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World Health and Population. 2008; 10(2):25-39.Our study examines factors influencing demand for contraception for spacing as well as for limiting births in India. Data on socio-economic, demographic and program factors affecting demand for contraception in India are from the National Family Health Survey, 1998--99. The recent document from the National Rural Health Mission has completely ignored the use of contraception in controlling fertility in India. Empirical results of our study suggest giving priority to and focusing attention on supply-side factors such as a regular and sustained supply of quality contraceptive methods to improve accessibility and affordability. Further, strengthening the information, education and communication (IEC) component of the reproductive and child health (RCH) package would allay misapprehensions about the side effects and health risks of contraception. Focusing attention on demand-side factors such as women's empowerment through education, gainful employment and exposure to mass-media would help reduce the unmet demand for family planning. The resulting reduction in fertility would hasten the process of demographic transition and population stabilization in India.
Vitamin A deficiency and increased mortality among human immunodeficiency virus-infected adults in Uganda.
Nutrition Research. 2003 May; 23(5):595-605.The specific aims of the study were to determine the prevalence of vitamin A deficiency and to examine the relationship between vitamin A deficiency and mortality among human immunodeficiency virus (HIV)-infected adults in sub-Saharan Africa. A prospective cohort study was conducted at the outpatient clinic of Mulago Hospital, Kampala, Uganda, among HIV-infected adults enrolled in the placebo arms of a randomized clinical trial to prevent Mycobacterium tuberculosis infection. Of 519 subjects at enrollment, 186 (36%) had serum vitamin A concentrations consistent with deficiency (<1.05 µmol/L). During follow-up (median 17 months), the mortality among subjects with and without vitamin A deficiency at enrollment was 30% and 17%, respectively (P = 0.01). In a multivariate model adjusting for CD4+ lymphocyte count, age, sex, anergy status, body mass index, and diarrhea, vitamin A deficiency was associated with a significantly elevated risk of death [relative risk (RR) = 1.78, 95% confidence interval (CI) 1.2-2.6]. Vitamin A deficiency is common among HIV-infected adults in this sub-Saharan population and is associated with higher mortality. (author's)
BMJ. British Medical Journal. 1991 Nov 9; 303(6811):1185-8.Surveillance of Acquired Immunodeficiency Syndrome (AIDS) provides a measure of severe morbidity and mortality caused by the human immunodeficiency virus (HIV); these cases represent severe symptomatic illness within the health care system. AIDs reporting in the US is considered complete with 70-90% of deaths related to HIV. In Africa, WHO estimates that 10% of AIDs cases are reported. This article suggests modifications in the WHO clinical definition of AIDs and discusses problems in the surveillance system. It is noted that clinical work required a simple staging system of HIV infection and disease, rather than epidemiological monitoring. The WHO definition requires 2 major symptoms with at least 1 minor sign in the absence of known causes of immunosuppression such as cancer or severe malnutrition or other recognized etiologies. The major signs are weight loss >10% of body weight, chronic diarrhea >1 month, and prolonged fever >1 month (intermittent or constant). Minor signs are persistent cough >1 month, generalized pruritic dermatitis, recurrent herpes zoster, oropharyngeal candidiasis, chronic progressive and disseminated herpes simplex infection, and generalized lymphadenopathy. The present of generalized Karposi's sarcoma or cryptococcal meningitis are sufficient alone for an AIDs diagnosis. Inadequacies of the WHO definition are its lack of sensitivity, moderate predictive value, and failure to include common symptoms of HIV infection. There is evidence of HIV associated disease not recognized as AIDs. The common symptoms of AIDs in Africa are profound weight loss, chronic diarrhea, and chronic fever (slim disease). The WHO definition was modified in 1987 to include the manifestation of the wasting syndrome. This increased sensitivity was shown in a hospital study in Abidjan in 1988/9. The WHO clinical case definition based on tuberculosis patients in Abidjan. HIV infection and case definitions for AIDs in patients with neurological disease and Kaposi's sarcoma is also discussed. Recommendations for future action are proposed including surveillance of severe HIV associated disease based on clinical presentation combined with serologic tests of HIV--I or II. The WHO definition with modifications is suggested and the need for strong political and medical commitment to complete and timely reported of AIDs and interventions to control the spread of HIV infection.