Volume 7, Number 42
5 November 2007

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ADOLESCENT HEALTH NEWS

India: Youth to speak their mind on sexuality
(News Article; Asia)
29 Oct 2007
The Times of India
Related News Article: South Asia: Youth Demand Sex Education in Schools

Uganda: New school curriculum to fight AIDS launched
(News Article; Sub-Saharan Africa)
Serunjogi T, New Vision (Kampala)

Exploring new frontiers in sexual, reproductive health
(News Article; Asia)
29 Oct 2007
NewKerala.com

Uganda: Bbumba wants teenage pregnancy top on agenda
(News Article; Sub-Saharan Africa)
29 Oct 2007
Mulondo M, New Vision (Kampala)

India: Parents need to grow up to give kids sex education - Experts
(News Article; Asia)
29 Oct 2007
IANS

Ghana: New reports say females have sex earlier
(News Article; Sub-Saharan Africa)
1 Nov 2007
Public Agenda (Accra)

ADOLESCENT HEALTH RESEARCH

Contraception use and pregnancy among 15-24 year old South African women: A nationally representative cross-sectional survey
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMC Medicine. 2007 Oct 28;5:31.
MacPhail C | Pettifor AE | Pascoe S | Rees HV
Adolescent reproductive health has not continued to receive the attention it deserves since the start of the HIV epidemic. In South Africa, high numbers of adolescent women report pregnancies that are unwanted. Enabling contraception use is vital for meeting the goals of HIV prevention. A nationally representative survey of South African 15-24 year olds was undertaken. Participants completed a questionnaire on sexual behaviour and provided an oral fluid sample for HIV testing. Analysis of the data was restricted to women (n = 6 217), particularly those who reported being sexual active in the last 12 months (n = 3 618) and was conducted using svy methods in the program STATA 8.0 to take account of sampling methods. Univariate and multivariate analyses were conducted to explore factors associated with contraceptive use. Two thirds of all women reported having ever been sexually active and among these 87% were sexually active in the past 12 months. Among women who reported currently being sexually active, 52.2% reported using contraceptives. There was evidence of association between contraceptive use and being employed or a student (vs unemployed); fewer sex partners; type of last sex partner; having talked to last partner about condom use and having ever been pregnant. Specific emphasis must be placed on encouraging young women to use contraceptive methods that offer protection against pregnancy and STIs/HIV. Our consistent finding of a relationship between discussing condom use with partners and condom use indicates the importance of involvement of male partners in women's contraceptive decisions.

Outcome of teenage pregnancy
(Research Article; Asia)
Indian Journal of Pediatrics. 2007 Oct;74:927-931.
Kumar A | Singh T | Basu S | Pandey S | Bhargava V
The objective of the study was to evaluate the obstetric, fetal and neonatal outcomes of teenage pregnancy in a tertiary care teaching hospital. A retrospective case control study was performed over a period of 5 years. Date were retrieved from hospital records. All teenage mothers (aged 13-19 completed years at delivery) delivering in the University Hospital were taken as cases. Next 3 consecutive deliveries in the age group 20-30 year were selected as controls for each case. For statistical analysis, the cases were further subdivided into 2 groups, less than or equal to 17 years (Group A) and 18-19 years (Group B). Groups were compared for obstetric complications and neonatal outcome. Statistical analysis was done by software package SPSS 10. The incidence of teenage deliveries in hospital over last 5 years was 4.1%. Majority of the teenagers were primigravida (83.2% vs 41.4%, p less than 0.01). Complications like pregnancy induced hypertension (PIH) (11.4% vs 2.2%, p less than 0.01), pre-eclamptic toxemia (PET) (4.3% vs 0.6%, p less than 0.01) eclampsia (4.9% vs 0.6%, p less than 0.01) and premature onset of labor (26.1% vs 14.6%, p less than 0.01) occurred more commonly in teenagers compared to controls. Teenage mothers also had increased incidence of low birth weight (LBW) (50.4% vs 32.3%, p less than 0.01), premature delivery (51.8% vs 17.5%, p less than 0.01) and neonatal morbidities like perinatal asphyxia (11.7% vs 1.9%, p less than 0.01) jaundice (5.7% vs 1.2%, p less than 0.01) and respiratory distress syndrome (1.9% vs 0.3%, p less than 0.05). Teenage pregnancy was also associated with higher fetal (1.9% vs 0.3%, p less than 0.05) and neonatal mortality (3.8% vs 0.5%, p less than 0.05). Teenage pregnancy was associated with a significantly higher risk of PIH, PET, eclampsia, premature onset of labor, fetal deaths and premature delivery. Increased neonatal morbidity and mortality were also seen in babies delivered to teenage mothers. Younger teenage group (less than or equal to 17 years) was most vulnerable to adverse obstetric and neonatal outcomes.

Psychosocial predictors of adolescent sexual behavior
(Research Article; Asia)
Indian Journal of Pediatrics. 2007 Oct;74:923-926.
Lakshmi PV | Gupta N | Kumar R
The objective was to find out the psychosocial factors associated with adolescent sexual behavior. A cross sectional study was carried out in Chandigarh Union Territory of India by enrolling 11th class students from six randomly selected schools. A pre-tested questionnaire containing 83 items was administered after ensuing privacy and confidentially. Socio-economic status, residence, gender, grade in the class, religion, acculturation level, self esteem, social support and coping behavior were considered as independent explanatory variables and physical sexual contact (which included kissing, hugging, and sexual intercourse) was taken as dependent variable. Two-hundred and fifty-seven students enrolled for the study had mean age of 17 yr. The prevalence of sexual activity was 20% (95% CI: 13.6% - 28.1%) among males and 6% (95% CI: 1.3% - 18.8%) among females. Four percent of males and 1% of females reported sexual intercourse. The main reason for not having sexual physical contact was societal norms. After adjusting for confounders in multivariate analysis, male gender (OR: 3.5; 95% CI: 1.5 - 8.1) and modern attitudes (OR: 0.77; 95% CI: 0.6 - 0.98) were found to be the risk factors for initiation of sexual activity in adolescence. Cultural norms rather than the individual/psychological factors tend to govern adolescent sexual behavior in Indian society.

Predictors of sexual intercourse among Korean adolescents
(Abstract; subscription needed for full text; Asia)
Journal of School Health. 2007 Nov;77(9):615-622.
Ryu E | Kim K | Kwon H
The proportion of adolescents experiencing unwanted pregnancy and abortion caused by the premature initiation of sexual intercourse is increasing at an alarming rate in Korea. This study aimed at developing a theoretical model for identifying individual and environmental risk factors affecting the initiation of sexual intercourse by adolescents. A descriptive survey was used to identify the predictors of sexual intercourse among Korean adolescents. Data were collected from students attending 10 senior high schools in 2 cities and 3 provinces in Korea. A total of 1012 students were chosen by convenience sampling, with 50 of them being excluded due to their failing to respond properly. Logistic regression analysis of the data showed that gender, socialization traits, and disinhibition were the statistically significant individual factors, and that parental living arrangement, career track, school record, having a boy-/girlfriend, and sexual permissiveness with a boy-/girlfriend were the statistically significant environmental factors associated with sexual intercourse by adolescents. The theoretical model developed on the basis of the above findings should be useful in the development of effective counseling and preventive intervention programs provided to adolescents by school and community nurses.

FAMILY PLANNING NEWS

China: Women suffer contraceptive confusion
(Editorial; Asia)
26 Oct 2007
Shanghai Daily

Australia: Condom alarm for under-aged teenagers
(News Article; Oceania)
2 Nov 2007
Australian Associated Press

FAMILY PLANNING RESEARCH

Contraceptive vaginal ring use for women has less adverse metabolic effects than an oral contraceptive
(Abstract; subscription needed for full text; Global)
Contraception. 2007 Nov;76(5):348-356.
Elkind-Hirsch KE | Darensbourg C | Ogden B | Ogden LF | Hindelang P
This study compared metabolic, hormonal and lipid profiles before and during use of a contraceptive vaginal ring (RING) releasing 15 mcg ethinyl estradiol (EE) and 120 mcg etonogestrel per day (NuvaRing, Organon USA Inc., Roseland, NJ) versus a low-dose oral contraceptive (PILL) containing 20 mcg EE and 100 mcg levonorgestrel daily (Aviane, Barr Pharmaceuticals Inc., Pomona, NY). Sixty-five women were randomized to either the RING or PILL treatment for five cycles. In the pretreatment cycle (Cycle Days 2-5) and during Weeks 2 and 3 of the fifth treatment cycle, a 75-g oral glucose tolerance test (OGTT) was performed. Baseline samples were used to evaluate basal hormonal, metabolic and lipid levels. Forty-two women completed the study. Basal insulin resistance (HOMA-IR) was slightly decreased, whereas a significant reduction in the insulin sensitivity index (ISOGTT) was found in women on PILL therapy compared to those in the RING group (p less than .035). Pancreatic beta-cell function was not significantly altered with either treatment. The lower-dose, nonoral hormonal RING had a lesser impact on carbohydrate metabolism and greater reduction of free androgen and dehydroepiandrosterone sulfate levels than PILL treatment.

Noncontraceptive benefits of two combined oral contraceptives with antiandrogenic properties among adolescents
(Abstract; subscription needed for full text; Global)
Contraception. 2007 Nov;76(5):342-347.
Sabatini R | Orsini G | Cagiano R | Loverro G
The aim of this study was to assess the noncontraceptive benefits of two combined oral contraceptives, containing progestins with well-known antiandrogenic properties, in adolescent girls. In this prospective observational study, the effects of two formulations containing 30 mcg of ethinyl estradiol combined with 2 mg chlormadinone acetate or 3 mg drospirenone were compared. Six-month data were obtained from 156 sexually active adolescents requiring contraception. We investigated the advantages of these regimens on intermenstrual bleeding, dysmenorrhea, acne and hair and skin disorders. Furthermore, their effects on sexual interest, intercourse frequency and sexual satisfaction were evaluated. Both preparations provided effective contraception, good cycle control and beneficial effects on preexisting hair and skin disorders without effects on body weight. However, the best results were obtained with the formulation containing chlormadinone acetate, with the difference being statistically significant. Furthermore, the contraceptive adherence to teenager expectations and the counseling effectiveness enhancing compliance contribute to a high rate of continuation.

GENDER and HEALTH NEWS

Botswana: Tsholofelo targets sex workers and drivers
(News Article; Sub-Saharan Africa)
31 Oct 2007
Chwaane T, Mmegi/The Reporter

Nigeria: Students assessed on gender based violence
(News Article; Sub-Saharan Africa)
30 Oct 2007
Esin H, This Day

Kenya: Fight against breast cancer gets boost
(News Article; Sub-Saharan Africa)
31 Oct 2007
The Nation

Preference for sons in Asia could have severe social consequences: UN agency
(News Article; Asia)
29 Oct 2007
UN News Center

GENDER and HEALTH RESEARCH

Gender sensitization among health providers and communities through transformative learning tools: Experiences from Karachi, Pakistan
(Abstract; subscription needed for full text; Asia)
Education for Health. 2007 Aug;20(2):[1] p.
Shaikh BT | Reza S | Afzal M | Rabbani F
Pakistan lags far behind most developing countries in women's health and gender equity. Appropriateness of health care services vis-a-vis the gender specific cultural norms that influence clients' needs are not very visible and are more difficult to monitor. Programs and services need to be sensitively designed to facilitate women's access to physical and social needs. This paper narrates the experience of working with health providers from public and private sectors, community, local government representatives and community-based organizations. Through transformative learning, this endeavour focused on initiating a process of sensitization on gender related health issues for women. The initiative was primarily based on the use of the following two standardized tools: 'Health Workers for Change' for working with health providers and 'Initiating Women Empowerment for Health' for interacting with the community. Both tools focus primarily on women's health and social issues affecting their health status. The research methodology used was predominantly qualitative, using focus group discussions, participatory rural appraisal and interactive workshops. This approach endeavours to sensitize the health service providers to the health needs of female clients and encourages behavioural changes. Simultaneously, it creates an opportunity to raise awareness among women and the community in general regarding appropriate health-seeking behaviour and the timely use of health services. The information collected is evidence for policy makers regarding the gender-based problems faced by women who are seeking health care and it suggests how to overcome these problems.

Gender inequalities while rearing of children under 5 years in a rural area of West Bengal
(Research Article; Asia)
Indian Journal of Community Medicine. 2007 Jul-Sep;32(3):215-216.
Pal I | Chaudhuri RN
Girls of today are the women of tomorrow. Mounting evidence of the special needs of girl children is increasingly attracting attention worldwide. Exploring the problems of the girl child in the South-East Asia region (SEAR) countries has raised several important issues. The health problems currently affecting the girls arise from a complex combination of factors. In most societies, girls face discrimination due to their under valuation, and this is further aggravated by other economic and social problems, leading to their poor health status. The targeted interventions for child survival programs have benefited mostly by the male children, where as, the female children continue to decrease due to high mortality rater and ambient health-seeking behavior of parents and families. Disparity between boys and girls is either a choice of a family of a community. It is at this level that gender equality must be sought and campaigned for. Discrimination against women begins even before birth and must therefore be addressed from birth and then onwards. Therefore, this study was undertaken to determine the differences, if any, in rearing of under-5 years of male and female children.

Female genital mutilation: The situation in Africa and in France
(Abstract; subscription needed for full text; North Africa | Europe | Sub-Saharan Africa)
Population and Societies. 2007 Oct;(438):1-4.
Andro A | Lesclingand M
To combat female genital mutilation (FGM) in France, we need to know more about the populations of women concerned -- mainly of African origin -- and the practice of FGM in their home countries. Armelle Andro and Marie Lesclingand explain that the situation varies from one African country to another, independently of religion. For France, they attempt to quantify the number of women who have already undergone genital mutilation and present an upcoming survey to assess the health consequences of this practice so that these women's needs can be better addressed.

HIV/AIDS and STIs NEWS

Mozambique: Conference on HIV and the sex trade opens
(News Article; Sub-Saharan Africa)
31 Oct 2007
Agencia de Informacao de Mocambique (Maputo)

Africa: Anti-Aids program scores successes
(Feature Article; Sub-Saharan Africa)
30 Oct 2007
Kurata P, USINFO

Uganda: How Teens Can Live Positively With HIV
(News Article; Sub-Saharan Africa)
1 Nov 2007
Muyiyi S, Daily Monitor (Kampala)

Namibia: Stories aim to promote 'safe sex'
(News Article; Sub-Saharan Africa)
31 Oct 2007
Gaomas S, New Era (Windhoek)

Southern Africa: Alarming spread of HIV in SADC military
(News Article; Sub-Saharan Africa)
30 Oct 2007
Agencia de Informacao de Mocambique (Maputo)

South Africa: Student devastated by home HIV test result
(News Article; Sub-Saharan Africa)
30 Oct 2007
Natash J, Cape Argus (Cape Town)

Nigeria: People living with HIV/Aids to trek against stigmatization
(News Article; Sub-Saharan Africa)
30 Oct 2007
Akoni O, Vanguard (Lagos)

Nigeria: Bauchi - 111, 504 women infected with HIV/Aids
(News Article; Sub-Saharan Africa)
28 Oct 2007
Oche M, Leadership (Abuja)

HIV/AIDS and STIs RESEARCH

Low specificity of the Murex fourth-generation HIV enzyme immunoassay in Tanzanian adolescents
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Tropical Medicine and International Health. 2007 Nov;12(11):1-4.
Everett DB | Weiss HA | Changalucha J | Anemona A | Chirwa T
The objective was to determine the specificity of the Abbott Murex HIV antigen/antibody combination enzyme immunoassay (EIA) for the diagnosis of HIV infection in Tanzania. A cross-sectional survey of 7333 Tanzanian adolescents and young adults was carried out. Sera testing positive by the Murex assay were further evaluated using a battery of other EIA which detect either antibody to HIV-1 or p24 antigen, and by PCR using pol primers. Of the 674 sera testing positive by the Murex assay, only 53 (7.9%) were confirmed. The specificity of the Murex assay was 91.5%. Serological tests for HIV may perform differently in different populations. New diagnostic tests should not be introduced into populations in which they have not been evaluated.

A randomized controlled safety trial of the diaphragm and cellulose sulfate microbicide gel in sexually active women in Zimbabwe
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Contraception. 2007 Nov;76(5):389-399.
van der Straten A | Napierala S | Cheng H | Mauck C | Depineres T
Cellulose sulfate (CS) is an antimicrobial and contraceptive agent. We assessed its safety when used alone or with the diaphragm in Harare, Zimbabwe. This was a randomized controlled safety trial with three arms: diaphragm with 6% CS gel vs. diaphragm with KY gel vs. CS gel alone. Participants were instructed to use their study products before every sex act for a period of 6 months. Safety end points were assessed monthly by questionnaires and urinanalysis and bimonthly by clinical examinations, colposcopy, wet mounts and gram stains. One hundred nineteen monogamous women were enrolled (28% HIV+) and 105 (88%) completed the study. No urinary tract infections were diagnosed during the study; 81.4% women had symptoms and/or signs of genital irritation considered at least possibly related to the gel or device, and 41.5% had changes in vaginal flora. There were no statistically significant differences between treatment groups in safety end points. All six women with deep epithelial disruption were diaphragm users, and all such findings were on the external genitalia. Of those, 4 had herpetic ulcers which were unrelated to products use. Cellulose sulfate appeared safe when used for 6 months alone or with a diaphragm.

Strategies for the scale-up of antiretroviral therapy in South Africa through health system optimization
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Infectious Diseases. 2007 Dec 1;196 Suppl 3:S457-S463.
Barker PM | McCannon CJ | Mehta N | Green C | Youngleson MS
In the face of the massive burden created by human immunodeficiency virus/acquired immunodeficiency syndrome and other infectious diseases, developing nations must find ways to rapidly begin treatment for infected persons. Although infusions of personnel, supplies, and diagnostics would make a major contribution to expanding the capacity to treat these diseases, the lack of these resources creates a long-term challenge, and there is a need for additional approaches to spread effective interventions that can leverage existing resources and the much-needed infusions of new resources. This article describes one such approach -- applied in several forms in South Africa -- that aims to significantly increase the number of patients receiving antiretroviral therapy.

The realities of antiretroviral therapy rollout: Overcoming challenges to successful programmatic implementation
(Abstract; subscription needed for full text; Global | Sub-Saharan Africa)
Journal of Infectious Diseases. 2007 Dec 1;196 Suppl 3:S445-S448.
Ojikutu B
In 2006, 2 million human immunodeficiency virus (HIV)-infected people living in low- to middle-income countries were receiving antiretroviral therapy (ART). Although this is an improvement over previous years, significant operational challenges have inhibited progress toward universal access to HIV care and treatment. Despite these challenges, the intense efforts focused on addressing the HIV epidemic present an opportunity for overall health systems improvement in developing nations. In October 2006, Harvard University's Centers for AIDS Research, the Nelson Mandela School of Medicine, the Department of Health of KwaZulu-Natal, and the Medical Research Council of South Africa held a conference entitled "The Realities of Antiretroviral Therapy Rollout: Challenges to Successful Programmatic Implementation" in Durban, South Africa. The goal of the meeting was to bring together international and local leadership, including policy makers, health care workers, and funders, to propose an agenda that would address the challenges to more expeditious provision of HIV care and treatment in resource-limited settings.

Women at risk for sexually transmitted diseases: Correlates of intercourse without barrier contraception
(Abstract; subscription needed for full text; North America)
American Journal of Obstetrics and Gynecology. 2007 Nov;197(5):474.e1-474.e8.
Peipert JF | Lapane KL | Allsworth JE | Redding CA | Blume JL | Lozowski F | Stein MD
The purpose of this study was to evaluate the correlates of vaginal intercourse without barrier contraception (unprotected intercourse). Baseline data from a randomized trial were analyzed to evaluate factors that are associated with intercourse without barrier method use among women less than 35 years old. Logistic regression models provided estimates of the association of demographic, reproductive, and sexual history variables with unprotected intercourse. Intercourse without barrier contraception was common; 65% of participants had greater than or equal to 2 episodes of intercourse without barrier contraception use in the past month. Factors that were associated with increased odds of unprotected intercourse included the number of coital episodes, a male partner's unwillingness to use condoms (adjusted odds ratio, 4.1; 95% CI, 2.3-6.9), and, among women less than 20 years old, low condom use self-efficacy score (adjusted odds ratio, 1.6; 95% CI, 1.0-2.9). Risk factors for unprotected intercourse included coital frequency and the male partner's unwillingness to use condoms. Self-efficacy for condom use was especially important for women less than 20 years old.

MATERNAL AND CHILD HEALTH NEWS

Nigeria: Country's maternal mortality ratio second largest, says report
(Editorial; Sub-Saharan Africa)
30 Oct 2007
This Day

Uganda: Expectant mothers get free nets
(News Article; Sub-Saharan Africa)
28 Oct 2007
New Vision
Related Fact Sheet: Bednets Reduce Malaria

Cameroon: New hope for mothers, children
(News Article; Sub-Saharan Africa)
22 Oct 2007
Bongben L, The Post

Ghana: Pregnant women advised to use IPT to prevent malaria
(News Article; Sub-Saharan Africa)
25 Oct 2007
Accra Mail
Related Fact Sheet: Prevent and Treat Malaria During Pregnancy

MATERNAL AND CHILD HEALTH RESEARCH

Improving child survival through environmental and nutritional interventions: The importance of targeting interventions toward the poor
(Research Article; Global)
JAMA. Journal of the American Medical Association. 2007 Oct 24-31;298(16):1876-1887.
Gakidou E | Oza S | Fuertes CV | Li AY | Lee DK
The United Nations Millennium Development Goals (MDGs) set targets related to important global poverty, health, and sustainability issues. A critical but under-investigated question for planning and allocating resources toward the MDGs is how interventions related to one MDG might affect progress toward other goals. The objectives were to estimate the reduction in child mortality as a result of interventions related to the environmental and nutritional MDGs (improving child nutrition and providing clean water, sanitation, and fuels) and to estimate how the magnitude and distribution of the effects of interventions vary based on the economic status of intervention recipients. Population-level comparative risk assessment modeling the mortality effects of interventions on child nutrition and environmental risk factors, stratified by economic status. Data on economic status, child underweight, water and sanitation, and household fuels were from the nationally representative Demographic and Health Surveys for 42 countries in Latin America and the Caribbean, South Asia, and sub-Saharan Africa. Data on disease-specific child mortality were from the World Health Organization. Data on the hazardous effects of each MDG-related risk factor were from systematic reviews and meta-analyses of epidemiological studies. The main outcome measure was child mortality, stratified by comparable international quintiles of economic status. Implementing interventions that improve child nutrition and provide clean water and sanitation and clean household fuels to all children younger than 5 years would result in an estimated annual reduction in child deaths of 49 700 (14%) in Latin America and the Caribbean, 0.80 million (24%) in South Asia, and 1.47 million (31%) in sub-Saharan Africa. These benefits are equivalent to 30% to 48% of the current regional gaps toward the MDG target on reducing child mortality. Fifty percent coverage of the same environmental and nutritional interventions, as envisioned by the MDGs, would reduce child mortality by 26 900, 0.51 million, and 1.02 million in the 3 regions, respectively, if the interventions are implemented among the poor first. These reductions are 30% to 75% larger than those expected if the same 50% coverage first reached the wealthier households, who nonetheless are in need of similar interventions. Interventions related to nutritional and environmental MDGs can also provide substantial gains toward the MDG of reducing child mortality. To maximize the reduction in childhood mortality, such integrated management of interventions should prioritize the poor.

Infant feeding, poverty and human development
(Research Article; Global)
International Breastfeeding Journal. 2007 Oct 22;2:14.
Beasley A | Amir LH
The relationship between poverty and human development touches on a central aim of the International Breastfeeding Journal's editorial policy which is to support and protect the health and well-being of all infants through the promotion of breastfeeding. It is proposed that exclusive breastfeeding for 6 months, followed by continued breastfeeding to 12 months, could prevent 1,301,000 deaths or 13% of all child deaths under 5 years in a hypothetical year. Although there is a conventional wisdom that poverty 'protects' breastfeeding in developing countries, poverty actually threatens breastfeeding, both directly and indirectly. In the light of increasingly aggressive marketing behaviour of the infant formula manufacturers and the need to protect the breastfeeding rights of working women, urgent action is required to ensure the principles and aim of the International Code of Breastmilk Substitutes, and subsequent relevant resolutions of the World Health Assembly, are implemented. If global disparities in infant health and development are to be significantly reduced, gender inequities associated with reduced access to education and inadequate nutrition for girls need to be addressed. Improving women's physical and mental health will lead to better developmental outcomes for their children.

Using relative and absolute measures for monitoring health inequalities: Experiences from cross-national analyses on maternal and child health
(Research Article; Global | Europe)
International Journal for Equity in Health. 2007 Oct 29;6:15.
Houweling TA | Kunst AE | Huisman M | Mackenbach JP
As reducing socio-economic inequalities in health is an important public health objective, monitoring of these inequalities is an important public health task. The specific inequality measure used can influence the conclusions drawn, and there is no consensus on which measure is most meaningful. The key issue raising most debate is whether to use relative or absolute inequality measures. Our paper aims to inform this debate and develop recommendations for monitoring health inequalities on the basis of empirical analyses for a broad range of developing countries. Wealth-group specific data on under-5 mortality, immunisation coverage, antenatal and delivery care for 43 countries were obtained from the Demographic and Health Surveys. These data were used to describe the association between the overall level of these outcomes on the one hand, and relative and absolute poor-rich inequalities in these outcomes on the other. The authors demonstrate that the values that the absolute and relative inequality measures can take are bound by mathematical ceilings. Yet, even where these ceilings do not play a role, the magnitude of inequality is correlated with the overall level of the outcome. The observed tendencies are, however, not necessities. There are countries with low mortality levels and low relative inequalities. Also absolute inequalities showed variation at most overall levels. The study shows that both absolute and relative inequality measures can be meaningful for monitoring inequalities, provided that the overall level of the outcome is taken into account. Suggestions are given on how to do this. In addition, the paper presents data that can be used for benchmarking of inequalities in the field of maternal and child health in low and middle-income countries.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Uganda: Population growth highest around Lake Victoria
(News Article; Sub-Saharan Africa)
1 Nov 2007
New Vision

China not pursuing "one child norm"
(News Article; Asia)
31 Oct 2007
Dhar A, The Hindu

South Africa: Quarter of population gets social grants
(News Article; Sub-Saharan Africa)
28 Oct 2007
Momberg E, Independent Online

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Three decades of population policies and programs
(Report; Global)
(You need Adobe Acrobat Reader to access this document)
Washington, D.C., World Bank, 2007. [485] p.
Robinson WC | Ross JA
A short three decades ago, it appeared that the "population bomb" would undermine efforts at development in the Third World and that little could be done about it. This book takes the reader back to the first efforts by 23 countries to hammer out novel policy positions and field programs to deal with the threat. These touched on the daily habits and entrenched values of ordinary people, and there was no "textbook" for guidance. Few public programs had attempted to reduce excessive fertility and provide contraceptive means to whole populations, certainly none on the scale and with the urgency required. The 23 cases of the early family planning efforts tell the story. Their successes were original and so were their failures. These essays, one for each country, recount the experience as experienced by the men and women who actually led the efforts. It provides a unique look inside the programs. These cases offer valuable guidance to other health-related policy objectives that are now emerging. The rise of new bacterial and viral threats (HIV-AIDS and others) make it clear that new health services and program interventions into human behavior will continue to be vital. Even though the problems differ, the organizational structures and behavior-modification campaigns needed can learn much from the pioneering efforts at reducing fertility.

Interplay of socio-economic factors, consanguinity, fertility, and offspring mortality in Monastir, Tunisia
(Abstract; subscription needed for full text; North Africa)
Croatian Medical Journal. 2007 Oct;48(5):701-707.
Kerkeni E | Monastiri K | Seket B | Guediche MN | Cheikh HB
The aim was to assess the association among social status, prevalence of consanguineous marriages, and the effects of consanguinity on reproductive behavior and mortality in Tunisia. The study included data on a total of 1741 live-births born from November 1989 to October 1990 in the maternity ward of the University-Hospital Fattouma Bourguiba of Monastir, Tunisia. After delivery, women filled out a questionnaire on the age of the parents at marriage, the number of pregnancies and abortions, the number of neonatal and post-neonatal deaths, and deaths of children under 5 years. Three categories of marriages were distinguished as follows: marriages between first cousins, marriages between cousins of other degree, and non consanguineous marriages. Consanguineous marriages represented 432 (24.81%) of the unions. Most consanguineous marriages were contracted between first cousins (n = 303; 70.13%). Consanguineous couples had a lower age at marriage and a higher fertility index than non-consanguineous couples. The rates of spontaneous abortions and stillbirths were not correlated with consanguinity. However, higher rates of neonatal and post-neonatal deaths, and deaths of children younger than 5 years were observed in consanguineous couples. Fertility index and mortality, especially in the first year of life, were significantly higher in consanguineous marriages. This important socio-economical factor needs to be considered in assessing equity on health in specific social and cultural contexts.

SPECIAL REPORTS/PROFILES/RESOURCES

World congress on communication for development: Lessons, challenges and the way forward
(Report; Global)
Washington, D.C., The International Bank for Reconstruction and Development / The World Bank, 2007.
World Bank
The first World Congress on Communication for Development, held in October 2006 in Rome, was an opportunity for dialogue among three key stakeholders: policy makers, practitioners, and academicians. It aimed to highlight the necessity of incorporating Communication for Development into development policies and practices.

The experiences recounted in this report are drawn from the various sessions of the Congress and emphasise the value of using Communication for Development to engage stakeholders in a professional and systematic manner for more effective and sustainable project design and implementation.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 7, Number 42 5 November 2007