Fertility levels, trends, and differentials in sub-Saharan Africa in the 1980s and 1990s.

This study presents an assessment of fertility trends in 23 countries of sub-Saharan Africa. It examines trends and differentials in proximate determinants and fertility preferences. Findings from the Demographic and Health Surveys for these countries over a period of 15 years show that desired family size has decreased significantly. Two-thirds of the countries examined show evidence of fertility decline, a particularly rapid decline in the cases of Kenya and Zimbabwe. Areas with higher education for women and lower child mortality experienced larger reductions in fertility and desired family size. Contraceptive use far exceeds other proximate determinants in explaining these changes. The striking regularity in fertility reduction across all ages indicates that contraception is practiced mostly for birth spacing and that contraceptive methods have gained wide acceptance among younger cohorts. Good prospects are seen for further intensification of fertility declines in East Africa and urban West Africa. However, low levels of education and high child mortality make rapid changes unlikely in rural West Africa.

PIP: This study examined fertility decline and its determinants in 23 countries in sub-Saharan Africa. Demographic and Health Surveys (DHS) during 1986-95, provided the data for analysis. A map of total fertility rates (TFR) showed a clear pattern of lower fertility in southern Africa, and transitional fertility in East Africa, especially Kenya and Rwanda. Fertility decline is less dramatic in West Africa. Central Africa has surprisingly low fertility. Fertility decline is confined to 3 groups according to the TFR data. Group A countries have a relatively advanced fertility transition and include Botswana, Ghana, Kenya, Namibia, and Zimbabwe. Group B countries include Cameroon, Cote d'Ivoire, Madagascar, Nigeria, Rwanda, Senegal, Tanzania, Togo, and Zambia. Group C countries, with the least decline, include Burkina Faso, Burundi, Liberia, Malawi, Mali, Niger, and Uganda. Age specific fertility did not vary much by group. Differences between the 3 groups were greatest at ages 40-44 years. Bongaarts model indicates that contraceptive use was the strongest determinant of fertility decline for all ages and between countries. Fertility differed between Groups A and C by 27%, between A and B by 17%, and between B and C by 13%. Contraceptive use varied by type of method and the strength of the family planning program. Age at marriage increased as fertility transition advanced. Postpartum factors were important explanatory factors for birth intervals. Education factors affected fertility preferences, contraceptive use, age at first marriage, postpartum amenorrhea and abstinence, and child survival.

Pachydermoperiostosis with gastric hypertrophy, anemia, and increased serum bone Gla-protein levels.

We evaluated a patient in whom pachydermoperiostosis occurred in conjunction with anemia and gastric hypertrophy. The mechanism of the anemia appears multifactorial because, besides a myelofibrosis, a serum inhibitor of the late stage of erythropoiesis was detected. The elevated serum bone Gla-protein (osteocalcin) favors the hypothesis that primary hypertrophic osteoarthropathy represents an imbalance between increased osteoblastic bone formation and normal bone resorption.

[Recovery after treatment for cirrhotic ascites : a study of 90 cases. Frequency of arterial hypertension (author's transl)]. / La guérison de l'ascite cirrhotique. Etude de 30 cas. Fréquence de l'hypertension artérielle.

Thirty patients with alcoholic cirrhosis, ascitic during 13.6 +/- 13 months (mean +/- S.D.) were cured of ascites and followed up during 2 to 9 years (4.3 +/- 2.7 years). Twenty six were compared with a same number of cirrhotics, matched for age and sex, who died during the year after the first admission. Many biological data show statistical difference. Nevertheless no valuable prognosis can be predicted in an individual case. The clinical improvement is associated with major, sometimes total biological recovery. Other complications of cirrhosis (gastro-intestinal bleeding, hepatoma) may occur (7 cases with 5 deaths) or alcoholic hepatitis if alcohol withdrawal is stopped (3 cases, 2 deaths). Some associated diseases look unexpectedly frequent: diabetes (4 cases), obesity (9), nodular lipomatosis (14 cases) whose frequency looks higher than that can be calculated for a similar group of healthy subjects.

Functional classification of undernourished populations in the Republic of El Salvador. Methodological development.

Typical government nutrition programmes usually lack precise information on the size of groups that could benefit from interventions, on the different types of potential beneficiaries and their location, and on socio-economic and cultural characteristics through which they could readily be identified. In the functional classification approach to the definition of nutritional problems, detailed information on human behaviour and social constraints is collected at family and community levels. The data are then interpreted in general terms in order to understand how these factors contribute to inadequate levels of nutrition within larger groups. This new approach should enable more effective measures for reducing the numbers of those living under conditions of deprivation to be presented to planners and decision makers.