This paper examines factors that may predispose unmarried and unemployed out-of-school youth to risky sexual behaviour. Data for analysis were derived from the Behaviour Surveillance Survey carried out in Kenya in late 2002. A total of 6129 male and female unmarried and unemployed out-of-school youth in the age range 15–24 years were successfully interviewed. However, for this paper only a sample of 3961 comprising sexually experienced youth in the 12 months preceding the survey was used. Methods of analysis included descriptive statistics and multinomial logistic regression. Results for males indicate that factors associated with low and high risk were whether they had fathered a child, district of residence and frequency of alcohol use, while current age and age at first sexual debut stood out for those with low risk alone. For females the district of residence and age of partner at sexual debut were the factors that predisposed them to low-risk sexual behaviour, while for high risk the district of residence, current age and ever being pregnant were significant. The results indicate that for these youth, contextual and probably social factors appear to be the main determinants of risky sexual behaviour for both males and females. The findings also support those of other studies that link risky sexual behaviour among youth, especially males, to alcohol consumption. Programmes for intervention therefore need to focus on these aspects. There is also a need for studies that can look at district-specific factors for more focused interventions.

Four hundred and sixty-five pregnant women and their newborn babies were studied at a maternal and child health training institute in Dhaka, Bangladesh, between July 2002 and June 2003 with the objective of (1) examining the relationship between birth weight and maternal factors, and, if there was a dose–response relationship between quality of antenatal care and birth weight, (2) predicting the number of antenatal visits required for women with different significant characteristics to reduce the incidence of low-birth-weight babies. The study revealed that 23·2% of the babies were of low birth weight according to the WHO cut-off point of <2500 g. Mean birth weight was 2674·19±425·31 g. A low birth weight was more common in younger (<20 years) and older (≥30 years) mothers, the low-income group and those with little or no education. The mean birth weight of the babies increased with an increase in quality of antenatal care. The babies of the mothers who had 6+ antenatal visits were found to be 727·26 g heavier than those who had 1–3 visits and 325·88 g heavier than those who had 4–5 visits. No significant relationship was found between number of conception, birth-to-conception interval, BMI at first visit, sex of the newborn and birth weight. Further, from multiple regression analysis (stepwise), it was revealed that number of antenatal visits, educational level of the mother and per capita yearly income had independent effects on birth weight after controlling the effect of each variable. Using multiple regression analysis, the estimated number of antenatal visits required to reduce the incidence of low-birth-weight babies for women with no education and below-average per capita income status was 6; the number required for women with no education and above-average per capita income status was 5; and that for women with education and with any category of income status was 4 visits. So there is a need to stratify women according to their income and educational status so that, along with other measures, the required number of antenatal visits can be estimated beforehand to reduce the incidence of low-birth-weight babies.

The aim of this paper is to assess the spatial distribution of nutritional status of children of less than three years through Z-scores of weight-for-age, height-for-age and weight-for-height using data collected by the National Family Health Survey (NFHS-2, 1998–99), India. The nutritional status of pre-school children was regressed on different socio-demographic factors after eliminating the effect of age. The data show that there are gender differences and spatial variations in the nutritional status of children in India. Gender difference is not very pronounced and almost disappears when the effects of age and socio-demographic variables are removed. The spatial difference, especially the rural–urban difference, was found to be very large and decreased substantially when the effects of age and socioeconomic variables were removed. However, the differences were not close to zero. All the variables were found to affect significantly the nutritional status of children. However, the literacy of mothers did not affect height-for-age significantly. The weight-for-age and height-for-age scores showed a dismal picture of the health condition of children in almost all states in India. The worst affected states are Bihar, Madhya Pradesh, Orissa and Uttar Pradesh. Assam and Rajasthans are also lagging behind. Weight-for-height scores do not give a clear picture of state-wise variation. Goa, Kerala and Punjab are the three most developed states in India and also have the lowest percentages of underweight children according to the Z-scores. Along with these three states come the north-eastern states where women are well educated. Thus overall development, enhancement of level of education and low gender inequality are the key factors for improvement in the health status of Indian children.

The Principality of Andorra is a small European state located in the central Pyrenees. Since the Middle Ages, it has retained political independence from its two neighbouring countries, France and Spain. Until recently, Andorra maintained a relative stable population and was dependent upon agriculture and livestock. Since 1940, however, a marked change in these conditions has given rise to an explosive increase in the size of the population and traditional systems of production have been replaced by tourism, commerce and service industries. These changes have influenced the model of nuptial seasonality. Based on data from 10,188 marriage certificates covering a period from 1606 to 1960, nuptial seasonality was assessed by estimating Henry’s seasonality coefficient. Temporal and geographic changes in the seasonality model were assessed using linear regression analysis and analysis of variance. In addition, the Ũhindex – an estimate of the intensity of the seasonality model – is proposed to assess changes in the different seasonality models. The results indicate a relaxation of seasonality over time and in those parishes in which substantial demographic and socioeconomic change has occurred in recent years, suggesting a strong dependence of seasonality on the system of production.

The US Army’s 1988 Anthropometric Survey (ANSUR) data set is analysed in order to estimate the secular trend of their physical stature and body mass index while controlling for ethnic composition as well as place of birth of their parents. Separate analysis for blacks and whites stratified by gender is presented. The stature of the American population remained constant during most of the period considered, and no substantial ethnic or spatial effects were found. These results add further support to trends based on the National Health and Nutrition Examination Surveys and imply that the stagnation in height found in those data sets is most probably not biased by the omitted variables pertaining to own ethnicity or second-generation effects of parents’ ethnicity or foreign birth.

A strong case has recently been made by academics and policymakers to develop national programmes for the integrated control of Africa’s ‘neglected tropical diseases’. Uganda was the first country to develop a programme for the integrated control of two of these diseases: schistosomiasis and soil-transmitted helminths. This paper discusses social responses to the programme in Panyimur, north-west Uganda. It shows that adults are increasingly rejecting free treatment. Resistance is attributed to a subjective fear of side-effects; divergence between biomedical and local understandings of schistosomiasis/bilharzia; as well as inappropriate and inadequate health education. In addition, the current procedures for distributing drugs at a district level are problematic. Additional research was carried out in neighbouring areas to explore the generalizability of findings. Comparable problems have arisen. It is concluded that the national programme will not fulfil its stated objectives of establishing a local demand for mass treatment unless it can establish more effective delivery strategies and promote behavioural change in socially appropriate ways. To do so will require new approaches to social, economic and political aspects of distribution. There are reasons why populations infected with the ‘neglected tropical diseases’ are themselves neglected. Those reasons cannot just be wished away.

Maternal mortality is a serious public health concern in Bangladesh. However, most deaths could be prevented through proper and timely care seeking and adequate management. Unfortunately, fewer than half of pregnant women in Bangladesh seek antenatal care, and only one in eight receive delivery care from medically trained providers. The specific objectives of this research are to examine the socioeconomic differentials of maternity care seeking, and to determine whether accessibility of health services reduces the socioeconomic differentials in maternity care seeking. A multi-level logistic regression method is employed to analyse longitudinal data collected from a sample of 1019 women from all over Bangladesh. The study finds significant socioeconomic disparities in both antenatal and delivery care seeking. Service accessibility, however, significantly reduces the socioeconomic differentials in delivery care seeking. Services need to be made accessible to reduce the inequality in maternity care seeking between rich and poor, empowered and non-empowered.

Demographic transition theory states that fertility declines in response to development, thus wealth and fertility are negatively correlated. Evolutionary theory, however, suggests a positive relationship between wealth and fertility. Fertility transition as a result of industrialization and economic development started in the late 19th and early 20th centuries in Western Europe; and it extended to some of the Asian and Latin American countries later on. However, economic crises since the 1980s have been co-incident with fertility decline in sub-Sahara Africa and other developing countries like Thailand, Nepal and Bangladesh in the last decade of the 20th century. A very low level of fertility is observed in Addis Ababa (TFR=1·9) where contraceptive prevalence rate is modest and recurrent famine as well as drought have been major causes of economic crisis in the country for more than three consecutive decades, which is surprising given the high rural fertility. Detailed socioeconomic and demographic characteristics of 2976 women of reproductive age (i.e. 15–49 years) residing in Addis Ababa were collected during the first quarter of 2003 using an event history calendar and individual women questionnaire. Controlling for the confounding effects of maternal birth cohort, education, marital status and accessible income level, the poor (those who have access to less than a dollar per day or 250 birr a month) were observed to elongate the timing of having first and second births, while relatively better-off women were found to have shorter birth intervals. Results were also the same among the ever-married women only model. More than 50% of women currently in their 20s are also predicted to fail to reproduce as most of the unmarried men and women are ‘retreating from marriage’ due to economic stress. Qualitative information collected through focus group discussions and in-depth interviews also supports the statistical findings that poverty is at the root of this collapse in fertility. Whilst across countries wealth and fertility have been negatively correlated, this study shows that within one uniform population the relationship is clearly positive.

This study examined the hypothesis that multiple dimensions of gender inequality increase women’s risk for HIV infection using a population-based survey of 1418 women aged 20 to 44 in Moshi, Tanzania. Three forms of HIV exposures were assessed reflecting gender power imbalance: economic exposures (age difference between partners and partner’s contributions to children’s expenses), physical exposures (coerced first sex and intimate partner violence) and social exposures (ever had problems conceiving). Behavioural risk factors included number of sexual partners for women in the last three years, partner had other wives or girlfriends, non-use of condom and alcohol use at least once a week in the last 12 months. Multivariate logistic regression analysis showed that a woman had a significantly elevated risk for HIV if she had a partner more than 10 years older (OR=2·5), her partner made low financial contributions to children’s expenses (OR=1·7), or she experienced coerced first sex before age 18 years (OR=2·0) even after taking into account the effects of risk behaviour factors. The association between ever had problem conceiving and HIV infection was explained away by risk behaviour factors. The findings lend support to the hypothesis that economic deprivation and experience of sexual violence increase women’s vulnerability to HIV, providing further evidence for extending the behavioural approach to HIV interventions to incorporate women’s economic empowerment, elimination of gender-based violence and promotion of changing attitudes and behaviours among men.

Synchronous with the decline in fertility that took place in the post-war period in the Netherlands, patterns of birth seasonality changed as well. In this paper seasonal fluctuations in fertility in the Netherlands are examined using population register data for the period 1952 to 2005. The peak in births has changed from spring to summer and subsequently to August/September, thereby shifting from the European to the American pattern. The seasonal shift can be attributed to parity-specific changes. Before the transition, birth seasonality did not differ much between the different parities. In the transition period from higher to low fertility, differences between parities increased which persist up to today. At present, the overall seasonality pattern is determined by first births. Moreover, birth seasonality varies by maternal age. The findings stimulate the discussion on the role of planning as a cause of birth seasonality.

In India, the eight socioeconomically backward states of Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal and Uttar Pradesh, referred to as the Empowered Action Group (EAG) states, lag behind in the demographic transition and have the highest infant mortality rates in the country. Neonatal mortality constitutes about 60% of the total infant mortality in India and is highest in the EAG states. This study assesses the levels and trends in neonatal mortality in the EAG states and examines the impact of bio-demographic compared with health care determinants on neonatal mortality. Data from India’s Sample Registration System (SRS) and National Family and Health Survey (NFHS-2, 1998–99) are used. Cox proportional hazard models are applied to estimate adjusted neonatal mortality rates by health care, bio-demographic and socioeconomic determinants. Variations in neonatal mortality by these determinants suggest that universal coverage of all pregnant women with full antenatal care, providing assistance at delivery and postnatal care including emergency care are critical inputs for achieving a reduction in neonatal mortality. Health interventions are also required that focus on curtailing the high risk of neonatal deaths arising from the mothers’ younger age at childbirth, low birth weight of children and higher order births with short birth intervals.

Contraceptive prevalence has risen markedly in rural Bangladesh due in part to a doorstep-delivery system initiated by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). This study investigates effects of residence in the Matlab MCH-FP treatment area on men’s involvement in family planning. The analysis compares for treatment and comparison areas knowledge of and attitudes toward contraception, as well as levels of contraceptive use, among 413 married men interviewed at the baseline of an ICDDR,B men’s involvement project. Although residence in the MCH-FP area is associated with a higher overall contraceptive prevalence, it also is associated with a lower adjusted ratio of male-to-female method use, and lower odds of other indicators of men’s involvement in family planning. Historical decisions to exclude men from contraceptive decision-making may place the ‘burden’ of contraception on women and may preclude the productive involvement of men. These and other implications and strategies for increased men’s involvement are discussed.

This paper explores the course of infant and childhood mortality in the Greek island of Paros from the end of the nineteenth until the mid-twentieth century. For this purpose the method of family reconstitution has been applied to two towns on the island. Official population statistics have been used to derive basic mortality estimates for the Cyclades and Greece as a whole. Reference to other studies concerning island mortality is also made. Hence, there appears the chance to compare insular with mainland mortality and realise that insular mortality presented some distinct features. It is shown that island populations presented lower mortality than the national average until the first decades of the twentieth century. However, by the 1950s Greece’s infant and childhood mortality had dropped to the same or even to lower levels than those of the islands.

A survey was conducted among 2800 students studying in Wrocław, Poland. The questionnaire included questions on the body height of the students and their parents, and place of residence and migration patterns of the students themselves, their parents and their grandparents. Body height in both students and their parents was positively correlated with the size of their place of residence. This was particularly true for male students and their fathers. Body height in students and parents from mobile families was not significantly different from that of their peers from non-mobile families. Body height in mobile individuals was generally between that of non-mobile individuals from rural areas and that of non-mobile individuals from large urban centres. Students from families that had migrated from smaller urban centres to larger ones were taller than students from families that had migrated from rural areas to urban centres. Body height in students was also correlated with the kind of migration that took place. In the students’ mothers, body height was higher if the maternal grandparents moved from smaller urban centres to larger urban centres than if the maternal grandparents moved from rural areas to urban centres. In female students, body height depended on whether their mothers had migrated from smaller places of residence to larger places of residence, but was not affected by the degree of migration. Intra-generational migration during the generation of the students’ grandparents was associated with increased body height in the students’ mothers. On the other hand, intergenerational migration during the generations of the students’ grandparents and parents was associated with increased body height in the students’ fathers and in female students. Body height was not a reliable indicator of whether an individual migrated from rural areas to Wrocław. Far more reliable indicators were the size of the place the student lived their whole life and whether the family had lived in an urban environment for at least two generations.

A method for decomposing partner availability into its demographic components (preferences, previous birth trends, migration and mortality, and structure by marital status) is presented and applied to marriage market estimates for selected census years 1911–91 in England and Wales. Preferences are a key component at the youngest ages. The role of other factors varies by age and time period. Contrary to widespread assumption, variation in cohort sizes resulting from past fertility trends is not the dominant contributor to partner availability during this period. Mortality and migration effects tend to be larger than the effect of birth trends and the two marital status components are generally the largest in size. Determinants of intercensal change are similar to the cross-sectional picture. Reasons for the modest contribution of trends in annual births are discussed. Cohort effects on partner supply are not necessarily absent but could arise through a number of mechanisms.

While the ‘immigrant health paradox’ posits better health behaviours and outcomes for immigrants upon arrival to the US, research suggests that this advantage may deteriorate over time. This study analysed the relationship of acculturation and breast-feeding initiation and duration among a sample of predominantly Latina, low-income women in the US. The four measures of acculturation included: mother’s nativity (foreign born vs US born), mother’s parents’ nativity (foreign born vs US born), years of US residence (<8 years vs ≥8 years) and a dichotomous measure of language acculturation adapted from three items on Marin’s acculturation scale (preferred language spoken at home, reading language and writing language) as exclusive use of native language versus non-exclusive use (mixed or English only) (Marin et al., 1987; Marin & Gamba, 1996). Final multivariable models showed that mothers who exclusively used their native language were more likely to initiate breast-feeding as well as breast-feed for longer duration compared with mothers with non-exclusive use, whereas years of US residence and mother’s nativity were not significantly associated with breast-feeding initiation or duration. Mother’s parents’ nativity also emerged as a significant predictor of breast-feeding duration, both within final models for immigrants and across study participants. Programmes providing nutrition education to low-income women may wish to consider the role of language as an important determinant of breast-feeding. The role of mother’s parents’ nativity on breast-feeding practices deserves exploration in future studies, as the cultural practices taught by family members born outside the US may exert strong pressure within immigrant families now living in the US.

This paper compares the structures of the surnames of 75 municipal populations living in six north-western Mediterranean regions. Its purpose is to unravel the relations between the local populations in Corsica and Sardinia and the links between these populations and those living in the Italian and French continental territory. On the basis of the matrix of similarity of surnames, some topological representations have been drafted showing the above-mentioned relations between populations under the light of their geographical position, their recent history and studies of genetic analysis. Corsica has an eterogeneous surname structure and evident similarity of the north with Tuscany and some centres of continental France. When only the populations of Sardinia were taken into consideration, it emerged that they differ among each other in relation to their geographical position and their history; when, instead, they were considered in relation to other populations outside the island, it was possible to observe that they form a highly different cluster. This study also identified many differences in the analysed geographical areas of Sardinia. In the minor islands – Elba, Giglio, Capraia – the structure of the surnames has a Tuscan origin as well as some similarity with other geographically distant areas, as in the case of the island of Giglio, if compared with some communities of Liguria.

Stroke is an emerging problem in sub-Saharan Africa, about which little is known since most research to date has been based on retrospective, hospital-based studies. This anthropological work, designed to complement a large community-based project on stroke incidence, focuses on local understandings and treatment-seeking behaviours in urban (Dar-es-Salaam) and rural (Hai) areas of Tanzania. Semi-structured interviews (n=80) were conducted with 20 stroke patients, 20 relatives of stroke patients, ten traditional healers, and 30 other local residents. In contrast to common expectations, and literature that finds witchcraft beliefs to be most common in rural areas, stroke in urban Dar was widely believed to emanate from supernatural causes (demons and witchcraft), while in rural Hai, explanations drew mostly on ‘natural’ causes (hypertension, fatty foods, stress). These different beliefs and explanatory models fed into treatment-seeking behaviours. The first option in Hai was hospital treatment, while in Dar-es-Salaam, where belief in demons led to hospital avoidance, it was traditional healers. In both sites, multiple treatment options (serially or simultaneously) were the norm. Analysis of patient and carer narratives suggested that causation beliefs outweighed other factors, such as cost and distance, in shaping effective treatment. Three policy implications are drawn. First, as other studies have also shown, it is important to engage with, rather than dismiss, local explanations and interpretations of stroke. Stroke awareness messages need to take into account the geographical and belief systems differences. Developing an understanding of explanatory models that recognizes that local beliefs arise from dynamic processes of social interaction will be critical to designing effective interventions. Second, there is a clear role for multiple healing systems with possibility of cross-reference in the case of a chronic, disabling condition like stroke, since biomedical treatment cannot offer a ‘quick fix’ while traditional healers can help people come to terms with their condition. Third, issues of communication between health services and their patients are particularly critical.

Age at menarche is associated with anthropometry in adolescence. Recently, there has been growing support for the hypothesis that timing of menarche may be set early in life but modified by changes in body size and composition in childhood. To evaluate this, a cohort of 255 girls aged <5 years recruited in 1988 were followed up in 2001 in Matlab, Bangladesh. The analysis was based on nutritional status as assessed by anthropometry and recalled age at menarche. Data were examined using lifetable techniques and the Cox regression model. The association between nutritional status indicators and age at menarche was examined in a multivariate model adjusting for potential confounding variables. Censored cases were accounted for. The median age at menarche was 15·1 years. After controlling for early-life predictors (birth size, childhood underweight, childhood stunting) it appeared that adolescent stunting stood out as the most important determinant of age at menarche. Adolescent stunting still resonates from the effect of stunting in early childhood (OR respectively 2·63 (p<0·01 CI: 1·32–5·24) and 8·47 (p<0·001 CI: 3·79–18·93) for moderately and severely stunted under-fives as compared with the reference category). Birth size was not a significant predictor of age at menarche. It is concluded that age at menarche is strongly influenced by nutritional status in adolescence, notably the level of stunting, which is in turn highly dependent on the level of stunting in early childhood. A ‘late’ menarche due to stunting may be detrimental for reproductive health in case of early childbearing because of the association between height and pelvic size.

This was a hospital-based cross-sectional study of 224 randomly selected antenatal women receiving care at the University College Hospital, Ibadan, Nigeria. The study aimed to seek the attitude and preferences of respondents about social support during childbirth and also identify variables that may influence their decisions. Seventy-five per cent of respondents desired companionship in labour. Approximately 86% preferred their husband as companion while 7% and 5% wanted their mother and siblings as support person respectively. Reasons for their desire for social support were emotional (80·2%), spiritual (17·9%), errands (8·6%) and physical activity (6·8%). Socio-demographic variables found to be statistically significant on logistic regression analysis for the desire of a companion in labour were nulliparity (OR 3·57, 95% CI 1·49–8·52), professionals (OR 3·11, 95% CI 1·22–7·94) and women of other ethnic groups besides Yoruba (OR 2·90, 95% CI 1·02–8·26), which is the predominant ethnic group in the study area. Only those with post-secondary education were found to want their husbands as doula (OR 2·96, 95% CI 1·08–8·11). More than half of the respondents wanted information about labour prior to their experience. It is important that Nigerian women are allowed the benefit of social support during childbirth, particularly as there is a lack of one-to-one nursing care and other critical services, including epidural analgesia in labour, at many of the health care facilities in Nigeria. Men could play a pivotal role in the process of introducing support in labour so as to improve the outcome for both the mother and her newborn.