The objective of this study was to evaluate trends in the availability of socially marketed condoms in urban Tanzania, and to assess the effect of changes in the social marketing programme’s strategy for distributing condoms to retail outlets. Three retail outlet surveys conducted in urban Tanzania in 1996/97, 1998 and 1999 were analysed. Multiple Classification Analysis (MCA) was used to determine changes in availability of condoms, after adjusting for differences in the composition of the samples. Consistent with the changes in the condom social marketing distribution system, the proportion of condom outlets that were supplied by wholesalers increased from 42% in 1997 to 60% in 1999. The increasing use of wholesalers allowed sales agents to devote more time to opening new outlets. Hence, the percentage of outlets that had been solicited to sell condoms by social marketing condom sales persons increased from 14% in 1997 to 25% in 1999. Following these changes in the distribution system, the percentage of outlets selling socially marketed condoms increased from 25% to 32% between 1997 and 1998, and stabilized at that level. More detailed examination showed that availability of socially marketed condoms increased significantly in most non-traditional outlets, and in all regions of the country. In conclusion, distribution survey data indicate that changes in the distribution system increased the role of wholesalers, and enabled sales teams to allocate more time to soliciting new condom outlets. Concurrent with these changes, the availability of socially marketed condoms in non-traditional retail outlets increased significantly. Regular monitoring of condom availability can ensure that any emerging supply problems are identified and remedied quickly.

Differences in the prevalence of obesity between adjacent regions are quite common, but usually unexplained. This study examined whether birth place, selective migration, intelligence or education – which are both inversely and possibly causally related to obesity – are determinants of such differences. This population-based case-control study (case-cohort design) took place in the greater Copenhagen area (region 1) and surrounding provincial areas of Zealand (region 2), Denmark. A total of 2948 men with a median age of 19 years from two draft board regions during 1966–1977 were examined. The odds ratio (OR) for being obese (defined as body mass index ≥31 kg/m2) was investigated using multiple logistic regression analyses. The OR for being obese in region 2 compared with region 1 was 1·74 (1·50–2·03). Adjustment for birth place, intelligence test score and educational level reduced the OR to 1·42 (1·10–1·82). The OR for being obese for those born in region 2 compared with region 1 was 1·71 (1·46–2·01). Adjustments for intelligence test score, educational level and examination region reduced this OR to 1·13 (0·87–1·46). Irrespective of birth place, men examined in region 2 had a higher OR for being obese than those examined in region 1; this effect was most pronounced for those born in region 2 and examined in either region 1 or 2, with an OR of 1·06 (0·71–1·57) and 1·87 (1·58–2·22) respectively. In conclusion, the regional differences in the prevalence of obesity could not be explained by birth place or later selective migration, but educational level and intelligence test score did explain some of the difference.

This paper explores the pathways of the determinants of unfavourable birth outcomes, such as premature birth, the size of the baby at birth, and Caesarean section deliveries, in Kenya using graphical log-linear chain models. The results show that a number of factors that do not have direct associations with unfavourable birth outcomes contribute to these outcomes indirectly through intermediate factors. Marital status, the desirability of a pregnancy, the use of family planning and access to health facilities have no direct associations with poor birth outcomes, such as premature births and the small size of the baby at birth, but are linked to these outcomes through antenatal care. Antenatal care is identified as a central link between various sociodemographic or reproductive factors and birth outcomes.

This study investigates the possible effects of pre-term births and low birth weight on infant mortality rates (IMRs) over a 15-year period in Ribeirão Preto, Brazil, based on surveys carried out in 1978/79 and 1994. The 1978/79 survey included 6750 births over a 12-month period and the 1994 survey 2846 births over a 4-month period. Infant deaths were retrieved monthly from the city register. Infant mortality rate decreased from 36·6 to 16·9 deaths per 1000 over 15 years. The decrease in IMR was larger in the 2500–2999 g group than in any other group. The observed falls in IMR were attributable to decreases in birth-weight-specific mortality rates. Likewise, there was a general decrease in IMR in mild, moderate and severe pre-term births. The incidence rate ratio of infant mortality between surveys was 0·46 (95% CI 0·34–0·63); it increased to 0·57 (95% CI 0·35–0·75) when adjusted for birth weight and other factors in the model and rose to 0·69 (95% CI 0·49–0·97) when adjusted for length of gestation and other variables. The increase in pre-term births and low birth weight may have had, at most, a marginal effect on the IMR. Progress in the care of newborns may have decreased the mortality risk, but even mild pre-term birth still has an impact on infant mortality. There is room for further improvement in IMR by tackling the high rates of pre-term birth.

The aim of this study is to test prevailing assumptions that Guatemalan men are authoritative or aloof husbands and, in turn, are either problematic or irrelevant to child health. Based on survey data collected in 1994–95 about 959 children, this research examines whether, how and why husbands were involved in recent episodes of young children’s illness and sheds light on the potential effect of husband involvement on treatment. A relatively high percentage of women reported that they asked for advice or assistance from their husbands regarding child illness, and, contrary to popular notions, the multivariate analyses suggest that husbands' involvement was not driven by their household authority. Rather, key determinants of whether husbands gave advice or assistance included characteristics of the illness and child and the availability of sources of social support, while key determinants of what kind of support husbands gave (namely whether they gave/bought medicines, recommended a provider visit, or gave other advice or assistance) largely related to characteristics of the illness and child, as well as the availability of biomedical health care providers in the community and ethnicity.

It is hypothesized that recent trends in US and worldwide obesity are, in part, related to an increase in the marginal rate of time preference, where time preference refers to the rate at which people are willing to trade current benefit for future benefit. The higher the rate of time preference, the larger is the factor by which individuals discount the future health risks associated with current consumption. Data from the United States, as well as international evidence, suggest that a relationship between these two variables is plausible. The authors encourage researchers to explore the possible link between obesity and time preference, as important insights are likely to result.

The effects of religion, population sub-division and geography on the prevalence of deaf-mutism were investigated using information collected in the 1921 Census of Punjab. The total sample size was 9·36 million, and comprised data on thirteen Hindu castes, seventeen Muslim biraderis and two Sikh castes. A two-way analysis of variance comparing males in Hindu castes in which consanguineous marriage was prohibited, with males in Muslim biraderis which favoured first cousin marriage, indicated major differences with respect to the patterns of deaf-mutism within each religion. In the Muslim population 9·1% of the relative variation in the prevalence of deaf-mutism was inter-biraderi, 36·8% between geographical regions, and 48·8% an interaction between biraderi and region, whereas among Hindus 46·8% of the observed variation was inter-caste, 12·8% inter-region and 33·6% due to caste–region interaction. From a wider disease perspective the results obtained with the Hindu community indicate the significant genetic differentiation associated with caste endogamy. As the overwhelming majority of Hindu marriages continue to be within-caste, it can be predicted that similar levels of inter-caste differences in disease frequency currently exist. By comparison, the lower level of inter-biraderi variation among Muslims is probably indicative of the dissolution of pre-existing caste boundaries and the resultant gene pool mixing that followed the large-scale conversion of Hindus to Islam during Muslim rule in North India from the 13th to the 19th centuries.

This study examined 28 anthropometrical and physiological traits in 107 married couples living in the province of Biscay (Basque Country, Spain). The aim was to verify the existence of a phenotypic and/or social preference when choosing a mate. For this, correlations between pairs of spouses were estimated by maximum likelihood, and a model of familial transmission (path analysis) was applied in order to test if social homogamy between mates existed. The results provide significant evidence of phenotypic as well as social homogamy in several of the studied traits. Even if an assortment existed when choosing a mate for bony traits such as height, the effect of cohabitation cannot be discounted as the main causal factor for the high phenotypic resemblance observed between spouses for body composition traits. In addition, with the social homogeneity of the studied sample, significant evidence of the existence of social homogamy between mates was only found for 20% of the studied variables.