Volume 8, Number 11
17 March 2008

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ADOLESCENT HEALTH NEWS

Uganda: Youth to test for HIV at Munyonyo meet
(News Article; Sub-Saharan Africa)
9 Mar 2008
Namutebi J, New Vision (Kampala)

Nigeria: Women, girl-child conditions still terrible - NWC
(News Article; Sub-Saharan Africa)
12 Mar 2008
This Day (Lagos)

ADOLESCENT HEALTH RESEARCH

Growth parameters in HIV-vertically-infected adolescents on antiretroviral therapy in Rio de Janeiro, Brazil
(Abstract; subscription needed for full text; South America)
Annals of Tropical Paediatrics. 2008 Mar;28(1):59-64.
Buonora S | Nogueira S | Pone MV | Aloe M | Oliveira RH
Growth failure in HIV-infected children is an important factor in either initiating or changing antiretroviral therapy (ART). This study assesses the impact of HIV infection on growth parameters of adolescents who acquired HIV vertically. This retrospective, longitudinal study involved adolescents aged 10-20 years with vertically-acquired HIV infection who were followed up in one of the three main referral centres for paediatric HIV/AIDS in Rio de Janeiro, Brazil. Length, weight and variables related to demographic, clinical and laboratory issues were analysed. 108 subjects were enrolled. Median age was 12.7 years, median duration of follow-up was 97.2 months and 61 (56.5%) were female. The difference between the baseline and final weight Z-scores was -0.31 (p = 0.02). Patients with final weight Z-scores less than or equal to 2 used more ART regimens (average 4.13) than those with Z-scores greater than -2 (average 2.90, p less than 0.01) and also had a lower final CD4+ cell percentage - average 19% vs 24% (p less than 0.01), respectively. The difference between baseline and final-height Z-scores was -0.27 (p less than 0.01). Several factors were associated with a final-height Z-score less than or equal to -2: clinical stage C during follow-up (RR 1.60, 95% CI 1.11-2.31), chronic diarrhoea during follow-up (RR 2.02, 95% CI 1.04-3.90), HAART use (RR 1.41, 95% CI 1.16-1.71), number of ART regimens (p less than 0.01) and final CD4+ cell percentage (p less than 0.01). In multivariate analysis, presentation in clinical stage C during follow-up was the only significant variable (OR 4.04, 95% CI 1.23-13.28). Even on HAART, HIV-infected adolescents have lower growth parameters than the normal population and this is associated with a worse prognosis.

Problems related to menstruation amongst adolescent girls
(Research Article; Asia)
Indian Journal of Pediatrics. 2008 Feb;75(2):125-129.
Sharma P | Malhotra C | Taneja DK | Saha R
The objective was to study the types and frequency of problems related to menstruation in adolescent girls and the effect of these problems on daily routine. Girls in the age group 13-19 years who had had menarche for at least one year at the time of study. 198 adolescents girls have been studied. Data was collected by personal interviews on a pre-tested, semi-structured questionnaire. The questions covered menstrual problems, regularity of menses in last three cycles of menstruation and the effect of these problems on the daily routine. Analysis was done using SPSS version 12. Percentages were calculated for drawing inferences. More than a third (35.9%) of the study subjects were in the age group 13-15 years followed by 17-19 years, 15-17 years respectively. Mean age of study participants was calculated to be 16.2 years. Dysmenorrhea (67.2%) was the commonest problem and (63.1%) had one or the other symptoms of Pre-menstrual syndrome (PMS). Other related problems were present in 55.1% of study subjects. Daily routine of 60% girls was affected due to prolonged bed rest, missed social activities/commitments, disturbed sleep and decreased appetite. 17.24% had to miss a class and 25% had to abstain from work. Mothers and friends were the most common source of information on the issue. Screen adolescent girls for menstruation related problems and provide them with counseling services and relevant information on possible treatment options. Besides, there is a need to emphasize on designing menstrual health programmes for adolescents.

FAMILY PLANNING NEWS

Rwanda: 14 million condoms imported anually
(News Article; Sub-Saharan Africa)
12 Mar 2008
Musoni E, The New Times (Kigali)

Nigeria: Fertility in developing countries: Words into action
(News Article; Sub-Saharan Africa)
12 Mar 2008
De Potter S, EurekAlert

FAMILY PLANNING RESEARCH

Contraceptive efficacy of intrauterine devices
(Abstract; subscription needed for full text; Global)
American Journal of Obstetrics and Gynecology. 2008 Mar;198(3):248-253.
Thonneau PF | Almont TE
To compare the contraceptive efficacy of various types of intrauterine devices (IUD; copper devices, Nova-T, intrauterine contraceptive systems, levonorgestrel-releasing devices), we reviewed all relevant publications on this subject that have been published over the last 2 decades. The first point to be highlighted by this review is the excellent effectiveness of IUDs, with a global cumulative pregnancy rate less than 2% at 5 years, whatever the type of device used. We observed a large variation in efficacy rate according to the type of IUD and also according to study design. Nevertheless, of all the types of IUDs, the levonorgestrel-releasing IUD and to a lesser extent the TCu380A IUD seem to be the most effective, with a cumulative pregnancy rate at 5 years of less than 0.5% for the levonorgestrel-releasing IUD and between 0.3% and 0.6% for the TCu380A IUD.

Heterogeneous condom use in contemporary Russia
(Abstract; subscription needed for full text; Europe)
Studies in Family Planning. 2008 Mar;39(1):1-17.
Gerber TP | Berman D
Using data from a panel survey of a representative probability sample of Russian households, we examine how individual traits, locality, and "sex-event context" are associated with condom use in contemporary Russia. At the individual level, age has negative effects and measures of risk orientation have positive effects on the probability of condom use; for women, education has positive effects and Muslim belief has negative effects. Condom use is higher among residents in Moscow and St. Petersburg and lower (for women) among rural residents. Most importantly, the same individuals make different choices about condom use from one sex event to the next, and their choices are systematically related to the nature and duration of their relationship to their partner, as well as to their partner's age. Condom use is prevalent in casual encounters and in those involving new partners or commercial sex workers. Coupled with the strong effects of age for both partners, this pattern represents good news regarding the potential for the spread of HIV in Russia. Other findings are more worrisome: HIV awareness and knowledge of condoms' effectiveness in blocking transmission of the virus do not influence condom use at all, and married people are relatively unlikely to use condoms even in extramarital encounters and especially in long-term affairs. Accordingly, interventions should target older Russians who are married and have sex with long-term nonspousal partners.

Contraceptive methods with male participation: A perspective of Brazilian couples
(Abstract; subscription needed for full text; South America)
International Nursing Review. 2008 Mar;55(1):103-109.
Marchi NM | de Alvarenga AT | Bahamondes L
The objective was to assess the perspectives of couples who requested vasectomy in a public health service on the use of male participation contraceptive methods available in Brazil: male condoms, natural family planning/calendar, coitus interruptus and vasectomy. A qualitative study with semi-structured interviews was held with 20 couples who had requested vasectomy at the Human Reproduction Unit of the Universidade Estadual de Campinas, Brazil. Data analysis was carried out through thematic content analysis. The couples did not, in general, know any effective contraceptive options for use by men and/or participating in their use, except for vasectomy. The few methods with male participation that they knew of were perceived to interfere in spontaneity and in pleasure of intercourse. Men accepted that condom use in extraconjugal relations offered them protection from sexually transmitted diseases; that their wives might also participate in extra-marital relationships was not considered. The few contraceptive options with male participation lead to difficulty in sharing responsibilities between men and women. On the basis of perceived gender roles, women took the responsibility for contraception until the moment when the situation became untenable, and they faced the unavoidable necessity of sterilization. Specific actions are necessary for men to achieve integral participation in relation to reproductive sexual health. These include education and discussions on gender roles, leading to greater awareness in men of the realities of sexual and reproductive health.

Reproductive health knowledge and practices in northern Nigeria: Challenging misconceptions
(Report; Sub-Saharan Africa)
Abuja, Nigeria, Pathfinder International, [2008]. [31] p.
Pathfinder International's Reproductive Health/Family Planning Service Delivery Project, funded by the David and Lucile Packard Foundation, aims to improve the Reproductive Health (RH) status of adults and adolescents in northern Nigeria, and to increase the utilization of services through a network of public- and private-sector facilities and community-based providers. In the third phase, the project sought to respond more positively to its target communities by conducting a community survey to inform implementation of its future interventions in six states of northern Nigeria (Borno, Kaduna, Kano, Katsina, Niger, and Sokoto) and the Federal Capital Territory. Pathfinder is implementing the project in northern Nigeria to address the region's depressed socioeconomic conditions and low demand for and use of services, as compared to the southern region. The community survey used qualitative methods (including focus group discussions, key informant interviews, and in-depth interviews) to elicit information from 511 respondents on their knowledge, practices, and beliefs about RH and Family Planning (FP). It also served to establish the stakeholders' level of awareness of the project in target communities.

The contraceptive efficacy of Implanon: A review of clinical trials and marketing experience
(Abstract; subscription needed for full text; Global)
European Journal of Contraception and Reproductive Health Care. 2008 Jun;13 Suppl 1:4-12.
Graesslin O | Korver T
The objectives were to evaluate the contraceptive efficacy of the etonogestrel-releasing implant Implanon as assessed in international studies and during nine years of marketing experience. The analysis included 11 international studies and data collected during nine years of marketing experience (1998-2007). Seven of these studies were noncomparative; the four other studies included the 6-rod levonorgestrel implant system or an intrauterine device as a comparator. All studies except one were of at least two years in duration, and all had contraceptive efficacy as the objective. Market data were provided unsolicited to Organon, part of Schering Plough. The integrated efficacy analysis included 923 non-breastfeeding women who were exposed to the implant for 24,100 cycles. No in-treatment or pretreatment pregnancies were reported. Fifty post-treatment pregnancies were reported, six of which occurred within 14 days of implant removal, indicating that fertility had quickly returned. Over a nine-year marketing period an overall pregnancy rate of 0.049 per 100 implants sold (estimated Pearl Index = 0.031 based on all pregnancies reported) was calculated. When only counting contraceptive method failures the pregnancy rate amounts to 0.010 per 100 implants sold (estimated Pearl Index = 0.006). Implanon is a highly effective and quickly reversible subdermal method of long-acting hormonal contraception for women. Typical use of this implant achieves a contraceptive protection exceeding 99%.

GENDER and HEALTH NEWS

Kenya: Violence victims suffer in camps
(News Article; Sub-Saharan Africa)
13 Mar 2008
Mathenge O, The Nation (Nairobi)

Gambia: International Women's Day commemorated
(News Article; Sub-Saharan Africa)
10 Mar 2008
Gaye A, Foroyaa

Pakistan: Domestic violence endemic, but awareness slowly rising
(News Article; Asia)
11 Mar 2008
UN Integrated Regional Information Networks (IRIN)

GENDER and HEALTH RESEARCH

Self-reported prevalence of endometriosis and its symptoms among Puerto Rican women
(Abstract; subscription needed for full text; Central America and the Caribbean)
International Journal of Gynecology and Obstetrics. 2008 Mar;100(3):257-261.
Flores I | Abreu S | Abac S | Fourquet J | Laboy J
The objective was to determine the prevalence of endometriosis and its symptoms in a Puerto Rican cohort, and to describe the menstrual, obstetric, and clinical profiles of the women. A self-administered questionnaire was given to 1285 Puerto Rican women. Categorical variables were compared using x/2 analysis or Fisher exact test. There were 57 self-reported cases of endometriosis (48 surgically confirmed) among 1193 valid questionnaires, for a point prevalence of 4.0%. A diagnosis of endometriosis was significantly associated with dysmenorrhea, dyspareunia, and chronic pelvic pain, but not with menstrual cycle characteristics. Undiagnosed women commonly reported signs and symptoms of endometriosis. The estimated prevalence of endometriosis in Puerto Rico is 4.0%, comparable to what has been reported in other populations. Endometriosis symptoms were common in the population surveyed, indicating the need for increased awareness and development of public health policies leading to early diagnosis and appropriate management.

The impact and cumulative effects of intimate partner abuse during pregnancy on health-related quality of life among Hong Kong Chinese women
(Abstract; subscription needed for full text; Asia)
Midwifery. 2008 Mar;24(1):22-37.
Lau Y | Wong DF | Chan KS
The objective was to explore the prevalence of intimate partner abuse during pregnancy and to examine the effect and cumulative effects of different types of intimate partner abuse on health-related quality of life. A retrospective, cross-sectional, comparative design was used for the study. The setting used was three postnatal wards of a university-affiliated regional public hospital in Hong Kong. The participants were a community-based sample (n = 1200) of postnatal women. The women were identified as abused or non-abused using the Abuse Assessment Screen Questionnaire (AAS), and various types of abuse were elaborated using the Revised Conflict Tactics Scale (CTS-2). The Medical Outcomes Study Short-form 36 Health Survey (SF-36) measured the health-related quality of life. The prevalence rate of intimate partner abuse during pregnancy was 134 out of 1200 (11.2%, 95% confidence interval [CI] 9.4-13.0%). They consisted of an only psychologically abused group (32.1%, 95% CI 24.2-40.0%), an only physically abused group (20.9%, 95% CI 14.0-27.8%), and a combined psychological and physically abused group (47.0%, 95% CI 38.5-55.5%). Over half of the women (53.0%, 95% CI 44.5-61.5%) experienced more than one type of abuse. Women who had experienced different types of intimate partner abuse were associated with lower scores in the majority of domains and the subscales of the SF-36 (p less than 0.05), and there was a cumulative effect of abuse on the health-related quality of life of the women. The problem of intimate partner abuse during pregnancy is similar to most Western countries, and the negative effect of different types of such abuse on the health-related quality of life over time seems to be cumulative. Implications for practice: the relatively poor health-related quality of life of the abused women highlights the necessity of developing a checklist or a structured questionnaire that will assist in the detection of different types and combinations of intimate partner abuse, and that will be helpful in the development of more effective preventive interventions or programmes.

The prevalence of cervical HPV and cytological abnormalities in association with reproductive factors of rural Nigerian women
(Research Article; Sub-Saharan Africa)
Journal of Women's Health. 2008 Mar;17(2):279-285.
Schnatz PF | Markelova NV | Holmes D | Mandavilli SR | O'Sullivan DM
The objective was to estimate the prevalence of cervical human papillomavirus (HPV) and cytological abnormalities while addressing demographic and reproductive variables in a sample of rural Nigerian patients. In March 2004, a medical project was conducted in Okene, Nigeria. The obstetrics/ gynecology team collected demographics of 231 patients and 199 ThinPrep Pap smears (Cytyc, Marlborough, MA), which were analyzed cytologically and for the presence of HPV DNA. Of 231 patients (mean age 32.2), 76% had seen a physician four times or less. From 199 Pap smears performed, 21.6% had high-risk (HR) HPV, low-risk (LR) HPV, or both. HR HPV was present in 16.6% of the women. There were 13 (6.5%) abnormal Pap smears, of which 9 (4.5%) had atypical squamous cells of undetermined significance (ASCUS), 1 (0.5%) had atypical glandular cells (AGC), 2 (1%) had low-grade squamous intraepithelial lesions (LSIL), and 1 (0.5%) had a high-grade SIL (HSIL). Other findings were Trichomonas vaginalis in 18 patients (9%) and Candida in 27 patients (13.5%). The prevalence of cervical HPV and SIL in Okene, Nigeria, is consistent with reports from other African regions. Improved access to healthcare and cervical cancer screening programs may help to decrease transmission of HPV and subsequent cervical cancer in underprivileged areas.

Couple decision making and use of cultural scripts in Malawi
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Nursing Scholarship. 2008 Mar;40(1):12-19.
Mbweza E | Norr KF | McElmurry B
The purpose was to examine the decision-making processes of husband and wife dyads in matrilineal and patrilineal marriage traditions of Malawi in the areas of money, food, pregnancy, contraception, and sexual relations. Qualitative grounded theory using simultaneous interviews of 60 husbands and wives (30 couples). Data were analyzed according to the guidelines of simultaneous data collection and analysis. The analysis resulted in development of core categories and categories of decision-making process. Data matrixes were used to identify similarities and differences within couples and across cases. Most couples reported using a mix of final decision-making approaches: husband-dominated, wife-dominated, and shared. Gender based and nongender based cultural scripts provided rationales for their approaches to decision making. Gender based cultural scripts (husband-dominant and wife-dominant) were used to justify decision-making approaches. Non-gender based cultural scripts (communicating openly, maintaining harmony, and children's welfare) supported shared decision making. Gender based cultural scripts were used in decision making more often among couples from the district with a patrilineal marriage tradition and where the husband had less than secondary school education and was not formally employed. Nongender based cultural scripts to encourage shared decision making can be used in designing culturally tailored reproductive health interventions for couples. Nurses who work with women and families should be aware of the variations that occur in actual couple decision-making approaches. Shared decision making can be used to encourage the involvement of men in reproductive health programs.

HIV/AIDS and STIs NEWS

Nigeria: FG to integrate military HIV/Aids activities
(News Article; Sub-Saharan Africa)
11 Mar 2008
Fleischman J, This Day (Lagos)

Rift over AIDS treatment lingers in South Africa
(News Article; Sub-Saharan Africa)
9 Mar 2008
Dugger C, The New York Times

United States: US Senate committee approves $50 billion global AIDS bill
(News Article; North America)
14 Mar 2008
Associated Press

HIV/AIDS and STIs RESEARCH

Coping with HIV-related stigma in five African countries
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of the Association of Nurses in AIDS Care. 2008 Mar-Apr;19(2):137-146.
Makoae LN | Greeff M | Phetlhu RD | Uys LR | Naidoo JR
People living with HIV (PLWH) and their families are subjected to prejudice, discrimination, and hostility related to the stigmatization of AIDS. This report examines how PLWH cope with HIV-related stigma in the five southern African countries of Lesotho, Malawi, South Africa, Swaziland, and Tanzania. A descriptive qualitative research design was used to explore the experience of HIV-related stigma of PLWH and nurses in 2004. A total of 43 focus groups were conducted with 251 participants (114 nurses, 111 PLWH, and 26 volunteers). In describing incidents of stigma, respondents reported strategies used or observed to cope with those incidents. Nurse reports of coping strategies that they used as well as observed in HIV-infected patients were coded. Coping strategies used by PLWH in dealing with HIV-related stigma were coded. A total of 17 different self-care strategies were identified: restructuring, seeing oneself as OK, letting go, turning to God, hoping, changing behavior, keeping oneself active, using humor, joining a support or social group, disclosing one's HIV status, speaking to others with same problem, getting counseling, helping others to cope with the illness, educating others, learning from others, acquiring knowledge and understanding about the disease, and getting help from others. Coping appears to be self-taught and only modestly helpful in managing perceived stigma.

The 100% Condom Use Program: A demonstration in Wuhan, China
(Abstract; subscription needed for full text; Asia)
Evaluation and Program Planning. 2008 Feb;31(1):10-21.
Zhongdan C | Schilling RF | Shanbo W | Caiyan C | Wang Z
The 100% Condom Use Program (100% CUP) was evaluated in Wuhan, China. The program sought to increase knowledge of STI/ HIV transmission, increase condom use rates, and reduce the prevalence of sexually transmitted infections (STIs) among sex workers (commercial sex workers (CSWs)), via condom availability and use policies in entertainment establishments and STI services including education and counseling. Entertainment establishment owners and CSWs participated in educational sessions and multiple community sectors were involved in the program. At baseline, 170 female CSWs were assessed, and 102 CSWs were assessed at the final 21-month follow-up. At 6-month follow-up, 95% of entertainment establishments were in compliance with 100% CUP policies. At 15 months, condoms were readily available in retail outlets, and condom use rates rose by 94.5%. Refractive rates of chlamydia and methodological limitations of the evaluation leave unanswered questions about the effectiveness of the program. Nonetheless, outcomes suggest that the 100% CUP may be a promising approach to HIV prevention in China.

Raltegravir: An integrase inhibitor for HIV-1
(Abstract; subscription needed for full text; Global)
Expert Opinion on Investigational Drugs. 2008;17(3):413-422.
Evering TH | Markowitz M
The need to develop antiretroviral agents with novel mechanisms of action persists for the treatment of both antiretroviral-experienced and antiretroviral-naive patients with HIV/AIDS. This is mandated, in part, by the perpetual advent of antiretroviral-resistant HIV-1 strains. Raltegravir has been shown to specifically inhibit the essential, HIV-1-encoded, integrase enzyme. As a result, this agent represents a promising chemotherapeutic agent for the treatment of HIV/AIDS. The objective was to form an evidence-based determination of the clinical efficacy, pharmacokinetics and safety profile of raltegravir. We discuss available peer-reviewed publications, preliminary data presented in abstract from relevant scientific meetings and data available from the US Food and Drug Administration (FDA). Current evidence strongly supports raltegravir use in highly active antiretroviral therapy (HAART) regimens constructed to treat patients failing current therapies with multidrug-resistant HIV-1. Additional data are needed to determine its role in the treatment of less advanced patients. Issue surrounding long-term adverse effects and genetic barriers to raltegravir resistance will be critical in determining the potential of this agent.

Knowledge, attitudes and practices concerning HIV / AIDS among Iranian at-risk sub-populations
(Research Article; Middle East)
Eastern Mediterranean Health Journal. 2008 Jan-Feb;14(1):142-156.
Tehrani FR | Malek-Afzali H
This study in 2003 looked at knowledge, attitudes and behaviours concerning HIV among 3 high-risk groups (201 cross-border truck drivers, 50 female sex workers and 754 youths) in 4 cities in the Islamic Republic of Iran. The level of knowledge about HIV was low on average, especially among individuals with high-risk behaviours. Truck drivers and female sex workers had higher knowledge about sexually transmitted infections than youths but their knowledge came primarily from personal experience rather than public awareness programmes. Truck drivers had a more positive attitude to temporary marriage and pre- and extramarital sex than youths. Condom use was low in all groups. Better targeted education of high-risk groups is needed.

Assessing microbicide acceptability: A comprehensive and integrated approach
(Abstract; subscription needed for full text; Global)
AIDS and Behavior. 2008 Mar;12(2):272-283.
Morrow KM | Ruiz MS
A safe, effective, and acceptable microbicide is needed in order to decisively impact the global AIDS pandemic. As such, microbicide acceptability research is of paramount importance. In order to best utilize limited financial resources and save precious development time, acceptability studies should be fully integrated into preclinical and clinical trial contexts where candidate products are being developed and tested. An integrated approach for examining theoretically valid and relevant variables is needed so that data across studies and products can more effectively advance the field. We propose an approach for measuring factors related to microbicide acceptability in each phase of product development, and dependent on what product-specific knowledge is already established in the field. We discuss the roles that behavioral and social science methodologies should play in all phases of microbicide development, as well as the challenges faced when conducting acceptability research in the context of preclinical and clinical trial settings.

MATERNAL AND CHILD HEALTH NEWS

Liberia: Maternal health worsened since war ended
(News Article; Sub-Saharan Africa)
10 Mar 2008
UN Integrated Regional Information Networks (IRIN)

Ghana: Unicef stresses importance of investing in maternal health
(News Article; Sub-Saharan Africa)
10 Mar 2008
Public Agenda (Accra)

Nigeria: Maternal mortality, the silent emergency
(News Article; Sub-Saharan Africa)
12 Mar 2008
Salkida A, Daily Trust (Abuja)

MATERNAL AND CHILD HEALTH RESEARCH

Stillbirth in rural Bangladesh: Arsenic exposure and other etiological factors: A report from Gonoshasthaya Kendra
(Research Article; Asia)
Bulletin of the World Health Organization. 2008 Mar;86(3):172-177.
Cherry N | Shaikh K | McDonald C | Chowdhury Z
Objective To use data collected by Gonoshasthaya Kendra, a large nongovernmental organization providing health care to some 600 villages, to describe the epidemiological pattern of stillbirth and any additional contribution made by arsenic contamination of handpump wells in Bangladesh. Methods Completed pregnancies and outcomes (n = 30 984) for two calendar years, together with existing data on 26 socioeconomic and health factors were selected for study. The health care in these villages was administered from 16 geographical centres; information on the average arsenic concentration in each centre was obtained from the National Hydrochemical Survey. After univariate analysis, a multivariate, multilevel, logistic model for stillbirth was developed. The additional effect of arsenic was calculated having adjusted for all potential confounders thus identified. Findings The overall stillbirth rate was 3.4% (1056/30 984) and increased with estimated arsenic concentration (2.96% at less than 10 microg/l; 3.79% at 10 microg/l to less than 50 microg/l; 4.43% at greater than or equal to 50 microg/l). Having adjusted for 17 socioeconomic and health factors, the odds ratios estimated for arsenic (with less than 10 microg/l as reference) remained raised: 1.23 (95% confidence interval, CI: 0.87-1.74) at 10 microg/l to less than 50 microg/l and 1.80 (95% CI: 1.14-2.86) at 50 microg/l or greater. Conclusion An increased risk of stillbirth is associated with arsenic contamination. This risk, substantial enough to be detected by an ecological approach and not readily attributable to unmeasured confounding, is essentially preventable and all efforts must be made to protect women at high risk.

The association of bacterial vaginosis and preterm labor
(Research Article; Middle East)
Journal of Pakistan Medical Association. 2008 Mar;58(3):104-106.
Nejad VM | Shafaie S
The objective was to determine the relationship between bacterial vaginosis and preterm labour. In this study 160 labouring women admitted in Bahonar Hospital were studied for the presence of bacterial vaginosis based on the presence of clue cells. Control group consisted of 80 women with the gestational age of more than 38 weeks and the case group consisted of 80 women with the gestational age of 20-37 weeks. The two groups were compared in regard to the presence of bacterial vaginosis. In the study group 25% of subjects with preterm labour had bacterial vaginosis, while in the control group only 11.3% had symptoms of bacterial vaginosis that shows a significant difference (P = 0.039). Bacterial vaginosis can induce preterm labor. Therefore the screening of high-risk women for bacterial vaginosis is highly recommended.

Antenatal care in The Gambia: Missed opportunity for information, education and communication
(Research Article; Sub-Saharan Africa)
BMC Pregnancy and Childbirth. 2008 Mar 7;8:9.
Anya SE | Hydara A | Jaiteh LE
Antenatal care is widely established and provides an opportunity to inform and educate pregnant women about pregnancy, childbirth and care of the newborn. It is expected that this would assist the women in making choices that would contribute to good pregnancy outcome. We examined the provision of information and education in antenatal clinics from the perspective of pregnant women attending these clinics. A cross sectional survey of 457 pregnant women attending six urban and six rural antenatal clinics in the largest health division in The Gambia was undertaken. The women were interviewed using modified antenatal client exit interview and antenatal record review questionnaires from the WHO Safe Motherhood Needs Assessment kit. Differences between women attending urban and rural clinics were assessed using the Chi-square test. Relative risks with 95% confidence intervals are presented. Ninety percent of those interviewed had attended the antenatal clinic more than once and 52% four or more times. Most pregnant women (70.5%) said they spent 3 minutes or less with the antenatal care provider. About 35% recalled they were informed or educated on diet and nutrition, 30.4% on care of the baby, 23.6% on family planning, 22.8% on place of birth and 19.3% on what to do if there was a complication. About 25% of pregnant women said they were given information about the progress of their pregnancy after consultation and only 12.8% asked their provider any question. Awareness of danger signs was low. The proportions of women that recognised signs of danger were 28.9% for anaemia, 24.6% for hypertension, 14.8% for haemorrhage, 12.9% for fever and 5% for puerperal sepsis. Prolonged labour was not recognised as a danger sign. Women attending rural antenatal clinics were two times more likely to recognise signs of anaemia and hypertension as indicative of danger compared to women attending urban antenatal clinics. Information, education and communication during antenatal care in the largest health division are poor. Pregnant women are ill-equipped to make appropriate choices especially when they are in danger. This contributes to the persistence of high maternal mortality ratios in the country.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

World population growth: Fertile ground for uncertainty
(News Article; Global)
13 Mar 2008
Worldwatch Institute

Africa’s greatest challenge is to reduce fertility
(News Article; Sub-Saharan Africa)
13 Mar 2008
May J | Guengant JP, Financial Times

Bangladesh: Containing population growth
(News Article; Asia)
13 Mar 2008
The New Nation

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Recent fertility decline in Eritrea: Is it a conflict-led transition?
(Research Article; Sub-Saharan Africa)
Demographic Research. 2008 Mar 1;18(2):27-28.
Woldemicael G
During a period of military conflict towards the end of the 1990s, Eritrea experienced a remarkable decline in fertility. This decline has been a concern to many Eritreans. An important issue of concern has been whether the decline is driven primarily by the recent border conflict with Ethiopia or by changes in other factors including delay in age at marriage, improvements in child survival and the socio-cultural changes that predated the conflict. Using retrospective event histories from the 1995 and 2002 Eritrea Demographic and Health Surveys (EDHS), this study provides an in-depth exploration of recent fertility change in Eritrea. The findings illustrate that although marriage delay might have played a role in the decline of first births, a decline in fertility within marriage - partly due to cessation of childbearing after families reach their desired family size - is the major contributor to the overall decline. Even though we cannot conclude that the overall fertility decline primarily is the outcome of the conflict, there is evidence that it has contributed substantially to the decline, particularly for first birth fertility. The implications of these findings for theories about fertility change in times of military conflict is that crises may not be likely to initiate a sustainable overall fertility transition, but can still prompt short-term fertility changes among certain social groups or modify an ongoing decline.

The burden of disease profile of residents of Nairobi's slums: Results from a Demographic Surveillance System
(Research Article; Sub-Saharan Africa)
Population Health Metrics. 2008 Mar 10;6(1):[26] p..
Kyobutungi C | Ziraba AK | Ezeh A | Ye Y
With increasing urbanization in sub-Saharan Africa and poor economic performance, the growth of slums is unavoidable. About 71% of urban residents in Kenya live in slums. Slums are characteristically unplanned, underserved by social services, and their residents are largely underemployed and poor. Recent research shows that the urban poor fare worse than their rural counterparts on most health indicators, yet much about the health of the urban poor remains unknown. This study aims to quantify the burden of mortality of the residents in two Nairobi slums, using a Burden of Disease approach and data generated from a Demographic Surveillance System. Data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected between January 2003 and December 2005 were analysed. Core demographic events in the NUHDSS including deaths are updated three times a year; cause of death is ascertained by verbal autopsy and cause of death is assigned according to the ICD 10 classification. Years of Life Lost due to premature mortality (YLL) were calculated by multiplying deaths in each subcategory of sex, age group and cause of death, by the Global Burden of Disease standard life expectancy at that age. The overall mortality burden per capita was 205 YLL/1,000 person years. Children under the age of five years had more than four times the mortality burden of the rest of the population, mostly due to pneumonia and diarrhoeal diseases. Among the population aged five years and above, HIV/AIDS and tuberculosis accounted for about 50% of the mortality burden. Slum residents in Nairobi have a high mortality burden from preventable and treatable conditions. It is necessary to focus on these vulnerable populations since their health outcomes are comparable to or even worse than the health outcomes of rural dwellers who are often the focus of most interventions.

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Volume 8, Number 1117 March 2008