Premarital fertility and HIV/AIDS in Sub-Saharan Africa

The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub-Saharan African countries. The DHS surveys provided data to compute the prevalence of premarital fertility, defined as any birth before the first marriage. The UNAIDS database provided data to compute the prevalence of HIV infection among pregnant women. Results indicate a moderate association between the prevalence of premarital fertility and the prevalence of HIV infection (correlation coefficient = 0.64, P< 0.0001), and similar geographical patterns. Compared with the average pattern, outlier countries had either high levels of premarital fertility and relatively low HIV prevalence (Liberia, Madagascar, Gabon, Congo), or high levels of HIV prevalence despite low levels of premarital fertility (Lesotho, Malawi, Zambia, Zimbabwe). The overall relationship is discussed in light of the relationships between age at marriage, permissiveness and lack of protection during intercourse and their impact on premarital fertility and HIV infection among women. (Afr J Reprod Health 2008; 12[2]:64-74)

Social context of premarital fertility in rural South-Africa

A qualitative study was conducted in Agincourt, a rural area of South Africa, to document the perceptions and attitudes towards premarital fertility and late marriage among young adults of both sexes. Two focus groups and 35 individual interviews were conducted among 17-30 year olds, randomly selected. Most interviewees perceived premarital fertility as undesirable, and a new phenomenon in a context of major social changes, in particular loss of authority of parents and increasing freedom of the youth. In contrast, late marriage was perceived as positive, by both sexes, primarily for economic reasons. Much stigma was associated with premarital fertility, from friends, institutions and families who occasionally apply mild or severe sanctions. Consequences of premarital fertility were numerous: school abandonment, economic adversity, health risks, stigmatization. In extreme cases, premarital fertility might lead to exclusion and deviant behavior. Premarital fertility was ultimately due to a lack of contraception among young women, and to refusal of abortion for religious reasons, and is associated with the risk of contracting STD's. (Afr J Reprod Health 2008; 12[2]:98-110)

Changing cause of death profile in Morocco: the impact of child-survival programmes.

This study was carried out to evaluate the trends in cause-specific mortality and the impact of child-survival programmes in Morocco. Two national surveys on causes and circumstances of child deaths were conducted in Morocco in 1988 and 1998 (ECCD-1 and ECCD-2 respectively). These surveys were based on a representative sample of deaths of children aged less than five years (432 and 866 respectively). Causes of death were assessed by verbal autopsy and were validated on a subsample of 94 cases. Data on causes of deaths were matched with death rates from demographic surveys (Enquête Nationale Démographique à Passages Répétés and Demographic and Health Survey) to compute cause-specific death rates. Morocco underwent a dramatic mortality decline since independence, and the decline in mortality among children aged less than five years was particularly rapid over the 1988-1997 period, at an average rate of -6% a year, and faster for children (aged 1-4 year(s)) than for infants. The decline in mortality varied markedly by causes of death and was most pronounced for causes due to vaccine-preventable diseases, such as neonatal tetanus, measles, whooping cough, tuberculosis, for diarrhoeal diseases and malnutrition, and for selected infectious diseases. However, mortality due to acute lower respiratory infection (ALRI) outside the neonatal period did not change significantly as was the case for some neonatal conditions (birth trauma and prematurity) and for accidents. The decline in cause-specific mortality could be attributed to the success of public-health programmes: the Expanded Programme on Immunization, the management of diarrhoeal diseases and malnutrition, and the use of antibiotics for selected infectious diseases. It is likely that improvements in living conditions, child-feeding practices, hygiene, and sanitation also contributed to the decline in mortality, although these could not explain the magnitude of the changes for target diseases. In contrast, the ALRI programme, which started after 1997, could not have any effect yet, and conditions of delivery and care of the newborn improved only marginally over the study period.

A wealth index to screen high-risk families: application to Morocco.

This study defined a wealth index that was strongly correlated with a health indicator: the survival of children aged less than five years. This index allowed the most vulnerable social groups for health outcomes to be identified. These groups could become the target for focused interventions and in particular for health-insurance schemes. The study was based on a thorough analysis of data collected in Morocco in the 1992 Demographic and Health Survey (DHS). Results of the analysis showed that a simple score based on 15 socioeconomic indicators provided a proper discriminatory tool for screening families at higher risk of infant and child mortality. The score was based on characteristics of housing and household goods which are easy to collect in the field. The scoring system was shown to be as powerful as more complex statistical techniques, such as discriminant analysis. It could be used for determining who could be eligible for free health insurance.

Under-five mortality trends in Africa: reconstruction from demographic sample survey

The study presents a reconstruction of under-five mortality trends derived from data provided by the Demographic and Health Surveys (DHS) and World Fertility Surveys (WFS) in sub-Saharan Africa from 1950 to 2000. Death rates were first calculated by single years for each of the 64 surveys available. When several surveys were available for the same country; they were combined for each of the overlapping years. Then the series was analyzed to identify periods of monotonic trends; whether they were declining; steady; or increasing. Changes in trends were tested using a linear logistic model. All calculations were done at the national level and by urban-rural residence. Among the 33 countries studied; which account for some 80 percent of the sub-Saharan population; only eight had monotonic or quasimonotonic mortality trends; which indicate a smooth health transition. Another eight countries had periods when mortality rose significantly for a variety of reasons. In at least eight other countries mortality increased through 1985-90-the most recent period covered in the study as a result of increasing levels of AIDS mortality. Reconstructed levels and trends are compared with other estimates made by international organizations. These estimates are usually based on indirect methods. Results indicate that in sub-Saharan Africa; progress was made in the health transition during the second half of the twentieth century. However; improvement was slower than expected; with an average decline in mortality of -1.7 percent per year. The transition was not smooth in more than half of the countries; and cases of reversals in mortality trends occur that appear to be linked to political; economic; and epidemiological crises; particularly the HIV/AIDS pandemic