Volume 8, Number 10
10 March 2008

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ADOLESCENT HEALTH NEWS

Botswana: BNYC launch youth month against Aids
(News Article; Sub-Saharan Africa)
4 Mar 2008
Setshogo T, Mmegi/The Reporter (Gabarone)

Ghana: Saboba ladies suffocating under forced-marriages
(News Article; Sub-Saharan Africa)
5 Mar 2008
Jalulah WN, Ghanaian Chronicle (Accra)

ADOLESCENT HEALTH RESEARCH

Transtheoretical model and risky sexual behaviour in HIV + youth in Thailand
(Abstract; subscription needed for full text; Asia)
AIDS Care. 2008 Feb;20(2):205-211.
Naar-King S | Rongkavilit C | Wang B | Wright K | Chuenyam T
The purpose of the study was to determine the applicability of the Transtheoretical Model for predicting unprotected intercourse in HIV+ Thai youth. Questionnaires and interviews about sexual behaviour, readiness to change, self-efficacy, substance use, emotional distress and social support were obtained from 70 HIV+ Thai youth (ages 17 to 25). Path analysis suggested the model was an excellent fit with the data. Readiness to change but not self-efficacy was directly related to unprotected intercourse acts. This differed from HIV+ youth in the US where self-efficacy fully mediated the relationship between readiness to change and condom use. In the Thai sample, social support and self-efficacy were indirectly related to unprotected intercourse through stage of change. Substance use was unrelated to unprotected intercourse, but rates of use were low. Potential cultural differences in the construct of self-efficacy and its relationship to risky behaviours in Thailand require further study. However, results highlight the potential of prevention interventions that increase readiness to change through boosting self-efficacy and social support specific to practicing safer sex while addressing mental health concerns.

Negotiating the transition from adolescence to motherhood: Coping with prenatal and parenting stress in teenage mothers in Mulago hospital, Uganda
(Research Article; Sub-Saharan Africa)
BMC Public Health. 2008 Mar 4;8(83):1-20.
Kaye DK
Adolescence is a transitional stage from childhood to adulthood that is characterized by physical, physiological, psychosocial and behavioral changes that are influenced to a large extent by the age, culture and socialization of the individual. To explore what adolescent mothers perceive as their struggles during the period of transition from childhood to parenthood (through motherhood) and to describe strategies employed in coping with stress of pregnancy, motherhood and parenthood. Longitudinal qualitative study involving twenty two in-depth interviews and six focus group discussions among pregnant adolescents who were followed from pregnant to delivery, from January 2004 to August 2005. Participant were selected by theoretical sampling and data was analyzed using grounded theory. Overall, young adolescents reported more anxiety, loss of self esteem (when they conceived), difficulty in accessing financial, moral and material support from parents or partners and stigmatization by health workers when they sought care from health facilities. Three strategies by which adolescent mothers cope with parenting and pregnancy stress that were described as utilizing opportunities (thriving), accommodating the challenges (bargaining and surviving), or failure (despairing), and varied in the extent to which they enabled adolescents to cope with the stress. Adolescents on the transition to motherhood have variable needs and aspirations and utilize different strategies to cope with the stress of pregnancy and parenthood.

FAMILY PLANNING NEWS

Yemen, UNFPA discuss reproductive health, family planning program
(News Article; Middle East)
3 Mar 2008
Saba Net

India Booming: Guns, not babies
(News Article; Asia)
5 Mar 2008
Kidwai R, The Telegraph, Calcutta

FAMILY PLANNING RESEARCH

Comparing the complications of 2 copper intrauterine devices: T380A and Cu-Safe 300
(Research Article; Middle East)
Eastern Mediterranean Health Journal. 2008 Jan-Feb;14(1):95-102.
Nahidi F | Jalalinia S
This single-blind case-control study compared the complications of 2 intrauterine devices in consecutive referrals for device insertion in clinics of Shaheed Beheshti University of Medical Sciences, Islamic Republic of Iran. Women who met the inclusion criteria (n = 110) were randomly allocated to receive copper T380A (controls) or Cu-Safe 300 (cases). Moderate or severe pain during the device insertion was reported in 69.1% of controls and 47.3% of cases. Bleeding, vertigo and crampy pain at insertion were not significantly different between the groups. After 3 months follow-up, blood spotting was reported in 16.3% and 32.7% of controls and cases respectively. The Cu-Safe-300 group had less pain and menstrual bleeding but copper T380A had less spotting after 3 months. Studies on longer term complications are strongly recommended.

Comparability of contraceptive prevalence estimates for women from the 2002 Behavioral Risk Factor Surveillance System
(Abstract; subscription needed for full text; Global)
Public Health Reports. 2008 Mar-Apr;123(2):147-154.
Santelli J | Lindberg LD | Finer LB | Rickert VI | Bensyl D | Posner S | Makleff S | Kost K | Singh S
This article assesses the comparability of contraceptive use estimates for adult women obtained from the 2002 Behavioral Risk Factor Surveillance System (BRFSS), using the 2002 National Survey of Family Growth (NSFG) as a benchmark. The 2002 BRFSS uses data collection methods that are considerably different from the NSFG. We compared demographic differences and national estimates of current contraceptive methods being used and reasons for nonuse. Variables were recoded in the BRFSS and NSFG systems to make the two samples comparable. Women in the NSFG and BRFSS were similar in age and race/ethnicity. Compared with the NSFG, the BRFSS sample was more educated and of higher income, less likely to be cohabiting, and more likely to be married. After adjusting for differences in the coding of hysterectomy, many BRFSS estimates for current contraceptive use were statistically similar to those from the NSFG. Small but statistically significant differences were found for vasectomy (7.7% and 6.3%), the pill (21.9% and 19.6%), rhythm (1.5% and 1.0%), the diaphragm (0.5% and 0.2%), and withdrawal (0.3% and 2.7%) for the BRFSS and NSFG, respectively. Major reasons for nonuse were similar: seeking pregnancy and currently pregnant. The percentage of women who were not currently sexually active was higher in the BRFSS (16.0%) compared with the NSFG (12.5%). The BRFSS is a useful source of population-based data on contraceptive use for reproductive health program planning; however, planners should be cognizant that lower-income women are not fully represented in telephone surveys.

Oral contraceptives, postmenopausal hormones, and risk of asynchronous bilateral breast cancer: The WECARE study group
(Abstract; subscription needed for full text; Global)
Journal of Clinical Oncology. 2008 Mar 20;26(9):[8] p..
Figueiredo JC | Bernstein L | Capanu M | Malone KE | Lynch CF | Anton-Culver H | Stovall M | Bertelsen L | Haile RW | Bernstein JL
The purpose was to investigate whether oral contraceptive (OC) use and postmenopausal hormones (PMH) are associated with an increased risk of developing asynchronous bilateral breast cancer among women diagnosed with breast cancer younger than 55 years. The WECARE (Women's Environment, Cancer, and Radiation Epidemiology) study is a population-based, multicenter, case-control study of 708 women with asynchronous bilateral breast cancer and 1,395 women with unilateral breast cancer. Risk factor information collected during a telephone interview focused on exposures before and after the first breast cancer diagnosis. Treatment and tumor characteristics were abstracted from medical records. Multivariable conditional logistic regression was used to estimate rate ratios (RR) and 95% CIs. OC use before the first breast cancer diagnosis was not associated with risk of asynchronous bilateral breast cancer (RR = 0.88; 95% CI, 0.67 to 1.16). OC use after breast cancer diagnosis was also not significantly associated with risk (RR = 1.56; 95% CI, 0.71 to 3.45). Risk did not increase with longer duration of use or among women who had begun using OCs at a younger age. No evidence of an increased risk of asynchronous bilateral breast cancer was observed with PMH use before (RR = 1.21; 95% CI, 0.90 to 1.61) or after breast cancer diagnosis (RR = 1.10; 95% CI, 0.67 to 1.77). Neither duration nor type of PMH were associated with risk. Age at and time since first breast cancer diagnosis did not substantially affect these results. This study provides no strong evidence that OC or PMH use increases the risk of a second cancer in the contralateral breast.

Combined oral contraceptive use and epithelial ovarian cancer risk: Time-related effects
(Abstract; subscription needed for full text; Global)
Epidemiology. 2008 Mar;19(2):237-243.
Lurie G | Wilkens LR | Thompson PJ | McDuffie KE | Carney ME | Terada KY | Goodman MT
Although the protective effect of oral contraceptives (OCs) use against epithelial ovarian cancer is well-established, there remain gaps in our understanding of the contributions of time-related characteristics of OC use to risk. This population-based case-control study, carried out in Hawaii and Los Angeles 1993-2006, included 813 cases of epithelial ovarian cancer and 992 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression. Epithelial ovarian cancer risk was reduced 5 or more years after initiation of OC use (OR = 0.18; CI = 0.08-0.39). Each year of use provided a 5% reduction (CI = 2%-8%) in risk. A positive gradient in risk with time since first OC use was independent of duration of OC use. The inverse association of OCs with risk was attenuated decades after last use, but was not affected by age at first or last use. OC use for less than 1 year was associated with decreased ovarian cancer risk (OR = 0.45; CI = 0.26-0.79) only among recent users (less than or equal to 20 years from diagnosis/interview). Women who used OCs for a year or more were protected for at least 3 decades after they stopped use. Reduction in epithelial ovarian cancer risk associated with OC use became apparent after a short latency period and short duration of use, and was long-lasting. Time since first use and time since last use seem to modify the association of OCs with ovarian cancer risk independently of duration of use.

GENDER and HEALTH NEWS

Botswana: Men urged to take lead
(News Article; Sub-Saharan Africa)
4 Mar 2008
Kajevu Z, The Voice (Francistown)

Africa: International Women's Day 2008 - Message from Unifem
(News Article; Global)
5 Mar 2008
UN Press Release

Ethiopia: Prominent artists engage UNFPA's 'Stop Early Marriage' campaign
(News Article; Sub-Saharan Africa)
5 Mar 2008
Tesfaye F, The Africa Monitor

GENDER and HEALTH RESEARCH

Implications of incorrect determination of fetal sex by ultrasound
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of Gynecology and Obstetrics. 2008 Mar;100(3):287-290.
Chigbu CO | Odugu B | Okezie O
The objective was to assess the experiences of women following incorrect determination of fetal sex by ultrasound. A 3-year prospective cohort study of 102 women with discordance between fetal sex determined by ultrasound scan and birth sex. Participants were interviewed using 2 structured pretested questionnaires. The first questionnaire was undertaken within 24 h of delivery. The women were followed up with a second questionnaire 6-9 months later. In-depth interviews were also carried out at this time. Women who had received an incorrect determination of fetal sex by ultrasound experienced marital conflicts, domestic violence, negative perceptions of ultrasound, and a desire for reversal of tubal ligation. Incorrect determination of fetal sex by ultrasound has implications that can affect the mental and psychological health of the mother and the upbringing of the newborn.

Intimate partner violence (IPV) and preeclampsia among Peruvian women
(Abstract; subscription needed for full text; South America)
European Journal of Obstetrics, Gynecology and Reproductive Biology. 2008 Mar;137(1):50-55.
Sanchez SE | Qiu C | Perales MT | Lam N | Garcia P
Mounting evidence supports the view that intimate partner violence (IPV) is an important cause of maternal mortality. Some, but not all, prior studies suggest that IPV is associated with increased risks of maternal medical conditions such as hypertensive disorders of pregnancy which are leading causes of maternal mortality worldwide. We assessed the relation between IPV and risk of preeclampsia among Peruvian women. We conducted a case-control study at two large hospitals in Lima, Peru. Preeclampsia cases were 339 women with pregnancy-induced hypertension and proteinuria (i.e., preeclampsia). Controls were 337 normotensive women. Information concerning women's exposure to physical and emotional violence during pregnancy was collected during in-person interviews conducted after delivery and while patients were in hospital. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from logistic regression models. The prevalence of IPV was 43.1% among cases and 24.3% among controls. Compared with those reporting never exposure to IPV during pregnancy, women reporting any exposure had a 2.4-fold increased risk of preeclampsia (OR = 2.4; 95% CI: 1.7-3.3). The association was strengthened slightly after adjusting for maternal age, parity and pre-pregnancy adiposity (OR = 2.7; 95% CI: 1.9-3.9). Emotional abuse in the absence of physical violence was associated with a 3.2-fold (95% CI: 2.1-4.9) increased risk of preeclampsia. Emotional and physical abuse during pregnancy was associated with a 1.9-fold increased risk of preeclampsia (95% CI: 1.1-3.5). IPV among pregnant women is common and is associated with an increased risk of preeclampsia. These data support recent calls for coordinated global health efforts to prevent violence against women.

Baseline assessment of the prevalence and geographical distribution of HPV types in Chile using self-collected vaginal samples
(Research Article; South America)
BMC Public Health. 2008 Feb 28;8(78):[34] p.
Ferreccio C | Corvalan A | Margozzini P | Viviani P | Gonzalez C
Chile has broad variations in weather, economics and population from the far desert north (Region 1) to the cold, icy south (Region 12). A home-based self-collected vaginal sampling was nested in the 2003 Chilean population-based health survey in order to explore the possibility of a type-specific geographical variation for human papillomavirus The population was a national probability sample of people 17 years of age and over. Consenting women provided self-collected cervicovaginal swabs in universal collection media (UCM). DNA was extracted and typed to 37 HPV genotypes using PGMY consensus PCR and line blot assay. Weighted prevalence rates and adjusted OR were calculated. Of the 1,883 women participating in the health survey, 1,219 (64.7%) provided a cervicovaginal sample and in 1,110 (56.2% of participants and 66.5% of those eligible) the samples were adequate for analysis. Refusal rate was 16.9%. HPV prevalence was 29.2% (15.1% high-risk HPV and 14.1% low-risk HPV). Predominant high-risk types were HPV 16, 52, 51, 56 and 58. Predominant low-risk HPVs were HPV 84, CP6108, 62, 53 and 61. High-risk and low-risk HPV rates were inversely correlated between the regions. High-risk HPV prevalence was highest among the youngest women, whereas low-risk HPV increased slightly with age. Self-obtained vaginal sampling is adequate for monitoring HPV in the community, for identifying high-risk areas, and for surveying the long term impact of interventions.

HIV/AIDS and STIs NEWS

Malawi: Malawi seeks to oust fake AIDS healers
(News Article; Sub-Saharan Africa)
04 March 2008
AFP

Africa: U.S. Health Policy Updates
(News Article; North America)
3 Mar 2008
AfricaFocus

Botswana: Having Children the Safe Way With HIV
(News Article; Sub-Saharan Africa)
28 Feb 2008
Chwanne T, Mmegi/AllAfrica

HIV/AIDS and STIs RESEARCH

Prevalence and correlates of HIV infection among female sex workers in 2 Mexico-US border cities
(Abstract; subscription needed for full text; North America)
Journal of Infectious Diseases. 2008 Mar;197(5):728-732.
Patterson TL | Semple SJ | Staines H | Lozada R | Orozovich P
We examined human immunodeficiency virus (HIV) prevalence and correlates among female sex workers (FSWs) in Tijuana and Ciudad Juarez, 2 large cities on the Mexico-US border. FSWs aged greater than or equal to 18 years underwent interviews and testing for HIV, syphilis, gonorrhea, and chlamydia. Logistic regression identified factors associated with HIV infection. In 924 FSWs, the prevalence of HIV, gonorrhea, chlamydia, and syphilis titers greater than or equal to 1:8 was 6%, 6.4%, 13%, and 14.2%, respectively. Factors independently associated with HIV were the injection of cocaine (odds ratio [OR], 2.96); the smoking, snorting, or inhalation of methamphetamine (OR, 3.32); and syphilis titers greater than or equal to 1:8 (OR, 4.16). Culturally appropriate interventions are needed to identify and treat ulcerative sexually transmitted infections and reduce HIV risks associated with stimulants among FSWs in the Mexico-US border region.

Probiotics: Potential to prevent HIV and sexually transmitted infections in women
(Abstract; subscription needed for full text; Global)
Sexually Transmitted Diseases. 2008 Mar;35(3):214-225.
Bolton M | Van der Straten A | Cohen CR
Women are at significant risk of human immunodeficiency virus (HIV) and sexually transmitted infection (STI) acquisition with the genital mucosa serving as the main portal of infection. Exogenously supplied lactobacillus used as a probiotic may prove a cost-effective, female-initiated method to prevent HIV and STI infection in women. A probiotic may act indirectly through treating and preventing recurrent bacterial vaginosis or directly by secreting endogenous (e.g., hydrogen peroxide) and exogenous substances that block HIV and STI transmission. This review summarizes the preclinical and clinical studies that have been conducted so far to test probiotic bacteria for these purposes. Although significant progress has been made in this field, more fundamental research is required to better understand vaginal ecology to maximize probiotic formulations. Once identified, a suitable product will require testing in a well-designed, randomized, placebo-controlled trial to measure its effectiveness in augmenting antibiotic treatment to prevent bacterial vaginosis. If results from such a trial demonstrate efficacy, future studies should be designed to determine whether a probiotic can significantly lower the risk for HIV and STIs in at-risk female populations.

Treating curable sexually transmitted infections to prevent HIV in Africa: Still an effective control strategy?
(Abstract; subscription needed for full text; Sub-Saharan Africa)
JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Mar;47(3):346-353.
White RG | Orroth KK | Glynn JR | Freeman EE | Bakker R
Evidence regarding the effectiveness of sexually transmitted infection (STI) treatment for HIV prevention in Africa is equivocal, leading some policy makers to question whether it should continue to be promoted for HIV control. We explore whether treating curable STIs remains a cost-effective HIV control strategy in Africa. The model STDSIM was fitted to the characteristics of 4 populations in East and West Africa. Over the simulated HIV epidemics, the population-attributable fractions (PAFs) of incident HIV attributable to STIs, the impact of syndromic STI management on HIV incidence, and the cost per HIV infection averted were evaluated and compared with an estimate of lifetime HIV treatment costs (US $3500). Throughout the HIV epidemics in all cities, the total PAF for all STIs remained high, with $50% of HIV transmission attributed to STIs. The PAF for herpes simplex virus type 2 increased during the epidemics, whereas the PAF for curable STIs and the relative impact of syndromic management decreased. The models showed that the absolute impact of syndromic management remains high in generalized epidemics, and it remained cost-saving in 3 of the 4 populations in which the cost per HIV infection averted ranged between US $321 and $1665. Curable STI interventions may remain cost-saving in populations with generalized HIV epidemics, particularly in populations with high-risk behaviors or low male circumcision rates.

HIV morbidity and mortality in Jamaica: Analysis of national surveillance data, 1993 -- 2005
(Abstract; subscription needed for full text; Central America and the Caribbean)
International Journal of Infectious Diseases. 2008 Mar;12(2):132-138.
Losina E | Figueroa P | Duncan J | Divi N | Wolf LL
Pre-antiretroviral therapy (ART) HIV-related survival and timing of HIV identification have not been reported from the Caribbean. Using Jamaican national surveillance data, we estimated overall, AIDS-free, and AIDS survival, identified factors influencing HIV-related mortality, and examined factors associated with late HIV/AIDS identification. The Jamaican HIV/AIDS tracking system (HATS) national surveillance data included timing of first positive HIV test, stage at identification, date of AIDS diagnosis, and death. We estimated overall and AIDS-free survival by initial stage, using a proportional hazard model to identify factors associated with worse survival, and logistic regression to examine factors related to later case identification. Of 10 674 reported HIV cases, 48% were asymptomatic, 14% symptomatic, and 38% first reported with AIDS. Five-year AIDS-free survival was 77% for asymptomatic persons and 63% for symptomatic. Median survival after AIDS diagnosis was 1.02 years. Age, number of opportunistic diseases, and initial stage were strongly associated with mortality. Older age, drug use, and sex with a commercial sex worker were associated with later identification. In the pre-ART era, over one-third of HIV-infected persons in Jamaica were first identified with advanced disease. This highlights the need for earlier diagnosis as ART programs roll out in the Caribbean.

Use of WHO clinical stage for assessing patient eligibility to antiretroviral therapy in a routine health service setting in Jinja, Uganda
(Report; Sub-Saharan Africa)
AIDS Research and Therapy. 2008 Feb 28;5(4):[9] p.
Jaffar S | Birungi J | Grosskurth H | Amuron B | Namara G
In a routine service delivery setting in Uganda, we assessed the ability of the WHO clinical stage to accurately identify HIV-infected patients in whom antiretroviral therapy should be started. Among 4302 subjects screened for ART, the sensitivity and specificity (95% CI) of WHO stage III, IV against a CD4 count less than 200 x 10/6/l were 52% (50, 54%) and 68% (66, 70%) respectively. Plasma viral load was tested in a subset of 1453 subjects in whom ART was initiated. Among 938 subjects with plasma viral load of 100,000 copies or more, 391 (42%, 95% CI 39, 45%) were at WHO stage I or II. In this setting, a large number of individuals could have been denied access to antiretroviral therapy if eligibility to ART was assessed on the basis of WHO clinical stage. There is an urgent need for greater CD4 count testing and evaluation of the utility of plasma viral load prior to initiation of ART to accompany the roll-out of ART.

MATERNAL AND CHILD HEALTH NEWS

United States: Countries must expand services to protect mothers and children from HIV/AIDS
(News Article; North America)
5 Mar 2008
The Elizabeth Glaser Pediatric AIDS Foundation

Africa: Study offers hope for child survival
(News Article; Sub-Saharan Africa)
3 Mar 2008
Ochieng Z, The East African (Nairobi)

Nigeria: Minister decries high maternal mortality
(News Article; Sub-Saharan Africa)
2 Mar 2008
Kaduna AA, The Daily Trust (Abuja)

Maternal health biggest challenge facing Afghan women - UN agency
(News Article; Asia)
3 Mar 2008
UN News Centre

MATERNAL AND CHILD HEALTH RESEARCH

The effects of unintended pregnancy on infant, child, and parental health: A review of the literature
(Abstract; subscription needed for full text; Global)
Studies in Family Planning. 2008 Mar;39(1):18-38.
Gipson JD | Koenig MA | Hindin MJ
This article provides a critical review of studies assessing the effects of unintended pregnancy on the health of infants, children, and parents in developed and developing countries. A framework for determining and measuring the pathways between unintended pregnancy and future health outcomes is outlined. The review highlights persistent gaps in the literature, indicating a need for more studies in developing countries and for further research to assess the impact of unintended pregnancy on parental health and long-term health outcomes for children and families. The challenges in measuring and assessing these health impacts are also discussed, highlighting avenues in which further research efforts could substantially bolster existing knowledge.

Persistent neonatal mortality despite improved under-five survival: A retrospective cohort study in northern Vietnam
(Abstract; subscription needed for full text; Asia)
Acta Paediatrica. 2008 Feb;97(2):166-170.
Hoa DP | Nga NT | Malqvist M | Persson LA
The aim was to examine trends in neonatal, infant and under-five mortality rates in a northern Vietnamese district during 1970-2000, and to analyze socioeconomic differences in child survival over time. Retrospective interviews with all women aged 15-54 years in Bavi district in Northern Vietnam (n = 14 329) were conducted. Of these women, 13 943 had been pregnant, giving birth to 26 796 children during 1970-2000. There was a dramatic reduction in infant and under-five mortality rate (47%) over time. However, the neonatal mortality rate (NMR) showed a very small reduction, thus causing its proportion of the total child mortality to increase. Mortality trends followed the political and socioeconomic development of Vietnam over war, peace and periods of reforms. There were no differences in under-five and neonatal mortalities associated with family economy, while differentials related to mothers' education and ethnicity were increasing. Interventions to reduce child mortality should be focused on improving neonatal care. In settings with a rapid economic growth and consequent social change, like in Vietnam, it is important that such interventions are targeted at vulnerable groups, in this case, families with low level of education and belonging to ethnic minorities.

Stillbirth rates in Peruvian populations at high altitude
(Abstract; subscription needed for full text; South America)
International Journal of Gynecology and Obstetrics. 2008 Mar;100(3):221-227.
Gonzales GF | Tapia V | Carrillo CE
The objective was to compare the stillbirth rates in 4 cities at different altitudes in Peru. The stillbirth rates from a sample of 22,662 births recorded in the Perinatal Information System database were analyzed between 2005 and 2006 for the cities of Lima (150 m), Huancayo (3280 m), Cuzco (3430 m), and Puno (3850 m). Stillbirths were higher at high altitude (greater than 3000 m) (OR 4.82; CI, 3.05-7.72) compared with low altitude. The effect of altitude was observed after controlling for socioeconomic (OR 4.29; CI, 2.61-6.93), demographic and biological (OR 4.18; CI, 2.65-6.77), maternal health care (OR 4.72; CI, 2.96-7.61), and fetal factors (OR 3.96; CI, 2.48-6.45). Inhabitants from the southern Andes demonstrated a protective effect on stillbirth rate compared with the central Andes, which may be due to an ancestry effect with longer multigenerational residence in the southern Andes population. Stillbirth rate is higher at high altitude compared with low altitude.

A prospective key informant surveillance system to measure maternal mortality -- findings from indigenous populations in Jharkhand and Orissa, India
(Abstract; subscription needed for full text; Asia)
BMC Pregnancy and Childbirth. 2008 Feb 28;8(6):[22] p.
Barnett S | Nair N | Tripathy P | Borghi J | Rath S
In places with poor vital registration, measurement of maternal mortality and monitoring the impact of interventions on maternal mortality is difficult and seldom undertaken. Mortality ratios are often estimated and policy decisions made without robust evidence. This paper presents a prospective key informant system to measure maternal mortality and the initial findings from the system. In a population of 228 186, key informants identified all births and deaths to women of reproductive age, prospectively, over a period of 110 weeks. After birth verification, interviewers visited households six to eight weeks after delivery to collect information on the ante-partum, intra-partum and post-partum periods, as well as birth outcomes. For all deaths to women of reproductive age they ascertained whether they could be classified as maternal, pregnancy related or late maternal and if so, verbal autopsies were conducted. 13 602 births were identified, with a crude birth rate of 28.2 per 1000 population (C.I. 27.7-28.6) and a maternal mortality ratio of 722 per 100 000 live births (C.I. 591-882) recorded. Maternal deaths comprised 29% of all deaths to women aged 15-49. Approximately a quarter of maternal deaths occurred ante-partum, a half intra-partum and a quarter post-partum. Haemorrhage was the commonest cause of all maternal deaths (25%), but causation varied between the ante-partum, intra-partum and postpartum periods. The cost of operating the surveillance system was US$386 a month, or US$0.02 per capita per year. This low cost key informant surveillance system produced high, but plausible birth and death rates in this remote population in India. This method could be used to monitor trends in maternal mortality and to test the impact of interventions in large populations with poor vital registration and thus assist policy makers in making evidence-based decisions.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Ugandan population: What path to eco-growth?
(News Article; Sub-Saharan Africa)
4 Mar 2008
African Path

Filipinos could number 150 million if you don't act now
(News Article; Asia)
4 Mar 2008
Jeannette Andrade, The Philippine Daily Inquirer

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Refining the criteria for stalled fertility declines: An application to rural KwaZulu-Natal, South Africa, 1990 -- 2005
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Studies in Family Planning. 2008 Mar;39(1):39-48.
Moultrie TA | Hosegood V | McGrath N | Hill C | Herbst K
Stalled fertility declines have been identified in several regions across the developing world, but the current conceptualization of a stalled fertility decline is poorly theorized and does not lend itself to objective measurement. We propose a more rigorous and statistically testable definition of stalled fertility decline that can be applied to time-series data. We then illustrate the utility of our definition through its application to data from rural South Africa for the period 1990-2005 collected from a demographic surveillance site. Application of the approach suggests that fertility decline has indeed stalled in rural KwaZulu-Natal, at about three children per woman. The stall, some 20 percent above the replacement fertility level, does not appear to be associated with a rise in wanted fertility or attenuated access to contraceptive methods. This identification of a stalled fertility decline provides the first evidence of such a stall in southern Africa, the region with the lowest fertility levels in sub-Saharan Africa.

Afghan refugees in Pakistan: Not all refugees, not always in Pakistan, not necessarily Afghan?
(Abstract; subscription needed for full text; Asia)
Journal of Refugee Studies. 2008;21(1):43-63.
Kronenfeld DA
In 2001, there were estimated to be two million Afghan refugees in Pakistan. In the past six years, however, over 3.5 million refugees have returned, and recent census data show that nearly 2.5 million still remain in Pakistan. Three straightforward explanations for this monumental discrepancy have been posited: Afghans' high birthrates, their history of cross-border migration, and increasing levels of urbanization in Pakistan. Yet the fact that none of these processes comes as a surprise to researchers familiar with the history of Afghan refugees begs a still deeper question: how and why were these processes so utterly overlooked in 2001? The answer, it is argued, is a fundamental confusion not only in how we count refugees but in how we conceptualize them. The dichotomous distinction between refugees and non-refugees, while possessing a certain legal clarity, does a poor job of describing the reality of individuals whose movements are influenced by numerous social, political, and economic factors.

Decline in sex ratio at birth after Bam (Kerman Province, southern Iran) earthquake
(Abstract; subscription needed for full text; Middle East)
Journal of Biosocial Science. 2008 Feb 19;:[3] p.
Saadat M
On 26th December 2003, a severe earthquake hit the city of Bam in Kerman province, southern Iran. It destroyed around 90% of houses and at least 60% of the public buildings, and claimed the lives of more than 20,000 persons. To investigate whether acute stress caused by the Bam earthquake could alter the sex ratio at birth (SRB) 6-12 months later, the present study was done. The number of live births by sex was obtained from the National Organization for Civil Registration (Kerman province). The SRB was expressed as the male proportion. A prominent decline in the SRB (approximately 0.467) 11 months after the earthquake was observed (x/2 = 6.68, df = 1, p = 0.009). There was no significant difference between Bam and Kerman province (excluding Bam) for SRB (x/2 = 0.44, df = 1, p = 0.51) for a period of 33 month before the earthquake (from April 2001 to December 2003). It might be concluded that psychological tensions and stress are associated with a decrease in SRB.

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Volume 8, Number 1010 March 2008