This study investigates the association between body height and inter-generational social advancement through education. Questionnaire data were collected from 2800 students (1023 men and 1777 women) from the universities of Wrocław, Poland. The questions referred to three generations: the students and their parents and grandparents. Information was collected on the age, body height and weight of the students and their parents, and on the parents’ and grandparents’ education. The lowest body heights were typically found for individuals from families with the lowest educational levels, whereas the greatest body heights were found for those brought up in families with a high educational status or in families who had upgraded their status. The size of the change in the educational level of parents is only associated with fathers’ and female students’ body height. Individuals who had advanced from a middle educational level or who came from families with this type of advancement were found to be significantly taller, on average, than those upgrading their educational level from the lowest position. The results show that, for men, educational advancement during the course of their lives or in the earlier generation is more favourable to achieving higher stature, whereas for women, the multi-generational tradition of a high educational status is of greater significance.

With declining levels of international donor funding for financing reproductive health programmes, developing country governments and international donors are looking towards private sector strategies to expand the supply of quality reproductive health services. One of the challenges of a health franchise is to improve the quality of services provided by independent private practitioners. Private providers are more likely to abide by the quality standards set by a franchiser if they see a financial benefit resulting from franchise participation. This study was conducted to measure whether (a) there were improvements in perceived quality of care and perceived access to health facilities once these facilities became part of a franchise and (b) improvements in perceived quality and perceived access were associated with increased client loyalty to franchised clinics. Franchisees were given basic reproductive health training for seven days and services marketing training for two days. Exit interviews were conducted with male and female clients at health facilities. A pre-test measurement was taken in April 2001, prior to the start of project activities. A post-test measurement was taken in February/March 2002, about 9 months after the pre-test. Multilevel regression analysis, which takes the hierarchical structure of the data into account, was used for the analysis. After taking provider-level variation into account and controlling for client characteristics, the analyses showed significant improvements in perceived quality of care and perceived access to services. Private provider participation in a franchise network helps improve client perceptions of quality of, and access to, services. Improvements in client perceptions of quality and access contribute to increased client loyalty to franchised clinics. Once increased client loyalty translates into higher client volumes, providers are likely to see the benefits of franchise participation. In turn, this should lead to increased provider willingness to remain part of the franchise and to abide by the standards of quality set by the franchiser.

In South Asia women are often the primary decision-makers regarding child health care, family health and nutrition. This paper examines the proposition that constraints on women’s status adversely affect the survival of their children. Survey data are used to construct indices of women’s household autonomy and authority, which are then linked to longitudinal data on survival of their children. Proportional hazard models indicate that enhanced autonomy significantly decreases post-neonatal mortality. Enhanced household authority significantly decreases child mortality. A simulation based on estimated effects of eliminating gender inequality suggests that achieving complete gender equality could reduce child mortality by nearly fifty per cent and post-neonatal mortality by one-third.

This paper models the proximate determinants of children born to over 13,000 Ethiopian women and of the women’s stated preferences for additional births using the data from the Ethiopian Demographic and Health Survey 2000. Empirical models for the number of children born to women were estimated using Poisson and ordinal regressions. The results show the importance of variables such as maternal education for smaller family size, and that variables reflecting desired family size are strong predictors of the numbers of children born to women. Secondly, binary logistic models for dichotomous variables for women not wanting more children and if getting pregnant would be a ‘big problem’ showed non-linear effects of the surviving and ‘ideal’ number of children. Moreover, the results indicated a desire on the part of women to limit family size, especially as the number of surviving children increased. Probit models were estimated to address potential endogeneity of certain variables. Overall, the results indicated that counselling couples about small family size and increasing the utilization of health care services can lower fertility in Ethiopia.

Causality for the seasonality of human births, which affects populations wordwide, has been a profound mystery for nearly two centuries. Most explanations for seasonality fail because of inconsistent global application. In two previous studies, Cummings (2002, 2003) hypothesized that human reproduction has been responsive to changes in both seasonal environmental light intensity (surface luminosity) and photoperiod. Except at higher latitudes, photoperiod is of secondary importance to that of environmental light intensity. Because of a lack of data, the presence or lack of cloud cover is used as a general proxy for environmental light intensity. These studies show a positive correlation between conceptual seasonality and cloud cover on a worldwide basis, and propose that there is a delay between exposure to increased light and the onset of conceptions. This delay is three months at higher latitudes and one to two months for lower latitudes. Both studies suggest that an excellent means of hypothesis confirmation would be to provide one or more examples of how a seasonal change in cloud cover might alter the number of conceptions in subsequent months. The present study tests this hypothesis. The percentage of possible sunshine and averaged sunshine hours are used to investigate their influence on seasonality of births in Germany and the Netherlands. The evidence shows that a seasonal change in environmental light intensity preceded a change in the peak months for conceptions in Germany and the Netherlands. Although secondary influences are possible, the primary reason for this transition in peak conceptual months seems to be related to the seasonal changes in environmental light intensity for both countries. Although this transitional relationship was predicted in Cummings (2002, 2003), further research is required, especially with regard to more precise measurements of environmental light intensity and its physiological effect on the human endocrine system.

Women in Benue State have for years had the highest HIV rate in the country, but because the sentinel surveys are anonymized and unlinked, not much is known about the socio-demographic, behavioural and other risk factors that predispose these women to the disease. The HIV/AIDS epidemic in Nigeria does not appear to be a single epidemic but rather multiple epidemics of varying magnitude and trends. This cross-sectional study was therefore carried out to identify the risk factors for HIV/AIDS among these women. A total of 404 consecutive consenting mothers enrolled at the booking clinic were followed up until delivery of their babies. They were interviewed using a semi-structured questionnaire and tested for HIV infection using an ELISA-based kit after obtaining informed consent. Mean age of the mothers was 26±6·1 years, 94·8% were married while 50·5% had at least secondary level education. Sixty-one (15·1%) mothers were HIV positive with mothers aged 15–24 years being responsible for 50·8% of all infection. Following bivariate analysis, being single, having a partner with low level of formal education, living in a rural location, being in a polygamous/multiple partner union, being a higher order polygamous wife, being married more than once and reporting a history of a sexually transmitted infection were significantly associated with HIV infection. Monogamous women who lived apart from their partners and women who had ever had blood transfusion were also more likely to be HIV positive. Following multivariate logistic regression, a young age of 15–24 years (multivariate OR=3·3, 95% CI=1·2–8·4, p=0·02); ever had other STIs (OR=1·6, 95% CI 1·1–2·3, p=0·009); no formal maternal education (OR=0·6, 95% CI 0·4–0·9, p=0·021) and having one lifetime sexual partner (OR=0·4, 95% CI 0·3–0·5, p<0·00001) were significantly associated with HIV infection in the study population. Appropriate interventions must be directed at young people and should include STI control and abstinence education. Blood safety must be ensured as well as a general improvement in the level of formal and health education in this community.

The present paper seeks to analyse the spatial distribution of surnames in the province of Belluno in the Italian Alps, and describes the internal mobility of the population taking into consideration one of the most important and ancient roads in the area. The study is based on the analysis of the similarity of the frequencies of some autochthonous surnames depending on their geographical distance apart. The population considered turned out to be basically sedentary. When forced to migrate, the population preferred to go far from their homeland rather than inside the area: this happened probably because the opportunities that the province of Belluno could offer were quite scarce throughout the whole territory, and people hoped to improve their economic situation by going abroad.

A fundamental public health strategy to reduce the risk of HIV/AIDS is to increase levels of awareness and knowledge about the disease. Although knowledge about HIV/AIDS and protective sexual behaviour are linked theoretically, relatively little is known about their empirical relationship. Using Demographic and Health Survey data from 23 low- and middle-income countries, this study used multilevel logistic regression models: to examine cross-national variability in the relationship between HIV/AIDS knowledge and protective behaviour (condom use and restricted sex); to investigate the moderating influences of women’s educational attainment on this relationship; and to test the extent to which severity of the HIV/AIDS epidemic accounts for cross-national variability in the association between HIV/AIDS knowledge and protective behaviour. There was an association between increased knowledge of HIV/AIDS and condom use that varied in strength and form cross-nationally. This cross-national variation was accounted for partially by the socioeconomic characteristics of women resident in the study countries and between-country differences in the severity of the HIV epidemic. While education modified the association between HIV/AIDS knowledge and protective behaviour – stronger associations at lower levels of education – epidemic severity exerted a stronger influence on behaviour than any other characteristic. Finally, this study indicates that protective sexual practices are disturbingly low. In eight of 23 countries, overall levels of condom use to prevent STDs and HIV/AIDS were less than 5·0%. Waiting for the spread of HIV/AIDS infection to change sexual practices in low- and middle-income countries will result in dramatic unnecessary suffering.

A characteristic of African pre-transitional fertility regimes is large ideal family size. This has been used to support claims of cultural entrenchment of high fertility. Yet in Kenya fertility rates have fallen. In this paper this fall is explored in relation to trends in fertility norms and attitudes using four sequential cross-sectional surveys spanning the fertility transition in Kenya (1978, 1984, 1989 and 1998). The most rapid fall in the reported ideal family size occurred between 1984 and 1989, whilst the most rapid fall in the total fertility rate occurred 5 to 10 years later, between 1989 and 1998. Thus these data, spanning the fertility transition in Kenya, support the traditional demographic model that demand for fertility limitation drives fertility decline. These data also suggest that the decline in fertility norms over time was partly a period effect, as the reported ideal family size was seen to fall simultaneously in all age cohorts, and partly a cohort effect, as older age cohorts reporting higher ideal family sizes were replaced by younger cohorts reporting lower ideal family sizes. These data also suggest that a new fertility norm of four children may have developed by 1989 and continued until 1998. This is consistent with, and perhaps could have been used to predict, the stall in the Kenyan fertility decline after 1998.

There is evidence that ‘health life expectancy’ (expected number of years to be lived in health) differs by socioeconomic status. Time spent in health or disability plays a critical role in the use of health care services. The objective of this study was to estimate ‘disability life expectancy’ by age, gender and education attainment for the elderly of the city of São Paulo, Brazil, in the year 2000. Data came from the SABE database, population censuses and mortality statistics (SEADE Foundation). Life expectancy with disability was calculated using Sullivan’s method on the basis of the current probability of death and prevalence of disability by educational level. The prevalence of disability increased with age, for both sexes and both levels of educational attainment studied. Men showed a lower prevalence of disability, in general, and persons with lower educational attainment showed a higher prevalence of disability. Regarding life expectancy, women could expect to live longer than men, with and without disability. For both sexes, the percentage of life expectancy lived with disability decreased with increasing educational attainment. With increasing educational attainment, the sex differences in the percentage of remaining years to be lived with disability increased for most ages. Finally, the percentage of remaining years to be lived with disability increased with age for males and females, except for males with high educational attainment between the ages 70–75 and 75–80. The results may serve as a guide for public policies in the country, since health problems faced by older persons, such as disability, are the result of a number of past experiences during their life-times, such as health care, housing conditions, hygiene practices and education. Education influences health behaviours and is related, to some extent, to all these factors. Therefore, improvements in education for the disadvantaged may improve health.

A number of studies have found that Ashkenazi Jews in the United States have a high average IQ. It has been proposed by Cochran, Hardy and Harpending (2006) that this can be explained by the occupational constraints imposed on the Ashkenazi for many centuries in Europe, when they were largely confined to money-lending. They propose that this selected for the high verbal and mathematical intelligence that has several times been found in American Ashkenazim. The current study investigates how far this theory holds for European and Oriental Jews in Israel. A review of studies shows that Oriental Jews in Israel have an average IQ 14 points lower than that of European (largely Ashkenazi) Jews. It is proposed that this difference can be explained in terms of the Cochran, Hardy and Harpending theory because Oriental Jews were permitted to engage in a much wider range of occupations and hence did not come under the selection pressure to develop the high verbal and mathematical intelligence that was present for Ashkenazim.