Intimate partner violence in early adolescence:the role of gender; socioeconomic factors and the school

BACKGROUND:Intimate partner violence (IPV) among adolescents is common worldwide; but our understanding of perpetration; gender differences and the role of social-ecological factors remains limited.OBJECTIVES:To explore the prevalence of physical and sexual IPV perpetration and victimisation by gender; and associated risk and protective factors.METHODS:Young adolescents (N=2 839) from 41 randomly selected public high schools in the Western Cape region of South Africa (SA); participating in the PREPARE study; completed a self-administered questionnaire. RESULTS:The participants' mean age was 13.65 years (standard deviation 1.01); with 19.1% (541/2 839) reporting being victims/survivors of IPV and 13.0% (370/2 839) reporting perpetrating IPV. Girls were less likely to report being a victim/survivor of physical IPV (odds ratio (OR) 0.72; 95% confidence interval (CI) 0.57 - 0.92) and less likely to be a perpetrator of sexual IPV than boys (OR 0.33; 95% CI 0.21 - 0.52). Factors associated with perpetration of physical and sexual IPV were similar and included being a victim/survivor (physical IPV: OR 12.42; 95% CI 8.89 - 17.36; sexual IPV: OR 20.76; 95% CI 11.67 - 36.93); being older (physical IPV: OR 1.26; 95% CI 1.08 - 1.47; sexual IPV: OR 1.36; 95% CI 1.14 - 1.62 ); having lower scores on school connectedness (physical IPV: OR 0.59; 95% CI 0.46 - 0.75; sexual IPV: OR 0.56; 95% CI 0.42 - 0.76) and scoring lower on feelings of school safety (physical IPV: OR 0.66; 95% CI 0.57 - 0.77; sexual IPV: OR 0.50; 95% CI 0.40 - 0.62).CONCLUSIONS:Physical and sexual IPV was commonly reported among young adolescents in SA. Further qualitative exploration of the role of reciprocal violence by gender is needed; and the role of 'school climate'-related factors should be taken into account when developing preventive interventions

A Decade of Research Involving Men who have Sex with Men in Sub-Saharan Africa: Current Knowledge and Future Directions

It has been just over 10 years since the first large behavioral survey of men who have sex with men (MSM) was implemented in Senegal in 2001. Since then; behavioral and/or HIV prevalence surveys have been conducted in over 14 other countries in sub- Saharan Africa. Current available evidence and review have established that HIV prevalence among MSM in these countries are significantly higher than corresponding general populations; that MSM engage in sexual risk behaviors that place them and sexual partners at higher risk; and that issues of discrimination and stigmatization inhibit HIV interventions for MSM. This paper summarizes the existing knowledge; describes limitations of this evidence; and proposes new and enhanced research approaches to fulfill needed gaps to inform national HIV responses for MSM populations

Prevalence of Sexually Transmitted Infections in Women Attending Antenatal Care in Tete Province; Mozambique

Objective. To determine the prevalence of Chlamydia trachomatis (CT); Neisseria gonorrhoeae (NG) and syphilis in pregnant women. Methods. A cross-sectional study was conducted among women attending antenatal care clinics (ANCs). Blood samples were tested for syphilis using the rapid plasma reagin (RPR) and treponemal haemaggluti- nation (TPHA) tests; CT and NG were diagnosed using a manual polymerase chain reaction assay on first-void urine samples. A socio-demographic questionnaire was completed. Results were compared with previous published data on sexually transmitted infection (STI) prevalence in Mozambique. Results. Blood and urine samples were collected from 1 119 and 835 women; respectively. The prevalence of CT was 4.1; and that of NG 2.5. The RPR test was positive in 5.2of the women; and 7.1had a positive TPHA test. Active syphiliswas found in 4.7. In univariate analysis; CT was associated with having had any level of education (p0.05); reactive RPR and TPHA were associated with illiteracy (p0.05); and TPHA was associated with age 25. Multivariate analysis did not show any significant association. In comparisonwith published data from 1993; a decline was observed for CT (p0.05); NG and syphilis (p0.001). Conclusions. Compared with available data; a decline of STI prevalence was observed in our setting. This might be the result of community-based education programmes focusing on changes to sexual behaviour; as well as the widespread use of the syndromic approach to managing STIs and the expansion of syphilis screening in primary health care settings. However; STI rates are still high; and the problem needs more concrete and sustained efforts for its control

Trends in caesarean section rates at a maternity hospital in Mumbai, India.

The steady rise in caesarean section rates is an emerging area of concern in mother-child healthcare and a matter of international attention, since the trend is no longer confined to western industrialized countries. Crude and caesarean section-related perinatal mortality and case-fatality rates may well serve as public-health indicators. Monitoring time-trends in caesarean section rates has been considered a useful approach in the recognition of this rapidly-changing health policy and in estimating the magnitude of this problem. The study examined the observed time-trends in caesarean section rates in relation to perinatal mortality rates and maternal case-fatality rates in a hospital setting in Mumbai, India, using 1957-1998 data on retrospective cohort. Both overall rates and those specific to type of delivery were assessed. During 1957-1998, the caesarean section rates in the Nowrosjee Wadia Maternity Hospital (NWMH) increased from 1.9% to 16%, with the most significant rise over the past decade. The perinatal mortality rate showed a significant reduction from 69 per 1,000 in 1957 to 36 per 1,000 in 1992 and remained steady in the 1990s despite the higher caesarean section rates. The caesarean section rate in the NWMH rose by almost 10-fold during 1957-1998. No improvement in perinatal outcome was observed beyond a caesarean section rate of 10%, but the perinatal mortality rate in caesarean births increased significantly due to a more liberal use of caesarean sections in preterm deliveries and those that yielded low-birth-weight babies.

Rate of caesarean section as a process indicator of safe-motherhood programmes: the case of Kenya.

The study assessed the value of currently-available data on the rates of caesarean section as an indicator of safe-motherhood programmes. Data, collected through the routine health information system of the Ministry of Health, Kenya, were used for analyzing the available process indicators. The methodology of this study illustrates both usefulness and limitations of readily-available healthcare information. The rate of hospital-based caesarean section was 6.3% of all births (range 0.3-37%), whereas the rate of population-based caesarean section was 0.95% (range 0.1%-4%). The rate of population-based caesarean section indicates a significant unmet need for obstetric care in the rural areas and may be a useful tool for monitoring progress on safe-motherhood initiatives in poor settings. Rates of population-based caesarean section are low in Kenya, especially in the rural areas. The rate of caesarean section may be a valuable process indicator for identifying the gaps in obstetric care and may be used for advocating improvements for healthcare to the relevant authorities.