Volume 7, Number 37
1 October 2007

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FAMILY PLANNING RESEARCH

Association of oral contraceptive use, other contraceptive methods, and infertility with ovarian cancer risk
(Abstract; subscription needed for full text; Global)
American Journal of Epidemiology. 2007 Oct 15;166(8):894-901.
Tworoger S | Fairfield K | Colditz G | Rosner B | Hankinson S
Although oral contraceptives are protective for ovarian cancer, it is unclear how long this protection persists. The authors prospectively assessed this question as well as associations of other, less studied contraceptive methods (tubal ligation, rhythm method, diaphragm, condoms, intrauterine device, foam, spousal vasectomy) and infertility with ovarian cancer risk among 107,900 participants in the US Nurses' Health Study. During 28 years of follow-up (1976-2004), 612 cases of invasive epithelial ovarian cancer were confirmed. Duration of oral contraceptive use was inversely associated with risk (p-trend = 0.02), but no clear trend was observed for years since last use. However, for women using oral contraceptives for greater than 5 years, the rate ratio for ovarian cancer for less than or equal to 20 years since last use was 0.58 (95% confidence interval (CI): 0.39, 0.87), with no association found for greater than 20 years since last use (rate ratio (RR) = 0.92, 95% CI: 0.61, 1.39). Tubal ligation (RR = 0.66, 95% CI: 0.50, 0.87) was associated with decreased ovarian cancer risk, whereas intrauterine device use (RR = 1.76, 95% CI: 1.08, 2.85) and infertility (RR = 1.36, 95% CI: 1.07, 1.75) were associated with an increased risk. Results suggest that the beneficial effect of oral contraceptives on ovarian cancer risk attenuates after 20 years since last use. Furthermore, tubal ligation, intrauterine device use, and infertility were associated with ovarian cancer risk.

Hair loss with use of the levonorgestrel intrauterine device
(Abstract; subscription needed for full text; Global)
Contraception. 2007 Oct;76(4):306-309.
Paterson H | Clifton J | Miller D | Ashton J | Harrison-Woolrych M
The levonorgestrel intrauterine device (IUD) has associated systemic side effects. However, there is little published information about the risk of alopecia. Review of both the New Zealand Intensive Medicines Monitoring Programme (IMMP) data on alopecia associated with levonorgestrel IUD and the international evidence. The IMMP uses Prescription Event Monitoring to study the safety of medicines during the postmarketing period. All reported cases of alopecia with levonorgestrel IUD use were identified in the IMMP databases and assessed for causality. World Health Organization (WHO) spontaneous reporting data were also obtained. Five reports of alopecia associated with the levonorgestrel IUD were identified in the IMMP database. From the cohort of insertions during 2000-2001, the estimated cumulative incidence of alopecia was 0.33% (95% CI 0.07-0.95) in the responder population. The WHO database contained a further 68 reports. Counselling prior to insertion of the levonorgestrel IUD should include information on systemic effects, including the possibility of alopecia.

Review: Advance provision of emergency contraception increases its use but does not reduce unplanned pregnancies
(Abstract; subscription needed for full text; Global)
Evidence-Based Nursing. 2007;10:106.
Quinn S
Question: Does advance provision of emergency contraception (EC) to women reduce pregnancy rates without increasing rates of sexually transmitted diseases (STDs) or reducing use of more effective methods of contraception? Data sources: Cochrane Central Register of Controlled Trials, Medline, EMBASE/Excerpta Medica, POPLINE, and International Consortium for Emergency Contraception website (to August 2006); reference lists; and experts. Study selection and assessment: English-language randomised controlled trials (RCTs) that compared provision of EC in advance of need with a control intervention (counselling, which may or may not have included a discussion of EC; information about EC; or provision of EC on request by a clinic or pharmacy) in women of reproductive age. 8 RCTs (n = 6389) met the selection criteria. Quality of individual trials was assessed based on randomisation method, allocation concealment, sample size calculation, and loss to follow-up. Outcomes: pregnancy, STD infection, use of EC, timing of EC use, unprotected intercourse, and use of condoms. Main Results: Groups did not differ for pregnancy, STD infection, (table) unprotected intercourse (6 RCTs), or use of condoms (6 RCTs).

Developing Spanish-language family planning materials: Lessons learned from extensive field tests
(Abstract; subscription needed for full text; Global)
Perspectives on Sexual and Reproductive Health. 2007 Sep;39(3):176-180.
Denny-Garamendi C | Lopez-Rabin J | Guendelman S | Schafer S
Despite the importance of providing family planning clients with educational materials that are easy to read and understand, scant information is available on the development of materials for clients who feel most comfortable speaking and reading Spanish. Language difficulties and low health literacy, including lack of knowledge about contraception or where to get it, are important barriers to Latinas' utilization of reproductive health services and understanding of health information among Latinas. Other barriers, such as cost and lack of health insurance coverage, compound difficulties in accessing services, placing low-income Latina women at high risk of unintended pregnancy. Noncitizens and most recent immigrants are not eligible for Medicaid-covered family planning services, and the proportions of 15-44-year-old women who have no insurance are nearly twice as high among these groups (63% and 66%, respectively) as among those born in the United States (35%).

Reality Check Family Planning Forecasting Tool User's Guide (Draft)
(Tool; Global)
(You need Adobe Acrobat Reader to access this document)
New York, NY, EngenderHealth, Sep 2007.
EngenderHealth/The ACQUIRE Project
Reality Check allows one to project the future CPR needs of the geographic area where oneâ€™s program is operating and is important for programmers in planning activities and interventions. The data can also provide evidence to use for advocacy purposesâ€”one can advocate for an increase in family planning resources based on projected data. ACQUIRE developed a Long-Acting and Permanent Method Programming Resource Package, of which the Reality âˆš tool is a key component.

FAMILY PLANNING NEWS

India: Compensation for family planning hiked
(News Article; Asia)
24 Sep 2007
Dhar A, The Hindu

Vietnam: Family planning helps Kon Tum village thrive
(News Article; Asia)
26 Sep 2007
Vietnam News Agency

United States: Breakthrough in male birth control remains elusive
(News Article; Global)
27 Sep 2007
Black C, Seattle Post-Intelligencer

Save the Children educates Guatemalan women
(Editorial; Central America and the Caribbean)
24 Sep 2007
Reichman J, NBC News

HIV/AIDS and STIs RESEARCH

Simultaneous use of multiple condoms among male Cambodian military personnel visiting female sex workers
(Abstract; subscription needed for full text; Asia)
Sexually Transmitted Diseases. 2007 Oct;34(10):808-812.
Morineau G | Prybylski D | Song N | Natpratan C | Neilsen G
The objectives were to estimate the prevalence of simultaneous use of multiple condoms (SUMC) and identify the characteristics of the multiple condoms users. Cross-sectional survey among military men from a purposively selected Cambodian military region; military men were interviewed face to face. From the 1638 respondents, 40% never had sex with female sex workers (FSWs), 55% had used condom(s), and 5% had unprotected sex at their last encounter with a FSW. Among those reporting sex with FSWs, 21% had used multiple condoms simultaneously at their last sex with a FSW. Compared with single condom users, multiple condom users were younger, had lower rank, had first sex more recently, had lower knowledge of HIV transmission, had received less HIV peer-education sessions, were more likely to have visited multiple FSWs, and were more likely to have sought their HIV serostatus. As it is unknown if SUMC increases or decreases condom effectiveness, more research is needed to investigate the effect of SUMC on condom failure rates.

The future of AIDS in Africa: Lessons from two scenario projects
(Abstract; subscription needed for full text; Sub-Saharan Africa)
African Journal of AIDS Research. 2007 Aug;6(2):97-107.
Fourie P
Scenario planning or futures studies have their origin in military planning, but have also been used with great success in the private sector, most notably in the energy industry. UNAIDS and the South African financial services group Metropolitan each recently published a set of scenarios regarding the future impact of HIV/AIDS in Africa and South Africa, respectively. This article reviews the methodologies and outcomes of those two studies, and highlights the many lessons to be gleaned for HIV-related health planning and policy-making in general. This is the first time that a comparative study has been done on scenario planning that refers to HIV in particular, and the findings may inspire the conceptualisation of futures studies elsewhere.

Assessment of quality of life in HAART-treated HIV-positive subjects with body fat redistribution in Rwanda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Research and Therapy. 2007 Sep 18;4(1):19.
Mutimura E | Stewart A | Crowther NJ
The introduction of HAART has initially improved the quality of life (QoL) of HIV-positive (HIV+) patients, however body fat redistribution (BFR) and metabolic disorders associated with long-term HAART use may attenuate this improvement. As access to treatment improves in sub-Saharan Africa, the disfiguring nature of BFR (peripheral atrophy and/or central adiposity) may deter treatment adherence and initiatives and decrease QoL. We examined the relationship between BFR and domains of QoL in HAART-treated HIV+ African men and women with (HIV+BFR, n=50) and without (HIV+noBFR, n=50) BFR in Rwanda. HIV+ subjects with BFR were less satisfied with their body image (4.3 plus or minus 0.1 versus 1.5 plus or minus 0.2; p less than .001), self-esteem and social life (4.1 plus or minus 1.4 versus 2.1 plus or minus 0.3; p=0.003). HIV+BFR were more ashamed in public (4.5 plus or minus 1.2 versus 1.1 plus or minus 1.1), reported less confident about their health (4.6 plus or minus 1.4 versus 1.5 plus or minus 1.2) and were frequently embarrassed due to body changes (4.1 plus or minus 1.1 versus 1.1 plus or minus 0.9) (p less than .001) than HIV+noBFR. HIV+ Rwandan women with BFR reported more dissatisfaction with psychological (8.3 plus or minus 2.9 versus 13.7 plus or minus 1.9), social relationships (6.9 plus or minus 2.3 versus 11.1 plus or minus 4.1) and HIV HAART-specific domain of well-being (3.1 plus or minus 4.8 versus 6.3 plus or minus 3.6) (p less than .001). Age was associated with independence (r2 =0.691; p=0.009) and marital status was associated with psychological (r2 =0.593; p=0.019) and social relationships (r2 =0.493; p=0.007). CD4 count (r2 =0.648; p=0.003) and treatment duration (r2 =0.453; p=0.003) were associated with HIV HAART-specific domain of well-being. HIV+ Rwandan women with BFR were significantly more affected by abdominal adiposity (p less than .001), facial and buttocks atrophy (p less than .05) than HIV+ men with BFR. Body fat alterations negatively affect psychological and social domains of quality of life. These symptoms may result in stigmatization and marginalization mainly in HAART-treated African women, adversely affecting HAART adherence and treatment initiatives. Efforts to evaluate self-perceived body fat changes may improve patients' well-being, HAART adherence and treatment outcomes and contribute towards stability in quality of life continuum.

Potential impact of antiretroviral chemoprophylaxis on HIV-1 transmission in resource-limited settings
(Abstract; subscription needed for full text; Global | Sub-Saharan Africa)
PLoS ONE. 2007 Sep;2(9):e875.
Abbas UL | Anderson RM | Mellors JW
The potential impact of pre-exposure chemoprophylaxis (PrEP) on heterosexual transmission of HIV-1 infection in resource-limited settings is uncertain. A deterministic mathematical model was used to simulate the effects of antiretroviral PrEP on an HIV-1 epidemic in sub-Saharan Africa under different scenarios (optimistic, neutral and pessimistic) both with and without sexual disinhibition. Sensitivity analyses were used to evaluate the effect of uncertainty in input parameters on model output and included calculation of partial rank correlations and standardized rank regressions. In the scenario without sexual disinhibition after PrEP initiation, key parameters influencing infections prevented were effectiveness of PrEP (partial rank correlation coefficient (PRCC) = 0.94), PrEP discontinuation rate (PRCC = -0.94), level of coverage (PRCC = 0.92), and time to achieve target coverage (PRCC = -0.82). In the scenario with sexual disinhibition, PrEP effectiveness and the extent of sexual disinhibition had the greatest impact on prevention. An optimistic scenario of PrEP with 90% effectiveness and 75% coverage of the general population predicted a 74% decline in cumulative HIV-1 infections after 10 years, and a 28.8% decline with PrEP targeted to the highest risk groups (16% of the population). Even with a 100% increase in at-risk behavior from sexual disinhibition, a beneficial effect (23.4%-62.7% decrease in infections) was seen with 90% effective PrEP across a broad range of coverage (25%-75%). Similar disinhibition led to a rise in infections with lower effectiveness of PrEP (less than or equal to 50%). Mathematical modeling supports the potential public health benefit of PrEP. Approximately 2.7 to 3.2 million new HIV-1 infections could be averted in southern sub-Saharan Africa over 10 years by targeting PrEP (having 90% effectiveness) to those at highest behavioral risk and by preventing sexual disinhibition. This benefit could be lost, however, by sexual disinhibition and by high PrEP discontinuation, especially with lower PrEP effectiveness (less than or equal to 50%).

HIV/AIDS and STIs NEWS

South Africa: Mbeki's role in Aids 'experiments' should be probed, says campaign
(News Article; Sub-Saharan Africa)
26 Sep 2007
Thom A, Health-e (Cape Town)

Uganda: Catching Aids is treason - Museveni
(News Article; Sub-Saharan Africa)
25 Sep 2007
Butagira TF | Kibuuka S, The Monitor (Kampala)

Nigeria: Bias against HIV positive workers is illegal - Minister
(News Article; Sub-Saharan Africa)
25 Sep 2007
Gulloma AM, Daily Trust (Abuja)

Nigeria: 70 percent of Borno's HIV/Aids victims are women, infants - Sheriff
(News Article; Sub-Saharan Africa)
24 Sep 2007
Umar Gusau I, Daily Trust (Abuja)

MATERNAL AND CHILD HEALTH RESEARCH

Health seeking and access to care for children with suspected dengue fever in Cambodia: An ethnographic study
(Abstract; subscription needed for full text; Asia)
BMC Public Health. 2007 Sep 24;7(1):262.
Khun S | Manderson L
The continuing contribution of dengue fever to the hospitalization and deaths in hospital of infants and small children in Cambodia is associated with delays in presentation for medical attention, diagnosis and appropriate care. It is important to identify the reasons that influence these delays, in order to develop appropriate interventions to redress the impact of dengue. Data on health seeking were collected during an ethnographic study conducted in two villages in the eastern province of Kampong Cham, Cambodia in 2004. Interviews were conducted with mothers whose children had been infected with suspected dengue fever, or who had been sick for other reasons, in 2003 and 2004. Women selected a therapeutic option based on perceptions of the severity of the child's condition, confidence in the particular modality, service or practitioner, and affordability of the therapy. While they knew what type of health care was required, poverty in combination with limited availability and perceptions of the poor quality of care at village health centers and public referral hospitals deterred them from doing so. Women initially used home remedies, then sought advice from public and private providers, shifting from one sector to another in a pragmatic response to the child's illness. The lack of availability of financial resources for poor people and their continuing lack of confidence in the care provided by government centres combine to delay help seeking and inappropriate treatment of children sick with dengue.

Midwifery and the development of nursing capacity in the Dominican Republic: Caring, clinical competence, and case management
(Abstract; subscription needed for full text; Central America and the Caribbean)
Journal of Midwifery and Women's Health. 2007 Sep;52(5):499-504.
Foster J | Heath A
The contribution of midwifery care to positive health outcomes has been acknowledged both nationally and internationally, yet currently there are insufficient numbers of midwives and nurses to meet the maternal-infant health needs around the globe. Project ADAMES, (ADelante, Asegurando Madres E Infantes Sanos; in English: Onward! Assuring Healthy Mothers and Babies), is a non-profit nongovernmental organization created as a collaborative, community-based partnership between the maternity nurses in a hospital in the Dominican Republic and a group of certified nurse-midwives from the United States. After attending a series of educational conferences in midwifery over the course of 3 years, a subset of motivated Dominican nurses and auxiliaries (the Comite) have trained hospital volunteers to be doulas, to provide the caring and supportive role to laboring women they do not have the time to provide themselves. The Comite also proposed to initiate a postpartum assessment flow sheet and precept nursing student volunteers from Project ADAMES to demonstrate the performance of routine assessments among postpartum women. The Comite desires to train nurses in other neighboring hospitals. As the nurses and midwives implement improvements in quality of care, they strive to develop a sustainable, transferable program that could be available to other sites where nurses similarly manage vaginal deliveries.

Breast-feeding performance index: A composite index to describe overall breast-feeding performance among infants under 6 months of age
(Abstract; subscription needed for full text; Asia)
Public Health Nutrition. 2007 Oct;10(10):996-1004.
Senarath U | Dibley MJ | Agho KE
The objectives were to develop a composite index to describe the overall breast-feeding performance of infants less than 6 months of age; and, using this index, to identify the factors associated with poor breast-feeding practices and the association between breastfeeding and infant morbidity. The 2003 Demographic and Health Survey was a multistage cluster sample survey of 4320 households in Timor-Leste which covered 573 infants aged less than 6 months. Breast-feeding Performance Index (BPI) was constructed by allocating one point for each of seven infant feeding practices: first suckling within an hour of birth; absence of prelacteals; non-use of feeding bottles; current breastfeeding; not receiving liquids; not receiving formula or other milk; and not receiving solids in the last 24 hours. BPI was treated as the dependent variable in univariate and multivariate analyses to identify the factors associated with poor breast-feeding. Exclusive breast-feeding rate was 29.9%. The BPI (mean 4.4, standard deviation 1.77) was categorised as low, average and high according to tertiles. Multivariate analysis indicated that infants from the richest households were 1.70 (95% confidence interval (CI) 1.04-2.77) times more likely to have 'low BPI' than the poorest. Maternal BMI less than 18.5 kgm/-2 was predictive of poor breast-feeding (odds ratio = 1.79; 95% CI 1.27-2.52). In the 'low' BPI group, the incidence of diarrhoea (13.4%) and acute respiratory infections (20.7%) during the previous two weeks was significantly higher than in 'average' (4.3 and 9.3%) and 'high' BPI groups (4.6 and 5.5%). Creating a composite index to assess the overall breast-feeding performance among infants, 6 months of age is feasible. BPI can be effectively used to identify target groups for breast-feeding promotion interventions.

MATERNAL AND CHILD HEALTH NEWS

UN-backed global drive to slash maternal and child deaths kicks off
(News Article; Global)
26 Sep 2007
UN News Centre

Making pregnancy safer in Bangladesh
(Editorial; Asia)
24 Sep 2007
Austin C, The Daily Star

More pregnancy-related deaths to happen in RP: WHO
(News Article; Asia)
21 Sep 2007
Sun Star

GENDER and HEALTH RESEARCH

Experiences of women war-torture survivors in Uganda: Implications for health and human rights
(Research Article; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Journal of International Women's Studies. 2007 May;8(4):1-17.
Liebling-Kalifani H | Marshall A | Ojiambo-Ochieng R | Kakembo NM
This paper will describe the resulting long-term health needs of women wartorture survivors of the civil war years in Luwero District, Uganda. To do this sections of case studies from interviews carried out in Kikamulo Sub-County, Luwero, are utilised. The effects of gender-based violence and torture and its long term, severe and enduring impact on women s health will be highlighted. In 1994, the Centre for Health and Human rights at Harvard University led the first international conference on health and human rights. This recognised that human rights are an essential pre-condition for physical and mental health. Women's resulting health needs following war, including the urgent need for reproductive and gynaecological health services, are argued to be a fundamental human right which should be upheld through the legal mechanisms available. The paper suggests ways of assisting the women war survivors of Luwero and concludes that to be successful integrated health interventions for war-torture survivors need to be combined with the further collective legal, social and political empowerment of women and address the health inequalities and discriminations that exist.

Family law reform and the feminist debate: Actually-existing Islamic feminism in the Maghreb and Malaysia
(Abstract; subscription needed for full text; Asia)
(You need Adobe Acrobat Reader to access this document)
Journal of International Women's Studies. 2007 May;8(4):49-59.
Archer B
For an increasing number of Muslim women and women's rights activists, the stark disparity between the principles of justice and equality guaranteed by international and domestic legal norms on the one hand, and the oppressive environment of their homes that is legitimated by repressive family laws on the other, has acted as the catalyst for a unified call for reform. In the Maghreb, an influential Islamic feminist movement has successfully lobbied for family law reform, and this movement s positivist framework has recently been adopted as the model for Malaysia s increasingly vociferous demands for gender equality. Although secular feminists in the West frequently criticize the aims of this Islamic feminism as an oxymoronic anti-feminism, the Maghreby movement serves as proof that only an Islamic feminist reform model can serve as a pragmatic challenge to discriminatory laws.

Poverty and devastation of intimate relations: Tanzanian women's experience of living with HIV/AIDS
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of the Association of Nurses in AIDS Care. 2007 Sep-Oct;18(5):6-16.
Balaile G | Laisser R | Ransjo-Arvidson AB | Hojer B
In Tanzania, women of reproductive age constitute the largest group infected by HIV. This study aimed to explore the lived experiences related to health and sexuality of Tanzanian women who had known their positive serostatus for 1 year. In-depth interviews with 10 women were analyzed using a phenomenological-hermeneutic approach and showed frustration and despair at not having resources to maintain daily life. The women needed regular medical treatment for themselves and for their HIV-positive children. Their sexual desires had declined or vanished, and they had come to view sexuality as a source of transmittable disease. For some women, casual sex was an option to solve urgent financial needs. Happiness was something for their children, not for them. Access to social support from the women's community would help prevent further HIV transmission and enhance survival so the children could grow up with at least one devoted parent.

Gendered-caste violations and the cultural politics of voice in rural Orissa, India
(Abstract; subscription needed for full text; Asia)
Gender, Place and Culture. 2007 Oct;14(5):609-616.
Kapoor D
Despite the legal ban on untouchability over four decades ago, caste discrimination and atrocities perpetrated against 'untouchable' women (or Dalits) continue to be a part of the social landscape in India. Based on a decade-long partnership between a Canadian NGO, a partner Dalit/Adivasi local organization and 75 partner villages in South Orissa, this article provides a localized snapshot of the contemporary nature of caste atrocities committed against Dalit women in the Mohana administrative block. It briefly elaborates on Dalit explanations for such assaults and suggests that when it comes to addressing gendered-caste victimization, there are limits to open democratic advocacy which need to be acknowledged by activists and critical scholarship engaged with the cultural politics of 'voice'.

The impact of perceived stigma and mediating social factors on infertility-related stress among women seeking infertility treatment in Southern Ghana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Social Science and Medicine. 2007 Oct;65(8):1683-1694.
Donkor ES | Sandall J
This research aimed to investigate the extent to which women in Southern Ghana seeking infertility treatment perceived themselves as stigmatised in order to investigate the relationship between perceived stigma and infertility-related stress. A survey was conducted using face-to-face interviews in three languages with 615 women receiving infertility treatment on three health sites in Southern Ghana. The majority (64%) of women in this sample felt stigmatised. Sequential multiple regression analyses indicated that higher levels of perceived stigma were associated with increased infertility-related stress. Also women with higher levels of education felt less infertility-related stress. The presence of an existing child/children, the number of years spent in infertility treatment and the type of marriage (monogamous/polygamous union) were less important in predicting stress. The findings suggest that the social status of infertile women derived from other factors can be of importance in minimising the impact of stigmatisation and stress related to infertility. These findings highlight the wider beneficial effects of improved educational opportunities for girls and women.

GENDER and HEALTH NEWS

Burkina Faso succeeds in reducing female genital mutilation
(News Article; Sub-Saharan Africa)
27 Sep 2007
Agence France-Presse (AFP)

Sudan: Curse of the janjaweed
(Feature Article; North Africa)
23 Sep 2007
McFerran A, The Sunday Times

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Morocco's migration experience: A transitional perspective
(Abstract; subscription needed for full text; North Africa)
International Migration. 2007 Oct;45(4):39-70.
de Haas H
Using a 'transitional' perspective on migration, which combines three theoretical approaches on dynamic development-migration linkages, this paper interprets the evolution of migration within, from, and to Morocco over the twentieth century. Colonization and the incorporation of rural areas, along with a certain level of socio-economic development, have spurred internal and international wage labour migration both within Morocco and from Morocco to Europe. Migration seems to be the result of development rather than the lack of development. Populations from highly marginalized regions were less likely to participate in migration than populations from the three, moderately enclosed "migration belts" which had established traditions of pre-modern, largely circular migration. At the onset of large-scale emigration in the 1960s, the spatial patterns of labour migration were significantly influenced by colonial bonds with Spain and France, selective labour recruitment, and Moroccan selective passport issuance policies. However, the influence of such policies rapidly decreased due to the effects of migration-facilitating networks. Increasingly restrictive policies coincided with a growing reliance on family migration, permanent settlement, undocumented migration, and the exploration of new migration itineraries, and had no success in reducing migration levels. Alongside patterns of decentralizing internal migration, a spatial diffusion of international out-migration has expanded beyond the historical migration belts in response to new labour opportunities in southern Europe. Persistent demand for migrant labour, along with demographic factors and increasing aspirations, suggest that migration over formally closed borders is likely to remain high in the near future. However, in the longer term, out-migration might decrease and Morocco could increasingly develop into a migration destination for migrants from sub-Saharan Africa, a transition process which may already have been set in motion.

Health status of temporary migrants in urban areas in Vietnam
(Abstract; subscription needed for full text; Asia)
International Migration. 2007 Oct;45(4):101-134.
Nguyen LT | White MJ
The rapid economic growth after economic reform, known in Viet Nam as "Doi Moi", and the growing scope of urban migration raise specific questions for social policy, including migration and health policies. This paper compares issues of health status and its determinants as they affect temporary urban migrants versus permanent urban migrants and non-migrants. The analyses utilize multivariate logistic regression and data from the 1997 Vietnam Migration and Health Survey. The results show that temporary migrants staying in guest houses are most vulnerable to health problems. Though most of them are initially healthier, their reported health deteriorates faster than other groups of urban residents. The findings also present important implications for the current migration and health policies in Vietnam: 1) A special attention should be given to temporary migrants in guest houses; 2) Different priorities in health policy should be applied to different groups of migrants and non-migrants; 3) The current population management policy by registration system needs to be reviewed; 4) Providing clean water is one of the most important ways to improve health of temporary migrants; 5) Targeting educational investments and reducing unemployment would likely to improve overall health; 6) A higher priority on health policies targeting women would likely pay dividends, and; 7) Improving management and collaboration between government offices and interested partners is important to improving health status and reducing inequity.

Can we achieve Millennium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015
(Abstract; subscription needed for full text; Global)
Lancet. 2007 Sep 22;370(9592):1040-1054.
Murray CJ | Laakso T | Shibuya K | Hill K | Lopez AD
Global efforts have increased the accuracy and timeliness of estimates of under-5 mortality; however, these estimates fail to use all data available, do not use transparent and reproducible methods, do not distinguish predictions from measurements, and provide no indication of uncertainty around point estimates. We aimed to develop new reproducible methods and reanalyse existing data to elucidate detailed time trends. We merged available databases, added to them when possible, and then applied Loess regression to estimate past trends and forecast to 2015 for 172 countries. We developed uncertainty estimates based on different model specifications and estimated levels and trends in neonatal, post-neonatal, and childhood mortality. Global under-5 mortality has fallen from 110 (109-110) per 1000 in 1980 to 72 (70-74) per 1000 in 2005. Child deaths worldwide have decreased from 13.5 (13.4-13.6) million in 1980 to an estimated 9.7 (9.5-10.0) million in 2005. Global under-5 mortality is expected to decline by 27% from 1990 to 2015, substantially less than the target of Millennium Development Goal 4 (MDG4) of a 67% decrease. Several regions in Latin America, north Africa, the Middle East, Europe, and southeast Asia have had consistent annual rates of decline in excess of 4% over 35 years. Global progress on MDG4 is dominated by slow reductions in sub-Saharan Africa, which also has the slowest rates of decline in fertility. Globally, we are not doing a better job of reducing child mortality now than we were three decades ago. Further improvements in the quality and timeliness of child-mortality measurements should be possible by more fully using existing datasets and applying standard analytical strategies.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Health, population services: We stand exactly where we were at the turn of the century
(News Article; Asia)
24 Sep 2007

HIV/AIDS: The impact in Zimbabwe less severe than expected
(News Article; Sub-Saharan Africa)
26 Sep 2007
Destination Sante

Fertility rate dips in Pakistan, contraceptive awareness rises
(News Article; Asia)
22 Sep 2007
India News and Muslim Information

India heading for 2 billion population
(News Article; Asia)
24 Sep 2007
People and Planet

Low birthrate harming Romania
(News Article; Europe)
23 Sep 2007
Gulf Times

ADOLESCENT HEALTH RESEARCH

Child maltreatment, youth violence, and intimate partner violence
(Abstract; subscription needed for full text; Global)
American Journal of Preventive Medicine. 2007 Oct;33(4):281-290.
Fang X | Corso P
Related News Article: Victims of child maltreatment more likely to perpetrate youth violence, intimate partner violence
Understanding the cycle of violence, from victimization to perpetration across the life span, is critical for designing successful prevention interventions. This study uses a nationally representative sample to examine the developmental relationships among three forms of child maltreatment, youth violence perpetration or victimization, and young adult intimate partner violence (IPV) perpetration or victimization. Data describing self-reported youth violence perpetration (or victimization) from Wave I of the National Longitudinal Study of Adolescent Health (1994-1995) were matched with self-reported IPV perpetration (or victimization) in young adult sexual relationships and retrospective reports of child maltreatment collected during Wave III (2001-2002). Bivariate probit regression models were used to analyze the developmental relationships between child maltreatment, youth violence, and IPV. Analyses were completed in September 2006. Compared to nonvictims of child maltreatment, victims of child maltreatment are more likely to perpetrate youth violence (a likelihood increase ranging from −1.2% to 6.6% for females and 3.7% to 11.9% for males) and young adult IPV (an increase from 8.7% to 10.4% for females and from 1.3% to 17.2% for males), although the direct and indirect effects vary by type of child maltreatment experienced. Gender differences exist in the links between child maltreatment, youth violence and IPV, and in the effects of socioeconomic factors on youth violence and IPV. Results suggest that it may be important to account for gender differences when designing violence prevention programs, and an integrative approach is critical for stopping the developmental trajectory of violence.

Long-acting contraceptives in adolescents
(Abstract; subscription needed for full text; Global)
Current Opinion in Obstetrics and Gynecology. 2007 Oct;19(5):453-460.
Tolaymat LL | Kaunitz AM
The purpose of review was to help clinicians guide adolescent patients to sound choices regarding long-acting contraceptives. The safety, side effects and non-contraceptive benefits of injectable, implantable and intrauterine contraception are detailed. The use of depot medroxyprogesterone acetate contraceptive injections has been associated with declines in teenage pregnancies in the United States. Although the US Food and Drug Administration has placed a black box warning concerning skeletal health and depot medroxyprogesterone acetate, data in adolescents confirm that declines in bone mineral density with depot medroxyprogesterone acetate are fully reversible. Concerns regarding skeletal health should not restrict the initiation or continuation of depot medroxyprogesterone acetate in adolescents. A highly effective, convenient, and easy to insert/remove single rod progestin-only contraceptive implant (Implanon) is now available in the United States. Although not widely used in adolescents, intrauterine devices offer selected adolescents convenient, highly effective, safe birth control. Use of the progestin-releasing intrauterine device (Mirena) is also associated with important non-contraceptive benefits. The efficacy and convenience associated with long-acting contraceptives make them indispensable for adolescent patients. This review will help clinicians guide teenage patients towards sound contraceptive choices and the successful long-term use of injectable, implantable and intrauterine methods of birth control.

Chilean university students: Knowledge and concern about HIV/AIDS
(Abstract; subscription needed for full text; South America)
Journal of the Association of Nurses in AIDS Care. 2007 Sep-Oct;18(5):51-56.
Ferrer L | Cianelli R | Guzman E | Cabieses B | Irarrazabal L
According to a 2004 report by the Joint United Nations Programme on HIV/AIDS, Chile has an incipient HIV/AIDS epidemic. Regardless of the classification, every year the cumulative incidence of HIV/AIDS increases. Young Chileans have been the most affected group; still, their knowledge, attitudes, and concerns about HIV/AIDS are not known. This study describes Chilean university students' HIV/ AIDS-related knowledge, their worry about getting the virus, and the correlation between both variables. A convenience sample of 45 university students responded to an anonymous self-administered questionnaire after orally consenting to participate in this study. Overall, students had good levels of HIV/ AIDS-related knowledge, with 77% responding correctly to at least 85% of the questions. Despite this knowledge, almost 56% of students stated that they were not worried about getting HIV/AIDS. The situation was corroborated by a nonsignificant statistical correlation between both variables (p greater than .05). These results are congruent with literature from other countries and strengthen the need for further research to clarify why university students, the majority of whom are well-educated and engage in behaviors that place them at risk for contracting the virus, do not worry about HIV.

Reaching disenfranchised youth and mobile populations in Ghana through voluntary counselling and testing services for HIV
(Abstract; subscription needed for full text; Sub-Saharan Africa)
African Journal of AIDS Research. 2007 Aug;6(2):121-128.
Wyss S | Ablordeppey J | Okrah J | Kyei A
This paper documents the evaluation of a 20-month project to provide voluntary counselling and testing (VCT) to a mobile population of youth surrounding the Agbogbloshie market in Accra, Ghana. The specific objectives of the evaluation were to determine: 1) to what extent targets for providing VCT services to the specified population were reached; 2) how HIV prevalence among clients compared to that of the general population; 3) to what extent former clients self-reported behaviour change; and 4) whether useful lessons could be drawn regarding fees, hours, and location of services, as well as use of peer educators to increase use of VCT services among the target population. Various methodologies, including questionnaires, focus group discussions, a review of the service statistics and an exit poll of clients were used to evaluate the project. The service statistics demonstrated that the project exceeded the life-of-project target for number of clients by nearly 40%. Prevalence for the VCT client population (aged 15-25) was higher than for the general population (aged 15-24), although the gender differentials were similar. Focus group data suggested that clients may have adopted behaviour changes as a result of VCT. Finally, focus group discussions and VCT service trends showed that the high number of clients was largely influenced by three factors: services being free, location and hours of services being convenient to the target population, and use of peer educators to promote the services. In addition, the evaluation highlighted the importance of the counselling component of VCT, even as counselling can get short-changed at the expense of HIV testing when large numbers of clients are involved. The evaluation stressed the need to appropriately remunerate peer educators for their work whenever possible. Finally, VCT programmes continue to face challenges such as: HIV stigma as a barrier to people coming to be counselled and tested; insufficient availability of medication, support and services for HIV-positive clients; and difficulty of ensuring the sustainability of VCT programmes.

Knowledge of HIV/AIDS, sexual behaviour and prevalence of sexually transmitted infections among female students of the University of Buea, Cameroon
(Abstract; subscription needed for full text; Sub-Saharan Africa)
African Journal of AIDS Research. 2007 Aug;6(2):157-163.
Nkuo-Akenji T | Nkwesheu A | Nyasa R | Tallah E | Ndip R
The study investigates the cognitive effect of knowledge and protective practices on the prevalence of HIV and some sexually transmitted infections (STIs) among female students of the University of Buea, Cameroon. A cross-sectional study involving the analysis of a questionnaire completed by 522 female students and the voluntary testing of 108 sexually active females for HIV, syphilis, Chlamydia and gonorrhoea was carried out. Knowledge of the protective effects of abstinence, condom-use and fidelity were independent of sexual practices (OR = 0.86, p = 0.611, f = 0.22; OR = 1.26, p = 0.213, f = 0.05; and OR = 1.18, p = 0.344, f = 0.029, respectively). The prevalence of HIV, syphilis, Chlamydia and gonorrhoea among the participants tested was 3.9%, 6.1%, 24.1% and 30.1%, respectively. We conclude that relatively high prevalence of STIs among female students of the University of Buea stems from inadequate knowledge of the major modes of STI/HIV transmission and inadequate use of preventive methods.

ADOLESCENT HEALTH NEWS

Making sense of sex education in schools - state trends (India)
(News Article; Asia)
25 Sep 2007
Kurian S, The Hindu

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Volume 7, Number 37 1 October 2007