A health facility-based (HF) approach to delivering anthelminthic drugs to children aged 12–59 months in Zambia was compared with an approach where community-directed treatment (ComDT) was added to the HF approach (HF+ComDT). This paper reports on the socio-demographic factors associated with treatment coverage in the HF+ComDT and HF areas after 18 months of implementation. Data were collected by interviewing 288 and 378 caretakers of children aged 12–59 months in the HF+ComDT and HF areas, respectively. Bivariate and multivariate logistic regression analyses were used for data analysis. Statistically significant predictors of a child being treated were: a child coming from the HF+ComDT area, being 12–36 months old, the family having lived in the area for >20 years, coming from a household with only one under-five child and living ≤3 km from the health facility. It is concluded that socio-demographic factors are of public health relevance and affect treatment coverage in both the HF+ComDT and the HF approaches. The implementation and strengthening of interventions like ComDT that bring treatment closer to households will enable more children to have access to treatment.

This article documents understandings and responses to mass drug administration (MDA) for the treatment and prevention of lymphatic filariasis among adults and children in northern coastal Tanzania from 2004 to 2011. Assessment of village-level distribution registers, combined with self-reported drug uptake surveys of adults, participant observation and interviews, revealed that at study sites in Pangani and Muheza districts the uptake of drugs was persistently low. The majority of people living at these highly endemic locations either did not receive or actively rejected free treatment. A combination of social, economic and political reasons explain the low uptake of drugs. These include a fear of treatment (attributable, in part, to a lack of trust in international aid and a questioning of the motives behind the distribution); divergence between biomedical and local understandings of lymphatic filariasis; and limited and ineffective communication about the rationale for mass treatment. Other contributory factors are the reliance upon volunteers for distribution within villages and, in some locations, strained relationships between different groups of people within villages as well as between local leaders and government officials. The article also highlights a disjuncture between self-reported uptake of drugs by adults at a village level and the higher uptake of drugs recorded in official reports. The latter informs claims that elimination will be a possibility by 2020. This gives voice to a broader problem: there is considerable pressure for those implementing MDA to report positive results. The very real challenges of making MDA work are pushed to one side – adding to a rhetoric of success at the expense of engaging with local realities. It is vital to address the kind of issues raised in this article if current attempts to eliminate lymphatic filariasis in mainland coastal Tanzania are to achieve their goal.

Birth seasonality responds to a variety of environmental and socio-cultural factors. The present study was carried out to quantify the trends in seasonal variation in birth rate in seven districts in the Kayes region of Mali between 2007 and 2010 and to attempt to link climatic- and agricultural-cycle-dependent factors with birth seasonality. Lagged regression analysis based on time series analysis techniques was used to investigate seasonality of births registered in health facilities and its association with climate, labour migration, agriculture workload, malaria infection and food supply. There was a clear bimodal pattern in month-to-month institutional delivery rate variation, and this seasonal pattern repeated each year over the study period. The data showed that rates of health-facility-attended deliveries were high at the end of the dry season (April–June), fell rapidly in the first half of the rainy season, rose again during the later part of the rainy season (August–October) and fell to their lowest values after the rains. The first peak observed in spring (April–June) corresponded to conception nine months earlier during the rainy season (between July and September), while the second peak observed in the third quarter of the year (August–October) corresponded with conception at the beginning of the dry season right after the harvest period (between November and January). Between these peaks was an abrupt trough in July. The findings support a causal process through which climate change influences conception/birth seasonality in two direct and indirect pathways. On one side climate change influences conception/birth seasonality from the effects on fetal loss (changes in annual rainfall leading to changes in malaria incidence) and on the other side by affecting fecundability (changes in agricultural cycles leading to changes in food production, agricultural workload and socio-cultural events, which in turn influence energy balance and sexual behaviour). Labour migration, which is closely linked with the agricultural cycle, influences sexual intercourse and thus marital fertility. Finally, the model emphasizes an ecosystemic approach to the study of birth seasonality.

Based on evolutionary reasoning, Trivers & Willard (1973) predicted status-biased sex composition and parental investment with son-preferencing effects in higher, and daughter-preferencing effects in lower status groups. Previous research shows mixed results. This study uses event-history methods and Swedish register data to study one possible mechanism in isolation: do parents in different status groups vary in their proclivities to continue fertility based on the sex composition of previous offspring? The results show no support for the Trivers–Willard hypothesis on a wide range of different status indicators. Future research on the stated hypothesis should focus on physiological rather than behavioural mechanisms.

It is evident that sexual activity tends to decrease with age. Nonetheless, it is still prevalent enough to be considered a risk factor for the spread of HIV among older people. This paper uses quantitative data for 2053 individuals to examine HIV risk perception and correlates of perceived risk among older people aged 50 years and older living in Nairobi slums. It emerged that a majority of older people did not consider themselves at risk of infection. Of those who felt at risk, a greater proportion sensed only a small chance of contracting HIV. Women cited ‘no sexual activity’ while men mentioned ‘having only one and/or a faithful sexual partner’ as the primary reasons for perceiving minimal risk of HIV infection. There were no differences by sex in the basis for perceiving moderate-to-great risk of infection. Religion is a key factor in risk perception with Muslims perceiving higher levels of risk and, conversely, devotees irrespective of faith perceiving lower levels of risk. Older people willing to be tested for HIV had a decreased likelihood of perceived risk compared with those unwilling to be tested. This paper recommends evaluation of older people's perception of risk in order to better inform interventions aimed at minimizing their vulnerability to HIV infection.

Knowledge of inbreeding levels in historical times is necessary to estimate the health consequences of past inbreeding, and to contextualize the current public debate about cousin marriage in Britain. This research aims to calculate the level of cousin marriage using the intensive technique of multi-source parish reconstitution and to determine whether village organization, religion and occupational class influenced the level of consanguineous marriage. A wide variety of documentary sources were used to create extensive pedigrees of spouses in over 800 marriages in the 19th century in the rural villages of Stourton and Kilmington. The closed village of Stourton had higher levels of inbreeding than the open village of Kilmington. Catholics had lower rates of 1st cousin marriage but higher rates of 2nd cousin marriage than Protestants. Farmers had higher levels of 1st cousin marriage than labourers. The levels of consanguinity in south-western Wiltshire in the 19th century were related to the economic structure of the villages and the religion and social class of the spouses.

A detailed database on the genealogy of the Makarska region in Croatia has been created. The twinning rate for three villages in the region (Podgora, Tučepi and Brela) were analysed over the period 1870 to 1940 and factors such as mother's age and birth order are discussed. Of the three villages, Podgora was identified as having the highest twinning rate and consequently records for Podgora were examined further to include almost 400 years of historical data (from 1621 to 1950).

The aim of this study was to examine the changes in body composition (fatness and muscle and bone mass) and BMI in three cohorts of boys living in Krakow, Poland, over the last 30 years, and to assess how overweight and obesity frequencies have developed over the period. The anthropological survey was conducted in 2010, and comprised 1863 boys from Krakow aged 3–18 years. The analysis compared the latest measurements of selected skinfold thicknesses, BMI, total body muscle mass and bone mass with the results of surveys from 1983 (N=1934) and 2000 (N=2323). The frequency of overweight and obesity was assessed for the last survey series, and their trends determined for the years 1983–2000 and 2000–2010. The analysis of fat tissue distribution showed that the boys from the 2010 cohort, as compared with those examined in 2000, had a higher trunk adiposity, as manifested by greater thickness of subscapular and suprailiac skinfold thicknesses, and boasted a larger muscle mass and lower bone mass. The survey results also showed that, from 1983 to 2000, the percentage of overweight boys increased slightly (from 11.69% to 12.48%), whereas the frequency of obesity did not change. Over the last decade, the percentage of overweight people has increased to 15.94%, and the frequency of obesity has doubled, equalling 4.94% in 2010. The last decade has seen a minor trend in boys towards increased trunk adiposity, muscle mass, BMI and prevalence of overweight and obesity, and a slight decrease in bone mass.

Early onset of menarche has been shown to be associated with breast cancer and ischaemic heart disease. Studies on age at menarche of the Malaysian population are poorly documented. This study aimed to determine the influence of anthropometric and socio-demographic factors on the age at menarche of university students in Malaysia. Data were obtained in 2010–11 from 961 students between the ages of 18 and 25 years from the University of Malaya using stratified sampling, and multiple regression analysis was applied. Sixty-three per cent of students reached menarche at the age of 12 or 13 years, with the mean and median of age at menarche being 12.45±1.17 and 12.01 years, respectively. Menarcheal age was positively associated with height (p<0.05) and negatively associated with BMI (p<0.001). Students from urban areas attained menarche earlier than those from rural areas (p<0.05). Students from small-sized families attained menarche earlier than those from larger families (p<0.05). First-born students experienced menarche earlier than those who were seventh-born or later. Obese and overweight students reached menarche earlier than students who were underweight or of normal weight (p<0.01). The variations in age at menarche among the Malaysian ethnic groups were statistically insignificant. The results suggest that heavier and first-born students from small families are more likely to attain menarche earlier than their counterparts.

The influence of religion on health remains a subject of considerable debate both in developed and developing settings. This study examines the connection between the religious affiliation of the mother and under-five mortality in Mozambique. It uses unique retrospective survey data collected in a predominantly Christian area in Mozambique to compare under-five mortality between children of women affiliated to organized religion and children of non-affiliated women. It finds that mother's affiliation to any religious organization, as compared with non-affiliation, has a significant positive effect on child survival net of education and other socio-demographic factors. When the effects of affiliation to specific denominational groups are examined, only affiliation to the Catholic or mainstream Protestant churches and affiliation to Apostolic churches are significantly associated with improved child survival. It is argued that the advantages of these groups may be achieved through different mechanisms: the favourable effect on child survival of having mothers affiliated to the Catholic or mainstream Protestant churches is probably due to these churches' stronger connections to the health sector, while the beneficial effect of having an Apostolic mother is probably related to strong social ties and mutual support in Apostolic congregations. The findings thus shed light on multiple pathways through which organized religion can affect child health and survival in sub-Saharan Africa and similar developing settings.

This paper investigates whether ethnic diversity at the Demographic and Health Surveys (DHS) cluster level predicts HIV serostatus in three sub-Saharan African countries (Kenya, Malawi and Zambia), using DHS household survey and HIV biomarker data for men and women aged 15–59 collected since 2006. The analysis relates a binary dependent variable (HIV positive serostatus) and a weighted aggregate predictor variable representing the number of different ethnic groups within a DHS Statistical Enumeration Area (SEA) or cluster, which roughly corresponds to a neighbourhood. Multilevel logistic regression is used to predict HIV prevalence within each SEA, controlling for known demographic, social and behavioural predictors of HIV serostatus. The key finding was that the cluster-level ethnic diversity measure was a significant predictor of HIV serostatus in Malawi and Zambia but not in Kenya. Additional results reflected the heterogeneity of the epidemics: male gender, marriage (Kenya), number of extramarital partners in the past year (Kenya and Malawi, but probably confounded with younger age) and Muslim religion (Zambia) were associated with lower odds of positive HIV serostatus. Condom use at last intercourse (a spurious result probably reflecting endogeneity), STD in the past year, number of lifetime sexual partners, age (Malawi and Zambia), education (Zambia), urban residence (Malawi and Zambia) and employment (Kenya and Malawi) were associated with higher odds of positive serostatus. Future studies might continue to employ multilevel models and incorporate additional, more robust, controls for individual behavioural risk factors and for higher-level social and economic factors, in order to verify and further clarify the association between neighbourhood ethnic diversity and HIV serostatus.

Orissa, one of the extremely backward states of India with moderately high infant mortality, extreme poverty, low female literacy and very low level of industrialization and urbanization, has shown an impressive fertility decline in the last two decades. This anomaly calls for an indepth understanding of the fertility transition of the state. An analysis of the period parity progression ratios computed from the fertility histories obtained in the National Family Health Survey III shows a high progression up to the second birth, but a gradual decline after that. Thus, the transition at low level of socioeconomic development suggests a fall in the thresholds for fertility decline from levels presumed to be required in the past.

Prior studies examining the association between self-reported experiences of racial/ethnic discrimination and obesity have had mixed results and primarily been cross-sectional. This study tests the hypothesis that an increase in self-reported experiences of racial/ethnic discrimination predicts gains in waist circumference and body mass index in Black and White women and men over eight years. In race/ethnicity- and gender-stratified models, this study examined whether change in self-reported experiences of racial/ethnic discrimination predicts changes in waist circumference and body mass index over time using a fixed-effects regression approach in SAS statistical software, providing control for both measured and unmeasured time-invariant covariates. Between 1992–93 and 2000–01, self-reported experiences of racial/ethnic discrimination decreased among 843 Black women (75% to 73%), 601 Black men (80% to 77%), 893 White women (30% to 23%) and 856 White men (28% to 23%). In fixed-effects regression models, controlling for all time-invariant covariates, social desirability bias, and changes in education and parity (women only) over time, an increase in self-reported experiences of racial/ethnic discrimination over time was significantly associated with an increase in waist circumference (β=1.09, 95% CI: 0.00–2.19, p=0.05) and an increase in body mass index (β=0.67, 95% CI: 0.19–1.16, p=0.007) among Black women. No associations were observed among Black men and White women and men. These findings suggest that an increase in self-reported experiences of racial/ethnic discrimination may be associated with increases in waist circumference and body mass index among Black women over time.

This study estimates the effect of dysgenic trends in Taiwan by exploring the relationships among intelligence, education and fertility. Based on a representative adult sample, education and intelligence were negatively correlated with the number of children born. These correlations were stronger for females. The decline of genotypic intelligence was estimated as 0.82 to 1.33 IQ points per generation for the Taiwanese population.

The secondary sex ratio (SSR) has been suggested to decrease with adverse physical and psychological environments. Previous studies have focused on reduced SSR under adverse conditions, such as war, terrorism attack and earthquake, but few studies have investigated fluctuations in SSR in moderately adverse environments. This study analysed municipality-level vital statistics records in Japan collected between 1998 and 2002 to identify high-SSR clusters and low-SSR clusters with spatial-scan statistics. In 999 runs of simulation, high- and low-SSR clusters were detected but fewer than 950 times, indicating that SSR was not geographically clustered in Japan if type I error of 5% was adopted. Explorative analyses comparing demographic attributes between high-SSR clusters and low-SSR clusters that were detected more than 500 times in 999 runs of simulation, showed that rate of spontaneous abortion, rate of artificial abortion and divorce rate were higher in low-SSR clusters, while male life expectancy, female life expectancy and total fertility rate were higher in a high-SSR cluster.