Volume 8, Number 28
14 July 2008

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ADOLESCENT HEALTH RESEARCH

Predictors of intention to practice safer sex among Korean college students
(Abstract; subscription needed for full text; Asia)
Archives of Sexual Behavior. 2008 Aug;37(4):641-651.
Cha ES | Kim KH | Patrick TE
This study examined the efficacy of the Theory of Planned Behavior (TpB) among Korean college students on intentions of condom use. A cross-sectional, correlational design was conducted with an exploratory survey method. Young men and women aged 18-25 were recruited from a university in Seoul, Korea using a flyer and self-referral. Students completed a background and sexual behavior questionnaire, a parent-adolescent communication scale, and instruments derived from the TpB. Age, parent-adolescent communication, and perceived risk of sexual behavior were added to the model as potential determinants of intention of condom use. All the TpB components significantly predicted intention of condom use for young men, but only condom attitude and condom efficacy significantly predicted intention of condom use for young women. Age and quality of parent-adolescent communication indirectly affected the intention of condom use; however, perceived risk of sexual behavior did not predict intention of condom use, nor was it affected by age. Older students had a higher condom efficacy and a higher perceived peer norm of condom use. The quality of parent-adolescent communication significantly predicted a higher condom efficacy for young men, but not women.

Sexual risk and bridging behaviors among young people in Hai Phong, Vietnam
(Abstract; subscription needed for full text; Asia)
AIDS and Behavior. 2008 Jul;12(4):643-651.
Duong CT | Nguyen TH | Hoang TT | Nguyen VV | Do TM
The risk of the HIV epidemic spreading from high-risk groups to the general population in Vietnam depends on sexual risk and bridging behaviors between high and low-risk individuals. A cross-sectional study was used to describe sexual activities of youth aged 18-29 years. Nearly half (41.4%) were sexually active. Premarital sex was reported by 43.3% of them; 78.3% of sexually active males and 13.5% of sexually active females. Multiple sex partners were reported by 31.0%; 56.7% of males and 9.2% of females. Almost 27% of males and 5% of females engaged in sexual bridging behaviors. Being unmarried was significantly associated with having sex with non-regular partners. Being unmarried and early age at first intercourse were associated with having sex with a sex worker. Consistent condom use was high with commercial sex workers but low with regular partners. Education to delay early sexual debut, increased employment, and strategies to inform young sexually active people to adopt safer behaviors are urgently needed.

Correlates of ever had sex and of recent sex among teenagers and young unmarried adults in the Democratic Republic of Congo
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS and Behavior. 2008 Jul;12(4):585-593.
Kayembe KP | Mapatano MA | Busangu FA | Nyandwe KJ | Mashinda KD
The future of the HIV/AIDS epidemic in the Democratic Republic of Congo will depend on the behavior that teenagers and young adults are likely to adopt. Documenting teenagers and young adults behavior can help design effective interventions. The premarital sexual activity of 13,091 teenagers and young adults aged 15-24 years was examined. Logistic regression models were used to identify the correlates of ever had sex and recent sex. Ever had sex and recent sex were associated with older individuals, males, school dropouts, those addicted to alcohol and drug use, those living alone or with friends, those involved in an income generating activity, those with low capacity to resist sex, those with low socioeconomic status and those living in permissive milieu. Controlling access to alcohol and drugs, teaching teenagers skills to resist sex, getting schools involved in teaching values of abstinence and delayed sex, could impact the age at first sex and trigger the adoption of lower risk behavior.

Teenage pregnancy and frequent use of alcohol and drugs in the home environment
(Abstract; subscription needed for full text; South America)
Revista de Saude Publica. 2008 Jun;42(3):402-410.
Caputo VG | Bordin IA
The objective of this study was to assess individual and family factors associated to teenage pregnancy, including frequent use of alcohol and illicit drugs by family members. A case-control study was conducted with a sample of 408 sexually active female adolescents (aged 13-17 years) in school from the city of Marília (Southeastern Brazil) in 2003-2004. Cases consisted of 100 primigravid teenagers assisted in prenatal care programs in health units. Controls were 308 nulligravid students from state public schools. Standardized instruments identified demographic and educational factors, contraceptive behavior, mental health problems, and family characteristics. Statistical analysis included chi-square tests and logistic regression models. Low paternal education (p=0.01), lack of information on sexuality and fertilization (p=0.001) and the use of illicit drugs by a resident family member (p=0.006) were independent risk factors. Family income per capita and asking the partner to use a condom were confounders. The frequent use of illicit drugs by a resident family member is a factor strongly associated to teenage pregnancy, regardless of other risk factors. The expectation of going to college constitutes a protective factor, mainly in the presence of low maternal education.

FAMILY PLANNING RESEARCH

New findings on contraceptives
(Report; Global)
Population Reports. Series M: Special Topics. 2008 Jun;(20):1-20.
Ramchandran D | Salem RM
This report on new findings in contraception research can help program managers, providers, teachers, and communicators to: update colleagues and students on recent research findings; draw attention to the new, longer 'grace period' for DMPA reinjection recently recommended by WHO, and advocate clear and prominent changes in program policy and training; answer concerns about ready access to emergency contraceptive pills; adopt and use checklists that qualify more women to use IUDs; recommend LAM to women with HIV who are breastfeeding; offer a wide range of contraceptive methods to women with HIV; check whether program guidelines reflect important research findings that have long been neglected in many places.

Physiologic and psychologic symptoms associated with use of injectable contraception and 20 micrograms oral contraceptive pills
(Abstract; subscription needed for full text; Global)
American Journal of Obstetrics and Gynecology. 2008;:[12] p.
Berenson AB | Odom SD | Breitkopf CR | Rahman M
The objective of the study was to compare menstrual, physiologic, and psychologic symptoms over 2 years among women initiating use of depot medroxyprogesterone acetate or an oral contraceptive pill with a reduced pill-free interval and those not using hormonal contraception. A total of 608 women reported their experience regarding 17 symptoms prior to initiating contraception and every 6 months thereafter for 24 months. Longitudinal relationships between symptoms and contraceptives were assessed after adjusting for age, visits, and baseline status of symptoms. Oral contraceptive pills were protective against mastalgia (odds ratio [OR], 0.7), cramping (OR, 0.5), hair loss (OR, 0.6), acne (OR, 0.4), nervousness (OR, 0.5), and mood swings (OR, 0.7). Depot medroxyprogesterone acetate (DMPA) was protective against bloating (OR, 0.5) and mood swings (OR, 0.7) but caused weight gain (OR, 2.3), bleeding episodes more than 20 days (OR, 13.4), and missed periods (OR, 96.9). Both methods caused intermenstrual bleeding. Evidence-based data regarding beneficial and adverse symptoms associated with these methods may help clinicians counsel patients appropriately prior to contraceptive initiation.

SILCS diaphragm: Postcoital testing of a new single-size contraceptive device
(Abstract; subscription needed for full text; Global)
Contraception. 2008;:[8] p.
Schwartz JL | Ballagh SA | Creinin MD | Rountree RW | Kilbourne-Brook M
This study was conducted to compare the effectiveness of a new, single-size silicone contraceptive diaphragm used with either spermicide [2% nonoxynol-9 (N-9)] or lubricant in preventing sperm from penetrating midcycle cervical mucus. A crossover postcoital test (PCT) in healthy, sexually active women not at risk for pregnancy due to tubal occlusion was conducted. Couples had a baseline PCT without a device to verify normal fertility parameters. Qualified couples underwent up to two test cycles using the SILCS diaphragm with a metal spring. A subgroup of couples underwent a third test cycle with the SILCS polymer spring diaphragm used with N-9 gel. Fifteen couples completed a baseline cycle and were randomized to order of study gel. Of these, 14 couples completed a baseline cycle and at least one test cycle, 12 couples completed a baseline cycle and two test cycles and 8 couples completed a third test cycle with the polymer spring prototype. Sperm was detected in the vaginal pool in all completed test cycles. The SILCS metal spring diaphragms used with N-9 gel reduced the average number of progressively motile sperm per high power field in the cervical mucus from a baseline of 12.5 to 0, while use of this device with lubricant reduced the number to 0.5. The SILCS polymer spring diaphragm used with N-9 performed the same as the metal spring used with N-9. The SILCS diaphragm used with N-9 gel performed well. It is likely that the SILCS diaphragm will give acceptable results in a contraceptive effectiveness study but that adjunctive use of a chemical barrier such as N-9 gel will be necessary for it to be most effective.

Estrogen-progestin contraceptive use during adolescence prevents bone mass acquisition: A 4-year follow-up study
(Abstract; subscription needed for full text; Global)
Contraception. 2008;:[6] p.
Pikkarainen E | Lehtonen-Veromaa M | Mottonen T | Kautiainen H | Viikari J
Estrogen-progestin contraception may affect estrogen production and alter the development of peak bone mass. A 4-year follow-up study was conducted with 122 adolescent women aged 12-19 years. The data were divided into three groups based on estrogen-progestin contraceptive (EPC) use: (i) nonusers (n=52), (ii) 1-2 years of use (n=24) and (iii) use for more than 2 years (n=46). The estrogen dose of the preparations was less than or=35 mcg. Height, weight, and the amount of exercise (ratio of work metabolic rate, h/week) as well as bone mineral content (BMC) of lumbar spine and femoral neck were measured repeatedly. There was a significant trend showing less of an increase in the mean adjusted BMC of lumbar spine in the group of adolescent women who had used EPC for more than 2 years compared with the two other groups. In the mean adjusted BMC of the femoral neck, there was a significant trend of a smaller increase in EPC users for more than 2 years compared with 1-2 years of use. Long-term EPC with low-dose estrogen preparations seems to suppress normal bone mineral accrual in adolescent women.

GENDER and HEALTH RESEARCH

Opinions of married women about potential causes and triggers of intimate partner violence against women. A cross-sectional investigation in an Iranian city
(Research Article; Middle East)
BMC Public Health. 2008;8(209):[27] p..
Hamzeh B | Farshi MG | Laflamme L
Population-based perception studies on potential causes and triggers of intimate partner violence against women (IPVAW) may enlighten context-relevant primary preventive actions in settings where data are limited. This study, conducted in one specific city, deals with married women's opinions concerning potential causes and triggers of IPVAW and seeks to highlight areas of consensus and divergence in the views. A convenient sample of women aged 25-45 years and married for at least 5 years was consecutively recruited in the 48 public health centres of Kermanshah city, where free health services are provided to mothers and children under 6 years old. Respondents were individually interviewed on site by trained and experienced female interviewers (response rate 94.3%). A structured pilot-tested questionnaire was used that consisted mainly of closed questions about individual assessment of the extent to which various items could be regarded as a potential cause, a potential trigger or a potential consequence of IPVAW. Individual item frequencies were compiled and the association between socio-demographic attributes of the spouses and also respondents' prior exposure to violence and women answers was explored. For most factors covered, women mainly 'agreed' or 'agreed very much' about their potential as a trigger or a cause of IPVAW; agreements were stronger for individual-related potential causes. Generally, women's socio-demographic characteristics and prior victimisation did not much affect the opinions they expressed. For some triggers however, women's own occupation and their husband's educational level affected how much in agreement they were. The women interviewed consider that most potential causes and triggers proposed may, at some point in a relationship, engender IPVAW. In the main, their views are not much altered by their own and their husbands' socioeconomic position or their prior victimisation. It remains to be seen whether married men and, for that matter, even women married for a shorter duration or from other settings will answer in a similar manner.

Male circumcision: An overview
(Abstract; subscription needed for full text; Global)
African Journal of Paediatric Surgery. 2008 Jan-Jun;5(1):32-36.
Bhattacharjee PK
Circumcision is one of the common operations performed worldwide, for various reasons. Controversy exists as to whether circumcision is an operation. This literature review discusses the indications of circumcision, benefits and complications of circumcision, and alternatives to circumcision. Relevant articles on the benefits, complications, indications and alternative to circumcision from 1964 to 2005 were reviewed, from National Library of Medicine's Pubmed database. Additional articles were obtained from the reference lists of key articles and recent reviews.

Vaccination and the evolutionary ecology of human papillomavirus
(Abstract; subscription needed for full text; Global)
Vaccine. 2008 Jul 18;26 Suppl 3:C25-C30.
Poolman EM | Elbasha EH | Galvani AP
New and upcoming vaccines provide protection against types 16 and 18 of human papillomavirus (HPV), which are responsible for an estimated 70% of all cervical cancers. One vaccine also protects against HPV types 6 and 11, which cause more than 90% of genital warts. We use a mathematical model of HPV transmission and immunity to explore the effect of vaccination on the evolution of HPV types. If vaccination provides cross-immunity at least equal to that of natural infection, it may contract the niche space available to other HPV types a million-fold. If natural infection provides greater cross-immunity than vaccination, vaccination may expand available niche space up to 470-fold. The balance of epidemiologic data suggests vaccination will reduce the available niche space.

Ureaplasma urealyticum or Mycoplasma hominis. Infections and semen quality of infertile men in Abidjan
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Reproduction and Contraception. 2008 Jun;19(2):65-72.
Zinzendorf NY | Kouassi-Agbessi BT | Lathro JS | Don C | Kouadio L
The objective of this study was to determine the prevalence of U. urealyticum and M. hominis in semen samples collected from men admitted in clinic for infertility, and to compare the quality of these semen samples. A total of 1058 semen samples collected were investigated. Sperm semiological assays were performed according to the guidelines of the World Health Organisation (WHO). Semen were examined by Mycoplasma IST for the detection of mycoplasma. Semen culture on agar media was used to detect other microorganisms. Chlamydia was detected using direct fluorescent assay (DFA) of Clamydia Trachomatis. Among 1058 semen samples, microorganisms were detected in 638 (60.3%). The infected sperms consisted of mycoplasma alone in 507 cases (47.9%), mycoplasma and other microorganisms in 98 (9.3%), giving in all 605 (57.2%) samples infected with mycoplasma. The last 33 (3.1%) consisted of other microorganisms alone. The frequency of U.urealyticum, M. hominis and mixed genital infections detected in semen samples of infertile men were 39%, 23.8% and 5.6%, respectively. The rates of abnormal semen parameters recorded among patients infected with mycoplasma were for volume (22.2%-25%), viscosity (29.6%-43.5%), pH (64.7%-72.9%), motility (80.8%-93.8%), morphology (36.3%-47.9%), sperm concentration (53.3%-58.3%) and leukocyte count (51.4%-58.3%). Frequency of U. urealyticum infection was higher than that of M. hominis. Mycoplasma infections were associated with disorders of pH, motility and sperm concentration. In addition M. hominis infection affected spermatozoa morphology. Therefore, screening of U. urealyticum and M. hominis for routine semen analysis is clinically relevant in Abidjan.

Attitudes toward intimate partner violence against women in Moscow, Russia
(Abstract; subscription needed for full text; Asia)
Journal of Family Violence. 2008 Aug;23(6):447-456.
Stickley A | Kislitsyna O | Timofeeva I | Vagero D
This study examines attitudes towards violence against women among the populace in Moscow, Russia using data drawn from the Moscow Health Survey. Information was obtained from 1,190 subjects (510 men and 680 women) about their perceptions of whether violence against women was a serious problem in contemporary Russia, and under what circumstances they thought it was justifiable for a husband to hit his wife. Less than half the respondents thought violence was a serious problem, while for a small number of interviewees there were several scenarios where violence was regarded as being permissible against a wife. Being young, divorced or widowed, having financial difficulties, and regularly consuming alcohol were associated with attitudes more supportive of violence amongst men; having a low educational level underpinned supportive attitudes among both men and women. Results are discussed in terms of the public reemergence of patriarchal attitudes in Russia in the post-Soviet period.

HIV/AIDS and STIs RESEARCH

Determinants of Zambian men's extra-marital sex: A multi-level analysis
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Archives of Sexual Behavior. 2008 Aug;37(4):517-529.
Benefo KD
Research interest in extra-marital sex has increased as scholars have become aware of its role in sustaining epidemics of STDs in sub-Saharan Africa and elsewhere. While most research has used the socioeconomic and demographic features of individuals as determinants of extra-marital sexual behavior, this study examined the role played by community characteristics. Using data from the 2003 Zambian Sexual Behavior Survey for a sample of 1,118 men aged 15-59 and multilevel logistic regression techniques, the study analyzed the effects of community social and demographic characteristics on involvement in extra-marital sex while controlling for the men's individual level characteristics. Men's involvement in extra-marital sex was found to vary with the characteristics of communities. The chances of men's involvement in extra-marital sex increased with community-level ethnic heterogeneity and urbanization, decreased in commercial centers, and in communities with a demographic surplus of males, health workers active in AIDS prevention, and access to the mass media. These results show that scholars trying to understand the motivations for extra-marital sex must pay attention to the characteristics of both individuals and communities.

HIV infection returning to Mexico with migrant workers: An exploratory study
(Abstract; subscription needed for full text; North America)
Journal of the Association of Nurses in AIDS Care. 2008 Jul-Aug;19(4):267-282.
Sowell RL | Holtz CS | Velasquez G
Men migrating to the United States are at high risk of acquiring HIV and spreading it to their wives and children in Mexico. Yet there is limited understanding of this phenomenon from the perspective of these men and their wives. This exploratory study used face-to-face interviews to gain insight into factors influencing the increased risk of Mexican men migrating to the United States for contracting HIV as well as the consequences of their infections on returning to Mexico. Transcripts from audiotaped interviews provided the data for analysis. Thematic analysis revealed two overall categories and six interrelated themes. Categories were HIV Risk and Living with HIV. Study themes included social isolation, lack of knowledge/ denial, machismo, powerlessness, and making the best of it. Results provide new insight into the spread of HIV in rural Mexico.

New populations at high risk of HIV / STIs in low-income, urban coastal Peru
(Abstract; subscription needed for full text; South America)
AIDS and Behavior. 2008 Jul;12(4):544-551.
Caceres CF | Konda KA | Salazar X | Leon SR | Klausner JD
The HIV epidemic in Peru is concentrated primarily among men who have sex with men. HIV interventions have focused exclusively on a narrowly defined group of MSM and FSW to the exclusion of other populations potentially at increased risk. Interventions targeting MSM and FSW are insufficient and there is evidence that focusing prevention efforts solely on these populations may ignore others that do not fall directly into these categories. This paper describes non-traditional, vulnerable populations within low-income neighborhoods. These populations were identified through the use of ethnographic and epidemiologic formative research methods and the results are reported in this publication. Although the traditional vulnerable groups are still in need of prevention efforts, this study provides evidence of previously unrecognized populations at increased risk that should also receive attention from HIV/STI prevention programs.

Roles of clinical and subclinical reactivated herpes simplex virus type 2 infection and human immunodeficiency virus type 1 (HIV-1)-induced immunosuppression on genital and plasma HIV-1 levels
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Infectious Diseases. 2008 Jul;198(2):241-249.
Nagot N | Ouedraogo A | Konate I | Weiss HA | Foulongne V
Few longitudinal studies have described the interactions between reactivation of herpes simplex virus type 2 (HSV-2) infection (hereafter, 'HSV-2 reactivation') and genital and systemic replication of human immunodeficiency virus type 1 (HIV-1). Women in Burkina Faso who were seropositive for both HIV-1 and HSV-2 were enrolled in a randomized placebo-controlled trial of therapy to suppress reactivation of HSV-2 infection (hereafter, 'HSV suppressive therapy'). During the baseline phase, 6 enriched cervicovaginal lavage specimens were obtained over 12 weeks to detect and quantify the HIV-1 RNA and HSV-2 DNA loads. Women with genital ulcer disease (GUD) detected at least once were more likely than women in whom GUD was not detected (risk ratio [RR], 1.23;95%confidence interval [CI], 1.09-1.37) to have genital HIV-1 RNA detected during greater than or = 1 visit. Similarly, women with genital HSV-2 DNA detected during greater than or = 1 clinic visit were more likely than women in whom genital HSV-2 DNA was not detected (RR, 1.17; 95% CI, 1.01-1.34) to have genital HIV-1 RNA detected at least once. In addition, the mean genital HIV-1 RNA loads for women with GUD detected during greater than or = 1 visit and women with HSV-2 genital shedding detected during greater than or = 1 visit were greater than that for women in whom genital HSV-2 DNA or GUD was never detected. The plasma HIV-1 RNA load was increased among women for whom greater than or = 1 visit revealed GUD (+0.25 log10 copies/mL; 95% CI, -0.05-0.55) or genital HSV-2 DNA (+0.40 log10 copies/mL; 95% CI, 0.15-0.66), compared with women who did not experience GUD or HSV-2 genital shedding, respectively. The association of HSV-2 reactivations on HIV-1 replication tended to be stronger in patients with a higher CD4+ cell count (i.e., greater than 500 cells/_L). The contribution of HSV-2 to HIV-1 replication among women with CD4+ cell count of less than or = 500 cells/uL was reduced because almost all experienced HIV-1 genital shedding. Both clinical and subclinical HSV-2 reactivations play a role in increasing the rate of HIV-1 replication. HSV suppressive therapy is a promising tool for HIV control. Initiation of such therapy when the CD4+ cell count is greater than 500 cells/uL deserves further investigation.

Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries
(Research Article; Asia | South America | Sub-Saharan Africa)
Bulletin of the World Health Organization. 2008 Jul;86(7):559-567.
Brinkhof MW | Dabis F | Myer L | Bangsberg DR | Boulle A
The objective of the study was to analyse the early loss of patients to antiretroviral therapy (ART) programmes in resource-limited settings. Using data on 5491 adult patients starting ART (median age 35 years, 46% female) in 15 treatment programmes in Africa, Asia and South America with 12 months of follow-up, we investigated risk factors for no follow-up after treatment initiation, and loss to follow-up or death in the first 6 months. Overall, 211 patients (3.8%) had no follow-up, 880 (16.0%) were lost to follow-up and 141 (2.6%) were known to have died in the first 6 months. The probability of no follow-up was higher in 2003-2004 than in 2000 or earlier (odds ratio, OR: 5.06; 95% confidence interval, CI: 1.28-20.0), as was loss to follow-up (hazard ratio, HR: 7.62; 95% CI: 4.55-12.8) but not recorded death (HR: 1.02; 95% CI: 0.44-2.36). Compared with a baseline CD4-cell count greater than or = 50 cells/microl, a count less than 25 cells/microl was associated with a higher probability of no follow-up (OR: 2.49; 95% CI: 1.43-4.33), loss to follow-up (HR: 1.48; 95% CI: 1.23-1.77) and death (HR: 3.34; 95% CI: 2.10-5.30). Compared to free treatment, fee-for-service programmes were associated with a higher probability of no follow-up (OR: 3.71; 95% CI: 0.97-16.05) and higher mortality (HR: 4.64; 95% CI: 1.11-19.41). Early patient losses were increasingly common when programmes were scaled up and were associated with a fee for service and advanced immunodeficiency at baseline. Measures to maximize ART programme retention are required in resource-poor countries.

MATERNAL AND CHILD HEALTH RESEARCH

Gynaecological morbidity among HIV positive pregnant women in Cameroon
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Reproductive Health. 2008 Jul 3;5(3):[11] p.
Mbu ER | Kongnyuy EJ | Mbopi-Keou FX | Tonye RN | Nana PN
The objective of this study was to compare the prevalence of gynaecological conditions among HIV infected and non-infected pregnant women. Two thousand and eight (2008) pregnant women were screened for HIV, lower genital tract infections and lower genital tract neoplasia at booking antenatal visit. About 10% (198/2008) were HIV positive. All lower genital tract infections except candidiasis were more prevalent among HIV positive compared to HIV negative women: vaginal candidiasis (36.9% vs 35.4%; p = 0.678), Trichomoniasis (21.2% vs 10.6%; p less than 0.001), gonorrhoea (10.1% vs 2.5%; p less than 0.001), bacterial vaginosis (21.2% vs 15.2%; p = 0.026), syphilis (35.9% vs 10.6%; p less than 0.001), and Chlamydia trachomatis (38.4% vs 7.1%; p less than 0.001). Similarly, HIV positive women more likely to have preinvasive cervical lesions: low-grade squamous intraepithelial lesion (SIL) (18.2% vs 4.4%; p less than 0.001) and high-grade squamous intraepithelial lesion (12.1% vs 1.5%; p less than 0.001). We conclude that (i) sexually transmitted infections (STIs) are common in both HIV positive and HIV negative pregnant women in Cameroon, and (ii) STIs and preinvasive cervical lesions are more prevalent in HIV-infected pregnant women compared to their non-infected compatriots. We recommend routine screening and treatment of STIs during antenatal care in Cameroon and other countries with similar social profiles.

Maternal and birth attendant hand washing and neonatal mortality in southern Nepal
(Abstract; subscription needed for full text; Asia)
Archives of Pediatrics and Adolescent Medicine. 2008 Jul;162(7):603-608.
Rhee V | Mullany LC | Khatry SK | Katz J | LeClerq SC
More than 95% of neonatal deaths occur in developing countries, approximately 50% at home. Few data are available on the impact of hand-washing practices by birth attendants or caretakers on neonatal mortality. The objective of this study was to evaluate the relationship between birth attendant and maternal hand-washing practices and neonatal mortality in rural Nepal. An observational prospective cohort study was conducted in Sarlahi District in rural southern Nepal. Newborn infants were originally enrolled in a community-based trial assessing the effect of skin and/or umbilical cord cleansing with chlorhexidine on neonatal mortality in southern Nepal. A total of 23 662 newborns were enrolled and observed through 28 days of life. Questionnaires were administered to mothers on days 1 and 14 after delivery to identify care practices and risk factors for mortality and infection. Three hand-washing categories were defined: (1) birth attendant hand washing with soap and water before assisting with delivery, (2) maternal hand washing with soap and water or antiseptic before handling the baby, and (3) combined birth attendant and maternal hand washing. Mortality within the neonatal period was measured. Birth attendant hand washing was related to a statistically significant lower mortality rate among neonates (adjusted relative risk [RR]=0.81; 95% confidence interval [CI], 0.66-0.99), as was maternal hand washing (adjusted RR=0.56; 95% CI, 0.38-0.82). There was a 41% lower mortality rate among neonates exposed to both hand-washing practices (adjusted RR=0.59; 95% CI, 0.37-0.94). Birth attendant and maternal hand washing with soap and water were associated with significantly lower rates of neonatal mortality. Measures to improve or promote birth attendant and maternal hand washing could improve neonatal survival rates.

Perceptions of mothers and hospital staff of paediatric care in 13 public hospitals in northern Tanzania
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 Aug;102(8):805-810.
Mwangi R | Chandler C | Nasuwa F | Mbakilwa H | Poulsen A
User and provider perceptions of quality of care are likely to affect both use and provision of services. However, little is known about how health workers and mothers perceive the delivery of care in hospital paediatric wards in Africa. Paediatric staff and mothers of paediatric inpatients were interviewed to explore their opinions and experience of the admission process and conditions on the ward. Overcrowding, unsanitary conditions and lack of food were major concerns for mothers on the ward, who were deterred from seeking treatment earlier due to fears that hospital admission posed a significant risk of exposure to infection. While most staff were seen as being sympathetic and supportive to mothers, a minority were reported to be judgmental and authoritarian. Health workers identified lack of trained staff, overwork and low pay as major concerns. Staff shortages, lack of effective training and equipment are established problems but our findings also highlight a need for wards to become more parent-friendly, particularly with regard to food, hygiene and space. Training programmes focused on professional conduct and awareness of the problems that mothers face in seeking and receiving care may result in a more supportive and cooperative attitude between staff and mothers.

Risk factors for sudden infant death syndrome in a developing country
(Abstract; subscription needed for full text; South America)
Revista de Saude Publica. 2008 Jun;42(3):396-401.
Pinho AP | Aerts D | Nunes ML
The objective of this study was to analyze whether previously identified risk factors for sudden death syndrome have a significant impact in a developing country. A retrospective longitudinal case-control study was carried out in Porto Alegre, Southern Brazil. Cases (N=39) were infants born between 1996 and 2000 who died suddenly and unexpectedly at home during sleep and were diagnosed with sudden death syndrome. Controls (N=117) were infants matched by age and sex who died in hospitals due to other conditions. Data were collected from postmortem examination records and questionnaires answers. A conditional logistic model was used to identify factors associated with the outcome. Mean age at death of cases was 3.2 months. The frequencies of infants regarding gestational age, breastfeeding and regular medical visits were similar in both groups. Sleeping position for most cases and controls was the lateral one. Supine sleeping position was found for few infants in both groups. Maternal variables, age below 20 years (OR=2, 95% CI: 1.1; 5.1) and smoking of more than 10 cigarettes per day during pregnancy (OR=3, 95% CI: 1.3; 6.4), significantly increased the risk for the syndrome. Socioeconomic characteristics were similar in both groups and did not affect risk. Infant-maternal and socioeconomic profiles of cases in a developing country closely resembled the profile described in the literature, and risk factors were similar as well. However, individual characteristics were identified as risks in the population studied, such as smoking during pregnancy and maternal age below 20 years.

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Lithuania: Fertility decline and its determinants
(Abstract; subscription needed for full text; Europe)
Demographic Research. 2008 Jul 1;19(20):705-742.
Stankuniene V | Jasilioniene A
Since the beginning of the 1990s, Lithuania has been undergoing significant transformations in family life and has experienced a precipitous decline in fertility. The determinants of the changes are diverse in character and are associated with socioeconomic transformations, economic difficulties faced by the post-Soviet society, inadequate social and family policies and changing value orientations and life styles. This article traces the fertility trends in Lithuania from the period and cohort perspective, providing adjusted TFR estimates that reveal the significance of the tempo effect on the recent decline in fertility. Furthermore, the main factors leading to the recently observed changes in family and fertility are identified and analysed. Finally, the characteristic features and necessary improvements of current Lithuanian family policy and its possible effects on individual behaviour and fertility trends are discussed.

Slovakia: Fertility between tradition and modernity
(Abstract; subscription needed for full text; Europe)
Demographic Research. 2008 Jul 1;19(25):973-1018.
Potancokova M | Vano B | Pilinska V | Jurcova D
In the last 60 years, Slovakia has experienced comparatively high and most recently very low fertility, long periods of stable fertility alternating with periods of changes, periods of substantial as well as lesser state interventions. Fertility was above replacement in 1990 and declined to the lowest-low levels during the period of transformation. Postponement of life course transitions -leaving the parental home, marrying and becoming a parent -became widespread among younger cohorts after 1990. High unemployment of young adults, increasing economy-driven migration and problems to gain a stable job contribute to this phenomenon. Reproductive behavior is changing, yet Slovak society remains culturally conservative. The dominant form of partnership is marriage, although extra-marital childbearing is rising. Cohabitation is spreading mainly as a prelude to marriage but is not widely approved. Population measures have a long tradition, although 15 years after regime change their nature is very different than that of the state socialist era. Considerable attention was and is being paid to population problems, however, the government has not designed and implemented a comprehensive system of family and population policies.

Slovenia: Generous family policy without evidence of any fertility impact
(Abstract; subscription needed for full text; Europe)
Demographic Research. 2008 Jul 1;19(26):1019-1058.
Stropnik N | Sircelj M
Slovenia was not a typical socialist country; the transformation that had started at the end of the 1980s did not cause such great turbulences as in other countries in transition. However, unfavorable consequences did accompany the transition, particularly for some segments of the population. Fertility trends in Slovenia, as seen in the total fertility rate, have not surpassed the replacement level since the end of the 1970s. The lowest level of 1.21 was reached during the 1999-2003 period. Since then, the total fertility rate has been increasing slightly. Postponement in childbearing began with cohorts born after 1960. In today's Slovenian society, on average young women achieve higher education than men, and they perceive (potential) motherhood as a drawback in the labor market. Almost all parents in Slovenia are employed full-time, even those with small children. Nevertheless, the traditional gender-division of roles persists in the family. Extended education, relatively high unemployment among the young, and a shortage of adequate housing prolong the stay in the parental home. Together with insecure employment, a responsible parenthood norm, and the perceived high costs of children, this results in childbearing postponement and a lower final number of children. Slovenia has a relatively well-developed family policy, particularly on parental leave and pre-school childcare. Notwithstanding, almost no impact of family policy on fertility has ever been observed.

Opinions on early-age marriage and marriage customs among Kurdish-speaking women in southeast Turkey
(Abstract; subscription needed for full text; Europe)
Journal of Family Planning and Reproductive Health Care. 2008 Jul;34(3):147-152.
Ertem M | Kocturk T
For women, marriage before the age of 18 years has adverse consequences for physical, mental and emotional well-being and constitutes a barrier for continued education. According to a national survey, about 50% of all women in Eastern Turkey were aged under 18 years at first marriage. This study explored women's opinions and experiences of early marriage and culture-specific marriage customs in the province of Diyarbakir, a region of Turkey populated mostly by people of Kurdish ethnicity. A random sample of 966 women aged 15 years or older living in urban and rural areas of the province completed a questionnaire on age at marriage and social status. Qualitative data on women's opinions and experiences were also collected through focus group interviews with 90 women. The frequency of early marriage ranged from 19% in the youngest age group to 63% in women aged 60 years or older. Analysis of focus group interviews through a qualitative modified content method showed that girls were considered marriageable some years after the menarche and considerations regarding the protection of family honour were key factors leading parents to arrange the early marriage of their daughters, sometimes without their consent. Some culture-specific marriage customs included cradle betrothal, cousin marriage and berdel (exchange of brides between two families). There is a need for public health and family planning workers to create greater awareness of the adverse consequences of early marriage through parental arrangements.

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