Volume 8, Number 5
5 February 2008

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ADOLESCENT HEALTH NEWS

Somali refugee wins US State Department award for courage
(News Article; Sub-Saharan Africa)
31 Jan 2008
UNHCR

Survey: HK's majority support sex education at young
(News Article; Asia)
29 Jan 2008
China View

ADOLESCENT HEALTH RESEARCH

Girls count: A global investment and action agenda
(Report; Global)
Washington, D.C., Center for Global Development, 2008. 89 p.
Levin R | Lloyd C | Greene M | Grown C
This report is about why and how to put girls at the center of development. It is about how the health of economies and families depends on protecting the rights of and fostering opportunities for today's girls. It is about how far girls in many developing countries have come-but how far we remain from a world in which girls' rights are respected. With adolescent girls the case is perfectly clear that the economic and human rights agendas are perfectly aligned: in new global economy girls and young women are no longer as sheltered by their parents and communities, but they also are not armed with education or understanding of their own rights to protect themselves in the world. Unfortunately, adolescent girls are awkward for governments and donors to think about, with their physical sexuality but their nonadult vulnerability. Ministries of health and education do not have a mandate to serve them, ministries of social welfare have more politically rewarding programs to operate, and donor agencies find it far easier to promote investments in very young children and older mothers than to deal with the complicated and controversy-generating age between childhood and adulthood.

Family structure and adolescent sexual behavior in a poor area of Sao Paulo, Brazil
(Abstract; subscription needed for full text; South America)
Journal of Adolescent Health. 2008 Feb;42(2):177-183.
Peres CA | Rutherford G | Borges G | Galano E | Hudes ES
In Brazil, as elsewhere, behavior during adolescence can place young people at risk for serious medical and social problems, including sexually transmitted infections, unintended pregnancy, drugs, crime, and violence. Few studies internationally have examined the influence of family structure on risk behavior among low-income youths. This cross-sectional study included 296 young people in one of the poorest areas of Sao Paulo who were recruited through a vocational school and completed an anonymous, self-administered questionnaire. We examined associations between family structure and various risk behaviors. Ages ranged from 13-24 years (82%, 15-18); 67% were of Afro-Brazilian ancestry, and 56% were female. Median family monthly income was about US$200. Less than half lived with both parents, and 14% lived with neither parent. Rates of many risk behaviors, including involvement in crime and violence, drug and alcohol use, and sexual risk, were lowest among those living with both parents, higher among those living with one parent, and highest among those living with neither parent. For example, 26% of females living with both parents, 37% with one parent, and 71% with neither parent were sexually active (p = .003). Family structure and a personal or parental history of drug or alcohol problems were significant independent predictors of sexual activity. The presence of both parents is an important protective factor for Brazilian youth vulnerable to multiple risks. Prevention programs should explore ways to support parents to be present and involved in the lives of their adolescent children.

Global youth tobacco surveillance, 2000 -- 2007
(Report; Global)
MMWR. Morbidity and Mortality Weekly Report. 2008 Jan 25;57(1):1-28.
Warren CW | Jones NR | Peruga A | Chauvin J | Baptiste JP
Tobacco use is a major contributor to deaths from chronic diseases. The findings from the Global Youth Tobacco Survey (GYTS) suggest that the estimate of a doubling of deaths from smoking (from 5 million per year to approximately 10 million per year by 2020) might be an underestimate because of the increase in smoking among young girls compared with adult females, the high susceptibility of smoking among never smokers, high levels of exposure to secondhand smoke, and protobacco indirect advertising. This report includes GYTS data collected during 2000-2007 from 140 World Health Organization (WHO) member states, six territories (American Samoa, British Virgin Islands, Guam, Montserrat, Puerto Rico, and the U.S. Virgin Islands), two geographic regions (Gaza Strip and West Bank), one United Nations administered province (Kosovo), one special administrative region (Macau), and one Commonwealth (Northern Mariana Islands). For countries that have repeated GYTS, only the most recent data are included. For countries with multiple survey sites, only data from the capital or largest city are presented. GYTS is a school-based survey of a defined geographic site that can be a country, a province, a city, or any other geographic entity. GYTS uses a standardized methodology for constructing sampling frames, selecting schools and classes, preparing questionnaires, conducting field procedures, and processing data. GYTS standard sampling methodology uses a two-stage cluster sample design that produces samples of students in grades associated with students aged 13-15 years. Each sampling frame includes all schools (usually public and private) in a geographically defined area containing any of the identified grades. In the first stage, the probability of schools being selected is proportional to the number of students enrolled in the specified grades. In the second sampling stage, classes within the selected schools are selected randomly. All students in selected classes attending school the day the survey is administered are eligible to participate. Student participation is voluntary and anonymous using self-administered data collection procedures. The GYTS sample design produces independent, cross-sectional estimates that are representative of each site. The findings in this report indicate that the level of cigarette smoking between boys and girls is similar in many sites; the prevalence of cigarette smoking and use of other tobacco products is similar; and susceptibility to initiate smoking among never smokers is similar among boys and girls and is higher than cigarette smoking in the majority of sites. Approximately half of the students reported that they were exposed to secondhand smoke in public places during the week preceding the survey. Approximately eight in 10 favor a ban on smoking in public places. Approximately two in 10 students own an object with a cigarette brand logo on it, and one in 10 students have been offered free cigarettes by a tobacco company representative. Approximately seven in 10 students who smoke reported that they wanted to stop smoking. Approximately seven in 10 students who smoked were not refused purchase of cigarettes from a store during the month preceding the survey. Finally, approximately six in 10 students reported having been taught in school about the harmful effects of smoking during the year preceding the survey. The findings in this report suggest that interventions that decrease tobacco use among youth (e.g., increasing excise taxes, media campaigns, school programs in conjunction with community interventions, and community interventions that decrease minors' access to tobacco) must be broad-based, focused on boys and girls, and have components directed toward prevention and cessation. If effective programs are not developed and implemented soon, future morbidity and mortality attributed to tobacco probably will increase. The synergy between countries in passing tobacco-control laws, regulations, or decrees; ratifying the WHO Framework Convention on Tobacco Control; and conducting GYTS offers a unique opportunity to develop, implement, and evaluate comprehensive tobacco-control policy that can be helpful to each country. The challenge for each country is to develop, implement, and evaluate a tobacco-control program and make changes where necessary.

Effectiveness of a school-based AIDS education program among rural students in HIV high epidemic area of China
(Abstract; subscription needed for full text; Asia)
Journal of Adolescent Health. 2008 Feb;42(2):184-191.
Cheng Y | Lou CH | Mueller LM | Zhao SL | Yang JH
The purpose was to evaluate the feasibility and effectiveness of a life-planning skills training program using participatory methods among rural senior high school students in Shangcai County, Henan Province, China. The study was a quasi-experimental study conducted in three Shangcai County senior high schools with comparable socioculture-economic and demographic characteristics (two interventions and one control). The intervention, a life-planning skills program that uses participatory training methods, combining information education with effective skills building, was provided to all first-grade students (14-18 years old; 87% of them are between 15 and 17 years old) in the intervention group from October 2003 to December 2003. In total, 717 students from the intervention group, and 457 from the control enrolled at baseline, and over 91% of these were followed up at posttest. Group x time interaction effects in ordinal logistic regression analysis were found on HIV/AIDS-related knowledge (p less than .0001), attitudes toward daily contact with HIV-positive persons (p less than .0001), and subjects' protection self-efficacy (p less than .0001), suggesting the intervention increased subjects' knowledge significantly, changed their attitudes positively, and improved their protection self-efficacy. The intervention also significantly improved subjects' communication with teachers and peers on HIV/AIDS issues (p less than .0001). However, no significant change was observed on respondents' attitudes toward premarital sex or their communication with parents between the two surveys (p greater than .05). Three months of short-term HIV/AIDS education through life-planning skills training was welcomed by students and positively influenced HIV/AIDS-related knowledge, attitudes, protection self-efficacy, and communication among senior high school students in a rural area with high HIV prevalence.

FAMILY PLANNING NEWS

Fiji- Revise population policy, Khan says
(News Article; Oceania)
28 Jan 2008
Fiji Times Online

Zambia: Injectable contraceptive depo provera safe, U.S. embassy maintains
(News Article; Sub-Saharan Africa)
(28 Jan 2008)
The Times of Zambia (Ndola)

Philippines: Manila women want law on family planning revoked
(News Article; Asia)
30 Jan 2008
Mogato M, Reuters UK

FAMILY PLANNING RESEARCH

A Phase I study of the functional performance, safety and acceptability of the BufferGel Duet
(Abstract; subscription needed for full text; Global | Central America and the Caribbean)
Contraception. 2008 Feb;77(2):130-137.
Ballagh SA | Brache V | Mauck C | Callahan MM | Cochon L | Wheelessd A | Moench TR
The purpose of this study was to assess the functional performance of the BufferGel Duet, a buffering microbicide and spermicide gel applied to the cervix and vagina by a novel applicator that also serves as a mechanical barrier. This was a noncomparative Phase I safety trial in 30 healthy couples, aged 20-50 years, at low risk for sexually transmitted infections, who agreed to use the gel-device combination twice in 1 week and respond to detailed questionnaires about their experience. The female participants were examined with colposcopy before and 6-18 h after using the second device. Based on written instructions alone, 25 women successfully placed and 28 women successfully removed the device. Three women reported feeling the device dislodge around the time of intercourse. The product was equally acceptable to both men and women. Most users concluded that intercourse was the same or better with the device than with no product. About 73% would choose Duet over male condoms, and no one preferred the standard diaphragm. Colposcopic findings were noted in 79% of women with external genital findings (9) or cervicovaginal peeling (18) predominating. Only one finding breached the epithelium. Most product-related adverse events were mild (10/11) and confined to the genitourinary tract. The successful placements and acceptability suggest that further product development is warranted and could target over-the-counter use. During increased duration of use or more frequent dosing, cervicovaginal monitoring is advised based on the extent of peeling and external colposcopic findings in this short-term study.

Feasibility of recruitment for an efficacy trial of emergency contraceptive pills
(Abstract; subscription needed for full text; North America | Sub-Saharan Africa)
Contraception. 2008 Feb;77(2):118-121.
Raymond EG | Liku J | Schwarz EB
The efficacy of emergency contraceptive pills (ECPs) is currently uncertain. The best way to obtain a robust efficacy estimate would be to conduct a placebo-controlled randomized trial. We aimed to assess the feasibility of identifying women eligible for such a trial. We conducted a survey of women aged 18-35 years in five sexually transmitted disease clinics and urgent care centers in Kenya and the United States in 2006. Of 177 women surveyed, only 10 (6%) reported no reasons for exclusion from a potential efficacy trial. Of the rest, 149 (83%) had not recently had sex that conferred a substantial risk of pregnancy. At all sites combined, the rate of identification of potentially eligible women was 0.6 per day of interviewing. A placebo-controlled efficacy trial of ECPs would likely require several thousand participants. Recruitment for such a trial in these types of sites would be prolonged.

"Saathiya" country research brief: Evaluating demand-side impacts of a youth-friendly initiative (YFI) in India: Baseline findings
(Progress Report; Asia)
Bethesda, Maryland, Abt Associates, Private Sector Partnerships One [PSP-One], 2008. 10 p. (Array)
Kohler-Banke K | Yam E | O'Sullivan G
In October 2007, with funding and support from USAID/India, PSPOne launched a Youth Friendly Initiative (YFI) in Lucknow, India known as "Saathiya", or "trusted partner" in Hindi. The Saathiya campaign includes messages and materials disseminated to young, low-income, married couples through channels such as billboards, radio, community theater and a helpline. The Saathiya Campaign aims to motivate young, married couples to seek family planning (FP) information and products at medical shops, through Indigenous Systems of Medical Providers (ISMPs), and from physicians such as obstetrician-gynecologists (OB/ GYNs) and family doctors. Through Saathiya these providers have been trained to strengthen their capacity to provide youth with high quality FP information and counseling, along with products, in an environment conducive to these interactions. USAID's Global Leadership Program for Youth provided funding to conduct a baseline survey on young Indian married couples' FP knowledge, attitudes, and practices to (1) inform program development by better understanding the existing situation and needs of married youth in Lucknow, and (2) serve as a baseline against which to compare changes over time and evaluate elements of the program, with a follow-on survey planned for early 2009. In order to assess the impact of the YFI in Lucknow, the same survey will also be conducted among a comparison group of married youth in the city of Kanpur Nagar, in which no intervention is taking place. This report presents a preliminary analysis of the baseline data collected in both cities in summer 2007.

Male university students' views, attitudes and behaviors towards family planning and emergency contraception in Turkey
(Abstract; subscription needed for full text; Europe)
Journal of Obstetrics and Gynaecology Research. 2007;:[7] p..
Sahin NH
The aim was to determine male university students' views, attitudes and behavior towards family planning and emergency contraception as an important aspect of reproductive health. This descriptive study was carried out with 278 men who were chosen using the convenience sampling method at several universities in Istanbul during the spring semester of 2005. Data were obtained through interviews with men by means of a 32 item self-administered questionnaire. Data analyses were made with the Statistical Package for the Social Sciences (SPSS). Almost all of the men (96.6%) were single. Students' (n = 200) average age at their first sexual intercourse experience was 17.4 years. Seventy-three percent of the students used a family planning (FP) method in their first sexual experiences (69.5% used a condom). The male condom is the most well known (95.8%) and commonly used (70.1%) FP method. The number of students taking a shared responsibility for FP was 79.4%. One third of the students had negative attitudes towards vasectomy and 1/5 of them were against the use of condoms. The percentage of the students who had heard about emergency contraception (EC) was 14.5%. Male university students who are sexually active generally do not have enough knowledge about FP and EC. They tend to engage in high-risk behavior. It is imperative that education and counseling in reproductive and sexual health must be offered to all young men. In addition, men's attitudes toward contraceptive methods should be evaluated in other cultures and useful comparisons made with Turkey.

GENDER and HEALTH NEWS

Ghana: Practitioners of FGM to serve prison terms when caught
(News Article; Sub-Saharan Africa)
28 Jan 2008
Public Agenda (Accra)

Kenya: Women and children suffering in camps
(News Article; Sub-Saharan Africa)
27 Jan 2008
The Nation (Nairobi)

GENDER and HEALTH RESEARCH

Quality of life in obese pregnant women: A longitudinal study
(Abstract; subscription needed for full text; Central America and the Caribbean)
American Journal of Obstetrics and Gynecology. 2008 Feb;198(2):203.e1-203.e5.
Amador N | Juárez JM | Guízar JM | Linares B
The purpose of this study was to assess the contribution of obesity on quality of a woman's life during pregnancy. At the Hospital of Gynecology and Obstetrics in Leon, Mexico, we followed-up 220 pregnant women (110 obese and 110 nonobese) who completed the 12-item short-form health survey at the beginning and during the third trimester of pregnancy. The mental component score was lower in obese than in nonobese women at the beginning of gestation and at the third trimester but increased in the entire group during pregnancy. The physical component score (PCS) decreased during pregnancy and was lower in obese than in nonobese pregnant women (43.5 vs 47.2; P = .01) at the third trimester. Baseline body mass index, weight gain, and complications during pregnancy were associated negatively with PCS (R/2 = 0.11; P less than .001 for the model). Baseline body mass index, weight gain, and complications during gestation are associated negatively with PCS of quality of life.

Ovarian cancer and oral contraceptives
(Abstract; subscription needed for full text; Global)
Lancet. 2008 Jan 26;371(9609):277-278.
Franco EL | Duarte-Franco E
Since the 1960s, oral contraceptives have become a dominant form of female contraception in most developed countries. In the UK, 25% of women aged 16-49 years and 62% of women aged 16-24 years rely on combined oestrogen-progestin or progestin-only (minipill) oral contraceptives. In the USA, 19% of women aged 15-44 years (and 32% of 20-24-year-olds) take oral contraceptives. These drugs are the most effective reversible birth-control method, and widespread use has been the cornerstone of family-planning initiatives worldwide. A causal role for oral contraceptives in various cancers was first suspected soon after their use became widespread, but today's low-dose formulations are relatively safe drugs. Oral contraceptives have been linked with increased risks for some cancers (breast and cervix) and with protective effects for others (ovarian, endometrial, and colorectal). Calculation of the net effect on women's health is fraught with uncertainties. There are inherent difficulties associated with ascertaining the nature of exposure to oral contraceptives, such as age at first use, duration of use, time since last use, formulation of contraceptives (sequential, combined, or progestin-only), and dose. Furthermore, epidemiological studies must include information about potential confounders, such as sociodemographics, family history of cancer, comorbidity, reproductive-health variables, history of hormone-replacement therapy (HRT), and relevant lifestyle characteristics. For a woman in her 50s or 60s, recalling past use of oral contraceptives is not easy. In case-control studies, recall bias may further compound this problem because women with cancer might make a greater effort to recollect past exposures than their cancer-free counterparts.

HIV/AIDS and STIs NEWS

Scientists study how HIV hides in body
(News Article; Global)
31 Jan 2008
Neergaard L, Associated Press

Ethiopia: New health kit launched to better manage STIs
(News Article; Sub-Saharan Africa)
30 Jan 2008
allafrica.com

Antiretroviral therapy and sexual transmission of HIV
(Press Release; Global)
(You need Adobe Acrobat Reader to access this document)
1 Feb 2008
UNAIDS Press Office
Related News Article: Patients with HIV could have sex without condoms

Male circumcision no aid to women in study
(News Article; Global)
4 Feb 2008
The New York Times
Related Fact Sheet: Male Circumcision: A New Approach to HIV Prevention

Swiss change safe sex message on HIV
(News Article; Europe)
31 Jan 2008
Jordans F, Associated Press
Related Press Release: Antiretroviral therapy and sexual transmission of HIV
(You need Adobe Acrobat Reader to access this document)

HIV/AIDS and STIs RESEARCH

A hidden HIV epidemic among women in Vietnam
(Abstract; subscription needed for full text; Asia)
BMC Public Health. 2008 Jan 28;8(37):[32] p.
Nguyen TA | Oosterhoff P | Hardon A | Tran HN | Coutinho RA
The HIV epidemic in Vietnam is still concentrated among high risk populations, including IDU and FSW. The response of the government has focused on the recognized high risk populations, mainly young male drug users. This concentration on one high risk population may leave other populations under-protected or unprepared for the risk and the consequences of HIV infection. In particular, attention to women's risks of exposure and needs for care may not receive sufficient attention as long as the perception persists that the epidemic is predominantly among young males. Without more knowledge of the epidemic among women, policy makers and planners cannot ensure that programs will also serve women's needs. More than 300 documents appearing in the period 1990 to 2005 were gathered and reviewed to build an understanding of HIV infection and related risk behaviors among women and of the changes over time that may suggest needed policy changes. It appears that the risk of HIV transmission among women in Vietnam has been underestimated; the reported data may represent as little as 16% of the real number. Although modeling predicted that there would be 98,500 cases of HIV-infected women in 2005, only 15,633 were accounted for in reports from the health system. That could mean that in 2005, up to 83,000 women infected with HIV have not been detected by the health care system, for a number of possible reasons. For both detection and prevention, these women can be divided into sub-groups with different risk characteristics. They can be infected by sharing needles and syringes with IDU partners, or by having unsafe sex with clients, husbands or lovers. However, most new infections among women can be traced to sexual relations with young male injecting drug users engaged in extramarital sex. Each of these groups may need different interventions to increase the detection rate and thus ensure that the women receive the care they need. Women in Vietnam are increasingly at risk of HIV transmission but that risk is under-reported and under-recognized. The reasons are that women are not getting tested, are not aware of risks, do not protect themselves and are not being protected by men. Based on this information, policymakers and planners can develop better prevention and care programs that not only address women's needs but also reduce further spread of the infection among the general population.

Young citizens as health agents: Use of drama in promoting community efficacy for HIV/AIDS
(Abstract; subscription needed for full text; Sub-Saharan Africa)
American Journal of Public Health. 2008 Feb;98(2):201-204.
Kamo N | Carlson M | Brennan RT | Earls F
A community-based cluster randomized control trial in a medium-sized municipality in Tanzania was designed to increase local competence to control HIV/AIDS through actions initiated by children and adolescents aged 10 to 14 years. Representative groups from the 15 treatment communities reached mutual understanding about their objectives as health agents, prioritized their actions, and skillfully applied community drama ("skits") to impart knowledge about the social realities and the microbiology of HIV/AIDS. In independently conducted surveys of neighborhood residents, differences were found between adults who did and did not witness the skits in their beliefs about the efficacy of children as HIV/AIDS primary change agents.

Lost opportunities in HIV prevention: Programmes miss places where exposures are highest
(Abstract; subscription needed for full text; Sub-Saharan Africa)
BMC Public Health. 2008 Jan 24;8:[34] p.
Sandoy IF | Siziya S | Fylkesnes K
Efforts at HIV prevention that focus on high risk places might be more effective and less stigmatizing than those targeting high risk groups. The objective of the present study was to assess risk behaviour patterns, signs of current preventive interventions and apparent gaps in places where the risk of HIV transmission is high and in communities with high HIV prevalence. The PLACE method was used to collect data. Inhabitants of selected communities in Lusaka and Livingstone were interviewed about where people met new sexual partners. Signs of HIV preventive activities in these places were recorded. At selected venues, people were interviewed about their sexual behaviour. Peer educators and staff of NGOs were also interviewed. The places identified were mostly bars, restaurants or sherbeens, and fewer than 20% reported any HIV preventive activity such as meetings, pamphlets or posters. In 43% of places in Livingstone and 26% in Lusaka, condoms were never available. There were few active peer educators. Among the 432 persons in Lusaka and 676 in Livingstone who were invited for interview about sexual behaviour, consistent condom use was relatively high in Lusaka (77%) but low in Livingstone (44% of men and 34% of women). Having no condom available was the most common reason for not using one. Condom use in Livingstone was higher among individuals socializing in places where condoms always were available. In the places studied we found a high prevalence of behaviours with a high potential for HIV transmission but few signs of HIV preventive interventions. Covering the gaps in prevention in these high exposure places should be given the highest priority.

Are condoms the answer to rising rates of non-HIV sexually transmitted infections? Yes
(Editorial; Global)
BMJ. British Medical Journal. 2008 Jan 26;336(7637):184-185.
Steiner MJ | Cates W
For people who are sexually active, condoms remain our best solution to reducing risks of acquiring sexually transmitted infections (if uninfected) or transmitting these infections (if infected). Strong evidence from laboratory studies and mounting clinical studies shows that condoms effectively reduce the risk of transmission. In addition, for specific populations, increased levels of condom use have been associated with decreases in reported sexually transmitted infections.

Use of probiotics in HIV-infected children: A randomized double-blind controlled study
(Abstract; subscription needed for full text; South America)
Journal of Tropical Pediatrics. 2008 Feb;54(1):19-24.
Trois L | Cardoso EM | Miura E
HIV/AIDS is an infection characterized by immune cell dysfunction and subsequent immunodeficiency, as well as intestinal disorder. Probiotics are live microbial feed supplements that beneficially affect the host animal by improving intestinal microbial balance and promoting health benefits. The goals of this study were to determine whether the use of probiotics could improve the immune response determined by CD4 cells mm/-3 counts and reduce liquid stool episodes. A randomized double-blind controlled trial with 77 HIV-infected children (2-12 years), divided into two groups: one receiving probiotics (formula containing Bifidobacterium bifidum with Streptococcus thermophilus -2.5 x 10/10 colony forming units) and the other, a standard formula (control group), for 2 months. The CD4 counts (cells mm/-3) were collected at the beginning and end of the study. The quality and number of stools were assessed by a questionnaire (watery to normal stool consistency). There was an increase in the mean CD4 count in the probiotics group (791 cells mm/-3) and a small decrease in the control group (538 cells mm/-3). The change from baseline in mean CD4 cell count was +118 cells mm/-3 vs. -42 cells mm/-3 for children receiving the probiotic formula and control formula, respectively (p = 0.049). A similar reduction in liquid stool consistency in both the groups (p less than 0.06), with a slight enhancement in the probiotics group, was observed, but without significant difference (p less than 0.522). The incidence of loose-soft stools showed a small decrease in both groups (p less than 0.955) and there was an increase in the incidence of normal stool consistency in both the groups (p less than 0.01). Our study showed that probiotics have immunostimulatory properties and might be helpful in the treatment of HIV-infected children.

SAVVY vaginal gel (C31G) for prevention of HIV infection: A randomized controlled trial in Nigeria
(Research Article; Sub-Saharan Africa)
PLoS One. 2008 Jan;3(1):e1474.
Feldblum PJ | Adeiga A | Bakare R | Wevill S | Lendvay A
The objective of this trial was to determine the effectiveness of 1.0% C31G (SAVVY) in preventing male-to-female vaginal transmission of HIV infection among women at high risk. This was a Phase 3, double-blind, randomized, placebo-controlled trial. Participants made up to 12 monthly follow-up visits for HIV testing, adverse event reporting, and study product supply. The study was conducted between September 2004 and December 2006 in Lagos and Ibadan, Nigeria, where we enrolled 2153 HIV-negative women at high risk of HIV infection. Participants were randomized 1:1 to SAVVY or placebo. The effectiveness endpoint was incidence of HIV infection as indicated by detection of HIV antibodies in oral mucosal transudate (rapid test) or blood (ELISA), and confirmed by Western blot or PCR testing. We observed 33 seroconversions (21 in the SAVVY group, 12 in the placebo group). The Kaplan-Meier estimates of the cumulative probability of HIV infection at 12 months were 0.028 in the SAVVY group and 0.015 in the placebo group (2-sided p-value for the log-rank test of treatment effect 0.121). The point estimate of the hazard ratio was 1.7 for SAVVY versus placebo (95% confidence interval 0.9, 3.5). Because of lower-than-expected HIV incidence, we did not observe the required number of HIV infections (66) for adequate power to detect an effect of SAVVY. Follow-up frequencies of adverse events, reproductive tract adverse events, abnormal pelvic examination findings, chlamydial infections and vaginal infections were similar in the study arms. No serious adverse event was attributable to SAVVY use. SAVVY did not reduce the incidence of HIV infection. Although the hazard ratio was higher in the SAVVY than the placebo group, we cannot conclude that there was a harmful treatment effect of SAVVY.

Balancing between normality and social death: Black, rural, South African women coping with HIV/AIDS
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Qualitative Health Research. 2008 Feb;18(2):182-195.
Dageid W | Duckert F
The millions of people living with HIV/AIDS are in urgent need of effective care and support interventions. Such interventions should take people's reported needs, coping strategies, and context into account. Usually, active problem-focused coping strategies have been encouraged because they are considered to be more beneficial than passive emotion-focused strategies. However, this may not be the case in the South African context. This study was based on in-depth interviews with Black, rural, South African women about their coping strategies. The overriding aim of coping was to solve the tasks of physical, psychological, and social survival. Strategies involving avoidance of, escaping from, or minimizing HIV/AIDS and its accompanying emotional distress were predominant. We argue that such strategies could be adaptive in a society with scarce resources and marked by gender inequalities. Our findings suggest that care and support interventions should be sensitive to culture and context, should be holistic and participatory, and should include income generation and child care services.

Acceptability of microbicidal surrogates among Zambian women
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Diseases. 2008 Feb;35(2):147-153.
Jones DL | Weiss SM | Chitalu N | Bwalya V | Villar O
This study assessed the acceptability after the use of vaginal lubricants as surrogates for microbicides among women in Zambia and the role of cultural factors as facilitators or impediments to their potential use for HIV risk reduction within the Zambian context. HIV seronegative women (N = 301) recruited from the University Teaching Hospital HIV Voluntary Counseling and Testing Center were randomized into group, individual, or enhanced usual care arms. Participants attended pre- and post-HIV test counseling, followed by a 3-session, 2-hour once-a-month intervention introducing them to vaginal lubricants (2 types of gels, suppositories) in addition to male and female condoms. Supplies were offered at months 4 and 5; assessments were at baseline, 6, and 12 months. At baseline, the majority of women reported minimal previous exposure to vaginal products and low levels of condom use. Participants' use of products was influenced by product characteristics and perceived partner acceptability; the majority of participants preferred drier products and suppository delivery systems. The basis for decisions regarding vaginal product acceptability changed over time and followed product exposure, and was greatly influenced by perceptions of partner acceptability. Results illustrate the influence of male partners on Zambian seronegative women's preferences for microbicidal products, and the change in preferred characteristics over time.

Increase in non-AIDS related conditions as causes of death among HIV-infected individuals in the HAART era in Brazil
(Research Article; South America)
PLoS One. 2008 Jan;3(1):e1531.
Pacheco AG | Tuboi SH | Faulhaber JC | Harrison LH | Schechter M
In 1996, Brazil became the first developing country to provide free and universal access to HAART. Although a decrease in overall mortality has been documented, there are no published data on the impact of HAART on causes of death among HIV-infected individuals in Brazil. We assessed temporal trends of mortality due to cardiovascular diseases (CVD), diabetes mellitus (DM) and other conditions generally not associated with HIV-infection among persons with and without HIV infection in Brazil between 1999 and 2004. Odds ratios were used to compare causes of death in individuals who had HIV/AIDS listed on any field of the death certificate with those who did not. Logistic regression models were fitted with generalized estimating equations to account for spatial correlation; co-variables were added to the models to control for potential confounding. Of 5,856,056 deaths reported in Brazil between 1999 and 2004 67,249 (1.15%) had HIV/AIDS listed on the death certificate and non-HIV-related conditions were listed on 16.3% in 1999, increasing to 24.1% by 2004 (p less than 0.001). The adjusted average yearly increases were 8% and 0.8% for CVD (p less than 0.001), and 12% and 2.8% for DM (p less than 0.001), for those who had and did not have HIV/AIDS listed on the death certificate, respectively. Similar results were found for these conditions as underlying causes of death. In Brazil between 1999 and 2004 conditions usually considered not to be related to HIV-infection appeared to become more likely causes of death over time than reported causes of death among individuals who had HIV/AIDS listed on the death certificate than in those who did not. This observation has important programmatic implications for developing countries that are scaling-up access to antiretroviral therapy.

MATERNAL AND CHILD HEALTH NEWS

Nigeria: Media tasked on maternal child health issues
(News Article; Sub-Saharan Africa)
24 Jan 2008
Okpalakunne N, Daily Champion (Lagos)

Namibia: Maternal death rate shoots up
(News Article; Sub-Saharan Africa)
29 Jan 2008
Tjaronda W, New Era (Windhoek)

Sierra Leone: Kenema records low maternal mortality rate
(News Article; Sub-Saharan Africa)
22 Jan 2008
Jalloh T, Concord Times (Freetown)

South Africa: Breast-feeding is still the best
(News Article; Sub-Saharan Africa)
24 Jan 2008
Ntuli S, BuaNews (Tshwane)
Related Abstract; subscription needed for full text: Breastfeeding questions answered: A guide for providers
Related Report: Better breastfeeding, healthier lives

MATERNAL AND CHILD HEALTH RESEARCH

The macrosomic fetus: A challenge in current obstetrics
(Abstract; subscription needed for full text; Global)
Acta Obstetricia et Gynecologica Scandinavica. 2008;87(2):134-145.
Henriksen T
There has been a rise in the prevalence of large newborns over a few decades in many parts of the world. There is ample evidence that fetal macrosomia is associated with increased risk of complications both for the mother and the newborn. In current obstetrics, the macrosomic fetus represents a frequent clinical challenge. Evidence is emerging that being born macrosomic is also associated with future health risks. The objective was to provide a review of causes and risks, prevention, prediction and clinical management of suspected large fetus/fetal macrosomia, primarily aimed at clinical obstetricians. Medline and EMBASE were searched between 1980 and 2007 by combining either 'fetal macrosomia' or 'large for gestational age' with other relevant terms. The Cochrane Database of Systematic Reviews was searched for the term 'fetal macrosomia'. Although the causes of high birthweight include both genetic and environmental factors, the rapid increase in the prevalence of large newborns has environmental causes. The evidence is extensive that maternal overweight and associated metabolic changes, including type 2 and gestational diabetes, play a central role. There is a paucity of studies of the effect of intervention before and/or during pregnancy on the risk of having an 'overweight newborn'. It appears rational, however, that preventive measures should primarily be implemented before pregnancy and should include guidance about nutrition and physical activity in order to reduce the prevalence of overweight. In pregnancy, limited weight gain, especially in obese women, seems to reduce the risk of macrosomia, as do good control of plasma glucose among those with diabetes. Prediction of fetal macrosomia remains an inaccurate task even with modern ultrasound equipment. There is little evidence that routine elective delivery (induction or caesarean section) for the mere reason of suspected macrosomia should be employed in a general population. Vaginal delivery of a macrosomic fetus requires considered attention by an experienced obstetrician and preparedness for operative delivery, shoulder dystocia and newborn asphyxia.

Where to deliver? Analysis of choice of delivery location from a national survey in India
(Research Article; Asia)
BMC Public Health. 2008 Jan 24;8:29.
Thind A | Mohani A | Banerjee K | Hagigi F
In order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries. We assess the determinants of home, private and public sector utilization for a delivery in a Western state. Cross sectional analyses of the National Family Health Survey - 2 dataset. Setting: Maharashtra state. The dataset had a sample size of 5391 ever-married females between the ages of 15 to 49 years. Data were abstracted for the most recent birth (n=1510) and these were used in the analyses. Conceptual framework was the Andersen Behavioral Model. Multinomial logistic regression analyses was conducted to assess the association of predisposing, enabling and need factors on use of home, public or private sector for delivery. A majority delivered at home (n=559, 37%); with private and public facility deliveries accounting for 32% (n=493) and 31% (n=454) respectively. For the choice set of home delivery versus public facility, women with higher birth order and those living in rural areas had greater odds of delivering at home, while increasing maternal age, greater media exposure, and more then three antenatal visits were associated with greater odds of delivery in a public facility. Maternal and paternal education, scheduled caste/tribe status, and media exposure were statistically significant predictors of the choice of public versus private facility delivery. As India's economy continues to grow, the private sector will continue to expand. Given the high household expenditures on health, the government needs to facilitate insurance schemes or provide grants to prevent impoverishment. It also needs to strengthen the public sector so that it can return to its mission of being the safety net.

Maternal and child undernutrition: Consequences for adult health and human capital
(Abstract; subscription needed for full text; Asia | Central America and the Caribbean | South America | Sub-Saharan Africa)
Lancet. 2008 Jan 26;371(9609):340-357.
Victora CG | Adair L | Fall C | Hallal PC | Martorell R | Richter L | Sachdev HS |
In this paper the authors review the associations between maternal and child undernutrition with human capital and risk of adult diseases in low-income and middle-income countries. The authors analysed data from five long-standing prospective cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa and noted that indices of maternal and child undernutrition (maternal height, birthweight, intrauterine growth restriction, and weight, height, and body-mass index at 2 years according to the new WHO growth standards) were related to adult outcomes (height, schooling, income or assets, off spring birthweight, body-mass index, glucose concentrations, blood pressure). The authors undertook systematic reviews of studies from low-income and middle-income countries for these outcomes and for indicators related to blood lipids, cardiovascular disease, lung and immune function, cancers, osteoporosis, and mental illness. Undernutrition was strongly associated, both in the review of published work and in new analyses, with shorter adult height, less schooling, reduced economic productivity, and-for women-lower off spring birthweight. Associations with adult disease indicators were not so clear-cut. Increased size at birth and in childhood were positively associated with adult body-mass index and to a lesser extent with blood pressure values, but not with blood glucose concentrations. In the authors' new analyses and in published work, lower birthweight and undernutrition in childhood were risk factors for high glucose concentrations, blood pressure, and harmful lipid profiles once adult body-mass index and height were adjusted for, suggesting that rapid postnatal weight gain - especially after infancy - is linked to these conditions. The review of published works indicates that there is insufficient information about long-term changes in immune function, blood lipids, or osteoporosis indicators. Birthweight is positively associated with lung function and with the incidence of some cancers, and undernutrition could be associated with mental illness. We noted that height-for-age at 2 years was the best predictor of human capital and that undernutrition is associated with lower human capital. The authors conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations. Its prevention will probably bring about important health, educational, and economic benefits. Chronic diseases are especially common in undernourished children who experience rapid weight gain after infancy.

Risk factors for pregnancy-related mortality: A prospective study in rural Nepal
(Abstract; subscription needed for full text; Asia)
Public Health. 2008 Feb;122(2):161-172.
Christian P | Katz J | Wu L | Kimbrough-Pradhan E | Khatry SK | LeClerq SC | West KP
This study examined the risk factors of mortality related to pregnancy for the first year post partum in a cohort of 25,580 pregnancies. Study design: Longitudinal cohort follow-up. Details of socio-economic status, mid-upper arm circumference (MUAC), diet, illness, work, substance use and previous pregnancy history were collected during early to mid-gestation, and these women were followed for 1 year post partum. All-cause mortality rates per 100,000 pregnancies were calculated for deaths during pregnancy or up to 42 days post partum (early period) and 43-364 days post partum (late period). Odds ratios (OR) of mortality were estimated using five groups of risk factors: biological; morbidity; dietary; lifestyle; and socio-economic. Significant factors within each group were included in a single risk model for each time period. Early and late pregnancy-related mortality rates were 469 [95% confidence interval (CI) 385-553] and 254 (95% CI 192-316), respectively. Maternal age greater than 35 years was associated with a three- to four-fold increase in mortality, whereas increasing parity conferred increasing protection. In the final model, a larger MUAC and consumption of dark green leaves were associated with decreased risk of death in the early period (OR 0.76, 95% CI 0.67-0.87 and 0.64, 95% CI 0.41-0.99, respectively). A larger MUAC was also associated with a lower risk of death in the late period. Diarrhoea/dysentery and pre-eclampsia were associated with increased risk of death in the early period (OR 2.78, 95% CI 1.40-5.51 and 2.95, 95% CI 1.48-5.90, respectively). Factors weakly associated (P less than 0.1) with mortality in both periods included night blindness, strenuous work activity and cigarette smoking. No socio-economic factors were significant in the models. Maternal age, parity, MUAC, diet and illness in early to mid-gestation were associated with risk of death during pregnancy and the first year post partum in rural Nepal.

Perception of bleeding as a danger sign during pregnancy, delivery, and the postpartum period in rural Nepal
(Abstract; subscription needed for full text; Asia)
Qualitative Health Research. 2008 Feb;18(2):196-208.
Matsuyama A | Moji K
Many developing countries implement safe motherhood programs to tackle high maternal mortality rates. The approach requires recognition of the signs of emergency obstetric cases in order to facilitate immediate care seeking, followed by immediate medical care. Whether such signs are recognized in a timely manner at the community level is determined by how the community perceives health problems. We explore the local understanding of one danger sign - bleeding during pregnancy and at delivery - and the meaning attached to it. The study was conducted in the Kavrepalanchowk district of Nepal. Different qualitative methods were applied. The findings indicate that the community's perception of bleeding might be quite different from that of health professionals and that perceptions and meanings attached to bleeding vary depending on the actors in the family. They all have significant implications for what should be the focus of health education and who should be involved in promoting maternal health.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

Russia has best birth rates in 25 years
(News Article; Asia)
02 Feb 2008
Earth Times

Armenia: Birth rate increased
(News Article; Asia)
31 Jan 2008
Panorama

Romania facing labour crisis
(News Article; Europe)
31 Jan 2008
The Press Association

Impact of high population growth highlighted
(News Article; Asia)
30 Jan 2008
The International News

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Palestinian primary health care in light of the National Strategic Health Plan 1999 -- 2003
(Abstract; subscription needed for full text; Middle East)
Public Health. 2008 Feb;122(2):125-139.
Abu Mourad T | Radi S | Shashaa S | Lionis C | Philalithis A
In 1994, the Palestinian Health Authority took over responsibility for primary health care (PHC) in Gaza Strip and West Bank. This paper reports on the Palestinian National Strategic Health Plan (PNSHP 1999-2003). The extent to which the PHC objectives were achieved is discussed, together with areas that still require improvement. This descriptive study used content analysis with a retrospective review of data gathered from the PNSHP and other related reports and publications. The crude death rate and total fertility rate had improved, but the infant mortality rate had increased by the end of the study period. Heart diseases were the primary cause of death in Palestine. Acceptable vaccination coverage had mainly been achieved, particularly for tetanus, diphtheria, measles and polio. There were still concerns regarding water supply and other sanitary conditions, a notable increase in the incidence of vector-borne diseases, especially cutaneous Leishmaniasis in West Bank, and mental health had worsened by the end of the study period. Certain health promotion and environmental health actions should be undertaken urgently by the Palestinian health care services to cope with environmental and sanitary conditions, and to further improve health status regarding communicable and non-communicable diseases in Palestinians. Health research and surveys are insufficient and should be undertaken regularly. The main barrier to the success of the PNSHP was the lack of follow-up due to political and socio-economic instability. There is an urgent need for international intervention and support.

Childbearing in crisis: War, migration and fertility in Angola
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Biosocial Science. 2008;:1-18.
Avogo W | Agadjanian V
This study examines the short- and long-term effects of war-induced and war-unrelated migration on fertility outcomes using data from two peri-urban municipalities of Greater Luanda in Angola. In the short term, results from multi-level discrete-time logistic regression models indicate that net of other factors, war-unrelated migration is associated with a lower probability of birth than war-induced migration in a given year. Similar results are obtained when the effects of migration are lagged by a year. At the same time, the effects of war-triggered migration do not differ significantly from those of not migrating in a given year but are statistically significant when the effects of migration are lagged by a year. In the long term, the effects of migration experience on cumulative fertility are negligible and not statistically significant net of demographic and socioeconomic variables. Interpretations of the results are offered in the context of Angola and their broader implications are reflected on.

The health of urban populations in developing countries
(Report; Global)
(You need Adobe Acrobat Reader to access this document)
New York, New York, United Nations, Department of Economic and Social Affairs, Population Division, 2008 Jan 14. 33 p. (UN/POP/EGM-URB/2008/11)
Montgomery MR
To convey the scale of the urban health challenge that lies ahead, we summarize in Section A the urban health differentials that can be identified in data from internationally-comparable sample surveys. Here we begin by documenting urban-rural differences and proceed to give closer attention to the within-urban inequalities in health. Section B focuses attention on the supply side of urban health, with particular emphasis on the money costs and quality of health care. In Section C, we turn to a description of urban health risks that have not been sufficiently appreciated, or which, to be effectively addressed, would require an expansive conception of the role of the public health system. Section D concludes.

An overview of urbanization, internal migration, population distribution and development in the world
(Report; Global)
(You need Adobe Acrobat Reader to access this document)
New York, New York, United Nations, Department of Economic and Social Affairs, Population Division, 2008 Jan 14. 34 p. (UN/POP/EGM-URB/2008/01)
The distribution of humanity on the earth's surface has always responded to the opportunities that different territories provide. After the invention of agriculture, the availability of arable land largely determined the place where most people settled. The practice of agriculture also permitted the accumulation of food surpluses and the differentiation of productive activities that led to the emergence of more complex settlements generically identified as "cities". In modern history, cities have played key roles as centres of Government, production, trade, knowledge, innovation and rising productivity. The changes brought about by the industrial revolution would be unimaginable in the absence of cities. The mechanization of production made necessary the concentration of population. Rapid industrialization was accompanied by increasing urbanization. In 1920, the more developed regions, being the most industrialized, had just under 30 per cent of their population in urban areas. As industrialization advanced in the developing world so did urbanization, particularly in Latin America where 41 per cent of the population was urban by 1950. In Africa and Asia levels of urbanization remained lower, although the urban population increased markedly, particularly in Asia. Between 1920 and 2007, the world's urban population increased from about 270 million to 3.3 billion, with 1.5 billion urban dwellers added to Asia, 750 million to the more developed regions, just under 450 million to Latin America and the Caribbean, and just over 350 million to Africa. These changes foreshadow those to come. Between 2007 and 2050, the urban population is expected to increase as much as it did since 1920, that is, 3.1 billion additional urban dwellers are expected by 2050, including 1.8 billion in Asia and 0.9 billion in Africa. These powerful trends will shape and in turn be shaped by economic and social development.

Trends in demographic and reproductive health indicators in Nepal. Further analysis of the 1996, 2001, and 2006 Demographic and Health Surveys data
(Report; Asia)
(You need Adobe Acrobat Reader to access this document)
Calverton, Maryland, Macro International, MEASURE DHS, 2007 Dec. 66 p. (DHS Trend Report No. 5)
Pradhan A | Pant PD | Govindasamy P
This report highlights trends in key demographic and health indicators in Nepal from data collected in the three demographic and health surveys: the 1996 Nepal Family Health Survey (NFHS), the 2001 Nepal Demographic and Health Survey (NDHS) and the 2006 Nepal Demographic and Health Survey (NDHS). Specifically, the report discusses changes in demographic and reproductive health outcomes over the last decade, including changes in fertility, knowledge and practice of family planning, maternal and child health, nutrition, and infant, child and adult mortality. The report also explores the knowledge of HIV/AIDS over the decade in the country. In addition, this report compares Nepal with other South and Southeast Asian countries that have data from similarly conducted demographic and health surveys. These include India, Bangladesh, Sri Lanka, Pakistan, Cambodia, Indonesia, Vietnam and the Philippines. The primary objective of this report is to provide information needed by planners, policymakers and program administrators to assess the current situation and trends in Nepal, and to design more effective population and reproductive health programs aimed at achieving positive outcomes in the future. The study aims to present the relative importance of socio-demographic and economic variables in highlighting inter-regional differences in Nepal in 1996-2006 and to gauge the country's progress in achieving the Millennium Development Goals.

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Volume 8, Number 5 5 February 2008