Volume 7, Number 43
12 November 2007

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...to receive a free WHO Medical Eligibility Criteria (MEC) Wheel, an easy-to-use job aid that helps providers quickly identify the contraceptive methods their family planning clients can use. Just take 5 minutes out of your day to fill out a short survey telling us of your interest in online training and education courses in family planning: http://www.zoomerang.com/survey.zgi?p=WEB2274FTNWFT2. The survey closes Wednesday, November 14, 2007. We appreciate your input!--The INFO Project

ADOLESCENT HEALTH NEWS

Namibia: MTC gives to youth aids project
(News Article; Sub-Saharan Africa)
6 Nov 2007
Mbangula W, New Era (Windhoek)

Zimbabwe: HIV/Aids youth projects get US$1,9m boost
(News Article; Sub-Saharan Africa)
6 Nov 2007
The Herald (Harare)

Namibia: Worries over pregnant schoolgirls
(News Article; Sub-Saharan Africa)
6 Nov 2007
The Namibian (Windhoek)

ADOLESCENT HEALTH RESEARCH

Rebel girls? Unplanned pregnancy and colonialism in highlands Papua, Indonesia
(Abstract; subscription needed for full text; Asia)
Culture, Health and Sexuality. 2007 Nov-Dec;9(6):585-598.
Butt L | Munro J
In highlands Papua, Indonesia, rapid social change under a colonial system of governance has created novel sexual opportunities for young indigenous women. Recent scholarship has viewed similar youthful sexual practices that challenge the status quo as expressions of personal agency. By looking at how young women and their families cope with unplanned pregnancies, this study suggests that a more viable analytic approach would be to view sexuality, pregnancy and childbirth as a single unit of analysis. From this perspective, young women's experiences are primarily ones of constraint. Case studies offer insights into the ways a political context of colonial domination limits options and choices for young women who have children born out of wedlock. In particular, this paper describes how the 'settler gaze' - omnipresent colonial norms and judgments - creates regulatory effects in the realm of reproduction.

Predictors of sexual behaviors among Thai young adults
(Abstract; subscription needed for full text; Asia)
Journal of the Association of Nurses in AIDS Care. 2007 Nov-Dec;18(6):13-21.
Rasamimari A | Dancy B | Talashek M | Park CG
To identify correlates of sexual behaviors among Thai young adults between 18 and 24 years, the authors used a cross-sectional survey of 405 young adults from eight randomly selected Thai urban and rural vocational schools. The young adults completed self-report questionnaires. Logistic regressions were used to determine the correlates between a Thai young adult's ever having had sexual intercourse and the correlates of the number of sexual partners and consistent condom use among those who were sexually active. The independent variables were age, gender, socioeconomic status, geographic residence, parental residence, parental-young adult communication, HIV knowledge, and negotiation for safer sex. The results showed that geographic residence and negotiation for safer sex were related to a young adult's ever having had sexual intercourse; gender, HIV knowledge, and negotiation for safer sex were related to the number of sexual partners; and geographic residence was related to condom use. HIV prevention programs should incorporate HIV knowledge and negotiation skills for both genders and for all geographical areas.

FAMILY PLANNING NEWS

India: State to study early marriages
(News Article; Asia)
5 Nov 2007
Kashyap S, The Times of India

India: Men believe family planning is woman's business
(News Article; Asia)
6 Nov 2007
The Times of India

Tanzania: UMATI attacks anti-family planning traditions
(News Article; Sub-Saharan Africa)
5 Nov 2007
Seleman F, The Guardian

FAMILY PLANNING RESEARCH

Sexual partners and condom use of migrant workers in Thailand
(Abstract; subscription needed for full text; Asia)
AIDS and Behavior. 2007 Nov;11(6):905-914.
Ford K | Chamrathrithirong A
The objectives of this paper were to identify the types of sexual partners and condom use of migrant workers. Data for the study were drawn from a survey of 3,426 migrant workers in southern coastal and northern areas of Thailand conducted in 2004. Among sexually active men, 25% reported visiting a sex worker, 57% reported a regular partner, and 6% reported another non-regular partner in the last year. Reported condom use was high with sex workers (79% reported always use), but low with regular partners (4% ever use). Factors related to visiting sex workers included marital status (more visits if not married), longer residence in Thailand, occupation of seafarer or seafood production worker, Cambodian origin, and perceived AIDS risk. Condom use with sex workers was higher for younger men, married men, men who had been in Thailand longer, men with lower perceived AIDS risk, and men who drank alcohol less frequently.

Knowledge, perceptions, and motivations for contraception: Influence on teens' contraceptive consistency
(Abstract; subscription needed for full text; North America)
Youth and Society. 2007 Dec;39(2):182-208.
Ryan S | Franzetta K | Manlove J
Using data from the National Longitudinal Study of Adolescent Health, the authors examine the association between contraceptive use patterns in teens' first sexual relationships and their knowledge of, perceptions of, and motivations for contraception and pregnancy prevention. Results from logistic regression analyses show that knowledge, perceptions, and motivations surrounding sexual activity and contraception are indeed important predictors of contraceptive outcomes, and they influence males and females differently. For both genders, perceived ease of access to contraceptives is associated with increased odds of ever using contraception and using contraception consistently. For males, greater perceived condom knowledge is associated with increased odds of ever using contraception. For females, higher levels of actual reproductive health knowledge is associated with increased odds of ever using contraception, and holding negative views of pregnancy and having greater contraceptive self-efficacy are both associated with increased odds of consistent contraceptive use.

Contraception and adolescents
(Abstract; subscription needed for full text; North America)
Pediatrics. 2007 Nov;120(5):1135-1148.
Committee on Adolescence
Although adolescent pregnancy rates in the United States have decreased significantly over the past decade, births to adolescents remain both an individual and public health issue. As advocates for the health and well-being of all young people, the American Academy of Pediatrics strongly supports the recommendation that adolescents postpone consensual sexual activity until they are fully ready for the emotional, physical, and financial consequences of sex. The academy recognizes, however, that some young people will choose not to postpone sexual activity, and as health care providers, the responsibility of pediatricians includes helping teens reduce risks and negative health consequences associated with adolescent sexual behaviors, including unintended pregnancies and sexually transmitted infections. This policy statement provides the pediatrician with updated information on contraception methods and guidelines for counseling adolescents.

GENDER and HEALTH NEWS

Botswana: Working with the sex workers
(News Article; Sub-Saharan Africa)
6 Nov 2007
Mokgwathi N, The Voice (Francistown)

Congo-Kinshasa: Little justice for victims of sexual violence - UN Representative
(Interview; Sub-Saharan Africa)
6 Nov 2007
Yacoubian N, United Nations Mission in the Democratic Republic of Congo (Kinshasa)
With the continuous tense situation in Eastern Congo triggering sexual violence against women, this newspaper interviewed MONUC Deputy Special Representative of the UN Secretary General, Ross Mountain, about this issue and the efforts of the international community and the DRC government to solve the problem.

Côte d'Ivoire: Religion mobilises against female mutilation
(News Article; Sub-Saharan Africa)
6 Nov 2007
Zamblé F, Inter Press Service (Johannesburg)
In certain parts of Africa, female genital mutilation (FGM) has been linked to religion, with Muslim communities mistakenly believing that the practice is a religious requirement. But in Côte d'Ivoire, religion is also being put at the service of fighting FGM.

Sierra Leone: Government asked to apologize to sexually abused
(News Article; Sub-Saharan Africa)
6 Nov 2007
Horner R | Glenwright D, Concord Times (Freetown)
Amnesty International estimates that as many as 250,000 women and girls were subjected to rape, sexual slavery and other sexual violence between 1991 and 2002 - around 33 per cent of Sierra Leone's female population.

GENDER and HEALTH RESEARCH

The global impact of income inequality on health by age: An observational study
(Abstract; subscription needed for full text; Global)
BMJ. British Medical Journal. 2007 Oct;335(7625):[5] p.
Dorling D | Mitchell R | Pearce J
The objectives were to explore whether the apparent impact of income inequality on health, which has been shown for wealthier nations, is replicated worldwide, and whether the impact varies by age. The design used was an observational study. 126 countries of the world for which complete data on income inequality and mortality by age and sex were available around the year 2002 (including 94.4% of world human population). Data on mortality were from the World Health Organization and income data were taken from the annual reports of the United Nations Development Programme. The main outcome measures were mortality in 5-year age bands for each sex by income inequality and income level. At ages 15-25 and 29-39 variations in income inequality seem more closely correlated with mortality worldwide than do variations in material wealth. This relation is especially strong among the poorest countries in Africa. Mortality is higher for a given level of overall income in more unequal nations. Income inequality seems to have an influence worldwide, especially for younger adults. Social inequality seems to have a universal negative impact on health. Humans are social animals and are not well constructed physiologically to survive in uncooperative surroundings-particularly during the prime of life.

Poverty, development, and women: Why should we care?
(Abstract; subscription needed for full text; Global)
Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2007 Nov-Dec;36(6):523-530.
Thompson JE
Healthy, prosperous nations require healthy women and newborns. Young girls and women in resource-poor nations suffer the greatest ill-health consequences from low status, denial of basic human rights, and poverty. Poverty and poor health result in poor economic development. The Millennium Development Goals call for immediate efforts to reduce poverty, improve health, especially of girls and women, and foster development in the world' s poorest nations.

Global rights, local realities: Negotiating gender equality and sexual rights in the Caprivi Region, Namibia
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Culture, Health and Sexuality. 2007 Nov-Dec;9(6):599-614.
Thomas F
Gender inequalities are frequently cited as a major reason for high HIV-prevalence rates in southern Africa. While steps have been taken to promote and pass legislation that upholds equal rights for women, this paper examines the ways in which discourses of gender equality and ensuing sexual rights can have complex, contradictory and even adverse implications when they are mobilised, resisted and reinterpreted at local level. Drawing upon research undertaken in the Caprivi Region of Namibia, this paper examines this ways in which men and women respond to ideas about gender equality, and seeks to place these responses within the wider context of socioeconomic change and understandings of morality prevalent within the region. The tendency of many young women to seek out relationships with older men and the increasing costs of bride-wealth payments play a key role in reinforcing patriarchal attitudes and fuelling disrespect for women's rights both before and within marriage. In addition, a failure to adhere to customary norms, which uphold men's dominant role, continues to threaten the support networks and assets available to women. The consequences of this situation are examined with particular focus on implications for the future transmission of HIV.

Quality of life of women with gynecologic cancer: Associated factors
(Abstract; subscription needed for full text; Global)
Archives of Gynecology and Obstetrics. 2007 Dec;276(6):583-589.
Vaz AF | Pinto-Neto AM | Conde DM | Costa-Paiv L | Morais SS
The objective was to evaluate quality of life (QOL) and identify its associated factors in a cohort of women with gynecologic cancer. A cross-sectional study was conducted, including 103 women with cervical or endometrial cancer, aged between 18 and 75 years who were receiving their entire treatment at the institution where the investigation was carried out. QOL was measured by the World Health Organization's QOL instrument-abbreviated version (WHOQOL-BREF). Clinical and sociodemographic characteristics, in addition to prevalence of cancer-related symptoms prior to radiotherapy were investigated. Bivariate analysis was performed, applying the Mann-Whitney test. Multivariate analysis was used to identify factors associated with QOL. The mean age of the participants was 56.8 plus or minus 11.6 years. The study included 67 (65%) women with cervical cancer and 36 (35%) women with endometrial cancer. Most participants were at an advanced stage (63.1%). The most common complaints were pain (49.5%) and vaginal bleeding (36.9%). The prevalence of anemia was 22.3%. On multivariate analysis, it was observed that anemia (P = 0.006) and nausea and/or vomiting (P = 0.010) determined impairment in physical domain. Pain negatively influenced physical domain (P = 0.001), overall QOL (P = 0.024), and general health (P = 0.013), while the history of surgery positively affected general health (P = 0.001). Cancer-related symptoms were factors that most interfered with QOL in women with gynecologic cancer. Therefore, more attention should be focused on identifying these symptoms, adopting measures to minimize their repercussions on QOL.

HIV/AIDS and STIs NEWS

South Africa: Figth HIV, Aids and TB together - expert
(News Article; Sub-Saharan Africa)
6 Nov 2007
Independent Online

Indonesia to launch first-ever national condom campaign
(News Article; Asia)
8 Nov 2007
Agence France Presse

United States: Failed AIDS vaccine may have increased infection risk
(News Article; Global)
7 Nov 2007
Oberman M, AFP

South Africa: SA's president 'failed' on Aids
(News Article; Sub-Saharan Africa)
BBC News
South Africa's President Thabo Mbeki remains an "Aids dissident" - doubting the link between the HIV virus and Aids, according to his new biographer.

HIV/AIDS and STIs RESEARCH

Gradations of researchers' obligation to provide ancillary care for HIV / AIDS in developing countries
(Abstract; subscription needed for full text; Global)
American Journal of Public Health. 2007 Nov;97(11):1956-1961.
Richardson HS
Three principal factors affect the stringency of medical researchers' obligation to provide antiretroviral treatment to participants in non-HIV/AIDS studies that are conducted in developing countries: (1) the centrality of HIV/AIDS to the study design, (2) the extent of the researcher-participant interaction, and (3) the cost relative to the study budget. I provide a basis for assessing the comparative stringency of the researchers' obligation to provide this type of ancillary care. Practically, given the range of possible responses to study participants' needs, calibrating the researcher's responsibility to provide ancillary care is a useful step in ethical analysis. Theoretically, a gradation of obligation suggests how research ethics committees or institutional review boards can take multiple, potentially conflicting ethical factors into account without undertaking spurious efforts to quantify their importance.

Economic stress and HIV-associated health care utilization in a rural region of China: A qualitative study
(Abstract; subscription needed for full text; Asia)
AIDS Patient Care and STDs. 2007 Nov;21(11):787-797.
Xu J | Sullivan SG | Dou Z | Wu Z
China is experiencing an emerging HIV epidemic, primarily affecting the rural poor. For this group, the costs of staying healthy are often beyond their means. A qualitative study was undertaken with 20 HIV-positive people living in a rural area in Anhui, eastern China, 20 of their family members, 20 health care providers, and 20 uninfected villagers. In this area, the majority of HIV-positive people were infected through contaminated commercial plasma/blood donation procedures. In-depth interviews were conducted with participants to identify the barriers and enablers to accessing health care services for HIV. A major concern for affected villagers was the unaffordable costs of health care, which leads them to delay seeking services until symptoms are severe. Use of the health care system was also influenced by the availability of subsidized medications, distance to the health care centre and quality of available services. In contrast, participants were very positive about antiretroviral treatment services, which are now free. In the study area, access to health care is heavily subsidized , yet many still found these services unaffordable. More equitable and affordable services will be needed if China is to control its HIV epidemic.

Clinical outcomes and CD4 cell response in children receiving antiretroviral therapy at primary health care facilities in Zambia
(Abstract; subscription needed for full text; Sub-Saharan Africa)
JAMA. Journal of the American Medical Association. 2007 Oct 24-31;298(16):1888-1899.
Bolton-Moore C | Mubiana-Mbewe M | Cantrell RA | Chintu N | Stringer EM
The Zambian Ministry of Health provides pediatric antiretroviral therapy (ART) at primary care clinics in Lusaka, where, despite scale-up of perinatal prevention efforts, many children are already infected with the human immunodeficiency virus (HIV). The objective was to report early clinical and immunologic outcomes of children enrolled in the pediatric treatment program. Open cohort assessment using routinely collected clinical and outcome data from an electronic medical record system in use at 18 government primary health facilities in Lusaka, Zambia. Care was provided primarily by nurses and clinical officers ("physician extenders" akin to physician assistants in the United States). Patients were children (less than 16 years of age) presenting for HIV care between May 1, 2004, and June 29, 2007. The intervention used was a three-drug ART (zidovudine or stavudine plus lamivudine plus nevirapine or efavirenz) for children who met national treatment criteria. The main outcome measures were survival, weight gain, CD4 cell count, and hemoglobin response. After enrollment of 4975 children into HIV care, 2938 (59.1%) started ART. Of those initiating ART, the median age was 81 months (interquartile range, 36-125), 1531 (52.1%) were female, and 2087 (72.4%) with World Health Organization stage information were in stage III or IV. At the time of analysis, 158 children (5.4%) had withdrawn from care and 382 (13.0%) were at least 30 days late for follow-up. Of the remaining 2398 children receiving ART, 198 (8.3%) died over 3018 child-years of follow-up (mortality rate, 6.6 deaths per 100 child-years; 95% confidence interval [CI], 5.7-7.5); of these deaths, 112 (56.6%) occurred within 90 days of therapy initiation (early mortality rate, 17.4/100 child-years; post-90-day mortality rate, 2.9/100 child-years). Mortality was associated with CD4 cell depletion, lower weight-for-age, younger age, and anemia in multivariate analysis. The mean CD4 cell percentage at ART initiation among the 1561 children who had at least 1 repeat measurement was 12.9% (95% CI, 12.5%-13.3%) and increased to 23.7% (95% CI, 23.1%-24.3%) at 6 months, 27.0% (95% CI, 26.3%-27.6%) at 12 months, 28.0% (95% CI, 27.2%-28.8%) at 18 months, and 28.4% (95% CI, 27.4%-29.4%) at 24 months. Care provided by clinicians such as nurses and clinical officers can result in good outcomes for HIV-infected children in primary health care settings in sub-Saharan Africa. Mortality during the first 90 days of therapy is high, pointing to a need for earlier intervention.

Human papillomavirus detection by penile site in young men from Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Diseases. 2007 Nov;34(11):928-934.
Smith JS | Moses S | Hudgens MG | Agot K | Franceschi S
Limited data are available on whether sampling from the penile shaft or urethra increases detection of penile HPV infection in men beyond that found in the glans and coronal sulcus. Within a randomized clinical trial, a validation study of penile sampling was conducted in Kisumu, Kenya. Young men (18-24 years) were invited to provide penile exfoliated cells using prewetted Dacron swabs to determine the best site for HPV detection. ß-Globin gene PCR and HPV DNA type GP5+/6+ PCR status were ascertained from 3 anatomical sites. A total of 98 young HIV-seronegative, uncircumcised men participated. Penile HPV prevalence varied by anatomical site: 50% in penile exfoliated cells from the glans, coronal sulcus, and inner foreskin tissue; 43% in the shaft and external foreskin tissue; and 18% in the urethra (P less than 0.0001). For each anatomical site, over 87% of samples were ß-globin positive. Beyond that found in the glans/coronal sulcus, urethral sampling resulted in no increase in HPV positivity and shaft sampling resulted in an additional 7.3% of overall HPV positivity. The prevalence of high-risk HPV positivity varied by anatomical site: 39% in glans/coronal sulcus, 31% in shaft, and 13% in the urethra (P less than 0.0001). HPV 16 was the most common type identified. Penile HPV prevalence was approximately 50% among young men in Kisumu, Kenya. Urethral sampling for HPV detection in men added no sensitivity for HPV detection over that found from sampling the glans/coronal sulcus and penile shaft. These data will help inform studies on HPV transmission dynamics, and on the efficacy of HPV prophylactic vaccines on penile HPV carriage in men.

Evidence behind the WHO guidelines: Hospital care for children: What are the risks of HIV transmission through breastfeeding?
(Abstract; subscription needed for full text; Global)
Journal of Tropical Pediatrics. 2007 Oct;53(5):298-302.
Bulteel N | Henderson P
The World Health Organization (WHO) has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHO's recommendations. This review addresses the question: What are the risks of HIV transmission through breastfeeding? The WHO Pocketbook of Hospital Care for Children estimates the additional risk of mother-to-child transmission (MTCT) of HIV through breastfeeding without interventions to be 5-20%. This risk varies depending on duration and method of breastfeeding, and also because of differences in population characteristics, such as maternal and CD4+ cell counts and RNA viral load.

"A bull cannot be contained in a single kraal": Concurrent sexual partnerships in Botswana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS and Behavior. 2007 Nov;11(6):822-830.
Carter MW | Kraft JM | Koppenhaver T | Galavotti C | Roels TH
To inform efforts to curb HIV in Botswana, we describe sexual concurrency and related norms and behaviors among a sample of 807 Botswana age 15-49 years who participated in a 2003 population-based survey. Of 546 sexually active respondents, 23% reported ever having a concurrent sexual partnership with any of the last three partners from the last 12 months. Multivariate analysis found that men and youth (age less than 25 years), and non-religious people were more likely than their respective counterparts to report concurrency. Respondents reporting concurrency were more likely than those not, to have norms that support multiple partnerships and report low self-efficacy to be faithful to one partner. However, a majority of both groups reported believing that fidelity is important and that they would be looked down upon by family and friends if discovered to have multiple partnerships. The findings suggest that concurrency in Botswana is not uncommon, and yet may not be generally acceptable.

A model for adapting evidence-based behavioral interventions to a new culture: HIV prevention for psychiatric patients in Rio de Janeiro, Brazil
(Abstract; subscription needed for full text; South America)
AIDS and Behavior. 2007 Nov;11(6):872-883.
Wainberg ML | McKinnon K | Mattos PE | Pinto D | Mann CG
As in other countries worldwide, adults with severe mental illness in Brazil have elevated rates of HIV infection relative to the general population. However, no HIV prevention interventions have been tested for efficacy with psychiatric patients in Brazil. We conducted participatory research with local providers, community leaders, patient advocates, and patients using an intervention adaptation process designed to balance fidelity to efficacious interventions developed elsewhere with fit to a new context and culture. Our process for adapting these interventions comprised four steps: (1) optimizing fidelity; (2) optimizing fit; (3) balancing fidelity and fit; and (4) pilot testing and refining the intervention. This paper describes how these steps were carried out to produce a Brazilian HIV prevention intervention for people with severe mental illness. Our process may serve as a model for adapting existing efficacious interventions to new groups and cultures, whether at a local, national, or international level.

MATERNAL AND CHILD HEALTH NEWS

Nigeria: Delivering women from maternal mortality
(Editorial; Sub-Saharan Africa)
6 Nov 2007
Saraki T, This Day (Lagos)

Zimbabwe: Marondera women resist maternity fees top up
(News Article; Sub-Saharan Africa)
7 Nov 2007
The Herald (Herare)

Namibia: Maternal mortality rate up
(News Article; Sub-Saharan Africa)
5 Nov 2007
Tjaronda W, New Era (Windhoek)
The Namibian government will have to roll out emergency obstetric care to reduce the current maternal mortality rate by three quarters by the year 2015, the United Nations Children's Fund (Unicef) said. At the current rate of reduction of 2.1 percent, UNICEF says Namibia would require 40 years to reach the Millennium Development Goals of reducing child mortality and improving maternal health. The maternal mortality rate has increased from 271 per 100 000 births to 449 deaths per 100 000 live births in six years.

Kenya: Fistula affects 5,000 women at delivery
(News Article; Sub-Saharan Africa)
2 Nov 2007
Mwaie E, The East African Standard
More than 5,000 women in Kenya experience complications during delivery leading to a condition referred to as obstetric fistula. The problem occurs when a pregnant woman goes through prolonged labour, causing damage on the birth which then results in a hole either between the birth canal and bladder or between the birth canal and rectum.

MATERNAL AND CHILD HEALTH RESEARCH

Invasive pneumococcal disease burden and implications for vaccine policy in urban Bangladesh
(Abstract; subscription needed for full text; Asia)
American Journal of Tropical Medicine and Hygiene. 2007 Nov;77(5):795-801.
Brooks WA | Breiman RF | Goswami D | Hossain A | Alam K
The authors undertook active population-based surveillance in 5,000 urban households among children less than 5 years old to determine invasive pneumococcal disease (IPD) incidence, serotype distribution, clinical presentation, and antimicrobial resistance, which have not been previously described in population-based studies from the region. IPD was documented by blood culture isolation. From 01 April 2004 to 31 March 2006, 5,903 blood cultures were collected from 6,167 eligible children. Streptococcus pneumoniae was isolated from 34 pneumococcal patients; IPD was clinically associated with pneumonia (24%), upper respiratory infection (62%), and febrile syndromes (14%). Overall, IPD and 13-valent serotype-related IPD incidences were 447 and 276 episodes/100,000 child-years, respectively. Peak IPD incidence occurred during the cool dry seasons. Penicillin, cotrimoxazole, chloramphenicol, and ciprofloxacin resistances were 2.9%, 82.4%, 14.7%, and 24.1%, respectively. Current conjugate vaccines should substantially reduce IPD, childhood pneumonia, and antimicrobial resistance in Bangladesh.

The relationship of intrapartum and antepartum stillbirth rates to measures of obstetric care in developed and developing countries
(Abstract; subscription needed for full text; Global)
Acta Obstetricia et Gynecologica Scandinavica. 2007 Nov;86(11):1303-1309.
Goldenberg RL | McClure EM | Bann CM
The objective of this study was to explore the relationship between intrapartum and antepartum stillbirths and various measures of obstetric care in developing and developed countries. For 51 countries, the authors obtained data about intrapartum and antepartum stillbirth rates and obstetric care measures from the World Health Organisation (WHO) and other sources. Using piecewise regression techniques, the relationships between the intrapartum and antepartum stillbirth rates and the various measures of obstetric care were determined. Developed countries had lower total stillbirth rates (6.0 versus 21.3/1,000 births, p = 0.0002) as well as a lower fraction of stillbirths that were intrapartum (0.16 versus 0.31, p = 0.0019). Developed country antepartum stillbirth rates were 5.2 versus 14.0/1,000 in developing countries (p = 0.0002). The highest antepartum stillbirth rates, all in southern Africa and Asia, ranged from 25 to 35/1,000 births. Intrapartum stillbirth rates averaged 0.9/1,000 births for developed countries compared to 7.3/1,000 in developing countries (p = 0.0024), but ranged as high as 20-25/1,000 births for some countries in southern Africa and Asia. The relationship between intrapartum stillbirth and the various measures of care were generally stronger than those for antepartum stillbirth. Over the entire range of values, for each 1% increase in the percentage of women with at least 4 antenatal visits, the intrapartum stillbirth rate decreased by 0.16 per 1,000 births (p less than 0.0001). As cesarean section rates increased from 0 to 8%, for each 1% increase, there was a decrease of 1.61 intrapartum stillbirths per 1,000 births. There was no relationship between the cesarean section rates and intrapartum stillbirth rates in developed countries. The intrapartum stillbirth rate is more closely related to various measures of obstetric care than the antepartum stillbirth rate. Increases in cesarean section rates up to 8% are associated with significant improvements in intrapartum stillbirth rates.

Maternal mortality decline in the Kassena-Nankana district of nothern Ghana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Maternal and Child Health Journal. 2007 Oct 24;
Mills S | Williams JE | Wak G | Hodgson A
In the absence of an adequate vital registration system in Ghana, the Navrongo demographic surveillance system (NDSS) established in 1993 presents a viable alternative to monitor, in a poor rural district, the UN Millennium Development Goal on maternal health (MDG) of reducing maternal mortality by 75% between 1990 and 2015. Methods: Of the 518 women aged 12-49 years identified in the NDSS database to have died in the Kassena-Nankana district in the period January 2002-December 2004, spouses or family members completed verbal autopsy interviews for 516 female deaths. Results Of the 516 female deaths, 45 were identified as maternal deaths. 71% of the maternal deaths were attributed to direct maternal causes while 29% were due to indirect maternal causes. Abortion-related deaths were the most frequent cause of maternal deaths. The maternal mortality ratio for the period 2002-2004 was 373 maternal deaths per 100,000 live births indicating a 40% reduction of maternal mortality from the 1995-1996 level of 637 maternal deaths per 100,000 live births. However, the health-facility based maternal mortality ratio in the district (which excludes maternal deaths outside health facilities) was 141 maternal deaths per 100,000 live births for the period 2002-2004. Conclusion This district may be on track to achieve the MDG on maternal health. Ultimately, strengthening vital registration systems to provide timely information to policymakers should supersede the other methods of measuring maternal mortality.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

China: Most only-child couples want one child
(News Article; Asia)
6 Nov 2007
Ying W, China Daily

China: Year of Pig leads to spike in birthrate
(News Article; Asia)
8 Nov 2007
China Daily

Israel: Birthrate up for Jews, down for Muslims
(News Article; Middle East)
6 Nov 2007
Siegel-Itzkovich J, The Jerusalem Post

Russia: Primorye specialists developed plan to increase population
(News Article; Asia)
5 Nov 2007
Vladivostok Times

Israel: Jewish births lead rise in Israeli fertility rates in 2006
(News Article; Middle East)
7 Nov 2007
Bassok M, Haaretz

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

The effects of high HIV prevalence on orphanhood and living arrangements of children in Malawi, Tanzania, and South Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Population Studies. 2007 Nov;61(3):327-336.
Hosegood V | Floyd S | Marston M | Hill C | McGrath N
Using longitudinal data from three demographic surveillance systems (DSS) and a retrospective cohort study, we estimate levels and trends in the prevalence and incidence of orphanhood in South Africa, Tanzania, and Malawi in the period 1988-2004. The prevalence of maternal, paternal, and double orphans rose in all three populations. In South Africa - where the HIV epidemic started later, has been very severe, and has not yet stabilized - the incidence of orphanhood among children is double that of the other populations. The living arrangements of children vary considerably between the populations, particularly in relation to fathers. Patterns of marriage, migration, and adult mortality influence the living and care arrangements of orphans and non-orphans. DSS data provide new insights into the impact of adult mortality on children, challenging several widely held assumptions. For example, we find no evidence that the prevalence of child-headed households is significant or has increased in the three study areas.

Darfurian livelihoods and Libya: Trade, migration, and remittance flows in times of conflict and crisis
(Abstract; subscription needed for full text; North Africa)
International Migration Review. 2007 Dec;41(4):826-849.
Young H | Osman A | Dale R
Labor migration and commerce between Sudan and Libya have long been features of livelihoods in Darfur. This paper describes the importance of historical trade and migration links between Darfur and Libya, and provides a background to the political and economic situation in Libya which has influenced opportunities for Sudanese migrant workers. A case study of the situation of the Darfurian migrants in Kufra (an oasis and transnational trade hub in southern Libya) illustrates how the recent Darfur conflict has affected migration patterns from Darfur and remittance flows in the opposite direction. Official estimates of Darfurian migrant workers in Libya were unavailable but were estimated to be between 150,000 and 250,000. The closure of the national border between Sudan and Libya in May 2003, largely a result of insecurity in Darfur, stopped the traffic of migrant workers between northern Darfur and southern Libya (which prevented the onward travel to Sudan of several thousand migrants in Kufra), and curtailed the well-established trade routes, communications, and remittance flows. The current limited economic prospects for migrant workers in Libya, combined with the threat of detention, difficulties of return to Sudan, and loss of contact with and uncertainty about the fate of their families in Darfur, have created a sense of despair among many Darfurians. The paper concludes with a series of recommendations to improve the conditions of the Darfurian migrants in Libya, including an amnesty for illegal migrants, and also to ease the travel of migrants, promote communications between Libya and Darfur, and support the flow of remittances.

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Volume 7, Number 4312 November 2007