Effects of birth spacing on maternal health: A systematic review.
The objective of the study was to explore the association between birth spacing and risk of adverse maternal outcomes. The study was a systematic review of observational studies that examined the relationship between interpregnancy or birth intervals and adverse maternal outcomes. Twenty-two studies met the inclusion criteria. Overall, long interpregnancy intervals, possibly longer than 5 years, are independently associated with an increased risk of preeclampsia. There is emerging evidence that women with long interpregnancy intervals are at increased risk for labor dystocia and that short intervals are associated with increased risks of uterine rupture in women attempting a vaginal birth after previous cesarean delivery and uteroplacental bleeding disorders (placental abruption and placenta previa). Less clear is the association between short intervals and other adverse outcomes such as maternal death and anemia. Long interpregnancy intervals are independently associated with an increased risk ofpreeclampsia. Both short and long interpregnancy intervals seem to be related to other adverse maternal outcomes, but more research is needed. (author's)
Predictors of unintended pregnancy among South African youth.
Although unintended pregnancy is recognized as a major public health problem in South Africa, studies on it have been limited and at local level. Using the 1998 South African Demographic and Health Survey (SADHS) data set, this study examined the distribution of and factors associated with unintended pregnancy among South African youth. Analysis was based on a sub-sample of 1, 395 women aged 15-24 who were interviewed during the survey and who had pregnancy at the time of and/or three years preceding the survey. Univariate, bivariate and multivariate methods of analysis were employed. The results show a high level of unintended pregnancy with only 29% of the pregnancies wanted. The level of unintended pregnancy varies by region and some socio-economic variables. Five critical predictors of unintended pregnancy among South African youth were identified. These are: age group, region, marital status, education and relationship to the last sexual partner. The findings of this study have implications for reproductive health policies and programmes in designing appropriate national programmes for reducing the incidence of unintended pregnancy among South African youth. The need for further research into this area using triangulated methodology is recommended. (author's)
Population and labour force projections are made for 27 selected European countries for 2002--2052, focussing on the impact of international migration on population and labour force dynamics. Starting from single scenarios for fertility, mortality and economic activity, three sets of assumptions are explored regarding migration flows, taking into account probable policy developments in Europe following the enlargement of the EU. In addition to age structures, various support ratio indicators are analysed. The results indicate that plausible immigration cannot offset the negative effects of population and labour force ageing. (author's)
The dynamics of fertility amongst Palestinians in Israel from 1980 to 2000.
A dynamic stalled fertility transition is the best way to describe the recent fertility experience of Muslim Palestinians in Israel. It is generally assumed that once fertility levels fall by 10%, transition is well underway. Muslims in Israel experienced rapid fertility decline from TFR levels near 9 in the 1960s to about 4.5 in the early 1980s, but period TFRs have remained essentially constant since then. This article uses multilevel statistical models and census data to examine the changing determinants of fertility amongst Muslim Palestinians in Israel during the stage when aggregate fertility levels approached stagnation. The results show that as educational levels increased among Israeli Muslim women, the strength and nature of the relationship between education and fertility has changed at both the individual and community levels. We also explore other potential determinants of fertility such as minority status and cultural affiliation--exciting new directions for explaining the stagnationof aggregate fertility levels. (author's)
One step forward, two steps back? Conundrums of the rape legal reform campaign in Malaysia.
This article looks at how initiatives to improve laws relating to rape in Malaysia have affected the overall national discourse on sexuality and gender, including that on sexuality rights. Following the introduction which lays out the context in which the article's analysis is grounded, the article traces the history of the rape legal reform campaign--how this began, what its initial motivations were, and which demands were finally achieved out of the first phase of lobbying by women's groups in the mid- to late-1980s. An update and discussion on the outcome of the second phase of the anti-rape campaign (late-1990s to present day) is also provided. Through this, the article examines the movement's successes, shortcomings and the factors governing these, as well as critiques the actions by women's groups in advocating further reforms to the law. It concludes with a discussion on the lessons learnt and what needs to be considered to ensure that sexual spaces, discourses and rights are not marginalized further in the current political milieu. (author's)
The preconceptual contraception paradigm: Obesity and infertility.
Obesity is a major health problem across the world. Recent editorials suggest that obese patients should be denied treatment of any kind aimed to improve ovulation rates and achieve pregnancy until they have reduced their BMI. We propose that this approach is not a resolution of the problem, but indeed may amplify the maternal and perinatal complications attributed to fertility centres. Obesity independent of polycystic ovary syndrome (PCOS) is associated with anovulation, and minimal weight loss alone is an effective therapy for induction of ovulation in both obese women and obese PCOS women. Consequently, lifestyle programmes encouraging weight loss should be considered to be an ovulation induction therapy and due consideration for a potential pregnancy in an obese woman given. We propose that women with a BMI in excess of 35 kg m2 should lose weight prior to conception--not prior to receiving infertility treatment. Therefore, clinicians undertaking the management of infertility in obese women should adopt measures to reduce their body mass prior to exposing them to the risks of pregnancy. We advocate that this approach should be aggressively managed including pharmacological strategies; intrinsic in this programme is the use of contraception and high-dose folic acid during that period of preconceptual weight reduction. (author's)
Exclusive breastfeeding, though better than other forms of infant feeding and associated with improved child survival, is uncommon. We assessed the HIV-1 transmission risks and survival associated with exclusive breastfeeding and other types of infant feeding. 2722 HIV-infected and uninfected pregnant women attending antenatal clinics in KwaZulu Natal, South Africa (seven rural, one semiurban, and one urban), were enrolled into a non-randomised intervention cohort study. Infant feeding data were obtained every week from mothers, and blood samples from infants were taken monthly at clinics to establish HIV infection status. Kaplan-Meier analyses conditional on exclusive breastfeeding were used to estimate transmission risks at 6 weeks and 22 weeks of age, and Cox's proportional hazard was used to quantify associations with maternal and infant factors. 1132 of 1372 (83%) infants born to HIV-infected mothers initiated exclusive breastfeeding from birth. Of 1276 infants with complete feeding data, median duration of cumulative exclusive breastfeeding was 159 days (first quartile [Q1] to third quartile [Q3], 122-174 days). 14.1% (95% CI 12.0-16.4) of exclusively breastfed infants were infected with HIV-1 by age 6 weeks and 19.5% (17.0-22.4) by 6 months; risk was significantly associated with maternal CD4-cell counts below 200 cells per µL (adjusted hazard ratio [HR] 3.79; 2.35-6.12) and birthweight less than 2500 g (1.81, 1.07-3.06). Kaplan-Meier estimated risk of acquisition of infection at 6 months of age was 4.04% (2.29-5.76). Breastfed infants who also received solids were significantly more likely to acquire infection than were exclusively breastfed children (HR 10.87, 1.51-78.00, p=0.018), as were infants who at 12 weeks received both breastmilk and formula milk (1.82, 0.98-3.36, p=0.057). Cumulative 3-month mortality in exclusively breastfed infants was 6.1% (4.74-7.92) versus 15.1% (7.63-28.73) in infants given replacement feeds (HR 2.06, 1.00-4.27, p=0.051). The association between mixed breastfeeding and increased HIV transmission risk, together with evidence that exclusive breastfeeding can be successfully supported in HIV-infected women, warrant revision of the present UNICEF, WHO, and UNAIDS infant feeding guidelines. (author's)
Pubertal transitions in health.
Puberty is accompanied by physical, psychological, and emotional changes adapted to ensure reproductive and parenting success. Human puberty stands out in the animal world for its association with brain maturation and physical growth. Its effects on health and well-being are profound and paradoxical. On the one hand, physical maturation propels an individual into adolescence with peaks in strength, speed, and fitness. Clinicians have viewed puberty as a point of maturing out of childhood-onset conditions. However, puberty's relevance for health has shifted with a modern rise in psychosocial disorders of young people. It marks a transition in risks for depression and other mental disorders, psychosomatic syndromes, substance misuse, and antisocial behaviours. Recent secular trends in these psychosocial disorders coincide with a growing mismatch between biological and social maturation, and the emergence of more dominant youth cultures. (author's)
Male circumcision for prevention of HIV and other sexually transmitted diseases.
A recent commentary in Pediatrics reviewed the documented medical benefits of newborn male circumcision, including protection against balanoposthitis, phimosis, infections of the urinary tract in male infants, and protection against human papillomavirus-associated genital cancers and HIV and Chlamydia infection in adolescents and adults. Low rates of minor surgical complications (0.2%-0.6%) and safety and efficacy of local anesthesia were noted. The ability of newborn circumcision to protect against sexually transmitted diseases (STDs) was also shown in a recently published cohort study from New Zealand. Recent large randomized clinical trials in South Africa, Kenya, and Uganda demonstrated reduction of HIV-acquisition risk by male circumcision performed outside the newborn period, showing the role of adult male circumcision in prevention of STDs in adolescents and adults. An association between lack of male circumcision and acquisition of HIV infection was first noted in 1986. Over the next 10 years, more than 35 studies including ecologic, cross-sectional, case-control, and cohort studies in general and high-risk populations throughout the world evaluated the possible protective effect of male circumcision against HIV acquisition. A systematic review summarized the studies from sub-Saharan Africa and showed an estimate of the adjusted relative risk of HIV acquisition of 0.42 (95% confidence interval [CI]: 0.34-0.54; protection of 58%) in circumcised compared with uncircumcised male subjects. The impact of male circumcision on prevention of HIV acquisition was greater in high-risk groups than in the general population. A cohort study has also suggested that transmission of HIV to female partners of men with HIV may be lower when the male partner is circumcised. (excerpt)
We aimed to retrospectively assess the efficacy of pill-swallowing training provided as a clinical intervention to referred pediatric patients with HIV in relation to improved adherence and subsequent related health outcomes. The primary goal of this study was to demonstrate participation in pill-swallowing training is associated with improved medication adherence as documented by routine pharmacy pill counts. Secondary objectives were to assess corresponding improvements in clinically observed biologic indicators of adherence, specifically, immunologic functioning (CD4+ T-cell%) and viral load, over time. A retrospective chart review of 23 pediatric patients with HIV aged 4 to 21 years who were clinically referred for pill-swallowing training by an experienced pediatric psychologist for either noted difficulties with currently prescribed antiretroviral regimens and/or desire to change the child's regimen/ formulary. Patient demographics, reason(s) for pill-swallowing training referral, number of pill-swallowing training sessions required to attain success, adherence, CD4+ T-cell%, and viral load were abstracted at baseline and at ~3 and 6 months posttraining. Modal number of sessions required to acquire the pill-swallowing skill was 1 session. Younger children (aged 4-5 years) required a median of 2 training sessions, while older children required = 3 sessions. A significant improvement in adherence from baseline to 6 months post--pill-swallowing training completion was observed, as were significant related improvements in CD4+ T-cell% and viral load. Participation in pill-swallowing training related to improved medication adherence at 6 months posttraining. Subsequent improvements in related CD4+ T-cell% and viral load were noted over time, most significantly at 6 months postintervention. These preliminary findings provide justification for additional study via a prospective, randomized, controlled clinical trial. Pill-swallowing training potentially is a successful time-limited, cost-effective intervention to improve adherence to antiretroviral therapies, and thus medical status, in children with HIV. (author's)
Masculine beliefs, parental communication, and male adolescents' health care use.
Male adolescents frequently become disconnected from health care, especially as they get older, which limits physicians' abilities to address their health needs and results in missed opportunities to connect them to the health care system as they enter adulthood. In this study we tested the ability of modifiable (beliefs about masculinity, parental communication, sex education, and health insurance) and nonmodifiable (age, race/ethnicity, and region of residence) factors to prospectively predict health care use by male adolescents. We conducted a prospective analysis of data from 1677 male participants aged 15 to 19 years who completed the National Survey of Adolescent Males, a household probability survey conducted throughout the United States in 1988 (wave 1, participation rate: 74%) and in 1990-1991 (wave 2, follow-up rate: 89%). We present percentages and adjusted relative risks of the factors that predict male adolescents' self-report of a physical examination by a regular provider in the past year measured at wave 2. On average, 1067 (66%) of 1677 male adolescents at wave 2 reported having a physical examination within the last year. Factors associated with a lower likelihood of a physical examination included living in the South, Midwest, and West; being older in age; and holding more traditional masculine beliefs. Factors associated with a higher likelihood of a physical examination included communicating about reproductive health with both parents and being insured. Male adolescents who were sexually active or engaged in = 2 other risk behaviors had neither a higher nor lower likelihood of a physical examination. Efforts to enhance male adolescents' health through health care should include work to modify masculine stereotypes, improve mothers' and fathers' communication about health with their sons, expand health insurance coverage, and identify interventions to connect male adolescents at increased risk for health problems with health care. (author's)
Moving lives: Migration and livelihoods in the Lao PDR.
Laos is one of the poorest and most 'rural' countries in the world. Yet there is evidence of heightened levels of mobility as the country is drawn into the wider mainland Southeast Asian region. Mobility is becoming increasingly important in supporting and defining livelihoods for some households and villages. The paper reviews the evidence for growing levels of mobility in Laos and, drawing on the experience of the wider region, reflects upon the implications of this for source communities in terms of economy and society. The paper highlights the shifting nature of the meaning of mobility for migrants and, therefore, for villages of origin and those 'left behind'. The paper proposes that rather than searching out hard-and-fast views of migration and its impacts, the focus should be on 14 identified questions or lines of influence. (author's)
Able to come and go: Reproducing gender in female rural-urban migration in the Red River Delta.
By examining household gender relations between migrant women and their left-behind husbands, we aim to understand how gender shapes rural--urban migration and is being negotiated in the context of market-driven rural transformations in the Red River Delta. In this study, rural women ensure the survival of their households as they link up with urban informal labour markets, moving to the city to work as junk collectors and buyers. Female migration destabilises conventional gender roles as left-behind husbands take up social reproductive work that is partially relieved by wives' frequent home visits. Additionally, invoking women's traditional obligations, left-behind husbands continue to 'feel like men', underscoring the resilience of conventional gendered norms on work, even where men actually take up women's work in their wives' absence. The article argues for a more nuanced understanding of this resilience premised on the principles of structured agency, suggesting that actors may actively reproduce gendered notions of work in order to cope with changing spatial arrangements of household livelihood strategies brought about by political economic pressures and opportunities in rural and urban Vietnam. (author's)
Developing an HPV vaccine to prevent cervical cancer and genital warts.
The challenges of the journey from target identification through development of a prophylactic quadrivalent human papillomavirus (HPV) vaccine have been met in Gardasil. Cervical cancer is the second leading cause of cancer-related death in women worldwide. Approximately 70% of cervical cancer is caused by infection with HPV types 16 and 18 and ~90% of genital warts are caused by HPV types 6 and 11. The quadrivalent HPV vaccine was generated by expression of the major capsid protein (L1) of HPV types 16, 18, 6 and 11 in yeast. L1 proteins self assemble into pentamer structures and these pentamer structures come together to form virus-like particles (VLPs). The VLPs are antigenically indistinguishable from HPV virions. The VLPs contain no viral DNA and therefore the vaccine is non-infectious. Gardasil is composed of VLPs of HPV types 16, 18, 6 and 11 conjugated to a proprietary amorphous aluminum hydroxyphosphate sulfate adjuvant. The results of a rigorous clinical program have demonstrated that the vaccine is safe and highly efficacious in preventing dysplasias, cervical intraepithelial neoplasias (CIN 1-3) the precursors of cervical cancer and external genital lesions caused by vaccine-HPV types. In conclusion, Gardasil addresses a major medical need, that is, reduction of HPV-related disease including cervical cancer as a safe, immunogenic, and highly efficacious vaccine. (author's)
Prophylactic vaccination against high risk human papilloma virus (HPV) 16 and 18 represents an exciting means of protection against HPV related malignancy. However, this strategy alone, even if there is a level of cross protection against other oncogenic viruses, cannot completely prevent cervical cancer. In some developed countries cervical screening programmes have reduced the incidence of invasive cervical cancer by up to 80% although this decline has now reached a plateau with current cancers occurring in patients who have failed to attend for screening or where the sensitivity of the tests have proved inadequate. Cervical screening is inevitably associated with significant anxiety for the many women who require investigation and treatment following abnormal cervical cytology. However, it is vitally important to stress the need for continued cervical screening to complement vaccination in order to optimise prevention in vaccinees and prevent cervical cancer in older women where the value of vaccination is currently unclear. It is likely that vaccination will ultimately change the natural history of HPV disease by reducing the influence of the highly oncogenic types HPV 16 and 18. In the long term this is likely to lead to an increase in recommended screening intervals. HPV vaccination may also reduce the positive predictive value of cervical cytology by reducing the number of truly positive abnormal smears. Careful consideration is required to ensure vaccination occurs at an age when the vaccine is most effective immunologically and when uptake is likely to be high. Antibody titres following vaccination in girls 12-16 years have been shown to be significantly higher than in older women, favouring vaccination in early adolescence prior contact with the virus. Highest prevalence rates for HPV infection are seen following the onset of sexual activity and therefore vaccination would need to be given prior to sexual debut. Since 20% of adolescents are sexually active at the age of 14 years, vaccinationhas been suggested at 10-12 years. However, parental concerns over the sexual implications of HPV vaccination may reduce uptake of vaccination thereby reducing the efficacy of an HPV vaccination programme. Concerns have already been raised over the acceptability of a vaccine preventing a sexually transmitted infection in young adolescents, particularly amongst parents or communities who consider their children to be at low risk of infection. This may be a particularly sensitive issue for ethnic minority groups. This paper considers the factors which will influence the efficacy of a public HPV vaccination programme and its impact on cervical screening. (author's)
Rotavirus vaccines -- An update.
Rotavirus infection is the most common cause of severe diarrhea disease in infants and young children worldwide and continues to have a major global impact on childhood morbidity and mortality. Vaccination is the only control measure likely to have a significant impact on the incidence of severe dehydrating rotavirus disease. Rotavirus disease prevention efforts suffered a severe setback in 1999 with the withdrawal of the RRV-TV vaccine less than a year after its introduction. Several new rotavirus vaccines have been developed and have proven to be safe and efficacious. These new safe and effective rotavirus vaccines offer the best hope of reducing the toll of acute rotavirus gastroenteritis in both developed and developing countries. (author's)
Maternal anemia: a preventable killer.
Iron deficiency is one of the most prevalent nutritional deficiencies in the world and is reported by the World Health Organization (WHO) to affect four to five billion people. WHO estimates that two billion people suffer from anemia. Approximately 50% of all anemia is estimated to be due to iron deficiency, a condition of deteriorating iron reserves in the body caused by low dietary intake of iron, poor absorption of dietary iron, or blood loss (for example, from hookworm, repeated childbirth or heavy menstruation) which leads to loss of iron. Iron deficiency anemia (IDA) is the most severe form of iron deficiency, and results when the body's iron supply cannot support production of hemoglobin in adequate amounts to maintain normal functioning of the body. Anemia from other causes (and therefore, not iron deficiency anemia), results from malaria or from genetic disorders, among other causes. Other micronutrient deficiencies (e.g., vitamins A, B6 and B12, riboflavin, and folic acid) are also knownto cause anemia (Figure 1). Anemia and iron deficiency remain at epidemic levels among women and children in many nations. Given the availability of proven interventions to prevent and treat anemia caused by a variety of determinants, the persistent high prevalence represent a lack of political will and failure of the public health sector. New estimates of the numbers of maternal and perinatal deaths associated with iron deficiency anemia underscore the urgent need to refocus resources and public health priorities to more effectively tackle the problem. (excerpt)
Albania domestic violence law: final report and recommendations for future technical assistance.
In 2006, Dianne Post, an American independent consultant with extensive experience developing systems to implement domestic violence legislation internationally, assisted Albanian policy makers in their efforts to implement Albania's new law against domestic violence. In this report Ms. Post summarizes her activities and provides recommendations for further action by Albanian authorities. (author's)
HIV, health, and your community: a guide for action.
The idea for this book grew out of our experiences working to help growing numbers of people with HIV (human immunodeficiency virus). In Rwanda, one of us met a doctor who struggled to care for a hospital ward overflowing with women with HIV and tuberculosis. Families were camped outside, cooking and caring for their sick relatives; patients without families suffered because food and other supplies were scarce, but often other people shared what they had. Working long days under tough conditions, the members of the health care team had to make difficult decisions about treatment. They watched as a few patients died each day despite their best efforts. Health workers, social workers, and educators joined together to lessen the suffering caused by HIV. When asked where they had learned to do their jobs, they shrugged their shoulders and pointed to each other. They had learned from experience and word of mouth. Why was there no guide that addressed some of the basic issues regarding HIV disease in areas where most of the people with HIV live? There were thousands of scientific articles about HIV, but the language in them was often obscure and the topics not relevant. In addition, these articles were often unavailable to health care workers in the less industrialized world. What was missing was a comprehensive reference book covering basic topics related to the HIV epidemic. (excerpt)
The HIV / AIDS epidemic in sub-Saharan Africa.
The HIV/AIDS epidemic has had its most profound impact to date in Sub-Saharan Africa. The majority of people living with HIV/AIDS (63%), new HIV infections (65%), and AIDS-related deaths (72%) are in this region, which only accounts for 11% of the world's population. Life expectancy gains over the past century have been halted and in some cases reversed in many of the hardest hit countries in Sub-Saharan Africa, including Botswana, South Africa, Swaziland, Zambia, and Zimbabwe. There are 5.5 million people living with HIV in South Africa alone and Swaziland has the highest adult HIV/AIDS prevalence rate (percent of people living with HIV/AIDS)5 in the world. Almost all countries in Sub-Saharan Africa have generalized epidemics; that is, their prevalence rates are greater than 1%. In several nations, more than 10% of adults are already estimated to be HIV-positive. Women make up the majority of those living with HIV/AIDS in the region, and young people are at particular risk. The epidemic has already posed serious development challenges for the region and has affected communities, families, livelihoods, and numerous sectors of society. Most countries in the region are low-income and heavily or moderately indebted, according to the World Bank, and other challenges some face include food insecurity, internal migration, and conflict. Yet the epidemic is quite diverse throughout Sub-Saharan Africa and, despite these challenges, there have been success stories, with some countries experiencing stabilization and even reductions in HIV prevalence. (excerpt)
The HIV / AIDS epidemic in the Caribbean.
The HIV/AIDS epidemic has had a profound impact on the Caribbean region, the second-most affected region in the world, after sub-Saharan Africa, and the most affected in the Americas. AIDS is a leading cause of death among 15-44 year-olds in the region. Within the region, the epidemic varies significantly by country and population, reflecting the Caribbean's cultural, ethnic, and geographic diversity. Many of the countries in the region have adult HIV/AIDS prevalence rates (the percent of people living with HIV/AIDS) of at least 1%, the highest rates in the world outside of sub-Saharan Africa; countries with prevalence rates greater than 1% are considered to have generalized epidemics. Half of all people living with HIV/AIDS in the region are women, and young people--especially young women--are at particular risk. Factors that exacerbate HIV/AIDS in the Caribbean and complicate the region's response to the epidemic include poverty, unemployment, stigma, discrimination, and gender inequalities. (excerpt)
Young South Africans, broadcast media, and HIV / AIDS awareness: results of a national survey.
HIV prevention efforts in South Africa are at a critical stage. Considerable investment in HIV/AIDS awareness and education through the media and other programs has been made in recent years. Previous surveys have found high levels of awareness among young people about HIV, the means of transmission and the required sexual behavioral modifications. However, surveys have also found that many sexually active youth still do not think of themselves as personally at risk of HIV infection, and misconceptions about the transmission, prevention, and treatment of HIV/AIDS still exist. Broadcast and other media have a crucial role to play in promoting sustained behavior change for HIV prevention. However, more research is needed to understand the reach of current media messaging, as well as the types of messages that resonate most with young people. The purpose of the current study is to help inform the approach of the national public broadcasters and other broadcasters in South Africa to HIV/AIDS messagingand programming in the future, as well as other principal actors in the field of HIV prevention. In order to do this, we conducted a nationwide survey of young South Africans, including questions designed to: Gauge what media young people use and how often they use it; Assess the general attitudes of young people towards broadcast media programming in relation to HIV/AIDS; Measure exposure to and attitudes about various HIV/AIDS communications campaigns that have run on radio and television; Determine young South Africans' general feelings about their lives and their future; Assess the general level of HIV/AIDS awareness and knowledge among young people; Measure sexual behavior patterns and perceptions of risk of HIV infection. (excerpt)
In collaboration with national AIDS control programs, International Network for Rational Use of Drugs (INRUD) groups conducted a survey to ascertain the current practices in measuring and calculating adherence and defaulting behaviors by patients receiving antiretroviral (ARV) medicines in antiretroviral therapy (ART) programs as well as to find what data are routinely recorded and where in five East African countries: Ethiopia, Kenya, Rwanda, Tanzania, and Uganda. Overall, interviews were conducted with 24 programs or facility grouping managers that provide ARVs in the five countries and with facility managers or clinicians in 48 facilities with 86,807 patients on ART. These facilities included a wide range of types. Definitions of both adherence and defaulters or dropouts vary considerably, if they exist at all. Fourteen different definitions of defaulting were used. Measurement at individual or facility level is haphazard, using various data sources and various methods of calculation. Nevertheless, as much information is recorded at both the clinic and pharmacy, a standardized measurement should be possible. A regional meeting was held at the Imperial Resort Beach Hotel, Entebbe, Uganda, April 27-29, 2006, in which 38 participants took part. They came from Management Sciences for Health (MSH), the national AIDS control programs, and local INRUD groups who had coordinated the survey. The meeting was held to discuss findings of the ARV adherence survey and plan work to develop and validate reliable and feasible indicators of adherence. (excerpt)
In collaboration with national AIDS control programs, International Network for Rational Use of Drugs (INRUD) groups conducted a survey to ascertain the current practices in measuring and calculating adherence and defaulting behaviors by patients receiving antiretroviral (ARV) medicines in antiretroviral therapy (ART) programs and to find what data are routinely recorded and where in five East African countries: Ethiopia, Kenya, Rwanda, Tanzania, and Uganda. Overall, interviews were conducted with 24 programs or facility grouping managers that provide ARVs in the five countries and with facility managers or clinicians in 48 facilities with 86,807 patients on ART. These facilities included a wide range of types. Definitions of both adherence and defaulters or dropouts vary considerably, if they exist at all. Fourteen different definitions of defaulting were used. Measurement at individual or facility level is haphazard, using various data sources and various methods of calculation. Nevertheless, much information is recorded at both the clinic and pharmacy locations, so a standardized measurement should be possible. A regional meeting was held at the Imperial Resort Beach Hotel, Entebbe, Uganda, April 27-29, 2006, in which 38 participants took part. They came from Management Sciences for Health (MSH), the national AIDS control programs, and local INRUD groups who had coordinated the survey. The main objective of the meeting was to discuss findings of the ARV adherence survey and plan work to develop and validate reliable and feasible indicators of adherence. (excerpt)
New methods of delivering hormonal contraception.
The ob/gyn's armamentarium for contraception continues to expand, with the addition of several new sustained-release devices that may increase patient satisfaction and compliance. In the United States, 71% of all women aged 25 to 34 years use contraceptives; of these women, 33% choose oral contraceptives. Many patients who desire contraception try OCs and then opt for another method, whether because they don't want to take a pill every day, want sustained contraception, or have experienced side effects. Several new devices that provide sustained release of contraceptive hormones--including a vaginal ring, a transdermal patch, and a new intrauterine device--are or soon will be available. Many patients choose sustained-release contraceptives because they are convenient, easy to comply with, discrete, and have a low failure rate. These delivery systems avoid first-pass metabolism, result in a low daily dosage of hormone, and produce steady blood hormone levels. A brief description of the new hormonalrelease methods follows. (excerpt)
The latest contraceptive option: The single-rod implant.
A reversible, highly effective, and long-acting contraceptive is expected to become available soon to women in the United States. Once approved by the Food and Drug Administration, Implanon will be the only contraceptive implant available in this country. It will give women seeking long-acting reversible contraception a new option in addition to the levonorgestrel intrauterine system, the Copper-T IUD, and the depot medroxyprogesterone acetate quarterly injection. Already being used in Australia, Indonesia, the Netherlands, and at least 30 other countries, this single-rod implant has proven to be safe and highly effective. It provides continuous efficacy for up to 3 years, can be quickly inserted and removed, provides constant hormone levels, and does not affect bone mineral density. Furthermore, the new implant can be used during lactation and may even improve dysmenorrhea and acne. Yet, like most progestin contraceptives, it can cause side effects, particularly irregular vaginal bleeding. (excerpt)
Geographic, demographic and inbreeding patterns in a Basque mountainous region of Guipuzcoa.
The Goierri, a mountain region within the Basque Hills of Guiptlzcoa, includes one of the most culturally controlled autochthonous populations within the Basque area, mainly from linguistic point of view. The effects of geography and demographic changes (1862-1995) on consanguinity variables over its 21 Municipalities have been investigated. Rates of consanguineous marriages and mean inbreeding levels recorded in some of the southern villages can be considered high but, average values for the entire region were lowered due to the early industrialization of the province. In spite of that, consanguinity in the study area has been, for a long time, a prevailing and conspicuous phenomenon when compared to the other Guiptizcoa regions. The impact of marriages between first cousins from immigrant groups on the regional inbreeding levels represents an interesting result as well. Geographic and demographic factors seem to be related both to the extent of marriages as well as to the number of potential mates within populations, which, in turn, are associated with mean inbreeding levels. Altitude seems to show weak relationship with population distribution and population consanguinity variables. Nevertheless, levels of endogamy appear positively correlated with consanguinity rates and mean inbreeding coefficient and, inversely related -but not statistically significant- to mean village sizes. First cousin marriages yield the highest levels of exogamy and exogamous M22 marriages were mostly concentrated within short (1-10 km) and long-range marital distances (>50 km). The average values of Goierri have been compared with a consanguinity data set of some selected Spanish mountain populations taken from the literature. One of the main results is that geographic and demographic variables are poorly correlated with the most important inbreeding parameters. However, different clusters of populations can be observed with specific characteristics for each of them, not highly correlated with geography. (author's)
Fertility of the Tibetans migrated to northern India.
This paper aims to study the fertility rate of the migrant Tibetans residing in Northern India and finding out the factors which are affecting the fertility level among them. Data are reported on age at menarche, age at marriage, first childbirth, use of contraception, widowhood, migration and on various fertility measures in the Tibetans of Northern India living at low and moderate altitude (600-2000 m), who have migrated from high altitude (4000 m above sea level) in Tibet. The migrant Tibetans reported a relatively lower fertility as compared to the high and moderate altitude populations. This lower fertility is mostly attributable to the use of contraception, the later mean age at marriage and first childbirth, and relatively high proportion of widows in the migrant Tibetans. However, the social as well as biological changes in population during migration should not be overlooked, which have a sufficient impact on fertility. (author's)
This study analyses the relationship between consanguinity, fertility and child mortality in a rural population of two moroccan High-Atlas valleys. Among this very endogamous population, we have reconstituted, by inquiries, for each family, the totality of its reproductive life as well as the genealogic relationships that exist between the spouses on several generations. The analysis carried out on the group of families with women who are over 40 years old (438 families) has shown that the population was very strong related (28% of marriages are consanguineous). A positive association between levels of fertility, infant mortality and consanguinity was observed. (author's)
Environmental contributions to variation on menarcheal age were studied in 2018 Spanish girls and women from de Province of Cuenca. (Spain).This province has a big variation in altitude and is one of the most representative as middle-altitude population in Spain. Maturation's delay in high populations is well referenced but there are less studies in European middle-altitude populations. To give news about this topic is the main objective of this paper. Retrospective Method was employed in adult sample and Status-Quo in young population (9 to 15 years old). Another social, nutritional, somatic and educational levels was recording to give a variation contest. Our study shows a significantly variation between the provincial areas. In effect, the population of "Sierra", the mountain region has the last maturation in the adults (13.45 ± 0.73) as well as in girls (13.26 ± 1.07). Secular change was observed in relation with this parameter., but less intense that in total of province. We can confirm the utility of the age of menarche as evaluator of human variation in time and ecological situations. (excerpt)
The United Nations 2002 Revision of the world population projections has radically reviewed the results of the preceding revision. The results obtained show that it is reasonable to dispel the fear of an excessive and perhaps uncontrolled growth of world population, which alarmed public opinion and many international organizations in the last decades. Even in the medium variant, by the year 2050 world population will be less than 9 billion, with zero growth. In view of the fact that fertility will remain below replacement level, after that a process of slow decrease might set in, despite a further sharp increase in survival rates. The objectives of the projections are of an administrative nature: firstly, to adapt global and local policies to the real needs of the population; secondly, to distinguish the trends that are favourable or harmful for the population's greater well-being; thirdly, to govern society in such a way as to achieve the highest possible standard of living, which must be extended to everyone, long-lasting, and therefore compatible with the limits imposed by the environment; the final objective is not to subtract resources from the future generations. (excerpt)
The HIV / AIDS epidemic in African American communities: Lessons from UNAIDS and Africa.
The HIV/AIDS pandemic has afflicted Africa more than any other region of the world. In the United States, the AIDS scourge has disproportionately affected African American communities. In their tragic experiences with HIV/AIDS, both African states and African American communities can benefit from the new communication framework that the United Nations Global AIDS Programme and the Pennsylvania State University have developed to combat the HIV/AIDS pandemic. The framework contains five universal values that are recommended for AIDS intervention programs across the world. The five values are incorporation of government policies, socioeconomic status, culture, gender issues, and spirituality. There are six additional values, two of which apply uniquely to each of the three world regions of Africa, Asia, and Latin America. For Africa, the two unique values are community-based approaches and regional cooperation. The situation in Africa presents valuable lessons for African Americans in the United States. (author's)
Discriminatory attitudes and practices by health workers toward patients with HIV / AIDS in Nigeria.
Nigeria has an estimated 3.6 million people with HIV/AIDS and is home to one out of every 11 people with HIV/AIDS worldwide. This study is the first population-based assessment of discrimination against people living with HIV/AIDS in the health sector of a country. The purpose of this study was to characterize the nature and extent of discriminatory practices and attitudes in the health sector and indicate possible contributing factors and intervention strategies. The study involved a cross-sectional survey of 1,021 Nigerian health-care professionals (including 324 physicians, 541 nurses, and 133 midwives identified by profession) in 111 health-care facilities in four Nigerian states. Fifty-four percent of the health-care professionals (550/1,021) were sampled from public tertiary care facilities. Nine percent of professionals reported refusing to care for an HIV/AIDS patient, and 9% indicated that they had refused an HIV/AIDS patient admission to a hospital. Fifty-nine percent agreed that people with HIV/AIDS should be on a separate ward, and 40% believed a person's HIV status could be determined by his or her appearance. Ninety-one percent agreed that staff and health-care professionals should be informed when a patient is HIV-positive so they can protect themselves. Forty percent believed that health-care professionals with HIV/AIDS should not be allowed to work in any area of health-care that requires patient contact. Twenty percent agreed that many with HIV/AIDS behaved immorally and deserve the disease. Basic materials needed for treatment and prevention of HIV were not adequately available. Twelve percent agreed that treatment of opportunistic infections in HIV/ AIDS patients wastes resources, and 8% indicated that treating someone with HIV/AIDS is a waste of precious resources. Providers who reported working in facilities that did not always practice universal precautions were more likely to favor restrictive policies toward people with HIV/AIDS. Providers who reported less adequate training in HIV treatment and ethics were also more likely to report negative attitudes toward patients with HIV/AIDS. There was no consistent pattern of differences in negative attitudes and practices across the different health specialties surveyed. While most health-care professionals surveyed reported being in compliance with their ethical obligations despite the lack of resources, discriminatory behavior and attitudes toward patients with HIV/AIDS exist among a significant proportion of health-care professionals in the surveyed states. Inadequate education about HIV/AIDS and a lack of protective and treatment materials appear to contribute to these practices and attitudes. (author's)
For individually packaged devices, the expiration date on package refers to sterility of product, assuming packaging is not damaged. IUDs should be protected from heat and direct sunlight. Any break or perforation of sterile package makes the product nonsterile. Copper IUDs sometimes tarnish; copper tarnish does not affect IUD efficacy or safety and does not indicate that the package seal has been broken. Shelf life should not be confused with use life; for example, FEI Products Inc. Copper T 380As inserted at any time during their shelf life (7 years from date of manufacture) have a use life that is at least 12 years from the date of insertion. Because different brands may have different insertion instructions, it is essential that all devices be clearly labeled. (excerpt)
Reporting manual on HIV / AIDS.
Reporting on HIV/AIDS--and the many ways the epidemic can touch the life of an individual as well as a country and the world--is extremely rewarding for a journalist. It is also extremely challenging. AIDS is a complex medical syndrome intertwined with issues of stigma, discrimination, sex, fear, ignorance, denial and death. Mia Milan, a senior resident advisor in Kenya to Internews adds that HIV/AIDS "has taken on a life of its own, a life that depends upon a multitude of vested interests linked to power, prestige, religion and money." Because reporting on HIV/AIDS ultimately deals with matters of life and death, and because many people will form their understanding of HIV/AIDS through the media, the story must be approached with clarity, precision and sensitivity. In 1992, a seminal book on AIDS was published. AIDS in the World contains an essay written by journalist Phyllida Brown that remains relevant today. She writes, "AIDS has become the first global health story. Like no other health storybefore it, AIDS spans all cultures and societies, in industrialized and developing countries alike. Yet for all its importance as a story, AIDS carries with it another obligation--thrusting onto the media the often unwanted and ambiguous role of educator for an audience that, by and large, relies on the press for nearly all it knows about AIDS." (excerpt)
Armenia Demographic and Health Survey, 2005.
The Armenia Demographic and Health Survey (ADHS) is a nationally representative survey of 6,566 women and 1,447 men age 15-49. Survey fieldwork was conducted during the period of September to December 2005. The ADHS was conducted by the National Statistical Service and the Ministry of Health of the Republic of Armenia. The MEASURE DHS Project provided technical support for the survey. The U.S. Agency for International Development (USAID)/Armenia provided funding, and the United Nations Children=s Fund (UNICEF)/ Armenia and the UN Population Fund (UNFPA)/ Armenia supported the survey through in-kind contributions. Armenia is an ethnically homogeneous country; virtually all respondents are Armenian and reported that they are Christians. The majority, approximately 60 percent, live in urban areas. Yerevan accounts for more than one-third of all respondents. All households in Armenia have electricity and a majority of households have water piped into the residence, a flush toilet, a finished floor, and a color television. All but a handful of women and men in the sample have attended school. Approximately 40 percent have reached only secondary school, one-quarter have reached secondary-special school, and one-quarter have attended university. Twenty-nine percent of women and 66 percent of men were employed in the 12 months prior to the survey. (excerpt)
Increased numbers of tuberculosis (TB) cases, coupled with a rise in human immunodeficiency virus (HIV) and multi-drug resistant TB (MDR-TB), are a significant public health problem--as well as an economic threat--in Ukraine. TB rates more than doubled in Ukraine between 1992 and 2002, a result of the economic and social challenges that came with independence, stabilizing by 2004 at 82 notified cases per 100,000 population, the eighth highest rate of 53 countries in the World Health Organization (WHO) European Region. This represents an estimated 40,000 TB cases per year. Ukraine faces a number of challenges in TB control: strategies inconsistent with international recommendations and resource use that is not cost-effective. Ongoing use of mass photofluorography and annual tuberculin screening of children for active case detection, multiple BCG (Bacillus of Calmette and Guerin) re-vaccination, mandatory and lengthy hospitalization of smear-positive patients, TB diagnosis restricted to specialists (even in cases confirmed by a laboratory), and long-term follow-up of patients after completion of treatment contribute to inefficient and ineffective TB control. All of these activities illustrate the underlying issue in TB control in Ukraine: namely that there has been a strong commitment to Soviet-style TB practices among both policymakers and providers, and hence, significant resistance to adopting the internationally-recommended TB control strategy (DOTS). It was in this context that international donors and partner organizations began work to support Ukraine in modernizing its TB control system in 2000. (excerpt)
Congolese women confront legacy of rape: War and sexual violence leave survivors in desperate need.
"If there had been peace, this would not have happened to us," says Kasoke Kabunga. Like thousands of other women, Kasoke and her daughter were raped by armed militiamen in the eastern Democratic Republic of the Congo (DRC). Her daughter died. Kasoke survived, but contracted HIV/AIDS. Their tragedy is the female face of 10 years of war in the DRC, which has claimed more than 3 million lives and displaced another 3.5 million people. Today, a handful of courageous Congolese women are seeking to help Kasoke and other rape survivors find solutions to the many problems facing them. Rachel Kembe, a medical doctor, is one of those providing help. In 1997, when hundreds of women from the Masisi and Ruchuru areas were arriving in the town of Goma with serious injuries, she and five other professional women came together to assist them through the Association nationale des mamans pour l'aide aux déshérités (ANAMAD, National Mothers' Association to Aid the Dispossessed). "We contributed US$20-50 every month," Ms. Kembe explains. "That is how we initially began our work. Today we have 2,500 rape survivors from Goma and the surrounding villages that we have assisted in one way or another." But the number keeps growing. (excerpt)
Combating Zambia's "hidden hunger": NEPAD and partners fortify food with vitamins and minerals.
The majority of children in Zambia eat a meal at least once or twice daily. But despite a full stomach, many lack nutrients essential for their physical and mental development. The Zambian government is fighting this "hidden hunger" by fortifying maize meal, the staple food, with life-saving vitamins and minerals. "A child can eat three meals per day, but still have problems," says Mr. Ward Siamusantu, who manages the country's Maize Meal Fortification Programme. "A few doses short of vitamin A or iron, and you throw away a child's ability to do their best in life. Impaired children will grow up to be impaired adults, costing Africa billions of dollars in lost productivity." African leaders, through the New Partnership for Africa's Development (NEPAD), are at the forefront of continent-wide efforts to infuse micronutrients -- vitamins and minerals -- into maize meal, salt, flour, oil, sugar, soy and other foods. One of the goals of NEPAD, the framework guiding Africa's efforts to accelerate development, is to ensure that all citizens are healthy enough to contribute their full physical and mental potential. (excerpt)
Millions of activists for a day: Stand up campaign seeks to garner public support to fight poverty.
In October, more than 23 million people -- some 3.6 million of them in Africa -- set a world record by literally standing up to bring attention to persistent global poverty and to prompt world leaders to act on their promises to eradicate the scourge. The message of the Stand Up Against Poverty campaign, coordinated by the New York--based UN Millennium Campaign, reached people at more than 11,000 events in over 80 countries -- cricket fans in Jaipur, India, music lovers at a concert in Harare, Zimbabwe, children in school in Lebanon and soccer supporters in Mexico. Organizers timed the global campaign to coincide with other events marking the International Day for the Eradication of Poverty. "Together, we sent a clear message to our political leaders that we are going to keep pushing them to deliver on aid, on debt cancellation, on trade justice and to provide good and accountable governments," said Mr. Kumi Naidoo of the Global Call to Action Against Poverty (GCAP). An alliance of community organizations, faith-based groups, trade unions and campaigners in over 100 countries, GCAP was one of the organizations supporting the Stand Up campaign. (excerpt)
What will it cost to attain the health MDGs? [editorial]
There is an old saying that "amateurs talk strategy and professionals talk logistics". A professional approach to achieving the health-related Millennium Development Goals (MDGs) requires us to move beyond the discussion of possible strategies that could be used. It requires active planning of the practical actions that need to be taken, including raising the necessary funds to ensure these actions can be financed. This cannot be done without information on the costs of implementing the logistical plans. Without detailed plans, countries cannot be sure if they will meet the MDGs. Without accurate costing, countries and donors do not know the extent of the additional funds that will be required. This is a particularly important issue now that we are nearly halfway between the signing of the Millennium Declaration and the target date for achievement, 2015. All recent assessments suggest that few countries are on track and that intensified efforts to raise and use funds well are needed. How much additional funding is required, and where should it be spent? (excerpt)
Saving women's lives: evidence-based recommendations for the prevention of postpartum haemorrhage.
Failure of the uterus to contract adequately after childbirth (atonicity) is the most common cause of postpartum haemorrhage (PPH), the leading cause of maternal death in Africa and Asia. Attempts to identify women at risk of atonic PPH have been unsuccessful. Numerically, more women without risk factors have atonic PPH compared to those with risk factors. To prevent atonic PPH, interventions should therefore be targeted at all women during childbirth. Active management of the third stage of labour has been described as a package comprising the following interlocking interventions: administration of a prophylactic uterotonic after birth of the baby, and usually also early cord clamping and cutting, and controlled cord traction. Other definitions in this package include uterine massage, but without reference to the timing of cord clamping. In contrast, expectant (also called physiological or conservative) management involves waiting for signs of separation and allowing the placenta to deliver spontaneously, or aided by gravity or nipple stimulation. While there is agreement on the beneficial effects of active management of the third stage of labour for prevention of PPH, there is less consensus on issues such as importance of the intervention's individual components, the best methods and the requirements for safe administration of this intervention under conditions of limited resources. In particular, the choice of uterotonics has been the subject of discussion and debate. (excerpt)
Setting priorities for health research: lessons from low- and middle-income countries.
During the past two decades, researchers and policy-makers have become interested in priority setting for health research both at the country and international levels, and this has increased its visibility. The 1990 report by the Commission on Health Research for Development clearly acted as a catalyst in creating this momentum. It recommended that each country should develop a strong national plan to conduct research on both country-specific and global health problems, and that each country should set its own national priorities for research. As a result, a number of low- and middle-income countries started to experiment with comprehensive and problem-focused approaches to setting priorities for health research involving various stakeholders from health and non-health sectors in a consensus- building process. The Council on Health Research for Development, which was established as a direct result of the commission's report, facilitated, reviewed and documented many of these developments. In parallel, the WHO Ad Hoc Committee on Health Research Relating to Future Intervention Options published its report in 1996.3 This report was intended to complement the commission's work which emphasized national level research. This committee's report focused on setting priorities for global health research, and recommended a five-step approach that could be used to inform decision-making about the priority allocation of research and development resources. In January 2006, resolution EB117. R13 of WHO's Executive Board highlighted the importance and relevance of priority setting, reflecting the growing consensus that setting priorities for health research is as critical as conducting the research itself. This paper looks at major issues emerging from countries' experiences in setting priorities during the past 15 years, and at the challenges still to be addressed. (excerpt)
Unpacking the assumption of gender neutrality: Akshaya Project of the Kerala IT Mission in India.
Programs and projects that are not targeted to specific population groups often implicitly assume that they have no adverse distributional effects. However, this is hardly ever the case, especially if the intended beneficiary groups are not reasonably homogeneous. There is increasing recognition in development circles that in the absence of informed affirmative action, inequalities in income distribution and human resources can seriously distort the distribution of project outcomes of seemingly neutral projects. Gender experts have been suggesting that similar kinds of distortions can arise also across gender divides, but this has not translated into restructured project designs in any substantive ways. This article is based on a study of a high-profile ICT (Information and Communication Technology) Project of the Kerala (a Southern Indian state) IT Mission--Akshaya. The study finds that there are indeed varied kinds of gender differences in the impact of the project, and that the differences are pretty sharply defined, especially within the entrepreneur group. It also suggests that with a somewhat greater degree of gender sensitivity and some flexibility in the project design, some of the problems that women entrepreneurs have been facing could have been addressed without much trouble even within the existing project design. (author's)
Workplace violence among domestic workers in urban households in Kenya: a case of Nairobi city.
This paper discusses findings of a study conducted in 2004/2005 on the prevalence and impact of domestic labour migration in Nairobi. Specifically, the paper examines the profile of domestic workers and extent of their vulnerability and exposure to different forms of abuse. The study integrated both qualitative and quantitative research techniques to attain its objectives. The qualitative approach included key informant survey and in-depth interviews. The quantitative approach on the other hand involved a cross-sectional household stratified sample survey in urban residential areas in Nairobi. The results reveal that overall, children account for a higher proportion of domestic workers, most of them girls from poor family backgrounds. Child domestic workers in Nairobi face many workplace social hazards that include injury, verbal harassment and sexual abuse. Based on these findings, the study makes appropriate policy recommendations. (author's)
The debate around prostitution has existed for as long as sex work has. With each new era comes a new sensibility adding more complexity to the debate. In this age of information technology, the world's oldest profession has also found new spaces and new media for itself. This exploratory study seeks to examine women's engagement with technology in the area of sex work. The first section summarizes the most prevalent views on prostitution, which range from 'bad women' to 'poor victims' to 'agents'. The second section recapitulates the context of sex work in Thailand, especially its historical, socio-economic and cultural complexity. Literature on sex work in Thailand is plentiful; however, there is little on freelance sex workers who are a critical part of the sex work scene. The third section presents field data on the use of technology to seek sex work in Bangkok, arguing that women choose to use technology to offer sexual services for a variety of economic and social reasons; and that within the situation of gendered inequities that places them in vulnerable situations, they have empowered themselves through the use of technology. (excerpt)
Contraceptive considerations for breastfeeding women within Jewish law.
Breast milk has been shown to have multiple benefits to infant health and development. Therefore, it is important that maternal contraceptive choices consider the effects on lactation. Women who observe traditional Jewish law, halakha, have additional considerations in deciding the order of preference of contraceptive methods due to religious concerns including the use of barrier and spermicidal methods. In addition, uterine bleeding, a common side effect of hormonal methods and IUD, can have a major impact on the quality of intimacy and marital life due to the laws of niddah. This body of Jewish laws prohibits any physical contact from the onset of uterine bleeding until its cessation and for an additional week. Health care professionals should understand the issues of Jewish law involved in modern contraceptive methods in order to work in tandem with the halakha observant woman to choose a contraceptive method that preserves the important breastfeeding relationship with her infant and minimizes a negative impact on intimacy with her husband. (author's)
Adolescent health: an opportunity not to be missed.
With its launch of this adolescent health Series, The Lancet aims to highlight an area of health care that remains neglected, marginalised, or ignored in many countries. Under the guidance of Glenn Bowes and George Patton from the Royal Children's Hospital, Melbourne, Australia--one of the few hospitals with a longstanding tradition and experience of adolescent medicine--The Lancet publishes six papers that put the spotlight on special health issues of adolescents and young people and that argue strongly for a concerted effort to create youth-friendly health services worldwide. Adolescence is a time in life that harbours many risks and dangers, but also one that presents great opportunities for sustained health and well-being through education and preventive efforts. In the 21st century, young people face an unprecedented situation in many ways. Worldwide there are now an estimated 1.5 billion people aged between 12 and 24 years, the largest ever adolescent group. Never before--at least in developed countries--has adolescence, if defined by the time from puberty onset to that of an independent responsible role in society, been as long as now. Never before was there such a discrepancy between sexual and psychosocial maturity. (excerpt)
Cambodia is facing a food crisis. Since October, 2006, a drop in donations has forced the UN World Food Programme (WFP) to progressively reduce the number of people it can provide food assistance to in the country, which includes 70 000 people with HIV/AIDS and 18 000 people with tuberculosis. Food is important for everyone, but it can help HIV/AIDS or tuberculosis patients in several direct and indirect ways. Optimum nutrition in a digestible form can help maintain health and prevent weight loss in HIV/AIDS patients, who are at increased risk of malnutrition because of a loss of appetite, eating difficulties, malabsorption of micronutrients, and an increased metabolic rate. Food may also help mitigate the side-effects of taking drugs on an empty stomach, thereby improving adherence to treatment. According to the WFP, food aid can be an incentive for tuberculosis patients to attend health-care centres for treatment. And food, combined with medical treatment, might help improve survival of HIV/AIDSpatients. (excerpt)
Us and them: worldwide health issues for adolescents.
Why do the health and social needs of young people sometimes command attention, but sometimes remain obscure? The invisibility of certain societal problems is caused partly by a lack of documentation. Examples abound: the stark photographs by Jacob Riis, the Danish reformer who went to the USA in the late 19th century, shocked the conscience of a nation, with images of child factory-workers and extended families languishing in dank tenement buildings. Michael Harrington's The other America: poverty in the United States achieved the same for hunger and poverty as public-health priorities of the early 1960s. In Australia, Burdekin's report highlighted the plight of homeless and socially disadvantaged youth in a way that provoked shock and shame. Common to these examples is the slow agenda-building on behalf of groups that have remained invisible because of their stigmatised or diminished status. (excerpt)
Africa battles to make female genital mutilation history.
During the past 2 years, substantial progress has been made in changing attitudes towards female genital mutilation in countries such as Guinea, Egypt, Tanzania, Kenya, and Senegal. But the practice remains widespread across Africa. Wairagala Wakabi reports. In Guinea, where 97% of all women undergo female genital mutilation, about 150 communities made a declaration to collectively abandon the practice at the beginning of this year. Attitudes towards the harmful procedure are also changing in other countries in Africa such as Egypt, Tanzania, Kenya, and Senegal. But despite this growing momentum against the practice, it is still prevalent in these countries and it remains widespread in at least 28 countries on the continent. Poor education and low levels of income among women in African countries, coupled with inadequate governmental support in efforts to eradicate the practice, mean it will take longer to stamp out. Human rights activists place much of the blame for slow progress at the door of governments. "The struggle to have communities in Africa abandon female genital mutilation is taking too long because it's only civil society who have taken it seriously. Governments are yet to take up the matter to the expected level", says Faiza Mohamed, Africa regional director of women rights group Equality Now, which works with 23 organisations in 16 African countries. (excerpt)
Elizabeth Mapella: prioritising adolescent health in Tanzania.
In Tanzania, as in many sub-Saharan African countries, the evolution of the HIV/AIDS epidemic has brought into stark relief the need for policies to protect the health of adolescents, a group frequently lost to health services. But for Elizabeth Mapella, who since 1998 has been working to improve the country's adolescent and reproductive health services through her work in the ministry of health, the problems afflicting this age-group have long been a cause for concern: "I want to know why young people are suffering and what to do to make a difference. And that curiosity is also part of what makes me continue to work in this area." Becoming a doctor was the realisation of an ambition Mapella had held since a hospital visit when she was 14 years old. "When I was young, I had an attack of malaria and I was taken by my parents for treatment in a nearby centre. I was so impressed by the clinician who attended me and from then on my ambition was to be a doctor", she explains. Although adolescent healthwas not regarded as a specialist area when she was doing her clinical training, through her obstetric training and modules on child health she began to realise that there was a real need for services that adolescents felt comfortable using: "In that age bracket I started to see how severe the problem is--especially when they are pregnant", Mapella says. (excerpt)
Exclusive breastfeeding and HIV.
Promotion of breastfeeding has been ranked as the most cost-effective intervention for child survival, and could prevent 13-15% of child deaths in low-income countries. But in some circumstances, breastfeeding can transmit HIV, which presents a terrible dilemma for parents and policymakers. UNAIDS estimates that over 300 000 children are infected with HIV through breastfeeding every year. To weigh the risks we need good data, but such research is fraught with difficulties. Hoosen Coovadia and colleagues' meticulous prospective study in KwaZulu--Natal, South Africa, published in today's Lancet, is a breakthrough. It provides crucial confirmatory evidence that when HIV-positive mothers breastfeed exclusively, their babies have only a low risk of infection with HIV. This risk is lower than that in babies who receive other food or liquids in addition to breastmilk before 6 months of age. Mixed feeding before or after 14 weeks nearly doubled transmission risk and the addition of solids increased the risk 11-fold. Importantly, Coovadia and colleagues also re ported that mortality by 3 months of age for replacement-fed babies was more than double that of those who were exclusively breastfed. This result adds to the accumulation of new evidence on the hazards of formula feeding. An investigation of a serious outbreak of diarrhoea in Botswana in 2006 showed that 93% of the infants admitted to hospital were not breastfeeding, and these children had the greatest risk of dying. (excerpt)
Effect of war on the menstrual cycle.
The objective was to study the effect of a short period of war on the menstrual cycles of exposed women. Six months after a 16-day war, women in exposed villages aged 15-45 years were asked to complete a questionnaire relating to their menstrual history at the beginning, 3 months after, and 6 months after the war. A control group, not exposed to war, was also interviewed. The data collected were analyzed to estimate the effect of war on three groups of women: those who stayed in the war zone for 3-16 days (Group A), those who were displaced within 2 days to safer areas (Group B), and women not exposed to war or displacement (Group C-control). More than 35% of women in Group A and 10.5% in Group B had menstrual aberrations 3 months after the cessation of the war. These percentages were significantly different from each other and from that in Group C (2.6%). Six months after the war most women regained their regular menstrual cycles with the exception of 18.6% in Group A. We found a short period of war, acting like an acute stressful condition, resulted in menstrual abnormalities in 10-35% of women and is probably related to the duration of exposure to war. This might last beyond the war time and for more than one or two cycles. In most women the irregular cycles reversed without any medical intervention. (author's)
Editorial introduction: Community and identity in the new Chinese migration order.
Migration from China has fundamentally changed in the past 25 years. Much has been written on the benefits and threats of different types of Chinese migration flows for receiving countries. Almost equally as much has been written about the many forms of Chinese transnationalism and cosmopolitanism brought forth by the new Chinese migration. This article discusses the new types of migratory flows emanating from China, with a focus on ethnic identity formation, competition and cooperation between different migrant Chinese groups, both new and old, in different settings in Europe, North America and Africa. The article concludes with some observations on future changes in the pattern of Chinese migration and their impact on the world migration order. (author's)
Increasing antiretroviral drug access for children with HIV infection.
Although there have been great gains in the prevention of pediatric HIV infection and provision of antiretroviral therapy for children with HIV infection in resource-rich countries, many barriers remain to scaling up HIV prevention and treatment for children in resource-limited areas of the world. Appropriate testing technologies need to be made more widely available to identify HIV infection in infants. Training of practitioners in the skills required to care for children with HIV infection is required to increase the number of children receiving antiretroviral therapy. Lack of availability of appropriate antiretroviral drug formulations that are easily usable and inexpensive is a major impediment to optimal care for children with HIV. The time and energy spent trying to develop liquid antiretroviral formulations might be better used in the manufacture of smaller pill sizes or crushable tablets, which are easier to dispense, transport, store, and administer to children. (author's)
Inequalities in mortality by marital status during socio-economic transition in Lithuania.
The objectives were to analyse the changes in mortality inequalities by marital status over the period of socio-economic transition in Lithuania and to estimate the contribution of major causes of death to marital-status differences in overall mortality. A survey based on routine mortality statistics and census data for 1989 and 2001 for the entire country. The proportion of married population has declined over the past decade. Widowed men and never married women were found to be at highest risk of mortality throughout the period under investigation. Although inequalities have not grown considerably, mortality rates have increased significantly for divorced populations and for never married men, widening the mortality gap. Cardiovascular diseases contributed most to excess mortality of never married and divorced men, as well as all unmarried groups of women. The excess mortality of widowed men from external causes was greatest in 2001. Marriage can be considered as a health protecting factor, particularly in relation to mortality from cardiovascular diseases and external causes. Local and national policies aimed at health promotion must focus primarily on improving the position of unmarried groups and providing psychological support. (author's)
A middle-aged man moves from the hinterland of China to the east coast to find work as a construction worker; a young woman from rural Indonesia takes up a factory job in Jakarta; a Vietnamese woman joins her fellow villagers in Hanoi to work as a scavenger . . . Migration scholars, policy-makers and the public media may see in these phenomena the migrant, the journey and the arrival. But for the migrants, these activities also signal departure, separation and leaving family members, loved ones and familiar places behind. Indeed, 'leaving behind' often entails emotional and psychological struggles as well as complex rearrangements of the material aspects of daily life of a magnitude as significant as 'moving to' and 'settling in' places of destination. An individual's 'migration' presents a major rupture of the inner workings and everyday life of an entire household. While it is well recognised that rural--urban labour mobility continues to rise in terms of both magnitude and geographical scope across Pacific Asia -- more people are migrating from more places to more destinations -- the 'left behind' (by definition, a much larger group than the migrants themselves) are often forgotten. (excerpt)
The Child Survival XIII Cost Extension project is located in the Bara District of the Narayani Zone of the Central Development Region of Nepal. The district is in the Terai, a lowland area that extends along the Indian border. The project area includes 98 Village Development Committees (VDCs). Bara has a total population of 600,000 inhabitants. Approximately 80,000 children under five years of age and 110,000 women of reproductive age are the target beneficiaries. The goal of the project is to assist the Ministry of Health to improve the health status of children under five and of women of reproductive age (15-49) in Bara district. The end-of- project objectives are: Behavioral: Women of reproductive age and mothers of children under five years of age will be practicing healthy behaviors and seeking medical care from trained providers. Increased access to services: Communities and families will have increased access to health education, quality care and essential medicines. Quality of care: Ministry of Health personnel, community volunteers and other service providers will be practicing appropriate integrated management of sick children (particularly pneumonia and diarrhea case management). Practitioners and volunteers will also deliver quality family planning and maternal and newborn preventive care. Institutional strengthening: Community-based organizations, local non-governmental organizations, and Ministry of Health facilities in the district will be developed and strengthened to support and implement activities that enhance child survival. (excerpt)
The project interventions fell under the following categories: 5) Malaria (35%): Reduction of mortality and morbidity associated with malaria in children and pregnant women, through prevention education, promotion of use of impregnated bed nets, improved treatment of malaria, and prenatal chemo-prophylaxis. 6) Diarrhea (20%): Reduction of diarrhea-associated mortality and morbidity through a) teaching and promoting prevention measures in the home, b) strengthening mothers' capacity to recognize and provide home treatment for mild diarrhea with fluid and dietary management, and c) strengthening mother's capacity to identify signs of moderate and severe diarrhea, know sources of care, take the child for care, and comply with health provider recommendations. 7) Immunizations (35%): Increased immunization coverage in the program area for all infants by the end of the first year of life, and tetanus toxoid (second dose) immunization for pregnant women, increased measles vaccination (including twice yearly vitamin A) and prevention of measles-caused diarrhea and death. 8) Pneumonia (10%): Reduction of pneumonia-associated mortality through prompt, appropriate and standardized pneumonia case management, a sustainable supply of antibiotics at the health centers (CSComs), prompt recognition by relays of pneumonia signs (fever, fast breathing) and referral of suspected cases to the nearest health center, and appropriate mothers' care-seeking behavior. The program approach used was to help strengthen the existing health care system. This comprised of two strategies: 1. Training and building the capacity of health personnel and supporting community health Associations (ASACOs) in order to increase utilization of health care services; 2. Supporting IMCI implementation in health facilities (CSComs). (excerpt)
The USAID project for maternal health and family planning in Senegal, named Projet de réduction de la mortalité and de la morbidité maternelles (PREMOMA) and administered by Management Sciences for Health and the Futures Group International, took over from the Maternal Health and Family Planning Project (PSM/PF, 2000-2004) as of November 2004. PREMOMA has made a significant contribution to the efforts of the government of Senegal and local nongovernmental organizations in improving maternal health by decreasing maternal mortality and increasing awareness of family planning. Two key interim results (KIRs) should allow the project to achieve these objectives: improved access to prenatal services, assisted delivery, postnatal follow-up, and family planning by integrating and decentralizing services; and increased demand for these services. (excerpt)
Croatia has a strategic location along European human trafficking routes. The country is a source and destination country for human trafficking but also a bridge across which victims are transferred from Southeastern Europe and the former Soviet states to the rest of Europe, particularly Italy, France, Switzerland and Spain. Croatian communities along the borders of Bosnia-Herzegovina (BiH), Serbia, and Montenegro sit on the front lines of the fight against trafficking in humans. From September 30, 2004 to September 20, 2006 the STAR Network of World Learning implemented the Croatian Trafficking Prevention Activity (CTPA) through a $239,887 cooperative agreement with USAID Croatia. CTPA's strategy for reducing trafficking in Croatia focused on a) raising awareness of local communities on the risks of trafficking; and b) promoting increased knowledge of professionals that deal with trafficking issues. Because trafficking is a regional problem, CTPA took a regional approach by supporting local-levelawareness raising and networking particularly along Croatia's porous border with Bosnia-Herzegovina. (excerpt)
The importance of prevention to faith communities.
A s early as 1986 the Executive committee of the World Council of Churches (WCC) stated: to confess that churches as institutions have been slow to speak and to act, - that many Christians have been quick to judge and condemn many of the people who have fallen prey to the disease; and that through their silence, many churches share responsibility for the fear that has swept our world more quickly than the virus itself "and called on the churches to respond appropriately to the need for pastoral care, education for prevention and social ministry" . In September 1996, a landmark, comprehensive statement, the Impact of HIV/AIDS and the Churches' Response, was adopted by the WCC Central Committee on the basis of the WCC Consultative Group on AIDS study process. The statement clearly states that: Churches can do much to promote, both in their own lives and in the wider society, a climate of sensitive, factual and open exploration of the ethical issues posed by the pandemic. ... in accordance with theiremphasis upon personal and communal responsibility the churches' can promote conditions -- personal, cultural, and socioeconomic -- which support persons in making responsible choices. This requires a degree of personal freedom which is not always available: for example, women, even within marriage, may not have the power to say "no" or to insist on the practice of such effective preventive measures such as abstinence, mutual fidelity and condom use. (excerpt)
The ABC strategy, which stands for Abstinence, Be faithful and Condoms has been a key strategy in comprehensive HIV prevention programmes. To its credit, the catchy and simple acronym has popularized HIV prevention measures. It has brought to the forefront the role of sex in HIV transmission and put forward the promotion of condoms as a key component of HIV prevention. It has also, in no uncertain terms, underlined the important role of behavioural modification such as delaying sexual debut and reducing the number of sexual partners in curbing HIV transmission in communities. But some of the messages used for HIV prevention have had the unfortunate consequence of adding to the stigma surrounding HIV. In some respects, ABC is one such message. ABC has proven less than ideal to address the complexities of human life, as it does not take into account the critically important issue of gender. It has failed to address masculinity, and its often harmful and violent expression. It avoids the reality of women being deprived of their right to negotiate sexual relationships. Some women's empowerment programmes for HIV prevention have also added to the existing burden on women as safe sex negotiation strategies have become their exclusive responsibility. (excerpt)
Churches in the lead on HIV prevention reinvigoration.
Saving lives is the paramount goal of all HIV programmes. Successful HIV prevention programmes utilize all approaches known to be effective, not implementing one or a few select actions in isolation. These include promoting sexual abstinence, fidelity among married couple and the use of condoms for those who are not in a position to abstain or be faithful. It also includes ensuring that injecting drug users have access to clean needles and syringes as well as programmes supporting them to stop drug use. The strategies also include assurance that HIV-positive pregnant women receive treatment to prevent HIV transmission to the child. These strategies (See insert) were endorsed by the UNAIDS board last year and provide the framework for re-energizing HIV prevention globally. (excerpt)
In theory, a person exposed to HIV during sexual assault or other activity involving exposure to potentially infected blood and other body fluids can reduce the risk of infection by taking antiretroviral drugs soon after exposure, a treatment known as post-exposure prophylaxis. Antiretroviral prophylaxis following occupational exposure has been a standard of care for health workers since the 1980's. Prophylaxis following sexual exposure and other exposures including injecting drug use has been extensively considered and debated. Practical guidelines and policy recommendations for non-occupational HIV prophylaxis must consider the limitations of current scientific knowledge and lack of definitive evidence concerning efficacy to support such recommendations. Post-exposure prophylaxis should be considered following non-occupational exposures that include sexual assault, needle sharing, trauma involving human bites where there is exchange of blood, condom breakage or other exposures. Because there areno randomized, placebo-controlled clinical trials on which to definitively base recommendations, current recommendations are based on best practice evidence and the considered opinion of experts in this field. Several studies also support the feasibility of post-exposure prophylaxis. (excerpt)
At the end of 2005 an estimated 38.6 million [33.4 million--46.0 million] people worldwide were living with HIV. In the same year an estimated 4.1 million [3.4 million--6.2 million] became newly infected with HIV and an estimated 2.8 million [2.4 million--3.3 million] lost their lives to AIDS. Despite having just over 10% of the world's population, Sub-Saharan Africa is home to more than 60% of all people living with HIV -- some 25.4 million -- and AIDS is the leading cause of adult morbidity and mortality. Without a rapid increase in the HIV response most if not all of the people living with HIV in Sub-Saharan Africa will have died by 2020. Statistics mask a deeper truth about HIV which points to important issues about inequality, vulnerability and how best to fight the disease. The global AIDS epidemic is composed of many small, often overlapping epidemics that reflect different patterns of risk and vulnerability. The burden of HIV does not fall evenly across the world but concentrates its impact on regions and populations, exacerbating the impact of poverty, marginalization and human rights violations. As a result, within countries some groups are disproportionately affected by HIV. (excerpt)
Since HIV made its debut on the international stage over 25 years ago, much has been learnt about prevention. Knowledge about HIV transmission and the role of key interventions to prevent HIV transmission from mother-to-child and harm reduction initiatives for injecting drug users have dramatically altered the prevention landscape. However, in the face of increased treatment and the key to sustained behaviour change(s) remaining largely elusive, HIV prevention fatigue is a reality which has not been adequately addressed. The weariness of both the "post-AIDS" generation for whom past hard won battles have little meaning as they explore their sexuality and for those who have reaped the rewards of antiretroviral therapy are realities that our prevention efforts need to address more boldly. (excerpt)
An epidemic of stigma and discrimination.
The AIDS epidemic is one of the world's most significant challenges. AIDS has exposed the perilous state of many countries' health care systems as well as killing 8000 people daily, leaving thousands of children orphaned and reducing communities' productive capacity. The AIDS pandemic has seen an epidemic of HIV-related stigma, discrimination and denial follow in its wake. Stigma and discrimination increase vulnerability and the impact of HIV among people living with and affected by it. They both seriously threaten the effectiveness of HIV prevention and treatment, which means tackling stigma and discrimination must be at the heart of the AIDS response. (excerpt)
A HIV vaccine: Why we need one, current efforts and challenges.
Why we need a vaccine? The news about the AIDS epidemic is bleak and relentless. Since the start of the epidemic, an estimated 65 million people have been infected with HIV, of whom some 25 million have died. In 2005 alone almost 3 million people lost their lives to AIDS, children accounted for one in every six of these AIDS-related deaths. In the same year, there were over four million new HIV infections worldwide, almost three million of these in sub-Saharan Africa. Despite progress made in a small but growing number of countries, the AIDS epidemic continues to outstrip global efforts to contain it. H IV prevention interventions are essential to make an impact on the pandemic. Where HIV prevalence is high--either in a geographic area (for example sub-Saharan Africa) or concentrated in particular populations (such as drug users in the Russian Federation)--maximum coverage is needed in order to slow the epidemic. It is also important to achieve optimal coverage of HIV prevention programmes in allsettings in order to have an impact. It is estimated that the implementation of a comprehensive HIV prevention package could avert 29 million (or 63%) of the 45 million new infections expected to occur between 2002 and 2010. (excerpt)
Prevention of mother-to-child HIV transmission.
Recent gains in child survival rates are threatened by the AIDS epidemic. Each year, approximately 600 000 infants, most of them in Sub-Saharan Africa, are born with or become HIV-positive as a result of mother-to-child HIV transmission. The rising number of HIV-positive children places an enormous burden on families and health care systems. Mother-to-child HIV transmission can be greatly reduced by expanding high quality antenatal and obstetric care, voluntary HIV counselling and testing, access to antiretroviral therapy, and the use of breast milk substitutes or exclusive breastfeeding. In Kenya, AIDS was declared a national in 1999. Over 2.5 million people are living with HIV, an estimated 15% of the adult population. In addition to the estimated 220 000 HIV-positive children, there are almost 1 million AIDS orphans. The social and economic repercussions are devastating and are reversing hard-won gains in development and rolling back the child survival gains made since independence. Kenyan studies show that there is a nine-fold increase in the risk of death for HIV-positive children compared to HIV-negative children and approximately 50% of HIV-positive children die before their second birthday. In the event that the mother dies, there is an eight-fold risk of death of an infant irrespective of HIV status. (excerpt)
Microbicides and their role in HIV prevention.
Infectious diseases traditionally evoke two public health responses - prevention and treatment. Unfortunately, the virus that causes AIDS has proven to be much more difficult than anticipated to defeat, forcing scientists to be innovative. HIV vaccines have proven elusive, while treatment has required the combination of several drugs to be effective. Increasingly it is clear that a combination of approaches, both new and old, within a comprehensive response is needed. Microbicides -- informed by what has been learned to date about HIV treatment and prevention -- represent one of the most promising new ideas to have emerged out of the pandemic. In 2005, microbicides were hailed as one of ten new technologies poised to make an impact on reaching the health-related Millennium Development Goals. (excerpt)
HIV / AIDS and care of the teeth and gums.
Many things in the world have changed since Where There Is No Dentist was first published in 1983. One of the most profound changes has been the spread of HIV/AIDS worldwide. Although millions of people are now infected with HIV, the illness is still surrounded by fear and disinformation. This chapter explains HIV/AIDS, what it means for people who are infected and for oral health workers, and how we can all work together to prevent the disease from continuing to spread. (excerpt)
Information for mothers and midwives.
The menopause or climacteric is the time in a woman's life when the menstrual periods stop coming. After menopause, she can no longer bear children. In general, this 'change of life' happens between the ages of 40 and 50. The periods often become irregular for several months before they stop completely. There is no reason to stop having sex during or after the menopause. But a woman can still become pregnant during this time. If she does not want to have more children, she should continue to use birth control for 12 months after her periods stop. When menopause begins, a woman may think she is pregnant. And when she bleeds again after 3 or 4 months, she may think she is having a miscarriage. If a woman of 40 or 50 starts bleeding again after some months without, explain to her that it may be menopause. (excerpt)
Family planning -- having the number of children you want.
Some mothers and fathers want a lot of children--especially in countries where poor people are denied a fair share of land, resources, and social benefits. This is because children help with work and provide care for their parents in old age. In such areas, having just a few children may be a privilege only wealthier people can afford. The situation is different in poor countries where resources and benefits are fairly distributed. Where employment, housing, and health care are guaranteed and where women have equal opportunities for education and jobs, people usually choose to have smaller families. This is in part because they do not need to depend on their children for economic security. In any society, parents have a right to make their own decision about how many children to have, and when to have them. Different parents have different reasons for wanting to limit the size of their family. Some young parents may decide to delay having any children until they have worked and saved enough so that they can afford to care for them well. Some parents may decide that a small number of children is enough, and they never want more. Others may want to space their children several years apart, so that both the children and their mother will be healthier. Some parents feel they are too old to have more children. In some places, men and women know that if they have a lot of children, when the children grow up there may not be enough land for all of them to grow the food their families need. (excerpt)
Health and sicknesses of children. What to do to protect children's health.
It is important that children eat the most nutritious foods they can get, so that they grow well and do not get sick. The best foods for children at different ages are: in the first 6 months: breast milk and nothing more; from 6 months to 1 year: breast milk and also other nutritious foods--such as boiled cereals, mashed-up beans, eggs, meat, cooked fruits and vegetables; from 1 year on: the child should eat the same foods as adults--but more often. To the main food (rice, maize, wheat, potatoes, or cassava) add 'helper foods' as discussed in Chapter 11; Above all, children should get enough to eat--several times a day; All parents should watch for signs of malnutrition in their children and should give them the best food they can. (excerpt)
It is important to understand how your body works. The more you know about your body, the better able you will be to take care of yourself. When you understand your body and your normal changes, you will be able to recognize if something happens because of your disability or if it is a normal change that happens to all women. This will also help you decide for yourself if the advice others give you is helpful or harmful. (excerpt)
Rebels at risk: young women and the shadow of AIDS in Africa.
AIDS casts a deep shadow of uncertainty and danger as young women face unenviable choices in a changing world. It is in this context that we shall explore the extent to which a peer culture of adolescence is emerging and how it is gendered, the way in which familial relations are being tested and tried, the extent of communication between those of different generations regarding sexuality and protection, the way in which marriage is being rethought by some young women, and the potential for women to create futures in which they are autonomous of male support. Norms describing sexual behaviour have undergone considerable change over recent years within many African countries, including Tanzania and Zambia, particularly in urban areas and among those who are more educated. While marriage may be occurring later,1 sexual experimentation has often come early, sometimes leading to worrying levels of STD infection and teenage, extra-marital, pregnancies. At the same time former mechanisms of instruction in sexual matters have in many cases broken down. Among many groups it was and remains improper to speak of sexual matters in the presence of one's parents or for parents to teach their children about sex, particularly across gender lines. But as Tumbo-Masabo (1994) notes, whereas pre-colonial patterns of initiation were rule governed and characterised by an 'openness,' today there is more commonly a socialisation of 'silence'. Although this 'silence' is being challenged within the context of the AIDS epidemic and many parents recognise the need to fill the gap, they frequently find themselves, in practice, not always able to do so. Some sex education occurs in schools, but its limited nature means that young people are often left to learn about such matters from their peers. (excerpt)
Prostitutes are one of the most frequently cited groups at risk for AIDS in Africa and elsewhere. Working in major population centers and at busy crossroads, and generally highly infected with the HIV virus, they are often held responsible, at least partly, for the propagation of HIV infection. Numerous publications describe their reported sexual behavior and offer statistics relevant to HIV epidemiology. Studies of prostitutes abound, but are generally city-based, and women are selected solely because they practice prostitution. Ethnic background, geographical origin, family situation, and personal circumstances are usually mentioned briefly, if at all. Sometimes the only common denominator for these women is that they work as prostitutes, and that term itself refers to a wide range of practices. In this village-based study, the proverbial horse and cart are inverted. The women are considered first and foremost as members of their families, village, and culture, and only secondarily as having opted for prostitution as a means to earn cash. Most women born in the study area remain there, following a more or less traditional way of life. Yet, for various reasons, some leave to work as prostitutes in Bissau, Ziguinchor and other population centers of Guinea-Bissau and Casamance, sometimes venturing as far as Banjul. (excerpt)
A story to tell. Better health in Latin America and the Caribbean.
Over the past few decades, major improvements in health status have occurred throughout the Latin America and Caribbean (LAC) region. USAID has been one of the principal health sector donors in countries where these improvements have occurred. This report reviews some of the major health trends in USAID-assisted countries in the LAC region and presents an overview of 2005 program activities and achievements. Several regional and country-level programs are showcased throughout the report to highlight innovative approaches, outstanding progress, and lessons learned in 2005. Overall, USAID resources in support of maternal and child health, reproductive health, and health systems strengthening have declined in the LAC region over the past several years. It is thus important to highlight major challenges anticipated for the coming years and to identify strategies for maximizing scarce resources to meet the highest-priority health needs and achieve U.S. Government foreign policy priorities. The report's final chapter discusses these challenges and new directions for future programming. (excerpt)
This discussion is particularly timely, as only three weeks ago the 16th International AIDS Conference came to a close in Toronto, Canada. The International AIDS Conference is intended to be a scientific meeting, but it offers an opportunity to spotlight the HIV/AIDS epidemic on a global stage. Both Ambassador Dybul and I had the opportunity to engage conference participants in robust, frank dialogue about the critical interventions needed to accelerate the prevention of HIV. Against the backdrop of the conference, I returned to Washington with three overarching themes dominant in my thinking: One: The United States is recognized as the global leader in the fight against HIV/AIDS. The sheer magnitude of resources the U.S. has committed to this single disease is unprecedented, and beyond that of any other nation in the world. In both public comments and in the press, the Emergency Plan is repeatedly cited as the single greatest contributor to the fight against HIV/AIDS. Two: The fight against HIV/AIDS is far from over. In fact, I don't believe we've yet even turned the corner. Despite impressive achievements in the expansion of treatment numbers, four million new infections every year threaten to dwarf the global resources available to meet the treatment requirements in the years ahead. This simple arithmetic fact means that we have no alternative but to scale up significantly and strengthen the prevention of new HIV infections globally. And since the vast majority of new infections occur through sexual transmission, we must focus particularly on that area. Three: Although opinions can and do diverge regarding the relative importance of various prevention interventions, we must differentiate between legitimate debate and the much more common misinformation so often associated with discussion of the U.S. endorsement of ABC - "abstinence or delay of sexual debut," "be faithful and at the very least partner reduction," and "correct and consistent use of condoms." The ABC approach is an evidence-based, flexible, and common-sense based strategy which plays a major role in stemming the tide of the HIV/AIDS pandemic. It is too important to be bogged down in the politics of passion. Too much is at stake, too many lives hang in the balance, too many children are vulnerable to become orphans if we fail in our prevention efforts. (excerpt)
Country profile, President's Malaria Initiative (PMI): Malawi.
All Malawians are at risk of contracting malaria. Malaria is responsible for up to 30 percent of outpatient visits, 20 percent of hospital admissions, and 25 percent of hospital deaths. The goal of the PMI is to reduce malaria-related mortality by 50 percent in target countries by reaching 85 percent of the most vulnerable groups - principally pregnant women, children under 5 years of age, and persons living with HIV/AIDS - with lifesaving services, supplies, and medicines. (excerpt)
Country profile, President's Malaria Initiative (PMI): Mozambique.
Malaria is endemic in 99 percent of Mozambique and is the leading cause of morbidity and mortality. It is responsible for up to 40 percent of outpatient visits and 30 percent of hospital deaths. Approximately 60 percent of all children admitted to the hospital are admitted for severe malaria. The goal of the PMI is to reduce malaria-related mortality by 50 percent in target countries by reaching 85 percent of the most vulnerable groups - principally pregnant women, children under 5 years of age, and persons living with HIV/AIDS - with lifesaving services, supplies, and medicines. (excerpt)
Country profile, President's Malaria Initiative (PMI): Rwanda.
Approximately 90 percent of Rwandans are at risk of contracting malaria, which is one of the leading causes of illness and death in Rwanda. The goal of the PMI is to reduce malaria-related mortality by 50 percent in target countries by reaching 85 percent of the most vulnerable groups - principally pregnant women, children under 5 years of age, and persons living with HIV/AIDS - with lifesaving services, supplies, and medicines. (excerpt)
Country profile, President's Malaria Initiative (PMI): Senegal.
All Senegalese are at risk of contracting malaria. Malaria is responsible for up to 30 percent of outpatient visits, 20 percent of hospital admissions, and 25 percent of hospital deaths. The goal of the PMI is to reduce malaria-related mortality by 50 percent in target countries by reaching 85 percent of the most vulnerable groups - principally pregnant women, children under 5 years of age, and persons living with HIV/AIDS - with lifesaving services, supplies, and medicines. (excerpt)
Across the world some 10.8 million children under five years of age die every year. Most of these deaths are preventable and almost all occur in poor countries. I recognize the enormous impact of child hunger and malnutrition on future development and as an underlying cause of the deaths of these millions of children. For that reason, I welcome this opportunity to discuss what USAID is doing to reduce this awful and unnecessary blight on the world's future. According to UN estimates, currently, 296 million undernourished children live in the developing world. Other estimates are even higher. For many of these children the damage from hunger and malnutrition can be life-long. Almost all nutritional deficiencies impair immune function and other host defenses leading to a cycle of longer lasting and more severe infections and ever-worsening nutritional status. Hunger leads to physical stunting, lowers intelligence, and increases susceptibility to diseases, dramatically increasing health care costs and severely limiting their full potential to contribute to nation building. USAID programs recognize that well nourished children rarely die from diarrhea and common childhood infections, and maintaining good nutritional status is an integral part of improving child survival. USAID interventions are designed to decrease child and maternal mortality; reduce crippling healthcare costs; and boost intellectual and physical potential and national productivity. (excerpt)
Although a cure for Tuberculosis has existed for more than half a century, the disease is often diagnosed or treated improperly, or doesn't reach those who need it, and so it continues to infect and kill some 2 million people every year, according to the World Health Organization (WHO). Nearly 9 million people will develop TB during 2005. Worldwide, the number of new TB cases increases by about 1 percent every year. The global resurgence of TB has been fueled by increasing HIV/AIDS prevalence, inadequate investments in public health system and emerging resistance to anti-TB drugs. Persistent poverty, crowded living conditions, and delayed diagnosis and treatment contribute to transmission of the disease. TB threatens the poorest and most marginalized groups, disrupts the social fabric of society, and slows or undermines gains in economic development. An overwhelming 98% of the 2 million annual TB deaths - and 95% of the new TB cases each year - occur in developing countries. On average, TB causes three to four months of lost work time and lost earnings of 20-30 percent of household income. For families of persons who die from the disease, the impact of TB is even greater as about 15 years of income is lost due to premature death. In developing countries, the impact of TB on the family is even more important as TB generally afflicts the most economically active segment of the population between the ages of 15 and 54. (excerpt)
This paper explores communication and negotiation regarding contraception and childbearing based on multiple semi-structured interviews with 19 married couples in southwestern Bangladesh. The narratives of three couples are presented to describe how sociocultural context and gender-based norms influence interactions between husbands and wives and their fertility decision-making. Despite national-level declines in fertility, the couples' stories illustrate the ongoing struggles to balance their desired number of male and female children with their financial and social well-being. The stories also indicate that the nature of the interactions between spouses evolves throughout the course of their marital and reproductive lifespans, resulting in a shift in fertility decision-making power. Both wives and husbands described the relative powerlessness of new wives in negotiating fertility with husbands and extended family; however, wives' preferences appeared to dominate as they became more established in their households. Many wives acted independently and often contrary to their husbands' desires, through their covert use or non-use of contraception and pregnancy termination. These findings illustrate that, despite efforts to increase contraceptive availability within Bangladesh, without concurrent changes in the opportunities available for women beyond their reproductive capacities, the demand for children, and particularly for male children, is not likely to change. (author's)
Contraceptive security in the Central Asian republics: Kazakhstan, Kyrgyzstan, and Tajikistan.
Lack of contraceptive commodities has plagued the CAR region for many years. USAID has determined contraceptive security is a barrier to achieving the Mission's health objectives, identifying a need for more information on this topic in Kazakhstan, Kyrgyzstan, and Tajikistan. The PSP-One and DELIVER Projects assessed the state of the family planning commodities as well as evaluated the private sector role in promoting contraceptive security. The report provides an overview of these two areas and offers specific recommendations for possible USAID interventions to improve the availability of affordable and quality family planning products in the three Central Asian countries. (author's)
Biblical reflections: Challenging Christians to take up HIV prevention in a holistic manner.
Jesus brought a Gospel of life to his hearers. In the verse quoted above, the mission of Jesus was to invite people to a full life. The first question is: who is Jesus referring to as the recipient of the abundant life? This invitation is timeless and it is to all humanity. It is valid now as much as it was during the ministry of Jesus. It requires a response from all humanity to choose to live under the authority of God. The second question that comes to mind is: what is this full life that Jesus is talking about? The answer to this question is found in Jesus' mission statement, which he read in a Temple in Nazareth from the book of Isaiah (Luke 4:18-19 NRSV), stating: The Spirit of the Lord is upon me, because he has anointed me to bring good news to the poor. He has sent me to proclaim release to the captives and recovery of sight to the blind, to let the oppressed go free, to proclaim the year of the Lord's favour. (excerpt)
Male circumcision: a potentially important new addition to HIV prevention.
Behaviour change or 'ABC', including promoting of social norms to address the practice of multiple (concurrent) sexual partnerships, remains the most important strategy for preventing sexual transmission of HIV. However, especially in the most severely affected regions of southern and east Africa, additional prevention measures are urgently needed. While actual deployment of other potentially valuable technologies, such as an HIV vaccine and microbicides, remains many years away, male circumcision, which is probably the oldest and certainly the most common surgical procedure known, has become increasingly discussed in relation to HIV, along with emerging evidence of other health benefits such as protection against penile, cervical and prostate cancers. (excerpt)
Things to come: Nano-technology and HIV prevention.
The Australian pharmaceutical company Starpharma performs research on an nano-technology-based anti-microbial gel which prevents HIV infection of cells. The vaginal gel, SPL7013, uses nanoparticle called dendrimers to encapsulate and disable HIV. "VivaGel had good results in Phase 1 human clinical trials: it appears to be non-toxic, non-irritating, and successful at preventing HIV and genital herpes" . Studies also show that viruses are not evolving resistance to the microbicide. The product is now in expanded phase 1-2 trials, being tested around the world in various populations. It still has along way to go but the indications are positive. The United States' National Institutes of Health's National Institute of Allergy and Infectious Diseases (NIAID) signed a $20.3 million contract to fund VivaGel development for HIV prevention in October 2005. Two months ago, the NIAID signed another agreement to fund clinical trials of VivaGel aimed to study its application for genital herpes prevention. The United States Food and Drug Administration has granted VivaGel fast track status, which will be beneficial for phase 3 trials, cutting in half the time it takes for product registration and getting the product to market. The Food and Drug Administration's support of VivaGel has been something of a landmark as this is the first dendrimer to go through its system. (excerpt)
Knowledge, attitude and practice of breastfeeding in the north of Jordan: a cross-sectional study.
In Jordan, as in neighboring countries in the Middle East, higher education and higher employment rates in recent years among women have had an impact on traditionally based infant feeding. The objective of this study was to evaluate practice, knowledge and attitude to breastfeeding and to assess factors associated with breastfeeding among women in the north of Jordan. A cross sectional study was carried out between 15 July 2003 and 15 August 2003. A total of 344 women with children aged between 6 months and 3 years from five different villages in the north of Jordan were randomly selected and interviewed. Information regarding participants' demographics, infant feeding in first six months of life, knowledge and attitude towards breastfeeding was collected. Full breastfeeding was reported by 58.3%, mixed feeding was reported by 30.3% and infant formula feeding was reported by 11.4%. Almost one third of the full breastfeeding group did so for 6-2 months, and almost two thirds did continue breastfeeding for more than one year. Employed women were more likely not to practice full breastfeeding compared to unemployed women (odds ratio 3.34, 95% CI 1.60, 6.98), and women who had caesarian delivery were more likely not to practice full breastfeeding compared to those who had vaginal delivery (odds ratio 2.36, 95% CI 1.17, 4.78). Jordanian women had a positive attitude but work place and short maternity leaves had a negative impact on breastfeeding. This study showed that a high proportion of Jordanian women did breastfeed for more than one year. However, working women and those who deliver by caesarean section were less likely to breastfeed. It is speculated that adopting facilitatory measures at hospitals and work place could increase the rate of full breastfeeding. (author's)
To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding fol