The impact of sex, gender and pregnancy on 2009 H1N1 disease.

Children and young adults of reproductive age have emerged as groups that are highly vulnerable to the current 2009 H1N1 pandemic. The sex of an individual is a fundamental factor that can influence exposure, susceptibility and immune responses to influenza. Worldwide, the incidence, disease burden, morbidity and mortality rates following exposure to the 2009 H1N1 influenza virus differ between males and females and are often age-dependent. Pregnancy and differences in the presentation of various risk factors contribute to the worse outcome of infection in women. Vaccination and antiviral treatment efficacy also vary in a sex-dependent manner. Finally, sex-specific genetic and hormonal differences may contribute to the severity of influenza and the clearance of viral infection. The contribution of sex and gender to influenza can only be determined by a greater consideration of these factors in clinical and epidemiological studies and increased research into the biological basis underlying these differences.

Malaria in adolescence: burden of disease, consequences, and opportunities for intervention.

The problem of malaria in adolescence has largely been overshadowed by the huge burden of disease in young children. A substantial number of adolescents are at risk from malaria infection, but the burden of disease and consequences of infection in this age-group have rarely been studied. Our understanding of specific risk factors and beneficial interventions for adolescents is also limited. Data show that, from an adolescent viewpoint, malaria is a common cause of clinical illness and a preventable cause of death, even in areas of stable malaria transmission. Younger adolescents might be at a higher risk than older adolescents, because of immunological and hormonal factors. There are limited data about the adverse consequences of malaria in non-pregnant adolescents. However, in pregnant adolescents, the consequences of malaria are of great concern and simple interventions might lead to a substantial benefit. Malaria infection in adolescents is an under-recognised problem, and the prevention, diagnosis, and treatment of malaria should have a high priority within adolescent health programmes.

Reducing maternal mortality from unsafe abortion among adolescents in Africa.

Initiation of sexual behaviour is a normal part of human development and it often occurs during adolescence. This is common and universal to all societies and cultures around the world with profound implications for sexual and reproductive health. Adolescence is the period when much of the changes that are associated with becoming an adult take place. These are changes which societies expect and welcome. Unsafe abortion is a major cause of maternal mortality among adolescents in Africa. The need for a public health response to unsafe abortion in Africa is compelling. It is important to focus on primary prevention including the provision of appropriate sexuality education and information as well as supportive services to allow adolescents to prevent unwanted pregnancy. Secondary prevention efforts include prompt diagnosis and treatment of complications by ensuring that services are made more responsive to the needs of adolescents, and by improving access to and quality of care for them. Post-abortion care in adolescents must include contraception as well as several elements of life planning.