Volume 7, Number 38
8 October 2007

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FAMILY PLANNING RESEARCH

Contraceptive discontinuation attributed to method dissatisfaction in the United States
(Abstract; subscription needed for full text; North America)
Contraception. 2007 Oct;76(4):267-272.
Moreau C | Cleland K | Trussell J
This study examines contraceptive discontinuation due to method dissatisfaction among women in the United States. The study population, drawn from the 2002 National Survey of Family Growth, consisted of 6724 women (15-44 years of age) who had ever used a reversible contraceptive method. We first estimated the overall proportion of women who had ever discontinued their contraceptive due to dissatisfaction. We then calculated method-specific discontinuation risks due to dissatisfaction and analyzed the reasons for dissatisfaction given by women who had ever stopped using Norplant, Depo-Provera, oral contraceptives or condoms. Overall, 46% of women had ever discontinued at least one method because they were unsatisfied with it. Dissatisfaction-related discontinuation risks varied widely by method: the diaphragm and cervical cap showed the highest proportions of such discontinuation (52%), followed by long-acting hormonal methods (42%). Oral contraceptives were associated with an intermediate risk of dissatisfaction-related discontinuation (29%), while condoms had the lowest risk (12%). A broader understanding of women's concerns and experiences using contraception could help health care providers redesign counseling strategies to improve contraceptive continuation.

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;166(8):894-901.
Tworoger SS | Fairfield KM | Colditz GA | Rosner BA | Hankinson SE
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.

The role of delayed childbearing in the prevention of obstetric fistulas
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of Gynecology and Obstetrics. 2007 Nov;99 Suppl 1:S98-S107.
Tsui AO | Creanga AA | Ahmed S
The objective was to examine the role of delayed childbearing in the prevention of obstetric fistulas (OFs). Data on 4798 deliveries in Niger (1995-1998), 3552 in Nigeria (1996-1999), and 6789 in Tanzania (1991-1996) were analyzed with logistic regression models. Young maternal age and primiparous status were identified as correlates of prolonged/obstructed labor. The annual incidence of OFs in Nigeria was found to be 2.11 per 1000 births, with 9817 cases developing each year, 28% in women and girls younger than 20 years. The predicted proportion of women experiencing prolonged/obstructed labor would be reduced by 11.2% in Niger, 11.4% in Nigeria, and 13.1% in Tanzania if the risks associated with young maternal age at first delivery and primiparity were eliminated. Community programs to educate young, newly married women about delaying childbearing until they reach physical maturity should be implemented in countries with a high incidence of OFs.

Pregnancy, hormonal contraceptive use, and HIV-related death in Rwanda
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Women's Health. 2007 Sep;16(7):1017-1027.
Allen S | Stephenson R | Weiss H | Karita E | Priddy F
Few studies have examined the influence of pregnancy and hormonal contraception on HIV-related deaths in African women. Rwanda is a country with high fertility, high HIV prevalence, and frequent use of hormonal contraception in urban areas. Data from a prospective cohort study of 460 HIV-infected urban childbearing (18-35 years) women followed at 6-monthly intervals for 6 years in Kigali, Rwanda, were analyzed. The relationship of time-dependent measures of pregnancy and hormonal contraceptive use to death from HIV disease was assessed with multivariate models. Incident pregnancy was not associated with elevated risk of death among HIV-infected women. Oral and injectable hormonal contraceptive use had borderline protective effects associated with reduced mortality (HR 0.40, 95% CI 0.15-1.07 and HR 0.48, 95% CI 0.21-1.08 for mortality, respectively) in a multivariate model including time-dependent measures. The results point to the benefits of integrating family planning and HIV services. In a highly pronatalist society, such as Rwanda, which is experiencing high HIV prevalence, service integration affords an opportunity to provide HIV testing to women at risk of pregnancy and to promote family planning among HIV-positive women.

FAMILY PLANNING NEWS

Philippines: Manila women to fight ban on contraceptives
(Feature Article; Asia)
2 Oct 2007
Gonzales S, IPS News

Canada: New male birth control may be 100% reversible
(News Article; North America)
28 Sep 2007
Ward D, CanWest News Service

India: Non-surgical vasectomy not popular among men
(Abstract; subscription needed for full text; Asia)
1 Oct 2007
Sharma SK, Indian Express Newspapers

United States: Men on the pill? Doctors say it's no dream
(News Article; North America)
27 Sep 2007
Ostrom C, The Seattle Times

HIV/AIDS and STIs RESEARCH

Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique
(Abstract; subscription needed for full text; Sub-Saharan Africa)
JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2007 Oct 1;46(2):238-244.
Pearson CR | Micek MA | Simoni JM | Hoff PD | Matediana E
The objective was to assess the efficacy of a peer-delivered intervention to promote short-term (6-month) and long-term (12-month) adherence to HAART in a Mozambican clinic population. A 2-arm randomized controlled trial was conducted between October 2004 and June 2006. Of 350 men and women (greater than or equal to 18 years) initiating HAART, 53.7% were female, and 97% were on 1 fixed-dose combination pill twice a day. Participants were randomly assigned to receive 6 weeks (Monday through Friday; 30 daily visits) of peer-delivered, modified directly observed therapy (mDOT) or standard care. Peers provided education about treatment and adherence and sought to identify and mitigate adherence barriers. Participants' self-reported medication adherence was assessed 6 months and 12 months after starting HAART. Adherence was defined as the proportion of prescribed doses taken over the previous 7 days. Statistical analyses were performed using intention-to-treat (missing = failure). Intervention participants, compared to those in standard care, showed significantly higher mean medication adherence at 6 months (92.7% vs. 84.9%, difference 7.8, 95% confidence interval [CI]: 0.0.02, 13.0) and 12 months (94.4% vs. 87.7%, difference 6.8, 95% CI: 0.9, 12.9). There were no between-arm differences in chart-abstracted CD4 counts. A peer-delivered mDOT program may be an effective strategy to promote long-term adherence among persons initiating HAART in resource-poor settings.

Effects of trimethoprim-sulfamethoxazole and insecticide-treated bednets on malaria among HIV-infected Ugandan children
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2007 Oct;21(15):2059-2066.
Kamya MR | Gasasira AF | Achan J | Mebrahtu T | Ruel T
Trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis and insecticide-treated bednets reduce malaria risk among HIV-infected adults. The efficacy of TMP/SMX may be diminished where antifolate resistance to malaria is high. We evaluated the efficacy of these interventions for malaria prevention among Ugandan children. We concurrently followed 300 HIV-infected children aged 1-10 years and a community-based cohort of 561 healthy children aged 1-11 years over 11 months in Kampala, Uganda. The HIV-infected children received TMP/SMX prophylaxis and insecticide treated bednets. In the community cohort, insecticide-treated bednets were introduced during the observation period. Children from both cohorts were followed using a standardized protocol to measure the incidence of malaria. Only nine episodes of malaria were diagnosed among HIV-infected children (incidence = 0.07/person-year) in comparison with 440 episodes among children from the community (incidence = 0.90/person-year; P less than 0.0001). The use of insecticide-treated bednets was associated with a 43% reduction in malaria incidence (P less than 0.001), and a combination of TMP/SMX and use of insecticide-treated bednets with a 97%reduction in malaria incidence (P less than 0.001). The prevalence of five mutations associated with antifolate resistance was high among malaria cases detected in both the HIV(100%)and community cohorts (75%). Malaria accounted for only 4% of febrile episodes in the HIV cohort in comparison with 33% in the community-based cohort (P less than 0.0001). In a malaria endemic area with a high level of molecular markers of antifolate resistance, the combined use of TMP/SMX prophylaxis and insecticide-treated bednets was associated with a dramatic reduction in malaria incidence among HIV-infected children.

Self-reported condom use is associated with reduced risk of chlamydia, gonorrhea, and trichomoniasis
(Abstract; subscription needed for full text; Central America and the Caribbean)
Sexually Transmitted Diseases. 2007 Oct;34(10):829-833.
Gallo MF | Steiner MJ | Warner L | Hylton-Kong T | Figueroa JP
The objectives were to evaluate the association between self-reported condom use and prevalent and incident chlamydia, gonorrhea, and trichomoniasis. Prospective study of 414 males attending a sexually transmitted infection (STI) clinic in Jamaica. Condom use and STI status were assessed at enrollment and at 4 follow-up visits. The analyses on condom use and prevalent STI included data from 414 men, while those on incident STI were based on 1111 intervals from 355 men. We diagnosed prevalent STI (chlamydia, gonorrhea, and/or trichomoniasis) in 54.6% (n = 226) of the participants at enrollment. About 14% (n = 51) of participants had at least 1 of the study STIs during follow-up. Follow-up visits in which participants reported consistent condom use (100% of acts) for the past 7 days had less incident STI (adjusted OR, 0.4; 95% CI, 0.2-0.9) compared with visits where no condom use was reported. Self-reported condom use was more closely correlated with incident than prevalent STI. For example, the adjusted OR for prevalent infection for participants reporting consistent versus no condom use in past 7 days was 0.7 (95% CI, 0.4-1.2). Classifications based on the number of unprotected acts yielded findings similar to those based on the proportion of acts protected. Consistent condom use was associated with reduced risk of incident urethral STI. Research on condom effectiveness should focus on incident STI outcomes, where the temporal relationship between condom use and infection is clearer.

Routine voluntary HIV testing in Durban, South Africa: The experience from an outpatient department
(Abstract; subscription needed for full text; Sub-Saharan Africa)
JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2007 Oct 1;46(2):181-186.
Bassett IV | Giddy J | Nkera J | Wang B | Losina E
The objective was to evaluate the yield of a routine voluntary HIV testing program compared with traditional provider-referred voluntary counseling and testing (VCT) in a hospital-affiliated outpatient department (OPD) in Durban, South Africa. In a prospective 14-week "standard of care" period, we compared OPD physician logs documenting patient referrals to the hospital VCT site with HIV test registers to measure patient completion of HIV test referral. The standard of care period was followed by a 12-week intervention during which all patients who registered at the OPD were given an educational intervention and offered a rapid HIV test at no charge as part of routine care. During the standard of care period, OPD physicians referred 435 patients aged $18 years for HIV testing; 137 (31.5%) of the referred patients completed testing at the VCT site within 4 weeks. Among those tested, 102 (74.5%) were HIV infected. During the intervention period, 1414 adults accepted HIV testing and 1498 declined. Of those tested, 463 (32.7%, 95% confidence interval: 30.3 to 35.3) were HIV infected. Routine HIV testing in the OPD identified 39 new HIV cases per week compared with 8 new cases per week with standard of care testing based on physician referral to a VCT site (P less than 0.0001). Routine voluntary HIV testing in an OPD in South Africa leads to significantly higher rates of detection of HIV disease. This strategy should be implemented more widely in high HIV prevalence areas where treatment is available.

HIV risk behaviors among female IDUs in developing and transitional countries
(Research Article; Global)
BMC Public Health. 2007 Oct 1;7(271):[20] p.
Cleland CM | Des Jarlais DC | Perlis TE | Stimson GV | Poznyak VB
A number of studies suggest females may be more likely to engage in injection and sex risk behavior than males. Most data on gender differences come from industrialized countries, so data are needed in developing countries to determine how well gender differences generalize to these understudied regions. Between 1999 and 2003, 2512 male and 672 female current injection drug users (IDUs) were surveyed in ten sites in developing countries around the world (Nairobi, Beijing, Hanoi, Kharkiv, Minsk, St. Petersburg, Bogota, Gran Rosario, Rio, and Santos). The survey included a variety of questions about demographics, injecting practices and sexual behavior. Females were more likely to engage in risk behaviors in the context of a sexual relationship with a primary partner while males were more likely to engage in risk behaviors in the context of close friendships and casual sexual relationships. After controlling for injection frequency, and years injecting, these gender differences were fairly consistent across sites. Gender differences in risk depend on the relational contexts in which risk behaviors occur. The fact that female and male risk behavior often occurs in different relational contexts suggests that different kinds of prevention interventions which are sensitive to these contexts may be necessary.

HIV/AIDS and STIs NEWS

In Thailand, the shy get their condoms at the bank
(News Article; Asia)
2 Oct 2007
Nopporn W-A, Reuters

Nigeria: UNFPA lauds implementation of curriculum on HIV/Aids
(News Article; Sub-Saharan Africa)
1 Oct 2007
Aminu M, This Day (Lagos)

Mozambique: Cultural factors undermine fight against Aids
(News Article; Sub-Saharan Africa)
2 Oct 2007
Agencia de Informacao de Mocambique (Maputo)

Nigeria: Scientist kicks against compulsory HIV test before marriage
(News Article; Sub-Saharan Africa)
2 Oct 2007
Yusuf B, Leadership (Abuja)

South Africa: Cellphones to help spread word on HIV
(News Article; Sub-Saharan Africa)
2 Oct 2007
Kahn T, Business Day (Johannesburg)

Namibia: More men partake in Aids care
(News Article; Sub-Saharan Africa)
2 Oct 2007
Mbangula WJ, New Era (Windhoek)

Africa: Simpler Aids drugs to benefit children
(News Article; Sub-Saharan Africa)
28 Sep 2007
Appel A, Inter Press Service (Johannesburg)

Malaysia set to meet AIDS MDGs
(News Article; Asia)
1 Oct 2007
BuaNews-NNN

MATERNAL AND CHILD HEALTH RESEARCH

Complications of treatment of obstetric fistula in the developing world: Gynatresia, urinary incontinence, and urinary diversion
(Abstract; subscription needed for full text; Global)
International Journal of Gynecology and Obstetrics. 2007 Nov;99 Suppl 1:S57-S64.
Gutman RE | Dodson JL | Mostwin JL
Related Abstract; subscription needed for full text: Obstetric fistula: Ending the silence, easing the suffering
The objective was to provide a comprehensive review of the pathophysiology, evaluation, and treatment of gynatresia and urinary incontinence, 2 conditions that can arise following the repair of obstetric fistulas. The article discusses relevant issues with respect to urinary diversion in the treatment of obstetrical fistula and associated urinary incontinence. A review was conducted of the existing literature and of the expert recommendations issued at the Gates Institute fistula meeting held in July 2005 at the Johns Hopkins Bloomberg School of Public Health. Gynatresia and urinary incontinence develop in approximately 10% and 16% of patients, respectively, after the first repair. Urinary diversion may be necessary when fistulas cannot be closed vaginally or in cases of severe urinary incontinence following successful closure. Gynatresia, urinary incontinence, and urinary diversion are all associated with morbidity, and they require surgical and nonsurgical expertise for proper management. Closing the anatomical fistula is not always sufficient, and treatment paradigms must shift toward the prevention and repair of gynatresia and urinary incontinence at the time of the primary operation.

Efficacy of highly active antiretroviral therapy in HIV-1-infected children in Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Pediatrics. 2007 Oct;120(4):e856-e861.
Song R | Jelagat J | Dzombo D | Mwalimu M | Mandaliya K
Few studies have investigated the efficacy of antiretroviral therapy among HIV-infected children in resource-poor settings. This observational, retrospective analysis describes the clinical, immunologic, and virologic effects of highly active antiretroviral therapy in treatment-naive, HIV-infected children in Mombasa, Kenya. In keeping with a public health approach, all children were treated by using a simplified, nationally approved, triple-drug regimen. Clinical data and stored plasma samples from 29 children who were followed prospectively between April 2003 and October 2004 were analyzed. All children received generic formulations of nevirapine, zidovudine, and lamivudine and were evaluated at baseline and at 3, 6, 9, 12, and 15 months. At each visit, weight and CD4 lymphocyte counts were measured and plasma samples were stored for analysis. HIV RNA load was determined retrospectively at baseline and 9 months after initiation of therapy. The mean age of the children was 8.5 years (range: 2-16 years). At baseline, the mean CD4 count (plus or minus SD) was 182.3 x 10/6 cells per microL (plus or minus 145.6). On treatment, CD4 counts increased step-wise by a mean of 187 x 106 cells per microL at 3 months, 293 cells per microL at 6 months, 308 cells per microL at 9 months, 334 cells per microL at 12 months, and 363 cells per microL at 15 months. The mean plasma viral load decreased from a baseline level of 622 712 to 35 369 copies per mL, and at 9 months was undetectable in 55% of the patients. Mean z scores for weight for age increased from a baseline of -1.61 to -1.12 at 12 months into therapy. A public health approach using 1 treatment regimen in generic form showed excellent efficacy among treatment-naive, HIV-infected children in a resource-limited country. Clinical and immunologic improvement occurred in all patients, but 9 months after the start of therapy, only 55% of the children had an undetectable viral load.

Pregnancy complications and delivery outcomes in pregnant women with severe migraine
(Abstract; subscription needed for full text; Europe)
European Journal of Obstetrics & Gynecology and Reproductive Biology. 2007 Oct;134(2):157-163.
Banhidy F | Acs N | Horvath-Puho E | Czeizel AE
The objective was to study the possible association among maternal migraine during pregnancy, pregnancy complications, and the delivery outcomes: sex ratio, gestational age/birth weight and preterm birth/low birth weight. The population-based large data set of newborn infants without any defects of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996 was analyzed. Out of 38,151 newborn infants, 713 (1.9%) had mothers who had severe migraine during pregnancy; 68% were medically recorded. Pregnant women with severe migraine had a higher prevalence of preeclampsia and severe nausea/vomiting, but a lower occurrence of threatened abortion and preterm delivery. However, mean gestational age and birth weight, as well as the proportion of low birth weight and preterm births, were similar in newborn infants born to mothers with or without migraine. Severe maternal migraine and its related drug treatment may increase the occurrence of preeclampsia and severe nausea/ vomiting during pregnancy, but is not associated with unfavorable delivery outcomes.

MATERNAL AND CHILD HEALTH NEWS

Special delivery: Midwife pledges to help save mothers' and infants' lives after losing her own babies
(Feature Article; Sub-Saharan Africa)
5 Oct 2007
UNFPA

The quiet scandal of 10 million deaths
(Feature Article; Global)
2 Oct 2007
Stahl A, IPS
Related Feature Article: UN heads welcome new campaign to avert maternal and child deaths, and Norway's $1 billion pledge

Nigeria: UNFPA donates anti-shock garments to reduce maternal mortality
(News Article; Sub-Saharan Africa)
1 Oct 2007
Ibrahim S | Kebbi B, This Day

GENDER and HEALTH RESEARCH

The dynamics of gender and class in access to health care: Evidence from rural Karnataka, India
(Abstract; subscription needed for full text; Asia)
International Journal of Health Services. 2007;37(3):537-554.
Iyer A | Sen G | George A
In the early 1990s, India embarked upon a course of health sector reform, the impact of which on an already unequal society is now becoming more apparent. This study sought to deepen understanding of equity effects by exploring gender and class dynamics vis-a-vis basic access to health care for self-reported long-term ailments. The authors drew on the results of a cross-sectional household survey in a poor agrarian region of south India to test whether gender bias in treatment-seeking is class-neutral and whether class bias is gender-neutral. They found evidence of "pure gender bias" in non-treatment operating against both non-poor and poor women, and evidence of "rationing bias" in discontinued treatment operating against poor women overall, but with some differences between the poor and poorest households. In poor households, men insulated themselves and passed the entire burden of rationing onto women; but among the poorest, men, like women, were forced to curtail treatment. There were economic class differences in continued, discontinued, and no treatment, but class was a gendered phenomenon operating through women, not men.

Spectrum of epithelial cell abnormalities of uterine cervix in a cervical cancer screening programme: Implications for resource limited settings
(Abstract; subscription needed for full text; Asia)
European Journal of Obstetrics, Gynecology and Reproductive Biology. 2007 Oct;134(2):238-242.
Gupta S | Sodhani P | Halder K | Chachra KL | Sardana S | Singh V | Sehgal A
The objectives were to compute the frequencies and peak age incidences of epithelial cell abnormalities (ECA) of uterine cervix in a cytology-based screening programme and to analyze the comparative frequencies of squamous intraepithelial lesions (SIL) and malignancies in age groups less than 40 and greater than or equal to 40 years, in order to assess the implications for screening protocol in resource limited settings. Pap smears from 29,475 women were cytologically screened over a 4-year period as a part of hospital-based screening programme. The frequencies, peak age incidences and mean age of various ECA detected were computed. The data was further stratified into age groups less than 40 (Gp 1) and greater than or equal to 40 (Gp 2) and comparative profile of the lesions was analyzed. On cytologic screening of the smears 5.6% ECA were detected. Atypical squamous cells-undetermined significance (ASC-US) and low grade SILs (LSIL) were diagnosed more frequently in Gp 1 (p less than 0.001) while atypical glandular cells (AGC) and malignancies were more significantly more frequent in Gp 2 (p less than 0.001). The frequency of HSIL was similar in the two groups. The SILs predominated in the fourth decade while the malignant lesions were most frequent in age greater than 50 years. The mean age for LSIL and HSIL was 34.7 and 37.7 years, respectively, while for malignancy it was 51.8 years thus corroborating the hypothesis that a prolonged latent phase exists between the precursor lesions and the onset of invasive cancer. Since the goal of any screening programme should be to pick up majority of the precursor lesions and not frank cancers, it is desirable to initiate screening before 40 years of age. The WHO recommendation of once in a life time screening between 35 and 40 years of age seems appropriate for resource limited settings like ours.

GENDER and HEALTH NEWS

Women's empowerment key to achieving UN's goals, says Ban Ki-moon
(News Article; Global)
3 Oct 2007
UN News Centre

Rwanda: Unifem, RDF decry gender violence
(News Article; Sub-Saharan Africa)
29 Sep 2007
Muramila G, New Times

Angola: Minister of familiy and women promotion expected Tuesday
(News Article; Sub-Saharan Africa)
2 Oct 2007
Ondjiva, Angola Press Agency

Liberia: Ecowas gender center holds disparities w'shop
(News Article; Sub-Saharan Africa)
3 Oct 2007
Saulwas RM, The Inquirer

Nigeria: Group renews call for gender parity
(News Article; Sub-Saharan Africa)
2 Oct 2007
Esin H, This Day

Cameroon: Women plead for humanisation of widowhood rites
(News Article; Sub-Saharan Africa)
1 Oct 2007
Mosima E, Cameroon Tribune

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Measuring population pressure on the landscape: Comparative GIS studies in China, India, and the United States
(Abstract; subscription needed for full text; Global)
Population and Environment. 2007 Jul;28(6):321-336.
Rain DR | Long JF | Ratcliffe MR
Measures of the effects of population pressure on the landscape using traditional methods for classifying urban territory are inadequate. The crude scale at which population densities are calculated and dependence on country-specific administration divisions hinder their ability to address such questions as the environmental impacts of cities and suburbs and make cross-national comparisons particularly difficult. This paper examines comparative urbanization measures among three case studies: the Pearl River Delta in Guangdong Province of China, the Indian state of Kerala, and the southern part of Florida in the United States. It proposes a measure based on the distribution of local population densities, taking advantage of the detailed data on small area populations and land area available in modern censuses and model-derived population databases such as LandScan, and the increasing potential of spatial analysis using geographic information systems (GIS). Examined with a similar set of thresholds, the resulting density distributions offer the potential to show better the ecological effects of population than do traditional measures.

Land use and first birth timing in an agricultural setting
(Abstract; subscription needed for full text; Asia)
Population and Environment. 2007 Jul;28(6):289-320.
Ghimire DJ | Hoelter LF
The dramatic changes in the earth's landscape have prompted increased interest in the links between population, land use, and land cover. Previous research emphasized the notion of population pressure (population pressure increases demands on natural resources causing changes in land use), overlooking the potentially important effects of changes in land use on humans. Using multiple data sets from the Chitwan Valley Family Study in Nepal, we test competing hypotheses about the impact of land use on first birth timing. We argue that while agricultural land should encourage early childbearing, land area devoted to public infrastructure should discourage it. The results show that individuals from neighborhoods with larger proportions of land under agriculture experienced first birth at rates higher than those from neighborhoods with smaller proportions. On the other hand, individuals from neighborhoods with larger proportions of land under public infrastructure experienced first birth at rates lower than those from neighborhoods with smaller proportions. However, the effects of public infrastructure are not as strong as the land area devoted to agriculture.

The future population of India: A long-range demographic view
(Report; Asia)
(You need Adobe Acrobat Reader to access this document)
2007 Aug;:[15] p..
Population Foundation of India | Population Reference Bureau
In this publication, two scenarios of India's future population are offered. Both assume that fertility will decline continuously to the point where couples average two children each, the goal of India's National Population Policy 2000. The scenarios differ in one respect: one assumes that states with higher current fertility will decline to the "replacement level" of 2.1 children, a common assumption in projections. The second assumes that the decline will continue to 1.85 children, near the level observed in states such as Kerala. The first scenario results in an India of two billion population while the second falls short of that mark and results in eventual population decline.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Cuba: Providing the tools for an active, fruitful old age
(News Article; Central America and the Caribbean)
4 Oct 2007
Acosta D, IPS

UN issues 'age-friendly cities' guide to both help and tap value of older people
(News Article; Global)
1 Oct 2007
UN News Centre

ADOLESCENT HEALTH RESEARCH

Powerful partners: Adolescent girls' education and delayed childbearing
(Policy Brief; Global)
(You need Adobe Acrobat Reader to access this document)
Population Reference Bureau. 2007 Sep;:[6] p..
Murphy E | Carr D
More-educated women have fewer children. This seemingly straightforward relationship is actually complex, and the benefits associated with different levels of education can vary considerably by setting. This policy brief describes adolescent girls’ reproductive health risks and how increasing their educational attainment reduces those risks, including early and unwanted fertility, and benefits their future families and society. This brief also highlights some factors that contribute to this powerful education-fertility dynamic. Many successful programs are keeping adolescent girls in school and many programs offer reproductive health information and services out of school, including family planning. Combining such programs may yield more benefits than either one alone.

Long-term protection against HBV chronic carriage of Gambian adolescents vaccinated in infancy and immune response in HBV booster trial in adolescence
(Research Article; Sub-Saharan Africa)
PLoS ONE. 2007 Aug 15;2(8):[7] p.
van der Sande MA | Waight PA | Mendy M | Zaman S | Kaye S
Chronic infection with hepatitis B virus (HBV) arising in childhood is associated with hepatocellular carcinoma in adult life. Between 1986 and 1990, approximately 120,000 Gambian newborns were enrolled in a randomised controlled trial to assess the effectiveness of infant HBV vaccination on the prevention of hepatocellular carcinoma in adulthood. These children are now in adolescence and approaching adulthood, when the onset of sexual activity may challenge their hepatitis B immunity. Thus a booster dose in adolescence could be important to maintain long-term protection. Fifteen years after the start of the HBV infant vaccination study, 492 vaccinated and 424 unvaccinated children were identified to determine vaccine efficacy against infection and carriage in adolescence. At the same time, 297 of the 492 infant-vaccinated subjects were randomly offered a booster dose of HBV vaccine. Anti-HBs was measured before the booster, and two weeks and 1 year afterwards (ISRCTN71271385). Vaccine efficacy 15 years after vaccination was 67.0% against infection as manifest by anti-HBc positivity (95% CI 58.2-74.6%), and 96.6% against HBsAg carriage (95% CI 91.5-100%). 31.2% of participants had detectable anti-HBs with a GMC of 32 I/l. For 168 boosted participants GMC anti-HBs responses were 38 I/l prior to vaccination, 524 I/l two weeks after boosting, and 101 I/l after 1 year. HBV vaccination in infants confers very good protection against carriage up to 15 years of age, although a large proportion of vaccinated subjects did not have detectable anti-HBs at this age. The response to boosting persisted for at least a year.

Young people need help in preventing pregnancy and HIV; how will the world respond?
(Review/Synthesis; Global)
Guttmacher Policy Review. 2007 Summer;10(3):2-8.
Boonstra HD
The world in which teenagers are growing up today is very different from that of their parents’ and grandparents’ youth. Especially in developing countries, things are changing fast. Compared even with 20 years ago, young people are entering adolescence earlier and healthier, and they are likely to spend more time in school and enter the workforce later. As a result, marriage and childbearing now generally occur later than they did in the past, especially for women. And, inevitably, postponing marriage has meant that sex before marriage has become more common.

ADOLESCENT HEALTH NEWS

Nigeria: Education secretary charges teachers on sexual health programm
(News Article; Sub-Saharan Africa)
3 Oct 2007
Leadership (Abuja)

Health: UNAIDS head puts the spotlight on children and teens
(News Article; Global)
30 Sep 2007
Appel A, IPS

Zimbabwe: Ministry urged to include HIV issues in curricular
(News Article; Sub-Saharan Africa)
2 Oct 2007
The Herald (Harare)

Ghana: Stop early sex - MP cautions children
(News Article; Sub-Saharan Africa)
1 Oct 2007
Paintsil DA, Ghanaian Chronicle (Accra)

South Africa: Dancing against teen pregnancy
(News Article; Sub-Saharan Africa)
4 Oct 2007
Cullinan K, Health-e (Cape Town)

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 7, Number 38 8 October 2007