A Regional Multilevel Analysis: Can Skilled Birth Attendants Uniformly Decrease Neonatal Mortality?

Globally 40% of deaths to children under-five occur in the very first month of life with three-quarters of these deaths occurring during the first week of life. The promotion of delivery with a skilled birth attendant (SBA) is being promoted as a strategy to reduce neonatal mortality. This study explored whether SBAs had a protective effect against neonatal mortality in three different regions of the world

Construction of Wave IV dbGaP GWAS Sample Weight

This document provides a brief overview of the steps in constructing GWAS sample weights. It also reports results of some statistical analysis using the constructed weights. The total number of GWAS sample (N=9,975) who were actually assayed and number of those (N=12,234) who consented to be archived and assayed are different. When the proportions of subjects who have consented and who have actually been assayed are different for certain Add Health post-stratification domains, this might cause problems if we simply use grand sample weights for GWAS sample (Bethlehem 2002). We thus developed weights for this special sample

Do Safer Sex Self-Efficacy, Attitudes toward Condoms, and HIV Transmission Risk Beliefs Differ among Men who Have Sex with Men, Heterosexual Men, and Women Living with HIV?

To understand sexual decision-making processes among people living with HIV, we compared safer sex self-efficacy, condom attitudes, sexual beliefs, and rates of unprotected anal or vaginal intercourse with at-risk partners (UAVI-AR) in the past 3 months among 476 people living with HIV: 185 men who have sex with men (MSM), 130 heterosexual men, and 161 heterosexual women. Participants were enrolled in SafeTalk, a randomized, controlled trial of a safer sex intervention. We found 15% of MSM, 9% of heterosexual men, and 12% of heterosexual women engaged in UAVI-AR. Groups did not differ in self-efficacy or sexual attitudes/beliefs. However, the associations between these variables and UAVI-AR varied within groups: greater self-efficacy predicted less UAVI-AR for MSM and women, whereas more positive condom attitudes – but not self-efficacy – predicted less UAVI-AR for heterosexual men. These results suggest HIV prevention programs should tailor materials to different subgroups

Early Sex Work Initiation and Violence against Female Sex Workers in Mombasa, Kenya

Between 20 and 40 % of female sex workers (FSWs) began sex work before age 18. Little is known concerning whether early initiation of sex work impacts later experiences in adulthood, including violence victimization. This paper examines the relationship between early initiation of sex work and violence victimization during adulthood. The sample included 816 FSWs in Mombasa, Kenya, recruited from HIV prevention drop-in centers who were 18 years or older and moderate-risk drinkers. Early initiation was defined as beginning sex work at 17 or younger. Logistic regression modeled recent violence as a function of early initiation, adjusting for drop-in center, age, education, HIV status, supporting others, and childhood abuse. Twenty percent of the sample reported early initiation of sex work. Although both early initiators and other FSWs reported commonly experiencing recent violence, early initiators were significantly more likely to experience recent physical and sexual violence and verbal abuse from paying partners. Early initiation was not associated with physical or sexual violence from non-paying partners. Many FSWs begin sex work before age 18. Effective interventions focused on preventing this are needed. In addition, interventions are needed to prevent violence against all FSWs, in particular, those who initiated sex work during childhood or adolescence

Maternal autonomy is inversely related to child stunting in Andhra Pradesh, India

Child stunting, an outcome of chronic undernutrition, contributes to poor quality of life, morbidity and mortality. In South Asia, the low status of women is thought to be one of the primary determinants of undernutrition across the lifespan. Low female status can result in compromised health outcomes for women, which in turn are related to lower infant birthweight and may affect the quality of infant care and nutrition. Maternal autonomy (defined as a woman’s personal power in the household and her ability to influence and change her environment) is likely an important factor influencing child care and ultimately infant and child health outcomes. To examine the relationship between maternal autonomy and child stunting in Andhra Pradesh, India, we analysed data from National Family Health Survey (NFHS)-2. We used cross-sectional demographic, health and anthropometric information for mothers and their oldest child <36 months (n = 821) from NFHS-2. The main explanatory variables of autonomy are presented by four dimensions – decision making, permission to travel, attitude towards domestic violence and financial autonomy – constructed using seven binary variables. Logistic regression models were used to test associations between indicators of female autonomy and the risk of having a stunted child. Women with higher autonomy {indicated by access to money [odds ratio (OR) = 0.731; 95% confidence interval (CI) 0.546, 0.981] and freedom to choose to go to the market [OR = 0.593; 95% CI 0.376, 0.933]} were significantly less likely to have a stunted child, after controlling for household socio-economic status and mother’s education. In this south Indian state, two dimensions of female autonomy have an independent effect on child growth, suggesting the need for interventions that increase women’s financial and physical autonomy

Forest Clearing in the Ecuadorian Amazon: A Study of Patterns Over Space and Time

This study tests four hypotheses related to forest clearing over time in Ecuador’s northern Amazon: (1) a larger increase in population over time on a farm (finca) leads to more deforestation; (2) rates of forest clearing surrounding four primary reference communities differ (spatial heterogeneity); (3) fincas farther from towns/communities experience lower rates of forest clearing over time; and (4) forest clearing differs by finca settlement cohort, viz., by year of establishment of the finca. In this paper, we examine the relationship between forest clearing and key variables over time, and compare three statistical models—OLS, random effects, and spatial regression—to test hypotheses. Descriptive analyses indicate that 7–15% of forest area was cleared on fincas between 1990 and 1999; that more recently established fincas experienced more rapid forest clearing; and that population size and forest clearing are both related to distance from a major community. Controlling for key variables, model results indicate that an increase in population size is significantly related to more forest clearing; rates of forest clearing around the four major communities are not significantly different; distances separating fincas and communities are not significantly related to deforestation; and deforestation rates are higher among more recently established fincas. Key policy implications include the importance of reducing population growth and momentum through measures such as improving information about and provision of family planning services; increasing the low level of girls education to delay and reduce fertility; and expanding credit and agricultural extension services to increase agricultural intensification

Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: a cross-sectional analysis

Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya

Does motivational interviewing counseling time influence HIV-positive persons’ self-efficacy to practice safer sex?

This study examined the impact of motivational interviewing (MI) counseling time on self-efficacy to practice safer sex for people living with HIV/AIDS (PLWHA)

Gender inequality and the risk of HIV among married couples in North India

This study investigated the distribution and determinants of HIV risks among married couples in North India. Gender inequality emerged as a potential driver of HIV risks in this region. Data collection took place in 2003 in a probability survey of 3,385 couples living in India’s most populous state – Uttar Pradesh – and Uttaranchal. Couples’ analyses utilizing generalized estimating equations showed that compared with husbands, wives were less knowledgeable about HIV (OR=0.31, 95% CI= 0.27–0.36), more likely to consider themselves at risk for infection (OR=6.86, 95% CI= 4.65–10.13), and less likely to feel that a wife had the right to refuse sex with her husband (OR=0.50, 95% CI= 0.44–0.58). The proportion of husbands reporting non-marital sex in the past year was 7.1% and transactional sex in the past year, 2.2%. Among their wives, 73.4% were unaware of their husbands’ non-marital sexual behaviors and only 28.9% of husbands reported condom use during their last non-marital sexual encounter. Logistic regression analyses showed that husbands’ alcohol use, husbands’ mobility, and urban residence were positively associated with husbands’ non-marital sexual behaviors adjusting for other covariates. The data demonstrate that HIV prevention programs among couples in North India should consider both sexual risks and gender inequalities which potentially fuel HIV spread in this region

Gender-Based Power and Couples’ HIV Risk in Uttar Pradesh and Uttarakhand, North India

Gender inequality is a long-recognized driver of the HIV epidemic. However, few studies have investigated the association between gender-based power and HIV risk in India, which has the world's third largest HIV epidemic