking.

Comparative study of four candidate strategies to detect cervical cancer in different health care settings
(Abstract; subscription needed for full text; Asia)
Journal of Obstetrics and Gynaecology Research. 2007 Aug;33(4):480-489.
Kamal MM | Sapkal RU | Sarodey CS | Munshi MM | Alsi YD
Considering the differing but potentially supplementary properties of visual inspection of the cervix with acetic acid (VIA) and the cytological examination (CYTO) of cervical smears for the screening of cervical cancers, we examined the performance of these two tests and their combinations for the screening of cervical cancer in different health care settings. In this cross-sectional diagnostic test performance evaluation study of 4235 female subjects in the reproductive age group, we assessed the screening performance of four strategies: VIA alone, CYTO alone, VIA and CYTO combined in a parallel fashion, and VIA and CYTO combined in tandem. Subjects were recruited from three settings: Hospital, Urban Community and Rural Community. Colposcopy was used as the reference standard. Screening performance was assessed using sensitivity, specificity, post-test probabilities and likelihood ratios (LR), diagnostic odds, area under receiver operating characteristic curve and LR x/2. Both VIA and CYTO when used alone had a low sensitivity but high specificity, especially in the Rural Community setting. A combination of the results of VIA and CYTO improved the diagnostic accuracy but the strategy using a parallel combination of VIA and CYTO was the most accurate. In general, all screening strategies using VIA and CYTO showed a modest screening performance. In the settings of varying levels of health care and low resources, caution is needed for a generalized use of VIA for cervical cancer screening. Further evaluation of the cost-effective ways of combining VIA and CYTO is needed in these circumstances.

Randomised controlled trial on whether advance knowledge of prostate-specific antigen testing improves participant reporting of unprotected sex
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2007 Aug 1;83(5):419-420.
Thomsen SC | Gallo MF | Ombidi W | Omungo Z | Janowitz B
The objectives were to determine whether the process of informing research participants that they would be tested for the presence of a biological marker of semen exposure would reduce bias in their reports of unprotected sex. A randomised trial of 210 female sex workers from Mombasa, Kenya, was conducted, where half the group had advance knowledge (via the request for informed consent) that they would be tested for prostate-specific antigen (PSA) in their vaginal fluid before they reported on sex and condom use for the past 48 h. The other half were invited to participate (via additional informed consent) in the test for PSA after they had already consented to be questioned and reported on these sexual behaviours. A trained nurse instructed participants to self-swab to collect vaginal fluid specimens, which were tested for PSA using ELISA. Reporting of unprotected sex did not differ between those with advance knowledge of the test for PSA and those without this knowledge (14.3% v 11.4%, respectively; p = 0.27). Surprisingly, more women with advance knowledge (15.8%) had discrepant self reports and PSA results than women without advance knowledge (9.1%); however, the difference was not statistically significant (OR 1.9; 95% CI 0.8 to 4.5). Knowing that one's answers to a questionnaire could be verified with a biological marker of semen exposure did not make respondents more likely to report unprotected sex.

GENDER and HEALTH NEWS

Experimental HPV vaccine Cervarix does not accelerate clearance of virus, study says
(News Article; Global)
15 Aug 2007
Kaiser Network Daily Reports
Related Abstract; subscription needed for full text: Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection

Kenya: Give us free condoms, women tell the state
(News Article; Sub-Saharan Africa)
15 Aug 2007
Awuor E, East African Standard (Nairobi)

Most Sierra Leone parliamentary, presidential candidates unwilling to speak against female genital cutting
(News Article; Sub-Saharan Africa)
14 Aug 2007
Medical News Today

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Hidden spaces of resistance of the subordinated: Case studies from Vietnamese female migrant partners in Taiwan
(Abstract; subscription needed for full text; Asia)
International Migration Review. 2007 Fall;41(3):706-727.
Wang HZ
This paper explores how contradictory social structures influence power relations between "Vietnamese brides" and their Taiwanese family members. By analyzing two aspects of interaction between "Vietnamese brides" and their husbands' families, i.e. , how the families require them to integrate into Taiwanese society and what strategies they employ to escape from these constraints, we argue that contradictory social relations together with commodified marriage and liminality help them to develop strategies of escape into the "hidden space." The development of these strategies indicates one thing: hegemony is never fully achieved -- it is always negotiated and contested.

A Bayesian multinomial model to analyse spatial patterns of childhood co-morbidity in Malawi
(Abstract; subscription needed for full text; Sub-Saharan Africa)
European Journal of Epidemiology. 2007 Aug;22(8):545-556.
Kazembe LN | Namangale JJ
Children in less developed countries die from a relatively small number of infectious diseases, some of which epidemiologically overlap. Using self-reported illness data from the 2000 Malawi Demographic and Health Survey, we applied a random effects multinomial model to assess risk factors of childhood co-morbidity of fever, diarrhoea and pneumonia, and quantify area-specific spatial effects. The spatial structure was modelled using the conditional autoregressive prior. Various models were fitted and compared using deviance information criterion. Inference was Bayesian and was based on Markov Chain Monte Carlo simulation techniques. We found spatial variation in childhood co-morbidity and determinants of each outcome category differed. Specifically, risk factors associated with child co-morbidity included age of the child, place of residence, undernutrition, bednet use and Vitamin A. Higher residual risk levels were identified in the central and southern-eastern regions, particularly for fever, diarrhoea and pneumonia; fever and pneumonia; and fever and diarrhoea combinations. This linkage between childhood health and geographical location warrants further research to assess local causes of these clusters. More generally, although each disease has its own mechanism, overlapping risk factors suggest that integrated disease control approach may be cost-effective and should be employed.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Population in Bulgaria steadily grows older and decreases
(News Article; Europe)
16 Aug 2007
SofiaEcho

Russia allows citizens time off to have babies as underpopulation worsens
(News Article; Asia)
15 Aug 2007
LifeNews

Burundi: Population growth and poor farming methods weigh on the land
(News Article; Sub-Saharan Africa)
14 Aug 2007
Bigirimana J, Inter Press Service News Agency

Belarus propagates economic and demographic successes
(News Article; Europe)
14 Aug 2007
Marples D, Eurasia Daily Monitor

ADOLESCENT HEALTH RESEARCH

Sexual attitudes and risk-taking behaviors of high school students in Turkey
(Abstract; subscription needed for full text; Europe)
Journal of School Health. 2007 Sep;77(7):359-366.
Aras S | Semin S | Gunay T | Orcin E | Ozan S
The risk of sexually transmitted diseases is high but opportunities of sexual education for adolescents are limited in Turkey. The aim of this study was to evaluate sexual attitudes and behaviors and to determine the predictors of sexual initiation among adolescents. A questionnaire designed by the researchers was administered to 861 senior year high school students in their classrooms. The rates of masturbation and sexual intercourse and the median partner numbers among males were higher than females. The rates of having negative feelings after the first sex among females were higher than males. The rates of having sexual intercourse and the mean age at first sexual intercourse among males were similar to developed countries. However, the use of a condom at first intercourse was low. Lower academic performance and grade repetition experience among males and cigarette smoking among both gender groups were related to having sexual intercourse. This is one of the first studies about sexual risk-taking behaviors among high school students in Turkey. Differences found between gender groups regarding attitudes and behaviors reflect the social structure in Turkey. These findings may be helpful in producing effective solutions for improving education and preventive health care.

Vulnerability and sexual and reproductive health among Zambian secondary school students
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Culture, Health and Sexuality. 2007 Sep-Oct;9(5):533-544.
Warenius L | Pettersson KO | Nissen E | Hojer B | Chishimba P
The present study aimed to explore secondary school students' needs in relation to sexual and reproductive health in order to inform efforts to improve the quality of health services available to young people. The study involved data collection from 716 11-22-year-old students in four secondary schools in an urban area in Zambia. Students completed a questionnaire and were invited to write down any inquiries they had regarding sexuality and reproduction. Findings revealed that boys and girls lack adequate information about human reproduction and STIs, including HIV. To avoid misconceptions and myths, they also need clear information on contraceptives and masturbation. Responses indicate that young people would welcome guidance and support related to contraception, pregnancy, abortion and STIs/HIV, but also on love and relationships. Culture, religion and gender are important factors influencing sexuality and sexual abuse. These issues need to be taken into consideration when developing youth-friendly programmes for young people.

Passionate uprisings: Young people, sexuality and politics in post-revolutionary Iran
(Abstract; subscription needed for full text; Middle East)
Culture, Health and Sexuality. 2007 Sep-Oct;9(5):445-457.
Mahdavi P
This paper examines the sexual and social practices of young people in contemporary Iran. Young people in urban areas live under the rubric of a fundamentalist, Islamist regime which restricts social freedoms such as premarital heterosexual contact, homosexual encounters, dancing, alcohol consumption and large group gatherings. Drawing on close focus research and individual and group interviews, this paper seeks to analyse young people's responses to these constraints. Findings suggest that many young adults use their 'rebellious' social behaviour to make political statements against a regime that dissatisfies them; saying, in their own words, that they are enacting and bringing about a 'sexual revolution'.

ADOLESCENT HEALTH NEWS

Ghana: Girls and early & child marriage
(Feature Article; Sub-Saharan Africa)
13 Aug 2007
Amankwah A, Public Agenda

Angola: Afrobasket2007 - Aids campaigns in Moxico coincide with championship
(News Article; Sub-Saharan Africa)
15 Aug 2007
Angola Press Agency

Zimbabwe: Virginity tests useful in fighting HIV, Aids
(News Article; Sub-Saharan Africa)
14 Aug 2007
The Herald

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Volume 7, Number 3120 August 2007