Teenage pregnancy and child health in the urban Sahel

Longitudinal data for more than 20,000 live births in the cities of Bamako (Mali) and Bobo-Dioulasso (Burkina Faso) are used to study the effects of young maternal age (less than 18 years and 18-19) on birth weight, child health care and feeding behavior, and child mortality, after controlling for other socioeconomic and demographic factors. Teenage pregnancies are associated with significantly worse prenatal health care and vaccination behavior, lower birth weights, earlier weaning, and, especially during the second year of life, higher mortality. A proxy for mother's school enrollment at the time of pregnancy is strongly linked to worse prenatal health behavior and weakly associated with other poor behaviors and health outcomes. Overall, the results highlight the importance of behavioral factors relative to strictly biological factors for explaining child health differentials.

Oral contraception and risk of a cerebral thromboembolic attack: results of a case-control study

OBJECTIVE

To assess the risk of cerebral thromboembolism in women using low dose oral contraceptives.

DESIGN

A retrospective case-control study.

SETTING

All Danish medical, neurological, neurosurgical, and gynaecological departments.

SUBJECTS

All 794 women in Denmark aged 15-44 who had suffered a cerebral thromboembolic attack during 1985-9 and 1588 age matched randomly selected controls.

RESULTS

Of 692/1584 case/control questionnaires sent out, 590/1396 (85.3%/88.1%) were returned. Among the cases, 15 refused to participate, 69 had a revised or unreliable diagnosis, 40 had had thromboembolic disease previously, 13 were pregnant, and 152 had a disease predisposing to a cerebral thromboembolic attack. Of the 323 cases without a known predisposition, 320 reported use or non-use of oral contraception. Among the 1396 controls, eight refused to participate, were mentally retarded, or lived abroad; 18 returned an uncompleted questionnaire; 17 had had thromboembolic disease previously; 31 were pregnant; and 130 had a disease predisposing to a cerebral thromboembolic attack. Thus 1198 non-predisposed controls were available, among whom 1197 reported use or non-use of oral contraception. Among the 320 cases, 116 (36.3%) were oral contraceptive users at the time of the cerebral thromboembolic attack. By comparison there were 191 users (16.0%) among the 1197 controls, giving a crude odds ratio of 3.0. After multivariate analysis, including confounder control for age, smoking, years of schooling, and trend in use of different types of oral contraceptives during 1985-90, pills containing 50 micrograms oestrogen were associated with an odds ratio for cerebral thromboembolic attack of 2.9 (95% confidence interval 1.6 to 5.4), those containing 30-40 micrograms oestrogen an odds ratio of 1.8 (1.1 to 2.9), those containing progestogen only an odds ratio of 0.9 (0.4 to 2.4). The odds ratio did not change with increasing age or with duration of oral contraceptive use. A 50% increased risk of a cerebral thromboembolic attacks among cigarette smokers (after confounder control) was independent of oral contraception status and age.

CONCLUSION

Low dose oral contraceptives are associated with an increased risk of cerebral thromboembolic attack. Combined or sequential pills containing 30-40 micrograms oestrogen are associated with a one third reduced risk compared with preparations containing 50 micrograms oestrogen. Progestogen only pills did not increase the risk of a cerebral thromboembolic attack.

Some factors affecting the secondary sex ratio in a Latin American sample

A sample based on hospital birth records from the Latin American Collaborative Study on Congenital Malformations (ECLAMC) was used in this study. ECLAMC, which covers 11 countries (Uruguay, Chile, Argentina, Brazil, Bolivia, Peru, Paraguay, Ecuador, Venezuela, Colombia, and Costa Rica), registered 1,037,272 live births in the period 1982-1986. We applied several multivariate analysis models to the data and found that the sex ratio was significantly affected by secular, spatial (countries), biological (maternal age, birth order, and ethnic group), and socioeconomic (evaluated by hospital payment) variables. The black ethnic component carried sufficient weight to remove the spatial effect (Brazil and Venezuela) in certain cases. The Amerindian admixture effect on the sex ratio was negative and significant.

Behavioural mechanisms in AIDS patients under stress

Clinical observation at the Kenyatta National Hospital showed unusually rapid deterioration of patients testing seropositive to HIV infection and being moved to a side room for nursing. This pilot study tested the hypothesis that deterioration was at least partly, mediated by B-endorphins and other endogeneous opioids. The study design was a prospective and comparative study looking at 6 HIV seropositive and 10 control (HIV seronegative) patients matched for sex, age, and clinical status at time of study. The laboratory measures compaired were baseline, and daily serum B-endorphin and ACTH. A significant variation is noted between the two groups. The significance of this study is discussed.

Breastfeeding and postpartum amenorrhea in a traditional society: a hazards model analysis

There is considerable variation in the length of the postpartum amenorrhea during which breastfeeding suppresses fertility, both within and between societies. In this paper, we investigate the association between breastfeeding and the resumption of menses and the impact of various biological and social covariates thereon, using data from two retrospective surveys in India. We use both univariate life table and multivariate time-dependent hazards techniques to analyze the data. Most prior investigations related the impact of breastfeeding to postpartum amenorrhea by taking duration of breastfeeding as a fixed covariate. However, breastfeeding beyond the resumption of menstruation cannot affect the duration of menses. Accordingly, the present study has a methodological focus in the sense that breastfeeding is treated as a time-dependent covariate. We found that breastfeeding, age of mother at child's birth, social status, level of income, religion and caste (subcaste), and residential status have significant effects on return of menses in Indian traditional society.

A 13-year follow-up of treatment and snail control in an area endemic for Schistosoma mansoni in Brazil: incidence of infection and reinfection

The incidences of Schistosoma mansoni infection and reinfection were investigated in an endemic area of Brazil (Peri-Peri, State of Minas Gerais) where chemotherapy and snail control had been used for 13 years (1974-87). Two cohorts were followed: the first consisted of 584 individuals with no evidence of infection at entry (infection cohort), and the second comprised 296 individuals who were treated and did not eliminate eggs 8-12 months afterwards (reinfection cohort). The incidence of infection (per 100 person-years) decreased from 7.5 in 1974-77 to 3.6 in 1986-87, and that of reinfection from 21.3 in 1974-77 to 3.7 in 1986-87. Calendar period, age at risk, and sex were independently associated with both infection and reinfection, while a heavy S. mansoni egg count prior to treatment (> or = 500 epg (eggs per gram of stools)) was independently associated with reinfection. The geometric mean number of eggs after treatment among those reinfected (47 epg) was approximately half that among those infected for the first time (81.5 epg). Age at risk had the greatest effect on both infection and reinfection. The rate ratios of infection and reinfection were 3 to 6 times higher among individuals younger than 20 years than among those aged > or = 25 years, even after adjusting for confounders. This suggests the existence of a strong protective effect with increased age (because of biological and/or environmental factors) for both infection and reinfection.

Men and family planning in Zambia

This paper examines the sociodemographic factors which influence familiarity with methods of family planning among 85 males holding low paying jobs in the University of Zambia, Lusaka. The results showed that wife's education had a significant and positive effect on husband's familiarity with family planning methods. In the longer term, female education is likely to emerge as an important factor in the onset of fertility decline in Zambia.

Reference limits of plasma fibrinogen

Fibrinogen is considered to be a strong predictor and independent factor of cardiovascular diseases. The data presented here describe the baseline measurements of fibrinogen in 1008 apparently healthy subjects, aged 4-60 years and their relationship to age, sex, body weight, smoking, alcohol, and use of oral contraceptives. Pearson's correlations and a linear multiple regression model were used. Plasma fibrinogen was measured kinetically in a photometer, the Behring Chromotimer, using the CTS-fibrinogen method. There were neither statistical difference between girls and boys aged 4-20 years nor correlation with variables related to cardiovascular diseases. In adults, we found an increase of plasma fibrinogen concentration with age and no statistical difference between men and women, except in subjects aged 40-50 years. There was a positive correlation between fibrinogen and ponderal index. In women aged 20-30, 30-40, 40-50 and 50-60 years, the mean fibrinogen concentrations increased of 0.009, 0.021, 0.010 and 0.015 g/l for one percent of overweight, in each subgroup respectively. In women aged 20-30 years using oral contraceptives, the mean fibrinogen concentration was 0.19 g/l higher than in women not using oral contraceptives. The smoking effect was observed only in 30-40 year-old men. Each cigarette smoked per day increases of the mean fibrinogen by 0.35 g/l after standardization for ponderal index and alcohol consumption. Alcohol consumption was negatively correlated to plasma fibrinogen in subjects 30-40 years old. In women, 1 g of alcohol per day induces a 0.008 g/l decrease in the mean fibrinogen while in men the decrease is 0.004 g/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Substance use and other factors associated with risky sexual behavior among pregnant adolescents

A study of the relationship between substance use and risky sexual behavior was conducted among 241 unmarried pregnant adolescents aged 17 and younger who lived in a metropolitan area in the Northwest. The respondents had comparable or higher lifetime use rates for all substances than did women in a national sample of high school seniors, even though the pregnant adolescents were younger. Ninety-four percent had used alcohol, 78% marijuana, 30% cocaine and 30% stimulants, compared with 92%, 48%, 14% and 23%, respectively, among women in the national sample. Among the pregnant adolescents, 84% had had more than one sexual partner, 39% had had a sexually transmitted disease and 60% had used contraceptives during less than half of their sexual encounters. At the bivariate level, use of cigarettes and alcohol in general and use of alcohol and drugs during sex were positively associated with risky sexual behavior. However, when other characteristics associated with risky sexual behavior--family bonding, parental monitoring, commitment to conventional values, peer associations, self-esteem and delinquent activities--were included in the multivariate analysis, the effect of substance use disappeared.

High-risk sexual behavior in the general population. Results from a national survey, 1988-1990

The responses of 2,896 adults who completed the General Social Survey (1988-1990), a nationally representative household probability sample of the United States adult population, were analyzed. Three outcome variables were examined: engaging in sexual intercourse with two or more partners, with five or more partners, or with a stranger in the past year. Age, marital status, gender, pattern of alcohol consumption, and race have the strongest and most consistent relationship with having multiple sexual partners or sex with a stranger. Marriage reduces the odds of having 5 or more sexual partners by a factor of 90% (odds ratio, OR, = 0.10). For each single year increase in age, the odds of having multiple partners or sex with a stranger also decrease (OR = 0.95). Alcohol consumption, on the other hand, increases the odds of sexual risk behavior by a factor of 2 to 3 in the three models. Men are more likely to have 5 or more sexual partners (OR = 7.17) and sex with a stranger (OR = 5.62) than women; and blacks are more likely to have multiple partners (OR = 2.82) than members of other racial or ethnic groups. In the United States last year, an estimated 3 to 6 million adults had sex with 5 or more partners and an estimated 5 to 8 million had sex with a stranger.

A hazard logit model analysis of covariates of childhood mortality in Matlab, Bangladesh

In a prospective study in Matlab, a rural area in Bangladesh, the relationship between a variety of covariates and childhood mortality was examined. Economic status of household, education of mother, sex of the children, health intervention programmes, age of mother, and live birth order of the children were identified as having a statistically significant impact on child survival when the effect of age was controlled. The effects of sex of the children, health programmes, age of mother, and birth order were found to be dependent on the age of the children, but the effect of mother's education was dependent on sex of the children.

Determinants of current contraceptive use among Ghanaian women at the highest risk of pregnancy

This study uses data from the Ghana Demographic and Health Survey (GDHS) of 1988 to examine factors determining the continued low levels of contraceptive use in Ghana. The women currently using efficient contraception are those who have sexual intercourse regularly, who discuss family planning with their partner, whose husbands approve of the use of family planning, and who live in the northern sector of the country. The finding that husband's approval is an important determinant of efficient contraceptive use has significant policy implications for Ghana and other African countries, to motivate both husbands and wives to share fertility control responsibilities.

Demography of the human sex ratio in some Latin American countries, 1967-1986

A sample based on hospital births recorded for the Latin American Collaborative Study on Congenital Malformations (ECLAMC) program was used in the present study to determine sex ratios for live births and for stillbirths. Sixty-four cities and 147 hospitals in 11 countries (Uruguay, Chile, Argentina, Brazil, Bolivia, Peru, Paraguay, Ecuador, Venezuela, Colombia, and Costa Rica) were included in the present analyses. The number of live births was 1,886,653 in the period 1967-1986, and the number of stillbirths was 24,818 in the period 1978-1986. The sex ratio for the total sample was 0.5112 for live births and 0.5477 for stillbirths. The sex ratio as a whole is decreasing with time in a parabolic fashion. Each country in our study behaved differently. Except for Peru and Uruguay, the countries experienced a significant decrease in the sex ratio after 1978 for live births; only Brazil did not show a temporal trend for the sex ratio for stillbirths.

Contraceptive use in Matlab, Bangladesh: the role of gender preference

Research in several Asian societies has suggested that sons are generally preferred over daughters. The implications of gender preferences for actual fertility behavior have not been adequately investigated, however. This analysis examines the effect of the sex composition of surviving children on the acceptance and discontinuation of contraception in a sample of 3,145 women in Matlab, Bangladesh, who were observed for 60 months. Hazards regression analyses are employed in the analysis. Strong and highly significant effects of gender preference on contraceptive use are observed. The preference is not monotonically son-biased but is moderated toward a balanced composition, because parents desire to have several sons and at least one daughter. These findings suggest that gender preferences, particularly a preference for sons, represent a significant barrier to fertility regulation in rural Bangladesh.

The Israel perinatal census

A nation-wide perinatal census which included 22,815 deliveries was carried out. The cesarean section rate was 9.6% and the perinatal mortality rate was 13.5/1000. Using a logistic regression analysis the risk factors for cesarean section and for perinatal mortality were ranked. Breech presentation and one uterine scar were found to be the most important risk factors for cesarean section and breech presentation, maternal disease and multiple pregnancy for perinatal mortality. Low birth weight rate was 6.9% with nonsignificant differences between the various ethnic groups. The national cesarean section rate in breech presentation was 57.8%. It was performed mainly at the extremes of birth weight. From those with one previous cesarean section 55.1% delivered vaginally and 44.9% abdominally. The chance for vaginal delivery is higher (67.2%) providing the woman had delivered vaginally in the past. Comparison between primiparae and multiparae showed that preeclampsia, hypertension and diabetes mellitus were all significantly more frequent among older parturients and among primiparae.

Utilization of maternal health-care services in Peru: the role of women's education

This article explores the hypothesis that formal education of women influences the use of maternal health-care services in Peru, net of the mother's childhood place of residence, household socioeconomic status and access to health-care services. The findings are consistent with the hypothesis; both cross-sectional and fixed-effects logit models yield quantitatively important and statistically reliable estimates of the positive effect of maternal schooling on the use of prenatal care and delivery assistance. In addition, large differentials were found in the utilization of maternal health-care services by place of residence, suggesting that much greater efforts on the part of the government are required if modern maternal health-care services are to reach women in rural areas.

Determinants of child-bearing intentions of low-income women: attitudes versus life circumstances

Surveys of low-income women in Los Angeles County in 1985 and 1986 were used to examine the relative impact of child-bearing motivations versus life circumstances on the intention to have a(nother) child. Future child-bearing intentions are strongly related to current parity level regardless of marital status, race/ethnicity or economic status. Psychological motivating factors predict child-bearing intentions of nulliparous women, but not those of parous women. Multivariate analyses showed that motivation for parenthood and life circumstances combined predicted women's child-bearing intentions 88.6% of the time for nulliparous women, but 73.7% for parous women. These findings suggest that, in a low-income population, the onset of parenthood reduces the relationship between specific motivations for child-bearing and actual child-bearing intentions, and diminishes the ability to predict child-bearing intentions based on both attitudinal and social/structural factors.