The association between HIV and fertility in a cohort study in rural Tanzania

Recent studies in sub-Saharan Africa have shown that fertility is reduced among HIV-infected women compared with uninfected women. The size and pattern of this fertility reduction has important implications for antenatal clinic-based surveillance of the epidemic and also for estimates and projections of the demographic impact of the epidemic. This paper examines the association between HIV and fertility in Kisesa, a rural area in Tanzania, where HIV prevalence among adults is about 6% and gradually increasing. The analysis is based on data obtained through a demographic surveillance system in Kisesa during 1994-98 and two large sero-surveys of all residents in 1994-95 and 1996-97. The HIV-associated fertility reduction among women was investigated by estimating fertility rates by HIV status and prevalence rates by fertility status. A substantial reduction (29%) was observed in fertility among HIV-infected women compared with HIV-uninfected women. The fertility reduction was most pronounced during the terminal stages of infection, but no clear association with duration of infection was observed. Use of modern contraception was higher among HIV-infected women. However, both among contracepting and non-contracepting women, a substantial reduction in fertility was seen among HIV-infected women.     

Modernization and childlessness among the governorates of the Arab Republic of Egypt, 1976

This paper examines the degree to which childlessness is influenced by levels of modernization among the governorates of the Arab Republic of Egypt. The data have been derived mainly from the 1976 Population and Housing Census of the Arab Republic of Egypt. The childlessness rates used are based on census data on number of children born to married women. In 1976, the higher the levels of modernization, the lower the rates of childlessness among women aged 30 and over, and the higher the rates of childlessness among women aged 20-30. The lower rates are found in and around Cairo, and some of the governorates with higher rates are in Upper Egypt. Of the 25 governorates, Suez has the lowest childlessness rate. To some degree, the patterns of childlessness may be affected by changing patterns in age-specific 1st marriage rates. The childlessness rates for the younger women in the Egyptian governorates are associated with some of the modernization variables. The findings suggest that childlessness among women aged 30 and older is mostly involuntary, but that for younger women it is partly voluntary. Increases in modernization among the Egyptian governorates should, therfore, result in net increases in rates of childlessness and net decreases in fertility. There are at least 3 statistically independent sources of variation in modernization which characterize the governorates of Egypt: factors that reflect structural development, female status, and health personnel.     

High fertility does not cause spontaneous intrauterine fetal loss: the determinants of spontaneous fetal loss in Egypt

This study is concerned with a major, though relatively neglected, reproductive health issue: fetal loss. In particular, the determinants of spontaneous intrauterine mortality in Egypt are investigated with stress on the demographic determinants. To this end, a conceptual framework is developed. Using pregnancy history data from a national survey conducted in Egypt in 1995, the determinants of spontaneous intrauterine fetal deaths among currently married women aged 18-45 are examined using multiple logistic models. It is found that the probability of intrauterine fetal loss rises with maternal age. The apparent positive association of the risk with gravidity is shown to be an artifact, due to the heterogeneity among women with respect to the risk of pregnancy loss, the consequent selection process, and reproductive compensation behavior according to the "success/failure" stopping rule. Therefore, high fertility cannot be said to cause spontaneous fetal loss. Two other features of a woman's reproduction are of strong significance, namely, her pregnancy history and spacing among pregnancies. Once a woman suffers from spontaneous fetal loss, the probability of undergoing further pregnancy losses rises sharply. And the shorter the pregnancy interval, the higher the probability of pregnancy loss. Pregnancies conceived after long intervals are less likely to end in loss.     

The recovery of fertility during breast-feeding in Assiut, Egypt

A longitudinal study of twenty-six breast-feeding and twelve non-breast-feeding postpartum women was conducted in Assiut, Egypt in order to determine the time that ovulation resumed after childbirth, and the effect of breast-feeding frequency on the period of lactational anovulation. Breast-feeding women experienced the onset of follicular development, vaginal bleeding, ovulation and pregnancy significantly later than women who did not breast-feed. Ovulatory and non-ovulatory breast-feeders reported similar frequencies of breast-feeding episodes. The introduction of dietary supplements commonly preceded ovulation. An algorithm using three simple variables observable to the breast-feeding mother was found to predict up to 100% of the first ovulations. All breast-feeding women who did not give supplements and did not have a vaginal bleeding episode by 6 months postpartum were anovular by strict criteria for ovulation. Ovulation did not precede bleeding or supplementation in the women who experienced these events before 6 months, yielding a highly effective formula for preventing unplanned pregnancy by the informed use of breast-feeding.     

Intermediate variables in the explanation of differential fertility: Results of a village study in rural Java

A tendency for fertility to be higher among middle-class women than among lower-class women has been found in all the recent sources of data on fertility levels and patterns in Indonesia. After briefly reviewing these findings, this article presents the results of a community study in rural Java which systematically investigates the positive relation between fertility and socioeconomic status, focusing on the so- called intermediate variables (first inventoried by Davis and Blake in 1956) which directly determine fertility. Differential patterns of marital stability, secondary sterility, and the practice of postpartum abstinence in particular were found to contribute to the contrasts in fertility levels observed. The use of modern contraceptives, a recent innovation at the time of the study, was found to a greater extent among middle-class women, and may prove to be an important determinant of future patterns of fertility and fertility differentials.This article is based on a study of fertility patterns undertaken in Yogyakarta during 1972–1973. The research was funded by the Australian National University. A complete account of the research findings is contained in Hull (1975), and a detailed analysis of the topics discussed here can be found in Hull (1976).     

First detection of Anaplasma ovis in sheep and Anaplasma platys-like variants from cattle in Menoufia governorate,Egypt

Tick-borne diseases are of global economic importance, especially due to the costs associated with disease treatment and productivity losses in livestock. In this study, 244 livestock animals (cattle N = 92, buffaloes N = 86 and sheep N = 66) from Menoufia, Egypt were tested for Anaplasma, Ehrlichia and Babesia species using PCR. Results revealed detection of A. ovis (9.1%) in sheep while Anaplasma spp. (14.1%), A. marginale (15.2%), B. bigemina (6.5%) and B. bovis (5.4%) in cattle. On the other hand, Anaplasma spp. (1.2%), A. marginale (1.2%) and B. bovis (1.2%), were detected in buffaloes. Significantly higher detection rates were observed in cattle for Anaplasma spp. (P = .020), A. marginale (P = .001) and B. bigemina (P = .022) than in buffaloes. Sequence analysis of Anaplasma spp. isolates from cattle, revealed A. platys-like strains. Phylogenetic analyses of the A. platys-like isolates revealed variation among the strains infecting cattle. The A. marginale buffalo isolate, on the other hand, showed some level of divergence from the cattle isolates. This study reports the first detection of A. ovis in sheep and A. platys-like strains in cattle in Menoufia and Egypt at large. The results of the current study provide valuable information on the epidemiology and genetic characteristics of tick-borne pathogens infecting livestock in Egypt.     

Fungal populations and mycotoxins in silage in Assiut and Sohag governorates in Egypt,with a special reference to characteristic Aspergilli toxins

Forty silage samples were collected from Assiut and Sohag governorates in Egypt to measure the presence of fungal population in silage. Forty-three species and 2 species varieties belonging to 17 genera were isolated using glucose Czapeks and Sabourauds dextrose agar media at 28 ^°C. The most prevalent genera were Aspergillus (57.5 and 100 of the samples), Penicillium (100 and 55%) on the two mentioned media, respectively. Also, Fusarium oxysporum and Gibberella fujikurori were recovered in moderate incidences. Mycotoxin profiles were also determined in these samples: Aflatoxins showed the highest incidence rates of occurrence, it occurred in 22.5% of all samples analyzed. Other mycotoxins were detected from all samples (T₂ toxins and sterigmatocystin at incidence of 7.5 and 5%, respectively). The screening of the characteristics mycotoxins of different isolates of Aspergillus isolated from silage samples was tested. The results clarified that some mycotoxins (aflatoxins – aspergillic acid – beta nitro propionic acid – cyclopiazonic acid– kojic acid and sterigmatocystin) were produced by some isolates of A. flavus. Some isolates of A.fumigatus could produce gliotoxin and verrucologen. All of A. niger isolates tested were able to produce kojic acid. One isolate of A. ochraceous formed ochratoxin A and other isolate produced penicillic acid. Concerning A. terreus isolates, the results showed that 5 isolates were able to produce citrinin and 4 isolates had ability to produce patulin. A. versicolor isolates showed the ability to produce ochratoxin A.     

Proximate determinants of fertility in Nigeria

Data from the 1981-82 Nigeria Fertility Survey (NFS) are used to identify the key proximate determinants of fertility in Nigeria. The patterns of their individual and collective effects are analyzed in a search for possible sources of fertility change. Exposure to the risk of childbearing through first marriage is found to be the most important proximate determinant of Nigerian fertility. Subsequent to marriage, fertility is determined mainly by breastfeeding and postpartum sexual abstinence. Where fertility shows significant socioeconomic variations, there are equally identifiable patterns of the impact of the proximate determinants which explain these differentials to a large extent. On a national scale, the observed patterns of the impact of the measured proximate determinants do not appear to suggest that Nigerian fertility is soon to experience a large decline.     

Clinical signs and household characteristics associated with human fascioliasis among rural population in Egypt: a case-control study

The symptomatology associated with human fascioliasis has been studied mostly in hospitalised subjects. Very little is known about clinical signs and symptoms associated with infections in human endemic zones, as well as on possible new ways of transmission which might be responsible for the increased number of human cases reported in recent years. This information is of great importance to facilitate diagnosis and plan effective control measures. With the objective to identify clinical signs, blood tests, household characteristics and hygienic habits associated with human fascioliasis, a cross-sectional case-control study was implemented among the rural population of three endemic foci in the Nile Delta, Egypt. Clinical history was collected from 53 cases of fascioliasis and the same number of individually matched controls. They received a complete clinical examination and a range of blood tests was performed on them. Information on socio-economic conditions, dietary and hygienic habits was also collected. The most important complaints, associated with the infection, were right abdominal pain (Odds Ratio 20, P = 0.005), epigastric burning (o.r. 16, P = 0.007) and nausea (o.r. 8, P = 0.05). Blood analyses reported a marked increase in blood eosinophils (o.r 1.3, P = 0.001) among cases. The presence of cows (o.r 3.2), buffaloes (o.r 3.0) and goats (o.r 2.6) in the household was closely associated with the infection together with the habit to bring those animals to the canal for bathing and/or drinking (o.r. 3.2). Among dietary habits investigated, eating raw seeds was more common in cases than controls (o.r. 9, P = 0.03) and emerged as a possible new way of infection.     

Proximate determinants of fertility in the Kathmandu Valley, Nepal: an anthropological case study

The analytical model of Bongaarts and Potter is employed to compare the proximate determinants of fertility among 3 populations in Nepal's Kathmandu valley. 3 sub-groups are studied: high caste (Brahmin and Chetri) urban residents, high caste urban fringe residents, and low caste untouchables (Sarki). Both survey and anthropological methods are employed. According to the analytical model, the transition in fertility follows 4 phases. The changes in fertility levels from Phase 1 to Phase 4 generally indicate that the transition from natural to controlled fertility is characterized by declines in the proportions of women married and the duration of postpartum infecundability, and a substantial increase in the prevalence and effectiveness of contraceptive practices. The results of this study show that Nepal as a whole is entrenched in Phase 1 of the fertility transition. However, data from the 3 populations reported here clearly indicate that each has begun to experience a demographic transition to different degrees. The Sarkis in this study fall between Phases 2 and 3, as indicated by the total fertility rate (TFR). The rural high castes most closely approximate a population in Phase 3, while urban high castes included in this study are approaching Phase 4. Each of the 3 populations is characterized by a decline in the proportion of women married when compared to all of Nepal. It is also apparent that the relative use-effectiveness of contraceptive methods currently employed is high. Gains in the reduction of fertility, then, will have to be made from increasing and retaining the number of acceptors and in reducing the desired family size of those at reproductive risk.     

Socioeconomic status and fertility in rural Bangladesh

Using a unique set of birth registration data from the Demographic Surveillance System of the International Center for Diarrheal Disease Research, Bangladesh, for the period 1974-77, and socioeconomic information collected in the 1974 census, fertility was studied in relation to occupation, size of dwelling, number of cows and number of boats owned. The total fertility rate was found to vary between 6 and 6.5 except in the famine year of 1975. There was no consistent relationship between fertility and education of women. The age-specific fertility rates by religion show that Muslims had higher fertility at all ages in 1974 and 1977 and at older ages in 1975 and 1976. Overall, however, fertility of Hindus is consistently lower than that of Muslims, but the relative differences are under 10%. Fertility differentials by occupation showed that the household heads who were farm laborers had relatively lower fertility compared to other occupational groups, except for the year 1977 where the families of service holders were found to have relatively lower fertility. Women in households whose heads were businessmen or farmers (owning their land) had above average fertility. In 1974, households in the business occupational groups had, on average, 1 birth more than other households. Women in households with fishermen as heads had below average fertility in 1974 and 1975, but very high fertility in 1976 and 1977. Fertility levels differed according to the type of household in which the family resided. Nuclear families had below average fertility up to the age of 35 and above average fertility at the end of the reproductive age. In the 15-19 age group, augmented families had higher fertility each year examined. The association between dwelling place and fertility is positive each year, the relative differences in fertility between the groups being largest in 1974. Positive relations were found between economic status and fertility.     

Infant and child mortality in rural Egypt.

This research examines determinants of infant and child mortality in rural Egypt, primarily the effects of household economic status and the availability of health services. Certain features of the health service environment affect survival in the neonatal period. In early childhood, survival chances improve markedly as income increases and if the household depends almost exclusively on employment income. In infancy and in early childhood, mortality is strongly associated with region of residence and maternal demographic characteristics, and is weakly associated with parental schooling.     

Child health in rural Colombia: determinants and policy interventions

We study the determinants of child anthropometrics on a sample of poor Colombian children living in small municipalities. We focus on the influence of household consumption, and public infrastructure, taking into account the endogeneity of household consumption using two different sets of instruments: household assets and municipality average wage. We find that both household consumption and public infrastructure are important determinants of child health. We have also found that the coverage of the piped water network positively influenced child health if the parents have some education.     

Social determinants of health and depression: a preliminary investigation from rural China

Background

In the last several years, research related to social determinants of health (SDH) has begun to resonate in the medical, behavioral, social and political sciences arena. The aim of the present study was to explore the relationship between SDH and depression, and to provide new evidences and clues for depression control and prevention.

Methodology/Principal Findings

This research was a cross-sectional survey executed door to door from October 2006 to April 2008, with a sample of 3,738 individuals aged 18 and older in rural China. The three variables of SDH were socioeconomic status (years of schooling and self-reported economic status of family), social cohesion and negative life events. Demographic variables and self-perceived physical health were taken as potential confounders. The cross-table analysis showed that variations in levels of depression were associated with variations in SDH, and logistic regression analysis confirmed the association even after adjusting for potential confounding variables.

Conclusions

Although there were some limitations, the current study provides initial evidence of the importance of SDH in depression. Findings indicate that social inequity and the role of policy action emphasized by SDH should be considered high priorities when addressing the issue of depression. In addition, cell-to-society and pill-to-policy approaches should be encouraged in the future.     

Effect of famine on fertility in a rural area of Bangladesh

Data on household socioeconomic status collected in the 1974 census and registration data on births, deaths, and migrations for the 1974-77 period from the Demographic Surveillance System of the International Centre for Diarrheal Disease Research, Bangladesh, were used to investigate the effects of the 1974-75 famine on differential fertility in a rural population of Bangladesh. Occupation of household head was used as a measure of socioeconomic status. Overall, fertility declined by 34% over the 1975-76 period and increased by 17% in 1976-77 from the 1974-75 figure. Significantly lower fertility was observed in 1975-76, irrespective of socioeconomic status, but the lower socioeconomic groups were affected more than the higher groups. Post-famine fertility was significantly higher only in the 2 middle occupation categories. The age-specific fertility rates suggest that the famine affected all age groups. The post-famine fertility was higher than that of 1974-75 in all but those aged below 20. At age 40 and over the recovery was slight. Husband-wife separation showed an increase during the famine and particularly among the lower socioeconomic groups. The males of the lower socioeconomic households migrated to other regions to obtain food for the family, thus affecting frequency of coitus. The decline in fertility may be due to several factors: deferred marriage; increase in divorces and husband-wife separations; high fetal wastage; voluntary fertility control through contraception, abstention, or induced abortion; and infecundability. An indirect measure of marriage rate indicated that fewer couples entered into marriage in 1974-75, particularly in the lower socioeconomic groups. Both the higher and lower socioeconomic groups were affected by the famine but the precise mechanisms were not the same. At this stage, it is not feasible to estimate the contribution of each factor to the fertility decline. The lower socioeconomic groups were more affected by husband-wife separations and deferred marriages; the higher socioeconomic groups were affected by mental stress and anxiety.