The effects of type of female circumcision on infertility and fertility in Sudan

This study explores the association between type of female circumcision and infertility and fertility in Sudan using the 1989-90 Demographic and Health Survey. It is hypothesized that women with either Pharaonic or Intermediate circumcision would have higher infertility and lower fertility compared with women with Sunna circumcision, and that uncircumcised women would have the lowest infertility and highest fertility of the three groups. This hypothesis, a widely held assumption, proved to be largely incorrect. Though women with Pharaonic or Intermediate circumcision did have a higher prevalence of primary infertility than uncircumcised women, women with Sunna circumcision had even lower rates of primary infertility compared with uncircumcised women. This pattern prevailed in multivariate models controlling for confounding variables, where women with Pharaonic or Intermediate circumcision had significantly higher primary infertility. Moreover, though women with Pharaonic or Intermediate circumcision also had the highest prevalence of secondary infertility, once confounding covariates were controlled in multivariate models, there was no significant difference among the three groups of women. With respect to fertility, the total fertility rate was 7.6 for women with Pharaonic or Intermediate circumcision, 8.1 for women with Sunna circumcision and 8.3 for uncircumcised women. Differences in fertility were found to be insignificant when covariates were controlled. The multivariate models were estimated using logistic regression. In conclusion, Pharaonic or Intermediate circumcision may be associated with higher primary infertility while there was no evidence suggesting that either secondary infertility or fertility was associated with a woman's circumcision status.     

Female genital cutting and reproductive experience in Minya, Egypt

In African populations practicing female genital cutting (FGC), beliefs exist that these procedures enhance reproduction and that their medicalization may diminish adverse effects, yet available findings are mixed in part for methodological reasons. We use data from a representative sample of ever-married women aged 17-55 years in Minya, Egypt, to examine the effects of type of FGC and type of circumciser on a woman's risks of primary infertility and pregnancy loss. Contrary to previous studies in Egypt, neither type of circumcision nor type of circumciser is associated with adverse fertility outcomes among circumcised women in Minya.     

Determinants of coital frequency among married women in Central African Republic: the role of female genital cutting

This paper examines determinants of one aspect of sexual behaviour--coital frequency--among 2,188 married women in the Central African Republic using a secondary analysis of data from the Demographic and Health Survey of 1994-95. Female genital cutting (or circumcision) is practised in the Central African Republic and self-reported circumcision status was included in the questionnaire enabling it to be examined as a possible determinant of coital frequency. Multiple logistic regression was used to find a subset of factors independently associated with coital frequency. Decreased coital frequency was found in those who had longer duration of marriage, those who were not the most recent wife in a polygamous marriage and those who had more surviving children. Coital frequency was higher in more educated women and those not contracepting because they wanted to get pregnant. After adjusting for confounders no association between female genital cutting and coital frequency was found. The extent to which women can control coital frequency in this culture is not known and fertility desires may override any negative effects of circumcision on sexual pleasure. It was therefore not possible to draw conclusions about how female genital cutting affects a woman's desire for sexual intercourse and consequently there is a need to develop research methods further to investigate this question.     

Patrilocality and recent migrations have little impact on shaping patterns of genetic structure of the armenian population

In general, genetic distances between human populations (also within one ethnic group) are larger for the Y chromosome markers than for the mtDNA. It is usually explained by higher rate of female versus male migration due to the cultural practice of patrilocality, when women move to their husbands’ residence after marriage. Recently found a reversed picture for the genetic variation in some ethno-territorial groups confirm the strict role of cultural traditions in shaping patterns of populations’ genetic structure. To test the role of patrilocality for the genetic structure of the Armenian population, we compared the Y chromosome and the mtDNA haplotype variations among and between geographical groups identified according to paternal (maternal) grandparental place of birth, from one side, and the populations currently living in the same geographical areas, from the other side. The results demonstrate that the Armenian population is regionally more structured for the Y chromosome than for the mtDNA. Additionally, in spite of expressed directivity of migration processes (caused by the phenomenon of patrilocality as well), the patterns of genetic variations for the populations of the same geographic areas remain without any significant changes during the last three generations.     

Male circumcision: hope for HIV infection decrease in southern Africa

Given the magnitude of the HIV pandemic, development of new prevention means is necessary. Male circumcision reduces HIV transmission from female to male by 57 % [95 % Confident Interval (CI): 42-68 %]. Its generalization in sub-Saharan Africa could avert, among men and women, from 1 to 4 millions new HIV infections over the next ten years. Acceptability of this new prevention mean is high in countries which could benefit the most from male circumcision, that means located in southern Africa, a region where in majority men are uncircumcised and where HIV prevalence is high. Male circumcision is a cost-effective prevention strategy. Actual prevention means (condoms, sexual abstinence and fidelity) are not used enough to curb the HIV epidemic. Research is ongoing on other prevention means (vaccine, pre- and post-exposition prophylaxis, microbicides, diaphragm) but their efficiency has not been demonstrated yet. Nevertheless, generalization of circumcision in southern Africa is responsible for contestations in part due to the fact that this prevention mean protects only partially from HIV infection. Moreover, for now, only a few countries integrated circumcision in their HIV prevention program in spite of WHO (World Health Organization) recommendations supporting male circumcision acknowledgement as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men. Significant available funding should allow the situation to evolve quickly. At the same time, research goes on in order to know more about the effects and to facilitate the generalization of this prevention mean which is a great hope for southern Africa.     

“After my husband’s circumcision,I know that I am safe from diseases”: Women’s Attitudes and Risk Perceptions Towards Male Circumcision in Iringa,Tanzania

While male circumcision reduces the risk of female-to-male HIV transmission and certain sexually transmitted infections (STIs), there is little evidence that circumcision provides women with direct protection against HIV. This study used qualitative methods to assess women’s perceptions of male circumcision in Iringa, Tanzania. Women in this study had strong preferences for circumcised men because of the low risk perception of HIV with circumcised men, social norms favoring circumcised men, and perceived increased sexual desirability of circumcised men. The health benefits of male circumcision were generally overstated; many respondents falsely believed that women are also directly protected against HIV and that the risk of all STIs is greatly reduced or eliminated in circumcised men. Efforts to engage women about the risks and limitations of male circumcision, in addition to the benefits, should be expanded so that women can accurately assess their risk of HIV or STIs during sexual intercourse with circumcised men.     

Age Specific Survival Rates of Steller Sea Lions at Rookeries with Divergent Population Trends in the Russian Far East

After a dramatic population decline, Steller sea lions have begun to recover throughout most of their range. However, Steller sea lions in the Western Aleutians and Commander Islands are continuing to decline. Comparing survival rates between regions with different population trends may provide insights into the factors driving the dynamics, but published data on vital rates have been extremely scarce, especially in regions where the populations are still declining. Fortunately, an unprecedented dataset of marked Steller sea lions at rookeries in the Russian Far East is available, allowing us to determine age and sex specific survival in sea lions up to 22 years old. We focused on survival rates in three areas in the Russian range with differing population trends: the Commander Islands (Medny Island rookery), Eastern Kamchatka (Kozlov Cape rookery) and the Kuril Islands (four rookeries). Survival rates differed between these three regions, though not necessarily as predicted by population trends. Pup survival was higher where the populations were declining (Medny Island) or not recovering (Kozlov Cape) than in all Kuril Island rookeries. The lowest adult (> 3 years old) female survival was found on Medny Island and this may be responsible for the continued population decline there. However, the highest adult survival was found at Kozlov Cape, not in the Kuril Islands where the population is increasing, so we suggest that differences in birth rates might be an important driver of these divergent population trends. High pup survival on the Commander Islands and Kamchatka Coast may be a consequence of less frequent (e.g. biennial) reproduction there, which may permit females that skip birth years to invest more in their offspring, leading to higher pup survival, but this hypothesis awaits measurement of birth rates in these areas.     

Morphological Drift Accompanying Nascent Population Differentiation in the Ciliate Euplotes vannus

A rare phenomenon can occur in ciliated protists of the genus Euplotes, which can undergo genetic recombination by the normal outbreeding process of conjugation following mild starvation. Occasionally, the dominant mutation for the autogamy trait arises. Individuals possessing the trait show obligate self-fertilization upon mild starvation. This yields, after normal asexual division, a population of individuals that are reproductively isolated from the parental outbreeding strain. A morphometric analysis of sympatric autogamous and non-autogamous populations of Euplotes vannus from Somalia demonstrates that there has been morphological drift in gross body proportions in the autogamous populations. However, the positional patterns of the locomotory organelles on the ventral surface remain unchanged. The changes in body proportions in the autogamous populations are relevant to the mechanics of the conjugation process, which involves fusion of the oral regions of paired cells belonging to complementary mating types.     

Female fecundity in highland Papua New Guinea

Demographers often assume that interpopulation variation in birth spacing is attributable primarily to behavioral differences (e.g., in breastfeeding, coital frequency, or contraceptive practice), and that the contribution of physiological factors is negligible. This assumption may be correct, but it should be tested, especially in light of recent evidence that there may be more variation in ovarian function among human populations than was previously believed. In this paper, we apply a stochastic model of the determinants of fecundability (the monthly probability of conception) to endocrinological data collected among the Gainj, a tribal population in highland Papua New Guinea. Based on previous research, the Gainj are known to have age patterns of ovarian function that differ markedly from the Western norms. When account is taken of the late menarche, early menopause, and long ovarian cycles that appear to characterize Gainj women, mean apparent fecundability across the female reproductive span is reduced by about 27 per cent (from 0.316 to 0.235), and the mean waiting time to next apparent conception is increased by just over one month. Thus, despite the fact that Gainj women differ from Western women with respect to reproductive physiology by as much as or more than any other known population, the demographic impact of these differences appears to be slight.     

Acute undernutrition is not associated with excess of females at birth in humans: the Dutch hunger winter

It has been suggested that maternal undernutrition results in adjustment of the sex ratio at birth, favouring females. We tested this hypothesis using births during the Dutch Hunger Winter of 1944-1945, an acute severe famine of seven months' duration. There was no evidence of an excess of female births among deliveries of human infants exposed to famine in any period in gestation. Indeed, among deliveries to women maximally exposed to famine prior to conception, there was an excess (odds ratio = 1.31, 95% CI 1.09-1.58; p = 0.004) of male offspring. Our data do not provide any support for acute and severe maternal undernutrition as a trigger for an increase in female conceptions or in male foetal deaths in human populations.     

Male Circumcision and STI Acquisition in Britain: Evidence from a National Probability Sample Survey

Background

It is well-established that male circumcision reduces acquisition of HIV, herpes simplex virus 2, chancroid, and syphilis. However, the effect on the acquisition of non-ulcerative sexually transmitted infections (STIs) remains unclear. We examined the relationship between circumcision and biological measures of three STIs: human papillomavirus (HPV), Chlamydia trachomatis and Mycoplasma genitalium.

Methods

A probability sample survey of 15,162 men and women aged 16-74 years (including 4,060 men aged 16-44 years) was carried out in Britain between 2010 and 2012. Participants completed a computer-assisted personal interview, including a computer-assisted self-interview, which asked about experience of STI diagnoses, and circumcision. Additionally, 1,850 urine samples from sexually-experienced men aged 16-44 years were collected and tested for STIs. Multivariable logistic regression was used to calculate adjusted odds ratios (AOR) to quantify associations between circumcision and i) self-reporting any STI diagnosis and ii) presence of STIs in urine, in men aged 16-44 years, adjusting for key socio-demographic and sexual behavioural factors.

Results

The prevalence of circumcision in sexually-experienced men aged 16-44 years was 17.4% (95%CI 16.0-19.0). There was no association between circumcision and reporting any previous STI diagnoses, and specifically previous chlamydia or genital warts. However, circumcised men were less likely to have any HPV type (AOR 0.26, 95% confidence interval (CI) 0.13-0.50) including high-risk HPV types (HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and/or 68) (AOR 0.14, 95% CI 0.05-0.40) detected in urine.

Conclusions

Circumcised men had reduced odds of HPV detection in urine. These findings have implications for improving the precision of models of STI transmission in populations with different circumcision prevalence and in designing interventions to reduce STI acquisition.     

"Taming tradition": medicalized female genital practices in western Kenya

This article considers the question of female genital practices at the hands of health workers in western Kenya. Recent articles in Medical Anthropology Quarterly have critically engaged with the biomedical arguments condemning such practices. This article studies the case of medicalized circumcision in which biomedical concerns over health risks have become incorporated in their vernacular practice. Although some suggest that medicalization may provide a harm-reduction strategy to the abandonment of the practice, research in one region challenges this suggestion. It argues that changing and conflicting ideologies of gender and sexuality have led young women to seek their own meaning through medicalized practice. Moreover, attributing this practice to financial motivations of health workers overlooks the way in which these "moral agents" must be situated within their social and cultural universe. Together, these insights challenge the view that medicine can remain neutral in the mediation of tradition.     

Distribution of blood groups in the East African Somali population

The results of a population survey on blood group distribution in Somalia, East Africa, are presented. Over 1,000 subjects were tested for most blood groups included in the survey. The sampling covered the whole country and was well in accordance with the population density as estimated by the recorded birth places of the subjects. Altogether, 46 blood group antigens were tested, partly common antigens within 11 of the major blood group systems, but also infrequent and very frequent antigens, some not tested before in Africa, were included. The results were compared with the available data for other related peoples and for populations from the same geographical area. The standard genetic distances were also applied in the comparison. The results suggest that only a minor component in the genetic constitution of the Somali population can be ascribed to Caucasian admixture. They are markedly in contrast with some earlier findings. During the survey we observed a previously unknown Rh gene complex occurring with a polymorphic frequency in Somalis.     

Benefits and risks of circumcision.

Circumcisions are performed either prophylactically in the neonatal period or therapeutically at a later age. About 10% of males not circumcised at birth will eventually require circumcision. The present neonatal circumcision rate is about 80% in the United States and 40% in Canada. The single most important determinant of whether a newborn male will be circumcised is the attitude of the attending physician. The literature was reviewed to determine the proven benefits of circumcision and to compare these with the known risks. Circumcising the newborn facilitates penile hygiene, prevents cancer of the penis and decreases the incidence of genital herpes in later life. Whether it decreases the incidence of cancer of the cervix is still uncertain. More important, neonatal circumcision is associated with much lower morbidity and mortality and with lower costs than therapeutic circumcision. Thus, prophylactic circumcision is recommended for the male population as a whole.     

Role of seasonal factors in pre- and postnatal ontogenesis for etiology of type 1 diabetes mellitus

Type 1 diabetes mellitus is a chronic disease characterized by autoimmune degradation of insulin-producing beta-cells. It was shown in a number of epidemiological studies of seasonality of birth in children with type 1 diabetes that the autoimmune process began during fetal and postnatal development. No such studies were carried out in the former Soviet Union countries. The aim of the present study is to compare the seasonal birth month pattern in patients with type 1 diabetes (10780 men and 9337 women) born in 1960-2002 to that in the total population of Ukraine (14 785601 men and 13 911370 women) born during the same period. Significant differences were found between these two populations: chi-squared = 103.97, p < 0.0001 and 135.17, p < 0.0001 in men and women, respectively. The results of cosinor analysis showed similar sinusoidal birth patterns of patients with type 1 diabetes in all sub-groups, irrespective of the age of clinical disease expression: 0-9, 10-19, or 20-29 years. In all cases, the highest and lowest predispositions to type 1 diabetes were inherent in the people born in spring and autumn, respectively. We propose that seasonal differences in the birth pattern in the two above populations could be due to long-term programming of glucose-insulin metabolism determined by the effect of certain seasonal factors during early ontogenesis.     

Projected Effect of Increased Active Travel in German Urban Regions on the Risk of Type 2 Diabetes

Background

Future transportation policy is likely to reduce emissions in the cities and urban regions by strengthening active travel. Increased walking and cycling are known to have positive effects on health outcomes. This work estimates effects of increased active travel on type 2 diabetes in Germany, where 64% of the population live in urban regions.

Methods

Based on the effect size of an increased active travel scenario reported from a recent meta-analysis, we project the change in the life time risk, the proportion of prevented cases and the change in diabetes free life time in a German birth cohort (born 1985) compared to business as usual.

Results

The absolute risk reduction of developing type 2 diabetes before the age of 80 is 6.4% [95% confidence interval: 3.7-9.7%] for men and 4.7% [2.2-7.7%] for women, respectively. Compared to business as usual, the increased active travel scenario prevents 14.0% [8.1-21.2%] of the future cases of diabetes in men and 15.8% [9.3-23.1%] in women. Diabetes free survival increases by 1.7 [1.0-2.7] years in men and 1.4 [0.6-2.3] in women.

Conclusions

Our projection predicts a substantial impact of increased active travel on the future burden of type 2 diabetes. The most striking effect may be seen in the number of prevented cases. In all urban regions with an increased active travel transport policy, about one out of seven male and one out of six female cases can be prevented.     

Low genetic diversity and recovery implications of the vulnerable Bankoualé Palm Livistona carinensis (Arecaceae), from North-eastern Africa and the Southern Arabian Peninsula

The Bankoualé Palm, Livistona carinensis is the only known species of Livistona occurring in Africa and is currently classified as vulnerable (IUCN 2004). This extreme outlier species of the genus is restricted to Yemen, Somalia and Djibouti, where all populations are in rapid decline. In Djibouti the palm is confined to three valley systems within the upland plateau of the Goda Massif. This study used microsatellite markers to investigate the genetic diversity and relationships within the species. At the species level L. carinensis contained very low genetic diversity. Most variation was due to the variation between the samples from Yemen and Somalia compared with those in Djibouti. The Djibouti populations were almost monomorphic across the nine loci tested. Interestingly, and despite the small sample sizes, the individuals from botanic gardens collections of the Yemen and Somalia populations were more genetically diverse than the Djibouti populations. This study indicates that the populations in Yemen and Somalia are highly significant for the conservation of the species genetic diversity. Given the lack of genetic diversity both within and among L. carinensis populations in Djibouti, plants could be cultivated for in-situ population enhancement from any seed that is available from within Djibouti with no significant genetic impacts of provenance mismatch. Clearly the populations from Djibouti, Somalia and Yemen are different genetic provenances raising some issues for the conservation and recovery of L. carinensis.     

Contraception after childbirth in Thailand

Data from the Third Contraceptive Prevalence Study conducted in 1984 in Thailand were analyzed to learn the extent of contraceptive practice after childbirth. Focusing on those women who had a birth within a given period prior to the survey, for some purposes the analysis was limited to those women whose most recent birth occurred within 1 year of interview, while for others it was extended to women whose most recent birth occurred within the last 2-4 years. The number of women in 4 years following childbirth in the Contraceptive Prevalence Survey 3 sample were 3442 in the unweighted ever married group and 3342 in the unweighted currently married group; the figures were 3447 for the weighted ever married group and 3342 for the weighted currently married group. Thai couples adopted contraception in very substantial proportions and very soon following the birth of a child. Based on women interviewed within 1 year of most recent birth, over half started some contraception by the end of the 6th month and almost 4/5 by the end of the 1st year. The timing of female sterilization was quite different from initiation of all other methods. Female sterilization in Thailand occurred primarily during the immediate postpartum period, while women are still in the hospital after delivery. Relatively few women sterilized in the 2 years following the 1st postpartum month. Of women in their first 2 years following childbirth, 17% were sterilized by the end of the 1st postpartum month and only an additional 3% by the end of the 2nd year. Initiation of temporary methods was not linked to the immediate postpartum period but occurred throughout the 1st year following birth. Contraceptive use during the 1st year following childbirth was more likely among menstruating women than among women who were still amenorrheic. Methods other than female sterilization predominated among women who already experienced the return of menses, suggesting that the return of menses was an important stimulus to their adoption. The data suggest that the proportion of Thai women exposed to risk of unwanted pregnancies for any extended period of time following childbirth is quite modest.     

Male versus female genital alteration: Differences in legal,medical, and socioethical responses

The different legal, social, and medical approaches to ritually based male and female genital circumcision in the United States are highlighted in this article. The religious and historical origins of these practices are briefly examined, as well as the effect of changing policy statements by American medical associations on the number of circumcisions performed. Currently, no state or federal laws single out male circumcision for regulation. The tolerant attitudes toward male circumcision in law, medicine, and societal opinion stand in striking contrast to the attitudes of those disciplines toward even the least invasive form of female genital alteration. US law tacitly condones male circumcision by providing exemptions that are not available for other medical procedures, while criminalizing any similar or even less extensive procedure on females. The increase in immigration, over the past few decades, of people from countries in which female genital alteration is a cultural tradition has brought the issue to the United States. The medical profession's changing approach over time toward male circumcision is primarily responsible for such different legal and societal reactions toward female genital alteration.     

Epidemiological effects of seasonal oscillations in birth rates

Seasonal oscillations in birth rates are ubiquitous in human populations. These oscillations might play an important role in infectious disease dynamics because they induce seasonal variation in the number of susceptible individuals that enter populations. We incorporate seasonality of birth rate into the standard, deterministic susceptible-infectious-recovered (SIR) and susceptible-exposed-infectious-recovered (SEIR) epidemic models and identify parameter regions in which birth seasonality can be expected to have observable epidemiological effects. The SIR and SEIR models yield similar results if the infectious period in the SIR model is compared with the "infected period" (the sum of the latent and infectious periods) in the SEIR model. For extremely transmissible pathogens, large amplitude birth seasonality can induce resonant oscillations in disease incidence, bifurcations to stable multi-year epidemic cycles, and hysteresis. Typical childhood infectious diseases are not sufficiently transmissible for their asymptotic dynamics to be likely to exhibit such behaviour. However, we show that fold and period-doubling bifurcations generically occur within regions of parameter space where transients are phase-locked onto cycles resembling the limit cycles beyond the bifurcations, and that these phase-locking regions extend to arbitrarily small amplitude of seasonality of birth rates. Consequently, significant epidemiological effects of birth seasonality may occur in practice in the form of transient dynamics that are sustained by demographic stochasticity.