Knowledge and attitude of college going adolescent girls towards family planning.
Adolescents play a crucial role in controlling the growth of population in the country as they are in the preparatory stage for their future productive and reproductive roles in society and family respectively. The present study aims to understand the knowledge and attitudes of adolescent girls towards family planning and to get their suggestions for arresting the rate of growth of population. The sample consists of 130 adolescent girls aged 15 to 19 years. Results reveal that knowledge about the various aspects of family planning is incomplete and is mostly based on advertisements, hoardings, married friends and relatives. Their attitude towards family planning is favourable and respondents view the introduction of systematic sex education in the study curriculum as an important measure to control the rapidly increasing population of India. Therefore there is an urgent need to provide accurate, user-friendly information about reproduction and contraception to adolescents along with easy access tothese services in order to achieve the population stabilization targets. (author's)
Son preference among rural married men in Maharashtra, India.
The term 'son preference' refers to the attitude that sons are more important and valuable than daughters. Son preference is found almost in all parts of India and is reflected in the attitudes and behaviour of people and is an important indicator of social development. It is a rough indicator of sexual inequality and status of women in society. Son preference is thus almost a universal phenomenon, leaving apart a few developed areas. In India, couples have been observed to have a strong preference for sons, over daughters. The reasons for such a preference are deep-rooted in Indian culture. Looking at Indian society and going through the demographic and social literature it is observed that a son is valued more than a daughter for multiple reasons. Son is desired for religious, cultural, social, economic and psychological reasons. Sons not only continue the family name and inherit the ancestral property. They are also caretakers of the parents in their old age, although there is some recognition that sons are no longer a dependable source of old age support. Presence of a son is thus socially very beneficial and in the old age is a psychological need. The utility of having sons arises from the important religious functions that only sons can perform. According to Hindu tradition, sons are needed to kindle the funeral pyre of their deceased parents and to help in the salvation of their souls. Though sons are preferred and desired doesn't necessarily imply a dislike for daughters. Most of the couples want one daughter but not more. (excerpt)
A field study on cause of death in East Delhi.
Reliable statistics on causes of death in a population are essential for setting priorities in the health sector. Conventional measures of mortality like infant mortality and maternal mortality continue to play an important role in the health policy. Acute Respiratory Infections (ARI), pneumonia and diarrhoeal diseases are major causes of death among infants and children under the age of five years. In India, cause of death reporting system, is inadequate in terms of coverage and also there is poor compliance with guidelines of classification and coding. Earlier, there was a system known as Survey Causes of Death (Rural) (Registrar General of India, Govt. of India), which is based mainly on lay reporting for identification of causes of death in rural areas, where adequate medical facilities are not available. Now, this component of identifying causes of death has been incorporated in the Sample Registration System (Registrar General of India, Govt. of India) that provides estimates only at the State level. There are not many research studies in this direction. Reddaiah et. al studied socio-biological factors among deaths in the 0-5 age group in a rural area. There is greater need for establishing a reliable system in India to ascertain cause of deaths that can provide reliable data for better planning. Indian Council of Medical Research has made an attempt in this direction by developing some instruments based on verbal autopsy and a Study on causes of Deaths by Verbal Autopsy is being undertaken in many states. In the present paper, information has been presented on the causes of deaths that were ascertained by a survey undertaken in the East Delhi. (excerpt)
Reproductive health perceptions in educated urban women.
The present study was undertaken to ascertain the state of awareness amongst women about their own reproductive health and to what extent formal education and media publicity about RCH has helped. The biological and sociological aspects of reproduction have been extensively studied separately, independent of each other. We wanted to examine them together, and to see how awareness about one was influencing the other. In principle, the approach was twofold. Firstly, to examine how knowledgeable women were about the basic scientific facts of human reproduction. And, secondly, to see to what extent this knowledge was actually guiding their day-to-day life, social perceptions and reproductive behaviour. It would of course be wrong to presume that imparting knowledge would by itself immediately bring about the desired change in individuals. Constant persuasion and motivation may be needed over a long period of time, but it would be pertinent to examine how far it was actually happening today. (excerpt)
Strategic options for population stabilization in Madhya Pradesh.
Madhya Pradesh is one of those states of India which have recently evolved and adopted its own population policy to address population related issues specific to the state. The Madhya Pradesh Population Policy aims at achieving the goal of a total fertility rate of 2.1 children per woman by the year 2011. The Policy stipulates that in order to reach the total fertility rate goal, the contraceptive prevalence rate should increase to 65 per cent while the infant mortality rate must come down to 62 infant deaths per 1000 live births and the maternal mortality ratio should be reduced to around 220 maternal deaths for every 100,000 live births by the year 2011. Obviously, a massive social transformation in terms of changes in the prevailing social norms, family formation patterns and reproduction related behaviour including delay in the age at first birth and adoption of small family norm is required to achieve these goals and objectives. This is a challenging task as the social and economic advancement such as universalisation of education, a radical change in the structure of employment, modernization of agriculture, status of woman in the society, etc. The prevailing social, cultural and economic scenario of the state, however, does not provide a conducive environment for processes of change in family formation patterns and reproductive behaviour. (excerpt)
Every year 68,000 women the world over die as a result of complications of unsafe abortion. 20,000 of these deaths occur in India alone. Countless more women suffer serious injuries. The poor, the rural, the illiterate, the young and the unmarried remain the most vulnerable. The unjust tragedy continues despite the fact that abortion has been legal in India since 1972. An estimated 6.7 million induced abortions are performed in India each year. This large number testifies to a widespread deficiency in awareness and knowledge, and also an unmet need in the availability and access to contraceptive services. Besides this, the inherent failure of every available contraceptive method is bound to lead to unwanted pregnancies. While the prevention of all unwanted pregnancies would be ideal, their inevitable occurrence will always require the backup of safe induced abortion services. Women have a right to life and health. India's National Population Policy aims to reduce maternal mortality ratio to <100 by the year 2010. India is also committed to ICPD, ICPD +5, CEDAW and to achieving the Millennium Development Goal of reducing maternal mortality. None of these can be achieved, unless we address the issue of unsafe abortion. (excerpt)
Centrality of reproductive health in achieving Millennium Development Goals: a framework for action.
The links between women's status, reproductive health, and social and economic development were first recognized at the landmark International Conference on Population and Development, a UN meeting held in Cairo in 1994. The Programme of Action adopted at the Conference (referred to here as the ICPD) spelled out a comprehensive plan for making reproductive health including family planning services universally available within a rights framework. While the principles of the ICPD were being translated into action by signatory countries, the Millennium Summit in September 2000 adopted the UN Millennium Declaration, committing nations to a global partnership to reduce poverty, improve health, and promote peace, human rights, gender equality, and environmental sustainability. The Declaration resulted in eight Millennium Development Goals (MDGs), which together formed a policy framework for alleviating poverty and enhancing the well-being of people. The MDGs are the world's time-bound and quantified targets for addressing extreme poverty in its many dimensions - income poverty, hunger, disease, lack of adequate shelter, and exclusion - while promoting .gender equality, education, and environmental sustainability. These are also seen as basic human rights - the rights of each person on the planet to health, education, shelter and security as pledged in the Universal Declaration of Human Rights and the UN Millennium Declaration. (excerpt)
Medical termination of pregnancy in the private sector.
The dawn of the new millennium has seen little improvement in terms of women's capacity to maintain the delicate balance between sexual intercourse and reproductive intentions. Consequently, unplanned pregnancies continue to occur in every society and varying proportions of women have to cope with unplanned pregnancies and resort to unsafe abortions. In order to ensure that women have access to safe abortion, India was one of the first countries in the world to legitimize abortion as far back as 1971. Despite this, a 1998 survey on the causes of maternal deaths conducted by the Vital Statistics Division of the Office of the Registrar General of India, indicates that 12 percent of all maternal deaths are abortion-related and, by and large, attributed to unsafe abortion. WHO defines unsafe abortion as "a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both". What constitutes "necessary skills" or "minimal medical standards" in the WHO definition varies according to the legal and medical standards of each country. In India, abortion is regulated by the Medical Termination of Pregnancy (MTP) Act, 1971. Under the MTP Act, abortion can be provided only by a registered medical practitioner who has the necessary qualifications (a degree in allopathic medicine) and adequate training, and only in a place that meets the standards specified under the Rules and Regulations of the Act. Thus, abortions carried out by persons in a place not registered or certified under the MTP Act would be illegal. (excerpt)
Reproductive and sexual rights: history and contemporary challenges.
Control over women's reproductive abilities and functions have been one of the key aspects of the domination over women and their secondary status in society. It is, therefore, not surprising that from the earliest times, movements for women's rights have included reproductive and sexual rights as some of their key concerns. This may sound surprising to many who consider reproductive rights as a modernday struggle, a struggle that has intensified only after the International Conference for Population and Development in 1994. This is not so. The earliest demands of women's movements in the West included demands for the right to vote, equal pay for equal work, the right to property, the right to education, as well as the right to initiate divorce, obtain and use contraceptives, have abortions and decide whether or not to go through pregnancy. In India too, the work on women's upliftment done by the great social reformers of the nineteenth century like Pandit Iswar Chandra Vidyasagar in Bengal or Mahatma Jyotiba Phule in Maharashtra included issues like widow remarriage, polygamy, and child marriage which are clearly within the realm of reproductive rights. (excerpt)
Interventions addressing the sexual and reproductive health of young people: What works?
There remain many compelling reasons for investing in young people's health and development in India. For one, young people aged 10-24 constitute some 327.2 million and represent 30 per cent of the nation's population. Second and more important, behaviours formed and choices made by this large population have lasting implications for individual and public health, and will not only determine the health of this generation as adults but will also determine the health and future of the nation Third, although cohorts of young people are healthier, more urbanised and better educated than earlier generations, they face significant risks related to sexual and reproductive health, and many young people lack the knowledge and power to make informed sexual and reproductive choices. Fourth, programmes thus far that address young people's sexual and reproductive health (SRH) needs have had varied success, and many have overlooked the fact that young people are not a homogeneous group, and the ways in which they experience vulnerabilities and the extent to which interventions designed to ameliorate them are successful vary enormously by such factors as age, sex, marital status, class, schooling, work status, family and economic conditions, region and cultural context. Moreover, and further confounding the situation is the lack of evidence-based precedent about effective interventions. (excerpt)
Prevalence, nature and determinants of violence against women in Bangladesh.
Violence against women has serious consequences on the physical and mental health of women, and the urgent need to address the issue needs no emphasis. It is a major public health problem and a violation of the rights of women. Available studies indicate that 16-50 percent of women face violence in their lifetime. In patriarchal societies, particularly in South-Asian countries, the situation is much worse as violence against women is an accepted norm for "controlling" them. In countries like Bangladesh, the problem is compounded by extreme poverty, illiteracy and early marriage. What makes it very difficult to respond effectively to gender based violence is the fact that, even today, domestic violence is treated as a normal part of married life by both men and women. For programmatic interventions to address such culturally deep-rooted problems, detailed and reliable information on the prevalence, nature and causes of gender violence in the given context, is critical. One such effort is a WHO multi-country study which also covers Bangladesh. The present paper is one such attempt to understand the dynamics of gender based violence in Bangladesh. (excerpt)
Acquired Immunodeficiency Syndrome (AIDS) has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed 3.1 million (2.8-3.6 million) lives in 2005; more than half a million (570 000) were children. The epidemic in Asia is expanding rapidly. An estimated 7.4 million people are living with HIV in the region and 1.1 million people became newly infected last year alone - more than in any single year before. Home to 60 percent of the world's population, the fast-growing Asian epidemic has huge global implications. In all affected countries with either high or low HIV prevalence, AIDS hinders development, exacting a devastating toll on individuals and families. In the hardest-hit countries, it is erasing decades of health, economic and social progress - reducing life expectancy by years, deepening poverty, and contributing to and exacerbating food shortages. (excerpt)
Making excellence a strategic outcome.
The year 2005 has been a year of operationalizing a new vision in the South Asia Region (SAR). It has been a year during which, as a family, we in the SAR, have jointly dreamed a new vision - a vision that compromises for nothing else but excellence and a vision that thinks innovation, moving the cognitive outside of the stereotypical box The IPPF SAR family came to a visionbuilding workshop in New Delhi in November 2004 with a determination to evolve a new identity by visioning a shared set of standards and values and visualizing what the organization COULD be like and SHOULD be like. Some realizations dawned as we deliberated. We realized that the special niche that family planning programmes had created was no longer occupying an important space in the development agenda of countries in South Asia. We also realized that we were living in a glorious past and often seemed to permit mediocrity as an acceptable benchmark. (excerpt)
Proper IUD use requires training.
Women must be fully informed about the intrauterine device (IUD) before choosing it, and health care workers must be adequately trained to insert the device, if the IUD is to be used properly. "Many providers are not comfortable with the method," says Dr. Roberto Rivera, FHI corporate director for international medical affairs, who notes that good training can improve access to the method. "For wide-scale IUD use, providers need to have a commitment that they are doing something for the benefit of the client, to improve the health and life of the woman. Then they are willing to spend whatever time is necessary to help the client select the method of her choice and provide it under the conditions that are required." Providing the IUD takes more time than do many other methods. Good IUD services require good client screening and counseling, a pelvic exam, assuring that no pregnancy or infection is present, good insertion technique, proper follow-up, and management of side effects. (excerpt)
Key precautions minimize PID risk.
Understanding the relationship of the intrauterine device (IUD) to sexually transmitted diseases (STDs), pelvic inflammatory disease (PID) and infertility has improved in recent years. Studies have shown that the risks of infection associated with IUD use are greater for certain clients (those at high risk of acquiring a sexually transmitted disease) and at certain times (within the first few months after insertion). This new knowledge has enabled family planning programs to develop criteria to determine who is an appropriate candidate for IUD use, and who is not. Numerous studies have shown that IUDs by themselves do not cause PID, and for most IUD users, fertility returns quickly after the device is removed. However, IUD use does carry some risk of infection for some women, primarily due to nonsterile insertion techniques or the clients' STD exposure. (excerpt)
Intrauterine devices (IUDs) have no systemic health effects or harmful side effects except an increased risk of anemia, making them among the most attractive of all contraceptive methods. "Copper IUDs are popular in many countries because they are safe, in addition to being convenient and effective," says FHI's Gaston Fair, who has coordinated multicountry clinical trials involving the Copper T. In countries where the IUD is not widely used, misinformation about health concerns can be a significant barrier to use. Copper-bearing IUDs are not a direct cause of pelvic inflammatory disease (PID), although users face some risk of PID when the device is inserted under unsterile conditions. Also, women at high risk of a sexually transmitted disease (STD) usually are not good candidates for IUD use because of a correlation between STDs and PID. There is no evidence that IUDs increase the risk of cervical, uterine or endometrial cancer. However, women with known or suspected cancer of the uterus or endometrium, or undiagnosed vaginal bleeding, are not good candidates for the IUD. IUDs, like some uterine cancers, may cause uterine bleeding between menstrual periods. Bleeding abnormalities could be attributed to the IUD in error, and the real reason for bleeding overlooked. (excerpt)
IUD insertion timing vital in postpartum use.
As a contraceptive used during the postpartum period, the IUD has a distinct advantage: It does not affect breastfeeding, as do many systematic contraceptive methods. The postpartum period may also be a convenient time during a woman's life to have an IUD inserted, since it may be one of the few times she is in contact with medical services. In addition, IUDs do not require regular user compliance. Coital-dependent methods may be used inconsistently during the postpartum period by couples who think conception is less likely this during period. Also, if a woman says she wants no more children but has not had time to consider sterilization carefully, an IUD offers a reversible alternative. Timing of insertion, counseling, provider training and programmatic support are critical factors for IUD use during the postpartum period. The timing of insertion is important primarily because it influences the risk of expulsion. Expulsion can leave a woman unprotected from pregnancy without her realizing it. Ideally, postpartum insertion should take place within 10 minutes of placental delivery ( immediate postplacental) or at about six weeks after birth, when a woman returns for routine postpartum care visit. (excerpt)
A new IUD available in few countries uses a synthetic hormone to achieve a high rate of long-acting contraceptive, typically with less bleeding than any other type of currently available IUD. Menstrual bleeding is reduced in all women who use the levonogestrel (LNg) releasing device, in some by so much that they hardly bleed at all. The LNg IUD can be inserted early in a woman's reproductive life and its contraceptive effect is reversible. The device combines the high efficacy of modern hormonal contraceptives, such as injectables, with the convenience of intrauterine contraception. The device is available in Europe and Singapore. Since it has not yet been approved by the U.S. Food and Drug Administration for use in the United States, it is not available through the U.S. Agency for International Development, which provides contraceptive commodities to many developing countries. The LNg IUD, also known as the LNg-20 IUD because it releases 20 micrograms of levonorgestrel daily, is manufactured by Leiras Pharmaceuticals in Turku, Finland. It received approval for use in Finland in 1900 and in Sweden, Norway and Denmark in 1992, where it is marketed under the brand name Levonova, and in Singapore and the United Kingdom in 1995, where it is sold as Mirena. (excerpt)
Newer OCs and blood clot risks.
Recent news reports in Europe and elsewhere have mentioned a possible link between the use of oral contraceptives (OCs) containing the newest formulations of progestins and the development of blood clots. Family Health International recently provided background materials to scientist and health providers worldwide to help clarify this relationship. The following is from a "Question and Answer Sheet circulated by FHI. Oral contraceptives (OCs) have been studied for years. Why have concerns about cardiovascular risks been raised now? A large epidemiological study, designed to gain more information on contraceptive use and cardiovascular disease, has been conducted by the World Health Organization (WHO). While study results are preliminary, some results were published in British newspapers. According to a news release from WHO, these preliminary study results suggest that users of combined oral contraceptives containing estrogen and the newest synthetic progestins, desogestrel and gestodene, appearedto have twice the risk of venous thromboembolism (blood clots) than users of pills containing the older progestins, levonorgestrel and norethindrone. (excerpt)
Use of an intrauterine levonorgestrel (SIU-LNG) delivery system (Mirena 52mg has become popular in recent years, particularly among younger women. Mirena is currently the contraceptive method of choice used as an alternative to classical copper-containing intrauterine devices after oral contraception. The purpose of this study was to evaluate patient satisfaction among young women during the first year of use of the intrauterine hormonal system. This multicentric phase IV trial with a non-comparative methodology was conducted among 211 young women aged 25-35 years. The SIU-LNG was prescribed for women who wanted to change their contraception after oral estrogen progesterone taken for at least three months prior to inclusion in the study. A total of 211 patients were included and review was planned at one year: 197 patients (93.36%) were reviewed. Mean patient age was 31.48 ± 3.25 years. The SIU-LNG was inserted successfully at the first attempt in 99.05% of women. The continuation rate was 85.65%at one year. Evaluation of cycle characteristics showed less voluminous blood loss and fewer dysmenorrheal phenomena as well as, in 40%, the development of amenorrhea. At the last visit, 85% of women were satisfied or very satisfied with this method of contraception. As has been demonstrated in earlier studies, Mirena offers a contraception with a reliability equivalent to that of oral estrogen progesterone (IP: 0 - 0.2), with very few hormonal side effects due to the low plasma passage of levonorgestrel. Mirena is particularly well adapted for young women who desire a reliable long-term easy-to-use contraception after taking oral contraception. (author's)
At the UN, Baha'is host panel on violence against women.
UNITED NATIONS -- Stemming the global tide of violence against women will require changes in deeply rooted attitudes that for the most part transcend culture and national borders, said participants in a panel discussion here on 8 September 2006. Titled "Beyond Violence Prevention: Creating a Culture to Enable Women's Security and Development," the discussion was hosted by the Baha'i International Community and the International Presentation Association. It was held as part of the 59th Annual United Nations Department of Public Information/ Non-Governmental Organization conference. The panelists agreed that violence against women remains a severe problem in almost every nation and culture. "We all know that at least one out of every three women around the world has been beaten, coerced into sex, or otherwise abused in her lifetime," said Letty Chiwara, a program specialist with the Africa section of the United Nations Fund for Women (UNIFEM). In some places, such as rural Ethiopia, some 71 percent of women are abused, she said. "Harmful traditional practices -- female genital mutilation, dowry murder, the so-called honor killings, and early marriage -- bring death, disability, and psychological dysfunction for millions of women," said Ms. Chiwara. (excerpt)
Raising public awareness on population and human development.
The public's perceptions and endorsement of certain issues affect the enactment of proposed policy measures. Therefore, in any advocacy endeavor, efforts are made to influence public opinion. In order to gain public support, it is essential that the public be made aware of how the issue would directly affect their lives. Thus, PLCPD launched Talkpoint Radio in recognition of broadcast media's effectiveness in reaching the public. By informing the public on population and human development issues through Talkpoint Radio, PLCPD aims to raise public awareness and critical thinking on the said issues, and consequently, public support for these areas of advocacy as well. The radio production is part of a three-year communications and research project titled "Involving Legislators in Informing the Public on Reproductive Health Issues," with funding assistance from the Ford Foundation. Talkpoint Radio Talkpoint Radio started broadcast in August 1999 to become the first and only human development, population, and reproductive health-centered radio program in the country. Talkpoint began as a special segment in Womantouch, a daily radio program in DZRM that tackles gender issues. Talkpoint served as a medium for meaningful debate and interactive discussions on reproductive health, population, and human development issues, as well as a source of news on legislative and civil society advocacy efforts. (excerpt)
What works in fighting diarrheal diseases in developing countries? A critical review.
The Millennium Development Goals call for reducing by half the proportion of people without sustainable access to safe drinking water. This goal was adopted in large part because clean water was seen as critical to fighting diarrheal disease, which kills 2 million children annually. There is compelling evidence that provision of piped water and sanitation can substantially reduce child mortality. However, in dispersed rural settlements, providing complete piped water and sanitation infrastructure to households is expensive. Many poor countries have therefore focused instead on providing community-level water infrastructure, such as wells. Various traditional child health interventions have been shown to be effective in fighting diarrhea. Among environmental interventions, handwashing and point-of-use water treatment both reduce diarrhea, although more needs to be learned about ways to encourage households to take up these behavior changes. In contrast, there is little evidence that providing community-level rural water infrastructure substantially reduces diarrheal disease or that this infrastructure can be effectively maintained. Investments in communal water infrastructure short of piped water may serve other needs and may reduce diarrhea in particular circumstances, but the case for prioritizing communal infrastructure provision needs to be made rather than assumed. (excerpt)
With more than 800 VCT centers spread all over Kenya (NASCOP 2006), VCT services are now an important entry point for HIV prevention, treatment, and care. During pre-test counseling, clients are given information on modes of HIV transmission and triggers of risky behavior. Thus, the VCT setting offers an optimal venue for discussing alcohol as a factor in HIV transmission and for helping clients formulate a risk-reduction plan. Because both HIV and alcohol abuse are stigmatized, VCT centers can offer a supportive atmosphere to bring up risk behaviors that are otherwise uncomfortable to discuss, and can offer appropriate referrals. In order to document whether there is an unmet need for alcohol counseling among VCT clients in Kenya, focus group discussions and exit interviews were conducted in a variety of VCT service delivery points. This research is part of a larger operations research project being implemented by the Horizons Program, Liverpool VCT and Care, and the Steadman Group. Its goal is to provide information on the alcohol and substance use counseling needs of clients seeking HIV services, and provide guidance on how substance use can be effectively integrated into HIV counseling and testing. (excerpt)
The papers in this volume are a selection of those presented at the Conference on Understanding Gender Inequalities in Kenya, held at Egerton University, Kenya, from 5th to 8th April 2004. Organised by the Centre (now Institute) for Women's Studies and Gender Analysis at Egerton, in conjunction with the Department of Comparative and Applied Sciences at the University of Hull, it brought together academics from inside and outside Kenya, practitioners and politicians to explore the many dimensions of women's subordination and to discuss ways of confronting the entrenched legacy of male domination. Despite many years of academic analysis and practical feminist activity, despite prestigious international resolutions and declarations of intent, despite the increased prominence of women's issues in the discourses of governmental and non-governmental organisations alike, progress towards gender equality is still painfully slow. Moreover, just as advances seem to be made on particular fronts, new problemsemerge. Economic restructuring, the crisis of the state, the explosion of ethnic conflicts and the toll of HIV/AIDS are all examples of issues which have had a profound impact on gender relations and perhaps nowhere have women felt their effects quite so sharply as in sub-Saharan Africa. Given the scope and speed of contemporary change it is thus essential to keep the changing patterns of gender relations under continual examination, to monitor the extent to which progress is being made towards women's emancipation and to interrogate the adequacy of prevailing strategies towards this goal. (excerpt)
The aims were to explore whether the low HIV prevalence observed in Bangladesh results from prevention activities, this study uses mathematical modelling to estimate the impact of a needle/syringe exchange intervention for injecting drug users (IDUs) in Dhaka, Bangladesh. Epidemiological, behavioural and intervention monitoring data were used to parameterize a dynamic mathematical model, and fit it to National HIV Sero-surveillance data among IDUs (2000-02). The model was used to estimate the impact of the intervention on HIV transmission among IDUs and their sexual partners. Dhaka, Bangladesh, where the HIV prevalence has remained low despite high-risk sexual and injecting behaviours, and growing HIV epidemics in neighbouring countries. The model predicts that the intervention may have reduced the incidence of HIV among IDUs by 90% (95% CI 74-94%), resulting in an IDU HIV prevalence of 10% (95% CI 4-19%) after 8 years of intervention activity instead of 42% (95% CI 30-47%) if the intervention hadnot occurred. The analysis highlights the potential for rapid HIV spread among IDUs in Dhaka, and suggests that the intervention may have substantially reduced IDU HIV transmission. However, there is no room for complacency. Sustained and expanded funding for interventions in Dhaka and other regions of Bangladesh are crucial to maintaining the low HIV prevalence. (author's)
Alcohol use in pregnant and nonpregnant Russian women.
Alcohol consumption in Russia is reportedly high for both men and women; most studies of Russian drinking have used questionnaires not designed specifically to measure alcohol consumption or to interview women. This study was designed specifically to measure drinking patterns among pregnant and nonpregnant Russian women. Eight hundred ninety-nine women of child-bearing age in St. Petersburg, Russia, were interviewed in employment centers, educational centers, and at obstetric and gynecologic (OB/GYN) clinics and hospitals. Measurement of drinking used several types of drinking questions and time frames. Nearly all nonpregnant Russian women (95.9%) reported consuming alcohol in the last 12 months. Among nonpregnant women drinkers, 7.6% reported drinking heavily (29.58 mL or more ethanol/d), and 18.4% reported drinking = 5 on at least 1 occasion. Contrary to expectations of Russian obstetricians, pregnant Russian women readily answered detailed questions about their drinking behavior during pregnancy. Nearly all pregnant women drank in the year before they became pregnant; of these, 60.0% reported drinking when they knew they were pregnant, and 34.9% drank in the past 30 days. Among pregnant women who drank in the past 30 days, 7.4% reporting having = 5 drinks on at least 1 occasion. Nevertheless, more than 90% of pregnant and nonpregnant Russian women believed that alcohol has a detrimental effect on pregnancy outcomes. Pregnant and nonpregnant Russian women were willing to answer detailed questions about their drinking behavior. Although most pregnant women studied reduced their drinking during pregnancy, one-third of the pregnant women did not stop drinking. It is important to find out what enabled two-thirds of the pregnant women to stop drinking before or during their pregnancy. (author's)
Designing snacks to address micronutrient deficiencies in rural Kenyan schoolchildren.
Three snacks were designed to improve nutrient intakes among school-age children living in rural Kenya. Snacks containing animal-source foods (milk and meat) provided more nutrients than an equicaloric vegetarian snack. The vegetarian snack provided extra vitamin A (primarily from fortified cooking fat; the milk snack was rich in calcium, vitamin A, and vitamin B-12; and the meat snack supplied vitamin B-12, iron, and zinc. When changes in intakes from baseline to the feeding period were compared across the 4 groups, total energy intake increased the most for children in the meat group and the least for children in the control group. Differences in energy intakes across the 3 feeding groups were primarily caused by decreases in home intake for the vegetarian and milk snack groups. It is important to evaluate the change in home intakes as well as intakes from the foods provided by the study when evaluating the effect of feeding programs on nutrient adequacy. (author's)
We evaluated the effectiveness of a 2-mo treatment of Sprinkles containing 12.5 mg iron, 5 mg zinc, 400 µg vitamin A, 160 µg folic acid, and 30 mg vitamin C in reducing anemia among children 9- to 24 mo old in Haiti. Ten food distribution points (FDP) where children received take-home rations of fortified wheat-soy blend (WSB) were randomly allocated into 2 groups: 1) Sprinkles-WSB (S-WSB) (6 FDP; n = 254), receiving 30 sachets of Sprinkles monthly for 2 mo; and 2) WSB only (WSB) (4 FDP; n = 161), not receiving Sprinkles. At baseline, anemia prevalence [hemoglobin (Hb) < 100 g/L], adjusted for age and sex, was 54 and 39%in S-WSB and WSB groups, respectively. After the 2-mo intervention (1st follow-up), anemia, adjusted for baseline prevalence, age, and sex dropped to 24% in S-WSB (P < 0.001) and increased to 43% in WSB (P = 0.07). At 7-mo postintervention, anemia in S-WSB declined to 14%; 92% of children who were nonanemic at 1st follow-up remained so without further Sprinkles consumption. From baseline to 1st follow-up, mean Hb increased by 5.5 g/L and dropped by 1.0 g/L in the S-WSB and WSB groups, respectively (P < 0.001). From baseline to 2nd follow-up, mean Hb increased by 10.9 g/L in S-WSB (P < 0.001). Changes in mean Hb were greater for younger children (< 21 mo at onset of intervention) (P < 0.05) and for children who were anemic at baseline (P < 0.001). In populations with a high prevalence of anemia, such as rural Haiti, 2 mo of Sprinkles are effective in reducing anemia among 9- to 24-mo-old children. (author's)
Although failure of tuberculosis (TB) control in sub-Saharan Africa is attributed to the HIV epidemic, it is unclear why the directly observed therapy short-course (DOTS) strategy is insufficient in this setting. We conducted a cross-sectional survey of pulmonary TB (PTB) and HIV infection in a community of 13,000 with high HIV prevalence and high TB notification rate and a well-functioning DOTS TB control program. Active case finding for PTB was performed in 762 adults using sputum microscopy and Mycobacterium tuberculosis culture, testing for HIV, and a symptom and risk factor questionnaire. Survey findings were correlated with notification data extracted from the TB treatment register. Of those surveyed, 174 (23%) tested HIV positive, 11 (7 HIV positive) were receiving TB therapy, 6 (5 HIV positive) had previously undiagnosed smear-positive PTB, and 6 (4 HIV positive) had smear-negative/culture-positive PTB. Symptoms were not a useful screen for PTB. Among HIV-positive and -negative individuals, prevalence of notified smear-positive PTB was 1,563/100,000 and 352/100,000, undiagnosed smear-positive PTB prevalence was 2,837/100,000 and 175/100,000, and case-finding proportions were 37 and 67%, respectively. Estimated duration of infectiousness was similar for HIV-positive and HIV-negative individuals. However,87% of total person-years of undiagnosed smear-positive TB in the community were among HIV-infected individuals. PTB was identified in 9% of HIV-infected individuals, with 5% being previously undiagnosed. Lack of symptoms suggestive of PTB may contribute to low case-finding rates. DOTS strategy based on passive case finding should be supplemented by active case finding targeting HIV-infected individuals. (author's)
Fish is important in the diets and livelihoods of many poor people suffering from vitamin and mineral deficiencies. In this article, fish intake in rural Bangladesh and Cambodia and the vitamin A, calcium, iron, and zinc contents and nutrient bioavailability of commonly consumed species are presented. The contribution of these species to nutrient intakes as well as their potential to meet dietary recommendations are presented and discussed. Data from consumption surveys were analyzed to obtain fish intake by species. Commonly consumed species were analyzed for nutrient contents, and studies on nutrient bioavailability were conducted. In poor, rural, Bangladeshi households, mean fish intake was 13--83 g raw, whole fish per person/d. Frequency of intake of small fish was high, and small fish made up 50--80% of all fish eaten during the fish production season in rural Bangladesh and Cambodia. Many small fish are eaten whole and therefore are a rich calcium source; some are also rich in vitamin A, iron, and zinc. Even small production of the vitamin A--rich fish mola in ponds in Bangladesh can meet the annual vitamin A recommendation of 2 million children, and a traditional daily meal with the iron-rich fish trey changwa plieng can meet 45% of the daily median iron requirement of Cambodian women. Fish consumption data on the species level, nutrient analyses, awareness of the nutritional value of fish, as well as promotion of the production and accessibility of nutrient-dense species can lead to the use of fish in food-based strategies to combat nutrient deficiencies in poor people in Asia and Africa. (author's)
A nutribusiness strategy for processing and marketing animal-source foods for children.
Nutritional benefits of animal source foods in the diets of children in developing countries indicate a need to increase the availability of such foods to young children. A nutribusiness strategy based on a dried meat and starch product could be used to increase children's access to such foods. The "Chiparoo" was developed at The Pennsylvania State University with this objective in mind. Plant-based and meat ingredients of the Chiparoo are chosen based on regional availability and cultural acceptability. Chiparoo processing procedures, including solar drying, are designed to ensure product safety and to provide product properties that allow them to be eaten as a snack or crumbled into a weaning porridge. Continued work is needed to develop formulation and processing variations that accommodate the needs of cultures around the world. (author's)
Zinc deficiency: a special challenge.
In the development and testing of programs designed to improve complementary feeding globally, local nonfortified food-based solutions comprise an important strategy for the foreseeable future. These solutions are especially vital for the rural poor of less-developed countries. Zinc is notable among individual nutrients that have been designated as "problem" nutrients, adequate intake of which is difficult from complementary foods without fortification. This article considers the potential role of meat ± liver in addressing this apparent problem. In a recent Colorado study, beef and cereal have been determined to be equally acceptable between age 5-7 mo as first and regular complementary foods. Average intake and absorption of Zn from beef by 7 mo of age, together with the modest intake/absorption of Zn from breast milk at that age, were adequate to meet average dietary and physiologic zinc requirements, respectively. Barriers to acceptability and availability of affordable meat are considered, but these are neither universal nor irresolvable in all populations. (author's)
Meat supplementation improves growth, cognitive, and behavioral outcomes in Kenyan children.
A randomized, controlled school feeding study was conducted in rural Embu District, Kenya to test for a causal link between animal-source food intake and changes in micronutrient nutrition and growth, cognitive, and behavioral outcomes. Twelve primary schools were randomly assigned to 1 of 4 groups. Children in Standard I classes received the local plant-based dish githeri as amid morning school snack supplemented with meat, milk, or fat added to equalize energy content in all feedings. The Control children received no feedings but participated in data collection. Main outcome measures assessed at baseline and longitudinally were 24-h food intake recall, anthropometry, cognitive function, physical activity, and behaviors during school free play. For cognitive function, the Meat group showed the steepest rate of increase on Raven's Progressive Matrices scores and in zone-wide school end-term total and arithmetic test scores. The Plain githeri and Meat groups performed better over time than the Milkand Control groups (P < 0.02-0.03) on arithmetic tests. The Meat group showed the greatest increase in percentage time in high levels of physical activity and in initiative and leadership behaviors compared with all other groups. For growth, in the Milk group only younger and stunted children showed a greater rate of gain in height. The Meat group showed near doubling of upper midarm-muscle area, and the Milk group a smaller degree of increase. This is the first randomized, controlled feeding study to examine the effect of meat- vs. milk- vs. plant-based snacks on functional outcomes in children. (author's)
Dietary quality is an important limiting factor to adequate nutrition in many resource-poor settings. One aspect of dietary quality with respect to adequacy of micronutrient intakes is bioavailability. Several traditional household food-processing and preparation methods can be used to enhance the bioavailability of micronutrients in plant-based diets. These include thermal processing, mechanical processing, soaking, fermentation, and germination/malting. These strategies aim to increase the physicochemical accessibility of micronutrients, decrease the content of antinutrients, such as phytate, or increase the content of compounds that improve bioavailability. A combination of strategies is probably required to ensure a positive and significant effect on micronutrient adequacy. A long-term participatory intervention in Malawi that used a range of these strategies plus promotion of the intake of other micronutrient-rich foods, including animal-source foods, resulted in improvements in both hemoglobin and lean body mass and a lower incidence of common infections among intervention compared with control children. The suitability of these strategies and their impact on nutritional status and functional health outcomes need to be more broadly assessed. (author's)
Assuming a higher risk of latent tuberculosis (TB) infection in the population of Rio de Janeiro, Brazil, in October of 1998 the TB Control Program of Clementino Fraga Filho Hospital (CFFH) routinely started to recommend a two-step tuberculin skin test (TST) in contacts of pulmonary TB cases in order to distinguish a boosting reaction due to a recall of delayed hypersensitivity previously established by infection with Mycobacterium tuberculosis (M.tb) or BCG vaccination from a tuberculin conversion. The aim of this study was to assess the prevalence of boosted tuberculin skin tests among contacts of individuals with active pulmonary tuberculosis (TB). Retrospective cohort of TB contacts = 12 years old who were evaluated between October 1st, 1998 and October 31st 2001. Contacts with an initial TST = 4 mm were considered negative and had a second TST applied after 7-14 days. Boosting reaction was defined as a second TST = 10 mm with an increase in induration = 6 mm related to the first TST. All contacts with either a positive initial or repeat TST had a chest x-ray to rule out active TB disease, and initially positive contacts were offered isoniazid preventive therapy. Contacts that boosted did not receive treatment for latent TB infection and were followed for 24 months to monitor the development of TB. Statistical analysis of dichotomous variables was performed using Chi-square test. Differences were considered significant at a p < 0.05. Fifty four percent (572/1060) of contacts had an initial negative TST and 79% of them (455/572) had a second TST. Boosting was identified in 6% (28/455). The mean age of contacts with a boosting reaction was 42.3 ± 21.1 and with no boosting was 28.7 ± 21.7 (p = 0.01). Fifty percent (14/28) of individuals whose test boosted met criteria for TST conversion on the second TST (increase in induration = 10 mm). None of the 28 contacts whose reaction boosted developed TB disease within two years following the TST. The low number of contacts with boosting and the difficulty in distinguishing boosting from TST conversion in the second TST suggests that the strategy of two-step TST testing among contacts of active TB cases may not be useful. However, this conclusion must be taken with caution because of the small number of subjects followed. (author's)
Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program. A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. HIV was not considered a priority issue by all study participants and external funding for the program was thought to have been accepted because of poor foreign currency reserves and donor agency influence rather than local need. Political influences from the federal government and donor agencies were thought to manipulate distribution of funds within the program. These influences were thought to occur despite the existence of a well-laid out procedure to determine allocation of public resources. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise, paucity of information and an atmosphere of ad hoc decision making were thought to reduce resistance to external pressures. Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, to enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening available databases for effective decision making is required to make financial allocations based on real, rather than perceived needs. With a large part of HIV program funding dedicated to public-private partnerships, it becomes imperative to develop public sector capacity to administer contracts, coordinate and monitor activities of the non-governmental sector. (author's)
High HPV genetic diversity in women infected with HIV-1 in Brazil.
The present study on genetic diversity of human papillomaviruses in women infected by HIV in Brazil describes the frequency, the genotypes, and five new variants of HPV. One hundred fifty cervical smears of HIV-positive women were subjected to cytological examination, and the DNA samples obtained were assayed by MY09/MY11 amplification, followed by RFLP typing. The overall HPV-DNA-positive rate was 42.7%. One hundred twenty-two samples (81.3%) had benign cellular alterations or normal cytological results, and HPV DNA frequency among them was 30.3%. Otherwise, 96.4% of samples with altered cytology were positive for HPV-DNA. A high diversity of genotypes was observed. HPVs-16 and 81 were the most prevalent (14.1%) and were followed by HPVs 52, 35, 62, 33, 53, 56, 66, 70, 18, 58, 6b, 11, 31, 39, 40, 61, 71, 32, 54, 59, 67, 68, 85, and 102. Five new variants of the high-risk HPVs 18, 33, 53, 59, and 66 were detected. Possible associations between the detection of HPV genotypes and the cytological classification, HIV viral load, CD4 count, and antiretroviral treatment were also examined. We observed that a high proportion of HIV-infected women are infected with HPV and may carry oncogenic genotypes, even when cytological evaluation shows normal results. (author's)
Maternal depression increases infant risk of diarrhoeal illness: -- a cohort study.
The aims were to examine the associations between postnatal depression in mothers and diarrhoeal illness in their infants in the first year of life in a low-income country. Using a prospective cohort design, 265 infants (n = 130 of mothers having a depressive episode according to the International Classification of Diseases, 10th revision, at 3 months postnatal and n = 135 of psychologically well mothers) living in rural Rawalpindi, Pakistan, were followed up for 1 year. Frequency of diarrhoeal episodes was measured fortnightly by health workers using a standard questionnaire. Infants of depressed mothers had significantly more diarrhoeal episodes per year than those of controls (mean 5.5 v 4.0; 95% confidence interval (CI) 0.9 to 2.0). The relative risk of having >5 diarrhoeal episodes per year in infants of depressed mothers was 2.3 (95% CI 1.6 to 3.1). The association remained significant after adjustment for other risk factors by multivariate analysis. Maternal depression is associated with infant diarrhoeal morbidity in a low-income community setting. It is independent of the effects of known factors such as undernutrition, socioeconomic status and parental education. Preventive child health programmes targeting mothers must consider their mental health. (author's)
Diarrheal diseases in the history of public health.
While the public health threat of HIV/AIDS in developing countries has drawn increasing attention from the international community for more than two decades, other health problems such as diarrheal diseases continue to contribute to higher morbidity and mortality rates in much of the developing world. This literature review is an account of both the history and current risks associated with diarrheal diseases. (author's)
In short-term studies, hormonal contraceptives (HC) have been suggested to induce a rise in blood pressure (BP) and urinary albumin excretion (UAE), while the effect of HC in renal function (GFR) is still under debate. Data on long-term and withdrawal effects of HC use on these outcomes are, however, not available. We therefore studied whether the start and cessation of HC induce changes in BP, UAE and GFR. We used data from the PREVEND Study, a prospective cohort of subjects aged 28-75 years. Eligible were women aged = 45 years with complete clinical and pharmacy data on baseline and follow-up screening (4 years later). Multivariate regression analysis was used to estimate the effects of HC on BP, UAE and GFR in those who started (n = 73), stopped (n = 117) or continued (n = 183) with those who never used HC (n = 286) as the reference group. BP increased among starters and fell in stoppers. These changes compared with never-users were statistically significant, even after adjustment for relevant variables. UAE increased by 14.2% in starters (P = 0.074) and fell by 10.6% in stoppers (P = 0.021), while GFR fell by 6.3% in starters ( P < 0.001) and did not change in stoppers. The effects of stopping HC on UAE and GFR were significantly different compared with changes among never-users, even after adjustment for other variables (P = 0.023 and 0.036, respectively). The start of HC was independently associated with worsening of BP, UAE and GFR, while stopping HC use resulted in an improvement. These data suggest that long-term HC use (aged 28-45 years) may be deleterious from the cardiovascular and renal point of view, but stopping may result in correction of these effects. (author's)
Isotretinoin, pregnancies, abortions and birth defects: a population-based perspective.
The aims were to estimate the population-based incidence rates of pregnancy, spontaneous and elective abortions, and birth defects associated with isotretinoin use, and to determine predictors of pregnancy while on isotretinoin. Using the RAMQ (medical and pharmaceutical data), MED-ECHO (hospitalizations) and ISQ (births and deaths) databases for the period 1984--2002, a cohort of 8609 women between 13 and 45 years of age and with a first prescription for isotretinoin (date of entry in the cohort) was identified. Women were eligible if they were insured by RAMQ for their medications at least 12 months before entry in the cohort and until 1 month after the end of their isotretinoin treatment. Pregnancies, spontaneous and elective abortions, and birth defects were identified using procedure codes and medical diagnoses. Of the 8609 women included, 90 became pregnant, an annual incident pregnancy rate during isotretinoin treatment of 32.7 per 1000 person-years of treatment (95% confidence interval 26.6, 40.1). Of the 90 women who became pregnant while on the drug, 76 terminated the pregnancy (84%), three had a spontaneous abortion (3%), two had trauma during delivery resulting in neonatal deaths (2%) and nine had a live birth (10%). Among the live births, only one had a congenital anomaly of the face and neck (11%). Adjusting for potential confounders, predictors of becoming pregnant while on isotretinoin were lower socio-economic level, one or more visits to the doctor or to the emergency department, or one or more hospitalization while on isotretinoin; concomitant isotretinoin and oral contraceptive use had a preventive effect. This first non-interventional population-based study generated incidence rates of pregnancy while on isotretinoin four times greater than what has been reported in the literature thus far; elective abortion rates were also much higher in our study. This shows the importance of using population-based data for public health purposes. (author's)
The aim of this cross-sectional analysis was to examine the skeletal effects of low-dose monophasic oral contraceptive (OC) use in a cohort of 248 young Caucasian women aged 18-24 years. A real bone mineral density (BMD) of the femoral neck and lumbar spine was evaluated by dual-energy X-ray absorptiometry. Volumetric BMD, bone mineral content (BMC), and bone geometry were assessed in the tibia by peripheral quantitative computed tomography (pQCT). The women were allocated into ever or never OC users, and also into 5 different OC groups according to duration and time of initiation of OC use. Women with >2 years of OC use and OC initiation within 3 years after menarche were characterized by 10% lower femoral neck areal BMD (P < 0.001), 5% lower spine areal BMD (not significant, P = 0.101), 7% lower distal tibial total BMC (P < 0.05), and 6% lower total BMC at the tibial shaft (P < 0.05) relative to never users. In addition, women who had ever used OCs had lower bone mass at the femoral neck and tibial shaft, despite similar age, height, weight, BMI, hours of exercise, and calcium intake compared with never users. At the tibial shaft, OC users showed reduced total cross-sectional area, and increased cortical BMD. In conclusion, our data suggest that OC use is associated with a detrimental effect on bone mass in young women, and provide further insight into the pathophysiological mechanisms involved. (author's)
The abortion debate in Mexico: Realities and stalled policy reform.
Over 500,000 clandestine abortions occur annually in Mexico, many under unfavourable health conditions. An uneasy silence about this situation has long prevailed. Since the 1970s, abortion has appeared periodically in public discourse and on the decision-making agenda, only for action to be repeatedly postponed. Mobilisation around the abortion issue grew slowly, but debate and controversy became nationwide as the country began to experience systemic change in 2000. Despite increasing political pluralism and growing awareness of the existing problems, for now in Mexico, as elsewhere in Latin America, the question of abortion is not judged sufficiently pressing to merit major policy change. However, improved contraceptive use and the institution of new technologies and post-abortion care are helping to make abortions safer and rarer. (author's)
Traditional herbal medicine is predominantly practiced by the rural people of India, especially remote areas such as the Uttara Kannada District in Western Ghats of Karnataka. Local traditional healers play an important role in the management of reproductive health problems of the native population due to socioeconomical and geographical factors. In the present study, 92 traditional medicine practitioners/healers from various regions of Uttara Kannada district were interviewed to collect information on the use of herbal treatments for a range of female and male reproductive disorders. Information was also collected on the method of preparation, dose and duration along with the botanical names, family and local names of the medicinal plants. The plants were then collected and identified. A total of 18 formulations from 25 plant species belonging to 17 families were identified, which are commonly used to treat 12 different reproductive ailments. This study identifies herbal remedies not previously documented, that are used by indigenous people in the treatment of reproductive disorders. Additionally, the paper highlights the need to retain and explore the rich biodiversity associated with Indian rain forests that may result in the discovery of new medical treatments. Finally, this paper notes the continuing reliance on herbal medicines and healing traditions by local people in remote areas. Understanding and working with local healers and tribes provides a unique opportunity to learn about the use of potentially new herbal and plant medications. (author's)
Male circumcision as a preventive measure against HIV and other sexually transmitted diseases.
In 2005, 4.1 million people were infected with HIV. There is an urgent need to intensify and expand HIV prevention methods. Male circumcision is one of several potential approaches. This review summarizes recent evidence for the potential of male circumcision to prevent HIV and other sexually transmitted infections. The first randomized controlled trial of adult male circumcision found a highly significant 60% reduction in HIV incidence among men in the intervention arm. Modelling this effect predicts that widespread implementation of male circumcision could avert 2 million HIV infections over the next decade in sub-Saharan Africa. The biological rationale is that the foreskin increases risk of HIV infection due to the high density of HIV target cells and lack of keratinization of the inner mucosal surface. There is strong evidence that male circumcision reduces risk of HIV, syphilis and chancroid. If results are confirmed by two ongoing trials in sub-Saharan Africa, provision of safe male circumcision could be added to HIV prevention packages in high-incidence settings. This would also provide an opportunity for HIV-prevention education and counselling to young men at high risk of infection. (excerpt)
The purpose of review was to describe the impact of highly active antiretroviral therapy on the burden of pneumococcal disease and advances in our understanding of the impact of HIV on this disease. Although highly active antiretroviral therapy has reduced the burden of pneumococcal disease among HIV-infected adults, these infections remain far more common than in HIV uninfected adults. HIV-infected adults who smoke or have comorbidities are at particular risk. In the absence of highly active antiretroviral therapy, pneumococcal meningitis has emerged in Africa as a major disease burden with a high mortality among HIV-infected children and adults. Conjugate pneumococcal vaccine protects HIV-infected infants from pneumococcal pneumonia. In the United States, where conjugate vaccine is given to children, herd immunity has reduced the burden of invasive pneumococcal disease among HIV-infected adults. The pneumococcus remains a significant cause of morbidity and mortality among HIV-infected children and adults, both in developed and in developing countries. (excerpt)
Sexually transmitted disease and gender roles: an index of cultural evolution.
In the last 25 years of the 20th century, two events occurred that may affect cultural evolution into the foreseeable future. First, birth rates in a number of industrialized nations dropped below the level of population maintenance, and, second, the HIV/AIDS virus emerged, spread, and became embedded and endemic in many nations. The relationship between the spread of HIV/AIDS and several parameters of a nation's demography is empirically examined. Then, three distinct cultural responses to the incidence HIV/AIDS are examined in three regions of the world: Europe, Sub-Saharan Africa, and a Muslim area stretching from Mauritania to Pakistan. (author's)
The purpose of this study was to examine the effects of program interventions in a school-based teen pregnancy program on hypothesized constructs underlying teens' attitudes toward sexuality. An important task related to this purpose was the validation of the constructs and their stability from pre- to postintervention measures. Data from 1,136 middle grade students were obtained from an earlier evaluation of an abstinence-based teen pregnancy prevention program. Latent trait structural equation modeling was used to evaluate the impact of the intervention program on changes in constructs of teens' attitudes toward sexuality. Gender was also taken into consideration. This investigation provides credible evidence that both 1st- and 2nd-order constructs related to measures of teens' attitudes toward risky sexual behavior are sufficiently stable and sensitive to detect program effects. (author's)
Circumcision and HIV transmission.
The purpose was to review the recent literature on male circumcision and its effect on HIV acquisition. The report from the randomized clinical trial of male circumcision in South Africa demonstrating a 60% protective effect in preventing HIV acquisition provided the first clinical trial evidence of efficacy of male circumcision in protecting men against HIV infection. This protective effect was consistent with both ecological and epidemiologic studies which also show a protective effect of 50--70% in men at high risk for HIV infection. Biological studies also demonstrate an increased number of HIV receptor cells in the mucosa of foreskin providing additional evidence of HIV susceptibility in the uncircumcised male. Male circumcision may also have a beneficial effect in preventing HIV acquisition in women and lowering selected sexually transmitted infections in both sexes. The results of two ongoing randomized clinical trials of male circumcision in Kenya and Uganda are awaited with interest, however male circumcision should be carefully considered as a potential public health tool in preventing HIV acquisition. If other trials confirm the results of the South African trial, implementation of this surgical procedure will need to be carefully scaled up and integrated into other prevention programs with emphasis on surgical training, aseptic techniques, acceptability, availability and cultural considerations. (author's)
Headaches and oral contraceptives: impact of eliminating the standard 7-day placebo interval.
The aim was to assess the timing and severity of self-reported headaches in patients utilizing a standard 28-day oral contraceptive (OC) cycle consisting of 21 hormone (estrogen + progestin)-containing pills and 7 placebo pills (ie, 21/7-day cycle) converted to a placebo-free extended OC regimen. An open label single-center prospective analysis of headaches recorded daily on a severity scale of 0 to 10, along with the headache item of the Penn Daily Symptom Rating (DSR17) and a weekly modified Migraine Disability Assessment (MIDAS) headache questionnaire, during standard 21/7-day cycles followed by a 168-day extended placebo-free regimen of an OC containing 3 mg of drosperinone and 30 mcg of ethinyl estradiol (DRSP/EE). Of the 114 patients who began the trial, 111 completed the 21/7-day cycle portion of the study. Based on the headaches scales, there were significant differences in headache severity among the 28 days of the standard 21/7 cycles (P <.001). Greater headache severity occurred on days25 through 28 during the 7-day placebo interval of the 21/7 cycles (P < .05). Of the 111 patients who completed the 21/7 phase of the study, 102 (92%) completed the 168-day extended placebo-free OC regimen. During the first 28 days of the extended placebo-free regimen, daily headache scores decreased (P < .0001) compared to those of the previous 21 active/7 placebo day cycle. The difference on a daily basis was first detected on extended cycle days 25 through 28 (P < .0001) and persisted throughout the remainder of the 168-day regimen. Subjects were divided into 2 groups (severe and mild) based on the median of the total headache score during the 21/7 OC cycle. The group with higher total headache scores demonstrated a significant (P < .0001) reduction in daily headaches beginning in the first 28-day interval of the extended placebo-free regimen, persisting throughout the entire 168-day extended regimen. In contrast, the group with the lower total headache score remained unchanged (P = .79) throughout the extended regimen. Impact of headaches on work, family, and social functions also improved on the extended placebo-free regimen in 6 of 8 measures (P < .05) assessed by weekly headache questionnaires. Compared to a 21/7-day OC regimen, a 168-day extended placebo-free regimen of DRSP/EE led to a decrease in headache severity along with improvement in work productivity and involvement in activities. This is a preliminary study and results may not be widely generalizable. (author's)
The presence of organochlorine pesticides (a-HCH, lindane, aldrin, HCB, pp'-DDE, op'-DDD, pp'-DDD, and op'-DDT) and PCBs (congeners 10, 28, 52, 138, and 180) were investigated in raw, pasteurized, and UHT milk from Rio Grande do Sul State (Brazil). Considering the toxicity of these compounds and the importance of milk and dairy products for child nutrition, the estimated daily intake (EDI) of these compounds, through milk, by elementary school children of Santa Maria (Rio Grande do Sul, Brazil) was also determined. HCB and pp'-DDE were found in all samples analyzed. Pp'-DDE (11.9 ng/g), op'-DDD (7.38 ng/g), lindane (6.09 ng/g), and PCB 180 (5.31 ng/g) were the compounds found at the highest average concentrations. The EDIs for organochlorine pesticides were below the acceptable daily intakes established by FAO/WHO. Furthermore, few samples exceeded the maximum residue limits for the compounds evaluated. (author's)
As Latin Americans' exposure to the USA increases through migration patterns and US political and economic ties to their countries of origin, they become susceptible to adopting not only the cultural expressions of the USA such as fashion, but also the health-related behaviors of the US population. In assessing potential health risks for Salvadoran youth that may result from the connection between Latin Americans and the USA, this study compared the prevalence of health risk behaviors from four behavior domains (aggression and victimization, depression and suicidal ideation, substance use, and sexual behavior) between Salvadoran and US Latino secondary school students aged 14-17 years. A secondary analysis was performed on two 1999 cross-sectional survey data. In the USA, results were based on 1,063 Latino high school students who answered the nationally representative Youth Risk Behavior Survey (YRBS) conducted by the Centers for Disease Control and Prevention. In El Salvador, results were based on 793 public secondary school students who answered a local YRBS survey conducted in coordination with the Ministry of Education of El Salvador. The prevalence rates for aggression/victimization and for depression and suicidal ideation behaviors were similar between Salvadoran and US Latino adolescents. Substance use prevalence, however, was 10-40% higher for US Latino adolescents. While the prevalence of sexual intercourse was higher among US Latino youth (between 13 and 27% higher, depending on age), the prevalence of condom use was lower among sexually active Salvadoran youth (between 11 and 42% lower, depending on age). In the context of the transnationalization of the Salvadoran population, with potential for increased influence of the USA in Salvadoran culture, these differences in risk behavior are important for targeting effective interventions for Latino adolescents in El Salvador and in the USA. (author's)
The association between lower birthweight and metabolic syndrome may result from fetal undernutrition (fetal programming hypothesis) and/or genes causing both low birthweight and insulin resistance (fetal insulin hypothesis). We studied associations between the birthweight of parents and metabolic syndrome in the offspring. We identified men and women (aged 35-68 years), who had been born in Holdsworth Memorial Hospital, Mysore, India. We also identified the offspring (20-46 years) of these men and women. In total, 283 offspring of 193 mothers and 223 offspring of 144 fathers were studied. Investigations included anthropometry, oral glucose tolerance, plasma insulin and lipid concentrations and blood pressure. The metabolic syndrome was defined using WHO criteria. Among the offspring, lower birthweight was associated with an increased risk of glucose intolerance (impaired glucose tolerance, impaired fasting glucose or type 2 diabetes) and higher cholesterol and triacylglycerol concentrations (p < 0.05 for all adjusted for sex and age). Most outcomes in the offspring, including most individual components of the metabolic syndrome, were unrelated to parental birthweight. However, both maternal and paternal birthweight were inversely related to offspring metabolic syndrome (odds ratio [OR] 0.36 [95% CI: 0.13-1.01] per kg, p = 0.053 for mother-offspring pairs; OR 0.26 [0.07-0.93], p = 0.04 for father--offspring pairs, adjusted for offspring age, sex, BMI and socioeconomic status). Maternal birthweight was inversely related to offspring systolic blood pressure (ß = -2.5 mmHg [-5.00 to 0.03] per kg maternal birthweight; p = 0.052). Factors in both parents may influence the risk of metabolic syndrome in their offspring. There are several possible explanations, but the findings are consistent with the fetal insulin (genetic) hypothesis. (author's)
Detainees have a substantial risk to develop tuberculosis (TB) due to a higher incidence of TB in remand prison compared to the civil community. They develop TB during incarceration not only due to poor living conditions in remand prison, but also due to some factors affecting their life before imprisonment. Prevention measures against TB spread from penitentiary institutions to society include study of factors, which contribute to TB development. Current study aims at identification of important risk factors of TB development in remand prison in St. Petersburg, Russia. Methods: A retrospective matched case-control study was performed from May 2002 to May 2003 in two remand prisons in St. Petersburg. One hundred and fourteen prisoners (57 cases, 57 controls) were interviewed by using standardised questionnaire. Logistic regression analysis was performed to identify risk factors. Six factors were significantly linked to the risk of developing TB: narcotic drug use (odds ratio (OR): 2.6, 95% confidence interval (CI): 1.0-6.9), low income (OR: 3.2, CI: 1.2-8.6), high ratio of prisoners per available bed (OR: 4.0, CI: 1.1-15.0), not having own bed clothes (OR: 13.0, CI: 2.7-61.6), and little time outdoors (OR: 3.3, CI: 1.3-8.5). However, good housing before imprisonment (OR: 4.2, CI: 1.1-15.7) was a separate risk factor for TB. Three of the risk factors (high number of prisoners per bed, not having own bed clothes, and little time outdoors) are certainly possible to approach by improvement of conditions in remand prisons. The remaining three factors (narcotic drug use, good housing before imprisonment, and low income) provide knowledge about study population, but cannot be intervened by prison's medical staff. (author's)
Demographic history of HIV-1 subtypes B and F in Brazil.
The reconstruction of the epidemic history of several HIV populations, by using methods that infer the population history from sampled gene sequence data, has revealed important subtype-specific and regional-specific differences in patterns of epidemic growth. Here, we employ Bayesian coalescent-based methods to compare the population history of the HIV-1 subtype B and F1 epidemics in Brazil from non-contemporary env and pol gene sequences. Our results suggest that after the introduction of the subtypes B and F1 into Brazilian population, around mid to late 1960s and late 1970s, respectively, these subtypes experienced an initial period of exponential growth with similar epidemic growth rates (~0.5-0.6 year/-1). Later, the spreading rate of both subtypes seems to have slowed-down since mid to late 1980s. This demographic pattern is very similar to that reported for the subtype B epidemics in high-income countries where HIV was initially transmitted through homosexual intercourse and injecting druguse, as in Brazil; suggesting that the characteristics of transmission networks may be a key determinant of the HIV epidemic growth pattern. It is important to note that most of the subtype B and F1 sequences used in this study come from the Southeast region that has been the most affected by the AIDS epidemic in Brazil, being responsible for around 63% of all AIDS cases reported since the early eighties; but may not represent the demographic trend of the HIV-1 epidemic in other Brazilian regions. (author's)
Oral ulcer as an unusual feature of visceral leishmaniasis in an AIDS patient.
Leishmaniasis, a globally prevalent parasitic disease, occurs in three forms, viz., visceral, cutaneous and mucocutaneous. It is transmitted by female Phlebotomus sandflies. Human immunodeficiency virus (HIV) infection is increasing worldwide, and several reports indicate a rising trend of VL / HIV co-infection, modifying the traditional anthroponotic pattern of VL transmission. India is one of the countries having the largest burden of leishmaniasis; nevertheless, there are very few HIV / leishmania co-infection cases reported so far. We report a 35-year-old homemaker infected with the human immunodeficiency virus; she presented with an oral ulcer. The investigations carried out on her revealed that she was afflicted by visceral leishmaniasis, and the oral ulceration was a part of the same. This is only the second such case from the Indian subcontinent, and more significantly from a non-endemic area. (author's)
The role of parents and partners in the pregnancy behaviors of young Latinas.
Pregnancy among young Latinas demands attention. These teens have higher birthrates than other teen populations. Seven focus groups (N = 40) were conducted with Latinas to explore how relationships between young Latinas and their mothers, fathers, and male partners contribute to teen pregnancy. ATLAS/ti (a qualitative data analysis software program) was used to assist in coding and analysis of data. Salient themes were identified. Mothers rely on cultural values regarding sexuality and pregnancy outside of marriage and fear about birth control to dissuade their daughters from pregnancy. Fathers echo these traditional messages. Open communication about sexuality and contraception rarely occurs. Male partners increase pregnancy susceptibility given the difficulty with negotiating condom use. It is important that research and prevention programs recognize the social context in which pregnancy prevention and susceptibility occur. (author's)
Effect of maternal HIV infection on child survival in Ghana.
The purpose of this study was to measure the association between maternal HIV infection and infant mortality in Ghana. Using a censored synthetic cohort life table based on the birth history of 3,639 childbirths during 1999-2003 obtained from the interviews of a nationally representative sample of 5,691 women age 15-49 in 6,251 households in the 2003 Ghana Demographic and Health Survey. The survey collected demographic, socioeconomic, and health data of the respondents as well as obtained voluntary counseling test for HIV infection from all eligible women. The effects of maternal HIV status and other factors on infant mortality were estimated using multivariate survival regression analysis and the results are presented as Hazard Ratios (HR) with 95% confident interval (95% CI). Children born to HIV infected mothers were three times as likely to die during infancy as those born to uninfected mothers (HR = 3.01; 95% CI: 1.64, 5.50). Controlling for other factors affecting infant mortality further sharpens this relationship (HR = 3.51; 95% CI: 1.87, 6.61). Not receiving antenatal care, low birth weight, and living in households that use high pollution cooking fuels were associated with a higher risk of infant mortality. Maternal HIV status is a strong predictor of infant mortality in Ghana, independent of several other factors. The results of this study suggest that HIV/AIDS epidemic has had great impact on child well-being and child survival. This impact tends to increase as the HIV/AIDS epidemic matures and infection in adults increases. (author's)
AIDS dementia complex in China.
The AIDS dementia complex (ADC) is one of the most common neurological complications in patients with AIDS. However, little is known about the clinical features of ADC in China. We prospectively studied six patients with confirmed ADC out of a total of 36 AIDS patients treated from 1999 to 2003. All patients had short-term memory loss and poor concentration, with preserved alertness. Motor disability was identified in three patients. Of the six ADC patients, two had accompanying vacuolar myelopathy. All of the patients died, with a mean age at death of 41.8 years. The median survival of these ADC patients from the time of diagnosis was 4.7 months. In this context, we suggest that early diagnosis and highly active antiretroviral therapy treatment is an urgent priority in developing countries. (author's)
The main aim of this study was to compare the health promotion practices of Taiwanese (n = 265) and American (n = 285) adolescents, using the revised Adolescent Health Promoting scale. A comparative and descriptive design was used. Categorical data analysis was applied to explore the association of culture differences and adolescent health-promoting behaviors. Findings indicated significant differences between Taiwanese and American adolescents in some demographic characteristics: American participants had higher self-perceived health status (p < 0:001), parental educational level (p < 0:001), overweight percentage (p < 0:001), and rate of living only with the mother (p < 0:001) than the Taiwanese participants. Taiwanese adolescents had a higher frequency of health-promoting behavior than Americans in terms of healthy diet behavior, stress management, health responsibility, and social support (p < 0:01), but less frequently engaged in exercise and life appreciation (p < 0:001). Because many of thedemographic characteristics between the two countries, such as the parent's educational level, differ significantly, a comparison can be difficult. However, healthy behavior is an important measure of demand for preventive health services. The findings should sound an alarm for all public health professionals to take heed of what is happening to our youth based on culture differences. School and family health promotion counseling should be encouraged for adolescents to improve their lifestyle habits. Based on the findings, school health promotion programs should focus on factors for which there may be significant local ethnic differences. For the locales in this study, Taiwanese adolescents need encouragement to improve their exercise and life appreciation behaviors. For American adolescents, healthy diet, stress management, health responsibility, and social support should be emphasized. (author's)
This study was conducted among female subjects to assess the possible association between selected risk factors and lung function as well as airway symptoms in a 32-year perspective. The Prospective Population Study of Women was initiated in 1968-1969 in Goteborg, Sweden (population about 450 000) with follow-ups in 1974-1975, 1980-1981, 1992-1993 and 2000-2001. Women born in 1930, representative of women of the same age in the general population in 1968, were selected. Initially, 372 participants were included in the cohort. In 2000-2001, 231 of these women (73%), now 70 years old, underwent lung function tests. The main outcome measures were lung function values, airway symptoms and health outcome in 2000-2001 in relation to self-reported exposures in 1968-1969 including smoking status. Smoking in 1968-1969 was associated with self-reported chronic bronchitis, obstructive symptoms and poor health 32 years later as well as lower lung function values, compared to non-smokers. Obesity, low socio-economic status and self-reported mental stress in 1968-1969 were associated with obstructive symptoms 32 years later. There are only a few longitudinal studies concerning women's health problems in this field and epidemiological studies of lung function impairment in women and risk factors in a long-term perspective are scarce. The results of the study suggest that life-style factors such as mental stress, obesity and smoking among women are related to airway symptoms and also quality of life many years later. (author's)
Adolescent's sexuality and related reproductive health and rights problems are sensitive issues in Vietnam. Globalisation has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among youth are posing major health concerns in the country. These problems need to be addressed. Midwives belong to a key category of health personnel in Vietnam, whose task it is to promote adolescents' sexual and reproductive health and prevent reproductive ill health. It is important to understand future midwives' perceptions and attitudes in order to improve their education and training programmes. The aim of this study was to investigate Vietnamese midwifery students' values and attitudes towards adolescent sexuality, abortion and contraception and their views on professional preparation. A quantitative survey including 235 midwifery students from four different secondary medical colleges in northern Vietnam was carried out in 2003. A qualitative study addressing similar questions was performed and 18 midwifery students were individually interviewed. Findings revealed a general disapproval of adolescent pre-marital sexual relations and abortion-'an ethics of justice'-but also an empathic attitude and willingness to support young women, who bear the consequences of unwanted pregnancies and social condemnation-'an ethics of care'. Gender-based imbalance in sexual relationships, limited knowledge about reproductive health issues among youth, and negative societal attitudes were concerns expressed by the students. The students saw their future tasks mainly related to childbearing and less to other reproductive health issues, such as abortion and prevention of STI/HIV. Midwifery education in Vietnam should encourage value-reflective thinking around gender inequality and ethical dilemmas, in order to prepare midwives to address adolescents' reproductive health needs. (author's)
Sexual behavior and drug use among Asian and Latino adolescents: association with immigrant status.
This paper contributes new evidence on the association between immigrant status and health by describing and attempting to explain patterns of co-occurring sex and drug use behaviors among Asian and Latino adolescents in the United States. Nine patterns of sex and drug use behaviors were identified from a cluster analysis of data from 3,924 Asian and Latino youth (grades 7-12) who participated in the National Longitudinal Study of Adolescent Health (Add Health). The relationship between immigrant status and risk cluster membership was evaluated with multinomial logistic regression. Compared to foreign-born youth, U.S. born Asian and Latino adolescents were more likely to engage in sex and drug risk behaviors. Family and residential characteristics associated with immigrant status partly accounted for this finding. The results indicate that among Asian and Latino adolescents, assimilation to U.S. risk behavior norms occurs rapidly and is evident by the second generation. (author's)
The HIV incidence data are relevant in depicting the current dynamics and trend of the epidemic. Using a new laboratory method for HIV-1 incidence, we aimed at estimating a 10-year trend in HIV-1 incidence in Addis Ababa, Ethiopia. We determined the temporal trends in HIV incidence based on a total of 7744 serum specimens from pregnant women who attended antenatal clinics in Addis Ababa between 1995 and 2003. HIV incidence was determined by IgG-capture HIV-1 BED incidence enzyme immunoassay following a validation using a well-characterized panel of serial serum specimens from subtype C-infected seroconverters. Of the 1350 HIV+ specimens tested as part of the annual sentinel survey between 1995 and 2003, a total of 1332 (98.7%) were tested by BED HIV-1 incidence assay. The incidence rate of HIV-1 infection declined significantly from 7.7% (95% CI, 3.9-11.5%) in 1995 to 2.0% (95% CI, 0.7-3.3%) in 2003. Although there was a trend, amongst the age group of 15-29 years, in age-specific decline in incidence, it was not statistically significant. No change in HIV incidence rate was observed for the group aged above 30 years. A corresponding decline in the incidence of HIV infection was observed with the decline in the prevalence of HIV infection between 1995 and 2003 in Addis Ababa City. Whether the declines were because of changes in sexual behaviours or other reasons needs to be explored. The BED HIV-1 incidence assay provides a valuable tool in obtaining information on recent HIV-1 infection. (author's)
Medicinal plants used to induce labour during childbirth in western Uganda.
Traditional medicine usage in rural Ugandan population for day-to-day health care needs is close to 90%.Women and children form the bulk of the people reliant on herbal medicine. This study was undertaken to document how ethnomedical folklore aids childbirth in rural western Uganda by conducting field surveys, discussions and interviews with the resource users (mothers) and health providers (traditional birth attendants). Health surveys revealed that over 80% of childbirths are conducted at home by using herbal remedies in Bushenyi district. Seventy-five plants have been recorded for usage in inducing labour and some of these plants may be oxytocic. The dilemma lies in the toxicity levels and the unspecified dosages that may threaten the life of the unborn baby and the mother. The high population growth rate, high total fertility rate coupled with high maternal mortality and morbidity in Uganda calls for rethinking in gendered health provision policies and programmes for which herbal medicine integration in health care systems seems viable. (author's)
Evaluation of the flora of northern Mexico for in vitro antimicrobial and antituberculosis activity.
The aim of the present study was to evaluate the potential antimicrobial activity of 14 plants used in northeast Mexico for the treatment of respiratory diseases, against drug-sensitive and drug-resistant strains of Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae type b and Mycobacterium tuberculosis. Forty-eight organic and aqueous extracts were tested against these bacterial strains using a broth microdilution test. No aqueous extracts showed antimicrobial activity, whereas most of the organic extracts presented antimicrobial activity against at least one of the drug-resistant microorganisms tested. Methanol-based extracts from the roots and leaves of Leucophyllum frutescens and ethyl ether extract from the roots of Chrysanctinia mexicana showed the greatest antimicrobial activity against the drug-resistant strain of Mycobacterium tuberculosis; the minimal inhibitory concentration (MIC) were 62.5, 125 and 62.5 µg/mL, respectively; methanol-based extract from the leaves ofCordia boissieri showed the best antimicrobial activity against the drug-resistant strain of Staphylococcus aureus (MIC 250µg/mL); the hexane-based extract from the fruits of Schinus molle showed considerable antimicrobial activity against the drug-resistant strain of Streptococcus pneumoniae (MIC 62.5µg/mL). This study supports that selecting plants by ethnobotanical criteria enhances the possibility of finding species with activity against resistant microorganisms. (author's)
This brief report reviews twenty years of progress on one front of the AIDS war: perinatal HIV transmission. The rate of infected infants born to HIV-positive women has fallen from 25-30% at the beginning of the epidemic to 2% today. AIDS cases in infected infants rose from about 200 in 1985 to 945 in 1992 and then declined to about 48 in 2004. Although more difficult to estimate, the somewhat higher numbers for HIV infection have followed the same pattern. This dramatic improvement was almost entirely the result of an evolving series of interventions. One of these was the expansion of HIV testing for pregnant women, marked by several milestones. Testing was offered at first only to women at high risk, but in 1995 after a drug trial was found to reduce perinatal transmission, voluntary testing of all pregnant women was recommended; that was followed after a few years by the call to screen these women routinely unless they specifically declined. Later, the advent of a rapid HIV test in 2002 allowedfor testing during labor when the mother's HIV status was unknown. Recent data show that HIV status is now known before or at birth in 93% of mothers of infected infants. (excerpt)
Morbidity and mortality associated with pre-eclampsia at two tertiary care hospitals in Sri Lanka.
The aim was to report the occurrence of morbidity and mortality associated with carefully phenotyped pre-eclampsia in a sample of nulliparous Sinhalese women with strictly defined disease. A phenotyping database of 180 nulliparous women with pre-eclampsia and 180 nulliparous normotensive pregnant women who were recruited for a study into genetics of pre-eclampsia was analyzed. Women who developed pre-eclampsia had significantly higher systolic blood pressure (SBP; P = 0.002) and diastolic blood pressure (DBP; P = 0.002) at booking (at approximately 13 weeks of gestation). 38.3%, 28.3% and 33.3% of women delivered at < 34 weeks, at 34--36 weeks, and at term, respectively. 78% required a cesarean section. Complications included SBP = 160 mmHg (75.5%); DBP = 110 mmHg (83.8%); proteinuria = 3 + (150 mg/dL) in the urine protein heat coagulation test (87%); renal failure requiring dialysis (2%); platelet counts < 100 x 10/9/L (13%); = 70 U/L in aspartate and/or alanine aminotransaminase (15%); placentalabruption (4%); eclampsia (9%); and one maternal death. Maternal complications indicative of severe disease, apart from the incidence of SBP = 160 mmHg and DBP = 110 mmHg, were not significantly different in early and late-onset pre-eclampsia; fetal outcome was better with late-onset disease. 48% of babies were small for gestational age. Only 80 of 135 babies of women with pre-eclampsia whose condition could be confirmed at 6 weeks post-partum were alive. Pre-eclampsia in Sinhalese women is associated with severe maternal morbidity and fetal morbidity and mortality, suggesting that modification of the Western diagnostic criteria and/or guidelines for medical care may be necessary. There is an urgent need to improve neonatal intensive care services in Sri Lanka. (author's)
The Missoula-Vitas Quality-of-Life Index (MVQOLI) is a unique tool specifically designed to measure quality of life (QOL) in advanced illness in a palliative care setting. The aim of this study was to explore its cross-cultural validity. We used a culturally adapted version in a local language, Luganda, and tested the MVQOLI-M in 200 patients with advanced AIDS in urban Kampala, Uganda. Content validity was assessed using the content validity ratio approach. Reliability was assessed using Cronbach's alpha (a), and test-retest reliability was evaluated using the intraclass correlation coefficient. All items and domains were rated content valid and there was good construct validity. The instrument demonstrated good internal consistency (a = 0.83). The transcendence domain was the best predictor of overall QOL. The MVQOLI-M is an acceptable, valid, and reliable measure of QOL for people with advanced AIDS and findings demonstrate the importance of measuring the transcendence domain in QOL in advancedillness. (author's)
The relationship of school-based health centers (SBHCs) to falling birth rates for Black teenagers in Denver was studied by comparing over time the decline in births in high school districts where the schools had SBHCs (n = 3) to the decline in districts where the high schools did not have SBHCs (n = 4). Birth certificates were used to identify the number of births to Denver Black women aged 15-17 years for each year between 1991 and 1997 in each district (the numerators). The number of Black female adolescents in the district was estimated for each school by using its annual Black female enrollment data for grades 9-11 (the denominators). Fertility rates, calculated as births per 1,000, were aggregated for the SBHC schools and for the non-SBHC schools. For the entire study period there were 932 births to Black 15- to 17-year-olds; their enrollment combined for all seven schools varied annually from 964 to 1,056. (excerpt)
Early child development in developing countries [letter]
"Finally I have data to convince my Minister of Finance to invest in early child development" reported the Minister of Women and Child Development, Malawi, at a meeting held at the Institute of Child Health, London, UK, to mark The Lancet's series on child development in developing countries (Jan 6--Jan 20).1--3 At the meeting, hosted by the Centre for International Health and Development, presenters explained that more than 200 million children younger than 5 years are not developing to their potential owing to poverty, poor health, and nutrition. Although effective interventions are available, coverage is low. Representatives from WHO, UNICEF, and the World Bank expressed a strong commitment to strengthening programmes and research to move the Lancet recommendations forward. Other agencies including UNESCO, the Bernard van Leer and Aga Khan Foundations, and many non-governmental organisations explained how they are putting the recommendations into practice. The Lancet steering group will become the International Child Development Committee. This year, we plan to advocate for early child development programmes through presentations at meetings in Turkey, India, Spain, Venezuela, and Bangladesh and at the Society for Research in Child Development and the Pediatric Academic Societies. We will meet at the Rockefeller Foundation's Bellagio Study and Conference Center to develop implementation strategies and establish priorities in collaboration with the Child Health and Nutrition Research Initiative. We will provide guidance in assessment of existing programmes, development of new models for delivering services, and integration of child development activities into health and nutrition services. In 2 years, we will report on global progress in early child development programmes. (full text)
Pippaliyadi yoga or pippaliyadi vati is an ayurvedic contraceptive used in India since ancient times. It is a combination of powdered fruit berries of Embelia ribes Burm.f. (Myrsinaceae), Piper longum L. (Piperaceae) and borax in equal proportion. Though the contraceptive potential is known since ancient times, no systematic developmental toxicity studies have been carried out. The present study was carried out to evaluate the postnatal developmental toxicity and the reproductive performance of the progeny exposed in utero to pippaliyadi. Pippaliyadi yoga was obtained from National Institute for Pharmaceutical Education and Research (NIPER), India and the developmental toxicity was studied by administering three doses, viz. 140, 300 and 700 mg/(kg day) to gravid females from day 6 to day 16 of gestation. Pippaliyadi did not have any adverse developmental effects with low doses, however, with the five times higher dose, a decrease in body weight of the pups was observed. The reproductive performance of the progeny born to mothers treated with pippaliyadi was not significantly affected. The present study suggests that in utero exposure to pippaliyadi does not have any adverse effect on the postnatal development and reproductive performance of the F/1 progeny. (author's)
Risk factors for adverse outcomes in developing countries [letter]
In their child development series article, Susan Walker and colleagues cite two of our recent pub lications: "Two small Brazilian studies suggest an association between incidence of diarrhoea in the first 2 years of life and impaired cognitive performance in later childhood. However, a larger cohort study in Peru with control for confounders saw no independent association..." Our Brazilian birth cohort studies examined several confounders including education, income, helminthiases, and anaemia. After controlling for these, early childhood diarrhoea and nutritional status still predicted cognitive function, but not independently of each other. Early childhood diarrhoea was a good, if not better, predictor of cognitive function than nutritional status. Much research on child development in developing countries addresses undernutrition, but fails to capture the effect that repeated dehydrating, malnourishing episodes of diarrhoea in the first years of life can have on cognitive potential--an effect that can persist despite catchup growth. Indeed, our follow-up studies show that early childhood diarrhoea and height-for-age Z scores at age 2 years predict impaired school performance. The message is that diarrhoea impairs nutritional status, and that both signal adverse risks for child development. Both warrant effective interventions, be they nutrition, sanitation, or treatment. We wholeheartedly agree with Walker and colleagues that intervention studies are needed to clarify these associations. Such studies are under way with trials of vitamin A, zinc, and glutamine among high-risk children in Brazil. Further work on the prevention and treatment of repeated enteric infections and nutritional shortfalls is badly needed. (full text)
Reductions in child mortality levels and inequalities in Thailand: analysis of two censuses.
Thailand's progress in reducing the under-five mortality rate (U5MR) puts the country on track to achieve the fourth Millennium Development Goal (MDG). Whether this success has been accompanied by a widening or narrowing of the child mortality gap between the poorest and richest populations is unknown. We aimed to measure changes in child-mortality inequalities by household-level socioeconomic strata of the Thai population between 1990 and 2000. We measured changes in the distribution of the U5MR by economic strata using data from the 1990 and 2000 censuses. Economic status was measured using household assets and characteristics. The U5MR was estimated using the Trussell version of the Brass indirect method. Average household economic status improved and inequalities declined between the two censuses. There were substantially larger reductions in U5MR in the poorer segments of the population. Excess child mortality risk between the poorest and richest quintile decreased by 55% (95% CI 39% to 68%).The concentration index, measured using percentiles of economic status, in 1990 was -0.20 (-0.23 to -0.18), whereas in 2000 it had dropped to -0.12 (-0.15 to -0.08), a 43% (22% to 63%) reduction. These findings draw attention to the feasibility of incorporating equity measurement into census data. Thailand has achieved both an impressive average decrease in U5MR and substantial reductions in U5MR inequality over a 10 year period. Contributing factors include overall economic growth and poverty reduction, improved insurance coverage, and a scaling-up and more equitable distribution of primary health-care infrastructure and intervention coverage. Understanding the factors that have led to Thailand's success could help inform countries struggling to meet the fourth MDG and reduce inequality. (author's)
Changing service systems for high-risk youth using state-level strategies.
Despite the considerable efforts of those who service youth through the many governmental and voluntary programs, these programs and services are not meeting the challenge of effective intervention to address and ameliorate the problems associated with high-risk youth and their broader social environments. One important reason why these programs are missing the mark is that states continue to fund categorical and fragmented programs, i.e., narrow interventions targeted on "fixing" certain problems or behaviors. Meeting the challenge of effective intervention requires local and regional systemic change that creates public health-oriented, comprehensive, interagency initiatives that target deficient environments and reorganize services and programs to strengthen assets among individuals, families, and communities. The state is the level from which the leadership for that change must come. A values-based conceptual framework that can be adapted to a public health approach is "systems of care," a set of principles that show how services should be delivered to children with serious emotional disturbances and their families-in other words, those for whom treatment rather than prevention is needed. Coordinated systems of care provide a range of services to effectively serve children and their families in the context of their families and communities, rather than to focus just on the singular problems they may have. This systems of care approach can be adapted for positive youth development and prevention strategies with adolescents. (excerpt)
This paper describes and evaluates the first demographic surveillance system (DSS) in Malawi, covering a rural population of 30,000. Unlike others, the Karonga DSS relies on trained village informants using formatted registers for the primary notification of vital events and migrations. Seven project enumerators subsequently collect detailed data on events notified by the village informants, using stringent identification procedures for households and individuals. Internal movements are traced systematically to augment event registration and data quality. Continuous evaluation of data collection is built into the methods. A re-census conducted after 2 years indicated that the routine system had registered 97% of 1,588 births, 99% of 521 deaths and 92% of 13,168 movements. (author's)
Contraception: A social revolution.
Modern contraceptive technology is more than a technical advance: it has brought about a true social revolution, the 'first reproductive revolution' in the history of mankind. This latter was followed in rapid succession by other major changes in human reproductive strategies. In the human species, sexual activity began to lose its exclusive reproductive meaning at an early stage of its evolution. Human beings must have practiced non-conceptive sex from the outset and therefore must have had a need to avoid, rather than to seek conception during intercourse from time immemorial. The search for methods to control fertility went on for millennia, but a valid solution was only found during the twentieth century, when the population explosion had forever changed the shape of humanity: in only one century the total population of the planet had grown from some 1.6 billion to more than 6 billion. That increase will remain unique in the history of Homo sapiens. At the global level, contraception provided a tool to deal with overpopulation and, in only 50 years, went a long way towards its resolution. However, to solve the problem, national and international family planning initiatives were required. For individuals, contraception also meant a revolution. It allowed sexual intercourse without reproduction. Only 25 years later, in vitro fertilisation permitted childbearing without sexual intercourse. Other advances followed and now cloning, that is, reproduction without the two gametes, looms on the horizon. Such a series of rapid, major changes in human reproductive strategies has confused many. For this reason, a constructive dialogue between sociology and biology is mandatory. Contraception is a powerful tool to promote equity between sexes; it improves women's status in the family and in the community. Avoiding pregnancy during the teens increases opportunities for a young woman's education, training and employment. By controlling their fertility, women get a chance to contribute economically to their household, which in turn may give them a greater share in decision-making. There are other specific areas in which contraception has produced beneficial social effects, first and foremost in reducing the need for induced abortion. It has also helped avoiding sexually-transmitted infections and is a very useful tool for educating youngsters to adopt more responsible sexual behaviors. Interventions in the field of family planning are among the most cost-effective health interventions. (author's)
Contraceptive counseling for orthodox Jewish women.
Objectives: The evaluation of birth control issues among orthodox Jews who strictly follow the Halachah (the Jewish codes of conduct). Methods: We examine traditional Jewish concepts and practices of reproduction, review various contraceptive methods, and define problems that may arise with their use in the Jewish orthodox society. We focus on the orthodox and ultra-orthodox (Haredi) elements of the Jewish community. Results: The choices of orthodox religious women are limited and determined largely by considerations related to religious doctrine. Conclusions Understanding the religious, social and cultural background of patients, religious orthodox women in particular, enables to appropriately counsel them. (author's)
Outcome of vasectomies performed at a Turkish metropolitan maternity hospital.
Objective: To determine prospectively the outcome of vasectomies performed by two trained surgeons over a 9-month period at the Ministry of Health Ankara Etlik Maternity and Women's Health Teaching and Research Hospital Family Planning Centre. Methods: The demographic data, source of information concerning the method, sexual function before and after voluntary no-scalpel vasectomy, compliance with the postvasectomy follow-up program of men applying for a vasectomy were analyzed. All patients were contacted by telephone and invited for follow-up visits for counseling, inquiry regarding sexual dysfunction, and performance of a semen analysis. Results: The patients were married men, mostly primary school graduates, with more than one child. Sources of information were health services and/or health personnel for 89% of the patients. Of the 279 men who underwent a vasectomy and who were later contacted by phone, 131 (47%) came for a follow-up assessment. There was only one post-vasectomy pregnancy (0.8%). The incidence of reported sexual problems did not change after the procedure. Vasectomy did not affect the sexual function of men in our study. Conclusion: Compliance with follow-up after vasectomy, which is extremely important for assessment of its successful outcome, is low. (author's)
Objectives: To determine the number of women fitted with a diaphragm or cervical cap at family planning clinics across the Australian State of New South Wales (NSW) from 2000 to 2005. To compare the demographic characteristics of women fitted with this form of contraceptive with women prescribed the combined oral contraceptive pill (COCP). Method: An audit of women presenting for contraceptive services between 2000 and 2005 was undertaken. The demographic characteristics of women fitted with a barrier method or prescribed the COCP between 1st April, 2002, and 31st October, 2004, were obtained from the Family Planning NSW Activity Data Set (FADS). Results: The proportion of women fitted with a diaphragm or cap remained constant between 2001 and 2005 at approximately 5%. During the 31 months that the study period lasted, 793 women were fitted with a diaphragm or cervical cap compared with 8047 women prescribed the COCP during the same time frame (including 76 women who received both a diaphragm and COCP prescription during this period). Women fitted with the barrier contraceptive were significantly more likely to be older, to have received a tertiary level education and to have private health insurance than their counterparts prescribed the COCP. They were less likely to come from a non-English speaking background. Discussion: The diaphragm and cervical cap are viable contraceptive methods for a specific group of older, well-educated women. The possible benefits of female-controlled barrier devices in the prevention of sexually transmissible infections may result in a wider demographic use in the future. (author's)
Objective: To investigate the efficacy of a combined oral contraceptive containing 30 ethinyloestradiol and 3 mg drospirenone in the treatment of hyperandrogenism affecting women with the polycystic ovary syndrome (PCOS). Methods: Prospective open study of 20 women for six cycles. At the beginning and at the end of the study the following values were determined: the Ferriman-Gallwey (F-G) score, body mass index, waist/hip ratio, serum levels of testosterone, SHBG, immune reactive insulin (IRI), glucose, the free androgenic index, and insulin resistance (HOMA-IR). Results: All 20 women completed six cycles of therapy. The medication was well tolerated. At the end of the study there was a significant improvement of hirsutism, expressed in the decrease of the F-G score, accompanied by a decrease of testosterone and an increase SHBG values. The carbohydrate metabolism was not affected significantly. Conclusion: The combined oral contraceptive containing 30 mg ethinyloestradiol and 3 mg drospirenoneis an effective drug in the treatment of hyperandrogenism in women with PCOS; it elicits few side effects and does not significantly influence insulin resistance. (author's)
Predictors and confounders of unprotected sex: A UK web-based study.
Objectives: To evaluate the effects of gender, sex orientation, age, relationship status, age at first sex education, age at first sex, frequency of sex and number of sexual partners on the likelihood of unprotected sex in the United Kingdom (UK). Methods: A web-based survey was conducted in the UK in 2004 with 10,138 respondents. Eight variables were chosen as potential predictors of unprotected sex. Responses from sexually active participants were combined and crude/adjusted odds ratios (AORs) were calculated for binary/categorical variables. Results: No differences were found in AOR for gender, sex orientation, relationship status and frequency of sex. Differences were found in AOR for age, sex education, age at first sex and number of sexual partners, e.g. AOR 21-24 years of age versus under 16 (1.92, CI 1.38-2.68; p-value<0.001); AOR sex education never received versus first sex education under 10 years of age (1.45, CI 1.12-1.87; p-value<0.01); AOR first sex at 20 years versus at 14 years (0.56, CI 0.40-0.79; p-value<0.01); and AOR 11-20 partners versus one partner (24.91, CI 20.02-30.98; p-value<0.001). The association of sex orientation and relationship status with unprotected sex is confounded by the number of sexual partners. Conclusions: UK health and education authorities should develop strategies to provide sex education starting in primary school and continuing throughout secondary school. Prevention programs and policies should focus on particular sexual behaviours. Furthermore, an understanding of sexual diversity and reducing stigmatisation of sexual orientation is necessary. (author's)
A survey intended to ascertain the rate of use and type of contraceptive methods applied by Spanish women aged 40 to 50 years, and to determine the proportion of women in this group at risk of an unwanted pregnancy, was designed and validated. To achieve representative national results for the study population, it was estimated that a sample size of 2000 women was required. Women were selected using probabilistic, stratified random sampling. The survey questionnaire was prepared by the research group with the collaboration of experts in the conduct of population studies of this type. Participants were interviewed face to face by qualified and trained staff from a specialised company external to the research group. Overall, 1039 women (52%) resorted to some contraceptive method, of which (male or female) sterilisation was the most common. We estimate that in Spain there are 840,000 women (31.8%) aged 40 to 50 years at risk of unwanted pregnancy. (author's)
Objective: To assess readability of over-the-counter (OTC) contraceptive product instructions currently available, compare the results with previous studies from a decade ago, and review the implications for health care providers, in particular pharmacists counseling on OTC contraceptives. Methods: A sample of contraceptive instructions was submitted to a readability analysis using four standard readability formulas. Products included condoms, spermicides, and emergency contraception instruction pamphlets. Results: Reading grade levels for condoms ranged from 6th to 12th grade. The average reading levels for the spermicides were 9th-10th grade and for the emergency contraceptives 10th-12th grade. These results were consistent with those of similar studies performed a decade ago. Conclusions: Consumers need to have at least a high school reading level in order to comprehend current produ