Association between fertility and HIV status: what implications for HIV estimates?

Background: Most estimates of HIV prevalence have been based on sentinel surveillance of pregnant women which may either under-estimate or over-estimate the actual prevalence in adult female population. One situation which can lead to either an underestimate or an overestimate of the actual HIV prevalence is where there is a significant difference in fertility rates between HIV-positive and HIV-negative women. Our aim was to compare the fertility rates of HIV-infected and HIV-uninfected women in Cameroon in order to make recommendations on the appropriate adjustments when using antenatal sentinel data to estimate HIV prevalence Methods: Cross-sectional, population-based study using data from 4493 sexually active women aged 15 to 49 years who participated in the 2004 Cameroon Demographic and Health Survey. Results: In the rural area, the age-specific fertility rates in both HIV positive and HIV negative women increased from 15-19 years age bracket to a maximum at 20-24 years and then decreased monotonically till 35-49 years. Similar trends were observed in the urban area. The overall fertility rate for HIV positive women was 118.7 births per 1000 woman-years (95% Confidence Interval [CI] 98.4 to 142.0) compared to 171.3 births per 1000 woman-years (95% CI 164.5 to 178.2) for HIV negative women. The ratio of the fertility rate in HIV positive women to the fertility rate of HIV negative women (called the relative inclusion ratio) was 0.69 (95% CI 0.62 to 0.75). Conclusion: Fertility rates are lower in HIV-positive than HIV-negative women in Cameroon. The findings of this study support the use of summary RIR for the adjustment of HIV prevalence (among adult female population) obtained from sentinel surveillance in antenatal clinics

Measures of frailty in population-based studies: An overview

Although research productivity in the field of frailty has risen exponentially in recent years, there remains a lack of consensus regarding the measurement of this syndrome. This overview offers three services: first, we provide a comprehensive catalogue of current frailty measures; second, we evaluate their reliability and validity; third, we report on their popularity of use

Reasons for second trimester abortions in England and Wales

This paper summarises the findings of a study on second trimester abortion in England and Wales in 2005. Second trimester abortions constitute a relatively small proportion of the total number of legal abortions performed in these countries yet attract quite substantial public, and particularly media, attention. Discussion of these abortions has, however, been conducted within a context of little understanding of the factors which explain why they happen. This paper starts with a brief introduction to the policy context for provision of second trimester abortion, and a summary of existing research in the area. It then presents the results of a survey of 883 women of their own reasons why they had abortions in the second trimester. The key concept is that of ‘‘delay’’ and reasons for delay in seeking or obtaining abortion at five stages in the pathway to abortion. No clear, single reason emerges. Amongst the main reasons identified are uncertainty about what to do if they were pregnant, not realising they were pregnant, experiencing bleeding which may have been confused with continuing to have periods, and changes in personal circumstances. The paper ends with a consideration of the implications of the results for education, policy development and service provision