Volume 8, Number 30
28 July 2008

The XVII International AIDS Conference, will take place August 3-8, 2008 in Mexico City, Mexico. The conference brings together scientists, researchers, clinicians and people living with or affected by HIV/AIDS to discover the latests research and programming and share best practices. The theme of this years conference is Universal Action Now, and emphasizes the need for all stakeholders to respond to the HIV/epidemic. INFO staff member, Seth Rosenblatt, will be attending the conference to promote the Resources for HIV/AIDS and Sexual and Reproductive Health Web site at www.hivandsrh.org. He will also be blogging about the sessions he attends and posting daily updates on the INFO Blog at www.infoforhealth.org/blog/.

ADOLESCENT HEALTH RESEARCH

Current issues in adolescent immunization
(Abstract; subscription needed for full text; Global)
Vaccine. 2008 Aug;26(33):4120-4134.
Brabin L | Greenberg DP | Hessel L | Hyer R | Ivanoff B
Based on the December 2006 Fondation Merieux International Scientific Symposium, the current state of adolescent immunization is reviewed with a focus on the policy and programmatic issues that impact the acceptability, initiation, and successful implementation. Key questions are identified with proposed strategies to help achieve successful adolescent immunization programs. The role of current vaccines targeted to adolescents, such as those directed against invasive meningitis, pertussis, and the human papillomavirus, is reviewed as well as their role in rejuvenating interest in adolescent immunization, and more importantly, adolescent health as a whole.

Pregnancy and lactation hinder growth and nutritional status of adolescent girls in rural Bangladesh
(Abstract; subscription needed for full text; Asia)
Journal of Nutrition. 2008 Aug;138(8):1505-1511.
Rah JH | Christian P | Shamim AA | Arju UT | Labrique AB
Adolescent pregnancy is associated with adverse birth outcomes. Less is known about its influence on maternal growth and nutritional status. We determined how pregnancy and lactation during adolescence affects postmenarcheal linear and ponderal growth and body composition of 12-19 y olds in rural Bangladesh. In a prospective cohort study, anthropometric measurements were taken among primigravidae (n = 229) in the early first trimester of pregnancy and at 6 mo postpartum. Randomly selected never-pregnant adolescents (n = 458) of the same age and time since menarche were measured within 1wk of these assessments. Annual changes in anthropometric measurements were compared between the 2 groups adjusting for confounders using mixed effects regression models. The mean + or - SD age and age at menarche of adolescents were 16.3 + or - 1.6 y and 12.7 + or - 1.2 y, respectively. Unlike pregnant girls who did not grow in height (-0.09 + or - 0.08 cm/y), never-pregnant girls increased in stature by 0.35 + or - 0.05 cm/y. The adjusted mean difference between the 2 groups was 0.43 + or - 0.1cm (P less than 0.001). Similarly, whereas never-pregnant girls gained BMI, mid-upper arm circumference, and percent body fat, pregnant girls declined in every measurement by 6 mo postpartum, resulting in adjusted mean + or - SD differences in annual changes of 0.62 + or - 0.11 kg/m2, 0.89 + or - 0.12 cm, and 1.54 + or - 0.25%, respectively (all P less than 0.001). Differences in changes in all anthropometric measurements except height were greater among adolescents whose first pregnancy occurred less than 24 mo vs. greater than or = 24 mo since menarche (BMI, -1.40 + or - 0.18 vs. -0.60 + or - 0.11 kg/m2; all interaction terms, P less than 0.05). Pregnancy and lactation during adolescence ceased linear growth and resulted in weight loss and depletion of fat and lean body mass of young girls.

A guide for conducting research on the formulation of sexual and health-related behaviour among young men: Training guidelines, resources, study guides, and informed consent forms
(Programming Guide; Asia)
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[Washington, D.C.], CATALYST Consortium, 2005 Sep. [350] p. (USAID Cooperative Agreement No. HRN-A-00-00-00003-)
Khan S | Khan SI | Hollerbach PE
This guide provides all of the resources and information necessary to replicate the study conducted in 2002 in the thana of Demra in Dhaka, Bangladesh entitled In Their Own Words: The Formulation of Sexual and Health-related Behaviour Among Young Men in Bangladesh. The study was a collaboration between Naz Foundation International, Bandhu Social Welfare Society, and the CATALYST Consortium. The principal lens in which the study approached the subject was through "social and sexual scripting." Examining reproductive health behaviours from the perspective of social and sexual scripts allows the researcher to organise and link together what people think, what they do, and how they are affected by the sociocultural context in which they live. Learning and applying a sexual script is part of growing up in any culture and society. Social and sexual scripts are rarely the outcome of a systematic and conscious learning process, but rather an accumulation of responses to the multiplicity of cues operating within one's culture and society. The study generated qualitative formative and contextual data to better understand the scripts through which normative sexual attitudes and sexual and health-related behaviour among young men aged 10-24 are influenced and formulated from early adolescence on. In particular, the study examined closely the influential roles that socialising agents play in constructing norms regarding sexual behaviour, young males' masculine and sexual images regarding themselves and others, and their actual sexual and health-related behaviour, health beliefs, attitudes, and behaviour. The study also sought to understand the impact of educational level and length of residence in Dhaka on the construction of masculinities and sexualities among adolescent males. However, these intervening variables had no discernible impact on the attitudes, behaviours, and beliefs of the different age cohorts.

FAMILY PLANNING RESEARCH

A comparative analysis of unmet need in Nepal: Further analysis of the 2006 Nepal Demographic and Health Survey
(Report; Asia)
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Calverton, Maryland, Macro International, MEASURE DHS, 2008 May. 18 p. (USAID Contract No. GPO-C-00-03-00002-00)
Aryal RH | Pathak RS | Dottel BR | Pant PD
This paper examines the levels, trends, and differentials in the unmet need for family planning in Nepal and explores factors that contributed to its decline over the ten-year period from 1996 to 2006. The data for this study come from the three population-based demographic and health surveys conducted in Nepal in 1996, 2001, and 2006. Selected socioeconomic and demographic characteristics of currently married women age 15-49 are used to explore the determinants of the unmet need for family planning. The same groups of variables are then used to examine the factors associated with reducing the levels of unmet need in Nepal. A detailed description of the sampling methodology, number of respondents in each survey, and information gathered are presented in the final reports for each survey.

Knowledge attitude to modern family planning methods in Abraka communities, Delta State, Nigeria
(Research Article; Sub-Saharan Africa)
East African Journal of Public Health. 2008 Apr;5(1):10-12.
Aninyei IR | Onyesom I | Ukuhor HO | Uzuegbu UE | Ofili MI
The objective of this study was to assess the level of regard and misconceptions of modern family planning methods in Abraka communities. The interviewer's administered questionnaire method was used to gather the required information from 657 respondents randomly chosen from PO, Ajalomi, Erho, Oria, Otorho, Umeghe, Urhuoka and Uruagbesa communities in Abraka kingdom. Results show that 75.3% of those interviewed were aware of modern family planning but only 42.9% were using it to plan their families. Those using condom, safe periods and withdrawal constitute 32.6% of the 42.9% figure. Thus, data indicate a fairly high degree of awareness but little regard for family planning. Campaigns should be organized in order to educate Abraka communities on the benefits and need for family planning. Government should provide quality, comprehensive and subsidized family planning services. In addition, research efforts should be intensified on how to take advantage of the traditional methods of family planning to systematically introduce the modern method, so as to gradually eliminate the associated bias and misconceptions associated with modern methods of family planning.

Social and logistical barriers to the use of reversible contraception among women in a rural Indian village
(Research Article; Asia)
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Journal of Health, Population and Nutrition. 2008 Jun;26(2):241-250.
Hall MA | Stephenson RB | Juvekar S
Women in a small coastal village in western India were asked to explain their preference for female sterilization over modern reversible contraceptive methods. Married women aged 19+ years were interviewed in six focus groups (n=60) and individually (n=15) regarding contraceptive methods and their use and side-effects. Women publicly denied contraceptive use but privately acknowledged limited use. They obtained contraceptive information from other village women and believed that modern reversible methods and vasectomy have high physical and social risks, and fertility goals could be achieved without their use. Women felt that reversible contraception is undesirable, socially unacceptable, and usually unnecessary, although the achievement of fertility goals is likely due to the use of female sterilization with abortion as a back-up method. Economic migration of village men may also play a role. Although women with high social capital can effectively disseminate correct knowledge, the impact on the uptake of reversible method is uncertain.

GENDER and HEALTH RESEARCH

Effects of communication campaigns on the health behavior of women of reproductive age in Nepal: Further analysis of the 2006 Nepal Demographic and Health Survey
(Report; Asia)
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Calverton, Maryland, Macro International, MEASURE DHS, 2008 May. 24 p. (USAID Contract No. GPO-C-00-03-00002-00)
Karki YB | Agrawal G
The aim of the study is to examine whether observed differences in the levels of modern contraceptive use and the intention to use a method among women in Nepal after the implementation of health communication programs signified a positive relationship between exposure to family planning messages and improved perceptions and use. Multivariate regression analyses are employed to help elucidate the relationship between intensity of exposure to BCC messages and family planning attitudes and practices, controlled for the effects of a number of background characteristics including age, parity, education, ethnicity, economic well-being, and residence. The analyses take into consideration the intensity of exposure both in terms of the dose effects of multichannel interventions and of the influences of particular combinations of media messages.

Sex-trafficking, violence, negotiating skill, and HIV infection in brothel-based sex workers of eastern India, adjoining Nepal, Bhutan, and Bangladesh
(Research Article; Asia)
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Journal of Health, Population and Nutrition. 2008 Jun;26(2):223-231.
Sarkar K | Bal B | Mukherjee R | Chakraborty S | Saha S
A community-based cross-sectional study was conducted among brothel-based sex workers of West Bengal, eastern India, to understand sex-trafficking, violence, negotiating skills, and HIV infection in them. In total, 580 sex workers from brothels of four districts participated in the study. A pretested questionnaire was introduced to study their sociodemography, sex-trafficking, violence, and negotiating skills. Blood sample of 4-5 mL was collected from each sex worker using an unlinked anonymous method to study their HIV status. Data were edited and entered into a computer using the Epi Info software (6.04d version). Both univariate and multivariate analyses were done to find out any association between HIV and relevant risk factors. Results of the study revealed that a sizeable number of the participants were from Nepal (9%) and Bangladesh (7%). The seroprevalence of HIV was strikingly higher among Nepalese (43%) than among Bangladeshis (7%) and Indians (9%). Almost one in every four sex workers (24%) had joined the profession by being trafficked. Violence at the beginning of this profession was more among the trafficked victims, including those sold by their family members (57%) compared to those who joined the profession voluntarily (15%). The overall condom negotiation rate with most recent two clients was 38%. By multivariate analysis, HIV was significantly associated with sexual violence (odds ratio=2.3; 95% confidence interval 1.2-4.5). The study has documented that the trafficked victims faced violence, including sexual violence, to a greater magnitude, and sexual violence was associated with acquiring HIV in them. There is a need for an in-depth study to understand the problem of trafficking and its consequences.

Predictors of attitudes toward intimate partner violence: A comparative study of men in Zambia and Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Interpersonal Violence. 2008 Aug;23(8):1056-1074.
Lawoko S
Attitudes toward intimate partner violence (IPV) were compared between Zambian and Kenyan men on sociodemographic, attitudinal, and structural predictors of such attitudes. Data were retrieved from the latest Demographic and Health Surveys in each country. The results showed that many men in Zambia (71%) and Kenya (68%) justified IPV to punish a woman for transgression from normative domestic roles. In priority order, sociodemographic, autonomy, and access-to-information indicators predicted attitudes toward IPV in both countries. Whereas in Kenya, education reduced the likelihood of justifying IPV, the reverse was observed in Zambia. Access to information reduced the likelihood of justifying IPV among men in Zambia but not in Kenya. Men's positive attitudes toward women's autonomy reduced the likelihood of justifying IPV in Kenya but not in Zambia. Differences in specific predictors between the countries demonstrate the significance of capitalizing on need-adapted interventions tailored to fit conditions in each country.

HIV/AIDS and STIs RESEARCH

Role of governmental and non-governmental organizations in mitigation of stigma and discrimination among HIV / AIDS persons in Kibera, Kenya
(Research Article; Sub-Saharan Africa)
East African Journal of Public Health. 2008 Apr;5(1):1-5.
Odindo MA | Mwanthi MA
This study assessed the role of governmental and non-governmental organizations in mitigation of stigma and discrimination among people infected and affected by HIV/AIDS in informal settlements of Kibera. This was a descriptive cross-sectional study and used a multi stage stratified sampling method. The study was conducted in Kibera, an informal settlement with a population of over one million people which makes it the largest slum not only in Kenya but in sub-Saharan Africa. The study targeted infected individuals, non-infected community members, managers of the organizations implementing HIV/AIDS programmes and service providers. In the process 1331 households were interviewed using qualitative and quantitative data collection instruments. Statistical Package for Social Sciences (SPSS) and Nudist 4 packages were used to analyze the quantitative and qualitative data respectively. More than 61% of the respondents had patients in their households. Fifty five percent (55%) of the households received assistance from governmental and non-governmental organizations in taking care of the sick. Services provided included awareness, outreach, counseling, testing, treatment, advocacy, home based care, assistance to the orphans and legal issues. About 90% of the respondents perceived health education, counseling services and formation of post counseling support groups to combat stigma and discrimination to be helpful. Stigma and discrimination affects the rights of People Living with HIV/AIDS (PLWHAs). Such stigmatization and discrimination goes beyond and affects those who care for the PLWHAs, and remains the biggest impediment in the fight against HIV/AIDS in Kibera. Governmental and non-governmental organizations continue to provide key services in the mitigation of stigma and discrimination in Kibera. However, personal testimonies by PLWHAs showed that HIV positive persons still suffer from stigma and discrimination. Approximately 43% of the study population experienced stigma and discrimination.

World disasters report 2008: Focus on HIV and AIDS
(Report; Global)
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Geneva, Switzerland, International Federation of Red Cross and Red Crescent Societies, 2008. 248 p.
Knight L | Adams S | Fink S | Hoover J | Patterson D
HIV and AIDS confront the world with many challenges. Humanitarian organizations have worked hard to meet them and to make up for a lack of action in the first years of the epidemic. But far, far more needs to be done, in partnership with governments but also, above all, with communities whose wisdom and resilience offer so much to the HIV response. That is why we have selected HIV as the theme for this year's World Disasters Report. National Red Cross and Red Crescent Societies around the world have come together in a Global Alliance on HIV with the resolve to do much more and much better in our collective endeavour against this epidemic. This commitment to scale-up is linked to specific and measurable targets to double, by 2010, the magnitude of our HIV programming in prevention, treatment, care and support, and in tackling stigma and discrimination.

When to start antiretroviral therapy: A swinging pendulum?
(Research Article; Global)
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Topics in HIV Medicine. 2008 Jun-Jul;16(2):82-88.
Gallant JE
Although early initiation of antiretroviral treatment has long been associated with some benefit over later initiation, the magnitude of the benefit is becoming better defined with longer follow-up of large numbers of patients in cohort studies. These benefits have become more evident in part because of improvements in efficacy, tolerability, and convenience of antiretroviral treatment regimens. The benefits also reflect growing recognition of the effect of such treatment in reducing risk of both HIV-related and non- HIV-related complications that are not associated with low CD4+ cell count. On balance, currently available information supports using a CD4+ count of 350 cells/microL as a general threshold for initiating treatment, with immediate treatment warranted for selected patients, including those with conditions for which antiretroviral therapy is the best or only treatment. This article summarizes a presentation on when to initiate antiretroviral therapy made by Joel E. Gallant, MD, MPH, at an International AIDS Society-USA Continuing Medical Education course in New York in October 2007.

MATERNAL AND CHILD HEALTH RESEARCH

The effect of maternal anthropometric characteristics and social factors on gestational age and birth weight in Sudanese newborn infants
(Research Article; North Africa)
BMC Public Health. 2008;8(244):[24] p.
Elshibly EM | Schmalisch G
In Africa low birth weight (LBW) ( less than 2500g), is the strongest determinant of infant morbidity and mortality. The aim of this study was to quantify the effect of maternal anthropometry, education and socio-economic status on gestational age and birth weight. In 1000 Sudanese mothers with singleton births, anthropometric measurements (weight, height, mid-arm circumference) and newborn birth weight were taken within 24 hours of delivery. Furthermore, maternal education and socio-economic status were recorded. The effect of these maternal variables on gestational age and birth weight was investigated by receiver operating characteristic (ROC) curves and by multivariate logistic regression analysis. Although maternal height was significantly correlated (p=0.002) with gestational age, we did not find maternal characteristics of value in determining the risk for preterm birth. Birth order was the strongest determinant of birth weight compared to other maternal characteristics. The LBW rate of first born babies of 12.2% was nearly twice that of infants of multiparous mothers. Maternal age and all maternal anthropometric measurements were positively correlated (p less than 0.001) with birth weight. A maternal height of less than 156 cm, a maternal weight of less than 66kg, a maternal mid arm circumference of less than 27cm and years of education of less than or = 8 years were found to increase the relative risk of LBW but this was statistically significant only in the case of maternal height. Maternal age and BMI had no statistically significant effect on determining the risk for LBW. The social class did not affect the birth weight, while the number of years of education was positively correlated with birth weight (p=0.01). The LBW rate decreased from 9.2 % for less than or = 8 years of education to 6.0 % for greater than 12 years of education. Birth order and maternal height were found to be the most important maternal parameters which influences birth weight and the risk for LBW. The duration of maternal education and not social class was found to significantly affect the risk for LBW.

Dar es Salaam perinatal care study: Needs assessment for quality of care
(Research Article; Sub-Saharan Africa)
East African Journal of Public Health. 2008 Apr;5(1):17-21.
Nyamtema AS | Urassa DP | Massawe S | Massawe A | Mtasiwa D
Poor obstetric care in low income countries has been attributed to a wide range of factors. We conducted a perinatal care needs assessment in Dar es Salaam health institutions to assess the factors underlying the present poor perinatal outcome. A cross sectional study was conducted in 2005 in all four public hospitals and all five public health centres purposively selected, and in six dispensaries selected using simple random sampling method. WHO Safe Motherhood needs assessment instruments were used to assess structural, systemic and process needs for quality perinatal care. Health care providers, administrators and clients were interviewed about perinatal care services in their respective health institutions. The majority (72%) of all deliveries in Dar es Salaam took place in the four available public hospitals. The potential coverage of comprehensive and basic emergency obstetric care (EmOC) services were 360% and 350% of the United Nations minimum recommended health institution categories per 500,000 population respectively. The coverage for health centres and dispensaries based on Tanzanian standards were 20% and 24% respectively. Two of the hospitals did not provide theatre and blood transfusion services for 24 hours per day. Two public health centres did not provide delivery services at all and 83% of the dispensaries had poorly established obstetric services. There was only one public neonatal unit that served as a referral institution for all sick newborns delivered in public health institutions in the region. This paper reveals the state of inadequate infrastructure, equipments and supplies for perinatal care in Dar es Salaam public health institutions. A major investment is needed to establish new public infrastructure for maternal and neonatal care, upgrade and optimize use of the existing ones, and improve supply of essential material resources in order to achieve the Millennium Development Goals set for maternal and child survivals by 2015.

Training in complementary feeding counselling of healthcare workers and its influence on maternal behaviours and child growth: A cluster-randomized controlled trial in Lahore, Pakistan
(Research Article; Asia)
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Journal of Health, Population and Nutrition. 2008 Jun;26(2):210-222.
Zaman S | Ashraf RN | Martines J
Malnutrition is common among children aged 6-24 months in developing countries. It increases the risk of mortality. Interventions to improve infant-feeding hold the promise of reducing malnutrition among these children. A study in Brazil has shown the success of training in communication and counselling skills among health workers in improving the nutritional status of young children. Questions were raised whether the method used in the study in Brazil would also be effective when applied in other countries. The aim of the present study was to reduce growth faltering in young children through proper nutrition-promotion techniques. The objective of the study was to determine the efficacy of training health workers in nutrition counselling in enhancing their communication skills and performance, improving feeding practices, and reducing growth faltering in children aged 6-24 months. A cluster-randomized controlled trial was carried out. The method used in this study was a replica of the method in a similar study in Pelotas, Brazil. Forty health centres were paired, and one centre of each pair was randomly allocated to the intervention group, and the other to the control group. The Integrated Management of Childhood Illness (IMCI) module-'Counsel the mother'-was used for training health workers in the health centres in the intervention group. Data from 36 paired health centres and 375 mothers and their children aged 6-24 months recruited from these health centres following consultation with health workers were included in analysis. Independent observers, masked to the intervention status, examined the performance of health workers within the first month after training. Mother-child pairs were visited at home within two weeks, 45 days, and 180 days after recruitment. Information was recorded on the feeding practices, recall of the recommendations of health workers, and sociodemographic variables at these home-visits. Weight and length of the child were measured at each contact. The communication skills and consultation performance of health workers were significantly better in the intervention group than in the control group. The mothers' recall of the recommendation of health workers and reported infant-feeding practices were also significantly better in the intervention group than in the control group, even 180 days after the recruitment consultation. Growth faltering was less in the intervention group, with the largest effect observed among children in the age-group of 12 + months. These results indicate that training in IMCI feeding counselling can enhance the communication skills and performance of health workers. Improved feeding practices of counselled mothers can, in turn, reduce growth faltering in their children.

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Factors responsible for the rapid decline of fertility in Nepal -- an interpretation. Further analysis of the 2006 Nepal Demographic and Health Survey
(Report; Asia)
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Calverton, Maryland, Macro International, MEASURE DHS, 2008 May. [30] p. (USAID Contract No. GPO-C-00-03-00002-00)
Karki YB | Krishna R
The total fertility rate (TFR) in Nepal in mid-1976 was estimated at 6.3 births per woman, contraceptive use among currently married women was low (3 percent) and the proportion married was high. Given these demographic parameters, no immediate change in the fertility rate in Nepal seemed plausible. In recent years however, several researchers have noted that a fertility transition has been underway in Nepal. Many factors-socioeconomic and biological-may have contributed to this precipitous decline in fertility. However, actual levels and rates of change in fertility are less certain because they also depend on the quality of data and the accuracy of measurements used. Ideally, it would have been better to re-examine the levels and trends of fertility from the survey data with earlier surveys. Instead, the focus of this paper is on examining the possible factors underlying the recent unprecedented declines in fertility. The principal measure of fertility in this part of the analysis is the total fertility rate (TFR). The paper is organized into three main parts. The first part deals with fertility levels, trends and differentials. The second part discusses the role of intermediate or proximate factors and the final part deals with the contextual or antecedent factors affecting these intermediate factors. Survey data are used to analyze the proximate determinants of fertility decline. The results of the analysis provide quantitative estimates of the contribution of changes in contraceptive use, marriage, breastfeeding and postpartum insusceptibility to the observed decline.

Pakistan Demographic and Health Survey 2006-07
(Report; Asia)
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Islamabad, Pakistan, National Institute of Population Studies, 2008 Jun. [400] p.
The 2006-07 Pakistan Demographic and Health Survey is the fifth in a series of demographic surveys conducted by the National Institute of Population Studies since 1990. However, the PDHS 2006-07 is the second survey conducted as part of the worldwide Demographic and Health Surveys programme. The survey was conducted under the aegis of the Ministry of Population Welfare and implemented by the National Institute of Population Studies. The 2006-07 PDHS supplements and complements the information collected through the censuses and demographic surveys conducted by the Federal Bureau of Statistics. It updates the available information on population and health issues, and provides guidance in planning, implementing, monitoring and evaluating health and population programmes in Pakistan. The results of the survey assist in the monitoring of the progress made towards meeting the Millennium Development Goals (MDGs). The 2006-07 PDHS includes topics related to fertility levels and determinants, family planning, fertility preferences, infant, child and maternal mortality and their causes, maternal and child health, immunization and nutritional status of mothers and children, knowledge of HIV/AIDS, and malaria. The 2006-07 PDHS also includes direct estimation of maternal mortality and its causes at the national level for the first time in Pakistan. The survey provides all other estimates for national, provincial and urban-rural domains. This being the fifth survey of its kind, there is considerable trend information on reproductive health, fertility and family planning over the past one and a half decades. The primary purpose of the 2006-07 PDHS is to furnish policymakers and planners with detailed information on fertility, family planning, infant, child and adult mortality, maternal and child health, nutrition, and knowledge of HIV/AIDS and other sexually transmitted infections.

Spousal agreement on reproductive preferences in sub-Saharan Africa
(Report; Sub-Saharan Africa)
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Calverton, Maryland, Macro International, MEASURE DHS, 2008 May. 44 p. (DHS Analytical Studies No. 10)
Gebreselassie T
This study investigates spousal agreement on reproductive preferences (fertility preferences and ideal number of children) in sub-Saharan Africa. The analysis uses matched couples' data from 14 Demographic and Health Surveys (DHS) carried out between 1999 and 2004. Additionally, pooled data from the 14 countries are used to explore the aggregate effect of different levels of polygyny (high and low) on spousal agreement on reproductive preferences. Agreement between partners/spouses to have another child ranges from 36 percent in Namibia to 90 percent in Chad. The multivariate analysis indicates that in many countries agreement on having another child is less likely if the woman has some formal education. Additionally, in most countries, the results show that wife's age and the number of living children are consistent predictors of spousal agreement on having another child. Economic status has an important role in 7 of the 14 countries; couples living in wealthier households are less likely to agree to have another child than those in poorer households. Agreement between partners/spouses on the ideal number of children ranges from 13 percent in Chad to 32 percent in Kenya. Overall, a larger proportion of husbands than wives consider a higher number of children to be the ideal. However, the multivariate analysis indicates that, in most countries, the odds of spousal agreement on the ideal number of children are increased if the wife has formal education. The study also looks at the aggregate effect of high and low levels of polygyny on spousal agreement on fertility preferences and ideal number of children. The findings from the multivariate analysis indicates that, regardless of level of polygyny, the most important factors influencing the likelihood that both partners want another child are wife's education, wife's age, number of living children, and household wealth status. However, in countries with high levels of polygyny, type of marriage, difference in spouses' education, and infecundity can have a significant negative impact on agreement to have another child. In all 14 countries, wife's education has a positive impact on spousal agreement on the ideal number of children, regardless of level of polygyny. However, if the husband's level of education exceeds that of his wife, the wife is working for cash, or the household is not poor, the likelihood of spousal agreement on ideal number of children is greater only in the high polygyny group.

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Volume 8, Number 3028 July 2008