This paper aims to describe the nutritional status of Caboclo adolescents living in two areas of the Amazon Basin. Two cross-sectional studies, the first in the dry and the second in the wet season, were carried out in two Amazonian ecosystems: the forest and black water ecosystem, and the floodplain and white water ecosystem. Measurements of weight, stature, arm circumference and triceps, subscapular and suprailiac skinfolds were performed on 247 adolescents (10–19 years of age). Nutritional status was classified using body mass index according to international criteria and the prevalence of underweight and overweight was estimated. Linear mixed effects models were used with the anthropometric measurements as dependent variables and time interval, place of residence, sex, age and stature variation as independent variables. During the wet season, the prevalence of overweight among girls was higher in the forest (42%) than in the floodplain (9%). Longitudinal linear regression models showed that the arm circumference measurement was influenced both by seasonality and location, revealing that the increment between dry and wet seasons was less pronounced in the floodplain. At the time of the study, overweight already constituted a major public health concern among girls living in the forest area. In order to develop adequate public health policies for this important segment of the Amazon population further studies are necessary to investigate the role of environment and seasonality on the growth and nutritional status of adolescents.

Consanguineous marriage is traditionally common throughout the eastern Mediterranean region. Research has suggested that it is closely linked to the sociocultural and socioeconomical status of individuals, and education plays a critical role in decreasing the number of cases. This study aimed to determine the effects of a formal training programme on consanguineous marriages on the knowledge of, and attitudes towards, consanguineous marriage of high school students (n=804) in the Mediterranean region of Turkey. Seniors from three randomly selected public high schools participated in the pre-test and post-test design study. To determine the effects of the programme, students who received the training were compared with those who did not receive any formal training about the subject. After the post-tests were administered, data were collected and analysed using chi-squared and McNemar tests. The results showed significant differences in knowledge and attitudes among the students who had received the formal training programme and those who had not. In addition, the results indicated potential peer influence between the students who received training in consanguineous marriage and those who did not.

Based on a 1900 census sample of 34,166 post-reproductive females (≥45 years), the birth month effect was put to the test, for both lifetime fertility as well as child survival, controlling for maternal birth cohort (1826–1835, 1836–1845, 1846–1855), Duncan's SEI, urbanity, nativity, literacy and marital duration. Testing for potential cohort effects did not indicate a temporal trend in fertility by maternal birth month (seasonal Mann-Kendall test, p=0.578), while a minute increase in offspring survival was detected (p<0.001, Sen's estimator of slope=0.02, 95% CI=0.02 to 0.03). Further analyses of the maternal birth month effect on child survival were therefore seized. For lifetime fertility, ANOVA results indicated that maternal birth month was a major predictor for total offspring count (F11, 33606=1809.0, p<0.001), accounting for 37.2% of the total variability. In addition to main effects, a statistically significant interaction effect was observed (F538, 33606=2.2, p<0.001), with a corresponding effect size of η2=0.40. Planned contrasts revealed that birth-month-specific differences in fertility achieved statistical significance (F11, 31798=1712.9, p<0.001), while post-hoc multiple comparisons for literacy and nativity displayed an inverse relationship with fertility, which meets demographic expectations. Controlling for all factors of interest, models of cohort-specific offspring counts (independent ANOVAs for 1826–1835: F157, 3467=26.3, p<0.001; 1836–1845: F182, 10299=75.5, p<0.001; 1846–1855: F199, 19859=137.9, p<0.001) indicated that women born in the first half of the year (particularly, January, February, April and May) achieved above-average parity, while those born in the latter half (namely, July, October, November and December) displayed markedly lower fertility averages. These monthly disparities are in line with previous observations and appear to be linked to seasonal optimal ripening of the oocyte or seasonal preovulatory over-ripeness ovopathy (Jongbloet, 1992).

Consanguinity, the marriage between relatives, has been associated with adverse child health outcomes. The objective of the present study was to assess the effect of consanguinity on offspring weight gain from birth to 12 months after birth. Data were collected on 250 consecutive live-born singleton newborns referred to a local health centre in Shiraz (Fars province, southern Iran). Collected data covered socio-demographic characteristics (such as parental age at delivery and parental education), sex, birth order, weights from birth to 12 months after birth and consanguinity of marriages of parents. Considering the low prevalence of double first cousin, first cousin once removed, second cousin, and beyond second cousin marriages, only first cousin and unrelated marriages were included in the study. The study population consisted of a total of 207 newborns (57 offspring of first cousins, 150 offspring of unrelated marriages). Based on the results of repeated measurements analysis of variance, weight gain was associated with type of marriage (p=0.018), sex of offspring (p=0.001) and paternal education (p<0.001). There was no interaction between type of marriage and sex (p=0.831). Birth weight was not affected by type of marriage (p=0.46). There was significant interaction between inbreeding and time (p=0.034). Offspring of consanguineous marriages showed lower weight gain in comparison with those of unrelated marriages during 3–12 months after birth.

This study evaluated the prevalence of overweight and obesity in the male Sardinian population (Italy), and verifies that it has increased over the last 30 years. Data were collected during 2003–2004 from military registers in the Archive of the Military District of Cagliari for the years 1969 and 1998. A total of 22,345 forms were analysed from all Sardinia. The conscripts were classified on the basis of their place of residence and socioeconomic status. The overall prevalence of overweight and obesity in Sardinia were 4.33% and 0.55%, respectively, for the conscripts of 1969 and 9.8% and 3% for 1998. Olbia-Tempio (northern Sardinia) was the province with the highest incidence of overweight and obesity in 1969, and Nuoro (central Sardinia) had the highest incidence in 1998. Distribution of body mass index, overweight and obesity across the island showed a statistically significant heterogeneity that strongly decreased from 1969 to 1998. Among the conscripts of 1969, the incidence of overweight and obesity were higher in rural than in urban regions. An opposite trend was observed for the 1998 prevalence, it being more frequent in urban than rural regions. Comparison with other Italian regions was made. The percentages of overweight and obese individuals in Sardinia have markedly increased during the last 30 years, but their low incidence with respect to other Italian populations could be explained by the genetic peculiarity of the island. The change in the internal distribution of obesity clearly reflects socioeconomic changes.

Maternal mortality persists in low-income settings despite preventability with skilled birth attendance and emergency obstetric care. Poor access limits the effectiveness of life-saving interventions and is typical of maternal health care in low-income settings. This paper examines access to care in obstetric emergencies from the perspectives of service users, using established and contemporary theoretical frameworks of access and a routine health surveillance method. The implications for health planning are also considered. The final caregivers of 104 women who died during pregnancy or childbirth were interviewed in two rural districts in Indonesia using an adapted verbal autopsy. Qualitative analysis revealed social and economic barriers to access and barriers that arose from the health system itself. Health insurance for the poor was highly problematic. For providers, incomplete reimbursements, and low public pay, acted as disincentives to treat the poor. For users, the schemes were poorly socialized and understood, complicated to use and led to lower quality care. Services, staff, transport, equipment and supplies were also generally unavailable or unaffordable. The multiple barriers to access conferred a cumulative disadvantage that culminated in exclusion. This was reflected in expressions of powerlessness and fatalism regarding the deaths. The analysis suggests that conceiving of access as a structurally determined, complex and dynamic process, and as a reciprocally maintained phenomenon of disadvantaged groups, may provide useful explanatory concepts for health planning. Health planning from this perspective may help to avoid perpetuating exclusion on social and economic grounds, by health systems and services, and help foster a sense of control at the micro-level, among peoples' feelings and behaviours regarding their health. Verbal autopsy surveys provide an opportunity to routinely collect information on the exclusory mechanisms of health systems, important information for equitable health planning.

The strong association of very low birth weight (VLBW; <1500 g) with infant mortality is well known. There are no data related to VLBW trends in Brazil although findings from some large surveys carried out in small- and medium-sized cities have demonstrated an increase in low birth weight (LBW; <2500 g) rates over the last 30 years. The aim of this study was to evaluate the secular trend of VLBW in the city of Porto Alegre, a large city in a developed area in southern Brazil, and the potential determinants of this trend during the 1990s and early 2000s. This is a registry-based study. Data were obtained from birth certificates of all live births in the city from 1994 to 2005. The variables analysed were: VLBW as the dependent variable and maternal age and schooling, type of delivery, type of hospital, number of live births, gestational age, newborn gender and unemployment rate. The incidence ratio rate (IRR) using Poisson regression was calculated to identify possible trends in VLBW rates. Poisson regressions were performed in order to assess the influence of some independent variables on VLBW. A total of 257,740 singleton newborns were delivered in the city during the period, with a steady reduction in the total number of live births per year from 23,296 in 1994 to 18,325 in 2005. The results showed a small but significant increase in VLBW (p for trend=0.049). There was a significant trend towards adequacy for gestational age per birth weight, suggesting a reduction in rates of intrauterine growth restriction (IUGR) (p<0.001). The findings showed a significant increase of 1% per year in the probability of VLBW. The main risk factors were related to VLBW mothers with low levels of schooling, public hospitals and multiparity and nulliparity. After adjustment, nulliparity remained as a significant risk factor. The interaction between type of hospital and type of delivery indicated that the probability for VLBW was 3.6 times higher (p<0.001) among those born in public hospitals by Caesarean section than those born in private hospitals by vaginal delivery. The results show that southern Brazil is going through a demographic transition characterized by a significant decrease in number of live births associated with a small increase in VLBW rates, a decrease in IUGR rates and stabilization of LBW.

This study examined men's justification of wife beating in relation to their perceived rights and autonomy using a nationally representative sample of 18,047 men in India with childhood exposure to parental violence. Five reasons for wife beating justification, four items of men's perceived rights, and five items of household autonomy were analysed using χ2 test and logistic regression. Among 18,047 participants, 67% justified wife beating. Low education, economic stress and being unmarried were generally more associated with justifying wife beating for all five reasons. Wife's refusal of sex and husband's final say on household autonomy are risk factors. Joint autonomy on household decision making and wife's autonomy on managing her own earnings are protective factors. Perceived relationship rights and autonomy are highly predictive of wife-beating justification for the men who have been exposed to parental violence during childhood. The study has significant implications for public health planners and education strategies.

Understanding care-seeking practices and barriers to prevention of mother-to-child transmission (PMTCT) of HIV is necessary in designing effective programmes to address the high disease burden due to HIV/AIDS in Uganda. This study explored perceptions, care-seeking practices and barriers to PMTCT among young and HIV-positive women. A household survey (10,706 women aged 14–49 years), twelve focus group discussions and 66 key informant interviews were carried out between January and April 2009 in Wakiso district, central Uganda. Results show that access to PMTCT services (family planning, HIV counselling and testing and delivery at health units) was poor. Decision making was an important factor in accessing PMTCT services. Socioeconomic factors (wealth quintile, age, education level) and institutional practices also influenced access to PMTCT. Overall, having had an HIV test was highest when both men and women made decisions together or when women were empowered to make their own decisions. This was significant across wealth quintiles (p=0.0001), age groups (p=0.0001) and education levels (p=0.0001). The least level of HIV testing was when men made decisions for their spouses; and this was the case with family planning and deliveries at health units. Other barriers to PMTCT were fear of women and male spouses to have an HIV test and the perception that HIV testing is compulsory in antenatal clinics. In conclusion, to increase access to PMTCT among women, especially the young, poor and least educated, there is a need to empower them to make decisions on health seeking, and also to empower men to support their spouses to make good decisions. Other barriers like fear of having an HIV test should be addressed through appropriate counselling of clients.