The relationship between hepatitis B infection in parents and the sex ratio at birth of their offspring is examined in four populations. The hepatitis B carrier state in parents may increase the sex ratio of their offspring, but it seems that immunization against hepatitis B is unlikely to affect the sex ratio at birth of future generations.

Childhood overweight and obesity, especially among migrant children, are current health problems in several European countries. In the present study the prevalence of overweight and obesity among migrant children from Turkey and the former Yugoslavia was documented and compared with that of Austrian children in Vienna. Anthropometric data from 1786 children were collected at the ages of 6, 10 and 15 years. Body mass was estimated by means of the body mass index and percentile curves were used to determine weight status. The prevalence of overweight and obesity was found to be significantly higher among migrant children. Children and adolescents from the former Yugoslavia and Turkish girls exhibited especially high rates of overweight and obesity. Biosocial and cultural factors are discussed as causes of these observations.

Perceived discrimination has been linked to poor health outcomes among ethnic and racial minorities in the United States, though the relationship of discrimination-related stress to immigrant health is not well understood. This article reports findings from a preliminary study that examined blood pressure and Epstein-Barr virus antibody levels in relation to self-reported indicators of stress, acculturation and social support among 79 adult immigrant Latino farm workers in Oregon, US. Findings show that increases in discrimination-related stress predicted elevated systolic blood pressure (SBP) and Epstein-Barr virus antibody levels among male participants. Though female participants reported similar levels of discrimination stress, this perceived stress was not reflected in biological measures. Among women, greater English language engagement was linked to higher SBP, and more years in the US was associated with higher diastolic blood pressure. Study results suggest that male and female immigrants' physiological responses to stress may be influenced in distinctive ways by processes of adjustment to life in the US. If replicated, the finding that discrimination stress predicts elevated SBP may have clinical and public health implications given that elevated SBP is an established risk factor for cardiovascular disease.

Research on health care behaviour in sub-Saharan Africa usually considers the mother as the reference in the household when a child is sick. The study of health care management within the family is a key issue for understanding therapeutic rationales. This study was conducted in the region of Fatick in Senegal among 902 children with malaria-related fever. The data were taken from a retrospective quantitative survey conducted in all compounds of the DSS (Demographic Surveillance Site) of Niakhar. The results show that child care-taking is fundamentally a collective process: in 70·9% of out-of-home resorts, the treatment decision was collective. The health care process of 68·1% of morbid episodes involved several individuals. The involvement of the mother, the father and other relatives in the collective management of health care followed different logics. Each care-giver had a specific and complementary function depending on gender norms, intergenerational relations and characteristics of the family unit. Family management of illness aims at optimizing financial and human resources given the economic, logistical and social constraints on health care. Nevertheless, collective management also favoured home-based care, prevented good treatment compliance and delayed the resort to health facilities. These results suggest that health education campaigns should focus on an early involvement of fathers in health care-giving and also on the strengthening of the autonomy of mothers. Mothers’ empowerment should give women more autonomy in their child’s treatment choice. Lastly, there is a need to develop community health facilities and establish shared funding at the community level.

All available data for thirteen Pacific Island nations are used in a comparative analysis of suicide levels and characteristics. Age, sex and method of suicide are examined in detail. Global comparison shows Pacific rates are amongst the highest reported. Female youth rates exceed male rates in Western Samoa and amongst Fiji Indians. Method of suicide (paraquat ingestion) is instrumental in determining high rates in Western Samoa, especially in females. The broad causal theme is societal transition. Commonality and diversity are discussed.

Neonatal mortality during the first week of life, corresponding to the years 1975–1998, was studied in Spain. The first week of life is the time in which the highest number of deaths occur. The temporal decrease of the neonatal mortality rate (NMR) was modelled according to log10(NMR+1)= 2·784−0·023 per year. This decline cannot be explained by an increase in the mean birth weight (MBW=23440·835−10·107 g per year). From the most frequent of the causes of death to the least were: congenital anomalies, preterm born or low birth weight, respiratory problems, pregnancy difficulties, hypoxaemia/asphyxia, delivery difficulties and infectious diseases. This sequence changed when the specific age at death was considered. The NMR descended evenly for both sexes for the causes indicated above, except for preterm born or low birth weight, in which the male mortality decrease was greater since its rate was more elevated at the beginning of the period studied. For all the causes listed, NMR was more elevated both in urban areas and for males. Early neonatal mortality (first 24 hours) was higher for pregnancy difficulties, preterm born or low birth weight, congenital anomalies and hypoxaemia/asphyxia.

Stroke is an emerging problem in sub-Saharan Africa, about which little is known since most research to date has been based on retrospective, hospital-based studies. This anthropological work, designed to complement a large community-based project on stroke incidence, focuses on local understandings and treatment-seeking behaviours in urban (Dar-es-Salaam) and rural (Hai) areas of Tanzania. Semi-structured interviews (n=80) were conducted with 20 stroke patients, 20 relatives of stroke patients, ten traditional healers, and 30 other local residents. In contrast to common expectations, and literature that finds witchcraft beliefs to be most common in rural areas, stroke in urban Dar was widely believed to emanate from supernatural causes (demons and witchcraft), while in rural Hai, explanations drew mostly on ‘natural’ causes (hypertension, fatty foods, stress). These different beliefs and explanatory models fed into treatment-seeking behaviours. The first option in Hai was hospital treatment, while in Dar-es-Salaam, where belief in demons led to hospital avoidance, it was traditional healers. In both sites, multiple treatment options (serially or simultaneously) were the norm. Analysis of patient and carer narratives suggested that causation beliefs outweighed other factors, such as cost and distance, in shaping effective treatment. Three policy implications are drawn. First, as other studies have also shown, it is important to engage with, rather than dismiss, local explanations and interpretations of stroke. Stroke awareness messages need to take into account the geographical and belief systems differences. Developing an understanding of explanatory models that recognizes that local beliefs arise from dynamic processes of social interaction will be critical to designing effective interventions. Second, there is a clear role for multiple healing systems with possibility of cross-reference in the case of a chronic, disabling condition like stroke, since biomedical treatment cannot offer a ‘quick fix’ while traditional healers can help people come to terms with their condition. Third, issues of communication between health services and their patients are particularly critical.

Onset of capacity for childbearing in women is dated biologically by menarche, although actual onset may be delayed. The end of childbearing is less understood but recent demographic and biological research on fertility at older ages is clarifying the end of fertility.

The demographic view of declining fertility with age is based on age-specific fertility in natural fertility populations, artificial insemination and pregnancy rates by age and World Fertility Survey data. New data from the Demographic and Health Surveys on exposure to the risk of pregnancy shows that whereas older women biologically need longer exposure to pregnancy, exposure declines on behavioural grounds such as duration of marriage. Actual fecundity is obscured by factors of fecundability. Recent research on medically assisted conception is adding to the understanding of declining fecundity with age, especially the relative contributions of endometrial and ovarian ageing.

This paper reviews the available information on declining fertility with age and discusses the implications of the extension of fertility through new medical technologies.

This paper examines the effects of exposure to mass media messages promoting family planning on the reproductive behaviour of married women in Nigeria using cross-sectional data. Longitudinal data are also used to ensure that exposure to media messages pre-dates the indicators of reproductive behaviour. Cross-sectional analysis suggests that: (1) contraceptive use and intention are positively associated with exposure to mass media messages, and (2) women who are exposed to media messages are more likely to desire fewer children than those who are not exposed to such messages. Similarly, analysis of the longitudinal data shows that exposure to mass media messages is a significant predictor of contraceptive use. Thus, exposure to mass media messages about family planning may be a powerful tool for influencing reproductive behaviour in Nigeria.

Using data derived from the 1992–1993 National Family Health Survey, the sociodemographic characteristics of consanguineous marriage were determined in the Muslim population of India. In this nationally representative sample of 8436 women, consanguineous marriages accounted for 22·0% of the total. No differences between the consanguineous and non-consanguineous groups were observed in terms of mean age at marriage or mean age at cohabitation. The study confirmed the negative association between consanguineous marriage and maternal education but also indicated that women in consanguineous unions were more likely to be employed, albeit mainly in agricultural work on behalf of the family. Consanguineous couples more frequently lived in smaller towns and in an extended family environment. Somewhat conflicting results were obtained with indicators of socioeconomic status, but the overall picture suggested that consanguineous households had greater access to consumer goods because of their larger number of co-resident persons.

Women in India suffer from a high incidence of reproductive disease, disability and death. Very little work has been done on men, but a much higher incidence of sexual experience outside marriage and sexually transmitted diseases (STDs) among males than previously expected for this population is now being documented. In north India, women are dependent on their husbands and other family members for health-related decisions. Therefore, the behaviour, knowledge and attitudes of men are integral to the reproductive health status of couples there. This study explores knowledge about three distinct areas of reproductive health among 6549 married men in five districts of the northern state of Uttar Pradesh, India. Factors contributing to men's knowledge in the areas of fertility, maternal health and STDs were investigated. Results showed that very few men had basic knowledge in any of these areas. The likelihood of reporting knowledge was associated with a set of determinants that differed in their magnitude and effect across the areas of reproductive health explored. In particular, men's belief about the ability of an individual to prevent pregnancy demonstrated an independent association with men's knowledge. After controlling for factors such as age, parity and educational and economic status, men who believed it not possible to prevent a pregnancy were less likely to know when during the menstrual cycle women would become pregnant and certain facts about STDs, but they were more likely to be able to name two or more symptoms of serious maternal health conditions. Possible explanations for this trend are discussed.

The second-to-fourth digit ratio (2D:4D) presents an anatomical sex difference in humans. On average, men tend to have lower 2D:4D compared with women. There is fairly strong evidence for a role of the 2D:4D ratio as a biomarker for the organizational (permanent) effects of prenatal testosterone on the brain and behaviour. Recently, an accumulating research programme has shown 2D:4D to be related to a multitude of sex-dependent, hormonally influenced biosocial traits and phenotypes which reach into the domains of ability, behaviour, fertility, health, personality and sexuality. This study investigated the degree of assortative mating (spousal similarity) in a sample of 239 native Austrian couples of parental or grandparental age, all of them having reproduced. Results included: (i) significant spousal correlations of +0·19 and +0·18 for right-hand and left-hand 2D:4D, respectively, and +0·24 for average 2D:4D; (ii) no assortative mating effect on the right-minus-left difference in 2D:4D; (iii) indications consistent with a possible generational decrease of spousal similarity in 2D:4D; (iv) a prevalence of couples with a lower right-hand 2D:4D observed in the husband compared with his wife; and (v) relations of spousal 2D:4D patterns to spousal age differences, such that matings of men with more male-typical trait expressions (namely, a generally low right-hand 2D:4D or showing a lower right-minus-left 2D:4D difference than their wives) implicated larger male-minus-female age differences, i.e. younger wives. It is argued that assortative mating on 2D:4D operates indirectly and may be mediated through the assortment on other, more perceptible, physical traits and psychological phenotypes that entertain associations with 2D:4D and are relevant for courtship and mate choice.

The gap in access to maternal health care services is a challenge of an unequal world. In 2015, each day about 830 women died due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. This study quantified the contributions of the socioeconomic determinants of inequality to the utilization of maternal health care services in four countries in diverse geographical and cultural settings: Bangladesh, Ethiopia, Nepal and Zimbabwe. Data from the 2010–11 Demographic and Health Surveys of the four countries were used, and methods developed by Wagstaff and colleagues for decomposing socioeconomic inequalities in health were applied. The results showed that although the Concentration Index (CI) was negative for the selected indicators, meaning maternal health care was poorer among lower socioeconomic status groups, the level of CI varied across the different countries for the same outcome indicator: CI of −0.1147, −0.1146, −0.2859 and −0.0638 for <3 antenatal care visits; CI of −0.1338, −0.0925, −0.1960 and −0.2531 for non-institutional delivery; and CI of −0.1153, −0.0370, −0.1817 and −0.0577 for no postnatal care within 2 days of delivery for Bangladesh, Ethiopia, Nepal and Zimbabwe, respectively. The marginal effects suggested that the strength of the association between the outcome and explanatory factors varied across the different countries. Decomposition estimates revealed that the key contributing factors for socioeconomic inequalities in maternal health care varied across the selected countries. The findings are significant for a global understanding of the various determinants of maternal health care use in high-maternal-mortality settings in different geographical and socio-cultural contexts.

Indoor air pollution resulting from the combustion of solid fuels has been identified as a major health threat in the developing world. This study examines how the choice of cooking fuel, place of cooking and behavioural risk factors affect respiratory health infections in Accra, Ghana. About 65·3% of respondents use charcoal and 4·2% use unprocessed wood. A total of 241 (25·4%) respondents who cook had had respiratory health symptoms in the two weeks preceding the study. Household socioeconomic status and educational attainment of respondents were found to have a significant impact on respiratory health through their particular influence on the choice of cooking fuel. Households that use wood and charcoal have a high incidence of respiratory health symptoms. The poor are more affected by respiratory health problems due to their heavy dependence on solid fuels as compared with their wealthy counterparts. Households that cook in multiple purpose rooms are more affected by respiratory health problems than those that cook outdoors. There is a positive correlation between the presence of children in the kitchen during cooking and the incidence of respiratory health symptoms among children (r=0·31, p<0·0001). Poverty and lack of education and awareness are the major factors affecting the choice of cooking fuel, place of cooking and respiratory health in Accra.

Using pooled children data from the 1998 and 2003 Ghana Demographic and Health Surveys, this study examines religious differences in child survival in Ghana. Guided by the particularized theology and selectivity theses, a piecewise constant hazard model with gamma-shared frailty is used to explore if there are denominational differences in child mortality, and whether these could be explained through other characteristics. At the bivariate level, children whose mothers identified as Muslim and Traditional were found to have a significantly higher risk of death compared with their counterparts whose mothers identified as Christians. In the multivariate models, however, the religious differences disappeared after the mediating and confounding influence of socioeconomic factors were controlled. The findings provide support for the selectivity hypothesis, which is based on the notion that religious variations mainly reflect differential access to social and human capital rather than religious theology per se.

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.

Consanguineous marriage has had considerable attention as a causative factor in the prevalence of genetic disorders. Iran, with its majority Muslim population, has a high rate of consanguineous marriage. In Iranian tradition, first cousin marriage is an acceptable and appreciated custom. However, there seems to be no encouragement of consanguineous marriage in the Islamic context; it is merely mentioned as a traditional and common custom. This paper may help medical professionals providing premarital genetic counselling, who are regularly asked about consanguineous marriage, especially in Islamic communities. Increased public awareness via the mass media would seem to be a priority.

The study examines the effects of nursing practices on the duration of lactation in middle-class American women. Thirty-two nursing mothers were followed for 2 years post-partum, data being collected at eight home visits by interview and by nursing records kept by the mothers. Those women who nursed frequently (>8/day) during exclusive breastfeeding remained amenorrhoeic longer than infrequent nursers, introduced supplements later and did not resume menses as promptly thereafter. They continued an hour or more of night nursing during supplemented nursing. Duration of exclusive nursing and night nursing after supplementation were the major influences on duration of amenorrhoea. Mothers' age, weight-for-height, and nursing frequency before supplementation showed no significant effect but night nursing after supplementation was a major factor in post-supplementation duration of amenorrhoea. Those women who both supplemented later and maintained an hour of night nursing after supplementing remained amenorrhoeic for 6–10 months longer than those who supplemented early and/or reduced subsequent night nursing.

Access to voluntary counselling and HIV testing (VCT) remains limited in most parts of Ghana with rural populations being the least served. Services remain facility-based and employ the use of an ever-dwindling number of health workers as counsellors. This study assessed approval for the use of lay counsellors to promote community-based voluntary counselling and testing for HIV and the extent of HIV/AIDS-related stigma in the Kassena-Nankana district of rural northern Ghana. A cross-sectional questionnaire survey was conducted. Logistic regression was used to identify predictors of the tendency to stigmatize people living with HIV/AIDS (PLWHAs). Focus group discussions were held and analytical coding of the data performed. The majority (91·1%) of the 403 respondents indicated a desire to know their HIV status. Most (88·1%) respondents considered locations outside of the health facility as preferred places for VCT. The majority (98·7%) of respondents approved the use of lay counsellors. About a quarter (24%) of respondents believed that it was possible to acquire HIV through sharing a drinking cup with a PLWHA. About half (52·1%) of the respondents considered that a teacher with HIV/AIDS should not be allowed to teach, while 77·2% would not buy vegetables from a PLWHA. Respondents who believed that sharing a drinking cup with a PLWHA could transmit HIV infection (OR 2·50, 95%CI 1·52–4·11) and respondents without formal education (OR 2·94, 95%CI 1·38–6·27) were more likely to stigmatize PLWHAs. In contrast, respondents with knowledge of the availability of antiretroviral (ARV) drugs were less likely to do so (OR 0·40, 95%CI 0·22–0·73). Findings from the thirteen focus group discussions reinforced approval for community-based VCT and lay counsellors but revealed concerns about stigma and confidentiality. In conclusion, community-based VCT and the use of lay counsellors may be acceptable options for promoting access. Interventional studies are required to assess feasibility and cost-effectiveness.

Although a growing body of research has linked religious involvement with HIV/AIDS protective behaviour in Africa, the focus has mainly been on women. Given the patriarchal nature of African culture, this paper argues for the inclusion of men, a critical group whose sexual behaviours have increasingly been linked to the spread and sustenance of the virus in the region. Drawing on different theoretical discourses and using data from the 2003 Ghana Demographic and Health Survey, this paper examines how religious affiliation influences men's risky sexual behaviours. While the results from the bivariate analysis suggested that Muslims and Traditionalists were significantly less likely to engage in risky sexual behaviour compared with Christians, those differences disappeared once socioeconomic variables were controlled, rendering support for the selectivity thesis. This finding could benefit programmatic and policy formulation regarding AIDS prevention in Ghana.