Volume 8, Number 16
21 April 2008

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ADOLESCENT HEALTH NEWS

Uganda: Muk starts students' HIV project
(News Article; Sub-Saharan Africa)
14 April 2008
New Vision (Kampala)

Uganda: Help HIV-positive school children
(News Article; Sub-Saharan Africa)
15 April 2008
New Vision (Kampala)

Sudan: Women and youth present their agenda to help heal nation
(News Article; North Africa)
11 April 2008
Catholic Information Service for Africa (Nairobi)

ADOLESCENT HEALTH RESEARCH

Identifying sources of adolescent exclusion due to violence: Participatory mapping in South Africa
(Summary Report; Sub-Saharan Africa)
New York, New York, Population Council, 2008 Jan. [4] p. (Promoting Healthy, Safe, and Productive Transition)
Kenworthy N | Hallman K | Diers J
As the first generation to grow up under democracy, adolescents in post-apartheid South Africa lead lives that are filled with new opportunities and overshadowed by rampant violence and crime. Even as the end of apartheid improved the lives of many South Africans and extinguished much of the political violence that preceded the transition, violent crime has increased dramatically within certain communities. The presence of multiple and simultaneous forms of violence and the systemic lack of safety are experienced most acutely by adolescents - in particular, adolescent girls. High levels of violence and crime within the community are coupled with violence within the home and in schools: again, both of these phenomena primarily affect girls. The Population Council's Transitions to Adulthood program examines the particular factors that shape adolescents' life chances and choices. In South Africa, for instance, Council researchers have studied how economic literacy and life skills education affect young men and women who are economically and socially disenfranchised and at high risk for HIV infection. To take full advantage of the skills these programs promote, however, young people must have access to safe spaces-both within the program and beyond: in the home, at school, and in the community.

Opportunities and challenges of sexual health services among young people: A study in Nepal
(Abstract; subscription needed for full text; Asia)
Journal of Sexual Medicine. 2008;:[10] p..
Regmi K
It has been well documented that young people are more likely to engage in high-risk sexual activity. Appropriate understanding of safe sex, sexual practices, and related behaviors must recognize the importance of socioeconomic and cultural factors in prevention efforts related to HIV and other sexual transmitted infections (STIs). The aim was to examine and summarize the opportunities and challenges of sexual health services among young people in Nepal. The main outcome measures were review of literature-assessing knowledge, attitudes, and understanding of sex, sexual health, and related sexual risk behaviors, among young people (15-24), in line with the current sociocultural and health service practices. Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Science, Cochrane database, and Google were searched. Similarly, documents published at the WHO, United Nations Population Fund, United Nations Development Program, and at national/local level-Ministry of Health, National Center for AIDS, and STD Control were also assessed to access the relevant reports and articles. Published and gray articles were also reviewed. This study contends growing expansion of communication and transportation networks, urbanization, and urban in-migration is creating a different sociocultural environment, which is conducive to more social interactions between young girls and boys in Nepal. Rising age at marriage opens a window of opportunity for premarital and unsafe sexual activity among young people and this creates risks of unwanted pregnancy, STIs/HIV and AIDS. Socioeconomic, demographic, and cultural factors have been identified as encouraging factors for risk-taking behaviors among young people. Understanding safer sex and responsible sexual/reproductive behavior is important. Effective and appropriate interventions on sexual and reproductive health education directed at young people and the whole family, including fathers, could have significant effect on reducing risk and related risk practices in the context of Nepal.

The sexual and reproductive health of young people in Latin America: Evidence from WHO case studies
(Abstract; subscription needed for full text; North America)
Salud Publica de Mexico. 2008 Jan-Feb;50(1):10-16.
Kostrzewa K
This original article addresses the sexual and reproductive health needs of young people aged 15 to 24 in Latin America. It introduces five articles from original research projects in three countries: Argentina, Brazil, and Peru. These projects were funded by the World Health Organization. This article explains the importance of studies that address the sexual and reproductive health of young people in developing countries. It provides an overview of sexual and reproductive health issues in Latin America and a discussion these issues in the three study countries. The five articles deal with difficult and challenging issues, including: knowledge of STIs and HIV/ AIDS; pregnancy related practices; quality of care; the role of young men in couple formation, pregnancy and adoption of contraceptive practice; and, the role of obstetricians and gynecologists in public policy debate about family planning and abortion. The four articles in this special section help to improve our understanding of the factors that contribute to risky sexual behavior and negative reproductive health outcomes among youth in Latin America. The findings are useful to help inform and improve health care interventions in various contexts.

FAMILY PLANNING NEWS

Africa: 'God should be so kind that I can have contraceptives'
(News Article; Sub-Saharan Africa)
10 Apr 2008
Oyaro K, Inter Press Service (Johannesburg)

Malaysian experts says Islam permits use of contraceptives
(News Article; Asia)
17 Apr 2008
Kuala L, Thaindian News

Yemeni men support the use of contraceptives to help plan families
(News Article; Middle East)
14 Apr 2008
Hamed T, Yemen Times

United Nations: Family planning gets mere sliver of aid pie
(News Article; Global)
12 Apr 2008
Deen T, Inter Press Service (IPS) News Agency

FAMILY PLANNING RESEARCH

Hormonal contraception and the risks of STI acquisition: Results of a feasibility study to plan a future randomized trial
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Contraception. 2008 May;77(5):366-370.
Hubacher D | Raymond ER | Beksinska M | Delany-Moretlwe S | Smit J | Hylton - Hong T | Moench T
Because of limitations in observational studies, a randomized controlled trial (RCT) would help clarify whether hormonal contraception increases the risks of acquiring a sexually transmitted infection (STI). However, the feasibility of such a trial is uncertain. We conducted a study to assess the feasibility of conducting an RCT that would compare the acquisition risk for Chlamydia trachomatis and Neisseria gonorrhoeae in women randomized to an intrauterine device (IUD) or depot medroxyprogesterone acetate (DMPA). In our cross-sectional survey conducted at three clinics, we gave information on a potential RCT to clients, asked them questions to assess comprehensibility and finally asked respondents whether they would consider enrolling in such a trial. In addition, the 190 participants provided urine or endocervical swab specimens so we could estimate the prevalence of STIs. Overall, 70% of participants stated that they would take part in a future trial and accept randomization to either the IUD or DMPA. Participant understanding of the trial requirements was high. Twenty-nine percent of the participants were infected with either N. gonorrhoeae or C. trachomatis. With a high prevalence of STI in this population and the apparent willingness of appropriate candidates to participate, an RCT to measure risks of incident STI infection from hormonal contraception appears feasible.

Pregnancy during breastfeeding in rural Egypt
(Abstract; subscription needed for full text; North Africa)
Contraception. 2008 May;77(5):350-354.
Shaaban OM | Glasier AF
Breastfeeding does not reliably protect against pregnancy except during the first 6 months postpartum and only then if accompanied by amenorrhea. Reluctance to use other methods of contraception during lactation may result in unplanned pregnancy. The aims of this study were to describe, among women in rural Egypt attending for antenatal care the prevalence of pregnancy during breastfeeding, contraceptive practice and unintended pregnancy. Finally, the study assessed women's impressions of the effect of conception during breastfeeding on breast milk and on the health of the breastfed infant. The study design was a descriptive study using an interviewer-administered structured questionnaire for 2617 parous women attending a hospital in Egypt for antenatal care. More than 95% of women breastfed the child before their current pregnancy; 25.3% conceived while breastfeeding. Conception occurred during the first 6 months postpartum in 4.4%, before resumption of menstruation in 15.1% and while exclusively or almost exclusively breastfeeding in 28.1%. Only 10 pregnancies (1.5%) occurred when all the prerequisites of the lactational amenorrhea method of contraception (LAM) were present. Twenty-nine percent of pregnancies conceived during breastfeeding were unintended, 10% of women had considered terminating their pregnancy while 4.4% of them reported trying to do so. Pregnancy during breastfeeding is common in Egypt and is often unintended. There is great potential for using LAM, but it must be properly taught, and women should be encouraged to start using effective contraception as soon as any of the prerequisites of LAM expires.

Fertility and family planning in Ethiopia: A new look at data from the 2005 Ethiopia demographic and health survey
(Summary Report; Sub-Saharan Africa)
Addis Ababa, Ethiopia, Central Statistical Agency, 2007. 20 p.
Measure DHS
The 2005 Ethiopia Demographic and Health Survey (EDHS) is the second in a series of national surveys conducted in Ethiopia. It is designed to measure levels, patterns, and trends in demographic and health indicators. In the 2005 EDHS, a nationally representative sample of 14,070 women and 6,033 men from 13,721 households were interviewed. Overall, 96 percent of women and 89 percent of men who were selected in the sample agreed to be interviewed. This sample provides estimates for Ethiopia as a whole, for urban and rural areas of the country, for each of the nine regions, and for the two Administrative Council Areas of Addis Ababa and Dire Dawa. The Ethiopia DHS provides data on fertility, family planning, maternal and child health, nutrition, malaria, HIV, and women's status. The background characteristics of women and men are also collected, allowing their health and demographic indicators to be compared to their age, residence, wealth, and educational level. This booklet looks exclusively at the fertility and family planning status of Ethiopians.

GENDER and HEALTH NEWS

Ethiopia: Bride-price key in increasing rate of rape
(News Article; Sub-Saharan Africa)
10 April 2008
The Daily Monitor (Addis Ababa)

Swaziland: One in three women sexually abused as child - report
(News Article; Sub-Saharan Africa)
9 April 2008
UN Integrated Regional Information Networks

Yemen’s MPs debate female circumcision, pre-marriage tests
(News Article; Middle East)
13 Apr 2008
Yemen Times

GENDER and HEALTH RESEARCH

Intimate partner violence among pregnant Thai women
(Abstract; subscription needed for full text; Asia)
Violence Against Women. 2008 May;14(5):509-527.
Thananowan N | Heidrich SM
The purposes of this study are to describe intimate partner violence (IPV) among pregnant women in Thailand and compare maternal characteristics, health practices during pregnancy, and maternal health between abused and nonabused pregnant women. Of 475 pregnant Thai women, 13.1% report ever being abused, whereas 4.8% report physical abuse during pregnancy. Women abused during pregnancy, compared to nonabused women, are more likely to be younger, unmarried, have low income, be unemployed, and report that the pregnancy was unwanted. They also report lower levels of positive health practices and higher levels of depressive symptoms. Results demonstrate a need for screening of IPV among pregnant Thai women.

Cervical cancer in Bangladesh: Community perceptions of cervical cancer and cervical cancer screening
(Abstract; subscription needed for full text; Asia)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 May;102(5):499-505.
Ansink AC | Tolhurst R | Haque R | Saha S | Datta S
We investigated the awareness of, and the attitude towards screening for, cervical cancer in Bangladesh. We performed a qualitative study using focus group discussions (FGD). The framework approach to qualitative analysis was used. The study was performed in the catchment areas of Addin Hospital, Jessore, Southern Bangladesh (peri-urban) and LAMB hospital, Parbatipur, North West Bangladesh (rural). A total of 220 men, women and adolescents participated in 28 FGDs. Awareness of cervical cancer was widespread. Knowledge about causes was often inadequate. The perceived consequences of cervical cancer were numerous and awareness of the need for cervical cancer treatment was present. Barriers to accessing care include: low priority for seeking help for symptoms, limited availability of health services and cost. Most women were unaware of the possibility of screening via speculum examination, which was considered acceptable to women (and men), as long as the examination was done by a female healthcare provider in an environment with sufficient privacy. In conclusion, adequate gynaecological services are not available or accessible for most women in rural and peri-urban Bangladesh. However, awareness of cervical cancer is widespread. Screening for cervical cancer in these communities is acceptable if done by a female healthcare provider under conditions with sufficient privacy.

Effectiveness of cryotherapy treatment for cervical intraepithelial neoplasia
(Abstract; subscription needed for full text; South America)
International Journal of Gynecology and Obstetrics. 2008 May;101(2):172-177.
Luciani S | Gonzales M | Munoz S | Jeronimo J | Robles S
The objective was to assess the effectiveness of cryotherapy treatment delivered by general practitioners in primary care settings, as part of a screen-and-treat approach for cervical cancer prevention. Women aged between 25 and 49 years residing in San Martin, Peru, who were positive on visual inspection screening were treated, if eligible, with cryotherapy following biopsy. At 12 months post cryotherapy treatment the participants were evaluated for treatment effectiveness and examined by visual inspection and Papanicolaou test and, if positive, referred to a gynecologist for colposcopy and biopsy. Cryotherapy treatment was performed for 1398 women; of these, 531 (38%) had a histology result of cervical intraepithelial neoplasia (CIN). Cryotherapy effectively cured CIN in 418 (88%) women, including 49 (70%) women with a baseline diagnosis of CIN 3. Cryotherapy is an effective treatment for cervical precancerous lesions; it can easily be administered by general practitioners in primary care settings following visual inspection screening.

Spousal abuse during pregnancy in Karachi, Pakistan
(Abstract; subscription needed for full text; Asia)
International Journal of Gynecology and Obstetrics. 2008 May;101(2):141-145.
Farid M | Saleem S | Karim MS | Hatcher J
The objectives were to determine the magnitude of and factors associated with spousal abuse during pregnancy in women presenting to tertiary care hospitals in Karachi, Pakistan. Five hundred women who delivered a live singleton baby were interviewed. Physical and/or emotional abuse during pregnancy (PEAP) was the primary outcome measure as determined by the World Health Organization's domestic violence module. Frequencies of different forms of abuse were measured and the relationship between PEAP and the risk factors was determined using multiple logistic regression. Of the women interviewed, 44% reported abuse during the index pregnancy; and of these, 43% experienced emotional abuse and 12.6% reported physical abuse. Factors independently associated with PEAP were number of living children (adjusted odds ratio [AOR] 1.34; CI, 1.08-1.65), interfamilial conflicts (AOR 3.03; CI, 1.85-4.96), husband's exposure to maternal abuse (AOR, 2.38; CI, 1.41-4.02), and husband's use of tobacco (AOR 1.59; CI, 1.05-2.42). Women who had adequate social support were less likely to be abused by their husbands (AOR 0.65; CI, 0.51-0.82). Almost half of the pregnant women interviewed were either physically or emotionally abused. Strong social support helps protect against abuse.

Effects of environmental and occupational pesticide exposure on human sperm: A systematic review
(Abstract; subscription needed for full text; Global)
Human Reproduction Update. 2008 May-Jun;14(3):233-242.
Perry MJ
Relatively recent discoveries of the hormone disrupting properties of some pesticides have raised interest in how contemporary pesticide exposures, which primarily take the form of low level environmental or occupational exposures, impact spermatogenesis. The objective of the present review was to summarize results to date of studies examining pesticide effects on human sperm. Outcomes evaluated included sperm parameters, DNA damage and numerical chromosome aberrations (aneuploidy (disomy, nullisomy) or diploidy). Studies investigating sperm in men environmentally and/or occupationally exposed to any types of pesticides were included in the review. The targeted literature search over the last 15 years showed a range of pesticide classes have been investigated including pyrethroids, organophosphates, phenoxyacetic acids, carbamates, organochlorines and pesticide mixtures. None of the studies involved acute exposure events such as chemical accidents. There were 20 studies evaluating semen quality, of which 13 studies reported an association between exposure and semen quality; 6 studies evaluating DNA damage, of which 3 reported an association with exposure; and 6 studies assessing sperm aneuploidy or diploidy, of which 4 reported an association with exposure. Studies varied widely in methods, exposures and outcomes. Although suggestive for semen parameters, the epidemiologic evidence accumulated thus far remains equivocal as to the spermatotoxic and aneugenic potential of pesticides given the small number of published studies. This question warrants more investigation and suggestions for future studies are outlined.

HIV/AIDS and STIs NEWS

Kenya: Govt Adopts Circumcision Policy to Fight HIV
(News Article; Sub-Saharan Africa)
10 Apr 2008
Okwemba A, The Nation (Nairobi)

Africa: At the cutting edge--male circumcision and HIV
(Feature Article; Sub-Saharan Africa)
18 Apr 2008
IRIN

HIV/AIDS and STIs RESEARCH

Mycobacterium tuberculosis resistance in HIV-infected patients from a tertiary care teaching hospital in Porto Alegre, southern Brazil
(Abstract; subscription needed for full text; South America)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 May;102(5):421-425.
Wolfart M | Barth AL | Willers D | Zavascki AP
Drug-resistant Mycobacterium tuberculosis isolates are a major public health concern worldwide. There are few studies assessing tuberculosis (TB) resistance in Brazil. This study assessed the prevalence of resistance to the five first-line anti-TB drugs in TB isolates from HIV-infected patients in a tertiary care teaching hospital in southern Brazil. From September 1997 to July 2003, 398 TB complex isolates were included in the study. Resistance to one or more first-line anti-TB drugs was found in 71 (17.8%) of patients and was significantly more frequent among previously treated patients (12 [30.8%] of 39 patients) than new cases (59 [16.4%] of 359) (P = 0.05). The highest resistance rates were found to isoniazid (9.9% overall; and 25.6% among previously treated patients). Multidrug-resistant TB was found in eight (2.0%) patients, with higher rates among previously treated patients than new cases: two (5.1%) patients vs. six (1.6%), respectively (P = 0.18). Multidrug resistance and particularly isoniazid resistance rates among previously treated HIV patients are of great concern. Our findings indicate the need to reappraise regional TB treatment policies and support the recommendation for routine performance of in vitro TB susceptibility tests in all previously treated patients.

Clinical and laboratory profile of patients with tuberculosis/HIV coinfection at a national referral centre: A case series
(Abstract; subscription needed for full text; Middle East)
Eastern Mediterranean Health Journal. 2008 Mar-Apr;14(2):283-291.
Tabarsi P | Mirsaeidi SM | Amiri M | Mansouri SD | Masjedi MR
This case series describes the clinical and laboratory profile of 15 patients with tuberculosis (TB) HIV coinfection admitted to a referral centre in the Islamic Republic of Iran. Most of the patients (13) were male; the mean age was 36.9 years. Intravenous drug use was the route of transmission for all males and heterosexual intercourse for the 2 females; 12 patients had a history of imprisonment. All patients had pulmonary TB; 13 were smear-positive and all except 1 had atypical radiological presentation. Drug-induced hepatitis occurred in 3 patients and 12 had hepatitis C coinfection. Five patients died. The mean CD4 count was 229.2 (SD 199.5) cells/mm3 and 78.6% had CD4 count less than 350. TB may be an AIDS-defining illness in this country.

Challenges to HIV prevention--seeking effective measures in the absence of a vaccine
(Editorial; Global)
New England Journal of Medicine. 2008 Apr 10;358(15):1543-1545.
Lagakos S | Gable A

A population-based survey of the prevalence of HIV, syphilis, hepatitis B and hepatitis C infections, and associated risk factors among young women in Vitoria, Brazil
(Abstract; subscription needed for full text; South America)
AIDS and Behavior. 2008;:7 p..
Miranda AE | Figueiredo NC | Schmidt R | Page-Shafer K
The objective was to estimate the prevalence of HIV, hepatitis B (HBV) and C (HCV), and syphilis infections and associated risk exposures in a population-based sample of young women in Vitoria, Brazil. From March to December 2006, a cross-sectional sample of women aged 18-29 years was recruited into a single stage, population-based study. Serological markers of HIV, HBV, HCV, and syphilis infections and associated risk exposures were assessed. Of 1,200 eligible women, 1,029 (85.8%) enrolled. Median age was 23 (interquartile range 20-26) years; 32.2% had less than or equal to 8 years of education. The survey weighted prevalence estimates were: HIV, 0.6% [(95% CI), 0.1%, 1.1%]; anti-HBc, 4.2% (3.0%, 5.4%); HBsAg, 0.9% (0.4%, 1.6%); anti-HCV, 0.6% (0.1%, 1.1%), and syphilis 1.2% (0.5%, 1.9%). Overall, 6.1% had at least one positive serological marker for any of the tested infections. A majority (87.9%) was sexually active, of whom 12.1% reported a previously diagnosed sexually transmitted infection (STI) and 1.4% a history of commercial sex work. Variables independently associated with any positive serological test included: older age (greater than or equal to 25 vs. less than 25 years), low monthly income (less than or equal to 4x vs. greater than 4x minimum wage), previously diagnosed STI, greater than or equal to 1 sexual partner, and any illicit drug use. These are the first population-based estimates of the prevalence of exposure to these infectious diseases and related risks in young women, a population for whom there is a scarcity of data in Brazil.

MATERNAL AND CHILD HEALTH NEWS

Critical health care fails to reach most women and children in high mortality countries despite gains in fighting child killer diseases
(News Article; Global)
16 Apr 2008
UNICEF

South Africa: Maternal mortality rate drops
(News Article; Sub-Saharan Africa)
14 Apr 2008
Khumalo G, BuaNews (Tshane)

Ghana: Anaemia among women contributes 20 percent maternal deaths
(News Article; Sub-Saharan Africa)
14 Apr 2008
Jalulah WN, Ghanaian Chronicle (Accra)

UNICEF heralds new children's protection laws in South Africa
(News Article; Sub-Saharan Africa)
10 April 2008
UN News Centre

MATERNAL AND CHILD HEALTH RESEARCH

Mind the gap: Equity and trends in coverage of maternal, newborn, and child health services in 54 countdown countries
(Abstract; subscription needed for full text; Global)
Lancet. 2008 Apr 12-18;371(9620):1259-1267.
Boerma JT | Bryce J | Kinfu Y | Axelson H | Victora CG
Increasing the coverage of key maternal, newborn, and child health interventions is essential if Millennium Development Goals (MDG) 4 and 5 are to be reached. The authors have assessed equity and trends in coverage rates of a key set of interventions through a summary index, to provide overall insight into past performance and progress perspectives. Data from household surveys from 54 countries in the Countdown to 2015 for Maternal, Newborn and Child Survival initiative during 1990-2006 were used to compute an aggregate coverage index based on four intervention areas: family planning, maternal and newborn care, immunisation, and treatment of sick children. The four areas were given equal weight in the computation of the index. Standard measures were applied to assess current levels and trends in the coverage gap measure by wealth quintile. The overall size of the coverage gap ranged from less than 20% in Tajikistan and Peru to over 70% in Ethiopia and Chad, with a mean of 43% for the most recent surveys in the 54 countries. Large intracountry differences were noted, with a country mean coverage gap of 54% for the poorest quintiles of the population and 29% for the wealthiest. Differences between the poorest and the wealthiest were largest for the maternal and newborn health intervention area and smallest for immunisation. In 40 countries with more than one survey, the coverage gap had decreased by an average of 0.9 percentage points per year since the early 1990s. Declines greater than 2 percentage points per year were seen in only three countries after 1995: Cambodia, Mozambique, and Nepal. Country inequity patterns were remarkably persistant over time, with only gradual changes from top inequity (disproportionately smaller gap for the wealthiest) in countries with coverage gaps exceeding 40%, to linear patterns and bottom inequity (disproportionately greater gap for the poorest) in surveys with gaps below 40%. Despite most Countdown countries having made gradual progress since 1990, coverage gaps for key interventions remain wide and, in most such countries, the pace of decline needs to be more than doubled to reach levels of coverage of these and other interventions needed in the context of MDG 4 and 5. In general, in-country patterns of inequality are consistant and change only gradually if at all, which has implications for the targeting of interventions.

Countdown to 2015: Assessment of donor assistance to maternal, newborn, and child health between 2003 and 2006
(Abstract; subscription needed for full text; Global)
Lancet. 2008 Apr 12-18;371(9620):1268-1275.
Greco G | Powell-Jackson T | Borghi J | Mills A
To track donor assistance to maternal, newborn, and child health-related activities is necessary to assess progress towards Millennium Development Goals 4 and 5 and to foster donor accountability. The authors' aim was to analyse aid flows to maternal, newborn, and child health for 2005 and 2006 and trends between 2003 and 2006. The authors analysed and coded the complete aid activities database for 2005 and 2006 with methods that they developed previously to track official development assistance. For the 68 Countdown priority countries, the authors report two indicators for use in monitoring donor disbursements: official development assistance to child health per child and official development assistance to maternal and neonatal health per livebirth. Donor disbursements increased from US$2119 million in 2003 to $3482 million in 2006; funding for child health increased by 63% and that for maternal and newborn health increased by 66%. In the 68 priority countries, child-related disbursements increased from a mean of $4 per child in 2003 to $7 per child in 2006; disbursements for maternal and neonatal health increased from $7 per livebirth in 2003 to $12 per livebirth in 2006. Nonetheless, disbursements fell in some countries. After adjustment for other determinants, countries with higher under-5 mortality received more official development assistance per child, but official development assistance to maternal and newborn health did not seem to be well targeted towards countries with the greatest maternal health needs. Donor resource tracking should be continued to help hold donors accountable and encourage targeting of resources to countries with greatest needs.

Countdown to 2015 for maternal, newborn, and child survival: The 2008 report on tracking coverage of interventions
(Abstract; subscription needed for full text; Global)
Lancet. 2008 Apr 12-18;371(9620):1247-1258.
Bryce J | Daelmans B | Dwivedi A | Fauveau V | Lawn JE | Mason E | Newby H | Requejo J | Salama P | Shankar A | Starrs A | Wardlaw T
The Countdown to 2015 for Maternal, Newborn, and Child Survival initiative monitors coverage of priority interventions to achieve the Millennium Development Goals (MDG) for reduction of maternal and child mortality. The authors aimed to report on 68 countries which have 97% of maternal and child deaths worldwide, and on 22 interventions that have been proven to improve maternal, newborn, and child survival. The authors selected countries with high rates of maternal and child deaths, and interventions with the most potential to avert such deaths. The authors analysed country-specific data for maternal and child mortality and coverage of selected interventions. The authors also tracked cause-of-death profiles; indicators of nutritional status; the presence of supportive policies; financial flows to maternal, newborn, and child health; and equity in coverage of interventions. Of the 68 priority countries, 16 were on track to meet MDG 4. Of these, seven had been on track in 2005 when the Countdown initiative was launched, three (including China) moved into the on-track category in 2008, and six were included in the Countdown process for the first time in 2008. Trends in maternal mortality that would indicate progress towards MDG 5 were not available, but in most (56 of 68) countries, maternal mortality was high or very high. Coverage of different interventions varied widely both between and within countries. Interventions that can be routinely scheduled, such as immunisation and antenatal care, had much higher coverage than those that rely on functional health systems and 24-hour availability of clinical services, such as skilled or emergency care at birth and care of ill newborn babies and children. Data for postnatal care were either unavailable or showed poor coverage in almost all 68 countries. The most rapid increases in coverage were seen for immunisation, which also received significant investment during this period. Rapid progress is possible, but much more can and must be done. Focused efforts will be needed to improve coverage, especially for priorities such as contraceptive services, care in childbirth, postnatal care, and clinical case management of illnesses in newborn babies and children.

Frequency of vaginal candidiasis in pregnant women attending routine antenatal clinic
(Abstract; subscription needed for full text; Asia)
Journal of the College of Physicians and Surgeons, Pakistan. 2008 Mar;18(3):154-157.
Parveen N | Munir AA | Ikram-Din | Majeed R
The objective was to determine the frequency of vaginal candidiasis in clinically symptomatic and asymptomatic cases of pregnant women attending routine antenatal clinic. The study design was a descriptive cross-sectional study. The setting for the study was the antenatal clinic of Gynaecology and Obstetric Department at Isra University Hospital, Hyderabad, from April to October 2005. A total of 110 pregnant women were nonrandomly recruited by convenient sampling. The studied variables included the demographic data information on parity, trimester of pregnancy, presence of vaginal discharge and the presence or absence of diabetes. Vulva and vagina were inspected for signs of inflammation and discharge with sterile speculum and vaginal specimens were collected with sterile cotton tipped swabs. Swabs were subjected to Gram staining and examined microscopically for the diagnosis of candidiasis. The frequency of vaginal candidiasis during pregnancy was found to be 38%, in which 27% were symptomatic and 11% were asymptomatic group. Increased ratio of infection was observed in multigravida and diabetic women. There was no marked differences in results with respect to age and trimester of pregnancy. Although there is generally a high frequency of vaginal candidiasis, an increased ratio of vaginal candidiasis in multigravida and diabetic pregnant women requires these women to be routinely screened for vaginal candidiasis regardless of symptomatic status.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Are TV soap operas downsizing Brazilian families?
(News Article; South America)
17 Apr 2008
AFP

The Philippines: Population increase is down
(Abstract; subscription needed for full text; Asia)
16 Apr 2008
Bas R., The Manila Times

8-year-old girl's divorce is finalized while a law to prevent early marriage stalls
(News Article; Middle East)
17 Apr 2008
Thabet H., Yemen Times

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Migration from Zimbabwe: Numbers, needs, and policy options
(Summary Report; Sub-Saharan Africa)
Johannesburg, South Africa, Centre for Development and Enterprise, 2008 Apr. [40] p.
Leslie R
On 13 November 2007 CDE hosted a workshop on the migration of Zimbabweans to South Africa. CDE took this initiative because it had become clear from media reports that increased migration flows from Zimbabwe were exacerbating and dramatising already existing inadequacies of regional migration management. By staging the workshop, and distributing this publication based on its proceedings, CDE hopes to broaden and inform the policy debate not only on the short-term pressures of crisis-driven movement of people out of Zimbabwe, but on the wider and longer-term issues of immigration policy in South Africa. Political instability and economic decline in Zimbabwe are driving migration to South Africa at an accelerating rate. This movement of people in unprecedented numbers is also fuelled by South Africa's skills shortages and comparatively robust - in regional terms at least - economic performance.

International migration and educational assortative mating in Mexico and the United States
(Working Paper; North America)
Los Angeles, California, University of California - Los Angeles, California Center for Population Research, 2008 Feb. [40] p. (California Center for Population Research On-Line)
Choi KH | Mare RD
Using data from the 2000 U.S. and Mexican Censuses, this paper examines the relationship between migration and marriage patterns by describing how the distributions of marital statuses and assortative mating patterns vary by individual and community experiences of migration. In Mexico, migrants and those living in areas with high levels of migration are less likely to marry a spouse with the same level of education. Return migrants from the U.S. to Mexico may use their improved economic position to marry up. In the U.S., Mexican migrants are also less likely to enter into homogamous unions; however, the odds of homogamy do not vary by couple level of migration. Migrants may expand their pool of potential spouses to include non-migrants and nonmigrants tend to be better educated than Mexican migrants. With individual migration experiences, the odds of marrying outside of one's education group increase the most among the least educated. With community level of migration in Mexico, the odds of marrying outside of the group increases the most among the best educated. These findings suggest that preferences for homogamy are disrupted by migration.

Fertility declining in the Middle East
(Summary Report; North Africa | Middle East)
Washington, D.C., Population Reference Bureau [PRB], 2008 Apr. [4] p.
Roudi-Fahimi F | Kent MM
The Middle East and North Africa includes some of the world's fastest growing countries, and the region as a whole saw its population quadruple in the second part of the 20th century, from 104 million to 400 million. It added another 32 million by 2007. But growth of the mainly Arab countries of the Middle East and North Africa has been slowed by a veritable revolution in marriage and childbearing in recent decades. While a young population structure ensures momentum for future growth, the pace has slackened thanks to fertility declines in some of the region's largest countries. MEAN's total fertility rate (TFR), or average number of children born per woman, declined from about seven children in 1960 to three children in 2006. The decline started first in Lebanon, then in a few other countries, including Egypt, Iran, and Tunisia. These last three countries were among the first to adopt policies to lower fertility as a way to slow population growth. In Iran, Lebanon, Tunisia, and Turkey, fertility was at or below the replacement level of about 2.1 children per woman. Yemen's TFR has edged downward, but remains the region's highest at 6.2 in 2005. Israel's TFR was the region's lowest in the 1950s, but has not declined as far as in many other countries.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 8, Number 1621 April 2008