Volume 8, Number 31
4 August 2008

The XVII International AIDS Conference, is taking 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 latest research and programming and share best practices. The theme of this year's conference is Universal Action Now, and emphasizes the need for all stakeholders to respond to the epidemic. INFO staff member Seth Rosenblatt is attending the conference to promote the Resources for HIV/AIDS and Sexual and Reproductive Health Web site at www.hivandsrh.org. He is also blogging about the sessions he attends and posting daily updates on the INFO Blog at www.infoforhealth.org/blog/. Check out his posting about the opening ceremony today.

ADOLESCENT HEALTH RESEARCH

Exploring opportunities to project a "responsible man" image: Gatekeepers' views of young men's sexual and reproductive health needs in Uttaranchal, India
(Abstract; subscription needed for full text; Asia)
International Quarterly of Community Health Education. 2008;28(1):13-31.
Khan ME | Mishra A | Morankar S
Increase in extramarital sex among youths, gender-based violence, lack of contraceptive knowledge among newly married couples and lack of knowledge of protection against diseases like STIs/HIV are the information and service needs of young people that need to be addressed urgently in order to make them future knowledgeable, responsible, and non-violent partners. In addressing these needs the gatekeepers, including parents, formal and informal community leaders and teachers, play a critical role, by facilitating/ hindering access to appropriate and correct information about sexual and reproductive health to young people. The study was conducted in a district of Uttaranchal, India. The specific objective was to understand the social context and gatekeepers' views on family planning and sexual and reproductive health needs of young men. Thirty-two in-depth interviews and four focus group discussions were conducted with parents, formal and informal community leaders, teachers, and selected development officials. The findings indicate that gatekeepers are worried about rapid changes in the aspiration, expectation, and behavior of young men. Most of them were seriously concerned about the increasing drinking habit, use of drugs, and changing values of sexuality leading to various risk behaviors among young men. They felt that many of these changes are consequences of wider societal changes, rising aspirations, explosion of electronic media, and globalization of a new youth culture where extramarital sex, alcohol consumption, and violence are expressions of different facets of masculinity and symbols of the affluent class. Overall, there was a feeling that TV/films and their peers now influence more the socialization of young people and parents are losing control in guidance and mentoring of their children.

The Iranian female high school students' attitude towards people with HIV / AIDS: a cross-sectional study
(Abstract; subscription needed for full text; Middle East)
AIDS Research and Therapy. 2008 Jul 22;5(15):[16] p.
Ghabili K | Shoja MM | Kamran P
Acquired Immunodeficiency Syndrome (AIDS) has become an important public health hazard in Iran. It is believed that AIDS-related knowledge does not necessarily translate into behavior modification. Hence, it has been suggested that culturally appropriate educational campaigns should be implemented to obtain satisfactory outcomes. Here, we evaluated the female high school students' attitude towards HIV/AIDS in Tabriz, Iran to assess the cultural needs for the related educational programs and to discover sources of information about AIDS. Anonymous, self-administered questionnaires were filled by the young female students. Among 300 students, 91% agreed that being an HIV carrier should not be an obstacle to obtaining education and employment. Moreover, 72.5% of the students declared that the community should be informed of HIV-positive people. In addition, one-tenth declared that they would feel extremely uncomfortable towards their HIV infected classmate. In addition, only 16% of the students stated that they would continue to shop at HIV infected grocer's store. The mass media and the experts were the major source and the most reliable source of information about AIDS, respectively. Tabrizian female students have overall negative attitudes towards HIV/AIDS. HIV/AIDS related educational campaigns should target the students, society and the families with emphasizing the leading roles of health staff.

Study of knowledge, perception and attitude of adolescent girls towards STIs / HIV, safer sex and sex education: (A cross sectional survey of urban adolescent schoolgirls in South Delhi, India)
(Research Article; Asia)
BMC Women's Health. 2008 Jul 23;8(12):[13] p.
McManus A | Dhar L
Sexually Transmitted Infections (STIs), including HIV (Human Immunodeficiency Virus) mainly affects sexually active young people. Young adults aged 15-29 years, account for 32% of AIDS (Acquired Immunodeficiency Syndrome) cases reported in India and the number of young women living with HIV/AIDS is twice that of young men. The aim of the study was to evaluate adolescent school girls' knowledge, perceptions and attitudes towards STIs/HIV and safer sex practice and sex education and to explore their current sexual behaviour in India. A cross sectional study was carried out in 2007 in South Delhi, India to investigate the perception, knowledge and attitude of adolescent urban schoolgirls towards sexually transmitted Infections (STIs), HIV/AIDS, safer sex practice and sex education. The self-administered questionnaire was completed by 251 female students from two senior secondary schools. More than one third of students in this study had no accurate understanding about the signs and symptoms of STIs other than HIV/AIDS. About 30% of respondents considered HIV/AIDS could be cured, 49% felt that condoms should not be available to youth, 41% were confused about whether the contraceptive pill could protect against HIV infection and 32% thought it should only be taken by married women. Though controversial, there is an immense need to implement gender-based sex education regarding STIs, safe sex options and contraceptives in schools in India.

A study of awareness about HIV / AIDS among senior secondary school children of Delhi
(Research Article; Asia)
Indian Journal of Community Medicine. 2008 Jul;33(3):190-192.
Lal P | Nath A | Badhan S | Ingle GK
School children of today are exposed to the risk of being victims of HIV/AIDS - which was quite unknown to their predecessors a few decades ago. The epidemic of HIV/AIDS is now progressing at a rapid pace among young people. Studies have reported that young people form a significant segment of those attending sexually transmitted infection (STI) clinics and those infected by HIV. Programme managers and policy makers have often recommended that schools can act at the center point for disseminating information and education on HIV/AIDS. Hence school education has been described as a 'social vaccine', and it can serve as a powerful preventive tool. In India, there is a wide gap between the inputs in the HIV/AIDS curriculum for schools and the actual education that is imparted. As children are a valuable resource for the future of a country, it is imperative that they be equipped with ample amount of information so as to protect themselves and their counterparts from falling prey to this still incurable killer disease. With this background, the present study was conducted with the following objectives: (i) To assess the awareness of school children regarding HIV/AIDS; (ii) to provide suggestions for school AIDS education.

FAMILY PLANNING RESEARCH

Vasectomy: Tools for providers
(Report; Global)
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Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health [INFO], 2008 Jun. 8 p. (Array)
Lande R | Kols A
Family planning providers can use the checklists and tables in this report to: 1) Counsel clients about vasectomy and ensure that they make an informed choice; 2) Identify men with conditions that require a delay or special consideration before they can have a vasectomy; 3) Explain the vasectomy procedure; 4) Try to make sure that the client's decision for vasectomy is well-considered and his own; and Explain to a man what he should do before and after the vasectomy.

Contraceptive method use by adolescents in Brazilian state capital
(Abstract; subscription needed for full text; South America)
Journal of Pediatric and Adolescent Gynecology. 2008 Aug;21(4):213-219.
Gomes KR | Speizer IS | Oliveira DD | Moura LN | Gomes FM
Adolescence is a period characterized by increased exploration and exposure to risk-taking behaviors, including unsafe sex. This cross-sectional study examines prior contraceptive method use by pregnant or recently pregnant adolescents in Teresina-Piaui, Brazil. It was conducted in four area hospital maternity units. Two-hundred and seventy-eight adolescents aged 15-19 admitted in four hospital maternity units for clinical treatment or for pregnancy resolution were interviewed. The sample was stratified proportional to the number of adolescents who visit each hospital. Chi-square and Fisher exact test are used to analyze differences between contraceptive users and non-users. Half of interviewed adolescents used some form of contraception at first intercourse (53.2%) and 40.3% used contraception at intercourse leading to the current pregnancy. Male condom was the most common method at first intercourse (96.6% among users of a method) and at the time of pregnancy (58.9%). The main reasons for contraceptive nonuse were that the adolescent had not thought about contraception at the time of first sex (36.1%) and the adolescent wished for a baby at the time of pregnancy (26.5%). About 57% of girls who did not want the pregnancy reported that they did not use any contraceptive method right before the pregnancy. Among pregnant adolescents with an unwanted pregnancy, a greater percentage who had access to health services reported contraceptive use (48%) compared to only 16.7% of those with no access to health services. Contraceptive method use by adolescents was unsatisfactory as indicated by unwanted pregnancies among both users and nonusers of contraception. Prevention of unintended pregnancies requires greater information and access to contraceptives among all sexually active youth.

Cross-sectional analysis of factors associated with prior contraceptive use among hospitalized obstetric patients in Kabul, Afghanistan
(Abstract; subscription needed for full text; Asia)
Contraception. 2008;:[8] p.
Todd CS | Isley MM | Ahmadzai M | Azfar P | Atiqzai F
This study was conducted to assess prevalence and correlates of prior contraceptive use among hospitalized obstetric patients in Kabul, Afghanistan. Medically eligible (e.g., conditions not requiring urgent medical attention, such as eclampsia, or not imminently delivering [dilation greater than or=8 cm]) obstetric patients admitted to three Kabul public hospitals were consecutively enrolled in this cross-sectional study. An interviewer-administered questionnaire assessed demographic information, health utilization history, including prior contraceptive use, and intent to use contraception. Correlates of prior contraceptive use were determined with logistic regression. Of 4452 participants, the mean age was 25.7 years (SD, +or-5.7 years), 66.4% reported pregnancy before the presenting gestation, 88.4% had greater than or=1 prenatal care visit and 82.4% reported the current pregnancy was desired. Most (67.4%) had no formal education. One fifth (22.8%) reported using contraception before this pregnancy. Among women with any pregnancy before the current gestation (98.6% of prior users), prior contraceptive use was independently associated with having lived outside Afghanistan in the last 5 years (adjusted odds ratio [AOR], 1.35; 95% confidence interval [CI], 1.12-1.63), having a skilled attendant at the last birth (AOR, 1.35; 95% CI, 1.07-1.71), having a greater number of living children (AOR, 1.30; 95% CI, 1.20-1.41), longer mean birth interval (years) (AOR, 1.21; 95% CI, 1.11-1.38) and higher educational level (AOR, 1.16; 95% CI, 1.09-1.22). Immediate desire for another pregnancy and spousal disapproval were the most common reasons for not utilizing contraception. Prior contraceptive use is low among the women in Kabul, Afghanistan, particularly for younger less educated women. Programming in Kabul to strengthen postpartum contraceptive counseling should address barriers to contraceptive use, including immediate desire for pregnancy and spousal attitudes.

GENDER and HEALTH RESEARCH

Socio-economic factors explain differences in public health-related variables among women in Bangladesh: A cross-sectional study
(Research Article; Asia)
BMC Public Health. 2008 Jul 23;8(254):[24] p.
Khan MM | Kraemer A
Worldwide one billion people are living in slum communities and experts projected that this number would double by 2030. Slum populations, which are increasing at an alarming rate in Bangladesh mainly due to rural-urban migration, are often neglected and characterized by poverty, poor housing, overcrowding, poor environment, and high prevalence of communicable diseases. Unfortunately, comparisons between women living in slums and those not living in slums are very limited in Bangladesh. The objectives of the study were to examine the association of living in slums (dichotomized as slum versus nonslum) with selected public health-related variables among women, first without adjusting for the influence of other factors and then in the presence of socio-economic variables. Secondary data was used in this study. 120 women living in slums (as cases) and 480 age-matched women living in other areas (as controls) were extracted from the Bangladesh Demographic and Health Survey 2004. Many socio-economic and demographic variables were analysed. SPSS was used to perform simple as well as multiple analyses. Pvalues based on t-test and Wald test were also reported to show the significance level. Unadjusted results indicated that a significantly higher percent of women living in slums came from country side, had a poorer status by household characteristics, had less access to mass media, and had less education than women not living in slums. Mean BMI, knowledge of AIDS indicated by ever heard about AIDS, knowledge of avoiding AIDS by condom use, receiving adequate antenatal visits (4 or more) during the last pregnancy, and safe delivery practices assisted by skilled sources were significantly lower among women living in slums than those women living in other areas. However, all the unadjusted significant associations with the variable slum were greatly attenuated and became insignificant (expect safe delivery practices) when some socio-economic variables namely childhood place of residence, a composite variable of household characteristics, a composite variable of mass media access, and education were inserted into the multiple regression models. Taken together, childhood place of residence, the composite variable of mass media access, and education were the strongest predictors for the health related outcomes. Reporting unadjusted findings of public health variables in women from slums versus non-slums can be misleading due to confounding factors. Our findings suggest that an association of childhood place of residence, mass media access and public health education should be considered before making any inference based on slum versus non-slum comparisons.

Who is getting Pap smears in urban Peru?
(Abstract; subscription needed for full text; South America)
International Journal of Epidemiology. 2008 Aug;37(4):862-869.
Paz Soldan VA | Lee FH | Carcamo C | Holmes KK | Garnett GP
Cervical cancer, although usually preventable by Pap smear screening, remains the leading cause of cancer-related deaths among women in Peru. The percentages and characteristics of women in Peru who have or have not had a Pap smear have not been defined. In an urban community randomized trial of sexually transmitted infection (STI)/HIV prevention in Peru, 6712 randomly selected women between the ages of 18 and 29 from 20 cities were interviewed regarding having had cervical Pap smears. Among women sampled, only 30.9% had had a Pap smear. By multivariate analysis, the main predictors of having a Pap smear were having had sex, having had children, completion of secondary education and increasing age. Regional variations were also found: women from the highlands and rainforest were less likely to have had Pap smears than women from the coast. A norm of seeking and receiving Pap smears has not been established among sexually active young Peruvian women. To improve Pap smear coverage in Peru, promotion efforts should target underserved women and regions with less coverage.

Endangered womanhood: Women's experiences with HIV / AIDS in China
(Abstract; subscription needed for full text; Asia)
Qualitative Health Research. 2008 Aug;18(8):1115-1126.
Zhou YR
Women in China are increasingly affected by HIV/AIDS. Current AIDS studies have examined the HIV risks faced by this gender group, paying inadequate attention to women's actual experiences with the disease. This oversight has inhibited our ability to understand the impact of gender on women's capacity to respond to HIV/AIDS in their postinfection lives. Based on a qualitative study on illness experiences of HIV-infected people, this article examines the interactions between HIV/AIDS and gender roles in the Chinese context. It was found that traditional gender norms have played a key role for HIV-infected women in their efforts to tackle this disease and to make sense of their daily lives. HIV infection has created a conflict between women's intention to fulfill their conception of "womanhood" and a decreased ability to do so, which, in turn, has adversely affected their self-perceptions and well-being. To avoid worsening the inequality of women's experience, therefore, we must also work on the socioeconomic conditions, for example, through delivering comprehensive care to affected families and developing a gender-sensitive welfare policy, so that the gender imparity that permeates this epidemic can be challenged and transformed.

HIV/AIDS and STIs RESEARCH

HIV / AIDS and cultural practices in western Kenya: The impact of sexual cleansing rituals on sexual behaviours
(Abstract; subscription needed for full text; Oceania)
Culture, Health and Sexuality. 2008 Aug;10(6):587-599.
Ayikukwei R | Ngare D | Sidle J | Ayuku D | Baliddawa J
This paper reports on an exploratory study examining the role of sexual cleansing rituals in the transmission of HIV among the Luo community in western Kenya. Data were collected using both indepth interviews and focus group discussions. The study population consisted of 38 widows, 12 community elders and 44 cleansers. Data were collected on non-behavioural causes, behavioural causes and behavioural indicators associated with sexual rituals. Content analysis revealed five central themes: the effect of the ritual on sexual behaviours; factors contributing to the continued practice of the ritual, including a sub-theme on the commercialization of the ritual; the inseparable relationship between the sanctity of sex, prosperity and fertility of the land; and the effects of modernization on the ritual, including a sub-theme on the effects of mass media on HIV-prevention awareness campaigns. Causal factors of unchanging sexual behaviours are deeply rooted in traditional beliefs, which the community uphold strongly. These beliefs encourage men and women to have multiple sexual partners in a context where the use of condoms is rejected and little HIV testing is carried out.

Opportunities and challenges for HIV care in overlapping HIV and TB epidemics
(Abstract; subscription needed for full text; Global)
JAMA. 2008 Jul 23-30;300(4):423-430.
Havlir DV | Getahun H | Sanne I | Nunn P
Tuberculosis (TB) and the emerging multidrug-resistant TB epidemic represent major challenges to human immunodeficiency virus (HIV) care and treatment programs in resource-limited settings. Tuberculosis is a major cause of mortality among patients with HIV and poses a risk throughout the course of HIV disease, even after successful initiation of antiretroviral therapy (ART). Progress in the implementation of activities directed at reducing TB burden in the HIV population lags far behind global targets. HIV programs designed for longitudinal care are ideally suited to implement TB control measures and have no option but to address TB vigorously to save patient lives, to safeguard the massive investment in HIV treatment, and to curb the global TB burden. We propose a framework of strategic actions for HIV care programs to optimally integrate TB into their services. The core activities of this framework include intensified TB case finding, treatment of TB, isoniazid preventive treatment, infection control, administration of ART, TB recording and reporting, and joint efforts of HIV and TB programs at the national and local levels.

Effectiveness of antiretroviral therapy among HIV-infected children in sub-Saharan Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Lancet Infectious Diseases. 2008 Aug;8(8):477-489.
Sutcliffe CG | van Dijk JH | Bolton C | Persaud D | Moss WJ
Assessment of antiretroviral treatment programmes for HIV-infected children in sub-Saharan Africa is important to enable the development of effective care and improve treatment outcomes. We review the eff ectiveness of paediatric antiretroviral treatment programmes in sub-Saharan Africa and discuss the implications of these findings for the care and treatment of HIV-infected children in this region. Available reports indicate that programmes in sub-Saharan Africa achieve treatment outcomes similar to those in North America and Europe. However, progress in several areas is required to improve the care of HIV-infected children in sub-Saharan Africa. The findings emphasise the need for low-cost diagnostic tests that allow for earlier identification of HIV infection in infants living in sub-Saharan Africa, improved access to antiretroviral treatment programmes, including expansion of care into rural areas, and the integration of antiretroviral treatment programmes with other health-care services, such as nutritional support.

National surveillance of antimicrobial susceptibility in Neisseria gonorrhoeae in 2005-2006 and recommendations of first-line antimicrobial drugs for gonorrhoea treatment in Russia
(Abstract; subscription needed for full text; Europe | Asia)
Sexually Transmitted Infections. 2008 Aug 1;84(4):285-289.
Kubanova A | Frigo N | Kubanov A | Sidorenko S | Priputnevich T
The objective of this study was to investigate comprehensively the antimicrobial susceptibility and resistance of Neisseria gonorrhoeae during 2005-2006 in a national survey and to recommend effective antimicrobial drugs for the treatment of gonorrhoea in Russia. The susceptibility of N gonorrhoeae isolates, cultured mainly from consecutive gonorrhoea patients (n = 1030) during the period January 2005 to December 2006 in Russia, to penicillin G, ceftriaxone, ciprofloxacin, tetracycline and spectinomycin was analysed using the agar dilution method. Nitrocefin discs were used for b-lactamase detection. All isolates were susceptible to ceftriaxone. During 2005 and 2006, however, 5%, 50%, 70% and 77% displayed intermediate susceptibility or resistance to spectinomycin, ciprofloxacin, tetracycline and penicillin G, respectively. Furthermore, 4% of the isolates were blactamase producing during these years. The different federal districts of Russia displayed substantial heterogeneities with regard to the prevalence of gonorrhoea and antimicrobial resistance among N gonorrhoeae isolates. In Russia, penicillins, ciprofloxacin, or tetracycline should definitively not be used in the empirical treatment of gonorrhoea. The recommended first-line antimicrobial drug should be ceftriaxone. If ceftriaxone is not available, spectinomycin ought to be used. Increasing levels of intermediate susceptibility and resistance to spectinomycin have, however, been observed during recent years and, accordingly, great care and monitoring should be undertaken when using this agent. Continuous local, national and international surveillance of N gonorrhoeae antimicrobial susceptibility, in order to reveal the emergence of new resistance, to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis, is crucial.

MATERNAL AND CHILD HEALTH RESEARCH

Health and civil war in rural Burundi
(Report; Sub-Saharan Africa)
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Brighton, United Kingdom, University of Sussex, Institute of Development Studies, Micro Level Analysis of Violent Conflict [MICROCON], 2008 Apr. 50 p. (MICROCON Research Working Paper No. 5)
Bundervoet T | Verwimp P | Akresh R
We combine household survey data with event data on the timing and location of armed conflicts to examine the impact of Burundi's civil war on children's health status. The identification strategy exploits exogenous variation in the war's timing across provinces and the exposure of children's birth cohorts to the fighting. After controlling for province of residence, birth cohort, individual and household characteristics, and province-specific time trends, we find an additional month of war exposure decreases children's height for age z-scores by 0.047 standard deviations compared to non-exposed children. The effect is robust to specifications exploiting alternative sources of exogenous variation.

Criteria for clinical audit of women friendly care and providers' perception in Malawi
(Research Article; Sub-Saharan Africa)
BMC Pregnancy and Childbirth. 2008 Jul 22;8(28):[15] p.
Kongnyuy EJ | van den Broek N
There are two dimensions of quality of maternity care, namely quality of health outcomes and quality as perceived by clients. The feasibility of using clinical audit to assess and improve the quality of maternity care as perceived by women was studied in Malawi. We sought to (a) establish standards for women friendly care and (b) explore attitudinal barriers which could impede the proper implementation of clinical audit. We used evidence from Malawi national guidelines and World Health Organisation manuals to establish local standards for women friendly care in three districts. We equally conducted a survey of health care providers to explore their attitudes towards criterion based audit. The standards addressed different aspects of care given to women in maternity units, namely (i) reception, (ii) attitudes towards women, (iii) respect for culture, (iv) respect for women, (v) waiting time, (vi) enabling environment, (vii) provision of information, (viii) individualised care, (ix) provision of skilled attendance at birth and emergency obstetric care, (x) confidentiality, and (xi) proper management of patient information. The health providers in Malawi generally held a favourable attitude towards clinical audit: 100.0% (54/54) agreed that criterion based audit will improve the quality of care and 92.6% believed that clinical audit is a good educational tool. However, there are concerns that criterion based audit would create a feeling of blame among providers (35.2%), and that manager would use clinical audit to identify and punish providers who fail to meet standards (27.8%). Developing standards of maternity care that are acceptable to, and valued by, women requires consideration of both the research evidence and cultural values. Clinical audit is acceptable to health professionals in Malawi although there are concerns about its negative implications to the providers.

Feasibility study of IMNCI guidelines on effective breastfeeding in a rural area of north India
(Research Article; Asia)
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Indian Journal of Community Medicine. 2008 Jul;33(3):201-203.
Gupta M | Aggarwal AK
Children younger than 3 years old commonly suffer from fever (27% prevalence in the previous 2-week period), acute respiratory infections (17%), diarrhoea (13%) and malnutrition (43%) - and often a combination of these conditions. During the mid-1990s, the World Health Organization (WHO), in collaboration with UNICEF and many other agencies, institutions and individuals, responded to this challenge by developing a strategy known as Integrated Management of Childhood Illness (IMCI). Due to high neonatal mortality and morbidity in the country, the Government of India revised the strategy to be called Integrated Management of Neonatal and Childhood Illness (IMNCI). This strategy addresses various aspects of nutrition, immunization and other important elements of disease prevention and health promotion in addition to early detection and prompt management of cited childhood illnesses. Great emphasis was given on effective breast-feeding in IMNCI guidelines. The present study was planned with the objective of implementing IMNCI guidelines of effective breastfeeding as an intervention and comparing the results in pre- and post-intervention period in rural areas.

Risk factors associated with low birth weight of neonates among pregnant women attending a referral hospital in northern Tanzania
(Research Article; Sub-Saharan Africa)
Tanzania Journal of Health Research. 2008;10(1):1-8.
Siza JE
According to the World Health Organization low birth weight (LBW) babies are those born with less than 2500g. A descriptive retrospective cross - sectional study using existing data from a one-year (2001) block of birth registers of 3464 pregnant women was done at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. The objective was to determine factors associated with LBW and their contribution to the problem. Out of 648 pregnant women who were tested for HIV infection 59 (9.1%) were positive for the infection. Twelve (20.3%) of HIV positive women gave birth to LBW neonates. HIV positive women were twice more likely to give birth to LBW infants than HIV negative ones ( 2 = 6.7; P less than 0. 01; OR = 2.4; 1.1, 5.1). Mothers without formal education were 4 times more likely to give birth to LBW neonates than those who had attained higher education (OR= 3.6; 2.2, 5.9). There was a linear decrease in low birth weights of newborns as fraternal educational level increased ( 2 for linear trend = 42.7; P less than 0.01). There was no statistically significant difference among parents' occupations regarding LBW of their newborns. Unmarried mothers were more likely to give birth to LBW neonates as compared to their married counterparts (OR = 1.65; 1.2, 2.2) and the difference was statistically significant ( 2=13.0, P less than 0.01). Hypertension, pre-eclampsia and eclampsia disease complex had the highest prevalence (46.67%) and population attributable fraction of low birth weight (PAF = 25.2%; CI= 22.0-27.6). Bleeding and schistosomiasis had the same prevalence (33.33%) of LBW babies. Other complications and diseases which contributed to high prevalence of LBW included anaemia (25%), thromboembolic diseases (20%), tuberculosis (17%) and malaria (14.8%). Prevalence of LBW was high in women with premature rupture of membrane (38%), placenta previa (17%) and abruption of placenta (15.5%). LBW was strongly associated with gestational age below 37 weeks (OR = 2; CI=1.5, 2.8) contributing to 42% of LBW deliveries in the study population (PAF = 42.4%: 25, 55). Pregnant women with malnutrition (BMI less than 18) gave the highest proportions 17% of LBW children followed by underweight (BMI; 18-22) who gave 15.5% of LBW neonates. There was a statistical significant difference between the proportions of LBW infants from mothers who did not receive antenatal care (28.6%) and those who attended for the services (13.8%) ( 2 = 8.8; P= 0.01). There is need of increasing promotion of reproductive health services in relation to safe motherhood at community level in order to reduce risk factors of LBW.

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Iraq Family Health Survey 2006/7
(Report; Middle East)
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[Amman, Jordan], WHO, [2008]. [64] p.
The Iraq Family Health Survey (IFHS) 2006/7 is a nationally representative survey of 9,345 households and 14,675 women of reproductive age and covers all governorates in Iraq. This is the second nationally representative health survey since the Family Gulf Survey in 1989, although it is the first survey to disseminate the results. The IFHS 2006/7 was conducted in the central and southern governorates during August and September 2006, in Anbar during October and November 2006, while fieldwork in the Kurdistan region was carried out during February and March 2007. The survey had gone through a detailed and intensive planning and preparatory phases which was particularly important given the dire security situation in Iraq at the time of the survey. Not only were rigorous training and pre-testing undertaken, but a planning approach based on a number of different scenarios was adopted to respond to anticipated challenges. All interview teams were carefully supervised and given continuous support through out the period of the survey. The principle objective of the survey is to provide critical information for policy-makers and programme managers working in health and development. It complements other surveys recently conducted in Iraq on the situation of women and children, namely the Iraq Child and Maternal Mortality Survey (ICMMS 1999), the Iraq Living Conditions Survey ILCS 2004, and the Multiple Indicators Cluster Survey MICS III 2006. Also the survey results will present data on a wide range of indicators related to women's and family health. It is also the first national survey ever conducted to present data on adult mortality, including the causes of deaths. The IFHS is the first national survey in Iraq to investigate domestic violence, as well as chronic illnesses. Detailed information was also collected on health expenditures and health care seeking behaviour, as well as a range of other health and demographic indicators. Blood test was carried out to measure the level of anaemia among women of reproductive age including pregnant and lactating women.

Declining trends of infant, child and under-five mortality in Nepal
(Abstract; subscription needed for full text; Asia)
Journal of Tropical Pediatrics. 2008 Aug;54(4):265-268.
Thapa S
Demographic and Health Surveys conducted quinquennially in 1996, 2001 and 2006 show that infant, child and under-five mortality in Nepal have declined steadily at least over the past 25 years. Estimates based on exponential-decline regression curves fitted to the 15-year data immediately preceding each survey, aggregated by 5-year period, show the infant, child and under-five mortality rates for the period 1986-1990 to be 106, 58 and 158 per 1000 live births and 52, 17 and 67 per 1000 live births for 2001-2005, respectively. The projected rates, assuming that the policy and program efforts are sustained, for the period 2011-2015 are 32, 7 and 38 per 1000 live births. Nepal is most likely to achieve the Millennium Development Goals (MDG) target of a two-thirds reduction in child mortality by 2015, the end of the MDG countdown.

Discrepancies between UN models and DHS survey estimates of maternal orphan prevalence: Insights from analyses of survey data from Zimbabwe
(Research Article; Sub-Saharan Africa)
Sexually Transmitted Infections. 2008;84 Suppl 1:i57-i62.
Robertson L | Gregson S | Madanhire C | Walker N | Mushati P
Model-based estimates of maternal (but not paternal) orphanhood are higher than those based on data from demographic and health surveys (DHS). We investigate the consistency of reporting of parental survival status in data from Manicaland, Zimbabwe. We compared estimates of paternal and maternal orphan prevalence in three rounds of a prospective household census in Manicaland (1998-2005) with estimates from DHS surveys and UNAIDS model projections. We investigated the consistency of reporting of parental survival status across the three rounds and compared estimates of adult mortality from the orphan data with direct estimates from concurrent follow-up of a general population cohort. Qualitative data were collected on possible reasons for misreporting. Paternal and maternal orphan prevalence is increasing in Zimbabwe. Mothers reported as deceased in round 1 of the Manicaland survey were more likely than fathers to be reported as alive in rounds 2 or 3 (33.3% vs 13.4%). This pattern was most apparent among younger children. The qualitative findings suggest that foster parents sometimes claim adopted children as their natural children. These results are consistent with misreporting of foster parents as natural parents. This appears to be particularly common among foster mothers and could partly explain the discrepancy between mathematical model and DHS estimates of maternal orphanhood.

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Volume 8, Number 31 4 August 2008