Volume 7, Number 48
17 December 2007

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ADOLESCENT HEALTH NEWS

Bangladesh: Taking care of the adolescents
(Commentary; Asia)
12 Dec 2007
The New Nation

Philippines: Youth peer counsellors in Biliran attend first general assembly
(News Article; Asia)
14 Dec 2007
Victoria R , Philippine Information Agency

Vietnam: 7.6% of young people have pre-marital sex
(News Article; Asia)
12 Dec 2007
VietNamNet Bridge

ADOLESCENT HEALTH RESEARCH

Jamaican Youth and Resiliency Behaviour Survey 2006: Community-based survey on risk and resiliency behaviours of 15-19 year olds
(Report; Central America and the Caribbean)
Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2007 Nov. [107] p. (Array)
Wilks R | Younger N | McFarlane S | Francis D | Van Den Broeck J
The Jamaica Youth Risk and Resiliency Behaviour Survey, a collaborative effort of the University of the West Indies (UWI), Mona, the Jamaican Ministry of Health (MoH), and United States Agency for International Development/Jamaica Caribbean (USAID/J-CAR), with technical assistance from the MEASURE Evaluation Project, gathered information from 1318 participants (599 males and 721 females) island-wide who were 15 - 19 years of age. The main objectives of the survey were to: describe lifestyle and behaviour patterns (exercise, cigarette smoking and alcohol consumption) by demographic and socio-economic characteristics; determine and document the context of adolescent reproductive and sexual health, including the magnitude, determinants and consequences for adolescents' lives; determine the association between resiliency and markers of abnormal mental health on risk-taking behaviours, including involvement in violence; obtain anthropometric measurements, fasting glucose levels and cholesterol levels in youth and relate these to chronic disease risks; and identify the sources of information influencing adolescents' health and health seeking behaviour. The study provides important data on the health status, health seeking behaviour, risk and resiliency factors affecting Jamaican youth. Protective factors, such as improved educational levels, parental involvement and expectations, and positive mental health trends should be augmented in order to improve reproductive and sexual health outcomes, reduce risky behaviors, and inform subsequent adolescent health policy and programmes.

Predictive factors for organic central precocious puberty and utility of simplified gonadotropin-releasing hormone tests
(Abstract; subscription needed for full text; Global)
Pediatrics International. 2007 Dec;49(6):806-810.
Choi JH | Shin YL | Yoo HW
The aim of the present study was to determine whether the clinical presentation of patients with central precocious puberty (CPP) permits differentiation between idiopathic and organic forms, and to examine whether luteinizing hormone (LH) determination in single blood sample after gonadotropin-releasing hormone (GnRH) administration is sufficient to diagnose CPP. Potential clinical and laboratory predictors for the presence of central nervous system (CNS) abnormalities were assessed. Sensitivities and specificities of LH and follicle-stimulating hormone (FSH) levels at 0, 15, 30, 60, 90 and 120 min were compared after GnRH stimulation. In 45 girls with signs of breast development, 26 were diagnosed as having CPP. The age of onset in patients with organic CPP was 4.75 plus or minus 2.01 years (range 1.2 - 7.1 years, median 5.0 years), whereas the age in patients with idiopathic CPP was 7.09 plus or minus 0.87 years (range 5.0 - 7.9 years, median 7.0 years). This parameter is the only one showing statistical significance. In addition, the specimen at 30 min after GnRH stimulation yielded highest sensitivity for the diagnosis of CPP. The earlier the onset of disease, the higher the possibility of presence of CNS lesion. According to the mean GnRH-stimulated LH levels and sensitivity at each time, a single blood sample obtained for LH determined after GnRH administration at 30 min can be used to diagnose CPP.

The influence of disclosure of HIV diagnosis on time to disease progression in a cohort of Romanian children and teens
(Abstract; subscription needed for full text; Europe)
AIDS Care. 2007 Oct;19(9):1088-1094.
Ferris M | Burau K | Schweitzer AM | Mihale S | Murray N
The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that in 2004, there were 39.4 million people living with HIV/AIDS worldwide (UNAIDS/WHO Report on the global HIV/AIDS epidemic, 2004). Children less than 15 years of age comprise 2.2 million of these individuals. As more children globally gain access to highly active antiretroviral therapy (HAART), more children are growing to the age when disclosure of their HIV status is inevitable. This information may affect a child's disease trajectory, and in the context of HAART, may have wide-ranging impact in the management of paediatric HIV infection. This study is an investigation of the effect of disclosure of a child's own HIV infection status on death and CD4 decline in a cohort of 325 HIV-infected Romanian children receiving highly active antiretroviral therapy (HAART). A retrospective database analysis was conducted. Data from a nearly three-year period were examined. Children who were aware of their HIV diagnosis were compared with those who were not aware. We found significant associations between not knowing the HIV diagnosis and death, and not knowing the HIV diagnosis and disease progression defined as either death or CD4 decline. Our results imply that in the context of HAART, knowledge of one's own HIV infection status is associated with delayed HIV disease progression.

FAMILY PLANNING NEWS

Niger: Population explosion threatens development gains
(News Article; Sub-Saharan Africa)
11 Dec 2007
Niamey, UN Integrated Regional Information Networks

Ethiopia: Country to provide family planning for over 8 million citizens
(News Article; Sub-Saharan Africa)
12 Dec 2007
The Daily Monitor

China: Baby boom set to start next year
(News Article; Asia)
12 Dec 2007
Chuanjiao X, China Daily

FAMILY PLANNING RESEARCH

Modern management of abnormal uterine bleeding -- the levonorgestrel intra-uterine system
(Abstract; subscription needed for full text; Global)
Best Practice and Research Clinical Obstetrics and Gynaecology. 2007 Dec;21(6):1007-1021.
Mansour D
Since its launch, more than 9 million women worldwide have used the levonorgestrel intra-uterine system (IUS) for contraception, as a treatment for heavy menstrual bleeding and as the progestogen component of hormone-replacement therapy. For women in their reproductive years, the IUS has become one of the most acceptable medical treatments for menorrhagia, reducing referrals to specialists and decreasing the need for operative gynaecological surgery. This article will outline the development of the IUS, highlighting the most important recent areas of research covering its use to control menstrual blood loss and pain.

Commandos do not use condoms
(Abstract; subscription needed for full text; Europe)
International Journal of STD and AIDS. 2007 Dec;18(12):823-826.
Baser M | Tasci S | Albayrak E
The aim of this study was to determine private soldiers' knowledge and attitudes about the use of condoms. This study includes privates discharged from the Zincidere 1st Commando Brigade, Kayseri, Turkiye. This study was composed of volunteers (n = 481) who were present at their Brigade at the time of the research. Data were collected with a questionnaire. It was found that 44.7% of the privates had not used a condom. Reasons for not using a condom included the following: lack of enjoyment and feeling of discomfort, belief in its unreliability and the difficulty of obtaining one. Privates stated that they had knowledge regarding protection against sexually transmitted diseases (95.8%), the importance of always using condoms (84.8%) and the importance of having a single partner (60.7%). The results of this study show that although knowledge of condoms is relatively good, they are not widely used.

Are Africans practicing safer sex? Evidence from demographic and health surveys for eight countries
(Abstract; subscription needed for full text; North Africa | Sub-Saharan Africa)
Economic Development and Cultural Change. 2008 Jan;56(2):397-439.
Glick PJ | Sahn DE
HIV/AIDS prevalence is higher in Africa than in any other region. Yet despite increasing commitment on the part of the international community and many African governments, there remain few cases of documented success in turning back the epidemic. In recent years, attention and resources have increasingly been focused on providing antiretroviral (ARV) drug therapies to the millions of infected people in Africa. However, ARV provision is not an HIV-prevention policy, and while there may be positive externalities with respect to prevention, there may also be negative ones. Nor is an AIDS vaccine likely to appear for years to come. Therefore, HIV prevention through reductions in sexual risk behaviors remains the cornerstone of any strategy to combat HIV/AIDS in Africa.

GENDER and HEALTH NEWS

Uganda: Kapchorwa district seeks to end female circumcision
(News Article; Sub-Saharan Africa)
12 Dec 2007
Mafabi, D, The Monitor (Kampala)

Awareness-raising key to tackling gender violence
(News Article; Global)
11 Dec 2007
IRIN

South Africa: Joburg men pledge to stand against abuse
(News Article; Sub-Saharan Africa)
11 Dec 2007
Mbola, B, BuaNews (Tshwane)

Botswana: How Zim women suffer sexual abuse in Botswana
(News Article; Sub-Saharan Africa)
10 Dec 2007
Baputaki, C, Mmegi (Gaborone)

GENDER and HEALTH RESEARCH

Genital tuberculosis: An important cause of Asherman's syndrome in India
(Abstract; subscription needed for full text; Asia)
Archives of Gynecology and Obstetrics. 2008 Jan;277(1):37-41.
Sharma JB | Roy KK | Pushparaj M | Gupta N | Jain SK
The objective was to demonstrate the association between genital endometrial tuberculosis and Asherman's syndrome. A total of 28 women who underwent hysteroscopy with or without laparoscopy for suspected Asherman's syndrome from symptoms (amenorrhoea or oligomenorrhoea, and or primary or secondary infertility) and who were found to have genital tuberculosis on endometrial biopsy (histopathology or culture) or positive polymerase chain reaction (PCR) on endometrial aspirate or positive findings of tuberculosis on laparoscopy or hysteroscopy were enrolled in this retrospective study. The mean age and parity were 26.5 years and 0.3, respectively. There was past history of TB in 67.8% women. All women had menstrual dysfunction, with oligomenorrhoea and hypomenorrhoea in 16 (57%) women and amenorrhoea in 12 (42.8%). All women had primary (n = 19, 67.8%) or secondary (n = 9, 32%) infertility. On hysteroscopy, there were various grades of adhesions in all women, with grade I in 17.8%, grade II in 28.5%, grade III in 28.5% and grade IV in 17.5% women. Only four women (14.3%) had open ostia, while others had bilateral (28.5%) or unilateral (21.3%) blocked ostia or inability to see ostia (28.5%). On laparoscopy performed on 18 women, there were varying grades of adhesions in 16 (88.8%) women, with beading (33.3%), tubercles (33.3%), caseation (11.1%) and tubo-ovarian masses (11.1%). The diagnosis of genital TB was made by histopathology (tuberculous granuloma) on endometrial biopsy in 28.6%, positive culture in 3.6%, positive polymerase chain reaction (PCR) in 46.4% and observation of tubercles, beading or caseation on laparoscopy in 17.8% or shaggy cavity with caseation on hysteroscopy in 3.6% women. Genital tuberculosis appears to be an important and common cause of Asherman's syndrome in India, causing oligomenorrhoea or amenorrhoea with infertility.

The association of tea consumption with ovarian cancer risk: A metaanalysis
(Abstract; subscription needed for full text; Asia)
American Journal of Obstetrics and Gynecology. 2007 Dec;197(6):594.e1-594.e6.
Zhou B | Yang L | Wang L | Shi Y | Zhu H
This metaanalysis was undertaken to evaluate the relationship between tea intake and ovarian cancer risk. A systematic literature search up to September 2006 was performed in Medline, Embase, CANCERLIT, and the Cochrane Database. The summary relative risk was calculated. A sensitivity analysis was conducted to test the influence of each single study. Heterogeneity and publication bias were also evaluated. Two cohort and 7 case-control studies were included. The combined relative risk did not show that tea consumption was associated with a reduced ovarian cancer risk (relative risk, 0.84; 95% confidence interval, 0.66-1.07). When the analyses were stratified into subgroups, there was no evidence that study design substantially influenced the estimate of effects. The sensitivity analysis which means removing one study at a time confirmed the stability of our results. Our findings did not support that tea consumption was related to the decreased risk of ovarian cancer.

HIV/AIDS and STIs NEWS

Factbook-AIDS in South Africa
(News Article; Sub-Saharan Africa)
7 Dec 2007
Cutler D, Reuters

United States: Lawmakers, specialists debate AIDS prevention funds
(News Article; North America)
12 Dec 2007
Donnelly J, The Boston Globe

'Best-kept secret' for HIV-free Africa: Birth control better than drugs, researchers say
(News Article; Sub-Saharan Africa)
16 Dec 2007
Timberg C, Washington Post

South Africa: Panelists push for e-health
(News Article; Sub-Saharan Africa)
13 Dec 2007
Nabwowe A, Highway Africa News Agency/ AllAfrica

HIV/AIDS and STIs RESEARCH

Care arrangements, grief and psychological problems among children orphaned by AIDS in China
(Abstract; subscription needed for full text; Asia)
AIDS Care. 2007 Oct;19(9):1075-1082.
Zhao G | Li X | Fang X | Zhao J | Yang H
The China Ministry of Health has estimated that there are at least 100,000 AIDS orphans in China. The UNICEF China Office estimates that between 150,000 and 250,000 additional children will be orphaned by AIDS over the next five years. However, limited data are available regarding the sociodemographic characteristics, care arrangements, barriers to appropriate grief resolution and psychological problems among AIDS orphans in China. In this article, we review secondary data and reports from scientific literature, government, non-governmental organisations and public media regarding children orphaned by AIDS in China to address their living situation, bereavement process and psychological problems. Our review suggests that AIDS orphans in China are living in a stressful environment, with many orphans struggling with psychological problems and unmet basic needs such as food, shelter, education and medical care. Based on our review, we suggest that future studies should address the psychosocial needs of AIDS orphans in China and develop health promotion programmes to mitigate the negative impact of parental death on the physical and psychosocial well-being of these orphans.

AIDS epidemic update, December 2007
(Report; Global)
(You need Adobe Acrobat Reader to access this document)
Geneva, Switzerland, UNAIDS, 2007 Dec. 50 p. (UNAIDS/07.27E / JC1322E)
Every day, over 6800 persons become infected with HIV and over 5700 persons die from AIDS, mostly because of inadequate access to HIV prevention and treatment services. The HIV pandemic remains the most serious of infectious disease challenges to public health. Nonetheless, the current epidemiologic assessment has encouraging elements since it suggests: the global prevalence of HIV infection (percentage of persons infected with HIV) is remaining at the same level, although the global number of persons living with HIV is increasing because of ongoing accumulation of new infections with longer survival times, measured over a continuously growing general population; there are localized reductions in prevalence in specific countries; a reduction in HIV-associated deaths, partly attributable to the recent scaling up of treatment access; and a reduction in the number of annual new HIV infections globally. Examination of global and regional trends suggests the pandemic has formed two broad patterns: generalized epidemics sustained in the general populations of many sub-Saharan African countries, especially in the southern part of the continent; and epidemics in the rest of the world that are primarily concentrated among populations most at risk, such as men who have sex with men, injecting drug users, sex workers and their sexual partners.

The protective effect of male circumcision on HIV infection in a sample of Kenyan men
(Abstract; subscription needed for full text; Sub-Saharan Africa)
African Journal of AIDS Research. 2007 Dec;6(3):199-204.
Djamba Y | Davis L
This article examines the association between male circumcision and HIV infection in a national sample. The analysis is based on the 2003 Kenya Demographic and Health Survey (KDHS), a nationally representative household-based population survey of adults, in which male respondents self-reported their circumcision status. In addition, in some households eligible for individual interview, blood samples were subsequently anonymously obtained for HIV testing, making this the first study linking socio-demographic information to HIV status at the national level. The study sample is limited to 3 413 men aged 15-54 years who gave valid information on their circumcision and HIV statuses. Nearly 5% of the men were HIV-positive, and 86% had been circumcised. HIV prevalence was significantly higher among the uncircumcised men (12%) than among the circumcised men (3%). This indication of the protective effect of male circumcision on HIV infection remained statistically significant(OR 0.15; 95%CI: 0.09-0.23) even after controlling for the effects of socio-demographic variables, age at first sexual intercourse, and use of paid sex. Based on these results, we recommend that HIV-prevention advocates and activists, scholars, bio-medical communities and political leaders find ways to include this oldest surgical procedure in their HIV/AIDS discourses and programmes in sub-Saharan Africa.

Feelings related to motherhood among women living with HIV in Brazil: A qualitative study
(Abstract; subscription needed for full text; South America)
AIDS Care. 2007 Oct;19(9):1095-1100.
Hebling EM | Hardy E
A qualitative study was carried out with 12 HIV-positive women to describe their feelings about motherhood, to learn whether they make plans for the care of their children, and to identify mechanisms of defence they use to face their seropositivity. Motherhood was seen as an essential attribute of women and a reason of living. Breastfeeding was considered a fundamental component of the maternal role. Some women made provisions with their family for the care of their children. Thinking about the possibility of their children becoming orphans made women feel impotent and guilty. Such painful feelings were minimized through mechanisms of defence like compensation, denial, rationalization and projection. Health care professionals should consider that clinical assistance and free distribution of medication are not sufficient to HIV-positive women. These women need continuous support and guidance with respect to their physical, mental and emotional health as well as that of their children.

Costs and health consequences of chlamydia management strategies among pregnant women in sub-Saharan Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2007 Dec 1;83(7):558-566.
Romoren M | Hussein F | Steen TW | Velauthapillai M | Sundby J
Chlamydia is the most common bacterial sexually transmitted infection worldwide and a major cause of morbidity-particularly among women and neonates. We compared costs and health consequences of using point-of-care (POC) tests with current syndromic management among antenatal care attendees in sub-Saharan Africa. We also compared erythromycin with azithromycin treatment and universal with age-based chlamydia management. A decision analytical model was developed to compare diagnostic and treatment strategies, using Botswana as a case. Model input was based upon (1) a study of pregnant women in Botswana, (2) literature reviews and (3) expert opinion. We expressed the study outcome in terms of costs (US$), cases cured, magnitude of overtreatment and successful partner treatment. Azithromycin was less costly and more effective than erythromycin. Compared with syndromic management, testing all attendees on their first visit with a 75% sensitive POC test increased the number of cases cured from 1500 to 3500 in a population of 100 000 women, at a cost of US$38 per additional case cured. This cost was lower in high-prevalence populations or if testing was restricted to teenagers. The specific POC tests provided the advantage of substantial reductions in overtreatment with antibiotics and improved partner management. Using POC tests to diagnose chlamydia during antenatal care in sub-Saharan Africa entails greater health benefits than syndromic management does -- and at acceptable costs -- especially when restricted to younger women. Changes in diagnostic strategy and treatment regimens may improve people's health and even reduce healthcare budgets.

Fertility desire and family-planning demand among HIV-positive women and men undergoing antiretroviral treatment in Addis Ababa, Ethiopia
(Abstract; subscription needed for full text; Sub-Saharan Africa)
African Journal of AIDS Research. 2007 Dec;6(3):223-227.
Tamene W | Fantahun M
Little information exists about desire to have children and family-planning use among HIV-positive individuals and how this may vary according to individual, social, health and demographic characteristics, especially in developing countries. To assess these topics in Ethiopia, a facility-based cross-sectional study was undertaken among 460 HIV-positive individuals receiving follow-up care at antiretroviral treatment (ART) centres in six public hospitals in Addis Ababa in 2006. One hundred and nine of the women (44.7%), 76 of the men (35.2%), and 40.2% overall of the HIV-positive individuals receiving care desired to have children. In comparison to those who said they did not desire to have children, those who did desire children tended to be younger (18-29 years) (adjusted odds ratio [OR]: 3.05, 95% CI: 1.5-6.4), married or in a relationship (adjusted OR: 3.4, 95% CI: 2.1-5.6), without a child (adjusted OR: 11.5, 95% CI: 5.3-24.9), and with a partner who also desired to have children (adjusted OR: 38.7, 95% CI: 16.7-89.1). Two hundred and forty-six individuals (53.5%) were using family planning (e.g. condoms, abstinence, injectables) and 85 wanted to use family planning in the future. The fertility desire and family-planning needs of these ART clients have implications for preventing vertical and heterosexual transmission of HIV, and the need for appropriate counselling and delivery of services.

Microbicides in human trials: Making successful advances 2007
(Teaching and Training Material; Global)
Washington, DC, USAID, 2007.
USAID
This presentation is an introduction to microbicides that covers the following: what is a microbicide, how does HIV infect the vagina, how does the vagina defend itself, how do microbicides work, who is involved in development, what is the development process, what is USAID's microbicide program, at what stage is the program and what are future prospects, what else is possible, and what are the key issues.

MATERNAL AND CHILD HEALTH NEWS

Ghana: High maternal mortality must be curbed - it affects socio economic development
(News Article; Sub-Saharan Africa)
10 Dec 2007
Alhassan I, Ghanaian Chronicle

Uganda: When pregnancy comes too soon after childbirth
(News Article; Sub-Saharan Africa)
10 Dec 2007
Nabusoba I, New Vision (Kampala)

UN says India must reduce child mortality rates
(News Article; Asia)
10 Dec 2007
Pasricha A, Voice of America

MATERNAL AND CHILD HEALTH RESEARCH

Use pattern of maternal health services and determinants of skilled care during delivery in southern Tanzania: Implications for achievement of MDG-5 targets
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMC Pregnancy and Childbirth. 2007 Dec 6;7:29.
Mpembeni RN | Killewo JZ | Leshabari MT | Massawe SN | Jahn A
Almost two decades since the initiation of the Safe Motherhood Initiative, maternal mortality is still soaring high in most developing countries. In 2000 WHO estimated a lifetime risk of a maternal death of 1 in 16 in sub-Saharan Africa while it was only 1 in 2800 in developed countries. This huge discrepancy in the rate of maternal deaths is due to differences in access and use of maternal health care services. It is known that having a skilled attendant at every delivery can lead to marked reductions in maternal mortality. For this reason, the proportion of births attended by skilled health personnel is one of the indicators used to monitor progress towards the achievement of the MDG-5 of improving maternal health. A cross sectional study was used which employed quantitative research methods. We interviewed 974 women who gave birth within one year prior to the survey. Although almost all (99.8%) attended ANC at least once during their last pregnancy, only 46.7% reported to deliver in a health facility and only 44.5% were assisted during delivery by a skilled attendant. Distance to the health facility (OR=4.09 (2.72-6.16), discussion with the male partner on place of delivery (OR=2.37(1.75-3.22), advise to deliver in a health facility during ANC (OR=1.43 (1.25-2.63) and knowledge of pregnancy risk factors (OR 2.95 (1.65-5.25) showed significant association with use of skilled care at delivery even after controlling for confounding factors. Use of skilled care during delivery in this district is below the target set by ICPD + of attaining 80% of deliveries attended by skilled personnel by 2005. We recommend the following in order to increase the pace towards achieving the MDG targets: To improve coverage of health facilities, raising awareness for both men and women on danger signs during pregnancy/delivery and strengthening counseling on facility delivery and individual birth preparedness.

HIV-infected children living in Central Africa have low persistence of antibodies to vaccines used in the expanded program on vaccination
(Research Article; Sub-Saharan Africa)
PLoS One. 2007 Dec 5;2(12):[8] p..
Tejiokem MC | Gouandjika I | Beniguel L | Zanga MC | Tene G
The Expanded Program on Immunization (EPI) is the most cost-effective measures to control vaccine-preventable diseases. Currently, the EPI schedule is similar for HIV-infected children; the introduction of antiretroviral therapy (ART) should considerably prolong their life expectancy. To evaluate the persistence of antibodies to the EPI vaccines in HIV-infected and HIV-exposed uninfected children who previously received these vaccines in routine clinical practice, we conducted a cross-sectional study of children, aged 18 to 36 months, born to HIV-infected mothers and living in Central Africa. We tested blood samples for antibodies to the combined diphtheria, tetanus, and whole-cell pertussis (DTwP), the measles and the oral polio (OPV) vaccines. We enrolled 51 HIV-infected children of whom 33 were receiving ART, and 78 HIV-uninfected children born to HIV-infected women. A lower proportion of HIV-infected children than uninfected children had antibodies to the tested antigens with the exception of the OPV types 1 and 2. This difference was substantial for the measles vaccine (20% of the HIV-infected children and 56% of the HIV-exposed uninfected children, p less than 0.0001). We observed a high risk of low antibody levels for all EPI vaccines, except OPV types 1 and 2, in HIV-infected children with severe immunodeficiency (CD4+ T cells less than 25%). Children were examined at a time when their antibody concentrations to EPI vaccines would have still not undergone significant decay. However, we showed that the antibody concentrations were lowered in HIV-infected children. Moreover, antibody concentration after a single dose of the measles vaccine was substantially lower than expected, particularly low in HIV-infected children with low CD4+ T cell counts. This study supports the need for a second dose of the measles vaccine and for a booster dose of the DTwP and OPV vaccines to maintain the antibody concentrations in HIV-infected and HIV-exposed uninfected children.

Effect of narghile and cigarette smoking on newborn birthweight
(Abstract; subscription needed for full text; Middle East)
BJOG: An international journal of obstetrics and gynaecology. 2008 Jan;115(1):91-97.
Tamim H | Yunis KA | Chemaitelly H | Alameh M | Nassar AH
The objective was to assess the effect of narghile smoking on the weight of newborns. The design used was a historical retrospective cohort. The setting for the study was six major hospitals in Greater Beirut, Lebanon. The population used was consecutive singleton newborns delivered from August 2000 to August 2003. Obstetric and nursery charts were reviewed to obtain information about maternal and neonatal variables. Information concerning initiation of smoking, dose of smoking, smoking habits during pregnancy, and socio-demographic characteristics was collected through interviews with mothers. The main outcome measures were low birthweight and newborn birthweight. Exclusive narghile smokers constituted 4.4% (378/8592) of women. Multiparas were significantly more likely to smoke cigarettes and narghile. Mothers smoking narghile more than once per day were at 2.4 increased odds of having low birthweight infants compared with nonsmoking mothers (OR 2.4; 95% CI 1.2-5.0) after adjusting for confounding variables. No difference was noted between women smoking narghile in the first trimester and those initiating smoking in subsequent trimesters regarding low birthweight. Narghile smoking more than once per day increases the odds of low birthweight by a 2.4-fold compared with nonsmokers, although to a lesser extent than cigarette smoking.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Costa Rica: Fertility rate at record low
(News Article; Central America and the Caribbean)
11 Dec 2007
Leff A, Tico Times

Yemen: PM warns of population growth on social, economic security
(News Article; Middle East)
10 Dec 2007
Saba Net

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Social mobility and fertility
(Abstract; subscription needed for full text; Global)
Demographic Research. 2007 Dec 4;17(15):441-464.
Zuanna GD
Intra- and inter-generational social mobility have in the past played an important role in attempts to explain fertility behaviour, and continue to do so today. The opinions expressed by social scientists in the first part of the 20th century are renewed and confirmed. More specifically: (1) intra-generational social mobility has been reinforced by the personal well-being aspirations and job careers of women; (2) status anxiety parents feel for their children pushes fertility down in large areas of the developed world (mainly in southern European and eastern Asian countries). Therefore, the provocative idea of Ariès that in the rich world, the child-king has now been replaced by the couple-queen does not perfectly hold.

Self-settled refugees in Uganda: An alternative approach to displacement?
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Refugee Studies. 2007 Dec;20(4):599-620.
Hovil L
This paper investigates the complex security and economic dynamics that influence the lives and opportunities of self-settled refugees living in Uganda. It focuses on the opportunities and problems faced by self-settled refugees, and questions the assumption that Uganda's current local settlement policy is best suited to the country's social, economic and political realities. It suggests that far from being passive victims, self-settled refugees are taking control of their lives without any additional external assistance and are planning for the day they can return to their homeland. Consequently, the paper argues that there is reason to believe that local integration is likely to succeed where other models have failed.

Fertility as a process of social exchange
(Abstract; subscription needed for full text; Global | Europe)
Demographic Research. 2007 Dec 7;17(16):465-496.
Heady P
By marrying and raising children, parents participate in a system of gift-exchange in which the gifts in question are human lives, and the parties to the exchange are the kinship groups recognised in the society concerned. Fertility reflects the attitudes of prospective parents to their place in the existing system of reproductive exchange, and the relationships of cooperation and authority which it implies - as well as their confidence in the system's continuing viability. It is shown that this view is compatible with earlier ideas about self-regulating population systems - and that changing economic circumstances are an important source of discrepancy between existing exchange systems and the attitudes and expectations of prospective parents. The discussion is developed with reference to data on European societies, including a case-study from the Alps, and concludes with an assessment of the relevance of the anthropological theory of gift exchange to contemporary fertility patterns in Europe and beyond.

SPECIAL REPORTS/PROFILES/RESOURCES

Private health sector quality improvement package for midwives and supervisors
(Report; Global)
Bethesda, MD, Private Sector Partnerships-One, 2007.
Segall M | Levin L
Promoting and evaluating quality care is a priority for anyone delivering, organizing, or monitoring clinical services. At the individual level, improved quality of care ensures clients receive respectful treatment by technically competent providers. At the population or community level, greater satisfaction with services should translate into better continuity of care and better utilization of preventive services. From policy makers and managers at the country level to international donor agencies, there is consensus that delivering quality services is important.
PSP-One created a QI package for the private sector that includes a review of service statistics, accompanying a QI self-assessment tool for midwives to identify quality issues, and a linked action plan for midwives and supervisors to help solve issues the QI tool identifies.

A gender guide to reproductive health publications: Producing gender-sensitive publications for health professionals
(Programming Guide; Global)
(You need Adobe Acrobat Reader to access this document)
Baltimore, MD, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, INFO Project, 2007 Nov. 20 p.
Kols A
This guide is designed for the editors, writers, designers, and distribution specialists who help develop and disseminate reproductive health publications for professional audiences. Such publications cover a broad range. They include briefing papers and research summaries for policymakers, press releases and media kits for journalists, handbooks and job aids for providers, project reports and newsletters for program managers, manuals and curricula for trainers, and conference proceedings for researchers. This guide outlines a five-step process for publications staff to follow: build organizational capacity so that staff have the awareness, skills, and supportive work environment needed to produce gender-sensitive publications; conduct a gender analysis of the audience to guide the content and distribution of each publication; produce a publication that considers gender in the choice of subject matter, language, program examples, training exercises, illustrations, design, and layout; design a dissemination strategy that makes sure a publication will reach both men and women in the audience; and monitor and evaluate the effectiveness, impact, and benefits of the publication for women and men in the audience.

Contraceptive implants: Safe, effective, long-acting, reversible
(Fact Sheet; Global)
Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health [INFO], 2007 Oct 16. (Array)
Carson-DeWitt R
Related Review/Synthesis: Implants: The Next Generation
This brief on contraceptive implants presents an overview of implant types, method characteristics, health benefits, and conditions that may make use of implants unsafe. It also touches on programmatic considerations and lessons learned that could increase the likelihood of success in a program offering implants as a contraceptive choice.

Why policy matters: Regulatory barriers to better primary care in Africa - Two private sector examples
(Policy Brief; Sub-Saharan Africa)
Bethesda, MD, Private Sector Partnerships-One, 2007 Aug.
Feeley R | O’Hanlon B
This is a PSP-One Policy Brief that examines the recent experiences in Zambia and Ethiopia that illustrate why policy matters for developing the private health sector and explains the regulatory barriers to primary care in Africa.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 7, Number 4817 December 2007