Volume 7, Number 34
10 September 2007

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FAMILY PLANNING RESEARCH

Reasons and correlates of contraceptive discontinuation in Kuwait
(Abstract; subscription needed for full text; Middle East)
European Journal of Contraception and Reproductive Health Care. 2007 Sep;12(3):260-268.
Shah NM | Shah MA | Chowdhury RI | Menon I
The objectives were: (1) To examine the probability of discontinuation of various methods within 1, 2, and three years of use and the reasons for discontinuation; 2) to analyse the sociodemographic correlates of discontinuation. Data from a survey of Kuwaiti women in reproductive ages conducted in 1999 were used. Information on duration of use of modern and traditional methods, and reasons for discontinuation during the 72 months before the survey were analysed. Probabilities of discontinuation were estimated through multiple decrement life table analysis. After 1 year, 30% of modern and 40% of traditional method users had discontinued; after 3 years, discontinuation increased to 66 and 70%, respectively. After 36 months, only 40% of IUD users discontinued compared with 74% of oral contraceptive users. The desire to become pregnant was the leading reason for discontinuation of most modern methods, while method failure was an equally important reason for traditional methods. Discontinuation was significantly more frequent among higher parity, non-working and Bedouin women, and among those who said Islam disapproves of contraception. Contraception is used largely for spacing. More than two-thirds of the women studied had discontinued most methods after three years, except the IUD, which was used only by about 10% of them. Traditional methods are often discontinued due to method failure and may result in an unintended pregnancy. Better counselling is warranted for traditional methods. Health care for managing side effects of modern methods also needs improvement.

Side effects and acceptability of Implanon: A pilot study conducted in eastern Turkey
(Abstract; subscription needed for full text; Europe)
European Journal of Contraception and Reproductive Health Care. 2007 Sep;12(3):248-252.
Yildizbas B | Sahin HG | Kolusari A | Zeteroglu S | Kamaci M
The objective was to assess side effects during the first 6 months of use of Implanon. The study was conducted in eastern Turkey between June 2004 and May 2005. Forty-one healthy women, aged 18-40 years who chose to use Implanon participated in the study. The implant was inserted between days 1 and 5 of the menstrual cycle. Findings were recorded before and during 6 months following insertion. Statistical analyses were performed using SPSS package programme including paired samples t-test. No pregnancy occurred during the study. Ninety days after initiation of therapy, three of the 41 patients (7.3%) had regular periods, 14 (34.1%) were amenorrhoeic and the remaining 24 (58.5%) had some type of abnormal bleeding. Dysmenorrhoea affected significantly less women (1/41, i.e. 2.4%) than before treatment (17/41, i.e. 41.5%), but mastalgia increased significantly as it was reported by five previously unaffected participants (12.2%). Mood changes appeared in seven patients (17.1%) and acne in 11 of them (26.8%). The circulating levels of protein C, total cholesterol and oestradiol dropped significantly. Endometrial thickness decreased significantly. At completion of the study period, removal of the implant was requested by eight of the 41 patients (19.5%) because of irregular bleeding (six women), depressive symptoms requiring treatment (one woman) or weight gain (one woman). Mainly because of irregular bleeding, the discontinuation rate of Implanon at 6 months among the women in this region is high (19.5%).

Clinical experience with NuvaRing in daily practice in Switzerland: Cycle control and acceptability among women of all reproductive ages
(Abstract; subscription needed for full text; Europe)
European Journal of Contraception and Reproductive Health Care. 2007 Sep;12(3):240-247.
Merki-Feld GS | Hund M
The objectives were to assess clinical experience with NuvaRing in daily practice in Switzerland, including a large subgroup of young women (aged less than or equal to 22 years). Open, prospective, multicentre, observational clinical experience study to investigate cycle control, acceptability and usage of NuvaRing. Altogether, 2642 women participated in the programme and were included in the analysis, of which 658 were aged less than or equal to 22 years (25% of the total group). A total of 744 women (28% of the total group) discontinued NuvaRing use; the main reason was adverse events (11% of all users). In younger women, there was a shift from moderate (-18%) and heavy (-45%) bleeding to mild bleeding (+71%) and dysmenorrhoea decreased by 60%, despite previous hormonal contraception use by 83% of women. Most women found ring insertion and removal to be straightforward (great than 95%), and were satisfied with its use (85%), primarily for the ring's once-a-month application (81%). Data were very similar for the total group. Cycle control and satisfaction were further improved with duration of treatment. In daily practice, NuvaRing improved cycle control and was highly acceptable to women, including young women. Switchers from other hormonal methods also showed improved cycle control and high satisfaction.

Lactational amenorrhoea method for family planning and women empowerment in Egypt
(Research Article; North Africa)
(You need Adobe Acrobat Reader to access this document)
Singapore Medical Journal. 2007 Aug;48(8):758-762.
Afifi M
This study aims to assess the potential for the lactational amenorrhoea method (LAM) and passive LAM among women with children below six months of age, and to examine its association with women empowerment in household decisions. Data from the Egypt Demographic Health Survey 2000 was downloaded from the Demographic and Health Surveys website. A sub-sample of women fulfilling all four criteria were selected: (1) women whose last birth of children was less than three years ago; (2) currently married; (3) not sterilised; and (4) currently breastfeeding their children. Accordingly, only 3,447 women entered into the statistical analysis of whom 1,141 had children below six months of age. Passive LAM users constituted 82 percent of the women who met LAM criteria, 57.1 percent of exclusive breastfeeding mothers, and 32.9 percent of all nursing mothers of children below six months of age. 11.8 percent of women who met the LAM criteria were under double coverage of family planning methods. In the logistic regression model where all variables were adjusted, women empowerment in household decisions, significantly and independently, inversely predicted passive LAM along with increase in child age (Odds Ratio [OR] of 0.86 and 0.43, respectively). Women with higher birth order children were more likely to use passive LAM (OR 1.11). Women of low empowerment index in household decisions were more likely to use passive LAM. Passive LAM users could be subjected to discontinuation or double coverage of contraceptives.

FAMILY PLANNING NEWS

Uganda: Rapid population growth worries government
(News Article; Sub-Saharan Africa)
Daily Monitor. 7 Sep 2007
Nafula J | Miti J

Syria: Bilal reviews with Osman the illuminating role of the media with regard to population issues
(News Article; Middle East)
5 Sep 2007
Idelbi AN, Syrian Arab News Agency
Related News Article: Syria: Otri reviews with delegation of Family Planning Associations issues of family planning

HIV/AIDS and STIs RESEARCH

Risk of cancers during interrupted antiretroviral therapy in the SMART study
(Abstract; subscription needed for full text; Global)
AIDS. 2007 Sep;21(14):1957-1963.
Silverberg MJ | Neuhaus J | Bower M | Gey D | Hatzakis A
The objective was to compare rates of AIDS-defining and non-AIDS-defining malignancies between patients on a CD4 T-cell-guided antiretroviral therapy (ART) strategy and continuous ART. A randomized clinical trial was used for the study. Malignancy rates were compared between the drug conservation arm in which ART was stopped if the CD4 T-cell count exceeded 350 cells/microl and (re)started if it fell to less than 250 cells/microl and the viral suppression arm utilizing continuous ART. Cox models were used to examine baseline characteristics including age, sex, race, cigarette use, previous malignancies, CD4 T-cell and HIV-RNA levels, hepatitis B or C, and ART duration. A total of 5472 participants were randomly assigned to treatment groups, of whom 70 developed cancer: 13 AIDS-defining malignancies and 58 non-AIDS-defining malignancies (one patient had both). The AIDS-defining malignancy rate per 1000 person-years was higher in the drug conservation arm (3.0 versus 0.5). Proximal CD4 T-cell and HIV RNA levels mediated much of this increased risk. The drug conservation arm also had higher rates of Kaposi's sarcoma (1.9 versus 0.3) and lymphoma (Hodgkin's and non-Hodgkin's; 1.1 versus 0.3). The non-AIDS-defining malignancy rate was similar between the drug conservation and viral suppression arms (8.8 versus 7.1). The most common non-AIDS-defining malignancies were skin (n = 16), lung (n = 8) and prostate (n = 6) cancers. Non-AIDS-defining malignancies were more common in this cohort than AIDS-defining malignancies. This analysis provides further evidence against the use of CD4 T-cell-guided ART because of a higher risk of AIDS-defining malignancies in addition to opportunistic infections and deaths.

Prior antiretroviral therapy experience protects against zidovudine-related anaemia
(Abstract; subscription needed for full text; Asia)
HIV Medicine. 2007 Oct;8(7):465-471.
Huffam SE | Srasuebkul P | Zhou J | Calmy A | Saphonn V
We investigated the use of antiretroviral therapy regimens containing zidovudine or stavudine, using data from the TREAT Asia HIV Observational Database (TAHOD), a multicentre, prospective, observational study of an HIV-infected cohort in the Asia-Pacific Region. A proportional hazards regression analysis of factors associated with the time to discontinuation of initial regimens containing zidovudine or stavudine and a logistic regression analysis to identify factors associated with a diagnosis of anaemia within 6 months of commencement of zidovudine in initial or subsequent regimens were performed. Patients who started zidovudine were more likely to stop within the first 9 months of treatment than those who started on stavudine; the reverse was true after 9 months. Anaemia (haemoglobin less than or equal to 10 g/dL) occurred in the first 6 months in 57 of 433 patients (13%) on zidovudine. Baseline anaemia was the strongest predictive factor for subsequent anaemia, and prior antiretroviral therapy (ART) experience was protective for development of anaemia. These data support baseline haemoglobin testing and avoidance of zidovudine if the patient is anaemic. The protective effect of prior ART for development of anaemia on zidovudine supports the short-term safety of a stavudine to zidovudine switch with routine haemoglobin monitoring in this cohort. Further studies in resource-poor settings of longer term efficacy and toxicities of ART switch strategies are needed.

Evaluation of the overall program effectiveness of HIV-related intervention programs in a community in Sichuan, China
(Abstract; subscription needed for full text; Asia)
Sexually Transmitted Diseases. 2007 Sep;34(9):653-662.
Lau JT | Wang R | Chen H | Gu J | Zhang J
The study evaluates the overall effectiveness of intervention programs among female sex workers in a Chinese community. Behavioral surveillance data in 2003, 2004, and 2005 obtained from 2 communities (intervened and control) were compared. The baseline data (2003) of the 2 counties were not significantly different. In 2004 and 2005, the intervened county had significantly higher prevalence of condom use with their clients and regular sex partners (last-time and consistent use in the last month; OR = 2.2-33.2 in 2004 and 3.8-8.3 in 2005), higher HIV-related knowledge level (OR = 7.9 in 2004 and 17.3 in 2005), and lower STD prevalence (OR = 0.22 in 2004 and 0.11 in 2005). Coverage rates of HIV antibody testing and HIV-related services increased in the intervened county but decreased in the control county. Intervention programs may result in substantial behavioral changes in a community within a few years.

HIV/AIDS and STIs NEWS

Rwanda: Govt may delay male circumcision
(News Article; Sub-Saharan Africa)
1 Sep 2007
Musoni E, New Times (Kigali)

Malawi: CD4 count testing more effective than WHO staging
(News Article; Sub-Saharan Africa)
4 Sep 2007
Kaufa M, The Chronicle Newspaper (Lilongwe)

Ghana: HIV/Aids increases
(News Article; Sub-Saharan Africa)
4 Sep 2007
Accra Mail (Accra)

Ethiopia: What other choices are there?
(News Article; Sub-Saharan Africa)
4 Sep 2007
Hassan SL, Daily Monitor (Addis Ababa)

Botswana: Country excels at PMTCT
(News Article; Sub-Saharan Africa)
28 Aug 2007
Chwaane T, Mmegi/The Reporter (Gaborone)

Sierra Leone: HIV/Aids testing center for soldiers in Bo
(News Article; Sub-Saharan Africa)
5 Sep 2007
Kandeh M, Concord Times (Freetown)

MATERNAL AND CHILD HEALTH RESEARCH

Utilisation of postnatal care among rural women in Nepal
(Research Article; Asia)
BMC Pregnancy and Childbirth. 2007 Sep 3;7(1)
Dhakal S | Chapman GN | Simkhada PP | van Teijlingen ER | Stephens J
Postnatal care is uncommon in Nepal, and where it is available the quality is often poor. Adequate utilisation of postnatal care can help reduce mortality and morbidity among mothers and their babies. Therefore, this study assessed the utilisation of postnatal care at a rural community level. A descriptive, cross-sectional study was carried out in two neighbouring villages in early 2006. A total of 150 women who had delivered in the previous 24 months were asked to participate in the study using a semi-structured questionnaire. The proportion of women who had received postnatal care after delivery was low (34%). Less than one in five women (19%) received care within 48 hours of giving birth. Women in one village had less access to postnatal care than women in the neighbouring one. Lack of awareness was the main barrier to the utilisation of postnatal care. The woman's own occupation and ethnicity, the number of pregnancies and children and the husband's socio-economic status, occupation and education were significantly associated with the utilisation of postnatal care. Multivariate analysis showed that wealth as reflected in occupation and having attended antenatal are important factors associated with the uptake of postnatal care. In addition, women experiencing health problems appear strongly motivated to seek postnatal care. The postnatal care has a low uptake and is often regarded as inadequate in Nepal. This is an important message to both service providers and health-policy makers. Therefore, there is an urgent need to assess the actual quality of postnatal care provided. Also there appears to be a need for awareness-raising programmes highlighting the availability of current postnatal care where this is of sufficient quality.

Development and evaluation of a childbirth education programme for Malawian women
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Advanced Nursing. 2007 Oct;60(1):67-78.
Malata A | Hauck Y | Monterosso L | McCaul K
This paper is a report of a study to develop and evaluate a childbirth educational programme for Malawian women. Providing parent education is integral to the midwife's role. Malawian midwives face a challenge in fulfilling this role, with no existing childbirth education programme to facilitate this process. A mixed method approach was used for this three-phase study. In Phase 1, childbirth information needs of Malawian women were determined from literature and interviews with midwives. In Phase 2, a structured childbirth education programme was developed. In Phase 3, a quasi-experimental design using sequential sampling was conducted to evaluate the education programme. Participants were pregnant women who attended antenatal clinics in 2002, with 104 in the control group and 105 in the intervention group. Changes in childbirth knowledge were determined over a 6-week period. The childbirth education programme included information, teaching strategies and a schedule for implementation for content relevant to the antenatal, labour and birth and postnatal time periods. Results revealed no significant difference in knowledge in the control group between pretest and post-test scores. For the intervention group, however, an overall significant increase in knowledge across all time periods was demonstrated (P less than 0.01). A childbirth education programme, developed for the Malawian context, was associated with important increases in maternal knowledge about antenatal, labour and birth and postnatal topics. The findings have implications for midwives in other developing countries and offer an example of a midwifery-led initiative to provide formal childbirth education to these vulnerable women.

Risk factors for maternal mortality in Delhi slums: A community-based case-control study
(Research Article; Asia)
Indian Journal of Medical Sciences. 2007 Sep;61(9):517-526.
Aggarwal A | Pandey A | Bhattacharya BN
In order to develop, implement and evaluate policy for reducing maternal mortality, it is essential to study the risk factors associated with maternal deaths. The study aims to determine the epidemiological risk factors and its related causes associated with maternal deaths in Delhi slums. A community-based case-control study was designed, wherein snowball-sampling method was used to identify the maternal deaths (cases) in the community, and circular systematic random sampling procedure was used to select the controls from the same area where a maternal death was found. Data on 70 cases and 384 controls that had live births as the outcome of the pregnancy were analyzed. Logistic regression was applied to identify the risk factors. In the study population, most of the deliveries were conducted at home by untrained 'dais.' Cases were mostly illiterate, young, having high parity and no antenatal care taken during pregnancy (P less than 0.05) as compared to controls. The distance of health facility from residence was also found to be a significant risk factor for maternal death (P less than 0.05). Complications during pregnancy, like jaundice, excessive bleeding and anemia, were also found to be significant. The major causes of maternal death were found to be hemorrhage after delivery, retained placenta and anemia. The study findings suggest that women should be educated about the importance of antenatal registration and regular checkups. Untrained 'dais' should be trained to recognize the obstetric complications at an early stage and refer high-risk cases for adequate management. These preventive measures could help in reducing maternal mortality at the community level.

MATERNAL AND CHILD HEALTH NEWS

Malawi: Men - architects of change in promoting maternal health
(News Article; Sub-Saharan Africa)
4 Sep 2007
Nkungula C, The Chronicle Newspaper

Gambia: Breastfeeding campaign gains momentum
(Report; Sub-Saharan Africa)
3 Sep 2007
Jammeh B, Daily Observer
Related Report: Better breastfeeding, healthier lives
(You need Adobe Acrobat Reader to access this document)

Uganda: Hope for premature babies
(News Article; Sub-Saharan Africa)
5 Sep 2007
Ajwang J, The Monitor

Nigeria: Govt gives free ante-natal
(News Article; Sub-Saharan Africa)
4 Sep 2007
Peter-Omale F, This Day

GENDER and HEALTH RESEARCH

Human papillomavirus and HPV vaccines: A review
(Research Article; Global)
Bulletin of the World Health Organization. 2007 Sep;85(9):719-726.
Cutts FT | Franceschi S | Goldie S | Castellsague X | de Sanjose S | Garnett G
Cervical cancer, the most common cancer affecting women in developing countries, is caused by persistent infection with "high-risk" genotypes of human papillomaviruses (HPV). The most common oncogenic HPV genotypes are 16 and 18, causing approximately 70% of all cervical cancers. Types 6 and 11 do not contribute to the incidence of high-grade dysplasias (precancerous lesions) or cervical cancer, but do cause laryngeal papillomas and most genital warts. HPV is highly transmissible, with peak incidence soon after the onset of sexual activity. A quadrivalent (types 6, 11, 16 and 18) HPV vaccine has recently been licensed in several countries following the determination that it has an acceptable benefit/risk profile. In large phase III trials, the vaccine prevented 100% of moderate and severe precancerous cervical lesions associated with types 16 or 18 among women with no previous infection with these types. A bivalent (types 16 and 18) vaccine has also undergone extensive evaluation and been licensed in at least one country. Both vaccines are prepared from non-infectious, DNA-free virus-like particles produced by recombinant technology and combined with an adjuvant. With three doses administered, they induce high levels of serum antibodies in virtually all vaccinated individuals. In women who have no evidence of past or current infection with the HPV genotypes in the vaccine, both vaccines show greater than 90% protection against persistent HPV infection for up to 5 years after vaccination, which is the longest reported follow-up so far. Vaccinating at an age before females are exposed to HPV would have the greatest impact. Since HPV vaccines do not eliminate the risk of cervical cancer, cervical screening will still be required to minimize cancer incidence. Tiered pricing for HPV vaccines, innovative financing mechanisms and multidisciplinary partnerships will be essential in order for the vaccines to reach populations in greatest need.

Cost-effectiveness of treatment strategies for cervical infection among women at high risk in Madagascar
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Diseases. 2007 Sep;34(9):631-637.
McClamroch K | Behets F | Van Damme K | Rabenja LN | Myers E
According to the national guidelines developed in 2001, a woman at high risk of gonorrhea and chlamydia in Madagascar is treated presumptively at her first sexually transmitted infection clinic visit; risk-based treatment (RB) is subsequently used at 3-month visits. The objectives were to compare health and economic outcomes for a 2-stage Markov process with the following 3 cervical infection treatment policies at baseline and at 3-month follow-up visit: presumptive treatment (PT), RB, and an interim laboratory/risk-based policy. Cost-effectiveness analysis was used to compare the 9 treatment strategies. When 3-month incidence of cervical infection is less than 20%, the national guidelines are less costly and less effective than both RB followed by PT, and PT at both visits. The national guidelines are a reasonable strategy, especially in the context of resource constraints, relatively low reinfection rates, and local preferences.

Cross-race, cross-culture, cross-national, cross-class, but same-gender: Musings on research in South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
NWSA Journal. 2007 Summer;19(2):79-103.
Lempert LB
This paper presents reflective reexaminations of, and musings about, a cross-race, cross-culture, cross-national, cross-class, but same-gender research process in the "new South Africa" from the vantage point of hindsight. The paper aims to make the research backstage more transparent by reflecting on ongoing negotiations of self in context with abused women's shelter service providers in South Africa. Discursive attention is focused on social locations and the ways that social privileges affect the research process, as well as on giving-and-taking as a significant set of research interactions.

GENDER and HEALTH NEWS

Malawi: Report card, a FPAM initiative
(News Article; Sub-Saharan Africa)
4 Sept 2007
Nkungula C, The Chronicle Newspaper (Lilongwe)

Nigeria: Group seeks to curtail gender based violence
(News Article; Sub-Saharan Africa)
5 Sep 2007
Esin H, This Day

Uganda: NGO donates sexual assault evidence kits
(News Article; Sub-Saharan Africa)
6 Sep 2007
Bagala A, The Monitor

Southern Africa: SADC summit postpones signing of gender protocol
(News Article)
4 Sep 2007
Lopi B, Southern African News Features

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Progress towards the child mortality millennium development goal in urban sub-Saharan Africa: The dynamics of population growth, immunization, and access to clean water
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMC Public Health. 2007 Aug 28;7(1):218.
Fotso JC | Ezeh AC | Madise NJ | Ciera J
Improvements in child survival have been very poor in sub-Saharan Africa (SSA). Since the 1990s, declines in child mortality have reversed in many countries in the region, while in others, they have either slowed or stalled, making it improbable that the target of reducing child mortality by two thirds by 2015 will be reached. This paper highlights the implications of urban population growth and access to health and social services on progress in achieving MDG 4. Specifically, it examines trends in childhood mortality in SSA in relation to urban population growth, vaccination coverage and access to safe drinking water. Correlation methods are used to analyze national-level data from the Demographic and Health Surveys and from the United Nations. The analysis is complemented by case studies on intra-urban health differences in Kenya and Zambia. Only five of the 22 countries included in the study have recorded declines in urban child mortality that are in line with the MDG target of about 4% per year; five others have recorded an increase; and the 12 remaining countries witnessed only minimal decline. More rapid rate of urban population growth is associated with negative trend in access to safe drinking water and in vaccination coverage, and ultimately to increasing or timid declines in child mortality. There is evidence of intra-urban disparities in child health in some countries like Kenya and Zambia. Failing to appropriately target the growing sub-group of the urban poor and improve their living conditions and health status - which is an MDG target itself - may result in lack of improvement on national indicators of health. Sustained expansion of potable water supplies and vaccination coverage among the disadvantaged urban dwellers should be given priority in the efforts to achieve the child mortality MDG in SSA.

Effects of modernisation on desired fertility in Egypt
(Abstract; subscription needed for full text; North Africa)
Population, Space and Place. 2007 Sep-Oct;13(5):353-376.
Baschieri A
Using a conceptual framework that borrows notions both from the economic theory of fertility and social interaction theory, this paper assesses the relative importance of social and economic modernisation at the individual and community level in explaining geographical differentials in desired fertility in Egypt. Using the 2000 Egyptian Demographic Health Survey and an up-to-date map of land cover in Egypt, this paper provides an application of an advanced methodology which uses a combination of multilevel modelling and geographical information system (GIS) techniques. The paper shows how GIS techniques facilitate the construction of several variables representing the level of economic modernisation, such as land use, road density and urbanisation. It illustrates how GIS techniques and multilevel modelling can help us to move forward a step in substantiating theories of community influences on fertility. This study also analyses the effect of current family composition on desired fertility in Egypt and reveals the desire of Egyptian society to have at least two children and at least one boy.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

China says one-child policy helps protect climate
(News Article; Asia)
30 Aug 2007
Reuters

Kenya: Fiscal gains under threat from population growth
(News Article; Sub-Saharan Africa)
3 Sep 2007
Business Daily

Birth rate hits 15-year high in Russia
(News Article; Asia)
4 Sep 2007
Trend News Agency

ADOLESCENT HEALTH RESEARCH

Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: A community-randomized trial
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2007 Sep;21(14):1943?1955.
Ross DA | Changalucha J | Obasi AI | Todd J | Plummer ML
The impact of a multicomponent intervention programme on the sexual health of adolescents was assessed in rural Tanzania. A community-randomized trial was used in the study. Twenty communities were randomly allocated to receive either a specially designed programme of interventions (intervention group) or standard activities (comparison group). The intervention had four components: community activities; teacher-led, peer-assisted sexual health education in years 5-7 of primary school; training and supervision of health workers to provide 'youth-friendly' sexual health services; and peer condom social marketing. Impacts on HIV incidence, herpes simplex virus 2 (HSV2) and other sexual health outcomes were evaluated over approximately 3 years in 9645 adolescents recruited in late 1998 before entering years 5, 6 or 7 of primary school. The intervention had a significant impact on knowledge and reported attitudes, reported sexually transmitted infection symptoms, and several behavioural outcomes. Only five HIV seroconversions occurred in boys, whereas in girls the adjusted rate ratio (intervention versus comparison) was 0.75 [95% confidence interval (CI) 0.34, 1.66]. Overall HSV2 prevalences at follow-up were 11.9% in male and 21.1% in female participants, with adjusted prevalence ratios of 0.92 (CI 0.69, 1.22) and 1.05 (CI 0.83, 1.32), respectively. There was no consistent beneficial or adverse impact on other biological outcomes. The beneficial impact on knowledge and reported attitudes was confirmed by results of a school examination in a separate group of students in mid-2002. The intervention substantially improved knowledge, reported attitudes and some reported sexual behaviours, especially in boys, but had no consistent impact on biological outcomes within the 3-year trial period.

Age at menarche in Turkish adolescents in Kahramanmaras, Eastern Mediterranean region of Turkey
(Abstract; subscription needed for full text; Europe)
European Journal of Contraception and Reproductive Health Care. 2007 Sep;12(3):289-293.
Ekerbicer HC | Celik M | Kiran H | Kiran G
The objectives were to determine the age at menarche in adolescents in the Eastern Mediterranean city of Kahramanmaras, Turkey. The study was conducted in primary and high schools of Kahramanmaras, during the academic year 2003-2004. Data of 8212 female students were collected by using a standard questionnaire. Mean and median ages at menarche (with 95% confidence intervals) were calculated by Kaplan-Meier survival analysis. Also, probit analysis was performed to determine the age at menarche for all girls by estimating the age at which 10, 25, 50, 75 and 90% of the girls reached menarche. According to the answers obtained through the questionnaire, 5506 (67.5%) of 8161 respondents had had their menarche. Mean age at menarche was 13.04 years (95% CI: 13.01-13.06), and median age 13.00 years (95% CI: 12.97-13.03). According to probit analyses, the probability of menstruating before the age of 11.48 years was 10% and before 15.08 years 90%. We provide data about age at menarche in Kahramanmaras, an Eastern Mediterranean city of Turkey.

ADOLESCENT HEALTH NEWS

Uganda: Campaigning against cross-generational sex
(News Article; Sub-Saharan Africa)
7 Sep 2007
IRIN

Malawi: Young people still reluctant to test
(News Article; Sub-Saharan Africa)
7 Sep 2007
IRIN

Uganda: Youth warned on immorality
(News Article; Sub-Saharan Africa)
4 Sep 2007
Nakaayi F, New Vision

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Volume 7, Number 3410 September 2007