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Volume 8, Number 8
25 February 2008
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ADOLESCENT HEALTH NEWS
Nigeria: Stakeholders urged to combat teenage pregnancy
(News Article; Sub-Saharan Africa)
18 Feb 2008
Umuahia EU, This Day (Lagos)
Namibia: Short film on teenage pregnancy to be launched
(News Article; Sub-Saharan Africa)
15 Feb 2008
Philander F, New Era (Windhoek)
ADOLESCENT HEALTH RESEARCH
Researching health inequalities in adolescents: The development of the health behaviour in school-aged children (HBSC) family affluence scale
(Abstract; subscription needed for full text; North America)
Social Science and Medicine. 2008 Mar;66(6):1429-1436.
Currie C | Molcho M; Boyce W | Holstein B | Torsheim T | Richter M
Socioeconomic inequalities in adolescent health have been little studied until recently, partly due to the lack of appropriate and agreed upon measures for this age group. The difficulties of measuring adolescent socioeconomic status (SES) are both conceptual and methodological. Conceptually, it is unclear whether parental SES should be used as a proxy, and if so, which aspect of SES is most relevant. Methodologically, parental SES information is difficult to obtain from adolescents resulting in high levels of missing data. These issues led to the development of a new measure, the Family Affluence Scale (FAS), in the context of an international study on adolescent health, the Health Behaviour in School-Aged Children (HBSC) Study. The paper reviews the evolution of the measure over the past 10 years and its utility in examining and explaining health related inequalities at national and cross-national levels in over 30 countries in Europe and North America. We present an overview of HBSC papers published to date that examine FAS-related socioeconomic inequalities in health and health behaviour, using data from the HBSC study. Findings suggest consistent inequalities in self-reported health, psychosomatic symptoms, physical activity and aspects of eating habits at both the individual and country level. FAS has recently been adopted, and in some cases adapted, by other research and policy related studies and this work is also reviewed. Finally, ongoing FAS validation work is described together with ideas for future development of the measure.
The HIV testing experiences of adolescents in Ndola, Zambia: Do families and friends matter?
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Care. 2008 Jan;20(1):101-105.
Denison JA | McCauley AP | Dunnett-Dagg WA | Lungu N | Sweat MD
This study explored how adolescents involve their families, friends and sex partners when making decisions about seeking HIV voluntary counseling and testing (VCT) and disclosing their HIV-status. The study is based on 40 qualitative in-depth interviews with 16 to 19 year olds who knew their HIV status in Ndola, Zambia. The findings show that: a) almost half of the youth turned to family members for advice or approval prior to seeking VCT; b) a disapproving reaction from family members or friends often discouraged youth from attending VCT until they found someone supportive; c) informants often attended VCT alone or with a friend, but rarely with a family member; and d) disclosure was common to family and friends, infrequent to sex partners, and not linked to accessing care and support services. Family members need access to information on VCT so they can support young peoples' decisions to test for HIV and to disclose their HIV status. These results reinforce the need to provide confidential VCT services for adolescents and the need to develop and test innovative strategies to reach adolescents, their families and sex partners with VCT information and services.
"You must do the test to know your status": Attitudes to HIV voluntary counseling and testing for adolescents among South African youth and parents
(Research Article; Sub-Saharan Africa)
Health Education and Behavior. 2008 Feb;35(1):87-104.
MacPhail CL | Pettifor A | Coates T | Rees H
Reduced HIV risk behavior and increased use of care and support services have been demonstrated among adults accessing HIV voluntary counseling and testing (VCT). The impact of VCT on adolescents is, however, not known. Focus group discussions were held with adolescents and parents in two South African townships to establish the perceptions of and needs for VCT among young people. Ecological theory informed the analysis. Adolescents had limited experience of VCT, were afraid of knowing their HIV status, and felt that testing was only for symptomatic individuals. Youth felt that they would disclose their HIV status to family members who they felt would be most supportive. Youth were afraid of stigma and discrimination; rarely referring to the community as a source of support. Discussions highlighted the inappropriateness of clinical facilities for youth VCT. We conclude with recommendations for youth-friendly VCT services
The long-term effects of intimate partner violence on adolescent mothers' depressive symptoms
(Abstract; subscription needed for full text; North America)
Social Science and Medicine. 2008 Mar;66(6):1322-1333.
Lindhorst T | Oxford M
Adolescent mothers are at high risk of experiencing intimate partner violence (IPV) which may increase their likelihood of depressive symptoms in adulthood, yet little is known about the long-term effects of IPV on adolescent mothers' trajectories of depressive symptoms. The study reported here uses prospective data spanning 14 years from a study of 229 adolescent mothers from Washington State, USA to evaluate the effects of adolescent exposure to IPV on the trajectories of depressive symptoms over time, as well as the likelihood of depressive symptoms at age 28 years. After controlling for levels of economic insecurity, the results indicate that adolescent IPV and an early vulnerability to depression were significantly related to the intercept, but not the slope of the adult depressive symptom trajectories. Both cumulative and concurrent IPV predicted the likelihood of depressive symptoms at age 28 years. Follow-up analyses indicate that adolescent IPV is associated with greater levels of adult IPV, and that women who report both adolescent and adult IPV have the highest mean levels of depressive symptoms. These findings suggest that exposure to IPV in adolescence may alter the life course of young women, increasing their risk for continuing exposure to intimate partner violence in adulthood and its concomitant negative mental health effects. Efforts aimed at prevention and early intervention in IPV among adolescent mothers are important components of the clinical care of young mothers.
Low prevalence of HIV and other sexually transmitted infections in young women attending a youth counselling service in Maputo, Mozambique
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Tropical Medicine and International Health. 2008 Jan;13(1):17-20.
Melo J | Folgosa E | Manjate D | Osman N | Francois I
The objectives were to determine the prevalence of sexually transmitted infections (STIs) in a group of young women attending the Adolescent and Youth Friendly Service, in Maputo, Mozambique, and to evaluate their level of knowledge, practices and attitudes about STI. A total of 445 women voluntarily participated in the study and filled in a self-administered knowledge, practices and attitudes (KAP) questionnaire; 435 of them underwent a laboratory examination for vaginosis, candidiasis, trichomoniasis, gonorrhoea, chlamydiosis, syphilis and HIV infection. Women had a high level of awareness and knowledge of STI and HIV. Candidiasis was the most prevalent reproductive tract infection (36%), followed by vaginosis (13%) and trichomoniasis (7.6%), and sexually transmitted diseases. HIV seroprevalence was 4%; 42% were negative in all tests. The low prevalence of STI and HIV may be related in part to the high level of awareness registered in the group.
FAMILY PLANNING NEWS
Philippines: Responsible parenting makes headway in Davao Norte
(News Article; Asia)
20 Feb 2008
Baquio N, Philippine Information Agency
Indonesia: Old family planning program revitalized
(News Article; Asia)
20 Feb 2008
The Jakarta Post
FAMILY PLANNING RESEARCH
Being strategic about contraceptive introduction: The experience of the Standard Days Method
(Abstract; subscription needed for full text; Global)
Contraception. 2008 Mar;77(3):147-154.
Gribble JN | Lundgren RI | Velasquez C | Anastasi EE
Many national and institutional family planning policies explicitly include fertility awareness-based methods among the method options that should be made available, but these methods are often not offered for a variety of reasons. After testing the efficacy of the Standard Days Method (SDM), which is a fertility awareness-based method that identifies Days 8-19 of the menstrual cycle as fertile for women with cycles lasting between 26 and 32 days, pilot studies were conducted to introduce it into programs. Through 14 pilot studies around the world, ministries of health, family planning associations and community development organizations introduced the SDM. Follow-up interviews with users and other data collection methodologies were used to track user characteristics and experiences. Supervision data and simulated clients assessed the effects on service delivery. The SDM appeals to a broad range of women throughout the world. Clients report using abstinence or condoms to manage the fertile days. Both men and women report high levels of satisfaction with the method. The cross-study first-year failure rate of 14.1 pregnancies per 100 woman-years of use is similar to typical-use rates found in the SDM efficacy trial. The results of the pilot studies offer guidance for scaling up service delivery of the SDM. Condom counseling can help many users manage the fertile window effectively. Because out-of-range cycles can lead to method failure, users must understand the importance of tracking cycle length and be willing to switch to another method when the SDM is contraindicated. Community providers can offer the method; within clinical settings, SDM counseling typically takes no more time than allowed in most program norms. Training providers to address alcohol use and gender-based violence improves SDM method use and contributes to better quality of care.
Delivering non-hormonal contraceptives to men: Advances and obstacles
(Abstract; subscription needed for full text; Global)
Trends in Biotechnology. 2008 Feb;26(2):90-99.
Mruk DD | Cheng CY
There have been major advances in male contraceptive research during the past two decades. However, for a contraceptive to be used by men, its safety requires more stringent scrutiny than therapeutic compounds for treatment of illnesses because the contraceptives will be used by healthy individuals for an extended period of time, perhaps decades. A wide margin is therefore required between the effective dose range and doses that cause toxicity. It might be preferable that a male contraceptive, in particular a non-hormone-based compound, is delivered specifically and/or directly to the testis and has a rapid metabolic clearance rate, reducing the length of exposure in the liver and kidney. In this article, we highlight the latest developments regarding contraceptive delivery to men and with the aim of providing useful information for investigators in future studies.
Knowledge and attitude of married Turkish men regarding family planning
(Abstract; subscription needed for full text; Europe)
European Journal of Contraception and Reproductive Health Care. 2008 Mar;13(1):97-102.
Pirincci E | Oguzoncul AF
Men play an essential role in reproduction. They should be encouraged to involve themselves in birth control, particularly in developing countries, where contraceptive goals have not been reached. This study, carried out in Mus, Turkey, was aimed at determining the attitudes and behaviour of married men with regard to family planning (FP). The study included 317 married men aged 20-56 who worked in an institution. Questionnaires were distributed to the participants at their workplace and collected after 30-40 minutes. The use of FP was approved by 78.9% of the men, but a contraceptive method was actually applied by only 65.6%. Whereas 27.6% of the high school and university graduates had five or more children, as many as 67.4% of the men with a lesser educational level had such a large offspring. Nearly 60% of the men had been given information about FP by healthcare professionals. Education has a great impact on knowledge and attitudes about FP.
Women's reproductive autonomy and barriers to contraceptive use in Pakistan
(Abstract; subscription needed for full text; Asia)
European Journal of Contraception and Reproductive Health Care. 2008 Mar;13(1):83-89.
Saleem A | Pasha GR
The objective was to determine through the log-linear model analysis technique the impact of women's reproductive autonomy, spouses' educational background and other factors on the use of contraception in Pakistan. Data from the Pakistan Reproductive Health and Family Planning Survey 2000 were used. In this survey a national sample of married women aged 15-49 years (n = 6579) were interviewed. A number of socio-economic, socio-demographic and women's reproductive autonomy variables were taken for the log-linear model fitting and analysis, in order to examine the impact of women's reproductive autonomy on contraceptive use and the factors affecting this latter. On the basis of partial and marginal association tests, two hierarchical log-linear models were selected. The first one concerned women's reproductive autonomy and contraceptive use, the second one analysed factors affecting contraceptive use. Standardized values of the model's parameter estimates showed that women's reproductive autonomy was significantly associated with husband-wife education attainment when they were using contraception. In the second model, contraceptive use was strongly associated with women's education, husband's desire for more children, sex preference for the next child and number of living children. An improved husband-wife educational level results in greater reproductive autonomy of the women and an increased use of contraception. The husband's desire for more children, a preference for the sex of the next child, and the woman's poor education attainment level are the main barriers to contraceptive use.
GENDER and HEALTH NEWS
Namibia: Forcible sterilisation rouses interest
(News Article; Sub-Saharan Africa)
20 Feb 2008
New Era (Windhoek)
Uganda: Legislators join fight against female genital mutilation
(News Article; Sub-Saharan Africa)
21 Feb 2008
The Monitor (Kampala)
Liberia: IRC trains women to report GBV cases
(News Article; Sub-Saharan Africa)
19 Feb 2008
The News (Monrovia)
GENDER and HEALTH RESEARCH
Intimate partner violence against women in rural Vietnam: Different socio-demographic factors are associated with different forms of violence. Need for new intervention guidelines?
(Research Article; Asia)
BMC Public Health. 2008 Feb 11;8(55):[26] p.
Vung ND | Ostergren PO | Krantz G
This population-based study investigated the different forms, magnitude and risk factors of men's violence against women in intimate relationships in a rural part of northern Vietnam and whether a difference in risk factors were at hand for the different forms of violence. Vietnam has undergone a rapid transition in the last 20 years, moving towards a more equal situation for men and women however, Confucian doctrine is still strong and little is known about men's violence against women within the Vietnamese family. This is a cross-sectional population-based study that used a questionnaire developed by the World Health Organisation for investigating women's health and violence against women in different settings. Face-to face structured interviewing was performed and 883 married women, aged 17 to 60 participated. Bi- and multivariate analyses was used for risk factor assessment. The lifetime prevalence of physical violence was 30.9 percent and past year prevalence was 8.3 per cent, while the corresponding figures for physical and sexual violence combined was 32.7 and 9.2 percent. The lifetime prevalence was highest for psychological abuse (27.9 percent) as a single entity. In most cases the violence was of a severe nature and exercised as repeated acts over time. Woman's low educational level, husband's low education, low household income and the husband having more than one wife/partner were risk factors for lifetime and past year physical/sexual violence. The pattern of factors associated with psychological abuse alone was however different. Husband's low professional status and women's intermediate level of education appeared as risk factors. Men's violence against women in intimate relationships is commonly occurring in rural Vietnam. There is an obvious need of preventive and treatment activities. Our findings point at that pure psychological abuse is different from physical/sexual violence in terms of differing characteristics of the perpetrators and it might be that also different strategies are needed to reduce and prevent this violence.
Age at menarche is not an independent risk factor for high-risk human papillomavirus infections and cervical intraepithelial neoplasia
(Abstract; subscription needed for full text; Global | Global)
International Journal of STD and AIDS. 2008 Jan;19(1):16-25.
Syrjanen K | Shabalova I | Petrovichev N | Kozachenko V | Zakharova T
Data are controversial as to the role of menarche age as a risk factor of high-risk human papillomavirus (HR-HPV) infections. The objective of this study was to analyse the risk estimates for age at menarche as determinant of cervical intraepithelial neoplasia (CIN) and HR-HPV infections. A cohort of 3187 women were stratified into three groups according to their age at menarche: (i) women less than 13 years of age; (ii) those between 13 and 14 years and (iii) women greater than 15 years of age. These groups were analysed for predictors of (a) HR-HPV, (b) high-grade CIN and (c) outcome of HR-HPV and cytological abnormalities during prospective follow-up. All the three groups had identical prevalence of HR-HPV, Papanicolaou smear abnormalities and CIN grades. In contrast to menarche age itself, the time from menarche to the first intercourse (TMI), to the first pregnancy (TMP) and to the first delivery (TMD) were all significant (P = 0.0001) predictors of HR-HPV (but not CIN2) in univariate analysis, but lost their significance in a multivariate model. Outcome of cervical disease and HR-HPV infection was unrelated to menarche age, the latter and the three intervals being not predictors of CIN2 in a multivariate model. In conclusion, age at menarche and the intervals between menarche and (i) onset of sexual activity, (ii) first pregnancy and iii) first delivery, are not independent predictors of HR-HPV infections and CIN2 in multivariate analysis.
Traditional circumcision during manhood initiation rituals in the Eastern Cape, South Africa: A pre-post intervention evaluation
(Research Article; Sub-Saharan Africa)
BMC Public Health. 2008 Feb 19;8:64.
Peltzer K | Nqeketo A | Petros G | Kanta X
Circumcisions undertaken in non-clinical settings can have significant risks of serious adverse events, including death. The aim of this study was to test an intervention for safe traditional circumcision in the context of initiation into manhood among the Xhosa, Eastern Cape, South Africa. Traditional surgeons and nurses registered with the health department were trained over five days on ten modules including safe circumcision, infection control, anatomy, postoperative care, detection and early management of complications and sexual health education. Initiates from initiation schools of the trained surgeons and nurses were examined and interviewed on 2nd, 4th, 7th and 14th day after circumcision. From 192 initiates physically examined at the 14th day after circumcision by a trained clinical nurse high rates of complications were found: 40 (20.8%) had mild delayed wound healing, 31 (16.2%) had a mild wound infection, 22 (10.5%) mild pain and 20 (10.4%) had insufficient skin removed. Most traditional surgeons and nurses wore gloves during operation and care but did not use the recommended circumcision instrument. Only 12% of the initiates were circumcised before their sexual debut and they reported a great deal of sexual risk behaviour. Findings show weak support for scaling up traditional male circumcision.
Vaccine-related HPV genotypes in women with and without cervical cancer in Mozambique: Burden and potential for prevention
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of Cancer. 2008;122(8):1901-1904.
Castellsagué X | Klaustermeier J | Carrilho C | Albero G | Sacarlal J
Knowledge about the burden of Human Papillomavirus (HPV) infections in Sub-Saharan Africa is very limited. We collected cervical samples from 262 women from the general population and 241 tumor samples from women with invasive cervical cancer in Mozambique and tested them for HPV genotyping by the SPF/10-LiPA/25 PCR system. Among the 195 women without cervical abnormalities by cytology HPV prevalence was 75.9%. In this group of women, the most frequently identified HPV types among HPV-positive women were in descending order of frequency: HPV51 (23.6%), HPV35 (19.6%), HPV18 (14.2%), HPV31 (13.5%) and HPV52 (12.8%). In women with cervical cancer HPV DNA detection was 100%. The type-specific distribution of the most frequent types in descending order of frequency was: HPV16 (47.0%), HPV18 (31.3%), HPV51 (14.8%), HPV52 (14.3%), HPV45 (12.6%), HPV35 (10.4%), HPV33 (4.8%) and HPV31 (2.6%). HPVs 16/18 and HPVs 16/18/31/45 were detected in 71.7% and 80.9% of cervical cancer tissue, respectively. While HPVs 51 and 35 were the two most common types in cytologically normal women in Mozambique, HPVs 16 and 18 remained the two most frequently identified types in cervical cancer. The introduction of an efficacious HPV 16/18 vaccine could potentially prevent the occurrence of 72% of cervical cancer cases and up to 81% of the cases if full cross-protection against HPVs 31 and 45 is assumed.
Efficacy of Etoricoxib for pain relief during endometrial biopsy; a double blind randomized controlled trial
(Abstract; subscription needed for full text; Asia)
Journal of the Medical Association of Thailand. 2008 Jan;19(1):13-18.
Tanprasertkul C | Pongrojpow D
The objective was to compare the efficacy of oral etoricoxib and placebo for pain relief during endometrial biopsy. A double-blind, randomized controlled trial that included 80 women who underwent endometrial biopsy was done at Thammasat University Hospital between 1 September 2005 and 30 June 2006. Forty women were randomly allocated to the etoricoxib group (120 mg, tablet) and 40 to the placebo group. The main outcome was the patient's assessment of intensity of pain measured by visual analog scale (VAS) before speculum insertion, during endometrial biopsy, immediately after endometrial biopsy, and 30 minutes after endometrial biopsy. Satisfactory score was also evaluated. Demographic data including age, BMI, previous vaginal deliveries, previous pelvic surgery and history of curettage were not significantly different between the etoricoxib group and the placebo group. Mean pain score in the etoricoxib group was not significantly lower when compared with the placebo group during endometrial biopsy (5.0 plus or minus 1.7 versus 5.25 plus or minus 2.2, p = 0.7) and immediately after endometrial biopsy (2.1 plus or minus 2.2 versus 2.8 plus or minus 1.7, p = 0.1) but significantly lower at 30 minutes after endometrial biopsy (0.2 plus or minus 0.5 versus 0.6 plus or minus 0.8, p = 0.01). Mean satisfactory score was significantly higher in the etoricoxib group (6.9 plus or minus 1.8 versus 5.1 plus or minus 2.3, p = 0.001). A single oral dose of etoricoxib for reduction of pain during endometrial biopsy had not significantly lower the pain score during the procedure compared with the placebo. However mean satisfactory score in the etoricoxib group was higher with statistically significant difference. Also the authors found no serious adverse effects of this drug.
HIV/AIDS and STIs NEWS
South Africa: Study: Gel fails to stop HIV infection
(News Article; Sub-Saharan Africa)
18 Feb 2008;
Marchione M, Associated Press
South Africa: African AIDS Crisis Outlives $15 Billion Bush Initiative
(News Article; Sub-Saharan Africa)
20 Feb 2008
Timberg C, The Washington Post
United States: Bush pressures congress to boost AIDS funding for Africa
(News Article; Sub-Saharan Africa)
20 Feb 2008
Stearns S
Glaxo cuts HIV drug prices for poor countries
(News Article; Europe)
19 Feb 2008
Reuters
HIV/AIDS and STIs RESEARCH
HIV and family planning service integration and voluntary HIV counselling and testing client composition in Ethiopia
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS Care. 2008 Jan;20(1):61-71.
Bradley H | Bedada A | Tsui A | Brahmbhatt H | Gillespie D
Integrating voluntary HIV counselling and testing (VCT) with family planning and other reproductive health services may be one effective strategy for expanding VCT service delivery in resource poor settings. Using 30,257 VCT client records with linked facility characteristics from Ethiopian non-governmental, non-profit, reproductive health clinics, we constructed multi-level logistic regression models to examine associations between HIV and family planning service integration modality and three outcomes: VCT client composition, client-initiated HIV testing and client HIV status. Associations between facility HIV and family planning integration level and the likelihood of VCT clients being atypical family planning client-types, versus older (at least 25 years old), ever-married women were assessed. Relative to facilities co-locating services in the same compound, those offering family planning and HIV services in the same rooms were 2-13 times more likely to serve atypical family planning client-types than older, ever-married women. Facilities where counsellors jointly offered HIV and family planning services and served many repeat family planning clients were significantly less likely to serve single clients relative to older, married women. Younger, single men and older, married women were most likely to self-initiate HIV testing (78.2 and 80.6% respectively), while the highest HIV prevalence was seen among older, married men and women (20.5 and 34.2% respectively). Compared with facilities offering co-located services, those integrating services at room- and counselor-levels were 1.9-7.2 times more likely to serve clients initiating HIV testing. These health facilities attract both standard maternal and child health (MCH) clients, who are at high risk for HIV in these data, and young, single people to VCT. This analysis suggests that client types may be differentially attracted to these facilities depending on service integration modality and other facility-level characteristics.
Proposal for the development of a standardized protocol for assessing the economic costs of HIV prevention interventions
(Abstract; subscription needed for full text; Global)
JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Mar;47 Suppl 1:s10-s14.
Pinkerton SD | Pearson CR | Eachus SR | Berg KM | Grimes RM
Maximizing our economic investment in HIV prevention requires balancing the costs of candidate interventions against their effects and selecting the most cost-effective interventions for implementation. However, many HIV prevention intervention trials do not collect cost information, and those that do use a variety of cost data collection methods and analysis techniques. Standardized cost data collection procedures, instrumentation, and analysis techniques are needed to facilitate the task of assessing intervention costs and to ensure comparability across intervention trials. This article describes the basic elements of a standardized cost data collection and analysis protocol and outlines a computer-based approach to implementing this protocol. Ultimately, the development of such a protocol would require contributions and "buy-in" from a diverse range of stakeholders, including HIV prevention researchers, cost-effectiveness analysts, community collaborators, public health decision makers, and funding agencies.
The estimated burden of HIV/AIDS in Uganda, 2005 -- 2010
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2008 Feb 19;22(4):503-510.
Hladik W | Musinguzi J | Kirungi W | Opio A | Stover J
The objectives were to estimate the burden of HIV disease in Uganda and the effect of HIV/AIDS control programmes to mitigate it. Mathematical modeling and projecting using surveillance and census data was the design used. Using antenatal clinic surveillance (1986-2002) and recent population-based survey (2004-2005) data, we modeled the adult national HIV prevalence over time (1981-2004), and kept prevalence constant at 6.4% for the years 2004-2010. Using Spectrum software and census data, we estimated the national burden of HIV disease and the effect of selected HIV-related prevention and treatment programmes. In 2005, we estimated that there were 135 300 new HIV infections (adult HIV incidence 0.96%), 691 900 asymptomatic prevalent infections, 88 100 AIDS cases, and 76 400 AIDS deaths. An estimated 647 000 (80%) HIV-infected adults were unaware of their infection; one third of all adult deaths were HIV related. As a result of population growth, by 2008 a similar number of people will be HIV infected (1.1 million) as during the peak of the epidemic in 1994. Although antiretroviral therapy (ART) coverage is expected to rise from 67 000 (2005) to 160 000 (2010), the number of persons needing but not receiving ART will decrease only slightly from 127 600 (2005) to 111 100 (2010). The use of single-dose in 2005 nevirapine probably averted only 4% of the estimated 20 400 vertical infections. HIV/AIDS continues to be a leading cause of adult disease and death in Uganda. Universal ART access is probably unachievable. With the absolute burden of HIV disease approaching the historic peak in the early 1990s, more effective prevention programmes are of paramount importance.
Trichomonas vaginalis infection and human immunodeficiency virus acquisition in African women
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Infectious Diseases. 2008;197(4):548-554.
Van der Pol B | Kwok C | Pierre-Louis B | Rinaldi A | Salata RA
Trichomoniasis vaginalis is the most common nonviral sexually transmitted infection (STI) worldwide, with a particularly high prevalence in regions of human immunodeficiency virus (HIV) endemicity. However, its impact as a cofactor for HIV acquisition is poorly understood. Samples from 213 women who experienced HIV seroconversion (cases) during a longitudinal study involving 4450 women in Uganda and Zimbabwe were matched with samples from HIV-uninfected women (controls). All samples underwent polymerase chain reaction (PCR) analysis for Trichomonas vaginalis DNA. For cases, analyzed samples were from the visit in which HIV seroconversion was detected and the visit preceding detection of seroconversion; for controls, one analyzed sample was from the visit matched by follow-up duration to the cases' seroconversion visit, and the other sample was from the visit immediately preceding the matched visit. The prevalence of T. vaginalis infection before HIV infection was 11.3% in cases and 4.5% in controls (P = .002). In multivariable analysis controlling for hormonal contraception, other STIs, behavioral, and demographic factors, the adjusted odds ratio for HIV acquisition was 2.74 (95% confidence interval, 1.25-6.00) for T. vaginalis-positive cases. The presence of behavioral risk factors for HIV infection, study recruitment from a referral population at high-risk for HIV, primary sex partner-associated risk for HIV infection, and herpes simplex virus type 2 seropositivity were also predictive of incident HIV infection. T. vaginalis infection is strongly associated with an increased risk for HIV infection in this general population of African women. Given the high prevalence of T. vaginalis infection in HIV-endemic areas, T. vaginalis control may have a substantial impact on preventing HIV acquisition among women.
Payment for antiretroviral drugs is associated with a higher rate of patients lost to follow-up than those offered free-of-charge therapy in Nairobi, Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 Mar;102(3):288-293.
Zachariah R | Van Engelgem I | Massaquoi M | Kocholla L | Manzi M
This retrospective analysis of routine programme data from Mbagathi District Hospital, Nairobi, Kenya shows the difference in rates of loss to follow-up between a cohort that paid 500 shillings/month (approximately US$7) for antiretroviral drugs (ART) and one that received medication free of charge. A total of 435 individuals (mean age 31.5 years, 65% female) was followed-up for 146 person-years: 265 were in the 'payment' cohort and 170 in the 'free' cohort. The incidence rate for loss to follow-up per 100 person-years was 47.2 and 20.5, respectively (adjusted hazard ratio 2.27, 95% CI 1.21-4.24, P = 0.01). Overall risk reduction attributed to offering ART free of charge was 56.6% (95% CI 20.0-76.5). Five patients diluted their ART regimen to one tablet (instead of two tablets) twice daily in order to reduce the monthly cost of medication by half. All these patients were from the payment cohort. Payment for ART is associated with a significantly higher rate of loss to follow-up, as some patients might be unable to sustain payment over time. In resource-limited settings, ART should be offered free of charge in order to promote treatment compliance and prevent the emergence of drug resistance.
Measuring stigma associated with tuberculosis and HIV/AIDS in southern Thailand: Exploratory and confirmatory factor analyses of two new scales
(Abstract; subscription needed for full text; Asia)
Tropical Medicine and International Health. 2008 Jan;13(1):21-30.
Van Rie A | Sengupta S | Pungrassami P | Balthip Q | Choonuan S
The objective was to develop scales to measure tuberculosis and HIV/AIDS stigma in a developing world context. Cross-sectional study of tuberculosis patients in southern Thailand, who were asked to rate their agreement with items measuring TB and HIV/AIDS stigma. Developing the scales involved exploratory and confirmatory factor analyses, internal consistency, construct validity, test-retest reliability and standardized summary scores. Factor analyses identified two sub-scales associated with both tuberculosis and HIV/AIDS stigma: community and patient perspectives. Goodness-of-fit was good (TLI = 94, LFI = 0.88 and RMSEA = 0.11), internal consistency was excellent (Cronbach's alphas 0.82-0.91), test-retest reliability was moderate, and construct validity showed an inverse correlation with social support. Our scales have good psychometric properties that measure stigma associated with tuberculosis and HIV/AIDS and allow assessment of stigma from community and patient perspectives. Their use will help document the burden of stigma, guide the development of interventions and evaluate stigma reduction programmes in areas with a high HIV/AIDS and tuberculosis burden.
MATERNAL AND CHILD HEALTH NEWS
Mozambique: Guebuza launches initiative on mother and child health
(News Article; Sub-Saharan Africa)
20 Feb 2008
Agencia de Informação de Moçambique (Maputo)
Uganda: Infant, maternal deaths still high
(News Article; Sub-Saharan Africa)
17 Feb 2008
Nabusoba I, New Vision (Kampala)
'Janani Express' for better maternal care
(News Article; Asia)
19 Feb 2008
newindpress.com
MATERNAL AND CHILD HEALTH RESEARCH
The impact of maternal HIV status on infant feeding patterns in Nakuru, Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Human Lactation. 2008 Feb;24(1):34-41.
Kamau-Mbuthia E | Elmadfa I | Mwonya R
The aim of the study was to assess the impact of maternal HIV status on infant feeding patterns. Two hundred eighty mothers (205 HIV uninfected, 75 infected) and their infants were recruited from the Provincial General Hospital, Nakuru, Kenya, from delivery and were followed for 14 weeks. From the feeding patterns, HIV-infected mothers were more likely to exclusively breastfeed in week 1 than HIV-uninfected mothers (71.7% vs 56.3%, P = .001), but there were no differences by week 14 (9.8% vs 4.8% P = .212). Mixed feeding increased for both groups from weeks 1 to 14. In multivariate logistic regression analysis, maternal age (younger mothers, P less than .05) was associated with exclusive breastfeeding in the 6th week and infant birth weight (greater than mean birth weight, P less than .05) in the 10th week. The results indicate a need to reassess adherence to infant feeding recommendations irrespective of maternal HIV status and also the infant feeding counseling process in the hospital.
Acute renal failure in pregnancy: One year observational study at Liaquat University Hospital, Hyderabad
(Abstract; subscription needed for full text; Asia)
Journal of the Pakistan Medical Association. 2008 Feb;58(2):61-64.
Ansari MR | Laghari MS | Solangi KB
The objective was to determine the incidence of pregnancy related acute renal failure (ARF), clinical spectrum, morbidity and mortality of this preventable complication of pregnancy. An observational and prospective hospital based study was conducted at a tertiary care hospital in Hyderabad for one year from Nov.2004-Oct.2005. Total 116 patients of ARF were admitted in Nephro-Urology ward during this period of whom 42 were of obstetric related ARF and they were included in the study. A predesigned proforma was used. The clinical history was noted and all underwent a physical examination. Urine output was recorded. Routine laboratory tests were performed and specialized tests as DTPA scan was done in some cases. The final outcome was recorded. The majority i.e. 31 patients were from village community of interior Sindh province and the remaining 11 were from Hyderabad city area. Pregnancy related ARF numbered 42 (36%) of which 28 (67%) were multipara and 14 (33%) were primigravida. Their ages were between 20 to 41 years. Majority 24 (57%) patients had not received any antenatal care and there was a history of traditional birth attendants TBA (Dai) assisted home delivery as compared to 6 (14%) cases with adequate antennal care. Six (14%) cases presented in their first trimester of pregnancy while 36(86%) patients developed ARF in their 3rd. trimester or in the puerperium and 19 (45%) were anuric. Blood loss causing hypotension due to APH and PPH was the common cause of ARF. Clinical spectrum of pregnancy related ARF showed APH in 6 (14%) cases, PPH in 9 (24%) cases, septic abortion and puerperal sepsis and DIC in 13 (31%) cases, IUD in 6 (14%) and preeclampsia / eclampsia in 5 (12%) cases. Thirty (71%) patients received haemodialysis and 12 (29%) did not require dialysis. Commonest clinical diagnosis was ATN in 23 (55%) cases with complete recovery. Acute bilateral renal cortical necrosis was seen in 9 (21%) cases and 2 (5%) patients had patchy cortical necrosis. Overall morbidity was 19% and mortality 26%. Pregnancy related acute renal failure is a major health problem especially in the villages of Sindh provinces and carries very high mortality and morbidity. Poor healthcare facilities and lack of antenatal healthcare clinics are major identified causes.
Risk screening, emergency care, and lay concepts of complications during pregnancy in Chiapas Mexico
(Abstract; subscription needed for full text; North America)
Social Science and Medicine. 2008 Mar;66(5):1057-1069.
Tinoco-Ojanguren R | Glantz NM | Martinez-Hernandez I | Ovando-Meza I
Maternal morbidity and mortality are widespread in Chiapas, Mexico's southernmost state, as in many developing regions. Globally, the utility of three approaches to addressing such problems has been debated: (a) obstetric risk screening (i.e. screening women for risk during pregnancy and channeling those at risk to preventive care); (b) emergency obstetric care (i.e. identifying complications during pregnancy or birth and providing prompt effective treatment); and (c) combined risk screening and emergency care. Unaddressed to date in peer-reviewed journals are the lay perceptions of complications and risk that precede and incite the quest for obstetric care in Mexico. High incidence of maternal mortality in Chiapas, exacerbated by the predominantly rural, highly indigenous, geographically dispersed, and economically marginalized nature of the state's southern Border Region, prompted us to conduct 45 open-ended interviews with a convenience sample of women and their close relative/s, including indigenous and non-indigenous informants in urban and rural areas of four municipalities in this region. Interviews suggest that none of the three approaches is effective in this context, and we detail reasons why each approach has fallen short. Specific obstacles identified include that (1) many women do not access adequate prenatal screening care on a regular basis; (2) emergency obstetric care in this region is severely circumscribed; and (3) lay notions of pregnancy-related risk and complications contrast with official clinical criteria, such that neither clinical nor extra-clinical prenatal monitoring encompasses the entire range of physical and social risk factors and danger signs. Findings reported here center on a rich description of the latter: lay versus clinical criteria for risk of antepartum complication.
Saving newborn lives in Asia and Africa: Cost and impact of phased scale-up of interventions within the continuum of care
(Abstract; subscription needed for full text; Asia | Sub-Saharan Africa)
Health Policy and Planning. 2008 Mar;23(2):101-117.
Darmstadt GL | Walker N | Lawn JE | Bhutta ZA | Haws RA | Cousens S
Policy makers and programme managers require more detailed information on the cost and impact of packages of evidenced-based interventions to save newborn lives, particularly in South Asia and sub-Saharan Africa, where most of the world's 4 million newborn deaths occur. We estimated the newborn deaths that could be averted by scaling up 16 interventions in 60 countries. We bundled the interventions in a variety of existing maternal and child health packages according to time period of delivery and service delivery mode, and calculated the additional running costs of implementing these interventions at scale (90% coverage) in sub-Saharan Africa and South Asia. The phased introduction and expansion of interventions was modelled to represent incremental strategies for scaling up neonatal care in developing country health systems. Increasing coverage of 16 interventions to 90% could save 0.59-1.08 million lives in South Asia annually at an additional cost of US$0.90-1.76 billion. In sub-Saharan Africa, 0.45-0.80 million lives saved would cost US$0.68-1.32 billion. Additional costs for increased antenatal interventions are low, but given relatively high baseline coverage and lower impact, fewer additional newborn lives can be saved through this package (5-10%). Intrapartum care has higher impact (19-34% of deaths averted) but is costly (US$1.66-3.25 billion). Postnatal family-community care, with potential for high impact at low cost (10-27%, US$0.38-0.75 billion), has been neglected. A first phase of scaling up care in 36 high (NMR 30-45) and 15 very high (NMR greater than 45) mortality countries would cost approximately US$0.56-1.10 and US$0.09-0.17 billion annually, respectively, and would avert 15-32% and 13-29% of neonatal deaths, respectively, in these countries. Full coverage with all interventions in the 51 high and very high mortality countries would cost US$2.23-4.37 billion, and avert 38-68% of neonatal deaths (1.13-2.05 million), at an extra cost per death averted of US$1100-3900. Low-cost, effective newborn health interventions can save millions of lives, primarily in South Asia and sub-Saharan Africa. Modelling costs and impact of intervention packages scaled up incrementally as health systems capacity increases can assist programme planning and help policy makers and donors identify stepwise targets for investments in newborn health.
Breast-feeding-associated hypernatremia: Retrospective analysis of 169 term newborns
(Abstract; subscription needed for full text; Europe)
Pediatrics International. 2008 Feb;50(1):29-34.
Unal S | Arhan E | Kara N | Uncu N | Aliefendioglu D
The aim of the present paper was to define the incidence, complications, morbidity and mortality of hypernatremic dehydration due to inadequate breast-feeding in a neonatal intensive care unit. A retrospective study was carried out between 2002 and 2005, to identify the term breast-fed neonates with serum sodium level greater than or equal to 150 mEq/L at the Ministry of Health Ankara Diskapi Children's and Research Hospital. The incidence of hypernatremic dehydration secondary to inadequate breast-feeding was 4.1%, occurring in 169 term infants among 4136 hospitalized term neonates with the following characteristics: mean gestational age, 39.1 weeks (37 - 42 weeks); birthweight, 3352 g (2200 - 4500 g); mother's age, 26.1 years (17 - 38 years); weight loss, 15.9% (5.4 - 32.7%); proportion of spontaneous vaginal deliveries, 75.7%; and proportion of first-time mothers, 74.6%. Major presenting symptoms were neonatal jaundice (47.3%) and poor infant suck (29.6%). The median sodium; blood urea nitrogen (BUN); and creatinine levels on admission were 155 mmol/L (150 - 194 mmol/L), 35 mg/dL (7 - 253 mg/dL), and 0.9 mg/dL (0.2 - 10 mg/dL), respectively. Major complications were as follows: acute renal failure, 82.8%; elevated liver enzymes, 20.7%; disseminated intravascular coagulation, 6.5%; brain edema, 5.2%; intracranial hemorrhage, 3.6%; cavernous sinus thrombosis, 1.2%; and bilateral iliac artery thrombosis, 0.6%. Ten patients (5.9%) developed seizure within the first 24 h of rehydration therapy with a mean sodium decrease of 11.9 mmol/L per day (4 - 19 mmol/L per day). Two patients (1.2%) died. There were positive correlation between weight loss and serum sodium, BUN, bilirubin levels (P less than 0.01); there was no correlation between weight loss and mothers' age, education level, delivery route, or first-born status (P greater than 0.05). Hypernatremic dehydration in neonates due to inadequate breast-feeding is a serious, potentially devastating and life-threatening disorder, and can damage the central nervous system. Follow up of infants for adequate breast-feeding is important. Pediatricians must maintain a high level of suspicion, especially in cases of pathologic infant weight loss after delivery.
Neonatal mortality: Description and effect of hospital of birth after risk adjustment 
(Research Article; South America)
(You need Adobe Acrobat Reader to access this document)
Revista de Saúde Pública. 2008 Feb;42(1):1-9.
Barros AJ | Matijasevich A | Santos IS | Albernaz EP | Victora CG
The objective was to assess the effect of hospital of birth on neonatal mortality. A birth cohort study was carried out in Pelotas, Southern Brazil, in 2004. All hospital births were assessed by daily visits to all maternity hospitals and 4558 deliveries were included in the study. Mothers were interviewed regarding potential risk factors. Deaths were monitored through regular visits to hospitals, cemeteries and register offices. Two independent pediatricians established the underlying cause of death based on information obtained from medical records and home visits to parents. Logistic regression was used to estimate the effect of hospital of birth, controlling for confounders related to maternal and newborn characteristics, according to a conceptual model. Neonatal mortality rate was 12.7% and it was highly influenced by birthweight, gestational age, and socioeconomic variables. Immaturity was responsible for 65% of neonatal deaths, followed by congenital anomalies, infections and intrapartum asphyxia. Adjusting for maternal characteristics, a three-fold increase in neonatal mortality was seen between similar complexity hospitals. The effect of hospital remained, though lower, after controlling for newborn characteristics. Neonatal mortality was high, mainly related to immaturity, and varied significantly across maternity hospitals. Further investigations comparing delivery care practices across hospitals are needed to better understand NMR variation and to develop strategies for neonatal mortality reduction.
POPULATION/FERTILITY/DEMOGRAPHY NEWS
Philippines: 3 Filipinos born every minute, says census
(News Article; Asia)
22 Feb 2008
Pacific News
POPULATION/FERTILITY/DEMOGRAPHY RESEARCH
Marriage and childbirth as factors in dropping out from school: An analysis of DHS data from sub-Saharan Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Population Studies. 2008 Mar;62(1):1-13.
Lloyd CB | Mensch BS
Leaving school prematurely is often claimed to be among the most negative consequences of early marriage and pregnancy for girls in less developed countries. However, an analysis of the relative frequency with which these events actually occur or are named as reasons for leaving school reveals that, at least in the case of francophone Africa, they explain no more than 20 per cent of dropouts. To the extent that demographic events trump school or family factors as determinants of school-leaving, our data indicate that it is union formation - defined by the DHS as first marriage or cohabitation - rather than childbirth that is more likely to have this effect. 'Schoolgirl pregnancy' typically accounts for only between 5 and 10 per cent of girls' departures from school. Furthermore, the risks of leaving school because of pregnancy or marriage have declined over time with the decline in rates of early marriage and childbearing.
A new estimate of permanent sterility by age: Sterility defined as the inability to conceive
(Abstract; subscription needed for full text; Global)
Population Studies. 2008 Mar;62(1):15-24.
Leridon H
The proportion of couples permanently sterile beyond a certain age is an important component of the reproductive process. Unless medical assistance is used, this age is the upper bound of the fecund period. Most estimates of sterility by age of the woman have been derived from natural fertility populations, in which the number of births and the timing of the last birth (of the complete reproductive history) were not controlled by the couples. Because data on these populations do not include pregnancies not ending in a live birth, the sterility estimates apply to the proportion of couples unable to conceive and to have a live birth. For this reason, it is useful to have an estimate of sterility based on the risk of conceiving, independently of the fate of the pregnancy. Using this new estimate, sterility increases with age much more slowly than with most previous estimates.
Association of educational level and child sex ratio in rural and urban India
(Abstract; subscription needed for full text; Asia)
Social Indicators Research. 2008 Mar;86(1):69-81.
Inchani LR | Lai D
Utilizing data from the Census of India, this study compared child sex ratio in rural and urban regions of India and analyzed whether the child sex ratio was associated with mother's education level. The child sex ratios in the rural and urban regions throughout India were analyzed using the two-sample and paired Student's t-test. Further, the Chi-square test for trend in binomial proportions was used to assess the association between child sex ratios and mother's education levels in rural and urban areas. Analysis of the data showed that there was a significant difference between the child sex ratios in rural areas versus urban areas. In addition, the Chi-square test for trend showed that there was a significant association of the child sex ratio and the educational levels of their mothers. This trend occurred in both rural and urban areas.
Age-specific analysis of reported morbidity in Kerala, India
(Abstract; subscription needed for full text; Asia)
World Health and Population. 2007 Dec;9(4):1-11.
Dilip TR
This paper attempts to provide a wider understanding of the differentials in reported health status in Kerala, while comparing morbidity in the state with other regions in the Indian subcontinent. Reported morbidity and the duration of life lived with a disease is higher in Kerala. Economic inequalities were found only in late-working ages and the elderly, primarily due to higher prevalence of life style-associated chronic conditions in these two age groups. Significant caste-wise differences among adolescents and prime working ages indicated potential for health problems induced by income deprivation in socially disadvantaged subgroups. Self-reported morbidity was 65% higher than proxy-reported morbidity. Regional differences were significant across all age groups, with high morbidity in the most developed region in the state. Results also suggested the need to factor for self- and proxy-reported status in any analysis of morbidity using similar survey data.
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