Advancing Sexual and Reproductive Health and Rights
 
International Perspectives on Sexual and Reproductive Health
Volume 35, Number 2, June 2009
UPDATE


RISK OF MISCARRIAGE ELEVATED AMONG TWO-SMOKER COUPLES

Married couples in which both partners smoke tobacco have an increased risk of experiencing a spontaneous abortion, according to a case-control study conducted in Morelos, Mexico, between January 2001 and July 2004.1 Of nearly 1,000 couples asked about their social and demographic characteristics, reproductive history and tobacco consumption before their civil wedding and at subsequent six-week follow-ups, 456 conceived during the study period. Of those, 23 experienced a spontaneous abortion, defined as a pregnancy loss during the first 20 weeks of gestation. One or both partners smoked before the pregnancy in 87% of couples with a spontaneous abortion, compared with 58% of couples whose pregnancy continued beyond 20 weeks. In multivariate analyses, neither paternal nor maternal preconception smoking was independently associated with pregnancy loss; however, couples in which both partners smoked had greater odds of a spontaneous abortion compared with couples in which neither partner smoked (odds ratio, 4.6). The authors comment, "women who are smokers, and whose partners also smoke, are more intensely exposed to tobacco smoke, which would explain the association observed when both partners smoke."

1. Blanco-Muñoz J, Torres-Sánchez L and López-Carrillo L, Exposure to maternal and paternal tobacco consumption and risk of spontaneous abortion, Public Health Reports, 2009, 124(2):317–322.

MALE CIRCUMCISION REDUCES WIVES' RISK OF SOME STIS

Circumcision of males reduces their female partners'; risk of genital ulcer disease, bacterial vaginosis and trichomoniasis, according to a study of data from a male circumcision trial conducted in Rakai, Uganda.1 Of the 4,996 uncircumcised HIV-negative men aged 18–49 recruited to participate in the trial, half were randomly assigned to the intervention group to be circumcised and half were assigned to the control group; approximately 800 HIV-negative wives of married participants from each group concurrently enrolled with their husbands were asked about symptoms of genital tract infections and tested for bacterial vaginosis and trichomoniasis at enrollment and again after one year. At the one-year follow-up, the wives of circumcised men were significantly less likely than control wives to have genital ulceration (adjusted prevalence risk ratio, 0.8). Wives of circumcised men also had a lower risk than wives in the control group of having trichomoniasis or bacterial vaginosis (0.5 and 0.6, respectively). The authors comment that their findings "may have implications for future programs providing male circumcision for HIV prevention because [genital ulcer disease] and vaginal infections are potential cofactors for HIV acquisition and reductions in these conditions… may potentially protect women from HIV infection."

1. Gray RH et al., The effects of male circumcision on female partners'; genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda, American Journal of Obstetrics & Gynecology, 2009, 200(1):42.e1–42.e7.

REPEAT HIV TESTING IS WELL ACCEPTED IN RURAL MALAWI

Repeat voluntary counseling and testing for HIV is almost universally accepted in rural Malawi, according to a study of two waves of data from the Malawi Diffusion and Ideational Change Project.1 Of the 3,284 respondents contacted in their homes during the 2004 wave of the project, 91% provided samples for HIV testing. Test results and posttest counseling were available 2–4 months later from mobile clinics, usually located within 5 km of respondents'; homes; 67% of those tested obtained their results. In the 2006 wave, 2,987 respondents were contacted in their homes, of whom 92% accepted a rapid HIV test. Test results and posttest counseling were available during the testing visit or at a mobile clinic; 98% of respondents obtained their results—almost all in their homes. Seventy-seven percent of those who were tested in 2004 and obtained their results were contacted again in 2006; 96% accepted repeat testing, and 99% obtained their results.

1. Obare F et al., Acceptance of repeat population-based voluntary counselling and testing for HIV in rural Malawi, Sexually Transmitted Infections, 2009, 85(2):139–144.

POLYGYNOUS MARRIAGE LINKED TO HIGHER CHILD MORTALITY

Children born from polygynous marriages have a greater risk than those born from monogamous marriages of dying before the age of five, according to an analysis of Ghana Demographic and Health Survey data from 1998 and 2003.1 Of the 4,938 children included in the combined sample, 75% were born from monogamous marriages and 25% from polygnous marriages. In multivariate analyses controlling for social and demographic characteristics and other variables associated with child mortality, children in polygynous families had a 62% higher risk of dying before age five than did children in monogamous families. In further analyses that allowed for age-specific effects, the association between polygynous marriage and child mortality was found not to be consistent over the entire childhood period: The difference in risk of death before the age of five by union type was more pronounced for children aged 2–5 years than it was for younger children. The author comments that it was "expected that children in polygynous households would be at a higher risk of death…primarily through the effects of resource constraint, paternal investment and selectivity," and adds that the results "suggest the need for a reconsideration of the monolithic view of marriage…to unravel the complex links between marriage and child outcomes."

1. Obeng Gyimah S, Polygynous marital structure and child survivorship in Sub-Saharan Africa: some empirical evidence from Ghana, Social Science & Medicine, 2009, 68(2):334–342.

NURSES TEACH ABOUT HIV BETTER WITHOUT PARENTS

Nurses may be more effective at getting students to have favorable attitudes toward HIV prevention measures by themselves than with the help of the children';s parents, according to a study conducted in three urban secondary schools in Akwa Ibom State, Nigeria—one in which nurses conducted an HIV/AIDS prevention intervention for students, one in which students'; parents received an education seminar before participating with nurses in the prevention intervention, and a nonintervention control.1 Of the 339 students who completed questionnaires about their attitudes toward HIV/AIDS prevention measures at baseline and again three months later, those in each of the intervention groups had significantly more favorable attitudes toward HIV/AIDS prevention, on average, than control students; however, students who participated in the nurse-only intervention had more favorable attitudes than students who took part in the parental involvement intervention. The authors comment that their finding confirms "that many parents are unable to educate their children appropriately on measures to prevent HIV/AIDS." They suggest "more intensive HIV/AIDS education for parents and guardians when involving them in HIV/AIDS health education effort for their children."

1. Akpabio II et al., Effects of school health nursing education interventions on HIV/AIDS-related attitudes of students in Akwa Ibom State, Nigeria, Journal of Adolescent Health, 2009, 44(2):118–123.

TALLER MOTHERS HAVE HEALTHIER CHILDREN

The height of mothers is negatively associated with their children';s risk of death before age five and with other adverse health outcomes, according to an analysis of 2005–2006 Indian National Family Health Survey data.1 Of the sample of 48,075 singleton children younger than five born to mothers aged 15–49, 6% died before their fifth birthday; of the surviving children, 42% were underweight (for their age and sex), 48% were stunted (i.e., below the median height for their age and sex) and 20% were wasted (i.e., below the median weight for their height and sex). About 12% of mothers were shorter than 145 cm, 27% were 145– 149.9 cm, 33% were 150–154.9 cm, 20% were 155–159.9 cm, and 8% were 160 cm or taller. In adjusted regression models, a 1-cm increase in maternal height was associated with a decreased risk of child mortality and of being underweight, stunted or wasted (relative risks, 0.97– 0.99). Children born to mothers in the shortest group had up to twice the risk of dying and of being underweight or stunted of those born to mothers in the tallest group (1.1–1.9). The authors comment that "maternal height may be one indicator of the stressful nutritional environment of the mother in early life" and its association with adverse health outcomes "suggests an intergenerational transfer of poor health from mother to child."

1. Subramanian SV et al., Association of maternal height with child mortality, anthropometric failure and anemia in India, Journal of the American Medical Association, 2009, 301(16):1691–1701.

SOME IUD SIDE EFFECTS DECREASE OVER TIME

Certain side effects of IUD use decrease over time, according to a secondary analysis of data from first-time copper IUD users in Santiago, Chile.1 Of the 1,947 participants who were followed for up to a year after IUD insertion, 9% reported experiencing serious pain within the first nine weeks of use; after accounting for women who had had their IUD removed before the end of the study period, smaller proportions of women reported pain during subsequent follow-ups: four percent from nine to 19 weeks, 7% from 19 to 39 weeks and 5% after 39 weeks. The proportion of women who reported increased menstrual bleeding also decreased over time—from 5% to 3%—when attrition was accounted for, but intermenstrual spotting did not change during the study period. The authors comment that their findings can help "potential IUD users (or current users) anticipate the overall prevalence of problems" and "avoid premature removal."

1. Hubacher D, Chen PL and Park S, Side effects from the copper IUD: do they decrease over time? Contraception, 2009, 79(5):356–362

THAIS LIVING WITH HIV NEED RISK REDUCTION PROGRAMS

Unsafe sexual practices are common among HIV-positive individuals seeking routine care at the National Infectious Disease Institute in Bangkok, Thailand.1 As part of a risk assessment study conducted at the institute between July 2005 and September 2006, 395 male and 499 female patients living with HIV were interviewed about sexual behavior and condom use. Of the sexually active men asked about male-to-male sex, 25% reported having had a same-sex partner in the three months prior to the interview. Forty-one percent of males and females had had one or more partners—including casual and commercial partners—of negative or unknown HIV status. Unprotected last sex with a partner of negative or unknown HIV status was more likely with casual, commercial or male-to-male partners than with steady heterosexual partners (odds ratio, 2.1). Only 63% of those who had had unprotected last sex with a steady partner had disclosed their HIV status; disclosure of HIV status to a steady partner was more common among those who had not had unprotected last sex than among those who had (2.5). The authors comment that their findings indicate "a need to reduce HIV transmission risk among persons attending HIV care, especially…among men with casual, commercial and same-sex partners." They suggest that "creative and sustainable behaviour change communication interventions materials need to be designed to reduce HIV transmission risk behaviours among people with HIV."

1. Tunthanathip P et al., Indicators for sexual HIV transmission risk among people in Thailand attending HIV care: the importance of positive prevention, Sexually Transmitted Infections, 2009, 85(1):36–41.