Impact of male circumcision on HIV risk compensation through the impediment of condom use in Botswana.

BACKGROUND: Male circumcision has been recommended as a method of reducing the risk of transmitting HIV. However, widespread uptake of male circumcision may lead to HIV risk compensation by impeding condom use. OBJECTIVE: To investigate the impact of male circumcision on condom use. METHODS: The study used cross-sectional data from the Botswana AIDS Impact Survey III on 1,257 men aged 15 years or older who were sexually active. Data were analyzed using Pearson's chi-square statistic and binary logistic regression. RESULTS: The study found that 15% of circumcised men did not use condoms compared to 12% of uncircumcised men, and circumcision was not significantly associated with condom use. Non-use of condoms was significantly affected by religious beliefs, low level of education, marriage, drunkenness, and misconceptions regarding antiretroviral therapy (ART). CONCLUSIONS: We conclude that male circumcision does not impede condom use. Condom use is impeded by low level of education, marriage, drunkenness, and misconceptions regarding ART. We recommend the emphasis of consistent condom use targeting people with low education, those in marriage, users of alcohol, and people receiving ART.

Factors influencing low birth weight and prematurity in Botswana.

The purpose of this study was to investigate the socioeconomic, biological and behavioural factors influencing low birth weight and prematurity in Botswana. Data were from the Botswana Obstetric Record covering the years 1990 to 1995, and were analysed with both descriptive statistics and multivariate analysis. The study found that the major positive risk factors for low birth weight were: late and less frequent attendance of antenatal care services, having experienced pregnancy termination before, low or no education, unmarried motherhood and place of birth. With regard to prematurity, age, late and less frequent attendance of antenatal care services, unmarried motherhood and place of birth were found to be the major positive risk factors. The importance of early and regular antenatal care attendance, marriage and place of birth cut across both low birth weight and prematurity.

Health implications of early childbearing on pregnancy outcome in Botswana: insights from the institutional records.

Early childbearing can have deleterious effects on pregnancy outcome. This study in Botswana found that both birth injuries and congenital abnormalities were common among infants born to teenage mothers compared to infants of women aged 20-34 years. This statistically significant relationship disappeared, however, when controls were introduced. Based on the results of this study, it appears that in order to improve pregnancy outcomes, frequent and early prenatal visits and improvements in the socioeconomic environment are needed. Thus, postponement of childbearing beyond teenage years alone would not necessarily improve pregnancy outcomes in Botswana.

Contributions of the proximate determinants to fertility change in Botswana.

This study uses Bongaarts' model to examine the relative contributions of three proximate determinants (non-marriage, contraceptive use and postpartum infecundability) to fertility change using data from the 1984 and 1988 Botswana Family and Health Surveys. Breast-feeding is shown to be the most important proximate determinant of fertility, followed by contraceptive use, and finally non-marriage, both in 1984 and 1988. However, contraceptive use increased between 1984 and 1988, leading to fertility decline over this period. Marriage is the least important proximate determinant of fertility, probably due to the high prevalence of premarital childbearing. Other factors such as induced abortion could have played a major role in the fertility decline but their effect could not be estimated due to lack of accurate data.

PIP: In recent years, some countries in sub-Saharan Africa, such as Botswana, Kenya, and Zimbabwe, have experienced declines in fertility. The author investigated the factors leading to the decline in fertility in Botswana. Bongaarts' model and data from the 1984 and 1988 Botswana Family and Health Surveys were used to examine the relative contributions of non-marriage, contraceptive use, and postpartum infecundability to fertility change. Breast feeding was identified as the most important proximate determinant of fertility, followed by contraceptive use, and non-marriage, in both 1984 and 1988. The extent of contraceptive use increased over the period 1984-88, supporting fertility decline. Marriage is the least important proximate determinant of fertility, most likely due to the high prevalence of premarital childbearing. The author further notes that factors such as induced abortion may have played a major role in the fertility decline, but their effect could not be estimated due to the lack of accurate data.