Volume 7, Number 40
22 October 2007

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Guest Editorials (free with every subscription)

Women Deliver conference sparks commitments to maternal health

by Ward Rinehart, INFO Project, Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health

Family planning leads the list of strategies for reducing maternal deaths that government ministers endorsed at the Women Deliver conference in London October 18-20, 2007. Eliminating unmet need for family planning would cut maternal deaths worldwide by one-third, it is estimated. Currently, each year over half a million women die giving birth.

Women Deliver gathered ministers and parliamentarians, representatives of donor governments and foundations, health care professionals’ organizations, activists, researchers, and technical assistance organizations—over 1,800 participants from more than 100 countries. Twenty years after the Nairobi conference launched the Safe Motherhood Initiative, the London conference sought to put new spark into the movement. Conference participants acknowledged that progress over the last two decades has been spotty.

Political will is what it will take. So said participants ranging from UK Prime Minister Gordon Brown, addressing the participants via tape recording, to Ghana’s minister of women and children’s affairs Hajia Alima Mahama. Millenium Development Goals (MDG) 4 and 5 focus world attention on the issue. MDG 4 calls for reducing the death rate among children under 5 by two-thirds by 2015. MDG 5 calls for reducing the maternal mortality ratio by three-quarters.

Several donor governments made their will clear with large commitments of funds. At the opening conference session, the UK announced a pledge of 100 million pounds sterling over 5 years to the UN Population Fund (UNFPA). Norway has pledged US$1 billion over 10 years toward achieving the MDG health goals. The Netherlands and Denmark also have made substantial pledges to similar goals recently.

Announcing the UK grant, Secretary of State for International Development Douglas Alexander said that every 1 million pounds sterling invested in family planning would avert an estimated 720,000 unwanted pregnancies, prevent 300,000 abortions, and avoid the deaths of 1,600 mothers and 22,000 infants.

The statement from the 70 ministers and parliamentarians at the conference also cited affordable, skilled care, including emergency care, as a key means to prevent mothers’ deaths. The ministers called the need to recruit, train, and retain health workers "vitally important."

The ministers committed themselves to developing national action plans to speed the spread of services. Still, they focused more on advocacy and funding than on specific activities. They called for a special session of the UN General Assembly to draw up a global plan of action. The ministers also endorsed creation of a global fund for women’s health, centered on maternal mortality.

References:

For the full text of the ministers’ statement, see: http://www.womendeliver.org/pdf/MinistersForumStatementFinal.pdf

For more on the UK grant to UNFPA, see:
http://www.dfid.gov.uk/news/files/women-deliver.asp

Safe Motherhood Initiative
www.safemotherhood.org

ADOLESCENT HEALTH NEWS

Kenya: Catholic youth hold anti-HIV/Aids campaign
(News Article; Sub-Saharan Africa)
16 Oct 2007
Catholic Information Service for Africa (Nairobi)

Sierra Leone: SPW trains 64 peer health educators
(News Article; Sub-Saharan Africa)
17 Oct 2007
Massaquoi M, Concord Times (Freetown)

Africa: U.S. soft drink company teaches teens about AIDS
(News Article; Sub-Saharan Africa)
17 Oct 2007
United States Department of State (Washington, DC)

Afghanistan: Widespread child marriage blamed for domestic violence
(News Article; Asia)
16 Oct 2007
IRIN

ADOLESCENT HEALTH RESEARCH

Sexual and reproductive health of adolescents and youths in the Republic of Korea: A review of literature and projects, 1990-2003
(Report; Asia)
Manila, Philippines, WHO, Western Pacific Region, 2007. 64 p.
This report encompasses materials and literatures published by the Government, nongovernmental organizations (NGOs), and academic researchers. Demographic data, policies and laws were also gathered from governmental websites related to adolescent health and education. This literature review found that less than 6% of adolescents have engaged in sexual intercourse. But despite the fact that the proportion of sexually active adolescents is not as high as in western countries, obstetricians and gynaecologists point out that the number of pregnancies is on the rise. Studies have shown that many adolescents do not use contraceptives when having sex. These results suggest that adolescents who are engaged in sex are exposed to risks, such as unwanted pregnancy or STI, including HIV/AIDS.

Sexual issues: Let's hear it from the Malaysian boys
(Abstract; subscription needed for full text; Asia)
Journal of Men's Health and Gender. 2007 Sep;4(3):283-291.
Low WY | Ng CJ | Fadzil KS | Ang ES
This paper explored adolescents' sexuality with specific reference to their attitudes towards sex, safe sex, their risk-handling skills, sources of sexual information and how this information influenced their knowledge and attitudes. This qualitative study utilized focus group methodology. Four focus groups were conducted, involving a total of 31 Malaysian adolescent boys aged between 13 and 17 years. Findings from the focus groups revealed that the concept of sex was seen within the context of marriage and sex was also viewed as synonymous with love. All the participants denied having sex. The reasons for having sex were: 'to have fun', 'part of natural urge', curiosity, tension and pressure from family, schoolwork and being away from family. Procreation and the expression of love were also noted as reasons why people have sex. Masturbation was fairly well known among the boys but was felt to have negative consequences on one's health. There was a general lack of awareness on the issue of wet dreams. There were mixed feelings with regards to sexual abstinence before marriage. Knowledge on safe sex was still vague. The boys also perceived themselves to be at risk of HIV infection, but lacked the skills for handling this issue. Sources of sexual information were mainly from male friends or through the mass media. None of their parents talked to them about sexual matters. Level of awareness and knowledge on sexual issues is still lacking. Misconceptions still prevail. Sex education and research in this area is warranted.

HIV risk perceptions and first sexual intercourse among youth in Cape Town, South Africa
(Research Article; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
International Family Planning Perspectives. 2007 Sep;33(3):98-105.
Anderson KG | Beutel AM | Maughan-Brown B
HIV prevalence is high among South African youth. Health behavior models posit that the perceived level of risk of HIV infection is associated with the level of HIV risk behavior; however, there has been limited research in Sub-Saharan Africa on factors associated with perceived risk or on the relationship between perceived risk and risk behaviors. Longitudinal data collected in 2002 and 2005 from 3,017 black, colored and white youth in Cape Town, South Africa, were analyzed using multivariate regression to examine whether a reciprocal relationship exists between sexual experience and perceived HIV risk. Independent variables taken from the 2002 survey were used to predict dependent variables taken from the 2005 survey. In 2005, most youth (82% of males and 83% of females) viewed themselves as being at no or small risk of HIV infection. A reciprocal relationship in which higher perceived HIV risk was associated with a delay in sexual debut (odds ratio, 0.8) and sexual experience was associated with higher perceived risk (1.4) was found for females, but not for males. Knowing someone who had died of AIDS was associated with sexual debut and with an elevated perceived HIV risk among females (1.7 and 1.3, respectively). The associations between race and perceived risk of HIV infection varied by gender. HIV/AIDS education and prevention programs should consider more carefully how gender and race may intersect to influence risk perceptions and risk behaviors. In addition, possible reciprocal relationships between risk behaviors and risk perceptions should be considered in education and intervention programs.

Consent and coercion: Examining unwanted sex among married young women in India
(Research Article; Asia)
(You need Adobe Acrobat Reader to access this document)
International Family Planning Perspectives. 2007 Sep;33(3):124-132.
Santhya KG | Haberland N | Ram F | Sinha RK | Mohanty SK
Although there is a growing body of research examining the issue of nonconsensual sex among adolescents, few studies have looked at coerced sex within marriage in settings where early marriage is common, or at sex that may not be perceived as forced, but that is unwanted. A cross-sectional study, using both survey research and in-depth interviews, was conducted among 1,664 married young women in Gujarat and West Bengal, India. Descriptive data and multinomial logistic regression were used to identify the prevalence and risk factors for occasional and frequent unwanted sex. Qualitative data were analyzed to examine the context in which unwanted sex takes place. Twelve percent of married young women experienced unwanted sex frequently; 32% experienced it occasionally. The risk of experiencing unwanted sex was lower among women who knew their husband fairly well at the time of marriage, regularly received support from their husband in conflicts with other family members or lived in economically better-off households. Frequent unwanted sex was associated with not yet having had a child or having become pregnant, with lower education and with agreeing with norms that justify wife beating. For married young women, sex is not always consensual or wanted. Further research is required to determine the effects of unwanted sex on sexual and reproductive health outcomes and to help programs develop the best strategies for dealing with coerced sex within marriage.

FAMILY PLANNING NEWS

India: Let men do their bit
(Editorial; Asia)
18 Oct 2007
Chandra S, The Pioneer

Rwanda: Reproductive health key to achieving Millennium Development Goals
(Editorial; Sub-Saharan Africa)
16 Oct 2007
Kamugisha J, The New Times

Scientists develop gene contraception free of hormones
(News Article; Global)
17 Oct 2007
Sample I, Guardian News

FAMILY PLANNING RESEARCH

Misconception of emergency contraception among tertiary school students in Akwa Ibom state, South-South, Nigeria
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Nigerian Journal of Clinical Practice. 2007;10(1):30-34.
Abasiattai AM | Umoiyoho AJ | Bassey EA | Etuk SJ | Udoma EJ
Objective: To assess the degree of awareness and use of emergency contraception among tertiary school students inAkwa Ibom State, Nigeria. Design: A self-administered questionnaire survey. Setting: The Akwa Ibom State Polytechnic, Ikot Osurua, located on the outskirts of Ikot Ekpene local government area between 1stApril 2002 and 31st April 2002. Subjects: 1,000 randomly selected female students ofthe Akwa Ibom State polytechnic, Ikot Osurua. Results: The students were aged between 16 and 43 years. Five hundred and eighty-nine (68.5%) of the respondents had heard of products that could be used as emergency contraceptives. However, only 49 (5.7%) of the respondents had practised some form of emergency contraception, which was most commonly practised by those between 16 and 25 years (71.4%). Menstrogen (30.6%), gynaecosid (24.5%), and quinine (14.3%) were the most common medications used for emergency contraception. Patent medicine dealers (40.9%) and friends/course mates (29.7%) were the most common sources of knowledge about emergency contraception. This study shows that awareness and use of emergency contraception by our youths is low. Community enlightenment about emergency contraception using specifically designed programmes, the formation of reproductive health clubs in our tertiary institutions and training of peer group educators in all our communities are advocated. Patent medicine dealers in our communities should have basic training in modern contraceptive methods and periodic evaluation should be carried out to assess their knowledge and practice of emergency contraception.

Changes in contraceptive method mix in developing countries
(Research Article; Global)
(You need Adobe Acrobat Reader to access this document)
International Family Planning Perspectives. 2007 Sep;33(3):117-123.
Seiber EE | Bertrand JT | Sullivan TM
Understanding shifts in contraceptive method mix is key to helping policymakers, program managers and donor agencies meet current contraceptive demand and estimate future needs in developing countries. Data from Demographic and Health Surveys, Reproductive Health Surveys and other nationally representative surveys were analyzed to describe trends and shifts in method mix among married women of reproductive age from 1980 to 2005. The analysis included 310 surveys from 104 developing countries. Contraceptive use among married women of reproductive age increased in all regions of the developing world, reaching 66% in Asia and 73% in Latin America and the Caribbean in 2000-2005, though only 22% in Sub-Saharan Africa. The proportion of married contraceptive users relying on the IUD declined from 24% to 20%, and the proportion using the pill fell from 16% to 12%. The share of method mix for injectables rose from 2% to 8%, and climbed from 8% to 26% in Sub-Saharan Africa, while the share for condoms was 5-7%. The overall proportion of users relying on female sterilization ranged from 29% to 39%, reaching 42-43% in Asia and in Latin America and the Caribbean in 2000-2005; on average, the share of all method use accounted for by male sterilization remained below 3% for all periods. Use of traditional methods declined in all regions; the sharpest drop -- from 56% to 31% of users -- occurred in Sub-Saharan Africa. To meet the rising demand for modern methods, it is critical that future programmatic efforts provide methods that are both accessible and acceptable to users.

Comparison of cycle control and side effects between transdermal contraceptive patch and an oral contraceptive in women older than 35 years
(Research Article; Asia)
(You need Adobe Acrobat Reader to access this document)
Journal of the Medical Association of Thailand. 2007 Sep;90(9):1715-1719.
Boonyarangkul A | Taneepanichskul S
The objective was to compare menstrual patterns and side effects between transdermal contraceptive patch and oral contraceptive use in Thai women over 35 years old. The design used was a pen labeled randomized control trial. The setting for the study was the Family Planning Clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Ninety-six women above the age of 35 years old were randomized to receive either transdermal contraceptive patch (n = 48) or oral contraceptive (n = 48). The patch regimen was three consecutive 7-day patches (21 days) followed by 1 patch-free week per cycle; the oral contraceptive contained with ethinyl estradiol (EE) 30 microg and levonorgestrel 150 microg. There were no statistically significant differences between the two groups in terms of cycle length. The mean duration in the transdermal contraceptive group was longer than the COC group with statistically significant difference. More patients in the COC group experienced spotting than the transdermal contraceptive group. Neither amenorrhea nor pregnancies occurred in both groups. Transdermal contraceptive patch provides reliable contraceptive efficacy. It also provides good cycle control equal to COC in Thai women aged above 35 years old. However, a higher incidence of minor adverse effects such as breast tenderness and nausea were demonstrated when compared to oral contraceptive containing with ethinyl estradiol (EE) 30 microg and levonorgestrel 150 microg.

GENDER and HEALTH NEWS

South Africa: SA men's forum outline gender challenges
(News Article; Sub-Saharan Africa)
17 Oct 2007
Plessis JD, BuaNews

Zambia: Male circumcision can reduce a man's risk of HIV
(News Article; Sub-Saharan Africa)
16 Oct 2007
Ndola, The Times of Zambia

Congo-Kinshasa: Sexual violence - the scourge of the East
(News Article; Sub-Saharan Africa)
16 Oct 2007
Goma, UN Integrated Regional Information Networks

GENDER and HEALTH RESEARCH

Changes and continuities: Implementation of gender equality in a South African high school
(Abstract; subscription needed for full text; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Africa Today. 2007 Fall;54(1):107-116.
Diko N
The 1996 constitution of the Republic of South Africa establishes a range of rights, including the right to gender equity. Careful observation shows that gender equity in South African education is far from being achieved. There is no education policy directed at ending gender inequity, and there seems to be little focus on implementing the recommendations of the country's Gender Equity Task Team Report for eliminating sexism and the sexual harassment of female students and teachers. This research note contends that gender equity in South African education remains elusive. Fewer women than men hold top administrative positions in education, many female administrators fill positions still considered feminine, and women in positions still considered masculine are being pushed out. Patriarchal attitudes in education thrive. Therefore, this paper records and analyzes the experiences of women in educational leadership and the messages sent to students. To expose the conflict between the policy intent and reality, it reanalyzes data collected on school-governing bodies to determine whether education offers women an opportunity to experience lives unrestricted by gender oppression.

The prevalence of domestic violence among pregnant women who were attended in Iran University of Medical Science Hospitals
(Abstract; subscription needed for full text; Middle East)
Journal of Family Violence. 2007 Nov;22(8):643-648.
Jahanfar S | Malekzadegan Z
The prevalence of domestic violence (DV) during pregnancy could be high and is associated with significant psychological and physical impairment for mother and the fetus. The major objective of this study was to determine the prevalence of DV in expectant mothers who have attended the Iran University of Medical Sciences' Hospitals (IUMS). In this cross-sectional study, 1,800 subjects were interviewed using a modified questionnaire to determine the prevalence of DV. Consecutive sampling was performed in six major hospitals of IUMS according to the number of referred patients. The prevalence of DV was found to be 60.6% including three types of physical, psychological, and sexual violence with the prevalence of 14.6, 60.5 and 23.5%, respectively. Severe physical DV was 5.3%. Severe psychological and sexual DV were also found in about 24.6 and 3.4% of cases, respectively. DV had a high prevalence in this study. It is recommended that all accessible pregnant women be screened for DV. Study of the prevalence of DV within the community with a larger sample size, and using cluster-sampling methodology would be of immense value.

Western education's impact on northern Igbo gender roles in Nsukka, Nigeria
(Abstract; subscription needed for full text; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Africa Today. 2007 Fall;54(1):29-51.
Abidogun J
This article analyzes gender perspectives at two secondary schools in Nsukka, Nigeria. It analyzes gender-role changes or perceptions of change based on students' reported interactions in formal education settings. It summarizes gender issues under students' perceptions of gender roles, norms, and practices in relation to themselves, their peer group, and their perceptions of generational change compared with those of their parents and grandparents. These perceptions demonstrate a pattern of gender roles shaped by Western Judeo-Christian doctrine within the formal education curriculum, minimal inclusion of local history or cultural content, and loss of indigenous knowledge and practices. Gender-role change is one aspect of a general Westernizing effect of formal models of Western education on indigenous cultures.

Evaluation of adjunctive tests for cervical cancer screening in low resource settings
(Abstract; subscription needed for full text; Asia)
Indian Journal of Cancer. 2007 Apr-Jun;44(2):51-55.
Bhatla N | Mukhopadhyay A | Kriplani A | Pandey RM | Gravitt PE | Shah KV | Iyer VK | Verma Kusum
Visual inspection of cervix after application of acetic acid (VIA) is an effective screening tool for cervical cancer in low resource settings, but its low specificity leads to high referral rates. Adjunctive testing may overcome this drawback. This pilot study was aimed to assess test performances of VIA, human papillomavirus (HPV) testing and Pap smear, individually and in simulated combinations, to determine the probable best screening option. The setting for the study was a gynecology outpatient department (OPD); the design used was a cross-sectional study. The materials and methods used were one hundred women with complaints of irregular vaginal bleeding or discharge, post coital bleeding or unhealthy cervix on examination underwent Pap smear, HPV testing, VIA, colposcopy and biopsy, if indicated, in this screening order. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each of the tests with a biopsy result of greater than or equal to HSIL taken as the gold standard. Simulated parallel and sequential combinations for VIA/Pap, VIA/HPV and HPV/Pap were calculated and compared with individual test performance. Prevalence of abnormal Pap smears was 5%, VIA positive 51% and HPV positive 16%. Sensitivity and specificity of VIA were 100% and 53.3% respectively. For HPV and Pap tests corresponding figures were 85.7%, 89.7% and 50%, 98.9% respectively. The best simulated combination with a balance of sensitivity and specificity was of VIA followed by HPV testing (sensitivity 85.7%, specificity 95.4%). Addition of HPV testing to VIA can increase the specificity of VIA, thereby reducing the referral rates without compromising the sensitivity of the test.

HIV/AIDS and STIs NEWS

Nigeria: HIV/Aids - Adopt preventive, not curative measures, Islamic researcher
(News Article; Sub-Saharan Africa)
16 Oct 2007
Nkwoada E, Leadership (Abuja)

Uganda: Mildmay to treat over 9,000 children infected with HIV
(News Article; Sub-Saharan Africa)
16 Oct 2007
Nakagwa F, New Vision (Kampala)

Ghana: Provide anti-retroviral drugs in all districts, says Ameyibor
(News Article; Sub-Saharan Africa)
16 Oct 2007
Accra Mail (Accra)

Cameroon: Laboratory technicians drilled on new HIV testing methods
(News Article; Sub-Saharan Africa)
15 Oct 2007
Mbunwe C, The Post (Buea)

Namibia: HIV/Aids dulls shine of good development scores
(News Article; Sub-Saharan Africa)
17 Oct 2007
UN Integrated Regional Information Networks

Botswana: Criminalizing HIV transmission sparks debate
(News Article; Sub-Saharan Africa)
16 Oct 2007
Moesi M, The Voice (Francistown)

HIV/AIDS and STIs RESEARCH

Variability of the human immunodeficiency virus type 1 polymerase gene from treatment naive patients in Accra, Ghana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Clinical Virology. 2007 Oct;40(2):163-167.
Sagoe KW | Dwidar M | Lartey M | Boamah I | Agyei AA | Hayford AA | Mingle JA | Arens MQ
Little is known about the HIV-1 drug resistance mutations in Ghana. The objectives were to determine the background protease (PR) and reverse transcriptase (RT) mutations of HIV-1 from treatment naive patients in Ghana. Twenty-five plasma samples randomly selected were analyzed for drug resistance mutations. The molecular phylogeny and recombinant patterns of the polymerase gene of HIV-1 were also analysed. No major drug-resistance mutations were seen in protease or reverse transcriptase genes. The L10I, L10V, V11I and E35G minor mutations were seen in four patients, while the V179E was observed in a patient with subtype G. An insertion of lysine was found at codon 36 of the protease gene of one patient. The predominant subtype was the CRF02 AG strain (n = 22), but 3 (13.6%) of these were recombinants with HIV-1 subtype K and/or A1. Two patients harboured unclassified/complex strains with D/CRF01 AE and G/CRFAG 02 subtypes for the PR and RT, respectively, using the Stanford Database. Viral loads (VL) ranged from 2290 to greater than 1,500,000 c/ml (mean = 339,065 c/ml). Treatment naive patients in Ghana before scale-up may have minor but not major PR mutations and high viral loads. The clinical effects of minor mutations/polymorphisms in the PR and RT genes and recombinants need to be investigated.

Association of Chlamydia trachomatis serology with tubal infertility in Nigerian women
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Obstetrics and Gynaecology Research. 2007 Oct;33(5):688-695.
Omo-Aghoja LO | Okonofua FE | Onemu SO | Larsen U | Bergstrom S
The aim was to determine the association between tubal infertility and Chlamydia trachomatis in Nigerian women. This case-control study is from the Departments of Obstetrics and Gynecology of two tertiary hospitals in Nigeria. One hundred and sixty-two infertile patients with tubal occlusion had 162 pregnant women matched for age as controls. Information on sociodemographic variables, sexual and reproductive risk factors, and history of previous pelvic infections were elicited using a study protocol. The prevalence of Chlamydia Trachomatis antibody was determined for cases and controls. The prevalence of serum Chlamydia antibody was significantly higher in cases (65.8%) compared with controls (17.3%; P less than 001). The effects of Chlamydia antibodies on infertility were strengthened in the multivariate model controlling for Chlamydia antibodies and gynecologic symptoms, compared to the univariate model. However, the association was attenuated and non-significant when the effects of gynecologic symptoms, sociodemographic characteristics, contraceptive and sexual history were controlled in the conditional logistic regression model. The strongest independent predictors of infertility in the model were vaginal discharge, education less than tertiary and more than three lifetime sexual partners (proxies of sexually transmitted infections). There was no strong independent association between Chlamydia antibodies and the risk of being infertile in Nigerian women. By contrast, the proxies of sexually transmitted infections were significant predictors of infertility in the women. Efforts to address these factors, which are proxies of sexually transmissible infections, Chlamydia infection, and health-seeking behavior for these infections, will likely contribute to reducing the burden of infertility in Nigerian women.

Maternal HIV-1 DNA load and mother-to-child transmission
(Abstract; subscription needed for full text; Asia)
AIDS Patient Care and STDs. 2007 Sep;21(9):638-643.
Arvold ND | Ngo-Giang-Huong N | McIntosh K | Suraseranivong V | Warachit B
While many factors contribute to mother-to-child transmission (MTCT) of HIV-1, maternal plasma HIV-1 RNA viral load (RNA-VL) has been consistently found as the main risk factor, including when antiretroviral prophylaxis was used to prevent MTCT. However the predictive value of RNA-VL is poor. A recent study of HIV-1-positive pregnant women who did not receive antiretroviral prophylaxis reported an association between HIV-1 DNA viral load (DNA-VL) and MTCT that was stronger than the association between RNA-VL and MTCT. We sought to determine if HIV-1 DNA-VL was independently associated with MTCT of HIV in a population of women who received zidovudine prophylaxis during pregnancy and whose infants received zidovudine after birth. Patients were 33 non-breastfeeding transmitting (TR) and 33 nontransmitting mothers (NTR) from Perinatal HIV Prevention Trial (PHPT-1), a multicenter clinical trial conducted in Thailand comparing zidovudine prophylaxis durations to prevent MTCT. TR and NTR mothers were matched according to baseline RNA-VL. Maternal peripheral blood mononuclear cell (PBMC)-associated HIV-1 DNA was extracted from whole blood, and DNA-VL was established by quantitative real-time polymerase chain reaction. We found that TR had a significantly higher cell-associated HIV-1 DNA viral load than did NTR. Median TR DNA-VL was 2.54 log10 copies per microgram PBMC DNA, while it was 2.28 log10 copies per microgram PBMC DNA in NTR (Wilcoxon p = 0.02). In summary, HIV-1 DNA viral load was associated with MTCT in a population of women who received antiretroviral prophylaxis during pregnancy, independently from RNA viral load.

Power brokering, empowering, and educating: The role of home-based care professionals in the reduction of HIV-related stigma in Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Qualitative Health Research. 2007 Oct;17(8):1028-1039.
Waterman H | Griffiths J | Gellard L | O'Keefe C | Olang G
In this article the authors report on how home-based care (HBC) professionals reduce stigmatizing behavior in Kenya. This study was part of an action research project that evaluated the introduction of HBC. HBC professionals coordinate the delivery of HIV/AIDS services at a district level and educate community-based health workers in HBC. Understanding how HBC professionals reduce stigma is crucial to reduce, prevent, and treat HIV/AIDS. Fifty HBC professionals participated in 27 focus group interviews over 18 months. Stigma featured strongly when they discussed barriers to the introduction of HBC. Using sociological theory, the authors organized the data into five themes: Power broking and mobilization, Stigma as a social construction, Community and structural interventions, Educating and training people, and Historical context. The HBC professionals appear to operate at mostly individual and community levels in their efforts to challenge stigma, and in spite of the difficulties they appear to be having some impact.

Causes and pattern of mortality in HIV-infected, hospitalized patients in a tertiary care hospital: A fourteen year study
(Abstract; subscription needed for full text; Asia)
Indian Journal of Medical Sciences. 2007 Oct;61(10):555-561.
Teja VD | Sudha T | Lakshmi V
The introduction of highly active antiretroviral therapy (HAART) in several centers in India has raised the expectation that many human immunodeficiency virus (HIV)-infected individuals will live longer. However, as most infected individuals remain undiagnosed till the late stage of infection, several continue to succumb to this infection even in the era of HAART. A retrospective study was conducted over a 14-year period on 2,050 HIV-infected, hospitalized patients to evaluate the pattern of mortality and to determine proportion, risk factors and causes of death. A total of 145 deaths among HIV-infected patients were documented during hospitalization, with an overall mortality rate of 8.15%: 2.94% in the pre HAART era (1992-1996), 7.29% in the early HAART era (1997-2000) and 9.73% in the present HAART era (2001-2005). 11.7% (17/145) of deceased patients were aware of their HIV-infected status before getting admitted. Only five patients were on any antiretroviral treatment prior to admission. Ninety (62.07%) deaths were HIV-related (AIDS-defining conditions) and 55 (37.93%) were non-HIV-related. Our study stresses the importance of early diagnosis of HIV infection to curb adult mortality, which will continue to rise unless effective treatment interventions are introduced.

MATERNAL AND CHILD HEALTH NEWS

Progress in slowing maternal deaths too slow, UN agencies warn
(News Article; Global)
15 Oct 2007
UN News Centre

Mozambique: Infant malaria vaccine is promising
(News Article; Sub-Saharan Africa)
17 Oct 2007
Health-e News Service

UK pledges 100 million [pounds sterling] to UNFPA to make childbirth safer and promote reproductive health
(Press Release; Global)
18 Oct 2007
United Nations Population Fund (UNFPA)

MATERNAL AND CHILD HEALTH RESEARCH

Use of antenatal services and delivery care in Entebbe, Uganda: A community based survey
(Research Article; Sub-Saharan Africa)
BMC Pregnancy and Childbirth. 2007 Oct 11;7(1):23.
Tann CJ | Kizza M | Morison L | Mabey D | Muwanga M
Disparities in perinatal health care occur worldwide. If the UN Millennium Development Goals in maternal and child health are to be met, this needs to be addressed. This study was conducted to facilitate our understanding of the changing use of maternity care services in a semi-urban community in Entebbe Uganda and to examine the range of antenatal and delivery services received in health care facilities and at home. We conducted a retrospective community survey among women using structured questionnaires to describe the use of antenatal services and delivery care. In total 413 women reported on their most recent pregnancy. Antenatal care attendance was high with 96% attending once, and 69% the recommended four times. Blood pressure monitoring (95%) and tetanus vaccination (91%) were the services most frequently reported and HIV testing (47%), haematinics (58%) and presumptive treatment for malaria (66%) least frequently. Hospital clinics significantly outperformed public clinics in the quality of antenatal service. A significant improvement in the reported quality of antenatal services received was observed by year (p less than 0.001). Improvement in the range and consistency of services at Entebbe Hospital over time was associated with an increase in the numbers who sought care there (p=0.038). Although 63% delivered their newborn at a local hospital, 11% still delivered at home with no skilled assistance and just under half of these women reported financial/transportation difficulties as the primary reason. Less educated, poorer mothers were more likely to have unskilled/no assistance. Simple newborn care practices were commonly neglected. Only 35% of newborns were breastfed within the first hour and delayed wrapping of newborn infants occurred after 27% of deliveries. Although antenatal services were well utilised, the quality of services varied. Women were able and willing to travel to a facility providing a good service. Access to essential skilled birth attendants remains difficult especially for less educated, poorer women, commonly mediated by financial and transport difficulties and several simple post delivery practices were commonly neglected. These factors need to be addressed to ensure that high quality care reaches the most vulnerable women and infants.

Breastfeeding practices in a public health field practice area in Sri Lanka: A survival analysis
(Research Article; Asia)
International Breastfeeding Journal. 2007 Oct 11;2(1):13.
Agampodi SB | Agampodi TC | Piyaseeli UD
Exclusive breastfeeding up to the completion of the sixth month of age is the national infant feeding recommendation for Sri Lanka. The objective of the present study was to collect data on exclusive breastfeeding up to six months and to describe the association between exclusive breastfeeding and selected socio-demographic factors. A clinic based cross-sectional study was conducted in the Medical Officer of Health area, Beruwala, Sri Lanka in June 2006. Mothers with infants aged 4 to 12 months, attending the 19 child welfare clinics in the area were included in the study. Infants with specific feeding problems (cleft lip and palate and primary lactose intolerance) were excluded. Cluster sampling technique was used and consecutive infants fulfilling the inclusion criteria were enrolled. A total of 219 mothers participated in the study. The statistical tests used were survival analysis (Kaplan-Meier survival curves and Cox proportional Hazard model). All 219 mothers had initiated breastfeeding. The median duration of exclusive breastfeeding was four months (95% CI 3.75, 4.25). The rates of exclusive breastfeeding at 4 and 6 months were 61.6% (135/219) and 15.5% (24/155) respectively. Bivariate analysis showed that the Muslim ethnicity (p = 0.004), lower levels of parental education (p less than 0.001) and being an unemployed mother (p = 0.021) were important associations of early cessation of exclusive breastfeeding. At the time of the study, 62% (135/219) of infants were receiving feeds via a bottle and 23% (51/219) were receiving infant formula. Muslim ethnicity was significantly associated with bottle and formula feeding (p less than 0.001). Bottle feeding was also significantly higher among mothers with a low level of education and among employed mothers. The rate of breastfeeding initiation and exclusive breastfeeding up to the fourth month is very high in Medical Officer of Health area, Beruwala, Sri Lanka. However exclusive breastfeeding up to six months is still low and the prevalence of inappropriate feeding practices is high.

Role of information and communication networks in malaria survival
(Research Article; Global)
Malaria Journal. 2007 Oct 10;6(1):136.
Mozumder P | Marathe A
Quite often symptoms of malaria go unrecognized or untreated. According to the Multilateral Initiative on Malaria, 70% of the malaria cases that are treated at home are mismanaged. Up to 82% of all malaria episodes in sub-Saharan Africa are treated outside the formal health sector. Fast and appropriate diagnosis and treatment of malaria is extremely important in reducing morbidity and mortality. Data from 70 different countries is pooled together to construct a panel dataset of health and socio-economic variables for a time span of (1960-2004). The generalized two-stage least squares and panel data models are used to investigate the impact of information and communication network (ICN) variables on malaria death probability. The intensity of ICN is represented by the number of telephone main lines per 1,000 people and the number of television sets per 1,000 people. The major finding is that the intensity of ICN is associated with reduced probability of deaths of people that are clinically identified as malaria infected. The results are robust for both indicators i.e. interpersonal and mass communication networks and for all model specifications examined. The results suggest that information and communication networks can substantially scale up the effectiveness of the existing resources for malaria prevention. Resources spent in preventing malaria are far less than needed. Expanded information and communication networks will widen the avenues for community based "participatory development", that encourages the use of local information, knowledge and decision making. Timely information, immediate care and collective knowledge based treatment can be extremely important in reducing child mortality and achieving the millennium development goal.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Sierra Leone: Rebirth of a nation
(News Article; Sub-Saharan Africa)
17 Oct 2007
The Independent

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Fertility rates and gross national income per capital
(Abstract; subscription needed for full text; Global)
CMAJ. Canadian Medical Association Journal. 2007 Oct 9;177(8):846.
Recently the World Health Organization reported 2005 fertility rates per woman and gross national incomes per capita from its 193 member countries. Figure 1 in the article shows these data for the 20 countries with the highest and lowest fertility rates for which gross national income data were available and for the G7 countries (Canada, United States, France, United Kingdom, Germany, Italy, Japan) for comparison. Countries with the highest fertility rates per woman tended to have a much lower gross national income per capita than countries with the lowest fertility rates. They also tended to be or to have recently been politically unstable. (The fertility rates per woman for Timor-Leste and Afghanistan were 7.8 and 7.3 respectively but are not included in Figure 1 in the article because data for their gross national income were not available.) A fertility rate per woman of just over 2.0-2.1 is recognized as being necessary to maintain a country's population size. Countries with a rate below this, which included most of the G7 countries, must rely on immigration if this is their intent.

Convention plus as a norm-setting exercise
(Abstract; subscription needed for full text; Global)
Journal of Refugee Studies. 2007 Sep;20(3):509-535.
Betts A | Durieux JF
This article reflects upon UNHCR's Convention Plus initiative, a multi-lateral process established in order to contribute to the development of a normative framework for global burden-sharing. Although the substantive achievements of the initiative have been limited, the article argues that Convention Plus has helped to develop significant new ideas relating to UNHCR's potential role in norm-creation within the refugee regime. Based on a regime theoretical perspective, and drawing on the wider literature relating to the role of norms in the refugee regime, the paper examines the procedural and conceptual innovations of Convention Plus, and how these might be adapted in future in light of the initiative's shortcomings. In particular, the article sets out two models for UNHCR's role in facilitating norm-creation, both developed in the context of the Convention Plus experience: firstly, a 'top-down' institutional bargaining model and, secondly, a 'bottom-up' good practice model. The former model emerges from the interests-linkages-norms approach implicit to the so-called 'generic' work of the initiative; the latter, from the situational work of the initiative, developed through the revival of 'comprehensive plans of action' and the use of pilot projects. The models are argued to be mutually supportive. The paper suggests that adapting these ideal-type models in light of the Convention Plus experience has implications for UNHCR's role in norm-creation, with regard both to developing a normative framework for global burden-sharing and also to developing other norms in response to other emerging challenges.

Refugee camp economies
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Refugee Studies. 2007 Sep;20(3):461-480.
Werker E
This paper describes the economy of a refugee camp. Key distortions to the economy of Kyangwali Refugee Settlement in Uganda are noted and the findings are used to construct a generic model of a refugee camp economy. Camp economies are influenced by host country policies, such as restrictions on refugees' movement and work, as well as by the physical and economic isolation of the site. Moreover, market outcomes interact with the nature of humanitarian assistance and the special demographic composition of the refugees to determine the prices and quantities that characterize the market. An awareness of the dynamics of the refugee camp economy has important implications for practitioners and scholars alike.

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Volume 7, Number 4022 October 2007